Patent Description:
In medical imaging, e.g. in X-ray imaging, appropriate subject positioning can be regarded as being crucial for achieving X-ray images, e.g. musculoskeletal X-ray images etc., of diagnostic quality due to the projective nature of this image modality.

This applies in particular if the positioning of an orthopedic implant is to be imaged, since even slight mispositioning of the subject can render an X-ray image, with respect to its quality, particularly in terms of the achieved projection, non-diagnostic. This can mitigate the X-ray image suitability for e.g. assessing the implant placement after e.g. a surgery or monitoring possible movements of the implant with respect to the bone over time.

<CIT> describes an implant fixable relative to a target area within a living body, comprising a transmitter arranged to emit an electromagnetic signal, wherein said electromagnetic signal is adapted to propagate with a wavelength in said living body so that a phase difference of said electromagnetic signal in at least three positions, preferably four, separated by a known distance is detectable by a receiver for tracking variations of a position of the implant relative to said receiver.

<CIT> describes a system for position matching of a patient for medical imaging includes a set of RFID tags configured to locate a patient position. A set of RFID interrogators are located to receive RFID position information from the set of RFID tags.

<CIT> relates to processing of a 2D projection image generated during a procedure of fracture treatment of a bone. The computer program element comprises sets of instructions for detecting the reference body in the 2D projection image, detecting at least one element out of the group consisting of an instrument, an implant and an anatomical structure in the 2D projection image, and identifying a current state of the element, determining a state of progress of the procedure of fracture treatment, and providing information regarding steps to be performed next.

There may, therefore, be a need for improved means for at least assisting positioning of a subject in a manner allowing acquiring a medical image with a desired positioning of an implant therein. The object of the present invention is solved by the subject matter of the independent claims, wherein further embodiments are incorporated in the dependent claims.

According to a first aspect, there is provided a computer-implemented method for assisting positioning of a subject having an implant in X-ray imaging. The method comprises the step of applying one or more radiofrequency (RF) signals to an anatomy of interest of the subject where the implant is located. Further, the method comprises detecting a response signal and/or signal change in response or reaction to the applied RF signal impacting, preferably impinging, the implant and tissue being adjacent to and/or surrounding the implant. In addition, the method comprises determining, from the detected response signal and/or signal change, an implant positioning estimation relative to an X-ray imaging device, and determining, from the implant positioning estimation, a feedback being indicative for positioning the X-ray imaging device and the subject to each other with respect to a target positioning, to be provided for assisting the positioning.

In this way, subject and/or implant positioning can be evaluated, and, if necessary, corrected, even prior to an actual X-ray image acquisition, i.e. without or at least with less radiation exposing to the subject. The above method allows measuring subject and/or implant positioning to give a feedback, such as a confirmation that the positioning is correct, a recommendation and/or action instruction for improving and/or correcting the positioning, or the like , to e.g. an operator, e.g. a radiographer or the like, handling the X-ray imaging for improving the positioning or to device or system for automatically positioning and/or adjusting positioning of e.g. an X-ray tube relative to the subject and/or implant. While a 3D pose and posture of the subject itself could be deduced from e.g. a single or from multiple RGB / grey-value or depth-camera images, classical radar or sonic-reflection images, the 3D pose of the implant cannot be estimated by any of these modalities. In contrast thereto, the above method allows utilizing e.g. reflection and/or absorption properties of RF signals, e.g. RF waves, at and/or in a metallic object, i.e. the implant, and/or the surrounding tissue, e.g. a bone etc., in order to assess positioning, e.g. the pose and/or posture, of metallic orthopedic implants, while keeping the radiation dose to the subject low.

In other words, given an X-ray image, e.g. a musculoskeletal X-ray image featuring an orthopedic implant, assessing its diagnostic quality might be difficult given high patient flow and the resulting time pressure and, in particular, for a novice operator, such as a radiographer. The above method accomplishes an automatic assessment of the subject and/or implant positioning. Further, when assessing image quality manually, individual subjective measures will be applied in general. The above method assists in standardizing image quality, e.g. across a medical imaging department and/or facility. Given that the subject and/or implant positioning deviates from a target or ideal positioning, the above method can assist the radiographer or an automatic positioning system to determine appropriate actions which could improve the image quality. Furthermore, conventional subject positioning can require an iterative process in which the positioning is improved upon the current image if required. These iterations delay the examination at a cost of a higher subject radiation dose than necessary. The above method can be used to optimize the subject's positioning also before the acquisition of an image.

As used herein, the positioning of the subject and/or implant may include providing a specific pose and/or posture relative to the X-ray imaging device, e.g. the X-ray tube, or vice versa. Accordingly, the feedback, which may be output graphically, e.g. via a display etc., via audio, e.g. via a loudspeaker, headphone, etc., or the like, may indicate whether the positioning is already correct or whether and/or how the positioning of the subject and/or implant is to be changed to comply with a target or desired positioning.

As used herein, the one or more RF signals may be applied in e.g. a microwave frequency range and/or in e.g. the Gigahertz (GHz) range, provided there is a suitable compromise regarding e.g. penetration depth and/or wavelength based spatial resolution limit with respect to the implant and/or the tissue surrounding it. For example, for relevant tissues, such as bone tissue or other tissue types surrounding and/or being adjacent to the implant, the penetration depth may be between approx. <NUM> and <NUM>, and the wavelength may be between approx. <NUM>,<NUM>. The one or more RF signals may be emitted from one or multiple mono- or multichromatic sources at one or multiple locations with an intensity chosen to not harm the patient via e.g. local heating. The one or more RF signals may be in a range of <NUM> to <NUM>, and/or may be in e.g. a wireless local area network (WLAN) frequency domain, e.g. between approx. <NUM> and <NUM>, wherein this is not limited herein. A wavelength may be, for example, in a range of approx. <NUM> to approx. Further, the RF signals may be applied for a relative short period of time, so that the above method may also be applicable to a subject with a pacemaker or the like. It is noted a wavelength-based spatial resolution limit of the above method may be extended, due to prior knowledge. For example, the prior knowledge may be implicitly encoded in the learned model or network weights.

As used herein, the orthopedic implant may be understood as a medical device configured to replace a missing joint or bone or to support a damaged one.

Further, the detected response signal and/or signal change may be derived passively, i.e., by omitting a sender or transmitting device within or inside the anatomy of interest, from detecting e.g. reflection and/or absorption properties of radiofrequency RF waves at and/or in the implant, which may be made of or may comprise e.g. a metal material etc., and/or in a tissue surrounding the implant. The detection may utilize a suitable detector or sensor, such as an RF receiver, e.g. in form of a coil, or the like.

The image-acquisition geometry, e.g. a radiation source and detector constellation, relative to the detected RF signal may be either been known, calibrated or measured. For example, the image-acquisition geometry may be determined using an optical image, e.g. a camera image or video.

The method may preferably be performed by use of a system according to the second aspect. Further, the method steps may be implemented in hardware and/or software.

According to an embodiment, the feedback may comprise an action instruction if the implant positioning is determined to deviate from the target positioning, and otherwise a confirmation that the positioning is correct. In other words, if the subject and/or implant positioning is determined to comply with the target positioning, the feedback may confirm correct or target positioning. In this way, the operator may receive the confirmation of correct positioning, or, in case of sub-optimal positioning, instructions how to achieve it from the current positioning determined. The action instruction may comprise a guidance how to achieve the target positioning from the current positioning.

In an embodiment, the detected response signal and/or signal change may be based on or may comprise one or more reflection and/or absorption properties of the one or more RF signals at the implant and/or the tissue. For example, the one or more RF signals may be absorbed and/or reflected to different extents by different materials and tissues, and this difference is measured by a detector or sensor. By way of example, the reflection and/or absorption properties of the joint of interest and its implant may be detected via one or multiple RF receivers, e.g. a coil or the like. By way of example of an implant in e.g. a tibia bone, the response signal and/or signal change, e.g. due to reflection and/or absorption properties, of one or more RF signals at the proximal plateau of the implant may be taken into account for positioning one or more receivers at positions with predictive power for assessing the implant pose. This allows a measuring to be carried out by harmless electromagnetic radiation, which enables a reconstruction of the current subject and/or implant positioning. In this way, the radiation to which the patient is exposed can be kept low.

According to an embodiment, the detected response signal and/or signal change may be detected and/or determined in a spatial distribution manner. Based on this determination, the pose and/or posture may be estimated, predicted and/or reconstructed in spatial relation, e.g. in 3D. In this way, the positioning can be more accurately.

In an embodiment, the positioning estimation may be determined by feeding the detected response signal and/or signal change into a physical simulation model of RF scattering and RF absorption at the implant and/or the tissue, and calculating the positioning estimation therefrom. In other words, the measured one or more RF signals, i.e. the detected response signal and/or signal change, may then be fed into a processor for predicting the pose and/or posture of the implant. The processor may be configured to provide a physical simulation, i.e. run the physical simulation model, of the RF scattering at the implant and its absorption. In this way, the pose and/or posture of the implant can be estimated, predicted, etc..

In an embodiment, the physical simulation model may be further fed with a 3D implant model of the implant. The 3D implant model may be similar to or of the implant. For example, the 3D implant model may be assigned to a specific implant type that at least largely corresponds to the implant type of the subject to be imaged. The 3D implant model may be provided as e.g. a 3D CAD-model. Thereby, the 3D implant model may be deformable to be adapted to the implant actually present in the given subject to be imaged. Optionally, the 3D implant model may be of the implant actually present in the given subject. Optionally, it may be configured to estimate a 3D pose and/or posture of the implant.

According to an embodiment, the positioning estimation may be determined by feeding the detected response signal and/or signal change into an implant pose and/or posture machine-learning model, which is trained by training data of a reflected and/or absorbed RF signal with known patient and/or implant positioning, and the implant positioning estimation may be calculated therefrom. For example, the implant pose and/or posture machine-learning model may be a deep learning forward-model that may be trained on real or simulated data of reflected and/or absorbed RF signals with known implant pose to estimate and/or predict the latter. The model may be trained to predict from RF reflection and/or absorption at a specific or various implant type, wherein a wavelength-based spatial resolution limit of the above method may be extended, since there is prior knowledge implicitly encoded in the learned model or network weights. In this way, the pose and/or posture of the implant can be estimated, predicted, etc..

In an embodiment, the method may further comprise comparing the implant positioning estimation with a further implant positioning determination derived from X-ray image data of the subject including the implant, wherein the comparison may be used to adapt the above physical simulation model or to adapt the above implant pose machine-learning model. This can also be understood as verification of the above method, which can be performed once or from time to time. In this way, each model can be trained, re-trained, fine-tuned, etc..

According to an embodiment, the method may further comprise:.

For example, the pose and/or posture of the implant derived based on the one or more RF signals may be combined with an estimated pose and/or posture of the subject, which may be determined based on a signal different to the one or more signals, such as optical detection, in order to apply compromise criteria for positioning quality or accuracy that take a variability in the relative positions of the implant and the tissue, e.g. bone(s), into account.

In an embodiment, the subject positioning estimation may be determined based on patient pose and/or posture measurement data derived from one or more of an optical camera, an RGB camera, a depth camera, a radar measuring device, and a sonic echo measuring device.

According to an embodiment, the method may be performed prior to the actual X-ray imaging. In this way, the method provides a prospective analysis of subject and/or implant positioning.

In an embodiment, the method may be performed during X-ray imaging, continuously monitoring implant and/or subject positioning. Thereby, the method further comprises generating a trigger signal for X-ray image acquisition if the monitored implant positioning and/or subject positioning meets an image acquisition criterion. In this way, continuous monitoring of the subject and/or implant positioning can be utilized for finding the optimal moment of image acquisition. For example, if the subject moves the limb of interest after seemingly accomplished patient positioning, the monitoring can indicate a sub-optimal positioning. Thereby, the radiographer can postpone the image acquisition either until the patient moved into a better positioning or until he / she has been re-positioned by the radiographer. Further, the trigger signal can be used for automatic imaging.

According to a second aspect, there is provided a system for assisting positioning of a subject having an implant in X-ray imaging. The system comprises:.

The system is configured to carry out the method of the first aspect. Accordingly, the system allows the subject and/or implant positioning to be evaluated, and, if necessary, corrected, even prior to an actual X-ray image acquisition, i.e. without or at least with less radiation exposing to the subject.

According to an embodiment, wherein the one or more RF signals are emitted in a Gigahertz frequency domain. In this way, the system allows a penetration depth and wavelength suitable for detecting the implant and estimating its positioning.

In an embodiment, the system may further comprise a communication interface configured to output the feedback. For example, the communication interface may be configured to provide the feedback graphically, in audio, or the like. It may comprise or may connected to a display, loudspeaker, or the like. In this way, the system may improve positioning of the subject and/or implant with precise instruction.

According to a third aspect, there is provided a computer program element, which when executed by a processor is configured to carry out the method of the first aspect, and/or to control a system according to the second aspect.

According to a fourth aspect, there is provided a computer-readable storage or transmission medium, which has stored or which carries the computer program element according to the third aspect.

It is noted that the above embodiments may be combined with each other irrespective of the aspect involved. Accordingly, the method may be combined with structural features of the device and/or system of the other aspects and, likewise, the device and the system may be combined with features of each other, and may also be combined with features described above with regard to the method.

These and other aspects of the present invention will become apparent from and elucidated with reference to the embodiments described hereinafter.

Exemplary embodiments of the invention will be described in the following drawings.

<FIG> shows in a schematic block diagram a system <NUM> that is configured to assist positioning of a subject S having an implant I, particularly orthopedic implant I, in X-ray imaging, the latter being be carried out using, for example, an X-Ray device <NUM> with a radiation source <NUM> and a detector <NUM>. The system <NUM> comprises a radiofrequency (RF) emitter <NUM>, an RF receiver <NUM> and a processor <NUM>.

The system <NUM> can be used for a prospective analysis for subject positioning prior to the actual X-ray imaging, as indicated in <FIG>, which shows indicates by an arrow that the positioning is analyzed first and only then the image is acquired. It should be noted that positioning also takes place in a preparation phase of the subject S, which precedes the image acquisition phase, in a different space than the image acquisition phase, such as a preparation room. In addition, it should be noted that the subject S may also already be at or in the X-ray device <NUM> so that the system <NUM> and the X-ray device <NUM> are combined, e.g. to be arranged at a same place, and the subject S does not need to be moved from the system <NUM> to the X-ray device <NUM>.

The RF emitter <NUM> is configured to apply one or more RF signals to an anatomy of interest of the subject S where the implant I is located. Preferably, the RF emitter <NUM> is located outside of the anatomy of interest. For example, the RF emitter <NUM> may comprise or may be formed by one or multiple mono- or multichromatic sources. Further, by way of example, the one or more RF signals may be applied in e.g. a microwave frequency range and/or in e.g. the Gigahertz (GHz) range, e.g. in a wireless local area network (WLAN) frequency domain, e.g. between approx. <NUM> and <NUM>.

The RF receiver <NUM> is configured to detect a response signal and/or a signal change in response to the applied RF signal impacting the implant I and tissue being adjacent to and/or surrounding the implant. Preferably, the RF receiver <NUM> is located outside of the anatomy of interest. The implant I may be made of or may comprise e.g. a metal material etc., and/or in a tissue surrounding the implant. The detection may utilize a suitable detector or sensor, such as an RF receiver, e.g. in form of a coil, or the like.

The processor <NUM> is configured to determine, from the detected response signal and/or signal change, an implant positioning estimation. Further, the processor <NUM> is configured to determine, from the implant positioning estimation, a feedback being indicative for positioning the X-ray imaging device <NUM> and the subject S to each other, to be provided for assisting the positioning.

Optionally, the processor <NUM> may be configured to provide the feedback during X-ray imaging for continuously monitoring implant and/or subject positioning. Thereby, the processor <NUM> may be configured to generate a trigger signal for X-ray image acquisition if the monitored implant positioning and/or subject positioning meets an image acquisition criterion. For example, the processor <NUM> may be configured to generate the trigger signal if the positioning complies with a target positioning.

<FIG> shows in a schematic block diagram a determination of a positioning estimation based on signal processing, according to one embodiment. The RF emitter <NUM> emits one or more RF signals towards the subject S, wherein the RF receiver <NUM> detects the response signal(s) and/or a signal change in response to the applied RF signal.

Optionally, the processor <NUM> may be configured to execute a physical simulation model <NUM> of RF scattering and RF absorption at the implant and/or the tissue for determining the positioning estimation by feeding the detected response signal and/or signal change into the physical simulation model. Thereby, the processor <NUM> may be configured to calculate the positioning estimation therefrom. Further optionally, the processor <NUM> may be configured to feed the physical simulation model with a 3D implant model of the implant. The 3D implant model may be similar to or of the implant. For example, the 3D implant model may be assigned to a specific implant type that at least largely corresponds to the implant type of the subject to be imaged. The 3D implant model may be provided as e.g. a 3D CAD-model.

Further optionally, the processor <NUM> may be configured to provide a physical simulation, i.e. run the physical simulation model, of the RF scattering at the implant and its absorption.

Optionally, the processor <NUM> may be configured to execute an implant pose and/or posture machine-learning model <NUM>, which is trained by training data of a reflected and/or absorbed RF signal with known implant positioning estimation, by feeding the detected response signal and/or signal change into the implant pose and/or posture machine-learning model. Thereby, the processor <NUM> may be configured to calculate the implant positioning estimation therefrom. For example, the implant pose and/or posture machine-learning model may be a deep learning forward-model that may be trained on real or simulated data of reflected and/or absorbed RF signals with known implant pose to estimate and/or predict the latter. The model may be trained to predict from RF reflection and/or absorption at a specific or various implant types.

Further, as shown in <FIG>, the system <NUM> may comprise a communication interface <NUM> configured to output the feedback. For example, the communication interface <NUM> may be configured to provide the feedback graphically, in audio, or the like. It may comprise or may connected to a display, loudspeaker, or the like.

<FIG> shows in a schematic block diagram the system <NUM> of <FIG>, further comprising an optical device <NUM> for detecting positioning data of the subject S. From a functional perspective, the optical device differs from the RF emitter <NUM> and RF receiver <NUM> by having less or no penetration into the subject S. The optical device <NUM> may comprise or may be formed by one or more of an optical camera, an RGB camera, a depth camera, a radar measuring device, and a sonic echo measuring device. Thereby, the processor <NUM> is configured to determine a subject positioning estimation based on patient pose and/or posture measurement data derived from the optical device <NUM> and to combine the implant positioning estimation and the subject positioning estimation with each other, and the feedback to be provided is determined from the combined implant positioning estimation, which utilizes the response signal and/or signal change of the one or more RF signals, and subject positioning estimation.

<FIG> shows in a flow diagram a method for assisting positioning of a subject having an implant in X-ray imaging. The method is carried out by utilizing the system <NUM> described above.

In a step S1, the RF emitter <NUM> emits one or more RF signals to be applied to an anatomy of interest of the subject S where the implant I is located.

In a step S2, the RF receiver <NUM> detects a response signal and/or signal change in response to the applied RF signal impacting the implant I and tissue, e.g. bone(s), being adjacent to and/or surrounding the implant I.

In a step S3, the processor <NUM> determines, from the detected response signal and/or signal change, an implant positioning estimation relative to the X-ray imaging device <NUM>.

In a step S4, the processor <NUM> determines, from the implant positioning estimation, a feedback being indicative for positioning the X-ray imaging device <NUM> and the subject to each other with respect to a target positioning, to be provided for assisting the positioning.

Optionally, the detected response signal and/or signal change is based on or comprises one or more reflection and/or absorption properties of the one or more RF signals at the implant and/or the tissue. It should be noted that the reflection and/or absorption characteristics of the RF signal due to material properties of the implant and/or surrounding tissue allow determination of, or inference or estimation of, the pose, posture, location, orientation, alignment, etc. Further optionally, the detected response signal and/or signal change is detected and/or determined in a spatial distribution manner.

For example, the positioning estimation is determined by feeding the detected response signal and/or signal change into a physical simulation model of RF scattering and RF absorption at the implant and/or the tissue, and calculating the positioning estimation therefrom. Alternatively, or additionally, the positioning estimation is determined by feeding the detected response signal and/or signal change into an implant pose machine-learning model, e.g. a fully-connected neural network, which is trained by training data of a reflected and/or absorbed RF signal with known implant positioning, and calculating the implant positioning estimation therefrom.

Optionally, when determining and/or generating the feedback, a distinction is made as to whether and how exactly the positioning matches the target positioning or in which respect the positioning deviates from it. If the positioning does not match the target positioning, the feedback is determined to guide e.g. the operator how to achieve the target positioning from the positioning determined with the above method.

As indicated in <FIG>, optionally, the method further comprises comparing the implant positioning estimation with a further implant positioning determination derived from X-ray image data of the subject including the implant, wherein the comparison is used to adapt the physical simulation model or to adapt the implant pose machine-learning model. For example, a subject positioning estimation, which differs from the implant positioning estimation by having less or no penetration into the subject may be determined, wherein
the implant positioning estimation and the subject positioning estimation are combined with each other, and wherein the feedback to be provided is determined from the combined implant positioning estimation and subject positioning estimation.

Further optionally, the above method is performed during X-ray imaging, continuously monitoring implant and/or subject positioning, wherein the processor <NUM> may be configured to generate a trigger signal for X-ray image acquisition if the monitored implant positioning and/or subject positioning meets an image acquisition criterion.

In another exemplary embodiment, a computer program or computer program element is provided that is characterized by being configured to execute the method steps of the method according to one of the preceding embodiments, on the system <NUM>.

The computer program element might therefore be stored to be executed by the processor <NUM>, which might also be part of an embodiment. This processor unit may be configured to perform or induce performing of the steps of the method described above. Moreover, it may be configured to operate the components of the above described device and/or system.

Further, the computer program element might be able to provide all necessary steps to fulfill the procedure of an exemplary embodiment of the method as described above.

The computer program element may be stored and/or distributed on a suitable medium, such as an optical storage medium or a solid state medium supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the internet or other wired or wireless telecommunication systems.

It is noted that embodiments of the invention are described with reference to different subject matters.

While the invention has been illustrated and described in detail in the drawings and the foregoing description, such illustration and description are to be considered illustrative or exemplary and not restrictive.

Claim 1:
A computer-implemented method for assisting positioning of a subject having an orthopedic implant in X-ray imaging, comprising:
applying (S1) one or more radiofrequency, RF, signals to an anatomy of interest of the subject where the orthopedic implant is located;
detecting (S2) a response signal and/or signal change in response to the applied RF signal impacting the orthopedic implant and tissue being adjacent to and/or surrounding the implant;
determining (S3), from the detected response signal and/or signal change, an implant positioning estimation relative to an X-ray imaging device; and
determining (S4), from the implant positioning estimation, a feedback being indicative for positioning the X-ray imaging device and the subject to each other with respect to a target positioning, to be provided for assisting the positioning.