Method and apparatus for conducting an interventional procedure involving heart valves using a robot-based X-ray device

• US 8,792,964 B2
• Filed: 03/12/2008
• Issued: 07/29/2014
• Est. Priority Date: 03/12/2008
• Status: Active Grant

• Current Assignee: Siemens Healthineers AG (Siemens AG)
• Original Assignee: Siemens AG
• Inventors: Maschke, Michael
• Primary Examiner(s): Le, Long V.
• Assistant Examiner(s): LARYEA, LAWRENCE N
• Application Number:
  US12/046,727
• Publication Number:
  US 20090234444A1
• Time in Patent Office: 2,330 Days
• Field of Search: 600/425, 600/407, 600/426, 378/197, 378/193, 378/196, 378/42, 378/189, 378/128, 378/98.12, 378/19, 378/114, 378/132, 414/146, 606/108, 560/0, 560/1
• US Class Current: 600/427
• CPC Class Codes: A61B 1/3137 for examination of the interior of blood vessels
• CPC Class Codes: A61B 2034/301 for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
• CPC Class Codes: A61B 2090/364 Correlation of different images or relation of image positions in respect to the body
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• 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 34/30 Surgical robots
• CPC Class Codes: A61B 34/71 Manipulators operated by drive cable mechanisms
• CPC Class Codes: A61B 5/01 Measuring temperature of body parts ; Diagnostic temperature sensing, e.g. for malignant or inflamed tissue clinical contact thermometers G01K13/20
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/145 Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/411 Detecting or monitoring allergy or intolerance reactions to an allergenic agent or substance
• CPC Class Codes: A61B 5/4821 Determining level or depth of anaesthesia A61B5/1106 takes precedence
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/4417 related to combined acquisition of different diagnostic modalities
• CPC Class Codes: A61B 6/4441 the rigid structure being a C-arm or U-arm
• CPC Class Codes: A61B 6/4458 the source unit or the detector unit being attached to robotic arms
• CPC Class Codes: A61B 6/4464 the source unit or the detector unit being mounted to ceiling
• CPC Class Codes: A61B 6/503 for diagnosis of the heart
• CPC Class Codes: A61B 6/541 involving acquisition triggered by a physiological signal
• CPC Class Codes: A61B 8/0883 : for diagnosis of the heart
• CPC Class Codes: A61B 8/12 : in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/4416 : related to combined acquisition of different diagnostic modalities, e.g. combination of ultrasound and X-ray acquisitions
• CPC Class Codes: B25J 15/0019 : End effectors other than grippers

Abstract

In a method and an apparatus for conducting minimally-invasive procedures involving heart valves at least one multi-access articulated x-ray imaging robot is employed that allows a radiation detector carried by the robot to be moved in arbitrary paths, such as in circle, an ellipse, or along a spiral, around a patient in order to generate multiple projection exposures of the relevant region of the patient during the procedure. An image processor reconstructs a 3D image from the projection exposures substantially in real time during the procedure, and the 3D image is displayed to operating personnel during the procedure.

Claims

1. A system for conducting medical interventional procedures involving heart valves, comprising:

a patient table configured to support a patient thereon;

a catheter system configured to interact with the patient on the patient table to implement a medical procedure involving a heart valve of the patient, said catheter system comprising a catheter and a catheter robot that at least semi-automatically manipulates said catheter intracorporeally in the patient;

a robotic x-ray imaging device comprising a robot arm having at least four degrees of freedom and a support arm carried by said robot arm, to which are mounted an x-ray source that emits x-rays and a radiation detector, said robot arm being operable to irradiate a region of the patient comprising said heart valve with said x-rays during said medical procedure from a plurality of different projection directions, with said radiation detector detecting x-rays attenuated by the patient at said different projection directions and emitting respective sets of projection data for said projection directions;

a control unit in communication with said catheter robot and said robotic x-ray imaging device, said control unit being mounted at said patient table and being configured to operate both said catheter system, including said catheter robot thereof, and said robotic x-ray imaging system from a single location at said patient table;

an image processor in communication with said radiation detector and supplied therefrom with the projection data sets that reconstructs a 3D image of said region from said projection data sets substantially in real time during said medical procedure; and

a display in communication with said image processor on which said 3D image is displayed during said medical procedure.

2. A system as claimed in claim 1 wherein said robot arm has six degrees of freedom.

3. A system as claimed in claim 1 wherein said support comprises a C-arm.

4. A system as claimed in claim 1 comprising a further imaging device that obtains a further image, different from said 3D image, of said heart valve.

5. A system as claimed in claim 4 wherein said further imaging device is an intracorporeal imaging device embodied in said catheter.

6. A system as claimed in claim 5 wherein said intracorporeal imaging device is selected from the group consisting of intracorporeal optical imaging devices, intracorporeal magnetic resonance imaging devices, and intracorporeal ultrasound imaging devices.

7. A system as claimed in claim 4 comprising an image fusion unit that generates a fused image comprising of said 3D image and said further image.

8. A system as claimed in claim 7 wherein said image fusion unit comprises a segmentation unit that implements a segmentation of said 3D image prior to fusion with said further image.

9. A system as claimed in claim 5 wherein said control unit is configured to also operate said intracorporeal imaging device from said single location.

10. A system as claimed in claim 1 comprising a tracking system that tracks intracorporeal movement of said catheter in the patient.

11. A system as claimed in claim 1 wherein said catheter system is configured to implement a balloon dilation procedure for treatment of stenosis of said heart valve.

12. A method for conducting a medical interventional procedure involving heart valves, comprising the steps of:

placing a patient on a patient table;

implementing a medical procedure involving a heart valve using a catheter system, comprising catheter and a catheter robot, by robotically manipulating said catheter intracorporeally in said patient with said catheter robot;

from a single control unit at said patient table, controlling both said catheter system, including said catheter robot thereof, and said robot arm from a single location at said patient table;

during said medical procedure, obtaining a plurality of projection data sets of a region of the patient comprising said heart valve by moving an x-ray source and a radiation detector around the patient with a robot arm having at least four degrees of freedom to obtain said projection data sets respectively at a plurality of projection directions;

reconstructing a 3D image from said plurality of projection data sets substantially in real time during said medical procedure; and

displaying said 3D image during said medical procedure.

13. A method as claimed in claim 12 wherein the step of implementing a medical procedure involving a heart valve comprises implementing a balloon dilation procedure to treat stenosis of said heart valve.

14. A method as claimed in claim 12 comprising obtaining a further image of said region, different from said 3D image, during said medical procedure.

15. A method as claimed in claim 14 comprising fusing said 3D image and said further image to produce a fused image, and displaying said fused image during said medical procedure.

16. A method as claimed in claim 15 comprising segmenting said 3D image to obtain a segmented image, and fusing said segmented image with said further image.

17. A method as claimed in claim 14 comprising embodying an imaging device in said catheter and intracorporeally obtaining said further image with said imaging device.

18. A method as claimed in claim 17 comprising intracorporeally obtaining said image using an imaging modality selected from the group consisting of intracorporeal optical imaging, intracorporeal magnetic resonance imaging, and intracorporeal ultrasound imaging.

19. A method as claimed in claim 17 comprising also operating said imaging device from said control unit at said single location to intracorporeally obtain said further image.