Patent Description:
A C-arm, or a mobile intensifier device, is one example of a medical imaging device that is based on X-ray technology. The name C-arm is derived from the C-shaped arm used to connect an X-ray source and an X-ray detector with one another. Various medical imaging devices, such as a C-arm device, can perform fluoroscopy, which is a type of medical imaging that shows a continuous X-ray image on a monitor. During a fluoroscopy procedure, the X-ray source or transmitter emits X-rays that penetrate a patient's body. The X-ray detector or image intensifier converts the X-rays that pass through the body into a visible image that is displayed on a monitor of the medical imaging device. Because medical imaging devices such as a C-arm device can display high-resolution X-ray images in real time, a physician can monitor progress at any time during an operation, and thus can take appropriate actions based on the displayed images. Monitoring the images, however, is often challenging during certain procedures, for instance during procedures in which attention must be paid to the patient's anatomy as well as the display of the medical imaging device. For example, aligning a drill bit to a distal locking hole can be difficult if a medical professional is required to maneuver the drill while viewing the display of the medical imaging device.

<CIT> discloses a medical automatic depth-measuring electric drill. <CIT> discloses a tool with an integrated navigation and guidance system. <CIT> discloses a drill apparatus and surgical fixation devices. <CIT> discloses a drill bit penetration measurement system and method. <CIT> discloses position recognition systems that allow measurement of instrumentation and tools in a patient using robot assisted surgical techniques. The surgical robot system includes a display on which a user can indicate the location of a surgical instrument on a three dimensional image of the patient's anatomy. Registration procedures for tracking objects and a target anatomical structure of the patient are disclosed in which a fluoroscope scan of the targeted anatomical structure of the patient which includes a registration fixture and a detectable imaging pattern of fiducials is imported into the system. An instrument with markings can be inserted into a guide tube and a distance from a top tip of the instrument to the top end of the tracked guide tube can be read using the markings and shown on a graphical image of the patient anatomy. <CIT> discloses a system for treating tissue during a medical procedure, comprising an instrument including a hand-held portion, a working portion movably coupled to the hand-held portion, a plurality of actuators operatively coupled to the working portion for moving the working portion in a plurality of degrees of freedom relative to the hand-held portion, and a tracking device attached to the hand-held portion for tracking the instrument. The system includes a navigation system for determining a position of the working portion relative to a virtual boundary associated with the tissue being treated. A display is in communication with the navigation system for indicating the position of the working portion relative to the virtual boundary.

<CIT> forms prior art according to Art. <NUM>(<NUM>) EPC and discloses an accelerometer based instrument alignment system wherein an accelerometer of a surgical instrument assembly is calibrated with a direction of X-ray travel from an X-ray generator to an X-ray receiver of a medical imaging device.

The present invention provides a surgical instrument assembly as recited in claim <NUM>. Optional features are recited in the dependent claims.

The following additional features are within the scope of the disclosure but are not explicitly claimed. The fluoroscopic data can be, for instance, X-ray images or video data. The surgical instrument assembly can receive the fluoroscopic data in real-time, via a wireless communications channel for example. The working end of the surgical instrument can be configured to operate on the anatomical structure. The surgical instrument assembly can include a drill having a drill bit. The surgical instrument assembly can display an X-ray image of an anatomical structure generated by the medical imaging device. The X-ray image can include a target location. A tip of the drill bit can be positioned on the anatomical structure, and the surgical instrument assembly can display a representation of a position of the tip of the drill bit with the target location. The surgical instrument assembly can further display an orientation image that includes a static region and a movable indicator that is representative of an orientation of the drill bit, wherein the drill is oriented with the direction of X-ray travel when the movable indicator has a predetermined spatial relationship to the static region. A hole can be drilled in the anatomical structure while the tip of the drill bit is aligned with the target location, and while the movable indicator has the predetermined spatial relationship to the static region.

The foregoing summarizes only a few aspects of the present disclosure and is not intended to be reflective of the full scope of the present disclosure. Additional features and advantages of the disclosure are set forth in the following description, may be apparent from the description, or may be learned by practicing the invention. Moreover, both the foregoing summary and following detailed description are exemplary and explanatory and are intended to provide further explanation of the disclosure.

The foregoing summary, as well as the following detailed description of example embodiments of the present disclosure, will be better understood when read in conjunction with the appended drawings. For the purposes of illustrating the example embodiments of the present disclosure, references to the drawings are made. It should be understood, however, that the application is not limited to the precise arrangements and instrumentalities shown. In the drawings:.

A medical professional can use a medical imaging device, for instance a C-arm device, to perform various medical procedures on a patient. For example, medical professionals can use imaging devices to assess bone fractures, guide surgical procedures, or verify results of surgical repairs. C-arm devices, for example, provide spot imaging and fluoroscopic imaging, which allows the generation of continuous real-time moving images. Such images are provided to a display of the C-arm device. It is recognized herein that, in some cases, the display of the C-arm system is not positioned in a manner that adequately assists a medical professional. In various embodiments described herein, images provided by imaging devices are transmitted in real-time to a display that can be mounted to a surgical instrument, such that fluoroscopic imaging provided by the imaging device can be viewed by a medical professional as the medical professional operates and views a working end of the surgical instrument. The display can receive the images in real-time, such that the images are displayed by the display at the same time that the images are generated by the imaging device. In one example, the display is mounted to a surgical drill, such that fluoroscopic images provided by the imaging device can be viewed during an intramedullary (IM) nailing procedure. In an embodiment, an alignment application can also be rendered by the display mounted to the surgical drill, so as to guide the medical professional during the IM nailing procedure.

As an initial matter, because fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor, the terms fluoroscopic data, fluoroscopic image, video data, and X-ray image may be used interchangeably herein, without limitation, unless otherwise specified. Thus, an X-ray image may refer to an image generated during a fluoroscopic procedure in which an X-ray beam is passed through the anatomy of a patient Further, it will be understood that fluoroscopic data can include an X-ray image, video data, or computer-generated visual representations. Thus, fluoroscopic data can include still images or moving images.

Referring to <FIG>, a medical imaging system <NUM> can include a medical imaging device <NUM> and a surgical instrument assembly <NUM> in electrical communication with the imaging device <NUM>. The medical imaging device <NUM>, which can be a C-arm device, can include an X-ray generator or transmitter <NUM> configured to transmit X-rays through a body (e.g., bone) and an X-ray detector or receiver <NUM> configured to receive the X-rays from the X-ray transmitter <NUM>. Thus, the medical imaging device <NUM> can define a direction of X-ray travel <NUM> from the X-ray transmitter <NUM> to the X-ray receiver <NUM>. The X-ray transmitter <NUM> can define a flat surface 106a that faces the X-ray receiver <NUM>. The medical imaging device <NUM> can further include an arm <NUM> that physically connects the X-ray transmitter <NUM> with the X-ray receiver <NUM>. The medical imaging device <NUM> can further be communication with a medical imaging device display <NUM> that is configured to display X-ray images from the X-ray detector <NUM>. In some cases, the medical imaging device display <NUM> can be hard-wired with the X-ray detector <NUM>, such that the display <NUM> can be in a fixed position relative to the arm <NUM>.

The medical imaging device <NUM> is presented as a C-arm device to facilitate description of the disclosed subject matter, and is not intended to limit the scope of this disclosure. Further, the imaging system <NUM> and the imaging device <NUM> are presented as a medical imaging system and a medical imaging device, respectively, to facilitate description of the disclosed subject matter, and are not intended to limit the scope of this disclosure. Thus, it will be appreciated that other devices, systems, and configurations may be used to implement the embodiments disclosed herein in addition to, or instead of, a system such as the system <NUM>, and all such embodiments are contemplated as within the scope of the present disclosure. It is recognized herein that the position of the display <NUM> can create problems for a medical professional. For example, in some cases, the medical professional may need to view images or data rendered by the display <NUM> while viewing a patient positioned between the X-ray generator <NUM> and the X-ray detector <NUM>. In an example, a medical professional may face challenges placing distal locking screws during an IM nailing procedure due to insufficient assistive instruments or guidance systems, such as an aiming arm used in placement of proximal screws. Distal screws are commonly inserted in a freehand technique under fluoroscopic guidance. The freehand technique is commonly referred to as the perfect circle technique. For example, once a perfect circle is established during an IM nailing procedure, it may be difficult to properly align a drill bit to the axis of the distal locking hole due to lack of visibility while using radiographic images. Improper alignment can lead to breaching or cracking of an implant during the drilling of a pilot hole, which can result in implant breakage, poor reduction/fixation, delay of surgery, or the like. It is further recognized herein that an orientation of an X-ray image rendered by the display <NUM> might not match the orientation of the patient's anatomy, thereby creating further challenges for a medical professional. In various examples described herein, a surgical instrument assembly can be configured so as guide and help a medical professional during various operations, such as an IM nailing procedure.

Referring now to <FIG>, in one embodiment, data (e.g., video or still images) provided by the medical imaging device <NUM> can be received by an instrument application, for instance a fluoroscopic mirror application, which can be a program, such as a software or hardware or combination of both, that can be run on any suitable computing device. A user can use the instrument application to view images generated by the medical imaging device <NUM>. The instrument application can receive and display fluoroscopic images at various locations, for instance at a location that is aligned with the view of a patient.

Referring to <FIG> and <FIG>, any suitable computing device <NUM> can be configured to host the instrument application. It will be understood that the computing device <NUM> can include any appropriate device, examples of which include a portable computing device, such as a laptop, tablet, or smart phone. In another example, the computing device <NUM> can be internal to the surgical instrument <NUM>.

In an example configuration, the computing device <NUM> includes a processing portion or unit <NUM>, a power supply <NUM>, an input portion <NUM>, a display <NUM>, a memory portion <NUM>, a user interface portion <NUM>, and an accelerometer <NUM>. It is emphasized that the block diagram depiction of computing device <NUM> is an example and not intended to imply a specific implementation and/or configuration. The processing portion <NUM>, input portion <NUM>, display <NUM>, memory <NUM>, user interface <NUM>, and accelerometer <NUM> can be coupled together to allow communications therebetween. The accelerometer <NUM> can be configured to generate accelerometer information that corresponds to an orientation of the computing device <NUM>. As should be appreciated, any of the above components may be distributed across one or more separate devices and/or locations.

In various embodiments, the input portion <NUM> includes a receiver of the computing device <NUM>, a transmitter of the computing device <NUM>, or a combination thereof. The input portion <NUM> is capable of receiving information, for instance fluoroscopic data in real-time, from the medical imaging device <NUM>. As should be appreciated, transmit and receive functionality may also be provided by one or more devices external to the computing device <NUM>, and thus the surgical instrument assembly <NUM>.

Depending upon the exact configuration and type of processor, the memory portion <NUM> can be volatile (such as some types of RAM), non-volatile (such as ROM, flash memory, etc.), or a combination thereof. The computing device <NUM> can include additional storage (e.g., removable storage and/or non-removable storage) including, but not limited to, tape, flash memory, smart cards, CD-ROM, digital versatile disks (DVD) or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, universal serial bus (USB) compatible memory, or any other medium which can be used to store information and which can be accessed by the computing device <NUM>.

The computing device <NUM> also can contain the user interface portion <NUM> allowing a user to communicate with the computing device <NUM>. The user interface <NUM> can include inputs that provide the ability to control the computing device <NUM>, via, for example, buttons, soft keys, a mouse, voice actuated controls, a touch screen, movement of the computing device <NUM>, visual cues (e.g., moving a hand in front of a camera on the computing device <NUM>), or the like. The user interface portion <NUM> can provide outputs, including visual information (e.g., via a display), audio information (e.g., via speaker), mechanically (e.g., via a vibrating mechanism), or a combination thereof. In various configurations, the user interface portion <NUM> can include a display, a touch screen, a keyboard, a mouse, an accelerometer, a motion detector, a speaker, a microphone, a camera, a tilt sensor, or any combination thereof. The user interface portion <NUM> can further include any suitable device for inputting biometric information, such as, for example, fingerprint information, retinal information, voice information, and/or facial characteristic information. Thus, a computer system such as the computing device <NUM> can include a processor, a display coupled to the processor, and a memory in communication with the processor. The memory can have stored therein instructions that, upon execution by the processor, cause the computer system to perform operations, such as the operations described herein. The display <NUM> can be configured to display visual information, such as described with reference to <FIG><FIG>, and <FIG>.

Referring to <FIG> and <FIG>, a transmitter unit <NUM> can be electrically coupled to, or can be part of, the medical imaging device <NUM>. The transmitter unit <NUM> can be any suitable computing device configured to receive and send images, for instance video signals including fluoroscopic images. It will be understood that the transmitter unit <NUM> can include any appropriate device, examples of which include a portable computing device, such as a laptop, tablet, or smart phone.

Referring in particular to <FIG>, in an example configuration, the transmitter unit <NUM> can include a processing portion or unit <NUM>, a power supply <NUM>, an input portion <NUM>, and an output portion <NUM>. It is emphasized that the block diagram depiction of transmitter unit <NUM> is an example and not intended to imply a specific implementation and/or configuration. The processing portion <NUM>, input portion <NUM>, and output portion <NUM> can be coupled together to allow communications therebetween. As should be appreciated, any of the above components may be distributed across one or more separate devices and/or locations.

In various embodiments, the input portion <NUM> includes a receiver of the transmitter unit <NUM>, and the output portion <NUM> includes a transmitter of the transmitter unit <NUM>. The input portion <NUM> is capable of receiving information, for instance fluoroscopic images or video data, from the medical imaging device <NUM>, in particular an output interface <NUM> of the medical imaging device <NUM>. The output interface <NUM> can include a coaxial output, a usb output, a component output, a wireless output, or the like. As should be appreciated, transmit and receive functionality may also be provided by the medical imaging device <NUM>. In an example, the transmitter unit <NUM> is electrically coupled to the output interface <NUM> of the medical imaging device <NUM>, so as to establish a wired or wireless electrical connection between the transmitter unit <NUM> and the display <NUM>. The output interface <NUM> can include or more video output connectors using the matching input module. In an example, the processing portion <NUM>, which can include or more processors running on an embedded operating system, can detect the presence of a signal, for instance a video signal including fluoroscopic images, from the medical imaging device <NUM>. The processing portion <NUM> can process the signal as necessary for transmitting to the surgical instrument assembly <NUM>. For example, the processing portion <NUM> can compress the signal so as to reduce the bandwidth that is used for transmitting the signal.

After the processing portion <NUM> performs processing on the video signal, as necessary, the video signal that can include fluoroscopic images can be sent by the output portion <NUM> of the transmitter unit <NUM> to the input portion <NUM> of the computing device <NUM>. The output portion <NUM> of the transmitter unit <NUM> can be configured to transmit fluoroscopic images in accordance with any communication protocol as desired. For example, the output portion <NUM> can include a ZigBee module connected to the processing portion <NUM> via a universal serial bus (USB), such that the output portion <NUM> can send data wirelessly (via a wireless communications channel) in accordance with any ZigBee protocol. The output portion <NUM> can send video signals, for instance fluoroscopic images, over Wi-Fi, Bluetooth, broadcast, or any other wireless communication channels as desired.

Accordingly, the input portion <NUM> of the device <NUM> can receive data or video signals in real-time, for instance fluoroscopic images, which are sent via a wireless communication channel from the medical imaging device <NUM>. The input portion <NUM> can be configured to receive ZigBee messages, Wi-Fi messages, Bluetooth messages, broadcast messages, or messages formatted in accordance with any wireless protocol as desired. In an example, when the input portion <NUM> of the device <NUM> receives the fluoroscopic images from the medical imaging device <NUM>, the images can be retrieved and verified by the processing portion <NUM> of the computing device <NUM>. For example, the processing portion <NUM> can verify that the received images are from the appropriate medical imaging device. The images can be forwarded to the display <NUM>, for example, when the images are verified. The processing portion <NUM> can also ensure that valid data is displayed. For example, if there is an interruption to the wireless communication channel or connection between the computing device <NUM> and the medical imaging device <NUM>, the processing portion <NUM> can identify the interruption, and send a message to the display <NUM> so that the interruption is conveyed to a medical professional who views the display <NUM>. In some cases, the processor <NUM> can cause the surgical instrument assembly <NUM> to display an indication of error on the display <NUM> when a quality of the communication link between the imaging device <NUM> and the surgical instrument assembly <NUM> is below a predetermined threshold. Thus, a wireless point-to-point communication channel or connection between the transmitter unit <NUM> and the computing device <NUM> can be established, and the wireless point-to-point connection can be managed by the input portion <NUM> and the output portion <NUM> on the physical layer, and the processing portions <NUM> and <NUM> at the application layer.

Referring now to <FIG> and <FIG>, the medical imaging system <NUM> can include the surgical instrument assembly <NUM> that can include the computing device <NUM> mounted to a surgical instrument <NUM>. The surgical instrument <NUM> can be configured to operate on an anatomical structure, such as an anatomical structure <NUM>. The surgical instrument <NUM> can define a body <NUM>, and the computing device <NUM> can be attached anywhere to the body <NUM> as desired. In an example, referring to <FIG>, the computing device <NUM>, and thus the display <NUM>, can be supported by a mount <NUM>. The mount <NUM> can include a support surface <NUM> that supports the computing device <NUM>, and thus the display <NUM>. The mount <NUM> can further include an arm <NUM> attached to the support surface <NUM> and the body <NUM> of the surgical instrument <NUM>, such that the display <NUM> is in a fixed position relative to the body <NUM> of the surgical instrument <NUM>. The arm <NUM> or the support surface <NUM> can be configured to rotate, so as to adjust the viewing angle of the display <NUM>. The mount <NUM> can be positioned such that the display does not interfere with the operation of the surgical instrument <NUM>. It will be understood that the computing device <NUM> can be alternatively mounted to the surgical instrument <NUM> as desired.

Referring to <FIG>, <FIG>, and <FIG>, for example, the surgical instrument assembly <NUM> can further include a depth gauge <NUM>. The depth gauge <NUM> can include one or more processors configured to measure, determine, and transmit data related to the depth of a drilling operation performed on an anatomical structure, as further described herein. In some examples, the depth gauge <NUM> is embodied in accordance with the measuring device suitable for bone screw length determination that is described in International Application Publication No. <CIT>. It will be understood that the depth gauge <NUM> can be alternatively embodied. The depth gauge <NUM> can be in communication with the display <NUM>. The depth gauge <NUM> can be configured to measure drill depths of the surgical instrument <NUM> as the surgical instrument <NUM> operates as a drill. The depth gauge <NUM> can be secured to the surgical instrument <NUM> in a fixed position relative to the surgical instrument <NUM>. The depth gauge <NUM> can be releasably attached or fixed to the body <NUM> of the surgical instrument <NUM>, so as to be secured in a fixed position relative to the body <NUM>. The depth gauge <NUM> can be supported by an adaptor <NUM> that can be secured to the body <NUM> and the depth gauge <NUM>. The adaptor <NUM> can be sized as desired to clamp to the body <NUM>, such that the adaptor <NUM>, and thus the depth gauge <NUM>, remain in a fixed position relative to the body <NUM> as the surgical instrument <NUM> operates. In an example, the adaptor <NUM> can be adjusted by moving, for instance turning, an actuator <NUM>. The actuator <NUM> can be configured as a knob or the like. For instance, the actuator <NUM> can be turned in a clockwise direction to tighten the adaptor <NUM>, and the actuator can be turned in a counterclockwise direction to loosen the adaptor <NUM>.

The depth gauge <NUM> can define a depth gauge body <NUM> that defines a first or front end 254a and a second or rear end 254b opposite the first end 254a along a longitudinal direction L. The depth gauge body <NUM> can further define a third or top end 254c and a fourth or bottom end 254d that is opposite the third end 254c along a transverse direction T that is substantially perpendicular to the longitudinal direction L. The adapter <NUM> can be secured to the fourth end <NUM> of the depth gauge <NUM>, though it will be understood that the depth gauge <NUM> can be alternatively secured to the adaptor <NUM> as desired. The adaptor <NUM> can be press fit to the body <NUM> of the surgical instrument <NUM>. The adaptor <NUM> can define a clamp collar that is secured to the body <NUM> of the surgical instrument <NUM>, though it will be understood that the adaptor <NUM> can be alternatively secured to the surgical instrument <NUM>. In another example, the depth gauge <NUM> can be secured directly to the surgical instrument <NUM> without the adaptor <NUM>.

Still referring to <FIG>, <FIG>, and <FIG>, the depth gauge <NUM> can further include a depth gauge member <NUM> that extends from the depth gauge body <NUM>, for instance at the second end 254b of the depth gauge body <NUM>. The computing device <NUM> can further define a computing device body 204a and a computing device member <NUM> that extends from the body 204a, so as to attach to the depth gauge member <NUM>. The computing device member <NUM> can be monolithic or otherwise attached to the computing device body 204a, such that the computing device member <NUM> can be in a fixed position relative to the computing device body 204a. Further, the display <NUM> can be in a fixed position relative to the computing device body 204a. Thus, the display <NUM> can be in a fixed position relative to the computing device member <NUM>. The computing device member <NUM> can be configured to rotate with respect to the depth gauge member <NUM>. In an example, the computing device member is configured to rotate about an axis <NUM> that is substantially parallel with the transverse direction T. Thus, the display <NUM> can be configured to rotate about the axis <NUM> that is substantially parallel with the transverse direction T. For example, the display <NUM> can be configured to rotate about the axis <NUM> so as to adjust the viewing angle of the display <NUM> while an operation is being performed. The axis <NUM> can be centered with respect to a width of the display <NUM> that is defined along a lateral direction A that is substantially perpendicular to both the longitudinal direction L and the transverse direction T. It will be understood that the display <NUM> can be configured to rotate about alternative axes as desired. The one or more processors of the depth gauge <NUM> can be communicatively coupled to the computing device <NUM>, and thus to the display <NUM>. In an example, the depth gauge <NUM> is configured to wirelessly transmit data to the computing device <NUM>. For example, the depth gauge <NUM> can provide real-time data to the computing device <NUM> over a Wi-Fi network.

It will also be understood that the computing device <NUM> can alternatively be monolithic to the surgical instrument <NUM>. Further, though the surgical instrument <NUM> is depicted as a surgical drill for purposes of example, it will be appreciated that the computing device <NUM> and the depth gauge <NUM> can be mounted to, or can be monolithic with, numerous suitable alternative equipment or instruments. For example, the surgical instrument assembly <NUM> can include an instrument or equipment configured to target an area of bone or other part of the anatomy, remove a medical implant, perform an osteotomy, or any other procedure, for instance any other procedure using fluoroscopy, as desired. Thus, although the anatomical structure <NUM> is presented as a bone, it will be understood that structures on which the surgical instrument assembly can be configured to operate are not limited to bones.

The computing device <NUM>, and thus the surgical instrument assembly <NUM>, can include the display <NUM> that can be attached to the surgical instrument. The display <NUM> can be configured to display fluoroscopic images of the anatomical structure <NUM> that are generated by the imaging device <NUM>. In an example configuration, the display <NUM> can display fluoroscopic images of the anatomical structure <NUM> in real-time, such that the images of the anatomical structure <NUM> are displayed by the display <NUM> at the same time that the images are generated by the imaging device <NUM>. In some cases, the display <NUM>, and thus the surgical instrument assembly <NUM>, can include a plurality of displays, for instance a first display 212a and a second display 212b that has a different orientation as compared to an orientation of the first display 212a. In another example configuration, for instance as shown in <FIG>, <FIG>, and <FIG>, the display <NUM>, and thus the surgical instrument assembly <NUM>, includes only one display.

With reference to <FIG> and <FIG>, the surgical instrument <NUM> can define a proximal end 203b and a working end 203a opposite the proximal end 203b. The working end 203a can be configured to operate on, for instance cut, drill, or otherwise target, a structure, for instance the anatomical structure <NUM>, of a medical patient. The display <NUM> can face the proximal end 203b. The display <NUM>, in particular the first display 212a and the second display 212b, can be positioned so as to provide a line of sight to both the working end 203a and the display <NUM> from a location proximate of the surgical instrument <NUM>. Thus, in some cases, for example, a medical professional can, while operating the surgical instrument <NUM>, view both the display <NUM> and the working end 203a of the surgical instrument <NUM>.

In an example, the surgical instrument <NUM> includes a cutting instrument <NUM> that includes a proximal end 226b adjacent to the body <NUM> of the surgical instrument <NUM>, and a cutting tip 226a opposite the proximal end 226b of the cutting instrument <NUM>. The cutting tip 226a can define a terminal end of the cutting instrument that is opposite to the proximal end 226b of the cutting instrument <NUM>. The cutting instrument <NUM> can have the cutting tip 226a that can be configured to remove anatomical material from an anatomical structure, for instance the anatomical structure <NUM>. In the illustrated example, the cutting instrument <NUM> is a drill bit, and the cutting tip 226a is a tip of the drill bit, though it be appreciated that other instruments and configurations may be used to implement the embodiments disclosed herein in addition to, or instead of, an instrument such as the cutting instrument <NUM>, and all such embodiments are contemplated as within the scope of the present disclosure.

The surgical instrument assembly <NUM> can include an alignment tool <NUM>, for instance an axis alignment tool, mounted to the body <NUM> of the surgical instrument <NUM>. It will be understood that the alignment tool <NUM> can alternatively be monolithic to the surgical instrument <NUM>. The alignment tool <NUM> can be rigidly attached to the body <NUM> of the surgical instrument <NUM>. In an example, the cutting instrument <NUM> is located at the working end 203a of the surgical instrument <NUM>, and the alignment tool <NUM> is located at the proximal end 203b of the surgical instrument, though it will be understood that that the alignment tool <NUM> can be alternatively located as desired. The alignment tool <NUM> can define a first surface 218a proximate to the surgical instrument <NUM> and a second surface 218b opposite the first surface 218a. The second surface 218b can define a flat surface, and thus the alignment tool <NUM> can define a flat surface. Thus, the second surface 218b of the alignment tool <NUM> can define a plane. The cutting instrument <NUM> (e.g., drill bit) can be oriented perpendicularly to the plane defined by the second surface 218b of the alignment tool <NUM>. In an example, the alignment tool <NUM> includes a pin that is oriented perpendicularly to the plane defined by the second surface 218b of the alignment tool. The pin can be configured to be received by a hole defined by the proximal end 203b of the surgical instrument <NUM>. The hole defined by the proximal end 203b of the surgical instrument <NUM> can have a parallel orientation with the cutting instrument <NUM>, such that, when the pin of the alignment tool <NUM> is received by the hole defined by the proximal end 203b of the alignment tool <NUM>, the second surface 218b of the alignment tool defines the plane that is perpendicular to the orientation of the cutting instrument <NUM>.

Referring also to <FIG>, fluoroscopic images of the anatomical structure <NUM> can include one or more target locations <NUM>. The target locations <NUM> can represent locations on the anatomical structure <NUM> that the surgical instrument <NUM> can drill, cut, or otherwise target. In accordance with the illustrated example, the target locations <NUM> can be defined by an implant <NUM>, for instance an IM nail or rod, in a bone. It will be understood that an example operation performed by the surgical instrument assembly is presented as an IM nailing operation to facilitate description of the disclosed subject matter, and the example IM operation is not intended to limit the scope of this disclosure. Thus, it will be appreciated that the surgical instrument assembly <NUM> may be used to perform other operations in addition to, or instead of, an operation such as the example IM nailing operation, and all such embodiments are contemplated as within the scope of the present disclosure.

The display <NUM> can display fluoroscopic images associated with IM nailing operations, among others. Further, the display <NUM> can display images or data associated with the depth gauge <NUM>. Further still, the display <NUM> can display images or data associated with the depth gauge <NUM> at the same time that the display <NUM> renders fluoroscopic images. The display <NUM> can be configured to display fluoroscopic images, for instance example fluoroscopic images 400a-c of the anatomical structure <NUM>, generated by, and received from, the medical imaging device <NUM>. Referring in particular to <FIG>, the display <NUM>, for instance the first display 212a, can display the example fluoroscopic image 400a, of the implant <NUM> in the anatomical structure <NUM>. The implant <NUM> can define one or more target locations <NUM> at which material can be removed from the anatomical structure <NUM>. In an example IM nailing operation, by viewing the display <NUM> that displays fluoroscopic images from the imaging device <NUM>, a medical professional can maneuver the patient or the imaging device <NUM> while viewing the patient and display <NUM> simultaneously, until the target locations <NUM> define perfect circles, as illustrated in <FIG>. In the IM nailing example, when the one or more target locations <NUM> define perfect circles, holes can be drilled at the target locations <NUM> for locking screws.

Referring now to <FIG>, the display <NUM> can display the example fluoroscopic image 400b. Thus, the display <NUM> can be configured to display a position of the cutting tip 226a of the cutting instrument <NUM> relative to the target location <NUM> on the fluoroscopic images of the anatomical structure <NUM>. The fluoroscopic image 400b can depict, for example, the position of the cutting tip 226a that is shown in <FIG>. The cutting tip 226a can be configured to remove anatomical material from the one or more target locations <NUM> of the anatomical structure <NUM>. Further, as shown in <FIG>, the tip 226a of the cutting instrument <NUM> (e.g., drill bit) can be positioned on the anatomical structure <NUM>, for instance at the center of the target location <NUM>. The display <NUM> can be positioned so as to provide a line of sight to both the tip 226a and the display <NUM> from a location proximate of the surgical instrument <NUM>, such that a medical professional can view both the fluoroscopic images 400b and 400c, and thus the tip 226a, and the anatomical structure <NUM>, so as to center the tip 226a at the target location <NUM>. The display <NUM> of the surgical instrument <NUM> can mirror the display <NUM> of the medical imaging device <NUM>, such that the display <NUM> of the surgical instrument assembly <NUM> can render the same images that the display <NUM> of the imaging device <NUM> renders at the same time, so as to display images in real-time.

In some cases, for instance based on a user selection via the user interface <NUM>, the surgical instrument assembly <NUM> can rotate the displayed fluoroscopic images on the display <NUM> to a rotated orientation such that a vertical or horizontal direction on the display <NUM> corresponds with a vertical or horizontal direction, respectively, of movement of the surgical instrument <NUM> relative to the anatomical structure <NUM>. Thus, in some cases, the fluoroscopic images in the rotated orientation that are displayed by the display <NUM> can be rotated as compared to the fluoroscopic images displayed on the medical imaging device display <NUM> that is separate from the display <NUM> that is coupled to the surgical instrument <NUM>.

Referring now to <FIG>, the display <NUM> is configured to provide a visual indication, for instance an orientation image <NUM>, of an alignment of the cutting tip 226a with respect to the direction of X-ray travel <NUM> from the X-ray transmitter <NUM> to the X-ray receiver <NUM>. In an example, the display <NUM> includes the first display 212a and the second display 212b, and the first display 212a is configured to display fluoroscopic images (e.g., fluoroscopic images 400a-c) from the imaging device <NUM>, and the second display 212b is configured to display orientation screens (e.g., orientation screens 500a-c) that include a visual indication of an orientation of the cutting instrument <NUM>. It will be understood that the first display 212a can also, or alternatively, display orientation screens, and the second display 212b can also, or alternatively, display fluoroscopic images. Further, the display <NUM> can, in some cases, include only one display, which can display both fluoroscopic images and orientation screens at the same time. Further still, referring to <FIG> and <FIG>, the display <NUM> can, in some cases, include only one display that can display any combination of fluoroscopic images, orientation screens, and depth gauge data at the same time. In an example, a user can select an option via the user interface <NUM> to select which of the fluoroscopic images, orientation screens, or depth gauge data are displayed by the display <NUM>. In another example, the display <NUM> can be separated, for instance split in half or split in thirds, such that any combination of the fluoroscopic images, orientation screens, and depth gauge data can be displayed by the display <NUM> at the same time. It will be understood that the examples described herein of images (e.g., <FIG>, <FIG>, <FIG>) that can be displayed by the display <NUM> are not exhaustive. The display <NUM> can provide a user with various information via a variety of arrangements or alternative visual depictions.

The visual indication of alignment, for instance the orientation image <NUM>, is based on the direction of X-ray travel <NUM>, and is further based on accelerometer information that corresponds to an orientation of the cutting instrument <NUM>. The accelerometer <NUM> of the surgical instrument assembly <NUM> is calibrated with the direction of X-ray travel <NUM> travel from the X-ray generator <NUM> to the X-ray receiver <NUM> of the medical imaging device <NUM>. In an example calibration, the alignment tool <NUM> that is attached to the surgical instrument <NUM> is configured to register with a surface of the medical imaging device <NUM> that has a predetermined orientation so as to align the cutting instrument <NUM> (e.g., drill bit) with the direction of X-ray travel <NUM>. In one example, the alignment tool <NUM> is configured to register with the flat surface 106a of the X-ray transmitter, though it will be understood that the alignment tool <NUM> can be configured to register with other surfaces of the medical imaging device <NUM> as desired. In particular, the second surface 218b of the alignment tool <NUM> can be a flat surface that can abut the flat surface 106a of the medical imaging device <NUM> when the cutting instrument <NUM> is aligned with the direction of X-ray travel <NUM>. Continuing with the example, a zero value can be set when the surface 218b of the alignment tool <NUM> abuts the flat surface 106a of the X-ray generator <NUM>, so as to calibrate the accelerometer <NUM> with the medical imaging device <NUM>, in particular the direction of X-ray beams generated by the medical imaging device <NUM>. In one example, to set the zero value, thereby calibrating the accelerometer <NUM> with the direction of X-ray travel <NUM>, a user can actuate a calibration option <NUM> on the display <NUM> when the surface 218b of the alignment tool is flat against the flat surface 106a of the X-ray generator <NUM>, such that the zero value is set when the cutting instrument <NUM> is oriented along the direction of X-ray travel <NUM>.

In another example, a calibration instrument can be part of, or attached to, the medical imaging device <NUM>. When the medical imaging device <NUM>, and in particular the direction of X-ray travel <NUM>, is oriented in the desired position to perform an operation, the calibration instrument of the medical imaging device <NUM> can identify a zero value relative to gravity, such that the zero value corresponds to the desired direction of X-ray travel <NUM>. The calibration instrument <NUM> of the medical imaging device <NUM> can send the zero value relative to gravity to the accelerometer <NUM>. Thus, the surgical instrument assembly <NUM> can receive, from the medical imaging device <NUM>, a zero value representative of the direction of X-ray travel <NUM> from the X-ray generator <NUM> to the X-ray receiver <NUM> of the medical imaging device <NUM>, so as to calibrate the accelerometer <NUM> of the surgical instrument assembly <NUM> with the direction of X-ray travel <NUM> defined by the medical imaging device <NUM>. The accelerometer <NUM> can set its zero value relative to gravity to the zero value that it receives from the calibration instrument of the medical imaging device <NUM>, thereby calibrating the accelerometer <NUM> with the direction of X-ray travel <NUM>. Thus, the accelerometer <NUM> can indicate the zero value when the cutting instrument <NUM> is oriented along the direction of X-ray travel <NUM>.

In an example, the accelerometer <NUM> corresponds to an orientation of the display <NUM>. Thus, in some cases, when the orientation of the display <NUM> with respect to the cutting instrument <NUM> is adjusted, the zero value is re-set to re-calibrate the accelerometer <NUM> with the direction of X-ray travel <NUM>. In some examples, the display <NUM> has one or more preconfigured orientations (e.g., <NUM> degrees, <NUM> degrees, etc.) with respect to the cutting instrument <NUM>. Thus, in some cases, after calibration at a first preconfigured orientation, the display <NUM> can be moved to a second preconfigured orientation. In an example, the user can select, using the user interface <NUM>, the preconfigured orientation at which the display <NUM> is positioned. The accelerometer <NUM> can receive the second preconfigured orientation, and adjust the zero value accordingly, such that the display <NUM> is adjusted without the accelerometer being re-calibrated. In yet another example, the medical imaging device <NUM> includes an accelerometer that can identify a change in orientation of the direction of X-ray travel. In this example, the accelerometer of the medical imaging device can send the change in orientation of the direction of X-ray travel to the surgical instrument assembly <NUM>, such that the zero value can be re-set without re-calibrating the accelerometer <NUM>. Thus, the zero value can be adjusted in accordance with a change in the orientation of the X-ray generator <NUM> and X-ray receiver <NUM>.

When the accelerometer <NUM> of the surgical instrument assembly <NUM> is calibrated with the direction of X-ray travel the accelerometer generates accelerometer information that indicates an orientation of the cutting instrument <NUM> relative to the direction of X-ray travel <NUM>. The accelerometer information can be displayed by the display <NUM> in various orientation screens, for instance orientation screens 500a-c, which can include the orientation image <NUM>. By way of an IM nailing example, by viewing the orientation image <NUM> while using the surgical instrument assembly <NUM>, the cutting instrument <NUM> can be maintained at the proper orientation while drilling. That is, holes can be drilled at the target locations <NUM> that define perfect circles.

For example, referring to <FIG>, the orientation screens 500a-c can include the orientation image <NUM> that can include a static region <NUM> and a movable indicator <NUM>. The movable indicator <NUM> can be representative of the orientation of the cutting instrument <NUM>. In an example, the cutting instrument <NUM> is oriented with the direction of X-ray travel <NUM> when the movable indicator <NUM> has a predetermined spatial relationship to the static region <NUM>. In an example, a hole is drilled in the anatomical structure <NUM> while the tip 226a of the cutting instrument <NUM> (e.g., drill bit) is aligned with the target location <NUM>, and the movable indicator <NUM> has the predetermined spatial relationship to the static region <NUM>. It will be understood that the predetermined spatial relationship can vary as desired. In some cases, for example, the cutting instrument <NUM> is oriented with the direction of X-ray travel <NUM> when the movable indicator <NUM> overlies the static region <NUM>. In some cases, as shown in <FIG>, the cutting instrument <NUM> is oriented with the direction of X-ray travel <NUM> when the movable indicator <NUM> is within a boundary defined by the static region <NUM>.

Referring to <FIG>, the display <NUM> can also be configured to provide a visual indication, for instance a depth gauge image <NUM>, of the depth of the cutting tip 226a with respect to one or more portions of the anatomical structure <NUM>. In an example, referring to <FIG>, the anatomical structure <NUM> defines a first or near cortex <NUM> and a second or far cortex <NUM> opposite the first cortex <NUM> along a first direction D1 or the direction of X-ray travel <NUM>, which can be in the direction of drilling. The first cortex <NUM> can define a first or near surface 125a and a second or far surface 125b opposite the first surface 125a along the first direction D1. Similarly, the second cortex <NUM> can define a first or near surface 127a and a second or far surface 127b opposite the first surface 127a along the first direction D1, which can also be along the direction X-ray travel <NUM>. The anatomical structure <NUM> can define a hollow portion <NUM>. For example, the hollow portion <NUM> can be defined between the second surface 125a of the first cortex <NUM> and the first surface 127b of the second cortex <NUM>. The visual indication of depth, for instance the depth gauge image <NUM>, can change as the cutting instrument <NUM>, in particular the cutting tip 226a, travels into the anatomical structure <NUM>. In particular, the depth gauge image <NUM> can include data that can change when the cutting instrument tip 226a contacts the respective first and second surfaces of the first cortex <NUM> and the second cortex <NUM>.

In an example operation, referring first to <FIG> and <FIG>, which depict an example depth gauge screen 1000a and an example split screen <NUM>, respectively, the depth gauge image <NUM> is configured to measure a first distance of a reference location relative to a portion of the anatomical structure <NUM>, and the display <NUM> is configured to indicate a second distance of the cutting tip 226a relative to the portion of the anatomical structure <NUM>. The depth gauge <NUM> can be configured to measure the first distance as the surgical instrument <NUM> drills a hole. The display <NUM> can be configured to indicate the second distance as the surgical instrument drills a hole, so as to indicate the second distance in real-time. The first cortex <NUM> can define the portion of the anatomical structure <NUM>. In an example, the first cortex <NUM>, in particular the first surface 125a of the first cortex <NUM>, defines the reference location from which the distance from the reference location is measured by the depth gauge <NUM>. In an example, the cutting tip 226a defines the reference location, such that the first distance is equal to the second distance.

In an alternative example, the surgical instrument <NUM> can include a drill sleeve that defines the reference location from which the distance from the portion of the anatomical structure <NUM> is measured by the depth gauge <NUM>, such that the first distance is greater than the second distance. The cutting instrument <NUM> can be placed in the sleeve to protect soft tissue surrounding the bone, among other reasons. During drilling, the depth gauge <NUM> can determine the distance from a terminal end of the drill sleeve to the first surface 125a of the first cortex <NUM>. The distance from the terminal end of the drill sleeve to the first surface 125a of the first cortex can be greater than the distance from the cutting tip 226a to the first surface 125a of the first cortex <NUM>. Thus, the depth gauge <NUM> can measure a real-time drill depth distance that is greater than a real-time drill depth distance that the display <NUM> displays. The difference between the first and second distance can be determined by calibrating the display <NUM> to account for the distance (which can be referred to as an offset distance) between the cutting tip 226a and the terminal end of the drill sleeve, so that the display <NUM> provides a total drill depth indication <NUM> that indicates the distance from the cutting instrument tip to the first surface 125a of the first cortex <NUM>. In an example, a user can enter the offset distance by selecting a calibration option on the user interface <NUM>. In another example, the depth gauge <NUM> can determine the offset distance during a calibration mode.

The display <NUM> can display the depth gauge screen 1000a and the example split screen <NUM>. In the illustrated examples, the total drill depth indication <NUM> indicates zero (<NUM>) when the cutting instrument tip 226a abuts the first surface 125a of the first cortex <NUM>. Alternatively, the depth gauge can be calibrated such that the total drill depth indication <NUM> can indicate zero (<NUM>) when the drill sleeve abuts the first surface 125a of the first cortex <NUM>. The surgical instrument <NUM> can be configured to drill a hole in the first direction D1 from the first cortex <NUM> to toward the second cortex <NUM>. Thus, the total drill depth indication <NUM> can indicate zero (<NUM>) before a drilling operation, whereby the cutting instrument tip 226a enters the anatomical structure <NUM> during the drilling operation. Referring also to <FIG> and <FIG>, which depict an example depth gauge screen 1000b and an example split screen <NUM>, respectively, as the drilling operation proceeds and the cutting instrument tip 226a travels through the first cortex <NUM>, the total drill depth indication <NUM> can increase so as to indicate the real-time distance that the cutting instrument tip 226a has traveled with respect to the first surface 125a of the first cortex <NUM>. As shown, the indications of the depth gauge image <NUM> are rendered in millimeters, though it will be understood that the indications may be rendered in any alternative units.

The depth gauge image <NUM> can further include a recent cortex exit point indication <NUM> that indicates the distance from the cutting instrument tip 226a to the far surface of the cortex that was most recently drilled. Thus, the display <NUM> can be configured to indicate a third distance when the cutting tip 226a exits the first cortex <NUM>, wherein the third distance can represent a width of the first cortex <NUM> along the first direction D1. As an example, when the cutting instrument tip 226a travels along the first direction D1, which can be the X-ray travel <NUM>, so as to exit the second surface 125b of the first cortex <NUM>, the recent cortex exit point indication <NUM> indicates the distance from the first surface 125a of the first cortex <NUM> to the second surface 125b of the first cortex <NUM>. Thus, in an example, at the moment that the cutting instrument tip 226a travels through the second surface 125b of the first cortex <NUM>, the recent cortex exit point indication <NUM> can indicate the same value as the total drill depth indication <NUM>.

Continuing the drilling operation example, when the cutting instrument tip 226a travels along the first direction D1 so as to exit the second surface 127b of the second cortex <NUM>, the recent cortex exit point indication <NUM> displays the distance from the first surface 125a of the first cortex <NUM> to the second surface 127b of the second cortex <NUM>. Thus, the display <NUM> can be configured to indicate a fourth distance when the cutting tip 226a exits the second cortex <NUM>, and the fourth distance can represent a bone width of the bone along the first direction D1. The display <NUM> can be configured to indicate the second distance, the third distance, and the fourth distance at the same time. Further, at the moment that the cutting instrument tip 226a travels through the second surface 127b of the second cortex <NUM>, the recent cortex exit point indication <NUM> can indicate the same value as the total drill depth indication <NUM>. The depth gauge image <NUM> can further include a previous cortex exit point indication <NUM> that displays an indication or value associated with the previous, but not most recent, cortex exit point. Thus, continuing with the example, when the cutting instrument tip 226a exits the second surface 127b of the second cortex <NUM>, the previous cortex exit point <NUM> displays the distance from the first surface 125a of the first cortex <NUM> to the second surface 125b of the first cortex <NUM>. Thus, the value displayed in the recent cortex exit point indication <NUM> is moved to the previous cortex exit point indication <NUM>. As the cutting instrument tip 226a travels away from the second surface 127b of the second cortex <NUM>, the total drill depth indication <NUM> can increase so as to indicate the real-time distance that the cutting instrument tip 226a has traveled with respect to the first surface 125a of the first cortex <NUM>, as exemplified by <FIG> and <FIG>.

Without being bound by theory, a user can view the depth gauge image <NUM> while the surgical instrument <NUM> operates, either under user control or autonomously, so as to better perform a drilling operation. For example, the user can view the total drill depth indication <NUM> while performing a drilling operation, so as to control the surgical instrument based on the total drill depth indication <NUM>. The surgical instrument <NUM> can be controlled based on the information in the depth gauge image <NUM> so that the cutting instrument <NUM> does not enter unwanted portions of the anatomy, such as soft tissue or a far cortex that is not intended to be drilled, either wholly or in part. In some cases, a user can view the depth gauge image <NUM>, in particular the total drill depth indication <NUM> or the recent cortex exit point indication <NUM>, to match the length of a screw with respective holes that are drilled, instead of having to measure the holes after the drilling operation is performed. In an example, the computing device <NUM> stores an inventory of available screws, such that a screw is automatically matched to a hole that is drilled, based on the depth of the hole in the anatomical structure <NUM>. In an example, a user can actuate a select screw option on the user interface <NUM>, so that a screw is selected that corresponds to one of the indications on the depth gauge image <NUM>, for instance the recent cortex exit point indication <NUM> or the total drill depth indication <NUM>.

Thus, in operation, the display <NUM> can receive and display a plurality of X-ray images in real-time, and the display <NUM> can display the orientation image <NUM> and the depth gauge image <NUM>, in particular the total drill depth indication <NUM>, as the surgical instrument <NUM> is operated. In particular, the depth gauge image <NUM> can be representative of distances that the cutting instrument <NUM> as moved. The fluoroscopic images, the orientation images, and the depth gauge images can be displayed by the display <NUM> at the same time. As the cutting instrument <NUM> moves along a drilling direction, the distance displayed by the display <NUM> can change, so as to update the distance in real-time.

In an example, referring to <FIG>, the surgical instrument <NUM> can be operated along the first direction D1 that is parallel to the direction of X-ray travel <NUM>, so as to drill a hole along the first direction D1. During drilling, for example, as the orientation of the cutting instrument <NUM> moves away from the zero value, the movable indicator <NUM> can move away from the static region <NUM>. The movable indicator <NUM> can move relative to the static region <NUM> at the same time that the orientation of the cutting instrument <NUM> moves relative to the zero value, such that the movable indicator <NUM> provides a real-time representation of the orientation of the cutting instrument <NUM>. For example, as the proximal end 226b of the cutting instrument <NUM> moves along a second direction D2 relative to the cutting tip 226a of the cutting instrument <NUM>, the movable indicator <NUM> can move along the second direction D2 (e.g., see <FIG>). The second direction D2 can be perpendicular to the first direction D1. Similarly, as the proximal end 226b of the cutting instrument <NUM> moves along a third direction D3 relative to the cutting tip 226a of the cutting instrument <NUM>, the movable indicator <NUM> can move along the third direction D3 (e.g., see <FIG>). The third direction D3 can be perpendicular to both the first and second directions D1 and D2, respectively. Further, it will be understood that as the proximal end 226b of the cutting instrument <NUM> moves along both the second and third directions relative to the cutting tip 226a of the cutting instrument <NUM>, the movable indicator <NUM> can move along both the second and third directions D3. Further, the orientation screens 500a-c can include a numerical representation <NUM> of the orientation of the cutting instrument <NUM> along the second and third directions D2 and D3.

Referring in particular to <FIG>, when the cutting instrument <NUM> is oriented in accordance with the zero value, the movable indicator <NUM> can be positioned within a boundary defined by the static region <NUM>. Further, in some cases, when the cutting instrument <NUM> is precisely aligned with the direction of X-ray travel <NUM>, the numerical representation <NUM> may indicate that zero values associated with both the second and third directions. By way of an IM nailing example, a medical professional can maintain the orientation image <NUM> illustrated in <FIG> while drilling, so as to drill holes having the appropriate orientation at the target locations <NUM>.

While example embodiments of devices for executing the disclosed techniques are described herein, the underlying concepts can be applied to any computing device, processor, or system capable of communicating and presenting information as described herein. The various techniques described herein can be implemented in connection with hardware or software or, where appropriate, with a combination of both. Thus, the methods and apparatuses described herein can be implemented, or certain aspects or portions thereof, can take the form of program code (i.e., instructions) embodied in tangible non-transitory storage media, such as floppy diskettes, CD-ROMs, hard drives, or any other machine-readable storage medium (computer-readable storage medium), wherein, when the program code is loaded into and executed by a machine, such as a computer, the machine becomes an apparatus for performing the techniques described herein. In the case of program code execution on programmable computers, the computing device will generally include a processor, a storage medium readable by the processor (including volatile and non-volatile memory and/or storage elements), at least one input device, and at least one output device, for instance a display. The display can be configured to display visual information. For instance, the displayed visual information can include fluoroscopic data such as X-ray images, fluoroscopic images, orientation screens, or computer-generated visual representations.

The program(s) can be implemented in assembly or machine language, if desired. The language can be a compiled or interpreted language, and combined with hardware implementations.

The techniques described herein also can be practiced via communications embodied in the form of program code that is transmitted over some transmission medium, such as over electrical wiring or cabling, through fiber optics, or via any other form of transmission. When implemented on a general-purpose processor, the program code combines with the processor to provide a unique apparatus that operates to invoke the functionality described herein. Additionally, any storage techniques used in connection with the techniques described herein can invariably be a combination of hardware and software.

Claim 1:
A surgical instrument assembly (<NUM>) comprising:
a processor;
a surgical instrument (<NUM>) having:
a cutting instrument (<NUM>) defining a cutting tip (226a), the cutting instrument (<NUM>) configured to operate on an anatomical structure; and
an accelerometer (<NUM>) calibrated with a direction of X-ray travel (<NUM>) from an X-ray transmitter (<NUM>) of an imaging device (<NUM>) to an X-ray receiver (<NUM>) of the imaging device (<NUM>), wherein the accelerometer (<NUM>) is configured to generate accelerometer information that indicates an alignment of the cutting instrument (<NUM>) with respect to the direction of X-ray travel (<NUM>);
a display (<NUM>) coupled to the processor and attached to the surgical instrument (<NUM>), the display (<NUM>) configured to display: <NUM>) a first distance of the cutting tip (226a) relative to a portion of the anatomical structure, <NUM>) fluoroscopic data of the anatomical structure, the fluoroscopic data generated by the imaging device (<NUM>), and <NUM>) a visual indication of the alignment of the cutting instrument (<NUM>) with respect to the direction of X-ray travel (<NUM>) indicated by the accelerometer information; and
a memory in communication with the processor, the memory having stored therein instructions that, upon execution by the processor, cause the surgical instrument assembly (<NUM>) to receive the fluoroscopic data in real-time from the imaging device (<NUM>).