Method for planning a surgical procedure

• US 8,160,676 B2
• Filed: 10/20/2006
• Issued: 04/17/2012
• Est. Priority Date: 09/08/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Gielen, Frans L. H., Hertel, Frank, Gemmar, Peter, Appenrodt, Peter
• Primary Examiner(s): Casler, Brian
• Assistant Examiner(s): Santos, Joseph M
• Application Number:
  US11/584,813
• Publication Number:
  US 20080123922A1
• Time in Patent Office: 2,006 Days
• Field of Search: 600/103, 600/409, 600/424, 600/426, 600/427, 600/429, 382/128
• US Class Current: 600/427
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• 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 5/062 using magnetic field
• CPC Class Codes: A61B 5/1127 using markers
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/506 for diagnosis of nerves
• CPC Class Codes: A61B 6/5235 combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT
• CPC Class Codes: A61B 6/5241 combining overlapping images of the same imaging modality, e.g. by stitching
• CPC Class Codes: A61B 6/5247 combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
• CPC Class Codes: G06T 2207/10088 Magnetic resonance imaging [MRI]
• CPC Class Codes: G06T 2207/30016 Brain
• CPC Class Codes: G06T 7/32 using correlation-based methods
• CPC Class Codes: G06T 7/73 using feature-based methods

Abstract

A method for planning a procedure, which can include determining anatomical landmarks is disclosed. The anatomical landmarks can be used to determine anatomical targets of a patient. The plan can include a path or trajectory to reach a selected target.

Claims

1. A method to determine a surgical plan for reaching an anatomical target in a portion of a human brain relative to identified anatomical landmarks, the method comprising:

capturing a plurality of slices of image data of the anatomy, wherein the slices are captured at selected distances from one another along an axis;

processing the image data at least by;

segmenting a third ventricle of a brain in each of the captured plurality of slices of image data;

after segmenting a third ventricle, aligning the plurality of slices of image data relative to each other based at least in part on the segmented third ventricle; and

after aligning the plurality of slices of image data, determining a location of the mid-sagittal plane in the aligned plurality of slices of image data;

after determining the location of the mid-sagittal plane, determining an anatomical landmark that is distinguishable in the processed image data including an intensity change at an edge of the segmented third ventricle;

after determining the anatomical landmark, determining an anatomical target that is relatively indistinguishable from the surrounding structures in the image data based on a position relative to the determined mid-sagittal plane and the determined anatomical landmark; and

after determining the anatomical target, determining a surgical plan, including;

determining an entry point into the anatomy illustrated in the image data;

weighting the image data;

inputting procedure specific data; and

determining a trajectory to reach a point relative to the anatomical target based on the weighted image data, at least a portion of the inputted procedure specific data, and the determined anatomical target.

2. The method of claim 1, wherein weighting the image data includes determining high contrast areas of the image data, determining bright areas of the image data, determining a location of the anatomical target in the image data, determining dark areas of the image data, determining flow areas in the image data, or combinations thereof.

3. The method of claim 1, further comprising:

providing a display; and

displaying the determined surgical plan on the display.

4. The method of claim 3, further comprising:

generating an image based on the image data;

displaying the image on the display; and

displaying an icon superimposed over the displayed image illustrating the determined surgical plan.

5. The method of claim 1, wherein weighting the image data includes determining a sulcus of the brain in the image data, determining a fluid filled region in the brain, determining a vein relative to the brain, or combinations thereof.

6. The method of claim 1, wherein determining the anatomical landmark includes determining at least one of an anterior commissure, a posterior commissure, or combinations thereof.

7. The method of claim 6, wherein determining the anatomical target includes determining a location of a sub-thalamic nucleus in the brain based at least in part on the determined location of the anterior commissure, the posterior commissure, or combinations thereof.

8. The method of claim 1, wherein segmenting the third ventricle of the brain includes providing a seed data.

9. The method of claim 8, wherein providing the seed data includes providing a seed voxel, determining a seed voxel, a user selecting a seed data, or combinations thereof.

10. The method of claim 1, wherein determining an entry point includes determining all possible entry points to reach the anatomical target based upon a trajectory that allow access to the anatomical target based upon a selected structure or limitation of a treatment device.

11. The method of claim 10, wherein determining all possible entry points includes:

determining a possible trajectory of the treatment device; and

determining all possible entry points to reach the determined anatomical target based upon the determined possible trajectory.

12. The method of claim 1, wherein determining a trajectory includes determining a straight trajectory, determining a curved trajectory, or combinations thereof.

13. The method of claim 1, further comprising:

providing instructions executable by a processor to at least one of process the image data, determine an entry point, weight the image data, determine a path, form the surgical plan, or combinations thereof.

14. The method of claim 13, further comprising:

selecting a deep brain stimulator;

wherein inputting the procedure specific data includes inputting the selected deep brain stimulator;

wherein the determined trajectory includes a determined trajectory to move the deep brain stimulator to a sub-thalamic nucleus.

15. The method of claim 1, further comprising:

providing a surgical frame operable to guide a device along the determined trajectory.

16. The method of claim 1, further comprising:

providing a tracking system;

providing a tracking device;

connecting the tracking device to a device;

tracking the tracking device; and

determining a position of the device based upon the tracked position of the tracking device.

17. The method of claim 16, further comprising:

generating an image based on the image data;

displaying the image; and

displaying an icon representing a position of the device superimposed on the displayed image.

18. The method of claim 17, further comprising:

providing feedback to a user based upon the tracked position of the device relative to the determined trajectory.

19. The method of claim 17, further comprising:

sensing activity within a region of a brain with an instrument positioned in the brain; and

refining the determined anatomical target based upon the sensed information of the region of the brain, including determining a boundary of the anatomical target in the brain.

20. The method of claim 19, further comprising:

providing a treatment to the determined anatomical target based at least in part on the refined determination of the anatomical target.

21. The method of claim 1, further comprising:

providing an imaging device to image the anatomy to provide the image data;

wherein the imaging device is at least one of a magnetic resonance imaging system, a computed tomography imaging system, an x-ray imaging system, an ultrasound imaging system, a positron emission tomography system, a single photo emission computed tomography system, a planar gamma tomography system, or combinations thereof.

22. A method to determine a surgical plan for reaching an anatomical target in a portion of a human brain relative to identified anatomical landmarks, the method comprising:

obtaining image data of a brain of a patient;

processing the image data with a processor for;

removing unneeded data, smoothing the image data, segmenting the image data, aligning the image data, and combinations thereof;

after removing unneeded data, smoothing the image data, segmenting the image data, aligning the image data, and combinations thereof, determining a location of the anatomical landmark in the image data of the brain; and

after determining the location of the anatomical landmark, determining a location of the anatomical target in the image data of the brain relative to the determined location of the anatomical landmark;

displaying the processed image data with a display device;

displaying a representation of the determined location of the anatomical target with the display device; and

executing instructions with the processor to determine a plan to reach the anatomical target, including;

weighting the processed image data including at least one of determining high contrast areas of the processed image data, determining low contrast areas of the processed image data, determining bright areas of the processed image data, determining dark areas of the processed image data, and determining sharp edges in the processed image data;

determining an entry point into the brain imaged in the image data including identifying a region of a skull and a plurality of possible entry points through the identified region of the skull that would allow access to the displayed representation of the determined location of the anatomical target, wherein the plurality of possible entry points can include limitations of the structure of a treatment device for a patient through which the treatment device can be passed;

determining a path to reach the anatomical target in the brain based at least one the weighted image data; and

displaying the determined plan for the procedure with the display device.

23. The method of claim 22, further comprising:

providing procedure specific data;

wherein the procedure specific data includes at least one of a treatment to be provided, an anatomical target, a patient history, a treatment device, a treatment therapy, a time constraint, details of a deep brain stimulator, a recorder, or combinations thereof.

24. The method of claim 22, wherein determining the anatomical landmark includes at least one of a user inputting at least a seed point of the anatomical landmark, a processor determining the anatomical landmark, or combinations thereof.

25. The method of claim 24, wherein a processor determining the location of the anatomical landmark includes a processor determining the position of an anterior commissure, a posterior commissure, a mid-sagittal plane, or combinations thereof.

26. The method of claim 25, wherein determining the location of the anatomical target includes determining a position of a point relative to the anatomical landmark.

27. The method of claim 26, wherein determining the location of the anatomical target includes determining the position of a sub-thalamic nucleus in the image data of the brain.

28. The method of claim 26, wherein determining a path includes determining all possible paths that would pass through the entry point to reach the anatomical target.

29. The method of claim 28, further comprising:

weighting a datum in the image data to obtain a weighted image data;

weighting the determined path based upon the weighted image data; and

providing a score of the determined path based upon the weighting of the image data.

30. The method of claim 29, further comprising:

determining a plurality of paths; and

providing a score for each of the plurality of the paths.

31. The method of claim 30, further comprising:

outputting a plurality of the determined plurality of paths and the score for each of the plurality of outputted paths with a human viewable display;

a user determining a selected path from the output of the plurality of the determined plurality of paths and the score based at least in part upon the score of each of the plurality of paths;

wherein the determined selected path forms a part of the determined plan.

32. The method of claim 31, wherein each of the plurality of paths extends from a single one of the plurality of possible entry points.

33. The method of claim 22, wherein displaying the determined plan includes displaying the image data and superimposing an icon representing the determined path on the image data.

34. The method of claim 22, wherein determining a path includes:

weighting the image data;

providing a plurality of paths based at least in part upon the anatomical target and the determined entry point;

automatically weighting each of the plurality of paths based upon the weight image data; and

determining a best path based upon the weighting for each of the plurality of paths.

35. A method to determine a surgical plan for reaching an anatomical target in a portion of a human brain relative to identified anatomical landmarks, the method comprising:

providing procedure specific data;

identifying an entry region to the portion of an anatomy including an area through which a plurality of entry points are defined into the portion of the anatomy;

executing instructions with a planning process for weighting image data of the portion of the anatomy to determine a relative importance of a first region of the image data to a second region of the image data; and

determining a plan, at least in part with the planning processor, to reach the anatomical target of the portion of the anatomy based on the weighted image data and the provided procedure specific data further including,

determining a mid-sagittal plane in the image data;

after determining a mid-sagittal plane, determining a location of an anterior commissure and a posterior commissure;

after determining a location of the anterior commissure and the posterior commissure, determining a location of a sub-thalamic nucleus in the image data by executing instructions with the planning processor to determine the location of the sub-thalamic nucleus relative to at least two of the determined location of the anterior commissure, the posterior commissure, the mid-sagittal plane, or combinations thereof in the image data;

determining a trajectory to reach the determined location of the sub-thalamic nucleus in the image data at least by determining all possible trajectories to provide a determined therapy to the anatomical target from each of the plurality of entry points identified with the entry region;

determining a factor for each of all possible trajectories to provide a determined therapy to the anatomical target based at least in part upon the weighted image data; and

displaying a sub-plurality of the all possible trajectories having a factor above a selected threshold on a first display device associated with the planning processor;

a user selecting a plan trajectory from one of the displayed sub-plurality of all possible trajectories, wherein the displayed sub-plurality of all possible trajectories are determined by the execution of instructions with the planning processor;

displaying only the selected plan trajectory; and

displaying the determined plan for the procedure on a second display device separate from the first display device.

36. The method of claim 35, wherein providing the procedure specific data includes entering the procedure specific data into a memory system accessible by the planning processor;

wherein the procedure specific data includes at least one of patient information;

user preference;

instruments available for the procedure;

therapy planned for the patient;

condition of the patient;

details of a deep brain stimulator;

details of a recorder;

or combinations thereof.

37. The method of claim 35, wherein determining an entry point is based at least in part on the provided procedure specific information.

38. The method of claim 35, further comprising:

obtaining the image data of a brain of a patient;

processing the image data to form processed image data;

displaying at least one of the image data, the processed image data, or combinations thereof; and

displaying a location of the anatomical target.

39. The method of claim 35, wherein weighting the image data of the anatomy to determine a relative importance of a first region to a second region includes at least one of:

determining that a first region and a second region cannot be intersected with a device, determining that a first region and a second region can both be intersected with a device, determining that it is preferable to traverse a first region rather than a second region, determining that it is only possible to traverse a first region and not a second region, or combinations thereof.

40. The method of claim 35, wherein weighting the image data to determine a relative importance of a first region includes determining that the first region is a sulcus, a vein, a fluid transport duct, a nerve bundle, a muscle bundle, a muscle fiber, a damaged region, or combinations thereof.

41. The method of claim 35, wherein weighting the image data includes determining a high contrast region in the image data, determining a low contrast region in the image data, determining a bright region in the image data, determining a dark region in the image data, or combinations thereof.

42. The method of claim 35, wherein determining a plan includes determining a path to intersect a portion of the first region, the second region, or combinations thereof.

43. The method of claim 42, wherein the path includes a straight path, a curved path, or combinations thereof.

44. The method of claim 35, wherein determining a plan includes:

determining a therapy to be provided;

evaluating the factor by a user of the sub-plurality of the all possible trajectories to determine whether the therapy to be provided will have a selected affect on the first region, the second region, or combinations thereof; and

wherein selecting the plan trajectory includes minimizing the selected affect on the first region, the second region, or combinations thereof while providing the therapy to the anatomical target.

45. The method of claim 44, wherein the determined therapy includes deep brain stimulation of a sub-thalamic nucleus.

46. The method of claim 35, wherein determining an entry point includes:

determining all possible entry points to reach a target based upon a selected path;

wherein the selected path includes a curved path.

47. The method of claim 35, wherein selecting a plan trajectory includes selecting the optimized trajectory;

and

wherein displaying only the selected plan trajectory includes displaying the optimized trajectory.