Reference structure for a tracking system

• US 9,101,285 B2
• Filed: 06/12/2013
• Issued: 08/11/2015
• Est. Priority Date: 04/18/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Markowitz, H. Toby, Warman, Eduardo N., Mehta, Pooja, Falkner, Phillip C., Fleming, Ioana, Giese, Chad T.
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): KIMBALL, JEREMIAH T
• Application Number:
  US13/916,403
• Publication Number:
  US 20130281813A1
• Time in Patent Office: 790 Days
• Field of Search: 600/523
• US Class Current: 1/1
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00053 Mapping
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00336 with a protective sleeve, e.g. retractable or slidable
• CPC Class Codes: A61B 2017/22051 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation A61B2017/22048, A61B2017/3486 take precedence
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• 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 5/05 Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves impedance plethysmography A61B5/0295; measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• 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 5/061 Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body A61B1/00158 takes precedence
• CPC Class Codes: A61B 5/062 using magnetic field
• CPC Class Codes: A61B 5/063 using impedance measurements
• 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 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/304 : Switching circuits
• CPC Class Codes: A61B 5/333 : Recording apparatus specially adapted therefor
• CPC Class Codes: A61B 5/339 : Displays specially adapted therefor
• CPC Class Codes: A61B 5/742 : using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 8/06 : Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• CPC Class Codes: A61B 8/4472 : Wireless probes

Abstract

An volume of a patient can be mapped with a system operable to identify a plurality of locations and save a plurality of locations of a mapping instrument. The mapping instrument can include one or more electrodes that can sense a voltage that can be correlated to a three dimensional location of the electrode at the time of the sensing or measurement. Therefore, a map of a volume can be determined based upon the sensing of the plurality of points without the use of other imaging devices. An implantable medical device can then be navigated relative to the mapping data.

Claims

1. A system to determine the position of an instrument within a volume of a patient and a reference location, comprising:

a first set of electrodes positioned on the patient operable to inject at least one axis of current relative to the patient between at least two electrodes of the first set of electrodes, wherein the injected at least one axis of current is used to determine a position within the patient;

a drive system operable to drive the set of electrodes to inject a current into the volume of the patient to inject the at least one axis of current between the at least two electrodes of the first set of electrodes;

an instrument operable to be positioned within the volume of the patient having a first position element and a second position element on the instrument operable to sense an electrical property at an instrument position;

a processor operable to control the drive system; and

a first reference electrode configured to be fixedly positioned on a surface of the patient at a first reference location over a xiphoid process of the patient on a ventral side of the patient and operable to sense an electrical property based on the current injected into the volume of the patient with the first set of electrodes;

wherein the processor is operable to determine a first reference electrical property at the first reference location and relative to the first set of electrodes based at least on the injected at least one axis of current;

wherein the processor is configured to determine at least one of a respiratory cycle or cardiac cycle based on the sensed electrical property of at least the first reference electrode;

wherein the processor is further configured to evaluate the electrical property with the first position element and the second position element on the instrument, determine a position of the first and second position elements within the volume based on the evaluated electrical property, determine a scalar distance between the first position element and the second position element on the instrument, evaluate the determined position of the first position element and the second position element based on the scalar distance to correct for a distortion of the injected current between the first set of electrodes in the patient to determine a corrected position determination, and generate a graphical representation of the corrected determined position of the first position element and the second position element.

2. The system of claim 1, further comprising:

a second reference electrode positioned at a second reference location on the patient, wherein the second reference location is at a dorsal location directly across from the first reference electrode;

wherein the second reference electrode is operable to sense the electrical property and the processor is operable to determine a second reference electrical property at the second reference location and relative to the first set of electrodes based at least on the injected at least one axis of current.

3. The system of claim 2,

wherein the processor is operable to evaluate the sensed electrical property at the first and second reference locations and the sensed electrical property at the instrument position and display an icon on a display device to show the relative position of the instrument and at least one of the first and second reference electrodes.

4. The system of claim 3, further comprising:

a memory system operable to store a plurality of instrument locations; and

the display device operable to display a representation of the plurality of instrument locations;

wherein at least one of a first reference electrode icon or a second reference electrode icon is displayed on the display device relative to the representation of the plurality of instrument locations.

5. The system of claim 4, wherein the processor is operable to be controlled to display the representation of the plurality of instrument locations relative to a selected one of either of the first reference electrode or the second reference electrode.

6. The system of claim 5, wherein the representation of the plurality of instrument locations represents at least a portion of a heart of the patient.

7. The system of claim 6, wherein the processor is operable to determine the relative position of the stored plurality of positions to generate a map of a heart of the patient;

wherein the processor is operable to determine a position of at least one of the first reference position or the second reference position relative to the map.

8. The system of claim 7, wherein the generated map includes a surface rendering based on the stored plurality of positions and the determined position of at least one of the first reference position or the second reference position displayed with the display device relative to the map.

9. The system of claim 6, wherein the processor is configured to determine at least one of the respiratory cycle or the cardiac cycle based on the sensed electrical property of both the first reference electrode and the second reference electrode.

10. The system of claim 1, wherein the first set of electrodes positioned on the patient includes at least two pairs of electrodes, wherein each electrode of the each pair of the two pair of electrodes are opposed to one another on the patient;

wherein the injected at least one axis of current relative to the patient includes at least two injected axes of current, wherein a first axis of the at least two injected axes of current is between a first pair of electrodes of the at least two pairs of electrodes and a second axis of the at least two injected axes of current is between a second pair of the at least two pair of electrodes;

wherein the processor is operable to determine a location of the first reference electrode based on the injected at least two injected axes of current.

11. A method of determining a position of an instrument within a volume of a patient with a reference member, comprising:

injecting a current into the patient with a set of axis electrodes connected to the patient;

evaluating an electrical property relative to the patient based on an input of a first reference electrode that is positioned on a ventral surface of the patient directly exterior to a xiphoid process of the patient, wherein the input includes measuring a voltage drop at an interface between the patient and at least one of the axis electrodes;

evaluating the electrical property within the patient based at least in part on sensing with a position element on an instrument positioned within the patient; and

evaluating an electrical property with the first position element and the second position element on the instrument;

determining a position of the first and second position elements within the volume based on the evaluated electrical property;

determining a scalar distance between the first position element and the second position element on the instrument;

evaluating the determined position of the first and second position elements based on the scalar distance to correct for a distortion of the injected current between the set of axis generation electrodes in the patient to determine a corrected position determination;

determining a position of the instrument based on the evaluated electrical property at the first position element and the second position element on the instrument;

generating a map based on the plurality of determined positions of the instrument;

displaying the map;

displaying a graphical representation of the corrected determined position of the first and second position elements;

determining a position of the first reference electrode relative to the displayed map based on the evaluated electrical property at the first reference electrode;

displaying the determined position of the first reference electrode relative to the displayed map; and

orientating the displayed map relative to the patient by displaying the determined first reference position of the first reference electrode relative to a determined position of the first reference electrode on the patient.

12. The method of claim 11, wherein displaying the determined position of the first reference electrode includes displaying the determined position of the first reference electrode as an icon relative to the displayed map.

13. The method of claim 12, further comprising:

evaluating an electrical property relative to the patient based on an input of a second reference electrode that is positioned on the patient, wherein the input includes measuring a voltage drop at an interface between the patient and at least one of the axis electrodes, wherein the second reference electrode is fixed at a second reference position on a dorsal surface of the patient substantially across the patient from the first reference position;

displaying a position of the second reference position relative to the displayed map; and

orienting the displayed map relative to a known position of the second reference electrode on the dorsal surface of the patient across from the xiphoid process of the patient.

14. The method of claim 11, further comprising:

at least one of;

determining a respiratory cycle based on an evaluated electrical property with both of the first reference electrode and a second reference electrode, or monitoring a cardiac cycle based on an evaluated electrical property with both of the first reference electrode and a second reference electrode.

15. A method of determining a position of an instrument within a volume of a patient, comprising:

operating a position sensing unit to drive at least three sets of electrodes positioned on the patient to inject a current along three substantially orthogonal axes into the volume of the patient between each set of the at least three sets of electrodes;

fixedly positioning a first reference electrode on a ventral surface of the patient directly over the xiphoid process at a first reference position;

fixedly positioning a second reference electrode on a dorsal surface of the patient, wherein the second reference position is across from the first reference position; and

operating the position sensing unit to evaluate an electrical property sensed with both the first reference electrode and the second reference electrode based on the injected current into the volume of the patient along the three substantially orthogonal axes;

automatically determining a first reference electrical property at the first reference position defined by the first reference electrode and a second reference electrical property at the second reference position defined by the second reference electrode to at least one of determine a respiratory cycle based on the evaluated electrical property with both of the first reference electrode and the second reference electrode or monitor a cardiac cycle based on the evaluated electrical property with both of the first reference electrode and the second reference electrode;

evaluating an electrical property with a first position element and a second position element on the instrument;

determining a position of the first position element and the second position element within the volume based on the evaluated electrical property;

determining a scalar distance between the first position element and the second position element;

evaluating the determined position of the first position element and the second position element based on the scalar distance to correct for a distortion of the injected current in the patient to determine a corrected position determination; and

displaying a graphical representation of the corrected determined position of the first position element and the second position element.

16. The method of claim 15, further comprising:

operating the position sensing unit to evaluate the electrical property using the first position element at a plurality of positions, wherein the first position element is associated with the instrument, wherein the instrument is configured to be moved to the plurality of positions within the volume;

displaying a map based on the evaluated electrical property using the first position element at a plurality of positions;

displaying an icon relative to the displayed map representing the first reference position; and

orienting a user relative to the map and the patient based on the first reference position of the first reference electrode fixedly positioned on a ventral surface of the patient directly over the xiphoid process and the displayed icon.

17. The method of claim 16, further comprising:

removing the first reference electrode; and

after removing the first reference electrode, operating the position sensing unit to maintain the orientation of the displayed map based on the evaluated electrical property sensed with both the second reference electrode and the second reference position being across the patient from the first reference position.

18. The method of claim 16, further comprising:

operating the position sensing unit to reorient the displayed map relative to the patient with at least one of the first reference electrode or the second reference electrode after removing at least one electrode of the at least three sets of electrodes to continue reference of the data acquired with the first position element including the orientation of the displayed map relative to the patient.