Determining and illustrating a structure

• US 8,768,434 B2
• Filed: 04/14/2009
• Issued: 07/01/2014
• Est. Priority Date: 04/18/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Markowitz, H. Toby, Karamanoglu, Mustafa, Mehta, Pooja, Fleming, Ioana, Scanlon, David A., Kryger, Michael, Campbell-Massa, Sean, Giese, Chad, Waldhauser, Steven L., Zhang, Shangqian Peter, Jannicke, Jeff, Falkner, Phillip, Hefner, Don, Warman, Eduardo N., Steeves, James, Receveur, Rogier, Michels, Koen, Eick, Olaf, Larik, Vincent
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): KIMBALL, JEREMIAH T
• Application Number:
  US12/423,477
• Publication Number:
  US 20090264742A1
• Time in Patent Office: 1,904 Days
• Field of Search: 600/523, 600/424
• US Class Current: 600/424
• 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 2017/00336 with a protective sleeve, e.g. retractable or slidable
• 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 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• 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 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/061 Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body A61B1/00158 takes precedence
• CPC Class Codes: A61B 5/062 using magnetic field
• 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 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/304 : Switching circuits
• CPC Class Codes: A61B 5/333 : Recording apparatus specially adapted therefor
• CPC Class Codes: A61B 5/339 : Displays specially adapted therefor
• CPC Class Codes: A61B 5/742 : using visual displays A61B5/339 takes precedence
• 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: A61B 8/4472 : Wireless probes

Abstract

An 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 system to identify a structure in a volume, comprising:

an instrument operable to be moved in the volume;

a first position element positioned near a first end of the instrument;

a display device operable to display a map of an internal surface of the volume; and

a processor configured to;

evaluate an electrical property sensed with the first position element,

generate a substantially pristine virtual filled volume superimposed on the displayed map of the internal surface, and

determine with input from the instrument a portion of the substantially pristine virtual filled volume superimposed on the displayed map of the internal surface that represents a physical surface of the volume.

2. The system of claim 1, further comprising:

a set of axis generation electrodes operable to be positioned on a surface of the volume;

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

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

the processor further operable to generate the map of the volume with the stored determined positions of the first position element.

3. The system of claim 2, further comprising:

a second position element on the instrument;

wherein the storage system is operable to store a plurality of determined positions of the second position element.

4. The system of claim 3, wherein the map is generated only with the stored plurality of determined positions.

5. The system of claim 4, wherein the volume is a heart of a patient;

wherein the structure is an ostium within the heart of the patient.

6. The system of claim 5, wherein the map of an internal surface of the volume is a map of an internal wall of the heart;

wherein the substantially pristine virtual filled volume is a virtual filled volume having a smooth surface displayed and superimposed on a portion of the map of the internal wall;

wherein the instrument is operable to move relative to the internal wall of the heart and contact a physical surface of the heart; and

wherein the processor is configured to determine a position of the instrument and remove a portion of the substantially pristine filled volume to display a detailed map of an internal surface of the volume.

7. The system of claim 6, wherein the set of axis generation electrodes includes at least three sets of axis generation electrodes;

wherein the driver is operable to inject a current between each of the three sets of axis generation electrodes;

wherein the current injected between each of the three sets of axis generation electrodes defines three different axes within the heart of the patient;

wherein the processor is operable to determine a position of the instrument along each of the three axes wherein the map of an internal surface of the volume is a three-dimensional map of the internal surface of the volume and the detail of the map is a three-dimensional detailed map representing a specific structure relative to the wall of the heart.

8. The system of claim 1, further comprising:

the further includes at least one of;

an inflatable portion;

at least two electrodes as the first position element;

a guidewire operable to be positioned through a cannula;

a plurality of the position elements along a length of the mapping instrument; and

a temperature sensor;

a position determination processor operable to determine a position of the mapping instrument;

a display device operable to display a map based at least on the determined position of the mapping instrument;

a display processor operable to augment the map on the display device, wherein the display processor is operable to at least one of;

determine a position of the position element that is positioned to sense a voltage formed in the volume;

determine a position of an input impedance reference electrode and display it on the display device relative to the map; and

determine a pseudo position of the axis electrodes on the display device relative to the map;

a physiological measuring device;

an introducer operable to be located with the position determination processor;

a reference electrode at a fixed position on a surface of the volume and a location of the reference electrode is operable to be determined with the position determination processor; and

a procedure instrument with a second position element operable to be located relative to the map;

wherein a map of a volume is displayed on the display device for visualization by a user based solely on determined positions of one or more of the position elements.

9. A method to identify a structure in a volume, comprising:

generating a map of an internal surface of the volume;

generating a virtual filled volume that is substantially pristine and independent of the map of the internal surface superimposed on the generated map;

displaying the virtual filled volume;

moving a position element towards a physical surface of the volume;

determining a position of the position element relative to the physical surface of the volume; and

redisplaying the virtual filled volume including a removed portion of the virtual filled volume if the virtual filled volume does not represent a physical surface of the volume based on a determination that the determined position of the position element is closer to the physical surface of the volume than represented by the virtual filled volume superimposed on the generated map.

10. The method of claim 9, further comprising:

providing an instrument extending between a first end and a second end;

providing the position element near the first end;

positioning a set of axis generation electrodes on a surface of the volume;

injecting a current into the volume between the set of axis generation electrodes;

sensing with the position element an electrical property due to the injected current into the volume between the set of axis generation electrodes; and

evaluating the sensed electrical property sensed with the position element.

11. The method of claim 10, wherein at least one of the generated map or the virtual filled volume is generated without an additional imaging system.

12. The method of claim 9, further comprising:

moving the instrument relative to a wall of a heart;

generating a first portion of the generated map;

generating the virtual filled volume relative to the first portion of the map;

wherein redisplaying the virtual filled volume includes generating a second portion of the map based on removing a portion of the virtual filled volume to represent a physical surface of the heart.

13. The method of claim 12, further comprising:

identifying an ostium in the heart based on the second portion of the map.

14. The method of claim 9, wherein generating a map of an internal surface of the volume includes moving the position element towards the physical surface of the volume, determining a position of the position element at a plurality of locations relative to the physical surface of the volume, and displaying a representation of an internal physical surface of the volume based on the determined plurality of positions;

wherein generating the virtual filled volume includes determining a volume relative to the map of the physical surface of the volume that is substantially smooth;

wherein redisplaying the virtual filled volume includes;

moving the instrument relative to the physical surface of the volume;

determining that a portion of the generated virtual filled volume does not represent a portion of the physical surface of the volume; and

augmenting the generated virtual filled volume to illustrate that the virtual filled volume does not represent a portion of the physical surface of the volume.

15. The method of claim 14, wherein moving a position element towards a physical surface of the volume includes moving a position element relative to an internal wall of the heart;

wherein generating a map of an internal surface of the volume includes moving a mapping instrument to a plurality of locations relative to the internal wall of the heart to generate the map of the internal surface of the volume based upon the plurality of positions determined with the mapping instrument;

wherein generating a virtual filled volume includes generating a virtual filled volume over a selected location on the generated map representing a selected location within the heart.

16. The method of claim 15, further comprising:

positioning a second and third set of axes generation electrodes on the surface of the volume;

injecting a current between each of the set, second set, and third set of axis generation electrodes to generate three axes within the volume;

wherein evaluating the sensed electrical property includes determining a position of the position element along each of the three axes to determine a three-dimensional position of the position element.

17. The method of claim 9, further comprising:

tracking a position of the position element in the volume;

collecting positions of the position element;

determining a validity of the collected positions;

displaying the map on a display device;

measuring a rhythmic feature of a volume;

wherein tracking the position element, includes at least one of;

selecting between a uni-polar and bi-polar collection of positions;

determining whether an interfering frequency is present during or prior to collecting the positions;

inflating a portion of the mapping instrument;

fixing a location of a first position element relative to a second position element;

moving a flexible member with a first position element relative to a second position element at a fixed position and measuring the position of the first member position element relative to the second position element;

measuring a temperature within the volume at least one of the position element, the first position element, and the second position element; and

displaying on a display device at least one of;

a corrected map data generated by reducing distortion of a measured position of a mapping instrument by determining a scaling factor between two position elements of the mapping instrument;

a pseudo location of an axis electrode relative to the map;

a location of a reference electrode relative to the map;

a map point determined by generating a virtual point based on a known position of a physical portion of the mapping instrument relative to a position element of the mapping instrument;

the map based on locations categorized relative to the measured rhythmic feature;

a virtual map data point determined based on a geometry of the mapping instrument relative to the position element; and

a location of an introducer through which the mapping instrument or the procedure instrument is passed.

18. The method of claim 9, further comprising:

determining curvilinear portions to be displayed relative to the filled volume with a mapping instrument.

19. A method to identify a structure in a volume, comprising:

moving a position element within a heart;

collecting a plurality of positions of the position element within the heart;

generating a map of an internal surface of the heart based on the collected plurality of positions;

generating a virtual filled volume that is substantially pristine and independent of the generated map, but is superimposed on the generated map;

displaying the virtual filled volume on a display device;

determining a disturbed virtual filled volume, including;

moving the position element towards a physical surface of the volume;

determining a position of the position element relative to the physical surface of the volume; and

generating the disturbed virtual volume including a removed portion of the virtual filled volume if the generated virtual filled volume does not represent a physical surface of the heart based on a determination that the position of the position element is closer to the physical surface of the volume than represented by the generated virtual filled volume superimposed on the generated map; and

displaying the disturbed virtual volume superimposed on the generated map.

20. The method of claim 19, further comprising:

identifying an anatomical structure in the heart based on the disturbed virtual volume;

wherein the anatomical structure is represented by a boundary that bounds the removed portion of the volume in the disturbed volume;

wherein the removed portion is determined based on determined positions of the position element.

21. The method of claim 20, further comprising:

selecting a location within the heart;

superimposing the generated virtual filled volume on the portion of the map representing the selected location.

22. The method of claim 21, wherein the generated virtual filled volume is substantially smooth;

wherein generating the disturbed volume includes displaying depressed portions into the virtual filled volume to represent depressions within the internal surface of the heart.

23. The method of claim 22, wherein generating the disturbed volume is generated only with determining a position of the position element relative to the physical surface of the volume and no additional image data;

and

wherein generating the map is generated only with collecting a plurality of positions of the position element within the heart and no additional image data.