Abstract:
In a method for the automatic alignment of a medical instrument with respect to a target point in a patient body such as, for subsequent removal of a tissue sample or for therapy of a tumor in the target point, using a computed tomography apparatus with fluoroscopy mode, a guidance system aligns the medical instrument at a paracentesis point of the patient body in a CT image plane, and the spatial coordinates of the CT image plane are determined for the guidance system.

Description:
BACKGROUND OF THE INVENTION  
         [0001]    1. Field of the Invention  
           [0002]    The present invention is directed to a method for the automatic alignment of a medical instrument with reference to a target point in the body of a patient, for example for subsequent removal of a tissue sample or for therapy of a tumor in the target point, using a computed tomography apparatus (with fluoroscopy mode).  
           [0003]    2. Description of the Prior Art  
           [0004]    A method for the alignment and introduction of a medical instrument to a target point in the body of a patient is known wherein the attending physician aligns a medical instrument at the paracentesis point of the body of the patient, perforates the skin and approaches the target point with imaging assistance using a computed tomography apparatus with fluoroscopy mode. The computed tomography apparatus with fluoroscopy mode thereby supplies image sequences of up to eight images/second (frames/second), so that the attending physician can observe the paracentesis motion directly at the picture screen.  
           [0005]    In order to avoid direct exposure to X-rays, the attending physician grasps the medical instrument with forceps or tweezers, resulting in an indirect and impractical manipulation of the medical instrument.  
         SUMMARY OF THE INVENTION  
         [0006]    An object of the present invention is to provide a method for alignment of a medical instrument with reference to a target point in the body of a patient that is automated and has an improved targeting precision.  
           [0007]    The above object is achieved in accordance with the principles of the present invention in a method for automatically aligning a medical instrument relative to a target point in a patient&#39;s body, such as for subsequent removal of a tissue sample or for therapy of a tumor in the target point, using a computed tomography apparatus with fluoroscopy mode, wherein the paracentesis tip of a medical instrument is positioned at a paracentesis point of the patient&#39;s body using an automated guidance system, and wherein the medical instrument is positioned using the guidance system into a first position within a CT image plane that contains the paracentesis point. The spatial coordinates of the medical instrument at the first position are determined and stored. The medical instrument is then positioned by the automated guidance system into a second position within the CT image plane that differs from the first position. The spatial coordinates of the second position are determined and stored. The spatial coordinates of the CT image plane are then determined from the stored spatial coordinate for the first and second positions of the medical instrument.  
           [0008]    Thus, the medical instrument in the inventive method is aligned with reference to a first CT image plane. As a result, the spatial coordinates of the first CT image plane are communicated to the guidance system of the medical instrument. The guidance system (“guide robot”) that, for example, is motor-driven or pneumatically driven, can be attached to or in the proximity of the computed tomography apparatus without prior registration of its own spatial coordinates.  
           [0009]    If, in the subsequent introduction of the instrument into the body of the patient, the paracentesis tip deviates from the previously defined, extended axis proceeding from the paracentesis point to the target point due to patient and/or organ movement, this can be automatically registered. The perforation procedure is then interrupted, corrected as needed, and then resumed.  
           [0010]    Given a renewed perforation procedure, a correction angle can be taken into consideration in the guidance of the medical instrument, this correction angle, for example, being derived from the deviation of the extended axis, between the paracentesis location and the target point, and the initial, incorrect perforation channel of the medical instrument.  
           [0011]    In an embodiment of the method, the paracentesis point at the patient body is located in the first CT image plane, whereas the target point in the patient body is located in a second CT image plane differing from the first plane.  
           [0012]    In another embodiment of the method, both the paracentesis point at the patient body, as well as the target point in the patient body, are located in the first CT image plane  
       
    
    
     DESCRIPTION OF THE DRAWINGS  
       [0013]    [0013]FIG. 1 is a schematic illustration of a guidance system with a medical instrument attached to a computed tomography apparatus for explaining a first embodiment of the inventive method.  
         [0014]    FIGS.  2 - 5  are schematic illustrations of individual method steps of the first embodiment of the inventive method during alignment and/or introduction of the medical instrument.  
         [0015]    [0015]FIG. 6 is a schematic illustration of a guidance system with a medical instrument attached to a computed tomography apparatus for explaining a second version of the inventive method.  
         [0016]    FIGS.  7 - 11  are schematic illustrations of individual method steps of the second embodiment of the inventive method during alignment and/or introduction of the medical instrument.  
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0017]    [0017]FIG. 1 shows a computed tomography apparatus  1  with the picture screen  9  of an appertaining EDP station. The medical instrument, a needle  7  here, is attached to the computed tomography apparatus  1 , to the CT table  4  here, via a guidance system  8 . The patient body  5  has been moved into the CT gantry  2  and has a paracentesis point  12  lying in a first CT image plane  3   a . The position of the needle  7  is indicated at the picture screen  9 . Dependent on whether the needle  7  is partially or completely located in the first CT image plane  3   a , the paracentesis tip  10 , a cross-section of the needle  7  or the entire length of the needle  7 , can be observed at the picture screen  9 .  
         [0018]    In the guidance position  11   a  of the guidance system  8  connected to the EDP station (the guidance position  11   a  being shown in the upper left half of FIG. 1), the needle  7  is in the proximity of the paracentesis point  12  at the patient body  5 .  
         [0019]    The needle  7  is now adjusted such with the guidance system  8  so that, as shown in the upper right half of FIG. 1, in the guidance position  11   b  of the guidance system  8 , the paracentesis tip  10  of the needle  7  is located at the paracentesis point  12  of the patient body  5  in the first CT image plane  3   a . The illustration according to guidance position  11   b  of the guidance system  8  is schematically imaged on the picture screen  9  of the EDP station in FIG. 1. The picture screen  9  shows the patient body  5  with the paracentesis tip  10  of the needle  7  at the paracentesis point  12  in the first CT image plane  3   a . The target point  6  is not visible at the picture screen  9  because it is located in a second CT image plane  3   b . The second CT image plane  3   d  is spaced from the CT image plane  3   a  by a distance  19  (see FIG. 2).  
         [0020]    Further details of the inventive method proceed from the illustrations of the following FIGS.  2 - 5 .  
         [0021]    [0021]FIG. 2 first shows the patient body  5  with the target point  6  in the second CT image plane  3   b . The patient body  5  is arranged such inside the CT gantry  2  on the CT table  4  so that the paracentesis point  12  is in the first CT image plane  3   a . The spatial coordinates of the target point  6  in the second CT image plane  3   b  are known from an examination previously implemented with the computed tomography apparatus  1 .  
         [0022]    The needle  7  is attached to (held by) the guidance system  8 . In a first method step, the paracentesis tip  10  of the needle  7  is located at the paracentesis point  12  of the patient body  5 . This can occur automatically by placing a marker, for example, a metallic marker (not shown), to which the guidance system  8  can align itself in a known way, at the paracentesis point  12  of the patient body  5 .  
         [0023]    As shown in FIG. 2, the needle  7  as a whole is not yet situated in the first CT image plane  3   a , and the guidance system  8  also does not yet have the information about the spatial coordinates of the first CT image plane  3   a , since the guidance system  8  is attached to or in the proximity of the computed tomography apparatus  1  without previous spatial coordinate balancing.  
         [0024]    As show in FIG. 3, the needle  7  is positioned in a first position  15  in the first CT image plane  3   a . The term “positioning” is used herein as meaning any type of movement of the needle  7 , i.e. any and all types of turning, displacement or other movement.  
         [0025]    As a result of storing the dimensional data, particularly the length, of the needle  7  in the EDP station, a determination can be made when the needle  7  is completely situated in the first CT image plane  3   a  after being positioned in the first position  15 . This is the case when the entire length of the needle  7  becomes imaged on the picture screen  9 , which can be automatically detected (for example, by counting the number of pixels).  
         [0026]    As soon as the needle  7  is completely located in the first CT image plane  3   a , the spatial coordinates of the needle  7  are stored and communicated to a memory of the EDP station of the guidance system  8 . In order to be able to completely inform the guidance system  8  of the position of the first CT image plane  3   a , the needle  7  is now positioned in a second position  16 —which deviates from the first position  15 —in the first CT image plane  3   a , whereupon the spatial coordinates of the needle  7  are determined anew. When the guidance axis  17  of the guidance system  8  resides at a right angle to the first CT image plane  3   c , the second position  16  can, for example, be achieved by rotation around the guidance axis  17  of the guidance system  8 .  
         [0027]    By relating the spatial coordinates of the needle  7  determined at the respective positions described above, the spatial coordinates of the first CT image plane  3   a  can be determined and communicated to the guidance system  8 , since the position of a plane can be unambiguously defined by the spatial coordinates of two intersecting straight lines in the plane.  
         [0028]    Subsequently, the needle  7  is automatically aligned over the known spatial coordinates of the target point  6  so that the projected extension of the needle  7 , namely the axis  13 , passes through the target point  6  (FIG. 4).  
         [0029]    Subsequently, the guidance system  8  inserts the needle  7  into the patient body  5  linearly along the extended axis  13 , and the needle  7  moves toward the target point  6  in the second CT image plane  3   b  until the target point  6  is reached. FIG. 5 shows the paracentesis tip  10  in an intermediate CT image plane  18  during the introduction that is located between the first CT image plane  3   a , which contains the paracentesis point  12 , and the second CT image plane  3   b , which contains the target point  6 .  
         [0030]    All method steps from the positioning of the paracentesis tip  10  of the needle  7  at the paracentesis point  12  of the patient body  5  by the alignment and introduction of the needle  7 , to the final attainment of the target point  6 , can sequence fully automatically.  
         [0031]    A particular advantage of the inventive method is that the guidance system  8  can be attached to the computed tomography apparatus  1  at a practically arbitrary location and the spatial coordinates of the first CT image plane  3   a  are automatically determined during the executive sequence of the inventive method, so that, finally, the needle  7  is aligned at the paracentesis point  12 , is inserted and can be guided to the target point  6 .  
         [0032]    If, upon insertion of the needle  7 , i.e. on the path between the paracentesis point  12  and the target point  6 , a deviation of the paracentesis path of the needle  7  from the designated path of the axis  13  occurs (for example, due to patient and/or organ movement), this is detected by an ongoing acquisition of the spatial coordinates of the paracentesis tip  10  of the needle  7 , and the paracentesis event can be interrupted and corrected or repeated from the start with a new alignment of the needle  7 . The deviation angle that occurs between the paracentesis tip  10  of the needle  7 , the paracentesis point  12  at the patient body  5 , and the axis  13  can be automatically acquired and taken into consideration for corrective use given a renewed paracentesis procedure.  
         [0033]    Analogously to FIG. 1, FIG. 6 shows the initial situation of a second embodiment of the method, again employing a computed tomography apparatus  1  with the picture screen  9  of an appertaining EDP station. The medical instrument—the needle  7  here—is attached to the computed tomography apparatus  1 , to the CT table  4  here, via a guidance system  8 . The patient body  5  has been moved into the CT gantry  2  and has a target point  6  in the first CT image plane  3   a.    
         [0034]    The position of the needle  7  is displayed at the picture screen  9 . Dependent on whether the needle  7  is partially or completed situated in the first CT image plane  3   a , the paracentesis tip  10 , a cross-section of the needle  7 , or the entire length of the needle  7  can be observed at the picture screen  9 .  
         [0035]    In the guidance position  11   a  of the guidance system  8  that is also connected to the EDP station and that is shown in the upper left half of FIG. 6, the needle  7  is located in the proximity of the paracentesis point  12  at the patient body  5 . The paracentesis point  12  is located in the CT image plane  3   a.    
         [0036]    The needle  7  is now adjusted with the guidance system  7  so that, as shown in the upper right half of FIG. 6 in the guidance position  11   b  of the guidance system  8 , the needle  7  with the paracentesis tip  10  at the paracentesis point  12  of the patient body  5  is completely located in the CT image plane  3   a . The illustration according to guidance position  11   b  of the guidance system  8  is schematically shown on the picture screen  9  of the EDP station in FIG. 6.  
         [0037]    The goal is to position the needle  7 , extended by the axis  13 , on the picture screen  9  within the first CT image plane  3   a  such that, for example by rotation in the direction  14 , it can be aligned such that the extended axis  13  intersects the target point  6 , whose spatial coordinates are known. This can ensue automatically. When this has been accomplished, the needle  7  can be linearly introduced along the axis  13  until the target point  6  is reached.  
         [0038]    Further details of the second version of the inventive method proceed from the illustrations of the following FIGS.  7 - 11 .  
         [0039]    [0039]FIG. 7, first, shows the patient body  5  with the target point  6 , which represents a specific organ or a tumor to be removed. The patient body  5  is arranged within the CT gantry  2  on the CT table  4  so that the target point  6  is located in the first CT image plane  3   a . The spatial coordinates of the target point  6  are known.  
         [0040]    The guidance system  8 , which is not shown in FIG. 7 and to which the needle  7  is attached, is shown in FIG. 8. In a first method step, the paracentesis tip  10  of the needle  7  is located at the paracentesis point  12  of the patient body  5 . This can occur automatically by placing a marker for example, a metallic marker (not shown), to which the guidance system  8  can align itself in a known way, at the paracentesis point  12  of the patient body  5 .  
         [0041]    As shown in FIG. 8, the needle  7  is not yet located in the first CT image plane  3   a , and the guidance system  8  does not yet have the information about the spatial coordinates of the first CT image plane  3   a , since the guidance system  8  is attached to or in the proximity of the computed tomography apparatus  1  without previous spatial coordinate referencing.  
         [0042]    As shown in FIG. 9, the needle  7  is then positioned in a first position  15  in the CT image plane  3   a . Again, the term “positioning” is used herein as meaning any type of movement of the needle  7 , i.e. any and all types of turning, displacement or other movement.  
         [0043]    As a result of storing the dimensional data, particularly the length, of the needle  7  in the EDP station, a determination can be made when the needle  7  is completely situated in the first CT image plane  3   a  after being positioned in the first position  15 . This is the case when the entire length of the needle  7  becomes imaged on the picture screen  9 , which can be automatically detected (for example, by counting the number of pixels).  
         [0044]    As soon as the needle  7  is completely located in the first CT image plane  3   a , the spatial coordinates of the needle  7  are stored and communicated to a memory of the EDP station of the guidance system  8 . In order to be able to completely inform the guidance system  8  of the position of the first CT image plane  3   a , the needle  7  is now positioned in a second position  16 —which deviates from the first position  15 —in the first CT image plane  3   a , whereupon the spatial coordinates of the needle  7  are determined anew. When the guidance axis  17  of the guidance system  8  resides at a right angle to the first CT image plane  3   a , the second position  16  can, for example, be achieved by rotating around the guidance axis  17  of the guidance system  8 .  
         [0045]    By relating the spatial coordinates of the needle  7  determined as just described, the spatial coordinates of the first CT image plane  3   a  can be determined and communicated to the guidance system  8 , since the position of a plane can be unambiguously defined by the spatial coordinates of two intersecting straight lines in the plane. With this spatial coordinate information, the guidance system  8  can displace or rotate the needle  7  within the CT image plane  3  without leaving the CT image plane  3 .  
         [0046]    After the needle  7 , for example as a result of rotation in the direction  14  which is seen on the picture screen  9  according to FIG. 6, is aligned such within the first CT image plane  3   a  that the extension of the needle  7 , namely the axis  13 , passes through the target point  7 , the stage of the method shown in FIG. 10 has been reached.  
         [0047]    Subsequently, the guidance system  8  linearly inserts the needle  7  into the patient body  5  along the extended axis  13  and moves it within the CT image plane  3   a  toward the target point  6  until the target point  6  is reached (FIG. 11). The subject located at the target point  6 , for example the tissue thereat or the tumor thereat, can now be treated.  
         [0048]    All method steps from the positioning of the paracentesis tip  10  of the needle  7  at the paracentesis point  12  of the patient body  5  by the alignment and introduction of the needle  7 , to the final attainment of the target point  6 , can sequence fully automatically.  
         [0049]    A particular advantage of the inventive method is that the guidance system  8  can be attached to the computed tomography apparatus  1  at a practically arbitrary location and the spatial coordinates of the first CT image plane  3   a  are automatically determined during the executive sequence of the inventive method, so that the needle  7  is aligned at the paracentesis point  12 , is inserted, and can be guided to the target point  6 .  
         [0050]    If, upon insertion of the needle  7 , i.e. on the path between the paracentesis point  12  and the target point  6 , a deviation of the paracentesis path of the needle  7  from the designated path of the axis  13  occurs (for example, due to patient and/or organ movement), this is detected by an ongoing acquisition of the spatial coordinates of the paracentesis tip  10  of the needle  7 , and the paracentesis event can be interrupted and corrected or repeated from the start with a new alignment of the needle  7 . The deviation angle that occurs between the paracentesis tip  10  of the needle  7 , the paracentesis point  12  at the patient body  5 , and the axis  13  can be automatically acquired and taken into consideration for corrective use given a renewed paracentesis procedure.  
         [0051]    Although modifications and changes may be suggested by those skilled in the art, it is the intention of the inventor to embody within the patent warranted hereon all changes and modifications as reasonably and properly come within the scope of his contribution to the art.