Intra-operative registration for navigated surgical procedures

• US 8,694,075 B2
• Filed: 12/21/2009
• Issued: 04/08/2014
• Est. Priority Date: 12/21/2009
• Status: Active Grant

• Current Assignee: Stryker European Operations Holdings, LLC (Stryker Corporation)
• Original Assignee: General Electric Company
• Inventors: Groszmann, Daniel Eduardo, Jensen, Vernon Thomas, Battle, Vianney Pierre
• Primary Examiner(s): MEHTA, PARIKHA SOLANKI
• Application Number:
  US12/643,824
• Publication Number:
  US 20110152676A1
• Time in Patent Office: 1,569 Days
• Field of Search: None
• US Class Current: 600/426
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• 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 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/4441 the rigid structure being a C-arm or U-arm
• CPC Class Codes: A61B 6/487 involving fluoroscopy
• CPC Class Codes: A61B 6/488 involving pre-scan acquisition
• CPC Class Codes: A61B 6/5235 combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT
• CPC Class Codes: A61B 6/5247 combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound

Abstract

A navigation system for use during a surgical procedure is provided. The navigation system is configured to use electromagnetic tracking data produced by electromagnetic tracking devices and 2D image data produced by a fluoroscope to intra-operatively register 2D images of a patient to a pre-operative 3D image of the patient. In some implementations, a surgeon may be able to perform an interventional or surgical procedure guided by the navigation system.

Claims

1. A surgical navigation method comprising the acts of:

establishing a coordinate frame by fixing a first electromagnetic device to a patient;

acquiring two or more two-dimensional fluoroscopic images of the patient each from a different perspective using an imaging apparatus, the imaging apparatus comprising a source of X-ray radiation and an X-ray detector having a second electromagnetic device and a calibration target affixed thereto, and wherein the calibration target comprises a series of radiopaque markers that are fixed in relation to one another;

modeling a geometry of the source of X-ray radiation and the X-ray detector based at least on a geometry of the radiopaque markers in each two-dimensional fluoroscopic image to obtain a perspective from which each image was taken;

providing a pre-operative three-dimensional image, the two or more two-dimensional fluoroscopic images, tracking data representing a position and orientation of the second electromagnetic device with respect to the first electromagnetic device, and the perspective from which each two-dimensional fluoroscopic image was taken to a computerized navigation system;

generating a respective two-dimensional projection via digital radiographic reconstruction (DRR) of the pre-operative three-dimensional image using the perspective from which each two-dimensional fluoroscopic image was taken and an input pose of the imaging apparatus relative to the pre-operative three-dimensional image;

comparing the generated two-dimensional projections to the acquired two or more two-dimensional fluoroscopic images;

updating the input pose based on the comparison to generate updated projections via DRR until the updated projections meet a predetermined matching criteria with the acquired two or more two-dimensional fluoroscopic images, the predetermined criteria being a result of a registration pose; and

generating a substantially real-time three-dimensional visualization of the patient based on the registration pose and the pre-operative three-dimensional image.

2. The method of claim 1, wherein the comparison between the generated two-dimensional projections and the acquired two or more two-dimensional fluoroscopic images is performed on a pixel-by-pixel basis.

3. The method of claim 1, wherein at least two of the two or more two-dimensional fluoroscopic images are taken from perspectives that are angled relative to one another.

4. The method of claim 1, wherein the first electromagnetic device does not comprise an optical sensor or marker.

5. The method of claim 1, wherein the first electromagnetic device is disposed on or within the patient percutaneously.

6. The method of claim 1, wherein the first electromagnetic device is attached to a bone of the patient.

7. The method of claim 1, wherein the three-dimensional representation comprises a CT scan.

8. The method of claim 1, wherein the two or more two-dimensional fluoroscopic images are acquired using a C-arm imager.

9. The method of claim 1, wherein the two or more two-dimensional fluoroscopic images comprise two, three, or four two-dimensional fluoroscopic images.

10. A method of surgical navigation comprising the acts of:

attaching a first electromagnetic device to a patient anatomy of interest to establish a coordinate frame;

performing an acquisition of two or more two-dimensional fluoroscopic images using a C-arm imaging system, wherein the C-arm imaging system comprises a second electromagnetic device and a calibration target;

performing a registration operation using a computerized navigation system configured to process the coordinate frame, the two or more two-dimensional fluoroscopic images, a projection model generated using calibration data derived based upon the calibration target and spatial data derived for the C-arm using the second electromagnetic device, digital radiographic reconstruction (DRR) images generated using the projection model and a calculated pose of the C-arm imaging system relative to a three-dimensional representation of the patient anatomy of interest generated prior to surgery, and the three-dimensional representation of the patient anatomy of interest generated prior to surgery, wherein the registration operation generates a three-dimensional visualization of the patient; and

monitoring a representation of a surgical tool depicted with respect to the three-dimensional visualization, wherein the surgical tool is equipped with a third electromagnetic device.

11. The method of claim 10, comprising:

acquiring additional two-dimensional fluoroscopic images after the three-dimensional visualization is generated; and

updating the registration and the three-dimensional visualization based on the additional two-dimensional fluoroscopic images.

12. The method of claim 10, wherein the two or more two-dimensional fluoroscopic images are taken from perspectives that are angled relative to one another.

13. The method of claim 10, wherein the first, second and third electromagnetic devices generate a signal representative of a position and orientation of the patient, the C-arm imaging system, and the medical device, respectively.

14. The method of claim 10, further comprising viewing the 3D visualization of the device and the patient from a coronal, sagittal, or axial plane perspective of the patient.