Image-guided therapy of a tissue

• US 9,700,342 B2
• Filed: 03/18/2015
• Issued: 07/11/2017
• 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, Ren, Brooke, Grant, Mark, Tyc, Richard
• Primary Examiner(s): Lamprecht, Joel
• Application Number:
  US14/661,194
• Publication Number:
  US 20150265366A1
• Time in Patent Office: 846 Days
• 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

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 or high-intensity focused ultrasound probe that provides thermal therapy to, e.g., a tissue in a brain of a patient.

Claims

1. A method for effecting thermal therapy using an in vivo side fire laser probe, comprising:

positioning the side fire laser probe in a volume in a patient at a target position;

identifying a three-dimensional region of interest at which to apply thermal therapy; and

delivering, by processing circuitry, thermal therapy to the three-dimensional region of interest, wherein delivering thermal therapy comprises applying a pulsed energy output pattern by

a) activating emissions exiting the side fire probe at a power output for a first period of time,

b) deactivating emissions exiting the side fire probe for a second period of time, wherein the second period of time is selected to avoid tissue scorching, and

c) repeating steps a) and b), while directing the pulsed energy output pattern in an initial trajectory until determining completion of thermal therapy at the initial trajectory, wherein the pulsed energy output pattern is delivered at a higher power density than achievable without causing tissue scorching using a constantly active energy output;

wherein

determining completion of thermal therapy at the initial trajectory comprises at least one of i) identifying the three-dimensional region of interest has reached a target temperature, and ii) identifying a thermal dose that is based on a temperature history of the three-dimensional region of interest over a specified time period.

2. The method of claim 1, further comprising, after determining completion of thermal therapy at the initial trajectory:

positioning the side fire probe in the patient at a second target position by causing actuation of the side fire probe, by the processing circuitry, in at least one of a rotational direction and a linear direction; and

delivering, by the processing circuitry, thermal therapy to the three-dimensional region of interest by applying a second pulsed energy output pattern to the three-dimensional region of interest at a second trajectory corresponding to the second target position.

3. The method of claim 1, wherein the second period of time is at least 0.3 second.

4. The method of claim 1 wherein a wavelength of energy delivered by the side fire probe is 1064 nanometers.

5. The method of claim 1, wherein delivering thermal therapy to the three-dimensional region of interest further comprises activating, by the processing circuitry, cooling of an emission region of the side fire probe while the emissions are deactivated from exiting the side fire probe.

6. The method of claim 5, further comprising:

controlling the cooling of the emission region of the side fire probe to hold the side fire probe at a temperature that is within a specified temperature range.

7. The method of claim 5, wherein delivering thermal therapy to the three-dimensional region of interest further comprises reading, by the processing circuitry, a thermocouple of the side fire probe while the emissions are deactivated from exiting the side fire probe.

8. A system for effecting thermal therapy using an in vivo side fire laser probe, comprising:

a processor; and

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

identify a three-dimensional region of interest at which to apply thermal therapy within a volume of a patient, wherein the side fire laser probe is positioned in the volume;

identify, based upon one or more of a) a probe type, b) a probe emission style, and c) a depth of the three-dimensional region of interest, a pulsed energy output pattern, wherein

the pulsed energy output pattern comprises an active duration and an inactive duration, wherein the inactive duration is selected to avoid tissue scorching, and

the pulsed energy output pattern is delivered at a higher power density than achievable without causing tissue scorching using a constantly active energy output; and

cause application of the pulsed energy output pattern to the three-dimensional region of interest along a first trajectory, wherein causing application of the pulsed energy output pattern comprises

a) activating probe emission for the active duration at a power output,

b) deactivating probe emission for the inactive duration,

c) repeating steps a) and b) while monitoring feedback data until identifying, based upon the feedback data, evidence of potential damage to tissue proximate an emission region of the probe;

d) responsive to identifying the evidence of potential damage, adjusting at least one of a) a period of the inactive duration and b) a period of the active duration to avoid overheating the tissue closest to the emission region, and

e) continuing to repeat steps a) and b) while monitoring further feedback data until identifying, based upon the further feedback data, conclusion of the thermal therapy;

wherein

the feedback data and further feedback data comprise at least one of temperature-sensitive data and imaging data, and

the feedback data and further feedback data are provided by at least one of a magnetic resonance (MR) imaging system and a thermometry imaging system.

9. The system of claim 8, wherein the active duration is at least 1 second.

10. The system of claim 8, wherein identifying the three-dimensional region of interest comprises identifying the three-dimensional region of interest within Digital Imaging in Communications and Medicine (DICOM) format data.

11. The system of claim 8, wherein the instructions, when executed, further cause the processor to capture, via magnetic resonance (MR) imaging equipment, magnetic resonance (MR) image data of the patient, wherein identifying the three-dimensional region of interest comprises identifying the three-dimensional region of interest within the MR image data.

12. The system of claim 8, wherein causing application of the pulsed energy output pattern further comprises, responsive to identifying the evidence of potential damage, adjusting the power output.

13. The system of claim 8, wherein:

monitoring feedback data comprises determining a temperature at tissue closest to the emission region of the side fire probe; and

adjusting the period of the inactive duration comprises lengthening the period of the inactive duration responsive to the temperature at the tissue to avoid overheating the tissue closest to the emission region of the side fire probe.

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

identify a three-dimensional region of interest at which to apply thermal therapy within a volume of a patient using a laser probe, wherein the laser probe is positioned in the volume;

identify a pulsed energy output pattern, wherein

the pulsed energy output pattern comprises an active duration, a target energy level, and an inactive duration, wherein the inactive duration is selected to avoid tissue scorching, and

the pulsed energy output pattern is delivered at a higher power density than achievable without causing tissue scorching using a constantly active energy output; and

cause application of the pulsed energy output pattern to the three-dimensional region of interest by the probe in an initial trajectory, wherein causing application of the pulsed energy output pattern comprises

a) activating probe emission for the active duration at the target energy level,

b) deactivating probe emission for the inactive duration, and

c) repeating steps a) and b) while monitoring feedback data, until identifying, within the feedback data, evidence comprising at least one of i) evidence of potential damage to tissue proximate to an emission region of the probe, and ii) evidence of a mismatch between a target depth of treatment and an actual depth of treatment, and

d) responsive to identifying the evidence, adjusting at least one of the inactive duration and the active duration.

15. The computer readable medium of claim 14, wherein causing application of the pulsed energy output pattern further comprises repeating steps a) and b) while monitoring feedback data until determining completion of thermal therapy, wherein determining completion comprises at least one of i) identifying the three-dimensional region of interest has reached a target temperature, and ii) identifying a thermal dose that is based on a temperature history of the three-dimensional region of interest over a specified time period.

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

monitoring the feedback data comprises applying thermographic analysis of MR images; and

identifying the three-dimensional region of interest has reached the target temperature comprises indicating cellular damage within the three-dimensional region of interest.

17. The computer readable medium of claim 14, wherein causing application of the pulsed energy output pattern further comprises, during the inactive duration, activating cooling of the emission region of the probe.

18. The computer readable medium of claim 17, wherein activating probe emission comprises transmitting one or more control signals to an energy emission source to activate energy emission of a side fire probe that directs energy via uncoated fiber tip;

and activating cooling of the emission region of the probe comprises transmitting one or more control signals to a cooling fluid source to select one of a cooling fluid pressure and a cooling fluid flow rate to circulate gas around the emission region of the probe.

19. The computer readable medium of claim 16, wherein identifying the three-dimensional region of interest has reached the target temperature comprises identifying indication of cell death.

20. The computer readable medium of claim 16, wherein identifying the three-dimensional region of interest has reached the target temperature comprises identifying indication of reversible cell damage.