Source: http://www.google.com/patents/US20020191814?dq=6,666,377
Timestamp: 2016-06-29 03:58:36
Document Index: 574914450

Matched Legal Cases: ['art 106', 'art 106', 'art 107', 'art 107', 'art 106', 'art 106', 'art 106', 'art 106', 'art 107', 'art 107', 'art 106', 'art 106', 'art 106', 'art 107', 'art 106', 'art 106', 'art 106', 'art 403', 'art 106', 'art 403', 'art 403', 'art 403', 'art 106', 'art 403', 'art 107', 'art 106', 'art 106', 'art 106', 'art 106', 'art 403', 'art 106', 'art 106', 'art 107', 'art 106', 'art 107', 'art 106', 'art 403', 'art 106', 'art 403', 'art 106', 'art 107', 'art 106', 'art 403', 'art 106', 'art 107', 'art 106', 'arts 107', 'art 107', 'arts 107']

Patent US20020191814 - Apparatuses and methods for surgical navigation - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsImaging, object tracking, integration apparatus 100 has tracking system 1, imaging system 3, communication system 5 and integration system 7. Tracking system 1 locates objects in 3-dimensions and determines respective poses. Imaging system 3 acquires object images. Integration system 7 correlates 3-dimensional...http://www.google.com/patents/US20020191814?utm_source=gb-gplus-sharePatent US20020191814 - Apparatuses and methods for surgical navigationAdvanced Patent SearchPublication numberUS20020191814 A1Publication typeApplicationApplication numberUS 09/879,987Publication dateDec 19, 2002Filing dateJun 14, 2001Priority dateJun 14, 2001Also published asUS6990220Publication number09879987, 879987, US 2002/0191814 A1, US 2002/191814 A1, US 20020191814 A1, US 20020191814A1, US 2002191814 A1, US 2002191814A1, US-A1-20020191814, US-A1-2002191814, US2002/0191814A1, US2002/191814A1, US20020191814 A1, US20020191814A1, US2002191814 A1, US2002191814A1InventorsRandy Ellis, Thomas RadcliffeOriginal AssigneeEllis Randy E., Radcliffe Thomas J.Export CitationBiBTeX, EndNote, RefManPatent Citations (24), Referenced by (18), Classifications (8), Legal Events (3) External Links: USPTO, USPTO Assignment, EspacenetApparatuses and methods for surgical navigation
BRIEF DESCRIPTION OF THE DRAWINGS [0047] For a better understanding of the present invention and to show more were clearly how it may be carried into effect, reference will now be made, by way of example, to the accompanying drawings that show the preferred embodiment of the present invention and in which: [0048] [0048]FIG. 1 is a general block diagram of an imaging apparatus according to the preferred embodiment of the present invention; [0049] [0049]FIG. 2 is a perspective view of the imaging apparatus of FIG. 1 imaging an object from a first perspective and displaying the image; [0050] [0050]FIG. 3 is a perspective view of the imaging apparatus of FIG. 1 imaging the object of FIG. 2 from a second perspective and displaying the image; [0051] [0051]FIG. 4 illustrates projection frames for the images of FIGS. 2 and 3; [0052] [0052]FIG. 5 is a perspective view of the imaging apparatus tracking the object of FIGS. 2 and 3, and a tracked part and tracked tool, and displaying the images of FIGS. 2 and 3, along with images of the tracked tool; [0053] [0053]FIG. 6 is a perspective view of the imaging apparatus used to determine the placement of a guard, and displaying the images of FIGS. 2 and 3, along with images of the guard; [0054] [0054]FIG. 7 is a perspective view of the imaging apparatus tracking the object of FIGS. 2 and 3, and the tracked tool of FIG. 5, and displaying the images of FIGS. 5, along with images of the guard of FIG. 6; and [0055] [0055]FIG. 8 illustrates a virtual imaging system employed in the imaging apparatus of FIG. 1.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT [0056] Referring to FIG. 1, an imaging apparatus 100 is used for representing and manipulating three-dimensional geometry derived from multiple two-dimensional images. For brevity, this paragraph defines certain terms that will be used in this description. The position and orientation of a geometrical entity or physical object will be called the “pose” of the entity or object, where it is understood that the orientation of a point is arbitrary and that the orientation of a line or a plane or other special geometrical objects may be specified with only two, rather than the usual three, orientation parameters. A geometrical entity with known three-dimensional geometry will hereafter be called a “guard”. A three-dimensional computer representation of the shape, surface, or volume of a geometrical entity will hereafter be called a “form”. A coordinate frame, relative to a physical object that is imaged by the imaging device, will hereafter be called an “anatomical coordinate frame”. A physical object, the pose of which can be determined by a computer by means of a three-dimensional tracking system, will hereafter be called a “tracked object”. A physical object, the pose of which is known with respect to a tracked object, will hereafter be called a “tracked part”. A tracked part that comprises a tracked object and an object that is manufactured or found will hereafter be called a “tracked tool”. A tracked tool for which the pose of the tool is known in the coordinate frame of the tracked part will hereafter be called a “calibrated tracked tool”. A guard, the pose of which is determined entirely or partly from the pose of a tracked tool, will hereafter be called a tool guard. A form of a tool guard will hereafter be called a “tool form”. An image that is produced by an imaging system, where the imaging system is a tracked tool, will hereafter be called a “tracked image”. A projection image or a tomographic image that is substantially a product of imaging geometry only, and not of artifacts or distortions introduced by the imaging system, whether calculated from geometry or calculated by processing an image derived from an imaging system, will be called a “geometrically corrected image”. An image for which the surface of image creation is known with respect to the coordinate frame of a tracked part will be called a “calibrated image”. An image that is the projection of one or more forms, each of which represents the geometry of a guard, onto a second two-dimensional image, will be called a “guidance image”. Tracking that occurs on a time scale short enough that significant changes in the pose of a tracked object have not occurred will hereafter be called “real-time tracking”. The terms defined in this paragraph are for brevity only and are not intended to restrict the principles described herein exclusively to medical applications or to any other specific application. [0057] Referring to the Figures, like elements will be referenced with the same reference numerals from Figure to Figure, and the description of previously introduced elements will not be repeated, except to the extent required to understand the principle being discussed. [0058] Referring to FIG. 1, an image acquisition, object tracking and integration apparatus 100 has a tracking system 1, imaging system 3, communication system 5 and integration system 7. The tracking system 1 locates objects in 3-dimensions and determines their respective poses. The imaging system 3 acquires images of objects (see FIGS. 2 and forward). Among other things, the integration system 7 correlates 3-dimensional poses captured at different times or using different capture means. The user communication system 5 provides information, such as images, sounds, or control signals to the user or other automated systems, such as a robotic control system, not shown. Two image ca techniques in common use are X-ray imaging and ultrasound imaging. The preferred embodiment is described with reference to X-ray imaging, but the principles described herein apply equally to any means of acquiring two-dimensional images and are not limited to X-ray imaging or ultrasound imaging or computed tomography or magnetic resonance imaging or any other specific means of acquiring images. Images can also be acquired by simply retrieving a digital file with the requisite information from storage on a computer readable medium. [0059] Referring to FIG. 2, the apparatus 100 captures a first X-ray image 110. The image 110 is created by photons emitted by electromagnetic source 101 that are detected by calibrated X-ray detector 102. The electromagnetic source 101 and detector 102 form an example of an imaging system 3 of FIG. 1. Photons that are directed at object 103 are attenuated, producing a variable X-ray photon density 104 on the detector 102. The variable photon density can be transduced and communicated to computer 109 as first image 110. The computer 109 can store the first image 110 on a hard disk or other storage means. The first image 110 can be displayed on monitor 111. The monitor forms an example of the communications system 5 of FIG. 1. [0060] In the preferred embodiment, tracking system 1 has a sensor 105 and a series of tracked parts, e.g. tracked part 106. The tracked parts utilize infrared transmitters, while the sensor 105 is an infrared sensor. The tracking system 1 determines a first pose of first tracked part 106 that is rigidly associated with the object 103 and determines a second pose of a second tracked part 107 that is rigidly associated with the detector 102. The first pose and the second pose are determined more or less simultaneously at the time that the first image 110 is captured. The tracking system 1 communicates the first pose and the second pose to the computer 109. In an alternative embodiment, the tracking system 1 determines the first pose with respect to the second pose and transmits that information to the computer 109. Examples of commercially available units that can form the basis of a tracking system 1 are the OptoTrak™ and Polaris™, manufactured by Northern Digital Incorporated, Waterloo, Canada, and various electromagnetic systems such as those made by Ascension Technology Corporation of Burlington, Vermont and Polhemus Incorporated of Colchester, Vermont. [0061] Coordinate frame 108 of the calibrated X-ray detector 102 relates the detector 102 to the electromagnetic source 101 in the coordinate frame of the second tracked part 107. In the preferred embodiment, this relation is computed by rigid transformations between coordinate frames. For example, let the pose of the calibrated X-ray detector 102 relative to the tracking system 1 be represented as a rotation R102 followed by a translation t102. If the coordinate of a point P is known in the coordinate frame of the calibrated X-ray detector 102 as P102, the coordinate of the point P in the coordinate frame of the tracking system 1 can be computed as P1=R102*P102+t102. Similarly, the pose of the first tracked part 106 relative to the tracking system 1 can be represented as a rotation R106 followed by a translation t106 and thus the coordinate of the point P in the coordinate frame of the first tracked part 106 can be computed as P106=R106 −1*(P1-t106), where R106 −1 is the inverse of R106 −. By such calculations, the pose of the electromagnetic source 101 in the coordinate frame of the calibrated X-ray detector 102 and any point on the surface of the calibrated X-ray detector 102 and any other point in the coordinate frame 108 can be calculated in the coordinate frame of the first tracked part 106. [0062] Referring to FIG. 3, the apparatus 100 acquires a second X-ray image 210. [0063] The second image 210 is acquired by emitting photons from electromagnetic source 101 and detecting incident photons at X-ray detector 102. Photons that encounter object 103 are attenuated, producing a variable X-ray photon density 204 on the detector 102. The variable photon density is transduced and communicated to computer 109, which displays the second X-ray image 210 on monitor 111. [0064] Tracking system 1 next determines a third pose of first tracked part 106 that is rigidly associated with the object 103 and determines a fourth pose of second tracked part 107 that is rigidly associated with the detector 102. The third pose and the fourth pose are determined more or less simultaneously at the time that the second image 210 is captured, so that correlation of poses and other geometrical entities in terms of the coordinate frame of object 103 have little or no error. The tracking system 1 communicates the third pose and the fourth pose to the computer 109. [0065] Second coordinate frame 208 of the calibrated X-ray detector 102 relates the detector 102 to the electromagnetic source 101 in the coordinate frame of the second tracked part 107. Calculations for points in the second coordinate frame 208 are performed analogously to the calculations for the first coordinate frame 108, so that the coordinates of any point in the second coordinate frame 108 can be calculated in the coordinate frame of first tracked part 106. In the preferred embodiment, a single detector 102 and source 101 are used for acquiring image 110, 210. It will be understood that multiple detectors 102 and source 101 could be used to acquire the images and related poses for the object 106 and detector 102. Alternatively, images 110, 210 could be acquired from storage, such as a hard disk, or scanned from film, rather than being acquired directly from the object 103. The related poses would need to be stored as well, or otherwise acquired. It will also be understood that tracking system 1 could communicate the poses of detector 102 in the coordinate frame of the first tracked part 106, or of any other coordinate frame, and that the relevant transformation from any coordinate frame to any other coordinate frame can be calculated from the relative poses of the coordinate frames. [0066] Referring to FIG. 4, knowing the first and third poses of the first tracked part 106 and second and fourth poses of second tracked part 107, the computer 109 relates the first coordinate frame 108 and the second coordinate frame 208 to the first tracked part 106. These relations are computed, as previously stated, by calculating the coordinates of a point in either coordinate frame 108 or 208 in the coordinate frame of the first tracked part 106. [0067] Referring to FIG. 5, tracking system 1 determines a fifth pose of first tracked part 106 that is rigidly associated with object 103. Tracking system 1 determines a sixth pose of third tracked part 403 that is rigidly associated with tracked calibrated tool 404. The fifth and sixth poses are determined more or less simultaneously. The fifth and sixth poses are communicated to computer 109. The computer 109 serves as a computing platform and has a computer program or other to control the functions described herein. It is recognized that the computer platform can take many different forms as desired by the apparatus designer. For example, without limiting the scope of the principles described herein, it can be a standalone computer, such as a personal computer, or a computer network, or it may be remotely accessible through a communications network such as the internet. Similarly, the computer program may run on a standalone computer or be distributed throughout a network, alternatively, it may run on a computer that is remotely accessible to obtain user input or input from one or more other parts of the systems 1, 3, 5, 7. The computer 109 and software together form the correlation system 7 of FIG. 1. As will be evident to those skilled in the art, other means such as a programmable logic array or dedicated hardwired computational means could be used in place of the computer 109 and computer program. It is also understood that functions of the computer 109 as described herein can be integrated or distributed as desired by the system designer, for example, separate computational means running discrete software may be provided for the tracking system 1, the imaging system 3, the correlation system 7 and the communication system 5, or the functions may be performed using computer programs running on computer 109. [0068] The computer 109 can relate the fifth pose of first tracked part 106 and the sixth pose of the third tracked part 403. Calculations for points in the coordinate frame of the third tracked part 403 are performed analogously to the calculations for the first coordinate frame 108, so that the coordinates of any point in the coordinate frame of the third tracked part 403 can be calculated in the coordinate frame of first tracked part 106. [0069] The computer 109 can use the first coordinate frame 108 and calibration information of the tool 404 to create a third image 408 of the tool 404. Third image 408 can be created using techniques from the field of computer graphics. For example, suppose that the form of the tool 404 is represented as a set F404 of points in the coordinate frame of the third tracked part 403, and that the surface of detector 102 is a polygon lying in a plane known in coordinates of second tracked part 107. By means of a rigid transformation, the poses of the points in set F404 can be computed in the coordinate frame of first tracked part 106 as set F106. By means of another rigid transformation, the pose of electromagnetic source 101 can be determined in the coordinate frame of first tracked part 106 as point S106 and the pose of the plane of the detector 102 can also be determined in the coordinate frame of first tracked part 106 as plane P106. For each point in set F106 that is distinct from point S106 there exists a line in three dimensions that comprises each point and that also comprises point S106. For each line, if the line intersects plane P106 then the intersection of each line with plane P106 can be calculated as a point lying on plane P106. By selecting a viewpoint, and applying techniques known in the art of computer graphics, a third image 408 of the tool 404 can be created from the points lying on plane P106. One useful viewpoint is the point S106, because third image 408 then is a computer rendering of how tool 404 would appear in coordinate frame 108. Other useful viewpoints may also be selected, for example, to render both the form of tool 404 and the coordinate frame 108 so that the relationships between the tool and the coordinate frame are visualized. Form F404 can be a set of line segments, known in the art as a wire-frame, or can be a set of surfaces, or can be a volume, or can be any other computer representation of tool 404 that can be rendered by means of computation. [0070] Similarly, the computer 109 can use the fifth pose of first tracked part 106 and the sixth pose of third tracked part 403 and the second coordinate frame 208 and calibration information of the tool 404 to create a fourth image 410 of the tool 404. Fifth image 409 can be created in ways analogous to the ways in which third image 408 can be created. [0071] In the preferred embodiment the third image 408 is merged with the first image 110 to present to the user of the apparatus 100 on the monitor 111 a visualization of the tool 404 with respect to the object 103 and the fourth image 410 is merged with the second image 210 to present to the user of the apparatus 100 on the monitor 111 a visualization of the tool 404 with respect to the object 103. [0072] In an alternative embodiment the third image 408 is presented to the user independently of the first image 110 and the fourth image 410 is presented to the user independently of the second image 210. This alternative embodiment can be useful in understanding relations between the tool 404 and the coordinate frames 108 and 208 and the first tracked object 103. [0073] Referring to FIG. 6, a pose of guard 504 is determined by computer 109 in the coordinate system of first tracked part 106. Pose of the guard 504 can be adjusted by a user of computer 109. [0074] The computer 109 can use the first pose of the tracked part 106 and second pose of second tracked part 107 and the pose of the guard 504 and other information relating to the guard 504 to create fifth image 507 of the guard 504. Fifth image 507 can be created in ways analogous to the ways in which third image 408 can be created. [0075] Similarly, the computer 109 can use the third pose of the first tracked part 106 and the fourth pose of the second tracked part 107 and the pose of the guard 504 and other information relating to the guard 504 to create sixth image 509 of the guard 504. Sixth image 509 can be created in ways analogous to the ways in which third image 408 can be created. [0076] In the preferred embodiment the fifth image 507 is merged with the first image 110 to present to the user of the apparatus 100 on the monitor 111 a visualization of the guard 504 with respect to the object 103, and the sixth image 509 is merged with the second image 210 to present to the user of the apparatus 110 on the monitor 111 a visualization of the guard 504 with respect to the object 103. [0077] In an alternative embodiment the fifth image is presented to the user independently of the first image 110 and the sixth image 509 is presented to the user independently of the second image 210. [0078] Referring to FIG. 7, the tracking system 1 determines the pose of first tracked part 106 that is rigidly associated with object 103. Tracking system 1 determines the pose of third tracked part 403 that is rigidly associated with tracked calibrated tool 404. The seventh and eighth poses are determined more or less simultaneously. The seventh and eighth poses are communicated to computer 109. [0079] The computer 109 can use the seventh pose of first tracked part 106 and the eighth pose of the third tracked part 403 and the first coordinate frame 108 and calibration information of the tool 404 to create a seventh image 608 of the tool 404. The computer 109 can use the first pose of the first tracked part 106 and second pose of the second tracked part 107 and the pose of the guard 504 and other information relating to the guard 504 to create eighth image 609 of the guard 504. Eighth image 609 can be created in ways analogous to the ways in which third image 408 can be created. [0080] Similarly, the computer 109 can use the seventh pose of first tracked part 106 and the eighth pose of the third tracked part 403 and the second coordinate frame 208 and calibration information of the tool 604 to create a ninth image 611 of the tool 404. The computer 109 can use the first pose of the first tracked part 106 and the second pose of the second tracked part 107 and the pose of the guard 504 and other information relating to the guard 504 to create tenth image 612 of the guard 504. Tenth image 612 can be created in ways analogous to the ways in which third image 408 can be created. [0081] In the preferred embodiment said first and second and seventh through tenth images 110, 210, 608, 609, 611, 612 are merged in combinations to present to the user of the apparatus 100 on the monitor 111 a visualization of the tool 404 with respect to the object 103 and the guard 504. For example, the first and seventh and eighth images 110, 608, 609 can be merged to create a first visualization of the tool 404 with respect to the object 103 and the guard 504. The second and ninth and tenth images 210, 611, 612 can be merged to create a second visualization of the tool 404 with respect to the object 103 and the guard 504. Alternatively, the seventh and eighth images 608, 609 images can be merged to create a third visualization of the tool 404 with respect to the guard 504. Similarly, the ninth and tenth images 611, 612 can be merged. By this means the user is presented with a multiplicity of visualizations that facilitate the user in guiding the tracked calibrated tool 404 with respect to the object 103 and the guard 504. [0082] In the preferred embodiment the user is further provided with graphical and numerical information relating geometric measurements between the tracked calibrated tool 604 and the guard 504. For example, tracked calibrated tool 604 may be a sharp surgical instrument with a substantially cylindrical shaft and guard 504 may represent an anatomical plane. The distance from the tip of tracked calibrated tool 604 to the plane of guard 504 can be calculated, as can the angle between the axis of the cylindrical shaft of tracked calibrated tool 604 and the plane of guard 504. The distance and angle can be calculated as absolute values or they can be calculated as signed values. The distance and angle can be represented numerically, for example as a distance in millimeters and an angle in degrees. The distance and angle can be represented graphically on monitor 111, for example the distance as a bar of varying length and the angle as a pie-shaped wedge of varying angle. In the preferred embodiment the user is provided with graphical and numerical information that aids the user in relating the pose of the tracked calibrated tool 604 to the pose of the guard 504. [0083] The preferred embodiment has been described with reference to projection images created by X-ray attenuation and detection. The principles apply as well to calibrated tomographic images, for which the poses of the surfaces of image creation are known in the coordinate frames of the respective tracked parts. For tomographic images, which may not have an associated focus point, preferred points of view may include points normal to one or more of the planes of the tomographic images, or points oblique to the normals of one or more of the planes of the tomographic images. Both projection and tomographic images may be rendered using computer graphics methods as opaque, translucent, transparent or volume-rendered images, among many possible ways of rendering images. [0084] The apparatus 100 has: a tracking system 1 tracking a tracked object, an imaging system 3, and operates with a tool 404. The imaging system 3 creates a calibrated, geometrically corrected two-dimensional image 110, 210. The correlation system 7 can receive instructions from a practitioner to create, destroy, and edit the properties of a guard. The communications system 5 displays images and calculations useful to a practitioner. The methods employed can determine geometrical relations between guards and/or present to a practitioner projections of forms of guards. An especially useful form is the form of a tracked tool. [0085] The apparatus 100 has tracking system 1 that tracks one or more physical objects 103 such that the pose of physical object 103 is determined by the tracking system 1. The object 103 thus becomes a tracked object 103. The tracking system 1 tracks the tracked object by tracking one or more one physical objects 106 that is attached to tracked object 103. The attached object is thus a tracked part 106. The tracking system 1 operates in one or more coordinate frame that is fixed with respect to a tracked part. The fixed coordinate frame is called an anatomical coordinate frame. The imaging system 3 creates calibrated, geometrically corrected two-dimensional images of one or more physical objects, either by projection or tomography. A calibrated image is a tracked image for which the pose of the surface of image creation is the coordinate frame of the tracked part. A geometrically corrected image is an image in which artifacts or distortions introduced by the imaging system have been corrected. One or more tracked tools that is not a tracked imaging system may be tracked by the tracking system 1. Examples of tracked tools are drills, probes, saws, guides, probes, or other physical objects that a practitioner can directly or indirectly manipulate. The tracking system 1 determines the pose of one or more tracked objects based on the pose information provided by the tracking system 1, where the tracked objects include: one or more tracked parts 107, all or some of each part 107 is imaged in a calibrated, geometrically corrected tracked image; one or more tracked imaging system 3, each of which produces a calibrated, geometrically corrected tracked image 110, 210; and one or more tracked tool 404. In the preferred embodiment there can be a plurality of tracked parts 107, tracked images 110, 210, and tracked tools 404. Some or all of the determination functions may be performed by the tracking system 1 utilizing software on the computer 109, which computer 109 and software form part of the tracking system 1 for this purpose. [0086] The imaging system 3 creates calibrated, geometrically corrected images from each detector 102 and source 101, whether by using prior information or by using information derived from the images. Some or all of the calibration and geometric correction may be performed by the imaging system 3 utilizing software on the computer 109, which computer 109 and software form part of the imaging system 3 for this purpose. [0087] Referring to FIG. 8, the communication system 5 generates two or more two-dimensional images from one or more points of view by means of a virtual imaging system 801. One of those points of view may be from the source of projected rays for projection image, where the virtual imaging system has a virtual source 803 of rays that project to a virtual surface of creation 805. As a further example, one of those points of view may be perpendicular to the surface of the image for tomographic images, where a virtual imaging system (not shown) is a computer model of the device that forms tomographic images. In the preferred embodiment a generated image is computed by a projection process or by a tomographic process. Included among those processes are perspective projection or orthographic projection or tomographic slicing among many projective mappings. One useful point of view is the pose of the X-ray source of a fluoroscopic imaging system. Some or all of the image generation may be performed by the communication system 5 utilizing software on the computer 109, which computer 109 and software form part of the communication system 5 for this purpose. [0088] The correlation system 7 transforms an anatomical coordinate frame to another coordinate frame, the latter of which may be a distinct anatomical coordinate frame or any other coordinate frame. [0089] The correlation system 7 can add and edit at least one guard in a known coordinate frame. In the preferred embodiment the correlation system 7 can receive directions from the practitioner or another person to add, move, or otherwise edit a guard in the anatomical coordinate frame correlated with a first calibrated, geometrically corrected image and simultaneously or successively add, move, or otherwise edit the guard in the anatomical coordinate frame correlated with a second calibrated, geometrically corrected image. In the preferred embodiment the correlation system 7 can also be directed to automatically deduce the pose of a guard from the calibrated, geometrically corrected images. The pose of a guard is preferably calculated in a third abstract coordinate frame, to which the first anatomical coordinate frame and the second anatomical coordinate frame can be transformed. [0090] The correlation system 7 calculates a guidance image. In the preferred embodiment the image is a perspective projection, the second image is a calibrated, geometrically corrected image, the surface on which the image is created is the surface of an imaging system that corresponds to said calibrated, geometrically corrected image, and the guidance image is created so that geometry of the guard appears to be superimposed upon said second image. The resulting guard image is a computer representation of an image that might result from physical objects, which have the geometry of the forms of guards, being physically present during the process of image formation. The computer representation may include color, or other effects that are not physically possible to produce, in order to present the skilled practitioner or other person with information that clearly distinguishes the forms from said two-dimensional image. [0091] The communication system 5 displays one or more guard images. [0092] The communication system 5 displays the guard images sufficiently often to serve the purposes of guidance. This can be real-time image guidance. [0093] The correlation system 7 calculates and the communication system 5 displays three-dimensional distances and angles between guards, particularly guards and tool forms. This provides relative pose information to the practitioner. This is real-time servo guidance. The communication system 5 can provide distance and angle information in many different ways. For example, it can be provided to the practitioner by means of the monitor 111 displaying numerical data or graphical data, or through audio feedback with sounds indicating “too high”, “too low”, “too close” or other such information. As a further example, it can be provided to a robotic control system for automated guidance of tools. [0094] The apparatus 100 can be used in many ways to improve three-dimensional guidance from multiple two-dimensional images. In one use a practitioner skilled in the art of making fluoroscopic images of human anatomy can make two or more images of an anatomical site, such as a hip that had been fractured. A practitioner skilled in the art of surgery can add guards to the displays and use them to estimate the three-dimensional geometry of the bones, and add further guards that represent the intended three-dimensional path of one or more drill holes. The surgeon can then use a tracked tool that is a drill to drill the planned hole(s) while the apparatus 100 displays on the monitor 111 both graphically and numerically the deviations in distance and angle between the planned and actual hole(s). [0095] The apparatus 100 improves three-dimensional guidance by introducing two-dimensional projections of one or more virtual objects of known three-dimensional geometry, the pose of each virtual object is known in a coordinate frame fixed relative to one or more physical objects that are imaged by an imaging device. [0096] The apparatus 100 improves three-dimensional guidance from two-dimensional images by uniting two-dimensional projections of one or more forms with one or more tracked images, preferably by means of real-time tracking The apparatus 100 permits a practitioner to: derive guards, either automatically or by directing a computer, from two or more tracked images; observe images that include projections of the forms of tracked tools and of guards; and to direct a computer to report the three-dimensional relationships between guards. [0097] The apparatus 100 provides a practitioner with a computer simulation of an arrangement of geometrical and physical objects that, in previous uses of multiple two-dimensional images, have relied primarily on the skill of the practitioner in interpreting the images. [0098] The apparatus 100 is an improvement on existing systems as it permits a practitioner to determine one or more guards, which are three-dimensional geometrical entities defined and edited in an anatomical coordinate frame. As an illustrative example a skilled practitioner might add to an anatomical coordinate frame a guard that is a hemisphere, and might further edit the pose and radius of the hemisphere so that the projection of the form of the guard closely corresponds in two or more calibrated, geometrically corrected images to the projected images of the articular surface of the femoral head. The practitioner might then observe the calculated distance between the guard of the drill and the guard of the hemisphere, as well as observing the projections of the tool form of the guard associated with the drill and the guard of the hemisphere united with the calibrated, geometrically corrected images. The skilled practitioner might understand thereby the three-dimensional relationship between the tip of the drill and the articular surface of the femoral head. [0099] It will be understood by those skilled in the art that this description is made with reference to the preferred embodiment and that it is possible to make other embodiments employing the principles of the invention which fall within its spirit and scope as defined by the following claims. 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