WO2000021450A1 - Device for carrying out medical interventions and a method for generating an image - Google Patents

Device for carrying out medical interventions and a method for generating an image Download PDF

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Publication number
WO2000021450A1
WO2000021450A1 PCT/EP1999/007540 EP9907540W WO0021450A1 WO 2000021450 A1 WO2000021450 A1 WO 2000021450A1 EP 9907540 W EP9907540 W EP 9907540W WO 0021450 A1 WO0021450 A1 WO 0021450A1
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Prior art keywords
image data
point
time
predetermined
updated
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PCT/EP1999/007540
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German (de)
French (fr)
Inventor
Ludwig M. Auer
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Auer, Dorothee
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Application filed by Auer, Dorothee filed Critical Auer, Dorothee
Priority to EP99950670A priority Critical patent/EP1119306A1/en
Publication of WO2000021450A1 publication Critical patent/WO2000021450A1/en

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    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/374—NMR or MRI
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
    • 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
    • A61B34/30—Surgical robots
    • 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
    • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis

Definitions

  • the invention relates to a device for performing medical interventions (operations) on the human or animal body, with a device for storing first image data about the operation area, which have been obtained, for example, by means of computer tomography and / or magnetic resonance imaging, and with a device for displaying image data.
  • the area of operation changes, for example in brain surgery and liver surgery, during the procedure.
  • coagulation of a brain tumor for example, two effects occur.
  • the brain tumor will decrease on the one hand and decrease in volume on the other hand, with the brain immediately taking up the volume released by the coagulating tumor. It is therefore necessary to update preoperatively obtained image data intraoperatively in order to prevent damage to the adjacent brain due to incorrect or missing information about the current position of the tumor to be coagulated.
  • Imaging methods such as magnetic resonance imaging and computed tomography are used to obtain detailed information about the area of operation. However, both imaging methods are only suitable to a limited extent or not at all for intraoperative imaging. Imaging methods using ultrasound can be used intraoperatively, but the image data obtained with them is usually not detailed enough.
  • the invention is therefore based on the object of specifying a device of the type mentioned at the outset, with which sufficiently detailed image data can be determined and displayed intraoperatively.
  • the object is achieved in a device of the type mentioned at the outset by an imaging device, for example using ultrasound, for obtaining second image data about the operation area during the operation and an update device which is designed to obtain second image data obtained at a first point in time to compare with second image data obtained after the first point in time, to update the first image data in accordance with the change resulting from the comparison and to forward the updated first image data to the display device.
  • an imaging device for example using ultrasound
  • an update device which is designed to obtain second image data obtained at a first point in time to compare with second image data obtained after the first point in time, to update the first image data in accordance with the change resulting from the comparison and to forward the updated first image data to the display device.
  • intraoperatively, or only difficult to obtain, but sufficiently detailed image data is obtained preoperatively and updated and displayed intraoperatively by means of image data that is easier to obtain but less detailed during the operation, so that a current and sufficiently detailed, albeit artificially generated image can be obtained and displayed.
  • the image data obtained intraoperatively are
  • the update device updates the first image data at predetermined time intervals.
  • the time intervals will be adapted to the requirements of the particular operation to be carried out. Some changes, such as shrinkage during coagulation, require that the update so done in real time. This can mean many updates per second.
  • the update device updates the first image data whenever the changes resulting from the comparison exceed a predetermined dimension. In other words, an update only takes place if this is necessary because changes have to be taken into account. As a result, the computing time and capacity required for updating can be reduced to a minimum.
  • the device according to the invention preferably has an operating robot which is designed to execute manually entered commands using the updated first image data and / or to carry out at least one operating step automatically according to a predetermined program.
  • the surgical robot works automatically on the basis of the respectively updated first image data, and / or it is guided by an operator who can take the respectively updated image data from the display device and, if necessary, has direct insight into the operation area through endoscopic devices.
  • the surgical robot is designed to work within a predetermined volume in the surgical area represented by the updated first image data.
  • This volume can be, for example, a brain tumor to be coagulated.
  • the surgical robot will limit the coagulation to the tumor, so that adjacent brain matter is not endangered.
  • the surgical robot can be designed to maintain a predetermined distance from a predetermined one Boundary surface in the operating area represented by the updated first image data. Again, this means that the brain substance adjacent to the operation area is safe from damage by the operation robot.
  • the surgical robot can be designed according to the invention to approach a predetermined point in the surgical area represented by the updated first image data.
  • a starting point can be, for example, the center of a brain tumor to be coagulated.
  • a device is preferably provided for entering the restriction volume, the boundary surface and / or the approach point. This enables the surgeon to set the surgical robot preoperatively and / or intraoperatively the limits required for safety and described above or to set a starting point that the surgical robot approaches at the beginning, in the course or towards the end of the operation should.
  • a calibration device is preferably provided which is to be attached firmly to the body and which has at least one landmark which, with respect to the body, represents a fixed common reference point for the first and the second image data.
  • a calibration device is used, for example, to be able to compare image data obtained by means of ultrasound immediately before the start of the operation with image data obtained preoperatively by computer tomography or magnetic resonance imaging by means of so-called co-registration.
  • the calibration device is preferably formed by a stereotactic frame.
  • other (equivalent) devices can also be used for this purpose.
  • the invention further relates to a method for generating an image of a human or animal body.
  • the object of the invention is therefore to specify a method of the type mentioned which also yields detailed image data intraoperatively if an imaging method which operates in a correspondingly detailed manner cannot be used intraoperatively.
  • the object is achieved by a method with the following steps:
  • the method according to the invention uses an imaging method in certain situations, ie for example during an operation, which delivers less detailed image data, not this less detailed image data, but based on the change in the less detailed image data updated detailed image data are displayed.
  • the method according to the invention relates exclusively to the generation or display of an image of the human or animal body, but not to a diagnosis or therapy.
  • diagnosis it is necessary not only to generate and display the image, but also to evaluate it. Measures on the body that go beyond mere generation and mere display are required for therapy.
  • the first point in time and the position of the body when the second image data are recorded are selected such that the second image data recorded at the first point in time correspond to the stored first image data.
  • a calibration is carried out in such a way that the first and the second image data are coordinated with one another by reflecting one and the same state of the body.
  • the step of updating can be carried out at predetermined time intervals.
  • the update step is always (only) carried out when the changes resulting from the comparison exceed a predetermined measure. This can save computing time and capacity.
  • the heart of the device is a computer 10 with a comparator 12.
  • a computed tomogram and / or a magnetic resonance tomogram is taken preoperatively, including landmarks, by means of a computer tomograph or core - Spin tomograph 16 added.
  • the image data obtained in this way are stored in a memory 18.
  • an ultrasound device 20 is recorded using an ultrasound device 20, which is compared with the computed tomogram or magnetic resonance tomogram for calibration purposes.
  • the preoperatively acquired computer tomogram or magnetic resonance tomogram is displayed by means of a display, for example in the form of a monitor 22.
  • the surgical robot 24 is among others to the following in the
  • a point can be a starting or destination point or a return point on an operational access route.
  • a route can be a connecting line between different points on an access path to an operating area or within the operating area.
  • a space or volume can be the circumference of a solid or cystic tumor or a cyst or ren wall, the outer border of which should not be touched with a surgical instrument.
  • the surgeon uses intraoperative ultrasound imaging to check the spatial conditions and their changes during an operation.
  • a 3D data set is produced using an imaging method such as magnetic resonance imaging or computer tomography.
  • This data set serves as reference imaging for the further steps.
  • the stereotactic frame 14 is attached to the patient's head for neurosurgical purposes.
  • This frame 14 contains landmarks which can be used to calibrate or co-register the systems at the start of the operation.
  • the operation robot 24, which has the shape of a robot arm, for example is brought into a fixed, predetermined spatial relationship with the mounted stereotactic frame 14 and is permanently mounted. Landmark points are then approached with the tip of the surgical instrument as a calibration device, as a result of which a clear relationship is created between the working space of the robot and the space of the pre-operative images.
  • a similar fixed connection is then made between the stereotactic frame 14 and the ultrasound head 20 to be implanted for the production of 3-dimensional ultrasound images.
  • This fixed, predetermined connection between the preoperative image space and the intraoperative ultrasound image space makes it possible to initially record changes in the operating field with the aid of ultrasound imaging.
  • this coregistration step makes it possible to obtain the highest quality representation of the current situation for the image representation, which serves as an orientation for the surgeon during the intervention, by, for example, the preoperative 3D nuclear spin data set recognized by the intraoperative ultrasound image through the coregistration spatial changes is modified and displayed.
  • the co-registered, modified MRI data record as an artifact of a co-registration step will therefore result in images which give the appearance that intraoperative magnetic resonance imaging has been carried out.
  • the image information from intraoperative ultrasound imaging was used to change the preoperative MRI data set in such a way that the new MRI image corresponds to the current spatial conditions and is identical to that of the current ultrasound image.
  • image details from the magnetic resonance image which cannot be represented in the ultrasound image, can also be displayed in this modified form, appropriate to the current situation, and can present the surgeon with a high-resolution virtual image of his area of operation.
  • image content that does not appear in the preoperative image, which can only be obtained using ultrasound.
  • this co-registration mechanism means that pre-planned target points, routes, areas and rooms of the robot room are each adapted to the current conditions in the operating area. They currently enable precise operation.
  • a coagulation probe that is activated to coagulate the central area of a tumor is called
  • the entire tumor shrinks and the tumor limit specified by the surgeon preoperatively no longer correspond to the current tumor boundaries.
  • the device according to the invention is able to observe and document movements of this predetermined limit, that is to say to register the volume changes and to pass them on to the operating robot.
  • the volume specified by the surgeon as part of his preoperative planning is referred to as the "alarm volume”.
  • the control software for registering changes in this volume or changes in the surface of this volume is referred to as the "alarm volume adaptation tool" (AVAT).
  • One of the programs for robotic operative services is to automatically coagulate a volume that has been planned by the surgeon.
  • the automatic coagulation process is stopped as soon as the currently coagulated volume at one point reaches the planned volume.
  • the performance of the AVAT must be taken into account, which ensures that the planned volume no longer corresponds to the current volume towards the end of the coagulation process because the entire tumor has shrunk during the coagulation process.
  • the coagulation process is therefore adapted in accordance with the movement of the tumor surface during the coagulation process and ended earlier.
  • the next step in the operation then consists, for example, in moving the tip of the coagulation probe into the center of that new sphere which contains the largest possible remaining tumor portion to be coagulated.
  • the AVAT for adapting between the planned and current volume must be taken into account.
  • the movement from the current position of the probe tip to a predetermined entry point and from there along an access route to the new destination point is carried out.
  • a further program flow is provided, for example, to scan the inner surface of a cystic tumor with a surgical instrument, to first coagulate a predetermined layer thickness and then to scrape off the coagulated tissue.
  • the distance-keeping program is activated, which ensures that a safety distance is kept from the coagulation limit so that bleeding is avoided when the tumor is removed.

Abstract

The invention relates to a device for carrying out medical interventions on the human or animal body and to a method for generating an image of the human or animal body. According to the invention, preoperatively obtained first image data is updated by means of intraoperatively obtained second image data according to the changes between two sets of second image data recorded at different points in time.

Description

VORRICHTUNG ZUM AUSFUHREN VON MEDIZINISCHEN EINGRIFFEN UND VERFAHREN ZUM ERZEUGEN EINES BILDES DEVICE FOR CARRYING OUT MEDICAL INTERVENTIONS AND METHOD FOR PRODUCING AN IMAGE
Die Erfindung betrifft eine Vorrichtung zum Ausführen von medizinischen Eingriffen (Operationen) am menschlichen oder tierischen Körper, mit einer Einrichtung zum Speichern von ersten Bilddaten über das Operationsgebiet, die beispielsweise im Wege der Computertomographie und/oder der Kernspintomographie gewonnen worden sind, und mit einer Einrichtung zum Anzeigen von Bilddaten.The invention relates to a device for performing medical interventions (operations) on the human or animal body, with a device for storing first image data about the operation area, which have been obtained, for example, by means of computer tomography and / or magnetic resonance imaging, and with a device for displaying image data.
Im Gegensatz zu Operationen in der Orthopädie ändert sich das Operationsgebiet z.B. in der Hirnchirurgie und der Leberchirurgie während des Eingriffs. Im Falle beispielsweise der Koagulation eines Hirntumors treten nämlich zwei Effekte auf. Der Hirntumor wird sich zum einen absenken und zum anderen an Volumen abnehmen, wobei das Gehirn jeweils sofort das von dem koagulierenden Tumor freigegebene Volumen einnimmt. Mithin ist es erforderlich, präoperativ gewonnene Bilddaten intraoperativ zu aktualisieren, um zu verhindern, daß wegen falscher oder fehlender Informationen über die aktuelle Lage des zu koagulierenden Tumors Schädigungen des angrenzenden Gehirns auftreten.In contrast to operations in orthopedics, the area of operation changes, for example in brain surgery and liver surgery, during the procedure. In the case of coagulation of a brain tumor, for example, two effects occur. The brain tumor will decrease on the one hand and decrease in volume on the other hand, with the brain immediately taking up the volume released by the coagulating tumor. It is therefore necessary to update preoperatively obtained image data intraoperatively in order to prevent damage to the adjacent brain due to incorrect or missing information about the current position of the tumor to be coagulated.
Um detaillierte Informationen über das Operationsgebiet zu erhalten, werden bildgebende Verfahren eingesetzt, wie beispielsweise die Kernspintomographie und die Computertomogra- phie. Beide bildgebenden Verfahren sind aber nur eingeschränkt oder gar nicht zur intraoperativen Bildgebung geeignet. Bild- gebende Verfahren mittels Ultraschalls können zwar intraoperativ angewendet werden, die damit gewonnenen Bilddaten sind aber meist nicht detailliert genug.Imaging methods such as magnetic resonance imaging and computed tomography are used to obtain detailed information about the area of operation. However, both imaging methods are only suitable to a limited extent or not at all for intraoperative imaging. Imaging methods using ultrasound can be used intraoperatively, but the image data obtained with them is usually not detailed enough.
Der Erfindung liegt mithin die Aufgabe zugrunde, eine Vorrichtung der eingangs genannten Art anzugeben, mit der intraoperativ ausreichend detaillierte Bilddaten ermittelt und angezeigt werden können.The invention is therefore based on the object of specifying a device of the type mentioned at the outset, with which sufficiently detailed image data can be determined and displayed intraoperatively.
Erfindungsgemäß wird die gestellte Aufgabe bei einer Vor- richtung der eingangs genannten Art gelöst durch eine beispielsweise mit Ultraschall arbeitende bildgebende Einrichtung zum Gewinnen von zweiten Bilddaten über das Operationsgebiet während der Operation und eine Aktualisierungseinrichtung, die dazu ausgelegt ist, zu einem ersten Zeitpunkt gewonnene zweite Bilddaten mit zu einem zweiten, nach dem ersten Zeitpunkt liegenden Zeitpunkt gewonnenen zweiten Bilddaten zu vergleichen, die ersten Bilddaten entsprechend der sich aus dem Vergleich ergebenden Veränderung zu aktualisieren und die aktualisierten ersten Bilddaten der Anzeigeeinrichtung zuzuleiten. Mit anderen Worten werden intraoperativ nicht oder nur schwer zu erhaltende, jedoch ausreichend detaillierte Bilddaten präoperativ gewonnen und intraoperativ mittels während der Operation leichter zu erhaltender, jedoch weniger detaillier- ter Bilddaten aktualisiert und angezeigt, so daß ein aktuelles und ausreichend detailliertes, wenngleich künstlich erzeugtes Bild erhalten und angezeigt werden kann. Es werden also erfindungsgemäß die intraoperativ erhaltenen Bilddaten nicht selbst zur Anzeige gebracht, sondern nur dazu verwendet, präoperativ erhaltene und wesentlich detailliertere Bilddaten zu aktualisieren.According to the invention, the object is achieved in a device of the type mentioned at the outset by an imaging device, for example using ultrasound, for obtaining second image data about the operation area during the operation and an update device which is designed to obtain second image data obtained at a first point in time to compare with second image data obtained after the first point in time, to update the first image data in accordance with the change resulting from the comparison and to forward the updated first image data to the display device. In other words, intraoperatively, or only difficult to obtain, but sufficiently detailed image data is obtained preoperatively and updated and displayed intraoperatively by means of image data that is easier to obtain but less detailed during the operation, so that a current and sufficiently detailed, albeit artificially generated image can be obtained and displayed. According to the invention, the image data obtained intraoperatively are therefore not displayed themselves, but are only used to update image data obtained preoperatively and in a much more detailed manner.
Verfahren zum Aktualisieren von Bilddaten sind in der Medizintechnik allgemein bekannt, und zwar beispielsweise aus folgenden Veröffentlichungen:Methods for updating image data are generally known in medical technology, for example from the following publications:
"Individualizing Anatomical Atlases of the Head" aus "Visualization in Biomedical Computing", 1996; "Medical Image Segmentation Using Topologically Adaptable Surfaces" , aus "CVRMed-MRCAS'97", März 1997, S. 23 - 32; "Segmentation Using Deformable Models with Affinity-Based Localization" , aus "CVRMed-MRCAS'97", März 1997, S. 54 - 62; "Volumetrie Medical Images Segmentation Using Shape Constrained Deformable Models", aus "CVRMed-MRCAS'97", März 1997, S. 13 - 22; "Shape- Based Segmentation and Tracking in 4D Cardiac MR Images", aus "CVRMed-MRCAS'θ?", März 1997, S. 43 - 52; "Decimation of Isosurfaces with Deformable Models", aus "CVRMed-MRCAS • 97" , März 1997, S. 84 - 92."Individualizing Anatomical Atlases of the Head" from "Visualization in Biomedical Computing", 1996; "Medical Image Segmentation Using Topologically Adaptable Surfaces", from "CVRMed-MRCAS'97", March 1997, pp. 23-32; "Segmentation Using Deformable Models with Affinity-Based Localization", from "CVRMed-MRCAS'97", March 1997, pp. 54-62; "Volumetry Medical Images Segmentation Using Shape Constrained Deformable Models", from "CVRMed-MRCAS'97", March 1997, pp. 13-22; "Shape-Based Segmentation and Tracking in 4D Cardiac MR Images", from "CVRMed-MRCAS'θ?", March 1997, pp. 43-52; "Decimation of Isosurfaces with Deformable Models", from "CVRMed-MRCAS • 97", March 1997, pp. 84 - 92.
Erfindungsgemäß bevorzugt kann vorgesehen sein, daß die Aktualisierungseinrichtung die ersten Bilddaten in vorbestimm- ten Zeitabständen aktualisiert. Die Zeitabstände werden dabei den der jeweilig durchzuführenden Operation eigenen Erfordernissen angepaßt sein. Manche Veränderungen, wie z.B. Schrump- fungen bei Koagulation erfordern, daß die Aktualisierung na- hezu in Echtzeit erfolgt. Dies kann viele Aktualisierungen pro Sekunde bedeuten.According to the invention, it can preferably be provided that the update device updates the first image data at predetermined time intervals. The time intervals will be adapted to the requirements of the particular operation to be carried out. Some changes, such as shrinkage during coagulation, require that the update so done in real time. This can mean many updates per second.
Es kann aber auch vorgesehen sein, daß die Aktualisie- rungseinrichtung die ersten Bilddaten immer dann aktualisiert, wenn die sich aus dem Vergleich ergebenden Änderungen ein vorbestimmtes Maß überschreiten. Mit anderen Worten erfolgt eine Aktualisierung nur dann, wenn dies erforderlich ist, weil zu berücksichtigende Änderungen eingetreten sind. Dadurch kann die zur Aktualisierung erforderliche Rechenzeit und -kapazität auf ein Minimum reduziert werden.However, it can also be provided that the update device updates the first image data whenever the changes resulting from the comparison exceed a predetermined dimension. In other words, an update only takes place if this is necessary because changes have to be taken into account. As a result, the computing time and capacity required for updating can be reduced to a minimum.
Bevorzugt weist die erfindungsgemäße Vorrichtung einen Operationsroboter auf, der dazu ausgelegt ist, unter Einbezie- hung der aktualisierten ersten Bilddaten manuell eingegebene Befehle auszuführen und/oder nach einem vorbestimmten Programm mindestens einen Operationsschritt selbsttätig auszuführen. Mit anderen Worten arbeitet der Operationsroboter selbsttätig auf der Grundlage der jeweils aktualisierten ersten Bilddaten, und/oder er wird von einem Operateur geführt, der die jeweils aktualisierten Bilddaten der Anzeigeeinrichtung entnehmen kann, und gegebenenfalls durch endoskopische Einrichtungen direkten Einblick in den Operationsbereich hat.The device according to the invention preferably has an operating robot which is designed to execute manually entered commands using the updated first image data and / or to carry out at least one operating step automatically according to a predetermined program. In other words, the surgical robot works automatically on the basis of the respectively updated first image data, and / or it is guided by an operator who can take the respectively updated image data from the display device and, if necessary, has direct insight into the operation area through endoscopic devices.
Erfindungsgemäß kann vorgesehen sein, daß der Operationsroboter dazu ausgelegt ist, auf ein vorbestimmtes Volumen in dem durch die aktualisierten ersten Bilddaten repräsentierten Operationsgebiet beschränkt zu arbeiten. Dieses Volumen kann beispielsweise ein zu koagulierender Hirntumor sein. Mithin wird der Operationsroboter in diesem Fall die Koagulation auf den Tumor beschränken, so daß angrenzende Gehirnsubstanz nicht gefährdet ist.According to the invention, it can be provided that the surgical robot is designed to work within a predetermined volume in the surgical area represented by the updated first image data. This volume can be, for example, a brain tumor to be coagulated. In this case, the surgical robot will limit the coagulation to the tumor, so that adjacent brain matter is not endangered.
Der Operationsroboter kann erfindungsgemäß dazu ausgelegt sein, einen vorbestimmten Abstand zu einer vorbestimmten Grenzoberfläche in dem durch die aktualisierten ersten Bilddaten repräsentierten Operationsgebiet einzuhalten. Wiederum gilt, daß dadurch an das Operationsgebiet angrenzende Hirnsubstanz vor einer Schädigung durch den Operationsroboter sicher ist.According to the invention, the surgical robot can be designed to maintain a predetermined distance from a predetermined one Boundary surface in the operating area represented by the updated first image data. Again, this means that the brain substance adjacent to the operation area is safe from damage by the operation robot.
Ferner kann der Operationsroboter erfindungsgemäß dazu ausgelegt sein, einen vorbestimmten Punkt in dem durch die aktualisierten ersten Bilddaten repräsentierten Operationsgebiet anzufahren. Bei so einem Anfahrpunkt kann es sich beispielsweise um das Zentrum eines zu koagulierenden Hirntumors handeln.Furthermore, the surgical robot can be designed according to the invention to approach a predetermined point in the surgical area represented by the updated first image data. Such a starting point can be, for example, the center of a brain tumor to be coagulated.
Erfindungsgemäß bevorzugt ist eine Einrichtung zum Einge- ben des Beschränkungsvolumens, der Grenzoberfläche und/oder des Anfahrpunktes vorgesehen. Dadurch hat der Operateur die Möglichkeit, dem Operationsroboter präoperativ und/oder intraoperativ die für die Sicherheit erforderlichen und oben beschriebenen Grenzen zu setzen bzw. einen Anfahrpunkt zu set- zen, der zu Beginn, im Verlauf oder gegen Ende der Operation von dem Operationsroboter angefahren werden soll.According to the invention, a device is preferably provided for entering the restriction volume, the boundary surface and / or the approach point. This enables the surgeon to set the surgical robot preoperatively and / or intraoperatively the limits required for safety and described above or to set a starting point that the surgical robot approaches at the beginning, in the course or towards the end of the operation should.
Erfindungsgemäß bevorzugt ist eine Eicheinrichtung vorgesehen, die fest an dem Körper anzubringen ist und die minde- stens eine Landmarke aufweist, welche bezüglich des Körpers einen festen gemeinsamen Bezugspunkt für die ersten und die zweiten Bilddaten darstellt. Eine solche Eicheinrichtung dient beispielsweise dazu, mittels Ultraschall erhaltene Bilddaten unmittelbar vor Beginn der Operation mit präoperativ im Wege der Computertomographie oder der Kernspintomographie erhaltenen Bilddaten durch sogenannte Koregistrierung abgleichen zu können.According to the invention, a calibration device is preferably provided which is to be attached firmly to the body and which has at least one landmark which, with respect to the body, represents a fixed common reference point for the first and the second image data. Such a calibration device is used, for example, to be able to compare image data obtained by means of ultrasound immediately before the start of the operation with image data obtained preoperatively by computer tomography or magnetic resonance imaging by means of so-called co-registration.
Die Eicheinrichtung ist erfindungsgemäß bevorzugt von ei- nem stereotaktischen Rahmen gebildet. Selbstverständlich sind auch andere (äquivalente) Einrichtungen für diesen Zweck einsetzbar.According to the invention, the calibration device is preferably formed by a stereotactic frame. Of course other (equivalent) devices can also be used for this purpose.
Die Erfindung betrifft ferner ein Verfahren zum Erzeugen eines Bildes eines menschlichen oder tierischen Körpers.The invention further relates to a method for generating an image of a human or animal body.
Wie bereits oben erwähnt, gibt es Situationen, beispielsweise während einer Operation, in denen nur Bildgebungsverfah- ren angewendet werden können, die keine ausreichend detail- lierten Bilddaten ergeben.As already mentioned above, there are situations, for example during an operation, in which only imaging methods can be used that do not result in sufficiently detailed image data.
Der Erfindung stellt sich mithin die Aufgabe, ein Verfahren der genannten Art anzugeben, das auch dann intraoperativ detaillierte Bilddaten ergibt, wenn ein entsprechend detail- liert arbeitendes Bildgebungsverfahren intraoperativ nicht anwendbar ist.The object of the invention is therefore to specify a method of the type mentioned which also yields detailed image data intraoperatively if an imaging method which operates in a correspondingly detailed manner cannot be used intraoperatively.
Erfindungsgemäß wird die gestellte Aufgabe durch ein Verfahren mit folgenden Schritten gelöst:According to the invention, the object is achieved by a method with the following steps:
- Speichern erster, beispielsweise im Wege der Computertomographie oder der Kernspintomographie gewonnener Bilddaten des Körpers,Storing first image data of the body obtained, for example, by means of computer tomography or magnetic resonance imaging,
- Aufnehmen zweiter Bilddaten des Körpers, beispielsweise mittels Ultraschalls, zu einem ersten und zu einem zweiten, nach dem ersten Zeitpunkt liegenden Zeitpunkt,Recording second image data of the body, for example by means of ultrasound, at a first and at a second point in time after the first point in time,
Vergleichen der zu dem ersten und zu dem zweiten Zeit- punkt aufgenommenen zweiten Bilddaten miteinander,Comparing the second image data recorded at the first and at the second point in time with one another,
Aktualisieren der ersten Bilddaten entsprechend einer sich aus dem Vergleich ergebenden Veränderung undUpdate the first image data according to a change resulting from the comparison and
- Anzeigen der aktualisierten ersten Bilddaten. Wie bereits oben unter Bezugnahme auf die erfindungsgemäße Vorrichtung detailliert erläutert, wird nach dem erfindungsgemäßen Verfahren in bestimmten Situationen, d.h. beispielsweise während einer Operation, ein Bildgebungsverfahren angewendet, das weniger detaillierte Bilddaten liefert, wobei nicht diese weniger detaillierten Bilddaten, sondern anhand der Änderung der weniger detaillierten Bilddaten aktualisierte detailliertere Bilddaten angezeigt werden.- Display of the updated first image data. As already explained in detail above with reference to the device according to the invention, the method according to the invention uses an imaging method in certain situations, ie for example during an operation, which delivers less detailed image data, not this less detailed image data, but based on the change in the less detailed image data updated detailed image data are displayed.
Es sei ausdrücklich darauf hingewiesen, daß sich das er- findungsgmäße Verfahren ausschließlich auf das Erzeugen bzw. Anzeigen eines Bildes des menschlichen oder tierischen Körpers, nicht aber auf eine Diagnose oder Therapie bezieht. Zur Diagnose ist es nämlich erforderlich, das Bild nicht nur zu erzeugen und anzuzeigen, sondern auch auszuwerten. Zur Therapie sind über die bloße Erzeugung und das bloße Anzeigen hinausgehende Maßnahmen an dem Körper erforderlich.It should be expressly pointed out that the method according to the invention relates exclusively to the generation or display of an image of the human or animal body, but not to a diagnosis or therapy. For diagnosis, it is necessary not only to generate and display the image, but also to evaluate it. Measures on the body that go beyond mere generation and mere display are required for therapy.
Erfindungsgemäß bevorzugt werden der erste Zeitpunkt und die Lage des Körpers bei dem Aufnehmen der zweiten Bilddaten derart gewählt, daß die zum ersten Zeitpunkt aufgenommenen zweiten Bilddaten den gespeicherten ersten Bilddaten entsprechen.According to the invention, the first point in time and the position of the body when the second image data are recorded are selected such that the second image data recorded at the first point in time correspond to the stored first image data.
Mit anderen Worten wird eine Eichung insofern vorgenommen, daß die ersten und die zweiten Bilddaten einmal aufeinander abgestimmt werden, indem sie ein und denselben Zustand des Körpers wiedergeben.In other words, a calibration is carried out in such a way that the first and the second image data are coordinated with one another by reflecting one and the same state of the body.
Erfindungsgemäß kann der Schritt des Aktualisierens in vorbestimmten Zeitabständen durchgeführt werden.According to the invention, the step of updating can be carried out at predetermined time intervals.
Es kann aber auch vorgesehen sein, daß der Schritt des Aktualisierens immer (nur) dann durchgeführt wird, wenn die sich aus dem Vergleich ergebenden Änderungen ein vorbestimmtes Maß überschreiten. Dadurch kann Rechenzeit und -kapazität eingespart werden.However, it can also be provided that the update step is always (only) carried out when the changes resulting from the comparison exceed a predetermined measure. This can save computing time and capacity.
Im folgenden ist die Erfindung anhand bevorzugter Ausführungsbeispiele unter Bezugnahme auf die beiliegende Zeichnung mit weiteren Einzelheiten näher erläutert, wobei die ZeichnungThe invention is explained in more detail below with the aid of preferred exemplary embodiments with reference to the accompanying drawing, wherein the drawing
schematisch ein Ausführungsbeispiel der erfin- dungsgemäßen Vorrichtungschematically an embodiment of the device according to the invention
zeigt.shows.
Herzstück der erfindungsgemäßen Vorrichtung ist ein Rech- ner 10 mit einem Vergleicher 12. Mittels eines fest am Körper, zu neurochirurgischen Zwecken beispielsweise am Kopf angebrachten stereotaktischen Rahmens 14 wird präoperativ unter Einbeziehung von Landmarken ein Computertomogramm und/oder ein Kernspintomogramm mittels eines Computertomographen bzw. Kern- spintomographen 16 aufgenommen. Die dabei erhaltenen Bilddaten werden in einem Speicher 18 abgelegt. Zu Beginn der Operation wird unter Benutzung desselben stereotaktischen Rahmens 14 mittels eines Ultraschallgeräts 20 ein Ultraschallbild aufgenommen, das zu Eichzwecken mit dem Computertomogramm bzw. Kernspintomogramm abgeglichen wird.The heart of the device according to the invention is a computer 10 with a comparator 12. By means of a stereotactic frame 14 attached to the body for neurosurgical purposes, for example to the head, a computed tomogram and / or a magnetic resonance tomogram is taken preoperatively, including landmarks, by means of a computer tomograph or core - Spin tomograph 16 added. The image data obtained in this way are stored in a memory 18. At the beginning of the operation, using the same stereotactic frame 14, an ultrasound device 20 is recorded using an ultrasound device 20, which is compared with the computed tomogram or magnetic resonance tomogram for calibration purposes.
Das präoperativ gewonnene Computertomogramm bzw. Kernspintomogramm wird mittels einer Anzeige, beispielsweise in Form eines Monitors 22 angezeigt.The preoperatively acquired computer tomogram or magnetic resonance tomogram is displayed by means of a display, for example in the form of a monitor 22.
Im Verlaufe der Operation, die beispielsweise mittels eines Operationsroboters 24 durchgeführt wird, werden immer wieder Ultraschallbilder erzeugt, die mit vorhergehenden Ultraschallbildern verglichen werden. Dabei sich ergebende Abwei- chungen dienen dazu, das Computertomogramm bzw. das Kernspin- tomogramm entsprechend zu ändern. Die jeweils so geänderte aktuellste Version des Computertomogramms bzw. Kernspintomo- gramms wird zum einen von dem Rechner 12 dem Monitor 22 zugeführt, so daß der Operateur durchgehend über den Verlauf der Operation informiert ist. Zum anderen wird sie aber auch verwendet, um den Operationsroboter 24 zu steuern, was beispielsweise beinhaltet, daß ihm ein (sich im Laufe der Operation veränderndes) Operationsvolumen zugewiesen wird, wobei er beispielsweise weiter dazu angehalten wird, einen vorbestimmten Abstand von einer vorher in den Rechner eingegebenen Grenzoberfläche einzuhalten.In the course of the operation, which is carried out, for example, by means of an operating robot 24, ultrasound images are repeatedly generated which are compared with previous ultrasound images. The resulting deviations serve to compute the computed tomogram or the nuclear spin change tomogram accordingly. The most recent version of the computer tomogram or magnetic resonance tomogram, as modified in each case, is supplied by the computer 12 to the monitor 22, so that the surgeon is continuously informed about the course of the operation. On the other hand, however, it is also used to control the surgical robot 24, which includes, for example, that an operation volume (which changes during the operation) is assigned to it, whereby it is further urged, for example, to move a predetermined distance from one previously into the Computer entered boundary surface.
Der Operationsroboter 24 ist u.a. zu folgendem in derThe surgical robot 24 is among others to the following in the
Lage:Location:
- automatisches Beschränken auf einen vom Operateur vorgeplanten Raum,- automatic restriction to a room pre-planned by the surgeon,
- automatisches Halten einer vorgegebenen Distanz zu einer Oberfläche im Operationsgebiet und/oder- Automatic maintenance of a predetermined distance to a surface in the operating area and / or
Zurückkehren zu einem vorgewähltem Punkt im Operationsfeld oder am operativen Zugangsweg.Return to a selected point in the surgical field or on the surgical access route.
Das Programmieren dieser robotischen Leistungen erfolgt dadurch, daß der Operateur auf Schichtbildern präoperativ erhaltener Bilddatensätze manuell Umgrenzungen angibt, welche sodann Punkte, Strecken oder Räume ergeben und für die Steuerung des Operationsroboters 24 verwendet werden können. Ein solcher Punkt kann ein Start- oder Zielpunkt oder ein Rückkehrpunkt auf einen operativen Zugangsweg sein. Eine Strecke kann eine Verbindungslinie zwischen verschiedenen Punkten auf einem Zugangsweg zu einem Operationsgebiet oder innerhalb des Operationsgebietes sein. Ein Raum oder Volumen kann der Umfang eines soliden oder zystischen Tumors oder einer Zyste bzw. de- ren Wandung sein, deren Außengrenze mit einem Operationsinstrument nicht berührt werden soll.These robotic services are programmed in that the surgeon manually specifies boundaries on slice images of preoperatively obtained image data sets, which then result in points, distances or spaces and can be used to control the surgical robot 24. Such a point can be a starting or destination point or a return point on an operational access route. A route can be a connecting line between different points on an access path to an operating area or within the operating area. A space or volume can be the circumference of a solid or cystic tumor or a cyst or ren wall, the outer border of which should not be touched with a surgical instrument.
Zur Kontrolle der räumlichen Gegebenheiten und ihrer Ver- änderungen während einer Operation bedient sich der Operateur der intraoperativen Ultraschallbildgebung.The surgeon uses intraoperative ultrasound imaging to check the spatial conditions and their changes during an operation.
Vor der Operation wird ein 3D-Datensatz mit einem bildgebenden Verfahren wie etwa der Kernspintomographie oder der Computertomographie hergestellt. Dieser Datensatz dient als Referenzbildgebung für die weiteren Schritte. Während dieser Untersuchung wird für neurochirurgische Zwecke dem Patienten der stereotaktische Rahmen 14 am Kopf befestigt. Dieser Rahmen 14 enthält Landmarken, welche zur Eichung bzw. Koregistrierung der Systeme zu Operationsbeginn verwendet werden können. Zum Zeitpunkt des Operationsbeginns wird der Operationsroboter 24, der beispielsweise die Form eines Roboterarms hat, in eine fest vorgegebene räumliche Beziehung zu dem montierten stereotaktischen Rahmen 14 gebracht und fest montiert. Sodann werden Landmarkenpunkte mit der Spitze des Operationsinstruments als Eichungsgerät angefahren, wodurch eine eindeutige Beziehung zwischen dem Arbeitsraum des Roboters und dem Raum der präoperativ hergestellten Bilder erzeugt wird. Eine ähnliche feste Verbindung wird sodann hergestellt zwischen dem stereotakti- sehen Rahmen 14 und dem zu inplantierenden Ultraschallkopf 20 zur Herstellung 3-dimensionaler Ultrschallbilder. Durch diese feste, vorgegebene Verbindung zwischen dem präoperativen Bildraum und dem intraoperativen Ultraschallbildraum besteht die Möglichkeit, Veränderungen im Operationsfeld mit Hilfe der Ul- traschallbildgebung zunächst einmal festzuhalten.Before the operation, a 3D data set is produced using an imaging method such as magnetic resonance imaging or computer tomography. This data set serves as reference imaging for the further steps. During this examination, the stereotactic frame 14 is attached to the patient's head for neurosurgical purposes. This frame 14 contains landmarks which can be used to calibrate or co-register the systems at the start of the operation. At the time of the start of the operation, the operation robot 24, which has the shape of a robot arm, for example, is brought into a fixed, predetermined spatial relationship with the mounted stereotactic frame 14 and is permanently mounted. Landmark points are then approached with the tip of the surgical instrument as a calibration device, as a result of which a clear relationship is created between the working space of the robot and the space of the pre-operative images. A similar fixed connection is then made between the stereotactic frame 14 and the ultrasound head 20 to be implanted for the production of 3-dimensional ultrasound images. This fixed, predetermined connection between the preoperative image space and the intraoperative ultrasound image space makes it possible to initially record changes in the operating field with the aid of ultrasound imaging.
Sodann erfolgt eine sogenannte Koregistrierung zwischen präoperativen und intraoperativen Bildern mit dem Ziel, dieseThen there is a so-called co-registration between preoperative and intraoperative images with the aim of this
Informationen in Echtzeit an den Roboterarm weiterzugeben und damit die geplanten operativen Schritte an die aktuellen räum- liehen Gegebenheiten anzupassen. Außerdem ermöglicht es dieser Koregistrierschritt, für die Bilddarstellung, welche dem Operateur während des Eingriffs als Orientierung dient, die jeweils qualitativ höchstwertige Darstellung der aktuellen Gege- benheiten zu erhalten, indem durch die Koregistrierung zum Beispiel der präoperative 3D-Kernspindatensatz nach den im intraoperativen Ultraschallbild erkannten räumlichen Veränderungen abgewandelt und dargestellt wird. Der koregistrierte, abgewandelte Kernspindatensatz als Kunstprodukt eines Koregi- strierschrittes wird daher Bilder ergeben, welche den Anschein erwecken, es sei intraoperative Kernspintomographie durchgeführt worden. Tatsächlich aber wurde die Bildinformation von der intraoperativen Ultraschallbildgebung dazu verwendet, den präoperativen Kernspindatensatz derart abzuändern, daß das neue Kernspinbild den aktuellen räumlichen Gegebenheiten entspricht und identisch mit denen des aktuellen Ultraschallbildes ist. Damit können gegebenenfalls auch Bilddetails aus dem Kernspinbild, welche im Ultraschallbild nicht darstellbar sind, in diese abgewandelten, der aktuellen Situation angegli- chenen Form dargestellt werden und dem Operateur ein hoch aufgelöstes virtuelles Bild seines Operationsgebietes präsentieren. Umgekehrt werden damit auch Bildinhalte präsentierbar, welche im präoperativen Bild nicht vorkommen, die also erst mittels des Ultraschalls erhalten werden können.Forward information in real time to the robot arm and thus the planned operational steps to the current spatial to adapt to the circumstances. In addition, this coregistration step makes it possible to obtain the highest quality representation of the current situation for the image representation, which serves as an orientation for the surgeon during the intervention, by, for example, the preoperative 3D nuclear spin data set recognized by the intraoperative ultrasound image through the coregistration spatial changes is modified and displayed. The co-registered, modified MRI data record as an artifact of a co-registration step will therefore result in images which give the appearance that intraoperative magnetic resonance imaging has been carried out. In fact, the image information from intraoperative ultrasound imaging was used to change the preoperative MRI data set in such a way that the new MRI image corresponds to the current spatial conditions and is identical to that of the current ultrasound image. In this way, image details from the magnetic resonance image, which cannot be represented in the ultrasound image, can also be displayed in this modified form, appropriate to the current situation, and can present the surgeon with a high-resolution virtual image of his area of operation. Conversely, it also makes it possible to present image content that does not appear in the preoperative image, which can only be obtained using ultrasound.
Im Detail bedeutet dieser Koregistriermechanismus, daß vorgeplante Zielpunkte, Strecken, Flächen und Räume des Roboterraumes jeweils den aktuellen Gegebenheiten im Operationsgebiet angepaßt werden. Sie ermöglichen aktuell präzises Operie- re .In detail, this co-registration mechanism means that pre-planned target points, routes, areas and rooms of the robot room are each adapted to the current conditions in the operating area. They currently enable precise operation.
Wenn also z.B. eine Koagulationssonde aktiviert wird, um den zentralen Bereich eines Tumors zu koagulieren, wird alsSo if e.g. a coagulation probe that is activated to coagulate the central area of a tumor is called
Folge des Koagulationsvorgangs der gesamte Tumor schrumpfen und die vom Operateur präoperativ vorgegebene Tumorgrenze nicht mehr den aktuellen Tumorgrenzen entsprechen. Die erfindungsgemäße Vorrichtung ist dazu in der Lage, Bewegungen dieser vorgegebenen Grenze zu beobachten und zu dokumentieren, also die Volumenveränderungen zu registrieren und an den Ope- rationsroboter weiterzugeben. Das vom Operateur im Rahmen seiner präoperativen Planung vorgegebene Volumen wird als "Alarmvolumen" bezeichnet. Die Steuersoftware zur Registrierung von Veränderungen dieses Volumens bzw. Veränderungen der Oberfläche dieses Volumens wird als "Alarmvolumen-Adaptie- rungstool" (AVAT) bezeichnet.As a result of the coagulation process, the entire tumor shrinks and the tumor limit specified by the surgeon preoperatively no longer correspond to the current tumor boundaries. The device according to the invention is able to observe and document movements of this predetermined limit, that is to say to register the volume changes and to pass them on to the operating robot. The volume specified by the surgeon as part of his preoperative planning is referred to as the "alarm volume". The control software for registering changes in this volume or changes in the surface of this volume is referred to as the "alarm volume adaptation tool" (AVAT).
Eines der Programme für robotische operative Leistungen besteht darin, ein vom Operateur vorgeplantes Volumen automatisch zu koagulieren. Dabei wird der automatische Koagulati- onsvorgang gestoppt, sobald das aktuell koagulierte Volumen an einer Stelle das geplante Volumen erreicht. Dabei ist die Leistung des AVAT zu berücksichtigen, welches gewährleistet, daß das geplante Volumen gegen Ende des Koagulationsvorgangs nicht mehr dem aktuellen Volumen entspricht, weil der gesamte Tumor während des Koagulationsvorgangs geschrumpft ist. Der Koagulationsvorgang wird also entsprechend der Bewegung der Tumoroberfläche während des Koagulationsvorgangs adaptiert und früher beendet.One of the programs for robotic operative services is to automatically coagulate a volume that has been planned by the surgeon. The automatic coagulation process is stopped as soon as the currently coagulated volume at one point reaches the planned volume. The performance of the AVAT must be taken into account, which ensures that the planned volume no longer corresponds to the current volume towards the end of the coagulation process because the entire tumor has shrunk during the coagulation process. The coagulation process is therefore adapted in accordance with the movement of the tumor surface during the coagulation process and ended earlier.
Der nächste Operationsschritt besteht dann beispielsweise darin, die Spitze der Koagulationssonde in den Mittelpunkt jener neuen Kugel zu befördern, welche den größtmöglichen nächsten zu koagulierenden Resttumoranteil beinhaltet. Auch dabei ist wieder das AVAT zur Adaptierung zwischen geplantem und ak- tuellem Volumen zu berücksichtigen. Außerdem wird für diesen und die darauffolgenden Schritte zur dritten, vierten, etc. Koagulation jeweils die Bewegung vom aktuellen Standpunkt der Sondenspitze zu einem vorgegebenen Eintrittspunkt und von dort entlang einer Zugangsstrecke zum neuen Zielpunkt geführt. Ein weiterer Programmablauf ist beispielsweise dazu vorgesehen, die innere Oberfläche eines zystischen Tumors mit einem Operationsinstrument abzuscannen, zuerst eine vorgegebene Schichtdicke zu koagulieren und sodann das koagulierte Gewebe abzuschürfen. Dabei wird das Distanzhalteprogramm aktiviert, welches gewährleistet, daß ein Sicherheitsabstand von der Koagulationsgrenze gehalten wird, damit bei der Tumorentfernung Blutungen vermieden werden.The next step in the operation then consists, for example, in moving the tip of the coagulation probe into the center of that new sphere which contains the largest possible remaining tumor portion to be coagulated. Again, the AVAT for adapting between the planned and current volume must be taken into account. In addition, for this and the subsequent steps for the third, fourth, etc. coagulation, the movement from the current position of the probe tip to a predetermined entry point and from there along an access route to the new destination point is carried out. A further program flow is provided, for example, to scan the inner surface of a cystic tumor with a surgical instrument, to first coagulate a predetermined layer thickness and then to scrape off the coagulated tissue. The distance-keeping program is activated, which ensures that a safety distance is kept from the coagulation limit so that bleeding is avoided when the tumor is removed.
Die in der vorstehenden Beschreibung, den Ansprüchen sowie der Zeichnung offenbarten Merkmale der Erfindung können sowohl einzeln als auch in beliebigen Kombinationen für die Verwirklichung der Erfindung in ihren verschiedenen Ausführungsformen wesentlich sein. The features of the invention disclosed in the above description, the claims and the drawing can be essential both individually and in any combination for realizing the invention in its various embodiments.

Claims

ANSPRÜCHE EXPECTATIONS
1. Vorrichtung zum Ausführen von medizinischen Eingriffen (Operationen) am menschlichen oder tierischen Körper, mit1. Device for performing medical interventions (operations) on the human or animal body, with
einer Einrichtung (18) zum Speichern von ersten Bilddaten über das Operationsgebiet unda device (18) for storing first image data on the operating area and
einer Einrichtung (22) zum Anzeigen von Bilddaten,a device (22) for displaying image data,
gekennzeichnet durchmarked by
eine bildgebende Einrichtung (20) zum Gewinnen von zweiten Bilddaten über das Operationsgebiet während der Operation undan imaging device (20) for obtaining second image data about the operating area during the operation and
eine Aktualisierungseinrichtung (10, 12), die dazu ausgelegt ist, zu einem ersten Zeitpunkt gewonnene zweite Bilddaten mit zu einem zweiten, nach dem ersten Zeitpunkt liegenden Zeitpunkt gewonnenen zweiten Bilddaten zu vergleichen, die ersten Bilddaten entsprechend der sich aus dem Vergleich ergebenden Veränderung zu aktualisieren und die aktualisierten ersten Bilddaten der Anzeigeeinrichtung (22) zuzuleiten.an update device (10, 12) which is designed to compare second image data obtained at a first point in time with second image data obtained at a second point in time after the first point in time, to update the first image data in accordance with the change resulting from the comparison and to supply the updated first image data to the display device (22).
2. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, daß die Aktualisierungseinrichtung (10, 12) die ersten Bilddaten in vorbestimmten Zeitabständen aktualisiert.2. Device according to claim 1, characterized in that the update device (10, 12) updates the first image data at predetermined time intervals.
3. Vorrichtung nach Anspruch 1, dadurch gekennzeichnet, daß die Aktualisierungseinrichtung (10, 12) die ersten Bilddaten immer dann aktualisiert, wenn die sich aus dem Vergleich ergebenden Änderungen ein vorbestimmtes Maß überschreiten.3. Apparatus according to claim 1, characterized in that the update device (10, 12) updates the first image data whenever the changes resulting from the comparison exceed a predetermined amount.
4. Vorrichtung nach einem der vorangehenden Ansprüche, ge- kennzeichnet durch einen Operationsroboter (24) , der dazu aus- gelegt ist, unter Einbeziehung der aktualisierten ersten Bilddaten manuell eingebene Befehle auszuführen und/oder nach einem vorbestimmten Programm mindestens einen Operationsschritt selbsttätig auszuführen.4. Device according to one of the preceding claims, characterized by an operating robot (24), which for this purpose is set to carry out manually entered commands, including the updated first image data, and / or to carry out at least one operation step automatically according to a predetermined program.
5. Vorrichtung nach Anspruch 4, dadurch gekennzeichnet, daß der Operationsroboter (24) dazu ausgelegt ist, auf ein vorbe- stimmes Volumen in dem durch die aktualisierten ersten Bilddaten repräsentierten Operationsgebiet beschränkt zu arbeiten.5. The device according to claim 4, characterized in that the operating robot (24) is designed to work limited to a predetermined volume in the operating area represented by the updated first image data.
6. Vorrichtung nach Anspruch 4 oder 5, dadurch gekennzeichnet, daß der Operationsroboter (24) dazu ausgelegt ist, einen vorbestimmten Abstand zu einer vorbestimmten Grenzoberfläche in dem durch die aktualisierten ersten Bilddaten repräsentier- ten Operationsgebiet einzuhalten.6. Apparatus according to claim 4 or 5, characterized in that the surgical robot (24) is designed to maintain a predetermined distance from a predetermined boundary surface in the operating area represented by the updated first image data.
7. Vorrichtung nach einem der Ansprüche 4 bis 6 , dadurch gekennzeichnet, daß der Operationsroboter (24) dazu ausgelegt ist, einen vorbestimmten Punkt in dem durch die aktualisierten ersten Bilddaten repräsentierten Operationsgebiet anzufahren.7. Device according to one of claims 4 to 6, characterized in that the operating robot (24) is designed to approach a predetermined point in the operating area represented by the updated first image data.
8. Vorrichtung nach einem der Ansprüche 4 bis 7, gekennzeichnet durch eine Einrichtung zum Eingeben des Beschränkungsvolumens, der Grenzoberfläche und/oder des Anfahrpunktes.8. Device according to one of claims 4 to 7, characterized by a device for entering the restriction volume, the boundary surface and / or the approach point.
9. Vorrichtung nach einem der vorangehenden Ansprüche, gekennzeichnet durch eine Eicheinrichtung (14) , die fest an dem Körper anzubringen ist und die mindestens eine Landmarke aufweist, welche bezüglich des Körpers einen festen gemeinsamen Bezugspunkt für die ersten und die zweiten Bilddaten darstellt.9. Device according to one of the preceding claims, characterized by a calibration device (14) which is to be fixedly attached to the body and which has at least one landmark which represents a fixed common reference point for the first and the second image data with respect to the body.
10. Vorrichtung nach Anspruch 9, dadurch gekennzeichnet, daß die Eicheinrichtung (14) von einem stereotaktischen Rahmen ge- bildet ist. 10. The device according to claim 9, characterized in that the calibration device (14) is formed by a stereotactic frame.
11. Vorrichtung nach einem der vorangehenden Ansprüche, dadurch gekennzeichnet, daß die ersten Bilddaten im Wege der Computertomographie und/oder der Kernspintomographie gewonnen worden sind.11. Device according to one of the preceding claims, characterized in that the first image data have been obtained by means of computer tomography and / or magnetic resonance imaging.
12. Vorrichtung nach einem der vorangehenden Ansprüche, dadurch gekennzeichnet, daß die bildgebende Einrichtung (20) zum Gewinnen von zweiten Bilddaten mit Ultraschall arbeitet.12. Device according to one of the preceding claims, characterized in that the imaging device (20) for obtaining second image data works with ultrasound.
13. Verfahren zum Erzeugen eins Bildes eines menschlichen oder tierischen Körpers, mit folgenden Schritten:13. A method of producing an image of a human or animal body, comprising the following steps:
- Speichern erster Bilddaten des Körpers,Storing first image data of the body,
- Aufnehmen zweiter Bilddaten des Körpers zu einem ersten und zu einem zweiten, nach dem ersten Zeitpunkt liegenden Zeitpunkt,Recording second image data of the body at a first and at a second point in time after the first point in time,
- Vergleichen der zu dem ersten und zu dem zweiten Zeitpunkt aufgenommenen zweiten Bilddaten miteinander,Comparing the second image data recorded at the first and at the second point in time with one another,
- Aktualisieren der ersten Bilddaten entsprechend einer sich aus dem Vergleich ergebenden Veränderung und- Update the first image data according to a change resulting from the comparison and
Anzeigen der aktualisierten ersten Bilddaten.Display the updated first image data.
14. Verfahren nach Anspruch 13, dadurch gekennzeichnet, daß der erste Zeitpunkt und die Lage des Körpers bei dem Aufnehmen der zweiten Bilddaten derart gewählt werden, daß die zum ersten Zeitpunkt aufgenommenen zweiten Bilddaten den gespeicherten ersten Bilddaten entsprechen. 14. The method according to claim 13, characterized in that the first point in time and the position of the body when the second image data is recorded are selected such that the second image data recorded at the first point in time correspond to the stored first image data.
15. Verfahren nach Anspruch 13 oder 14, dadurch gekennzeichnet, daß der Schritt des Aktualisierens in vorbestimmten Zeitabständen durchgeführt wird.15. The method according to claim 13 or 14, characterized in that the step of updating is carried out at predetermined time intervals.
16. Verfahren nach Anspruch 13 oder 14, dadurch gekennzeichnet, daß der Schritt des Aktualisierens immer dann durchgeführt wird, wenn die sich aus dem Vergleich ergebenden Änderungen ein vorbestimmtes Maß überschreiten.16. The method according to claim 13 or 14, characterized in that the step of updating is carried out whenever the changes resulting from the comparison exceed a predetermined amount.
17. Verfahren nach einem der Ansprüche 13 bis 16, dadurch gekennzeichnet, daß die ersten Bilddaten im Wege der Computertomographie oder Kernspintomographie gewonnen worden sind.17. The method according to any one of claims 13 to 16, characterized in that the first image data have been obtained by means of computer tomography or magnetic resonance imaging.
18. Verfahren nach einem der Ansprüche 13 bis 17, dadurch ge- kennzeichnet, daß die zweiten Bilddaten mittels Ultraschalls aufgenommen werden. 18. The method according to any one of claims 13 to 17, characterized in that the second image data are recorded by means of ultrasound.
PCT/EP1999/007540 1998-10-09 1999-10-07 Device for carrying out medical interventions and a method for generating an image WO2000021450A1 (en)

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