Patent Description:
Electrophysiological (EP) cardiac mapping may use visualizations methods previously proposed in the patent literature, to ease an interpretation of an EP map. For example, <CIT> describes an efficient system for diagnosing arrhythmias and directing catheter therapies that may allow for measuring, classifying, analyzing, and mapping spatial electrophysiological (EP) patterns within a body. The efficient system may use an electronic control system (ECU) for computing and providing the user with a variety of metrics, derivative metrics, high definition (HD) maps, HD composite maps, and general visual aids for association with a geometrical anatomical model shown on a display device. In one embodiment, out-of-range colors may be chosen to indicate values that are out of a range of interest. In another embodiment, a function may use the minimum value and the maximum value in an image as the default limits of the "color axes", with all the colors of the colormap being used to represent values between these limits. If the minimum or maximum value is an outlier, the image will be displayed with lower contrast because most of the colors from the colormap will be underutilized, while a few colors will be used to represent the majority of the data. The solution to this problem is to discard or ignore the outliers.

In <NPL>, there is described a system that can calculate consistency between data points and immediately remove all outliers before creating a color map. Document <CIT> (prior art under Article <NUM>(<NUM>) EPC) discloses displaying all or none of the electrophysiology outlier values from a color map.

Catheter-based electrophysiological (EP) mapping techniques may produce various types of EP maps of an organ, such as an atrium of a heart. Cardiac EP maps, such as a local activation time (LAT) map, a bipolar potential map, or a unipolar potential map, may be produced by acquiring electrograms from multiple locations on a heart chamber surface. EP values, such as LATs (or potentials), can then be derived from the electrograms for the respective locations. Such an EP map can be obtained by interpolating over EP values, with outlier EP values excluded from interpolation. The EP map can then be overlayed, e.g., using a color scale, onto a 3D anatomical map of the chamber.

The locations and respective EP values, called hereafter "data points," can also be subsequently overlaid onto the 3D map. In particular, the acquired EP values (e.g., LAT or peak-to-peak voltage values), including outlier data points, are typically displayed as a colored map using a color palette that assigns a range of colors for a range of the EP values. However, if the range of EP values is large, for example due to the presence of the outlier EP values, small differences of attribute values will be difficult or impossible to see as color differences.

In the context of the present disclosure, the term "outlier data points" refers to acquired EP values that are different from their nearest neighbors by at least a predetermined value, for example EP values distorted due to positions that are too deep inside the cavity, or too far out of tissue surface.

Some embodiments of the present invention that are described hereinafter provide methods and systems to improve EP map quality by a processor reducing the range of map values for the palette. The reduction is implemented by analyzing the EP values (e.g., LAT values) and classifying some of the data points as outlier data points. Excluding the values of these data points from the visible range (e.g., map scale) of EP values reduces the range of attribute values used to produce the map. In this way, regions which were previously difficult/impossible to distinguish are now well separated into regions of differing colors.

While outlier EP values may be hidden, hiding too many outliers may give a user a false feeling that there is no data captured in these areas. For this reason, other embodiments of the present invention show some of the EP value outliers - those that are considerably different from their neighbors, but by no more than a predefined "acceptable" value. Other outliers, whose EP values differ from their neighbors by more than the predefined acceptable value, are hidden.

In one embodiment, a processor receives a plurality of data points comprising EP values measured at respective positions in at least a portion of an organ of a patient, such as in a cardiac chamber. In alternative embodiment, the processor may also receive a modeled surface of at least a portion of a heart (e.g., an anatomical map) and the multiple EP values measured at multiple respective positions in the heart shown on the map.

Then, the processor classifies some of the EP values as outlier values in accordance with a defined criterion. The processor derives, from the plurality of data points, a visual representation of at least the portion of the organ that (i) represents the EP values with respective colors and (ii) visualizes less than all the outlier values, by performing one or both of (a) identifying outlier values that deviate from respective neighboring EP values by less than a defined deviation, and representing the identified outlier values using colors that match the neighboring EP values, and (b) setting for the visual representation a mapping, which maps the EP values to the colors and which excludes at least some of the outlier values. Finally, the processor displays the visual representation to a user.

In an optional embodiment, the processor interpolates over data points not classified as outliers, to derive a surface representation of the EP values over the mapped portion. The processor presents the surface representation of the EP values overlaid on the anatomical map, while graphically visualizing only outlier values falling within a predefined value by coloring only the outlier values according to a color code used in the interpolation.

In another embodiment, the processor graphically visualizes the surface representation of the EP values overlaid on the anatomical map using a scale that is narrowed by excluding the outlier values, so as to increase the map's color resolution.

In an embodiment, the number of outliers hidden depends on the relation between the EP value range and the color range. For example, when many colors are mapped to a small EP value range, the rest of the values receive the same color. Therefore, even if some points can be considered as outlier values according to some predefined threshold, in such a setting the processor may show them as conforming to the visual representation of the portion.

On the other hand, when colors are mapped to a wide range of EP values, small value difference between data points are reflected with different colors. Therefore, more data points will not be confirmed with the underlying map color. As such, more points will be considered as outliers and will be hidden.

Typically, the processor is programmed in software containing a particular algorithm that enables the processor to conduct each of the processor-related steps and functions outlined above.

By using the above-described graphical means, the disclosed techniques may assist the physician in the interpretation of EP maps and thus expedite and improve the quality of complicated diagnostic tasks, such as those required in diagnostic catheterizations.

<FIG> is a schematic, pictorial illustration of a system <NUM> for electrophysiological (EP) mapping, in accordance with an embodiment of the present invention. <FIG> depicts a physician <NUM> using a mapping Pentaray® catheter <NUM> to perform an EP mapping of a heart <NUM> of a patient <NUM>. Catheter <NUM> comprises, at its distal end, one or more arms <NUM>, which may be mechanically flexible, each of which is coupled with one or more electrodes <NUM>. During the mapping procedure, electrodes <NUM> acquire and/or inject unipolar and/or bipolar signals from and/or to the tissue of heart <NUM>. A processor <NUM> receives these signals via an electrical interface <NUM>, and uses information contained in these signals to construct an EP map <NUM> stored by processor <NUM> in a memory <NUM>. During and/or following the procedure, processor <NUM> may display EP map <NUM> on a display <NUM>.

EP map <NUM> may be an LAT map, a bipolar potential map, or another map type. EP map <NUM> has an improved quality using the disclosed technique to derive and present confidence level on the map, as described in <FIG> and <FIG>.

During the procedure, a tracking system is used to track the respective locations of sensing electrodes <NUM>, such that each of the signals may be associated with the location at which the signal was acquired. For example, the Active Catheter Location (ACL) system, made by Biosense-Webster (Irvine California), which is described in <CIT>, may be used. In the ACL system, a processor estimates the respective locations of the electrodes based on impedances measured between each of the sensing-electrodes <NUM>, and a plurality of surface electrodes <NUM> that are coupled to the skin of patient <NUM>. For example, three surface electrodes <NUM> may be coupled to the patient's chest and another three surface electrodes may be coupled to the patient's back. (For ease of illustration, only one surface electrode is shown in <FIG>. ) Electric currents are passed between electrodes <NUM> inside heart <NUM> of the patient and surface-electrodes <NUM>. Processor <NUM> calculates an estimated location of all electrodes <NUM> within the patient's heart based on the ratios between the resulting current amplitudes measured at surface electrodes <NUM> (or between the impedances implied by these amplitudes) and the known positions of electrodes <NUM> on the patient's body. The processor may thus associate any given impedance signal received from electrodes <NUM> with the location at which the signal was acquired.

The example illustration shown in <FIG> is chosen purely for the sake of conceptual clarity. Other tracking methods can be used, such as ones based on measuring voltage signals. Other types of sensing catheters, such as the Lasso® Catheter (produced by Biosense Webster) or basket catheters may equivalently be employed. Physical contact sensors may be fitted at the distal end of mapping catheter <NUM> to estimate contact quality between each of the electrodes <NUM> and an inner surface of the cardiac chamber during measurement.

Processor <NUM> typically comprises a general-purpose computer with software programmed to carry out the functions described herein. In particular, processor <NUM> runs a dedicated algorithm as disclosed herein, including in <FIG>, that enables processor <NUM> to perform the disclosed steps, as further described below. The software may be downloaded to the computer in electronic form, over a network, for example, or it may, alternatively or additionally, be provided and/or stored on non-transitory tangible media, such as magnetic, optical, or electronic memory.

<FIG> are schematic, pictorial volume renderings of, respectively, an EP map <NUM> of a right atrium visualized with all outlier EP values <NUM>, and the same EP map with only a partial subset of "allowable" outlier EP values <NUM> visualized, in accordance with an embodiment of the present invention. As seen a same full color scale <NUM> is used with the two map presentations.

In the examples of <FIG> (as well as in <FIG> below), the EP values (e.g., LATs) of the data points are visualized using different grey levels drawn from a predefined greyscale. In real-life implementations the EP values are typically represented using colors drawn from some color palette, although greyscale implementations are also feasible. In the context of the present disclosure and in the claims, different grey levels are regarded as different colors, and references to colors and grey levels are used interchangeably.

While the outlier EP values <NUM> of <FIG> may be hidden, hiding too many outliers may give a user a false sense that no data was captured in these areas. As shown in <FIG>, the disclosed techniques maintain some shown outliers (<NUM>), but only those that have an EP value relatively close, i.e., within a predefined value, to those of their neighbors. Other outliers are hidden. The resulting EP map is, at a same time, both sufficiently detailed and easier for a user interpret.

<FIG> are schematic, pictorial volume renderings of, respectively, an EP map <NUM> of a right atrium using a same color range <NUM> for a full (<NUM>) and narrowed (<NUM>) attributed EP value ranges, in accordance with an embodiment of the present invention;.

As seen in <FIG>, LAT map <NUM> is displayed with a wide range of LAT values (-<NUM> to -<NUM>). Most of the regions of the map are shades of similar colors (e.g., of yellow or green) and it is impossible to see small LAT value differences in these regions.

As seen in <FIG>, same LAT map <NUM> is displayed with a narrowed range of LAT values (-<NUM> to -<NUM>). The regions which were previously difficult/impossible to distinguish are now well separated into regions of different colors.

<FIG> is a flow chart that schematically illustrates a method for estimating and graphically visualizing EP values on the EP map of <FIG> and/or EP map <FIG>, in accordance with an embodiment of the present invention. The algorithm, according to the present embodiment, carries out a process that begins with processor <NUM> receiving a modeled surface (e.g., an anatomical map) of at least a portion of a heart, at a model receiving step <NUM>.

At a data points receiving step <NUM>, the processor receives multiple data points comprising EP values measured at multiple respective positions associated with the modeled surface. Step <NUM> may include all or part of the separate steps of acquiring electrograms using a multi-electrode catheter and processor <NUM> analyzing electrograms to derive EP values, such as LAT values.

Next, at outlier data points detection step <NUM>, processor <NUM> detects, using a predefined criterion, the outlier EP values among the EP values received in step <NUM>.

Next, at an interpolation step <NUM>, processor <NUM> derives a surface representation of EP values not detected as outliers (typically the majority of EP values are correct) by interpolating the EP values. The output is a color scale map, such as surface representation <NUM>.

Processor <NUM> then overlays the (color) surface representation on the anatomical map, at a surface representation overlying step <NUM>.

Next, processor <NUM> may produce one or more EP maps by performing at least one of steps <NUM> and <NUM>.

At an outlier displaying step <NUM>, processor <NUM> overlays outlier EP values on the anatomical map that fall within a predefined value by coloring the outlier values, such as outlier <NUM>, according to a color code used in the interpolation.

At a map graphical visualization step <NUM>, processor <NUM> graphically visualizes the surface representation using a scale that is narrowed, as seen in <FIG>, by excluding all of the outlier values, so as to increase color resolution of the map.

Finally, at an EP map presentation step <NUM>, processor <NUM> presents the one or more resulting EP maps to a user.

The example flow charts shown in <FIG> is chosen purely for the sake of conceptual clarity. In optional embodiments, various additional steps may be performed, for example to automatically register additional layers, such as of medical images, and to generate a display that can toggled among all layers.

Although the embodiments described herein mainly address cardiac applications, the methods and systems described herein can also be used in other applications.

Claim 1:
A computer implemented method, comprising:
receiving a plurality of data points comprising electrophysiological (EP) values measured at respective positions in at least a portion of an organ of a patient;
classifying some of the EP values as outlier values (<NUM>, <NUM>) in accordance with a defined criterion;
deriving, from the plurality of data points, a visual representation of at least the portion of the organ that (i) represents the EP values with respective colors and (ii) visualizes some, but less than all, of the outlier values, by
identifying outlier values that deviate from the EP values of neighboring data points by less than a defined deviation, representing the identified outlier values (<NUM>) using colors that match the neighboring EP values, and hiding the outlier values that differ from their neighbors by more than the defined deviation; and/or
setting for the visual representation a mapping,
which maps the EP values to the colors using a scale which is narrowed by excluding at least some, but not all, of the outlier values; and
displaying the visual representation to a user.