WO1999040869B1 - Lesion localizer for nuclear medicine - Google Patents

Lesion localizer for nuclear medicine

Info

Publication number
WO1999040869B1
WO1999040869B1 PCT/US1999/003366 US9903366W WO9940869B1 WO 1999040869 B1 WO1999040869 B1 WO 1999040869B1 US 9903366 W US9903366 W US 9903366W WO 9940869 B1 WO9940869 B1 WO 9940869B1
Authority
WO
WIPO (PCT)
Prior art keywords
needle
localizing
lesion
cable
guide needle
Prior art date
Application number
PCT/US1999/003366
Other languages
French (fr)
Other versions
WO1999040869A9 (en
WO1999040869A1 (en
Inventor
Kevin M Baskin
William H Barnhart
Original Assignee
Univ Iowa Res Found
Kevin M Baskin
William H Barnhart
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Univ Iowa Res Found, Kevin M Baskin, William H Barnhart filed Critical Univ Iowa Res Found
Priority to AU27686/99A priority Critical patent/AU2768699A/en
Publication of WO1999040869A1 publication Critical patent/WO1999040869A1/en
Publication of WO1999040869B1 publication Critical patent/WO1999040869B1/en
Publication of WO1999040869A9 publication Critical patent/WO1999040869A9/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/42—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis
    • A61B6/4208—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector
    • A61B6/4258—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector for detecting non x-ray radiation, e.g. gamma radiation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3904—Markers, e.g. radio-opaque or breast lesions markers specially adapted for marking specified tissue
    • A61B2090/3916—Bone tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/392—Radioactive markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis

Abstract

A needle localizing assembly is disclosed for marking the location of a bone lesion for subsequent surgical removal. The disclosed localizing assembly includes a localizing needle (14) with a radiation source contained therein to assist the surgeon in manipulating the needle tip, under nuclear medicine visualization, to a marker site near the lesion. The localizing needle (14) is then anchored into the bone. In one embodiment, the assembly includes a starter bit (48) which is introduced through a guiding needle (40) to form a starter hole (56) in the bone into which the screw-tipped localizing needle (14) is screwed to anchor the device to the bone. A driver (16) with an interfitting coupling for transmitting torque to localizing needle (14) is used to screw localizing needle (14) into the bone. In a second embodiment, the localizing needle includes a pair of hooked tips (78, 79) which screw into the bone to anchor the localizing needle to the bone.

Claims

AMENDED CLAIMS
[received by the International Bureau on 2 September 1999 (02.09.99); original claims 1, 6, 10, 13 and 15-17 amended; original claim 2 cancelled; remaining claims unchanged (6 pages)]
1. An apparatus to mark the site for treatment of a lesion within tissue, comprising: a localizing needle assembly having a rigid proximal portion and having a rigid distal portion having a distal end and having a longitudinal axis; one of said portions having a cavity therein containing radioactive material; said distal portion and said proximal portion being screwed together to close the cavity; and means for anchoring said distal portion in hard tissue;
3. The apparatus of claim 1 wherein said anchoring means comprises a screw tip at the distal end of said distal portion.
4. The apparatus of claim 1 wherein said anchoring means comprises hooks at the distal end of said distal portion.
5. The apparatus of claim 1 and further comprising: a cable having a proximal end and a distal end; the distal end of the cable being fixed to said proximal portion of said needle assembly.
6. The apparatus of claim 5 and further comprising a torque applicator device mounted to said cable to turn the needle assembly about said longitudinal axis.
7. The apparatus of claim 6 wherein said torque applicator device is removably, but non-rotatably, mounted to the cable.
8. The apparatus of claim 6 wherein said torque applicator device is slidably and rotatably mounted on said cable.
9. The apparatus of claim 8 wherein said torque applicator device and said proximal portion of the needle assembly, have interfittable ends configured to enable bi-directional torque transmission from the torque applicator device to the proximal portion of the needle assembly.
10. An apparatus to mark the site for treatment of a lesion within tissue, comprising: a localizing needle assembly having a proximal portion and having a distal portion having a distal end; at least one of the portions being adapted to exhibit radioactivity; and means for anchoring said distal portion in tissue; wherein one of said portions has a cavity therein to contain radioactive material; and said cavity opens at a junction of said portions and said portions are adapted to be separated to open said cavity, and to be securely joined to close said cavity.
11. The apparatus of claim 10 wherein said cavity is in the distal portion adjacent the distal end of said distal portion of the said localizing needle assembly.
12. The apparatus of claim 11 wherein said radioactive material is contained in the cavity.
13. The apparatus of claim 5 and wherein: the apparatus has a first length from said distal end of the distal portion of the needle assembly to the proximal end of the cable; the apparatus further comprising: a hollow guide needle having a proximal end and a sharp-tipped distal end for puncturing skin; and 19
the length of said guide needle between its ends being less than said first length; and the localizing needle assembly and part of the cable residing inside the guide needle and being longitudinally moveable therein relative to the distal end of the guide needle.
14. The assembly of claim 13 and further comprising: a torque applicator device mounted to said cable outside the proximal end of said guide needle.
15. A method for marking the location in tissue of a lesion to be removed from a subject during subsequent surgery, said method comprising the steps of: visualizing the lesion on a nuclear medicine monitor; placing a localizing needle containing a radiation source in the lumen of a guide needle, with a localizing needle point adjacent the guide needle point and with a cable connected to the localizing needle extending longitudinally in the guide needle lumen and exiting a proximal end of the guide needle; advancing the assembly of guide needle and localizing needle through the skin of the subject and observing in real time, the path of travel on the monitor and guiding the needle points toward the lesion; contacting hard tissue adjacent the lesion with the point of at least one of the needles; applying a rotational torque to the localizing needle to anchor the localizing needle in the hard tissue; and removing the guide needle from the cable such that the proximal end of the cable is outside the body of the subject.
16. A method for marking the location in tissue of a lesion to be removed from a subject during subsequent surgery, said method comprising the steps of: visualizing the lesion on a nuclear medicine monitor; placing a localizing needle containing a radiation source in the lumen of a guide needle, with a localizing needle point adjacent the guide needle 20
point and with a cable connected to the localizing needle extending longitudinally in the guide needle lumen and exiting a proximal end of the guide needle; advancing the assembly of guide needle and localizing needle through the skin of the subject and observing in real time, the path of travel on the monitor and guiding the needle points toward the lesion; contacting hard tissue adjacent the lesion with the point of at least one of the needles; applying a rotational torque to the localizing needle to anchor the localizing needle in the hard tissue; and removing the guide needle from the cable such that the proximal end of the cable is outside the body of the subject; and further comprising the steps of: prior to removing the guide needle, urging a sharp end of the guide needle against hard tissue adjacent the lesion; while keeping the guide needle securely engaged with the hard tissue, applying rotational torque to the cable to screw into the hard tissue, two anchor hooks at the tip of the localizing needle to secure it in the hard tissue.
17. A method for marking the location in tissue of a lesion to be removed from a subject during subsequent surgery, said method comprising the steps of: visualizing the lesion on a nuclear medicine monitor; placing a localizing needle containing a radiation source in the lumen of a guide needle, with a localizing needle point adjacent the guide needle point and with a cable connected to the localizing needle extending longitudinally in the guide needle lumen and exiting a proximal end of the guide needle; advancing the assembly of guide needle and localizing needle through the skin of the subject and observing in real time, the path of travel on the monitor and guiding the needle points toward the lesion; contacting hard tissue adjacent the lesion with the point of at least one of the needles; 21
applying a rotational torque to the localizing needle to anchor the localizing needle in the hard tissue; and removing the guide needle from the cable such that the proximal end of the cable is outside the body of the subject; and further comprising the steps of: prior to removing the guide needle, pushing a sharp point of the guide needle into the hard tissue adjacent the lesion; while holding the point of the guide needle securely against and immovably against the hard tissue adjacent the lesion, withdrawing the localizing needle from the guide needle and inserting in the guide needle the sharp point of a drill stylet and engaging the same with the hard tissue; while engaging the drill bit of the drill stylet with the hard tissue, applying axial force from the portion of the drill stylet outside the guide needle and torsional force to turn the drill bit into the hard tissue and thereby drill a starter hole in the tissue.
18. The method of claim 17 and further comprising the step of: after drilling the starter hole, and while maintaining the guide needle securely affixed against the hard tissue adjacent the lesion, withdrawing the drill stylet and re-inserting the localizing needle so that its point enters the starter hole; and driving the localizing needle into the hole while turning the localizing needle tip in the hole and thereby screwing the localizing needle into the starter hole and thereby securing it in the hard tissue adjacent the lesion.
19. The method according to claim 18 and further comprising the step of: after screwing the screw tip of the localizing needle into the hard tissue and thereby anchoring it into the hard tissue, removing from the cable, the guide needle and a localizing needle screw driver.
20. The method of claim 19 and further comprising the step of: 22
after removing the guide needle, taping to the skin that portion of the cable protruding through the skin toward the proximal end of the cable.
21. The method of claim 18 and further comprising the step of: after anchoring the localizing needle point in the hard tissue, visualizing the localizing needle point and lesion in two image planes to confirm the proper location of the localizing needle relative to the lesion, before withdrawing the guide needle.
PCT/US1999/003366 1998-02-17 1999-02-17 Lesion localizer for nuclear medicine WO1999040869A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU27686/99A AU2768699A (en) 1998-02-17 1999-02-17 Lesion localizer for nuclear medicine

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US09/025,056 US6175760B1 (en) 1998-02-17 1998-02-17 Lesion localizer for nuclear medicine
US09/025,056 1998-02-17

Publications (3)

Publication Number Publication Date
WO1999040869A1 WO1999040869A1 (en) 1999-08-19
WO1999040869B1 true WO1999040869B1 (en) 1999-10-14
WO1999040869A9 WO1999040869A9 (en) 1999-11-18

Family

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Family Applications (1)

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Country Status (3)

Country Link
US (1) US6175760B1 (en)
AU (1) AU2768699A (en)
WO (1) WO1999040869A1 (en)

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US9238151B2 (en) 2004-07-23 2016-01-19 Varian Medical Systems, Inc. Dynamic/adaptive treatment planning for radiation therapy
US9237860B2 (en) 2008-06-05 2016-01-19 Varian Medical Systems, Inc. Motion compensation for medical imaging and associated systems and methods
US9248003B2 (en) 2002-12-30 2016-02-02 Varian Medical Systems, Inc. Receiver used in marker localization sensing system and tunable to marker frequency
US9586059B2 (en) 2004-07-23 2017-03-07 Varian Medical Systems, Inc. User interface for guided radiation therapy

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US8857043B2 (en) 2002-12-30 2014-10-14 Varian Medical Systems, Inc. Method of manufacturing an implantable marker with a leadless signal transmitter
US9248003B2 (en) 2002-12-30 2016-02-02 Varian Medical Systems, Inc. Receiver used in marker localization sensing system and tunable to marker frequency
US9238151B2 (en) 2004-07-23 2016-01-19 Varian Medical Systems, Inc. Dynamic/adaptive treatment planning for radiation therapy
US9586059B2 (en) 2004-07-23 2017-03-07 Varian Medical Systems, Inc. User interface for guided radiation therapy
US9237860B2 (en) 2008-06-05 2016-01-19 Varian Medical Systems, Inc. Motion compensation for medical imaging and associated systems and methods

Also Published As

Publication number Publication date
WO1999040869A9 (en) 1999-11-18
AU2768699A (en) 1999-08-30
US6175760B1 (en) 2001-01-16
WO1999040869A1 (en) 1999-08-19

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