Patent Publication Number: US-2023157769-A1

Title: Systems and methods for monitoring patient motion during a medical procedure

Description:
RELATED APPLICATIONS 
     This patent application claims priority to and the benefit of the filing date of U.S. Provisional Patent Application No. 62/378,389, entitled “SYSTEMS AND METHODS FOR MONITORING PATIENT MOTION DURING A MEDICAL PROCEDURE,” filed Aug. 23, 2016, which is incorporated by reference herein in its entirety. 
    
    
     FIELD 
     The present disclosure is directed to systems and methods for monitoring the motion of a patient or of a medical system relative to the patient during a medical procedure. 
     BACKGROUND 
     Minimally invasive medical techniques are intended to reduce the amount of tissue that is damaged during medical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. Such minimally invasive techniques may be performed through natural orifices in a patient anatomy or through one or more surgical incisions. Through these natural orifices or incisions, an operator may insert minimally invasive medical instruments (including surgical, diagnostic, therapeutic, or biopsy instruments) to reach a target tissue location. One such minimally invasive technique is to use a flexible and/or steerable elongate device, such as a flexible catheter, that can be inserted into anatomic passageways and navigated toward a region of interest within the patient anatomy. Other minimally invasive techniques may include the user of relatively rigid devices manipulated within the patient anatomy. Control of such an elongate device by medical personnel involves the management of several degrees of freedom including at least the management of insertion and retraction of the elongate device as well as steering of the device. In addition, different modes of operation may also be supported. 
     During a medical procedure the patient, although likely anesthetized, may move. For example, an involuntary bodily movement may occur, or the patient may be bumped or otherwise moved by an operator or another person present in the surgical environment. Additionally, the minimally invasive system may be moved relative to the patient. Such movements can cause complications during the minimally-invasive procedures, including image-guided medical procedures. 
     Accordingly, it would be advantageous to provide improved methods and systems for monitoring patient motion during a medical procedure. 
     SUMMARY 
     The embodiments of the invention are best summarized by the claims that follow the description. 
     Consistent with some embodiments, a method of monitoring a medical instrument during a medical procedure involving motion of the medical instrument is disclosed. The method may include receiving state information from a control system in communication with the medical instrument; detecting motion of at least a portion of the medical instrument and comparing the motion of the portion of the medical instrument with a threshold motion value that is based on the state information received from the control system. The method may further include generating a communication message for presentation in a display system based on the comparison of the motion with the threshold motion value. Other embodiments of this aspect include corresponding computer systems, apparatus, and computer programs recorded on one or more computer storage devices, each configured to perform the actions of the methods. 
     Consistent with some embodiments, a teleoperated medical system is disclosed. The teleoperated medical system may include a teleoperational, elongate medical instrument, a master assembly configured to receive commands from a system operator to manipulate the medical instrument, and a control system in communication with the master assembly and the medical instrument. The control system may be adapted to perform operations including receiving state information from a control system in communication with the medical instrument, detecting motion of at least a portion of the medical instrument, and comparing the motion of the portion of the medical instrument with a threshold motion value that is based on the state information received from the control system. The control system may be adapted to generate a communication message for presentation to an operator based on the comparison of the motion with the threshold motion value. 
     It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory in nature and are intended to provide an understanding of the present disclosure without limiting the scope of the present disclosure. In that regard, additional aspects, features, and advantages of the present disclosure will be apparent to one skilled in the art from the following detailed description. 
    
    
     
       BRIEF DESCRIPTIONS OF THE DRAWINGS 
         FIG.  1    is a simplified diagram of a teleoperated medical system according to some embodiments. 
         FIG.  2 A  is a simplified diagram of a medical instrument system according to some embodiments. 
         FIG.  2 B  is a simplified diagram of a medical instrument system with an extended medical tool according to some embodiments. 
         FIG.  2 C  is a diagram of a medical instrument system with a kinematic chain according to some embodiments. 
         FIGS.  3 A and  3 B  are simplified diagrams of side views of a patient in patient coordinate space including a medical instrument mounted on an insertion assembly according to some embodiments. 
         FIG.  4    is a flowchart of a method for monitoring patient movement during a medical procedure according to some embodiments. 
         FIGS.  5 A,  5 B, and  5 C  illustrate the distal end of the medical instrument systems of  FIGS.  2 A-C ,  3 A, and  3 B, during use within a human lung according to some embodiments. 
         FIGS.  6 A and  6 B  illustrate images that may be used in identifying patient motion patient according to some embodiments. 
         FIG.  7    depicts simplified diagram of a side view of a patient having an endotracheal tube inserted to facilitate use to the medical instrument system according to some embodiments. 
         FIG.  8    depicts a user interface according to some embodiments. 
     
    
    
     Embodiments of the present disclosure and their advantages are best understood by referring to the detailed description that follows. It should be appreciated that like reference numerals are used to identify like elements illustrated in one or more of the figures, wherein showings therein are for purposes of illustrating embodiments of the present disclosure and not for purposes of limiting the same. 
     DETAILED DESCRIPTION 
     In the following description, specific details are set forth describing some embodiments consistent with the present disclosure. Numerous specific details are set forth in order to provide a thorough understanding of the embodiments. It will be apparent, however, to one skilled in the art that some embodiments may be practiced without some or all of these specific details. The specific embodiments disclosed herein are meant to be illustrative but not limiting. One skilled in the art may realize other elements that, although not specifically described here, are within the scope and the spirit of this disclosure. In addition, to avoid unnecessary repetition, one or more features shown and described in association with one embodiment may be incorporated into other embodiments unless specifically described otherwise or if the one or more features would make an embodiment non-functional. 
     In some instances well known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the embodiments. 
     This disclosure describes various instruments and portions of instruments in terms of their position, orientation, and/or pose in three-dimensional space. As used herein, the term “position” refers to the location of an object or a portion of an object in a three-dimensional space (e.g., three degrees of translational freedom along Cartesian X, Y, and Z coordinates). As used herein, the term “orientation” refers to the rotational placement of an object or a portion of an object (three degrees of rotational freedom—e.g., roll, pitch, and yaw). As used herein, the term “pose” refers to the position of an object or a portion of an object in at least one degree of translational freedom and to the orientation of that object or portion of the object in at least one degree of rotational freedom (up to six total degrees of freedom). As used herein, the term “shape” refers to a set of poses, positions, or orientations measured along an object. 
     The disclosure is generally directed to methods and systems for monitoring the motion of a patient undergoing a medical procedure. In some approaches a dedicated device may be used to monitor a patient P. Embodiments of the present disclosure utilize information from assemblies and instruments that have a primary purpose other than monitoring patient motion. Accordingly, embodiments of the present disclosure may obviate the need of a dedicated patient motion monitoring device by enabling other systems and devices to secondarily provide patient motion monitoring means. The principles of the present disclosure may also be applied to dedicated devices to improve their accuracy and performance in monitoring patient motion. 
       FIG.  1    is a simplified diagram of a teleoperated medical system  100  according to some embodiments. In some embodiments, teleoperated medical system  100  may be suitable for use in, for example, surgical, diagnostic, therapeutic, or biopsy procedures. As shown in  FIG.  1   , medical system  100  generally includes a teleoperational manipulator assembly  102  for operating a medical instrument  104  in performing various procedures on a patient P. Teleoperational manipulator assembly  102  is mounted to or near an operating table T. An input control device or master assembly  106  allows an operator  0  (e.g., a surgeon, a clinician, or a physician as illustrated in  FIG.  1   ) to control teleoperational manipulator assembly  102  and, in some embodiments, to view the interventional site. 
     Master assembly  106  may be located at a physician&#39;s console which is usually located in the same room as operating table T. However, it should be understood that operator O can be located in a different room or a completely different building from patient P. Master assembly  106  generally includes one or more control devices for controlling teleoperational manipulator assembly  102 . The control devices may include any number of a variety of input devices, such as joysticks, trackballs, data gloves, trigger-guns, hand-operated controllers, voice recognition devices, body motion or presence sensors, and/or the like. To provide operator O a strong sense of directly controlling instruments  104  the control devices may be provided with the same degrees of freedom as the associated medical instrument  104 . In this manner, the control devices provide operator O with telepresence or the perception that the control devices are integral with medical instruments  104 . 
     In some embodiments, the control devices may have more or fewer degrees of freedom than the associated medical instrument  104  and still provide operator O with telepresence. In some embodiments, the control devices may optionally be manual input devices which move with six degrees of freedom, and which may also include an actuatable handle for actuating instruments (for example, for closing grasping jaws, applying an electrical potential to an electrode, delivering a medicinal treatment, and/or the like). 
     Teleoperational manipulator assembly  102  supports medical instrument  104  and may include a kinematic structure of one or more non-servo controlled links (e.g., one or more links that may be manually positioned and locked in place, generally referred to as a set-up structure) and a teleoperational manipulator. Teleoperational manipulator assembly  102  may optionally include a plurality of actuators or motors that drive inputs on medical instrument  104  in response to commands from the control system (e.g., a control system  112 ). The actuators may optionally include drive systems that when coupled to medical instrument  104  advance medical instrument  104  into a naturally or surgically created anatomic orifice. Other drive systems may move the distal end of medical instrument  104  in multiple degrees of freedom, which may include three degrees of linear motion (e.g., linear motion along the X, Y, Z Cartesian axes) and in three degrees of rotational motion (e.g., rotation about the X, Y, Z Cartesian axes). Additionally, the actuators can be used to actuate an articulable end effector of medical instrument  104  for grasping tissue in the jaws of a biopsy device and/or the like. Actuator position sensors such as resolvers, encoders, potentiometers, and other mechanisms may provide sensor data to the medical system  100  describing the rotation and orientation of the motor shafts. This position sensor data may be used to determine motion of the objects manipulated by the actuators. 
     Teleoperated medical system  100  may include a sensor system  108  with one or more sub-systems for receiving information about the instruments of teleoperational manipulator assembly  102 . Such sub-systems may include a position/location sensor system (e.g., an electromagnetic (EM) sensor system); a shape sensor system for determining the position, orientation, speed, velocity, pose, and/or shape of a distal end and/or of one or more segments along a flexible body that may make up medical instrument  104 ; and/or a visualization system for capturing images from the distal end of medical instrument  104 . The sensor system  108  may include a plurality of sensors disposed along a kinematic chain of the manipulator assembly  102 , in some embodiments. 
     Teleoperated medical system  100  also includes a display system  110  for displaying an image or representation of the surgical site and medical instrument  104  generated by sub-systems of sensor system  108 . The display system  110  may further be used to render communications for presentation to the operator O. Display system  110  and master assembly  106  may be oriented so operator O can control medical instrument  104  and master assembly  106  with the perception of telepresence. 
     In some embodiments, medical instrument  104  may have a visualization system (discussed in more detail below), which may include a viewing scope assembly that records a concurrent or real-time image or images of a surgical site and provides the image(s) to the operator or operator O through one or more displays of medical system  100 , such as one or more displays of display system  110 . The concurrent image may be, for example, a two- or three-dimensional image captured by an endoscope or other medical instrument positioned within the surgical site. In some embodiments, the visualization system includes endoscopic components that may be integrally or removably coupled to medical instrument  104 . However in some embodiments, a separate endoscope, attached to a separate manipulator assembly may be used with medical instrument  104  to image the surgical site. The visualization system may be implemented as hardware, firmware, software or, a combination thereof which interact with or are otherwise executed by one or more computer processors, which may include the processors of a control system  112 . 
     Display system  110  may also display an image of the surgical site and medical instruments captured by the visualization system. In some examples, teleoperated medical system  100  may configure medical instrument  104  and controls of master assembly  106  such that the relative positions of the medical instruments are similar to the relative positions of the eyes and hands of operator O. In this manner operator O can manipulate medical instrument  104  and the hand control as if viewing the workspace in substantially true presence. By true presence, it is meant that the presentation of an image is a true perspective image simulating the viewpoint of an operator that is physically manipulating medical instrument  104 . 
     In some examples, display system  110  may present images of a surgical site recorded pre-operatively or intra-operatively using image data from imaging technology such as, computed tomography (CT), magnetic resonance imaging (MM), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, and/or the like. The pre-operative or intra-operative image data may be presented as two-dimensional, three-dimensional, or four-dimensional (including e.g., time based or velocity based information) images and/or as images from models created from the pre-operative or intra-operative image data sets. 
     In some embodiments, often for purposes of imaged guided surgical procedures, display system  110  may display a virtual navigational image in which the actual location of medical instrument  104  is registered (i.e., dynamically referenced) with the preoperative or concurrent images/model. This may be done to present the operator O with a virtual image of the internal surgical site from a viewpoint of medical instrument  104 . In some examples, the viewpoint may be from a distal tip of medical instrument  104 . Some embodiments may display both a virtual navigational image and a captured image, which correspond when the model is accurately registered to the patient during the procedure. An image of the tip of medical instrument  104  and/or other graphical or alphanumeric indicators may be superimposed on the virtual image to assist operator O controlling medical instrument  104 . In some examples, medical instrument  104  may not be visible in the virtual image. 
     In some embodiments, display system  110  may display a virtual navigational image in which the actual location of medical instrument  104  is registered with preoperative or concurrent images to present the operator O with a virtual image of medical instrument  104  within the surgical site from an external viewpoint. An image of a portion of medical instrument  104  or other graphical or alphanumeric indicators may be superimposed on the virtual image to assist operator  0  in the control of medical instrument  104 . As described herein, visual representations of data points may be rendered to display system  110 . For example, measured data points, moved data points, registered data points, and other data points described herein may be displayed on display system  110  in a visual representation. The data points may be visually represented in a user interface by a plurality of points or dots on display system  110  or as a rendered model, such as a mesh or wire model created based on the set of data points. In some examples, the data points may be color coded according to the data they represent. In some embodiments, a visual representation may be refreshed in display system  110  after each processing operation has been implemented to alter data points. 
     Teleoperated medical system  100  may also include a control system  112 . Control system  112  includes at least one memory and at least one computer processor (not shown) for effecting control between medical instrument  104 , master assembly  106 , sensor system  108 , and display system  110 , and/or other components of the medical system  100 . Control system  112  also includes programmed instructions (e.g., a non-transitory machine-readable medium storing the instructions) to implement some or all of the methods described in accordance with aspects disclosed herein, including instructions for providing information to display system  110 . While control system  112  is shown as a single block in the simplified schematic of  FIG.  1   , the system may include two or more data processing circuits with one portion of the processing optionally being performed on or adjacent to teleoperational manipulator assembly  102 , another portion of the processing being performed at master assembly  106 , and/or the like. The processors of control system  112  may execute instructions comprising instruction corresponding to processes disclosed herein and described in more detail below. Any of a wide variety of centralized or distributed data processing architectures may be employed. Similarly, the programmed instructions may be implemented as a number of separate programs or subroutines, or they may be integrated into a number of other aspects of the teleoperational systems described herein. In one embodiment, control system  112  supports wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and Wireless Telemetry. 
     In some embodiments, control system  112  may receive force and/or torque feedback from medical instrument  104 . Responsive to the feedback, control system  112  may transmit signals to master assembly  106 . In some examples, control system  112  may transmit signals instructing one or more actuators of teleoperational manipulator assembly  102  to move medical instrument  104 . Medical instrument  104  may extend into an internal surgical site within the body of patient P via openings in the body of patient P. Any suitable conventional and/or specialized actuators may be used. In some examples, the one or more actuators may be separate from, or integrated with, teleoperational manipulator assembly  102 . In some embodiments, the one or more actuators and teleoperational manipulator assembly  102  are provided as part of a teleoperational cart positioned adjacent to patient P and operating table T. 
     Control system  112  may optionally further include a virtual visualization system to provide navigation assistance to operator O when controlling medical instrument  104  during an image-guided surgical procedure. Virtual navigation using the virtual visualization system may be based upon reference to an acquired preoperative or intraoperative dataset of anatomic passageways. The virtual visualization system processes images of the surgical site imaged using imaging technology such as computerized tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, and/or the like. Software, which may be used in combination with manual inputs, is used to convert the recorded images into segmented two dimensional or three dimensional composite representation of a partial or an entire anatomic organ or anatomic region. An image data set is associated with the composite representation. The composite representation and the image data set describe the various locations and shapes of the passageways and their connectivity. The images used to generate the composite representation may be recorded preoperatively or intra-operatively during a clinical procedure. In some embodiments, a virtual visualization system may use standard representations (i.e., not patient specific) or hybrids of a standard representation and patient specific data. The composite representation and any virtual images generated by the composite representation may represent the static posture of a deformable anatomic region during one or more phases of motion (e.g., during a respiration cycle of a lung). 
     During a virtual navigation procedure, sensor system  108  may be used to compute an approximate location of medical instrument  104  with respect to the anatomy of patient P. The location can be used to produce both macro-level (external) tracking images of the anatomy of patient P and virtual internal images of the anatomy of patient P. The system may implement one or more electromagnetic (EM) sensors, fiber optic sensors, and/or other sensors to register and display a medical implement together with preoperatively recorded surgical images, such as those from a virtual visualization system, are known. For example U.S. patent application Ser. No. 13/107,562 (filed May 13, 2011) (disclosing “Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery”) which is incorporated by reference herein in its entirety, discloses one such system. Teleoperated medical system  100  may further include optional components and support systems (not shown) such as illumination systems, steering control systems, irrigation systems, and/or suction systems. In some embodiments, teleoperated medical system  100  may include more than one teleoperational manipulator assembly and/or more than one master assembly. The exact number of teleoperational manipulator assemblies will depend on the surgical procedure and the space constraints within the operating room, among other factors. Master assembly  106  may be collocated with the manipulator assembly/assemblies or they may be positioned in separate locations. Multiple master assemblies allow more than one operator to control one or more teleoperational manipulator assemblies in various combinations. 
       FIG.  2 A  is a simplified diagram of a medical instrument system  200  according to some embodiments. In some embodiments, medical instrument system  200  may be used as medical instrument  104  in an image-guided medical procedure performed with teleoperated medical system  100 . In some examples, medical instrument system  200  may be used for non-teleoperational exploratory procedures or in procedures involving traditional manually operated medical instruments, such as endoscopy. Optionally, medical instrument system  200  may be used to gather (i.e., measure) a set of data points corresponding to locations within anatomic passageways of a patient, such as patient P. 
     The medical instrument system  200  of  FIG.  2 A and  2 B  includes elongate device  202 , such as a flexible catheter, coupled to a drive unit  204 . The drive unit  204  may include a plurality of actuators that can be controlled to steer a distal portion of the elongate device. Elongate device  202  includes a flexible body  216  having proximal end  217  and distal end  218 . In some embodiments, flexible body  216  has an approximately 3 mm outer diameter. Other flexible body outer diameters may be larger or smaller. 
     Medical instrument system  200  further includes a tracking system  230  for determining the position, orientation, speed, velocity, pose, and/or shape of distal end  218  and/or of one or more segments  224  along flexible body  216  using one or more sensors and/or imaging devices as described in further detail below. The entire length of flexible body  216 , between distal end  218  and proximal end  217 , may be effectively divided into segments  224 . If medical instrument system  200  is consistent with medical instrument  104  of a teleoperated medical system  100 , tracking system  230  may be included as a subsystem of the control system  112 . Thus, tracking system  230  may optionally be implemented as hardware, firmware, software or a combination thereof, which interact with or are otherwise executed by one or more computer processors, which may include the processors of control system  112  in  FIG.  1   . 
     Tracking system  230  may optionally track distal end  218  and/or one or more of the segments  224  using a shape sensor  222 . Shape sensor  222  may optionally include an optical fiber aligned with flexible body  216  (e.g., provided within an interior channel (not shown) or mounted externally). In one embodiment, the optical fiber has a diameter of approximately 200 μm. In other embodiments, the dimensions may be larger or smaller. The optical fiber of shape sensor  222  forms a fiber optic bend sensor for determining the shape of flexible body  216 . In one alternative, multiple optical fiber cores including Fiber Bragg Gratings (FBGs) are used to provide strain measurements in structures in one or more dimensions. Various systems and methods for monitoring the shape and relative position of an optical fiber in three dimensions are described in U.S. patent application Ser. No. 11/180,389 (filed Jul. 13, 2005) (disclosing “Fiber optic position and shape sensing device and method relating thereto”); U.S. patent application Ser. No. 12/047,056 (filed on Jul. 16, 2004) (disclosing “Fiber-optic shape and relative position sensing”); and U.S. Pat. No. 6,389,187 (filed on Jun. 17, 1998) (disclosing “Optical Fibre Bend Sensor”), which are all incorporated by reference herein in their entireties. Sensors in some embodiments may employ other suitable strain sensing techniques, such as Rayleigh scattering, Raman scattering, Brillouin scattering, and Fluorescence scattering. In some embodiments, the shape of the elongate device may be determined using other techniques. For example, a history of the distal end pose of flexible body  216  can be used to reconstruct the shape of flexible body  216  over the interval of time. In some embodiments, tracking system  230  may optionally and/or additionally track distal end  218  using a position sensor system  220 . Position sensor system  220  may be a component of an EM sensor system with positional sensor system  220  including one or more conductive coils that may be subjected to an externally generated electromagnetic field. Each coil of EM sensor system  220  then produces an induced electrical signal having characteristics that depend on the position and orientation of the coil relative to the externally generated electromagnetic field. In some embodiments, position sensor system  220  may be configured and positioned to measure six degrees of freedom, e.g., three position coordinates X, Y, Z and three orientation angles indicating pitch, yaw, and roll of a base point or five degrees of freedom, e.g., three position coordinates X, Y, Z and two orientation angles indicating pitch and yaw of a base point. Further description of a position sensor system is provided in U.S. Pat. No. 6,380,732 (filed Aug. 11, 1999) (disclosing “Six-Degree of Freedom Tracking System Having a Passive Transponder on the Object Being Tracked”), which is incorporated by reference herein in its entirety. 
     In some embodiments, tracking system  230  may alternately and/or additionally rely on historical pose, position, or orientation data stored for a known point of an instrument system along a cycle of alternating physiological motion, such as breathing. This stored data may be used to develop shape information about flexible body  216 . In some examples, a series of positional sensors (not shown), such as electromagnetic (EM) sensors similar to the sensors in position sensor  220  may be positioned along flexible body  216  and then used for shape sensing. In some examples, a history of data from one or more of these sensors taken during a procedure may be used to represent the shape of elongate device  202 , particularly if an anatomic passageway is generally static. 
     Flexible body  216  includes a channel  221  sized and shaped to receive a medical instrument  226 .  FIG.  2 B  is a simplified diagram of flexible body  216  with medical instrument  226  extended according to some embodiments. In some embodiments, medical instrument  226  may be used for procedures such as surgery, biopsy, ablation, illumination, irrigation, or suction. Medical instrument  226  can be deployed through channel  221  of flexible body  216  and used at a target location within the anatomy. Medical instrument  226  may include, for example, image capture probes, biopsy instruments, laser ablation fibers, and/or other surgical, diagnostic, or therapeutic tools. Medical tools may include end effectors having a single working member such as a scalpel, a blunt blade, an optical fiber, an electrode, and/or the like. Other end effectors may include, for example, forceps, graspers, scissors, clip appliers, and/or the like. Other end effectors may further include electrically activated end effectors such as electrosurgical electrodes, transducers, sensors, and/or the like. In various embodiments, medical instrument  226  is a biopsy instrument, which may be used to remove sample tissue or a sampling of cells from a target anatomic location. Medical instrument  226  may be used with an image capture probe also within flexible body  216 . In various embodiments, medical instrument  226  may be an image capture probe that includes a distal portion with a stereoscopic or monoscopic camera at or near distal end  218  of flexible body  216  for capturing images (including video images) that are processed by a visualization system  231  for display and/or provided to tracking system  230  to support tracking of distal end  218  and/or one or more of the segments  224 . The image capture probe may include a cable coupled to the camera for transmitting the captured image data. In some examples, the image capture instrument may be a fiber-optic bundle, such as a fiberscope, that couples to visualization system  231 . The image capture instrument may be single or multi-spectral, for example capturing image data in one or more of the visible, infrared, and/or ultraviolet spectrums. Alternatively, medical instrument  226  may itself be the image capture probe. Medical instrument  226  may be advanced from the opening of channel  221  to perform the procedure and then retracted back into the channel when the procedure is complete. Medical instrument  226  may be removed from proximal end  217  of flexible body  216  or from another optional instrument port (not shown) along flexible body  216 . 
     Medical instrument  226  may additionally house cables, linkages, or other actuation controls (not shown) that extend between its proximal and distal ends to controllably the bend distal end of medical instrument  226 . Steerable instruments are described in detail in U.S. Pat. No. 7,316,681 (filed on Oct. 4, 2005) (disclosing “Articulated Surgical Instrument for Performing Minimally Invasive Surgery with Enhanced Dexterity and Sensitivity”) and U.S. patent application Ser. No. 12/286,644 (filed Sep. 30, 2008) (disclosing “Passive Preload and Capstan Drive for Surgical Instruments”), which are incorporated by reference herein in their entireties. 
     Flexible body  216  may also house cables, linkages, or other steering controls (not shown) that extend between drive unit  204  and distal end  218  to controllably bend distal end  218  as shown, for example, by broken dashed line depictions  219  of distal end  218 . In some examples, at least four cables are used to provide independent “up-down” steering to control a pitch of distal end  218  and “left-right” steering to control a yaw of distal end  281 . Steerable elongate devices are described in detail in U.S. patent application Ser. No. 13/274,208 (filed Oct. 14, 2011) (disclosing “Catheter with Removable Vision Probe”), which is incorporated by reference herein in its entirety. In embodiments in which medical instrument system  200  is actuated by a teleoperational assembly, drive unit  204  may include drive inputs that removably couple to and receive power from drive elements, such as actuators, of the teleoperational assembly. In some embodiments, medical instrument system  200  may include gripping features, manual actuators, or other components for manually controlling the motion of medical instrument system  200 . Elongate device  202  may be steerable or, alternatively, the system may be non-steerable with no integrated mechanism for operator control of the bending of distal end  218 . In some examples, one or more lumens, through which medical instruments can be deployed and used at a target surgical location, are defined in the walls of flexible body  216 . 
     In some embodiments, medical instrument system  200  may include a flexible bronchial instrument, such as a bronchoscope or bronchial catheter, for use in examination, diagnosis, biopsy, or treatment of a lung. Medical instrument system  200  is also suited for navigation and treatment of other tissues, via natural or surgically created connected passageways, in any of a variety of anatomic systems, including the colon, the intestines, the kidneys and kidney calices, the brain, the heart, the circulatory system including vasculature, and/or the like. 
     The information from tracking system  230  may be sent to a navigation system  232  where it is combined with information from visualization system  231  and/or the preoperatively obtained models to provide the operator or other operator with real-time position information. In some examples, the real-time position information may be displayed on display system  110  of  FIG.  1    for use by the operator O in the control of medical instrument system  200 . In some examples, control system  112  of  FIG.  1    may utilize the position information as feedback for positioning medical instrument system  200 . Various systems for using fiber optic sensors to register and display a surgical instrument with surgical images are provided in U.S. patent application Ser. No. 13/107,562, filed May 13, 2011, disclosing, “Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery,” which is incorporated by reference herein in its entirety. 
       FIG.  2 C  illustrates a medical instrument system  250 , which may be used as the medical instrument system  104  in a medical procedure performed with teleoperated medical system  100 .  FIG.  2 C  is a perspective view of a manipulator  252  of a control arm that may be mounted to or incorporated into the manipulator assembly  102  of  FIG.  1   . The medical instrument system  250  includes a kinematic chain made up of a plurality of joints. At least some of the joint in the kinematic chain include joint sensors or encoders that can communicate with the control system  112  of  FIG.  1    to provide joint sensor data to facilitate monitoring and control of the medical instrument system  250 . 
     The manipulator  252  includes a yaw servo joint  254 , a pitch servo joint  256 , and an insertion and withdrawal (“I/O”) actuator  258 . A surgical instrument  259  is shown mounted at an instrument spar  260  including a mounting carriage  261 . An illustrative straight cannula  262  is shown mounted to cannula mount  264 . Shaft  266  of instrument  259  extends through cannula  262 . Manipulator  252  is mechanically constrained so that it moves instrument  259  around a stationary remote center of motion located along the instrument shaft. Yaw servo joint  254  provides yaw motion  270 , pitch joint  256  provides pitch motion  272 , and I/O actuator  258  provides insertion and withdrawal motion  274  through the remote center. The manipulator  252  may include an encoder to track position and velocity associated with servo positions along the insertion axis of the I/O actuator  258  and other encoders to track position and velocity of yaw servo joint  254  and pitch servo joint  256 . 
     Matching force transmission disks in mounting carriage  261  and instrument force transmission assembly  276  couple actuation forces from actuators in manipulator  252  to move various parts of instrument  259  in order to position and orient a probe  278  mounted at the distal end of the curved shaft  266 . Such actuation forces may typically roll instrument shaft  266  (thus providing another DOF through the remote center). The amount of roll may be tracked via an encoder. In alternative embodiments, the instrument  259  may include a wrist at the distal end of the shaft that provides additional yaw and pitch DOF&#39;s. The probe  278  may be, for example, a vision probe, such as a stereoscopic imaging catheter having a stereoscopic camera or a three-dimensional, structured light scanner that can be introduced and positioned via the manipulator  252 . 
     In some examples, medical instrument system  200  or the medical instrument system  250  may be teleoperated within the context of the medical system  100  of  FIG.  1    as the manipulator assembly  102  or a component thereof In some embodiments, teleoperational manipulator assembly  102  of  FIG.  1    may be replaced by direct operator control. In some examples, the direct operator control may include various handles and operator interfaces for hand-held operation of the instrument. 
       FIGS.  3 A and  3 B  are simplified diagrams of side views of a patient coordinate space including a medical instrument mounted on an insertion assembly according to some embodiments. As shown in  FIGS.  3 A and  3 B , a surgical environment  300  includes the patient P is positioned on the operating table T. Patient P may be stationary within the surgical environment in the sense that gross patient movement is limited by sedation, restraint, and/or other means. Cyclic anatomic motion including respiration and cardiac motion of patient P may continue, unless patient is asked to hold his or her breath to temporarily suspend respiratory motion. Accordingly, in some embodiments, data may be gathered at a specific, phase in respiration, and tagged and identified with that phase. In some embodiments, the phase during which data is collected may be inferred from physiological information collected from patient P. Within surgical environment  300 , a medical instrument  304  is coupled to an instrument carriage  306 . The medical instrument  304  may be provided by the medical instrument system  200  of  FIGS.  2 A and  2 B . In some embodiments, medical instrument  304  may use EM sensors, shape-sensors, and/or other sensor modalities. Instrument carriage  306  is mounted to an insertion stage  308  fixed within surgical environment  300 . Alternatively, insertion stage  308  may be movable but have a known location (e.g., via a tracking sensor or other tracking device) within surgical environment  300 . Instrument carriage  306  may be a component of a teleoperational manipulator assembly (e.g., teleoperational manipulator assembly  102 ) that couples to medical instrument  304  to control insertion motion (i.e., motion along the A axis) and, optionally, motion of a distal end  318  of an elongate device  310  in multiple directions including yaw, pitch, and roll. The elongate device  310  may be a flexible, steerable catheter. Instrument carriage  306  or insertion stage  308  may include actuators, such as servomotors, (not shown) that control motion of instrument carriage  306  along insertion stage  308 . 
     Elongate device  310  is coupled to an instrument body  312 . Instrument body  312  is coupled and fixed relative to instrument carriage  306 . In some embodiments, an optical fiber shape sensor  314  is fixed at a proximal point  316  on instrument body  312 . In some embodiments, proximal point  316  of optical fiber shape sensor  314  may be movable along with instrument body  312  but the location of proximal point  316  may be known (e.g., via a tracking sensor or other tracking device). Shape sensor  314  measures a shape from proximal point  316  to another point such as distal end  318  of elongate device  310 . Medical instrument  304  may be substantially similar to medical instrument system  200 . 
     A position measuring device  320  provides information about the position of instrument body  312  as it moves on insertion stage  308  along an insertion axis A. Position measuring device  320  may include resolvers, encoders, potentiometers, and/or other sensors that determine the rotation and/or orientation of the actuators controlling the motion of instrument carriage  306  and consequently the motion of instrument body  312 . In some embodiments, insertion stage  308  is linear. In some embodiments, insertion stage  308  may be curved or have a combination of curved and linear sections. 
       FIG.  3 A  shows instrument body  312  and instrument carriage  306  in a retracted position along insertion stage  308 . In this retracted position, proximal point  316  is at a position Lo on axis A. In this position along insertion stage  308  an A component of the location of proximal point  316  may be set to a zero and/or another reference value to provide a base reference to describe the position of instrument carriage  306 , and thus proximal point  316 , on insertion stage  308 . With this retracted position of instrument body  312  and instrument carriage  306 , distal end  318  of elongate device  310  may be positioned just inside an entry orifice of patient P. Also in this position, position measuring device  320  may be set to a zero and/or the another reference value (e.g., I=0). In  FIG.  3 B , instrument body  312  and instrument carriage  306  have advanced along the linear track of insertion stage  308  and distal end  318  of elongate device  310  has advanced into patient P. In this advanced position, the proximal point  316  is at a position Li on the axis A. In some examples, encoder and/or other position data from one or more actuators controlling movement of instrument carriage  306  along insertion stage  308  and/or one or more position sensors associated with instrument carriage  306  and/or insertion stage  308  is used to determine the position L x  of proximal point  316  relative to position L 0 . In some examples, position L x  may further be used as an indicator of the distance or insertion depth to which distal end  318  of elongate device  310  is inserted into the passageways of the anatomy of patient P. 
       FIG.  4    is a flowchart of a method  400  of monitoring patient motion during a medical procedure to detect motion of the patient undergoing the procedure. The method  400  may utilize a medical instrument having a primary purpose other than patient motion monitoring. As illustrated in  FIG.  4   , the method  400  includes several enumerated steps or operations, which may be performed in the illustrated sequence. Embodiments of the method  400  may include additional or alternative operations before, after, in between, or as part of the enumerated operations. Some embodiments of the method  400  may omit one or more of the enumerated operations. Furthermore, embodiments of the method  400  may include executable instructions stored on a computer-readable medium and executed by a processor, such as a processor of the control system  112  of  FIG.  1   , to perform the operations of method  400 . 
     Accordingly, an embodiment of the method  400  may begin at operation  402  in which state information may be received from a control system in communication with the medical instrument. At operation  404 , the control system may detect motion of at least a portion of the medical instrument. The control system may compare the motion of the portion of the medical instrument with a threshold motion value that is based on the state information received from the control system, at operation  406  to determine patient motion. Based on the determination of patient motion based on the comparison of the detected motion with the threshold motion value, the control system may provide one or more system responses. At operation  408 , the control system may generate a communication for rendering in a display system based on the comparison of the motion with the threshold motion value and determination of patient motion. And at operation  410 , the control system may alter control of the medical instrument based on the comparison. 
     To better explain embodiments of the method  400 , reference is made herein to additional  FIGS.  5 A-C  and  6 A-B, which relate to the positioning of the elongate device  310  of  FIGS.  3 A and  3 B  through anatomic passageways  502  of the lungs  500  of the patient P of  FIGS.  1  and  3   . These passageways  502  include the trachea and the bronchial airways. As shown in  FIGS.  3 A and  3 B , as the carriage  306  moves along the insertion stage  308 , the elongate device  310  is advanced within the anatomic passageways  502  of the lungs  500 . To navigate the elongate device  310  within the lungs  500 , the operator O may steer the distal end  318  of the elongate device  310  while directing the movement of the carriage  306  along the insertion axis A. In navigating through the anatomic passageways  502  (i.e., in a drive state or drive mode), the elongate device  310  assumes a shape that may be measured by the shape sensor  314  extending within the elongate device  310 . The control system  112  may also interrogate the shape sensor  314  and/or additional sensors that may provide shape and/or positional information (such as electromagnetic systems and/or joint sensors) when the elongate device  310  is in a parked state or parked mode in which no movement commands are received via the master assembly  106  from the operator O. At operation  402 , the state of the medical system  100  may be received by the control system  112  from state information indicating which of several possible states is currently implemented. In addition to the parked state and the drive state, the medical system  100  may have a treatment state in which a medical treatment is being applied to the patient anatomy proximate the distal end  318  of the elongate device  310 . For example, the medical treatment may be the insertion of a biopsy needle, an ablation process, a cauterization process, an imaging process, an injection or drug delivery process, or any other medical treatment. 
     As described herein, in order to navigate to a desired location, the teleoperated medical system  100  may provide real-time imaging to the operator O. The real-time images may be captured images. In some embodiments, an image capture device is positioned at the distal end  318  of the elongate device  310 . The real-time images may be simulated or virtual images rendered based on a computer model derived from preoperative images or intraoperative images. The virtual images may depict the elongate device  310  in images that show an external perspective of the patient P. Additionally, the virtual images may depict a representation of the interior surfaces of the passageways  502  of the lung  500  from a perspective determined by the position and orientation of the distal and  318  of the elongate device  310 . Such imaging is discussed in more detail in connection with  FIGS.  6 A and  6 B , described further below. 
     At operation  404 , the control system  112  may detect motion of at least a portion of the elongate device  310 . Motion may be detected by monitoring for a change in the position of the elongate device  310  over time. For example, the position of the elongate device  310  may be sampled  10  times per second,  100  times per second, or at another suitable frequency. As shown in  FIG.  5 B , the distal tip  318  of the elongate device  310  has moved from a first position  504 A to a second position  504 B. This motion may be quantified using information from the fiber optic shape sensor  314 , an electromagnetic position sensor, or by comparison of optical images obtained within the anatomical passageways  502 . The control system  112  may compare the movement between the first and second positions  504  with a threshold movement value. The threshold movement value may be implemented by the control system  112  to prevent false identification of movement of the distal end  318  as patient movement. For example, due to temperature fluctuations or other minor changes, a change in the indicated position of the distal tip  318 , or another portion of the elongate device  310 , may be registered without any significant positional change or movement taking place. 
     As illustrated in  FIG.  5 B , the threshold movement value may be determined relative to the direction of movement. As shown, lateral movement of the distal tip  318  may have a lateral threshold movement value  506 A in a lateral direction, while the insertion/withdrawal (I/O) movement may have an insertion threshold movement value  506 B along a direction along the insertion axis of the elongate device. As illustrated, the lateral threshold movement value  506 A may be less than the  1 / 0  threshold movement value  506 B, in some embodiments. Additionally, the magnitude of the threshold movement values  506  may be dependent upon the state of the medical system  100 . For example, when the state information received at operation  402  indicates that the medical system  100  (or the manipulator assembly  102  thereof) is in a parked state, the magnitude of the threshold movement values  506  may be smaller than when the state information indicates a drive state. Furthermore, the threshold movement value may be realized as a shape in three-dimensions around the distal tip  318 , in some embodiments. Thus, a given movement of the distal tip  318  in Cartesian X, Y, and Z coordinates that moves beyond that three-dimensional threshold may be regarded by the control system  112  as indicative of patient motion. The shape may be circular, ovoid, rectangular, symmetric, asymmetric, or otherwise shaped. The three-dimensional threshold shape may be defined in part by the threshold movement values  506  and be a function thereof. In some embodiments, frequency of detected movement and threshold movement may be quantified and compared alternatively or in addition to magnitude of detected and threshold movements to determine patient motion. 
     In general, actual movement of the elongate device  310  may occur when the medical system  100  is in the parked state due to cyclical physiological motion, such as respiratory motion in the lung  500 . In other embodiments, cardiac motions may be detected from shape/position information obtained from the elongate device  310 . Such expected natural motions may be considered by the control system  112  when identifying patient motion. In order to avoid incorrectly triggering the control system  112  to identify motion of the patient P due to expected physiological movement, the threshold movement values  506  associated with the parked state may be sufficient to account for such physiological motion. The shape/position information obtained from the elongate device  310  during the parked state may be used to identify and quantify physiological motion such as from heartbeat or respiration. For example, shape/position information may be collected over a period of time and when identified as cyclical or periodic, can be considered physiological motion. The frequency and/or magnitude of the periodic motion can be used to help determine a value for threshold movement values used to establish patient motion. In additional embodiments, because the effect of physiological motion may depend upon the position of the elongate device  310 , the magnitude of the threshold movement values  506  may be based on an insertion depth or a three-dimensional position of the distal tip  318 . For example, because the main bronchii of the lungs  500  may move less than the bottom lobe of the lungs  500  during normal respiration, the threshold movement values may be lower when the portion of the elongate device  310  being monitored is positioned within the main bronchii than when it is positioned more deeply in the lungs  500 . In alternative embodiments, physiological motion can be detected using separate sensors or equipment such as a respiratory monitor, monitoring an artificial respirator, monitoring an electro-cardiogram of the patient, monitoring thoracic movement of the patient using a movement pad, and/or the like. 
     As shown in  FIG.  5 B , the distal tip  318  has moved a distance greater than the lateral threshold movement value  506 A. Consequently, when the control system  112  compares the movement of the distal tip  318  with the lateral threshold movement value  506 A at operation  406 , the control system  112  may detect the movement as indicative of significant movement of the patient P. 
     Referring now to  FIG.  5 C , patient motion may be detected during a drive state as well. As noted above, the threshold movement values  506  may be different when the medical system  100  is in a drive state than when the medical system  100  is in a parked state. Additionally, when the medical system  100  is in a parked state as indicated by state information received at operation  402 , the control system  112  may receive and analyze movement commands from the operator O as provided via the master assembly  106 . For example, prior to receipt of a movement command, the distal tip  318  of the elongate device  310  may be in a first position  508 A. A received movement command may be represented by the commanded motion vector  510 . In other words, the movement command received from the operator O is intended to and should direct the distal tip  318  (and the trailing portions of the elongate device  310 ) to move as indicated by the vector  510 , e.g. toward the wall at the first branch point in the bronchus. 
     Instead, the distal tip  318  moves to a second position  508 B, as shown in  FIG.  5 C . This movement may be calculated by the control system  112  as the actual motion vector  512 , which is different than the commanded motion vector  510 . Because the state information indicates that the medical system  100  is in a drive state, the control system  112  may compare the commanded motion vector  510  with the actual motion vector  512  and determine a difference therebetween. When the difference between the commanded motion vector  510  and the actual motion vector  512  exceeds a threshold motion value, the control system  112  may determine that some motion of patient P has occurred. In some embodiments, actuator current or torque may be measured and compared to the actual motion vector  512 . The comparison can be evaluated against a threshold actuator value to determine patient motion. For example, actuators may apply an amount of torque to hold or move the elongate device  310  at or to a desired position. If the elongate device  310  made contact with tissue during patient motion, the amount of torque required for the desired motion would be increased above the threshold actuator value indicating patient movement. 
     Referring now to  FIGS.  6 A and  6 B , shown therein are images that may be used by the control system  112  to determine a motion of the distal tip  318  of the elongate device  310 .  FIG.  6 A  includes an image  600 A that represents a virtual view from the distal tip  318 . This virtual view is an interior view of a model of the lungs  500 , such as a surface model derived from preoperative or intraoperative medical images, such as a CT scan.  FIG.  6 B  includes an image  600 B that represents an actual view obtained by an image capture device positioned at the distal tip  318  of the elongate device  310  positioned within lungs  500 . The control system  112  may select to the virtual view of image  600 A based on the state indicated by the received state information, in some embodiments. For example, when the medical system  100  is in a parked state, a position and orientation of the distal tip  318  of the elongate device  310  may be used to generate a virtual view of the three-dimensional surface model of the lungs from the perspective indicated by the position and orientation. When the medical system  100  is in a drive state, the control system  112  may generate and use a predicted perspective of the distal tip  318 , so that the actual image  600 B may be compared with the portion of the surface model that should be in view at a given time based on the commanded motion of the distal tip  318 . The control system  112  may utilize image processing techniques to compare the virtual view of the image  600 A with the actual view of the image  600 B. Depending on the relationship between the images  600 , the control system  112  may be able to estimate a difference in the perspectives therebetween. 
     In some embodiments, the control system  112  may search the model to find an image best corresponding to the actual image  600 B and then calculate a difference in position and orientation therebetween. The position of the expected image  600 A and the position of the searched-for image identified in the model corresponding best to the actual image  600 B may be calculated by the control system  112 . Additionally, the control system  112  may compare the actual image  600 B with the virtual image  600 A to determine a difference in position and/or orientation therebetween. The difference in position may be used by the control system  112  to determine a motion of the distal tip  318 . This motion may then be compared with a threshold motion value to determine whether the patient P has moved significantly. 
     In some embodiments, both the images  600 A and  600 B may be actual images. For example, the image  600 A may be an image obtained before a degree of motion is detected while the image  600 B may be an image obtained after that degree of motion is detected. The control system  112  may compare the images  600  with virtual views obtained from the model of the lungs  500 . For example, the control system  112  may utilize the images  600  to search for matching images provided by virtual views in an area close to the distal tip  318 . When matches of both the images  600  are identified, a vector between positions associated with the matched images in the model of lungs  500  may be used to identify motion of the distal tip  318 . This identified motion vector may be compared with a threshold motion value in an embodiment of the operation  406  of method  400  to determine significant patient movement. 
     In some additional embodiments, more than one motion sensing modality may be used in detecting patient motion in order to improve accuracy. For example, information from both the shape sensor  314  (a first motion detecting modality) and image processing (a second motion detecting modality) may be used to determine that a patient motion has occurred. In some embodiments, thresholds may be set such that if either of two sensing modalities indicates motion, then the control system  112  takes steps to mitigate the motion. Additionally, other embodiments may include thresholds that are lower and are required to be exceeded for multiple modalities before the control system  112  identifies patient motion. 
     As described herein, reference is frequently made to motion of the patient P. Some embodiments of the present disclosure provide for the detection of motion of the patient P relative to the patient coordinate frame, the detection of motion of a portion of the patient P with respect to another portion (e.g., motion of the lungs relative to the trachea), and/or the detection of motion of the patient P relative to the medical system  100  itself. Some other embodiments of the present disclosure provide for the detection of motion of the patient P by detecting motion of the medical system  100  relative to the patient P. Thus, motion of the patient P as used herein may refer to relative motion between the body of the patient P and the medical instrument  104  and/or the manipulator assembly  102 , regardless of whether it is the body of the patient P that moves or whether it is the medical instrument  104  or manipulator  102  that moves. 
     In some instances, the operator O or another person present in the vicinity of the medical instrument  104  and/or the manipulator assembly  102  may cause motion of the medical instrument  104  and/or the manipulator assembly  102 . For example, the operator O may accidentally bump the instrument  104 , causing motion of the distal tip of the elongate device  310 . This accidental bumping of the instrument  104  may thus be interpreted by the control system  112  as patient motion. The control system  112  may automatically perform one or more operations to prevent harm from resulting from this patient motion. For example, the operator O may bump the medical instrument system  250  of  FIG.  2 C . The encoders at the servo joints  254  and  256  may report motion or a change in position to the control system  112 . That motion would be compared with expected motion, whether in a parked state or a drive state, to determine whether or not the patient has moved. Thus, motion of components of the medical system  100  relative to patient P may be detected and responded to by the control system  112  as motion of the patient P. 
     Referring now to  FIG.  7   , an exemplary endotracheal (ET) tube  700  is illustrated as positioned within the patient P to facilitate insertion of the elongate device  310  into the lungs  500  of the patient P. A cross-sectioned portion  702  shows a portion of the elongate device  310  extending within the ET tube  700 . The geometry of the ET tube  700  may be provided to the control system  112  so that a bend  704  of the ET tube  700  may be known to the control system  112 . Even if a bend  704  in the tube is not precisely known, the curvature may be sufficiently distinctive to be identified in shape data as corresponding to the upper respiratory track and trachea because the portion of the elongate device  310  at the proximal end of the ET tube  700  forms a known angle (nearly) 90 ° with respect to the portion of the elongate device  310  at the distal end of the ET tube  700 . The pose of the proximal end of the elongate device  310  may be known due to sensors extending therein, like the optical fiber shape sensor  314  in the illustrated embodiment. Based on this shape information and known curvature of the ET tube  700 , the trachea of the patient P may be identified. During a medical procedure within the lungs, the trachea of the patient P may be unlikely to move due to the presence of the elongate device  310 . Accordingly, the portion of the elongate device  310  positioned within the ET tube  700  at any given time may be monitored in order to identify any motion of the patient P. When motion of this portion of the elongate device  310  is detected by the control system  112 , the motion is likely to be interpreted by the control system  112  as indicative of patient motion. In other words, a threshold motion value associated with the endotracheal tube  700  may be smaller than a threshold motion values used to detect patient motion at the distal tip  318  of the elongate device  310 . 
     Some embodiments of the ET tube  700  may include a known shape feature, such as the perturbation  706  shown near the distal end of the ET tube  700 . The perturbation  706  may be a small undulation or other feature that may be readily detected by the control system  112  from the shape information received from the elongate device  310 . In such embodiments, the portion of the elongate device  310  disposed within the perturbation  706  may be monitored to detect patient motion as described herein. Other embodiments of the method  400  of  FIG.  4    may rely on other structures in detecting motion of at least a portion of the medical instrument that is indicative of patient motion. 
     Returning again to  FIG.  4   , after motion of the portion of the medical instrument as compared with a threshold motion value or several threshold motion values, the control system  112  may generate a communication or message for rendering or presentation in the display system  110  based on the comparison and determination of significant patient movement performed at operation  406 . At operation  408 , the message may be generated and rendered in a display as shown in  FIG.  8   .  FIG.  8    depicts an embodiment of the display system  110  which includes a rendering of a graphical user interface  800 . As shown in  FIG.  8   , the user interface  800  includes a rendering of the lungs  500 , which may be a surface model derived from preoperative or intraoperative image data or a rendering of the image data itself. A model of the elongate device  310  is also rendered in the illustrated embodiment of the user interface  800 . An exemplary communication, patient motion message  802 , may be overlaid on the user interface  800  to communicate to the operator O that the patient P has moved or is likely to have moved is determined by the control system  112 . For example, the patient motion message  802  may include text (e.g. “Warning: patient motion detected!”) and/or graphical elements to communicate to the operator O. In some embodiments, the message may be displayed as a moving message or graphic across the bottom, middle, or top of a display. The patient motion message  802  may include one or more graphical user interface elements associated with options to be presented to the operator O. For example, the patient motion message  802  may include an interface element (e.g., a selectable button) associated with an option  804 A whereby the operator O may request that the control system  112  discard the existing registration and perform a new registration between the lungs  500  and a model of the lungs  500 . Selecting the option  804 A may also comprise a request to update an existing registration. The message  802  may include displaying a numerical value (or a graphical representation of the numerical value) indicating a detected magnitude of patient motion based on sensor measurements and/or differences in sequential images. In some embodiments, the patient motion message  802  may include an interface element associated with an option  804 B, the selection of which may cause the control system  112  to resume operation without updating the registration or performing a new registration. 
     Other communications or messages may be generated by the control system  112 . For example, the control system  112  may cause the screen or an element on the screen to flash or pulse. The message may include a sound emitted from a speaker coupled to the control system  112 , such as an alarm sound or a verbal message. The message may be interactive and provide options of some actions the operator O may take (for example, request an update to a registration or request a new registration) or to ignore the detected motion. In some implementations, the control system  112  may ignore or filter out any movement commands or end effector actuation commands, until the physician  0  acknowledges the alert message by pushing a physical button, a virtual button, or speaks a verbal command. 
     Some implementations of the method  400  may include an operation that identifies a magnitude of the difference between the motion of the portion of the medical instrument and the threshold motion value or values. A threshold control value may be applied such that ignoring the patient motion message  802  by selecting the option  804 B is permitted by the control system  112  only when the difference is below the threshold control value. When the difference is greater than a threshold control value, the option  804 B may not be presented to the operator O. Accordingly, a first intervention may be implemented by the control system  112  when a first level of difference is detected, while a second intervention may be implemented by the control system  112  when a second, higher level of difference is detected. Additionally, when the difference exceeds the threshold control value, the control system  112  may alter control of the medical instrument at operation  410 . For example, the control system  112  may ignore subsequent motion commands received from the master assembly  106  until a new registration is performed or an existing registration is updated. In this manner, the control system  112  may prevent the operator O from relying on a registration that is likely to be unreliable due to a relatively large motion of the patient P or of the medical system  100 . Similarly, any commands associated with the performance of a treatment, such as the performance of a biopsy with a biopsy needle protruding from the distal tip  318 , may be ignored until a reliable registration is provided to compensate for the motion of the patient P. 
     One of ordinary skill in the art may be able to identify combinations of disclosed embodiments and additional features that are within the scope of the present disclosure. Accordingly, the spirit and scope of the present disclosure may be best understood by reference to the following claims.