Surgery – Diagnostic testing – Detecting nuclear – electromagnetic – or ultrasonic radiation
Reexamination Certificate
2000-06-09
2003-10-28
Lateef, Marvin M. (Department: 3737)
Surgery
Diagnostic testing
Detecting nuclear, electromagnetic, or ultrasonic radiation
C600S429000, C600S414000, C600S417000, C606S130000
Reexamination Certificate
active
06640127
ABSTRACT:
CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims benefit of Japanese Applications No. 11-163962, filed on Jun. 10, 1999; and No. 11-273067, filed on Sep. 27, 1999, the contents of which are incorporated by this reference.
BACKGROUND OF THE INVENTION
This invention relates to a reference frame to be suitably used for surgical operations including those of brain surgery and also to a marker to be used with such a reference frame. The present invention also relates to a surgical operation navigating system using such a reference frame.
In the field of surgical operations including those of brain surgery, it is highly important to accurately determine the positional relationship between the target portion of the patient for surgery and the surgical instrument to be used for the operation through measurement. It is also important to establish the positional correspondence between the target portion of the patient and an image of the target portion obtained for examination. The operation of defining the positional relationship between the target portion of the patient and the surgical instrument and also that of defining the positional relationship between the target portion of the patient and an image of the target portion are referred to as operative calibration. Known techniques for operative calibration include the one proposed in R. H. Taylor (ed.), “Computer-Integrated Surgery”, MIT Press, 1996 (hereinafter referred to as Document 1) that utilizes a stationary frame.
N. Hata, et. al, “Development of a frameless and armless stereotactic neuronavigation system with ultrasonographic registration”, Nueorsurgery, Vol. 41, No. 3, September 1997, pp. 609-614 (hereinafter referred to as Document 2) describes the use of a specifically designed reference frame fitted to the patient and used to register the coordinates representing the target portion of the patient and an image of the target portion obtained for examination.
The technique described in Document 1 utilizes a stationary metal frame, by means of which a metal marker is driven into the body of the patient from the body surface like a screw for the purpose of fixing and registration. In other words, this technique is highly invasive to the body of the patient.
According to Document 2, the reference frame is made of acrylic resin and held stationary to the body of the patient by way of the left auditory tube and the nasal projection and a total of four metal cubes are fitted onto the reference frame and used as markers.
Then, the left auditory tube and the nasal projection are made rigid by means of silicone rubber.
Thereafter, the markers are located in a CT image and actually detected by means of a probe on the body of the patient. In actual operation scenes, the doctor carries out the operation while watching the markers as detected by an ultrasonic wave.
However, the method described in Document 2 are accompanied by the following problems.
1) The accuracy of registration using the reference frame is rather poor because the frame is anchored to the body of the patient at two positions to make it held stationary.
2) Once the reference frame is removed from the body of the patient, it is difficult to accurately restore the original posture of the frame because it is anchored to the body of the patient by silicone rubber.
3) The markers cannot be used in an MRI image because they are made of metal.
4) The images of the markers can vary enormously depending on the view angle and hence it is highly difficult to define a position to be probed and the corresponding position in the image obtained for examination because the metal markers have a cubic profile.
5) It is difficult to conduct the surgical operation while leaving the reference frame on the patient and it is also difficult to put a drape on the frame in order to maintain the clean environment of the operation because the frame is large due to its intrinsic structure.
Meanwhile, Japanese Patent Application KOKAI Publication No. 7-311834 proposes an auxiliary device adapted to register images obtained for different examinations by using a reference frame that is a sort of mouthpiece reflecting the impression of the teeth of the patient.
However, the frame as described in the above KOKAI Publication is designed to register images obtained for different examinations and hence cannot suitably be m used for actual surgical operations. For example, a connector that looks like an antenna is used and arranged between the mouthpiece and the forehead of the patient and the markers are put to the front end of the connector so that it is not possible to put a drape on the frame for the surgical operation. In the case of a surgical operation using an endoscope inserted into the body through one of the nostrils of the patient that is attracting attention recently, the connector arranged at the center of the face of the patient obstructs the endoscope trying to enter the body through the nostril. Additionally, the markers are located at upper positions of the mouthpiece. In other words, they are arranged around the oral cavity. Additionally, a total of three markers are arranged on a horizontal plane on the head at the cost of accuracy of registration particularly when images of the brain are taken for brain surgery at a position right above the head. Still additionally, since an upper portion and a central portion of the brain are not covered by the markers, a relatively large error can become involved when computationally determining the coordinate transformation parameters necessary for the registration of an upper portion and an central portion of the head even if the markers can be detected in the images obtained for examination.
Furthermore, in actual operation scenes, there are cases it is impossible to observe the markers on the reference frame in a real space. Such an occasion may arise when the path to be used for the operation is not located near the reference frame or when the markers of the reference frame have to be located at positions that cannot be detected by means of a three-dimensional sensor because of the selected method for the surgical operation.
BRIEF SUMMARY OF THE INVENTION
In view of the above identified circumstances, it is therefore an object of the present invention to provide a reference frame 1) that is structurally stable and can be used during the surgical operation, 2) that can be removably arranged in position when obtaining tomographic images for the purpose of examination and restored to the position prior to the surgical operation and 3) that has markers that can be detected in the tomographic images obtained for the purpose of examination and their positions can be identified on the frame arranged on the body of the patient.
It is another object of the present invention to provide a surgical operation navigator adapted to utilize such a reference frame.
It is another object of the present invention to provide an operative calibration method and an operative calibration apparatus that are flexible enough and adapted to complex paths to be used for surgical operation.
According to a 1st aspect of the present invention, there is provided a reference frame adapted to be fitted to a subject of medical treatment and provided with markers for determining the position or the orientation of the subject, the reference frame comprising:
fixing section for fixing the reference frame with the subject at least three spots along the undulations of the surface thereof; and
three or more than three markers detectable at least ether in an X-ray image or in an MRI image of the reference frame, the markers being to be arranged at predetermined positions not connectable by a straight line.
According to a 2nd aspect of the present invention, there is provided a surgical operation navigating system comprising:
a coordinate computing section for computationally determining the coordinates of markers on a reference frame fitted to a subject of medical treatment in a tomographic image of the subject in terms of a coordinate system uniquely defined for the i
Asano Takeo
Furuhashi Yukihito
Kosaka Akio
Matsuzaki Hiroshi
Saito Akito
Lateef Marvin M.
Lin Jeoyuh
Olympus Optical Co,. Ltd.
Scully Scott Murphy & Presser
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