WO2007118189B1 - Frameless stereotactic guidance of medical procedures - Google Patents

Frameless stereotactic guidance of medical procedures

Info

Publication number
WO2007118189B1
WO2007118189B1 PCT/US2007/066132 US2007066132W WO2007118189B1 WO 2007118189 B1 WO2007118189 B1 WO 2007118189B1 US 2007066132 W US2007066132 W US 2007066132W WO 2007118189 B1 WO2007118189 B1 WO 2007118189B1
Authority
WO
WIPO (PCT)
Prior art keywords
subject
article
head
medical procedure
attachment
Prior art date
Application number
PCT/US2007/066132
Other languages
French (fr)
Other versions
WO2007118189A1 (en
Inventor
Frank J Bova
William A Friedman
Original Assignee
Univ Florida
Frank J Bova
William A Friedman
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 Florida, Frank J Bova, William A Friedman filed Critical Univ Florida
Publication of WO2007118189A1 publication Critical patent/WO2007118189A1/en
Publication of WO2007118189B1 publication Critical patent/WO2007118189B1/en

Links

Classifications

    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A61B2017/3405—Needle locating or guiding means using mechanical guide means
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/107—Visualisation of planned trajectories or target regions
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
    • 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
    • A61B2034/2046—Tracking techniques
    • A61B2034/2051—Electromagnetic tracking systems
    • 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
    • A61B2034/2046—Tracking techniques
    • A61B2034/2055—Optical tracking systems
    • 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
    • A61B2034/2072—Reference field transducer attached to an instrument or patient
    • 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
    • A61B34/25—User interfaces for surgical systems
    • A61B2034/256—User interfaces for surgical systems having a database of accessory information, e.g. including context sensitive help or scientific articles
    • 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
    • A61B2090/3983—Reference marker arrangements for use with image guided surgery
    • 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
    • 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
    • A61B90/11—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 with guides for needles or instruments, e.g. arcuate slides or ball joints
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B33—ADDITIVE MANUFACTURING TECHNOLOGY
    • B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y80/00—Products made by additive manufacturing

Abstract

Devices, methods and systems for frameless guidance of image-based medical procedures such as stereotactic radiotherapy and surgery. Devices including custom fitting subject-specific articles include contoured surfaces that provide spatial reference to the location of target regions within the subject. The devices are attached exclusive of fasteners anchored to the tissue of the subject and reside on the front of a head of the subject when attached. The devices and articles can be fabricated using computer-directed fabrication technology.

Claims

AMENDED CLAIMS received by the International Bureau on 05 November 2007 (05.11.2007)What is claimed is;
1. A device for guiding a medical procedure pre-planned using a virtual model of a head of a subject, comprising: a subject-specific article comprising at least one substantially reference portion, said reference portion having dimensions for following a contour of a first exterior surface portion υf the head of the subject to be treated, wherein said reference portion dimension are derived from head surface dimensions of the virtual model, said article rigidly attachable to said first surface portion exclusive of fasteners anchored to tissue of the subject underlying said article upon attachment, wherein said article upon attachment exclusively resides on a front of a head of the subject in one configuration, said article including one or more openings to access one or more surface portions of the head of the subject during the pre-planned medical procedure, wherein locations of said openings are based upon locations of one or more target regions for the pre-planned medical procedure in the virtual model, and said one configuration providing a customized spatially unambiguous reference for alignment of said preplanned medical procedure to said target regions.
2. The device of claim I, wherein said article upon attachment exclusively contacts non-opposing exterior points of said head of said subject.
3. The device of claim 1, wherein said first surface portion comprises a surface portion selected from the group consisting of the nose, the eye socket, and the eyebrow ridge.
4- The device of claim 1, wherein said article includes at least one opening for access to a second surface portion, further comprising a probe guide emerging from said opening.
5 The device of claim 4, wherem an angle of said probe guide emerging from said opening is adjustable.
6. The device of claim 4, wherein said probe guide is oriented at a predetermined angle with respect to said article for guidance to said opening or embedded regions under said opening aligned with said probe guide.
7. The device of claim 6, further comprising at least one structure for directing a biopsy or incision depth attached to said article.
8. The device of claim 1, wherein said article includes at least one opening for access to a second surface portion, further comprising ax least one surface along a periphery of said opening for attachment of a custom skin clip or reiracior.
9. The device of claim 1, wherein said article includes a structure for attachment to a stereotactic phantom device,
10. A method for guiding a medical procedure, comprising the steps of: generating a virtual model of a head of a subject; providing a subject-specific article comprising at least one substantially rigid reference portion, said reference portion having dimensions for following a contour of a first exterior surface portion of the head of the subject to be treated, wherein said reference portion dimension are derived from head surface dimensions of said virtual model, said article rigidly attachable to said first surface portion exclusive of fasteners anchored to tissue of the subject underlying said article upon attachment, wherein said article upon attachment exclusively resides υn a front of the head of The subject in one configuration, said article including one or more openings to access one or more surface portions of The head of the subject during the pre-planned medical procedure, wherem locations of said openings are based upon locations of one or more target regions for the pre-planned medical procedure in the virtual model, said one configuration providing a customized spatially unambiguous reference for alignment of said preplanned medical procedure to said target regions; attaching said article to said bead of said subject; and performing a medical procedure on said target regions through said associated openings,
11. The method of claim 10, further comprising the step of: checking for proper alignment of said article upon attachment to said subject using a stereotactic phantom device procedure before performing said medical procedure on said target region.
12. A system for performing a medical procedure, comprising: an imaging system for generating a virtual model of a head of a subject; a subject-specific article comprising at least one substantially rigid reference portion, said reference portion following a contour of a first exterior surface portion of the head of a subject to be treated, wherein said reference portion dimensions are derived from head surface dimension of the virtual model, said article rigidly attachable to said first surface portion exclusive of fasteners anchored to tissue of said subject underlying said article upon attachment, wherein said article upon attachment exclusively resides on a front of said head of said subject in one configuration, said article including one or more openings to access one or more surface portions of the head of the subject during the pre-planned medical procedure, wherein locations of said openings are based upon locations of one or more target regions for the pre-planned medical procedure in the virtual model, said one configuration providing a customized spatially unambiguous reference for alignment of said preplanned medical procedure to said target regions; and a therapeutic, diagnostic or surgical device, wherein said device is physically guided to said target regions at least in part by said associated openings of said subject- specific article,
13 The system of claim 12, wherein said subject-specific article further comprises a plurality of external reference markers.
14. The system of claim 13, wherein said reference markers are optical markers.
15. The system of claim 14, wherein said article includes at least one opening for access to a second surface portion, further comprising a probe guide emerging from said opening.
16. A system for forming a device comprising a subject specific article comprising ax least one reference contour for guiding a medical procedure, comprising: compuring structure for providing 3 -dimensional data representing a subject- specific article comprising a reference contour dimensioned to replicate a contour of an exterior surface portion of the head of a subject to be Treated, said article attachable to a first surface portion exclusive of fasteners anchored to tissue of said subject underlying said article upon attachment, wherein said article upon attachment exclusively resides on a front of said head of said subject; and a machine for forming said device from said 3~dimemional data.
17, The system of claim 16, wherein said contour of said subject to be treated is computed from a 3-dimensional planning image of said subject.
18 The system of claim 16, wherein said machine is a rapid prototyping machine.
PCT/US2007/066132 2006-04-07 2007-04-06 Frameless stereotactic guidance of medical procedures WO2007118189A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US11/400,015 2006-04-07
US11/400,015 US7651506B2 (en) 2003-10-02 2006-04-07 Frameless stereotactic guidance of medical procedures

Publications (2)

Publication Number Publication Date
WO2007118189A1 WO2007118189A1 (en) 2007-10-18
WO2007118189B1 true WO2007118189B1 (en) 2007-12-21

Family

ID=38328458

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2007/066132 WO2007118189A1 (en) 2006-04-07 2007-04-06 Frameless stereotactic guidance of medical procedures

Country Status (2)

Country Link
US (1) US7651506B2 (en)
WO (1) WO2007118189A1 (en)

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