Identifying a structure for cannulation

• US 8,364,252 B2
• Filed: 04/15/2009
• Issued: 01/29/2013
• Est. Priority Date: 04/18/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc), Regents of The University of Minnesota (University of Minnesota)
• Original Assignee: Medtronic Incorporated (Medtronic Plc), Regents of The University of Minnesota (University of Minnesota)
• Inventors: Markowitz, H. Toby, Chelgren, Brent, Hurtig, Noelle Christine, Smith, Marie P., Falkner, Phillip, Phillips, Lane A.
• Primary Examiner(s): Gedeon, Brian T
• Application Number:
  US12/424,007
• Publication Number:
  US 20090264749A1
• Time in Patent Office: 1,385 Days
• Field of Search: 600/374, 600/407, 600/523, 600/547, 606/41, 607/101, 607/111, 607/122
• US Class Current: 600/523
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00053 Mapping
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/22051 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation A61B2017/22048, A61B2017/3486 take precedence
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2068 using pointers, e.g. pointers having reference marks for determining coordinates of body points
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/063 for measuring volume
• CPC Class Codes: A61B 2090/371 with simultaneous use of two cameras
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/25 User interfaces for surgical systems
• CPC Class Codes: A61B 5/05 Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves impedance plethysmography A61B5/0295; measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 : invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/063 : using impedance measurements
• CPC Class Codes: A61B 5/066 : Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
• CPC Class Codes: A61B 5/068 : using impedance sensors
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 8/06 : Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• CPC Class Codes: G06T 19/003 : Navigation within 3D models or images

Abstract

A volume of a patient can be mapped with a system operable to identify a plurality of locations and save a plurality of locations of a mapping instrument. The mapping instrument can include one or more electrodes that can sense a voltage that can be correlated to a three dimensional location of the electrode at the time of the sensing or measurement. Therefore, a map of a volume can be determined based upon the sensing of the plurality of points without the use of other imaging devices. An implantable medical device can then be navigated relative to the mapping data.

Claims

1. A method of determining a structure in a volume for cannulation, comprising:

moving an instrument having a position element in the volume;

determining a plurality of positions of the position element;

rendering a map of a surface of the volume using at least a sub-plurality of the plurality of positions of the position element;

moving a portion of the position element into a bore in the surface of the volume; and

illustrating a rendered bore relative to the rendered map.

2. The method of claim 1, wherein the instrument includes a position element that is moveable relative to a catheter.

3. The method of claim 2, further comprising;

providing the catheter with a cross-sectional diameter greater than that of a cross-sectional diameter of the position element.

4. The method of claim 3, further comprising;

providing a guide wire as the position element;

moving the guide wire into a coronary sinus ostium;

determining a plurality of positions of the position element in the coronary sinus ostium;

wherein illustrating a rendered bore relative to the rendered map includes rendering only the determined plurality of positions of the position element in the coronary sinus ostium.

5. The method of claim 1, further comprising:

generating a navigation field relative to the volume;

forming the position element to include a coil of wire;

inducing a current in the coil of wire due to the generated navigation field;

wherein determining a plurality of positions of the position element includes determining a plurality of induced currents in the coil of wire at a plurality of locations.

6. The method of claim 1, further comprising;

positioning three pairs of axis electrodes on a surface of the volume;

injecting a current into the volume between each of the pairs of axis electrodes to form three axes of current in the volume;

evaluating an electrical property based on the injected current and information received from the position element;

wherein determining the plurality of positions of the position element includes evaluating the electrical property at a plurality of positions when moving the position element within the volume.

7. The method of claim 6, wherein rendering the map of the surface of the volume occurs without additional image data of the volume.

8. A method of determining a structure in a volume for cannulation, comprising:

moving an instrument having at least a first position element and a catheter in the volume, wherein the first position element includes a cross-sectional dimension less than a cross-sectional dimension of the catheter;

determining a plurality of positions of the first position element;

rendering a map of a surface of the volume using at least a sub-plurality of the determined plurality of positions of the position element;

moving a portion of the first position element into a bore in the surface of the volume; and

illustrating a rendered bore relative to the rendered map.

9. The method of claim 8, wherein the first position element is moveable relative to the catheter;

wherein moving the portion of the first position element into the bore includes;

positioning the catheter near the bore in the surface;

substantially holding the catheter near the bore;

moving substantially only the first position element into the bore; and

determining a position of the first position element within the bore.

10. The method of claim 9, further comprising;

determining a plurality of positions of the position element in the bore;

wherein illustrating a rendered bore relative to the rendered map includes rendering only the determined plurality of positions of the position element in the bore.

11. The method of claim 10, further comprising:

moving the instrument into a heart of a human;

wherein determining a plurality of positions of the position element in the bore includes determining a plurality of positions within a coronary sinus ostium;

wherein illustrating a rendered bore relative to the rendered map includes rendering only the determined plurality of positions of the position element in the coronary sinus ostium.

12. The method of claim 11, further comprising identifying the coronary sinus as the rendered bore.

13. The method of claim 12, further comprising;

positioning three pairs of axis electrodes on a surface of the volume;

injecting a current into the volume between each of the pairs of axis electrodes to form three axes of current in the volume;

evaluating an electrical property based on the injected current and information received from the position element;

wherein determining the plurality of positions of the position element includes evaluating the electrical property at a plurality of positions when moving the position element within the heart.

14. The method of claim 13, wherein rendering the map of the surface of the volume occurs without additional image data of the volume.

15. A system to determine a structure in a volume for cannulation, comprising:

an instrument having at least a first position element moveable relative to a catheter in the volume, wherein the first position element has a cross-sectional dimension less than a cross-sectional dimension of the catheter;

a position sensing unit, including;

a set of axis electrodes positionable on a surface of the volume;

a driver operable to inject a current into the volume between the set of axis electrodes;

wherein the injected current defines an axis within the volume;

a processor operable to evaluate an electrical property with the first position element and execute instruments to determine a position of the position element within the volume;

a storage device operable to store a plurality of determined positions of the first position element; and

a display device operable to display a rendered map of a surface of the volume using at least a sub-plurality of the stored determined plurality of positions of the position element;

wherein the display device is further operable to display a rendered bore relative to the rendered map.

16. The system of claim 15, wherein the instrument includes a catheter and the first position element includes a guidewire moveable within the catheter.

17. The system of claim 16, further comprising:

a second position element positioned at a distal terminal end of the catheter;

wherein the guide wire is operable to protrude from the distal terminal end.

18. The system of claim 16, further comprising;

a procedure instrument operable to move with the guidewire relative to the guidewire.

19. The system of claim 18, further comprising;

a second position element moveable with the procedure instrument;

wherein the processor is further operable to determine a position of the second position element;

wherein the display device is further operable to display a rendered bore and in representing the position of the second position element relative to the rendered map.