Image-guide therapy of a tissue

• US 9,510,909 B2
• Filed: 03/16/2015
• Issued: 12/06/2016
• Est. Priority Date: 08/13/2009
• Status: Active Grant

• Current Assignee: Monteris Medical Incorporated (Monteris Medical US, Inc.)
• Original Assignee: Monteris Medical Incorporated (Monteris Medical US, Inc.)
• Inventors: Sootsman, W. Keith, Grant, Mark Andrew, Andrews, Eric, Tyc, Richard, Qureshi, Salman, Fernandes, Luis Filipe Silva, Carreira, Daniel Prazeres, Schellhorn, John
• Primary Examiner(s): SHI, KATHERINE MENGLIN
• Application Number:
  US14/659,488
• Publication Number:
  US 20150202008A1
• Time in Patent Office: 631 Days
• Field of Search: 606/1, 606/2, 606/2.5, 606/7, 606 13- 16, 606/32, 606/39, 606/40, 606/45, 606/130, 607/88, 607/89, 600/407, 600410-412, 600/417
• US Class Current: 1/1
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/0206 ultrasonic, e.g. for destroying tissue or enhancing freezing
• CPC Class Codes: A61B 18/06 caused by chemical reaction , e.g. moxaburners
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/1815 using microwaves
• CPC Class Codes: A61B 18/22 the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
• CPC Class Codes: A61B 18/28 for heating a thermal probe or absorber
• CPC Class Codes: A61B 2017/00017 Electrical control of surgical instruments
• CPC Class Codes: A61B 2017/00911 for fields applied by a magnetic resonance imaging system
• CPC Class Codes: A61B 2017/3407 including a base for support on the body
• CPC Class Codes: A61B 2018/00017 with gas
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00446 Brain
• CPC Class Codes: A61B 2018/00577 Ablation
• 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 2018/00791 Temperature
• 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 2018/0212 using an instrument inserted into a body lumen, e.g. catheter
• CPC Class Codes: A61B 2018/0293 : using an instrument interstitially inserted into the body, e.g. needle
• CPC Class Codes: A61B 2018/1807 : using light other than laser radiation
• CPC Class Codes: A61B 2018/1861 : with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2018/20351 : Scanning mechanisms
• CPC Class Codes: A61B 2018/2211 : Plurality of fibres
• CPC Class Codes: A61B 2018/2261 : with scattering, diffusion or dispersion of light
• CPC Class Codes: A61B 2034/107 : Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2068 : using pointers, e.g. pointers having reference marks for determining coordinates of body points
• 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 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/374 : 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 34/25 : User interfaces for surgical systems
• CPC Class Codes: A61B 34/71 : Manipulators operated by drive cable mechanisms
• 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 5/4839 : combined with drug delivery
• CPC Class Codes: A61B 5/742 : using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 5/746 : Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B
• 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: 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 7/022 : intracavitary
• 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 33/4804 : Spatially selective measurement of temperature or pH

Abstract

Image-guided therapy of a tissue can utilize magnetic resonance imaging (MRI) or another medical imaging device to guide an instrument within the tissue. A workstation can actuate movement of the instrument, and can actuate energy emission and/or cooling of the instrument to effect treatment to the tissue. The workstation and/or an operator of the workstation can be located outside a vicinity of an MRI device or other medical imaging device, and drive means for positioning the instrument can be located within the vicinity of the MRI device or the other medical imaging device. The instrument can be an MRI compatible laser probe that provides thermal therapy to, e.g., a tissue in a brain of a patient.

Claims

1. A system for effecting treatment to a tissue, comprising:

a motorless drive mechanism that is compatible with and can operate within an operational field of a medical imaging system to image the tissue without substantially disrupting imaging performed by the medical imaging system, the motorless drive mechanism including a holder to hold a treatment device to treat the tissue, and a first wire translation mechanism that couples one or more wires to the holder, such that a translation of the one or more wires effects one or more of a longitudinal displacement of the holder and a rotation of the holder;

a base unit that is coupled to the motorless drive mechanism by the one or more wires, the base unit including a second wire translation mechanism to translate the one or more wires;

an electronic controller including an input interface to receive position control signals for setting a position of the treatment device, and an output interface that is coupled to the second wire translation mechanism of the base unit, such that the output interface effects movements of the second wire translation mechanism to translate the one or more wires based on the position control signals received by the input interface to effect movements of the first wire translation mechanism, such that one or more of the longitudinal displacement of the holder and the rotation of the holder are effected based on the position control signals received by the input interface; and

an energy emission probe as the treatment device including a first laser fiber and a second laser fiber for outputting a plurality of different output patterns.

wherein the first laser fiber outputs a symmetrical output pattern with respect to a longitudinal axis of the first laser fiber, and the second laser fiber outputs an asymmetrical output pattern with respect to a longitudinal axis of the second laser fiber.

2. The system according to claim 1, further comprising a guide assembly that is attachable to a surface of a patient, the guide assembly including:

a base structure that remains stationary relative to the patient when the guide assembly is attached to the surface of the patient in a locked state; and

a tilt portion that is coupled to the base structure, the tilt portion that holds the motorless drive mechanism at a position that is separated from the surface of the patient, and the tilt portion providing an adjustable tilt between a trajectory of the motorless drive mechanism and the base structure when the base structure remains stationary relative to the patient.

3. The system according to claim 2, wherein the guide assembly further includes a rotation portion that provides an adjustable rotation of the tilt portion relative to the base structure.

4. The system according to claim 1, wherein:

the medical imaging system is a magnetic resonance imaging (MRI) system that includes a thermal imaging function, and

the motorless drive mechanism consists of MRI and thermal imaging compatible materials and structures.

5. The system according to claim 1, wherein:

the electronic controller is to process a sequence of the position control signals to move the holder to a first position for effecting the treatment to the tissue at a first portion of the tissue that coincides with the first position, and move the holder, after the effecting the treatment to the tissue as the first portion, to a second position for effecting the treatment to the tissue at a second portion of the tissue that coincides with the second position; and

the electronic controller is to cause the holder to move from the first position to the second position while the medical imaging system continuously images the tissue.

6. The system according to claim 5, further comprising:

a workstation to transmit the position control signals to the controller and to display thermometry images of the tissue.

7. The system according to claim 6, wherein the workstation continuously displays the thermometry images of the tissue during the treatment to the tissue at the first and second portions of the tissue, while the medical imaging system continuously images the tissue, and while the holder moves between the first and second positions.

8. The system according to claim 1, further comprising:

an energy source to generate energy for the probe; and

a workstation to transmit the position control signals to the electronic controller, and to transmit energy control signals to the energy source, wherein the workstation is to process a sequence of the energy control signals to

effect a symmetrical treatment to the tissue with the probe, and

effect an asymmetrical treatment to the tissue with the probe after the symmetrical treatment.

9. The system according to claim 1, further comprising:

a laser source to generate laser energy for the laser probe; and

a workstation to transmit the position control signals to the controller, and to transmit laser control signals to the laser source, wherein the workstation is to process a sequence of the position and laser control signals to

move the holder to a first position for effecting the treatment to the tissue at a first portion of the tissue that coincides with the first position,

effect a symmetrical treatment to the first portion of the tissue with the first laser fiber,

move the holder to a second position for effecting the treatment to the tissue at a second portion of the tissue that coincides with the second position, and

effect an asymmetrical treatment to the second portion of the tissue with the second laser fiber.

10. The system according to claim 9, wherein the workstation is to display thermometry images of the tissue continuously throughout processing of the sequence of the position and laser control signals and throughout moving the holder and effecting the symmetrical and asymmetrical treatments.

11. The system according to claim 1, further comprising:

the medical imaging system to output images of the tissue and the treatment device, including thermometry images of the tissue, in real time, continuously throughout one or more steps of effecting the treatment to the tissue; and

a workstation to transmit the position control signals to the controller based on one or more of the images, as the images are received by the workstation in real time, and to display, in real time, one or more of the images throughout the one or more steps of effecting the treatment to the tissue.

12. The system according to claim 11, wherein the workstation is to display, in real time, the thermometry images of the tissue with the images of the tissue and the treatment device continuously throughout a processing of the position control signals and throughout moving the holder and effecting the treatment to the tissue.

13. The system according to claim 11, wherein the workstation is to process, in real time, the images of the tissue and the treatment device and the thermometry images of the tissue to forecast errors or interruptions in the treatment to the tissue and display a corresponding warning.

14. The system according to claim 1, wherein the energy emission probe includes a plurality of the emitters.

15. The system according to claim 14, wherein the plurality of the emitters are longitudinally spaced with respect to a longitudinal axis of the energy emission probe.

16. The system according to claim 1, further comprising:

a guide sheath including a plurality of probes of different modalities as the treatment device, wherein the modalities include one or more of;

laser, radiofrequency, high-intensity focused ultrasound, microwave, cryogenic, photodynamic therapy, chemical release and drug release.

17. The system according to claim 16, wherein the guide sheath includes one or more off-axis holes for positioning an emitting point of one or more of the plurality of probes at an off-axis angle.