Determining a location of a member

• US 9,179,860 B2
• Filed: 04/14/2009
• Issued: 11/10/2015
• 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:
  US12/423,466
• Publication Number:
  US 20090262982A1
• Time in Patent Office: 2,401 Days
• Field of Search: 600/424
• US Class Current: 1/1
• 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 locate and determine a position of portions of an instrument in a volume, comprising:

an elongated and flexible single member extending a length between a first end and a second terminal end;

a first position element positioned near the first end of the elongated and flexible single member;

a second position element positioned near the second terminal end of the elongated and flexible single member;

a plurality of third position elements positioned along at least a portion of the length of the elongated and flexible single member between the first end and the second terminal end, wherein the plurality of third position elements is configured to allow for determination of a resolution of a geometry of the elongated and flexible single member;

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

a driver to inject a current at a selected first frequency into the volume between the set of axis generation electrodes;

a processor operable to evaluate an electrical property sensed with the first position element, the second position element, and at least a sub-plurality of the third position elements of the plurality of the third position elements based on the injected current into the volume;

wherein the elongated and flexible single member is operable to flex between the first position element and the second position element such that the first position element and the second position element are not aligned;

wherein the first position element, the second position element, and at least the sub-plurality of the third position elements of the plurality of the third position elements are operable to sense the electrical property within the volume due to the injected current into the volume between the set of axis generation electrodes and the processor is configured to execute instructions to determine a geometry of at least a portion of the elongated and flexible single member between the first end and the second terminal end based at least on the sensed electrical property with the at least the sub-plurality of the third position elements;

wherein the processor is configured to execute instructions to determine the position of at least one of the first position element, the second position element, or the plurality of third position elements using only the processor and at least one of the first position element, the second position element, the plurality of third position elements, or a fourth position element and to determine if an anomalous current at an anomalous frequency is present within the patient other than the selected first frequency, wherein the anomalous frequency is an interfering frequency.

2. The system of claim 1, further comprising:

a mapping instrument having a fourth position element;

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

the processor further operable to generate a map of the volume with the stored determined positions of the fourth position element;

a display device operable to display the map;

wherein a first icon representing the position of the first position element, a second icon representing a position of the second position element, and a third icon operable to illustrate the determined geometry of at least the portion of the elongated and flexible single member between the first end and the second terminal end;

wherein the first icon, the second icon, and the third icon are operable to be superimposed on the map displayed on the display device to illustrate a position of two portions of the elongated and flexible member within the volume.

3. The system of claim 1, wherein the elongated and flexible member has an outer wall and both the first position member and the second position member are fixed to the outer wall.

4. The system of claim 3, wherein the first position member is formed integrally with the outer wall.

5. The system of claim 1, further comprising:

an elongated flexible sleeve;

wherein the first position element and the second position element are fixed to the elongated flexible sleeve;

wherein the elongated and flexible member is positioned through the elongated flexible sleeve.

6. The system of claim 1, wherein the elongated and flexible member is an implantable lead;

wherein the second position element is positioned at a terminal distal end of the elongated and flexible member and is operable to be implanted into a wall of a heart.

7. The system of claim 1, further comprising:

a mapping instrument having a position element and operable to be located in a volume, wherein the mapping instrument includes at least one of;

an inflatable portion;

at least two electrodes as the position element;

a guidewire operable to be positioned through a cannula; and

a temperature sensor;

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;

a state determining processor operable to determine a location of the mapping instrument;

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 catheter including an opening in a sidewall of the catheter operable to allow a fluid into an interior of the catheter;

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.

8. A system to locate and determine a position of portions of an instrument in a volume of a patient, comprising:

an elongated and flexible implantable single lead extending between a first end and a second terminal distal end;

a first position element positioned near the first end of the implantable lead, wherein the first position element includes a plurality of first position element portions positioned along a length of the flexible implantable single lead between the first end and the second distal terminal end;

a second position element positioned at the second end of the implantable lead;

a set of axis generation electrodes configured 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;

a mapping instrument having a third position element;

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

a processor operable to evaluate an electrical property sensed with the first position element, the second position element, and the third position element based at least on the injected current, wherein the processor is further operable to generate a map of at least an internal surface of the volume with the stored determined positions of at least the third position element; and

a display device operable to display the map;

wherein the processor is further configured to generate a substantially pristine virtual filled volume superimposed on the displayed map of at least the internal surface of the volume and determine with an input a portion of the substantially pristine virtual filled volume that represents a physical surface of the volume;

wherein the implantable lead is operable to flex between the first position element and the second position element such that the first position element and the second position element are not aligned;

wherein the first position element and the second position element are operable to sense the electrical property within the volume due to the injected current into the volume between the set of axis generation electrodes;

wherein the processor based on the evaluated electrical property sensed with the plurality of first position element portions is operable to determine a resolution of a non-linear geometry of the flexible implantable single lead related to the first position element not aligned with the second position element;

wherein the display is configured to display a first icon representing the non-linear geometry of the flexible implantable single lead based on a first position of the first position element portions and a second icon representing a second position of the second position element superimposed on the map to illustrate the not aligned portions of the elongated and flexible implantable single lead within the volume.

9. The system of claim 8, wherein the first position member is formed integrally with an outer wall of the implantable lead.

10. The system of claim 8, further comprising:

an elongated flexible sleeve;

wherein the first position element includes a plurality of first position elements;

wherein all of the plurality of first position elements are fixed to the elongated flexible sleeve;

wherein the flexible implantable lead is positioned through the elongated flexible sleeve and wherein the sleeve is operable to move and flex with the flexible implantable lead.

11. The system of claim 8, wherein all of the plurality of first position elements are removable from the flexible implantable lead.

12. The system of claim 8, wherein all of the plurality of first position elements are fixed to an exterior wall of the flexible implantable lead.