Clinician programmer system and method for steering volumes of activation

• US 9,026,217 B2
• Filed: 08/23/2011
• Issued: 05/05/2015
• Est. Priority Date: 05/15/2008
• Status: Active Grant

• Current Assignee: IntElect Medical, Inc. (Boston Scientific Corporation)
• Original Assignee: IntElect Medical, Inc. (Boston Scientific Corporation)
• Inventors: Kokones, Scott, Blum, David Arthur, Carlton, Keith
• Primary Examiner(s): Kahelin, Michael
• Assistant Examiner(s): FAIRCHILD, MALLIKA DIPAYAN
• Application Number:
  US13/137,512
• Publication Number:
  US 20110313268A1
• Time in Patent Office: 1,351 Days
• Field of Search: 607/45, 607/46, 607/50, 607/39
• US Class Current: 607/45
• 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 2090/103 Cranial plugs for access to brain
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 5/055 involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: A61N 1/36128 Control systems
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: G06V 40/10 Human or animal bodies, e.g. vehicle occupants or pedestrians; Body parts, e.g. hands
• 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 40/63 for local operation
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders
• CPC Class Codes: G16H 70/20 relating to practices or guidelines

Abstract

A system and method for selection of stimulation parameters for Deep Brain Stimulation (DBS) may include a processor that displays in a display device and in relation to a displayed model of a leadwire including model electrodes, a current field corresponding to a first stimulation parameter set, provides a user interface for receipt of user input representing a shift of the current field, in response to the user input, moves, in the display device, the current field with respect to the displayed model, determines a second stimulation parameter set that results in the moved current field, and outputs the second stimulation parameter set and/or sets a stimulation device with the second stimulation parameter set, where the stimulation device is configured for performing a stimulation using the leadwire in accordance with the second stimulation parameter set.

Claims

1. A computer-implemented anatomical modeling system comprising:

a processor configured to;

import from an external system at least one medical image associated with a patient;

display one or more of the at least one medical image;

generate a patient-specific anatomical model that outlines anatomical structures based on the at least one medical image;

display the patient-specific anatomical model; and

display, overlying the patient-specific anatomical model that was generated based on the at least one medical image, a graphical representation of at least one of;

a leadwire that is (a) implanted into an anatomical region of the patient that is modeled by the anatomical model, and (b) configured for stimulating tissue in the anatomical region; and

a volume of tissue estimated by the processor to be activated by the implanted leadwire;

wherein;

the imported at least one medical image was generated prior to the implantation of the leadwire; and

the displayed anatomical model and the displayed one or more of the at least one medical image are displayed overlying each other so that the outlines of the anatomical model outline the anatomical structures within the display of the one or more of the at least one medical image.

2. The system of claim 1, wherein the anatomical model is a three-dimensional anatomical model.

3. The system of claim 1, wherein, for the generation of the patient-specific anatomical model, the processor is configured to:

automatically modify a model according to image data of the at least one medical image; and

subsequent to the automatic modification, receive user input according to which to further modify the automatically modified model.

4. The system of claim 1, wherein the generation of the patient-specific model is performed by morphing an atlas to the at least one medical image.

5. The system of claim 1, wherein for the generation of the patient-specific anatomical model, the processor is configured to:

select one of a plurality of models; and

one of;

(I) display the selected model, receive user input dragging a portion of the model, and modify the model according to the received user input; and

(II) automatically modify the selected model according to information in the at least one medical image, wherein at least one of;

(1) the plurality of models include at least one model of an anatomical region generated based on a plurality of sub-models that are each of an entirety of the anatomical region, each of the plurality of sub-models corresponding to image data of a respective patient of a patient population; and

(2) for the selection of the one or more of the plurality of models, the processor is configured to one of;

(a) compare image data of the at least one medical image to image data of each of a patient population to which the plurality of models correspond, the one of the plurality of models that is selected being that which corresponds to the image data that is determined to be most similar to the image data of the at least one medical image, and (b) compare micro electrode recording (MER) data of the patient to MER data of each patient of a patient population to which the plurality of models correspond, the one of the plurality of models that is selected being that which corresponds to the MER data that is determined to be most similar to the MER data of the patient with which the at least one medical image is associated.

6. A computer-implemented anatomical modeling system comprising:

a processor configured to;

import from an external system at least one medical image associated with a patient;

generate a patient-specific anatomical model of anatomical structures based on the at least one medical image; and

display, overlying the patient-specific anatomical model that was generated based on the at least one medical image, a graphical representation of at least one of;

a leadwire that is (a) implanted into an anatomical region of the patient that is modeled by the anatomical model, and (b) configured for stimulating tissue in the anatomical region; and

a volume of tissue estimated by the processor to be activated by the implanted leadwire;

wherein;

the imported at least one medical image was generated prior to the implantation of the leadwire;

for the generation of the patient-specific anatomical model, the processor is configured to;

select one of a plurality of models; and

automatically modify the selected model according to information in the at least one medical image; and

for the selection of the one of the plurality of models, the processor is configured to compare image data of the at least one medical image to image data of each of a patient population to which the plurality of models correspond, the one of the plurality of models that is selected being that which corresponds to the image data that is determined to be most similar to the image data of the at least one medical image.

7. A computer-implemented anatomical modeling system comprising:

a processor configured to;

import from an external system at least one medical image associated with a patient;

generate a patient-specific anatomical model of anatomical structures based on the at least one medical image; and

display, overlying the patient-specific anatomical model that was generated based on the at least one medical image, a graphical representation of at least one of;

a leadwire that is (a) implanted into an anatomical region of the patient that is modeled by the anatomical model, and (b) configured for stimulating tissue in the anatomical region; and

a volume of tissue estimated by the processor to be activated by the implanted leadwire;

wherein;

the imported at least one medical image was generated prior to the implantation of the leadwire;

for the generation of the patient-specific anatomical model, the processor is configured to;

select one of a plurality of models; and

automatically modify the selected model according to information in the at least one medical image; and

the plurality of models include at least one model of an anatomical region generated based on a plurality of sub-models that are each of an entirety of the anatomical region, each of the plurality of sub-models corresponding to image data of a respective patient of a patient population.

8. The system of claim 7, wherein the at least one model generated based on the plurality of sub-models includes a plurality of models that are each (a) of the entirety of the anatomical region, and (b) generated based on a different respective plurality of sub-models, each of the sub-models being of the entirety of the anatomical region.

9. The system of claim 7, wherein different ones of the plurality of sub-models correspond to respective image data of a different single respective patient of the patient population.

10. A computer-implemented anatomical modeling system comprising:

a processor configured to;

import from an external system at least one medical image associated with a patient;

generate a patient-specific anatomical model of anatomical structures based on the at least one medical image; and

display, overlying the patient-specific anatomical model that was generated based on the at least one medical image, a graphical representation of at least one of;

a leadwire that is (a) implanted into an anatomical region of the patient that is modeled by the anatomical model, and (b) configured for stimulating tissue in the anatomical region; and

a volume of tissue estimated by the processor to be activated by the implanted leadwire;

wherein;

the imported at least one medical image was generated prior to the implantation of the leadwire;

for the generation of the patient-specific anatomical model, the processor is configured to;

select one of a plurality of models; and

automatically modify the selected model according to information in the at least one medical image; and

for the selection of the one of the plurality of models, the processor is configured to compare micro electrode recording (MER) data of the patient to MER data of each patient of a patient population to which the plurality of models correspond, the one of the plurality of models that is selected being that which corresponds to the MER data that is determined to be most similar to the MER data of the patient with which the at least one medical image is associated.

11. A computer-implemented anatomical modeling system comprising:

a processor configured to;

import from an external system at least one medical image associated with a patient;

generate a patient-specific anatomical model of anatomical structures based on the at least one medical image; and

display, overlying the patient-specific anatomical model that was generated based on the at least one medical image, a graphical representation of at least one of;

a leadwire that is (a) implanted into an anatomical region of the patient that is modeled by the anatomical model, and (b) configured for stimulating tissue in the anatomical region; and

a volume of tissue estimated by the processor to be activated by the implanted leadwire;

wherein;

the imported at least one medical image was generated prior to the implantation of the leadwire; and

for the generation of the patient-specific anatomical model, the processor is configured to;

select one of a plurality of models;

display the selected model;

receive user input dragging a portion of the model; and

modify the model according to the received user input.

12. The system of claim 11, further comprising:

a display device, wherein the processor is configured to serially navigate between display, in the display device, of a plurality of two-dimensional image slices of a three dimensional anatomical region, based on the at least one medical image, each discrete navigation of the serial navigation including a respective display of a slice that is spatially adjacent to a respective slice from which the respective discrete navigation takes place.

13. The system of claim 11, further comprising:

a display device, wherein the processor is configured to display the anatomical model in the display device.

14. The system of claim 11, wherein, for the generation of the patient-specific anatomical model, the processor is further configured to automatically modify the selected model according to information in the at least one medical image.

15. The system of claim 11, wherein the user input is provided in a user interactive interface in which the selected model is displayed overlaid on one or more of the at least one medical image.

16. The system of claim 11, wherein the processor is configured to display a grid of nodes overlaid on the model, and the user input dragging the portion of the model is provided by dragging one or more of the displayed nodes.

17. The system of claim 16, wherein the modification of the model according to the received user input includes non-linearly modifying the model, the non-linear modification including at least one respective first region about the one or more of the displayed nodes being displaced by a first distance in response to the user input and at least one region that is further from each of the one or more of the displayed nodes than the at least one respective first region being displaced by a second distance that is less than the first distance in response to the user input.

18. The system of claim 16, wherein the grid of nodes is an automatically generated uniform distribution of nodes displayed overlying the model.

19. The system of claim 11, wherein, the processor is configured to modify the model according to boundaries associated with the displayed model, the boundaries including a first boundary between a draggable anatomical region and an adjacent region that is modified responsive to and according to the dragging of the draggable anatomical region.

20. The system of claim 19, wherein the boundary includes a second boundary between the adjacent region and a further region, the further region not being modified responsive to the dragging of the draggable region.

21. The system of claim 11, wherein, for the generation of the patient-specific anatomical model, the processor is further configured to:

record an identification of at least one predefined anatomical region in the at least one medical image; and

automatically modify the selected model to align structures of the selected model corresponding to the at least one anatomical region with the identified predefined anatomical region of the at least one medical image.

22. The system of claim 11, for the generation of the patient-specific anatomical model, the processor is further configured to:

record an identification of an anterior commissure (AC) and a posterior commissure (PC) in the at least one medical image; and

automatically modify the selected model to align structures of the selected model corresponding to the AC and PC with the identified AC and PC of the at least one medical image, wherein the alignment includes stretching of one or more predefined anatomical structures.

23. The system of claim 11, wherein the at least one medical image includes a magnetic resonance (MR) image and a computer tomography (CT) image, and the processor is configured to record an alignment of the MR image with the CT image.

24. The system of claim 11, wherein the processor is configured to display the anatomical model in a user interface in which a region of the anatomical model is user definable as a target stimulation region.

25. The system of claim 24, wherein, based on the target stimulation region, the processor is configured to determine and output a suggested surgical site and trajectory for insertion of a stimulation leadwire to stimulate a region that at least partly overlaps the target stimulation region.

26. The system of claim 24, wherein the target stimulation region is definable by selection by the user of a plurality of points to outline the target stimulation region.

27. The system of claim 26, wherein one or more points of the outlined target stimulation region are user selectable and draggable for modifying the defined target stimulation region.

28. The system of claim 11, wherein:

the at least one medical image includes a first medical image of the patient, in which the anatomical structures are identifiable;

the processor is configured to obtain a second medical image of the patient in which a surgically implanted stimulation leadwire is identifiable, and automatically identify, based on the second medical image, a location of the leadwire with respect to the first medical image;

the generation of the model is based on the first medical image and the identified location; and

the model is of the anatomical structures and of the leadwire, the modeled leadwire being positioned in the model relative to the anatomical structures according to the identified location of the leadwire.

29. The system of claim 28, wherein the first medical image is a magnetic resonance (MR) image and the second medical image is a computer tomography (CT) image.

30. The system of claim 11, wherein:

the at least one medical image includes a first medical image of the patient, in which the anatomical structures are identifiable;

the model is of anatomical regions and is initially generated based on the first medical image; and

the processor is configured to;

obtain a second medical image of the patient in which a surgically implanted stimulation leadwire is identifiable;

automatically identify, based on the second medical image, a location of the leadwire relative to structures of the model; and

modify the model to include a representation of the leadwire according to the identified location of the leadwire.

31. The system of claim 30, wherein the first medical image is a magnetic resonance (MR) image and the second medical image is a computer tomography (CT) image.

32. The system of claim 11, wherein the processor is configured to display the graphical representation of the volume of tissue estimated by the processor to be activated by the implanted leadwire overlying the patient-specific anatomical model that was generated based on the at least one medical image.

33. The system of claim 32, wherein the importation is performed subsequent to the implantation of the leadwire.

34. The system of claim 11, wherein the modification of the model according to the received user input includes modifying at least one of a shape and a size of at least one of the anatomical structures of the model.