US20130217997A1 - Method and apparatus for localizing an ultrasound catheter - Google Patents
Method and apparatus for localizing an ultrasound catheter Download PDFInfo
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- US20130217997A1 US20130217997A1 US13/778,864 US201313778864A US2013217997A1 US 20130217997 A1 US20130217997 A1 US 20130217997A1 US 201313778864 A US201313778864 A US 201313778864A US 2013217997 A1 US2013217997 A1 US 2013217997A1
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- 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
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
- A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
- A61B5/062—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
- A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
- A61B5/063—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using impedance measurements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
- A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
- A61B5/064—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using markers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/42—Details of probe positioning or probe attachment to the patient
- A61B8/4245—Details of probe positioning or probe attachment to the patient involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient
- A61B8/4254—Details of probe positioning or probe attachment to the patient involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient using sensors mounted on the probe
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/42—Details of probe positioning or probe attachment to the patient
- A61B8/4245—Details of probe positioning or probe attachment to the patient involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient
- A61B8/4263—Details of probe positioning or probe attachment to the patient involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient using sensors not mounted on the probe, e.g. mounted on an external reference frame
-
- 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
- A61B8/4483—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device characterised by features of the ultrasound transducer
- A61B8/4488—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device characterised by features of the ultrasound transducer the transducer being a phased array
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
- A61B8/461—Displaying means of special interest
- A61B8/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
- A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/54—Control of the diagnostic device
Definitions
- the present invention relates generally to medical imaging systems, and more particularly to a method and apparatus for localizing an ultrasound imaging catheter.
- Medical imaging technology is used to improve the diagnosis and treatment of medical conditions.
- Presently available medical imaging technology includes a wide variety of ultrasound, X-ray, nuclear, magnetic resonance imaging (MRI) and other imaging systems.
- MRI magnetic resonance imaging
- a technology of particular benefit to diagnosis and treatment of cardiovascular conditions uses imaging ultrasound detectors mounted a percutaneous catheter.
- Dupree generates an electric field with one of a basket electrode and a roving electrode, the electric field being characterized by the physical dimensions and spacing among the basket electrodes.
- a navigation application is provided which analyzes the spatial variations in the electrical potentials sensed within the field, and provides a location output which locates the roving electrode within the space defined by the basket, in terms of its position relative to the position of the multiple basket electrodes.
- Other such systems also exist.
- the Dupree system may be problematic in some applications due to its use of an electrode generated electric field to determine the location of the probe.
- electric fields generated intra-body can generate electrical currents which flow in the body that may cause muscle stimulation, which may result in heart arrhythmias, etc., when used in or near the heart, such as intra-cardiac sensing or treatment.
- catheter locating methods that are compatible with ultrasound imaging catheters, and for methods of utilizing localized position information in combination with image rendering.
- an imaging system is provided with an ultrasound catheter including a tubular body, and a controller coupled to the ultrasound catheter.
- the ultrasound catheter includes a localizer sensor adapted and configured to generate positional information for the ultrasound catheter, and an imaging ultrasound sensor positionable relative to the tubular body so as to have a first restricted field of view.
- the controller co-registers images from the imaging ultrasound sensor with positional information from the localizer sensor.
- the first restricted field of view spans less than 360 degrees about the tubular body.
- a method of displaying medical images from a catheter-based imaging ultrasound sensor having a first restricted field of view including generating at least one image with the imaging ultrasound sensor, calculating a position of the imaging ultrasound sensor, coregistering the calculated position with the at least one generated image, and displaying the at least one generated image based on the calculated positional information, wherein the first restricted field of view spans less than 360 degrees about a body of the catheter.
- an imaging system including means for generating a plurality of two dimensional (2D) images of a structure, means for determining a section of the structure corresponding to each of the plurality of 2D images, and means for displaying a three dimensional (3D) display of at least a portion of the structure from the plurality of 2D images.
- FIG. 1A depicts an ultrasound catheter probe according to an embodiment of the present invention.
- FIG. 1B depicts a field of regard and a field of view for one side of one of the ultrasound sensors of FIG. 1A .
- FIG. 2 depicts a yaw angle and a roll of the ultrasound catheter probe of FIG. 1A .
- FIG. 3 depicts a pitch angle of the ultrasound catheter probe of FIG. 1A .
- FIG. 4 depicts a positioning system according to an embodiment of the present invention.
- FIG. 5 depicts an ultrasound catheter probe according to another embodiment of the present invention.
- FIG. 6 depicts a cross sectional view of catheter probes including a plurality of directional sensors according to another embodiment of the present invention.
- FIG. 7 depicts a method of displaying medical images from a catheter-based imaging sensor having a restricted field of view according to another embodiment of the present invention.
- the various embodiments of the present invention provide capabilities to determine the location of medical instrumentation and/or treatment devices within a patient's body using ultrasound echolocation and/or three dimensional (3D) triangulation techniques, and to use this localized information in conjunction with medical images. Relative positions of one instrument with respect to other instruments and registration of instrumentation positions with respect to the patient's body may be obtained, which is generally referred to herein as “localizing” the instrumentation.
- references to catheters as particular types of medical instrumentation and treatment devices are not intended to be limiting since the claimed systems and methods equally apply to other non-catheter probes/medical devices positional within the body, including remote or robotic surgery, esophageal probes, and medical, veterinarian and forensic applications where an instrumentation or tools require positioning within a body where they cannot be observed directly by the operator.
- the various embodiments of the present invention employ sensors on a probe, such as a catheter, that are capable of sensing a signal to determine a range or bearing to an emitter in combination with 1, 2, 3 or more emitters in order to determine a one-dimensional (1D), two-dimensional (2D) or three-dimensional (3D) position, respectively, of the probe with respect to the emitters.
- the range or bearing information is referred to herein as positional information because the information permits determining the position of the sensor with respect to an emitter and/or a frame of reference.
- the sensors that receive signals from emitters are referred to herein as localizer sensors, because the sensors permit locating the sensor with respect to an emitter and/or a frame of reference.
- the emitters may be placed on or within a body, preferably at dispersed positions around and near an area in which the probe will be operated.
- the emitters are preferably positioned at predetermined, fixed or determinable (i.e., measurable) positions on, in or near the body to provide a relative frame of reference for locating the probe.
- the positions of emitters are based upon the patients body, such as on the chest at measured distances from a part of the anatomy (e.g., the sternum), the emitters provide a relative frame of reference for positioning the probe with respect to the body.
- emitters may be positioned at predetermined or measured locations with respect to an external or absolute frame of reference, such as an operating table or electrophysiology lab. When the positions of emitters are measured against an external frame of reference, they are said to be “registered” to the external frame of reference and may serve as fiducial references for locating the probe within the external frame of reference.
- Magnetic field emitters may be used to localize a probe within a patient's body by using magnetic field sensors positioned on the probe, such as a catheter to measure the magnetic field strength or sense a direction of the magnetic field.
- magnetic field emitters are magnets of a known or measurable field strength, such as permanent magnets and electromagnets.
- electromagnets are used so that the emitted magnetic field can be turned on and off sequentially to permit sensors to determine a range or bearing to each electromagnet sequentially.
- a magnetic field strength sensor is positioned at a known or fixed position on a probe, such as a catheter, that is capable of measuring the relative or absolute magnetic field around it. Since the strength of a magnetic field decreases with distance from a magnet, a range or distance to the magnet from the sensor can be calculated using known methods and simple calculations. By measuring the range R.sub.i to three or more magnets, a 3D position of the sensor is easily calculated using well known methods as the intersection of three or more spheres of radius R.sub.i each centered on each magnet.
- a magnetic field direction sensor is positioned at a known or fixed position on a probe, such as a catheter, that is capable of sensing the direction of a local magnetic field. Similar to a compass, this sensor may be configured to sense the direction or bearing to the magnet in 1, 2 or 3 dimensions with respect to the catheter. By measuring the bearing to three or more magnets, a 3D position of the sensor is easily calculated using well known triangulation methods as the intersection of three or more vectors each passing through a magnet.
- Electric field emitters may be used to localize a probe within a patient's body by using electric field sensors positioned on the probe, such as a catheter to measure the electric field strength or other electric field properties such as impedance.
- an electric field may be applied to the body by means of an electrode to which a voltage or alternating field (such as radio frequency) is applied of a known or measurable strength.
- the electric field applied to electrodes can be turned on and off sequentially to permit sensors to determine a range to each electrode sequentially.
- a voltage sensor such as an electrode
- a probe such as a catheter
- a range or distance to the magnet from the sensor can be calculated using known methods and simple calculations.
- a 3D position of the sensor is easily calculated using well known methods as the intersection of three or more spheres of radius R.sub.i each centered on each magnet.
- a electric field sensor such as an electrode
- a probe such as a catheter
- a probe such as a catheter
- the impedance between the electrode emitter and sensor electrode on the catheter varies with distance
- a range or distance to the emitter electrode can be calculated using known methods and simple calculations. Similar to other embodiments, by measuring the range R.sub.i to three or more electrodes, a 3D position of the sensor is easily calculated using well known methods as the intersection of three or more spheres of radius R.sub.i each centered on each electrode.
- Ultrasound emitters may be used to localize a probe within a patient's body by using ultrasound sensors positioned on the probe, such as a catheter to measure receive ultrasound pulses emitted by emitters positioned within or external to the body.
- an ultrasound catheter 200 includes an imaging ultrasound sensor 240 , and a positional array with positional sensors 210 , 220 , 230 .
- positional sensors 210 , 220 , 230 comprise ultrasound sensors as will be described in greater detail below.
- Other positional sensors are also contemplated, such as the magnetic positional sensors and resistance/impedance positional sensors described above, as would be readily apparent to one of ordinary skill in the art after reading this disclosure.
- a first annular ultrasound sensor 230 may be positioned at or near a proximal end of the catheter 200 and second annular ultrasound sensor 210 may be positioned at some distance from the first annular ultrasound sensor 230 .
- the first annular ultrasound sensor 230 and the second annular ultrasound sensor 210 are positioned so as to bracket the imaging ultrasound sensor 240 along a length of the catheter 200 .
- annular refers to sensors which have a “field of view” that extends substantially all the way around the long axis of the catheter 200 .
- Magnetic, electric and ultrasound sensors may each be configured as annular sensors.
- Annular ultrasound sensors are typically ring shaped transducers that create ultrasound pulses and receive echoes from those pulses around the circumference of the catheter 200 . Due to their configuration, annular ultrasound sensors may create and/or receive minimal or no ultrasound pulses along the length (i.e., long axis) of the catheter 200 (see FIG. 1B , which shows a restricted field of view with no ultrasound pulses being created/received along the length of the catheter 200 ).
- An annular ultrasound sensor may comprise a single sensor, such as a ring-shaped transducer, or an array of sensors.
- a directional sensor 220 may be circumferentially positioned at a known angle about the catheter axis relative to the imaging ultrasound sensor 240 .
- the known angle between the directional sensor 220 and the imaging ultrasound sensor 240 is in the range of about 90 degrees to about 180 degrees. Most preferably, the known angle is about 180 degrees around the catheter circumference from the transmission face of the imaging ultrasound sensor 240 .
- the directional sensor 220 is positioned substantially opposite the imaging ultrasound sensor 240 about the catheter 200 . Other configurations are also contemplated.
- directional refers to sensors which do not transmit or which do not have a field of view that extends substantially all the way around the long axis of catheter 200 . Due to this configuration, directional ultrasound sensors, for example, create and/or receive ultrasound pulses along a restricted field of view (i.e., a field of view less than 360 degrees about the long axis of catheter 200 ). Such a field of view may be cone-shaped where the angle of the cone of transmitted and/or received ultrasound may narrow to nearly 180 degrees. However, the breadth of the restricted field of view may vary depending on the particular directional sensor 220 utilized, as would be readily apparent to one of ordinary skill in the art after reading this disclosure.
- a near-omni directional transducer may be mounted on a tip of catheter 200 ; e.g. a transducer which has a 4.pi. radians (approximate) field of view except along the length of catheter 200 (i.e., the long axis). This near-omni directional transducer may be substituted for or be provided in addition to the annular ultrasound sensors 210 , 230 .
- Multipath refers to ultrasound pulses generated by a first source arriving at first receiver at different times due to different path lengths.
- the speed of ultrasound is different in bones, tissues, and fluids (e.g., blood).
- ultrasound may refract in, reflect off and preferentially conduct through different body structures, permitting an ultrasound pulse to reach a sensor along different paths.
- the combined effects are multipath errors that may reduce location accuracy achievable with ultrasound localization because determination of the travel time of an ultrasound pulse does not correlate exactly to the distance traveled.
- the combined distance measurements can be correlated to help reduce multipath induced errors.
- one or more of ultrasound sensors 210 , 220 , 230 may be positioned on a rigid portion of catheter 200 , and/or one or more of ultrasound sensors 210 , 220 , 230 may be positioned on a flexible portion of catheter 200 .
- at least imaging ultrasound sensor 240 and directional ultrasound sensor 220 are positioned on a rigid portion of catheter 200 .
- additional sensors e.g., one for each positionable segment may be used to provide 3D position information on the catheter segments.
- the ultrasound pulses of the first annular ultrasound sensor 230 and the second annular ultrasound sensor 210 are used to determine the 3D position of the catheter 200 with respect to a frame of reference.
- frame of reference refers to any known position and/or coordinate system which can be used to determine the absolute position of catheter 200 within a patient's body by knowing the relative position between the frame of reference and the catheter 200 and the relative position of the patient's body and the frame of reference.
- the frame of reference may be established using a second or third catheter (see FIG. 4 ) having a known position or an image obtained by other technology (e.g., fluoroscopy, x-ray, etc.).
- the frame of reference may be a fixed frame of reference to which the catheters and the patient are located (e.g., on an exam table or the like), a frame of reference fixed on the patient's body (e.g., externally generated ultrasound signals provided at registered fiducial points on the patient's body), a detected and recognizable structure (e.g., the heart wall or valve).
- a frame of reference is also applicable to embodiments using non-ultrasound positional sensors, such as the magnetic positional sensors, and resistance/impedance positional sensors previously described. It should be appreciated that multiple frames of reference may be used to further improve the accuracy and reliability of the position determination, the selection of which may depend upon the nature of the medical procedure and the required positional precision.
- the ultrasound pulses generated by the first annular ultrasound sensor 230 and the second annular ultrasound sensor 210 as well as the echoes in response thereto are measured (in time and/or strength) and are used to determine the planar angle 250 along the X-Y plane (the “yaw” angle) and the Z offset angle 252 (the “pitch” angle) with respect to the frame of reference using positioning algorithms known in the art. For example, knowing the speed of sound in blood and the time when a pulse is emitted, the measured delay of a received pulse can be used to determine position by spherical triangulation. It should be appreciated that increasing the number of annular ultrasound sensors 210 , 230 as previously noted would improve accuracy of the pitch and yaw determination, as more relational data is generated for the positioning algorithms.
- the direction an instrument such as an ultrasound imaging transducer, optical imager or microsurgical instrument, is facing.
- interpretation of intracardiac echocardiography images would be facilitated if the direction that the imaging ultrasound sensor 240 is facing is known with respect to the frame of reference, particularly for an imaging ultrasound sensor 240 with a limited field of view.
- This determination can be achieved by receiving in some but not all catheter sensors the ultrasound pulse generated by directional ultrasound sensor 220 as well as the echo off other sensors (in time and/or strength) and the pulses from those other catheter sensors within the field of view of directional ultrasound sensor 220 , the data from which is collectively used to calculate the direction the directional ultrasound 220 is pointed.
- the direction 254 of ultrasound sensor 240 (the “roll” of catheter 200 ) relative to the frame of reference can be determined based on the measured direction of directional ultrasound sensor 220 .
- the aforementioned configuration thus has the capability of determining the 3D position of the catheter 200 relative to the frame of reference, as well as the direction of imaging ultrasound sensor 240 .
- This provides a user of the system with a greater amount of information as to the position of a given image generated by catheter 200 than in conventional systems.
- various embodiments provide the user with the pitch, yaw, and roll position of catheter 200 having an imaging ultrasound sensor 240 with a restricted field of view.
- 6D six dimensional
- a catheter positioning system for more accurately determining the position (or relative position) of catheter 200 of FIG. 1A .
- the catheter positioning system includes a first positioning catheter 300 and a second positioning catheter 400 preferably positioned at some angle from catheter 200 as shown.
- the first positioning catheter 300 and second positioning catheter 400 may be positioned so as to better triangulate the position of the catheter 200 within the heart.
- Other locations for positioning catheters 300 , 400 are also contemplated.
- an external location source/system such as an X-ray system and/or external ultrasound transducers/beacons, may be used in conjunction with the aforementioned configuration to better determine or to confirm the position of ultrasound catheter 200 .
- the position of one or both of catheters 300 , 400 may be established by an external localizing means (e.g., an x-ray), so as to qualify as a frame of reference for determining the position of catheter 200 .
- This embodiment may be used to reduce x-ray exposure to the patient and attendants by using one or a few x-ray images to localize the positioning catheters 300 , 400 , which then can be used to localize the imaging catheter 200 during an intracardiac echocardiography session without the case of additional fluoroscopy.
- additional or other frames of references may also be used as previously described.
- the first positioning catheter 300 includes at least two annular localizer sensors 310 , 320 positioned on a tubular body thereof so as to generate respective near-omni directional ultrasound pulses.
- the second positioning catheter 400 includes at least two annular localizer sensors 410 , 420 positioned on the tubular body thereof so as to generate respective near-omni directional ultrasound pulses.
- the positional sensors 310 , 320 , 410 , 420 illustrated in FIG. 4 comprise ultrasound sensors, however non-ultrasound sensors may also be used, such as the magnetic positional sensors, and resistance/impedance positional sensors previously described.
- the annular ultrasound sensors 310 , 320 , 410 , 420 of the positioning catheters 300 , 400 can be similar to the annular ultrasound sensors 210 , 230 of catheter 200 in that they create and/or receive ultrasound pulses from substantially all angles about the circumference of catheters 300 , 400 , respectively.
- Other configurations are also contemplated, such as positioning catheters each with only one annular ultrasound sensor, positioning catheters each with more than two annular ultrasound sensors, and configurations with only one positioning catheter or more than two positioning catheters.
- two, three, four or more directional ultrasound sensors may be spaced at known angular intervals to provide near-omni directional ultrasound pulses.
- This alternative embodiment may further feature using different ultrasound frequencies on each such directional sensor or pulsing such sensors at different known times so that received pulses can be processed to identify which of the directional sensors emitted the received pulse.
- This additional information may be useful in certain applications where multipath errors may be an issue or where high positional precision is required (e.g., when microsurgery is being performed).
- An exemplary implementation of this technique is shown in greater detail in FIG.
- catheters 600 , 610 generating a plurality of ultrasound pulses from directional sensors having individual field of views P 1 , P 2 , P 3 (for catheter 600 ) and F 1 , F 2 , F 3 (for catheter 610 ).
- Other configurations are also contemplated.
- ultrasound positional sensors have been described, other non-ultrasound positional sensors may be used.
- non-ultrasound positional sensors include magnetic positional sensors and resistance/impedance positional sensors.
- a combination of the ultrasound and non-ultrasound positional sensors may be used for some applications. Such a combination may be used for positioning catheter 300 , positioning catheter 400 , and/or catheter 200 .
- the positioning catheters 300 , 400 and the ultrasound catheter 200 are electrically coupled to controller 299 , the controller 299 being adapted and configured to receive the echo data and to determine therefrom a three dimensional (3D) position of the ultrasound catheter 200 relative to a frame of reference from electrical signals generated by positioning catheters 300 , 400 and ultrasound catheter 200 .
- the controller 299 may comprise an appropriately programmed microprocessor, an application specific integrated circuit (ASIC) or other similar control and calculation device, as would be readily apparent to one of ordinary skill in the art after reading this disclosure.
- ASIC application specific integrated circuit
- the positioning catheters 300 , 400 and the ultrasound imaging catheter 200 are coupled to controller 299 via an integrated positioning and imager junction box.
- the integrated positioning and imager junction box may include isolation circuitry to reduce or eliminate stray currents from controller 299 , which would otherwise be radiated along the length of catheter 200 .
- the annular ultrasound sensors 310 , 320 of first positioning catheter 300 , the annular ultrasound sensors 410 , 420 of second positioning catheter 400 , and the annular ultrasound sensors 210 , 230 of ultrasound catheter 200 record the time of arrive of pulses from all positioning sensors in their field of regard. Additionally, echoes of a given sensor's own pulses bouncing off another catheter may also be received and used to determine location.
- an imaging ultrasound sensor may image a catheter within its field of view.
- the field of view and field of regard of a given sensor may differ, where the “field of regard” refers to the direction(s) from which a given sensor may receive echoes (see FIG. 1B ).
- the field of regard may be the same or different from a given sensor's overall field of view, which is the directions in which the sensor is facing.
- the controller 299 is able to calculate the relative positions of the sensors by spherical triangulation. More specifically, the ultrasound sensors 310 , 320 detect the ultrasound sensors 210 , 230 , 410 , 420 ; the ultrasound sensors 210 , 230 detect the ultrasound sensors 310 , 320 , 410 , 420 ; and the ultrasound sensors 410 , 420 detect the ultrasound sensors 310 , 320 , 210 , 230 .
- the relative positions of the three catheters 200 , 300 and 400 can be determined using known algorithms, and thus used to calculate the pitch and yaw of catheter 200 relative to the frame of reference.
- the annular ultrasound sensors 310 , 320 of catheter 300 , the directional ultrasound sensor 220 of catheter 200 , and the annular ultrasound sensors 410 , 420 of catheter 400 detect each other.
- the ultrasound sensors 310 , 320 detect the ultrasound sensors 220 , 410 , 420 ;
- the directional ultrasound sensor 220 detects the ultrasound sensors 310 , 320 , 410 , 420 ;
- the ultrasound sensors 410 , 420 detect the ultrasound sensors 310 , 320 , 220 .
- the relative positions of directional ultrasound sensor 220 from ultrasound sensors 310 , 320 , 410 , 420 can be determined using known algorithms.
- ultrasound sensors 310 , 320 , 410 , 420 may detect the directional ultrasound sensor 220 due to the restricted field of view of directional ultrasound sensor 220 .
- the direction of directional ultrasound sensor 220 can be determined. This allows the direction of imaging ultrasound sensor 240 to be determined based on the known angle between imaging ultrasound sensor 240 and directional ultrasound sensor 220 .
- each of the ultrasound sensors 310 , 320 , 210 , 220 , 230 , 410 , 420 can operate or emit pulses at different time intervals.
- each of the ultrasound sensors 310 , 320 , 210 , 220 , 230 , 410 , 420 may operate at different frequencies (preferably also different from imaging ultrasound sensor 240 ), such that multiple ones of the ultrasound sensors 310 , 320 , 210 , 220 , 230 , 410 , 420 may generate/detect simultaneously. In this manner, the identity of each positioning sensor can be easily determined by the controller 299 according to the received frequency. Other configurations and methods are also contemplated.
- an ultrasound imaging catheter 500 is provided, the ultrasound catheter including an imaging ultrasound sensor 540 , and a positional ultrasound array with positional ultrasound sensors 210 , 230 .
- first annular ultrasound sensor 230 is positioned at or near a proximal end of the catheter 200 and second annular ultrasound sensor 210 is positioned at some distance from first annular ultrasound sensor 230 .
- the first annular ultrasound sensor 230 and the second annular ultrasound sensor 210 are positioned so as to bracket the imaging ultrasound sensor 540 along a length of the catheter 500 .
- imaging ultrasound sensor 540 may be configured to operate in at least a positioning mode during which the imaging ultrasound sensor 540 generates and/or receives a positioning ultrasound pulse, and an imaging mode during which the imaging ultrasound sensor 540 generates and/or receives an imaging ultrasound pulse.
- the ultrasound catheter 500 may be configured to have imaging ultrasound sensor 540 only operate in the positioning mode when the ultrasound catheter 500 is moved or on command by a user thereof, or may be configured to periodically operate in the positioning mode for periodic updates of the position.
- the aforementioned technique can be performed by pulsing one or more single elements individually (e.g., one on each end of a linear array), by pulsing a plurality of elements together (e.g., non-phased), or by forming a directional pulse via phasing the pulses of each element (which may or may not include directing the direction pulse at specific positional sensors). Due to the high frequency of ultrasound and the high scan rate of a linear phased array ultrasound transducer, periodic localizing pulses may be transmitted so frequently that the positioning mode appears to be operating simultaneously with the imaging mode without noticeably degrading the quality of images.
- FIG. 5 eliminates the need for a directional ultrasound sensor 220 .
- the present embodiment benefits from a reduced cost.
- the particular frequency of a given ultrasound sensor for any one of the embodiments shown in FIGS. 1-6 may be selected based on the precision and penetration depth required.
- a lower frequency may be selected, in order to achieve a higher degree of penetration depth.
- an ultrasound imaging sensor such as sensor 240 in FIG. 1A
- a higher frequency may be selected, in order to achieve a higher degree of precision.
- higher frequencies are typically used than for ultrasound sensors positioned outside the body.
- Other configurations and methods are also contemplated.
- the positioning information from any one of the aforementioned embodiments may be used in control equipment to assist the operator in positioning and operating an ultrasound imaging catheter.
- a rectangle or other shape representing the field of regard of the imaging sensor may be projected onto a 3D (e.g., wire-frame, cartoon or stylized) representation of the patient's heart rendered on a display device to show the operator the portion of the patient's body that is or will be imaged based upon the present position and orientation of the sensor.
- the image generated by the imaging ultrasound sensor 240 , 540 and positional information may be correlated to heart structures within the 3D wire-frame image (or stylized image) of an idealized heart using known image processing techniques.
- the catheter localizer information and ultrasound image can be applied to the 3D wire-frame image (or stylized image) to graphically depict the image including the location of all (or some) catheters within the heart for easier interpretation by the user.
- This embodiment provides the operator with more visual information, and thus a more easily understood representation of the position of the ultrasound catheters 200 , 500 and the image generated thereby.
- a 3D wire-frame image may be transparent, allowing the operator to “see” the catheter(s) positions relative to the heart structures. This may be particularly useful in procedures where catheters are used to precisely position electrodes on the heart wall based upon real-time images provided by an intracardiac ultrasound imaging catheter since the positions of all catheters relative to the heart are displayed for the physician.
- the localizer information can be used in conjunction with images obtained from catheter 200 .
- one such process is described in copending application entitled “Method and Apparatus for Time Gating of Medical Images”, filed currently with the present application and incorporated by reference herein in its entirety. Another such process is shown in the flowchart of FIG. 7 , and described in greater detail below.
- At least one embodiment of the present invention includes methods of displaying medical images from a catheter-based imaging sensor having a restricted field of view, such as a two dimensional (2D) ultrasound imaging sensor.
- the imaging sensor is used to generate at least one image (preferably 2D) of a structure of interest.
- a position of the imaging sensor is calculated, and then coregistered in step 730 with the at least one image generated in step 710 . This may include, for example, coregistering a section of the structure of interest (e.g., a heart) with each image generated in step 710 .
- step 740 the at least one generated image of step 710 is displayed based on the calculated positional information from step 720 .
- step 740 may include displaying a 3D model of the structure of interest, and then highlighting a section of the 3D model of the structure of interest which corresponds to the coregistered section of step 730 .
- the 3D model is generally depicted in a first color or colors, and the highlighted section is depicted in a second color different from the first color(s).
- Other configurations are also contemplated.
Abstract
An imaging system is provided with an ultrasound catheter and a controller coupled to the ultrasound catheter. The catheter includes a localizer sensor configured to generate positional information for the ultrasound catheter, and an imaging ultrasound sensor having a restricted field of view. The controller co-registers images from the imaging ultrasound sensor with positional information from the localizer sensor.
Description
- This application is a continuation of U.S. patent application Ser. No. 12/650,521, filed 30 Dec. 2009 (the '521 application), now pending, which is a continuation of U.S. patent application Ser. No. 10/994,424, filed 23 Nov. 2004 (the '424 application) now U.S. Pat. No. 7,713,210, issued 11 May 2010. The '521 application and the '424 application are both hereby incorporated by reference in their entirety as though fully set forth herein.
- 1. Field of the Invention
- The present invention relates generally to medical imaging systems, and more particularly to a method and apparatus for localizing an ultrasound imaging catheter.
- 2. Description of the Related Art
- Medical imaging technology is used to improve the diagnosis and treatment of medical conditions. Presently available medical imaging technology includes a wide variety of ultrasound, X-ray, nuclear, magnetic resonance imaging (MRI) and other imaging systems. A technology of particular benefit to diagnosis and treatment of cardiovascular conditions uses imaging ultrasound detectors mounted a percutaneous catheter.
- Techniques exist for localizing catheters deployed within a patient's body. One such technique is described in U.S. Pat. No. 6,192,266 to Dupree (“Dupree” hereafter), which is incorporated by reference herein in its entirety. In particular, Dupree generates an electric field with one of a basket electrode and a roving electrode, the electric field being characterized by the physical dimensions and spacing among the basket electrodes. A navigation application is provided which analyzes the spatial variations in the electrical potentials sensed within the field, and provides a location output which locates the roving electrode within the space defined by the basket, in terms of its position relative to the position of the multiple basket electrodes. Other such systems also exist.
- The Dupree system, however, may be problematic in some applications due to its use of an electrode generated electric field to determine the location of the probe. In particular, electric fields generated intra-body can generate electrical currents which flow in the body that may cause muscle stimulation, which may result in heart arrhythmias, etc., when used in or near the heart, such as intra-cardiac sensing or treatment. Thus, a need exists for a non-electric field-based catheter locating system that does not induce significant electric currents in the body. There is also a particular need for catheter locating methods that are compatible with ultrasound imaging catheters, and for methods of utilizing localized position information in combination with image rendering.
- Other problems with the prior art not described above can also be overcome using the teachings of the present invention, as would be readily apparent to one of ordinary skill in the art after reading this disclosure.
- According to an embodiment of the present invention, an imaging system is provided with an ultrasound catheter including a tubular body, and a controller coupled to the ultrasound catheter. The ultrasound catheter includes a localizer sensor adapted and configured to generate positional information for the ultrasound catheter, and an imaging ultrasound sensor positionable relative to the tubular body so as to have a first restricted field of view. The controller co-registers images from the imaging ultrasound sensor with positional information from the localizer sensor. Preferably, the first restricted field of view spans less than 360 degrees about the tubular body.
- According to another embodiment of the present invention, a method of displaying medical images from a catheter-based imaging ultrasound sensor having a first restricted field of view is provided including generating at least one image with the imaging ultrasound sensor, calculating a position of the imaging ultrasound sensor, coregistering the calculated position with the at least one generated image, and displaying the at least one generated image based on the calculated positional information, wherein the first restricted field of view spans less than 360 degrees about a body of the catheter.
- According to another embodiment of the present invention, an imaging system is provided including means for generating a plurality of two dimensional (2D) images of a structure, means for determining a section of the structure corresponding to each of the plurality of 2D images, and means for displaying a three dimensional (3D) display of at least a portion of the structure from the plurality of 2D images.
-
FIG. 1A depicts an ultrasound catheter probe according to an embodiment of the present invention. -
FIG. 1B depicts a field of regard and a field of view for one side of one of the ultrasound sensors ofFIG. 1A . -
FIG. 2 depicts a yaw angle and a roll of the ultrasound catheter probe ofFIG. 1A . -
FIG. 3 depicts a pitch angle of the ultrasound catheter probe ofFIG. 1A . -
FIG. 4 depicts a positioning system according to an embodiment of the present invention. -
FIG. 5 depicts an ultrasound catheter probe according to another embodiment of the present invention. -
FIG. 6 depicts a cross sectional view of catheter probes including a plurality of directional sensors according to another embodiment of the present invention. -
FIG. 7 depicts a method of displaying medical images from a catheter-based imaging sensor having a restricted field of view according to another embodiment of the present invention. - Reference will now be made in detail to exemplary embodiments of the present invention. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.
- The various embodiments of the present invention provide capabilities to determine the location of medical instrumentation and/or treatment devices within a patient's body using ultrasound echolocation and/or three dimensional (3D) triangulation techniques, and to use this localized information in conjunction with medical images. Relative positions of one instrument with respect to other instruments and registration of instrumentation positions with respect to the patient's body may be obtained, which is generally referred to herein as “localizing” the instrumentation. Thus, references to catheters as particular types of medical instrumentation and treatment devices are not intended to be limiting since the claimed systems and methods equally apply to other non-catheter probes/medical devices positional within the body, including remote or robotic surgery, esophageal probes, and medical, veterinarian and forensic applications where an instrumentation or tools require positioning within a body where they cannot be observed directly by the operator.
- The various embodiments of the present invention employ sensors on a probe, such as a catheter, that are capable of sensing a signal to determine a range or bearing to an emitter in combination with 1, 2, 3 or more emitters in order to determine a one-dimensional (1D), two-dimensional (2D) or three-dimensional (3D) position, respectively, of the probe with respect to the emitters. The range or bearing information is referred to herein as positional information because the information permits determining the position of the sensor with respect to an emitter and/or a frame of reference. The sensors that receive signals from emitters are referred to herein as localizer sensors, because the sensors permit locating the sensor with respect to an emitter and/or a frame of reference. Three types of ranging/directional signals described herein include magnetic fields, electrical fields and ultrasound, but other signals are contemplated consistent with the purpose and techniques described herein. The emitters may be placed on or within a body, preferably at dispersed positions around and near an area in which the probe will be operated.
- As will be discussed, the emitters are preferably positioned at predetermined, fixed or determinable (i.e., measurable) positions on, in or near the body to provide a relative frame of reference for locating the probe. When the positions of emitters are based upon the patients body, such as on the chest at measured distances from a part of the anatomy (e.g., the sternum), the emitters provide a relative frame of reference for positioning the probe with respect to the body. Also, emitters may be positioned at predetermined or measured locations with respect to an external or absolute frame of reference, such as an operating table or electrophysiology lab. When the positions of emitters are measured against an external frame of reference, they are said to be “registered” to the external frame of reference and may serve as fiducial references for locating the probe within the external frame of reference.
- Magnetic field emitters may be used to localize a probe within a patient's body by using magnetic field sensors positioned on the probe, such as a catheter to measure the magnetic field strength or sense a direction of the magnetic field. In this embodiment, magnetic field emitters are magnets of a known or measurable field strength, such as permanent magnets and electromagnets. Preferably, electromagnets are used so that the emitted magnetic field can be turned on and off sequentially to permit sensors to determine a range or bearing to each electromagnet sequentially.
- In an embodiment employing magnetic field strength measurements, a magnetic field strength sensor is positioned at a known or fixed position on a probe, such as a catheter, that is capable of measuring the relative or absolute magnetic field around it. Since the strength of a magnetic field decreases with distance from a magnet, a range or distance to the magnet from the sensor can be calculated using known methods and simple calculations. By measuring the range R.sub.i to three or more magnets, a 3D position of the sensor is easily calculated using well known methods as the intersection of three or more spheres of radius R.sub.i each centered on each magnet.
- In an alternative embodiment employing magnetic field direction sensors, a magnetic field direction sensor is positioned at a known or fixed position on a probe, such as a catheter, that is capable of sensing the direction of a local magnetic field. Similar to a compass, this sensor may be configured to sense the direction or bearing to the magnet in 1, 2 or 3 dimensions with respect to the catheter. By measuring the bearing to three or more magnets, a 3D position of the sensor is easily calculated using well known triangulation methods as the intersection of three or more vectors each passing through a magnet.
- Electric field emitters may be used to localize a probe within a patient's body by using electric field sensors positioned on the probe, such as a catheter to measure the electric field strength or other electric field properties such as impedance. In such embodiments, an electric field may be applied to the body by means of an electrode to which a voltage or alternating field (such as radio frequency) is applied of a known or measurable strength. The electric field applied to electrodes can be turned on and off sequentially to permit sensors to determine a range to each electrode sequentially.
- In an embodiment employing electric field sensors, a voltage sensor, such as an electrode, is positioned at a known or fixed position on a probe, such as a catheter, that is capable of measuring the relative electric (i.e., voltage) field around it. Since the strength of an electric field decreases with distance from an electrode, a range or distance to the magnet from the sensor can be calculated using known methods and simple calculations. By measuring the range R.sub.i to three or more magnets, a 3D position of the sensor is easily calculated using well known methods as the intersection of three or more spheres of radius R.sub.i each centered on each magnet.
- In an alternative embodiment employing electric field sensors, a electric field sensor, such as an electrode, is positioned at a known or fixed position on a probe, such as a catheter, that is capable of receiving an alternating electric field and passing the signal, such as via a coaxial cable, to external equipment configured to measure impedance between the emitter electrode and the sensor electrode on the catheter. Since the impedance between the electrode emitter and sensor electrode on the catheter varies with distance, a range or distance to the emitter electrode can be calculated using known methods and simple calculations. Similar to other embodiments, by measuring the range R.sub.i to three or more electrodes, a 3D position of the sensor is easily calculated using well known methods as the intersection of three or more spheres of radius R.sub.i each centered on each electrode.
- Ultrasound emitters may be used to localize a probe within a patient's body by using ultrasound sensors positioned on the probe, such as a catheter to measure receive ultrasound pulses emitted by emitters positioned within or external to the body.
- According to such an embodiment of the present invention as shown in
FIG. 1A , anultrasound catheter 200 includes animaging ultrasound sensor 240, and a positional array withpositional sensors positional sensors - A first
annular ultrasound sensor 230 may be positioned at or near a proximal end of thecatheter 200 and secondannular ultrasound sensor 210 may be positioned at some distance from the firstannular ultrasound sensor 230. In this embodiment, the firstannular ultrasound sensor 230 and the secondannular ultrasound sensor 210 are positioned so as to bracket theimaging ultrasound sensor 240 along a length of thecatheter 200. - As referenced above, the term “annular” refers to sensors which have a “field of view” that extends substantially all the way around the long axis of the
catheter 200. Magnetic, electric and ultrasound sensors may each be configured as annular sensors. Annular ultrasound sensors are typically ring shaped transducers that create ultrasound pulses and receive echoes from those pulses around the circumference of thecatheter 200. Due to their configuration, annular ultrasound sensors may create and/or receive minimal or no ultrasound pulses along the length (i.e., long axis) of the catheter 200 (seeFIG. 1B , which shows a restricted field of view with no ultrasound pulses being created/received along the length of the catheter 200). An annular ultrasound sensor may comprise a single sensor, such as a ring-shaped transducer, or an array of sensors. - In addition to
annular ultrasound sensors directional sensor 220 may be circumferentially positioned at a known angle about the catheter axis relative to theimaging ultrasound sensor 240. Preferably, the known angle between thedirectional sensor 220 and theimaging ultrasound sensor 240 is in the range of about 90 degrees to about 180 degrees. Most preferably, the known angle is about 180 degrees around the catheter circumference from the transmission face of theimaging ultrasound sensor 240. In the exemplary embodiment illustrated inFIG. 1A , thedirectional sensor 220 is positioned substantially opposite theimaging ultrasound sensor 240 about thecatheter 200. Other configurations are also contemplated. - As referenced above, the term “directional” refers to sensors which do not transmit or which do not have a field of view that extends substantially all the way around the long axis of
catheter 200. Due to this configuration, directional ultrasound sensors, for example, create and/or receive ultrasound pulses along a restricted field of view (i.e., a field of view less than 360 degrees about the long axis of catheter 200). Such a field of view may be cone-shaped where the angle of the cone of transmitted and/or received ultrasound may narrow to nearly 180 degrees. However, the breadth of the restricted field of view may vary depending on the particulardirectional sensor 220 utilized, as would be readily apparent to one of ordinary skill in the art after reading this disclosure. - It should be appreciated that while only three
ultrasound sensors catheter 200; e.g. a transducer which has a 4.pi. radians (approximate) field of view except along the length of catheter 200 (i.e., the long axis). This near-omni directional transducer may be substituted for or be provided in addition to theannular ultrasound sensors - It should also be appreciated that ultrasound has a limited path length within the body due to sound absorption by tissue and blood, and therefore more than three sensors may be required in some applications to localize medical devices positioned near or beyond the maximum path length of the particular tissue. Further, in addition to the limited path length issue, multipath issues can also be problematic in ultrasound based localizers. Multipath refers to ultrasound pulses generated by a first source arriving at first receiver at different times due to different path lengths. The speed of ultrasound is different in bones, tissues, and fluids (e.g., blood). Thus a single ultrasound pulse passing through different body structures will arrive at a sensor at slightly different times. Also, ultrasound may refract in, reflect off and preferentially conduct through different body structures, permitting an ultrasound pulse to reach a sensor along different paths. The combined effects are multipath errors that may reduce location accuracy achievable with ultrasound localization because determination of the travel time of an ultrasound pulse does not correlate exactly to the distance traveled. However, by providing more than three sensors, the combined distance measurements can be correlated to help reduce multipath induced errors.
- Additionally, one or more of
ultrasound sensors catheter 200, and/or one or more ofultrasound sensors catheter 200. Preferably, at leastimaging ultrasound sensor 240 anddirectional ultrasound sensor 220 are positioned on a rigid portion ofcatheter 200. Other configurations are also contemplated. For example, with catheters that may be flexed or bent in one or more angles, additional sensors (e.g., one for each positionable segment) may be used to provide 3D position information on the catheter segments. - As shown in
FIGS. 2 and 3 , the ultrasound pulses of the firstannular ultrasound sensor 230 and the secondannular ultrasound sensor 210 are used to determine the 3D position of thecatheter 200 with respect to a frame of reference. As discussed above, it should be appreciated that the phrase “frame of reference” refers to any known position and/or coordinate system which can be used to determine the absolute position ofcatheter 200 within a patient's body by knowing the relative position between the frame of reference and thecatheter 200 and the relative position of the patient's body and the frame of reference. In this regard, the frame of reference may be established using a second or third catheter (seeFIG. 4 ) having a known position or an image obtained by other technology (e.g., fluoroscopy, x-ray, etc.). The frame of reference may be a fixed frame of reference to which the catheters and the patient are located (e.g., on an exam table or the like), a frame of reference fixed on the patient's body (e.g., externally generated ultrasound signals provided at registered fiducial points on the patient's body), a detected and recognizable structure (e.g., the heart wall or valve). The use of a frame of reference is also applicable to embodiments using non-ultrasound positional sensors, such as the magnetic positional sensors, and resistance/impedance positional sensors previously described. It should be appreciated that multiple frames of reference may be used to further improve the accuracy and reliability of the position determination, the selection of which may depend upon the nature of the medical procedure and the required positional precision. - According to the present embodiment, the ultrasound pulses generated by the first
annular ultrasound sensor 230 and the secondannular ultrasound sensor 210 as well as the echoes in response thereto are measured (in time and/or strength) and are used to determine theplanar angle 250 along the X-Y plane (the “yaw” angle) and the Z offset angle 252 (the “pitch” angle) with respect to the frame of reference using positioning algorithms known in the art. For example, knowing the speed of sound in blood and the time when a pulse is emitted, the measured delay of a received pulse can be used to determine position by spherical triangulation. It should be appreciated that increasing the number ofannular ultrasound sensors - In addition to determining the 3D position of the
catheter 200, it is also desirable to know the direction an instrument, such as an ultrasound imaging transducer, optical imager or microsurgical instrument, is facing. For example, interpretation of intracardiac echocardiography images would be facilitated if the direction that theimaging ultrasound sensor 240 is facing is known with respect to the frame of reference, particularly for animaging ultrasound sensor 240 with a limited field of view. This determination can be achieved by receiving in some but not all catheter sensors the ultrasound pulse generated bydirectional ultrasound sensor 220 as well as the echo off other sensors (in time and/or strength) and the pulses from those other catheter sensors within the field of view ofdirectional ultrasound sensor 220, the data from which is collectively used to calculate the direction thedirectional ultrasound 220 is pointed. Asdirectional ultrasound sensor 220 is positioned at a known angle from theultrasound sensor 240 about thecatheter 200, thedirection 254 of ultrasound sensor 240 (the “roll” of catheter 200) relative to the frame of reference can be determined based on the measured direction ofdirectional ultrasound sensor 220. - The aforementioned configuration thus has the capability of determining the 3D position of the
catheter 200 relative to the frame of reference, as well as the direction ofimaging ultrasound sensor 240. This provides a user of the system with a greater amount of information as to the position of a given image generated bycatheter 200 than in conventional systems. In particular, various embodiments provide the user with the pitch, yaw, and roll position ofcatheter 200 having animaging ultrasound sensor 240 with a restricted field of view. Thus a six dimensional (6D) (x, y, z, pitch, yaw, roll) localizing capability is afforded by embodiments of the present invention. - According to another embodiment of the present invention as shown in
FIG. 4 , a catheter positioning system is provided for more accurately determining the position (or relative position) ofcatheter 200 ofFIG. 1A . In particular, the catheter positioning system includes afirst positioning catheter 300 and asecond positioning catheter 400 preferably positioned at some angle fromcatheter 200 as shown. By way of example, if thecatheter 200 is used for intra-cardiac ultrasound (and thus positioned somewhere in the right atrium of a patient's heart), thefirst positioning catheter 300 andsecond positioning catheter 400 may be positioned so as to better triangulate the position of thecatheter 200 within the heart. Other locations for positioningcatheters ultrasound catheter 200. The position of one or both ofcatheters catheter 200. This embodiment may be used to reduce x-ray exposure to the patient and attendants by using one or a few x-ray images to localize thepositioning catheters imaging catheter 200 during an intracardiac echocardiography session without the case of additional fluoroscopy. Alternatively, additional or other frames of references may also be used as previously described. - According to the exemplary embodiment shown in
FIG. 4 , thefirst positioning catheter 300 includes at least twoannular localizer sensors second positioning catheter 400 includes at least twoannular localizer sensors positional sensors FIG. 4 comprise ultrasound sensors, however non-ultrasound sensors may also be used, such as the magnetic positional sensors, and resistance/impedance positional sensors previously described. Theannular ultrasound sensors positioning catheters annular ultrasound sensors catheter 200 in that they create and/or receive ultrasound pulses from substantially all angles about the circumference ofcatheters - Alternatively, instead of annular sensors, two, three, four or more directional ultrasound sensors may be spaced at known angular intervals to provide near-omni directional ultrasound pulses. This alternative embodiment may further feature using different ultrasound frequencies on each such directional sensor or pulsing such sensors at different known times so that received pulses can be processed to identify which of the directional sensors emitted the received pulse. This additional information may be useful in certain applications where multipath errors may be an issue or where high positional precision is required (e.g., when microsurgery is being performed). An exemplary implementation of this technique is shown in greater detail in
FIG. 6 , withcatheters - It should be appreciated that, while ultrasound positional sensors have been described, other non-ultrasound positional sensors may be used. As previously noted, examples of non-ultrasound positional sensors include magnetic positional sensors and resistance/impedance positional sensors. It should further be appreciated that a combination of the ultrasound and non-ultrasound positional sensors may be used for some applications. Such a combination may be used for positioning
catheter 300,positioning catheter 400, and/orcatheter 200. - According to another embodiment of the present invention, the
positioning catheters ultrasound catheter 200 are electrically coupled tocontroller 299, thecontroller 299 being adapted and configured to receive the echo data and to determine therefrom a three dimensional (3D) position of theultrasound catheter 200 relative to a frame of reference from electrical signals generated by positioningcatheters ultrasound catheter 200. Thecontroller 299 may comprise an appropriately programmed microprocessor, an application specific integrated circuit (ASIC) or other similar control and calculation device, as would be readily apparent to one of ordinary skill in the art after reading this disclosure. - According to an embodiment of the present invention, the
positioning catheters ultrasound imaging catheter 200 are coupled tocontroller 299 via an integrated positioning and imager junction box. The integrated positioning and imager junction box may include isolation circuitry to reduce or eliminate stray currents fromcontroller 299, which would otherwise be radiated along the length ofcatheter 200. - In operation, the
annular ultrasound sensors first positioning catheter 300, theannular ultrasound sensors second positioning catheter 400, and theannular ultrasound sensors ultrasound catheter 200 record the time of arrive of pulses from all positioning sensors in their field of regard. Additionally, echoes of a given sensor's own pulses bouncing off another catheter may also be received and used to determine location. For example, an imaging ultrasound sensor may image a catheter within its field of view. As such, the field of view and field of regard of a given sensor may differ, where the “field of regard” refers to the direction(s) from which a given sensor may receive echoes (seeFIG. 1B ). Hence, the field of regard may be the same or different from a given sensor's overall field of view, which is the directions in which the sensor is facing. - Using the known speed of sound through blood, the
controller 299 is able to calculate the relative positions of the sensors by spherical triangulation. More specifically, theultrasound sensors ultrasound sensors ultrasound sensors ultrasound sensors ultrasound sensors ultrasound sensors catheters catheter 200 relative to the frame of reference. - To further determine the roll of
catheter 200, theannular ultrasound sensors catheter 300, thedirectional ultrasound sensor 220 ofcatheter 200, and theannular ultrasound sensors catheter 400 detect each other. Thus, theultrasound sensors ultrasound sensors directional ultrasound sensor 220 detects theultrasound sensors ultrasound sensors ultrasound sensors directional ultrasound sensor 220 fromultrasound sensors ultrasound sensors directional ultrasound sensor 220 due to the restricted field of view ofdirectional ultrasound sensor 220. However, based off of the measured time delay and/or signal strength of the received pulses (including a measurement of no pulse received), the direction ofdirectional ultrasound sensor 220 can be determined. This allows the direction ofimaging ultrasound sensor 240 to be determined based on the known angle betweenimaging ultrasound sensor 240 anddirectional ultrasound sensor 220. - The aforementioned location technique can be enhanced by gating each of the
ultrasound sensors ultrasound sensors ultrasound sensors controller 299 according to the received frequency. Other configurations and methods are also contemplated. - According to an embodiment of the present invention as shown in
FIG. 5 , anultrasound imaging catheter 500 is provided, the ultrasound catheter including animaging ultrasound sensor 540, and a positional ultrasound array withpositional ultrasound sensors ultrasound catheter 200 ofFIG. 1A , firstannular ultrasound sensor 230 is positioned at or near a proximal end of thecatheter 200 and secondannular ultrasound sensor 210 is positioned at some distance from firstannular ultrasound sensor 230. Preferably, the firstannular ultrasound sensor 230 and the secondannular ultrasound sensor 210 are positioned so as to bracket theimaging ultrasound sensor 540 along a length of thecatheter 500. - While the
ultrasound catheter 500 ofFIG. 5 is similar toultrasound catheter 200 ofFIG. 1A , theultrasound catheter 500 utilizes one or more of the transducer elements of theimaging ultrasound sensor 540 in positioning determination rather than or in addition to adirectional sensor 220 as withcatheter 200. In this regard,imaging ultrasound sensor 540 may be configured to operate in at least a positioning mode during which theimaging ultrasound sensor 540 generates and/or receives a positioning ultrasound pulse, and an imaging mode during which theimaging ultrasound sensor 540 generates and/or receives an imaging ultrasound pulse. Theultrasound catheter 500 may be configured to haveimaging ultrasound sensor 540 only operate in the positioning mode when theultrasound catheter 500 is moved or on command by a user thereof, or may be configured to periodically operate in the positioning mode for periodic updates of the position. - The aforementioned technique can be performed by pulsing one or more single elements individually (e.g., one on each end of a linear array), by pulsing a plurality of elements together (e.g., non-phased), or by forming a directional pulse via phasing the pulses of each element (which may or may not include directing the direction pulse at specific positional sensors). Due to the high frequency of ultrasound and the high scan rate of a linear phased array ultrasound transducer, periodic localizing pulses may be transmitted so frequently that the positioning mode appears to be operating simultaneously with the imaging mode without noticeably degrading the quality of images.
- The embodiment illustrated in
FIG. 5 eliminates the need for adirectional ultrasound sensor 220. Thus, the present embodiment benefits from a reduced cost. - It should be appreciated that the particular frequency of a given ultrasound sensor for any one of the embodiments shown in
FIGS. 1-6 may be selected based on the precision and penetration depth required. Thus, for ultrasound sensors positioned outside the body (e.g., sensors used as extra-body fiducials) a lower frequency may be selected, in order to achieve a higher degree of penetration depth. For an ultrasound imaging sensor, such assensor 240 inFIG. 1A , a higher frequency may be selected, in order to achieve a higher degree of precision. Thus, particularly for ultrasound sensors positioned intra-body, higher frequencies are typically used than for ultrasound sensors positioned outside the body. Other configurations and methods are also contemplated. - According to another embodiment of the present invention, the positioning information from any one of the aforementioned embodiments may be used in control equipment to assist the operator in positioning and operating an ultrasound imaging catheter. Specifically, a rectangle or other shape representing the field of regard of the imaging sensor may be projected onto a 3D (e.g., wire-frame, cartoon or stylized) representation of the patient's heart rendered on a display device to show the operator the portion of the patient's body that is or will be imaged based upon the present position and orientation of the sensor. The image generated by the
imaging ultrasound sensor ultrasound imaging catheter 200 has been correlated to heart structures, and the 3D wire-frame image (or stylized image) has been correlated to those heart structures, the catheter localizer information and ultrasound image can be applied to the 3D wire-frame image (or stylized image) to graphically depict the image including the location of all (or some) catheters within the heart for easier interpretation by the user. This embodiment provides the operator with more visual information, and thus a more easily understood representation of the position of theultrasound catheters - According to another embodiment of the present invention, the localizer information can be used in conjunction with images obtained from
catheter 200. By way of example, one such process is described in copending application entitled “Method and Apparatus for Time Gating of Medical Images”, filed currently with the present application and incorporated by reference herein in its entirety. Another such process is shown in the flowchart ofFIG. 7 , and described in greater detail below. - As shown in
FIG. 7 , at least one embodiment of the present invention includes methods of displaying medical images from a catheter-based imaging sensor having a restricted field of view, such as a two dimensional (2D) ultrasound imaging sensor. Instep 710, the imaging sensor is used to generate at least one image (preferably 2D) of a structure of interest. Instep 720, a position of the imaging sensor is calculated, and then coregistered instep 730 with the at least one image generated instep 710. This may include, for example, coregistering a section of the structure of interest (e.g., a heart) with each image generated instep 710. - In
step 740, the at least one generated image ofstep 710 is displayed based on the calculated positional information fromstep 720. By way of example, step 740 may include displaying a 3D model of the structure of interest, and then highlighting a section of the 3D model of the structure of interest which corresponds to the coregistered section ofstep 730. Preferably, the 3D model is generally depicted in a first color or colors, and the highlighted section is depicted in a second color different from the first color(s). Other configurations are also contemplated. - The foregoing description of various embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed, and modifications and variations are possible in light of the above teachings or may be acquired from practice of the invention. The embodiments were chosen and described in order to explain the principles of the invention and its practical application to enable one skilled in the art to utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated.
Claims (26)
1-17. (canceled)
18. An imaging system, comprising:
an ultrasound catheter, comprising:
an elongate body including a proximal section and a distal section, the distal section configured to be received within a body of a patient;
an imaging ultrasound sensor disposed on the elongate body; and,
a plurality of magnetic positional sensors disposed on the elongate body;
a magnetic field emitter configured to generate a magnetic field and a frame of reference against which positions of the plurality of magnetic positional sensors are measured; and,
a controller configured to co-register images from the imaging ultrasound sensor with positional information from the plurality of magnetic positional sensors.
19. The imaging system of claim 18 , wherein the imaging ultrasound sensor comprises a directional sensor.
20. The imaging system of claim 18 , wherein the imaging ultrasound sensor comprises a phased-array transducer.
21. The imaging system of claim 18 , wherein the magnetic field emitter comprises a device disposed outside of the body of the patient.
22. The imaging system of claim 21 , wherein the device is configured to be positioned on or near the body of the patient and to generate the magnetic field within the body of the patient.
23. The imaging system of claim 18 , wherein the magnetic field emitter comprises a device configured for insertion within the body of the patient.
24. The imaging system of claim 18 , wherein the controller is further configured to project a three-dimensional position of the ultrasound catheter onto a display.
25. The imaging system of claim 18 , wherein the controller is further configured to generate a context map of a geometry of an anatomical structure on a display and highlight one or more features on the context map corresponding to a location for which ultrasound data has been captured by the imaging ultrasound sensor.
26. The imaging system of claim 18 , wherein the ultrasound catheter further comprises at least one directional ultrasound positioning sensor.
27. A method for displaying medical images, comprising:
generating an image using an ultrasound catheter including an imaging ultrasound sensor disposed on an elongate body disposed within a body of a patient;
determining positions of a plurality of magnetic positional sensors disposed on the elongate body relative to a frame of reference generated by a magnetic field emitter; and,
coregistering the image from the imaging ultrasound sensor with positional information from the plurality of magnetic positional sensors.
28. The method of claim 27 , wherein the imaging ultrasound sensor comprises a directional sensor.
29. The method of claim 27 , wherein the imaging ultrasound sensor comprises a phased-array transducer.
30. The method of claim 27 , wherein the magnetic field emitter comprises a device disposed outside of the body of the patient.
31. The method of claim 30 , wherein the device is configured to be positioned on or near the body of the patient and is configured to generate a magnetic field within the body of the patient.
32. The method of claim 27 , wherein the magnetic field emitter comprises a device configured for insertion within the body of the patient.
33. The method of claim 27 , further comprising projecting a three-dimensional position of the ultrasound catheter onto a display.
34. The method of claim 27 , further comprising generating a context map of a geometry of an anatomical structure on a display and highlighting one or more features on the context map corresponding to a location for which ultrasound data has been captured by the imaging ultrasound sensor.
35. The method of claim 27 , wherein the ultrasound catheter further comprises at least one directional ultrasound positioning sensor.
36. An ultrasound imaging catheter, comprising:
an elongate shaft including a proximal section and a distal section, the distal section configured to be received within a body of a patient;
an imaging ultrasound sensor disposed on the distal section of the elongate shaft; and,
a plurality of magnetic positional sensors disposed on the distal section of the elongate shaft, the plurality of magnetic positional sensors including a first magnetic positional sensor disposed at a first location along a length of the elongate shaft proximal to the imaging ultrasound sensor and a second magnetic positional sensor disposed at a second location along the length of the elongate shaft distal to the imaging ultrasound sensor.
37. The ultrasound imaging catheter of claim 36 , wherein the first and second magnetic positional sensors comprise phased-array transducers.
38. The ultrasound imaging catheter of claim 36 , wherein the plurality of magnetic positional sensors comprise a plurality of directional sensors equally spaced about a circumference of the elongate shaft.
39. The ultrasound imaging catheter of claim 36 , further comprising a directional sensor disposed at a known position relative to the imaging ultrasound sensor.
40. The ultrasound imaging catheter of claim 39 , wherein the directional sensor is disposed on the elongate shaft diametrically opposite the imaging ultrasound sensor.
41. The ultrasound imaging catheter of claim 36 , wherein the imaging ultrasound sensor is disposed on a first section of the elongate shaft and at least one of the plurality of magnetic positional sensors is disposed on a second section of the elongate shaft, the second section having a greater flexibility than the first section.
42. The ultrasound imaging catheter of claim 36 , wherein the imaging ultrasound sensor is configured to operate in an imaging mode in which the imaging ultrasound sensor generates an imaging ultrasound pulse and a positioning mode in which the imaging ultrasound sensor generates a positioning ultrasound pulse.
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Also Published As
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US8428691B2 (en) | 2013-04-23 |
US20140364719A1 (en) | 2014-12-11 |
US20060122514A1 (en) | 2006-06-08 |
US20100106011A1 (en) | 2010-04-29 |
US10639004B2 (en) | 2020-05-05 |
US7713210B2 (en) | 2010-05-11 |
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