Patent Description:
An imaging device (e.g., an endoscope) may be used during a surgical procedure to capture images of a surgical area associated with a patient. The images may be presented (e.g., in the form of a video stream) to a surgeon during the surgical procedure to assist the surgeon in performing the surgical procedure. In some examples, supplemental content such as ultrasound images may also be presented during the surgical procedure. However, there remains room to improve the presentation of the supplemental content so as to not interfere with the surgical procedure.

<CIT> discusses a system and method for image guidance focusing on perception of a display object in a rendered scene for medical device navigation.

<CIT> discusses a method for augmented reality guided instrument positioning, determining a graphics guide for positioning an instrument.

Christoph P. Bichlmeier: "Immersive and Contextual In-Situ Visualisation for Medical Applications" discusses methods to visualises a surgical scene immersivly and contextually in-situ for medical applications.

The present invention provides a system, method and computer readable medium as defined in the appended independent claims. Preferable features are defined in the dependent claims. The following description presents a simplified summary of one or more aspects of the methods and systems described herein in order to provide a basic understanding of such aspects. Its sole purpose is to present some concepts of one or more aspects of the methods and systems described herein in a simplified form as a prelude to the more detailed description that is presented below.

According to the invention, a system is disclosed in claim <NUM>.

According to the invention, a method is disclosed in claim <NUM>.

According to the invention, a medium is disclosed in claim <NUM>.

Composite medical imaging systems and methods are described herein. As will be explained in more detail below, an exemplary composite medical imaging system is disclosed in claim <NUM>.

To illustrate, during a minimally-invasive surgical procedure performed with a computer-assisted surgical system, a surgeon positioned at a user control system may teleoperate an ultrasound probe and a cautery instrument to perform a surgical procedure on a patient. An endoscope may capture an image of a surgical area associated with the patient, and a display device of the user control system may present the captured image to the surgeon to provide a visualization of the surgical area. When the ultrasound probe contacts surface anatomy at the surgical area, an ultrasound image may be generated that represents subsurface anatomy located beneath the surface anatomy contacted by the ultrasound probe. The ultrasound image is then displayed in an augmentation region of the image presented by the display device. The augmentation region creates an occlusion over the captured endoscopic image. In this example, the augmentation region is a region of the displayed image that appears to "cut" into or "open" the surface anatomy to show a representation (e.g., the ultrasound image) of subsurface anatomy located beneath the portion of the surface anatomy that is within the occlusion created by the augmentation region. The augmentation region may project from and be movable with the ultrasound probe, thus allowing the surgeon to see subsurface anatomy beneath the surface anatomy at any desired location in the surgical area by controlling the location of the ultrasound probe.

While the ultrasound image is displayed in the augmentation region, the surgeon may move the cautery instrument such that a view of the cautery instrument overlaps with the augmentation region in the image displayed by the display device. When the view of the cautery instrument overlaps with the augmentation region in the displayed image, the augmentation region (or a portion of the augmentation region within the overlap) and the corresponding ultrasound image may be removed from the displayed image and only the image captured by the endoscope is presented. Thus, the surgeon may easily see the surface anatomy at the location near the cautery instrument.

The systems and methods described herein may provide various benefits. For example, the systems and methods described herein may intelligently present, in a viewable image presented to a user (e.g., a surgeon) during a surgical procedure, an augmentation region that shows supplemental content (e.g., a representation of subsurface anatomy, such as an image of a three-dimensional model of anatomy or an ultrasound image). In this way the systems and methods present useful information (e.g., information about the patient's subsurface anatomy) and provide an improved visual experience for the user during the surgical procedure. Additionally, the systems and methods described herein may intelligently prevent the augmentation region and the supplemental content from being included in the viewable image when an object in the image (e.g., a surgical instrument, a pool of blood, etc.) overlaps with the augmentation region. In this way the systems and methods provide a view of the surface anatomy to facilitate performance of the surgical procedure. These and other benefits of the systems and methods described herein will be made apparent in the description that follows.

<FIG> illustrates an exemplary composite medical imaging system <NUM> ("system <NUM>") that may be configured to present a composite medical image. System <NUM> may be included in, implemented by, or connected to any surgical systems or other computing systems described herein. For example, system <NUM> may be implemented by a computer-assisted surgical system. As another example, system <NUM> may be implemented by a stand-alone computing system communicatively coupled to a computer-assisted surgical system.

As shown, system <NUM> may include, without limitation, a storage facility <NUM> and a processing facility <NUM> selectively and communicatively coupled to one another. Facilities <NUM> and <NUM> may each include or be implemented by hardware and/or software components (e.g., processors, memories, communication interfaces, instructions stored in memory for execution by the processors, etc.). For example, facilities <NUM> and <NUM> may be implemented by any component in a computer-assisted surgical system. In some examples, facilities <NUM> and <NUM> may be distributed between multiple devices and/or multiple locations as may serve a particular implementation.

Storage facility <NUM> may maintain (e.g., store) executable data used by processing facility <NUM> to perform any of the operations described herein. For example, storage facility <NUM> may store instructions <NUM> that may be executed by processing facility <NUM> to perform any of the operations described herein. Instructions <NUM> may be implemented by any suitable application, software, code, and/or other executable data instance. Storage facility <NUM> may also maintain any data received, generated, managed, used, and/or transmitted by processing facility <NUM>.

Processing facility <NUM> may be configured to perform (e.g., execute instructions <NUM> stored in storage facility <NUM> to perform) various operations associated with presenting a composite medical image. For example, processing facility <NUM> may be configured to direct a display device to display an image showing a view of a surgical area associated with a patient as captured by an imaging device included in a computer-assisted surgical system, the view of the surgical area showing surface anatomy located at the surgical area and an object located at the surgical area. The image also shows an augmentation region that shows supplemental content, the augmentation region creating an occlusion over at least a portion of the view of the surgical area. Processing facility <NUM> may further be configured to detect an overlap in the image between at least a portion of the object and at least a portion of the augmentation region. Processing facility <NUM> may also be configured to adjust, in response to the detection of the overlap, the image to decrease an extent of the occlusion within the overlap by the augmentation region. These and other operations that may be performed by processing facility <NUM> are described herein. In the description that follows, any references to operations performed by system <NUM> may be understood to be performed by processing facility <NUM> of system <NUM>.

System <NUM> is configured to direct a display device to display a composite medical image. As used herein, a composite medical image includes a surgical area image and an augmentation region. The augmentation region creates an occlusion over at least a portion of the surgical area image (e.g., is opaque or at least partially transparent), and may show (e.g., include or be populated with) any supplemental content as may suit a particular implementation. <FIG> illustrates an exemplary composite medical image <NUM> ("image <NUM>"). As shown, composite medical image <NUM> shows a surgical area image <NUM> and supplemental content <NUM> presented in augmentation region <NUM> of surgical area image <NUM>.

Surgical area image <NUM> shows a view of a surgical area associated with a patient, as captured by an imaging device (e.g., an endoscope). A "surgical area" may, in certain examples, be entirely disposed within a patient and may include an area within the patient at or near where a surgical procedure is planned to be performed, is being performed, or has been performed. For example, for a minimally invasive surgical procedure being performed on tissue internal to a patient, the surgical area may include the surface anatomy (e.g., surface tissue), subsurface anatomy underlying the surface anatomy (e.g., organs and vasculature underneath or behind the surface tissue), as well as space around the tissue where, for example, surgical instruments being used to perform the surgical procedure are located. In other examples, a surgical area may be at least partially disposed external to the patient at or near where a surgical procedure is planned to be performed, is being performed, or has been performed on the patient. For example, for an open surgical procedure, part of the surgical area (e.g., tissue being operated on) may be internal to the patient while another part of the surgical area (e.g., a space around the tissue where one or more surgical instruments may be disposed) may be external to the patient.

As used herein, "surface anatomy" (sometimes referred to herein as "surface tissue") may be disposed internally to the patient (e.g., organs, tissue, vasculature, etc.) or may be disposed externally to the patient (e.g., skin, etc.). In some examples the view of the surgical area shows surface anatomy located at the surgical area by capturing light reflected from the surface anatomy. In these examples surface anatomy refers to anatomy configured to reflect light to the imaging device. Additionally, as used herein, "subsurface anatomy" is disposed internally to the patient and is located beneath or behind surface anatomy, with respect to the view of the surface anatomy captured by the imaging device, and thus is not configured to reflect light to the imaging device.

Supplemental content <NUM> may include any suitable content configured to augment surgical area image <NUM>, such as but not limited to other medical images (e.g., images generated by fluorescence imaging, ultrasound imaging, computed tomography (CT), optical coherence tomography (OCT), magnetic resonance imaging (MRI), x-ray imaging, and the like), textual content (e.g., labels, surgical procedure information, surgical system information, patient information, messages, etc.), non-medical images (e.g., instructional images or videos, etc.), and the like. In some examples supplemental content <NUM> is a representation of subsurface anatomy of the patient, such as an ultrasound image, an x-ray image, a fluorescence image, an image of a three-dimensional model generated from a CT scan or MRI scan of the patient, and the like. In other aspects supplemental content <NUM> may include a combination (e.g., a blending) of multiple different types of supplemental content.

While <FIG> shows only one instance of supplemental content <NUM> and one augmentation region <NUM>, image <NUM> may include any number of distinct instances of supplemental content and/or augmentation regions as may suit a particular implementation. Additionally, while <FIG> shows that augmentation region <NUM> is rectangular, augmentation region <NUM> may be any shape or size as may suit a particular implementation. Additionally, while <FIG> shows that augmentation region <NUM> is opaque, augmentation region <NUM> may be semi-transparent and thus show a blending of supplemental content <NUM> and the portion of surgical area image <NUM> occluded by augmentation region <NUM>.

In some examples augmentation region <NUM> may be movable within image <NUM> based on user input. For instance, a user (e.g., a surgeon) may manipulate a user input device to change a position of augmentation region <NUM> within image <NUM>. In this way the user may view supplemental content <NUM> at any desired location within image <NUM>.

In some examples system <NUM> may be configured generate composite medical image <NUM>. Alternatively, composite medical image <NUM> may be generated by a computing system communicatively coupled to system <NUM> (e.g., a computing system included in a computer-assisted surgical system). Composite medical image <NUM> may be generated in any suitable way.

<FIG> illustrate an exemplary manner of generating a composite medical image during a minimally-invasive surgical procedure performed on a patient. However, it will be recognized that the principles that follow may be applied to any other type of surgical procedure, such as an open surgical procedure, a training procedure, a testing procedure, and the like. Additionally, it will be understood that a composite medical image may be generated by any other suitable method as may suit a particular implementation.

<FIG> illustrates an exemplary surgical area <NUM> associated with a patient. As shown, surgical area <NUM> includes patient anatomy <NUM>, surgical instruments <NUM> (e.g., ultrasound probe <NUM>-<NUM> and scissors <NUM>-<NUM>), and an imaging device <NUM> (e.g., an endoscope). Patient anatomy <NUM> may represent any organ or anatomical feature of the patient, and may include surface anatomy <NUM> (e.g., surface tissue) and subsurface anatomy (e.g., subsurface tissue, organs, vasculature, etc.) (not shown in <FIG>).

Ultrasound probe <NUM>-<NUM> is configured to capture an ultrasound image by emitting sound waves and detecting the sound waves reflected from subsurface anatomy beneath surface anatomy <NUM>. Scissors <NUM>-<NUM> are configured to cut patient tissue. Surgical instruments <NUM> may have any suitable shape and/or size as may serve a particular implementation. In some examples, surgical instruments <NUM> may have a shape and size that allow surgical instruments <NUM> to be inserted into the patient by way of a port in a body wall of the patient. In these examples, a movement and operation of surgical instruments <NUM> within the patient may be controlled manually (e.g., by manually manipulating a shaft to which ultrasound probe <NUM>-<NUM> or scissors <NUM>-<NUM> are connected). Additionally or alternatively, surgical instruments <NUM> may be controlled in a computer-assisted manner (e.g., by a computer-assisted surgical system that utilizes robotic and/or teleoperation technology).

In some examples, the poses (e.g., the positions and/or orientations) of surgical instruments <NUM> in surgical area <NUM> may be tracked by a computer-assisted surgical system. For instance, surgical instruments <NUM> may include one or more sensors (e.g., displacement transducers, orientational sensors, positional sensors, etc.) used to generate kinematics information. Kinematics information may include information such as pose (e.g., position and/or orientation), movement (e.g., velocity, direction, acceleration, etc.), state (e.g., open, closed, stowed, etc.), and/or other attributes of surgical instruments <NUM>, all of which may be tracked by a computer-assisted surgical system.

Imaging device <NUM> is implemented by a stereoscopic endoscope configured to capture stereoscopic images of surgical area <NUM>. However, it will be understood that imaging device <NUM> may be implemented by any other suitable imaging device. In some examples imaging device <NUM> may be coupled to a computer-assisted surgical system and controlled in a computer-assisted manner. Image data representative of one or more images captured by imaging device <NUM> may constitute one or more still images and/or video captured by imaging device <NUM>.

<FIG> illustrates an exemplary endoscopic image E as captured by imaging device <NUM>. Endoscopic image E has I x J pixels and represents only one of a pair of stereoscopic images (e.g., a left eye image or a right eye image). It will be understood that the description that follows applies equally to the other of the pair of stereoscopic images captured by imaging device <NUM>. Similarly, the description that follows may also apply to monoscopic images captured by imaging device <NUM>. As shown in <FIG>, endoscopic image E shows a view of surgical area <NUM> as captured by imaging device <NUM>. Endoscopic image E may be generated by illuminating surgical area <NUM> and capturing light reflected by surface anatomy <NUM> and surgical instruments <NUM> to imaging device <NUM>. Thus, the view of surgical area <NUM> shows a view of surgical instruments <NUM> and surface anatomy <NUM> located at surgical area <NUM>.

In some examples a slope image may be generated from endoscopic image E. As will be explained below in more detail, a slope image may be used in the generation of a composite medical image to enhance depth perception by a user. However, a slope image may be omitted from the composite medical image in other examples. <FIG> illustrates an exemplary slope image S generated from endoscopic image E. Slope image S is illustrated in black and white in <FIG>. However, slope image S may include black, white, and/or gray in various shades that represent degrees of slope. Slope image S is generated based on a gradient of endoscopic image E, and thus will have the same size (I x J pixels) as endoscopic image E. Slope image S may be generated in any suitable way using any suitable algorithm. In some examples slope image S is generated from the horizontal and/or vertical components of the gradient of endoscopic image E. For instance, a pixel value S(i,j) in slope image S may be set as the value of the next horizontally adjacent pixel E(i+<NUM>,j) in endoscopic image E less the value of the pixel E(i,j) in endoscopic image E. If S(i,j) is less than zero then S(i,j) is set to zero. For pixels at the far right edge where there is no horizontally adjacent pixel, the value of the next horizontally adjacent pixel E(i+<NUM>,j) may be set to a predetermined value (e.g., black, an average value of pixels in a surrounding region, etc.). This process may be performed for each pixel until slope image S is completed.

Referring now to <FIG>, a three-dimensional ("3D") virtual surgical area <NUM> is generated. Virtual surgical area <NUM> includes one or more representations of subsurface anatomy located beneath surface anatomy <NUM> at surgical area <NUM>. For example, as shown in <FIG>, virtual surgical area <NUM> includes a 3D model <NUM> of subsurface anatomy (e.g., a 3D model of subsurface anatomy generated based on pre-operative MRI and/or CT scan imaging) and an ultrasound image <NUM> generated by ultrasound probe <NUM>-<NUM>. Ultrasound image <NUM> represents subsurface anatomy located beneath surface anatomy <NUM>. As shown in <FIG>, virtual surgical area <NUM> also includes a frame <NUM> onto which ultrasound image <NUM> is projected, such as by texture mapping. Frame <NUM> will be described below in more detail. It will be recognized that any one or more of 3D model <NUM>, ultrasound image <NUM>, and frame <NUM> may be omitted from virtual surgical area <NUM> without departing from the scope of this disclosure.

Virtual surgical area <NUM> also includes a virtual imaging device <NUM> configured to "capture" an image of virtual surgical area <NUM>. <FIG> illustrates an exemplary virtual image V ("virtual image V") as captured by virtual imaging device <NUM>. As shown in <FIG>, a pose (e.g., position and orientation) of virtual imaging device <NUM> within virtual surgical area <NUM> determines the view of virtual surgical area <NUM>, including the view of 3D model <NUM>, ultrasound image <NUM>, and frame <NUM>, as depicted in virtual image V.

In some examples the view of virtual surgical area <NUM> as captured by virtual imaging device <NUM> may be registered with the view of surgical area <NUM> as captured by imaging device <NUM>. In other words, 3D model <NUM> and ultrasound image <NUM> may be positioned and oriented within virtual surgical area <NUM> such that, in composite medical image C ("composite image C") that combines endoscopic image E and virtual image V (see <FIG>), 3D model <NUM> and/or ultrasound image <NUM> appear to be located at their actual, physical location in the patient's body relative to surface anatomy <NUM>. Any suitable registration technique may be used to register the view of virtual surgical area <NUM> as captured by virtual imaging device <NUM> with the view of surgical area <NUM> as captured by imaging device <NUM>. In some examples registration may be based on a depth map of surgical area as generated based on images captured by imaging device <NUM>. A pose of virtual imaging device <NUM> in virtual surgical area <NUM> may be configured to change in accordance with a change in pose of imaging device <NUM> in surgical area <NUM> to thereby maintain the registration of virtual image V with endoscopic image E. In some examples virtual imaging device <NUM> is also configured with the same camera properties (e.g., resolution, zoom level, focus, etc.) as imaging device <NUM>.

As shown in <FIG>, frame <NUM> is a frame that is positioned and oriented within virtual surgical area <NUM>. As will be described below in more detail, frame <NUM> may be used to define an augmentation region in composite image C that provides a view of the representations of subsurface anatomy (e.g., 3D model <NUM> and/or ultrasound image <NUM>).

Frame <NUM> may be selectively movable within virtual surgical area <NUM> based on user input. In some examples a pose of frame <NUM> within virtual surgical area <NUM> may be based on a pose of a surgical instrument <NUM> located at surgical area <NUM>. As an example, a position of frame <NUM> in virtual surgical area <NUM> may be based on a position of ultrasound probe <NUM>-<NUM> in surgical area <NUM>, and the orientation of frame <NUM> (e.g., the direction of the plane of frame <NUM>) within virtual surgical area <NUM> is based on the orientation (e.g. rotation) of ultrasound probe <NUM>-<NUM> in surgical area <NUM>. For instance, frame <NUM> may be oriented in the direction in which ultrasound probe <NUM>-<NUM> emits and receives ultrasound signals, thereby ensuring that ultrasound image <NUM> generated by ultrasound probe <NUM>-<NUM> accurately represents subsurface anatomy located beneath surface anatomy <NUM> when projected onto frame <NUM>.

As shown in <FIG>, virtual image V shows a view of virtual surgical area <NUM>, including 3D model <NUM>, ultrasound image <NUM>, and frame <NUM>, as captured by virtual imaging device <NUM>. Thus, the view of virtual surgical area <NUM> in virtual image V shows a view of representations of subsurface anatomy located at surgical area <NUM>. In some examples virtual image V is the same size (I x J pixels) as endoscopic image E.

A mask image M is then generated from virtual image V. <FIG> illustrates an exemplary mask image M. Mask image M is set to be the same size (I x J pixels) as virtual image V and includes a mask region <NUM> and a window region <NUM>. The size, shape, and position of window region <NUM> determines the size, shape, and position of the augmentation region included in composite image C. As shown in <FIG>, the view of ultrasound image <NUM> projected onto frame <NUM> in virtual image V sets the size, shape, and position of window region <NUM> in mask image M. In alternative embodiments, the view of frame <NUM> in virtual image V may set the size, shape, and position of window region <NUM> in mask image M.

In some embodiments all pixels in mask region <NUM> are set to display black while all pixels in window region <NUM> are set to display white. For example, where a pixel value ranges from <NUM> (black) to <NUM> (white), a value of a pixel M(i,j) is set to <NUM> if the corresponding pixel V(i,j) in virtual image V is not included in the view of ultrasound image <NUM>, and the value of pixel M(i,j) is set to <NUM> (white) if the corresponding pixel V(i,j) in virtual image V is included in the view of ultrasound image <NUM>. With this arrangement, mask image M is configured to mask all pixels in virtual image V that do not overlap with a view of ultrasound image <NUM> in virtual image V.

Composite image C is generated by combining images E, S, V, and M. <FIG> illustrates an exemplary composite image C having the same size (I x J pixels) as endoscopic image E captured by imaging device <NUM>. Composite image C may be generated in any suitable way. In some examples, composite image C is generated by blending images E, S, V, and M by setting the value of each pixel C(i,j) according to the following equation [<NUM>]: <MAT>.

Thus, where M(i,j) = <NUM> (i.e., the pixel M(i,j) in mask image M is <NUM>, i.e. black), the value of pixel C(i,j) in composite image C is the value of pixel E(i,j). That is, mask region <NUM> of mask image M masks slope image S and virtual image V so that only the endoscopic image E captured by imaging device <NUM> is displayed. However, where M(i,j) = <NUM> (i.e., the pixel M(i,j) in mask image M is <NUM>, i.e., white), the value of pixel C(i,j) in composite image C is the value of S(i,j) + V(i,j). That is, window region <NUM> of mask image M provides an opaque augmentation region in endoscopic image E where only a combination of slope image S and virtual image V are displayed, such that the augmentation region creates an occlusion of a corresponding region of endoscopic image E.

In alternative embodiments, the augmentation region may be transparent. The augmentation region may be made transparent by any suitable method. For example, the value of pixel M(i,j) may be set to be less than <NUM> (e.g., <NUM>) if the corresponding pixel V(i,j) in virtual image V is included in the view of ultrasound image <NUM>. According to equation [<NUM>], when M(i,j) < <NUM> the value of pixel C(i,j) in composite image C is a blended combination of S(i,j), V(i,j) and E(i,j). That is, window region <NUM> of mask image M provides a transparent augmentation region that creates only a partial occlusion of the corresponding region of endoscopic image E. In some examples, the transparency of the augmentation region may be automatically or manually adjusted (e.g., increased or decreased) to adjust the extent of occlusion of the corresponding region of endoscopic image E.

As shown in <FIG>, composite image C shows a view of surgical area <NUM> associated with a patient and an augmentation region <NUM>. The view of surgical area <NUM> shows surgical instruments <NUM> (e.g., ultrasound probe <NUM>-<NUM> and scissors <NUM>-<NUM>) and surface anatomy <NUM> located at surgical area <NUM>, while augmentation region <NUM> shows a representation of subsurface anatomy (e.g., ultrasound image <NUM>). In embodiments where augmentation region <NUM> is created based on frame <NUM>, augmentation region <NUM> additionally or alternatively shows a view of 3D model <NUM>. Furthermore, because the view of 3D model <NUM> and ultrasound image <NUM> is registered with the view of surgical area <NUM>, as explained above, 3D model <NUM> and ultrasound image <NUM> provide an accurate representation of subsurface anatomy at the in-vivo location of the subsurface anatomy represented by 3D model <NUM> and ultrasound image <NUM>.

As mentioned, slope image S is generated based on the gradient of endoscopic image E. As a result, combining slope image S with virtual image V in augmentation region <NUM> enhances the perception by a viewer of composite image C that 3D model <NUM> and/or ultrasound image <NUM> are located beneath surface anatomy <NUM>. However, slope image S may be omitted from composite image C such that augmentation region <NUM> shows only virtual image V in other examples.

In composite image C, augmentation region <NUM> is depicted as projecting from ultrasound probe <NUM>-<NUM>, similar in appearance to a flag projecting from a flagpole. In alternative embodiments, augmentation region <NUM> projects from a different type of surgical instrument located in surgical area <NUM> or from a virtual surgical instrument rather than a real surgical instrument located in surgical area <NUM>. For instance, virtual surgical area <NUM> may include a virtual surgical instrument (not shown in <FIG>) that may be controlled based on user input. Ultrasound image <NUM> and/or frame <NUM> are positioned in virtual surgical area <NUM> based on the pose of the virtual surgical instrument in virtual surgical area <NUM>.

In further embodiments augmentation region <NUM> does not project from any surgical instrument, real or virtual, but is movable based on user input. For instance, a user may selectively operate a controller (e.g., a joystick, a master control, etc.) to move the position of frame <NUM> in virtual surgical area <NUM>, thereby also moving augmentation region <NUM> in composite image C. In this way the user may move augmentation region <NUM> to view subsurface anatomy without having to move a surgical instrument located in surgical area <NUM>.

As mentioned, <FIG> and <FIG> show that mask image M sets a shape of augmentation region <NUM> to be the same shape as the view of ultrasound image <NUM> in virtual image V. In alternative embodiments, mask image M sets a shape of augmentation region <NUM> to be the same shape as the view of frame <NUM> in virtual image V. This configuration may be used when ultrasound image <NUM> is not projected onto frame <NUM>, thereby showing 3D model <NUM> through augmentation region <NUM> in composite image C. Alternatively, when ultrasound image <NUM> is projected onto frame <NUM>, 3D model <NUM> may be displayed in the regions of frame <NUM> that are not covered by ultrasound image <NUM>.

As mentioned, system <NUM> may direct a display device to display composite image C. For instance, system <NUM> may direct a display device associated with a computer-assisted surgical system to display composite image C upon user activation of a composite image mode. The display device may be any suitable display device, such as a display device of a user control system used by a surgeon during a computer-assisted surgical procedure.

While composite image C is displayed, system <NUM> may detect an overlap in composite image C between at least a portion of an object located at surgical area <NUM> and at least a portion of augmentation region <NUM>. The object located at the surgical area may include any foreign object introduced to surgical area <NUM> (e.g., a surgical instrument, a surgical mesh, a hand or finger of a surgeon, etc.) and/or any object naturally present at the surgical area (e.g., blood, tissue, an organ, etc.). For instance, system <NUM> may detect that a surgical instrument has moved such that a view of the surgical instrument overlaps with a portion of augmentation region <NUM> in composite image C. As another example, system <NUM> may detect that a view of a pool of blood overlaps with a portion of augmentation region <NUM> in composite image C.

In response to detecting the overlap between the portion of the object and the portion of augmentation region <NUM>, system <NUM> may adjust the displayed image to decrease an extent of the occlusion within the overlap by augmentation region <NUM>. In some examples system <NUM> may adjust the displayed image by removing the augmentation region from the image. For instance, system <NUM> may switch from displaying composite image C to displaying another image (e.g., endoscopic image E', see <FIG>) that does not show augmentation region <NUM>. Thus, augmentation region <NUM> does not occlude the view of surgical area <NUM> as captured by the imaging device. As another example, system <NUM> may decrease the size and/or shape of augmentation region <NUM>, such as by removing a portion of augmentation region <NUM> within a predefined vicinity of the object (e.g., within the region of the overlap).

As another example of adjusting the displayed image to decrease the extent of the occlusion, system <NUM> may decrease the opacity of augmentation region <NUM> in composite image C. For example, system <NUM> may adjust the blending of images E, S, V, and M so that augmentation region <NUM> is more transparent. In some examples the degree of transparency may be modulated, such as based on a distance of the object to the surface anatomy and/or based on a type of object that overlaps with augmentation region <NUM>. Additionally or alternatively, system <NUM> may adjust the blending of images E, S, V, and M only within an area located within a predefined vicinity of the object (e.g., within the region of the overlap).

As a further example of decreasing the opacity of augmentation region <NUM>, system <NUM> may adjust slope image S to be more visible in augmentation region <NUM>. For instance, system <NUM> may adjust one or more parameters of an image filter for slope image S. Because slope image S is derived from endoscopic image E, increasing the visibility of slope image S will increase the visibility of the view of surgical area <NUM> as captured by the imaging device. In this way system <NUM> may adjust composite image C to decrease an extent of the occlusion of the view of surgical area <NUM> by augmentation region <NUM>.

<FIG> illustrate an example of an overlap between at least a portion of augmentation region <NUM> and at least a portion of a view of an object located at surgical area <NUM>. <FIG> is the same as <FIG> except that scissors <NUM>-<NUM> have been moved from their initial position (shown in broken lines in <FIG>) to a new position (shown in solid lines in <FIG>) closer to ultrasound probe <NUM>-<NUM>. <FIG> illustrates an exemplary composite image C' generated after scissors <NUM>-<NUM> have moved to the new position. Composite image C' shows a view of surgical area <NUM> and augmentation region <NUM> that shows ultrasound image <NUM> generated by ultrasound probe <NUM>-<NUM>. As shown in <FIG>, the distal end portion of scissors <NUM>-<NUM> overlaps with a portion of augmentation region <NUM> in composite image C'. System <NUM> is configured to detect the overlap between augmentation region <NUM> and scissors <NUM>-<NUM> and, in response, direct the display device to display only endoscopic image E', which shows the view of surgical area <NUM> as captured by imaging device <NUM>. <FIG> illustrates an exemplary endoscopic image E' captured after scissors <NUM>-<NUM> have moved to the new position. As can be seen, augmentation region <NUM> has been removed so that the surgeon can easily see surface anatomy <NUM> at surgical area <NUM> and thus determine a position of scissors <NUM>-<NUM> relative to surface anatomy <NUM>.

The manner in which system <NUM> may detect an overlap in a composite medical image between at least a portion of an augmentation region (e.g., augmentation region <NUM> or augmentation region <NUM> including 3D model <NUM> and/or ultrasound image <NUM>) and a view of an object located at the surgical area will now be described. System <NUM> may detect an overlap in a composite medical image between at least a portion of an augmentation region and a view of an object in any suitable manner.

An exemplary manner of overlap detection based on position tracking will now be described with reference to <FIG> illustrates an exemplary detection image D used in detecting an overlap. Detection image D includes an augmentation region representation <NUM> and an object representation <NUM>. Augmentation region representation <NUM> represents an augmentation region in a composite medical image (e.g., augmentation region <NUM> in image <NUM> or augmentation region <NUM> in composite image C). Object representation <NUM> represents an object (e.g., scissors <NUM>-<NUM>) located at a surgical area associated with a patient and is positioned within detection image D based on the location of the object in the surgical area. Generation of detection image D will be described below in more detail. In certain examples, overlap in the composite medical image between the augmentation region and the object may be detected when object representation <NUM> is detected to be in contact with augmentation region representation <NUM> in detection image D, as will be explained below in more detail.

<FIG> shows detection image D generated when the object (e.g., scissors <NUM>-<NUM>) is located at an initial position. As shown, object representation <NUM> is not in contact with augmentation region representation <NUM> because no pixel of object representation <NUM> is adjacent to or overlapping with a pixel of augmentation region representation <NUM>. Therefore, system <NUM> does not detect an overlap between the object and the augmentation region in the composite medical image (e.g., augmentation region <NUM> in composite image C).

<FIG> shows an exemplary detection image D' generated after movement of the object to a new position in the surgical area. As shown, object representation <NUM> is in contact with augmentation region representation <NUM> because one or more pixels of object representation <NUM> is adjacent to or overlapping one or more pixels of augmentation region representation <NUM>. In response to detecting that object representation <NUM> is in contact with augmentation region representation <NUM>, system <NUM> determines that at least a portion of the augmentation region (e.g., augmentation region <NUM> in composite image C) is overlapped by the object.

In some embodiments, detection image D does not include augmentation region representation <NUM>. Since detection image D is set to be the same size (I x J pixels) as mask image M, the window region (e.g., window region <NUM>) in the mask image M represents the augmentation region (e.g., augmentation region <NUM>) in the composite medical image. Therefore, overlap may be detected by comparing detection image D with mask image M to determine if object representation <NUM> in detection image D and the window region in mask image M (e.g., window region <NUM>) have one or more pixel locations in common.

Generation of detection image D will now be described. According to the invention, detection image D is set to be the same size (I x J pixels) as mask image M. As mentioned, augmentation region representation <NUM> represents an augmentation region in a composite medical image. Accordingly, augmentation region representation <NUM> is formed in detection image D with the same size, shape, and position as the augmentation region in the composite medical image (e.g., augmentation region <NUM> in image <NUM> or augmentation region <NUM> in composite image C). Augmentation region representation <NUM> may be formed in detection image D in any suitable way. For example, mask image M may be inverted by setting pixels in mask region <NUM> to white and pixels in window region <NUM> to black. Alternatively, ultrasound image <NUM> and/or frame <NUM> may be projected onto detection image D, such as by virtual imaging device <NUM> capturing detection image D. That is, detection image D shows a view of ultrasound image <NUM> and/or frame <NUM> in virtual surgical area <NUM> as captured by virtual imaging device <NUM>. As yet another example, augmentation region representation <NUM> may be formed in detection image D by using object recognition to detect a size, shape, and position of the augmentation region in the composite medical image.

As mentioned, object representation <NUM> represents an object located in the surgical area associated with the patient. Object representation <NUM> may be any size or shape as may suit a particular implementation. As shown in <FIG>, object representation <NUM> is circular and represents, for example, a distal end portion of a surgical instrument (e.g., scissors <NUM>-<NUM>). Additionally, object representation <NUM> is larger than the distal end portion of the surgical instrument, thereby encompassing the entire area in which an end effector of the surgical instrument may move. In other examples object representation <NUM> is the same shape and size as the distal end portion of the surgical instrument. Adjusting the size and/or shape of object representation <NUM> will adjust the sensitivity with which system <NUM> detects an overlap between an augmentation region in a composite medical image and an object located in the surgical area. Accordingly, in some examples system <NUM> may be configured to receive user input to adjust the sensitivity of overlap detection, such as by adjusting the size and/or shape of object representation <NUM>.

Object representation <NUM> may be formed in detection image D in any suitable way. In some examples object representation <NUM> is formed in detection image D by tracking the pose (e.g., position and/or orientation) of the corresponding object in the surgical area associated with the patient and projecting a view of the object (or a representation of the object) onto detection image D. For example, as mentioned above, the view of virtual surgical area <NUM> in virtual image V is registered with the view of surgical area <NUM> in endoscopic image E. Accordingly, the pose of scissors <NUM>-<NUM> may also be tracked in virtual surgical area <NUM>. A 3D bounding volume representing a distal end portion of scissors <NUM>-<NUM> may then be generated in virtual surgical area <NUM> at the tracked location of the distal end portion of scissors <NUM>-<NUM>. The 3D bounding volume representing scissors <NUM>-<NUM> may then be projected onto detection image D as object representation <NUM>.

<FIG> illustrates an exemplary virtual surgical area <NUM> including a 3D bounding volume representing scissors <NUM>-<NUM> located in surgical area <NUM>. <FIG> is the same as <FIG> except that virtual surgical area <NUM> includes a spherical bounding volume <NUM> generated around a distal end portion of scissors <NUM>-<NUM>. <FIG> shows that virtual surgical area <NUM> includes ultrasound image <NUM> and frame <NUM>, but these may be omitted from virtual surgical area <NUM> in some embodiments. Bounding volume <NUM> may be any shape and size as may suit a particular implementation. Because bounding volume <NUM> is projected onto detection image D as object representation <NUM>, the shape and size of bounding volume <NUM> determines the shape and size of object representation <NUM>. As shown in <FIG>, bounding volume <NUM> is spherical and is sized to encompass at least the entire area in which the distal end portion of scissors <NUM>-<NUM> (e.g., the end effector of scissors <NUM>-<NUM>) may move. In alternative embodiments bounding volume <NUM> may be the same shape and/or size as scissors <NUM>-<NUM>. Once bounding volume <NUM> is generated in virtual surgical area <NUM>, bounding volume <NUM> is projected onto detection image D as object representation <NUM>. For example, virtual imaging device <NUM> may "capture," as detection image D, an image of virtual surgical area <NUM> showing a view of bounding volume <NUM> as object representation <NUM>.

Object representation <NUM> may alternatively be formed in detection image D based on object recognition. For example, system <NUM> may be configured to analyze an image showing a view of the surgical area (e.g., endoscopic image E) to identify and recognize in the image an object located at the surgical area. System <NUM> may utilize any suitable image recognition technology to identify and recognize the object. When the object is detected, system <NUM> may generate object representation <NUM> in detection image D at a location corresponding to the location in the image of the surgical area where the object is detected.

In some examples the size and shape of object representation <NUM> is predefined based on the type of the object detected. To illustrate, system <NUM> may analyze endoscopic image E (see <FIG>) and detect scissors <NUM>-<NUM>. System <NUM> may then access a lookup table to determine a shape (e.g., circular), size (e.g., radius of <NUM> pixels), and position (e.g., at the joint of the end effector) of object representation <NUM> for scissors <NUM>-<NUM>.

In alternative examples the shape and size of object representation <NUM> is based on the size and shape of the detected object in the image. To illustrate, system <NUM> may analyze an image of a surgical area and detect a pool of blood. System <NUM> may then draw object representation <NUM> in detection image D to be the same shape and size as the detected pool of blood. In this way system <NUM> may be configured to detect when a view of excessive bleeding overlaps with augmentation region <NUM> in composite image C.

Forming object representation <NUM> based on object recognition is useful to detect an overlap with an object for which there may not be kinematic or positional information, such as a surgical mesh, a patch, a surgeon's finger or hand, and the like.

As mentioned, in response to detection of an overlap between at least a portion of an object with at least a portion of an augmentation region included in a composite medical image, system <NUM> is configured to adjust the image to decrease an extent of the occlusion over at least a portion of the view of the surgical area by the augmentation region. In some examples, the adjusting of the image is further conditioned on detecting that the object is in motion. In this example system <NUM> infers from the motion of the object (e.g., a surgical instrument) that the surgeon is intending to interact with patient tissue. However, if the object is stationary but the augmentation region is moving (e.g., the user is moving the augmentation region), system <NUM> infers from the lack of motion of the object that the surgeon is not intending to interact with patient tissue. Therefore, there is little risk of contact with the patient tissue by displaying the augmentation region. System <NUM> may determine that the object is in motion in any suitable way, such as based on kinematic information associated with the object, image recognition, sensors included in the object (e.g., surgical instrument sensors), and the like.

In some examples system <NUM> is configured to adjust the image only if the object is detected to be moving toward the augmentation region. Object motion toward the augmentation region may be detected in any suitable way. In some embodiments object motion toward augmentation region may be inferred by detecting object motion toward patient tissue since the augmentation region shows a view of subsurface anatomy beneath the patient tissue. To this end, a depth map may be generated from stereoscopic images of the surgical area, and movement of the object (e.g., a distal end of the surgical instrument) relative to the surface tissue may be determined based on the depth map and/or kinematic information associated with the object.

Additionally or alternatively to using a depth map, system <NUM> may determine that the object is moving toward the surface tissue if the object is detected to be moving away from the imaging device (e.g., imaging device <NUM>). On the other hand, the object is moving away from the surface tissue (and thereby determined to be moving away from the augmentation region) if the object is moving toward the imaging device. Movement of the object away from or toward the imaging device may be detected in any suitable way, such as based on kinematic information associated with the object and the imaging device.

In some embodiments, system <NUM> may be configured to detect that overlap between an augmentation region and an object in a composite medical image has ended. In response, system <NUM> may adjust the image to turn on and/or increase an extent of occlusion, by the augmentation region, over the portion of the view of the surgical area. For instance, while the display device is displaying composite image E' (see <FIG>), system <NUM> may detect that scissors <NUM>-<NUM> have moved to another position such that object representation <NUM> in detection image D does not contact augmentation region representation <NUM>. Accordingly, system <NUM> may direct the display device to display another composite image C that shows a view of surgical area <NUM> and augmentation region <NUM>, including ultrasound image <NUM> and/or 3D model <NUM>. As another example, if the opacity of an augmentation region (e.g., augmentation region <NUM>) has been decreased due to a detected overlap between the augmentation region and an object, system <NUM> may adjust the blending of images E, S, V, and M to increase the opacity of the augmentation region. In these ways system <NUM> may intelligently hide supplemental content only while a view of an object located at the surgical area would overlap with at least a portion of the augmentation region including the supplemental content.

In the foregoing description system <NUM> is configured to detect an overlap between an object located at a surgical area associated with a patient and at least a portion of an augmentation region included in composite medical image, the augmentation region showing a representation of subsurface anatomy. However, system <NUM> is not limited to detecting an overlap with a portion of an augmentation region showing subsurface anatomy, but may be configured to detect an overlap with an augmentation region showing any other type(s) of supplemental content.

In some implementations, system <NUM> may operate as part of or in conjunction with a computer-assisted surgical system. As such, an exemplary computer-assisted surgical system will now be described. The described exemplary computer-assisted surgical system is illustrative and not limiting. System <NUM> may operate as part of or in conjunction with the computer-assisted surgical system described herein and/or with other suitable computer-assisted surgical systems.

<FIG> illustrates an exemplary computer-assisted surgical system <NUM> ("surgical system <NUM>"). As described herein, system <NUM> may be implemented by surgical system <NUM>, connected to surgical system <NUM>, and/or otherwise used in conjunction with surgical system <NUM>.

As shown, surgical system <NUM> may include a manipulating system <NUM>, a user control system <NUM>, and an auxiliary system <NUM> communicatively coupled one to another. Surgical system <NUM> may be utilized by a surgical team to perform a computer-assisted surgical procedure on a patient <NUM>. As shown, the surgical team may include a surgeon <NUM>-<NUM>, an assistant <NUM>-<NUM>, a nurse <NUM>-<NUM>, and an anesthesiologist <NUM>-<NUM>, all of whom may be collectively referred to as "surgical team members <NUM>. " Additional or alternative surgical team members may be present during a surgical session as may serve a particular implementation.

While <FIG> illustrates an ongoing minimally invasive surgical procedure, it will be understood that surgical system <NUM> may similarly be used to perform open surgical procedures or other types of surgical procedures that may similarly benefit from the accuracy and convenience of surgical system <NUM>. Additionally, it will be understood that the surgical session throughout which surgical system <NUM> may be employed may not only include an operative phase of a surgical procedure, as is illustrated in <FIG>, but may also include preoperative, postoperative, and/or other suitable phases of the surgical procedure. A surgical procedure may include any procedure in which manual and/or instrumental techniques are used on a patient to investigate or treat a physical condition of the patient.

As shown in <FIG>, manipulating system <NUM> may include a plurality of manipulator arms <NUM> (e.g., manipulator arms <NUM>-<NUM> through <NUM>-<NUM>) to which a plurality of surgical instruments may be coupled. Each surgical instrument may be implemented by any suitable surgical tool (e.g., a tool having tissue-interaction functions), medical tool, imaging device (e.g., an endoscope), sensing instrument (e.g., a force-sensing surgical instrument), diagnostic instrument, or the like that may be used for a computer-assisted surgical procedure on patient <NUM> (e.g., by being at least partially inserted into patient <NUM> and manipulated to perform a computer-assisted surgical procedure on patient <NUM>). While manipulating system <NUM> is depicted and described herein as including four manipulator arms <NUM>, it will be recognized that manipulating system <NUM> may include only a single manipulator arm <NUM> or any other number of manipulator arms as may serve a particular implementation.

Manipulator arms <NUM> and/or surgical instruments attached to manipulator arms <NUM> may include one or more displacement transducers, orientational sensors, and/or positional sensors used to generate raw (i.e., uncorrected) kinematics information. One or more components of surgical system <NUM> may be configured to use the kinematics information to track (e.g., determine positions and orientations of) and/or control the surgical instruments.

User control system <NUM> may be configured to facilitate control by surgeon <NUM>-<NUM> of manipulator arms <NUM> and surgical instruments attached to manipulator arms <NUM>. For example, surgeon <NUM>-<NUM> may interact with user control system <NUM> to remotely move or manipulate manipulator arms <NUM> and the surgical instruments. To this end, user control system <NUM> may provide surgeon <NUM>-<NUM> with images (e.g., high-definition 3D images, composite medical images, etc.) of a surgical area associated with patient <NUM> as captured by an imaging system (e.g., including any of the imaging devices described herein). In certain examples, user control system <NUM> may include a stereo viewer having two displays where stereoscopic images of a surgical area associated with patient <NUM> and generated by a stereoscopic imaging system may be viewed by surgeon <NUM>-<NUM>. Surgeon <NUM>-<NUM> may utilize the images to perform one or more procedures with one or more surgical instruments attached to manipulator arms <NUM>.

To facilitate control of surgical instruments, user control system <NUM> may include a set of master controls. These master controls may be manipulated by surgeon <NUM>-<NUM> to control movement of surgical instruments (e.g., by utilizing robotic and/or teleoperation technology). The master controls may be configured to detect a wide variety of hand, wrist, and finger movements by surgeon <NUM>-<NUM>. In this manner, surgeon <NUM>-<NUM> may intuitively perform a procedure using one or more surgical instruments.

Auxiliary system <NUM> may include one or more computing devices configured to perform primary processing operations of surgical system <NUM>. In such configurations, the one or more computing devices included in auxiliary system <NUM> may control and/or coordinate operations performed by various other components (e.g., manipulating system <NUM> and user control system <NUM>) of surgical system <NUM>. For example, a computing device included in user control system <NUM> may transmit instructions to manipulating system <NUM> by way of the one or more computing devices included in auxiliary system <NUM>. As another example, auxiliary system <NUM> may receive, from manipulating system <NUM>, and process image data representative of images captured by an imaging device attached to one of manipulator arms <NUM>.

In some examples, auxiliary system <NUM> may be configured to present visual content to surgical team members <NUM> who may not have access to the images provided to surgeon <NUM>-<NUM> at user control system <NUM>. To this end, auxiliary system <NUM> may include a display monitor <NUM> configured to display one or more user interfaces, such as images (e.g., 2D images, composite medical images, etc.) of the surgical area, information associated with patient <NUM> and/or the surgical procedure, and/or any other visual content as may serve a particular implementation. For example, display monitor <NUM> may display images of the surgical area together with additional content (e.g., graphical content, contextual information, etc.) concurrently displayed with the images. In some embodiments, display monitor <NUM> is implemented by a touchscreen display with which surgical team members <NUM> may interact (e.g., by way of touch gestures) to provide user input to surgical system <NUM>.

Manipulating system <NUM>, user control system <NUM>, and auxiliary system <NUM> may be communicatively coupled one to another in any suitable manner. For example, as shown in <FIG>, manipulating system <NUM>, user control system <NUM>, and auxiliary system <NUM> may be communicatively coupled by way of control lines <NUM>, which may represent any wired or wireless communication link as may serve a particular implementation. To this end, manipulating system <NUM>, user control system <NUM>, and auxiliary system <NUM> may each include one or more wired or wireless communication interfaces, such as one or more local area network interfaces, Wi-Fi network interfaces, cellular interfaces, etc..

<FIG> shows an exemplary method <NUM>. While <FIG> illustrates exemplary operations according to one embodiment, other embodiments may omit, add to, reorder, combine, and/or modify any of the steps shown in <FIG> One or more of the operations shown in in <FIG> may be performed by system <NUM>, any components included therein, and/or any implementation thereof.

In operation <NUM>, a composite medical imaging system directs a display device to display an image (e.g., composite medical image C) showing a view of a surgical area associated with a patient, as captured by an imaging device included in a computer-assisted surgical system, and an augmentation region. The view of the surgical area shows surface anatomy located at the surgical area and an object located at the surgical area, and the augmentation region shows supplemental content, the augmentation region creating an occlusion over at least a portion of the view of the surgical area. Operation <NUM> may be performed in any of the ways described herein.

In operation <NUM>, the composite medical imaging system detects an overlap in the image between at least a portion of the object and at least a portion of the augmentation region. Operation <NUM> may be performed in any of the ways described herein.

In operation <NUM>, the composite medical imaging system adjusts, in response to the detection of the overlap, the image to decrease an extent of the occlusion within the overlap by the augmentation region. Operation <NUM> may be performed in any of the ways described herein.

<FIG> illustrates an exemplary computing device <NUM> that may be specifically configured to perform one or more of the processes described herein. Any of the systems, units, computing devices, and/or other components described herein may be implemented by computing device <NUM>.

As shown in <FIG>, computing device <NUM> may include a communication interface <NUM>, a processor <NUM>, a storage device <NUM>, and an input/output ("I/O") module <NUM> communicatively connected one to another via a communication infrastructure <NUM>. While an exemplary computing device <NUM> is shown in <FIG>, the components illustrated in <FIG> are not intended to be limiting. Additional or alternative components may be used in other embodiments. Components of computing device <NUM> shown in <FIG> will now be described in additional detail.

Claim 1:
A system (<NUM>) comprising:
a memory storing instructions (<NUM>); and
a processor communicatively coupled to the memory and configured to execute the instructions to:
direct a display device to display:
an image (<NUM>) captured by an imaging device (<NUM>) and showing a view of a surgical area (<NUM>) associated with a patient, the view of the surgical area (<NUM>) showing surface anatomy (<NUM>) located at the surgical area (<NUM>) and an object located at the surgical area (<NUM>), and
an augmentation region (<NUM>) within the image (<NUM>) that shows supplemental content (<NUM>), the augmentation region (<NUM>) creating an occlusion over at least a portion of the view of the surgical area (<NUM>);
detect an overlap in the image between at least a portion of the object and at least a portion of the augmentation region (<NUM>), wherein the detection of the overlap comprises:
generating a detection image (D) including an augmentation region representation (<NUM>) that represents the augmentation region (<NUM>) and an object representation (<NUM>) that represents the object, wherein:
the detection image (D) is set to be the same size I x J in pixels as the image (<NUM>) showing the view of the surgical area associated with the patient;
the augmentation region representation (<NUM>) is formed in the detection image (D) with the same size, shape, and position as the augmentation region (<NUM>) in the image (<NUM>) showing the view of the surgical area associated with the patient; and
the object representation (<NUM>) is positioned in the detection image (D) based on a location of the object in the surgical area associated with the patient; and
determining that the object representation (<NUM>) contacts the augmentation region representation (<NUM>) in the detection image (D); and
adjust, in response to the detection of the overlap, the image (<NUM>) to decrease an extent of the occlusion within the overlap by the augmentation region (<NUM>).