Navigational guidance via computer-assisted fluoroscopic imaging

• US 7,606,613 B2
• Filed: 09/05/2002
• Issued: 10/20/2009
• Est. Priority Date: 03/23/1999
• Status: Active Grant

• Current Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Inventors: Smith, Kurt R, Foley, Kevin T, Simon, David A
• Primary Examiner(s): Le; Long V
• Assistant Examiner(s): Cheng; Jacqueline
• Application Number:
  US10/236,013
• Publication Number:
  US 20030073901A1
• Time in Patent Office: 2,602 Days
• Field of Search: 600/407, 600/414, 600/426
• US Class Current: 600/426
• CPC Class Codes: A61B 2034/104 Modelling the effect of the tool, e.g. the effect of an implanted prosthesis or for predicting the effect of ablation or burring
• 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 2034/108 Computer aided selection or customisation of medical implants or cutting guides
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2034/256 having a database of accessory information, e.g. including context sensitive help or scientific articles
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• 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 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/463 characterised by displaying multiple images or images and diagnostic data on one display
• CPC Class Codes: A61B 6/547 involving tracking of position of the device or parts of the device
• CPC Class Codes: A61M 2025/0166 Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
• CPC Class Codes: A61M 25/0105 Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

Digital x-ray images taken before a surgical procedure by a fluoroscopic C-arm imager are displayed by a computer and overlaid with graphical representations of instruments being used in the operating room. The graphical representations are updated in real-time to correspond to movement of the instruments in the operating room. A number of different techniques are described that aid the physician in planning and carrying out the surgical procedure.

Claims

1. A system for realigning a first bone segment with a second bone segment in a patient comprising:

a first tracking marker attached to the first bone segment;

a second tracking marker attached to the second bone segment;

a tracking sensor for detecting the relative position, in three-dimensional space, of the first and second tracking markers;

a position examining portion for examining position information while acquiring image data and marking the image data as erroneous if a tracking target associated with an image acquisition system moves relative to the first tracking marker, the second tracking marker, or both the first and the second tracking markers;

a delineating portion for delineating the images of the first and second bone segments in an image and for, when the second bone segment is moved in the patient, correspondingly moving the delineated second bone segment superimposed on the image; and

a display coupled to the computer for displaying the image overlaid with representations of the delineated first and second bone segments;

wherein the first bone segment and the second bone segment are distinct complete bone members that are separate vertebrae.

2. The system of claim 1, wherein the delineating portion performs edge detection processing on the image to delineate boundaries of the first and second bone segments.

3. The system of claim 2, wherein the delineating portion performs edge detection by executing at least one of the Canny edge detector algorithm, the Shen-Casten edge detector algorithm, or the Sobel edge detector algorithm, or combinations thereof.

4. The system of claim 1, wherein the delineated image of the first and second bone segment is operable to be corresponded with the respective first and second bone segments with an automatic corresponding portion, manually, or combinations thereof.

5. The system of claim 1, further comprising:

the image acquisition system operable to acquire the image data of the first bone segment and the second bone segment for display on the display.

6. The system of claim 5, wherein the image acquisition system is operable to acquire the image data after the first and second tracking markers are attached to the respective first and second bone segments.

7. The system of claim 1, wherein the position examining portion and the delineating portion are a plurality of computers or a single computer, wherein the single computer is operable to receive input from both the image acquisition system and the tracking sensor.

8. A method for re-aligning a first bone segment with a second bone segment in a patient comprising:

attaching a first tracking marker to the first bone segment;

attaching a second tracking marker to the second bone segment;

acquiring an image of the first bone segment and the second bone segment after attaching the first tracking marker to the first bone segment and the second tracking marker to the second bone segment;

delineating the acquired image of the first and second bone segments in an image;

examining position information while acquiring the image data and marking the acquired image data as erroneous if a tracking target associated with an image acquisition system moves relative to the attached first tracking marker, the attached second tracking marker, or both the attached first and the second tracking markers;

detecting a relative position of the first and second bone segments in the patient using the first and second tracking markers;

selecting the first tracking marker to be a fixed reference frame marker;

selecting the second tracking marker to be a dynamic reference marker;

moving the second bone segment having the dynamic reference marker relative to the first bone segment, where the first bone segment is substantially fixed in a location;

moving the delineated second bone segment superimposed on the image when the second bone segment moves relative to the first bone segment;

displaying the image overlaid with representations of the delineated first and second bone segments.

9. The method of claim 8, further comprising performing edge detection processing on the image to delineate boundaries of the first and second bone segments.

10. The method of claim 9, further comprising:

corresponding the delineated boundary of the first bone segment to the first bone segment and the delineated boundary of the second bone segment to the second bone segment for display on a display.

11. The method of claim 10, further comprising:

calibrating the image; and

obtaining position information of the first bone segment and the second bone segment.

12. The method of claim 8, further comprising:

re-aligning the first bone segment with the second bone segment further includes at least one of;

re-aligning a first broken bone segment with a second broken bone segment of a single bone;

re-aligning a first broken bone segment with a second broken bone segment both of which are substantially separate, distinct, and complete bone members;

re-aligning a first broken bone segment with a second broken bone segment both of which are fractured portions of a femur;

re-aligning a first broken bone segment with a second broken bone segment both of which are separate vertebrae;

or combinations thereof.

13. The method of claim 8, wherein detecting a relative position of the first bone segment and the second bone segment includes:

providing a tracking sensor operable to determine the relative location of the first tracking marker relative to the second tracking marker;

displaying the determined relative positions of the first tracking marker and the second tracking marker to display the representations of the delineated first and second bone segments; and

updating the display to display the appropriate relative positions of the first bone segment and the second bone segment at a second time interval.

14. The method of claim 8, updating a display to show movement of the dynamic vertebra relative to the fixed vertebra.

15. The method of claim 8, wherein moving the delineated second bone segment superimposed on the image includes:

updating the display to display the appropriate relative positions of the first bone segment and the second bone segment at a second time interval to illustrate the delineated second bone segment relative to the first bone segment.

16. A system for realigning a first broken bone segment with a second broken bone segment in a patient comprising:

means for attaching a first tracking marker to the first bone segment;

means for attaching a second tracking marker to the second bone segment;

means for acquiring an image data of the first bone segment and the second bone segment after attaching the first tracking marker to the first bone segment and the second tracking marker to the second bone segment;

means for examining position information while acquiring image data and marking the image data as erroneous if the means for acquiring the image data moves relative to the first tracking marker, the second tracking marker, or both the first and the second tracking markers;

means for delineating boundaries of the first and second bone segments in the image;

means for detecting the relative position of the first and second bone segments in the patient using the first and second tracking markers;

means for correspondingly moving the delineated boundary of the second bone segment overlaid on the image when the second bone segment moves relative to the first bone segment;

means for displaying the image overlaid with representations of the delineated boundaries of the first and second bone segments; and

means for selecting one of the first bone segment and the second bone segment to be a dynamic bone segment and selecting the other of the first bone segment and the second bone segment to be a fixed bone segment.

17. The system of claim 16, wherein the first bone segment and the second bone segment are at least one of:

both substantially separate, distinct, and complete bone members;

are each separate and distinct portions of a fractured bone member;

are fractured portions of a femur, are separate vertebrae, or combinations thereof.

18. The system of claim 16, further comprising:

means for rigidly fixing the first tracking marker relative to the first bone segment and means for rigidly fixing the second tracking marker to the second bone segment.

19. The system of claim 16, further comprising:

means for corresponding the delineated boundaries of the first bone segment and the second bone segment relative to the image.

20. The system of claim 16, wherein means for delineating boundaries of images includes means for determining contours of the first and second bone segments.

21. The system of claim 16, further comprising:

means for determining position and location information.

22. A method for realigning a first bone segment with a second bone segment in a patient comprising:

selecting a first vertebra and a second vertebra;

attaching a first tracking marker to the first vertebra;

attaching a second tracking marker to the second vertebra;

acquiring a x-ray image of the first vertebra, the second vertebra, or combinations thereof;

examining position information of an image acquisition system while acquiring the x-ray image and marking an image as erroneous if a tracking target associated with the image acquisition system moves relative to the first tracking marker, second tracking marker, or both the first and the second tracking marker;

delineating images of the first vertebra and the second vertebra in the acquired x-ray image, wherein delineating images includes determining edges of the first vertebra and the second vertebra and providing a representation of the determined edges;

tracking the first tracking marker and second tracking marker;

detecting a relative position of the first vertebra and the second vertebra in the patient via the tracking;

corresponding the delineated images with the acquired x-ray image;

displaying the acquired x-ray image overlaid with the representations; and

moving at least one of the delineated first vertebra representation, the delineated second vertebra representation, or combinations thereof on a display overlaid on the acquired x-ray image when either of the first vertebra, the second vertebra, or combinations thereof moves relative to the other of the first vertebra the second vertebra, or combinations thereof.

23. The method of claim 22, further comprising:

selecting one of the first vertebra and the second vertebra to be a dynamic vertebra and selecting the other of the first vertebra and the second vertebra to be a fixed vertebra.