Abstract:
A system is provided for supporting a patient during computed axial tomography imaging. The system includes a movable platform formed of a radiolucent material, a discrete attachment region in the platform, and a curvilinear articulating arm coupled to the platform at the discrete attachment region. A method for supporting a patient during a plurality of procedures also is provided. The method includes: disposing the patient on a movable platform formed of a radiolucent material; positioning a device with respect to the patient, the device being disposed on a curvilinear articulating arm coupled to the platform; placing the platform, positioned device, and patient in a computed axial tomography imaging system and performing an imaging procedure.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The benefits of Provisional Application No. 60/559,414 filed Apr. 2, 2004, Provisional Application No. 60/575,792 filed May 28, 2004, and Provisional Application No. 60/614,593 filed Oct. 1, 2004 are claimed under 35 U.S.C. § 119(e), and the entire contents of these applications are expressly incorporated herein by reference thereto. 
    
    
     FIELD OF THE INVENTION 
     The invention relates to a support system for use when performing medical imaging of a patient. In particular, the invention relates to a patient support tray adapted to use in a variety of medical environments. 
     BACKGROUND OF THE INVENTION 
     Work-flows of patients from arrival at medical care facilities through post-operative recovery typically require a patient to be transferred among multiple supports on which the patient is transported and/or stabilized. For example, upon arrival at a hospital via an ambulance, a patient initially may be moved on a stretcher into the hospital. The patient then may be transferred to a hospital gurney and moved to an imaging room for assessment. In the imaging room, the patient may be transferred to an imaging table such as an x-ray table, and then returned to the gurney. Subsequently, the patient may be transferred to a patient bed while recovering or awaiting further evaluation, and/or the patient may be brought to an operating room (OR) and transferred to an operating table. Such extensive repositioning of the patient has numerous disadvantages, including a reduced ability to generally immobilize the patient, increased personnel requirements due to assisting or lifting the patient from one support to another, and even the potential for injuries to hospital personnel because of the lifting. Nevertheless, a standard patient support suitable for use in multiple hospital environments thus far has not been introduced because of the diverse design requirements that must be met for widespread application. 
     Patient supports used in ambulance settings, for example, must meet different standards from patient supports used in conjunction with imaging technologies. When transporting a patient in an ambulance, the patient must be immobilized so that further injury does not occur during transport. Some instrumentation may need to be supported, such as an intravenous (IV) bag, and this instrumentation may be coupled to the patient gurney. In contrast, in the imaging setting, many materials may not be present with the patient due to interference with the operation of the imaging equipment. Thus, the patient typically is supported on a tabletop or tray that is generally free of additional medical equipment. And, in some instances, several patient settings are needed at the same time, for example imaging while a patient undergoes surgery. It is clear that a patient support with generic use across many of the patient settings would be desirable. An explanation of the particular requirements of some of these settings thus is next introduced. 
     Various diagnostic imaging technologies are known for visualization of internal organs and structures. Computed axial tomography (CT), for example, is an x-ray scanning technique for producing cross-sectional images, while magnetic resonance imaging (MR) is a radiation-free technique that uses a strong magnet and radiofrequency waves to produce images in desired “slice planes.” During CT and MR procedures in the clinical or operating room setting, a patient is placed on a movable support that translates within a housing. Traditional CT and MR equipment includes a ring-type gantry, and the patient is moved within the gantry so that images may be acquired of the anatomical region of interest. CT is known to be particularly useful for volumetric imaging but also suffers from poor soft tissue contrast, while MRI offers multi-planar imaging with superior soft tissue contrast. 
     The use of CT and MR for intraoperative imaging and interventional radiology (e.g., performing minimally invasive, targeted treatments using imaging for guidance) previously has been limited because of the substantial challenges posed by the geometry and overall size of the imaging equipment. The donut-shaped, ring-type gantries of traditional CT and MR equipment, for example, are not easily accommodated in operating rooms, and can cause or suffer from various deleterious effects due to interactions with other equipment. However, advances in CT and MR equipment are permitting more widespread application in intraoperative and interventional applications. 
     Until recently, only simple procedures such as biopsy or aspiration of fluid were performed in these scanners, and the need for additional capabilities in the support or table was limited. However, dramatic improvements in the image resolution and the speed of image acquisition of modern CT and MR scanners, the development of software and tracking technology for instrument guidance that can correlate with the images, and the development of software that permits the integration of multiple imaging modalities has greatly stimulated the use of these scanners in therapeutic procedures where image guidance can improve safety and efficacy. Some of the new minimally invasive ablative therapies require high precision placement of the delivery probes, and the monitoring and documentation achieved with concurrent CT or MR imaging is essential. Also, some newly developed surgeries simply cannot be done without concurrent CT or MR image guidance. 
     In such imaging procedures, the movable imaging support typically is provided on a base or carriage that receives the support at a desired height. For example, as disclosed in U.S. Pat. No. 6,161,237 to Tang et al., assigned to Med-Tec, Inc., a table base or carriage is provided with a tabletop that is mounted for longitudinal movement upon side rails attached to opposite sides of the carriage. 
     Imaging supports for movement on a carriage may be generally featureless, and simply may be sized to accommodate patients of a given height, weight, and girth. The supports may form patient couches when, for example, radiotranslucent cushions are placed along the supports and attached for example using Velcro®. Such cushions may enhance patient comfort and also may be readily conformable to a patient&#39;s anatomical contours so that patient movement is minimized. Typically, such a scanning tray is formed of a polymer or composite and has a smooth, generally flush and featureless surface. The tray may be cantilevered and slides into the gantry, with movement of the tray controlled by imaging software so that elevational and longitudinal positions may be set as needed. 
     A single imaging support also may be used with multiple imaging systems, as disclosed for example in U.S. Pat. No. 6,782,571 to Josephson et al., assigned to GE Medical Systems. As described in the patent, mobile patient transport is provided, allowing for patient setup outside of imaging bays. A patient may be quickly transferred between imaging systems without lifting the patient, and a dual end docking of the patient transport allows in line motion of the patient between systems, thus minimizing patient disruption. 
     The surrounding geometry of the imaging equipment, along with the requisite patient translation during scanning, presents a challenge when performing invasive procedures that require or are benefited by having equipment that ideally should remain in a fixed relationship to the immobilized patient. For example, a typical practice is to hold medical instruments manually, rely on gravity, tissue structure and friction, and to improvise props using towels or other padding. However, as procedures are becoming more complex and, in particular, as CT and MR imaging equipment are moved into the operating room environment, there is a need for new approaches. Because of the needs of medical personnel conducting intraoperative and interventional procedures, new patient supports and associated components, and new instrument positioning and holding devices and methods are desired to address these needs. 
     A variety of modifications have been proposed or implemented for intraoperative procedures, particularly involving MRI. For example, it has been reported that patient tables may be modified to allow efficient transition between the MR scanner and the surgical pedestal, the tables may be tilted (Trendelenburg, reverse Trendelenburg), rotated/pivoted, elevated and/or lowered, and the patient can be translated past the outer edge of the scanner into the fringe field when scanning is not required. In addition, rigid skull clamps have been fixed to such a table. See, e.g., Daniel F. Kacher et al., “Design and Implementation of Surgical Instruments, Devices, and Receiver Coils for Intraoperative MRI-Guided Neurosurgical and Neuro Ablative Procedures,”  Automedica ( 2001); G. J. Rubino et al., “Interventional Magnetic Resonance Imaging Guided Neurosurgery—The UCLA Experience with the First 100 Cases,” Electromedica 68—neuro 2000, pp. 37-46. 
     Also known is a hybrid system in which an MRI scanner is connected to a digital subtraction angiography (DSA) unit by a 2.8 meter connecting table for patient repositioning, the connecting table being disposed between a standard removable MR table and the angiographic unit table. The imaging units are installed in adjacent rooms that may be separated by a shielding door, thereby allowing patient access to either system. The special table and environment of the combined imaging suite, however, required a custom-built clinical setup. See Th. J. Vogl, “MR-Guided Interventions with a DSA-MRI Hybrid System,”  Electromedica  68 (2), pp. 116-121 (2000). 
     Some materials suitable for use in patient supports and associated components for use in the operating environment are unsuitable for use in the imaging environment. Because a strong magnetic field is created during MRI, ferromagnetic metal objects (and many other magnetic objects) must be kept out of the proximity of the machine. Such metal objects may cause poor image resolution and result in image artifacts that can mask or be misinterpreted as pathology. Concomitantly, metal objects present a safety hazard to the patient due to their attraction to the magnetic source (e.g., becoming projectiles due to their attraction by the magnet to the vicinity of the scanner table). Thus, high carbon steel alloys and pure iron must be avoided. Carbon fiber, a radiolucent material that is essentially transparent to x-rays, often is used in the CT setting but not generally accepted for use with an MRI scanner. 
     Thus, even the design of a patient support for use in just two different settings—such as the OR and the MR imaging environment—must meet a variety of requirements particular to each setting. 
     Along with the need for a new support for a patient, a variety of additional new components and methods may be desired by the technician, physician or surgeon. For example, one possible advance that may be achieved by application of such new CT and MR equipment is respiratory gating. 
     It is well known that the chest and abdominal organs can move several inches during respiration. One resulting problem is that this anatomical motion can adversely affect data acquisition, causing so-called ghost, or motion artifacts and thus adversely affect image quality. This problem is traditionally managed by asking patients to hold their breath, or by halting respiration if it is controlled mechanically, during the acquisition of images. A second problem arises when interventional procedures are done because of the inability of a patient to precisely repeat a given breath. This repetition is essential for accurate image correlation with a patient&#39;s anatomy when he or she is moved out of the scanner. Thus, for safety and efficacy, it is desirable to employ some method for monitoring and recording respiratory position at the time of acquisition of the CT or MR targeting image(s) that can be used to repeat that same anatomic position at the time of instrument placement. Such an exercise defines respiratory gating. Techniques have been developed for synchronizing cardiac and vascular imaging with a phase of the cardiac cycle by using electrocardiography signals to time the image acquisition and thereby provide images with consistent positions of anatomical features and to allow more accurate minimally invasive procedures. A comparable, clinically practical, real time signal of respiratory phase or internal organ position that can be used with CT or MR has not been available to date. It is especially problematic in the patient who is breathing voluntarily and not intubated with an endotracheal tube where volume input may be controlled. Normal respiration is a complex mixture of diaphragmatic and chest wall movements that may vary from breath to breath. The result is that a similar breath may not result in a similar position of internal organs that move with respiration. New minimally invasive ablative techniques such as (RF) radio frequency and cryogenic ablation require very accurate probe placement to simultaneously allow effective treatment and avoid injury to surrounding structures. Accurate respiratory gating is essential for accurate instrument placement in organs or structures that move with respiration and, in many cases, is the sine qua non of these treatment modalities. One method of respiratory gating proposed herein is to use real time ultrasound to monitor the position of the diaphragm or an organ moving with respiration throughout a procedure. For example, as the patient holds his breath for the targeting CT image(s), a “snapshot” ultrasound image of the diaphragm or other surrogate organ is also obtained. The ultrasound transducer is held against the patient in a fixed position throughout the procedure by the instrumentation described in the present invention. The patient is then withdrawn from the scanner gantry and an angle of approach and entry point on the skin is chosen. The site is suitably prepped and sterile drapes are placed if not already done. Then, either on his own or with coaching, the patient is able to watch the real time ultrasound image and breathe to the point of perfect overlap or coincidence with the earlier “snapshot” image, and then hold his breath at that point while the instrument is placed. Ideally this will result in perfect correlation of the patient&#39;s real time anatomy with the previously obtained CT image. The clinical result will be fewer sticks to achieve the ideal placement of instruments, saving time and patient morbidity. The key to success using this method is that the ultrasound transducer must remain in an absolutely fixed relationship to the patient throughout the imaging and instrument placement phases of the procedure. The present invention makes this both possible and practical. 
     Thus, there is a need for technology that functions within the imaging environment and addresses the problems associated with respiratory gating. 
     The ability to choose points in space that can be fixed relative to the patient or some part of the patient&#39;s anatomy for holding instruments, medical support equipment and patient positioning devices in a desired fixed orientation and location is fundamental to surgical and medical practice. While standard operating tables, for example, may be fitted with a broad range of accessories and attachments to facilitate a wide array of operations, the versatility and convenience provided by such a standard operating table is currently unavailable for use during CT or MR imaging using the supports currently employed therewith. 
     There is a need for a system that can offer many of the functions of a standard operating table when a patient is on a scanner tray. There also is a need for accessories that cooperate with the scanner tray to increase the accuracy of targeting, instrument positioning and guidance in an imaging environment. 
     Finally, there is a need for a versatile emergency stretcher that can carry a patient through multiple medical environments during resuscitation, diagnostic evaluation and initial treatment without risking further injury to the patient or emergency personnel that may come from the physical handling that traditionally has been required. 
     SUMMARY OF THE INVENTION 
     The invention relates to a system for supporting a patient during computed axial tomography imaging including a movable platform formed of a radiolucent material, a discrete attachment region in the platform, and a curvilinear articulating arm coupled to the platform at the discrete attachment region. The system may further include an end effector demountably attached to the articulating arm. The end effector may be a clamp, a bracket, or a linear instrument guide. The system may further include an ultrasound transducer supported by the end effector. In addition, the system may include a cushion. 
     The platform may have a plurality of openings forming hold regions disposed proximate a cranial end and a caudal end thereof. A plurality of discrete attachment regions may be provided in spaced arrangement proximate the perimeter of the platform. In some embodiments, the platform may have a central arcuate portion disposed between a pair of ledge portions. Also, in some embodiments, the at least one discrete attachment region may be a threaded insert. 
     The curvilinear articulating arm may include a plurality of ball and socket connections. In some embodiments, the curvilinear articulating arm may include a plurality of balls and sleeves disposed on a tensioning wire. The curvilinear articulating arm may be coupled to the platform with a first handle associated with the discrete attachment region, and the first handle may include a pivotable lever for adjusting tension of the tensioning wire to vary flexibility of the curvilinear articulating arm. 
     The invention also relates to a method for supporting a patient during a plurality of procedures including: disposing the patient on a movable platform formed of a radiolucent material; positioning a device with respect to the patient, the device being disposed on a curvilinear articulating arm coupled to the platform; placing the platform, positioned device, and patient in a computed axial tomography imaging system and performing an imaging procedure; supporting the platform with the patient thereon on an operating room table and performing a surgical procedure. The platform may be disposed on a separate imaging system table while performing the imaging procedure. The positioned device may be maintained in substantially the same position during the imaging and surgical procedures. The method also may include supporting the platform with the patient thereon on a hospital bed. In addition, the method may include supporting the platform with the patient thereon on a stretcher. The device may be an ultrasound transducer, a probe, or a needle. Further, the method may include disposing a cushion between the patient and the platform, the cushion being conformable to anatomical contours of the patient. Moreover, the method may include coupling the platform to an electrohydraulic system for positioning and orienting the platform. 
     The present invention additionally relates to a method for supporting a patient during a plurality of procedures including: disposing the patient on a movable platform formed of a radiolucent material; positioning a device with respect to the patient, the device being disposed on a curvilinear articulating arm coupled to the platform; placing the platform, positioned device, and patient in a computed axial tomography imaging system and performing an imaging procedure; performing a surgical procedure while the platform, positioned device, and patient remain in the computed axial tomography imaging system. 
     Also, the present invention relates to a movable platform is provided for supporting a patient in multiple medical environments such as during computed axial tomography imaging and surgery. The platform may have at least one discrete attachment region formed therein for coupling the platform to another component. 
     The present invention further relates to providing a base platform and accessories that may enable efficient use of a CT or MR scanner in new and more complex minimally invasive surgical procedures. An exemplary system for use in this environment includes a platform or scanning tray and a set of manual devices that may achieve accurate and reliable positioning of a patient and/or required medical equipment that may move with the patient on the scanning tray. Such a tray also may serve as a fail-safe, manually controlled backup to the more sophisticated computer guided devices in procedures where accurate and stable equipment positioning are essential to success. 
     Optimally, the base platform may be designed to standardize and simplify indexing of the patient (or a patient&#39;s anatomy) to the imaging scanner and may simplify and speed up the process of image and equipment registration for image guided surgeries. 
     The surgical tray (platform) preferably does not interfere with image acquisition, may pass through the imaging ring/gantry of a scanner, may serve as a stable platform for the patient to lie upon, may be fitted with a mattress for patient comfort and positioning, may securely support a patient in a stable and relatively fixed position, may allow for selective support of individual extremities in a desired fixed position, may be keyed to acquired images and remain in a fixed relationship to a pre-existing scanner table and/or tray, and may have multiple or infinite locations around its perimeter for the secure attachment of lockable positioning arms, medical accessories such as armrests and IV poles and other devices that may be required to perform various procedures. 
     In one embodiment of the present invention, the platform is a separate tray that nests into or rests upon the pre-existing table and/or tray of the imaging equipment. Locating features may be provided in readily visible areas of the platform, allowing the platform to be easily indexed to the pre-existing table and/or tray. In some embodiments, the tray may be tiltable (Trendelenburg or reverse Trendelenburg positions), may be rolled in either direction and may be elevated independently of the pre-existing table and/or tray. 
     One or more lockable positioning arms with end effectors provided on a free end thereof may be coupled to the platform for various grasping, guiding and instrument stabilizing functions. An end of the lockable positioning arm may be fixed to the perimeter of tray at discrete locations provided for coupling, while the free end may be configured to receive a variety of end effectors. The lockable positioning arms may move with six degrees of freedom. Manually powered or externally powered locking mechanisms may be provided to arrest, limit, or provided resistance to motion of the arm. 
     In some embodiments, the arms may be designed and orientable to be passed with a patient into or through the gantry of the CT and/or MR scanner. The arms may be constructed of materials that are safe in the imaging environment and that will not interfere with the acquisition of images that are required for the procedure. 
     End Effectors that attach to the free end of the positioning arms may be sterilized and reusable or made as single use sterile disposable attachments. It may be desirable that the connection mechanism of the end effectors to the arms be a proprietary design (such as the one shown in figures herein). The end effectors may either include or accommodate a sterile sleeve type cover/drape to cover the positioning arm. Examples of end effectors that may be used include a clamp and a bracket to hold an ultrasound transducer that may be used to facilitate a procedure. For example, it may be used to monitor the position of internal organs during respiration (such as the diaphragm). 
     Another end effector or device for coupling to the platform may be an instrument positioning/guidance device that may be provided for holding and permitting the accurate translation of a linear instrument along the path of its axis. Such a guidance device may be configured to function with a wide range of linear instruments (e.g., cryotherapy probes, RF probes or needles) and have user adjustable drag (frictional resistance) to advancement or withdrawal. Such a device also may be configured to function with a software driven computer assisted tracking/targeting system that may be integral with the scanner. 
     A general purpose grasping clamp may be coupled to the platform for holding a variety of surgical instruments such as retractors, laparoscopes and laparoscopic instruments. 
     Other devices for coupling to the platform may: hold or function as a template grid for spaced apart parallel linear instrument placement; hold or function as a stereotactic device that may have micro-adjustment capability; function as a linear instrument driver with remote operator control; or may have locating features that could function with computer driven guidance systems (e.g., infrared or electromagnetic sensors) that may be integrated with the primary imaging system (e.g., the CT or MR scanner) or a single image. 
     Devices for positioning and maintaining the position of the patient with respect to the platform may be provided such as a shape conforming mattress (e.g., a beanbag-type mattress that may be formed around the anatomic area of concern, with a vacuum applied to the mattress to set the desired shape), arm rests, leg rests, head rests and other components to secure immobilization of various areas of anatomy. 
     Devices such as a bubble level may be attached to or embedded in the tray to enable a standard orientation within the scanning environment that may facilitate instrument guidance. For example, a transverse bubble level located at the end of the tray may permit accurate leveling of the parallel side surfaces and inserts. A rectilinear bridge across the tray connecting these surfaces and inserts for example incorporating a protractor oriented in this transverse plane, may then be used to determine a precise angle of approach in a transverse plane that may correlate with a CT image (note that a scanner may be leveled with a bubble level). 
     Preferably, the platform of the present invention may be portable and adapted or universal in design for use with many different brands of scanners. Some embodiments of the present invention may be constructed with all components applicable for use with either CT or MR scanners, because of the different requirements of the imaging environments and the potential for interference with image acquisition. Thus, the platform may be formed of a material suitable for use in CT scanner but not MR scanners, or vice versa, or the material may be suitable for use in both imaging environments. 
     In some embodiments, the perimeter of the platform/tray may be configured to accept equipment for use in the scanner or scanner environment in order to provide additional medical or analytic functions aside from the CT or MR scanning. For example, such equipment may include, but is not limited to, brackets, braces, stereotactic equipment, orthopedic positioning and stabilizing devices and instrument guidance equipment of any type. 
     Additional accessories may include an adjustable IV pole, armrest(s) and flatbar siderail sections that are the same as or similar to those that typically are found on a standard operating table. 
     Some platforms of the present invention may include both curved portions and flat portions. The curved portions, for example including a concave section, may be configured to retain a patient and may have a radius of greater than about 50 cm, greater than about 60 cm, or greater than about 70 cm. Flat portions may be provided proximate the edges of the platform and may form flanges configured to hold supplemental medical equipment. The flat portions may be parallel to one another and coplanar, allowing ease of positioning of medical equipment along the perimeter of the tray. In addition, the flat portions along the edges of the tray may be coplanar with a plane of travel of the tray within the scanning instrument. In some embodiments, the flat portions may be at least about 10 mm wide, at least about 20 mm wide, at least about 30 mm wide, or at least about 40 mm wide. The flat portions may extend away from the centerline of the tray on a plane spaced from the lowermost portion of the tray, thus allowing room to fasten through or around the edges of the tray by providing access to the underside thereof. The tray may be 10 mm or less in thickness at its curved portions, or may be less than 25 mm thick throughout. The tray instead may vary in thickness. 
     In some embodiments, the tray may contain coupling portions or holes configured to receive supplemental medical equipment. The holes may be threaded in some embodiments, or may have threaded inserts therein. The holes may allow rapid manual fixation of supplemental medical equipment and also may not interfere with image acquisition. In another embodiment, the edges of the tray may be configured as a rail, thus permitting a user an infinite choice of positions for instrument fixation as compared to a fixed number of defined points provided by threaded holes. Such a rail may be provided with teeth and function as a gear rack for permitting encoded motion of an arm or guidance device along its length. 
     A demountable tray may permit a patient to be placed in Trendelenburg position if desired by lifting the end thereof. 
     Additional components of the tray may include one or more flexible or articulated arms that may be placed at various desired points along either side or end of the tray. The arms may be configured to be removable from the tray and movable or repositionable along the perimeter thereof. In some embodiments, a free end of an arm may be manually positionable and able to hold a desired position when set by a user. The arms may function with several modes of resistance. For example, a low resistance mode may permit easy manipulation of the free end, and a locked mode may establish a fixed point in space with adequate resistance to movement to hold a steady position for a wide range of medical instruments (e.g., hold 10 pounds of weight without loss of position). In some embodiments, the arms may have a quick-release function at the end fixed to the tray that permits a user to easily remove the arm from the tray or reposition it along the perimeter of the tray. Multiple arms may be configured to join together at the free ends thereof for added stability or increased functionality of a grouping of instruments, either bridging over the patient between two or more edges of the tray, or extending from only one side thereof. Also, the arms may be dimensioned and configurable so as to conform closely to the body of a patient and not interfere with patient movement through the scanner while holding a given position. 
     In some embodiments, the components coupled to the tray such as articulating arms may be relatively non-conductive to electricity and non-ferrous, so that the components are not affected by a magnet or motion within a magnet. Also, in some embodiments the arms may be relatively radiolucent. Suitable materials for such components that may be placed in the imaging plane includes various plastics, resins, and composite materials, in addition to titanium, aluminum and some metal alloys and will vary depending on whether the imaging modality is CT or MR. 
     In some embodiments, the arms may be configured to have one or more end fittings that permit various instruments or devices to be attached or grasped. The end fittings may be detachable, easily sterilized and function with a sterile sleeve type drape to also cover the arm(s). In some embodiments, the end fittings may be pre-sterilized single use parts with a sterile sleeve type drape already attached thereto. 
     For some procedures, an arm may be provided with position encoders in the joints thereof for integrating the position of the arm or an instrument attached to the arm with an image recorded by the scanner. Such an arm may be anchored to a fixed location on the tray and subsequently indexed to the CT or MR image. Thus, an indexing capability of the tray and the arms with the imaging plane of the scanner may be provided. 
     In another embodiment the tray may be configured with handhold cutouts in each end. Also, handles may attach along the sides of the tray that may also function as locations for straps that can secure the patient to the tray. Thus, the tray may also function as a temporary stretcher and be used to transport a patient within an emergency medical environment. A device may be mounted to the tray that provides strain relief for ventilation tubing when a patient has an endotracheal tube in place. An IV pole may be mounted to the tray. Thus, the tray and attachments are configured to facilitate movement of a patient from an ambulance to a guerney and from a guerney to a CT scanner table where appropriate x-rays may be taken, and then from the CT scanner table back to a guerney and onto an OR table without having to physically handle or move the patient independent of the tray. 
     Thus, the invention relates to a tray configured for holding a patient within a scanning instrument or when the need for placement into a scanning instrument is likely, the tray including a surface configured to retain a patient, and a means for securing supplemental medical equipment along the edges of the tray. The surface configured to retain a patient may be concave. Also, the tray may contain a first edge and a second edge, and a plurality of holes along the first and second edges, with the holes being configured to receive supplemental medical equipment. The holes may be threaded. Third and fourth edges or ends may have handhold cutouts. Removable arms may extend from the surface of the tray. Further, the tray and supplemental medical equipment may be substantially electrically non-conductive. The tray and supplemental medical equipment may be substantially radiolucent. In some embodiments, one or more portions of the present invention may be radiopaque. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Preferred features of the present invention are disclosed in the accompanying drawings, wherein: 
         FIG. 1  is a perspective view of a support system according to the present invention; 
         FIG. 2  shows the tray of  FIG. 1 , including ( 2 A) a top view, ( 2 B) a cross-section taken perpendicular to the central axis of the tray, and ( 2 C) a partial cross-section showing detail taken at IIC; 
         FIG. 3  shows the curvilinear articulating arm assembly of  FIG. 1 , including ( 3 A) a partial cross-sectional perspective view, and ( 3 B) a side view; 
         FIG. 4  shows the base handle of  FIG. 1 , including ( 4 A) a perspective view, ( 4 B) a bottom view, ( 4 C) a top view, ( 4 D) a first side view, ( 4 E) a second side view, ( 4 F) a front view, and ( 4 G) a back view; 
         FIGS. 5A to 5G  show the free handle of  FIG. 1 , including ( 5 A) a perspective view, ( 5 B) a top view, ( 5 C) a bottom view, ( 5 D) a first side view, ( 5 E) a second side view, ( 5 F) a third side view, and ( 5 G) a fourth side view; 
         FIGS. 5H to 5J  show an interface portion for coupling end effectors to the free handle of  FIG. 1 , including ( 5 H) a perspective view, ( 5 I) a first side view, and ( 5 J) a second side view; 
         FIG. 5K  shows a perspective view of the interface portion of  FIG. 5H  with a interface lock assembled therewith; 
         FIGS. 5L to 5P  show the interface lock of  FIG. 5K , including ( 5 L) a perspective view, ( 5 M) a first side view, ( 5 N) a second side view, ( 5 O) a third side view, and ( 5 P) a fourth side view); 
         FIGS. 5Q to 5U  show a lever of the free handle of  FIG. 1  in combination with a rocker arm, including ( 5 Q) a first side view, ( 5 R) a second side view, ( 5 S) a top view, ( 5 T) a bottom view, a ( 5 U) a perspective view; 
         FIG. 5V  shows a perspective view of the rocker arm of  FIG. 5Q  with a swage pivot associated therewith; 
         FIG. 5W  shows a perspective view of the swage pivot of  FIG. 5V ; 
         FIG. 6  shows the clamp end effector of  FIG. 1 , including ( 6 A) a perspective view, ( 6 B) a front view, ( 6 C) a back view, ( 6 D) a first side view, ( 6 E) a second side view, ( 6 F) a top view, and ( 6 G) a bottom view; 
         FIG. 7  shows the bracket end effector of  FIG. 1 , including ( 7 A) a perspective view, and ( 7 B) a side view; 
         FIG. 8  shows the rail assembly of  FIG. 1 , including ( 8 A) a perspective view, ( 8 B) a first side view, and ( 8 C) a second side view; 
         FIG. 9  shows a perspective view of the IV pole of  FIG. 1 ; 
         FIG. 10  shows the arm board of  FIG. 1 , including ( 10 A) a bottom perspective view, and ( 10 B) a top view; 
         FIG. 11  shows a lift beam assembly for use with the support system according to the present invention, including ( 11 A) a perspective view, and ( 11 B) a side view; 
         FIG. 12  is a perspective view of another end effector according to the present invention; 
         FIG. 13  shows a perspective view of a stabilizing post for use with the support system according to the present invention; and 
         FIG. 14  shows a perspective view of a handle for use with the support system according to the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Terms such as “cephalad,” “caudal,” “upper” and “lower” as used herein are provided as non-limiting examples of the orientation of features. 
     Referring initially to  FIG. 1 , a support system  10  according to the present invention is shown with a variety of components coupled thereto. Support system  10  includes a tray  12 , curvilinear articulating arm assemblies  14 ,  16 , end effectors  18 ,  20  coupled to arms  14 ,  16 , IV pole  22 , arm board  24 , and rail assemblies  26 ,  28 . A variety of end effectors may be demountably attached to the ends of arms  14 ,  16  to assist a technician or practitioner with a medical/imaging procedure or provide other features useful with respect to a patient. End effector  18 , for example, is configured as a bracket or clamp, while end effector  20  is configured as a self-centering abdominal probe bracket. 
     In a preferred exemplary embodiment, tray  12  includes two pairs of hold regions  30 , each pair being disposed proximate a free cranial end  32  or free caudal end  34  of tray  12 . In alternate embodiments, other numbers of hold regions  30  may be provided such as two or more, and hold regions  30  may be provided in other regions of tray  12  such as intermediate ends  32 ,  34  proximate sides  36 ,  38 . Hold regions  30  may be configured as hand holds, or alternatively may be configured to receive strapping so that tray  12  may be releasably coupled to another object such as an ambulance stretcher, hospital bed, operating room table, or imaging scanner table. As also shown in  FIG. 1 , attachment regions  40  are provided proximate sides  36 ,  38  for demountably coupling components such as curvilinear arms  14 ,  16 , IV pole  22 , arm board  24 , and rail assemblies  26 ,  28  to tray  12 , as will be further described below. In the exemplary preferred embodiment, tray  12  is provided with thirteen attachment regions  40 , although in alternate embodiments other number of regions  40  may be provided such as at least one. 
     Turning to  FIGS. 2A-2C , additional features of tray  12  are shown. Although hand hold regions  30  are not included in the figure, such regions may be provided as shown in  FIG. 1 . Attachment regions  40  are provided in spaced arrangement along the perimeter of tray  12 . Preferably, tray  12  includes a central arcuate portion  42  disposed between outer ledge portions  44 . Preferably, regions  40  are provided on outer ledge portions  44 . Central arcuate portion  42  preferably has an upper concave surface  42   a  for receiving a patient and optionally a cushion (not shown) for the patient to rest against, and optionally includes a lower convex surface  42   b . Preferably, outer ledge portions  44  include upper and lower surfaces  44   a ,  44   b  connected by a sidewall  44   c  at an angle α with respect to surface  44   b . In a preferred exemplary embodiment, sidewall  44   c  is disposed at an angle α between about 60° and about 100°, more preferably between about 70° and about 90°, and most preferably at about 80°. 
     In a preferred exemplary embodiment, tray  12  is formed of natural finish carbon fiber, R-51 foam core, and phenolic. Attenuation preferably is less than 1 mm A1 equivalency. Thus, tray  12  is radiolucent and suitable for use with CT scanners. In other embodiments, tray  12  is formed of a material suitable for use with MR scanners. In addition, tray  12  preferably supports a load of 900 lbs. evenly distributed along centerline  46 , about which tray  12  may be substantially symmetric as shown. Indicia  48  optionally may be provided, as shown for example proximate ends  32 ,  34 . The indicia may for example indicate preferred orientation of tray  12  with respect to a patient lying thereon. 
     In the preferred exemplary embodiment, attachment regions  40  on each side of tray  12  are evenly spaced from each other by about 6 inches between centers thereof. To accommodate patients and equipment attached to tray  12 , in one preferred embodiment tray  12  has a length of about 78 inches, a width of about 21 inches, a generally uniform thickness of about 0.9 inch, and a height h of about 2.5 inches. Corners may be provided with a radius R of about 2 inches. In the preferred exemplary embodiment, attachment regions  40  preferably accommodate threaded inserts, which may be formed of aluminum. 
     In some embodiments, tray  12  is sized to hold an adult patient, and may be between about 180 cm and about 200 cm long. However, it will be appreciated that longer and shorter trays may be provided. In order to accommodate an adult patient, tray  12  may support an overall weight capacity of at least about 200 pounds, and preferably at least about 300 pounds. However, if a tray  12  is sized for use with a pediatric patient, tray  12  may only accommodate weights that do not exceed 200 pounds, and more preferably do not exceed 100 pounds. 
     Although the surface of portion  42  of tray  12  is substantially smooth in the preferred exemplary embodiment, in alternate embodiments the surface may be textured to provide additional resistance to motion of objects and/or a patient placed thereon. 
     Tray  12  thus is suitable for use in multiple environments, and thus may “move” with the patient from one environment (e.g., ambulance) to the next (e.g., CT scanner) without removing a patient supported thereon. 
     Turning to  FIG. 3 , a curvilinear articulating arm assembly  14  is shown in partial cross-section. Arm assembly  14  includes a central arm  52  with a ball-sleeve arrangement that forms joints. In particular, central arm  52  includes a plurality of sleeves  54  with spherical balls  56  disposed therebetween thus forming ball and socket connections. In the preferred exemplary embodiment, three balls  56   a  of a first size are disposed adjacent one another proximate one end of arm  52 , while the remaining balls  56   b  are of a second size smaller than the first size. Sleeves  54   a  of a first size and sleeves  54   c  of a second size smaller than the first size are provided for accommodating balls  56   a ,  56   b , respectively, while a transition sleeve  54   b  is provided intermediate sleeves  54   a ,  54   c  as shown for accommodating a ball  56   a  on one side and a ball  56   b  on the other side thereof. As shown in  FIG. 3A , sleeves  54  are configured and dimensioned to receive balls  56   a ,  56   b  at ends thereof and thus permit articulating of sleeves with respect to each other. A tensioning wire  58  runs generally centrally through sleeves  54  and balls  56 , as will be further described shortly. Preferably, wire  58  is formed of metal. One exemplary operation of a wire tensioning mechanism is shown and described in U.S. Pat. No. 3,858,578 to Milo, which is expressly incorporated herein by reference thereto. Preferably, curvilinear articulating arm assembly  14  may move with six degrees of freedom. 
     A base handle  60  is coupled to central arm  52  on a first end thereof, preferably adjacent a ball  56   a . In addition, a free handle  62  is coupled to central arm  52  on a second end thereof, preferably adjacent a ball  56   b.    
     Turning to  FIG. 4 , base handle  60  will be described. Base handle  60  includes a coupling  62  for demountable coupling to tray  12 . In the preferred exemplary embodiment, coupling  62  comprises a threaded portion  64  which may be threadably received in a threaded insert (not shown) disposed in an attachment region  40  of tray  12 . Coupling  62  may be threadably associated with an attachment region  40  of tray  12  (via a threaded insert therein), so that arm assembly  14  may be demountably attached to tray  12 . Actuation of a first lever  66 , which is pivotably associated with handle  60 , permits a user to apply a force on coupling  62  so that movement is resisted (e.g., in response to an 8 or 10 pound force applied to arm  52 ). A second lever  68  also is pivotably associated with base handle  60  and preferably is coupled to tensioning wire  58  so that actuation of second lever  68  may increase or decrease the tension in wire.  58  as desired. By increasing tension in wire  58 , central arm  52  preferably becomes less flexible. Thus, a user may orient curvilinear articulating arm assembly  14  as desired, and then increase the tension of wire  58  so that the orientation of arm  52  is releasably fixed. Base handle  60  thus has a body portion  60   a , with levers  66 ,  68  pivotably associated with body portion  60   a . As shown for example in  FIGS. 4D and 4E , cam mechanisms  70 ,  72  may be employed with levers  66 ,  68 , respectively. 
     Next turning to  FIG. 5 , free handle  62  will be described. Free handle  62  includes a wire receiving portion  80  and an end effector receiving portion  81 . In particular, wire receiving portion  80  preferably is configured to receive a ball  56   b  therein, along with an end of wire  58 . As described previously with respect to base handle  60 , a pivotable lever  82  is associated with free handle  62  and preferably is coupled to tensioning wire  58  so that actuation of lever  84  may increase or decrease the tension in wire  58  as desired. By increasing tension in wire  58 , central arm  52  preferably becomes less flexible. The operation of lever  82  will be described shortly. Thus, a user may orient curvilinear articulating arm assembly  14  as desired, and then increase the tension of wire  58  so that the orientation of arm  52  is releasably fixed. Free handle  62  has a body portion  62   a , and lever  82  is rotatable with respect thereto. An interface lock  83  also is rotatably associated with body portion  62   a  proximate end effector receiving portion  81 . 
     Turning to  FIGS. 5H to 5P , an interface portion  84  is provided for coupling end effectors to free handle  62 . Interface portion  84  includes a coupling portion  85   a  in the form of a cylindrical post with a groove  85   b  formed circumferentially therein. Coupling portion  85   a  preferably is configured to be received in portion  81  of free handle  62 . As now will be described, the bayonet-type mounting provided by free handle  62  permits coupling portion  85   a  to be releasably engaged and locked to free handle  62 . A support portion  85   c  preferably is integrally formed with coupling portion  85   a . Support portion  85   c  preferably is cylindrical with a diameter greater than coupling portion  85   a , and also includes a circumferential groove  85   d  therein as well as a pair of screws  85   e  for use in connecting interface portion  84  to the remainder of an end effector. The heads of screws  85   e  may be received in arcuate recessed portions of body portion  62   a  proximate end effector receiving portion  81 , as shown for example in a petal-like arrangement in  FIG. 5B . 
     As shown in  FIG. 5K , interface portion  84  may be operably associated with interface lock  83 . Interface lock  83  includes a handle portion  83   a  and a cylindrical post  83   b  that is provided with an arcuate cutout  83   c  and a groove  83   d . When post  83   b  is aligned with groove  85   b  in coupling portion  85   a  of interface portion  84 , handle portion  83   a  may be rotated so that interface portion  84  is releasably coupled to free handle  62  and retained thereon. More specifically, the contour and sizing of groove  85   b  preferably matches the contour and sizing of arcuate cutout  83   c , and thus when cutout  83   c  is aligned with groove  85   b , as shown in  FIG. 5K , interface lock  83  is in the unlocked position and thus interface portion  84  may be moved freely with respect thereto. When cutout  83   c  is not aligned with groove  85   b , the cylindrical portion  83   e  of post  83   b  is received in groove  85   b , and interface lock  83  is in the locked position and thus coupled to end effector receiving portion  81 . In a preferred exemplary embodiment, cylindrical portion  83   e  may be frictionally fit in groove  85   b  to generally resist rotational movement of interface portion  84  with respect to interface lock  83 . In addition, as shown in  FIG. 5K , a set screw or locking screw  86  may be aligned with groove  83   d , and also threadably associated with body portion  62   a  at a hole  62   e  to couple interface lock  83  to body portion  62   a  of free handle  62 . 
     End effector receiving portion  81  is configured to receive and couple to an end effector such as a bracket or clamp, as shown for example in  FIG. 1 . 
     As shown for example in  FIGS. 5Q to 5V , a cam arrangement  87  may be employed with lever  82 . In particular, a rocker arm  87   a  is moveably associated with lever  82  via cylindrical dowel  87   b  which extends through lever  82 . A cylindrical cam bushing  87   c  is mounted on dowel  87   b  and bears against arcuate surface  87   d  of rocker arm  87   a , as shown for example in  FIG. 5V . In addition, rocker arm  87   a  is provided with a cylindrical post  87   e  which bears against an arcuate surface  62   b  of body portion  62   a . Thus, when lever  82  pivots about dowel  87   b , cam action occurs such that the position of rocker arm  87   a  may move along central axis  62   c  of free handle  62 . 
     Lever  82  includes a cylindrical portion  82   a  proximate an end thereof which may be slidably and rotatably associated with arcuate surface  62   d  of body portion  62   a  as shown for example in  FIG. 5E . 
     Rocker arm  87   a  includes a cylindrical, arcuate recessed portion  87   f  in which bears against and seats a mating pivot or half-round bearing  88  with a through hole  89 , which may further be provided with a flat washer  88   a  and internally-threaded lock nut  88   b  for use in coupling tensioning wire  58  to free handle  62 . Tensioning wire  58  may be fitted on its end with a coupling (not shown) having a sleeve portion that is swaged or otherwise compressed thereon so that the wire  58  is securely coupled to the sleeve. In a preferred exemplary embodiment, the coupling preferably is formed of steel and is configured as a swage stud, while the lock nut is a nylock-type lock nut (a nut with a nylon insert to resist backing off). Integrally formed with the sleeve portion is an externally threaded end portion. Tensioning wire  58  may pass through hole  89  and washer  88   a , and the coupling for wire  58  may be threadably associated with lock nut  88   b  so that wire  58  is retained. The initial pre-tension of wire  58  may be selected because the coupling for wire  58  may be threaded into lock nut  88   b  so that only some of the threads of lock nut  88   b  are associated therewith. Thus, when cam action occurs and rocker arm  87   a  moves with respect to central axis  62   c , the orientation of tensioning wire  58  is changeable by swiveling of bearing  88  in recessed portion  87   f . In a preferred exemplary embodiment, bearing  88  preferably is formed of a polymer. 
     The mechanism of operation of the cam action in free handle  62  is likewise applicable to second lever  68  of base handle  60 . Moreover, the mechanism of attachment of wire  58  to free handle  62  is likewise applicable to base handle  60 . 
     Curvilinear articulating arm assembly  14  thus may be coupled to tray  12  to permit a user to freely orient an object such as a medical device with respect to a patient disposed on tray  12  and releasably lock the position of the object with respect to the patient. Preferably, different levels of resistance to movement of arm  52  are provided by levers  68 ,  84  of handles  60 ,  62  respectively. For example, increased tensioning of wire  58  by free handle  62  may permit arm  52  to change from freely or loosely articulatable to more resilient motion, whereas increased tensioning of wire  58  by base handle  60  may permit arm  52  to be relatively stiff so that movement is resisted. Preferably, arm  52  is harder to rotate as a function of increasing size of ball  56   a ,  56   b.    
     Curvilinear articulating arm assembly  14  preferably is formed of materials that may be used in the CT environment. 
     Referring now to  FIG. 6 , a clamp end effector  18  will be described. End effector  18  includes a coupling portion  90  in the form of a post with a groove  92  formed circumferentially therein. Coupling portion  90  preferably is configured to be received in portion  82  of free handle  62 . The bayonet mounting provided by free handle  62  permits coupling portion  82  to be releasably engaged and locked to free handle  62 . Clamp end effector  18  further includes jaws  94 ,  96  that are pivotably associated with each other about a pivot rod  98 . When jaws  94 ,  96  are in a closed position with respect to one another, a variety of devices may be releasably held in regions defined by opposing portions  100   a ,  100   b , opposing portions  102   a ,  102   b , and/or opposing portions  104   a ,  104   b  as shown in  FIG. 6E . Preferably, each of the opposing portions is generally V-shaped. Jaws  94 ,  96  each include a pivot rod  94   a ,  96   a . Preferably, a screw  106  is associated with jaws  94 ,  96 , with shaft  108  thereof extending through pivot rod  94   a  and threadably engaging a like-threaded hole in pivot rod  96   a . Thus, by rotating head  110  of screw  106 , jaws  94 ,  96  can be moved closer together or further apart from each other as the threaded portion of shaft  108  threads into or out of pivot rod  96   a.    
     An end effector  20  in the form of a self-centering abdominal probe bracket is shown in  FIG. 7 . Bracket  20  is configured and dimensioned to retain a device such as an ultrasound transducer  120  therein for use, for example, in connection with addressing respiratory gating as previously discussed. Also as previously discussed, end effector  20  includes a coupling portion  122  in the form of a post with a groove  124  formed circumferentially therein. Coupling portion  122  preferably is configured to be received in portion  82  of free handle  62 . The bayonet mounting provided by free handle  62  permits coupling portion  122  to be releasably engaged and locked to free handle  62 . 
     Additional components for use with tray  12  next will be described. As shown in  FIG. 8 , a rail assembly  26  is shown. Rail assembly  26  includes a coupling section  130  and a rail  132  spaced therefrom. In the preferred exemplary embodiment, coupling section  130  has a pair of couplings  134  that each have a threaded portion  136  that may be threadably received in a threaded insert (not shown) disposed in an attachment region  40  of tray  12 . Preferably, couplings  134  are rotatable by actuation of a lever  138  so that a user may threadably engage each of couplings  134  to tray  12  (via a threaded insert therein) simply by actuation of lever  138 . As shown in  FIG. 1 , when rail assembly  26  is couple to tray  12 , rail  132  is raised above tray  12  and spaced from sides  36 ,  38  thereof. Rail  132  is thus demountably couplable to tray  12  in a desired location along sides  36 ,  38 , and may be used to support equipment such as surgical devices that do not have end effectors readily couplable to attachment regions  40  of tray  12 . For example, rail assembly may be used to couple various supports, retractors, arms boards, leg supports, and/or surgical guidance equipment to tray  12 . 
     An IV pole  22  is shown in  FIG. 9 . Pole  22  includes hooks  140 , telescoping pole  142 , screw lock  144  for locking pole  142  at a desired extension thereof, and a coupling  146  having a threaded portion that may be threadably received in a threaded insert (not shown) disposed in an attachment region  40  of tray  12 . 
     An arm board  24  is shown in  FIG. 10 . Arm board  24  includes a board portion  150  and couplings  152 . Couplings  152  each have a threaded portion that may be threadably received in a threaded insert (not shown) disposed in an attachment region  40  of tray  12  to demountably attach arm board  24  thereto. At least one cutout  154  also may be provided for receiving an object therethrough or alternatively for making arm board  24  lighter. In a preferred exemplary embodiment, arm board  24  includes sides  156 ,  158  that are disposed transverse to one another so that a first end  160  of arm board  24  is wider than a second end  162  thereof. Arm board  24  for example may be formed of aluminum. 
     A lift beam assembly  170  is shown in  FIG. 11 . Lift beam assembly  170  may be used as a pair with one mounted on each side of the tray to removably couple support system  10  to the frame of an OR table. For example, in the preferred exemplary embodiment three couplings  172   a ,  172   b ,  172   c  may be provided, with each having a threaded portion that may be threadably received in a threaded insert (not shown) disposed in an attachment region  40  of tray  12  to demountably attach assembly  170  thereto. Preferably, coupling  172   c  may then be releasably coupled to the central platform of an electrohydraulically operated operating room table. Region  174  of the beam reacts against the underside of this central platform as the hydraulic lift mechanism begins to lift the tray. All movements present in the operating mechanism of the OR table may then be used to position or orient the tray. 
     Finally, yet another end effector for use in fine needles probes, or catheters is shown in  FIG. 12 . As can be seen, a pair of clamping plates  182 ,  184  are connected by a central screw  186 . Clamping plates  182 ,  184  are provided with a groove opposing a rounded edge  188  proximate free ends thereof, and an instrument  190  may be grasped within the grooves. As discussed with other embodiments, end effector  180  includes a coupling portion  192  in the form of a post with a groove  194  formed circumferentially therein. Coupling portion  192  preferably is configured to be received in portion  82  of free handle  62 . The bayonet mounting provided by free handle  62  permits coupling portion  192  to be releasably engaged and locked to free handle  62 . 
     As described previously, tray  12  may be provided with a central arcuate portion  42 . If tray  12  is to be placed on a rigid or semi-rigid flat surface, for example a flat ultrasound table, a patient in tray  12  may not be stable because of the tendency of central arcuate portion  42  to swivel about the contact region between portion  42  and the flat surface. In order to stabilize tray  12  on such a surface, as shown in  FIG. 13 , stabilizing posts  200  or “feet” may be provided. In an exemplary preferred embodiment, four posts  200  may be provided to stabilize tray  12 , one disposed proximate each of the four corners of tray  12 . Preferably, posts  200  are sized to provide sufficient support below outer ledge portions  44  to accommodate the portion of the vertical height h from the lowermost surface of tray  12  to lower surface  44   b  of outer ledge portion  44 . Advantageously, posts  200  include a threaded shaft  202  and a friction tip  204  disposed proximate one end of the post. Tip  204  preferably is formed of a material such as rubber that resist sliding on surfaces. Thus, threaded holes may be provided along lower surface  44   b  to threadably receive the posts  200 . In addition, to accommodate variations in the surface on which tray  12  rests as well as to address situations in which such a surface may not be “level,” one or more of the posts may be only partially threaded in its respective hole so that tray  12  may be stabilized, and potentially leveled, by providing varying post heights extending from lower surface  44   b.    
     Turning to  FIG. 14 , a handle  210  is shown for attachment to tray  12 . Once coupled to tray  12 , for example by threadable association of coupling  212  with an attachment region  40 , handle  210  may be held at hand grip portion  214  to facilitate movement of tray  12  particularly when a patient is supported thereon. In an exemplary preferred embodiment, at least two handles  210  are coupled to tray  12 , and in one embodiment four handles  210  are provided. 
     Some embodiments of support system  10  may provide one or more of the following: assist in stabilization and control of guidance devices and accessory instrumentation during image guided procedures; improved patient positioning and stabilization during imaging and image guided procedures; enabling of the use of ultrasound for respiratory gating during abdominal or thoracic image guided procedures (e.g., through the use of an arm assembly  14  for holding an ultrasound transducer in a position against the abdominal or chest wall to view the position of the diaphragm in real time during imaging in the CT or MR gantry); generally improved accuracy of targeting and placement of instruments during image guided procedures by holding instruments in a fixed relationship to the patient as the patient is moved for imaging purposes. In addition, some of the embodiment of support system  10  may be used in one or more of the following applications: integrated general laparoscopic surgical procedures with CT and MR image guidance; integrated computer assisted surgical tracking and navigation systems and robotic surgical devices with the CT and MR imaging systems. 
     One method of use of the of the present invention may for example include: placing a patient on the tray such as after locating and fixing the tray onto the pre-existing table or tray of a scanner (in the tray-on-tray model); positioning the patient in an optimal position on the tray and securing the patient in that position using a shape conforming mattress and accessory extremity support devices that may be attached to the tray as required; obtaining the appropriate images using the scanner with the patient in this optimal position; mounting lockable positioning arm(s) at desired site(s) alongside the patient by considering the instruments required, the position of the target site and the position of the operating physician; preparing and draping the surgical field; choosing an appropriate sterile end effector(s) for the arms and attaching them to the arms in conjunction with a sterile sleeve type drape to cover the arms to complete the protection of the sterile field; indexing one or more of the arms with the imaging plane of the scanner and registering the instrument that it holds with an image if required; capturing desired equipment or devices in the end effectors and positioning the equipment or devices as desired; re-imaging and re-positioning the arms/equipment based on new images or as otherwise desired during the procedure. 
     While various descriptions of the present invention are described above, it should be understood that the various features can be used singly or in any combination thereof. Therefore, this invention is not to be limited to only the specifically preferred embodiments depicted herein. 
     Further, it should be understood that variations and modifications within the spirit and scope of the invention may occur to those skilled in the art to which the invention pertains. For example, attachments regions  40  may comprise other releasably lockable constructions to accommodate, for example, quick locking of components to tray  12 , frictional locking, magnetic locking, or other modes of securement. Accordingly, all expedient modifications readily attainable by one versed in the art from the disclosure set forth herein that are within the scope and spirit of the present invention are to be included as further embodiments of the present invention. The scope of the present invention is accordingly defined as set forth in the appended claims.