CA2094933C - Ultrasonic imaging system and insonifier - Google Patents
Ultrasonic imaging system and insonifierInfo
- Publication number
- CA2094933C CA2094933C CA002094933A CA2094933A CA2094933C CA 2094933 C CA2094933 C CA 2094933C CA 002094933 A CA002094933 A CA 002094933A CA 2094933 A CA2094933 A CA 2094933A CA 2094933 C CA2094933 C CA 2094933C
- Authority
- CA
- Canada
- Prior art keywords
- insonifier
- catheter
- image
- sonic
- disposed
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6801—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be attached to or worn on the body surface
- A61B5/684—Indicating the position of the sensor on the body
- A61B5/6842—Indicating the position of the sensor on the body by marking the skin
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0833—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0833—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures
- A61B8/0841—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures for locating instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
- A61B8/4444—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to the probe
- A61B8/445—Details of catheter construction
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
- A61B8/4444—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to the probe
- A61B8/4461—Features of the scanning mechanism, e.g. for moving the transducer within the housing of the probe
Abstract
An imaging system and an insonifier (55) for detecting the position and orientation of devices adapted to produce intravascular ultrasonic images from a human body, especially from an artery. The system includes a catheter (20) having a pair of trans-ducers (34, 34a) rotate about the axis of the catheter One of the transducers is for receiving the transmitted sound. The insonifier (55) includes a third transducer (91) that transmits sound at a frequency that can be received by the transducer in the catheter and is op-eratively associated with the catheter to provide sound at the same frequency as the first transducer.
The sonogram that is produced can be displayed on a CRT (53a) and is the product of image detected by re-ceiver in the catheter. Both images are simultaneously displayed to form a composite which enables the user to determine the position and the orientation of the tip of the catheter.
The sonogram that is produced can be displayed on a CRT (53a) and is the product of image detected by re-ceiver in the catheter. Both images are simultaneously displayed to form a composite which enables the user to determine the position and the orientation of the tip of the catheter.
Description
2 -l- PCr/US91/06312 ~2iO~
ULTRASONIC IM~GING SYSTEM AND INSONIFIER
Field of the Inve~tion The present inventLon relates to a system for deter-mining the location and orientation of intravascular ultrasound images relative to the external anatomy of the organ being studied and an image rectification device l o that is especially usefi~l in the system .
Backgrou1ld of the Invention Ultrasound im2ging catheters provide for cross-sectional views of lumenal structures and are especially useful in the diagnosis of obstructive diseases that affect the vascular system in humans. Although there are various ways to ~r~ l 1 qll this type of imaging, most ultrasound imaging catheters employ ~ mq to direct scanning beams of ultrasonic energy into the area being 2û studied and receive the return echoes from these beams in a sequence for display on a cathode ray tube (CRT~.
Equipment that generates the sound and receives the return echoes so that the sound can be displayed on the CRT is well known.
2~ One of the more troublesome problems encountered dur-ing medical examinations using ultrasound imaging cathet-ers is the difficulty encountered in subsequently return-ing to the exact same site and with the same orientation of the tip if a second examination of the same area of the organ being studied is required. When the second examination of the organ is necessary the orientation of the ultrasound image displayed on the CRT might bear no relationship to the external anatomy of the catheterized body because insertion of the catheter sub~ ects 1t to WO 92/03972 ~ - 2 - PCr/US91/06312 twists, bendsr-a~other condltlons that make the orienta-tlon of the tlp dlfficult or lmpossible to predlct accu-rately. Thus, although the positlon of the catheter can be determined generally by X-ray, the physlcian cannot ldentlfy lts orientation easlly from the image on the CRT, that ls whether the lmage belng transmitted from the catheter to the CRT is ~up", "down" or somewhere in between .
Knowledge of the "up/down" posltionlng ls lmportant especially when a sequence of ultrasound lmages is pre-pared for display in a series so as to provide images that, when grouped together, can generate an approxima-tlon of a three dlmenslonal depiction of the organ belng studied .
Description of the Prlor Art Devices for uslng acoustical pulses to generate echo sounds relating to the internal and external features of varlous parts of the body have been known and descrlbed in the prior art. Martinelli et al, 4,821,731, describes an electro-acoustical transducer device positioned on the tip of a catheter. The transducer device can be inserted into a liquid fllled body canal or cavlty. The catheter ls moved lnto posltlon at a partlcular slte ln the body and the transducer generates acoustlcal pulses in the directions of interest which can be dlsplayed on a CRT.
Such devlces lnclude an acoustlcal output pulse gen-erator and a receiver to detect the pulses in the form of echoes. From surface discontinuities in the form of tmrPd~nc~e mismatches and the ultrasonlc frequency of the preclse part of the body at which the pulse is directed, an image of the portlon of the body being ~ i nPd can be dlsplayed on the CRT. The pulses provlde lnformation about the tissue through which the pulses travel and the relative timing of the return pulses corresponds to impe-dance discontinuitles whlch provlde lnformatlon on the Wo 92/03972 _3_ PCr/US91/06312 .~09~33 thickness of various t~pes of tissues at the speclflc location at whlch the ~nitial pulse is directed. The relative strength of the echoes reflects the differences in impedance between ad; acent boundaries of different types of tissues and t~lerefore the dif ference in densi-ties of the material. The acoustical technique can therefore be used to a~cribe the character of tissues from which the echoes are received.
The information that is generated is particularly useful in procedures such as removing arteriosclerotic plaque deposits which restrict the flow of blood in coro-na~y arteries. By moving the tip of the catheter to the location that is being studied, the plaque deposits can be identified. When the sites of the plaque or other irregularities are detPrm~ nPd, the obstructions can be remo~ved. Frequently, techniques such as laser radiation can be used in which an optical fiber or fibers are used to vaporize the plaque through known techniques. The plaque can thus be removed without the trauma associated with surgery. Such procedures, however, require specific knowledge of the location, thickness and density of the plaque to be removed in order to minimize damage to the arterial wall of the diseased site.
F~irly complicated - ' ~ni~mc to identify the site precisely have been disclosed and include x-ray detec-tion, the use of external magnetic fields or systems and methods for collecting sets of data derived from acousti-cal signals generated al: a coLLe~ollding plurality of locations at the diseased site and relating the sets of data with respect to th~3 relative locations from which they are obtained so that they can be used to create a coherent image of the d:lseased site.
~y~m~l ~ry of such s~stems is the l~artinelli et al apparatus that includes a catheter which is partially inserted into the body so that the tip is positioned rel-ative to the preselected site and imaging data relating WO 92/03972 4_ PCr/llS91/06312 ~9-~533 to the internal features can be acoustically determined by moving the tip to a plurality of positions relative to the site. An acoustic21 signal can be generated when the tip is in each of the posltions. The acoustical energy responsive to the acoustical signal at each of the posi-tions is sensed so 2S to create a set of data and the location i5 sensed magnetically in each of the positions.
The sensed data and the respective positions from which each was obtained is related to create an image of the internal features of the organ being studied.
In the prior art device, the creation of an image of an arteriosclerosis lesion on the interior wall of an artery is ~ hPrl by longitu~l1n;~11y and rotationally displacing the catheter tip ( and thus the transducer in the catheter tip) through the diseased site so that a set of return pulses is obtained from a series of locations within the diseased site. The set of return pulses obtained from each angular and longitudinal position of the catheter can then be related to one another so as to create relative spatial information of the structure of the portions of the diseased site represented by sets of return pulses based on the known signatures of various types of tissue encountered in such diseased sites. The orientation of the tip of the catheter is A~ h~l by sensing the orientation of magnetic fields. The equip-ment neC~s~ry to provide for such views and their orien-tations is complicated and bulky, at best.
Summary of the Invention According to the present inventlon, I have discovered a novel imaging system 1 nrl~ i nS a catheter tip having transducers housed inside and an insonifier for detecting both the position and orientation of a catheter tip when it has been inserted into an organ or canal of the body.
The system of my invention can display images of cross-sections of the organ or canal on a CRT and the CRT can ~0 92/03972 _5_ - PCr/US91/06312 9493~3 also display the orientation of the tip simultaneously.
One part of the system lncludes a catheter whlch has a longltudinal axis, a tip and a proximal end. Sonic image generating means and an image sensing means in the form of transducers are~ disposed in the tip of the cath-eter. An insonifier fc~rms another part of the system and is placed externally to the portion of the body being r ~ nr-c~ . The insonifier includes a sonic generator which produces sound at a frequency that can be received by the image sensing means housed ln the catheter tip.
The insonifier includes an image rectifier which has two modes of operation. In the first mode, a wide angle of ultrasound energy is gener2ted at a frequency that can be received and displayed by the image sensing means which is housed in the catheter that is placed inside the body. In operation, the wide angle ultrasound from the insonifier is urged against the outside of the body in the general area of where the catheter tip is thought to be. The representation of the wide angle sound will appear on the CRT and provide an interference pattern ad; acent where the cathlster tip is located . At the same time the sonic generator in the catheter is sending its own signals to the CRT. When the general area of the catheter is located, thls ultrasound of the insonlfler ls focused so as to determine precisely where the catheter tip is located. At the same time, the orientation of the catheter tip becomes evident on the CRT through the signal that is generated by the insonifier and detected by the image s2nsing means. The pattern from the insoni-fier shows on the CRT because the externally applied field can be picked up by the transducer wlthin the cath-eter that is disposed within the patient. The pattern is brightest when the in!::nn~ fier is in closest proximity to the tip of the catheter. The pattern also has a direc-tional characteristic which is due to the manner in which the sonic energy propagates through the tissue. The pat-W092/03972 -6- PCr/US91/06312~
.~209-~933 tern forms a viewable image on the CRT that correctly indicates the orientation of the catheter tip relative to the insonifier.
The most efficient transfer of sonic energy from the insonifier to the image sensing means occurs when the two devices face each other. By knowing the orientation of one of the devices, the position at any given time of either of them can be det~rmi nP-l . The viewable image of the insonlfler can be a bright light which shines to the area of the image and cuLL~GAds to the direction of the insonifier. If the display imaging system, the CRT, is equipped with a means to rotate image electronically, then the orientation ~up, down, etc. ) can be displayed correctly and repeatedly together with a knowledge of the exact position of the catheter tip. A marking device can be added to the insonifier to mark and identify perma-nently where the catheter is relative to the outside of the body.
6a- ~a~4~33 According to a still f urther broad aspect of the present invention there is provided an imaging system for detecting the position and axial orientation of a device adapted to produce intravascular ultrasonic images from a human body and to enable an operator of the system to reposition the device at the same location and axial orientation The system comprises a catheter having a lollgitudinal axis, a distal end and a proximal end The catheter further has a sonic image generating means ' and a sonic image sensing means disposed in the distal end thereof The catheter is adapted to be disposed in a vascular organ of the body and is susceptible of random axial orientation within the vascular organ . An insonif ier is disposed external to the body and is operatively associated with the sonic image serising means and provides sound at a frequency that can be detected and displayed by the sonic image sensing means . Means is provided for displaying an image detected by the sonic image sensing means and simultaneously displaying on the same display the signal produced by the insonif ier According to a still further broad aspect of the present invention there is provided an insonif ier adapted to provide for a display of axial orientation of an image produced by an ultrasound image device disposed within a hu~lan body The insonif ier comprises a housing having an ultrasonically transparent tip, a proximal end and a distal end. A chamber is disposed in the housing at the distal end thereof. Sonic image generating means is disposed in the chamber The sonic image generating means is movable on a longltudinal axis relative to the transparent tip from an advanced position where it can generate wide angle ultrasound transmissions that can be received as unfocused transmissions by the ultrasonic image generating device disposed within the body to a retracted position fi ~ -6b- 2094933 adjacent the transparent tip where it can generate focused sonic transmissions and can be received as focused transmissions by the device. Means is provided to move the sonic lmage generating means from the retracted position to the advanced position. Pulse generating means is disposed in the proximal end of the housing. Means is also provided to connect the pulse generating means to the sonic image generating means.
WO 92/03972 _7 ~ PCI/US9l/06312 ~ . - 2094333 Brief Descriptions of the Drawings Figure 1 is a view of the system, partially in cross section, according to the present invention 1 n~ ns a catheter disposed in an artery, an image rectifier and related electro-acoustical transmission and display devices .
Figure 2 is a cros,s-sectional view, a dual range acoustical transmissio~1 device that can be used with the system of the present invention.
Flgure 3 is a view of a sonogram as ls displayed on a catheter pulse tube wh~reby the orientation of the cath-eter can be detPrm1 ned by an interference signal.
Description of the Preferred Embodiments Referring to Figure 1, the catheter 20 is shown dis-posed within an artery 28 with the tip section 30 posi-tioned opposite a stenc~tic lesion shown at 32. A trans-ducer 34 disposed in t~le tip section 30 is positloned to transmit a beam of aco~stical pulses from tip section 30 transversely to the longitudinal axis 22 of catheter 20 preferably through a window 30a. Sonic pulses are gener- -ated in response to electrical pulses transmitted along a set of insulated electrical conductors ( not shown ) that are disposed within a cable 50. The generation and receiving of sound can be produced by the transducer 34 which can be a single transducer that is switched back and forth between a transmission mode and a receiving mode. Preferably, however, a set of transducers 34 and 34a is used, one connected for transmission and the other for receiving. The acoustical pulses will be transmitted along a radius of transmission 38 and pass into a lesion 32 and the undPrl~n~n~ arterial wall 28. Acoustical echos, deflected by i mredAnre mismatches of the various surfaces of the different substr~tes return to the trans-ducer 34 (or 34a~ and are converted to electrical signals which are transmitted through the conductors in the cable WO 92/03972 ~ -8- PCr/US9l/0631 209~933 2~
50. The transducer is preferably disposed within the tip section 30 and can rotate about the longitudinal axis 22.
Such rotation is ~rn"~rpl 1qhPd by turning cable 50 with a motor 51. Motor 51 and the use of a transducer disposed in a catheter on a rotatable cable is well known.
In the usual operation of ultrasonic image producing catheters and display of the image, a motor controller positions the transducer 34 for the next scan line.
Within a conventional unit 53, a transmit pulser drives the ultrasound tr~nqd~cPr. The transducer 34 converts the electrical energy to acoustical energy and emits a sound wave at a predetermi nPd frequency . The sound wave reflects off the section 32 of the organ being studied.
A portion of the sound wave returns to the transducer 34 ~ or to a second transducer 34a placed in close proximity to the first one). The acoustical energy is reconverted to electrical energy . A receiver in the unit 5 3 takes a waveform of the electrical energy and gates out the orig-inally transmitted pulse. The L~ in1ng information is processed so that signal amplitude is converted to lnten-sity, and time from the originally transmitted pulse and the signal is translated to distance. The brightness and distance lnformation is transmitted into a vector/scan controller which, together with the position information from the motor controller, converts the polar coordinates to rectangulal- coordinates for a raster monitor. The process is repeated many ~hmlqAnllq of times per second to form a real time, two dimensional ultrasound image of the subject being studied and for display on a CRT 53a and 3 0 reco rd ing .
In addition to the lmage displayed on the CRT 53a from the transducers in the catheter, a second image is displayed on the CRT by an image rectifying device 55.
As set out previously, the sonic emissions for the second image are produced by the image rectifying device 55 and are shown as dotted lines 56. In the illustrated ~ 92/03972 _9_ PCr/USgl/06312 example, an wide angle signal is produced by the image rectifying device 55 which enables the user to rub the device in the general area of the body 46 where the cath-eter tip 30 is thought to be. Once the device 55 has been located in the general region of the catheter tip 30, an interference signal will show on the CRT. When the area is generally located, the emission from the device 55 can be focused so as to produce a narrower sig-nal thereby to provide a bright area on the CRT which will correspond to the relative position of the device 55 and the tip 30 of the catheter. Then, with an appropri-ate adjustment, the "top" of the organ being PY~mln~d can be ad~usted on the CRT as desired. As can be seen from the drawing, in the preferred embodiment, there is no electrical connection between the unit 5 3 and the device 55, although in some instances it may be desirable to use a wand that is pulsed f rom a common pulse generator in unit 53 for supplying a pulse to both the device 55 and the tri~neduc~r 34. The signal from the device 55 should preferably be pulsed so as to conserve power since the device 55 is ~attery po~ered and continuous operation of the device 55 will quic}i~ly reduce its output. In those cases where lt is found to be more efficacious to use pulses in each tri~nC~ cf~r generated from a single source, an electrical connection is required between the device 55 and unit 53.
Referring to Figure 2, an embodiment of the sonic image rectifying device is shown. The preferred embodi-ment of my device has a tubular barrel with an operating end 82 and an ~Yi in~ng end 84. The operating end 82 is connected to the examin~ng end 84 by means of threads 79 and a male to female fitting. An on/off button 63 slides within a collar 65 that is attached, preferably by threads, to the end of operating end 82. The collar 65 can be unscrewed to enable the user to reach a battery set 67 for their replacement. - Button~ 63 is normally WO 92/0397~ PCr/US91/0631 2094~3~
.
biased in the "off" position by a spring 71, as is con-ventional with many battery operated devices. The bat-tery set 67 sits upon a spring 73 that rests on a wall 76 .
A chamber 74 disposed within the operating end 82 houses a conventional pulse generator circuit disposed on a circuit board 75. Electrical connection between the battery set 67 and the pulse generator circuit board 75 is ~rcn~ hPd through wire 77.
A coaxial wire 81 extends from the circuit board 75 and the upper chamber 74 through a wall 78 to the top of a plunger 83. Coaxial cable 81 is of a sufficient length to provide for motion of the plunger 83 along the axis of a lower chamber 85. The plunger 83 has a knob 83a that extends outwardly from lower chamber 85 and is moveable in a slot 85a. A hollow stem 87 extends from plunger 83 and receives the coaxial cable 81. A support plate 89, preferably supported by knees 89a, is disposed on the end of the stem 87 and within the ~ i n i ng end 84 of the device. A transducer 91 is disposed on the support plate 89 and is connected to coaxial cable 81. The tip of Py; in~n~ end 84 forms a fluid holding chamber 92 and is filled with fluid 93 commonly used for the transmission of sound. Fluids may be, for example, water, oil or sil-icones. To keep the fluids within the chamber 92, stem 87 rides within an 0-ring seal 92 which prevents leaking.
A window 95, generally formed of p' astlc that is trans-parent to son;c waves, is disposed ln the tip.
Movement of the plunger 83 relative to window 95 moves transducer 91 relative to the window 95. When the transducer 91 is most distantly positioned relative to window 95, the sonic radiatlon is most sharply in focus.
As it is moved nearer to the window 95, the focus is reduced, but the area that is being irradiated is wider.
Thus, the image rectifier 55 can be moved around over a wide area witll the transducer 91 nearest the window 95 92/03972 ~ PCI`/US91/063l2 ~ - 20:9~933 until the lnterference signal shows on the CRT. Then the focus can be narrowed by movlng the transducer 91 away from the window 95 to determine the precise location of , th,e "Gatheter tip .
In'`order to identify permanently the exact location of where the catheter ls on the inside of the body, I
have incorporated a marking sleeve' 97 that is slidably disposed around the end of the, ~ning end 84. The marking sleeve 97 can illclude a felt tip 97a and an ink supply 97b. When the i~lterference signal is seen by the operator of the equipme1lt on the CRT 53a, and when the catheter has been preci.5ely located, the sleeve 9 7 can be moved along the ~ i n ~ end 85 and can mark the precise location on the skin fo~ subsequent use. Conventional marking inks can be used at the end of the sleeve 97 to accomplish the marking.
Referring to Figure 3, a view is shown of an inter-ference pattern overlaying a typical sonogram of an artery. In the sonogram the circular dark area enter is the lumen of the catheter. The circular bright area is the wall of the cathetel-. To the right of the bright area (between 12 and 5 o'clock) is a dark section that is the portion o~ the artery carrying blood and not occupied by the catheter. The walls of the artery are delineated as the line between the blood-containing dark section and the bright area surroun~ing it. A circular dark area is shown at g o'clock. This area L~pIes~llts a vein that is ad~ acent to the artery . The generally radial bright lines at 12, 1 and 3 o ' clock are the interference pattern formed by the image rectifier. With this visual repre-sentation of the interference pattern, it is possib] e for the operator to establish with certainty the orientaticn of the catheter in the artery being PYr-'i n~Pd . With addi-tional reduction of the focus of the image rectifying device, the i~terference pattern can be narrowed, as desired, or it can be converted to an indicia such as an WO 92/03972 ,= 12- PCTJUS91/06312~
. 20~4933 arrow .
It is apparent the modification and changes can be made within the splrlt and scope of present invention.
It ls my intention, however, only to be limited by the scope of the appended clalms.
As my invention I claim:
ULTRASONIC IM~GING SYSTEM AND INSONIFIER
Field of the Inve~tion The present inventLon relates to a system for deter-mining the location and orientation of intravascular ultrasound images relative to the external anatomy of the organ being studied and an image rectification device l o that is especially usefi~l in the system .
Backgrou1ld of the Invention Ultrasound im2ging catheters provide for cross-sectional views of lumenal structures and are especially useful in the diagnosis of obstructive diseases that affect the vascular system in humans. Although there are various ways to ~r~ l 1 qll this type of imaging, most ultrasound imaging catheters employ ~ mq to direct scanning beams of ultrasonic energy into the area being 2û studied and receive the return echoes from these beams in a sequence for display on a cathode ray tube (CRT~.
Equipment that generates the sound and receives the return echoes so that the sound can be displayed on the CRT is well known.
2~ One of the more troublesome problems encountered dur-ing medical examinations using ultrasound imaging cathet-ers is the difficulty encountered in subsequently return-ing to the exact same site and with the same orientation of the tip if a second examination of the same area of the organ being studied is required. When the second examination of the organ is necessary the orientation of the ultrasound image displayed on the CRT might bear no relationship to the external anatomy of the catheterized body because insertion of the catheter sub~ ects 1t to WO 92/03972 ~ - 2 - PCr/US91/06312 twists, bendsr-a~other condltlons that make the orienta-tlon of the tlp dlfficult or lmpossible to predlct accu-rately. Thus, although the positlon of the catheter can be determined generally by X-ray, the physlcian cannot ldentlfy lts orientation easlly from the image on the CRT, that ls whether the lmage belng transmitted from the catheter to the CRT is ~up", "down" or somewhere in between .
Knowledge of the "up/down" posltionlng ls lmportant especially when a sequence of ultrasound lmages is pre-pared for display in a series so as to provide images that, when grouped together, can generate an approxima-tlon of a three dlmenslonal depiction of the organ belng studied .
Description of the Prlor Art Devices for uslng acoustical pulses to generate echo sounds relating to the internal and external features of varlous parts of the body have been known and descrlbed in the prior art. Martinelli et al, 4,821,731, describes an electro-acoustical transducer device positioned on the tip of a catheter. The transducer device can be inserted into a liquid fllled body canal or cavlty. The catheter ls moved lnto posltlon at a partlcular slte ln the body and the transducer generates acoustlcal pulses in the directions of interest which can be dlsplayed on a CRT.
Such devlces lnclude an acoustlcal output pulse gen-erator and a receiver to detect the pulses in the form of echoes. From surface discontinuities in the form of tmrPd~nc~e mismatches and the ultrasonlc frequency of the preclse part of the body at which the pulse is directed, an image of the portlon of the body being ~ i nPd can be dlsplayed on the CRT. The pulses provlde lnformation about the tissue through which the pulses travel and the relative timing of the return pulses corresponds to impe-dance discontinuitles whlch provlde lnformatlon on the Wo 92/03972 _3_ PCr/US91/06312 .~09~33 thickness of various t~pes of tissues at the speclflc location at whlch the ~nitial pulse is directed. The relative strength of the echoes reflects the differences in impedance between ad; acent boundaries of different types of tissues and t~lerefore the dif ference in densi-ties of the material. The acoustical technique can therefore be used to a~cribe the character of tissues from which the echoes are received.
The information that is generated is particularly useful in procedures such as removing arteriosclerotic plaque deposits which restrict the flow of blood in coro-na~y arteries. By moving the tip of the catheter to the location that is being studied, the plaque deposits can be identified. When the sites of the plaque or other irregularities are detPrm~ nPd, the obstructions can be remo~ved. Frequently, techniques such as laser radiation can be used in which an optical fiber or fibers are used to vaporize the plaque through known techniques. The plaque can thus be removed without the trauma associated with surgery. Such procedures, however, require specific knowledge of the location, thickness and density of the plaque to be removed in order to minimize damage to the arterial wall of the diseased site.
F~irly complicated - ' ~ni~mc to identify the site precisely have been disclosed and include x-ray detec-tion, the use of external magnetic fields or systems and methods for collecting sets of data derived from acousti-cal signals generated al: a coLLe~ollding plurality of locations at the diseased site and relating the sets of data with respect to th~3 relative locations from which they are obtained so that they can be used to create a coherent image of the d:lseased site.
~y~m~l ~ry of such s~stems is the l~artinelli et al apparatus that includes a catheter which is partially inserted into the body so that the tip is positioned rel-ative to the preselected site and imaging data relating WO 92/03972 4_ PCr/llS91/06312 ~9-~533 to the internal features can be acoustically determined by moving the tip to a plurality of positions relative to the site. An acoustic21 signal can be generated when the tip is in each of the posltions. The acoustical energy responsive to the acoustical signal at each of the posi-tions is sensed so 2S to create a set of data and the location i5 sensed magnetically in each of the positions.
The sensed data and the respective positions from which each was obtained is related to create an image of the internal features of the organ being studied.
In the prior art device, the creation of an image of an arteriosclerosis lesion on the interior wall of an artery is ~ hPrl by longitu~l1n;~11y and rotationally displacing the catheter tip ( and thus the transducer in the catheter tip) through the diseased site so that a set of return pulses is obtained from a series of locations within the diseased site. The set of return pulses obtained from each angular and longitudinal position of the catheter can then be related to one another so as to create relative spatial information of the structure of the portions of the diseased site represented by sets of return pulses based on the known signatures of various types of tissue encountered in such diseased sites. The orientation of the tip of the catheter is A~ h~l by sensing the orientation of magnetic fields. The equip-ment neC~s~ry to provide for such views and their orien-tations is complicated and bulky, at best.
Summary of the Invention According to the present inventlon, I have discovered a novel imaging system 1 nrl~ i nS a catheter tip having transducers housed inside and an insonifier for detecting both the position and orientation of a catheter tip when it has been inserted into an organ or canal of the body.
The system of my invention can display images of cross-sections of the organ or canal on a CRT and the CRT can ~0 92/03972 _5_ - PCr/US91/06312 9493~3 also display the orientation of the tip simultaneously.
One part of the system lncludes a catheter whlch has a longltudinal axis, a tip and a proximal end. Sonic image generating means and an image sensing means in the form of transducers are~ disposed in the tip of the cath-eter. An insonifier fc~rms another part of the system and is placed externally to the portion of the body being r ~ nr-c~ . The insonifier includes a sonic generator which produces sound at a frequency that can be received by the image sensing means housed ln the catheter tip.
The insonifier includes an image rectifier which has two modes of operation. In the first mode, a wide angle of ultrasound energy is gener2ted at a frequency that can be received and displayed by the image sensing means which is housed in the catheter that is placed inside the body. In operation, the wide angle ultrasound from the insonifier is urged against the outside of the body in the general area of where the catheter tip is thought to be. The representation of the wide angle sound will appear on the CRT and provide an interference pattern ad; acent where the cathlster tip is located . At the same time the sonic generator in the catheter is sending its own signals to the CRT. When the general area of the catheter is located, thls ultrasound of the insonlfler ls focused so as to determine precisely where the catheter tip is located. At the same time, the orientation of the catheter tip becomes evident on the CRT through the signal that is generated by the insonifier and detected by the image s2nsing means. The pattern from the insoni-fier shows on the CRT because the externally applied field can be picked up by the transducer wlthin the cath-eter that is disposed within the patient. The pattern is brightest when the in!::nn~ fier is in closest proximity to the tip of the catheter. The pattern also has a direc-tional characteristic which is due to the manner in which the sonic energy propagates through the tissue. The pat-W092/03972 -6- PCr/US91/06312~
.~209-~933 tern forms a viewable image on the CRT that correctly indicates the orientation of the catheter tip relative to the insonifier.
The most efficient transfer of sonic energy from the insonifier to the image sensing means occurs when the two devices face each other. By knowing the orientation of one of the devices, the position at any given time of either of them can be det~rmi nP-l . The viewable image of the insonlfler can be a bright light which shines to the area of the image and cuLL~GAds to the direction of the insonifier. If the display imaging system, the CRT, is equipped with a means to rotate image electronically, then the orientation ~up, down, etc. ) can be displayed correctly and repeatedly together with a knowledge of the exact position of the catheter tip. A marking device can be added to the insonifier to mark and identify perma-nently where the catheter is relative to the outside of the body.
6a- ~a~4~33 According to a still f urther broad aspect of the present invention there is provided an imaging system for detecting the position and axial orientation of a device adapted to produce intravascular ultrasonic images from a human body and to enable an operator of the system to reposition the device at the same location and axial orientation The system comprises a catheter having a lollgitudinal axis, a distal end and a proximal end The catheter further has a sonic image generating means ' and a sonic image sensing means disposed in the distal end thereof The catheter is adapted to be disposed in a vascular organ of the body and is susceptible of random axial orientation within the vascular organ . An insonif ier is disposed external to the body and is operatively associated with the sonic image serising means and provides sound at a frequency that can be detected and displayed by the sonic image sensing means . Means is provided for displaying an image detected by the sonic image sensing means and simultaneously displaying on the same display the signal produced by the insonif ier According to a still further broad aspect of the present invention there is provided an insonif ier adapted to provide for a display of axial orientation of an image produced by an ultrasound image device disposed within a hu~lan body The insonif ier comprises a housing having an ultrasonically transparent tip, a proximal end and a distal end. A chamber is disposed in the housing at the distal end thereof. Sonic image generating means is disposed in the chamber The sonic image generating means is movable on a longltudinal axis relative to the transparent tip from an advanced position where it can generate wide angle ultrasound transmissions that can be received as unfocused transmissions by the ultrasonic image generating device disposed within the body to a retracted position fi ~ -6b- 2094933 adjacent the transparent tip where it can generate focused sonic transmissions and can be received as focused transmissions by the device. Means is provided to move the sonic lmage generating means from the retracted position to the advanced position. Pulse generating means is disposed in the proximal end of the housing. Means is also provided to connect the pulse generating means to the sonic image generating means.
WO 92/03972 _7 ~ PCI/US9l/06312 ~ . - 2094333 Brief Descriptions of the Drawings Figure 1 is a view of the system, partially in cross section, according to the present invention 1 n~ ns a catheter disposed in an artery, an image rectifier and related electro-acoustical transmission and display devices .
Figure 2 is a cros,s-sectional view, a dual range acoustical transmissio~1 device that can be used with the system of the present invention.
Flgure 3 is a view of a sonogram as ls displayed on a catheter pulse tube wh~reby the orientation of the cath-eter can be detPrm1 ned by an interference signal.
Description of the Preferred Embodiments Referring to Figure 1, the catheter 20 is shown dis-posed within an artery 28 with the tip section 30 posi-tioned opposite a stenc~tic lesion shown at 32. A trans-ducer 34 disposed in t~le tip section 30 is positloned to transmit a beam of aco~stical pulses from tip section 30 transversely to the longitudinal axis 22 of catheter 20 preferably through a window 30a. Sonic pulses are gener- -ated in response to electrical pulses transmitted along a set of insulated electrical conductors ( not shown ) that are disposed within a cable 50. The generation and receiving of sound can be produced by the transducer 34 which can be a single transducer that is switched back and forth between a transmission mode and a receiving mode. Preferably, however, a set of transducers 34 and 34a is used, one connected for transmission and the other for receiving. The acoustical pulses will be transmitted along a radius of transmission 38 and pass into a lesion 32 and the undPrl~n~n~ arterial wall 28. Acoustical echos, deflected by i mredAnre mismatches of the various surfaces of the different substr~tes return to the trans-ducer 34 (or 34a~ and are converted to electrical signals which are transmitted through the conductors in the cable WO 92/03972 ~ -8- PCr/US9l/0631 209~933 2~
50. The transducer is preferably disposed within the tip section 30 and can rotate about the longitudinal axis 22.
Such rotation is ~rn"~rpl 1qhPd by turning cable 50 with a motor 51. Motor 51 and the use of a transducer disposed in a catheter on a rotatable cable is well known.
In the usual operation of ultrasonic image producing catheters and display of the image, a motor controller positions the transducer 34 for the next scan line.
Within a conventional unit 53, a transmit pulser drives the ultrasound tr~nqd~cPr. The transducer 34 converts the electrical energy to acoustical energy and emits a sound wave at a predetermi nPd frequency . The sound wave reflects off the section 32 of the organ being studied.
A portion of the sound wave returns to the transducer 34 ~ or to a second transducer 34a placed in close proximity to the first one). The acoustical energy is reconverted to electrical energy . A receiver in the unit 5 3 takes a waveform of the electrical energy and gates out the orig-inally transmitted pulse. The L~ in1ng information is processed so that signal amplitude is converted to lnten-sity, and time from the originally transmitted pulse and the signal is translated to distance. The brightness and distance lnformation is transmitted into a vector/scan controller which, together with the position information from the motor controller, converts the polar coordinates to rectangulal- coordinates for a raster monitor. The process is repeated many ~hmlqAnllq of times per second to form a real time, two dimensional ultrasound image of the subject being studied and for display on a CRT 53a and 3 0 reco rd ing .
In addition to the lmage displayed on the CRT 53a from the transducers in the catheter, a second image is displayed on the CRT by an image rectifying device 55.
As set out previously, the sonic emissions for the second image are produced by the image rectifying device 55 and are shown as dotted lines 56. In the illustrated ~ 92/03972 _9_ PCr/USgl/06312 example, an wide angle signal is produced by the image rectifying device 55 which enables the user to rub the device in the general area of the body 46 where the cath-eter tip 30 is thought to be. Once the device 55 has been located in the general region of the catheter tip 30, an interference signal will show on the CRT. When the area is generally located, the emission from the device 55 can be focused so as to produce a narrower sig-nal thereby to provide a bright area on the CRT which will correspond to the relative position of the device 55 and the tip 30 of the catheter. Then, with an appropri-ate adjustment, the "top" of the organ being PY~mln~d can be ad~usted on the CRT as desired. As can be seen from the drawing, in the preferred embodiment, there is no electrical connection between the unit 5 3 and the device 55, although in some instances it may be desirable to use a wand that is pulsed f rom a common pulse generator in unit 53 for supplying a pulse to both the device 55 and the tri~neduc~r 34. The signal from the device 55 should preferably be pulsed so as to conserve power since the device 55 is ~attery po~ered and continuous operation of the device 55 will quic}i~ly reduce its output. In those cases where lt is found to be more efficacious to use pulses in each tri~nC~ cf~r generated from a single source, an electrical connection is required between the device 55 and unit 53.
Referring to Figure 2, an embodiment of the sonic image rectifying device is shown. The preferred embodi-ment of my device has a tubular barrel with an operating end 82 and an ~Yi in~ng end 84. The operating end 82 is connected to the examin~ng end 84 by means of threads 79 and a male to female fitting. An on/off button 63 slides within a collar 65 that is attached, preferably by threads, to the end of operating end 82. The collar 65 can be unscrewed to enable the user to reach a battery set 67 for their replacement. - Button~ 63 is normally WO 92/0397~ PCr/US91/0631 2094~3~
.
biased in the "off" position by a spring 71, as is con-ventional with many battery operated devices. The bat-tery set 67 sits upon a spring 73 that rests on a wall 76 .
A chamber 74 disposed within the operating end 82 houses a conventional pulse generator circuit disposed on a circuit board 75. Electrical connection between the battery set 67 and the pulse generator circuit board 75 is ~rcn~ hPd through wire 77.
A coaxial wire 81 extends from the circuit board 75 and the upper chamber 74 through a wall 78 to the top of a plunger 83. Coaxial cable 81 is of a sufficient length to provide for motion of the plunger 83 along the axis of a lower chamber 85. The plunger 83 has a knob 83a that extends outwardly from lower chamber 85 and is moveable in a slot 85a. A hollow stem 87 extends from plunger 83 and receives the coaxial cable 81. A support plate 89, preferably supported by knees 89a, is disposed on the end of the stem 87 and within the ~ i n i ng end 84 of the device. A transducer 91 is disposed on the support plate 89 and is connected to coaxial cable 81. The tip of Py; in~n~ end 84 forms a fluid holding chamber 92 and is filled with fluid 93 commonly used for the transmission of sound. Fluids may be, for example, water, oil or sil-icones. To keep the fluids within the chamber 92, stem 87 rides within an 0-ring seal 92 which prevents leaking.
A window 95, generally formed of p' astlc that is trans-parent to son;c waves, is disposed ln the tip.
Movement of the plunger 83 relative to window 95 moves transducer 91 relative to the window 95. When the transducer 91 is most distantly positioned relative to window 95, the sonic radiatlon is most sharply in focus.
As it is moved nearer to the window 95, the focus is reduced, but the area that is being irradiated is wider.
Thus, the image rectifier 55 can be moved around over a wide area witll the transducer 91 nearest the window 95 92/03972 ~ PCI`/US91/063l2 ~ - 20:9~933 until the lnterference signal shows on the CRT. Then the focus can be narrowed by movlng the transducer 91 away from the window 95 to determine the precise location of , th,e "Gatheter tip .
In'`order to identify permanently the exact location of where the catheter ls on the inside of the body, I
have incorporated a marking sleeve' 97 that is slidably disposed around the end of the, ~ning end 84. The marking sleeve 97 can illclude a felt tip 97a and an ink supply 97b. When the i~lterference signal is seen by the operator of the equipme1lt on the CRT 53a, and when the catheter has been preci.5ely located, the sleeve 9 7 can be moved along the ~ i n ~ end 85 and can mark the precise location on the skin fo~ subsequent use. Conventional marking inks can be used at the end of the sleeve 97 to accomplish the marking.
Referring to Figure 3, a view is shown of an inter-ference pattern overlaying a typical sonogram of an artery. In the sonogram the circular dark area enter is the lumen of the catheter. The circular bright area is the wall of the cathetel-. To the right of the bright area (between 12 and 5 o'clock) is a dark section that is the portion o~ the artery carrying blood and not occupied by the catheter. The walls of the artery are delineated as the line between the blood-containing dark section and the bright area surroun~ing it. A circular dark area is shown at g o'clock. This area L~pIes~llts a vein that is ad~ acent to the artery . The generally radial bright lines at 12, 1 and 3 o ' clock are the interference pattern formed by the image rectifier. With this visual repre-sentation of the interference pattern, it is possib] e for the operator to establish with certainty the orientaticn of the catheter in the artery being PYr-'i n~Pd . With addi-tional reduction of the focus of the image rectifying device, the i~terference pattern can be narrowed, as desired, or it can be converted to an indicia such as an WO 92/03972 ,= 12- PCTJUS91/06312~
. 20~4933 arrow .
It is apparent the modification and changes can be made within the splrlt and scope of present invention.
It ls my intention, however, only to be limited by the scope of the appended clalms.
As my invention I claim:
Claims (10)
1. An imaging system for detecting the position and axial orientation of device adapted to produce intravascu-lar ultrasonic images from a human body and to enable an operator of the system to reposition the device at the same location and axial orientation, said system compris-ing:
a catheter having a longitudinal axis, a distal end and a proximal end, said catheter further having a sonic image generating means and a sonic image sensing means disposed in the distal end thereof, said catheter being adapted to be disposed in a vascular organ of the body and being sus-ceptible of random axial orientation within said vascular organ;
an insonifier disposed external to said body, said insonifier being operatively associated with said sonic image sensing means and providing sound at a frequency that can be detected and displayed by said sonic image sensing means;
means for displaying an image detected by said sonic image sensing means and simultaneously displaying on the same display the signal produced by said insonifier.
a catheter having a longitudinal axis, a distal end and a proximal end, said catheter further having a sonic image generating means and a sonic image sensing means disposed in the distal end thereof, said catheter being adapted to be disposed in a vascular organ of the body and being sus-ceptible of random axial orientation within said vascular organ;
an insonifier disposed external to said body, said insonifier being operatively associated with said sonic image sensing means and providing sound at a frequency that can be detected and displayed by said sonic image sensing means;
means for displaying an image detected by said sonic image sensing means and simultaneously displaying on the same display the signal produced by said insonifier.
2. The system according to claim 1 wherein the sonic image generating means and said sonic image sensing means are rotatable about said longitudinal axis of said catheter whereby to generate a sonogram representing a cross section of the vascular organ being catheterized.
3. The system according to claim 1 further including in said insonifier a means to produce both narrow and wide angle ultrasonic waves.
4. The system according to claim 1 wherein acoustical energy generated by said insonifier has two stages, the first stage providing a wide flood of acoustical energy and the second stage having an insonifying beam of narrow focus whereby to enable the user to initially identify the general area being studied and then to focus clearly upon the precise area.
5. An imaging system according to claim 1 further including a marking means to mark the location of the insonifier on the outside of the body being examined.
6. An imaging system for detecting the position and axial orientation of a device adapted to produce intravas-cular ultrasonic images from a human body and to enable an operator of the system to reposition the device in the same location and axial orientation, said system compris-ing:
a catheter having a longitudinal axis, a distal end and a proximal end, said catheter having an image generating means and an image sensing means disposed in the distal end of said catheter, said catheter being adapted to be disposed in a vascular organ of the body and being sus-ceptible of random axial orientation within said vascular organ;
an insonifier arranged external to said body, said insonifier being operatively associated with said image sensing means and providing sound that can be sensed and displayed by said image sensing means, said insonifier including a housing having an ultrasonically transparent tip, a proximal end, a distal end and a window disposed at said distal end, a chamber disposed in said housing at the distal end thereof, a sonic image generating means dis-posed in said chamber and a pulse generating means dis-posed in the proximal end to generate pulses for said sonic image generation means, and means connecting said pulse generating means to said sonic image generating means;
means for displaying an image detected by said image generating means and simultaneously displaying the image produced by said insonifier, the image produced by said insonifier being displayed as an interference signal so as to display the orientation of the catheter whereby the operator of the system can determine the axial orientation of the image generating and image sensing means.
a catheter having a longitudinal axis, a distal end and a proximal end, said catheter having an image generating means and an image sensing means disposed in the distal end of said catheter, said catheter being adapted to be disposed in a vascular organ of the body and being sus-ceptible of random axial orientation within said vascular organ;
an insonifier arranged external to said body, said insonifier being operatively associated with said image sensing means and providing sound that can be sensed and displayed by said image sensing means, said insonifier including a housing having an ultrasonically transparent tip, a proximal end, a distal end and a window disposed at said distal end, a chamber disposed in said housing at the distal end thereof, a sonic image generating means dis-posed in said chamber and a pulse generating means dis-posed in the proximal end to generate pulses for said sonic image generation means, and means connecting said pulse generating means to said sonic image generating means;
means for displaying an image detected by said image generating means and simultaneously displaying the image produced by said insonifier, the image produced by said insonifier being displayed as an interference signal so as to display the orientation of the catheter whereby the operator of the system can determine the axial orientation of the image generating and image sensing means.
7. An imaging system according to claim 6 further including a marking means to mark the location of the insonifier on the outside of the body being examined.
8. An insonifier adapted to provide for a display of axial orientation of an image produced by an ultrasound image device disposed within a human body, said insonifier comprising:
a housing having a ultrasonically transparent tip, a proximal end and a distal end;
a chamber disposed in said housing at the distal end thereof;
sonic image generating means disposed in said chamber, said sonic image generating means being movable on a lon-gitudinal axis relative to said transparent tip from an advanced position where it can generate wide angle ultra-sound transmissions that can be received as unfocused transmissions by the ultrasonic image generating device disposed within said body to a retracted position adjacent said transparent tip where it can generate focused sonic transmissions and can be received as focused transmissions by said device;
means to move said sonic image generating means from said retracted position to said advanced position;
pulse generating means disposed in the proximal end of said housing;
means connecting said pulse generating means to said sonic image generating means.
a housing having a ultrasonically transparent tip, a proximal end and a distal end;
a chamber disposed in said housing at the distal end thereof;
sonic image generating means disposed in said chamber, said sonic image generating means being movable on a lon-gitudinal axis relative to said transparent tip from an advanced position where it can generate wide angle ultra-sound transmissions that can be received as unfocused transmissions by the ultrasonic image generating device disposed within said body to a retracted position adjacent said transparent tip where it can generate focused sonic transmissions and can be received as focused transmissions by said device;
means to move said sonic image generating means from said retracted position to said advanced position;
pulse generating means disposed in the proximal end of said housing;
means connecting said pulse generating means to said sonic image generating means.
9. An imaging system according to claim 8 further including a marking means to mark the location of the insonifier on the outside of the body being examined.
10. The imaging system according to claim 8 wherein said sonic image generating means is a transducer disposed on a plunger movable on a longitudinal axis.
Applications Claiming Priority (2)
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|---|---|---|---|
| US579,010 | 1990-09-07 | ||
| US07/579,010 US5131397A (en) | 1990-09-07 | 1990-09-07 | Imaging system for producing ultrasonic images and insonifier for such systems |
Publications (2)
| Publication Number | Publication Date |
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| CA2094933A1 CA2094933A1 (en) | 1992-03-08 |
| CA2094933C true CA2094933C (en) | 1996-10-29 |
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|---|---|---|---|
| CA002094933A Expired - Fee Related CA2094933C (en) | 1990-09-07 | 1991-09-04 | Ultrasonic imaging system and insonifier |
Country Status (6)
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| US (1) | US5131397A (en) |
| EP (1) | EP0547159B1 (en) |
| JP (1) | JPH06504686A (en) |
| CA (1) | CA2094933C (en) |
| DE (1) | DE69124385T2 (en) |
| WO (1) | WO1992003972A1 (en) |
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1991
- 1991-09-04 EP EP91917993A patent/EP0547159B1/en not_active Expired - Lifetime
- 1991-09-04 CA CA002094933A patent/CA2094933C/en not_active Expired - Fee Related
- 1991-09-04 JP JP3516682A patent/JPH06504686A/en active Pending
- 1991-09-04 DE DE69124385T patent/DE69124385T2/en not_active Expired - Fee Related
- 1991-09-04 WO PCT/US1991/006312 patent/WO1992003972A1/en active IP Right Grant
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| JPH06504686A (en) | 1994-06-02 |
| CA2094933A1 (en) | 1992-03-08 |
| DE69124385T2 (en) | 1997-08-28 |
| DE69124385D1 (en) | 1997-03-06 |
| EP0547159A4 (en) | 1993-07-07 |
| WO1992003972A1 (en) | 1992-03-19 |
| EP0547159B1 (en) | 1997-01-22 |
| EP0547159A1 (en) | 1993-06-23 |
| US5131397A (en) | 1992-07-21 |
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