Endoscope structures and techniques for navigating to a target in branched structure

• US 10,743,748 B2
• Filed: 05/21/2019
• Issued: 08/18/2020
• Est. Priority Date: 04/17/2002
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Gilboa, Pinhas
• Primary Examiner(s): Chao, Elmer M
• Application Number:
  US16/418,464
• Publication Number:
  US 20190269307A1
• Time in Patent Office: 455 Days
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 1/012 characterised by internal passages or accessories therefor
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• 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 5/06 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 5/065 Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
• CPC Class Codes: A61M 25/0147 with movable mechanical means, e.g. pull wires

Abstract

Systems and methods employing a small gauge steerable catheter including a locatable guide with a sheath, particularly as an enhancement to a bronchoscope. A typical procedure is as follows. The location of a target in a reference coordinate system is detected or imported. The catheter is navigated to the target which tracking the distal tip of the guide in the reference coordinate system. Insertion of the catheter is typically via a working channel of a convention bronchoscope. Once the tip of the catheter is positioned at the target, the guide is withdrawn, leaving the sheath secured in place. The sheath is then used as a guide channel to direct a medical tool to target.

Claims

1. A method for steering a catheter through a bronchial tree to a target location, the method comprising:

receiving a computer tomographic (CT) image data set of the bronchial tree;

generating a three-dimensional (3D) model of the bronchial tree from the CT data set;

providing a flexible catheter including a sensor element, the sensor element being part of a position measuring system, the position measuring system determining a position and a pointing direction of a tip of the flexible catheter based on data from the sensor element;

identifying the target location;

determining a route through the 3D model of the bronchial tree to the target location;

detecting advancement of the flexible catheter through the bronchial tree; and

displaying a representation of a current position of the flexible catheter in the bronchial tree, a representation of a target, a representation of the route through the 3D model of the bronchial tree to the target location, a graphical representation of the pointing direction of the tip of the flexible catheter, and a graphical representation of a direction towards the target location.

2. The method of claim 1, further comprising displaying an angular deviation between the pointing direction of the tip of the flexible catheter and a direction towards the target location.

3. The method of claim 1, wherein the graphical representation of the pointing direction of the tip of the flexible, catheter is displayed in context of a representation of a view taken that is non-parallel to the pointing direction of the tip of the flexible catheter.

4. The method of claim 1, wherein the sensor element is part of a six-degrees-of-freedom position measuring system measuring the position and pointing direction of the tip of the flexible catheter in three translational and three rotational degrees of freedom.

5. The method of claim 1, wherein a graphical representation of a direction towards the target location is displayed when the target is at least partially outside a view of the flexible catheter.

6. The method of claim 1, further comprising displaying one or more of a virtual bronchoscopic view, slice views of computer tomographic data from which a virtual model is derived, and a live bronchoscopic image in a multi-view display screen.

7. The method of claim 6, further comprising displaying the graphical representation of the direction towards the target location at a periphery of the virtual bronchoscopic view.

8. The method of claim 7, wherein the graphical representation of the direction towards the target location includes at least an arrowhead.

9. The method of claim 1, further comprising displaying a distance to the target.

10. A method for depicting a position and pointing direction of a catheter in a branched structure bronchial tree comprising:

providing a flexible catheter with a sensor element located in the flexible catheter, the sensor element being part of a position measuring system, the position measuring system determining a position and pointing direction of a distal portion of the flexible catheter based on data from the sensor element;

identifying a target;

determining a route through a virtual model of the bronchial tree generated from a computer tomographic (CT) image data set of the bronchial tree to the target;

detecting advancement of the flexible catheter into the bronchial tree; and

displaying a representation of a current position of the distal portion of the flexible catheter in the virtual model of the bronchial tree, a representation of the target in the virtual model of the bronchial tree, a representation of the route through the virtual model of the bronchial tree to the target, and a graphical representation of at least one parameter defined by a geometrical relation between a pointing direction of the distal portion of the flexible catheter and a pointing direction to the target.

11. The method of claim 10, further comprising:

monitoring by use of the sensor element a path traveled by the distal portion of the flexible catheter; and

displaying a graphical representation of the path traveled together with the current position of the distal portion of the flexible catheter.

12. The method of claim 10, further comprising displaying a distance from the distal portion of the flexible catheter to the target.

13. The method of claim 12, further comprising:

designating by use of three-dimensional imaging data an intended route through the bronchial tree; and

displaying a graphical representation of the intended route together with the current position of the distal portion of the flexible catheter.

14. The method of claim 12, further comprising:

generating from three-dimensional imaging data a virtual endoscopy image corresponding to an image that would be viewed by a camera located in predefined spatial relationship and alignment relative to the sensor element; and

displaying the virtual endoscopy image.

15. The method of claim 10, wherein the graphical representation of at least one parameter is displayed in context of a representation of a view taken along the pointing direction of the distal portion of the flexible catheter.

16. The method of claim 10, wherein the sensor element is an electromagnetic sensor.

17. A method comprising:

acquiring a computer tomographic image data set of a bronchial tree;

generating a virtual model of the bronchial tree from the computer tomographic image data set of the bronchial tree, the virtual model including a representation of a target;

determining a planned pathway through the virtual model of the bronchial tree to the target;

displaying a representation of the planned pathway through the virtual model of the bronchial tree to the target;

registering the virtual model of the bronchial tree with a bronchial tree of a patient;

determining a position and pointing direction of a distal portion of a flexible catheter relative to the virtual model of the bronchial tree; and

displaying at least a portion of the representation of the planned pathway through the virtual model of the bronchial tree to the target with a graphical representation of the position and pointing direction of the distal portion of the flexible catheter in the virtual model.

18. The method of claim 17, wherein the registering is performed by:

providing a catheter with an image sensor; and

deriving a best fit registration between the computer tomographic image data set and images generated by the image sensor.

19. The method of claim 17, wherein a graphical representation of a geometrical relation between the pointing direction of the distal portion of the flexible catheter and a direction to the target, is displayed in the virtual model.

20. The method of claim 17, further comprising displaying one or more of a virtual bronchoscopic view, slice views of computer tomographic data from which the virtual model is generated, and a live bronchoscopic image.

21. The method of claim 17, further comprising displaying a distance from the distal portion of the flexible catheter to the target.

22. The method of claim 17, further comprising detecting a location of an electromagnetic sensor associated with the flexible catheter.

23. The method of claim 17, further comprising determining a change in position or pointing direction of the distal portion of the flexible catheter,

wherein the displaying the at least a portion of the representation of the planned pathway through the virtual model of the bronchial tree to the target with the graphical representation of the position and pointing direction of the distal portion of the flexible catheter in the virtual model is performed in response to determining the change in position or pointing direction of the distal portion of the flexible catheter.