User interface for three-dimensional imaging and therapy

Abstract

The user interface presents a 3D view of the tissue and a treatment plan. The 3D view includes a plurality of lateral images arranged along one or more longitudinal images. The user adjusts the treatment profile through input to the user interface, and the updated treatment profile is shown on other views. The user performs one or more operations of scaling, translation, or rotation on the 3D view (where the treatment profile is superimposed on the 3D view), and the treatment profile moves with the 3D view to maintain registration with the 3D view. In some embodiments, a 3D treatment plan is generated based on multiple angles between a treatment probe and one or more tissue structures. An AI algorithm may be used to identify tissue structures and to plan treatment angles and energy delivery according to the tissue structures, thereby providing more personalized treatment.

Description

Cross Reference to Related Applications

[0001] This application claims the benefit of the filing date of U.S. Patent Application No. 18 / 163,187, filed February 1, 2023, and U.S. Patent Application No. 18 / 163,197, filed February 1, 2023, the disclosure of which is incorporated by reference in its entirety. BACKGROUND

[0002] Existing methods of tissue planning and treatment with energy sources can be less than ideal in at least some respects. In at least some cases, energy directed at the tissue being treated can not be appropriate in at least some respects, and can over treat or under treat the target tissue. Work related to the present disclosure indicates that, in at least some cases, energy sources can not accurately be directed at the target tissue. Moreover, certain types of procedures treat tissue near fragile non-target tissue, and existing methods can result in more energy being delivered to the non-target tissue in at least some cases.

[0003] While image guided treatment has been proposed, in which a user can review a treatment contour overlaid on a patient image prior to treatment, work related to the present disclosure indicates that existing user interfaces can be somewhat more complex, or in at least some cases have omissions in the treatment area being reviewed. It would be helpful to provide an improved user interface to enable a user to quickly review a planned treatment in conjunction with an appropriate image. Moreover, in at least some cases, at least some existing methods of imaging tissue with a probe can be somewhat more complex than ideal, and can be somewhat more sensitive to alignment between a treatment probe and an imaging probe than ideal.

[0004] While the use of artificial intelligence to identify tissue has been proposed, at least some of these existing methods are not well suited for use in conjunction with surgical treatment planning. It would be helpful to have an improved user interface to enable a user to review and verify a treatment plan prior to treating a patient for at least some types of procedures.

[0005] In view of the foregoing, there is a need to improve energy tissue treatment and treatment planning to ameliorate at least some of the aforementioned limitations of existing methods. SUMMARY

[0006] In some embodiments, the user interface is configured to provide a plurality of images that have been rotated with respect to a treatment axis, such as an axis of an energy source on a probe, which can facilitate treatment planning. In some embodiments, the user interface is configured to present a 3D view of the tissue and a treatment plan, such as a treatment contour. In some embodiments, the 3D view includes a plurality of transverse images arranged along one or more longitudinal images, which can provide the user with an improved treatment perspective during treatment planning. In some embodiments, the one or more longitudinal images correspond to a longitudinal axis of a treatment probe. Alternatively or in combination, the one or more longitudinal images can correspond to a longitudinal axis of an imaging probe that acquired the images. In some embodiments, the one or more longitudinal images include images that have been rotated such that at least one of the one or more longitudinal images extends substantially along an elongate axis of the treatment probe, and the plurality of transverse images can include images that have been rotated in accordance with the rotation of the one or more longitudinal images.

[0007] In some embodiments, the user interface is configured to allow the user to select one or more views in addition to the 3D view, such as a plurality of transverse views and one or more longitudinal views. The one or more longitudinal views can include one or more sagittal images, such as one or more sagittal images or parasagittal images. In some embodiments, the user interface is configured to allow the user to adjust a treatment contour through input to the user interface, and the updated treatment contour is shown on the other views. In some embodiments, the user interface is configured to allow the user to one or more of scale, pan, or rotate the 3D view (with the treatment contour superimposed on the 3D view), and the treatment contour moves with the 3D view to maintain registration with the 3D view as the 3D view is one or more of scaled, panned, or rotated. Such an approach can allow the user to better understand the position of the treatment and tissue structures relative to the planned treatment, such as a planned treatment contour.

[0008] In some embodiments, a 3D treatment plan is generated from a plurality of images, such as one or more longitudinal images and a plurality of transverse images. In some embodiments, a 3D treatment plan is generated from a plurality of angles between a treatment probe and one or more tissue structures. While a treatment plan can be generated in a variety of ways, in some embodiments, an AI algorithm is used to identify tissue structures and plan treatment angles and energy delivery from the tissue structures, which can provide a more personalized treatment. In some embodiments, an AI generated treatment plan is provided to a user on a user interface so that the user can verify the AI generated treatment parameters. While such verification can be performed in a variety of ways, in some embodiments, the AI generated treatment plan is presented to the user in a plurality of views, which can allow the user to verify the AI generated treatment plan. In some embodiments, the user interface is configured for the user to select the plurality of views and adjust the AI generated treatment plan.

[0009] In some embodiments, a method of planning a treatment includes receiving a plurality of transverse images and one or more longitudinal images, and generating an arrangement of the plurality of transverse images along the one or more longitudinal images in a three-dimensional (3D) view. The one or more longitudinal images can include one or more sagittal images or parasagittal images. The three-dimensional view can include the plurality of transverse images at a plurality of corresponding positions along the one or more longitudinal images, such as one or more sagittal images or parasagittal images. A representation of a three-dimensional (3D) treatment contour is superimposed on the 3D view composed of the plurality of transverse images and the one or more longitudinal images, and the 3D view with the representation superimposed on the one or more longitudinal images and one or more of the plurality of transverse images is shown on a display of a user interface.

[0010] In some embodiments, a method of generating a treatment plan includes receiving a plurality of transverse images of a tissue to be treated. For each of the plurality of transverse images, a position of a treatment probe and a boundary of the tissue are determined, wherein the boundary is used to define a region of the tissue to be treated.

[0011] In some embodiments, for each of the plurality of lateral images, a first boundary angle from the treatment probe to a first location along the border on a first side of the region is determined, and a second boundary angle from the treatment probe to a second location along the border on a second side of the region is determined. The angles of the tissue border relative to the treatment probe can be used to determine a treatment angle. The treatment angle can be determined in response to the angles of the border in order to provide one or more tissue margins near an edge of the treatment. Alternatively or in combination, the treatment angle can be determined in response to a tissue penetration depth of the energy source and a thickness of tissue at an angle to the energy source to provide a depth margin. In some embodiments, the tissue margins include a safety margin to reduce interaction with other tissue near the tissue margins, such as the corona of the prostate or the trigone of the bladder.

[0012] INCORPORATED BY REFERENCE All patents, applications and publications, of which I am aware, that are referred to or indicated as being incorporated by reference herein are hereby incorporated by reference in their entirety into this application, and can be considered to be equivalents of what is stated in this application, even if not specifically referred to or indicated as being incorporated by reference herein. BRIEF DESCRIPTION OF DRAWINGS

[0013] A better understanding of the features, advantages, and principles of the present disclosure will be obtained by reference to the following detailed description and drawings that sets forth illustrative embodiments, in which: Figure 1 A front view of a system for performing tissue resection in a patient is shown, in accordance with some embodiments; Figure 2 A system for performing tissue resection in a patient is schematically illustrated, in accordance with some embodiments; Figure 3A A top view of a probe arrangement is shown, in accordance with some embodiments; Figure 3B A longitudinal view, such as a sagittal view, of a probe arrangement is shown, in accordance with some embodiments; Figure 3C A perspective view of a probe arrangement is shown, in accordance with some embodiments; Figure 3D Treatment probe and imaging probe axes are shown, in accordance with some embodiments, which are tilted at an angle relative to each other such that the treatment probe and the imaging probe do not extend along a common plane; Figure 4A A top view of a lateral image plane relative to an axis of a treatment probe is shown, in accordance with some embodiments; Figure 4B A three-dimensional view of a lateral image plane relative to a treatment probe is shown, in accordance with some embodiments; Figure 4CA longitudinal view, such as a sagittal view, of a treatment probe is shown according to some embodiments; Figure 5 A transverse image plane rotated relative to the elongate axis of the probe is shown according to some embodiments; Figures 6A to 6C A user interface and transverse image are shown according to some embodiments, where movement of the probe position in the transverse image is shown; Figure 7A A user interface with a three-dimensional view for three-dimensional treatment planning is shown according to some embodiments; Figure 7B A longitudinal image, such as a sagittal image, for three-dimensional treatment planning is shown according to some embodiments; Figure 7C and Figure 7D A plurality of rotation angles relative to a treatment probe that can be used to generate a plurality of longitudinal images is shown according to some embodiments; Figure 8A A first transverse view for three-dimensional treatment planning at a first depth of a three-dimensional treatment contour is shown according to some embodiments; Figure 8B A second transverse view for three-dimensional treatment planning at a second depth is shown according to some embodiments; Figure 9A Rotation angles of a probe and energy source on the probe are shown according to some embodiments, which are used to direct the energy source to the tissue for treatment at different depths; Figure 9B A probe and rotation angles and a treatment contour overlaid on an image of tissue are shown according to some embodiments; Figure 9C and Figure 9D A treatment plan with one or more tissue margins is shown according to some embodiments; Figure 10 A method of planning a three-dimensional (3D) treatment with a user interface is shown according to some embodiments; Figure 11 A method of planning a 3D treatment with automatic tissue identification is shown according to some embodiments; Figure 12 A method of treating a first tissue and reducing exposure to a second tissue with automatic tissue identification is shown according to some embodiments; Figure 13 A method of training an artificial intelligence (AI) algorithm is shown according to some embodiments; and Figure 14 A two-dimensional convolutional neural network is shown according to some embodiments. DETAILED DESCRIPTION

[0014] The following detailed description provides a better understanding of the features and advantages of the application described in the present disclosure according to embodiments disclosed herein. Although the detailed description includes many specific embodiments, these embodiments are provided by way of example only and should not be construed as limiting the scope of the application disclosed herein.

[0015] The presently disclosed systems and methods are well suited for use with many probes and diagnostic and surgical procedures. Although reference is made to use with prostate surgery, treatment probes including energy sources, and transrectal ultrasound ("TRUS") probes, the present disclosure is well suited for use with many types of probes inserted into many types of tissues, organs, cavities, and lumens (such as brain, heart, lung, intestine, eye, skin, kidney, liver, pancreas, stomach, uterus, ovary, testicle, bladder, ear, nose, mouth, tumors, cancer, soft tissues (such as bone marrow, adipose tissue, muscle, glandular and mucosal tissue, spinal cord, neural tissue, and cartilage), hard biological tissues (such as teeth, bone), and lumens (such as blood vessel lumens, nasal lumens and sinuses, colon, urethral lumens, gastric lumens, airways, esophageal lumens, transesophageal, intestinal lumens, anal lumens, vaginal lumens, transabdominal, abdominal cavities, throat, airways, lung passageways)); and surgeries such as kidney surgery, ureter surgery, kidney stones, prostate surgery, tumor surgery, cancer surgery, brain surgery, heart surgery, eye surgery, conjunctival surgery, liver surgery, gall bladder surgery, bladder surgery, spinal surgery, orthopedic surgery, arthroscopic surgery, liposuction, colonoscopy, intubation, minimally invasive incisions, minimally invasive surgery, and the like.

[0016] The presently disclosed systems and methods are well suited for use in combination with existing probes (such as imaging probes and treatment probes). For example, examples of such probes include laser treatment probes, water jet probes, RF treatment probes, radiation treatment probes, ultrasound treatment probes, phacoemulsification probes, imaging probes, endoscopic probes, resectoscope probes, ultrasound imaging probes, A-scan ultrasound probes, B-scan ultrasound probes, 3D ultrasound probes, Doppler ultrasound probes, transrectal ultrasound probes, transvaginal ultrasound probes, longitudinal plane ultrasound imaging probes, sagittal plane ultrasound imaging probes, transverse plane ultrasound imaging probes, and transverse plane and longitudinal plane (e.g., sagittal plane) ultrasound imaging probes.

[0017] The presently disclosed systems, methods, and devices are well suited for combination with many prior surgical procedures such as waterjet prostate enucleation, transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HOLEP), prostate brachytherapy, as well as with surgical robotic systems and automated surgical procedures. The following patent applications describe examples of systems, methods, probes, and procedures suitable for incorporation in accordance with the present disclosure: PCT / US2013 / 028441 filed February 28, 2013, entitled AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT, published as WO 2013 / 130895; PCT / US2014 / 054412 filed September 5, 2014, entitled AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT, published as WO 2015 / 035249; PCT / US2015 / 048695 filed September 5, 2015, entitled PHYSICIAN CONTROLLED TISSUE RESECTION INTEGRATED WITH TREATMENT MAPPING OF TARGET ORGAN IMAGES, published as WO 2016037137; PCT / US2019 / 038574 filed June 21, 2019, entitled ARTIFICIAL INTELLIGENCE FOR ROBOTIC SURGERY, published as WO 2019246580 Al on December 26, 2019; PCT / US2020 / 021756 filed March 9, 2020, entitled ROBOTIC ARMS AND METHODS FOR TISSUE RESECTION AND IMAGING, published as WO / 2020 / 181290; PCT / US2020 / 058884 filed November 4, 2020, entitled SURGICAL PROBES FOR TISSUE RESECTION WITH ROBOTIC ARMS, published as WO / 2021 / 096741;PCT / US2021 / 070760, published as WO / 2021 / 263276, filed June 23, 2021, entitled “INTEGRATION OF ROBOTIC ARMS WITH SURGICAL PROBES,” PCT / US2021 / 038175, published as WO / 2021 / 262565, filed June 21, 2021, entitled “SYSTEMS AND METHODS FOR DEFINING AND MODIFYING RANGE OF MOTION OF PROBE USED IN PATIENT TREATMENT,” and PCT / US2022 / 025617, filed April 20, 2022, published as WO / 2022 / 226103, entitled “SURGICAL PROBE WITH INDEPENDENT ENERGY SOURCES,” the entire disclosures of which are incorporated herein by reference.

[0018] In some embodiments, improved positional accuracy is provided for placement of the energy source and the imaging probe. The energy source can include any suitable energy source, such as an electrode, a ring electrode, a laser source, a mechanical shears, a mechanical energy source, a radiant energy source, a thermal energy source, a vibrational energy source, an ultrasound probe, a cavitation ultrasound probe, a water jet, a variable pressure water jet, a pressure controlled water jet, a flow rate controlled water jet, a pulsatile pressure water jet, a fixed pressure water jet, a plasma, a vapor, a morcellator, a transurethral needle, a photoablation, a water jet evacuation. The energy source can be combined with other treatments and compounds, such as compounds for treatment, hemostasis, photochemotherapy or contrast agents for imaging. For example, the imaging probe can include any suitable probe, such as an endoscopic probe, a resectoscope probe, an ultrasound imaging probe, an A-scan ultrasound probe, a B-scan ultrasound probe, a Doppler ultrasound probe, a transrectal ultrasound probe, a transvaginal ultrasound probe, a longitudinal plane (e.g., sagittal plane) ultrasound imaging probe, a transverse plane ultrasound imaging probe, and a transverse and longitudinal (e.g., sagittal) plane ultrasound imaging probe.

[0019] The probe including the energy source and the imaging probe can be configured in a variety of ways, and each probe can include one or more fiducial points for determining the position and orientation of the respective probe.

[0020] While the present disclosure relates to treatment planning with insertion of a probe into a patient, the presently disclosed systems and methods are equally suitable for pre-treatment planning. In some embodiments, the treatment planning is performed without insertion of a probe into a patient, e.g., using images obtained prior to insertion of one or more of a treatment probe or an image probe into a patient.

[0021] While the present disclosure relates to imaging probes separate from treatment probes, the presently disclosed methods and apparatus are equally suitable for use with treatment probes that include imaging probes. In some embodiments, an imaging probe is located on a treatment probe, e.g. An example of an imaging device, such as an imaging array located on a rotating and translating treatment probe, is described in PCT / US2013 / 028441, filed February 28, 2013, entitled AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT, published as WO 2013 / 130895, the entire disclosure of which is hereby incorporated by reference.

[0022] Figure 1An exemplary embodiment of a system 400 for performing a treatment on a patient is shown. The system 400 can include a treatment probe 450 as described herein and an imaging probe 460 as described herein. The treatment probe 450 can be coupled to a first arm 442 and the imaging probe 460 is coupled to a second arm 444. One or both of the first arm 442 and the second arm 444 can include a robotic arm, movement of which can be controlled by one or more computing devices operably coupled to the arms. The treatment probe 450 can include a device for removing target tissue from a target site within a patient. The treatment probe 450 can be configured to deliver energy from the treatment probe 450 to the target tissue sufficient to remove the target tissue, and the energy from the energy source can include any suitable energy as described herein. For example, the treatment probe 450 can include an electrosurgical ablation device, a laser ablation device, a transurethral needle ablation device, a water jet ablation device, a steam ablation device, a high intensity focused ultrasound (HIFU) device, or any combination thereof. The imaging probe 460 can be configured to deliver energy from the imaging probe 460 to the target tissue sufficient to image the target tissue. For example, the imaging probe 460 can include an ultrasound probe, a magnetic resonance probe, an endoscope, or a fluoroscopy probe. The first arm 442 and the second arm 444 can be configured to be independently adjustable, adjustable according to a fixed relationship, adjustable according to a user-selected relationship, independently lockable, or simultaneously lockable, or any combination thereof. The first arm 442 and the second arm 444 can have multiple degrees of freedom (e.g., six degrees of freedom) to manipulate the treatment probe 450 and the imaging probe 460, respectively. The treatment system 400 can be used to perform tissue resection in an organ of a patient, such as a prostate of a patient. The patient can be positioned on a patient support 449, such as a bed, table, chair, or platform. The treatment probe 450 can be inserted into a target site of the patient along an entry axis coinciding with an elongate axis 451 of the treatment probe. For example, the treatment probe 450 can be configured for insertion into a urethra of the patient so as to position an energy delivery region of the treatment probe within a prostate of the patient. The imaging probe 460 can be inserted into the patient at a site at or adjacent to the target site of the patient along an entry axis coinciding with an elongate axis 461 of the imaging probe. For example, the imaging probe 460 can include a transrectal ultrasound (TRUS) probe configured for insertion into a rectum of the patient to view the prostate and surrounding tissue of the patient. As Figure 1As shown, the first arm 442 and the second arm 444 can be covered in a sterile drape to provide a sterile operating environment, keep the robotic arms clean, and reduce the risk of damaging the robotic arms. Further details regarding various components of the system 400 suitable for use in conjunction with embodiments as disclosed herein can be found in U.S. Patent No. 7,882,841, U.S. Patent No. 8,814,921, U.S. Patent No. 9,364,251, and PCT Publication No. WO2013 / 130895, the entire disclosures of which are incorporated herein by reference.

[0023] Figure 2 An embodiment of a system 400 for performing tissue resection within a patient is schematically illustrated. The system 400 can include a treatment probe 450 as described herein, and can optionally include an imaging probe 460. The treatment probe 450 is coupled to a control console 420 and a connection mechanism 430. The connection mechanism 430 can include one or more components of a robotic arm 442. The imaging probe 460 is coupled to an imaging control console 490. For example, the imaging probe can be coupled to a second robotic arm 444. The patient treatment probe 450 and the imaging probe 460 can be coupled to a common base 440. The patient is supported by a patient support 449. The treatment probe 450 is coupled to the base 440 by a first arm 442. The imaging probe 460 is coupled to the base 440 by a second arm 444. One or both of the first arm 442 and the second arm 444 can include robotic arms, movement of which can be controlled by one or more computing devices operably coupled to the arms, as described in further detail herein.

[0024] Although reference is made to a common base, the robotic arms can be coupled to a bed rail, a control console, or any suitable support structure for supporting a base of the robotic arms.

[0025] In some embodiments, the system 400 includes a user input device 496 coupled to the processor 423 for a user to manipulate a surgical instrument on the robotic arm. The user input device 496 can be located anywhere suitable (e.g., on a control console, on the robotic arm, on a mobile base), and there can be one, two, three, four, or more user input devices used in conjunction with the system 400 to provide redundant input pathways, unique input commands, or combinations. In some embodiments, the user input device includes a controller for moving an end of a therapy probe or an imaging probe in response to mechanical movement of the user input device. The end of the probe can be shown on the display 425, and the user can manipulate the end of the probe. For example, the user input device can include a 6 degree of freedom input controller, where the user is able to move the input device in 6 degrees of freedom, and the distal end of the probe moves in response to movement of the controller. In some embodiments, the 6 degrees of freedom include three translational degrees of freedom and three rotational degrees of freedom. For example, the processor can be configured with instructions for probe control to switch between automated image-guided therapy with an energy source and therapy with an energy source by the user moving the user input device.

[0026] The patient is placed on the patient support 449 so that the therapy probe 450 and the ultrasound probe 460 can be inserted into the patient. For example, the patient can be placed in one or more of a number of body positions, such as prone, supine, upright, or reclined. In some embodiments, the patient is placed in a lithotomy position, and a footrest can be used, for example. In some embodiments, the therapy probe 450 is inserted into the patient in a first direction on a first side of the patient, and the imaging probe is inserted into the patient in a second direction on a second side of the patient. For example, the therapy probe can be inserted into the urethra of the patient from an anterior side of the patient, and the imaging probe can be inserted into the intestines of the patient transrectally from a posterior side of the patient. The therapy probe and the imaging probe can be placed in the patient with one or more of urethral tissue, urethral wall tissue, prostate tissue, intestinal tissue, or intestinal wall tissue extending therebetween.

[0027] The therapy probe 450 and the imaging probe 460 can be inserted into the patient in one or more of a number of ways. During insertion, each of the first and second arms can include a substantially unlocked configuration such that the therapy or imaging probe can be desirably rotated and translated in order to insert the probe into the patient. When the probe has been inserted to a desired location, the arms can be locked. For example, in the locked configuration, the probes can be oriented relative to one another in one or more of a number of ways, such as parallel, skewed, horizontal, tilted, or non-parallel. As described herein, it can be helpful to determine the orientation of the probes with an angle sensor in order to map the image date of the imaging probe to the therapy probe coordinate reference. Mapping the tissue image data to the therapy probe coordinate reference space can allow for accurate positioning and treatment of tissue identified for treatment by an operator, such as a physician.

[0028] In some embodiments, the therapy probe 450 is coupled to the imaging probe 460 in order to align the therapy with the probe 450 based on images from the imaging probe 460. As shown, the coupling can be achieved through a common base 440. Alternatively or in combination, the therapy probe and / or the imaging probe can include magnets to hold the probes in alignment through the tissue of the patient. In some embodiments, the first arm 442 is a movable and lockable arm such that the therapy probe 450 can be positioned in a desired location in the patient. When the probe 450 has been positioned in the desired location of the patient, the first arm 442 can be locked with an arm lock 427. The imaging probe can be coupled to the base 440 through a second arm 444, which can be used to adjust the alignment of the imaging probe when the therapy probe is locked in place. For example, the second arm 444 can include a lockable and movable arm under the control of the imaging system or console and user interface. The movable arm 444 can be micro-actuatable such that the imaging probe 460 can be adjusted in small movements (e.g., on the order of a millimeter or so) relative to the therapy probe 450.

[0029] In some embodiments, the therapy probe 450 and the imaging probe 460 are coupled to angle sensors so that therapy can be controlled based on the alignment of the imaging probe 460 and the therapy probe 450. A first angle sensor 495 can be coupled to the therapy probe 450 through the support 438. A second angle sensor 497 can be coupled to the imaging probe 460. The angle sensors can include one or more of many types of angle sensors. For example, the angle sensors can include a goniometer, an accelerometer, and combinations thereof. In some embodiments, the first angle sensor 495 includes a 3 -dimensional accelerometer for determining the orientation of the therapy probe 450 in three dimensions. In some embodiments, the second angle sensor 497 includes a 3 -dimensional accelerometer for determining the orientation of the imaging probe 460 in three dimensions. Alternatively or in combination, the first angle sensor 495 can include a goniometer for determining the angle of the therapy probe 450 along the elongated axis 451 of the therapy probe. The second angle sensor 497 can include a goniometer for determining the angle of the imaging probe 460 along the elongated axis 461 of the imaging probe 460. The first angle sensor 495 is coupled to the controller 424 of the therapy console 420. The second angle sensor 497 of the imaging probe is coupled to the processor 492 of the imaging console 490. Alternatively or in combination, the second angle sensor 497 can be coupled to the controller 424 of the therapy console 420.

[0030] The console 420 includes a display 425 coupled to a processor system located in components for controlling the therapy probe 450. The console 420 includes a processor 423 with a memory 421. A communication circuit 422 is coupled to the processor 423 and the controller 424. The communication circuit 422 is coupled to the imaging console 490 via the communication circuit 494 of the imaging console. An arm lock 427 of the console 420 can be coupled to the first arm 442 to lock the first arm or allow the first arm to be freely movable to insert the probe 450 into a patient.

[0031] Optionally, the console 420 can include components of an endoscope 426 coupled to the anchor 24 of the therapy probe 450. The endoscope 426 can include components of the console 420 and an endoscope that can be inserted with the therapy probe 450 to treat a patient.

[0032] In some embodiments, the console 420 includes impedance sensor circuitry 220 coupled to the energy source to measure the impedance of tissue treated with energy from the energy source. In some embodiments, the energy source includes an electrode, and the electrode includes the impedance sensor. In some embodiments, the processor is configured with instructions to adjust the amount of energy from the energy source in response to the amount of impedance. In some embodiments, the processor is configured with instructions to adjust the amount of deflection of the extension and the amount of offset of the energy source relative to the elongated axis in response to the impedance.

[0033] In some embodiments, the console 420 includes force sensor circuitry 210 coupled to force sensors on the treatment probe. For example, a force sensor can be coupled to the extension to measure tissue resistance associated with deflection of the extension. In some embodiments, a force sensor is coupled to the linkage to measure tissue resistance associated with movement of the energy source away from the elongate axis. In some embodiments, a force sensor is coupled to the energy source to measure tissue resistance associated with positioning distance of the energy source from the elongate axis. In some embodiments, a force sensor is configured to measure tissue resistance associated with amount of energy delivery from the energy source.

[0034] Optionally, the console 420 can include one or more of the modules operatively coupled with the treatment probe 450 to control aspects of treatment with the treatment probe. For example, the console 420 can include one or more of the following: an energy source 22 for providing energy to the treatment probe, a balloon inflation control 26 for affecting inflation of a balloon used to anchor the treatment probe at a target treatment site, an infusion / irrigation control 28 for controlling infusion and irrigation of the probe, an aspiration control 30 for controlling aspiration of the probe, an insufflation control 32 for controlling insufflation of a target treatment site (e.g., a prostate) with a gas, or a light source 33 (such as an infrared light source, a visible light source, or an ultraviolet light source) for providing light energy to the treatment probe. For example

[0035] The processors, controllers, and control electronics and circuitry can include one or more of a number of suitable components, such as one or more processors, one or more field programmable gate arrays (FPGAs), and one or more memory storage devices. In some embodiments, the control electronics control a control panel of a graphical user interface (hereinafter “GUI”) to provide preoperative planning according to user-specified treatment parameters, as well as to provide user control of the surgical procedure.

[0036] The treatment probe 450 can include an anchor 24. The anchor 24 can anchor the distal end of the probe 450 when energy is delivered to the energy delivery region 20 by the probe 450.

[0037] ​The probe 450 can include any suitable number and configuration of energy sources. In some embodiments, the probe includes an energy source 250 that can be offset from the elongate axis 451 of the probe by an offset distance 252, for example, by deflection of the extension to treat tissue. Examples of suitable energy sources to treat and remove a volume of tissue by deflection, translation, and rotation are described in PCT / US2022 / 025617, filed April 20, 2022, entitled SURGICAL PROBE WITH INDEPENDENT ENERGY SOURCES, published as WO / 2022 / 226103 on October 27, 2022, the entire disclosure of which is previously incorporated herein by reference. Alternatively or in combination, the probe 450 can include an energy source 200, such as a nozzle, and the energy source 200 can include any suitable energy source as described herein, such as a directional energy source that emits energy along a path in a direction to selectively treat tissue. Examples of suitable energy sources to treat tissue with a directional energy source, such as a water jet, are described in PCT / US2015 / 048695, filed September 5, 2015, entitled PHYSICIAN CONTROLLED TISSUE RESECTION INTEGRATED WITH TREATMENT MAPPING OF TARGET ORGAN IMAGES, published as WO 2016037137, the entire disclosure of which is previously incorporated herein by reference.

[0038] The treatment probe 450 can be coupled to the first arm 442 by a connection mechanism 430. The connection mechanism 430 can include components to move the energy delivery region 20 to a desired target location of a patient, for example, based on an image of the patient. The connection mechanism 430 can include a first portion 432, a second portion 434, and a third portion 436. The first portion 432 can include a substantially fixed anchor portion. The substantially fixed anchor portion 432 can be fixed to a support 438. The support 438 can include a frame of reference for the connection mechanism 430. The support 438 can include a rigid chassis or frame or housing to rigidly and hardy couple the first arm 442 to the treatment probe 450. The first portion 432 can remain substantially fixed while the second and third portions 434, 436 can move to direct energy from the probe 450 to the patient. The first portion 432 can be fixed at a substantially constant distance 437 to the anchor 24. The substantially fixed distance 437 between the anchor 24 and the fixed first portion 432 of the connection mechanism allows for accurate placement of the treatment device. The first portion 432 can include a linear actuator to accurately position a second energy source, such as the high pressure nozzle 200, in the energy delivery region 20 at a desired axial location along the elongate axis 451 of the treatment probe 450. Additional actuators and connection mechanisms can be provided and operatively coupled to the processor to offset, rotate, and translate the first energy source 250 as described herein.

[0039] The elongated axis 451 of the treatment probe 450 generally extends between a proximal portion of the probe 450 proximate the connection mechanism 430 to the distal end having the anchor 24 attached thereto. The third portion 436 can control the angle of rotation 453 about the elongated axis 451. The distance 439 between the energy delivery region 20 and the first portion 432 of the connection mechanism can vary with reference to the anchor 24 during treatment of the patient. The distance 439 can be adjusted in response to computer control with translation 418 of the probe to set a target position along the elongated axis 451 of the treatment probe. In some embodiments, the first portion of the connection mechanism remains fixed while the second portion 434 adjusts the position of the energy delivery region 20 along the axis 451. The third portion 436 of the connection mechanism adjusts the angle 453 about the axis in response to the controller 424 so that the distance along the axis at the treatment angle can be controlled very accurately with reference to the anchor 24. The probe 450 can include a rigid member such as a spine that extends between the support 438 and the anchor 24 so that the distance from the connection mechanism 430 to the anchor 24 remains substantially constant during treatment. The treatment probe 450 is coupled to a treatment component as described herein to allow treatment with one or more forms of energy such as mechanical energy from a jet, electrical energy from an electrode, or light energy from a light source such as a laser source. The light source can include infrared light, visible light, or ultraviolet light. The energy delivery region 20 can be moved under the control of the connection mechanism 430 to deliver the intended form of energy to the target tissue of the patient.

[0040] The imaging console 490 can include a memory 493, communication circuitry 494, and a processor 492. The processor 492 in the corresponding circuitry is coupled to the imaging probe 460. The arm controller 491 is coupled to the arm 444 to precisely position the imaging probe 460. The imaging console can further include a display 425.

[0041] To facilitate precise control of the treatment probe and / or the imaging probe during treatment of the patient, one or more treatment probes or imaging probes can be coupled to a computer controllable robotic arm. For example, with reference to Figure 2The system 400 shown, one or both of the first arm 442 coupled to the therapy probe 450 and the second arm 444 coupled to the imaging probe 460 as described herein can comprise a computer-controlled robotic arm. The robotic arm can be operably coupled with one or more computing devices configured to control movement of the robotic arm. For example, the first robotic arm 442 can be operably coupled with the processor 423 of the console 420, or the second robotic arm 444 can be operably coupled with the processor 492 of the imaging console 490 and / or the processor 423 of the console 420. The one or more computing devices, such as the processors 423 and 492, can comprise computer-executable instructions for controlling movement of the one or more robotic arms. The first and second robotic arms can be substantially similar in construction and function, or they can differ to suit particular functional requirements for controlling movement of the therapy probe and the imaging probe.

[0042] The robotic arms can comprise 6 or 7 or more joints to allow movement of the arms under computer control. Suitable robotic arms are commercially available from several manufacturers, such as RoboDK, Inc., Kinova, Inc., and several others.

[0043] The one or more computing devices operably coupled to the first and second robotic arms can be configured to automatically control movement of the therapy probe and / or the imaging probe. For example, the robotic arms can be configured to automatically adjust the position and / or orientation of the therapy probe and / or the imaging probe during treatment of the patient according to one or more preprogrammed parameters. The robotic arms can be configured to automatically move the therapy probe and / or the imaging probe along a pre-planned or programmed therapy or scan profile that can be stored on a memory of the one or more computing devices. In alternative or in addition to automatic adjustment of the robotic arms, the one or more computing devices can be configured to control movement of the therapy probe and / or the imaging probe in response to user input (e.g., through a graphical user interface of the therapy device). In alternative or in addition to automatic adjustment of the robotic arms, the one or more computing devices can be configured to control movement of the therapy probe and / or the imaging probe in response to real-time localization information (e.g., in response to anatomical structures identified in one or more images captured by the imaging probe or other imaging source from which a permissible range of motion of the therapy probe and / or the imaging probe can be established) and / or position information of the therapy probe and / or the imaging probe from one or more sensors coupled to the probes and / or the robotic arms.

[0044] Figure 3A , Figure 3B and Figure 3C show a top view, a longitudinal (e.g., sagittal) view, and a perspective view, respectively, of a probe arrangement for use in tissue treatment. In particular, Figure 3A , Figure 3B and Figure 3CThe relative arrangement is illustrated, including the position and orientation of the treatment probe 450 relative to the position and orientation of the imaging probe 460, for treating tissue (such as prostate tissue). The imaging probe 460 can be configured to generate lateral images (such as lateral ultrasound image 310) and one or more longitudinal images (such as one or more longitudinal (e.g., sagittal) ultrasound images 320). In some embodiments, the energy source of the treatment probe 450 is moved by a rotation angle 453 and a translation 418, such that the tissue to be treated and the energy source are within the field of view of the imaging probe 460.

[0045] like Figure 3A As shown in the top view, the treatment probe axis 451 and the imaging probe axis 461 are positioned in a substantially coplanar configuration, such that the imaging probe and the treatment probe extend along a common plane. Figure 3B Top view and Figure 3C As shown in the perspective view, the treatment probe axis 451 and the imaging probe axis 461 are positioned in a substantially coplanar and non-parallel configuration, such that the imaging probe and the treatment probe extend substantially along a common plane. This allows the imaging probe to image the treatment probe along the length of translation 418 with one or more longitudinal images (e.g., real-time longitudinal images, such as real-time sagittal images). In some embodiments, the treatment probe and the imaging probe are arranged in a substantially coplanar configuration, and the ultrasound probe is rotated to rotate the longitudinal (e.g., sagittal) field of view of the imaging probe so as to image the treatment probe along the length of the longitudinal field of view. (Refer again) Figure 3A For example, the imaging probe 460 can be rotated by an angle 336 around the elongated axis 461 to align with the treatment probe 450, thereby aligning the longitudinal field of view of the imaging probe with the elongated axis 451 of the treatment probe in the longitudinal field of view.

[0046] One or more of the treatment probes or imaging probes can be moved to adjust the alignment between the imaging probe and the treatment probe. In some embodiments, the proximal portion of the treatment probe is moved from a first position to a second position. (See again) Figure 3B This allows the treatment probe 450 to be moved from a first position 332 to a second position 334 to adjust the alignment between the probes, for example, based on data from one or more reference points as described herein.

[0047] In some embodiments, the imaging probe 460 and the treatment probe 450 are aligned to be substantially coplanar with each other within an error range, such that the imaging probe 460 can image the treatment probe 450 and the energy source of the treatment probe during treatment, for example, where the treatment probe is located within the field of view (e.g., longitudinal (e.g., sagittal) image field of view) of the imaging probe. In some embodiments, the treatment probe is aligned with the imaging probe such that the treatment probe is visible along the length of the longitudinal (e.g., sagittal) view of the imaging probe.

[0048] In some embodiments, for example, the imaging probe 460 and the therapy probe 450 can be slightly misaligned (e.g., beyond an error margin) such that the therapy probe can disappear from a portion of a longitudinal (e.g., sagittal) image because a portion of the imaging probe extends beyond the longitudinal (e.g., sagittal) field of view. In some embodiments, this can result in the imaging probe 460 not imaging a portion of the therapy with a longitudinal (e.g., sagittal) image. In some embodiments, the therapy probe 450 and the imaging probe 460 can be arranged in a substantially skewed orientation (e.g., beyond the error margin) as described herein such that the therapy probe extends outside the longitudinal (e.g., sagittal) field of view of the imaging probe but is within the field of view of a transverse image of the imaging probe. In such embodiments, the therapy can be monitored in real-time with a transverse image, where the imaging probe is moved to maintain the energy source and tissue being treated simultaneously within the transverse field of view of the imaging probe. In some embodiments, the transverse view of the tissue and energy source can reduce the sensitivity of the alignment between the two probes, and the imaging probe can be moved (e.g., in synchronization) with the energy source to image the tissue and energy source during therapy.

[0049] Figure 3D The therapy probe axis 451 and the imaging probe axis 461 are shown as being tilted at an angle 330 with respect to each other such that the therapy probe and the imaging probe do not extend along a common plane. This tilt angle can be reduced by adjusting the therapy probe or the imaging probe or both. The acceptable amount of tilt can depend on several factors, such as the field of view of the imaging probe, the length of the tissue being treated by one or more of rotating or translating the energy source. In some embodiments, for example, the error margin for the tilt angle is any of no more than 10 degrees, no more than 5 degrees, no more than 3 degrees, no more than 2 degrees, or no more than 1 degree. In some embodiments, the error margin for the alignment corresponds to the longitudinal (e.g., sagittal) field of view of the imaging probe and the tilt angle between the imaging probe and the therapy probe. When the alignment of the therapy probe and the imaging probe is within the error margin, the therapy probe is within the longitudinal (e.g., sagittal) field of view along the length of the translation of the therapy, and can be viewed in one or more real-time longitudinal (e.g., sagittal) images along the length of the longitudinal (e.g., sagittal) field of view. When the alignment of the therapy probe and the imaging probe is beyond the error margin, a portion of the therapy probe is outside the longitudinal (e.g., sagittal) field of view, and can disappear from a portion of the image along the length of the longitudinal (e.g., sagittal) field of view. In such embodiments, the therapy can be viewed in real-time using transverse imaging as described herein.

[0050] Figure 4AA top view of the transverse image planes relative to the axis of the therapy probe is shown. In some embodiments, the axis 451 of the imaging probe 450 includes a non-coplanar orientation relative to the elongate axis 461 of the imaging probe, such as with an oblique angle 330. In some embodiments, the transverse images 310 include a plurality of transverse images, such as a first transverse image 312, a second transverse image 314, and a third transverse image 316.

[0051] In some embodiments, the position of the therapy probe varies in the plurality of transverse images. The degree of probe position variation can be related to the non-parallel angle between the therapy probe and the imaging probe, such as the oblique angle 330. In some embodiments, the therapy probe 450 extends through the plane of the first transverse image 312 at a first position 313, through the plane of the second transverse image 314 at a second position 315, and through the plane of the third transverse image 316 at a third position 317. In some embodiments, the oblique angle 330 causes the lateral position of the therapy probe to vary in the transverse images 330, such as the pixel column position of the transverse images.

[0052] Figure 4B A three-dimensional view of the transverse images 310 and the corresponding planes of the transverse images relative to the therapy probe 450 is shown.

[0053] Figure 4CA longitudinal (e.g., sagittal) image 320 of the therapy probe 450 is shown. In some embodiments, the axis 451 of the therapy probe 450 extends at an angle 335 relative to the elongate axis 461 of the imaging probe. In some embodiments, the angle 335 corresponds to the angle of the axis 451 of the therapy probe 450 along the longitudinal (e.g., sagittal) plane of the image. This angle can cause the therapy probe to appear tilted in the longitudinal (e.g., sagittal) image, e.g., the position of the probe 450 changes in the transverse image 310. In some embodiments, the therapy probe is sufficiently co-planar with the imaging probe such that even though the position of the probe changes along the longitudinal (e.g., sagittal) image 320 and the corresponding transverse image 310, the therapy probe remains within the longitudinal (e.g., sagittal) field of view along the length of the longitudinal (e.g., sagittal) field of view of the imaging probe. In some embodiments, the angle 335 causes the vertical position of the therapy probe to change in the transverse image 310, such as the pixel row position in the transverse image. In some embodiments, the therapy probe 450 shown in the longitudinal (e.g., sagittal) image extends through the plane of the first transverse image 312 at a first position 313, through the plane of the second transverse image 314 at a second position 315, and through the plane of the third transverse image 316 at a third position 317. Although reference is made to a therapy probe angled relative to the imaging probe, in some embodiments, e.g., the angle 335 corresponds to the 3D vector projection of the therapy probe axis onto the longitudinal (e.g., sagittal) image plane of the field of view. In some embodiments, the angle of tilt 330 corresponds to the 3D vector projection of the therapy probe axis onto a plane perpendicular to the longitudinal (e.g., sagittal) image plane of the field of view.

[0054] In some embodiments, the position of the probe in the transverse images can be used to determine one or more of a three-dimensional position or a three-dimensional orientation of the therapy probe relative to the imaging probe. In some embodiments, a two-dimensional position of the probe 451 is determined in each of a plurality of transverse images, and these two-dimensional positions are used to determine a three-dimensional orientation of the therapy probe relative to the imaging probe. The two-dimensional position of the probe in each transverse image can include any suitable two-dimensional position, such as an X and Y position or a pixel position (e.g., a pixel row position and a pixel column position in each image). In some embodiments, e.g., the 3D orientation of the therapy probe relative to the imaging probe includes a 3D vector representation of the orientation.

[0055] The three-dimensional orientation of the therapy probe can be used to facilitate therapy planning, for example by generating rotated transverse images. Rotation of the image data set can also be used to generate one or more rotated longitudinal images, for example one or more rotated sagittal images. One or more longitudinal images can be rotated such that the position of the therapy probe remains substantially fixed along the one or more longitudinal images and the plurality of transverse images. In some embodiments, the rotated longitudinal images and transverse images are generated from a 3D tomographic image data set, such as a Digital Imaging and Communications in Medicine (DICOM) image data set, by selecting the planes of the plurality of transverse images and the one or more longitudinal images by generating images along planes oriented at an angle relative to the X, Y, and Z planes of the 3D tomographic image data set.

[0056] Figure 5 A rotated transverse image 510 is shown, which corresponds to the transverse image 310 that has been rotated to compensate for the angle of inclination 330 between the elongate axis of the therapy probe and the imaging probe. In some embodiments, the three-dimensional orientation of the therapy probe relative to the imaging probe can be used to rotate the transverse images such that the rotated transverse image plane is substantially perpendicular to the elongate axis 451 of the therapy probe 450, for example, within a perpendicular deviation of one or more of, for example, 5 degrees, 3 degrees, 2 degrees, 1 degree, 0.5 degrees, or 0.25 degrees. One or more longitudinal images, such as one or more sagittal images, can similarly be rotated to compensate for the angle 335. In some embodiments, the transverse image 310 and the one or more longitudinal images 320 comprise images of a 3D image data set, such as a Digital Imaging and Communications in Medicine (DICOM) image. The 3D vector orientation of the therapy probe relative to the imaging probe can be used to rotate the transverse images and the one or more longitudinal images such that the position of the therapy probe remains substantially fixed in the transverse images, which can facilitate therapy planning as described herein. In embodiments, for example, rotation of the 3D image data set results in the probe appearing at a substantially fixed height in the one or more longitudinal images, such as one or more sagittal images.

[0057] Figures 6A to 6C A user interface 600 and transverse images are shown, in which the movement of the probe position in the transverse images is shown, which can be related to the orientation of the therapy probe relative to the imaging probe. Figure 6A A transverse image 312 is shown, along with the position 313 of the therapy probe 450 in the image. Figure 6B A transverse image 314 is shown, along with the position 315 of the therapy probe in the image. Figure 6C A transverse image 316 is shown, along with the position 317 of the therapy probe in the image. As can be seen from the images, the position of the probe has changed in the transverse images. The position of the probe in the transverse images can be used to determine the orientation of the therapy probe relative to the imaging probe, as described herein.

[0058] In some embodiments, the markers 650 are used to identify the location of the probe in one or more of the transverse images. In some embodiments, a marker is shown on each of the plurality of transverse images. In some embodiments, a first marker 652 is shown at a first location of a first transverse image, such as location 353 of transverse image 312, a second marker 654 is shown at a second location of a second transverse image, such as location 355 of transverse image 314, and a third marker 656 is shown at a third location of a third transverse image, such as location 317 of transverse image 316.

[0059] In some embodiments, the artificial intelligence algorithm is configured to identify the location of the probe and utilize a marker corresponding to the location of the probe to identify the probe. The marker can include any suitable marker, such as a line, a flag, a series of flags, a reticle, a crosshair, or a geometric shape such as a triangle or a polygon (e.g., a square). In some embodiments, the user interface is configured to allow the user to adjust the location of the marker, for example after reviewing the initial location determined utilizing the algorithms described herein.

[0060] In some embodiments, the user interface 600 is configured to show the images on the display 425 in response to user input. In some embodiments, the user interface 600 is configured to show a scan plane 610 with associated user input 612 for the user to select one or more longitudinal (e.g., sagittal) plane images, and associated user input 614 for the user to select transverse images. In some embodiments, the user interface 600 includes a plurality of user selectable inputs 620 for the user to select a transverse image to view on the display. For example, the plurality of user selectable inputs 620 can include a separate input for each plane, such as a user selectable button, tab, or drop down menu. In some embodiments, a first user selectable input 622 corresponds to a first transverse image 312 along a first plane, a second user selectable input 624 corresponds to a second transverse image 314 along a second plane, a third user selectable input 626 corresponds to a third transverse image 316 along a third plane, a fourth user selectable input 628 corresponds to a fourth transverse image along a fourth plane, and a fifth user selectable input 629 corresponds to a fifth transverse image along a fifth plane.

[0061] In some embodiments, the first user input 622 corresponds to the intraprostatic prostatic protrusion (IPP), the second user input 624 corresponds to the bladder neck (BL), the third user input 626 corresponds to the mid-prostate (MID), the fourth user input 628 corresponds to the verumontanum (VERU), and the fifth user input 629 corresponds to the peripheral sphincter (P.SPH). Although reference is made to anatomical landmarks of the prostate, the user selectable inputs can correspond to any anatomical structure.

[0062] Although reference is made to five user inputs and five corresponding transverse images along corresponding planes, the number of inputs and corresponding images can include any suitable number, such as two user selectable inputs corresponding to a first transverse image and a second transverse image. Alternatively, more than five user selectable inputs and transverse images can be used.

[0063] Figure 7A A user interface 700 is shown with a three-dimensional view 710 for three-dimensional treatment planning. In some embodiments, an animation of a treatment probe 450 is overlaid on a plurality of 2D images, such as 2D ultrasound images, which are arranged in a 3D digital environment, allowing the images to be viewed in a 3D perspective. In some embodiments, the user interface is configured to allow a user to select a certain image from the plurality of images to maximize the view of the selected image in another view. The plurality of 2D images can include a plurality of transverse images 310 arranged along one or more longitudinal images, such as one or more sagittal images 320. In some embodiments, each of the plurality of transverse images 310 is located along the one or more longitudinal images, such as the one or more sagittal images 320, at a location corresponding to an intersection of the transverse image and the one or more longitudinal (e.g., sagittal) images, such as an intersection in the 3D dataset. In some embodiments, the user interface 700 is configured to allow a user to select an image to maximize the view of the image (e.g., by clicking on the image) and provide a magnified view of the image. For example, a user can select one or more longitudinal (e.g., sagittal) images or a transverse image to view the selected image in a magnified view.

[0064] In some embodiments, an AI algorithm is used to identify tissue structures and develop a 3D treatment plan, such as the 3D treatment contours described herein.

[0065] For example, the treatment contours 730 can include animated treatment contours that allow a user to view the treatment contours from different perspectives, angles, and images. In some embodiments, the user is provided with controls for one or more operations of zooming, panning, or rotating the perspective view. In some embodiments, the treatment contours 730 include animated treatment contours that match one or more operations of zooming, panning, or rotating the perspective view, maintaining the alignment of the treatment contours with the plurality of images. This approach can allow a user to view the treatment contours and their relationship to the corresponding tissue from any suitable perspective. In some embodiments, the animated treatment contours are configured to generate a simulation of the treatment with movement of the energy source and enlargement of the treatment tissue volume, similar to a movie simulating the treatment.

[0066] In some embodiments, user interface 700 is configured for a user to adjust a treatment contour, and the treatment contour is automatically updated and shown on the stereogram and other selected images, e.g., simultaneously and in real time. The user interface can include an input 755, such as a visible icon that a user can drag to change the position of the treatment contour. In some embodiments, user interface 700 is configured with an input 755, such as a 3D input, for a user to adjust the treatment contour shown in the 3D view. In some embodiments, when the treatment contour is adjusted in one of the views with user input, the treatment contour is automatically updated in the other views, e.g., simultaneously, so that the user can evaluate the changes to the treatment contour from more than one perspective. In some embodiments, the treatment contour includes a plurality of curves, such as splines, that are updated and shown together on the different views.

[0067] Figure 7B A longitudinal view, e.g., a sagittal view, 720 is shown for three-dimensional treatment planning. In some embodiments, a longitudinal treatment contour, such as a sagittal treatment contour 732, is superimposed on one of the one or more longitudinal images, such as one of the one or more sagittal images 320. While user interface 700 can be configured in a variety of ways, in some embodiments, for example, a longitudinal view 720 and a 3D stereogram 710 are presented to the user. In some embodiments, the user interface is configured for a user to select an image from one or more longitudinal, e.g., sagittal, images 320 in the stereogram and provide a longitudinal, e.g., sagittal, view of the image, as shown, for example, in FIG. 7B. Figure 7B

[0068] In some embodiments, the 3D treatment contour 730 is updated in response to user input, such as 3D user input, and the corresponding sagittal treatment contour 732 and transverse treatment contour 734 of the 3D treatment contour are updated in the corresponding views, such as the longitudinal views and transverse views described herein. For example, a longitudinal, e.g., sagittal, treatment contour 732 can be updated by user input 755 on 3D view 710 to move the longitudinal treatment contour 732 from a first longitudinal treatment contour to a second longitudinal treatment contour 782, and the updated treatment contour will be shown in the other views, such as the longitudinal, e.g., sagittal, view shown in FIG. 7B. Similarly, the 3D treatment contour 730 can be adjusted in the longitudinal, e.g., sagittal, view 720 from a first longitudinal treatment contour 732 to a second longitudinal, e.g., sagittal, treatment contour 782, and the updated treatment contour is shown in 3D view 710. For example, the treatment contour in the transverse view can be similarly adjusted, updated, and shown in the 3D view and the longitudinal, e.g., sagittal, view. Figure 7B

[0069] ​​The one or more longitudinal images 320 shown in the 3D view can be configured in a variety of ways and can include any suitable number of longitudinal images, such as a single longitudinal image or multiple longitudinal images. For example, the one or more longitudinal images can include one or more sagittal images or parasagittal images. In some embodiments, the user interface 700 is configured to receive user input identifying a selected image from the one or more longitudinal images 320 and the plurality of transverse images shown in the 3D view and display the selected image in a 2D view.

[0070] In some embodiments, the one or more longitudinal images includes a plurality of longitudinal images. In some embodiments, the user interface 700 is configured to allow a user to select one or more longitudinal images 320 from the plurality of longitudinal images. In some embodiments, the user interface 700 is configured to allow a user to select a longitudinal image in the 3D view. For example, the user interface 700 can be configured to allow a user to select a longitudinal image using a pointing device or touching the image on a touch screen display, as described herein. Alternatively or in combination, the plurality of inputs 620 can include a plurality of inputs corresponding to the plurality of longitudinal images. Alternatively or in combination, the user input 724 can include a plurality of inputs configured to allow a user to select a plurality of longitudinal images for display in a plurality of 2D views.

[0071] While the plurality of longitudinal images can be generated in a variety of ways, in some embodiments, the plurality of longitudinal images is generated from a 3D volume image of the tissue, as described herein.

[0072] In some embodiments, the plurality of longitudinal images is generated in response to a plurality of angles of an energy source for treating the tissue. In some embodiments, the 3D treatment profile 730 corresponds to a plurality of rotations and translations of the energy source on the probe 450 as described herein, and at least one of the plurality of longitudinal angles corresponds to a rotational angle of the energy source.

[0073] Figure 7C and Figure 7D A plurality of rotational angles relative to the treatment probe are shown that can be used to generate a plurality of longitudinal images. The plurality of longitudinal images can include longitudinal images corresponding to rotational angles of the energy source of the treatment probe 450 about the axis 451. For example, the 3D view can include a first longitudinal image 320a in the one or more images 320 corresponding to a first rotational angle 770 of the energy source and a second longitudinal image 320b corresponding to a second rotational angle 772 of the energy source, as shown in Figure 7B

[0074] In some embodiments, the plurality of longitudinal images includes a first longitudinal image 320a along a first portion 732a of the treatment profile and a second longitudinal image 320b along a second portion 732b of the treatment profile.​

[0075] In some embodiments, the arrangement in the 3D view shows a portion of a first longitudinal image along a first portion of the treatment contour and a portion of a second longitudinal image along a second portion of the treatment contour. In some embodiments, image 320b is placed in the 3D view 710 at an angle 772 and image 320a is also shown in the 3D view 710 at an angle 770. The user can select which longitudinal images to show in the 3D view with a user interface as described herein. The plurality of longitudinal images can include any suitable number of images and can include at least 3 longitudinal images each at a different rotational angle relative to the elongate axis of the treatment probe.

[0076] In some embodiments, the first longitudinal image includes a first transparency along the first portion of the treatment contour and a second transparency along the second portion of the treatment contour that is greater than the first transparency to increase visibility of the second longitudinal image along the second portion. In some embodiments, the second longitudinal image includes a first transparency along the first portion of the treatment contour and a second transparency along the second portion of the treatment contour, the first transparency being greater than the second transparency to increase visibility of the first longitudinal image along the first portion of the treatment contour.

[0077] In some embodiments, AI algorithms are used to process image data and identify one or more anatomical tissue structures and provide indicia on the one or more anatomical tissue structures in one or more views shown on the user interface, such as on longitudinal (e.g., sagittal) views and transverse views. In some embodiments, indicia, such as indicia 750, are shown on one or more transverse images 310 of the 3D volume and indicia 750 can be shown on the corresponding transverse view. In some embodiments, for example, indicia corresponding to one or more anatomical tissue structures, such as indicia 760, are shown on one or more longitudinal views 720 of one or more longitudinal images, such as one or more sagittal images 320. Indicia 750 and indicia 760 can generally include any suitable alteration to pixels superimposed on the images, such as one or more of highlighting, dashed lines, lines, icons, or other features, to indicate contours identified with the AI algorithms.

[0078] In some embodiments, multiple views are shown simultaneously on the user interface, for example Figure 7A a 3D volume and Figure 7B one or more longitudinal views. Alternatively or in combination, the 3D volume can be shown with one or more transverse views. Figure 7AThe multiple views can be arranged in any suitable manner, such as side-by-side configuration, or view-within-view configuration. In some embodiments, each user-selectable view is shown in a pop-up window, which the user can move, resize, or close, for example.

[0079] In some embodiments, the user interface 700 includes an input 712 for the user to select a three-dimensional view and an input 724 for the user to select one or more longitudinal views, such as one or more sagittal views 720, and a treatment profile, such as a 3D treatment profile 730, is superimposed on the images. In some embodiments, the 3D treatment profile includes multiple transverse treatment profiles 734 and one or more longitudinal (e.g., sagittal) profiles 732, which can be superimposed on corresponding images. For example, the user interface 700 can include one or more features of the user interface 600.

[0080] In some embodiments, the images shown in the user interface 700 include rotated images, such as images from a rotated 3D image, where the images have been rotated in response to the orientation between the imaging probe and the treatment probe, as described herein. Alternatively, the images can include unrotated images, such as unrotated 3D images.

[0081] Figure 8A A first transverse view 742 for a three-dimensional treatment plan at a first depth of the three-dimensional treatment profile 730 is shown. The first transverse view 742 can include a view of a plurality of user-selectable transverse views. In some embodiments, the first transverse view 742 corresponds to a transverse image of the IPP of the prostate, although the first view can include any transverse view at any suitable depth of any suitable tissue. The user interface 700 can include a plurality of inputs for the user to adjust the 3D treatment profile from the transverse view. The inputs can include a first two-dimensional input 812 to adjust a first side of the transverse treatment profile 734, and a second user input 814 to adjust a second side of the transverse treatment profile. The user interface can be configured to provide information related to the treatment profile, such as a depth 820 of the treatment profile 734 from the probe, and an angle 822 of the treatment profile, which can correspond to an angular sweep angle of the energy source along the tissue during treatment. In some embodiments, the treatment profile includes an angular opening, such as an angular opening line of the angle of the treatment profile relative to the axis 451, which can correspond to the position of the energy source during treatment. Although reference is made to an angular treatment profile with a corresponding radius, the treatment profile can include other shapes as described herein.

[0082] In some embodiments, other views are updated in response to adjustments to the treatment profile, as described herein. For example, input 814 can be used to adjust the treatment profile 734 from the first position to a second position 816 or a third position 818, and other views (besides the 3D view) are automatically updated, e.g., substantially contemporaneously and in real-time, e.g., within a few seconds.

[0083] Figure 8B A second lateral view 744 is shown for a three-dimensional treatment plan at a second depth of the three-dimensional treatment profile. In some embodiments, the first lateral view 742 and the second lateral view 744 include images in a plurality of user-selectable views, such as the user-selectable lateral views described herein. In some embodiments, the second view corresponds to a lateral image of the MID prostate at a different depth than the first depth, although the second view can include any lateral view at any suitable depth. In some embodiments, the second view includes a different view than the first view at a different depth than the first depth. The second lateral view 744 can include a user interface similar to the user interface shown in FIG. 8B for adjusting the treatment profile 734, and other views will be automatically updated, as described herein. Figure 8A

[0084] Figure 9A A lateral view of the probe 450 and a plurality of rotation angles 932 of the energy source 200 on the probe are shown for directing the energy source 200 at the tissue 910 for treatment at different depths according to a treatment plan. In some embodiments, the 3D treatment plan is determined from a plurality of lateral images, where the angle and treatment depth from each of the plurality of lateral images are combined to generate the 3D treatment plan. The plurality of rotation angles 932 can be referenced relative to a reference 930, which can include a fixed reference, such as a horizontal or vertical reference. While the treatment plan can be determined in a variety of ways, in some embodiments, the plurality of rotation angles 932 can be evaluated with a plurality of projections 940 from the probe at the plurality of angles 932. In some embodiments, the projections correspond to angles of the directional energy source 200 that can be rotated relative to the probe axis 451. The plurality of projections 420 can include any suitable number of projections, such as a first projection 942, a second projection 944, a third projection 946, a fourth projection 947, a fifth projection 968, and a sixth projection 969. While various aspects of the treatment plan and planning are described with reference to projections, those of ordinary skill in the art will appreciate that the treatment angles and depths as described herein can be determined in a variety of ways.

[0085] ​In some embodiments, the angular width and thickness of the tissue are determined at a plurality of angles 932 of the treatment probe 450, e.g., at a plurality of angles of a directional energy source such as a nozzle, a light beam, or other energy source as described herein. In some embodiments, the thickness of the tissue to be treated is determined with respect to the angular coordinates of the treatment probe. In some embodiments, the width of the tissue in the lateral view includes the angular width, such as the angular width between the first angle 934 and the second angle 936. In some embodiments, the first angle 932 corresponds to a projection such as the projection 944, and the second angle 926 corresponds to a projection such as the projection 948. In some embodiments, the treatment plan is configured to treat the tissue between the first treatment angle 934 and the second treatment angle 936, e.g., not to treat the tissue outside of these angles at the translational position corresponding to the image, which can reduce interaction with the second tissue 420.

[0086] In some embodiments, the thickness profile includes the thickness at each of the plurality of angles, and the thickness profile can be used to formulate a treatment plan. In some embodiments, the treatment plan is configured to selectively direct energy from the energy source to the tissue at the corresponding angles according to the depth of the tissue. In some embodiments, the treatment plan is configured to not direct energy to the tissue at the angles corresponding to zero thickness, which can reduce interaction of the energy source with the second tissue, e.g., the second tissue 920.

[0087] In some embodiments, the thickness includes the distance through the tissue at the corresponding angle. For example, the thickness can include the distance between the first location 962 and the second location 964 at the corresponding angle, such as the angle corresponding to the second projection 944. In some embodiments, the first distance from the treatment probe 450 to the first location 962 and the second distance from the treatment probe 450 to the second location 964 are used to determine the treatment plan. In some embodiments, the first location 962 and the second location 964 include a first location of the boundary 912 whose outer surface faces the probe at the corresponding angle and a second location of the boundary 912 whose outer surface faces away from the probe at the corresponding angle. In some embodiments, the tissue 910 is located a distance from the probe, e.g., the first location 962 of the boundary 912 is located a distance from the probe. In some embodiments, a gap extends between the treatment probe and the boundary, and the gap can include a body fluid such as urine as described herein.

[0088] In some embodiments, data related to the projections 940 of the energy source at multiple angles can be used to generate a treatment plan, and can be adjusted to more accurately treat tissue, for example to remove tissue, for example by tissue resection or ablation. In some embodiments, a first edge 952 of the tissue boundary 910 is determined relative to the treatment probe 450, and a second edge 954 of the tissue 910 is determined relative to the treatment probe. In some embodiments, a first edge 952 of the tissue boundary 912 is determined relative to the treatment probe 450, and a second edge 954 of the boundary 912 is determined relative to the treatment probe. In some embodiments, the first edge 952 and the second edge 954 are located on opposite sides of the region 914 of the tissue 910. For example, the first edge 952 can be located on a first side 916 of the region 914, and the second edge 954 can be located on a second side 918 of the region 914.

[0089] In some embodiments, an angle of a treatment plan is determined in response to an angle of the boundary. In some embodiments, the angle of the treatment plan is configured to provide a tissue edge proximate to the boundary. In some embodiments, the treatment plan is configured to adjust a treatment angle to limit treatment from extending beyond the first boundary edge 952 and the second boundary edge 954. In some embodiments, a user interface is configured to provide a notification to a user in the event that the treatment plan extends beyond the angular boundary, for example in the event that the treated tissue is adjacent to untreated tissue. In some embodiments, the tissue edge is located beyond an outer portion of the region to be treated. Alternatively or in combination, the treatment plan can be configured to treat tissue at the boundary of the tissue, for example when it is beneficial to completely remove the treated tissue. In some embodiments, the treatment plan is configured to treat tissue along a first portion of the treatment up to the tissue boundary, and to provide a tissue edge along a second portion of the treatment.

[0090] While the first boundary edge 952 and the second boundary edge 954 can be determined in a variety of ways, in some embodiments, for example, the location of the first boundary edge 952 corresponds to a first projection (such as the projection 942) that intersects the boundary 912 at a point in a tangential manner to define the boundary edge 952, and the second boundary edge 954 corresponds to a second projection (such as the projection 948) that intersects the boundary 912 at a point in a tangential manner to define the boundary edge 954. In some embodiments, for example, the first boundary edge is defined by a first angle at which a projection of the first angle intersects the boundary on a first side in a tangential manner, and the second boundary edge is defined by a second angle at which a projection of the second angle intersects the boundary 912 on a second side in a tangential manner.

[0091] In some embodiments, for example, the probe 450 is visible on a corresponding image, such as the lateral image 312, and the image can be shown on the display 425 of the user interface 700. The view shown on the display can include any of the user-selectable views described herein, for example, the IPP view 742.

[0092] In some embodiments, the image of the tissue 910 to be treated includes a boundary 912. The boundary 912 can be identified with an AI algorithm as described herein, or identified by a user, and by a combination thereof. In some embodiments, for example, the tissue 910 is located near a second tissue 920, which can include a different anatomical structure than the tissue 910 and can include tissue of a different organ as described herein. For example, the second tissue 920 can include an identifiable boundary 922 along a surface that can be oriented toward the first tissue. The boundary 912 can be identified in a variety of ways as described herein, for example, with an AI algorithm, identified by a user of the system, and by a combination thereof. In some embodiments, the boundary 912 defines a region 914 of the tissue to be treated, and the region 914 can include a first side 916 and a second side 918 that are generally disposed on opposite sides of the region 914 to be treated. In some embodiments, the boundary 912 encloses the region 914 to be treated. Each of the above-described boundaries can be identified with an AI algorithm, and the identified boundaries can be shown on a display by superimposing the boundaries on an image, for example, by modifying pixels along the boundaries, such as with pixels of a different color.

[0093] In some embodiments, the treatment plan is configured to treat the tissue 910 according to an angular tissue depth profile that includes a plurality of tissue depths at a plurality of angles. The treatment plan can be configured to adjust one or more of an energy intensity from the energy source, an energy power from the energy source, a translation of the probe along the treatment probe axis, a rotation of the probe about the treatment probe axis, a translation speed of the treatment probe, a rotation speed of the treatment probe, or a number of single scans of the energy source along the tissue in order to treat the tissue at different depths according to the angular tissue depth profile. In some embodiments, the intensity of the energy source decreases as the depth decreases, and increases for regions of increasing depth. Alternatively, the movement of the energy source can be adjusted in response to the tissue profile, and the energy from the energy source 200 remains substantially fixed, for example, with a fixed flow rate from a pump, such as a pulsatile pump coupled to the nozzle. In some embodiments, for example, the power of the energy source is adjusted in response to the tissue profile, such as a flow rate from a pump or a power from a laser. In some embodiments, one or more of the translation speed or the rotation speed of the energy source are adjusted in response to the angular tissue profile.

[0094] In some embodiments, the treatment plan is configured for the energy source to scan the region of tissue more than once so that energy can be delivered to the tissue by multiple single scans of the energy source. In some embodiments, the treatment plan is configured to remove multiple layers of tissue consecutively. In some embodiments, the treatment plan is configured to remove a first layer of tissue (e.g., by one or more of removal, ablation, excision), and to treat a second layer of tissue with the energy source to remove the second layer. In some embodiments, for example, the treatment plan is configured to treat the tissue to a first depth along a first removal profile 970 that extends from a first location 972 of the border 912 to a second location 964 of the border 912. The treatment plan is configured to remove a second layer of tissue with another scan of the energy source to remove tissue between the first removal profile and the border 912. Multiple layers of tissue can be removed as needed, and the depth of removal can be determined based on several factors, such as one or more of the type of energy from the energy source, the type of tissue, the distance from the energy source to the layer of tissue to be removed, the rotational speed of the energy source, or the translational speed of the energy source. In some embodiments, the treatment plan is configured to fix the translational position of the treatment probe 450 along the axis 451 substantially while the energy source scans the tissue with the energy source at the angular rotation of the energy source at multiple angles 932. For example, a first layer of tissue can be removed to the depth of the first removal profile 970, and a second layer of tissue located below the removal profile 970 is removed while the translational position of the energy source remains substantially fixed. Alternatively, the energy source can be scanned in translation along the elongate axis 451 while the angle of the energy source 200 remains substantially fixed in order to remove multiple layers.

[0095] In some embodiments, a treatment plan is developed for each of the multiple images, and these treatment plans are combined to generate a 3D treatment plan. In some embodiments, for example, the parameters of the treatment plans are interpolated for pairs of locations between the 3D images. Alternatively or in combination, the 3D angular depth profiles from each of the multiple images can be combined and interpolated to define a 3D angular depth treatment profile. In some embodiments, for example, the images comprise 3D images in which the spacing between lateral views is sufficiently small that interpolation is not performed.

[0096] In some embodiments, each of the multiple images is evaluated as described herein in order to determine multiple tissue removal profiles at multiple lateral image locations, and these removal profiles are combined to generate a 3D treatment plan. In some embodiments, multiple tissue profiles are combined from the multiple images and interpolated between locations of the images.

[0097] Figure 9BThe probe and angle of rotation are shown, as well as a treatment profile 980 overlaid on an image of the tissue, such as one or more longitudinal images or transverse images as described herein. Although the treatment plan can be generated in a variety of ways, in some embodiments, the treatment profile 980 can facilitate determining the profile of the treatment plan, and also allow the user to review and modify the planned treatment. In some embodiments, the treatment profile 980 is configured to substantially match the border 912, for example, with a deviation within 5% of the diameter of the border. In some embodiments, the treatment profile 980 is configured to provide one or more tissue margins as described herein. In some embodiments, an AI algorithm is configured to identify the border 912 and overlay a treatment profile on the border, or use the border 912 as a treatment profile for generating a treatment plan, for example, as described with reference to FIGS. 9A-9C. Figure 9A

[0098] Figure 9C and Figure 9D A treatment plan is shown with one or more tissue margins 985. For example, the one or more tissue margins can include one or more of an angular tissue margin 987 or a depth tissue margin 989. In some embodiments, the one or more tissue margins are referenced relative to the border 912 in order to reduce interaction with adjacent untreated tissue, such as the second tissue 920, when treating the first tissue 910. In some embodiments, the angular tissue margin 987 corresponds to an angle between the border 912 and a first treatment angle 934 at a border of the ablation profile 970. In some embodiments, the depth tissue margin 989 corresponds to a depth of tissue beyond a penetration depth of the energy source at the first treatment angle 934. In some embodiments, the first treatment angle corresponds to a projection of the energy source, such as the projection 944.

[0099] In some embodiments, the ablation profile 970 is configured to provide one or more tissue margins 990 at the second side 918. In some embodiments, a second angular tissue margin 992 corresponds to an angle between the border 912 and a second treatment angle 936 at a border of the ablation profile 970. In some embodiments, a depth tissue margin 994 corresponds to a depth of tissue beyond a penetration depth of the energy source at the second treatment angle 936, such as a depth of tissue at the second treatment angle beyond a depth of the ablation profile 980.

[0100] In some embodiments, a treatment profile 980 corresponding to the ablation profile 970 is overlaid on an image of the tissue, as described herein.

[0101] ​In some embodiments, the user interface is configured to allow the user to view the treatment profile 980 overlaid on the image of the tissue 910 and to allow the user to adjust the treatment profile. Alternatively or in combination, the boundary 912 identified with the AI algorithm can be marked on the display (e.g., by modifying the pixels) so that the user can verify the location of the boundary determined with the AI algorithm. In some embodiments, the user interface is configured to display the location of the boundary 912 determined with the AI algorithm and to display the treatment profile 980, both overlaid on the image of the tissue (such as the lateral image 312). The user interface can be configured to allow the user to select different views and images for the user to view and verify the treatment plan.

[0102] In some embodiments, the user interface is configured to allow the user to adjust the treatment profile in multiple views of the tissue, as described herein. In some embodiments, it can be helpful for the user to adjust the treatment profile based on one or more of a physician preference, a result from a previous patient, or a patient preference. Referring again to FIG. 9, Figure 9B In some embodiments, the user interface is configured to allow the user to adjust the treatment profile in multiple views of the tissue, as described herein. In some embodiments, it can be helpful for the user to adjust the treatment profile based on one or more of a physician preference, a result from a previous patient, or a patient preference. Referring again to FIG. 9,

[0103] While the user can adjust the treatment profile 980 in a variety of ways, in some embodiments, the user interface is configured to allow the user to select the location of the treatment profile and to drag the location of the treatment profile to a desired location on the image. In some embodiments, for example, the user interface is configured to drag a portion of the treatment profile to a desired location and to perform a curve fit to the desired location so that the treatment profile remains smooth and continuous. Alternatively or in combination, the user interface can be configured to allow the user to move the entire treatment profile relative to the tissue. The user interface can be configured to perform this selection and movement in a variety of ways, such as with a pointing device (e.g., a trackpad or a mouse) or a display (e.g., a touch screen display).

[0104] Once the treatment profile is determined, a treatment plan can be configured based on the treatment profile, similar to the determination of the treatment plan described herein with reference to the boundary 912, such as an angular depth profile of the treatment profile with respect to the energy source 200.

[0105] Figure 10 A method 1000 of planning a three-dimensional (3D) treatment with a user interface is shown.

[0106] At step 1010, one or more images are received. The one or more images can include any image or combination of images as described herein, such as a 3D image, a plurality of transverse images, or one or more longitudinal (e.g., sagittal) images, and combinations thereof.

[0107] At step 1020, a 3D view is generated from the one or more images. For example, the 3D view can include an arrangement of images, such as a plurality of transverse images arranged along one or more longitudinal images (e.g., along one or more sagittal images). In some embodiments, the 3D view includes a plurality of transverse images arranged at a plurality of corresponding locations along the one or more longitudinal images. In some embodiments, the plurality of transverse images intersects the one or more longitudinal images at the plurality of corresponding locations. In some embodiments, the plurality of transverse images includes volumetric pixels (voxels) that overlap the one or more longitudinal images at the plurality of corresponding locations, for example when the received images include a 3D volumetric image, such as a 3D ultrasound image. In some embodiments, the plurality of transverse images and the one or more longitudinal images include images from a 3D tomographic image. In some embodiments, in the 3D view, each of the plurality of transverse images appears substantially perpendicular to the one or more longitudinal images, for example with a perpendicular deviation of within five degrees. In some embodiments, the plurality of transverse images and the one or more longitudinal images include ultrasound images, such as the ultrasound images including images from an ultrasound probe inserted into a patient.

[0108] In some embodiments, the 3D view includes a perspective view in which the plurality of transverse images and the one or more longitudinal images are arranged and shaped to provide a perspective of viewing the 3D view from a distance from a user.

[0109] In some embodiments, the plurality of transverse images includes a first portion located on a first side of the one or more longitudinal images and a second portion located on a second side of the one or more longitudinal images, wherein the first portion is shown as being located in front of the one or more longitudinal images and the second portion is shown as being located behind the one or more longitudinal images. In some embodiments, wherein the one or more longitudinal images includes an amount of transparency sufficient to view the second portion comprised of one or more of the transverse images through the one or more longitudinal images.

[0110] At step 1025, a representation of the treatment probe is generated. For example, the representation can include an image of the treatment probe in an image received from the imaging device, a computer generated representation or animation of the treatment probe, and combinations thereof. In some embodiments, the representation of the treatment probe is shown extending in a sagittal direction in the 3D view. In some embodiments, for example, the representation includes a computer generated representation corresponding to a plurality of translational positions and rotational angles of the energy source. In some embodiments, for example, the representation includes an animation of the treatment probe. In some embodiments, the animation of the treatment probe is configured to move to show an animation of the treatment probe delivering energy from the energy source to the tissue according to the 3D treatment plan (e.g., according to the 3D treatment profile).

[0111] At step 1030, the 3D view is provided on the user interface. In some embodiments, the 3D view is provided to the user interface with the representation of the treatment profile superimposed on one or more of the longitudinal images and one or more of the lateral images. While the representation can be shown in a variety of ways, in some embodiments, the representation is shown at locations where the representation of the 3D treatment profile intersects the images.

[0112] At step 1035, the 3D view is adjusted. While the 3D view can be adjusted in any manner as described herein, in some embodiments, the 3D view is adjusted by manipulation of a user input device (such as a pointing device or touch screen display) by a user. In some embodiments, the relative position and orientation of the images shown in the 3D view is changed in response to the user input. In some embodiments, the plurality of lateral images includes a first portion located on a first side of the one or more longitudinal images and a second portion located on a second side of the one or more longitudinal images, wherein the first portion is located anterior to the one or more longitudinal images and the second portion is located posterior to the one or more longitudinal images.

[0113] In some embodiments, the arrangement includes a three-dimensional (3D) arrangement and the user interface includes input for the user to one or more of scale, pan, or rotate the 3D arrangement in the 3D view. In some embodiments, the user input is configured to rotate the one or more longitudinal images and the plurality of lateral images from a first orientation to a second orientation. The first orientation shows a first portion of the plurality of lateral images located anterior to the one or more longitudinal images and a second portion of the plurality of lateral images located posterior to the one or more longitudinal images, and the second orientation shows the second portion of the plurality of lateral images located anterior to the one or more longitudinal images and the second portion of the lateral images located posterior to the one or more longitudinal images.

[0114] At step 1040, user input is received to select a view(s) to display. The selected view can include any suitable view as described herein, such as a plurality of transverse views, a sagittal view, or a 3D view, and combinations thereof. In some embodiments, for example, the user selectable view includes one or more of the plurality of transverse images. In some embodiments, the user interface is configured to receive user input selecting a transverse image from the plurality of transverse images, and provide a two-dimensional (2D) view of the transverse image in response to the user input, with the representation superimposed on the 2D view of the transverse image. In some embodiments, for example, the user interface is configured to receive user input selecting one or more longitudinal images, and provide a 2D view of the one or more longitudinal images in response to the user input, with the representation superimposed on the 2D view of the one or more longitudinal images.

[0115] In some embodiments, the user interface is configured to receive user input identifying a selected image from the one or more longitudinal images and the plurality of transverse images shown in the 3D view, and display the selected image in a 2D view. In some embodiments, the user input corresponds to a location of the selected image in the 3D view, and input by the user at the location using a pointing device or touch screen display. Alternatively or in combination, the user interface includes a plurality of user selectable inputs corresponding to images to display, for example, the plurality of user selectable inputs includes a first input to display the 3D view, a second input to display the sagittal view, and a third input for the user to select one or more of the transverse images.

[0116] In some embodiments, the plurality of transverse images corresponds to a plurality of predefined anatomical locations of the organ. In some embodiments, the plurality of predefined anatomical locations includes anatomical locations of a first organ and a second organ, where the first organ and the second organ are visible in the one or more longitudinal images and the one or more transverse images. In some embodiments, for example, the first organ includes a prostate, and the second organ includes a bladder. In some embodiments, the plurality of predefined anatomical locations includes an intraprostatic protrusion (IPP), a bladder neck (BL), a mid-prostate (MID), a verumontanum (VERU), and a peripheral sphincter (P.SPH).

[0117] At step 1045, the received images are processed with an AI algorithm. The AI algorithm can be configured to identify one or more tissue structures as described herein. For example, the AI algorithm can include one or more of: image enhancement, image segmentation, neural networks, convolutional neural networks, transformers, transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modal image fusion. The location of the one or more tissue structures in the images can be used to identify images to show to the user, such as one or more transverse images corresponding to the location of the tissue structure. In some embodiments, a plurality of predefined anatomical locations are identified with the artificial intelligence algorithm. In some embodiments, the AI algorithm is configured to process the received images and identify images corresponding to the predefined anatomical locations, and present selected images to the user in response to the identified locations and corresponding image processing. In some embodiments, the plurality of predefined anatomical locations includes an intravesical prostatic protrusion (IPP), a bladder neck (BL), a mid-prostate (MID), a verumontanum (VERU), and a peripheral sphincter (P.SPH), and the transverse images shown to the user are based on the anatomical locations identified by the AI algorithm.

[0118] At step 1050, a treatment contour is generated, and the treatment contour can be generated in any of the ways described herein. In some embodiments, the treatment contour includes a 3D treatment contour.

[0119] At step 1060, the treatment contour is overlaid on one or more images. In some embodiments, for example, the one or more images include one or more selected images, where the images are selected in response to user input. In some embodiments, the representation of the 3D treatment contour includes a three-dimensional (3D) treatment volume overlaid on the image arrangement shown in the 3D view. In some embodiments, the 3D treatment volume extends in a longitudinal direction along one or more longitudinal images, and in a direction transverse to the one or more longitudinal images along one or more transverse images. In some embodiments, an outer boundary of the 3D treatment volume is shown extending transverse to the one or more longitudinal images along the one or more longitudinal images, and in a longitudinal direction along the transverse images.

[0120] In some embodiments, the representation of the 3D treatment contour in the 3D view includes an intersection of the 3D treatment contour with one or more of the one or more longitudinal images and the plurality of transverse images.

[0121] In some embodiments, the plurality of lateral images includes a first portion located on a first side of the one or more longitudinal images and a second portion located on a second side of the one or more longitudinal images, where, in the 3D view, the arrangement has the first portion located in front of the one or more longitudinal images and the second portion located behind the one or more longitudinal images. In some embodiments, the representation of the 3D treatment contour is overlaid on the first portion and the one or more longitudinal images in the 3D view, where the 3D representation extends from a common location where the first portion intersects the one or more longitudinal images along the first portion and the one or more longitudinal images. In some embodiments, the lateral view includes sufficient transparency to view the 3D representation of the treatment contour on the second portion of one or more of the lateral images. In some embodiments, the user interface is configured to display the treatment contour as a plurality of lines along the lateral images that connect to one or more lines along the one or more longitudinal images. In some embodiments, for example, the 3D representation is shown as a grid overlaid on the one or more images. In some embodiments, the images shown in the 3D view are user selectable when the 3D representation is shown in the 3D view. In some embodiments, for example, the user interface is configured for the user to select which images to show in the 3D view so that the user can select no images or a plurality of images that the 3D representation of the treatment contour is overlaid on.

[0122] In some embodiments, the user interface is configured to adjust the 3D view with the treatment contour overlaid on the 3D view. In some embodiments, the image arrangement includes a 3D arrangement and the user interface is configured for the user to one or more of scale, pan, or rotate the 3D arrangement in the 3D view and the treatment contour is adjusted accordingly in the 3D view with input to one or more of scale, pan, or rotate the 3D arrangement. In some embodiments, in response to user input to one or more of scale, pan, or rotate the 3D representation, the representation of the 3D treatment contour moves with the 3D arrangement to maintain registration of the 3D treatment contour with the 3D arrangement. In some embodiments, the representation of the treatment probe is shown extending along the one or more longitudinal images and the representation of the treatment probe moves with the 3D arrangement and the 3D treatment contour to maintain registration of the representation of the treatment probe with the 3D arrangement and the 3D treatment contour.

[0123] In some embodiments, the user input is configured to rotate the one or more longitudinal images and the plurality of lateral images from a first orientation to a second orientation. The first orientation shows a first portion of the plurality of lateral images and the 3D treatment contour in front of the one or more longitudinal images, and a second portion of the plurality of lateral images and the 3D treatment contour behind the one or more longitudinal images. The second orientation shows the second portion of the plurality of lateral images and the 3D treatment contour in front of the one or more longitudinal images, and the first portion of the lateral images and the 3D treatment contour behind the one or more longitudinal images.

[0124] At step 1070, user input is received to adjust the treatment contour. In some embodiments, the user interface is configured to receive user input to adjust the one or more images, for example by moving the boundaries of the treatment contour, as described herein.

[0125] At step 1080, the adjusted treatment contour is shown on the display of the user interface. In some embodiments, the adjusted treatment contour is shown and the treatment contour shown in the view that the user is adjusting is updated in real time, as well as additional views as described herein.

[0126] At step 1090, user input is received regarding the user accepting the adjusted treatment contour. The user input to accept the treatment can include user input received prior to the treatment. In addition, the user input as described herein can include user input from a first user and user input from a second user. Alternatively, for example, the user input can include input from a single user.

[0127] At step 1095, the patient is treated. Once the user accepts the treatment, the treatment can be performed in a substantially automated manner, for example, the user simply has to step on a foot pedal or other device.

[0128] While the method 1000 of planning a treatment is shown and described according to some embodiments, one of ordinary skill in the art will recognize many adjustments and variations according to the present disclosure. For example, the steps can be performed in any order. Some of the steps are repeated and some of the steps are omitted. Some of the steps can include sub-steps of other steps. In addition, one or more steps of the method 1000 can be combined with any step of any method described herein.

[0129] Figure 11 A method 1100 of planning a 3D treatment with automatic tissue recognition is shown.

[0130] At step 1101, a plurality of images is received. The plurality of images can include any suitable images as described herein, such as a plurality of transverse images, one or more longitudinal images, or images from a 3D volumetric image, and combinations thereof. In some embodiments, each of the plurality of images is received and evaluated, and a probe location and a tissue boundary is determined in each of the plurality of images to generate a 3D treatment plan. The following steps can be performed on each of the plurality of images.

[0131] At step 1103, the received images are processed with an AI algorithm. The AI algorithm can be configured to identify tissue structures for treatment planning as described herein. In some embodiments, the AI algorithm is configured to identify a location of a probe in the plurality of images. The plurality of images can include any suitable images as described herein, such as transverse images, one or more longitudinal images, or images from a 3D volumetric image, and combinations thereof. For example, the AI algorithm can include one or more of: image enhancement, image segmentation, neural networks, convolutional neural networks, transformers, transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modal image fusion.

[0132] At step 1105, a treatment probe location is determined. The probe location can include an elongate axis of the probe, which can correspond to a location of an energy source during treatment. In some embodiments, the energy source can not deviate from the elongate axis during treatment, and the treatment plan, as well as the angle and distance, are determined in response to the location of the energy source during treatment. In some embodiments, the location of the probe is determined with an AI algorithm as described herein. Alternatively or in combination, a user interface can be configured for a user to identify the location of the probe.

[0133] At step 1110, a tissue boundary is determined. In some embodiments, the boundary defines a region of tissue to be treated. In some embodiments, the boundary of the tissue is determined with an AI algorithm as described herein. Alternatively or in combination, a user interface can be configured for a user to identify the boundary.

[0134] In some embodiments, the boundary encloses an anatomical tissue structure, and can include, in each of the plurality of transverse images, a perimeter around the anatomical tissue structure, and parameters of the boundary that are relevant for planning treatment with a probe. In some embodiments, the boundary includes an edge relative to the treatment probe. In some embodiments, a first edge of the tissue boundary corresponds to a first line from the probe to a first location of the boundary that is tangent to the boundary at the first location, and a second edge of the tissue boundary corresponds to a second line from the probe that is tangent to the boundary at a second location of the boundary.

[0135] In some embodiments, the boundaries of the tissue are separated from the probe by a distance, and the distance and angle between the tissue boundaries can be used as input to determine a treatment profile and plan. In some embodiments, the distance between the probe and the boundaries is at a minimum at a location where the boundary is closest to the probe, and at a maximum at a location where the boundary is farthest from the probe.

[0136] At step 1115, a tissue profile is determined. In some embodiments, the tissue profile includes a variable thickness between a first angle of the boundary and a second angle of the boundary. In some embodiments, the variable thickness tissue profile includes a plurality of depths at a plurality of angles. In some embodiments, the tissue profile is separated from the probe, wherein there is a gap between the probe and the treatment tissue profile. In some embodiments, the tissue profile includes a first plurality of radial distances from the probe to a first portion of the boundary at a plurality of corresponding angles, and a second plurality of radial distances from the probe to a second portion of the boundary. In some embodiments, the first portion of the boundary is oriented toward the probe, and the second portion of the boundary is oriented away from the treatment probe. In some embodiments, the variable thickness profile of the tissue is defined by a difference between the first plurality of radial distances and the second plurality of radial distances at the corresponding angles.

[0137] At step 1120, a treatment angle is determined. In some embodiments, a first angle from the treatment probe to a first location along the boundary on a first side of the region and a second angle from the treatment probe to a second location along the boundary on a second side of the region are determined.

[0138] In some embodiments, the treatment plan is configured to provide one or more tissue margins. In some embodiments, a first treatment angle is oriented to provide a first tissue margin on a first side, and a second treatment angle is oriented to provide a second tissue margin on a second side of the tissue being treated. In some embodiments, the first treatment angle is selected to provide a first tissue margin thickness at the first treatment angle that is greater than a penetration depth of the energy source at the first treatment angle, and the second treatment angle is selected to provide a second tissue margin thickness at the second treatment angle that is greater than a penetration depth of the energy source at the second treatment angle. In some embodiments, the first tissue margin corresponds to a first tissue margin angle between the first treatment angle and a first angle of a first edge of the boundary of the first side of the tissue being treated, and the second tissue margin corresponds to a second tissue margin angle between the second treatment angle and a second angle of a second edge of the boundary of the second side of the tissue being treated.

[0139] In some embodiments, the first tissue margin angle is in a range from about 1 degree to about 15 degrees, and optionally in a range from about 1 degree to about 10 degrees, and further optionally in a range from about 2 degrees to about 10 degrees. In some embodiments, the second tissue margin angle is in a range from about 1 degree to about 15 degrees, and optionally in a range from about 1 degree to about 10 degrees, and further optionally in a range from about 2 degrees to about 10 degrees.

[0140] In some embodiments, the treatment plan corresponds to a first tissue penetration depth of the energy source at a first treatment angle, and the first tissue margin includes a first tissue margin thickness at the first treatment angle, where the first margin thickness is greater than the first tissue penetration depth. In some embodiments, the first margin thickness is greater than the first penetration depth by an amount in a range from about 1% to about 15%, and optionally in a range from about 1% to about 10%, and further optionally in a range from about 2% to about 10%. In some embodiments, the treatment plan corresponds to a second tissue penetration depth of the energy source at a second treatment angle, and the second tissue margin includes a second tissue margin thickness at the second treatment angle, where the second margin thickness is greater than the second tissue penetration depth. In some embodiments, the second margin thickness is greater than the second penetration depth by an amount in a range from about 1% to about 15%, and optionally in a range from about 1% to about 10%, and further optionally in a range from about 2% to about 10%.

[0141] In some embodiments, the first treatment angle is determined in response to a first boundary angle between the treatment probe and a boundary of tissue of the first side, and the second treatment angle is determined in response to a second boundary angle between the treatment probe and a boundary of tissue of the second side. In some embodiments, the first treatment angle and the first boundary angle are arranged to provide a first tissue margin between the first treatment angle and the first boundary angle, and the second treatment angle and the second boundary angle are arranged to provide a second tissue margin between the second treatment angle and the second boundary angle. In some embodiments, the first boundary angle is determined from a first angle of a first edge of the boundary to the first side from the treatment probe, and the second boundary angle is determined from a second angle of a second edge of the boundary to the second side from the treatment probe. In some embodiments, the first boundary angle corresponds to a first projection line from the probe that is tangent to the boundary of the first side, and the second boundary angle corresponds to a second projection line from the probe that is tangent to the boundary of the second side. In some embodiments, the first tissue margin extends between the first edge of the boundary and a first treatment location of the first side at the first treatment angle, and the second tissue margin extends between the second edge of the boundary and a second treatment location of the second side at the second treatment angle.

[0142] At step 1125, a removal layer is determined. In some embodiments, the removal layer is determined so as to provide for a treatment in which the energy source sweeps over the tissue more than once.

[0143] At step 1130, a layer boundary is determined. In some embodiments, the boundary of the removal layer is determined to provide for one or more tissue margins as described herein.

[0144] At step 1140, a treatment profile is generated for each of the plurality of images.

[0145] In some embodiments, the treatment profile includes a variable thickness between a first angle on a first side of the treatment and a second angle on a second side of the treatment region, and can include a plurality of depths at a plurality of corresponding angles. In some embodiments, the treatment profile is separate from the probe, wherein there is a gap between the probe and the treatment profile. In some embodiments, the treatment profile includes a plurality of thicknesses corresponding to a plurality of rotational angles of the energy source, and each of the plurality of thicknesses is determined for a corresponding angle of the plurality of rotational angles. In some embodiments, each of the plurality of thicknesses includes a distance between a first location of the tissue boundary and a second location of the tissue boundary at the corresponding angle. In some embodiments, for each of the plurality of thicknesses of the treatment profile, the first location is separated from the probe by a first distance and the second location is separated from the probe by a second distance.

[0146] At step 1145, a 3D treatment profile is generated. In some embodiments, the 3D treatment profile is generated from the plurality of 2D treatment profiles. Alternatively, the 3D treatment profile can be generated from a 3D tissue profile, wherein the 3D tissue profile is generated from the boundaries of the tissue profile in the plurality of images.

[0147] At step 1150, a 3D treatment plan is generated. In some embodiments, a 3D treatment plan is generated for each of the plurality of images and combined. The 3D treatment plan can be generated from the tissue boundaries, from the treatment profiles determined from the tissue boundaries, and from a combination of the two. Alternatively or in combination, the 3D treatment plan can be generated from the 3D tissue profile. In some embodiments, the 3D treatment plan is generated from the 3D treatment profile.

[0148] In some embodiments, the treatment plan is configured to rotate the probe for each of a plurality of positions along the treatment probe axis to direct energy from the energy source at a first angle for a first position and at a second angle for a second position. In some embodiments, the treatment plan is configured to rotate the energy source from the first angle to the second angle to cause the energy source to scan the tissue between the first angle and the second angle.

[0149] In some embodiments, the plurality of lateral images are positioned along a treatment axis that corresponds to an axial translation of a directional energy source on the probe during treatment, and each of the plurality of lateral images is at a position along the treatment axis. In some embodiments, the treatment plan is configured to rotate the probe for each of a plurality of positions along the treatment axis to direct energy from the energy source at a first angle for a first position and at a second angle for a second position. In some embodiments, the treatment plan is configured to rotate the energy source from the first angle to the second angle to cause the energy source to scan the tissue between the first angle and the second angle.

[0150] In some embodiments, the treatment plan includes machine readable instructions for moving the probe along the treatment probe axis to a plurality of axial positions and rotating the probe to a plurality of angles to deliver energy from the energy source at the plurality of axial positions and at the plurality of angles. In some embodiments, the treatment plan includes a first angle and a second angle for each of a plurality of positions and is configured to cause the energy source to scan the tissue between the first angle and the second angle at the each of the plurality of axial positions.

[0151] In some embodiments, the treatment plan is configured to treat the tissue according to a treatment contour corresponding to a boundary of the tissue. In some embodiments, the boundary includes a boundary of an anatomical tissue structure spaced apart from the probe by a distance. In some embodiments, the treatment plan is configured to adjust delivery of energy from the energy source in response to the distance. In some embodiments, the directional energy source has a cross-sectional area that gradually increases at a distance away from the energy source, and the distance can be used to adjust the energy delivered from the energy source, as described herein.

[0152] In some embodiments, the treatment plan is configured to remove tissue at a plurality of thicknesses at a plurality of corresponding angles between the first angle and the second angle. In some embodiments, the treatment plan is configured to remove tissue to a first depth with a first single scan of the energy source at a first angular aperture between the first angle and the second angle, and to remove tissue to a second depth with a second single scan of the energy source corresponding to a second angular aperture that is less than the first angular aperture, the second depth being greater than the first depth. In some embodiments, the second angular aperture corresponds to a third location along the boundary on a first side of the region and a fourth location along the boundary on a second side of the region. In some embodiments, the third location of the boundary is at or below the first removal depth, and the fourth location of the boundary is at or below the first removal depth.

[0153] In some embodiments, each of the plurality of thicknesses includes a distance from a proximal location of the boundary to a distal location of the boundary at a certain angle of the plurality of corresponding angles.

[0154] While treatment can be performed in a variety of ways, in some embodiments, the treatment plan is configured to adjust one or more of an energy intensity from the energy source, an energy power from the energy source, a translation speed of the energy source, a rotation speed of the energy source, or a number of single scans of the energy source at the plurality of corresponding angles to treat the tissue according to the plurality of thicknesses. In some embodiments, the treatment plan is configured to fix an axial position of the treatment probe and rotate the treatment probe at the axial position to scan energy from the energy source along the tissue with a first single scan between a first angle and a second angle at the axial position. Alternatively or in combination, for example, the treatment plan can be configured to fix a rotation angle of the treatment probe about the elongate probe axis and translate the treatment probe at the rotation angle to scan energy from the energy source along the tissue with a first single scan between a first translation position and a second translation position at the rotation angle. In some embodiments, the treatment plan is configured to increase a translation speed of the energy source on the treatment probe to decrease a treatment depth, and decrease the translation speed to increase the treatment depth. Alternatively or in combination, for example, the treatment plan can be configured to increase a rotation speed of the energy source on the treatment probe to decrease a treatment depth, and decrease the rotation speed to increase the treatment depth.

[0155] At step 1165, an image is presented to the user with the treatment contours superimposed on the image. The presented image can include any image or view as described herein. This can assist the user in evaluating and verifying the treatment plan. For example, with AI-based treatment planning, it can be helpful to have a human review the treatment plan before treating the patient.

[0156] At step 1167, user input is received to adjust the treatment profile. This can be helpful if the user wants to change the treatment plan. The treatment profile can be adjusted in any manner as described herein.

[0157] At step 1170, a second tissue boundary is determined. In some embodiments, the second tissue includes tissue that is not to be treated, although the second tissue can include a second treated tissue, for example. In some embodiments, the boundary of the second tissue is determined using an AI algorithm as described herein. In some embodiments, the first tissue includes a first anatomical tissue structure, and the second tissue includes a second anatomical tissue structure that is different from the first anatomical tissue structure. The first anatomical tissue structure includes an anatomical tissue structure of a first organ, and the second anatomical tissue structure includes a second anatomical tissue structure of a second organ that is different from the first organ.

[0158] In some embodiments, for example, the anatomical structure of the first tissue structure includes one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, or a lens of an eye. The second tissue structure can include any suitable tissue, such as one or more connective tissue, muscle tissue, epithelial tissue, muscle tissue, or anatomical structure associated with contrast in the image data.

[0159] In some embodiments, the second tissue structure includes a second type of tissue that is adjacent to a third type of tissue or adjacent to a fluid to provide contrast in the image data from the second tissue structure. For example, the fluid can include a liquid, such as urine.

[0160] In some embodiments, for example, the anatomical structure of the second tissue structure includes one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a trigone tissue, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, a prostate colliculus, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, or a retina of an eye.

[0161] At step 1180, the second tissue boundary is compared to the treatment plan. For example, the comparison can include a comparison of the angle and distance of the second tissue from the probe. In some embodiments, the comparison is made relative to the boundary of the first tissue, for example to determine whether the first tissue is located between the energy source and the second tissue. In some embodiments, for example, a distance between the boundary of the first tissue and the boundary of the second tissue is compared to determine whether there is sufficient distance between the first tissue boundary and the second tissue boundary.

[0162] At step 1185, output to a user interface is generated. While the output can be configured in a variety of ways, in some embodiments the output includes feedback to the user generated in response to the comparison at step 1180, and the feedback can include one or more of a notification or an alert to the user. In some embodiments, for example, the boundary of the first tissue is located between the boundary of the second tissue, and the output is generated in response to a distance between the probe and the location of the second tissue boundary. In some embodiments, the treatment plan includes a rotation angle of the energy source that exceeds an edge of the first tissue boundary, and the output is generated in response to the rotation angle that exceeds the edge. In some embodiments, the treatment plan corresponds to a penetration depth of the energy source that exceeds a thickness of the tissue, and the output is generated in response to the penetration depth that is greater than the thickness. In some embodiments, the thickness includes a plurality of thicknesses at a plurality of rotation angles of the energy source, where each of the plurality of thicknesses is determined for a corresponding angle of the plurality of rotation angles, and the penetration depth is determined for each of the plurality of angles. For example, the output can be generated in response to the penetration depth exceeding the thickness of the tissue.

[0163] While reference is made to output such as a notification or an alert, in some embodiments the boundary of the first tissue, the boundary of the second tissue, and the treatment contour are shown on one or more views of the image, and the user interface is configured to adjust the treatment plan, for example by moving the treatment contour, as described herein. In some embodiments, for example, the boundary of the first tissue, the boundary of the second tissue, and the treatment contour are shown on each of a plurality of transverse images, and the user interface is configured to adjust the treatment contour on the plurality of transverse images.

[0164] At step 1190, input from the user interface is received. The input can include any suitable input as described herein, such as input to modify the treatment contour. In some embodiments, the input includes input indicating that the user accepts the treatment plan, such as the treatment contour.

[0165] At step 1195, the patient is treated.

[0166] While a method 1100 of planning 3D treatment with automatic tissue recognition is shown and described according to some embodiments, one of ordinary skill in the art will recognize many adjustments and variations according to the present disclosure. For example, the steps can be performed in any order. Some of the steps are repeated and some of the steps are omitted. Some of the steps can include sub-steps of other steps. Further, one or more steps of the method 1100 can be combined with any step of any method described herein.

[0167] Figure 12 A method 1200 of treating a first tissue and reducing exposure to a second tissue with automatic tissue recognition is shown.

[0168] At step 1210, an AI algorithm detects a first tissue (such as IPP of the prostate) and a second tissue (such as trigone tissue of the bladder). For example, the AI algorithm can include one or more of: image enhancement, image segmentation, neural networks, convolutional neural networks, transformers, transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modal image fusion.

[0169] At step 1220, the AI algorithm detects the first tissue and the second tissue in a plurality of transverse images.

[0170] At step 1230, the AI algorithm measures a distance from an energy source (such as a nozzle) to the second tissue (such as IPP) and an angle of the IPP in the plurality of transverse images.

[0171] At step 1240, the AI algorithm generates an output (such as a warning) to indicate that a penetration depth of the first tissue (such as IPP) can exceed a tissue thickness, or that a treatment angle exceeds an angle of the first tissue (such as IPP).

[0172] At step 1250, the AI algorithm determines a boundary of the first tissue (such as IPP) and assesses whether a treatment plan exceeds energy delivery sufficient to treat the first tissue. For example, the AI algorithm can be configured to determine whether a penetration depth of an energy source exceeds a thickness of the first tissue. In some embodiments, for example, the AI algorithm is configured to determine whether a translational position of the energy source extends beyond the first tissue during treatment, thereby affecting the second tissue (such as IPP).

[0173] At step 1260, the treatment plan is adjusted. While the treatment plan can be adjusted in a variety of ways, in some embodiments, the treatment profile is adjusted to limit treatment to the first tissue, for example, one or more treatment angles are adjusted to appropriately limit the treatment angle, or the penetration depth of the tissue is adjusted to limit the penetration depth to within a thickness of the tissue.

[0174] While the method 1200 of planning a treatment is shown and described in accordance with some embodiments, one of ordinary skill in the art will recognize many adaptations and variations according to the present disclosure. For example, the steps can be performed in any order. Some of the steps are repeated and some of the steps are omitted. Some of the steps can include sub-steps of other steps. In addition, one or more steps of the method 1200 can be combined with any step of any method described herein.

[0175] Figure 13 A method 1300 of training an AI algorithm is shown.

[0176] At step 1310, images are collected and grouped. The images can include a collection of images taken prior to treatment and during treatment. The images can be appropriately classified and grouped, for example, with respect to tissue type. In some embodiments, for example, the images are grouped according to tissue type, such as prostate tissue types as described herein.

[0177] At step 1320, the grouped images from step 1310 are received by the AI model. The grouped images are labeled according to each group of images using machine assisted labeling (MAL). In some embodiments, each group of images can be segmented and classified and labeled with MAL. In some embodiments, for example, the images are segmented and annotated with labels to identify tissue structures as described herein.

[0178] At step 1330, the MAL images are received by a user interface that allows an expert to review and clean the MAL image data. For example, an initial set of MAL images can be reviewed by an expert, such as a radiologist. The review and cleaning of the MAL images by the expert generates high quality labeled image data. The high quality labeled image data can be added to a pool of high quality image data. This high quality image data can be used as a ground truth or true state for further training and refinement of the classifier and contains annotated data with appropriate labels to identify tissue types.

[0179] At step 1340, the high quality labeled data is received by an AI algorithm as described herein and used to train and validate the model. The annotated images can be used to train and validate the AI algorithm and develop model parameters for the AI algorithm. The AI algorithm can include any suitable algorithm as described herein, such as a neural network, for example, a deep neural network.

[0180] At step 1350, the trained model parameters generated at step 1340 are received to refine and tune the model. While this can be performed in a variety of ways, in some embodiments, model inference speed improvements are performed on the model to improve the speed of the model without materially compromising the output of the model. This can help to improve the throughput of the model and reduce processing bottlenecks in the model.

[0181] At step 1360, the model is published and deployed in the field. The field-deployed model can be used to process images to generate one or more tissue structures described herein.

[0182] In some embodiments, the model is further refined prior to field deployment at step 1360. For example, it can be helpful to iterate and refine the model by repeating steps 1320, 1330, 1340, and 1350 to generate acceptable model parameters for field deployment at step 1360. In some embodiments, steps 1320, 1330, 1340, and 1350 comprise elements of a feedback loop. In some embodiments, the new model parameters developed at step 1350 are provided to the grouped images at step 1320 for MAL, and then the MAL images are provided to experts for review at step 1330. In some embodiments, additional images are provided at step 1320 for testing and validation, and MAL images are generated and provided to experts for review at step 1330, and these images are added to the image data pool. In some embodiments, the new model parameters generated at step 1350 can be provided to the AI algorithm at step 1340 and used to evaluate images and to further refine and develop the AI algorithm at step 1340. Once the training and development of the AI algorithm is complete at step 1340, the trained model can be refined at step 1350, for example, for model inference speed improvements. Steps 1320, 1330, 1340, and 1350 can be performed multiple times as needed to further refine and improve the model prior to field deployment at step 1360.

[0183] While the method 1300 of training an AI algorithm is shown and described in accordance with some embodiments, one of ordinary skill in the art will recognize many adjustments and variations in accordance with the present disclosure. For example, the steps can be performed in any order. Some of the steps are repeated and some of the steps are omitted. Some of the steps can comprise sub-steps of other steps. Further, one or more steps of the method 1300 can be combined with any step of any method described herein.

[0184] A processor as described herein can be configured to perform one or more steps of any of the methods disclosed herein (e.g., method 1000, method 1100, method 1200, or method 1300).

[0185] Figure 14 An artificial intelligence (“AI”) algorithm suitable for incorporation is shown in accordance with embodiments of the present disclosure. In some embodiments, for example, the artificial intelligence algorithm includes one or more of: image enhancement, image segmentation, neural networks, convolutional neural networks, transformers, transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modal image fusion.

[0186] In some embodiments, the AI algorithm includes a two-dimensional convolutional neural network (CNN) 2100. In some embodiments, the AI, such as a CNN, is configured to identify one or more tissue structures of one or more tissues, and to process images, identify tissue structures, and determine a response of the tissue to a treatment. As described herein, the tissue can include a first tissue, or a second tissue, or a combination thereof. A dataset 2102 is initially provided, which can include imagery from historical treatment data of prior patients and procedures. A convolution operation 2104 produces data in a second dataset 2106, which in turn applies a pooling layer 2108 to produce a pooled layer 2110 of subsample data, in order to further compress the spatial size of the feature representation. The subsample data can be convolved 2112 to produce a third dataset 2114, which can further apply a pooling layer 2116 to provide subsample data 2118. The subsample data 2118 can pass through a first fully connected layer 2120 and a second fully connected layer 2122 to generate a classification matrix output 2124. One or more filters can be applied at each convolutional layer to provide different types of feature extraction. After the model is defined, the model can be compiled, and the model can utilize accuracy of feature recognition as a performance metric. The model can be trained over time, such as by using historical procedure data as training data, and validated against the model’s predictions, and validated over time until the model’s predictions converge with true data.

[0187] While the trained model can be configured in a variety of ways, in some embodiments, the trained model is configured to identify tissue structures and output one or more metrics associated with the tissue structures, such as one or more of shape data or movement data as described herein.

[0188] As described herein, the computing devices and systems described and / or illustrated herein broadly represent any type or form of computing device or system capable of executing computer-readable instructions, such as those contained within the modules described herein. In their most basic configuration, these computing devices can each include at least one memory device and at least one physical processor.

[0189] As used herein, the term "memory" or "memory device" generally refers to any type or form of volatile or non-volatile storage device or medium capable of storing data and / or computer-readable instructions. In one example, a memory device can store, load, and / or maintain one or more of the modules described herein. Examples of memory devices include, without limitation, Random Access Memory (RAM), Read Only Memory (ROM), flash memory, Hard Disk Drives (HDDs), Solid-State Drives (SSDs), optical disk drives, buffers, variations or combinations thereof, or any other suitable storage memory.

[0190] Additionally, as used herein, the term "processor" or "physical processor" generally refers to any type or form of hardware-implemented processing unit capable of interpreting and / or executing computer-readable instructions. In one example, a physical processor can access and / or modify one or more modules stored in a memory device described above. Examples of physical processors include, without limitation, microprocessors, microcontrollers, Central Processing Units (CPUs), Field-Programmable Gate Arrays (FPGAs) implementing softcore processors, Application-Specific Integrated Circuits (ASICs), portions of one or more of them, variations or combinations thereof, or any other suitable physical processors. A processor can include a distributed processor system (e.g., running a parallel processor) or remote processors (such as servers) and combinations thereof.

[0191] Although illustrated as separate elements, the method steps described and / or illustrated herein can represent portions of a single application. Additionally, in some embodiments, one or more of these steps can represent or correspond to one or more software applications or programs, which, when executed by a computing device, can cause the computing device to perform one or more tasks, such as method steps.

[0192] Additionally, one or more of the devices described herein can transform data, physical devices, and / or representations of physical devices from one form to another. Additionally or alternatively, one or more of the modules described herein can transform a processor, volatile memory, non-volatile memory, and / or any other portion of a computing device from one form to another by executing on the computing device, storing data on the computing device, and / or interacting with the computing device.

[0193] As used herein, the term “computer-readable medium” generally refers to any form of device, carrier, or medium capable of storing or carrying computer-readable instructions. Examples of computer-readable media include, without limitation, transmission-type media, such as carrier waves and non-transitory-type media, such as magnetic-storage media (e.g., hard disk drives, tape drives, and floppy disks), optical-storage media (e.g., compact discs, digital video discs, and Blu-ray discs), electronic-storage media (e.g., solid-state drives and flash media), and other distribution systems.

[0194] Those of ordinary skill in the art will appreciate that any of the processes or methods disclosed herein can be modified. The process parameters and sequence, which are described and / or illustrated herein are given by way of example only and can be varied as desired. For example, while the steps illustrated and / or described herein can be shown or discussed in a particular order, these steps do not necessarily need to be performed in the order illustrated or discussed.

[0195] The various illustrative methods described and / or illustrated herein can omit one or more of the steps described or illustrated herein or include additional steps in addition to those disclosed. Further, the steps of any of the methods disclosed herein can be combined with any one or more of the steps of any of the other methods disclosed herein.

[0196] A processor as described herein can be configured to perform one or more steps of any of the methods disclosed herein. Alternatively or in combination, a processor can be configured to combine one or more steps of one or more methods as disclosed herein.

[0197] Unless otherwise stated, the terms "connected to" and "coupled to" (and their derivatives), as used in the specification and claims, are to be interpreted as permitting both direct and indirect (i.e. via other elements or components) connections. In addition, the terms "a" or "an", as used in the specification and claims, are to be interpreted as meaning "at least one". Finally, for ease of use, the terms "including" and "having" (and their derivatives), as used in the specification and claims, can be used interchangeably with the phrase "comprising" and should have the same meaning as the phrase "comprising".

[0198] A processor as disclosed herein can be configured with instructions to perform any one or more steps of any method as disclosed herein.

[0199] It will be understood that, although the terms "first", "second", "third", etc. can be used herein to describe various layers, elements, components, regions or sections, these terms are not intended to denote any particular order or sequence. The terms are used merely to distinguish one layer, element, component, region or section from another. A first layer, element, component, region or section as described herein can be termed a second layer, element, component, region or section without departing from the teachings of the present disclosure.

[0200] As used herein, the term "or" is used in an inclusive sense, i.e., to mean "and / or".

[0201] As used herein, "e.g." means, for example.

[0202] As used herein, characters such as numerals refer to similar elements.

[0203] The present disclosure includes the following numbered clauses.

[0204] Clause 1. A method of planning a treatment, the method comprising: receiving a plurality of transverse images and one or more longitudinal images of a tissue; generating an arrangement of the plurality of transverse images along the one or more longitudinal images in a three-dimensional (3D) view, the three-dimensional view comprising the plurality of transverse images at a plurality of corresponding positions along the one or more longitudinal images; superimposing a representation of a three-dimensional (3D) treatment contour on the 3D view of the plurality of transverse images and the one or more longitudinal images; and providing, to a display of a user interface, the 3D view with the representation superimposed on the one or more longitudinal images and one or more of the plurality of transverse images.

[0205] Clause 2. The method of clause 1, wherein, in the 3D view, the plurality of lateral images includes a first portion located on a first side of the one or more longitudinal images and a second portion located on a second side of the one or more longitudinal images, the first portion being located in front of the one or more longitudinal images and the second portion being located behind the one or more longitudinal images.

[0206] Clause 3. The method of any of clauses 1-2, wherein the representation of the 3D treatment plan is overlaid on the first portion and the one or more longitudinal images in the 3D view, wherein the 3D representation extends along the first portion and the one or more longitudinal images from a common location where the first portion and the one or more longitudinal images intersect.

[0207] Clause 4. The method of any of clauses 1-3, wherein the one or more longitudinal images include an amount of transparency sufficient to view the second portion of one or more of the lateral images through the one or more longitudinal images.

[0208] Clause 5. The method of any of clauses 1-4, wherein the representation of the 3D treatment plan is overlaid on the second portion of the second side and the amount of transparency is sufficient to view the representation of the 3D treatment plan on the second side through the one or more longitudinal images.

[0209] Clause 6. The method of any of clauses 1-5, wherein the arrangement includes a three- dimensional (3D) arrangement and the user interface includes input for a user to one or more of scale, pan, or rotate the 3D arrangement in the 3D view.

[0210] Clause 7. The method of any of clauses 1-6, wherein, in response to the user input of one or more of scaling, panning, or rotating the 3D representation, the representation of the 3D treatment plan moves with the 3D arrangement to maintain registration of the 3D treatment plan with the 3D arrangement.

[0211] Clause 8. The method of any of clauses 1-7, wherein the user input is configured to rotate the one or more longitudinal images and the plurality of lateral images from a first orientation to a second orientation, the first orientation showing a first portion of the plurality of lateral images in front of the one or more longitudinal images and a second portion of the plurality of lateral images behind the one or more longitudinal images, and the second orientation showing the second portion of the plurality of lateral images in front of the one or more longitudinal images and the second portion of the lateral images behind the one or more longitudinal images.

[0212] Clause 9. The method of any of clauses 1-8, wherein a representation of a treatment probe is shown extending along the one or more longitudinal images, and the representation of the treatment probe moves with the 3D arrangement and the 3D treatment contour to maintain registration of the representation of the treatment probe with the 3D arrangement and the 3D treatment contour.

[0213] Clause 10. The method of any of clauses 1-9, wherein the representation of the 3D treatment contour comprises a three-dimensional (3D) treatment volume overlaid on the arrangement.

[0214] Clause 11. The method of any of clauses 1-10, wherein the 3D treatment volume extends in a longitudinal direction along the one or more longitudinal images, and in a direction transverse to the one or more longitudinal images along the one or more transverse images.

[0215] Clause 12. The method of any of clauses 1-11, wherein an outer boundary of the 3D treatment volume is shown extending transverse to the one or more longitudinal images along the one or more longitudinal images, and in the longitudinal direction along the transverse images.

[0216] Clause 13. The method of any of clauses 1-12, wherein in the 3D view, a representation of a treatment probe is shown extending in a longitudinal direction.

[0217] Clause 14. The method of any of clauses 1-13, wherein the representation comprises an animation of the treatment probe.

[0218] Clause 15. The method of any of clauses 1-14, wherein the animation of the treatment probe is configured to move to show an animation of the treatment probe delivering energy from an energy source according to a 3D treatment plan.

[0219] Clause 16. The method of any of clauses 1-15, wherein the representation comprises an image of the treatment probe from an imaging device.

[0220] Clause 17. The method of any of clauses 1-16, wherein the representation of the 3D treatment contour in the 3D view comprises an intersection of the 3D treatment contour with one or more of the one or more longitudinal images and the plurality of transverse images.

[0221] Clause 18. The method of any of clauses 1-17, wherein the plurality of transverse images correspond to a plurality of predefined anatomical locations of an organ.

[0222] Clause 19. The method of any of clauses 1-18, wherein the plurality of predefined anatomical locations includes anatomical locations of a first organ and a second organ, wherein the first organ and the second organ are visible in the one or more longitudinal images and one or more of the transverse images.

[0223] Clause 20. The method of any of clauses 1-20, wherein the plurality of predefined anatomical locations are identified with an artificial intelligence algorithm.

[0224] Clause 21. The method of any of clauses 1-20, wherein the first organ includes a prostate and the second organ includes a bladder.

[0225] Clause 22. The method of any of clauses 1-21, wherein the plurality of predefined anatomical locations includes an intraprostatic protrusion (IPP), a bladder neck (BL), the prostate (MID), a verumontanum (VERU), and a peripheral sphincter (P.SPH).

[0226] Clause 23. The method of any of clauses 1-22, wherein the user interface is configured to receive user input identifying a selected image from the one or more longitudinal images and the plurality of transverse images shown in the 3D view, and display the selected image in a 2D view.

[0227] Clause 24. The method of any of clauses 1-23, wherein the user input corresponds to a location of the selected image in the 3D view and input by the user at the location with a pointing device or touch screen display.

[0228] Clause 25. The method of any of clauses 1-24, wherein the user interface includes a plurality of user selectable inputs corresponding to images to be displayed, the plurality of user selectable inputs including a first input to display the 3D view, a second input to display the one or more longitudinal images, and a third input for the user to select one or more of the transverse images.

[0229] Clause 26. The method of any of clauses 1-25, wherein the user interface is configured to receive user input selecting a transverse image from the plurality of transverse images, and provide a two-dimensional (2D) view of the transverse image in response to the user input, wherein the representation is superimposed on the 2D view of the transverse image.

[0230] Clause 27. The method of any of clauses 1-26, wherein the user interface is configured to receive user input selecting the one or more longitudinal images and provide the 2D view of the one or more longitudinal images in response to the user input, wherein the representation is superimposed on the 2D view of the one or more longitudinal images.

[0231] Clause 28. The method of any of clauses 1-27, wherein the plurality of transverse images intersect the one or more longitudinal images at the plurality of corresponding locations.

[0232] Clause 29. The method of any of clauses 1-28, wherein the plurality of transverse images includes volumetric pixels (voxels) that overlap the one or more longitudinal images at the plurality of corresponding locations.

[0233] Clause 30. The method of any of clauses 1-29, wherein in the 3D view, each of the plurality of transverse images appears substantially perpendicular to the one or more longitudinal images, and optionally within five degrees of perpendicular.

[0234] Clause 31. The method of any of clauses 1-30, wherein the 3D view includes a perspective view of the plurality of transverse images and the one or more longitudinal images.

[0235] Clause 32. The method of any of clauses 1-31, wherein the plurality of transverse images and the one or more longitudinal images include images from a 3D tomographic image.

[0236] Clause 33. The method of any of clauses 1-32, wherein the plurality of transverse images and the one or more longitudinal images include ultrasound images, and optionally wherein the ultrasound images include images from an ultrasound probe inserted into a patient.

[0237] Clause 34. The method of any of clauses 1-33, wherein the one or more longitudinal images includes a plurality of longitudinal images.

[0238] Clause 35. The method of any of clauses 1-34, wherein the plurality of longitudinal images are generated from a 3D volumetric image of the tissue.

[0239] Clause 36. The method of any of clauses 1-35, wherein the plurality of longitudinal images are generated in response to a plurality of angles of an energy source used to treat the tissue.

[0240] Clause 37. The method of any of clauses 1-36, wherein the plurality of longitudinal images includes a first longitudinal image along a first portion of the treatment profile and a second longitudinal image along a second portion of the treatment profile.

[0241] Clause 38. The method of any of clauses 1-37, wherein the arrangement shows a portion of the first longitudinal image along a first portion of the treatment profile and a portion of the second longitudinal image along a second portion of the treatment profile.

[0242] Clause 39. The method of any of clauses 1-38, wherein the first longitudinal image includes a first transparency along a first portion of the treatment profile and a second transparency along a second portion of the treatment profile that is greater than the first transparency to increase visibility of the second longitudinal image along the second portion.

[0243] Clause 40. The method of any of clauses 1-39, wherein the second longitudinal image includes a first transparency along a first portion of the treatment profile and a second transparency along a second portion of the treatment profile, the first transparency being greater than the second transparency to increase visibility of the first longitudinal image along the first portion of the treatment profile.

[0244] Clause 41. The method of any of clauses 1-40, wherein the plurality of longitudinal images includes a first longitudinal image at a first angle relative to an axis of rotation and a second longitudinal image at a second angle relative to an axis of translation.

[0245] Clause 42. The method of any of clauses 1-41, wherein the first angle corresponds to a first rotational angle of an energy source about the axis and the second angle corresponds to a second rotational angle of an energy source, and optionally wherein the first angle and the second angle correspond to rotational angles of an energy source inserted into the patient.

[0246] Clause 43. The method of any of clauses 1-42, wherein the first longitudinal image extends at the first angle along a first portion of the treatment profile and a second portion of the longitudinal image extends at the second angle along a second portion of the treatment profile.

[0247] Clause 44. The method of any of clauses 1-43, wherein the plurality of longitudinal images includes at least 3 longitudinal images each at a different rotational angle relative to an elongate axis of a treatment probe.

[0248] Clause 45. A method of generating a treatment plan, the method comprising: receiving a plurality of transverse images of a tissue to be treated; determining, for each of the plurality of transverse images, a position of a treatment probe and a boundary of the tissue, the boundary defining a region of the tissue; determining, for each of the plurality of transverse images, a first treatment angle from the treatment probe to a first treatment position on a first side of the region responsive to the boundary, and a second treatment angle from the treatment probe to a second treatment position on a second side of the region responsive to the boundary; and generating the treatment plan responsive to the first treatment angle and the second treatment angle for the each of the plurality of transverse images.

[0249] Clause 46. The method of clause 45, wherein the first treatment angle is oriented to provide a first tissue margin at the first side, and the second treatment angle is oriented to provide a second tissue margin at the second side.

[0250] Clause 47. The method of any of clauses 45-46, wherein the first treatment angle is selected to provide a first tissue margin thickness at the first treatment angle that is greater than a penetration depth of the energy source at the first angle, and the second treatment angle is selected to provide a second tissue margin thickness at the second angle that is greater than a penetration depth of the energy source at the second angle.

[0251] Clause 48. The method of any of clauses 45-47, wherein the first tissue margin corresponds to a first tissue margin angle between the first treatment angle and a first angle of a first edge of the boundary of the first side, and the second tissue margin corresponds to a second tissue margin angle between the second treatment angle and a second angle of a second edge of the boundary of the second side.

[0252] Clause 49. The method of any of clauses 45-48, wherein the first tissue margin angle is in a range of about 1 degree to about 15 degrees, and optionally in a range of about 1 degree to about 10 degrees, and further optionally in a range of about 2 degrees to about 10 degrees.

[0253] Clause 50. The method of any of clauses 45-49, wherein the second tissue margin angle is in a range of about 1 degree to about 15 degrees, and optionally in a range of about 1 degree to about 10 degrees, and further optionally in a range of about 2 degrees to about 10 degrees.

[0254] Clause 51. The method of any of clauses 45-50, wherein the treatment plan corresponds to a first penetration depth of the energy source at the first treatment angle, and the first tissue margin comprises a first margin thickness at the first treatment angle, the first margin thickness being greater than the first depth.

[0255] Clause 52. The method of any of clauses 45-51, wherein the first margin thickness is greater than the first penetration depth by an amount in a range of about 1% to about 15%, and optionally in a range of about 1% to about 10%, and further optionally in a range of about 2% to about 10%.

[0256] Clause 53. The method of any of clauses 45-52, wherein the treatment plan corresponds to a second penetration depth of the energy source at the second treatment angle, and the second tissue margin comprises a second margin thickness corresponding to the first treatment angle, the second margin thickness being greater than the second penetration depth.

[0257] Clause 54. The method of any of clauses 45-53, wherein the second margin thickness is greater than the second penetration depth by an amount in a range of about 1% to about 15%, and optionally in a range of about 1% to about 10%, and further optionally in a range of about 2% to about 10%.

[0258] Clause 55. The method of any of clauses 45-54, wherein the first treatment angle is determined in response to a first boundary angle between the treatment probe and a boundary of tissue of the first side, and the second treatment angle is determined in response to a second boundary angle between the treatment probe and a boundary of tissue of the second side.

[0259] Clause 56. The method of any of clauses 45-55, wherein the first treatment angle and the first boundary angle are arranged to provide a first tissue margin between the first treatment angle and the first boundary angle, and wherein the second treatment angle and the second boundary angle are arranged to provide a second tissue margin between the second angle and the second boundary angle.

[0260] Clause 57. The method of any of clauses 45-56, wherein the first boundary angle is determined from the treatment probe to a first edge of a boundary of the first side, and the second boundary angle is determined from the treatment probe to a second edge of a boundary of the second side.

[0261] Clause 58. The method of any of clauses 45-57, wherein the first boundary angle corresponds to a first projection line from the probe to a first boundary location, the first projection line being tangent to a boundary of the first side, and the second edge of the tissue boundary corresponds to a second projection line from the probe, the second projection line being tangent to a boundary of the second side.

[0262] Clause 59. The method of any of clauses 45-58, wherein the first tissue edge extends between a first edge of the boundary and the first treatment location of the first side, and the second tissue edge extends between a second edge of the boundary and the second treatment location of the second side.

[0263] Clause 60. The method of any of clauses 45-59, wherein, for each of the plurality of lateral images, the treatment plan is configured to treat tissue according to a treatment profile corresponding to the first treatment angle and the second treatment angle.

[0264] Clause 61. The method of any of clauses 45-60, wherein the treatment profile comprises a variable thickness between the first treatment angle and the second treatment angle.

[0265] Clause 62. The method of any of clauses 45-61, wherein the treatment profile comprises a substantially uniform thickness between the first treatment angle and the second treatment angle, and optionally wherein a uniform deviation of the substantially uniform thickness is within 20%.

[0266] Clause 63. The method of any of clauses 45-62, wherein the treatment profile is separate from the probe, wherein there is a gap between the probe and the treatment profile.

[0267] Clause 64. The method of any of clauses 45-63, wherein the variable thickness comprises a first thickness corresponding to the first treatment angle, a second thickness corresponding to the second treatment angle, and a center thickness at an angle between the first angle and the second angle, the center thickness of the treatment profile being greater than the first thickness and the second thickness.

[0268] Clause 65. The method of any of clauses 45-64, wherein the treatment plan is configured to treat the first thickness and the second thickness with a first scan of energy from the energy source between the first treatment angle and the second treatment angle, and to treat the center thickness with the first scan and a second scan of energy from the energy source.

[0269] Clause 66. The method of any of clauses 45-65, wherein the first scan comprises a first rotational scan of the energy source between the first treatment angle and the second treatment angle, and the second scan comprises a second rotational scan of the energy source comprising a rotational angle less than the first rotational scan.

[0270] Clause 67. The method of any of clauses 45-66, wherein the treatment plan is configured to remove tissue at a plurality of thicknesses at a plurality of corresponding angles between the first treatment angle and the second treatment angle.

[0271] Clause 68. The method of any of clauses 45-67, wherein the treatment plan is configured to remove tissue to a first depth with a first single scan of the energy source at a first azimuth between the first treatment angle and the second treatment angle, and to remove tissue to a second depth with a second single scan of the energy source corresponding to a second azimuth less than the first azimuth, the second depth being greater than the first depth.

[0272] Clause 69. The method of any of clauses 45-68, wherein the second azimuth corresponds to a third location of a first side of the region and a fourth location of a second side of the region.

[0273] Clause 70. The method of any of clauses 45-69, wherein the third location is at or below the first removal depth and the fourth location is at or below the first removal depth.

[0274] Clause 71. The method of any of clauses 45-70, wherein each of the plurality of thicknesses comprises a distance from a proximal location of the boundary to a distal location of the boundary at a certain angle of a plurality of corresponding treatment angles.

[0275] Clause 72. The method of any of clauses 45-71, wherein the treatment plan is configured to adjust one or more of an energy intensity from the energy source, an energy power from the energy source, a translation speed of the energy source, a rotational speed of the energy source, or a number of single scans of the energy source at the plurality of corresponding angles to treat the tissue according to the plurality of thicknesses.

[0276] Clause 73. The method of any of clauses 45-72, wherein the treatment profile comprises a plurality of thicknesses corresponding to a plurality of rotational angles of an energy source, and each of the plurality of thicknesses is determined for a corresponding treatment angle of the plurality of rotational angles.

[0277] Clause 74. The method of any of clauses 45-73, wherein a distance between the probe and the boundary reaches a minimum at a location of the boundary closest to the probe and reaches a maximum at a location of the boundary furthest from the probe.

[0278] Clause 75. The method of any of clauses 45-74, wherein the first position at the first treatment angle is separated from the probe by a first distance and the second position at the second treatment angle is separated from the probe by a second distance.

[0279] Clause 76. The method of any of clauses 45-75, wherein the boundary comprises a boundary of an anatomical tissue structure separated by a distance from the probe and the treatment plan is configured to adjust energy delivery from the energy source in response to the distance and the first treatment angle and the second angle from the each of the plurality of lateral images.

[0280] Clause 77. The method of any of clauses 45-76, wherein the boundary encompasses the anatomical tissue structure and optionally comprises a perimeter around the anatomical tissue structure in the each of the plurality of lateral images.

[0281] Clause 78. The method of any of clauses 45-77, wherein the boundary is determined for the each of the plurality of lateral images by an artificial intelligence algorithm.

[0282] Clause 79. The method of any of clauses 45-78, wherein for the each of the plurality of lateral images, a position of the probe corresponds to a position of a directional energy source during treatment and the first angle corresponds to a first angle of the directional energy source during treatment and the second angle corresponds to a second angle of the energy source during treatment.

[0283] Clause 80. The method of any of clauses 45-79, wherein the first angle, the second angle of the each of the plurality of lateral images correspond to a plurality of treatment angles of a three-dimensional (3D) treatment plan.

[0284] Clause 81. The method of any of clauses 45-80, wherein the first angle and the second from the each of the plurality of lateral images are combined to generate the 3D treatment plan.

[0285] Clause 82. The method of any of clauses 45-81, wherein the plurality of transverse images are positioned along a treatment axis, the treatment axis corresponding to an axial translation of a directional energy source on the probe during treatment, and the each transverse image of the plurality of transverse images is at a location along the treatment axis.

[0286] Clause 83. The method of any of clauses 45-82, wherein the treatment plan is configured to rotate the probe for the each of the plurality of locations along the treatment axis to direct energy from an energy source at the first angle to the first location and at the second angle to the second location.

[0287] Clause 84. The method of any of clauses 45-83, wherein the treatment plan is configured to rotate the energy source from the first angle to the second angle to cause the energy source to scan the tissue between the first angle and the second angle.

[0288] Clause 85. The method of any of clauses 45-84, wherein the treatment plan includes machine-readable instructions for moving the probe along a treatment probe axis to a plurality of axial locations and rotating the probe to a plurality of angles to deliver energy from an energy source at the plurality of axial locations and at the plurality of angles.

[0289] Clause 86. The method of any of clauses 45-85, wherein the treatment plan includes the first angle and the second angle for each of the plurality of locations and is configured to cause the energy source to scan the tissue between the first angle and the second angle at the each of the plurality of axial locations.

[0290] Clause 87. The method of any of clauses 45-86, wherein the treatment plan is configured to adjust one or more of an energy intensity from the energy source, an energy power from the energy source, a translation of the probe along the treatment probe axis, a rotation of the probe about the treatment probe axis, a translation speed of the treatment probe, a rotation speed of the treatment probe, or a number of single scans of the energy source along the tissue in order to treat the tissue to different depths according to a treatment profile.

[0291] Clause 88. The method of any of clauses 45-87, wherein the treatment plan is configured to fix an axial position of the treatment probe and rotate the treatment probe at the axial position to scan energy from the energy source along the tissue by a first single scan between a first angle and a second angle at the axial position.

[0292] Clause 89. The method of any of clauses 45-88, wherein a first portion of tissue between the first angle does not overlap with the second angle to treat tissue to a first depth by the first single scan, and wherein the second angle overlaps with the first angle to treat tissue to a second depth by the first single scan and the second single scan.

[0293] Clause 90. The method of any of clauses 45-89, wherein the treatment plan is configured to fix a rotation angle of the treatment probe about an elongate probe axis and translate the treatment probe at the rotation angle to scan energy from the energy source along the tissue by a first single scan between a first translation position and a second translation position at the rotation angle.

[0294] Clause 91. The method of any of clauses 45-90, wherein the treatment plan is configured to increase a translation speed of the energy source on the treatment probe to decrease a treatment depth and decrease the translation speed to increase the treatment depth.

[0295] Clause 92. The method of any of clauses 45-91, wherein the treatment plan is configured to increase a rotation speed of the energy source on the treatment probe to decrease a treatment depth and decrease the rotation speed to increase the treatment depth.

[0296] Clause 93. The method of any of clauses 45-92, wherein each of the plurality of lateral images includes a second tissue, and a boundary of the second tissue is determined, and an output to a user interface is generated in response to a position of the boundary of the second tissue.

[0297] Clause 94. The method of any of clauses 45-93, wherein the position of the second tissue boundary is between the first angle and the second angle, and the output is generated in response to the position of the second tissue boundary being between the first angle and the second angle.

[0298] Clause 95. The method of any one of clauses 45-94, wherein a boundary of the first tissue is located between boundaries of the second tissue, and the output is generated in response to a distance between the probe and a location of the second tissue boundary.

[0299] Clause 96. The method of any one of clauses 45-95, wherein the treatment plan includes a rotation angle of an energy source that exceeds an edge of the first tissue boundary, and the output is generated in response to the rotation angle that exceeds the edge.

[0300] Clause 97. The method of any one of clauses 45-96, wherein the treatment plan corresponds to a penetration depth of an energy source that exceeds a thickness of the tissue, and the output is generated in response to the penetration depth being greater than the thickness.

[0301] Clause 98. The method of any one of clauses 45-97, wherein the thickness includes a plurality of thicknesses at a plurality of rotation angles of an energy source, and each of the plurality of thicknesses is determined for a corresponding angle of the plurality of rotation angles.

[0302] Clause 99. The method of any one of clauses 45-98, wherein the each of the plurality of thicknesses includes a distance between a first location of the first tissue boundary and a second location of the first tissue boundary at the corresponding angle, and the penetration depth is determined for the each of the plurality of thicknesses.

[0303] Clause 100. The method of any one of clauses 45-99, wherein the output to the user interface includes feedback to a user, and optionally, wherein the feedback includes one or more of a notification or an alert.

[0304] Clause 101. The method of any one of clauses 45-100, wherein the output to the user interface is configured for a user to adjust a treatment contour shown on one or more of the plurality of lateral images in response to the feedback.

[0305] Clause 102. The method of any one of clauses 45-101, wherein the treatment contour substantially encloses the region, and the user interface is configured for the user to adjust the treatment contour relative to the region by moving the treatment contour shown on a display for each of the plurality of lateral images.

[0306] Clause 103. The method of any of clauses 45-102, wherein the user interface is configured to adjust, by the user, one or more of an angle of the treatment contour relative to the probe or a depth of the treatment contour relative to the probe.

[0307] Clause 104. The method of any of clauses 45-103, wherein a boundary of the first tissue, a boundary of the second tissue, and a treatment contour are shown on each of the plurality of transverse images, and the user interface is configured to adjust the treatment contour on the plurality of transverse images.

[0308] Clause 105. The method of any of clauses 45-104, wherein the boundary of the first tissue and the boundary of the second tissue are determined with an AI algorithm.

[0309] Clause 106. The method of any of clauses 45-105, wherein the first tissue comprises a first anatomical tissue structure and the second tissue comprises a second anatomical tissue structure different from the first anatomical tissue structure.

[0310] Clause 107. The method of any of clauses 45-106, wherein the first anatomical tissue structure comprises an anatomical tissue structure of a first organ and the second anatomical tissue structure comprises a second anatomical tissue structure of a second organ different from the first organ.

[0311] Clause 108. The method of any of clauses 45-107, wherein the first anatomical tissue structure comprises one or more of anatomical structures of a first tissue structure comprising one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, or a lens of an eye, and the second anatomical tissue structure comprises one or more of anatomical structures of a second tissue structure comprising one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a trigone tissue, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, a prostate colliculus, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, or a retina of an eye.

[0312] Clause 109. The method of any of clauses 45 to 108, wherein the first anatomical tissue structure comprises an intravesical prostatic protrusion of the prostate and the second anatomical tissue structure comprises a trigone of the bladder.

[0313] Clause 110. The method or device of any of the preceding clauses, wherein the treatment comprises one or more of ablation, resection, or irradiation of the tissue.

[0314] Clause 111. The method of any of the preceding clauses, wherein the method comprises treating the patient.

[0315] Clause 112. A device comprising: a processor configured to perform the method of any of the preceding clauses.

[0316] Clause 113. The method or device of any of the preceding clauses, wherein the one or more longitudinal images comprise one or more of a sagittal image or a parasagittal image.

[0317] Clause 114. The method or device of any of the preceding clauses, wherein the plurality of transverse images extend transverse to the one or more longitudinal images, and optionally, perpendicular to the one or more longitudinal images.

[0318] Clause 115. The method or device of any of the preceding clauses, wherein the plurality of transverse images and the one or more longitudinal images have been rotated to align the one or more longitudinal images with an elongate axis of a treatment probe.

[0319] Clause 116. The method or device of any of the preceding clauses, wherein the processor is configured with instructions to determine a 3D treatment contour of the tissue with an AI algorithm, and provide the 3D treatment contour on a display for one or more of user verification or adjustment of the 3D treatment contour.

[0320] Embodiments of the present disclosure have been shown and described as described herein, and are provided by way of example only. Numerous adaptations, changes, variations, and alternatives to those embodiments will become apparent to those of ordinary skill in the art once the applications disclosed herein are made. Numerous substitutions, modifications, changes, and alterations of the applications disclosed herein will become apparent to those of ordinary skill in the art once the applications disclosed herein are made. It is intended that all such substitutions, modifications, changes, and alterations be considered as within the scope of the applications disclosed herein and the inventions disclosed herein. Accordingly, the scope of the present disclosure should be limited only by the appended claims and their equivalents.

Claims

1. A method of planning a treatment, the method comprising: receiving a plurality of transverse images and one or more longitudinal images of a tissue; generating an arrangement of the plurality of transverse images along the one or more longitudinal images in a three-dimensional (3D) view, the three-dimensional view including the plurality of transverse images at a plurality of corresponding positions along the one or more longitudinal images; superimposing a representation of a three-dimensional (3D) treatment contour on the 3D view of the plurality of transverse images and the one or more longitudinal images; and providing the 3D view with the representation superimposed on the one or more longitudinal images and one or more of the plurality of transverse images to a display of a user interface.

2. The method of claim 1, wherein, In the 3D view, the plurality of transverse images includes a first portion located on a first side of the one or more longitudinal images and a second portion located on a second side of the one or more longitudinal images, the first portion is located in front of the one or more longitudinal images, and the second portion is located behind the one or more longitudinal images.

3. The method of claim 2, wherein, The representation of the 3D treatment contour is superimposed on the first portion and the one or more longitudinal images in the 3D view, wherein the 3D representation extends along the first portion and the one or more longitudinal images from a common location where the first portion intersects the one or more longitudinal images.

4. The method of claim 2, wherein, The one or more longitudinal images include an amount of transparency sufficient to view the second portion of one or more of the transverse images through the one or more longitudinal images.

5. The method of claim 4, wherein, The representation of the 3D treatment contour is superimposed on the second portion of the second side, and the amount of transparency is sufficient to view the representation of the 3D treatment contour of the second side through the one or more longitudinal images.

6. The method of claim 1, wherein, The arrangement includes a three-dimensional (3D) arrangement, and the user interface includes input for a user to one or more of scale, pan, or rotate the 3D arrangement in the 3D view.

7. The method of claim 6, wherein, In response to the user input to one or more of scale, pan, or rotate the 3D representation, the representation of the 3D treatment contour moves with the 3D arrangement to maintain registration of the 3D treatment contour with the 3D arrangement.

8. The method of claim 7, wherein, The user input is configured to rotate the one or more longitudinal images and the plurality of transverse images from a first orientation to a second orientation, the first orientation showing a first portion of the plurality of transverse images located in front of the one or more longitudinal images and a second portion of the plurality of transverse images located behind the one or more longitudinal images, and the second orientation showing a second portion of the plurality of transverse images located in front of the one or more longitudinal images and a second portion of the transverse images located behind the one or more longitudinal images.

9. The method of claim 7, wherein, A representation of a treatment probe is shown extending along the one or more longitudinal images, and the representation of the treatment probe moves with the 3D arrangement and the 3D treatment contour to maintain registration of the representation of the treatment probe with the 3D arrangement and the 3D treatment contour.

10. The method of claim 1, wherein, The representation of the 3D treatment profile includes a three-dimensional (3D) treatment volume superimposed on the arrangement.

11. The method of claim 10, wherein, The 3D treatment volume extends in a longitudinal direction along the one or more longitudinal images and in a direction transverse to the one or more longitudinal images along the one or more transverse images.

12. The method of claim 11, wherein, An outer boundary of the 3D treatment volume is shown extending transverse to the one or more longitudinal images along the one or more longitudinal images and in the longitudinal direction along the transverse images.

13. The method of claim 1, wherein, In the 3D view, a representation of a treatment probe is shown extending in a longitudinal direction.

14. The method of claim 13, wherein, The representation includes an animation of the treatment probe.

15. The method of claim 14, wherein, The animation of the treatment probe is configured to move to show an animation of the treatment probe delivering energy from an energy source according to a 3D treatment plan.

16. The method of claim 13, wherein, The representation includes an image of the treatment probe from an imaging device.

17. The method of claim 1, wherein, The representation of the 3D treatment profile in the 3D view includes an intersection of the 3D treatment profile with one or more of the one or more longitudinal images and the plurality of transverse images.

18. The method of claim 1, wherein, The plurality of transverse images corresponds to a plurality of predefined anatomical locations of an organ.

19. The method of claim 18, wherein, The plurality of predefined anatomical locations includes anatomical locations of a first organ and a second organ, wherein the first organ and the second organ are visible in the one or more longitudinal images and one or more of the transverse images.

20. The method of claim 19, wherein, The plurality of predefined anatomical locations is identified using an artificial intelligence algorithm.

21. The method of claim 19, wherein, The first organ includes a prostate and the second organ includes a bladder.

22. The method of claim 21, wherein, The plurality of predefined anatomical locations includes an intraprostatic protrusion (IPP), a bladder neck (BL), the prostate (MID), a verumontanum (VERU), and a peripheral sphincter (P.SPH).

23. The method of claim 1, wherein, The user interface is configured to receive user input identifying a selected image from the one or more longitudinal images and the plurality of transverse images shown in the 3D view and to display the selected image in a 2D view.

24. The method of claim 23, wherein, The user input corresponds to a location of the selected image in the 3D view and input by a user at the location using a pointing device or touch screen display.

25. The method of claim 1, wherein, The user interface includes a plurality of user selectable inputs corresponding to images to be displayed, the plurality of user selectable inputs including a first input to display the 3D view, a second input to display the one or more longitudinal images, and a third input for the user to select one or more of the transverse images.

26. The method of claim 1, wherein, The user interface is configured to receive user input selecting a transverse image from the plurality of transverse images and to provide a two-dimensional (2D) view of the transverse image in response to the user input, wherein the representation is superimposed on the 2D view of the transverse image.

27. The method of claim 1, wherein, The user interface is configured to receive user input selecting the one or more longitudinal images and to provide a 2D view of the one or more longitudinal images in response to the user input, wherein the representation is superimposed on the 2D view of the one or more longitudinal images.

28. The method of claim 1, wherein, The plurality of lateral images intersect the one or more longitudinal images at the plurality of corresponding locations.

29. The method of claim 28, wherein, The plurality of lateral images includes volume pixels (voxels) that overlap the one or more longitudinal images at the plurality of corresponding locations.

30. The method of claim 1, wherein, In the 3D view, each of the plurality of lateral images appears substantially perpendicular to the one or more longitudinal images, and optionally within five degrees of perpendicular.

31. The method of claim 1, wherein, The 3D view includes a perspective view of the plurality of lateral images and the one or more longitudinal images.

32. The method of claim 1, wherein, The plurality of lateral images and the one or more longitudinal images include images from a 3D tomographic image.

33. The method of claim 1, wherein, The plurality of lateral images and the one or more longitudinal images include ultrasound images, and optionally wherein the ultrasound images include images from an ultrasound probe inserted into a patient.

34. The method of claim 1, wherein, The one or more longitudinal images includes a plurality of longitudinal images.

35. The method of claim 34, wherein, The plurality of longitudinal images is generated from a 3D volume image of the tissue.

36. The method of claim 35, wherein, The plurality of longitudinal images is generated in response to a plurality of angles of an energy source used to treat the tissue.

37. The method of claim 34, wherein, The plurality of longitudinal images includes a first longitudinal image along a first portion of the treatment contour and a second longitudinal image along a second portion of the treatment contour.

38. The method of claim 37, wherein, The arrangement shows a portion of the first longitudinal image along a portion of the first portion of the treatment contour and a portion of the second longitudinal image along a portion of the second portion of the treatment contour.

39. The method of claim 37, wherein, The first longitudinal image includes a first transparency along the first portion of the treatment contour and a second transparency along the second portion of the treatment contour that is greater than the first transparency to increase visibility of the second longitudinal image along the second portion.

40. The method of claim 39, wherein, The second longitudinal image includes a first transparency along the first portion of the treatment contour and a second transparency along the second portion of the treatment contour, the first transparency being greater than the second transparency to increase visibility of the first longitudinal image along the first portion of the treatment contour.

41. The method of claim 34, wherein, The plurality of longitudinal images includes a first longitudinal image at a first angle relative to an axis of rotation and a second longitudinal image at a second angle relative to an axis of translation.

42. The method of claim 41, wherein, The first angle corresponds to a first rotational angle of an energy source about the axis and the second angle corresponds to a second rotational angle of an energy source, and optionally wherein the first angle and the second angle correspond to rotational angles of an energy source inserted into the patient.

43. The method of claim 41, wherein, The first longitudinal image extends at the first angle along a first portion of the treatment contour and a second portion of the longitudinal image extends at the second angle along a second portion of the treatment contour.

44. The method of claim 34, wherein, The plurality of longitudinal images includes at least 3 longitudinal images, each longitudinal image at a different rotational angle relative to an elongate axis of a treatment probe.

45. A method of generating a treatment plan, the method comprising: receiving a plurality of lateral images of a tissue to be treated; for each of the plurality of lateral images, determining a position of a treatment probe and a boundary of the tissue, the boundary defining a region of the tissue; determining, for each of the plurality of lateral images, a first treatment angle from the treatment probe to a first treatment location on a first side of the region responsive to the boundary, and a second treatment angle from the treatment probe to a second treatment location on a second side of the region responsive to the boundary; and generating the treatment plan responsive to the first and second treatment angles for each of the plurality of lateral images.

46. The method of claim 45, wherein, the first treatment angle is oriented to provide a first tissue margin at the first side, and the second treatment angle is oriented to provide a second tissue margin at the second side.

47. The method of claim 45, wherein, the first treatment angle is selected to provide a first tissue margin thickness at the first treatment angle that is greater than a penetration depth of the energy source at the first angle, and the second treatment angle is selected to provide a second tissue margin thickness at the second angle that is greater than a penetration depth of the energy source at the second angle.

48. The method of claim 46, wherein, the first tissue margin corresponds to a first tissue margin angle between the first treatment angle and a first angle of a boundary of the first side, and the second tissue margin corresponds to a second tissue margin angle between the second treatment angle and a second angle of a boundary of the second side.

49. The method of claim 48, wherein, the first tissue margin angle is in a range of about 1 degree to about 15 degrees, and optionally in a range of about 1 degree to about 10 degrees, and further optionally in a range of about 2 degrees to about 10 degrees.

50. The method of claim 48, wherein, the second tissue margin angle is in a range of about 1 degree to about 15 degrees, and optionally in a range of about 1 degree to about 10 degrees, and further optionally in a range of about 2 degrees to about 10 degrees.

51. The method of claim 46, wherein, the treatment plan corresponds to a first penetration depth of the energy source at the first treatment angle, and the first tissue margin includes a first margin thickness at the first treatment angle that is greater than the first depth.

52. The method of claim 50, wherein, the first margin thickness is greater than the first penetration depth by an amount in a range of about 1% to about 15%, and optionally in a range of about 1% to about 10%, and further optionally in a range of about 2% to about 10%.

53. The method of claim 46, wherein, the treatment plan corresponds to a second penetration depth of the energy source at the second treatment angle, and the second tissue margin includes a second margin thickness at the first treatment angle that is greater than the second depth.

54. The method of claim 53, wherein, the second margin thickness is greater than the second penetration depth by an amount in a range of about 1% to about 15%, and optionally in a range of about 1% to about 10%, and further optionally in a range of about 2% to about 10%.

55. The method of claim 45, wherein, the first treatment angle is determined responsive to a first boundary angle between the treatment probe and a boundary of tissue of the first side, and the second treatment angle is determined responsive to a second boundary angle between the treatment probe and a boundary of tissue of the second side.

56. The method of claim 55, wherein, The first treatment angle and the first boundary angle are arranged to provide a first tissue margin between the first treatment angle and the first boundary angle, and wherein the second treatment angle and the second boundary angle are arranged to provide a second tissue margin between the second angle and the second boundary angle.

57. The method of claim 55, wherein, The first boundary angle is determined from the treatment probe to a first edge of the boundary of the first side, and the second boundary angle is determined from the treatment probe to a second edge of the boundary of the second side.

58. The method of claim 57, wherein, The first boundary angle corresponds to a first projection line from the probe to a first boundary location, the first projection line being tangent to the boundary of the first side, and the second edge of the tissue margin corresponds to a second projection line from the probe, the second projection line being tangent to the boundary of the second side.

59. The method of claim 57, wherein, The first tissue margin extends between the first edge of the boundary and the first treatment location of the first side, and the second tissue margin extends between the second edge of the boundary and the second treatment location of the second side.

60. The method of claim 45, wherein, The treatment plan is configured to treat tissue according to a treatment profile corresponding to the first treatment angle and the second treatment angle for each of the plurality of transverse images.

61. The method of claim 60, wherein, The treatment profile includes a variable thickness between the first treatment angle and the second treatment angle.

62. The method of claim 60, wherein, The treatment profile includes a substantially uniform thickness between the first treatment angle and the second treatment angle, and optionally wherein a uniform deviation of the substantially uniform thickness is within 20%.

63. The method of claim 60, wherein, The treatment profile is separate from the probe, wherein there is a gap between the probe and the treatment profile.

64. The method of claim 61, wherein, The variable thickness includes a first thickness corresponding to the first treatment angle, a second thickness corresponding to the second treatment angle, and a center thickness at an angle between the first angle and the second angle, the center thickness of the treatment profile being greater than the first thickness and the second thickness.

65. The method of claim 64, wherein, The treatment plan is configured to treat the first thickness and the second thickness with a first scan of energy from the energy source between the first treatment angle and the second treatment angle, and to treat the center thickness with the first scan and a second scan of energy from the energy source.

66. The method of claim 65, wherein, The first scan includes a first rotational scan of the energy source between the first treatment angle and the second treatment angle, and the second scan includes a second rotational scan of the energy source, the second rotational scan including a rotational angle less than the first rotational scan.

67. The method of claim 60, wherein, The treatment plan is configured to remove tissue at a plurality of thicknesses at a plurality of corresponding angles between the first treatment angle and the second treatment angle.

68. The method of claim 67, wherein, The treatment plan is configured to remove tissue to a first depth with a first single scan of the energy source at a first angular aperture between the first treatment angle and the second treatment angle, and to remove tissue to a second depth with a second single scan of the energy source corresponding to a second angular aperture less than the first angular aperture, the second depth being greater than the first depth.

69. The method of claim 68, wherein, The second angular aperture corresponds to a third position of a first side of the region and a fourth position of a second side of the region.

70. The method of claim 69, wherein, The third position is at or below the first removal depth and the fourth position is at or below the first removal depth.

71. The method of claim 67, wherein, Each of the plurality of thicknesses includes a distance from a proximal position of the boundary to a distal position of the boundary at a certain angle of a plurality of corresponding treatment angles.

72. The method of claim 67, wherein, The treatment plan is configured to adjust one or more of an energy intensity from the energy source, an energy power from the energy source, a translation speed of the energy source, a rotation speed of the energy source, or a number of single scans of the energy source at the plurality of corresponding angles to treat the tissue according to the plurality of thicknesses.

73. The method of claim 60, wherein, The treatment profile includes a plurality of thicknesses corresponding to a plurality of rotation angles of an energy source, and each of the plurality of thicknesses is determined for a corresponding treatment angle of the plurality of rotation angles.

74. The method of claim 45, wherein, A distance between the probe and the boundary reaches a minimum at a position of the boundary closest to the probe and reaches a maximum at a position of the boundary farthest from the probe.

75. The method of claim 45, wherein, The first position at the first treatment angle is separated from the probe by a first distance and the second position at the second treatment angle is separated from the probe by a second distance.

76. The method of claim 45, wherein, The boundary includes a boundary of an anatomical tissue structure separated by a distance from the probe, and the treatment plan is configured to adjust energy delivery from the energy source in response to the distance and the first treatment angle and the second angle from the each of the plurality of transverse images.

77. The method of claim 76, wherein, The boundary encloses the anatomical tissue structure and optionally includes a perimeter around the anatomical tissue structure in the each of the plurality of transverse images.

78. The method of claim 45, wherein, The boundary is determined for the each of the plurality of transverse images by an artificial intelligence algorithm.

79. The method of claim 45, wherein, For the each of the plurality of transverse images, the position of the probe corresponds to a position of a directional energy source during treatment and the first angle corresponds to a first angle of the directional energy source during treatment and the second angle corresponds to a second angle of the energy source during treatment.

80. The method of claim 45, wherein, The first angle, the second angle of the each of the plurality of transverse images correspond to a plurality of treatment angles of a three-dimensional (3D) treatment plan.

81. The method of claim 80, wherein, The first angle and the second of the each of the plurality of transverse images are combined to generate the 3D treatment plan.

82. The method of claim 80, wherein, The plurality of transverse images are positioned along a treatment axis corresponding to an axial translation of a directional energy source on the probe during treatment and the each of the plurality of transverse images is at a certain position along the treatment axis.

83. The method of claim 82, wherein, The treatment plan is configured to rotate the probe for the each of the plurality of positions along the treatment axis to direct energy from an energy source at the first angle to the first position and at the second angle to the second position.

84. The method of claim 83, wherein, The treatment plan is configured to rotate the energy source from the first angle to the second angle to cause the energy source to scan the tissue between the first angle and the second angle.

85. The method of claim 45, wherein, The treatment plan includes machine readable instructions for moving the probe along a treatment probe axis to a plurality of axial positions and rotating the probe to a plurality of angles to deliver energy from an energy source at the plurality of axial positions and at the plurality of angles.

86. The method of claim 85, wherein, The treatment plan includes the first angle and the second angle for each of the plurality of positions and is configured to cause the energy source to scan the tissue between the first angle and the second angle at the each of the plurality of axial positions.

87. The method of claim 85, wherein, The treatment plan is configured to adjust one or more of an energy intensity from the energy source, an energy power from the energy source, a translation of the probe along the treatment probe axis, a rotation of the probe about the treatment probe axis, a translation speed of the treatment probe, a rotation speed of the treatment probe, or a number of single scans of the energy source along the tissue in order to treat the tissue to different depths according to a treatment profile.

88. The method of claim 87, wherein, The treatment plan is configured to fix an axial position of the treatment probe and rotate the treatment probe at the axial position to cause energy from the energy source to scan the tissue by a first single scan between a first angle at the axial position and a second single scan between a second angle at the axial position.

89. The method of claim 88, wherein, A first portion of tissue between the first angle does not overlap the second angle to treat tissue to a first depth by the first single scan, and wherein the second angle overlaps the first angle to treat tissue to a second depth by the first single scan and the second single scan.

90. The method of claim 87, wherein, The treatment plan is configured to fix a rotation angle of the treatment probe about an elongate probe axis and translate the treatment probe at the rotation angle to cause energy from the energy source to scan the tissue by a first single scan between a first translation position at the rotation angle and a second single scan between a second translation position at the rotation angle.

91. The method of claim 85, wherein, The treatment plan is configured to increase a translation speed of an energy source on the treatment probe to decrease a treatment depth and decrease the translation speed to increase the treatment depth.

92. The method of claim 85, wherein, The treatment plan is configured to increase a rotation speed of an energy source on the treatment probe to decrease a treatment depth and decrease the rotation speed to increase the treatment depth.

93. The method of claim 45, wherein, Each of the plurality of transverse images includes a second tissue and a boundary of the second tissue is determined and an output to a user interface is generated in response to a position of the boundary of the second tissue.

94. The method of claim 93, wherein, The position of the second tissue boundary is between the first angle and the second angle and the output is generated in response to the position of the second tissue boundary being between the first angle and the second angle.

95. The method of claim 93, wherein, a boundary of the first tissue is between boundaries of the second tissue, and the output is generated in response to a distance between the probe and a location of the second tissue boundary.

96. The method of claim 93, wherein, the treatment plan includes a rotation angle of an energy source that exceeds an edge of the first tissue boundary, and the output is generated in response to the rotation angle exceeding the edge.

97. The method of claim 93, wherein, the treatment plan corresponds to a penetration depth of an energy source that exceeds a thickness of the tissue, and the output is generated in response to the penetration depth being greater than the thickness.

98. The method of claim 97, wherein, the thickness includes a plurality of thicknesses of the energy source at a plurality of rotation angles, and each of the plurality of thicknesses is determined for a corresponding angle of the plurality of rotation angles.

99. The method of claim 98, wherein, the each of the plurality of thicknesses includes a distance between a first location of the first tissue boundary and a second location of the first tissue boundary at the corresponding angle, and the penetration depth is determined for the each of the plurality of thicknesses.

100. The method of claim 93, wherein, the output to the user interface includes feedback to a user, and optionally, wherein the feedback includes one or more of a notification or an alert.

101. The method of claim 93, wherein, the output to the user interface is configured for the user to adjust a treatment contour shown on one or more of the plurality of lateral images in response to the feedback.

102. The method of claim 101, wherein, the treatment contour substantially encloses the region, and the user interface is configured for the user to adjust the treatment contour relative to the region by moving the treatment contour shown on the display for each of the plurality of lateral images.

103. The method of claim 101, wherein, the user interface is configured for the user to adjust one or more of an angle of the treatment contour relative to the probe or a depth of the treatment contour relative to the probe.

104. The method of claim 93, wherein, a boundary of the first tissue, a boundary of the second tissue, and a treatment contour are shown on each of the plurality of lateral images, and the user interface is configured to adjust the treatment contour on the plurality of lateral images.

105. The method of claim 93, wherein, the boundary of the first tissue and the boundary of the second tissue are determined with an AI algorithm.

106. The method of claim 93, wherein, the first tissue includes a first anatomical tissue structure, and the second tissue includes a second anatomical tissue structure different from the first anatomical tissue structure.

107. The method of claim 106, wherein, the first anatomical tissue structure includes an anatomical tissue structure of a first organ, and the second anatomical tissue structure includes a second anatomical tissue structure of a second organ different from the first organ. the first anatomical tissue structure includes an anatomical tissue structure of a first organ, and the second anatomical tissue structure includes a second anatomical tissue structure of a second organ different from the first organ.

108. The method of claim 108, wherein, The first anatomical tissue structure includes one or more of the anatomical structures of a first tissue structure, the anatomical structures of the first tissue structure including one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, or a lens of an eye, and the second anatomical tissue structure includes one or more of the anatomical structures of a second tissue structure, the anatomical structures of the second tissue structure including one or more of: a tissue wall, a vesicle, a lumen, a lumen wall, a bladder, a bladder wall, a bladder neck, a bladder neck wall, a trigone, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a ureter wall, a prostate, a prostate lobe, an intravesical prostate protrusion, a prostate capsule, a prostate colliculus, an internal and external sphincter, an artery, an artery wall, a vein, a vein wall, or a retina of an eye.

109. The method of claim 108, wherein, The first anatomical tissue structure includes an intravesical prostate protrusion of the prostate, and the second anatomical tissue structure includes a trigone of the bladder.

110. The method or apparatus of any of the preceding claims, wherein, The treatment includes one or more of ablating, resecting, or irradiating the tissue.

111. The method of any of the preceding claims, wherein, The method includes treating the patient.

112. An apparatus comprising: a processor configured to perform the method of any of the preceding claims.

113. The method or apparatus of any of the preceding claims, wherein, The one or more longitudinal images include one or more of sagittal images or parasagittal images.

114. The method or apparatus of any of the preceding claims, wherein, The plurality of transverse images extend transverse to the one or more longitudinal images, and optionally perpendicular to the one or more longitudinal images.

115. The method or apparatus of any of the preceding claims, wherein, The plurality of transverse images and the one or more longitudinal images have been rotated to align the one or more longitudinal images with an elongate axis of a treatment probe.

116. The method or apparatus of any of the preceding claims, wherein, The processor is configured with instructions to determine a 3D treatment profile of the tissue with an AI algorithm, and to provide the 3D treatment profile on a display for one or more of user verification or adjustment of the 3D treatment profile.

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