Image-guided therapy of a tissue

• US 9,504,484 B2
• Filed: 03/18/2015
• Issued: 11/29/2016
• Est. Priority Date: 03/18/2014
• Status: Active Grant

• Current Assignee: Monteris Medical Incorporated (Monteris Medical US, Inc.)
• Original Assignee: Monteris Medical Incorporated (Monteris Medical US, Inc.)
• Inventors: Andrews, Eric, Grant, Mark, Ren, Brooke, Tyc, Richard
• Primary Examiner(s): FOWLER, DANIEL WAYNE
• Application Number:
  US14/661,153
• Publication Number:
  US 20150265306A1
• Time in Patent Office: 622 Days
• US Class Current: 1/1
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1815 using microwaves
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00212 using remote controls
• CPC Class Codes: A61B 2017/320069 for ablating tissue
• CPC Class Codes: A61B 2018/00011 with fluids
• CPC Class Codes: A61B 2018/00017 with gas
• CPC Class Codes: A61B 2018/00446 Brain
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00589 Coagulation
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00702 Power or energy
• CPC Class Codes: A61B 2018/00732 Frequency
• CPC Class Codes: A61B 2018/00738 Depth, e.g. depth of ablation
• CPC Class Codes: A61B 2018/00761 Duration
• CPC Class Codes: A61B 2018/00791 Temperature
• CPC Class Codes: A61B 2018/00809 measured thermochromatically
• CPC Class Codes: A61B 2018/00904 Automatic detection of target tissue
• CPC Class Codes: A61B 2018/00994 combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
• CPC Class Codes: A61B 2018/0293 using an instrument interstitially inserted into the body, e.g. needle
• CPC Class Codes: A61B 2018/1861 : with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2090/374 : NMR or MRI
• CPC Class Codes: A61B 2090/3954 : magnetic, e.g. NMR or MRI
• 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 5/0036 : including treatment, e.g., using an implantable medical device, ablating, ventilating
• CPC Class Codes: A61B 5/015 : By temperature mapping of body part
• CPC Class Codes: A61B 5/055 : involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
• CPC Class Codes: A61B 90/10 : for stereotaxic surgery, e.g. frame-based stereotaxis
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/14 : Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61N 2007/0047 : interstitial
• CPC Class Codes: A61N 2007/025 : interstitial
• CPC Class Codes: A61N 5/0601 : Apparatus for use inside the body
• CPC Class Codes: A61N 5/062 : Photodynamic therapy, i.e. excitation of an agent
• CPC Class Codes: A61N 5/067 : using laser light
• CPC Class Codes: A61N 7/00 : Ultrasound therapy lithotripsy A61B17/22, A61B17/225; massage using supersonic vibration A61H23/00 ; using ultrasound for introducing media into the body A61M37/0092
• CPC Class Codes: G01R 33/285 : Invasive instruments, e.g. catheters or biopsy needles, specially adapted for tracking, guiding or visualization by NMR
• CPC Class Codes: G01R 33/34046 : Volume type coils, e.g. bird-cage coils; Quadrature bird-cage coils; Circularly polarised coils
• CPC Class Codes: G01R 33/4804 : Spatially selective measurement of temperature or pH
• CPC Class Codes: G01R 33/4833 : using spatially selective excitation of the volume of interest, e.g. selecting non-orthogonal or inclined slices

Abstract

Thermal monitoring of tissue during a thermal therapy may include identifying an imaging plane bisection axis lying along at least one of a longitudinal axis of a thermal therapy instrument and a vector through a region of interest. The method may include identifying multiple thermal monitoring planes used in monitoring thermal therapy of the volume, where each thermal monitoring plane intersects the region of interest, where a first thermal monitoring plane intersects a second thermal monitoring plane at the imaging plane bisection axis, and the first thermal monitoring plane is offset from the second thermal monitoring plane by an angle of intersection. The method may include and performing thermal monitoring of the thermal therapy by obtaining magnetic resonance (MR) images obtained from the first monitoring plane and the second monitoring plane, and calculating, based on the images, temperature data of the volume.

Claims

1. A method for thermal monitoring of tissue during a thermal therapy, comprising:

identifying, by processing circuitry, an imaging plane bisection axis, wherein the imaging plane bisection axis lies along at least one of a) a longitudinal axis of a thermal therapy instrument for performing thermal therapy in a patient, and b) a vector through a region of interest within a volume in the patient;

identifying, by the processing circuitry, at least a first thermal monitoring plane and a second thermal monitoring plane used in monitoring thermal therapy of the volume, wherein

each of the first thermal monitoring plane and the second thermal monitoring plane intersects the region of interest,

the first thermal monitoring plane intersects the second thermal monitoring plane at the imaging plane bisection axis, and

the first thermal monitoring plane is offset from the second thermal monitoring plane by an angle of intersection, wherein

the angle of intersection is determined by the processing circuitry based at least in part on at least one of i) an anatomy of the region of interest, wherein the region of interest is irregularly shaped, and ii) an anatomy of a region of a skull of the patient near the volume; and

performing, by the processing circuitry, thermal monitoring of the thermal therapy, wherein the thermal monitoring comprises;

obtaining, in real time or near real time from a magnetic resonance (MR) imaging apparatus, a current magnetic resonance (MR) image obtained from the first monitoring plane and a current MR image obtained from the second monitoring plane,

calculating, based on the current MR image obtained from the first monitoring plane and the current MR image obtained from the second monitoring plane, temperature data of the volume, and

analyzing at least one of the temperature data and a thermal dose that is based on a temperature history of the region of interest over a specified time period to identify completion of thermal therapy of a portion of the region of interest.

2. The method of claim 1, wherein identifying completion of thermal therapy comprises indicating cellular death within the portion of the region of interest.

3. The method of claim 1, wherein the first monitoring plane is orthogonal to the second monitoring plane.

4. The method of claim 1, wherein identifying the first thermal monitoring plane and the second thermal monitoring plane comprises receiving user selection of the first thermal monitoring plane and the second thermal monitoring plane, wherein the user selection is entered via a graphical user interface.

5. The method of claim 1, further comprising identifying the vector through the region of interest, wherein identifying the vector comprises calculating a greatest imaging volume achievable encompassing the region of interest.

6. A system for thermal monitoring of tissue during a thermal therapy, comprising:

a processor in communication with a display and a magnetic resonance (MR) imaging device; and

a memory having instructions stored thereon, wherein the instructions, when executed by the processor, cause the processor to;

identify an imaging plane bisection axis, wherein the imaging plane bisection axis lies along at least one of a) a longitudinal axis of a thermal therapy instrument for performing thermal therapy in a patient, and b) a vector through a region of interest within a volume in the patient;

identify at least a first thermal monitoring plane and a second thermal monitoring plane used in monitoring thermal therapy of a volume in a patient, wherein

each of the first thermal monitoring plane and the second thermal monitoring plane intersects the region of interest,

the first thermal monitoring plane intersects the second thermal monitoring plane at the imaging plane bisection axis, and

the first thermal monitoring plane is offset from the second thermal monitoring plane by an angle of intersection, wherein

the angle of intersection is determined based at least in part on at least one of i) an anatomy of the region of interest, wherein the region of interest is irregularly shaped, and ii) an anatomy of a region of a skull of the patient near the volume; and

perform thermal monitoring of the thermal therapy, wherein performing thermal monitoring comprises;

obtaining, in real time or near real time from a magnetic resonance (MR) imaging apparatus, a current magnetic resonance (MR) image obtained from the first monitoring plane and a current MR image obtained from the second monitoring plane,

calculating, based on the current MR image obtained from the first monitoring plane and the current MR image obtained from the second monitoring plane, temperature data of the volume, and

causing presentation, on the display, of a graphic rendering of the temperature data.

7. The system of claim 6, wherein causing presentation of the graphic rendering of the temperature data comprises causing presentation of graphic renderings of successive calculations of temperature data over time.

8. The system of claim 6, wherein causing presentation of the graphic rendering of the temperature data comprises causing presentation of a contour in a view pane of the display.

9. The system of claim 6, wherein identifying at least the first thermal monitoring plane and the second thermal monitoring plane comprises identifying a third thermal monitoring plane, wherein the third thermal monitoring plane bisects the imaging plane bisection axis.

10. The system of claim 9, wherein the first thermal monitoring plane, the second thermal monitoring plane, and the third thermal monitoring plane bisect to form respective substantially equal angles of intersection.

11. The system of claim 9, wherein an additional angle of intersection between the third monitoring plane and the second monitoring plane differs from the angle of intersection between the first monitoring plane and the second monitoring plane.

12. A non-transitory computer readable medium having instructions stored thereon, wherein the instructions, when executed by a processor, cause the processor to:

identify an imaging plane bisection axis, wherein the imaging plane bisection axis lies along at least one of a) a longitudinal placement of a thermal therapy instrument for performing thermal therapy in a patient, and b) a vector through a region of interest within a volume in the patient;

identify a first thermal monitoring plane and a second thermal monitoring plane used in monitoring thermal therapy of a volume in the patient, wherein

each of the first thermal monitoring plane and the second thermal monitoring plane intersects the region of interest,

the first thermal monitoring plane intersects the second thermal monitoring plane at the imaging plane bisection axis, and

the first thermal monitoring plane is offset from the second thermal monitoring plane by an angle of intersection, wherein

the angle of intersection is determined based at least in part on at least one of i) an anatomy of the region of interest, wherein the region of interest is irregularly shaped, and ii) an anatomy of a region of a skull of the patient near the volume; and

perform thermal monitoring of the thermal therapy, wherein performing thermal monitoring comprises;

obtaining, in real time or near real time from a magnetic resonance (MR) imaging apparatus, a current magnetic resonance (MR) image obtained from the first monitoring plane and a current MR image obtained from the second monitoring plane,

calculating, based at least in part on the current MR image obtained from the first monitoring plane and the current MR image obtained from the second monitoring plane, temperature data of the volume, and

analyzing the temperature data of the volume to identify one or more adjustments to at least one of a time of thermal therapy application, an emission pattern of the thermal therapy instrument, an emission level of the thermal therapy instrument, an emission frequency of the thermal therapy instrument, a pulse sequence of the thermal therapy instrument, and a position of the thermal therapy instrument.

13. The computer readable medium of claim 12, wherein:

analyzing the temperature data comprises;

calculating a depth of treatment, and

comparing the depth of treatment to a desired depth of treatment; and

performing thermal monitoring comprises, responsive to identifying a mismatch of depth of treatment to desired depth of treatment, causing adjustment of at least one of a time of thermal therapy application, a power level of the thermal therapy instrument, an emission level of the thermal therapy instrument, a pulse sequence of the thermal therapy instrument, and a power density of the thermal therapy instrument.

14. The computer readable medium of claim 12, wherein:

analyzing the temperature data comprises monitoring nearby tissue proximate to the thermal therapy instrument to identify evidence of overheating of the nearby tissue; and

performing thermal monitoring comprises, responsive to identifying the evidence of overheating, causing adjustment of at least one of a time of thermal therapy application, a power level of the thermal therapy instrument, an emission level of the thermal therapy instrument, a pulse sequence of the thermal therapy instrument, and a power density of the thermal therapy instrument.

15. The computer readable medium of claim 12, wherein the thermal therapy instrument comprises a plurality of ultrasonic elements spaced along the longitudinal axis of the thermal therapy instrument.

16. The computer readable medium of claim 15, wherein:

analyzing the temperature data comprises monitoring nearby tissue proximate to the thermal therapy instrument to identify evidence of overheating of the nearby tissue; and

performing thermal monitoring comprises, responsive to identifying the evidence of overheating, causing adjustment of at least a first ultrasonic element of the plurality of ultrasonic elements.

17. The computer readable medium of claim 12, wherein:

analyzing the temperature data comprises estimating cellular death; and

performing thermal monitoring comprises, responsive to identifying the evidence of cellular death, causing repositioning of the thermal therapy instrument to at least one of a new rotational position and a new linear position.

18. The computer readable medium of claim 17, wherein the instructions, when executed by the processor, cause the processor to, after repositioning the thermal therapy instrument and prior to performing additional thermal therapy, identify a new imaging plane bisection axis.