# Patent

## Title
Method for image-based robotic surgery

## Abstract

A robotic surgery method may include moving and temporarily fixing the position of a mobile base relative to the floor; coupling a first element of a fluoroscopic imaging system, including a source element and a detector element, to a first robotic arm coupled to the mobile base, the first robotic arm including a mounting fixture configured to be interchangeably coupled to a surgical tool and the first element; mounting a second element of the fluoroscopic imaging system in a position and orientation relative to the first element such that a targeted patient tissue structure may be positioned between the first and second elements of the fluoroscopic imaging system; and utilizing a sensing system and one or more sensing elements coupled to each of the first and second elements of the fluoroscopic imaging system to determine a relative spatial positioning between each of the first and second elements.

## Background
CROSS REFERENCE TO RELATED APPLICATIONS
The present application claims the benefit of U.S. Provisional Application No. 61/582,149, filed Dec. 30, 2011, the entirety of which is hereby incorporated by reference.


FIELD
The present invention relates generally to robotic surgery techniques, and more particularly to configurations which may be utilized to efficiently facilitate intraoperative imaging by fluoroscopy during surgical procedures such as joint resurfacing or replacement.
BACKGROUND
With continued surgery-related diagnostic and treatment specialization, and increases in the costs associated with maintaining and staffing operating room space, there is a continued need for capital equipment technologies and configurations that facilitate flexibility and efficiency. For example, radiography and fluoroscopy systems for providing intraoperative images during procedures such as orthopaedic surgery conventionally have comprised relatively large and unwieldly hardware configurations, such as the conventional fluoroscopy C-arm system depicted in FIG. 1A, and the conventional flat-panel radiography system depicted in FIG. 1B which is partially ceiling-mounted and partially floor mounted. Operation of these systems generally requires moving one or more movable portions into a position and/or orientation relative to one or more subject tissue structures of a patient, and often repositioning and/or reorientation to capture additional images from another viewpoint relative to the tissue structures. For example, in the case of many joint arthroplasty related procedures, it will be of interest for the surgeon to gather both antero/posterior and lateral views of the particular skeletal joint of interest, and gathering both views will require movements, either manually or electromechanically induced, of the various portions of imaging hardware. Further, it is sometimes the case that the anatomy of interest of the patient will move during the procedure, potentially requiring re-alignment of the imaging hardware to procure additional intraoperative views. To address the latter problem specifically in a scenario wherein a moving joint is to be imaged during active gait on a treadmill, one university research group has created a system wherein two robotic arms may be utilized to hold an imaging source and detector on opposite sides of a joint of interest and approximately maintain such a relationship while the joint is moved (i.e., as the patient walks on the treadmill). Such a system would not be usable in the tight quarters of an operating room setting, would not be portable (i.e., to facilitate maximum flexibility for the operating room usage scenario), and would require the relatively immense cost of installing and maintaining two robotic arms in the direct vicinity of the operating table. There is a need for a portable, flexible imaging system that facilitates efficient intraoperative imaging in a setting wherein repositioning and/or reorientation of the imaging source and detector relative to the patient anatomy and/or each other is likely required.
SUMMARY
One embodiment is directed to a robotic surgery method, comprising: moving a mobile base into a position upon an operating room floor adjacent a patient and temporarily fixing the position of the mobile base relative to the floor; coupling a first element of a fluoroscopic imaging system comprising a source element and a detector element to a first robotic arm coupled to the mobile base, the first robotic arm comprising a mounting fixture configured to be interchangeably coupled to a surgical tool and the first element of the fluoroscopic imaging system; mounting a second element of the fluoroscopic imaging system in a position and orientation relative to the first element such that a targeted patient tissue structure may be positioned between the first and second elements of the fluoroscopic imaging system; and utilizing a sensing system and one or more sensing elements coupled to each of the first and second elements of the fluoroscopic imaging system to determine a relative spatial positioning between each of the first and second elements of the fluoroscopic imaging system. Temporarily fixing the position of the mobile base may comprise applying a brake. The method further may comprise moving the first robotic arm to position the first element of the fluoroscopic imaging system relative to the second element of the fluoroscopic imaging system. The first robotic arm may comprise one or more joints and one or more motors configured to controllably regulate motion at the one or more joints, wherein moving the first robotic arm may comprise moving at least one of the one or more joints. Moving at least one of the one or more joints may comprise manually effecting a movement of at least one of the one or more joints. The method further may comprise haptically regulating the range of motion of movement that may be manually effected at the at least one of the one or more joints. The method further may comprise monitoring a position of at least a portion of the first robotic arm using a sensor. The at least one sensor may be selected from the group consisting of: an encoder, a potentiometer, an optical position tracker, an electromagnetic position tracker, and a fiber bragg deflection sensor. In one embodiment, the first element may be the source element and the second element may be the detector element. In another embodiment, the first element may be the detector element and the second element may be the source element. The method further may comprise producing a collimated beam with the source element having a cross-sectional shape selected from the group consisting of: a circle, an ellipse, a square, and a rectangle. The method further may comprise detecting the collimated beam with the detector element. The detector element may be a flat panel detector. The method further may comprise switching out the first element of the fluoroscopic imaging system for the surgical tool. The method further may comprise cutting bone with the surgical tool. Mounting the second element may comprise placing the second element on a movable stand. The movable stand may be coupled to the floor. The movable stand may be coupled to the mobile base. Utilizing a sensing system may comprise tracking the one or more sensing elements using a modality selected from the group consisting of: an optical sensing system, an electromagnetic sensing system, a joint rotation sensing system, and an elongate member deflection-sensing system. The method further may comprise coupling the one or more sensing elements to each of the first and second elements of the fluoroscopic imaging system, the one or more sensing elements selected from the group consisting of: a reflective marker, an electromagnetic localization sensor, a Bragg grating on an optical fiber, a strain gauge, a joint rotation encoder, and a joint rotation potentiometer. The method further may comprise using a controller to reposition one of the first or second elements in response to positional changes in the other of the first or second elements. Using a controller to reposition one of the first or second elements may comprise actuating one or more motors that are operatively coupled to the first or second element being repositioned by the controller. The method further may comprise using a controller to reorient one of the first or second elements in response to orientation changes in the other of the first or second elements. Using a controller to reorient one of the first or second elements may comprise actuating one or more motors that are operatively coupled to the first or second element being reoriented by the controller. The method further may comprise removably coupling a registration probe to the mounting fixture of the first robotic arm that may be used to register structures within reach of the probe to a coordinate system of the first robotic arm.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1A depicts a conventional fluoroscopic imaging system with a C-arm coupling a source and a detector.
FIG. 1B depicts a conventional radiographic imaging system with a flat panel detector.
FIG. 2A depicts an intraoperative imaging embodiment in accordance with the present invention in a knee lateral view configuration, wherein both a first and second imaging element are supported by manually movable stands.
FIG. 2B depicts an intraoperative imaging embodiment in accordance with the present invention in a knee antero-posterior view configuration, wherein both a first and second imaging element are supported by manually movable stands.
FIG. 3 depicts an intraoperative imaging embodiment in accordance with the present invention in a knee lateral view configuration, wherein both a first and second imaging element are supported by manually movable stands that are coupled to a fixed, or temporarily fixed, structure such as an operating table.
FIG. 4 depicts an intraoperative imaging embodiment in accordance with the present invention in a knee lateral view configuration, wherein both a first and second imaging element are supported by manually movable stands that are coupled to a fixed, or temporarily fixed, structure such as a mounting stem coupled to a movable base with braked wheels.
FIG. 5 depicts an intraoperative imaging embodiment in accordance with the present invention in a knee antero-posterior view configuration, wherein both a first and second imaging element are supported by movable stands, one of which is manually movable and the other of which is electromechanically movable.
FIG. 6 depicts an intraoperative imaging embodiment in accordance with the present invention in a knee antero-posterior view configuration, wherein both a first and second imaging element are supported by movable stands, both of which are electromechanically movable.
FIG. 7 depicts an intraoperative imaging embodiment in accordance with the present invention in a knee antero-posterior view configuration, wherein both a first and second imaging element are supported by movable stands, both of which are electromechanically movable, and one of which is a robotic arm comprising a portion of a robotic surgery system.
FIG. 8 depicts an intraoperative imaging embodiment in accordance with the present invention in a knee antero-posterior view configuration, wherein both a first and second imaging element are supported by movable stands, both of which are electromechanically movable, and one of which is a robotic arm comprising a portion of a robotic surgery system.
FIG. 9 depicts an intraoperative imaging embodiment in accordance with the present invention in a knee antero-posterior view configuration, wherein both a first and second imaging element are supported by movable stands, one of which is manually movable, and the other of which is a robotic arm comprising a portion of a robotic surgery system.
FIG. 10 is a flow diagram of a process for using an intraoperative imaging embodiment in accordance with the present invention.
FIG. 11 is a flow diagram of a process for using an intraoperative imaging embodiment in accordance with the present invention with an electromechanically adjustable image pair element mounting structure paired with a manually-adjustable structure.
FIG. 12 is a flow diagram of a process for using an intraoperative imaging embodiment in accordance with the present invention with two electromechanically adjustable image pair element mounting structures.
FIG. 13 is a flow diagram of a process for using an intraoperative imaging embodiment in accordance with the present invention with two electromechanically adjustable image pair element mounting structures, one of which is a robotic arm featuring a mounting fixture.
FIG. 14 is a flow diagram of a process for using an intraoperative imaging embodiment in accordance with the present invention with an electromechanically adjustable image pair element mounting structure that is a robotic arm featuring a mounting fixture.



DETAILED DESCRIPTION
Referring to FIG. 2A, one embodiment of a flexible and mobile intraoperative imaging configuration is illustrated. A patient (12) is shown on an operating table (18) that is supported by a movable base having braked wheels (20; in other words, wheels that can be controllably placed in a locked or fixed position to temporarily fix the operating table relative to the floor of the operating room). Two fluoroscopic imaging elements are shown with similar appearance (24, 26); these represent a matched pair of a fluoroscopic imaging source, and a fluoroscopic imaging detector, and may be interchangeably switched in position with each other (i.e., so long as the source is appropriately oriented toward the detector, it generally does not matter which side of the tissue structure of interest, here the knee (28), the source element lies on relative detector element). In the depicted embodiment, the first (24) and second (26) fluoroscopic imaging elements are set up to produce a lateral knee joint image; referring to FIG. 2B, the first (24) and second (26) fluoroscopic imaging elements are set up to produce an antero-posterior knee joint image. Each of the first (24) and second (26) fluoroscopic imaging elements has an electronic lead (58, 60 respectively) operatively coupling the elements (24, 26) to fluoroscopic imaging system (72), such as those sold by the Medical Systems division of General Electric, which is shown operatively coupled (88) to a controller (74) such as a computing workstation, which is shown operatively coupled (92) to user interface (78) such as a monitor and/or input device such as a keyboard. Also operatively coupled (90) to the controller (74) via an electronic lead is an optical sensing system (80) that receives input and sends commands via its connection (86) with an optical tracking transceiver (22), such as those sold by Northern Digital Corporation. The optical tracking transceiver (22) is located such that it is capable of tracking marker arrays (56) that may be fixedly coupled to structures that are to be tracked, such as the two imaging elements (24, 26), and the femur (14) and tibia (16) of the patient (12) in the depicted embodiment. In the embodiments of FIGS. 2A and 2B, the imaging elements (24, 26) are supported relative to each other and the subject tissue structure by first and second movable stands (30, 32), which are configured to stand solidly on the floor of the operating room, and to have manually releasable joints (68), such as spherical or compound joints, or slidable joints for length adjustment, which may be released to manually adjust the position and/or orientation of the imaging elements (24, 26) relative to each other or relative to the subject tissue structure to be imaged, here the knee (28) of the patient (12).
In operation, an operator or user of the system embodiment depicted in FIGS. 2A and 2B has the ability to geometrically characterize the positions and rotations of the imaging elements (24, 26) and tissue structures such as the femur (14) and tibia (16) of the patient (12) which may be the subject of the diagnostic and/or interventional procedure. In one configuration, a relatively low-power laser beam may be scanned about (using a mirror mounted to a high frequency galvanometer, for example) from the source element side of the imaging element pair to provide an aiming reticle that simulates the path of the source radiation toward the detector. This aiming reticle may be used to assist the operator in positioning and orienting the source side of the imaging element pair relative to the anatomy using the manually movable stand features. With the source side of the imaging element pair in place, the operator may utilize feedback from the optical sensing system (80), along with control software on the controller (74) and user interface (78) to manually move the detector side element of the imaging pair into alignment with the source side and the anatomy of interest, to ensure rotational and positional alignment of the pair (for image quality, and also to prevent any unneeded radiation overshoot that is not usable via the detector element for creating an image). The user interface (78) may be configured to present a two or three dimensional guidance display to assist the operator in quickly and efficiently aligning the imaging element pair (24, 26) with each other and the anatomy; the user interface (78) may be further configured to provide audio signals indicative of “docking” into alignment, or proximity thereto (for example, a tone that increases in frequency and ultimately beeps intermittently when alignment is achieved within a predetermined tolerance). Preferably a switch from lateral view to another common imaging view, such as an antero-lateral view as shown in FIG. 2B, is made relatively easy and efficient with the depicted system, since the imaging element pair (24, 26) may be repositioned and reoriented relative to each other and the subject anatomy by simply manually maneuvering the movable stands (30, 32) and going through an alignment procedure as described above, followed by capture of one or more images.
Referring to FIG. 3, an embodiment similar to that of FIG. 2A is depicted, with exception that the first and second fluoroscopic imaging element (24, 26) stands (36, 38) are coupled to the operating table (18) or other nearby sturdy mechanical element that is generally fixable relative to the global coordinate system of the operating floor. Such a configuration has individual leads (58, 60) to/from the imaging elements which may be joined into a common lead or conduit (62) to reach the fluoroscopic imaging system (72). The resultant footprint of this embodiment in the operating room is relatively efficient, and in operation, similar steps apply as have been described above in reference to FIGS. 2A and 2B.
For illustrative purposes, the embodiment of FIG. 4 features several other modalities for tracking the positions and/or orientations of various structures comprising the system (many modalities may be used separately or combined, including optical tracking techniques as described above, electromagnetic localization techniques (such as those described and offered by the Biosense division of Johnson & Johnson, Inc), joint encoder or potentiometer angle reading and aggregation techniques (such as those used in many articulated robots, wherein simple geometry is applied along with angle readings at joints to determine positions and orientations of structures in three-dimensional space), and fiber-Bragg shape sensing and localization techniques, such as those described and offered by Luna Innovations, Inc), in addition to optical tracking as described above in reference to FIGS. 2A-2B and FIG. 3. Further, the embodiment of FIG. 4 features a common mounting stem (46) fixedly coupled to a mobile base (44) having braked wheels (20) to be temporarily fixed relative to the operating room floor (98) and a global coordinate system (100) that may be associated thereto.
Referring to FIG. 4, many tracking options are presented. For example, the movable base (44) may be tracked using the optical tracking system (80) using one or more marker arrays (56) fixedly coupled to the movable base (44), so that the mobile base coordinate system (102) may be geometrically defined relative to the global coordinate system (100). The tibia (16) and femur (14) may also be optically tracked using one or more marker arrays (56) fixedly coupled thereto (i.e., using bone screws, k-wire, Steinman pins, relatively firm bracing constructs coupled around the skin surface, or the like). In this embodiment, the first fluoroscopic imaging pair element (24) is tracked in space using a group of electromagnetic localization sensors (108) coupled to the element (24) and coupled via electronic leads (112) back to an electromagnetic transducer subsystem (106) (and a coordinate system (104) associated therewith), which is coupled by electronic lead (113) back to the electromagnetic localization and sensing system (82), which is operatively coupled (94) to the controller. Finally, a Bragg grating fiber (110) is utilized in the depicted illustrative embodiment to show that fiber Bragg shape sensing and/or localization techniques may also be utilized to characterize the position and/or orientation of one or more elements of the system in space relative to a coordinate system such as the mobile base coordinate system (102). The Bragg fiber (110) leads back to the fiber Bragg (“FBG”) sensing system (84), which may be operatively coupled (96) to the controller (74). Strain gauges and structures containing them may also be utilized to monitor the positions of various elements. Thus a variety of position and/or orientation sensing means may be applied to assist in characterizing the elements of the system so that the controller (74) and user interface (78) may be utilized to guide an operator through easy, efficient alignment of source and detector elements for imaging purposes.
Referring to FIG. 5, an embodiment similar to that of FIG. 2B is shown, with the addition of electromechanically movable joints (70—symbolized as a square around a circle) on one of the movable stands (32). A joint actuation control lead (66) couples the various electromechanically movable joints (70) back to the controller (74) so they may be controllably actuated, braked, and the like. In one embodiment, a configuration such as that depicted in FIG. 5 may be utilized such that an operator manually places the non-electromechanical stand (30) into a desired position (say, for example, that the first imaging element (24) associated with this first stand is the source element, and that it may be conveniently aimed with the assistance of an aiming laser beam configuration as described above), and the controller automatically and electromechanically places the second imaging element into a predetermined alignment relative to the anatomy and the first imaging element, such as in an alignment that ensures orthogonal positioning and no roll angle between source and detector. In another embodiment, the electromechanically movable joints (70) may be utilized to haptically guide the electromechanically-actuated stand (32) into a predetermined desired position (i.e., under the power/urging force of an operator, but along a path that is haptically enforced using the motors of the electromechanically-actuated stand (32)).
Referring to FIG. 6, an embodiment is shown wherein both of the stands (30, 32) have electromechanical joints (70) that may be controlled precisely by the controller. The leads for controlling the joints are denoted by elements 64 and 66, as shown in FIG. 6. Preferably the joints have encoders, potentiometers, or other sensors to assist with the control paradigm of the stand elements (i.e., such as forward kinematics, closed loop control, etc). With such a configuration, the controller (74) may be programmed to allow an operator to overcome a stabilizing/fixating braking force to move one of the stands into a new position, and subsequently move the opposite stand into a desired orientation relative to the stand that was manually manipulated. For example, with such a configuration, the operator could pull the first stand (30) from a previous lateral view imaging plane configuration into a configuration wherein a laser aiming beam appears to provide a desirable antero-posterior view, and the second stand (32) could immediately and automatically follow to position/orient itself in a desirable opposite position to complete the antero-posterior imaging view (or in another embodiment wherein automated motion is not as desirable, the second stand (32) could lend itself to haptically-guided repositioning to complete the antero-posterior imaging view).
Referring to FIG. 7, an embodiment similar to that of FIG. 6 is depicted, with a robotic surgery system (48), such as that available from MAKO Surgical Corp. under the tradename RIO® functioning in the place of one of the electromechanical stands (30) that was shown in FIG. 6. The surgery system (48) has its own on-board controller (55), a mobile base with braked wheels (20), and comprises a sophisticated robotic arm (34) that may be utilized for precision affirmative navigation or haptic-guidance for manually-powered navigation of tools that may be coupled to a mounting fixture (50) configured not only to mount an imaging element manipulation tool (54) as shown, but also a surgical tool, such as a bone cutting tool, which may be utilized in the procedure. The mounting fixture (50) or the tool itself may comprise a motor. Bone cutting tools may comprise one or more bone cutting elements, such as a rotary cutting burr, an insertion/retraction motion reciprocal saw, and/or a lateral motion cutting saw. An optical sensor element or array (56), such as one containing one or more reflective spheres, discs, or other shapes, may be fixedly attached to the robotic surgery system (48) for tracking it, and a probe tool (not shown) may be mounted to the mounting fixture (50) to register the tip of the robotic arm (34) to other pertinent structures or coordinate systems, such as those of the patient anatomy, the other imaging element to a pair, etc. Using a highly sophisticated robotic arm such as that depicted as part of the robotic surgery system (48) may seem like too much technology and/or expense for orienting one half of an imaging element pair, but in a procedure wherein the system is going to be utilized anyway (such as one wherein the RIO® system is to be utilized to resurface a skeletal joint of a patient), the interchangeable mounting fixture (50) or tool chuck facilitates an opportunity to use the technology for the imaging aspect of the procedure as well.
Referring to FIG. 8, an embodiment similar to that of FIG. 7 is illustrated, with the second electromechanically-actuated imaging element stand structure (52) proximally fixedly mounted to the robotic surgery system (48) to reduce the overall system footprint and physically organize both sides of the imaging element pair from the ground up starting with as many common structures as possible to reduce errors in calculating the relative positioning and orientation of the imaging elements relative to each other.
Referring to FIG. 8, an embodiment similar to that of FIG. 7 is illustrated, with exception that the second imaging pair element stand (32) is a simple manually-movable configuration, as shown, for example, in FIGS. 2A and 2B. In one embodiment, the second imaging element (26) coupled to the manually movable stand (32) may be manually pulled into a position or orientation (i.e., by temporarily loosening or unlocking the manual joints 68), and the robotic arm (34) may be configured to automatically follow this action by placing the first imaging element (24) in a desired related position or orientation—or allow for haptic guidance to such desired related position or orientation under the power of the operator's own manual loads.
Again, many configurations and combinations of stands, sensing modalities, sensors, and control configurations may be utilized within the scope of this invention to facilitate high-efficiency and high-quality fluoroscopy intraoperatively. Various elements may be fixedly and/or removably mounted to the ceiling of the operating room as opposed to, or in addition to, mounting configurations to the floors or other structures as shown. The source element of the imaging element pair preferably will produce a collimated beam having a cross-sectional shape that is circular, elliptical, square, or rectangular—and preferably a detector will be matched to have an effective image area that has a circular, elliptical, square, or rectangular shape. Preferably the detector element will be a flat panel detector, such as those characterized as amorphous silicon detectors or CMOS flat panel detectors. In one embodiment, a relatively low-inertia rectangular flat panel of dimensions approximately 5 inches by 6 inches may be utilized with a relatively low inertia source that may be designed for dentistry or hand-held use, such as those available from Aribex, Inc. Preferably the detector will be capable of a “continuous acquisition mode” to facilitate real-time, or near-real-time, continuous imaging. In another embodiment, the detector may be configured to handle one image acquisition at a time, in a mode known as “digital radiography”.
Referring to FIGS. 10-14, various techniques for utilizing embodiments such as those described in reference to FIGS. 2A-9 are illustrated.
Referring to FIG. 10, subsequent to preoperative imaging, planning, and patient preparation (400), imaging source and detector elements may be provided and mounted upon manually-adjustable structures (402). After the procedure has begun (404) and intraoperative imaging is desired (406), the manually-adjustable structures may be positioned and oriented relative to each other using movable joints, in some embodiments using an alignment assistance feature such as a source pattern simulator such as a laser pattern. Controllably bendable, stretcheable, or otherwise deformable structures may also be utilized subject to the ability to characterize the positioning and orientation of the imaging elements. Sensing elements may be operatively coupled (408) to the imaging elements and configured to be utilized by a sensing system to characterize relative spatial positioning and/or orientation of the imaging elements relative to each other, and relative to other important structures, such as the tissue structures to be imaged. Feedback may be provided (410) to an operator to assist with positioning and/or orientation alignment of the imaging elements and anatomy. With everything aligned, one or more images may be captured (412) using the source and detector imaging elements. Subsequently, the source and detector elements may be repositioned and/or reoriented to provide a different imaging plane, for example (414), and the sensing configuration may be utilized to assist the operator and provide feedback as above (416), followed by image acquisition at the new position and/or orientation (418).
Referring to FIG. 11, an embodiment similar to that of FIG. 10 is illustrated, with the exception that the embodiment of FIG. 11 incorporates use of one electromechanically adjustable image pair element mounting structure (420) paired with the other manually-adjustable structure. One of the imaging elements (i.e., either source or detector) may be positioned electromechanically (422, 424)—either automatically using one or more motors that are operatively coupled to the pertinent joints of the structure, or via haptic guidance provided through one or more operatively coupled motors that are configured to allow the operator to move the structure with his own might, but to guide the path and geometry using electromechanical haptics. After capturing one or more images (412), the electromechanical assistance may be used again (426, 428) for an additional image acquisition (418).
Referring to FIG. 12, an embodiment similar to that of FIG. 11 is illustrated, with the exception that the embodiment of FIG. 12 incorporates use of two electromechanically adjustable image pair element mounting structures (430). Both elements may be positioned and/or oriented electromechanically (432, 434), followed by image acquisition (412), repeated positioning and/or reorientation electromechanically (436, 438), and further image acquisition (418).
Referring to FIG. 13, an embodiment similar to that of FIG. 12 is illustrated, with the exception that the embodiment of FIG. 13 incorporates use of two electromechanically adjustable image pair element mounting structures, one of which is a robotic arm featuring a mounting fixture that may be used for imaging as well as one or more surgical tools (440, 442).
Referring to FIG. 14, an embodiment similar to that of FIG. 11 is illustrated, with the exception that the embodiment of FIG. 14 incorporates use of one electromechanically adjustable image pair element mounting structure that is a robotic arm featuring a mounting fixture that may be used for imaging as well as one or more surgical tools (444).
Various exemplary embodiments of the invention are described herein. Reference is made to these examples in a non-limiting sense. They are provided to illustrate more broadly applicable aspects of the invention. Various changes may be made to the invention described and equivalents may be substituted without departing from the true spirit and scope of the invention. In addition, many modifications may be made to adapt a particular situation, material, composition of matter, process, process act(s) or step(s) to the objective(s), spirit or scope of the present invention. Further, as will be appreciated by those with skill in the art that each of the individual variations described and illustrated herein has discrete components and features which may be readily separated from or combined with the features of any of the other several embodiments without departing from the scope or spirit of the present inventions. All such modifications are intended to be within the scope of claims associated with this disclosure.
Any of the devices described for carrying out the subject diagnostic or interventional procedures may be provided in packaged combination for use in executing such interventions. These supply “kits” may further include instructions for use and be packaged in sterile trays or containers as commonly employed for such purposes.
The invention includes methods that may be performed using the subject devices. The methods may comprise the act of providing such a suitable device. Such provision may be performed by the end user. In other words, the “providing” act merely requires the end user obtain, access, approach, position, set-up, activate, power-up or otherwise act to provide the requisite device in the subject method. Methods recited herein may be carried out in any order of the recited events which is logically possible, as well as in the recited order of events.
Exemplary aspects of the invention, together with details regarding material selection and manufacture have been set forth above. As for other details of the present invention, these may be appreciated in connection with the above-referenced patents and publications as well as generally known or appreciated by those with skill in the art. The same may hold true with respect to method-based aspects of the invention in terms of additional acts as commonly or logically employed.
In addition, though the invention has been described in reference to several examples optionally incorporating various features, the invention is not to be limited to that which is described or indicated as contemplated with respect to each variation of the invention. Various changes may be made to the invention described and equivalents (whether recited herein or not included for the sake of some brevity) may be substituted without departing from the true spirit and scope of the invention. In addition, where a range of values is provided, it is understood that every intervening value, between the upper and lower limit of that range and any other stated or intervening value in that stated range, is encompassed within the invention.
Also, it is contemplated that any optional feature of the inventive variations described may be set forth and claimed independently, or in combination with any one or more of the features described herein. Reference to a singular item, includes the possibility that there are plural of the same items present. More specifically, as used herein and in claims associated hereto, the singular forms “a,” “an,” “said,” and “the” include plural referents unless the specifically stated otherwise. In other words, use of the articles allow for “at least one” of the subject item in the description above as well as claims associated with this disclosure. It is further noted that such claims may be drafted to exclude any optional element. As such, this statement is intended to serve as antecedent basis for use of such exclusive terminology as “solely,” “only” and the like in connection with the recitation of claim elements, or use of a “negative” limitation.
Without the use of such exclusive terminology, the term “comprising” in claims associated with this disclosure shall allow for the inclusion of any additional element—irrespective of whether a given number of elements are enumerated in such claims, or the addition of a feature could be regarded as transforming the nature of an element set forth in such claims. Except as specifically defined herein, all technical and scientific terms used herein are to be given as broad a commonly understood meaning as possible while maintaining claim validity.
The breadth of the present invention is not to be limited to the examples provided and/or the subject specification, but rather only by the scope of claim language associated with this disclosure.

## Claims

1. A robotic surgery method, comprising:
a. moving a mobile base into a position upon an operating room floor adjacent a patient and temporarily fixing the position of the mobile base relative to the floor;
b. coupling a first element of a fluoroscopic imaging system comprising a source element and a detector element to a first robotic arm coupled to the mobile base, the first robotic arm comprising a mounting fixture configured to be interchangeably coupled to a surgical tool and the first element of the fluoroscopic imaging system;
c. mounting a second element of the fluoroscopic imaging system in a position and orientation relative to the first element such that a targeted patient tissue structure may be positioned between the first and second elements of the fluoroscopic imaging system; and
d. utilizing a sensing system and one or more sensing elements coupled to each of the first and second elements of the fluoroscopic imaging system to determine a relative spatial positioning between each of the first and second elements of the fluoroscopic imaging system.

2. The method of claim 1, wherein temporarily fixing the position of the mobile base comprises applying a brake.

3. The method of claim 1, further comprising moving the first robotic arm to position the first element of the fluoroscopic imaging system relative to the second element of the fluoroscopic imaging system.

4. The method of claim 3, wherein the first robotic arm comprises one or more joints and one or more motors configured to controllably regulate motion at the one or more joints, wherein moving the first robotic arm comprises moving at least one of the one or more joints.

5. The method of claim 4, wherein moving at least one of the one or more joints comprises manually effecting a movement of at least one of the one or more joints.

6. The method of claim 5, further comprising haptically regulating the range of motion of movement that may be manually effected at the at least one of the one or more joints.

7. The method of claim 1, further comprising monitoring a position of at least a portion of the first robotic arm using a sensor.

8. The method of claim 7, wherein the at least one sensor is selected from the group consisting of: an encoder, a potentiometer, an optical position tracker, an electromagnetic position tracker, and a fiber bragg deflection sensor.

9. The method of claim 1, wherein the first element is the source element and the second element is the detector element.

10. The method of claim 1, wherein the first element is the detector element and the second element is the source element.

11. The method of claim 1, further comprising producing a collimated beam with the source element having a cross-sectional shape selected from the group consisting of: a circle, an ellipse, a square, and a rectangle.

12. The method of claim 11, further comprising detecting the collimated beam with the detector element.

13. The method of claim 12, wherein the detector element is a flat panel detector.

14. The method of claim 1, further comprising switching out the first element of the fluoroscopic imaging system for the surgical tool.

15. The method of claim 14, further comprising cutting bone with the surgical tool.

16. The method of claim 1, wherein mounting the second element comprises placing the second element on a movable stand.

17. The method of claim 16, wherein the movable stand is coupled to the floor.

18. The method of claim 16, wherein the movable stand is coupled to the mobile base.

19. The method of claim 1, wherein utilizing a sensing system comprises tracking the one or more sensing elements using a modality selected from the group consisting of: an optical sensing system, an electromagnetic sensing system, a joint rotation sensing system, and an elongate member deflection-sensing system.

20. The method of claim 1, further comprising coupling the one or more sensing elements to each of the first and second elements of the fluoroscopic imaging system, the one or more sensing elements selected from the group consisting of: a reflective marker, an electromagnetic localization sensor, a Bragg grating on an optical fiber, a strain gauge, a joint rotation encoder, and a joint rotation potentiometer.

21. The method of claim 1, further comprising using a controller to reposition one of the first or second elements in response to positional changes in the other of the first or second elements.

22. The method of claim 21, wherein using a controller to reposition one of the first or second elements comprises actuating one or more motors that are operatively coupled to the first or second element being repositioned by the controller.

23. The method of claim 21, wherein using a controller to reorient one of the first or second elements comprises actuating one or more motors that are operatively coupled to the first or second element being reoriented by the controller.

24. The method of claim 1, further comprising using a controller to reorient one of the first or second elements in response to orientation changes in the other of the first or second elements.

25. The method of claim 1, further comprising removably coupling a registration probe to the mounting fixture of the first robotic arm that may be used to register structures within reach of the probe to a coordinate system of the first robotic arm.