Abstract:
In a method or system for minimally-invasive therapy on a patient, a minimally-invasive therapy apparatus is provided. While performing the minimally-invasive therapy on the patient with a minimally-invasive therapy apparatus, the patient is ventilated with a jet ventilator to reduce a magnitude of the patient&#39;s breathing and increase a frequency of the patient&#39;s breathing.

Description:
BACKGROUND 
       [0001]    Minimally-invasive medical therapies are increasingly gaining importance. In the treatment of coronary heart disease, the surgical bypass operation on the heart is clearly declined in favor of balloon dilation (PTCA=percutaneous transluminal coronary angioplasty) and the insertion of a stent. In arterial fibrillation, ablation in the atrium has established itself in recent years. Minimally-invasive procedures are also clearly increasing in the fields of biopsies, spinal column therapies and tumor ablation. 
         [0002]    Medical imaging that shows the vessels, organs and medical instruments in the organism in real time remains a requirement in all minimally-invasive interventions. Image artifacts thereby arise due to body and organ movement (for example due to breathing). For example, given a lung tumor the tumor moves between 1 and 2 cm during one breathing cycle. 
         [0003]    Modern imaging devices such as computer tomographs have what is known as respiration gating; the breathing cycle is thereby taken into account in the image reconstruction, and the radiologist acquires exposures in which the movement artifacts that arise due to breathing have been corrected. 
         [0004]    A solution which takes into account the respiratory movement in radiation therapy is known from U.S. Pat. No. 5,764,723, “Apparatus and Method to Gate a Source for Radiation Therapy”. 
         [0005]    In biopsies or tumor ablation, the therapy needle must still be introduced manually by the physician into the organ area to be treated. For this the patient is required to hold his breath, or the physician attempts to insert the needle while estimating the breathing cycle. This method is very dependent on the cooperation of the patient and the manual / surgical skill of the physician. 
         [0006]    The solution described in pending Siemens AG German Patent Application 2008P0365 DE, (“Movement-Controlled, in Particular Breathing-Controlled Needle Guidance”), improves the guidance of rigid instruments in an organism and reduces the requirements for the cooperation readiness of the patient or the skillfulness of the physician. However, one disadvantage is that the respiratory movement of the patient must be correctly detected. 
       SUMMARY 
       [0007]    It is an object to find a solution that permits a safe insertion and guidance of an instrument, independent of the patient and the skill of the physician. 
         [0008]    In a method or system for minimally-invasive therapy on a patient, a minimally-invasive therapy apparatus is provided. While performing the minimally-invasive therapy on the patient with the minimally-invasive therapy apparatus, the patient is ventilated with a jet ventilator to reduce a magnitude of the patient&#39;s breathing and increase a frequency of the patient&#39;s breathing. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0009]      FIG. 1  is a side partial cross-sectional view illustrating a prior art jet ventilator needle injecting pulsating ventilated air into a nose of a patient; 
           [0010]      FIG. 2  is a graph showing a normal breathing curve and tumor movement during needle insertion into the tumor without respiration or with conventional respiration according to the prior art; 
           [0011]      FIG. 3  is a graph showing a breathing curve and tumor movement when a jet ventilation device is employed during needle insertion into a tumor; 
           [0012]      FIG. 4  is a schematic illustration of a jet ventilator being used for a patient to be scanned by a robotic x-ray radiator and detector system with an associated image system connected to the jet ventilator for processing control; 
           [0013]      FIG. 5  is a schematic illustration of the patient being respirated with a jet ventilator and undergoing a scan with a robotic x-ray radiation and detector during robotic needle insertion, such as into a tumor, and the use of a data bus for processing control by the use of the jet ventilator with at least one or more system modules; 
           [0014]      FIG. 6  is a block diagram of a first embodiment of a patient positioning table and a robotic x-ray detector system wherein a data bus with other system modules is connected with the jet ventilator via a gating image connection unit; and 
           [0015]      FIG. 7  is a second embodiment of a patient positioning table and robotic x-ray detector system where the jet ventilator is connected to a data line with other system modules via a physiological signal processing unit. 
       
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0016]    For the purposes of promoting an understanding of the principles of the invention, reference will now be made to preferred embodiments/best mode illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, and such alterations and further modifications in the illustrated devices and such further applications of the principles of the invention as illustrated as would normally occur to one skilled in the art to which the invention related are included. 
         [0017]    According to one preferred embodiment, the patient is respirated with what is known as a jet (high-frequency) ventilator during an intervention (advantageously for a needle insertion and guidance procedure such as into a tumor). 
         [0018]    Such a jet ventilator is available from the company http://www.acutronic-medical.ch or http://www.bunl.com/controls.html. U.S. Pat. No. 5,239,994, “Jet Ventilator System”, also discloses a jet ventilator. This document is incorporated herein. 
         [0019]    Due to the high-frequency respiration (60 to 700 respiration cycles per minute) and reduced magnitude of the respiration, a distinct rising and falling of the ribcage no longer occurs, rather only a high-frequency oscillation of the lungs with very small movement amplitude that barely causes interfering image artifacts. 
         [0020]    Two techniques can thereby be used: a) insertion of a respiration tube through the nose (see “Effectiveness of transnasal jet Ventilation—a teaching aid”, James R. Boyce); or b) insertion of a respiration tube via the trachea (see “Conventional Methods are Unsuccessful Provide Oxygenation and Ventilation When A Safe, Quick, and Temporary Way To: *Percutaneous Transtracheal Jet Ventilation”, Rajesh G. Patel). Technique a) above is preferred. 
         [0021]    Particularly advantageous is the integration of this device into an angiographic/cardiological x-ray system comprised of high voltage generator, x-ray radiator(s), radiation diaphragm, image display unit(s), patient table, radiator and detector tripod with a digital image system, in particular a DynaCT and/or DynaCT Card x-ray device (of Siemens AG). A device with which both angiographic x-ray exposures and CT-like images can be re-constructed is disclosed in DE 102005016472 “Operating Method for an X-ray System, Corresponding Operating Method for a Computer and Corresponding Subjects”. A gating signal can thereby additionally be derived by the jet ventilator and be taken into account in the image reconstruction. The respiration curve can be displayed at the imaging unit. 
         [0022]    The guidance of the instrument (needle) can thereby be implemented by hand by the medical personnel or via a needle guidance robot that does not need to be respiration-controlled due to the low movement amplitude. Alternatively, a signal can additionally be lifted from the jet ventilator in order to further improve the robot control. 
         [0023]    For example, the high-frequency respiration can be used by such methods in the following methods or combinations: a) x-ray systems; b) sonography, including IVUS; c) radioscopy (fluoroscopy); d) angiographic and cardiological x-ray systems; e) optical coherence tomography (OCT); f) positron emission tomography (PET); g) SPECT; h) computer tomography; i) nuclear magnetic resonance tomography, including intravascular/intracardial MR; j) optical exposures, including endoscopy; k) fluorescence and optical markers (molecular imaging); and l) radiation therapy or particle therapy 
         [0024]    A great advantage of the preferred embodiment lies in the avoidance of movements of the ribcage with large amplitude, which cause unwanted organ, tumor and vessel movements during the intervention. 
         [0025]    Preferred embodiments will now be described in greater detail with respect to  FIGS. 1-7 . 
         [0026]      FIG. 1  shows a prior art jet ventilator  10  with a ventilator output  11  comprising a hose  11 A and needle  11 B inserted at a nose  100 A of a patient  100 . 
         [0027]      FIG. 2  shows a known prior art relationship between movement of a tumor  7 A,  7 B as a result of respiration of a patient having a breathing curve  5  without respiration or with a conventional prior art respirator A needle robot  6  must therefore track the movement of the tumor, which is very disadvantageous as previously indicated. 
         [0028]      FIG. 3  shows a needle robot  6  for injecting a needle into a tumor  4 A,  4 B which does not move nearly as much as the tumor does in previous  FIG. 2  since a jet ventilation is employed so that the patient&#39;s breathing curve has much smaller peaks and valleys as indicated at  3 . Thus with the preferred embodiment, it is much easier for the needle robot to insert a needle to take a sample from the tumor over a time period corresponding to a plurality of small undulations of the patient&#39;s breathing curve  3 . 
         [0029]      FIG. 4  shows an illustration of a patient  12  respirated, such as by a needle to the patient&#39;s nose, via a ventilator output line  11  to a jet ventilator  10 . The patient lies on a table  16  for undergoing an x-ray scan by use of a floor-mounted articulated arm robot  15  with a C-shaped arm  15 A with x-ray radiator  15 B and detector  15 C. 
         [0030]    The jet ventilator  10  has a signal output time  10 A connected via an interface  13  between the jet ventilator  10  and an image system  14  for the x-ray system  15 . Thus the ventilator can control the image system to take a count of even small undulations in the patient&#39;s breathing curve. 
         [0031]    In  FIG. 5  a system is provided with a robot  1  for insertion of an intervention needle  2  with movement compensation. As shown in  FIG. 5 , the patient  12  may undergo an x-ray radiation scan for needle guidance by the robotic system  15  during the intervention with the needle robot  1  for example to obtain a biopsy from a patient&#39;s tumor while the patient  12  is being ventilated by a jet ventilator  10  via ventilator output line  11  and ventilator needle  11 B. The x-ray radiator system  15  with x-ray radiator  15 B and detector  15 C is used to continuously image the procedure to insure proper replacement of the needle into the tumor while the patient is being respirated by the jet ventilator. 
         [0032]    In  FIG. 5 , the jet ventilator  10  connects an output signal line  10 A through interface  13  to an interface unit  30  for movement sensor and movement evaluation. Interface  30  is connected to a data bus  3  which also connects to: a synchronization unit  31  for movement deactivation, image correction, and robot control; a robot unit  32 ; an image processing unit  33  with movement correction; and a planning unit  34  for planning the intervention, and determination of start and target coordinates for guidance of the needle  2  of the needle robot  1 . The method with jet-ventilator will also work without a needle robot when the operator uses his hands 
         [0033]    A patient-proximal control unit  300  for the x-ray system  15  with C-shaped arm  15 A and the needle robot  1  is provided for proper placement of the patient  12  on the patient table  16  with respect to the needle robot  1  and the x-ray system  15 . 
         [0034]      FIG. 6  is a first embodiment of a patient  12  on a patient table  16  using a jet ventilator  10  via ventilator output line  11  while undergoing an x-ray scan with a robotic x-ray unit  15  having C-shaped arm  15 A with x-ray radiator  15 B and detector  15 C. Jet ventilator  10  is connected via signal output  10 A through an interface  13  to an image correction unit  21  operating on the gating principle. As in  FIG. 5 , the patient is lying on patient table  16  and is being imaged by use of the x-ray system  15 . A high voltage generator  26  connects with detector  15 C and is controlled by a system controller  27  connected to the patient table  16  control input. A power supply unit  18  is also provided for the system. 
         [0035]    As shown in  FIG. 6 , a common data bus  17  is provided connected to a number of units. The data bus  17  connects to a display unit for x-ray images  19  with an associated user I/O unit  20 . The aforementioned image correction unit  21  also connects to the data bus  17 . The same is true of a physiological signal processing unit  22  and an image processing unit for x-ray images  24  (including 3D reconstruction and with soft tissue processor). 
         [0036]    A pre-processing unit for x-ray images unit  23  connects to the x-ray radiator  15 B and also to the data bus  17 . 
         [0037]    The aforementioned system controller  27  connects to the data bus  17  along with a calibration unit  25 , image data memory  28 , and interface for patient data and image data  29 . This interface has an input and output for CT or MR exposures and an input and output for HIS. 
         [0038]      FIG. 7  is a second embodiment employing the jet ventilator  10  ventilating, via ventilator output line  11 , a patient  12  undergoing an x-ray scan with robotic x-ray unit  15  having C-shaped arm  15 A with x-ray radiator  15 B and detector  15 C. The jet ventilator  10  has a signal output at  10 A connected through an interface  13  to a physiological signal processing unit (respiration, CO 2 ). An output of the unit  22  connects to a common data bus  17 . A power supply unit  18  is also provided. 
         [0039]    Also connected to the data bus  17  are the same units  18 ,  19 ,  20 ,  21 ,  23 ,  24 ,  25 ,  27 ,  25 ,  28 , and  29  described for  FIG. 6 . A high voltage generator  26  and system controller  27  are also provided connected to the patient table  16 , as was the case in  FIG. 6 . 
         [0040]    While preferred embodiments have been illustrated and described in detail in the drawings and foregoing description, the same are to be considered as illustrative and not restrictive in character, it being understood that only some possible embodiments have been shown and described and that all changes and modifications that come within the spirit of the invention both now or in the future are desired to be protected.