Patient movement during image guided surgery

Surgery – Diagnostic testing – Detecting nuclear – electromagnetic – or ultrasonic radiation

Reexamination Certificate

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Details

C005S610000, C005S607000, C005S608000

Reexamination Certificate

active

06249695

ABSTRACT:

BACKGROUND OF THE INVENTION
Traditional surgical procedures are conducted by making an incision in the patient's body to expose those organs which are to be treated. The physician can observe the treatment directly and can guide tools such as surgical instruments to the site requiring treatment by direct visual observation. In typical endoscopic procedures, an elongated probe having a visual observation device such as a lens and fiber optic system or a small television camera is inserted into the patient's body and guided to the desired treatment location using observation of the visual image acquired by the visual observation device. The observation device can also be used to monitor additional probes such as tools inserted through the bore of a hollow endoscope or separate surgical instruments advanced through the same or other orifices to the treatment location. Endoscopic procedures suffer from various limitations. They require relatively bulky optical elements at the distal end of the endoscope. Moreover, the physician must conduct the procedure based on a limited picture delivered by the optical system.
Image-guided interventional procedures have been developed. In image-guided procedures, an imaging device such as an x-ray device is employed to monitor the position of a probe within the body. In the simplest image-guided procedures, a fluoroscope can be used to observe the position of a radioopaque probe while the probe is inserted into the body. Fluoroscopic and other x-ray imaging modalities have serious drawbacks, including exposure of the patient and physician to ionizing radiation and inability or limited ability to image soft tissues. Accordingly, treatment methods relying on x-ray based imaging for guidance of an intrabody probe have been applied only in limited circumstances.
Magnetic resonance imaging offers the unique ability to obtain excellent images of all tissues in a patient's body without the use of ionizing radiation. MRI typically requires the use of a large magnet to apply a strong magnetic field in a patient receiving space, large enough to accommodate that region of the patient's body which is to be imaged. Some early types of MRI imaging apparatus using superconducting magnets had a patient-receiving space essentially surrounded by components of the apparatus, making it impractical to perform interventional procedures while the patient is being imaged. However, some current MRI apparatus provides an “open” environment so that a patient disposed in the imaging space of the apparatus is accessible to physicians and other medical personnel. For example, magnetic resonance imaging apparatus of the type illustrated in U.S. Pat. No. 5,754,085 provides open access to the patient so that a patient positioned within the magnet is readily accessible to a physician standing outside of the magnet, making it practical to perform MRI-guided interventional procedures. In such procedures, MRI images may be continually acquired while a probe such as a catheter, endoscopic instrument, or other device is advanced into the patient. The MRI images desirably show internal structures of the patient's body and also depict the probe.
The MRI images allow the physician to visualize the disposition of the probe relative to the organs and tissues of the body and allow the physician to maneuver the probe along a desired trajectory within the body. For example, the physician can use MRI images to guide a probe within a tubular or cavernous organ such as within the circulatory tract, digestive tract, respiratory tract or urinary tract. Also, the physician can guide a probe within soft tissue as the probe is advanced through the soft tissue as, for example, through muscle, lung tissue or the like. The MRI images can also be used to monitor the progress of the treatment being performed. For example, if particular tissues such as tumors are being removed, the MRI images can show the tumor in contrast to the surrounding tissue and can show the physician where additional tissue must be removed.
Despite all this progress in the art, still further improvements in image-guided interventional procedures would be desirable.
SUMMARY OF THE INVENTION
One aspect of the present invention provides methods of conducting image-guided medical procedures. A method according to this aspect of the invention includes the steps of advancing a probe within a patient and, during the probe-advancing step, periodically acquiring information defining an image of the probe and adjacent internal structures of the patient's body. Most preferably, the step of acquiring the image information is performed by magnetic resonance imaging. A method according to this aspect of the invention further includes the step of changing the orientation of the patient in response to the image information so as to facilitate the probe-advancing step. For example, the step of changing the orientation of the patient may include the step of changing the orientation of the patient so that tissue disposed in front of the probe along a desired probe path is displaced away from the probe path. For example, if an internal organ of the patient is disposed in front of the desired path of advancement of the probe, turning the patient to a new orientation may cause gravity to displace that organ to the surrounding portions of the patient's body and relative to the probe. Also, where a tubular organ such as a blood vessel is kinked or folded so that a straight or gently curving path along the tubular organ is blocked by the tissue at the kink or fold, the change in patient orientation can remove the kink or fold and thus take the blocking tissue away from the desired path of the probe. Alternatively or additionally, the step of changing the orientation of the patient may include the step of changing the orientation of the patient while the probe is disposed in the patient so as to alter the disposition of the probe. For example, the probe may be flexible and the step of changing the orientation of the patient is performed so that gravitational forces applied to the probe, to the surrounding tissues or both bend the probe to a more favorable configuration.
In particularly preferred methods according to this aspect of the invention, the patient's body is positioned on a support, and the step of changing the orientation of the patient includes the step of tilting the support. For example, the support may be tilted about a tilt axis substantially parallel with the long axis of the patient; around an inclination axis transverse to the long axis of the patient or both. In still further embodiments of the invention, the step of changing the orientation of the patient may include the step of moving one part of the patient's body relative to another part. For example, where a probe is advanced within the vasculature of a limb, a part of the limb may be moved relative to the torso or relative to another part of the limb so as to reconfigure the vascular system.
In the preferred methods according to this aspect of the invention, the orientation of the patient facilitates movement of the probe through the patient's body to the desired treatment location, with a minimum of damage to surrounding tissues. This benefit is particularly pronounced when the MRI is the imaging modality. The unique ability of MRI to provide details of soft tissue images, coupled with the ability to reposition soft tissues by reorienting the patient provides a particularly valuable combination.
These and other objects, features and advantages of the present invention will be more readily apparent from the detailed descriptions set forth below, taken in conjunction with the accompanying drawings.


REFERENCES:
patent: 4021028 (1977-05-01), Weber et al.
patent: 5013018 (1991-05-01), Sicek et al.
patent: 5386450 (1995-01-01), Ozawa
patent: 5419325 (1995-05-01), Dumoulin et al.
patent: 5794286 (1998-08-01), Scott et al.

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