Techniques to support clinical personnel with multiple navigation views

Abstract

A method of supporting a clinical person using a plurality of navigation views is provided. The method includes obtaining patient tracking information indicative of tracked poses of two or more patient trackers, each patient tracker having a fixed spatial relationship with respect to one or more anatomical elements of a patient's body; obtaining instrument tracking information indicative of tracked poses of the two or more medical instruments; and triggering a simultaneous display of a plurality of navigation views based on the patient tracking information and the instrument tracking information, each navigation view being determined based on a respective set comprising (i) at least one medical instrument and (ii) at least one patient tracker, where the sets differ from each other with respect to the at least one patient tracker. A system, computer program and carrier are also provided.

Description

Technical Field

[0001] The present disclosure generally relates to a method of supporting clinical personnel using multiple navigation views. A system, a computer program, and a carrier are also provided. Background Art

[0002] In many clinical scenarios, clinical personnel (such as surgeons) wish to be provided with feedback about the tracked position of a medical instrument. For example, a surgeon may wish to understand the current position of a handheld drill relative to the patient's body, or the alignment of a pedicle screw driver relative to another medical instrument (such as a trocar) manipulated by a robot.

[0003] Some surgical navigation systems may provide a single navigation view to the surgeon that visualizes the tracked pose of a handheld medical instrument relative to the patient's body as represented by the patient image data. Where multiple medical instruments are used, the tracked poses of the multiple medical instruments may be simultaneously visualized in a single navigation view. In particular, if the tracked medical instruments are located far from one another (e.g., at different vertebral levels of the patient's spine), or if the multiple medical instruments are being manipulated simultaneously by different surgeons, a single navigation view may not be optimal for navigating each medical instrument. Summary of the invention

[0004] What is needed is a technique for supporting clinical personnel that addresses one or more of the above or other issues.

[0005] According to a first aspect, a method for supporting clinical personnel using multiple navigation views is provided. The method is executed by at least one processor and includes: obtaining patient tracking information indicating tracked postures of two or more patient trackers, each patient tracker having a fixed spatial relationship relative to one or more anatomical elements of the patient's body. The method includes: obtaining instrument tracking information indicating tracked postures of two or more medical instruments. The method also includes: triggering simultaneous display of multiple navigation views based on the patient tracking information and the instrument tracking information, each navigation view being determined based on a corresponding set including (i) at least one medical instrument and (ii) at least one patient tracker, wherein the sets differ from each other in terms of the at least one patient tracker.

[0006] Each navigation view may be specific to a respective set for determining the respective navigation view.

[0007] Each patient tracker of the at least one patient tracker within the same set may have a fixed spatial relationship with respect to a common anatomical element of the patient's body.

[0008] The common anatomical elements of each set may be different.

[0009] The sets may differ from one another with respect to the at least one medical instrument.

[0010] At least one set may include at least one medical instrument that is not included in any other set.Alternatively or additionally, at least one set may include at least one medical instrument that is included in another set.

[0011] At least one set may be determined based on the patient tracking information and the instrument tracking information.

[0012] At least one set may be determined based on a relative pose between (i) at least one medical instrument and (ii) at least one of the one or more anatomical elements having a fixed spatial relationship relative to at least one patient tracker. At least one set may be determined based on a relative pose indicating that at least one of the following conditions is satisfied: the at least one medical instrument is aligned with at least one of the one or more anatomical elements having a fixed spatial relationship relative to the at least one patient tracker; the at least one medical instrument is positioned within a predefined area, the predefined area being associated with at least one of the one or more anatomical elements having a fixed spatial relationship relative to the at least one patient tracker.

[0013] At least one of the sets may be determined based on user input.

[0014] At least one navigation view may indicate a relative pose between (i) a medical instrument of a set used to determine the at least one navigation view and (ii) at least one of the one or more anatomical elements having a fixed spatial relationship with respect to one or more of at least one patient tracker in the same set. The at least one navigation view may also indicate a pose of another medical instrument in the set or another set.

[0015] Two or more navigation views may be triggered to be displayed on a common display unit. Alternatively or additionally, at least one navigation view may be triggered to be displayed on a single display unit.

[0016] At least one of the medical instruments may be operated by a robot. Alternatively or additionally, at least two of the medical instruments may be operated by different persons (eg simultaneously).

[0017] According to a second aspect, a system is provided. The system includes at least one processor, the processor being configured to: obtain patient tracking information indicating tracked postures of two or more patient trackers, each patient tracker having a fixed spatial relationship relative to one or more anatomical elements of a patient's body; obtain instrument tracking information indicating tracked postures of two or more medical instruments; and trigger simultaneous display of multiple navigation views based on the patient tracking information and the instrument tracking information, each navigation view being determined based on a corresponding set including (i) at least one medical instrument and (ii) at least one patient tracker, wherein the sets differ from each other in terms of the at least one patient tracker. The at least one processor can be configured to perform the method according to the first aspect.

[0018] The system may further include one or more display units configured to simultaneously display the navigation views. The system may include a tracking unit configured to track at least one entity selected from a patient tracker and a medical instrument. The system may include a robot configured to handle at least one of the medical instruments.

[0019] According to a third aspect, a computer program is provided. The computer program includes instructions that, when executed by at least one processor, configure the at least one processor to: obtain patient tracking information indicating tracked positions of two or more patient trackers, each patient tracker having a fixed spatial relationship relative to one or more anatomical elements of the patient's body; obtain instrument tracking information indicating tracked positions of two or more medical instruments; and trigger simultaneous display of multiple navigation views based on the patient tracking information and the instrument tracking information, each navigation view being determined based on a corresponding set including (i) at least one medical instrument and (ii) at least one patient tracker, wherein the sets differ from each other in terms of at least one patient tracker. The computer program may include instructions that, when executed by at least one processor, configure the at least one processor to perform the method according to the first aspect.

[0020] According to a fourth aspect, a carrier is provided, the carrier carrying the computer program according to the third aspect. The carrier may be a data stream or a non-transitory computer-readable storage medium. BRIEF DESCRIPTION OF THE DRAWINGS

[0021] Further details, advantages and aspects of the present disclosure can be clearly seen from the following embodiments in conjunction with the accompanying drawings, in which:

[0022] Figure 1 A schematic diagram of a system according to the present disclosure is shown;

[0023] Figure 2 A flowchart showing a method according to the present disclosure; and

[0024] Figure 3 An exemplary navigation view according to the present disclosure is schematically illustrated. DETAILED DESCRIPTION

[0025] In the following description, exemplary embodiments will be explained with reference to the accompanying drawings. The same reference numerals are used to denote the same or similar structural features.

[0026] Figure 1 A schematic diagram of a system 2 according to the present disclosure is shown. System 2 may be referred to as a surgical navigation system and includes a computing system 4. System 2 may also include a tracking unit 6, a display unit 8, and / or a robot 10. Computing system 4 includes at least one processor 12 communicatively connected to at least one memory 14 and at least one interface 16. At least one interface 16 may be communicatively connected to tracking unit 6, display unit 8, and / or robot 10 via one or more wired or wireless connections. Display unit 8 may be a stand-alone display screen, part of a surgical navigation station, or part of a handheld or head-mounted display. System 2 may include multiple display units 8, or one or more additional different display units.

[0027] Also shown is a patient's body 18 of a patient lying on a treatment couch 20 in an operating room 22, and three medical instruments 24, 26, 28. In this example, each of the medical instruments 24, 26 is a handheld instrument, such as a pointer, a drill, a chisel, or a screwdriver. The medical instruments 24, 26 can be manipulated simultaneously, for example by different surgeons. The medical instrument 24 includes a shaft 25 extending longitudinally along an axis 27 of the shaft. The medical instrument 26 includes a distal instrument end 29. The medical instrument 28 in the illustrated example is manipulated by the robot 10 (e.g., simultaneously) and includes a distal instrument end 31.

[0028] The tracking unit 6 is configured to track the pose of the medical instruments 24, 26 by positioning (e.g., optical or electromagnetic) trackers 30, 32 attached to the medical instruments 24, 26. The tracking unit 6 can also track the pose of the medical instrument 28 by positioning a tracker 34 attached to the medical instrument 28. The tracking unit 6 can be configured as an optical tracking unit and can include a (e.g., stereoscopic) tracking camera for positioning the optical tracker. The tracking unit 6 can alternatively be configured as an electromagnetic tracking unit and can include an electromagnetic field generator. Other types of tracking units are also possible.

[0029] Instead of tracking the medical instrument 28 using the tracking unit 6, the pose of the medical instrument 28 may be determined (e.g., by at least one processor 12) based on the pose of the robot 10 (e.g., based on the rotation and / or translation of the actuators of the robot 10). In the illustrated example, the pose of the medical instrument 28 may be determined based on the angular orientation of the arm segments 36, 38, 40 of the robot 10 defined by the joints 42, 44 between the arm segments 36, 38, 40 of the robot 10.

[0030] The tracking unit 6 can also be configured to track the pose of different parts of the patient's body 18 by positioning one or more patient trackers 33a-33cd, each patient tracker 33a-33cd having a fixed spatial relationship (e.g., adhesively attached to the patient's skin or clamped to an anatomical element of the patient's body) relative to one or more anatomical elements of the patient's body 18. The medical instruments 24, 26, 28 and the patient trackers 33a-33d can be arranged in the same operating room 22 where the patient's body 18 is located.

[0031] Registration between (e.g., pre-operative) patient image data of at least a portion of the patient's body 18 on the one hand and the patient's body 18 on the other hand can be used to convert a (e.g., pre-planned) position defined relative to the patient image data to a (e.g., real-world) position in the operating room 22. The registration can define a spatial relationship between a coordinate system of the patient image data and a real-world coordinate system defined by one or more patient trackers 33a-33d, for example in the form of a transformation matrix or transformation function. Various techniques for determining such patient-to-image registration are known to those skilled in the art. For example, points acquired on the surface of the patient's body 18 using a tracked registration probe can be matched to the surface of the patient's body 18 represented by the patient image data to obtain registration.

[0032] The patient's body 18 includes a plurality of anatomical elements, such as organs or bones. In the illustrated example, vertebrae 46-58 of the patient's spine 60 are indicated as examples of anatomical elements of the patient's body 18. It should be noted that although the patient's spine 60 generally includes a total of 33 vertebrae, in order to provide a better overview, the vertebrae 46-58 are shown in FIG. Figure 1 Only seven vertebrae 46-58 are shown. Figure 1 Also shown is a femur 62 , which is another example of an anatomical element of the patient's body 18 , with the two patient trackers 33 c , 33 d having a fixed spatial relationship relative to the femur 62 . Figure 1Also shown are spatial regions 64, 66. Spatial region 64 is associated with tracker 33a and encompasses vertebrae 46, 48. Spatial region 66 is associated with tracker 33b and includes vertebrae 56. Each spatial region may be user defined or automatically defined, for example as a region defining a predefined space around an enclosed anatomical element.

[0033] Figure 2 1 shows a flow chart of a method according to the present disclosure. The method may be performed by at least one processor 12 of the system 2. To this end, at least one memory 14 may store a computer program including instructions that, when executed by at least one processor 12, cause the at least one processor to perform the method disclosed herein. At least one memory 14 is an example of a carrier that carries a computer program. Alternatively, the computer program may be carried by at least one processor 12 via an interface 16, for example, from a server. Although the following will use Figure 1 The reference numerals are used to provide a better understanding of the method, but these reference numerals should not be construed as limiting the method to Figure 1 Specific details shown.

[0034] The method may be referred to as a computer-implemented method. In a particular variant, the method is not a method of treating the human or animal body by surgery or therapy and / or the method does not comprise a surgical step.

[0035] In step 202, patient tracking information indicating tracked poses of two or more patient trackers 33a-33d is obtained.

[0036] The patient tracking information may be obtained from the tracking unit 6 and may indicate a (eg, currently) tracked pose of each of the two or more patient trackers 33a - 33d .

[0037] Each of the patient trackers 33a - 33d has a fixed spatial relationship relative to one or more anatomical elements 46 - 62 of the patient's body 18 .

[0038] Anatomical elements may be understood as physically and / or biologically distinguishable parts of the patient's body 18. Examples of anatomical elements include bones (e.g., vertebrae) 46-62, organs, and tumors. In one example, each anatomical element may not deform (e.g., not more than a predefined amount, e.g., not more than 5% in length and / or volume) during surgical intervention of body tissue adjacent to the corresponding anatomical element. In this example, each anatomical element may be referred to as a rigid anatomical element.

[0039] Each patient tracker 33a - 33d may be associated with a registration between (eg, pre-operative) patient image data and the patient body 18 .

[0040] The patient image data may represent at least a portion of the patient's body 18. The patient image data may include at least one of two-dimensional image data and three-dimensional image data. For example, the patient image data may include computed tomography (CT) image data of at least a portion of the patient's body 18. As another example, the patient image data may include magnetic resonance (MR) image data of at least a portion of the patient's body 18.

[0041] The method may include associating a registration with each patient tracker. The method may include, for each patient tracker, obtaining or determining a registration. Such a registration may be used to transform coordinates from the patient image data into "real world" coordinates. To this end, the registration associated with a given patient tracker may define a transformation (e.g., defining three translation components and three rotation components) between a coordinate system of the patient image data and a "real world" coordinate system (also referred to as a patient tracker coordinate system) that has a fixed spatial relationship relative to the given patient tracker.

[0042] Various techniques for determining such transformations and registrations are known in the art. For example, the positions of points obtained on the surface of the patient's body 18 relative to a given patient tracker 33a-33d may be matched to the positions of the patient's surface represented by the patient image data to obtain a registration between the given patient tracker and the patient image data.

[0043] Since the poses of the patient trackers 33a-33d are different from each other, the registrations associated with the patient trackers are also different from each other. In other words, each of the patient trackers 33a-33d may be associated with a registration specific to that patient tracker.

[0044] In step 204 , instrument tracking information indicating tracked poses of two or more medical instruments is obtained.

[0045] The instrument tracking information may be obtained from the tracking unit 6 and / or the robot 10. The instrument tracking information may be determined by at least one processor 12 based on feedback from the robot 10, as described above. In one example, the instrument tracking information indicates a currently tracked pose of each of two or more medical instruments (e.g., for each of the medical instruments 24, 26, 28).

[0046] At least one of the medical instruments for which instrument tracking information has been obtained may be handled by a robot. Alternatively or additionally, at least one (e.g., two or more) of the medical instruments for which instrument tracking information has been obtained may be handled by different personnel (e.g., simultaneously). Figure 1 In the example of FIG. 1 , the medical instrument 28 is handled by the robot 10 , and the medical instruments 24 , 26 are handled by different personnel at the same time.

[0047] The method may also include an optional step 206 in which one or more sets are determined. As an alternative or in addition to optional step 206, the method may include obtaining set information indicating one or more sets. That is, one or more sets may be predefined and obtained by at least one processor 12. Whenever a set is referred to herein as being "determined", this includes determining as part of the method in step 206 as well as obtaining an alternative to a set that has been determined accordingly (e.g., in a step separate from the method).

[0048] The method disclosed herein does not use only one set, but multiple sets. Each set includes (i) at least one medical instrument (e.g., the medical instrument whose instrument tracking information is obtained in step 204) and (ii) at least one patient tracker (e.g., the patient tracker whose patient tracking information is obtained in step 202). Figure 1 In the example of , the first set may include the medical instrument 24 and the patient tracker 33a, the second set may include the medical instruments 26, 28 and the patient tracker 33b, and the third set may include the medical instruments 24, 26 and the patient trackers 33c, 33d.

[0049] The sets used in the methods disclosed herein (eg, in step 208 ) differ from one another in at least one patient tracker.

[0050] As described above, each patient tracker can be associated with a specific registration, which will cause each set to also be different in terms of registration. If a set includes only one patient tracker, it will be associated with only one registration. If a set includes two or more patient trackers, it will be associated with the registrations of these two or more patient trackers.

[0051] At least one set may include at least one patient tracker that is not included in any other set. Figure 1 In the example of , the first set includes only patient tracker 33a as a patient tracker, the second set includes only patient tracker 33b as a patient tracker, and the third set includes only patient trackers 33c, 33d as patient trackers. In this example, each patient tracker is "set-specific". In this example, each set includes only patient trackers that are not included in any other set.

[0052] At least one set may include at least one patient tracker included in another set. That is, one or more sets may include non-exclusive or non-set specific patient trackers.

[0053] In a first example, at least one set includes two or more patient trackers, wherein each of the two or more patient trackers has a fixed relationship with an anatomical element (e.g., tracker-specific or different) of the patient's body 18. That is, a set can include multiple trackers that are fixed relative to different anatomical elements. Thus, multiple trackers in such a set can move relative to each other.

[0054] In a second example, each patient tracker in at least one patient tracker in the same set may have a fixed spatial relationship (e.g., a fixed arrangement and / or a fixed pose) relative to a common anatomical element of the patient's body. In other words, all patient trackers in the same set may have a fixed spatial relationship relative to a common (e.g., the same) anatomical element. Thus, these patient trackers may not move relative to each other. Figure 1 In the example of FIG. 1 , a first set of patient trackers 33a are fixedly attached relative to vertebra 46, a second set of patient trackers 33b are fixedly arranged relative to vertebra 56, and a third set of patient trackers 33c, 33d have a fixed position and orientation relative to femur 62. Although the registrations of the patient trackers(s) having a fixed spatial relationship relative to common anatomical elements may differ from one another, these registrations may remain constant relative to one another even if anatomical elements of the patient's body 18 move over time.

[0055] The common anatomical elements of different sets can vary. Figure 1 In the example of , the common anatomical element of the first set is vertebra 26 , the common anatomical element of the second set is vertebra 56 , and the common anatomical element of the third set is femur 62 .

[0056] In one particular example, each set includes exactly one patient tracker, rather than two or more patient trackers.

[0057] These sets may differ from one another in at least one medical instrument. Figure 1 In the example of , the first set may include instrument 24, the second set may include instruments 26, 28, and the third set may include instruments 24, 26. In this case, each set differs from any other set in one or more medical instruments.

[0058] At least one set may include at least one medical instrument that is not included in any other set. In other words, at least one set may include unique or set-specific medical instruments. Figure 1 In the example of , the second set includes set-specific medical instruments 28 that are not included in the first set or the third set.

[0059] At least one set may include at least one medical instrument included in another set. In other words, at least one set may include non-exclusive or non-set-specific medical instruments. Figure 1 In the example of , the first set includes non-exclusive medical instruments 24, which are also included in the third set, and the second set includes non-set-specific medical instruments 26, which are also included in the third set.

[0060] At least one set may be determined based on the patient tracking information and the instrument tracking information (e.g., in step 206). At least one set may be determined based on a spatial relationship between one or more tracked patient trackers 33a-33d and one or more tracked medical instruments 24-28. It can be said that medical instruments and patient trackers may be assigned to the same set based on their relative tracked positions and / or orientations.

[0061] At least one set may be determined based on a relative pose between (i) at least one medical instrument in the set and (ii) at least one patient tracker in the set. At least one set may be determined based on a relative pose between (i) at least one medical instrument in the set and (ii) at least one of the one or more anatomical elements (e.g., the nearest one) having a fixed spatial relationship with respect to at least one patient tracker in the set. The relative pose of at least one of the one or more anatomical elements (e.g., the nearest one) represented by patient image data may be determined based on the pose of the latter, the registration associated with at least one patient tracker in the set, and the tracked pose of at least one medical instrument in the set. In other words, the tracked pose of the medical instrument may be compared with the pose of the anatomical element represented by the patient image data using different registrations associated with respective patient trackers having a fixed spatial relationship with the anatomical elements, and if such relative pose meets a predefined criterion (e.g., a maximum distance), the respective medical instruments and the respective patient trackers may be grouped together in a set. At least one set may be determined based on a relative pose indicating that at least one medical instrument is aligned with at least one of the one or more anatomical elements having a fixed spatial relationship relative to at least one patient tracker. Figure 1In the example of , the axis 27 of the shaft 25 of the medical instrument 24 points to the vertebra 46, which means that the instrument 24 is aligned with the vertebra 26. The vertebra 26 has a fixed spatial relationship relative to the patient tracker 33a. Therefore, in this example, the instrument 24 and the patient tracker 46 are grouped into a first set. At least one set can be determined based on a relative pose indicating that at least one medical instrument is positioned within a predefined (e.g., spatial) region associated with at least one of one or more anatomical elements that have a fixed spatial relationship relative to at least one patient tracker. Figure 1 In the example of , the tips 29, 31 of the instruments 26, 28 are both located within the spatial region 66 associated with the vertebra 56. Therefore, in this example, the instruments 26, 28 are both grouped into the second set together with the patient tracker 33b fixedly arranged relative to the vertebra 56.

[0062] At least one set may also be determined based on user input. For example, a user may select one or more of a plurality of tracked medical instruments and one or more of a plurality of tracked patient trackers, and the selected (multiple) instruments and (multiple) patient trackers may then be grouped together in a set. User input may be obtained by at least one processor 12 via a user input device such as a touch screen (e.g., a touch screen of display unit 8). Other variations for determining a set are also possible. For example, one or more sets may be predefined (e.g., by using (e.g., optical) trackers for instruments and patient trackers specific to a given set).

[0063] In step 206, based on the patient tracking information and the instrument tracking information, a simultaneous display of a plurality of navigation views is triggered, each navigation view being determined based on a corresponding (e.g., navigation view-specific) collection. That is, the plurality of navigation views are based on a plurality of collections, and each navigation view is determined based on exactly one collection. As described above, such a collection includes (i) at least one medical instrument and (ii) at least one patient tracker. The collections differ from one another in at least one patient tracker, and optionally differ from one another in at least one medical instrument.

[0064] Multiple navigation views may be determined based on the patient tracking information and the instrument tracking information and optionally based on the registration associated with the patient tracker of the set. The method may include determining multiple navigation views based on the patient tracking information and the instrument tracking information and optionally based on the registration associated with the patient tracker of the set (e.g., as part of step 208 or between steps 206 and 208), and triggering simultaneous display of the determined multiple navigation views. Whenever reference is made herein to navigation views being "determined," this includes determining navigation views as part of the method and obtaining alternatives to corresponding navigation views that have been determined accordingly (e.g., in steps separate from the method).

[0065] Two or more navigation views may be triggered to be displayed on a common display unit (eg, Figure 1 At least one navigation view may be triggered to be displayed on a display unit 8 shown in FIG. 2 . At least one navigation view may be triggered to be displayed separately on another display unit (e.g., separate from the common display unit). In other words, at least one navigation view may be triggered to be displayed on a single display unit. In all of these variations, multiple navigation views may be triggered to be displayed simultaneously, e.g., for different users in the operating room 22.

[0066] Each navigation view may be determined for a different set. Each navigation view may be specific to the respective set used to determine the navigation view. Each navigation view may be determined based on the pose(s) of the respective set(s) of the medical instrument(s) and / or may be specific to the pose(s) of the respective set(s). Each navigation view may be determined based on the pose(s) of the respective set(s) of the patient tracker(s) and / or may be specific to the pose(s) of the respective set(s).

[0067] At least one (eg, each) navigation view may be determined based on the patient image data and the registration(s) associated with the patient tracker(s) used to determine the respective set of navigation views.

[0068] If the corresponding set includes only one patient tracker, the alignment associated with the patient tracker can be used, and at least one navigation view can indicate the relative pose between at least one instrument in the set and at least one anatomical element having a fixed spatial relationship relative to the unique patient tracker in the set.

[0069] If the corresponding set includes two or more patient trackers that are fixedly arranged relative to each other via common anatomical elements (e.g., as described above for the second example), an average of the transformations included in the alignments associated with the two or more patient trackers can be used. The (multiple) alignments associated with the (multiple) patient trackers of the corresponding set used to determine the navigation view can be used to determine the relative pose between the (multiple) medical instruments of the corresponding set and the patient image data. At least one navigation view can indicate the relative pose between the (multiple) medical instruments of the corresponding set and the patient image data.

[0070] If the corresponding set includes two or more patient trackers that are fixedly arranged relative to each other via a common anatomical element (e.g., as described above for the second example), or if the corresponding set includes two or more patient trackers that are movably arranged relative to each other (e.g., as described above for the first example), at least one navigation view may indicate, for multiple patient trackers in the set, a pose of at least one anatomical element that has a fixed relationship relative to the corresponding patient tracker. The at least one navigation view may indicate a relative pose between (i) at least one anatomical element that has a fixed relationship relative to a first patient tracker in the set and (ii) at least one anatomical element that has a fixed relationship relative to a second patient tracker in the set. The at least one navigation view may indicate an angle and / or distance between (i) at least one anatomical element (e.g., a first surface, such as a vertebral endplate surface) that has a fixed relationship relative to a first patient tracker in the set and (ii) at least one anatomical element (e.g., a second surface, such as a vertebral endplate surface) that has a fixed relationship relative to a second patient tracker in the set.

[0071] At least one (e.g., each) navigation view may indicate a relative pose between (i) a medical instrument in a set for determining at least one navigation view and (ii) a portion of a patient's body 18 represented in (e.g., pre-operative) patient image data. At least one (e.g., each) of the navigation views may indicate a relative pose between (i) a medical instrument in a set for determining at least one navigation view and (ii) at least one of one or more anatomical elements having a fixed spatial relationship relative to one or more of at least one patient tracker in the same set. At least one (e.g., each) of the navigation views may also indicate a pose of another medical instrument in the set or in another set.

[0072] The navigation views disclosed herein can indicate the pose of a medical instrument relative to a portion of a patient's body 18 by indicating the pose of the medical instrument as an overlay on an image of the patient's body 18, the image being generated or extracted from (e.g., pre-operative) patient image data. The images and / or patient image data can be registered to a patient tracker that determines a set of navigation views. As described above, such registration can allow locations in the images to be associated with tracked locations, and vice versa, to determine navigation view(s).

[0073] Figure 3 Schematically illustrates an exemplary navigation view according to the present disclosure. In this example, four navigation views 68-74 are simultaneously displayed on a common screen of the display unit 8, which may be referred to as a split-screen visualization. In this example, each navigation view comprises a first selection section 76 indicating a currently selected view type, a second selection section 78 indicating a medical instrument in a set associated with the corresponding navigation view, and a third selection section 80 indicating a vertebra having a fixed spatial relationship with respect to a patient tracker 33a-33d in a set associated with the corresponding navigation view.

[0074] The user can use these selection sections 76-80 to select a view type, medical instrument and / or vertebra, which will cause the navigation view to be displayed accordingly. Once the navigation view is displayed, this collection of changes is displayed in Figure 2 This is indicated by arrow 210.

[0075] The set may also be automatically changed if one or more predefined conditions are met (e.g., if a medical instrument moves from one spatial region to another, such as from region 64 to region 66). If the patient tracker 33a-33d and / or the medical instruments in the corresponding navigation view set change their pose, the corresponding navigation view may be updated accordingly to allow for "real-time" navigation. This is useful in Figure 2 This is indicated by arrow 212.

[0076] exist Figure 3, the x-axis represents the superior direction, the y-axis represents the posterior direction, and the z-axis represents the lateral direction. Navigation view 68 is an axial view of the vertebra 46, in which the position of the tip of the instrument 24 is indicated in the form of a crosshair 82. The position of the first set of instruments 24 relative to the vertebra 46 is determined via the first set of patient trackers 33a and their associated registration relative to the patient image data; this improves navigation accuracy compared to, for example, navigating the instrument 24 on the vertebra 46 using the tracker 33b. Navigation view 70 is a sagittal view of the spine 60 as shown by the patient image data, in which the position of the tip of the instrument 24 is indicated in the form of a crosshair 82. Likewise, the position of the first set of instruments 24 relative to the vertebra 46 is determined via the first set of patient trackers 33a and their associated patient-to-image registration.

[0077] The navigation view 72 is a coronal view of the spine 60 represented by the patient image data into which the positions of the tips 29, 31 are projected and visualized as distinguishable crosshairs 84, 86 to indicate the current pose of the instruments 26, 28 relative to the vertebrae 56. The positions of the tips 29, 31 relative to the vertebrae 56 are determined via the patient tracker 33b (i.e., based on registration between the patient image data and the patient tracker 33b), thereby improving navigation accuracy compared to, for example, using the patient tracker 33a as a reference.

[0078] The navigation view 74 is a perspective view of the vertebra 46 represented by the patient image data, wherein the trajectory 27 of the instrument 24 is represented by the dashed line 88. In this case, the user chooses to determine the pose of the instrument 24 relative to the patient's body 18 via two patient trackers 33c, 33d. That is, the set used to determine the navigation view 74 does not include one patient tracker, but rather two patient trackers 33c, 33d. An average registration can be determined based on a first registration associated with the tracker 33c and a second registration associated with the tracker 33d, and the average registration can be used to convert coordinates from the patient image data to a real-world coordinate system or vice versa. Trackers 33c, 33d can also be used to track an intermediate position between the two trackers, and a registration relative to the intermediate position is used instead of an average registration. Using multiple patient trackers per set may also improve navigation accuracy.

[0079] Those skilled in the art will appreciate that other variations of the navigation views 68-74 are possible, such as using a freely selectable viewing direction, visualizing other parts of the patient's body 18 or visualizing the instrument's pose in a different manner. The navigation view can visualize other components, such as pre-planned implants, points, lines, planes, or segmentation boundaries.

[0080] Other words will now be used to describe the details of the present invention in order to provide a better understanding of the present invention. Figure 1-3 numerals, but should not be construed as limiting the technology to the specific details shown in these figures.

[0081] In some cases, it may be necessary to obtain navigation feedback from more than one medical instrument 24-28 and more than one anatomical element of the patient's body 18. Some systems only provide navigation feedback from multiple combinations of medical instruments and anatomical elements in sequence (one after another, and only one at a time), which makes the entire process tedious and requires a lot of time to collect the entire feedback. When a single patient tracker that is fixedly arranged relative to an anatomical element is used, the surgical procedure is generally limited to that anatomical element. That is, when other anatomical elements (e.g., remote vertebrae) are operated on, their position in space may change, and the anatomical elements associated with the tracker will not reflect this change. Therefore, when multiple anatomical elements are operated on, it may be necessary to physically move the single patient tracker from one anatomical element to another, and the alignment of the anatomical structure may need to be repeated.

[0082] The present technology allows the use of multiple patient trackers and multiple medical instruments. Trackers and instruments are grouped into different sets to cover different possible combinations of patient trackers and medical instruments to provide feedback. If two instruments 24, 26 and two patient trackers 33a, 33b are used, one or more of the following navigation views can be triggered to be displayed: 24 relative to 33a, 26 relative to 33a, 24 relative to 33b, 26 relative to 33b. If necessary, all sets can be tracked and displayed at once. For example, in a 2×2 window layout, all four possible combinations can be displayed simultaneously, and each window can provide different possible viewing options (e.g., sagittal view, coronal view, axial view, instrument orientation view, 3D view). When more than one screen is used to display navigation views, the number of windows and sets displayed can be further increased. Therefore, not only feedback is provided for a single instrument, but also navigation views of instruments operated by different surgeons and robots can be visualized simultaneously. This simultaneous display may be preferable to long sequential feedback and switching between cumbersome and distorted navigation views.

[0083] The technology disclosed herein enables multiple users to navigate multiple medical instruments on the same patient at the same time. Each user can use his own navigated instrument and obtain real-time feedback of the posture of the navigated instrument he uses. Users can share a common screen to obtain their individual navigation feedback, or each user can have a separate screen to obtain navigation feedback. If necessary, the number of screens can even exceed the number of users. Therefore, the navigation experience of each user can be independent of other users, which means that all users can obtain complete navigation functions. For example, the instruments handled by different surgeons may not be a master-slave relationship in which the master instrument determines the image used to superimpose the instrument posture, and the slave instrument is only projected into the image. In addition to surgeons, robots, for example, can also participate. Navigation feedback can be provided for the end effector posture of the robot. Navigation feedback of the navigated dilator can be provided. In general, the technology disclosed herein can navigate any tracked medical instrument of interest in its posture, whether it is a manually operated instrument, a robotic tool, or a mechanical fixture.

[0084] The position of each navigated instrument can be appropriately displayed in its respective navigation view independently of any other instrument. "Appropriate" here does not refer to the projection in the view of other instruments, but to the projection in the navigation view dedicated to the respective instrument, which can also include the end and axis of the navigated instrument if necessary. Examples of navigation views include: a trajectory view focused on lumbar vertebra 1 and used to navigate the Jamshidi needle as a medical instrument; a coronal view focused on lumbar vertebra 1 and used to navigate the microscope; a trajectory view focused on lumbar vertebra 4 and used to navigate the robot 10; a three-dimensional view focused on lumbar vertebra 4 and used to navigate the pointer as a medical instrument.

[0085] The use of multiple patient trackers can allow accurate navigation at different parts of the patient's body 18. For example, a surgeon and his assistant can navigate screws into a pedicle at the same time. They can work at the same vertebra at the same time, or each of them can work at a different vertebra, where each vertebra can be tracked separately with a separate patient tracker. The system 2 can include two monitors connected for feedback. Thus, two surgeons can work on the patient's body 18 at the same time, with their two medical instruments 24, 26 being navigated on two different vertebrae, which have corresponding patient trackers associated with them.

[0086] Multiple navigation views can be provided simultaneously on one or more screens, wherein any tracked medical instrument can be combined with any tracked patient tracker to display imaging content according to the relationship between the positions of the selected trackers and instruments. For example, a cross-sectional image at the position of a certain pointer tip in the coordinate system of a certain tracker can be visualized as a navigation view. In addition to the instrument tip position in the tracker coordinate system, the cross-sectional image can also be displayed as a navigation view determined by the axis / track of a certain instrument in the coordinate system of a certain tracker. Potential navigation views cover a collection of patient trackers and medical instruments, and each navigation view can provide the possibility to select multiple display options for the corresponding collection (e.g. axial, coronal, sagittal, track 1, track 2 or perpendicular to the tip).

[0087] The technology disclosed herein can be modified, for example, optional steps can be omitted, the order of steps 202 and 204 can be changed, or some method steps can be combined. For example, step 204 can be performed before step 202, or steps 202 and 204 can be performed simultaneously. In one example, tracking data is obtained, and the tracking data includes instrument tracking information and patient tracking information, and may include some further information, such as a timestamp, etc. Figure 1 Modifications to the hardware examples shown in are also possible. For example, a distributed (e.g., cloud) processing system may be provided that is configured to perform the methods disclosed herein. Further modifications and advantages of the technology according to the present disclosure may become apparent to those skilled in the art.

Claims

1. A method for supporting clinical personnel using multiple navigation views, the method being executed by at least one processor and comprising: obtaining patient tracking information indicative of tracked poses of two or more patient trackers, each patient tracker having a fixed spatial relationship relative to one or more anatomical elements of a patient's body; obtaining instrument tracking information indicating tracked poses of two or more medical instruments; as well as The simultaneous display of multiple navigation views is triggered based on the patient tracking information and the instrument tracking information, each navigation view is determined based on a corresponding set including (i) at least one medical instrument and (ii) at least one patient tracker, wherein the sets differ from each other in terms of the at least one patient tracker.

2. The method of claim 1, wherein: Each navigation view is specific to a corresponding set that is used to determine the corresponding navigation view.

3. The method of claim 1, wherein: Each patient tracker of the at least one patient tracker within the same set has a fixed spatial relationship with respect to a common anatomical element of the patient's body.

4. The method of claim 3, wherein: The common anatomical elements are different for each set.

5. The method of claim 1, wherein: The sets differ from one another with respect to the at least one medical instrument.

6. The method of claim 1, wherein: At least one of the following conditions is met: At least one set includes at least one medical instrument not included in any other set; At least one set includes at least one medical instrument included in another set.

7. The method of claim 1, wherein: At least one set is determined based on the patient tracking information and the instrument tracking information.

8. The method of claim 1, wherein: At least one set is determined based on a relative pose between (i) the at least one medical instrument and (ii) at least one anatomical element of the one or more anatomical elements having a fixed spatial relationship relative to the at least one patient tracker.

9. The method of claim 8, wherein: The at least one set is determined based on the relative pose indicating that at least one of the following conditions is satisfied: the at least one medical instrument being aligned with the at least one anatomical element of the one or more anatomical elements having a fixed spatial relationship relative to the at least one patient tracker; The at least one medical instrument is positioned within a predefined area associated with the at least one anatomical element of the one or more anatomical elements having a fixed spatial relationship relative to the at least one patient tracker.

10. The method of claim 1, wherein: At least one set is determined based on user input.

11. The method of claim 1, wherein: At least one navigation view indicates (i) a relative pose between a medical instrument in a set of the at least one navigation view and (ii) at least one anatomical element of the one or more anatomical elements having a fixed spatial relationship relative to one or more patient trackers in the at least one patient tracker in the same set.

12. The method of claim 11, wherein: The at least one navigation view further indicates a pose of another medical instrument in the set or another set.

13. The method of claim 1, wherein: At least one of the following conditions is met: Two or more navigation views are triggered to be displayed on a common display unit; At least one navigation view is triggered to be displayed on the single display unit.

14. The method of claim 1, further comprising: Associated with each patient tracker is a registration that can be used to convert coordinates from the patient image data to real-world coordinates.

15. The method of claim 14, wherein: The registration is different for each set.

16. The method of claim 14, wherein: Although the registrations of all patient trackers having a fixed spatial relationship relative to a common anatomical element are different from one another, these registrations can remain constant relative to one another even if the anatomical elements of the patient's body move over time.

17. The method of claim 1, wherein: One or more of the following conditions are met: At least one medical instrument is operated by a robot; At least two medical instruments are operated by different persons.

18. A system comprising at least one processor, wherein the at least one processor is configured to: obtaining patient tracking information indicative of tracked poses of two or more patient trackers, each patient tracker having a fixed spatial relationship relative to one or more anatomical elements of a patient's body; obtaining instrument tracking information indicating tracked poses of two or more medical instruments; as well as The simultaneous display of multiple navigation views is triggered based on the patient tracking information and the instrument tracking information, each navigation view is determined based on a corresponding set including (i) at least one medical instrument and (ii) at least one patient tracker, wherein the sets differ from each other in terms of the at least one patient tracker.

19. The system of claim 18, further comprising at least one of the following components: one or more display units, the one or more display units configured to simultaneously display the navigation views; a tracking unit configured to track at least one entity selected from the patient tracker and the medical instrument; A robot is configured to handle at least one of the medical instruments.

20. A computer program comprising instructions which, when executed by at least one processor, configure the at least one processor to: obtaining patient tracking information indicative of tracked poses of two or more patient trackers, each patient tracker having a fixed spatial relationship relative to one or more anatomical elements of a patient's body; obtaining instrument tracking information indicating tracked poses of two or more medical instruments; as well as The simultaneous display of multiple navigation views is triggered based on the patient tracking information and the instrument tracking information, each navigation view is determined based on a corresponding set including (i) at least one medical instrument and (ii) at least one patient tracker, wherein the sets differ from each other in terms of the at least one patient tracker.

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