Method and apparatus for optimizing a computer assisted surgical procedure

• US 8,660,635 B2
• Filed: 03/08/2007
• Issued: 02/25/2014
• Est. Priority Date: 09/29/2006
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Simon, David, Lent, Mark S., Singhal, Ruchika, Csavoy, Andrew N.
• Primary Examiner(s): Chen, Tse
• Assistant Examiner(s): Brutus, Joel F
• Application Number:
  US11/683,796
• Publication Number:
  US 20080081982A1
• Time in Patent Office: 2,546 Days
• Field of Search: 600407-436, 324306-309, 324318-322
• US Class Current: 600/424
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• 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 5/0066 Optical coherence imaging
• CPC Class Codes: A61B 5/0084 for introduction into the body, e.g. by catheters A61B5/1459 takes precedence
• CPC Class Codes: A61B 5/062 using magnetic field
• CPC Class Codes: A61B 5/066 Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
• CPC Class Codes: A61B 5/7435 Displaying user selection data, e.g. icons in a graphical user interface
• CPC Class Codes: A61B 90/06 Measuring instruments not otherwise provided for
• CPC Class Codes: A61N 1/0534 Electrodes for deep brain stimulation
• CPC Class Codes: A61N 5/1048 Monitoring, verifying, controlling systems and methods
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 20/70 relating to mental therapies, e.g. psychological therapy or autogenous training
• CPC Class Codes: G16H 30/20 for handling medical images, e.g. DICOM, HL7 or PACS
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders

Abstract

A method and apparatus for optimizing a computer assisted procedure is provided. A method and apparatus for performing a procedure is also provided. Data can be accessed and processed to optimize and perform a procedure. The data can be augmented or supplemented with patient specific data.

Claims

1. A method of performing a procedure on an anatomy of a patient, comprising:

selecting a position for the procedure within the anatomy;

proposing a first therapy;

obtaining a first data set including image data and functional data regarding the anatomy and registering the obtained image data to the anatomy at least by;

identifying a specific functional feature of selected anatomical portions within the anatomy, and

determining a location of the specific functional feature in the obtained image data at least by determining a position of a navigated functional sensing device, which is configured to sense the functional data regarding the specific functional feature within the anatomy and is associated with a tracking system including a localizer and a tracking device, based upon a tracked location of the tracking device;

planning the procedure at least in part with the obtained first data set regarding the anatomy;

navigating an instrument that is a deep brain stimulation lead to the selected position;

superimposing a first predicted physiological affect icon on an image of the anatomy based on the obtained image data to illustrate a graphical representation of a predicted first localized affect on the anatomy of the patient of the first therapy as the first therapy is performed; and

performing the first therapy on the anatomy at the selected position with the navigated instrument wherein the first therapy includes effecting the physiology of the anatomy.

2. The method of claim 1, further comprising:

obtaining a second set of data regarding the anatomy after performing the first therapy;

proposing a second therapy operable to effect a physiology of the anatomy;

illustrating a predicted second localized physiological affect of the proposed second therapy on the anatomy which is a graphical representation of a predicted second localized physiological affect of the proposed second therapy; and

performing the second therapy on the anatomy.

7. The method of claim 1, further comprising:

performing a second therapy on the anatomy;

wherein the instrument includes a plurality of instruments;

wherein performing the first therapy includes performing the first therapy via a first sub-plurality of the plurality of the instruments and performing the second therapy includes performing the second therapy via a second sub-plurality of the plurality of the instruments.

8. The method of claim 1, further comprising:

obtaining database data;

wherein illustrating a first localized physiological affect of a first therapy includes predicting a localized physiological affect based on the database data and at least one of optical coherence tomography data, temperature data, hydraulic data, or electrical data.

9. The method of claim 8, further comprising:

determining a specific current localized physiological effect on the anatomy due to the first therapy and after performing the first therapy on the anatomy; and

augmenting the database data to form an augmented database data including the determined specific current localized physiological effect on the anatomy due to the first therapy;

wherein the specific current localized physiological effect on the anatomy is based on a physical measurement of the anatomy at the selected position of the procedure within the anatomy where the first therapy is performed.

38. The method of claim 1, further comprising:

executing instructions with a processor to perform the registering of the obtained image data set with the anatomy; and

wherein selecting the position for the procedure within the anatomy includes identifying a target based upon the registering of the obtained image data of a specific patient and the provided first database data.

39. The method of claim 38, further comprising:

displaying the superimposed first predicted physiological affect icon on the image.

3. The method of 2, further comprising:

determining a first general effect of the first therapy on the anatomy;

wherein the second therapy is at least one of identical to the first therapy, different than the first therapy, or combinations thereof.

4. The method of claim 3, further comprising:

augmenting the second therapy compared to the first therapy so that the second therapy is different from the first therapy;

wherein the different second therapy includes a different electrical voltage, a different electrical pulse width, a different chemical delivered, a different dosage delivered, a different electrical lead activated, or combinations thereof.

5. The method of claim 3, further comprising:

determining a second general effect of the second therapy on the anatomy;

comparing the determined first general effect and the determined second general effect; and

determining an optimized therapy on the anatomy.

6. The method of claim 5, wherein the optimized therapy can be the same as the first therapy, the same as the second therapy, different from either of the first therapy or the second therapy, or combinations thereof.

10. A method of performing a procedure on an anatomy of a patient, comprising:

providing image data of a specific patient;

providing a first database data including statistical information regarding an anatomy similar to the specific patient;

performing an initial registration of the provided image data of the specific patient and the first database data;

obtaining functional physiological data of the specific patient;

refining the initial registration, at least by increasing an accuracy of the initial registration, of the provided image data of the specific patient and the first database data based at least in part on the obtained functional physiological data of the specific patient, wherein the provided first database data includes statistical functional physiological data regarding specific areas of the anatomy;

performing a procedure on the specific patient, including;

navigating an instrument that is a deep brain stimulation lead relative to the specific patient;

displaying a representation of the navigated instrument relative to the provided image data of the specific patient; and

forming a second database data for performing the procedure on the specific patient or a different patient other than the specific patient at least by augmenting the provided first database data with at least one of the obtained functional physiological data of the specific patient or the provided image data of a specific patient at least by altering a statistical functional data point from the provided first database data, wherein the statistical functional data point is used to assist in identifying a region in the provided image data of a specific patient.

11. The method of claim 10, further comprising:

implanting the deep brain stimulation lead in the specific patient; and

programming the deep brain stimulation lead based upon the formed second database data to provide a therapy to the specific patient after implantation of the device.

12. The method of claim 11, wherein programming the deep brain stimulation lead includes at least one of selecting a dosage voltage, selecting a pulse width, selecting a material to be delivered, or selecting a volume of a material to be delivered.

13. The method of claim 11, wherein implanting the deep brain stimulation lead includes implanting the deep brain stimulation lead into a brain of the specific patient, wherein the deep brain stimulation lead is operable to deliver an electrical potential to the brain;

wherein programming the device includes at least one of selecting a dosage voltage, selecting a pulse width, or combinations thereof.

14. The method of claim 13, wherein the statistical functional data point includes functional data used to assist in identifying a region in the provided image data of a specific patient, wherein the functional data includes at least one of microelectrode recording data, pressure data, or gating data.

15. The method of claim 14, further comprising:

executing instructions with a processor to perform a registration of the provided image data of a specific patient and the formed second database data; and

identifying a target in the anatomy of the patient in the registered image data of a specific patient and the formed second database data.

16. The method of claim 15, wherein forming a second database data includes determining an average location of an anatomical feature based upon information from a plurality of patients.

17. The method of claim 10, wherein providing the initial registration of the provided image data of the specific patient and the first database data includes morphing the provided image data of the specific patient to fit the first database data;

wherein refining the initial registration includes;

identifying specific functional features of selected anatomical portions of the specific patient; and

determining a location of the specific functional features in the provided image data of a specific patient.

18. The method of claim 17, further comprising:

providing a tracking system including a localizer and a tracking device associated with the navigated instrument;

wherein navigating the instrument includes determining a position of the instrument based upon a tracked location of the tracking device.

19. The method of claim 18, wherein the tracking device includes at least one of an optical tracking device, an electromagnetic tracking device, an acoustic tracking device, an accelerometer tracking device, a radiation tracking device, or combinations thereof.

20. The method of claim 18, further comprising:

displaying the refined registration of the provided image data of a specific patient and the first database data;

wherein displaying a representation of the navigated instrument includes displaying an icon representing the location of the navigatged instrument relative to the anatomy of the specific patient on a display device.

21. The method of claim 10, further comprising:

identifying a target based upon the refined initial registration of the provided image data of a specific patient and the provided first database data; and

providing a therapy to the target with the instrument.

22. A method of performing a procedure on an anatomy of a patient, comprising:

selecting a position for the procedure within the anatomy;

obtaining a first data set regarding the anatomy;

planning the procedure at least in part with the obtained first data set regarding the anatomy including;

selecting a first therapy type to be applied at the selected position in the anatomy;

predicting a first affect at the selected position in the anatomy of the first selected therapy type prior to performing the selected first therapy type;

illustrating a first localized graphical representation of the predicted first affect, wherein the first localized graphical representation is a first physiological affect icon superimposed on an image of the anatomy, wherein the first physiological affect icon illustrates an area of the anatomy predicted to be affected by the selected first therapy type, wherein illustrating the first localized graphical representation includes displaying the first physiological affect icon superimposed on the image data of a portion of a brain of the patient;

displaying an instrument icon representing a deep brain stimulation probe location based on a navigation of the deep brain stimulation probe into the brain of the anatomy of the patient; and

augmenting the first data set with feedback based upon an observed result of performing the selected first therapy type on the brain at the selected position.

23. The method of claim 22, wherein the physiological affect icon includes a viewable feature that changes based upon the first therapy and the physiological affect icon is illustrated near the instrument icon.

24. The method of claim 23, wherein the physiological affect icon illustrates a predicted geometrical shape that the first therapy will affect accounting for at least one of voltage or pulse width.

25. The method of claim 24, wherein the physiological affect icon illustrates a predicted time lapse area of effect of the first therapy.

26. The method of claim 25, further comprising:

selecting a second therapy type;

predicting a second affect that is a region of the brain that the selected second therapy type will affect;

illustrating a second localized graphical representation of the predicted second affect, wherein the second localized graphical representation is a second physiological affect icon superimposed on an image of the anatomy, wherein the second physiological affect icon illustrates the region in the brain predicted to be affected by the selected second therapy type;

wherein the first physiological affect icon and the second physiological affect icon illustrate a predicted region that is to be affected by the selected respective first therapy type and the second therapy type, where the region predicted to be affected may represent a region affected by the respective selected first therapy type and the selected second therapy type.

27. The method of claim 26, wherein the selected first therapy is a first brain stimulation therapy and the selected second therapy type is a second brain stimulation therapy different from the first brain stimulation therapy;

wherein the first physiological affect icon has a first size, shape and density and the second physiological affect icon has a second size, shape, and density to illustrate the predicted difference of affected region of the brain between the first selected therapy type and the selected second therapy type.

28. The method of claim 27, further comprising:

selecting for patient treatment at least one of the selected first therapy type or the selected second therapy type based at least on the first physiological affect icon and the second physiological affect icon; and

programming a device to provide the selected patient treatment through the deep brain stimulation probe.

29. The method of claim 28, wherein selecting for patient treatment includes determining an optimal treatment for the patient from between the selected first therapy type and the selected second therapy type based on the first physiological affect icon and the second physiological affect icon.

30. A method for performing a procedure on an anatomy of a patient, comprising:

accessing a first memory system having a stored data including statistical information regarding the anatomy;

performing, by executing instructions with a processor system, a first registration of the patient to the stored data;

obtaining current functional patient specific data during the procedure at a determined location in the anatomy of the patient to determine a location of a selected region in the anatomy of the patient;

performing, by executing instructions with the processor system, a second registration of the patient to the stored data that refines the first registration of the patient to the stored data, wherein the second registration is based at least in part on the obtained current functional patient specific data including registering the selected region from the stored data to the patient based on the obtained current functional patient specific data;

displaying a view of at least one of an image of the patient or the stored data based on the second registration; and

tracking a deep brain stimulation lead into a brain of the patient to determine a location of the deep brain stimulation lead relative to the patient.

31. The method of claim 30, further comprising:

acquiring the image of the patient as a procedure image data of the patient during the procedure;

wherein performing both the first registration and performing the second registration includes registering the stored data to the acquired procedure image data of the patient acquired during the procedure;

wherein the stored data is acquired prior to the procedure and includes an atlas data, an average functional data, a patient specific functional data acquired prior to the procedure, or combinations thereof.

32. The method of claim 31, further comprising:

displaying the obtained current functional patient specific data after performing the second registration, wherein the current functional patient specific data includes functional data collected with a navigated measuring instrument;

determining a data target in the stored data and then determining a patient target in the anatomy of the patient based on the performed second registration; and

displaying an icon superimposed on the displayed obtained current functional patient specific data representing the determined target in the displayed obtained current functional patient specific data.

33. The method of claim 32, further comprising:

refining a location of an atlas location of the selected region in the brain of the patient based at least on the second registration that was previously identified in the atlas data and operable to be illustrated with the atlas data;

predicting a localized physiological affect of a proposed therapy in the patient based upon the stored data; and

displaying an affect icon superimposed on the image of the patient to represent the predicted localized physiological affect.

34. The method of claim 33, wherein the affect icon displays a localized physiological affect of the therapy selected from a group consisting of a voltage, a pulse width, a chemical volume delivered, a biological treatment delivered, a radiation treatment delivered, a therapy delivered over time, or combinations thereof.

35. The method of claim 34, further comprising:

wherein tracking the deep brain stimulation lead into the anatomy of the patient assists in the predicting of the localized physiological affect.

36. The method of claim 35, further comprising:

moving the deep brain stimulation lead into the brain of the anatomy of the patient, after obtaining the current functional patient specific data;

wherein predicting the localized physiological affect of the proposed therapy in the patient based upon the stored data includes predicting at least a first physiological affect of a first proposed therapy and a second physiological affect of a second proposed therapy; and

wherein displaying an affect icon superimposed on the image of the patient to represent the predicted localized physiological affect includes superimposing on the image of the patient a first affect icon based on the predicted first physiological affect of the first proposed therapy and superimposing on the image of the patient a second affect icon based on the predicted second physiological affect of the second proposed therapy;

selecting a present therapy as at least one of the first proposed therapy or the second proposed therapy based on the predicted affect of the respective first proposed therapy or the second proposed therapy;

applying the present therapy to the patient with the deep brain stimulation lead operable to be moved into the anatomy of the patient;

programming a treatment device to provide the present therapy through the deep brain stimulation lead, when implanted in the anatomy based, at least in part on the predicted localized physiological affect; and

displaying a treatment functional patient specific data icon illustrating an actual current effect of the applied present therapy.

37. The method of claim 32, further comprising:

illustrating bread crumb icons superimposed on image data to refine a location within the anatomy of the patient;

wherein the bread crumb icons illustrate changes based upon an information recorded by the navigated measuring instrument.

40. A method for performing a procedure on an anatomy of a patient, comprising:

determining the procedure;

obtaining a first patient specific data of a first patient regarding the determined procedure;

accessing a database data regarding the determined procedure by executing instructions with a processor;

determining a first plan for performing the determined procedure based upon the obtained first patient specific data of the first patient and the accessed database data;

performing the procedure on the anatomy of the first patient with an instrument that includes a deep brain stimulation lead;

obtaining a second patient specific data of the first patient while performing the procedure on the anatomy of the first patient; and

augmenting the database data based upon the obtained second patient specific data of the first patient obtained while performing the procedure on the first patient.

41. The method of claim 40, further comprising:

saving the augmented database data;

determining a second procedure; and

determining a second plan for the determined second procedure based at least upon the augmented database data.

42. The method of claim 40, wherein the determined second procedure and the determined second plan are regarding an anatomy of a second patient different from the first patient.

43. The method of claim 40, further comprising:

displaying the obtained first patient specific data including image data of a brain in the anatomy of the first patient;

selecting a therapy to apply to the brain in the anatomy of the first patient;

predicting a localized physiological affect of the therapy in the brain in the anatomy of the patient based at least in part on the accessed database data including atlas data having statistical information regarding regions of the atlas data relating to the determined first plan; and

executing instructions to illustrate the predicted localized physiological affect of the therapy on the brain, based at least on the accessed database data, as an icon superimposed on the displayed image data of the anatomy of the first patient.

44. The method of claim 43, wherein determining the first plan for the determined procedure, includes:

selecting a target in the brain in the anatomy of the first patient;

determining a trajectory of the instrument to reach the selected target; and

determining a therapy to be applied to the brain in the anatomy of the first patient via the instrument.

45. The method of claim 44, wherein determining the trajectory includes automatically determining at least a path for the instrument to take to reach a selected region of the anatomy of the first patient from an entry point into the anatomy of the first patient.

46. The method of claim 45, further comprising;

navigating the instrument to achieve the determined first plan;

tracking a tracking device associated with the instrument with a tracking system having a localizer;

determining the location of at least a portion of the instrument relative to the brain in the anatomy of the first patient;

illustrating a physiological affect icon relative to an instrument icon to illustrate at least one optical coherence tomography data, temperature data, hydraulic data, electrical data, or gating data based on the determined therapy to be applied to the brain.

47. The method of claim 45, wherein the obtained first patient specific data includes obtaining first patient specific image data;

wherein determining an entry point includes determining an entry point with the obtained first patient specific image data and wherein determining a path includes determining a path with the obtained first patient specific image data.

48. The method of claim 47, further comprising:

navigating the instrument relative to the anatomy of the first patient;

superimposing an instrument icon on the obtained first patient specific image data representing the position of the instrument relative to the anatomy of the first patient; and

illustrating a physiological affect icon relative to the instrument icon to illustrate a physiological affect in the brain of the determined therapy to be applied to the brain;

wherein the physiological affect icon is operable to change based upon the determined therapy applied with the instrument.

49. The method of claim 48, further comprising:

providing a display device operable to display the obtained first patient specific image data and the physiological affect icon;

imaging the first patient with an imaging system to obtain the obtained first patient specific image data;

providing a tracking system including a localizer and a tracking device; and

tracking a position of the instrument with the tracking system.

50. The method of claim 40, further comprising:

performing the determined procedure based on the determined first plan for the determined procedure, including navigating an instrument to a planned position within a brain of the first patient as a part of the determined first plan and implanting the instrument into the brain of the first patient;

illustrating a plurality of predicted therapy icons on a display as icons superimposed on a first patient specific image data of the first patient based on the accessed database data including atlas brain data including information regarding a physiology of the atlas brain, wherein the predicted therapy icons illustrate predicted affects of various specific programming parameters of the instrument in the brain;

programming the instrument to provide a therapy based at least in part on the illustrated plurality of predicted therapy icons; and

performing the programmed therapy on the anatomy, including at least one of electrically stimulating the anatomy, providing a chemical therapy to the anatomy, providing a biological therapy to the anatomy, providing a radiation based therapy to the anatomy, or combinations thereof.

51. The method of claim 50, wherein illustrating a plurality of predicted therapy icons on a display as icons superimposed on patient specific image data of the first patient includes illustrating icons superimposed on patient specific image data of the brain of the first patient.

52. The method of claim 51, wherein obtaining first patient specific data includes at least one of obtaining image data, obtaining functional data, obtaining gating data, obtaining patient history data, or combinations thereof.