Identifying and targeting anatomical features

Abstract

A method of positioning a surgical instrument can involve advancing a first medical instrument to a treatment site of a patient, the first medical instrument including a camera; recording a target position associated with a target anatomical feature at the treatment site; generating a first image of the treatment site using the camera of the first medical instrument; identifying the target anatomical feature in the first image using a pre-trained neural network; and adjusting the target position based at least in part on the position of the identified target anatomical feature in the first image.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Application No. 62 / 955,991, filed December 31, 2019, and entitled “ANATOMICAL FEATURE IDENTIFICATION AND TARGETING,” the disclosure of which is incorporated by reference herein in its entirety.

[0002] FIELD OF THEINVENTION The present disclosure relates to the field of medical procedures. [Background technology]

[0003] Various medical procedures involve the use of one or more scope-type devices configured with specific image capture capabilities that can be utilized to provide visualization of specific anatomical features associated with the particular medical procedure, and certain operational processes can be guided, at least in part, by image data captured using such devices. Summary of the Invention [Means for solving the problem]

[0004] Described herein are systems, devices, and methods for facilitating identification and tracking of various anatomical features based on images of such features acquired using a scope device or other medical instrument. Identification and / or tracking of such features can facilitate targeting of specific anatomical features in connection with medical procedures, such as, for example, nephroscopy or other procedures that access the renal anatomy.

[0005] In some implementations, the present disclosure relates to a method of positioning a surgical instrument, the method including advancing a first medical instrument to a treatment site of a patient, the first medical instrument including a camera, recording a target position associated with a target anatomical feature at the treatment site, generating a first image of the treatment site using the camera of the first medical instrument, identifying the target anatomical feature in the first image using a pre-trained neural network, and adjusting the target position based at least in part on a position of the identified target anatomical feature in the first image.

[0006] The method may further include adjusting an orientation of the first medical instrument based at least in part on a location of the identified target anatomical feature in the first image. For example, adjusting the orientation of the first medical instrument may involve centering the identified target anatomical feature within a field of view associated with the camera.

[0007] In some embodiments, recording the target location involves contacting the target anatomical feature with a distal end of a first medical instrument, generating position data indicative of the target anatomical feature and the contact location of the distal end of the first medical instrument, and storing the position data in one or more data storage devices. For example, the method may further include retracting the distal end of the first medical instrument away from the target anatomical feature prior to said generation of the first image.

[0008] In some embodiments, the method further includes generating a second image of the treatment site using a camera of the first medical instrument after generating the first image, identifying an anatomical feature in the second image using a pre-trained neural network, determining that the anatomical feature of the second image and the target anatomical feature of the first image represent the same feature, and adjusting the target location in response to the determination based at least in part on the location of the identified anatomical feature in the second image. For example, determining that the anatomical feature of the second image and the target anatomical feature of the first image represent the same feature can involve determining that an amount of overlap between at least a portion of the anatomical feature of the second image and at least a portion of the target anatomical feature of the first image is greater than a predetermined threshold. The method may further include generating a first mask of the first image that masks at least a portion of the target anatomical feature of the first image, and generating a second mask of the second image that masks at least a portion of the anatomical feature of the second image, where the determination of the amount of overlap is performed using the first mask and the second mask. In some embodiments, determining that the anatomical feature in the second image and the target anatomical feature in the first image represent the same feature can involve tracking movement of the feature between the first image and the second image. In some embodiments, the method further includes estimating a three-dimensional position of the anatomical feature in the second image based at least in part on the first image and the second image. For example, the estimation of the three-dimensional position of the anatomical feature is based on one or more of a camera focal length, a camera principal point, a relative motion of the first medical instrument, a rotation of the first medical instrument, and electromagnetic, structured illumination, and / or time-of-flight sensor readings.

[0009] In some embodiments, adjusting the target location is further based at least in part on the determined movement of the first medical instrument. The method may further include percutaneously directing a second medical instrument through the patient's tissue toward the target location. For example, percutaneously directing the second medical instrument through the patient's tissue toward the target location may be performed using sensor data provided by matching sensors of both the first medical instrument and the second medical instrument. In some embodiments, the method is performed at least in part by a robotic system.

[0010] In some implementations, the present disclosure relates to a method for targeting an anatomical feature, the method including receiving target location data indicative of a target location associated with a target anatomical feature of a patient, storing the target location data in one or more data storage devices, receiving a first image of a surgical site within the patient, identifying a first morphology in the first image that is representative of the target anatomical feature using an artificial neural network, and storing updated target location data indicative of the target location based on the identified morphology in the first image.

[0011] The method may further include articulating the medical instrument in response to the updated target location data. In some embodiments, the method is performed by a control circuit of a medical system, and the target location data and the first image are received from an endoscope of the medical system. The target anatomical feature may be an exposed portion of a papilla within a calyx of a kidney of the patient. The artificial neural network may be pre-trained based on known image and labeling data. For example, the artificial neural network may include a multi-layer feature pyramid network.

[0012] The updated target location data can be based at least in part on known respiratory information associated with the patient. In some embodiments, the method further includes receiving a second image of the surgical site, identifying a second morphology in the second image representing the target anatomical feature using an artificial neural network, and determining a three-dimensional location of the target anatomical feature based at least in part on the first morphology and the second morphology. For example, the determination of the three-dimensional location of the target anatomical feature can be based at least in part on a relative size of the second morphology. In some embodiments, the determination of the three-dimensional location of the target anatomical feature is based on data generated by one or more external camera sensors, such as structured light sensors, time-of-flight sensors, and / or the like.

[0013] In some implementations, the present disclosure relates to a medical system comprising an endoscope having a camera, the endoscope having an electromagnetic position sensor associated with a distal end thereof, a robotic medical subsystem including a plurality of articulating arms, and a control circuit communicatively coupled to the endoscope and the robotic medical subsystem, the control circuit configured to: responsive to user input, advance the endoscope to a treatment site on a patient, record a position of the distal end of the endoscope within an electromagnetic field, generate user interface data indicating the position as a target anatomical location, receive a first image from a camera of the endoscope, identify a target anatomical feature in the first image using a pre-trained neural network, and adjust the target anatomical location based at least in part on the location of the identified target anatomical feature in the first image.

[0014] The control circuitry can be further configured to calibrate the distal end of the endoscope within the electromagnetic field. In some embodiments, the medical system further comprises a robotic nephroscope communicatively coupled to the control circuitry.

[0015] In some implementations, the present disclosure relates to a computing device comprising an endoscope interface and a control circuit including one or more processors and one or more data storage devices, wherein the control circuit is configured to receive matching sensor data indicative of a position of a distal end of an endoscope coupled to the control circuit on the endoscope interface, generate first user interface data indicative of the position of the distal end of the endoscope as a target nephroscopy position, receive a first image of the medical site on the endoscope interface, identify a first anatomical form in the first image, receive a second image of the medical site on the endoscope interface, identify a second anatomical form in the second image, determine that the first anatomical form and the second anatomical form represent a same target anatomical feature, and update the target nephroscopy position based on the determination.

[0016] The control circuitry may be further configured to determine that an amount of overlap of the first morphology and the second morphology in the overlay of the first image and the second image is greater than a predetermined threshold. In some embodiments, the control circuitry is configured to generate, in response to said updating of the target nephroscopy location, second user interface data indicative of the updated target nephroscopy location.

[0017] For purposes of summarizing the disclosure, certain aspects, advantages, and novel features have been described. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, the disclosed embodiments may be practiced in a manner that achieves or optimizes one advantage or group of advantages as taught herein, without necessarily achieving other advantages as may be taught or suggested herein. [Brief description of the drawings]

[0018] Various embodiments are depicted in the accompanying drawings for illustrative purposes and should not be construed as limiting the scope of the present invention in any way. In addition, various features of different disclosed embodiments can be combined to form additional embodiments that are part of the present disclosure. Throughout the drawings, reference numerals may be reused to indicate correspondence between referenced elements. [Figure 1] 1 illustrates an embodiment of a robotic medical system, in accordance with one or more embodiments. [Diagram 2] 2 illustrates an example device that may be implemented in the medical system of FIG. 1, according to one or more embodiments. [Diagram 3] 1 illustrates a ureteroscope placement portion of the urinary system, according to one or more embodiments. [Figure 4-1] FIG. 1 is a flow diagram illustrating a process for performing a guided percutaneous nephrolithotomy, according to one or more embodiments. [Figure 4-2] FIG. 1 is a flow diagram illustrating a process for performing a guided percutaneous nephrolithotomy, according to one or more embodiments. [Figure 5-1] 5 illustrates certain images that correspond to various blocks, states, and / or operations associated with the process of FIG. 4 in accordance with one or more embodiments. [Figure 5-2] 5 illustrates certain images that correspond to various blocks, states, and / or operations associated with the process of FIG. 4 in accordance with one or more embodiments. [Figure 6] FIG. 1 is a flow diagram illustrating a process for targeting anatomical features, according to one or more embodiments. [Figure 7] 1 illustrates a target identification and / or classification architecture, according to one or more embodiments. [Figure 8] 1 illustrates a neural network-based image segmentation architecture, according to one or more embodiments. [Figure 9] FIG. 1 is a flow diagram illustrating a process for tracking a target anatomical feature, according to one or more embodiments. [Figure 10-1] 1 provides a flow diagram illustrating a process for tracking a target anatomical feature, according to one or more embodiments. [Figure 10-2] 1 provides a flow diagram illustrating a process for tracking a target anatomical feature, according to one or more embodiments. [Figure 11] 10-1 and 10-2, in accordance with one or more embodiments. [Figure 12] 1 illustrates a three-dimensional localization framework in accordance with one or more embodiments. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0019] The headings provided herein are merely for convenience and do not necessarily affect the scope or meaning of the claimed invention. Although certain preferred embodiments and examples are disclosed below, the subject matter of the invention extends beyond the specifically disclosed embodiments to other alternative embodiments and / or applications, as well as to modifications and equivalents thereof. Thus, the scope of claims that may arise from this specification is not limited by any of the specific embodiments described below. For example, in any method or process disclosed herein, the acts or operations of the method or process may be performed in any suitable order and are not necessarily limited to any particular disclosed order. Various operations may be described as multiple separate operations in a manner that may be helpful in understanding a particular embodiment. However, the order of description should not be construed to imply that these operations are order dependent. In addition, the structures, systems, and / or devices described herein may be embodied as integrated components or as separate components. For purposes of comparing various embodiments, certain aspects and advantages of these embodiments are described. Not necessarily all such aspects or advantages are achieved by any particular embodiment. Thus, for example, various embodiments may be implemented in a manner that achieves or optimizes one advantage or group of advantages as taught herein, without necessarily achieving other aspects or advantages that may also be taught or suggested herein.

[0020] Certain standard anatomical terms of location are used herein to refer to animal, i.e., human, anatomical structures with respect to preferred embodiments. Certain spatially relative terms, such as "outer," "inner," "superior," "lower," "below," "upper," "vertical," "horizontal," "top," "bottom," and similar terms, are used herein to describe the spatial relationship of one device / element or anatomical structure to another device / element or anatomical structure, with it being understood that these terms are used herein for ease of description to describe the positional relationships between the elements / structures as illustrated in the drawings. It should be understood that the spatially relative terms are intended to encompass different orientations of the elements / structures during use or operation in addition to the orientation depicted in the drawings. For example, an element / structure described as "above" another element / structure may represent a position that is below or beside such other element / structure relative to the subject patient or alternative orientations of the element / structure, and vice versa.

[0021] The present disclosure relates to systems, devices, and methods for identifying and tracking target anatomical features of a patient to aid in certain medical procedures. Although certain aspects of the present disclosure are described in detail herein in the context of renal, urological, and / or nephrological procedures, such as kidney stone removal / treatment procedures, it should be understood that such context is provided for convenience and clarity, and that the anatomical feature identification and tracking concepts disclosed herein are applicable to any suitable medical procedures. However, as noted, a description of the anatomical structures of the renal / urinary system and associated medical problems and procedures is presented below to aid in the explanation of the inventive concepts disclosed herein.

[0022] Kidney stone disease, also known as urolithiasis, is a relatively common medical condition that involves the formation of solid pieces of material in the urinary tract, referred to as "kidney stones," "urinary stones," "nephrolithiasis," "nephrolithiasis," or "nephrolithiasis." Urinary stones can form and / or be found in the kidneys, ureters, and bladder (referred to as "bladder stones"). Urinary stones form as a result of concentrated minerals and can cause significant abdominal pain if they reach a size sufficient to block urine flow through the ureter or urethra. Urinary stones can be formed from calcium, magnesium, ammonia, uric acid, cysteine, and / or other compounds.

[0023] To remove urinary stones from the bladder and ureters, a surgeon may insert a ureteroscope through the urethra and into the urinary tract. Typically, the ureteroscope includes an endoscope at its distal end configured to allow visualization of the urinary tract. The ureteroscope may also include a stone extraction mechanism for capturing or breaking up urinary stones. During a ureteroscopy procedure, one physician / technician may control the position of the ureteroscope while another physician / technician may control the stone extraction mechanism.

[0024] To remove relatively large stones (i.e., "kidney stones") from the kidney, physicians may use percutaneous nephrolithotomy ("PCNL") techniques that involve inserting a nephroscope through the skin to break up and / or remove the stone. Locating the kidney stone may be accomplished using fluoroscopy to provide a target for insertion of the nephroscope. However, fluoroscopy increases the cost of the nephrolithotomy procedure due to the cost of the fluoroscope itself, as well as the cost of a technician to operate the fluoroscope. Fluoroscopy also exposes the patient to radiation for extended periods of time. Even with fluoroscopy, accurately making the percutaneous incisions to access the kidney stone can be difficult and unnecessarily inaccurate. Furthermore, some nephrolithotomy techniques involve a two- or three-day hospital stay. In short, certain nephrolithotomy techniques can be relatively expensive and problematic for patients.

[0025] Depending on the particular surgical procedure, an endoscope (e.g., ureteroscope) may be equipped with a position sensor, and the location of the sensor may be used as a target for percutaneous access, such as for PCNL. For example, a ureteroscope equipped with an electromagnetic sensor and / or a percutaneous access needle equipped with an electromagnetic sensor may be used to guide percutaneous renal access for kidney stone removal and / or the like. In such a procedure, a surgeon / physician may drive the ureteroscope to a target calyx of the kidney and use an electromagnetic sensor (e.g., a beacon) associated with the distal / tip of the ureteroscope as a percutaneous access target for the needle. In general, the effectiveness of the percutaneous axis relative to the target calyx may depend at least in part on where the physician positions / parks the ureteroscope, for example, relative to the position and / or leading orientation of the ureteroscope relative to the papilla through which percutaneous access may be performed to the target calyx. For some procedures where the distal end / tip of the ureteroscope is used as the percutaneous access target, it may be desirable for the distal tip of the ureteroscope to be as close to the papilla / calyx as possible during percutaneous access / approach.

[0026] The terms "scope" and "endoscope" are used herein according to their broad and ordinary meaning and may refer to any type of elongated medical instrument having imaging, viewing, and / or capturing capabilities and configured to be introduced into any type of organ, cavity, lumen, chamber, or space in the body. For example, references to a scope or endoscope herein may refer to a ureteroscope, cystoscope, nephroscope, bronchoscope, arthroscope, colonoscope, laparoscope, borescope, or the like. A scope / endoscope may, in some cases, comprise a rigid or flexible tube and may be sized to be passed within an outer sheath, catheter, introducer, or other luminal device, or may be used without such a device.

[0027] Robot-assisted percutaneous procedures can be implemented in connection with various medical procedures, such as kidney stone removal procedures, where the robotic tools can enable the physician / urologist to perform endoscopic target access (e.g., ureteroscope) as well as percutaneous access or treatment. However, movement of the target anatomical feature during operation can be problematic when the operating physician relies on a fixed percutaneous access target location. Advantageously, aspects of the present disclosure relate to real-time target tracking / guidance in medical procedures, which can be utilized by the operating physician to orient the percutaneous access instrument (e.g., needle or other rigid tool) and / or to guide the robotic instrumentation, such as by automatically adjusting the endoscope position and / or alignment in response to such real-time target tracking information. To facilitate such functionality, embodiments of the present disclosure can advantageously provide mechanisms for automatic target detection, tracking, and / or three-dimensional positioning estimation to assist the physician (e.g., urologist) in achieving relatively efficient and accurate percutaneous access for various surgical procedures, such as nephroscopy. Although aspects of the present disclosure are described herein for convenience in the context of ureteroscopically guided nephroscopy, it should be understood that the inventive aspects of the present disclosure may be implemented in any suitable or desired type of percutaneous and / or endoscopic medical procedure, whether robotic or not.

[0028] Healthcare System FIG. 1 illustrates an exemplary medical system 10 for performing various medical procedures according to aspects of the present disclosure. The medical system 10 includes a robotic system 11 configured to engage and / or control a medical instrument 32 and perform the procedure on a patient 13. The medical system 10 also includes a control system 50 configured to interface with the robotic system 11, provide information regarding the procedure, and / or perform various other operations. For example, the control system 50 may include a display 42 for presenting certain information and assisting a physician 5. The medical system 10 may include a table 15 configured to hold a patient 130. The system 10 may further include an electromagnetic (EM) field generator (not shown, see FIG. 3), which may be held by one or more of the robotic arms 12 of the robotic system 11 or may be a stand-alone device.

[0029] In some implementations, the system 10 may be used to perform a percutaneous procedure, such as a percutaneous nephrolithotomy (PCNL). Illustratively, if the patient 13 has a kidney stone 80 that is too large to be removed through the urinary tract, the physician may perform a procedure to remove the kidney stone through a percutaneous access point on the patient 13. In some embodiments, the physician may interact with the control system 50 and / or the robotic system 11 to control the robotic system 11 to advance and navigate the medical instrument 32 (e.g., a scope) from the urethra 67, through the bladder 65, up the ureter 63, and into the kidney 70 where the stone 80 is located. The control system 50 may provide information about the medical instrument 32, such as real-time endoscopic images captured therewith, via the display 42 to assist the physician 5 in navigating the medical instrument.

[0030] The anatomy of the kidney is described herein for reference with respect to certain medical procedures related to aspects of the inventive concept. The kidneys, shown generally in a typical anatomical location in FIG. 1, generally comprise two bean-shaped organs located side-by-side in the retroperitoneal space. In adult humans, the kidneys are generally about 11 cm in length. The kidneys receive blood from paired renal arteries, which drain into paired renal veins, neither of which are shown for visual clarity. Each kidney 70 is attached to a ureter 63, a tube that carries urine excreted from the kidney to the bladder 65.

[0031] The kidneys typically sit relatively high in the abdominal cavity, in a retroperitoneal position at a slight oblique angle. Intraperitoneal asymmetry caused by the position of the liver typically causes the right kidney to be slightly lower and smaller than the left, and slightly more centrally located than the left kidney. Above each kidney is the adrenal gland. The upper part of the kidney is partially protected by the 11th and 12th ribs. Each kidney with its adrenal gland is surrounded by two layers of fat: perirenal fat, which resides between the renal fascia and the renal capsule, and pararenal fat, which resides above the renal fascia.

[0032] The kidneys are responsible for controlling the volumes of various body fluid compartments, fluid osmolality, acid-base balance, various electrolyte concentrations, and the removal of toxins. The kidneys provide a filtration function by secreting certain substances and reabsorbing others. Examples of substances secreted in urine are hydrogen, ammonium, potassium, and uric acid. In addition, the kidneys also perform various other functions, such as hormone synthesis and others.

[0033] The recessed area on the concave border of the kidney 70 is the renal hilum 78, where the renal artery (not shown) enters the kidney and the renal vein (not shown) and ureter 63 exit. The kidney is surrounded by a tough fibrous tissue, the renal capsule 74, which is itself surrounded by perirenal fat, renal fascia, and pararenal fat. The anterior (front) surface of these tissues is the peritoneum, while the posterior (back) surface is the transversalis fascia.

[0034] The functional substance or parenchyma of the kidney is divided into two major structures: the outer renal cortex 77 and the inner renal medulla 87. These structures each take the form of multiple cone-shaped renal lobes that contain a renal cortex that surrounds a portion of the medulla called the renal pyramids 72. Between the renal pyramids 72 are processes of the cortex called the renal columns 73. The urine-producing functional structure of the kidney, the nephron (not shown in detail in FIG. 1), spans the cortex and medulla. The initial filtering portion of the nephron is the renal corpuscle, located in the cortex. This is followed by the renal tubules that pass from the cortex deep into the medullary pyramids. The medullary ray, part of the renal cortex, is a collection of tubules that drain into a single collecting duct.

[0035] The tip or papilla 79 of each pyramid drains urine into a separate minor calyx 75 which drains into a major calyx 76 which drains into the renal pelvis 71 where it passes into the ureter 63. At the renal hilum 78, the ureter 63 and renal vein exit the kidney and the renal artery enters. Hilar fat and lymphatic tissue with lymph nodes surround these structures. The hilar fat is adjacent to a fat-filled cavity called the renal sinus. The renal sinus collectively contains the renal pelvis and calyx and separates these structures from the renal medullary tissue.

[0036] With further reference to the medical system 10, a medical instrument (e.g., a scope) 32 may be advanced through the urinary tract into the kidney 70. Upon reaching the site of the kidney stone 80 (e.g., within the calyx of the kidney 70 through which the stone 80 is accessible), the medical instrument 32 may be used to designate / tag a target location for percutaneous access to the kidney 70. To minimize damage to the kidney and / or surrounding anatomical structures, the physician 5 may designate a particular papilla 79 of the kidney 70 as the target location for entering the kidney with a percutaneous access instrument (e.g., a needle, not shown). However, other target locations may also be designated or determined. Once the percutaneous access instrument reaches the target location (e.g., the calyx), the utilized percutaneous access path may be used to extract the kidney stone 80 from the patient 13.

[0037] In the example of FIG. 1, the medical instrument 32 is implemented as a scope. However, each of the medical instruments 32 may be implemented as any suitable type of medical instrument, such as a catheter, a guidewire, a lithotriptor, a basket retrieval device, etc. In some embodiments, the medical instrument is a steerable device, while in other embodiments, the medical instrument is a non-steerable device. In some embodiments, a surgical tool refers to a device configured to puncture or be inserted through the human anatomy, such as a needle, scalpel, guidewire, etc. However, a surgical tool may also refer to other types of medical instruments.

[0038] Scopes, such as scope 32, can be configured to navigate within the human anatomy, such as within an orifice or lumen of the human anatomy. Scopes can include, for example, ureteroscopes (e.g., for accessing the urinary tract), laparoscopes, nephroscopes (e.g., for accessing the kidneys), bronchoscopes (e.g., for accessing the airways such as the bronchi), colonoscopes (e.g., for accessing the colon), arthroscopes (e.g., for accessing joints), cystoscopes (e.g., for accessing the bladder), etc.

[0039] The robotic system 11 can be configured to at least partially facilitate the performance of a medical procedure. The robotic system 11 can be arranged in a variety of ways depending on the particular procedure. The robotic system 11 can include one or more robotic arms 12 configured to engage and / or control the scope 32 and perform the procedure. As shown, each robotic arm 12 can include multiple arm segments coupled to joints that can provide multiple degrees of movement. In the example of FIG. 1, the robotic system 110 is positioned adjacent to a patient's leg, and the robotic arm 12 is actuated to engage and position the scope 32 for access into an access point, such as the urethra 67 of the patient 13. Once the robotic system 110 is properly positioned, the scope 120 can be inserted into the patient 13 robotically using the robotic arm 12, manually by the physician 5, or a combination thereof.

[0040] The robotic system 11 can be coupled to any component of the medical system 100, such as the control system 50, the table 15, the EM field generator (not shown, see FIG. 3), the scope 32, and / or the percutaneous access instrument (e.g., needle, see FIG. 3). In some embodiments, the robotic system 11 is communicatively coupled to the control system 50. For example, the robotic system 11 can be configured to receive control signals from the control system 50 and perform operations such as positioning the robotic arm 12 in a particular manner, manipulating the scope 32, etc. In response, the robotic system 11 can control the components of the robotic system 11 and perform operations. In some embodiments, the robotic system 11 is configured to receive images and / or image data from the scope 32 representing the internal anatomical structure of the patient 13, i.e., the urinary system with respect to the particular depiction of FIG. 1, and / or transmit the image / image data to the control system 50, which can then be displayed on the display 43 or other output device. Further, in some embodiments, the robotic system 11 is coupled to components of the medical system 10, such as the control system 50, in a manner that allows fluids, optics, power, or the like to be received therefrom. Additional exemplary details of the robotic system are discussed in more detail below with reference to FIG.

[0041] The control system 50 can be configured to provide various functions to assist in performing a medical procedure. In some embodiments, the control system 50 can be coupled to the robotic system 11 and operate in cooperation with the robotic system 11 to perform a medical procedure on the patient 13. For example, the control system 50 can communicate with the robotic system 11 via a wireless or wired connection (e.g., to control the robotic system 11 and / or the scope 32, receive images captured by the scope 32, etc.), provide fluid to the robotic system 11 via one or more fluid channels, provide power to the robotic system 11 via one or more electrical connections, provide optics to the robotic system 11 via one or more optical fibers or other components, etc. Additionally, in some embodiments, the control system 50 can communicate with the needle and / or nephroscope to receive position data therefrom. Additionally, in some embodiments, the control system 50 can communicate with the table 15 to position the table 15 in a particular orientation or otherwise control the table 15. Additionally, in some embodiments, the control system 50 can be in communication with an EM field generator (not shown) to control the generation of the EM field in the area surrounding the patient 13 .

[0042] The control system 50 can include various I / O devices configured to assist the physician 5 or others in performing a medical procedure. For example, the control system 50 can include certain input / output (I / O) components configured to enable user input for controlling the scope 32, such as for navigating the scope 32 within the patient 13. In some embodiments, for example, the physician 5 can provide input to the control system and / or the robotic system, and in response, control signals can be sent to the robotic system 11 to operate the scope 32. As also shown in FIG. 1 , the control system 50 can include a display 42 to provide various information regarding the procedure. For example, the display 42 can provide information regarding the scope 32. For example, the control system 50 can receive real-time images captured by the scope 32 and display the real-time images via the display 42. Additionally or alternatively, the control system 140 can receive signals (e.g., analog, digital, electrical, acoustic / sonic, pneumatic, tactile, hydraulic, etc.) from sensors associated with the medical monitor and / or the patient 13, and the display 42 can present information regarding the health or environment of the patient 13. Such information may include information displayed via a medical monitor, including, for example, heart rate (e.g., ECG, HRV, etc.), blood pressure / velocity, muscle biosignals (e.g., EMG), body temperature, blood oxygen saturation (e.g., SpO2), CO2, brain waves (e.g., EEG), environmental and / or local or core body temperature, etc.

[0043] To facilitate the functioning of the control system 50, the control system may include various components (sometimes referred to as "subsystems"). For example, the control system 50 may include control electronics / circuitry, as well as one or more power sources, pneumatic devices, light sources, actuators, data storage devices, and / or communication interfaces. In some embodiments, the control system 50 includes control circuitry comprising a computer-based control system configured to store executable instructions that, when executed, cause various operations to be implemented. In some embodiments, the control system 50 is mobile, while in other embodiments, the control system 50 is a substantially stationary system. Although various functions and components are discussed as being implemented by the control system 50, any of such functions and / or components may be integrated with and / or performed by other systems and / or devices, such as, for example, the robotic system 11, the table 15, etc. Exemplary robotic system components are discussed in more detail below with reference to FIG. 2.

[0044] The medical system 10 can provide various benefits such as providing guidance (e.g., instrument tracking, instrument alignment information, etc.) to assist physicians in performing procedures, allowing physicians to perform procedures from an ergonomic position without requiring awkward arm movements and / or positions, allowing one physician to perform procedures with one or more medical instruments, avoiding radiation exposure (e.g., associated with fluoroscopy techniques), allowing procedures to be performed in a single surgical setting, providing continuous suction to more efficiently remove objects (e.g., removing kidney stones), etc. For example, the medical system 10 can provide guidance information to assist physicians in accessing target anatomical features using various medical instruments while minimizing bleeding and / or damage to anatomical structures (e.g., critical organs, blood vessels, etc.). Additionally, the medical system 10 can provide non-radiation based navigation and / or localization techniques to reduce physician and patient exposure to radiation and / or reduce the amount of equipment in the operating room. Additionally, the medical system 10 can provide functionality distributed between at least the control system 50 and the robotic system 11, which may be independently mobile. Such a distribution of functions and / or mobility may allow the control system 50 and / or robotic system 11 to be placed in an optimal location for a particular medical procedure, which may maximize the working area around the patient and / or provide an optimized location for the physician to perform the procedure.

[0045] The various components of system 10 may be communicatively coupled to one another over a network, which may include wireless and / or wired networks. Exemplary networks include one or more personal area networks (PANs), local area networks (LANs), wide area networks (WANs), Internet area networks (IANs), cellular networks, the Internet, etc. Additionally, in some embodiments, the various components of system 10 may be connected for data communication, fluid / gas exchange, power exchange, etc., via one or more supporting cables, conduits, or the like.

[0046] FIG. 2 provides a detailed illustration of an embodiment of a robotic system 11 (e.g., a cart-based robot-enabled system) and a control system 50 shown in FIG. 1. The robotic system 11 generally includes an elongated support structure 14 (also referred to as a "column"), a robotic system base 25, and a console 16 at the top of the column 14. The column 14 may include one or more arm supports 17 (also referred to as a "carriage") for supporting the deployment of one or more robotic arms 12 (three are shown in FIG. 2). The arm supports 17 may include individually configurable arm mounts that rotate along a vertical axis to adjust the base of the robotic arms 12 for better positioning relative to the patient. The arm supports 17 also include a column interface 19 that allows the arm supports 17 to translate vertically along the column 14.

[0047] The column interface 19 can connect to the column 14 through slots, such as slot 20, positioned on the opposite side of the column 14 to guide the vertical translation of the arm support 17. The slot 20 contains a vertical translation interface for positioning and holding the arm support 17 at various vertical heights relative to the robotic system base 25. The vertical translation of the arm support 17 allows the robotic system 11 to adjust the reach of the robotic arm 12 to meet various table heights, patient sizes, and physician preferences. Similarly, an individually configurable arm mount on the arm support 17 allows the robotic arm base 21 of the robotic arm 12 to be angled in various configurations.

[0048] The robotic arm 12 may generally comprise a robotic arm base 21 and an end effector 22 separated by a series of linkages 23 connected by a series of joints 24, each joint comprising one or more independent actuators. Each actuator may comprise an independently controllable motor. Each independently controllable joint 24 may provide or represent an independent degree of freedom available to the robotic arm. In some embodiments, each of the arms 12 has seven joints, thus providing seven degrees of freedom, including a "redundant" degree of freedom. The redundant degrees of freedom allow the robotic arms 12 to position their respective end effectors 22 at specific positions, orientations, and trajectories in space using different joint positions and joint angles. This allows the system to position and orient the medical instrument from a desired point in space, while at the same time allowing the physician to move the arm joints to a clinically advantageous position away from the patient to create better access while avoiding arm collisions.

[0049] The robotic system base 25 balances the weight of the column 14, arm support 17, and arm 12 on the floor. Thus, the robotic system base 25 can house heavier components such as electronics, motors, power supplies, and components that selectively enable movement or immobilize the robotic system. For example, the robotic system base 25 includes casters 28 in the form of wheels that allow the robotic system to be easily moved around a room prior to a procedure. After reaching the proper position, the casters 28 can be immobilized using wheel locks to hold the robotic system 11 in place during the procedure.

[0050] When positioned at the top of the column 14, the console 16 allows for both a user interface for receiving user input and a display screen (or dual-purpose device, such as, for example, a touch screen 26) for providing both pre-operative and intra-operative data to the physician user. Potential pre-operative data on the touch screen 26 may include pre-operative planning, navigation and mapping data derived from a pre-operative computerized tomography (CT) scan, and / or notes from a pre-operative patient interview. Intra-operative data on the display may include optical information provided by tools, sensor and coordinate information from sensors, and vital patient statistics such as respiration, heart rate, and / or pulse. The console 16 may be positioned and tilted to allow the physician to access the console from the side of the column 14 opposite the arm support 17. From this position, the physician may view the console 16, the robotic arm 12, and the patient while operating the console 16 from behind the robotic system 11. As shown, the console 16 may also include a handle 27 to aid in the manipulation and stabilization of the robotic system 11.

[0051] Each end effector 22 of the robotic arm 12 may include an instrument device manipulator (IDM), which may be attached using a mechanism changer interface (MCI). In some embodiments, the IDM may be removed and replaced with a different type of IDM, e.g., a first type of IDM may operate an endoscope while a second type of IDM may operate a laparoscope. The MCI may include connectors for communicating air pressure, power, electrical signals, and / or optical signals from the robotic arm 12 to the IDM. The IDM may be configured to operate a medical instrument (e.g., a surgical tool / instrument), such as the scope 32, using techniques including, for example, direct drive, harmonic drive, gear drive, belt and pulley, magnetic drive, and the like.

[0052] 2 can serve as a command console for the exemplary surgical robotic system 11. The control system 50 can include a console base 51 and one or more display devices 42.

[0053] The system 10 may include certain control circuits 60 configured to perform certain of the functions described herein. The control circuits 60 may be part of the robotic system, the control system 50, or both. That is, references to control circuits herein may refer to circuitry embodied in the robotic system, the control system, or any other component of a medical system, such as the medical system 10 shown in FIG. 1. The term "control circuits" is used herein according to its broad and ordinary meaning and may refer to any collection of processors, processing circuits, processing modules / units, chips, dies (e.g., semiconductor dies including one or more active and / or passive devices and / or connectivity circuits), microprocessors, microcontrollers, digital signal processors, microcomputers, central processing units, field programmable gate arrays, programmable logic devices, state machines (e.g., hardware state machines), logic circuits, analog circuits, digital circuits, and / or any devices that manipulate signals (analog and / or digital) based on hard-coded and / or operational instructions in the circuits. The control circuitry referred to herein may further include one or more circuit boards (e.g., printed circuit boards), conductive traces and vias, and / or mounting pads, connectors, and / or components. The control circuitry referred to herein may further include one or more storage devices, which may be embodied in a single memory device, multiple memory devices, and / or embedded circuitry of a device. Such data storage devices may include read-only memory, random access memory, volatile memory, non-volatile memory, static memory, dynamic memory, flash memory, cache memory, data storage registers, and / or any device that stores digital information. It should be noted that in embodiments where the control circuitry comprises hardware and / or software state machines, analog circuits, digital circuits, and / or logic circuits, the data storage devices / registers that store any relevant operating instructions may be embedded within or external to the circuitry that comprises the state machines, analog circuits, digital circuits, and / or logic circuits.

[0054] 2, the control circuitry 60 may comprise a computer-readable medium storing hard-coded and / or operational instructions corresponding to at least some of the steps and / or functions illustrated in one or more of the figures and / or described herein. Such a computer-readable medium may, in some cases, be included in an article of manufacture. The control circuitry 60 may be maintained / located entirely locally or may be at least partially remotely located (e.g., indirectly communicatively coupled via a local area network and / or wide area network).

[0055] In some embodiments, at least a portion of the control circuitry 60 is integrated with the robotic system 11 (e.g., within the base 25, the column 14, and / or the console 14), or another system communicatively coupled to the robotic system 11. In some embodiments, at least a portion of the control circuitry 60 is integrated with the control system 50 (e.g., within the console base 51 and / or the display unit 42). Thus, any description of functional control circuitry herein may be understood to be embodied at least in part in either the robotic system 11, the control system 50, or both, and / or in one or more other local or remote systems / devices.

[0056] System 10 includes specific user controls 65, which may comprise any type of user input (and / or output) device or device interface, and / or interface / connector therefor, such as one or more buttons, keys, joysticks, handheld controllers (e.g., video game-type controllers), computer mice, track pads, track balls, control pads, and / or sensors (e.g., motion sensors or cameras) that capture hand and finger gestures. User controls 65 are communicatively and / or physically coupled to at least a portion of control circuitry 60.

[0057] In some embodiments, the user controls 65 and / or the control circuitry 60 are configured to receive user inputs to allow a user to control a medical instrument, such as an endoscope or nephroscope, such as an instrument operable at least in part by a robotic system, in a velocity mode or a position control mode. In a velocity mode, a user may be allowed to directly control, for example, pitch and yaw motion of the distal end of the endoscope or other instrument based on direct manual control using the controls 65. For example, movements on a joystick may be mapped to yaw and pitch movements at the distal end of the scope / device. In some embodiments, the user controls 65 are configured to provide haptic feedback to the user. For example, the joystick or other control mechanism may vibrate to indicate invalid or potentially problematic inputs. In some embodiments, the control system 50 and / or the robotic system 11 may also provide visual feedback (e.g., a pop-up message) and / or audio feedback (e.g., a beep) to indicate a problem associated with the robotic operation.

[0058] In the position control mode, the control circuitry 60 may control a surgical instrument (e.g., an endoscope) using a three-dimensional (3D) map of the patient and / or a predetermined computer model of the patient. For example, the control circuitry 60 may be configured to provide control signals to the robotic arm 12 of the robotic system 11 to manipulate and position an associated instrument at a target location, position, and / or orientation / alignment. For embodiments implementing 3D mapping, the position control mode may require sufficiently accurate mapping of the patient's anatomy.

[0059] In some embodiments, a user can manually manipulate the robotic arm 12 of the robotic system 11 without the use of the user control device 65. For example, during a surgical room setup, a user can move the robotic arm 12 and / or any other medical instruments to provide a desired access to a patient. The robotic system 11 can rely on force feedback and inertial control from the user to determine the appropriate configuration of the robotic arm 12 and associated instrumentation.

[0060] The display device 42 of the control system 50 may be integrated with the user controls 65, for example as a tablet device with a touch screen that provides user input. The display device 42 may be configured to provide data and input commands to the robotic system 11 using the integrated display touch controls. The display device 42 may be configured to display a graphical user interface that shows information regarding the position and orientation of the patient and / or various instruments operating within the system based on information provided by one or more position sensors. In some embodiments, a position sensor associated with a medical instrument (e.g., an endoscope) may be configured to generate a signal indicative of the position and transmit the same over a wire and / or transmitter coupled to the sensor. Such connectivity components may be configured to transmit the position information to the console base 51 for processing thereof by the control circuitry 60 and for presentation via the display device.

[0061] FIG. 3 illustrates a ureteroscope 340 positioned in a portion of a patient's urinary system, according to one or more embodiments of the present disclosure. As referenced above, ureteroscopic procedures can be implemented to investigate and / or treat abnormalities within a human ureter. For example, ureteroscopic procedures can be implemented to treat and / or remove kidney stones. Such procedures can be implemented at least in part manually and / or performed at least in part using robotic technology, such as the robotic system 11 shown in FIGS. 1 and 2. For example, the use of robotic devices and / or systems for certain endoscopic procedures can provide a relatively high degree of precision, control, and / or coordination compared to strictly manual procedures. In some embodiments, the scope 340 includes a working channel 344 for deploying medical instruments (e.g., lithotriptors, basket devices, forceps, etc.), irrigation, and / or suction to a working area at the distal end of the scope.

[0062] The scope 340 may be articulatable, such as with respect to at least a distal portion of the scope, so that the scope may be maneuvered within the human anatomy. In some embodiments, the scope 340 is configured to be articulated with five degrees of freedom, including, for example, XYZ coordinate movement, as well as pitch and yaw. In some embodiments, the needle sensor provides six degrees of freedom, including X, Y, and Z ordinate positions, as well as pitch, roll, and yaw. The position sensors of the scope 340 may similarly have similar degrees of freedom with respect to the position information they generate / provide. The figures illustrate multiple degrees of motion of the scope 340, according to some embodiments. As shown in FIG. 3, the tip 342 of the scope 340 may be oriented with zero deflection relative to its longitudinal axis 306 (also referred to as the "roll axis").

[0063] To capture images at different orientations of the tip 342, the robotic system may be configured to deflect the tip 342 on the positive yaw axis 302, the negative yaw axis 303, the positive pitch axis 304, the negative pitch axis 305, or the roll axis 306. The tip 342 or the body 345 of the scope 342 may be extended or translated in the longitudinal axis 306, the x-axis 308, or the y-axis 309. The scope 340 may include a reference structure (not shown) for calibrating the position of the scope. For example, the robotic system may measure the deflection of the scope 340 relative to the reference structure. The reference structure may be located, for example, on the proximal end of the endoscope 340 and may include a key, a slot, or a flange. The reference structure may couple to a first drive mechanism for initial calibration and to a second drive mechanism for performing the surgical procedure.

[0064] For robotic implementations, a robot arm of a robotic system may be configured / configurable to manipulate the scope 340 using an elongated motion member. The elongated motion member may include one or more pull wires (e.g., pull or push wires), cables, fibers, and / or a flexible shaft. For example, the robot arm may be configured to actuate multiple pull wires (not shown) coupled to the scope 340 to deflect the tip 342 of the scope 118. The pull wires may include any suitable or desired material, such as metallic and non-metallic materials, such as stainless steel, Kevlar, tungsten, carbon fiber, and the like. In some embodiments, the scope 340 is configured to exhibit non-linear behavior in response to forces applied by the elongated motion members. The non-linear behavior may be based on the stiffness and compressibility of the scope, as well as slack or stiffness variability between different elongated motion members.

[0065] The scope (e.g., endoscope / ureteroscope) 340 may comprise a tubular, flexible medical instrument configured to be inserted into a patient's anatomy to capture images of the anatomy. In some embodiments, the scope 340 can house an optical assembly, which can include an imaging device 348, such as an optical camera, and wires and / or optical fibers for transmitting signals to / from a distal end 342 of the scope 340.

[0066] The camera / imaging device 348 can be used to capture images of an internal anatomical space, such as a target cupule / papilla of the kidney 70. The scope 340 can be further configured to accommodate an optical fiber for carrying light from a proximally located light source, such as a light emitting diode, to the distal end 342 of the scope. The distal end 342 of the scope 340 can include a port for a light source to illuminate the anatomical space when the camera / imaging device is in use. In some embodiments, the scope 340 is configured to be controlled by a robotic system similar in one or more respects to the robotic system 11 shown in FIGS. 1 and 2. The imaging device may comprise an optical fiber, a fiber array, and / or a lens. The optical components move with the tip of the scope 340 such that movement of the tip of the scope results in a change in the image captured by the imaging device 348.

[0067] For percutaneous nephrolithotomy (PCNL) procedures, access is made through the patient's skin and intervening tissue into the target calyx. Generally, the preferred access to the renal calyx is through the soft tissue papillary structures, and access through such tissues may generally be associated with a reduced risk of bleeding and / or other complications. In addition to the absence of bleeding when the needle is inserted through the papillary structures, such a route may provide complete access to the interconnected internal channels (e.g., calyx) of the kidney.

[0068] Although PCNL represents a relatively effective method for treating large kidney stones, many physicians opt for other procedures due in part to the difficulty of accurately targeting the target papilla / calyx. More specifically, performing PCNL involves using a needle to gain percutaneous access to the target calyx of the kidney through the patient's flank. This step can be considered crucial to the ultimate success of the procedure, as the physician must select a needle path to the kidney that does not traverse surrounding organs and allows a rigid instrument to reach and treat the urinary stone. If the physician is unable to do so effectively, there is a risk of causing visceral or pleural damage or failing to completely treat the stone. Due to these challenges, the learning curve associated with gaining percutaneous needle access to perform PCNL in a suitable patient position (e.g., modified supine) is very high.

[0069] In some procedures, the physician studies the patient's preoperative computed tomography (CT) images to determine the location of the urinary stone, the location of the surrounding organs and bone structures, and to examine the morphometry of the calyx. With this knowledge, the physician can mentally generate a preoperative plan for the percutaneous needle path. Typically, the physician must identify the posterior calyx to puncture to accommodate the rigid instrument. Specifically, the posterior calyx generally provides a relatively straight launch into the renal pelvis. The physician must attempt to insert the needle into the kidney through the papilla to avoid damaging the renal vasculature and causing bleeding. Intraoperatively, the physician relies on fluoroscopy or ultrasound in some procedures to guide the alignment and insertion of the needle into the target calyx. However, the resolution and interpretation difficulties associated with such imaging techniques can result in a relatively high degree of difficulty in adequately performing the needle puncture. Thus, embodiments of the present disclosure that provide improved tracking and visualization of target anatomical features such as the papilla and calyx may improve surgical outcomes and attract more physician interest than other PCNL methodologies.

[0070] In some embodiments, the medical instrument (e.g., scope) 340 includes a sensor configured to generate and / or transmit sensor position data to another device. The sensor position data may indicate a position and / or orientation of the medical instrument 340 (e.g., its distal end 342) and / or may be used to determine / estimate the position / orientation of the medical instrument. For example, the sensor (sometimes referred to as a "position sensor") may include an electromagnetic (EM) sensor with a coil of conductive material or other form / embodiment of an antenna.

[0071] 3 shows an EM field generator 315 configured to broadcast an EM field 90 that is detected by an EM sensor on the medical instrument. The magnetic field 90 can induce a small current in the coil of the EM position sensor that can be analyzed to determine the distance and angle / orientation between the EM sensor and the EM field generator 315. Additionally, the medical instrument / scope 340 can include other types of sensors, such as shape-sensing fibers, accelerometers, gyroscopes, satellite-based positioning sensors (e.g., global positioning system (GPS) sensors), radio frequency transceivers, etc. In some embodiments, the sensors on the medical instrument can provide sensor data to a control system, which is then used to determine the position and / or orientation of the medical instrument. In some embodiments, the position sensor is positioned on the distal end 342 of the medical instrument 340, while in other embodiments, the sensor is positioned elsewhere on the medical instrument. The ureteroscope can be driven to a position proximate to the target papilla.

[0072] In some implementations, as described in further detail below, the distal end of the ureteroscope 340 may be advanced to contact a target anatomical feature (e.g., the papilla). With a position sensor associated with the distal end of the scope 340 in contact with and / or proximity to the target anatomical feature, the position of the distal end of the scope 340 may be recorded as a target percutaneous access position where a percutaneous access instrument (e.g., a needle) may be directed to access the target cup through the papilla.

[0073] Certain embodiments of the present disclosure advantageously help automate and guide a physician through the process for gaining percutaneous access to a target anatomical feature. For example, electromagnetic positioning and scope imaging can be used together to guide the insertion of a needle into a patient. Such a solution can enable a non-skilled physician to gain access into a kidney in, for example, a modified supine position and perform PCNL.

[0074] Certain embodiments of the present disclosure involve position sensor guided percutaneous access to a target treatment site, such as a target location within a kidney. For example, if the scope 340 is fitted with one or more electromagnetic sensors and the nephroscope access needle further includes one or more electromagnetic sensors, and such sensors are subjected to the electromagnetic field 90 created by the electric field generator 315, the associated system control circuitry can be configured to detect and track their location. In some embodiments, the tip of the ureteroscope 340 acts as a guidance beacon while the user is inserting the percutaneous access needle. Such a solution can allow the user to hit the target from a variety of approaches, thereby eliminating the need to rely on fluoroscopy or ultrasound imaging.

[0075] In some embodiments, a control system (not shown in FIG. 3 ) associated with the scope 340 is configured to implement localization / positioning techniques to determine and / or track the location / position of the scope 340 and / or a medical instrument such as a percutaneous access needle (not shown). In some examples, as described above, the EM field generator 315 is configured to provide an EM field 90 within the patient's environment. The scope 340 and / or the percutaneous access needle may include an EM sensor configured to detect EM signals and transmit sensor data related to the detected EM signals to the control system. The control system may analyze the sensor data to determine the position and / or orientation of the scope 340 (e.g., the distance and / or angle / orientation between the EM sensor and the EM field generator 315). Alternatively or in addition, in some examples, the control system may use other techniques to determine the position and / or orientation of the scope 340. For example, the scope 340 (and / or needle) may include shape-sensing fibers, accelerometers, gyroscopes, accelerometers, satellite-based positioning sensors (e.g., Global Positioning System (GPS)), radio frequency transceivers, etc. The control system may receive sensor data from the scope 340 and determine its position and / or orientation. In some embodiments, the control system may track the position and / or orientation of the scope 340 relative to the patient's coordinate system and / or anatomy in real time.

[0076] The scope 340 may be controllable in any suitable or desirable manner, either based on user input or automatically. The controls 311, 312 provide examples that may be used to receive user input. In some embodiments, the controls for the scope 340 are located on the proximal handle of the scope, which may be relatively difficult to grasp in some procedural postures / positions as the orientation of the ureteroscope changes. In some embodiments, the scope 340 is controlled using a two-handed controller, as in image 312. Although the controllers 311, 312 are shown as handheld controllers, user input may be received using any type of I / O device, such as a touch screen / pad, mouse, keyboard, microphone, etc.

[0077] FIG. 4 (represented in portions 4-1 and 4-2) is a flow diagram illustrating a process 400 for accessing a target calyx or other organ of a patient, according to one or more embodiments of the present disclosure. FIG. 5 (represented in portions 5-1 and 5-2) shows certain images corresponding to various blocks, states, and / or operations associated with the process of FIG. 4, according to one or more embodiments. The process 400 may involve percutaneous access to the kidney 70 for removal of kidney stones (e.g., PCNL). Such percutaneous access may be desirable for extraction of stones that are large enough that removal via a ureteroscope is impractical or undesirable. For example, stones may be larger than 2 cm in diameter, while certain ureteroscopes have a working channel through which stones or fragments having a diameter of about 1.2 mm may be removed. Breaking stones into smaller fragments for removal via ureteroscopic surgery is successful in many cases, but studies have shown that remaining stone fragments are often the source of new stone formation, necessitating similar treatment in the future.

[0078] At block 402, process 400 involves accessing the kidney through the patient's ureter using a ureteroscope 440, as described above. In particular, the acts of block 402 may involve advancing the scope 440 through the ureter 63, past the renal pelvis 71, and into one or more calyxes or areas nearby.

[0079] At block 404, the process 400 involves locating a kidney stone 480 for which the patient is to be treated using an image capture device (e.g., a camera) associated with the distal end 442 of the endoscope. For example, the kidney stone 480 may be at least partially extracted as a target of the process 400.

[0080] At block 406, the process 400 entails identifying a target papilla 479 exposed within the target calyx 475, through which access to the kidney stone 480 may be achieved. Identifying the target papilla 479 may be important to create a workable tract through which access to the kidney stone 480 may be achieved via percutaneous access. For example, it may be necessary to determine an angle that is appropriate for access with a relatively rigid nephroscope in such a way as to access a calyx (e.g., minor calyx 475) through which the kidney stone 480 may be reached. In some implementations, it may be desirable or necessary to reach the kidney stone 480 through the posterior calyx to provide sufficiently straight access to the ureteropelvic junction 71. In general, the target minor calyx may be considered a relatively small target. For example, such a calyx may be approximately 4-8 mm in diameter. Thus, precise targeting may be important to effectively extract the kidney stone.

[0081] The path through which needle / nephroscope access to the target cup 475 is achieved may advantageously be as straight as possible to avoid hitting the blood vessels surrounding the renal pyramid 476 associated with the papilla 479 through which the needle / nephroscope may be positioned. Furthermore, the location of various critical anatomical structures of the patient may require navigation through a constrained window of the patient's tissue / anatomy. For example, the inferior pole cup below the 12th rib may provide suitable access to avoid the pulmonary pleura. Furthermore, the access path may advantageously be medial to the posterior axillary line (e.g., approximately 1 cm below and 1 cm medial to the tip of the 12th rib) to avoid the colon and / or paraspinal muscles. Additionally, the access path may advantageously avoid being within the proximity of the ribs and avoid the intercostal nerves. Furthermore, by targeting the approach within the area of ​​the axial center of the cup 475, major arteries and / or other blood vessels may be avoided in some cases.

[0082] At block 408, the process 400 entails tagging / recording the location of the exposed nipple 479 within the target cup 479 through which the desired access is to be achieved. For example, the location information / data may be represented / identifiable in a three-dimensional space, such as an electromagnetic field space.

[0083] To record the position of the nipple 179, the scope 440 may be advanced to physically touch / contact the target nipple 479 as indicated by the advanced scope tip 443, and in association therewith, such contact location may be identified and / or otherwise indicated by the scope 440 and / or the operator as a target location. In some implementations, an electromagnetic beacon or other sensor device associated with the distal end / tip 442 of the ureteroscope may indicate the target location, thereby aligning the target location in the electromagnetic field space. After contacting / touching the nipple 479 and recording the location, the end 442 of the scope may be retracted, and the depth of such retraction may be measured in some manner. In some implementations, the operator may be notified that the distal end 443 of the scope 440 is contacting the nipple 479, generally by monitoring the camera image generated thereby, which may be in an occluded / blacked out state when contact is made.

[0084] At block 410, the process 400 involves percutaneously introducing a medical instrument 450, such as a needle, into a patient. For example, such access may occur via the patient's flank in some implementations. At block 412, the process 400 involves directing the percutaneously advanced medical instrument 450 towards a target location, ultimately traversing a target papilla 479 and accessing therethrough a target cupule 475.

[0085] In some embodiments, visual confirmation of the entry of the tip of needle 450 into the target cup 475 may be provided by a camera on the scope 440. For example, the scope 440 may be retracted from the target position, as described above, thereby providing a field of view that includes the papilla 479 within the cup 475 as the tip of the needle 450 is seen as it protrudes through the surface of the papilla 479.

[0086] Once a target location is recorded, a percutaneously inserted medical instrument (e.g., needle 450) may be directed toward the recorded location. However, if such a recorded location is static, anatomical motion occurring after recording of the target location may result in a target location that does not accurately reflect the real-time location associated with the target anatomical feature through which access is desired. For example, the act of inserting needle 450 into a patient may cause the target organ (e.g., kidney 70) and / or certain anatomical structures surrounding the target organ itself to move and / or become distorted / unnatural in some manner, thereby causing the target anatomical feature (e.g., papilla 479) to assume a different position / shape than at the time the target access location was recorded. For renal procedures, ureteroscope 440 may be fixed in position at renal pelvis 71 such that deformation and / or motion of kidney 70 relative to the ureteroscope may result in such target location corruption. Thus, papilla 479 may not be tracked accurately once anatomical motion is introduced into the system.

[0087] Once needle access is made to the calyx 475, a larger diameter device may be exchanged for the needle 450 to provide a larger port for stone removal. In some implementations, the needle 450 comprises a stylet and a cannula. With the needle tip advanced into the calyx 475, the stylet may be removed leaving the cannula behind to create an open port to the location of the kidney stone. Through the cannula, a guidewire may be placed and used to perform the remainder of the process of removing the stone 480. For example, the guidewire may be used to pass a deflated balloon or dilator along the wire. The balloon or dilator may be expanded to create a port large enough to introduce a hollow suction tube, such as a nephrostomy tube, directly into the calyx 475. At this point, a nephroscope or any one of several other instruments may be introduced into the suction tube to assist in the removal of the stone 480. For example, lithotriptors, lasers, ultrasound, baskets, graspers, drainage tubes, etc. may be used to remove the stone or its fragments, and / or a drainage tube, such as a nephrostomy catheter, may be deployed under the suction tube to reduce intrarenal pressure. Any combination of such functionality may be embodied in the nephroscope (not shown) and / or ureteroscope 440.

[0088] Image processing enhancement instrument guidance and automation The processes described herein are described in the context of a ureteroscope, but may be applied to any other type of surgical procedure utilizing a position sensor (e.g., an electromagnetic field sensor) and / or a camera to track a target anatomical feature, such as a papilla or urinary stone. As described, a static position marker may be registered / recorded to identify a target location associated with the target anatomical feature / landmark. In some embodiments, the present disclosure provides systems, devices, and methods for guiding and / or automating an endoscope and / or percutaneous access instrument based at least in part on the static position marker, taking into account certain target identification and / or target tracking image processing techniques. Target identification and tracking according to embodiments of the present disclosure may be applied to any type of robotic endoscopy procedure.

[0089] In some implementations, certain image data can be collected and used to identify a target anatomical feature. Such identification can be accomplished, at least in part, using a machine learning framework. For example, the systems, devices, and methods of the present disclosure can provide for identification of a target anatomical feature in a real-time endoscopic image, where identification of the target anatomical feature in the image can prompt a certain responsive action. For example, a control circuit communicatively coupled to a robotic endoscopy and / or percutaneous access device can be configured to track movement of the target feature and take action, such as articulating one or more portions of the endoscope (e.g., the distal end) or adjusting the target location data. For example, the control circuit can be configured to articulate the endoscope to center the target location / point at or near the center of the field of view of the endoscopic camera interface and / or image field.

[0090] By utilizing robot-assisted percutaneous access, a physician may be able to perform operational target access and treatment. Additionally, percutaneous access may be further assisted utilizing automatic target identification and tracking according to aspects of the present disclosure described in more detail below, which may be relied upon to accurately maintain target location for percutaneous access guidance. Percutaneous access guided by scope-enabled target tracking according to aspects of the present disclosure may be relatively low skill-intensive. In some implementations, a single operator or robotic system may perform the process. Additionally, the need for fluoroscopy may be eliminated.

[0091] Automatic Target Detection FIG. 6 is a flow diagram illustrating a process 600 for targeting an anatomical feature, according to one or more embodiments. As with certain other processes disclosed herein, the process 600 involves, at block 610, advancing a medical instrument, such as a scope (e.g., a ureteroscope), to a treatment site, such as a lumen or chamber, disposed at least partially within a target organ. For example, the act of block 610 may involve advancing a medical instrument to a target calyx of a kidney of a patient. The relative position between the medical instrument and the target may change slightly due to anatomical motion and / or as the percutaneous needle instrument approaches the target, according to certain processes disclosed herein. Such relative changes in position may lead to a desire or need to track the position of the target organ. For example, the position may be tracked in two-dimensional space, and the position may be retrieved in three-dimensional space, as described in further detail below.

[0092] As referenced above, robotic endoscope-guided percutaneous access according to aspects of the present disclosure can utilize location tracking technology relative to the target anatomical features through which access to the treatment site is achieved. For example, position tracking mechanisms / sensors associated with the distal end of the medical instrument (e.g., scope) and / or percutaneous access instrument (e.g., needle) can be implemented to guide the physician / technician in aligning the percutaneous access instrument with the treatment site (e.g., target cup). Accurate real-time target tracking, as enabled by aspects of the present disclosure, can enable relatively precise single-puncture access to the treatment site.

[0093] In block 620, the process 600 involves tagging the location of the target anatomical structure. It should be clarified that this manual tagging process is not required when an image processing approach can provide the 3D location of the target. For example, tagging the location of the target anatomical location can involve determining and / or recording (e.g., capturing in volatile and / or non-volatile data storage of a particular control circuit as shown and described herein). Tagging the location of the target anatomical feature in relation to block 620 can be performed in any suitable or desirable manner, such as using at least partially manual tagging sub-process 622 or at least partially image-based tagging sub-process 621, described below in relation to blocks 624 and 623, respectively.

[0094] With respect to a particular manual tagging process, in block 622, the process 600 involves contacting a target anatomical feature within the treatment site with the distal end of a medical instrument. For example, the medical instrument may be equipped with a sensor device, such as an electromagnetic sensor / beacon, that may indicate the location of the distal end of the medical instrument, and thus, when the distal end of the medical instrument is positioned relative to and / or adjacent to the target anatomical feature, such a position reading may be relied upon as indicating the location of the target anatomical feature. As an example, a user may provide input to inform an associated computing / medical system of the feature contact location of the target anatomical feature by tagging / registering an exposed surface of the target anatomical feature (e.g., an exposed papillary surface within the target cupule) in some manner. Such tagging may be implemented through the provision of user input in some manner, or may be substantially automatic based on perceived tissue contact or the like.

[0095] With respect to a particular image-based tagging process, in block 623, process 600 involves determining the location of the target anatomical feature using image data input and particular neural network functions, as described in detail below with respect to Figures 7 and 8. In some implementations, a convolutional neural network is used for target location identification / tagging.

[0096] The feature contact positions recorded in connection with the operations of block 620 may be considered static positions relative to the potentially dynamic relative positions of the target anatomical features, which may change over time. The feature contact positions may be recorded and / or maintained in any suitable or desirable manner, such as stored in one or more data storage devices.

[0097] Process 600 proceeds to sub-process 630, which may include tracking the target anatomical feature throughout the procedure while advancing a percutaneous access instrument, such as a needle or the like, in the direction of the target anatomical feature. Real-time tracking of the dynamic relative position of the target anatomical feature can advantageously facilitate precise direction of the percutaneous access instrument to the treatment site.

[0098] Sub-process 630 may be implemented in a variety of ways. For example, as shown as sub-process 632, live instrument (e.g., scope) tracking may be implemented to provide motion tracking of the target anatomical feature. For example, throughout the associated surgical period, the distal end of the medical instrument may be maintained in contact with the target anatomical feature such that position sensor data exhibited by the medical instrument may provide a real-time accurate location of the target anatomical feature (block 634). Thus, as shown in block 636, the live position of the medical instrument may be targeted to provide a desired percutaneous access path. However, when the distal end of the medical instrument is in close proximity / contact with the target anatomical feature, real-time visualization of the target anatomical feature may not be possible or may not be clear enough due to occlusion of the target anatomical feature by the feature itself within the camera's field of view. That is, the camera associated with the local instrument may be sufficiently blocked or obscured by the mass of the target anatomical feature, thereby preventing the physician / user from having visual confirmation of penetration of the target anatomical feature by the percutaneous access instrument (e.g., needle).

[0099] An alternative sub-process 631 is shown for tracking a target anatomical feature while still maintaining a clear view of the target anatomical feature during approach of the percutaneous access instrument. Such a sub-process 631 may utilize a statically tagged position of the target anatomical feature in conjunction with the operations of block 620. For example, in block 633, sub-process 631 may involve recording a feature contact position associated with contact with the target anatomical feature as implemented in conjunction with the operations of block 620 described above.

[0100] Similar to sub-process 632, rather than continuing to maintain the medical instrument in contact / proximity with the target anatomical feature to provide motion tracking, sub-process 631 may involve retracting the medical instrument a distance away from the target anatomical feature (e.g., in a proximal direction), thereby allowing the medical instrument to clearly capture the target anatomical feature within the field of view of its associated camera, as shown in block 635. For example, in some implementations, the physician / user may notify the system in some manner when the medical instrument is parked a desired distance away from the target anatomical feature.

[0101] For clarity, note that sub-processes 631, 632 represent alternative implementations of sub-process 630. That is, process 600 may generally involve implementations of either sub-process 632 or sub-process 631, but not both. For example, sub-process 632 illustrates a solution that generally involves leaving a position tracking device (e.g., electromagnetic beacon) associated with a wire or scope at the location / surface of the target anatomical feature (e.g., nipple), which may be moved / allowed to move with the nipple during needle insertion. The target location may thus be continuously updated as the sensor moves with the target anatomical feature. Sub-process 632 generally does not / may not require any real-time image data. However, the solution of sub-process 632 may not provide immediate visual confirmation of needle penetration of the target nipple due to occlusion.

[0102] In some cases, it may be assumed that the scope will remain inside the target cup and the alignment of the nipple with the scope will be preserved. In the absence of relative movement of the target anatomical feature with respect to the scope position sensor, the target position may be continuously updated based on the determined current scope position. For example, the operations associated with block 634 may involve that the scope may be retracted away from the target to allow camera visibility thereof, rather than continually maintaining contact between the instrument / sensor and the target anatomical feature. Position data (e.g., EM data) collected during retraction of the scope may be used to register / record the location of the nipple with respect to the scope. For example, according to one use case, the retraction / positioning of the scope may be approximately 5 mm in front and 2 mm to the left of the nipple. Such position offset may be used to determine the position of the target with respect to the current position of the scope. However, relative movement between the target anatomical feature and the scope may result in a lack of reliability of the position offset calculation, and thus such a process may be inadequate without compensating for the relative movement.

[0103] In certain respects, sub-process 631 may represent an improvement over sub-process 632. For example, reliance on static position data and / or scope offset data may not by itself generally provide a robust solution for compensating for anatomical shifts relative to the target anatomical feature and / or other motions, which may result, for example, from the insertion of the percutaneous access instrument and / or other factors. In addition to anatomical motion, differences in the physical positioning of the robotic mechanism and / or other components associated with driving / positioning the medical instrument at the treatment site may further introduce inaccuracies to the relative positioning of the target anatomical feature and the distal end of the medical instrument. Due to undesired motion of the target anatomical feature, its static recorded position may not be relied upon with confidence to provide the actual tracked position of the target anatomical feature. It may therefore be desirable for the static target position recorded in block 620 to be updated to accommodate anatomical motions and / or other introduced inaccuracies as described above.

[0104] Once the medical instrument is no longer in contact / proximity with the target anatomical feature, the real-time position of the distal end of the medical instrument may therefore not itself be indicative of the real-time location of the target anatomical feature. Rather, sub-process 631 may implement various solutions for tracking the location of the target anatomical feature based on the static location recorded / tagged in connection with the operation of block 633. For example, in block 637, sub-process 631 may involve tracking the location of the target anatomical feature by processing a real-time image of the target anatomical feature using a neural network circuit and / or other image tracking functionality implemented by a particular system control circuit according to an embodiment of the present disclosure. For example, the neural network and / or other image tracking mechanism may receive as an input real-time image of the target anatomical feature, the neural network circuit and / or other image tracking mechanism configured to identify and determine the location of the target anatomical feature therein. Such feature identification functionality may be used to track the target anatomical feature in real-time relative to the static location recorded in connection with block 633.

[0105] Sub-process 631 may or may not include / involve contact 624 and retract 635 steps, where the user physically contacts the location of the target nipple and retracts the scope to present the nipple within the field of view of the scope. For example, if image-based tagging 621 is implemented in connection with block 620, it may not be necessary to physically contact the target anatomical feature to determine its position / location. Rather, the position / location may be determined using the target identification mechanism disclosed herein based on image data captured / generated by one or more cameras of the scope / instrument. For example, in some embodiments, the target is identified and tracked using multiple frames of image / visual and / or position (e.g., EM) data. An example of such target position determination is described below in connection with FIG. 12. In some implementations, the target position may be estimated / determined relative to three-dimensional space by viewing the target anatomical feature (e.g., nipple) from two distinctly different positions and / or alignments.

[0106] In block 639, sub-process 631 entails targeting the tracked location of the target anatomical feature with a percutaneous access device. For example, the centroid of an identified nipple shape or morphology within a real-time image of the treatment site may be used in the target location for the percutaneous access device.

[0107] In block 640, process 600 involves puncturing the target anatomical feature either without visual confirmation of the target anatomical feature for sub-process 632 or with visual confirmation by sub-process 631, depending on the particular implementation of process 600.

[0108] The various position sensors used in connection with the embodiments of the present disclosure, such as to record feature contact positions in block 633 or to target live instrument positions in block 636, may be any type of position sensor. As an example, such a sensor may be an electromagnetic (EM) sensor / probe. With respect to a scope, the position sensor may be mounted proximal to or integrated with its tip. Alternatively, the sensor may comprise a coil connected to an electrical wire running the length of the scope, which is connected to an external control circuit configured to interpret an electrical signal generated in the coil and passed down the wire. Examples of types of position sensor devices that may be implemented in connection with the embodiments of the present disclosure include, but are not limited to, accelerometers, gyroscopes, magnetometers, fiber optic shape sensing (e.g., via Bragg grating, Rayleigh scattering, interferometry, or related techniques), and the like. Depending on the implementation, registration to a separate form of patient image, such as a CT scan, may or may not be necessary to provide a frame of reference for locating urinary stones within the patient.

[0109] For reference, certain location determination / localization mechanisms that may be implemented in some of the disclosed embodiments are described. With respect to EM-type sensors such as coils or other antennas, such sensor devices may be configured to detect changes in the EM field as the EM sensor moves within the field (e.g., within the kidney). Thus, certain embodiments are implemented using one or more EM generators configured to emit an EM field that is picked up by the EM sensor. The EM generators may be modulated in any suitable or desirable manner so that when their emitted EM fields are captured by the EM sensor and processed by appropriate control circuitry, the signals from the different EM generators are separable to provide an additional dimension of location information. The EM generators may be modulated in time or frequency and may use quadrature modulation so that each signal is completely separable from each other signal, despite possibly overlapping in time. Furthermore, the separate EM generators may be oriented relative to one another in Cartesian space at a non-zero, non-orthogonal angle such that a change in the orientation of the EM sensor causes the EM sensor to receive at least some signal from at least one of the EM generators at any given moment.

[0110] With further reference to recording feature contact location in block 633 of FIG. 6, the EM position data may be registered to an image of the patient captured using a different technique other than EM, such as a CT scan, to establish a frame of reference for the EM data (or any mechanism may be used to capture alignment sensor data). In addition to the scope, the percutaneous access needle may include one or more position / alignment sensors, such as an EM sensor. Position / alignment data received from the needle EM sensor may be received and processed similarly to the scope position data, as described above. The various processes described herein may be performed fully or partially manually and / or fully or partially using a robot.

[0111] The processes disclosed herein may be implemented in connection with procedures other than kidney stone removal procedures, such as gallbladder stone removal, pulmonary (pulmonary / transthoracic) tumor biopsy, and others. In general, any type of percutaneous procedure may be performed by using an endoscope configured to capture image data for feature identification and tracking using neural network processing according to embodiments of the present disclosure. Additional examples include gastric surgery, esophageal and pulmonary surgery, and the like. Furthermore, the objects to be removed do not necessarily have to be urinary stones, they may be any object, such as a foreign body or object generated within the human body.

[0112] Anatomical feature identification and tracking based on neural networks 7 illustrates a feature identification framework for identifying one or more target anatomical features in an endoscopic camera image for dynamically updating target location data, according to one or more embodiments of the present disclosure. The feature identification framework 700 may be embodied in specific control circuitry, including one or more processors, data storage devices, connectivity features, substrates, passive and / or active hardware circuit devices, chips / dies, and / or the like. For example, the framework 700 may be embodied in the control circuitry 60 shown in FIG. 2 and described above. The feature identification framework 700 may employ machine learning capabilities to perform, for example, automatic target detection on ureteroscopic images of internal renal anatomical structures.

[0113] The feature identification framework 700 may be configured to operate on a particular image type of data structure, such as image data representing at least a portion of a treatment site associated with one or more medical procedures. Such input data / data structure may be operated on in some manner by a particular transformation circuit 720 associated with the image processing portion of the framework 700. The transformation circuit 720 may comprise any suitable or desirable transformation and / or classification architecture, such as any suitable or desirable artificial neural network architecture.

[0114] The transformation circuitry 720 may be trained according to the known anatomical images 712 and the target labels 732 corresponding to the individual images 712 as input / output pairs, and the transformation / classification framework 720 is configured to adjust one or more parameters or weights associated therewith to correlate the known input and output image data. For example, the transformation circuitry 720 (e.g., a convolutional neural network) may be trained using the labeled data set and / or machine learning. In some implementations, the machine learning framework may be configured to perform the learning / training in any suitable or desirable manner.

[0115] The known target markers 732 may be generated, at least in part, by manually marking anatomical features within the known anatomical image 712. For example, the manual markers may be determined and / or applied by an associated medical professional, such as, for example, marking where nipple anatomy is located within the intercuplet anatomical image. The known input / output pairs may represent parameters of the conversion circuit 720, which in some embodiments may be dynamically updatable.

[0116] The known target markers 732 may delineate the boundaries and / or interior regions of the target anatomical feature present therein. In some embodiments, the framework 700 may be configured to generate the real-time target markers 735 in a manner that indicates in a binary manner whether a particular image of the real-time anatomical images 715 contains the target anatomical feature, and further processing may be performed on images identified as containing one or more instances of the target anatomical feature to further identify the location and / or other aspects of the target anatomical feature. In some embodiments, further processing may be performed to determine the three-dimensional location of the identified target anatomical feature and / or one or more portions thereof.

[0117] The framework 700 may be further configured to generate a real-time target indicator 735 associated with the real-time anatomical image 715 using a trained version of the conversion circuitry 720. For example, a real-time image of a treatment site associated with an endoscope or other medical instrument placed at the treatment site during a medical procedure may be processed using the conversion circuitry 720 to generate a real-time target indicator 735 that identifies the presence and / or location of one or more target anatomical features within the real-time image. For example, in some implementations, a ureteroscope image may be processed by the conversion circuitry 720 to identify the presence, location, and / or shape of a target papilla that may be targeted with a percutaneous access instrument, as described in detail herein. With respect to ureteroscope applications, the papilla anatomy may generally be similar in appearance across subjects, and thus the papilla anatomy may be identifiable across a wide demographic.

[0118] In some embodiments, the transformation circuitry 720 may be configured to identify the target anatomical feature (e.g., nipple) as well as extra-segment regions that contain the identified anatomical feature and / or surround the identified anatomical feature in the image. The transformation framework 720 may include an artificial neural network, such as a convolutional neural network. For example, the framework 720 may implement a deep learning architecture that populates the input image and assigns learnable weights / biases to various aspects / objects in the image to distinguish one from the other. The filters / characteristics of the framework 720 may be manually designed or may be learned through machine learning.

[0119] The framework 720 may include a number of neurons (e.g., a layer of neurons as shown in FIG. 7) corresponding to overlapping regions of the input image that cover the visual region of the input image. The framework 720 may further operate to flatten the input image or portions thereof in some manner. The framework 720 may be configured to capture spatial and / or temporal dependencies within the input image 715 through application of certain filters. Such filters may be performed with various convolution operations to achieve desired output data. Such convolution operations may be used to extract features such as edges, contours, and the like. The framework 720 may include any number of convolution layers, with more layers providing higher levels of feature discrimination. The framework 720 may further include one or more pooling layers that may be configured to reduce the spatial size of the convolved features, which may be useful for extracting features that are rotation and / or position invariant, as well as certain anatomical features. Once prepared through flattening, pooling, and / or other processes, the image data may be processed by a multi-level perceptron and / or a feed-forward neural network. Additionally, back-propagation may be applied to each iteration of training. The framework may be capable of distinguishing between dominant features and specific low-level features in the input image and classifying them using any suitable or desired technique. In some embodiments, the neural network architecture includes any of the following well-known convolutional neural network architectures: LeNet, AlexNet, VGGNet, GoogLeNet, ResNet, or ZFNet.

[0120] The input to the framework 720 may be a video or a still image. In some embodiments, the input includes a video and the framework 720 is configured to generate an output (e.g., an implementation of a temporal model) that indicates how certain features of the video change. In some implementations, once the neural network 720 is trained, the motion input to the neural network framework may include multiple (e.g., two) images and the output 735 includes data indicating the location of one or more targets across the images (e.g., over time). The input 715 may include image or image data and / or may include data indicating differences between separate (e.g., successive) images. For example, the framework 720 may detect motion or spatial changes between pixels, where changes in pixel locations indicate motion between images and / or over time. The output may indicate differences between the images. In some embodiments, the neural network framework 720 is trained to estimate optical flow.

[0121] 8 illustrates an exemplary neural network feature classification / identification framework 800 according to one or more embodiments of the present disclosure. Framework 800 may represent a convolutional neural network architecture and may include one or more of the illustrated components, which may represent specific functional components, each of which may be embodied in one or more portions or components of control circuitry associated with any of the systems, devices, and / or methods of the present disclosure. Framework 800 may represent an embodiment of conversion circuitry 720 of FIG. 7, or a portion thereof.

[0122] The neural network framework 800 may include a pre-trained neural network 821, such as a ResNet50 neural network or equivalent. The framework 800 may further include a feature extraction component 822 (e.g., a feature extraction network (SDN)), such as a feature pyramid network. The feature extraction component 822 may be configured to extract one or more feature maps of an input image and / or design feature detector contours. In embodiments implementing a feature pyramid network function, multiple images may be processed at different levels of resolution to provide output variants.

[0123] Framework 800 may further include a region proposal network component 823. Region proposal network 823 may be configured to propose specific bounding boxes on the image that encapsulate targets indicated / identified on the feature map generated and / or provided by feature extraction component 822.

[0124] In some embodiments, a coarse-to-fine processing scheme can be implemented to extract targets within an image. The proposed bounding boxes provided by the region proposal network 823 can be used by one or more additional components 827. For example, a binary classification network component 826 can be configured to classify the bounding boxes based on whether they contain a target feature of interest. Further, a box regression network 825 can be positioned and configured to refine the bounding boxes proposed by the region proposal network 823. In addition, a mask prediction network component 824 can be configured to calculate and / or represent a silhouette or shape / form of the identified target feature.

[0125] Tracking of target anatomical features The ability to correctly identify a target anatomical feature and its location can advantageously enable targeting of the target anatomical feature by a medical instrument during a medical procedure. However, the occurrence of anatomical motion subsequent to the determination of the target location of the target anatomical feature may cause the target anatomical feature to move away from the known target location. Thus, embodiments of the present disclosure that provide real-time updates of target location data can help eliminate problems associated with intraoperative anatomical motion.

[0126] In some embodiments, a positioning system (e.g., an electromagnetic positioning system as described herein) may be implemented to determine the location of one or more medical instruments. In some embodiments, the positioning system may be calibrated using the camera images to determine the location of features depicted in the camera images within the positioning field.

[0127] Target anatomical feature tracking can be achieved according to various methodologies. For example, in some embodiments, target tracking can be achieved by comparing the output of a neural network (or other image processing) circuit of two consecutively or sequentially captured images of the treatment site. For example, silhouettes or masks of the target anatomical feature can be considered as the output of a neural network or other type of target identification circuit for images captured at different times to determine the overlap of such silhouettes / masks, such as in the context of the percentage of overlap (e.g., intersection-over-union, IOU). In general, it can be assumed that the content difference between consecutive images is not significantly different, at least for image capture at a sufficiently high sample rate. Thus, masks of consecutively captured images can be considered to represent the same target anatomical feature if the overlap rate is higher than a predefined / predetermined threshold, the threshold being related to the maximum movement of the target on sampling.

[0128] 9 is a flow diagram illustrating a process 900 for tracking target anatomical features at a treatment site, in accordance with one or more embodiments of the present disclosure. At block 902, the process 900 involves training a neural network using the labeled image data. For example, the neural network may include a framework similar in certain respects to frameworks 700, 800 shown in FIGS. 7 and 8, respectively.

[0129] At block 904, the process 900 involves receiving a first image of the treatment site from an endoscope or other medical instrument positioned at or near the treatment site. At block 906, the process 900 involves identifying a first feature in the first image using a neural network architecture / framework. For example, the first feature may be a target papilla present at the treatment site. For example, one or more machine learning components or modules may be implemented to perform segmentation of the first feature for the first image.

[0130] At block 908, the process 900 involves receiving a second image of the treatment site. The second image may be captured consecutively and / or sequentially to the first image. At block 910, the process 900 involves identifying a second feature in the second image using a neural network. For example, the second feature may be a nipple in the target cup treatment site. At block 912, the process 900 involves determining that the first feature and the second feature represent the same target anatomical feature, such as the same target nipple, in the treatment site. The determination that the first feature and the second feature represent the same target anatomical feature may be made in any manner, such as by comparing a determined overlap or shift of the first feature and the second feature and / or portions thereof.

[0131] At block 914, the process 900 involves modifying the target tracking position associated with the target anatomical feature based on the identified second feature and / or the instrument position data. For example, the instrument position data may correspond to an initial tagged position of the medical instrument and / or its articulation or relative movement. The modification of the target tracking position may serve to track the target anatomical feature by compensating for its dynamic relative movement. Additionally, the endoscope or other medical instrument used to capture the first and second images may have an electromagnetic sensor or other position sensor associated therewith. Such a position sensor may be used to introduce compensation for the movement of the medical instrument into the target tracking position data.

[0132] Modification of the target tracking position may be required and / or desirable based on relative motion of the target anatomical feature between the capture time of the first image and the capture time of the second image. As described above, such motion may be caused by the insertion and / or manipulation of a percutaneous access instrument, such as a needle, within the general area of ​​the treatment site. Due to motion, the target anatomical feature (e.g., nipple) may not generally remain fixed relative to the scope that may be used to determine the initial target location. Thus, the feature identification and tracking capabilities disclosed in connection with the systems, devices, and methods of the present disclosure may enable tracking of the target anatomical feature over time using camera images. Such tracking may be used to dynamically predict the three-dimensional location of the target anatomical feature, which may be used as a target tracking position for the percutaneous access instrument, as described herein. Achieving an engagement between the percutaneous access instrument and the target anatomical feature may be greatly aided by dynamic target estimation, as described herein.

[0133] The position of a camera of a medical instrument (e.g., an endoscope) can be determined with respect to the position of a position sensor associated with the distal end of the medical instrument. Using such camera position information, the location of an object / feature appearing in the image space can be determined with respect to a position space (e.g., electromagnetic field space) associated with the position sensor. Thus, the position of a second feature in a second image can be determined in three-dimensional space and can provide for the orientation of a percutaneous access instrument (e.g., a needle).

[0134] 9 describes modifying the target tracking position based on the second feature identification and / or location, it should be understood that any type of responsive action may be implemented based at least in part on the updated anatomical feature identification. For example, certain control circuitry communicatively coupled to the robot that controls the position of the endoscope may be implemented to adjust / articulate the scope based on movement of the target anatomical feature. For example, the scope may be moved such that the center of gravity or other portion of the target anatomical feature is at or near the center of the field of view of the camera, interface, or other visual representation of the treatment site.

[0135] The neural networks and masking concepts disclosed herein may be implemented according to aspects of the publication "Mask R-CNN" (He, Kaiming, Georgia Gkioxari, Piotr Dollar, and Ross Girshick. "Mask r-cnn." In Computer Vision (ICCV), 2017 IEEE International Conference on, pp. 2980-2988. IEEE, 2017), the entire contents of which are expressly incorporated herein by reference.

[0136] 10 is a flow diagram illustrating a process for tracking a target anatomical feature at a treatment site, according to one or more embodiments of the present disclosure. The tracking process 1000 of FIG. 10 may be considered a direct tracking embodiment. FIG. 11 shows certain feature masks and associated images for various steps of the process 1000 shown in FIG. 10.

[0137] At block 1002, the process 1000 entails generating a target mask 122 for a first image 121 of a treatment site taken at a first time (t). As shown in image 121, the first image includes at least a portion of a target anatomical feature 111, which may represent a papilla that is visible from within the calyx / renal treatment site. Image 122 represents a mask of the target anatomical feature. While any mask may be used in accordance with embodiments of the present disclosure, the illustrated mask 122 is a binary mask that includes feature regions 112 that represent the shape or form of the visible portion of the target anatomical feature 111, and background portions 119 that represent regions of the image 121 that do not correspond to the target anatomical feature 111. The mask 122 may be generated using any type of segmentation and / or machine learning mechanisms, where the segmented regions are branched to provide a region mask, as shown.

[0138] At block 1004, the process 1000 entails generating a target mask 124 for a second image 123 taken at a time (t+1) subsequent to the time (t) at which the first image 121 was captured. Through neural network image processing or other target identification mechanisms according to aspects of the present disclosure, the target anatomical feature 113 may be identified within the image 123. The mask 124 of the image 123 for the target feature 113 is shown as the image 124, which includes feature regions 114 representing the shape / silhouette or form of the target anatomical feature 113 and the visible portions of the image 123, and background portions 127 representing areas of the image 123 that do not correspond to the target anatomical feature 113.

[0139] At block 1006, the process 1000 entails determining target or feature overlap in the first image 121 and the second image 123 using the respective masks 122, 124. Image 125 represents an overlay of the first mask 122 and the second mask 124. The resulting image 125 includes a portion 115 corresponding to the background for both the first image 121 and the second image 123, a portion 116 corresponding to the background for the first image 121 other than the feature regions for the second image 123, and a portion 117 corresponding to the background for the second image 123 other than the feature regions for the first image 121. The remaining region 118 represents the overlap region between the identified anatomical features 111, 113. The overlap region / shape is shown separately as image 126 for clarity and represents the region below either of the feature regions of the masks 122, 124.

[0140] The process 1000 may proceed to decision block 1008, where it may be determined whether the amount of overlap 118, 126 is greater than a predetermined threshold amount of overlap for the first feature region 112, the second feature region 114, or both regions. If the determination is positive, the process 1000 may proceed to block 1010, where a responsive action may be taken. For example, in block 1010, the first identified anatomical feature 111 and the second identified anatomical feature 113 may be assumed to represent the same target anatomical feature. For example, both identified features may represent the same papilla within the patient's kidney. Thus, any change in position between the images 121 and 123 may represent anatomical movement, and thus the responsive action may involve adjusting the target position associated with the target anatomical feature and / or adjusting the position of the medical instrument utilized, such as an instrument utilized to capture the images 121, 123 (e.g., an endoscope and / or its camera). For example, one or more robotic arms may be configured to respond by adjusting an arm and / or an endoscope position controlled by the robotic arm. The determination of overlap of the relevant regions may be based on a two-dimensional X / Y axis. Although the differences between images 121, 123 are described as being due to anatomical movements, it should be understood that such differences may be due, at least in part, to movements of one or more surgical tools or instruments.

[0141] If the feature overlap does not meet the predefined threshold, the process 1000 may proceed to block 1012, which may or may not be associated with any response action. For example, in block 1012, the features 111, 113 may be assumed to represent separate anatomical features and / or portions thereof. Thus, the location difference between the features 111, 113 may not be relied upon as representing a particular anatomical movement of the target anatomical feature. In some embodiments, the predefined threshold may be dynamically adjustable and may be selected and / or determined to produce a desired or optimal discrimination performance. For example, the threshold may be determined based on an analysis of previous known data, as described herein. In some embodiments, movements that may be due to periodic breathing may be excluded such that such movements are not due to movements of the target anatomical feature. For example, the sampling of the images 121, 123 may be performed to correspond to similar points within the duration of a respiratory cycle. In some implementations, the images are sampled at about 30 frames per second, or any other suitable or desirable sampling rate.

[0142] In addition to the direct tracking methods as described above, indirect tracking methods may be implemented in accordance with the present disclosure. For example, optical flow tracking may be implemented to track the movement of a target anatomical feature and / or its corresponding pixel representation across multiple images. For example, tracking pixels that represent a common image feature may provide movement information of the target anatomical feature. Furthermore, other feature tracking mechanisms such as tracking of corners, blogs, pixel clusters, and / or any other image feature may be implemented.

[0143] While segmentation / masking can be performed using image processing methodologies as described herein, including neural network frameworks and the like, in some implementations segmentation / masking is performed at least partially manually by a physician or other technician / operator. For example, a technician may select a target anatomical feature and identify similar features in subsequent images, and the movement represented by the sequential feature identification / segmentation may be taken into account in any suitable or desirable manner in accordance with the present disclosure. In some implementations, feature descriptors may be performed locally within the identified feature regions, which may be considered as regions of high probability of feature presence in subsequent images.

[0144] Although aspects of the present disclosure are presented in the context of ureteroscopy, it should be understood that such concepts are applicable to any type of endoscopy application. For example, the feature identification and tracking techniques described herein may be utilized to identify and track polyps or other target anatomical features. With respect to bronchoscopy procedures, the target anatomical feature identification and tracking concepts of the present disclosure may be utilized to identify tumors and / or control scope position for the purpose of collecting samples or the like. With respect to respiratory procedures, feature identification and targeting according to the present disclosure may be utilized to identify and / or track nodules inside the target airway, the airway itself, and / or other features.

[0145] It should be understood that with any of the embodiments disclosed herein, known scope movement data may be compensated for target anatomical feature identification and / or tracking. Additionally, position sensor information may further provide information indicative of movement, for which compensation may be made for target feature tracking purposes. With further reference to FIG. 10, in some embodiments, prior to initiating any responsive action at block 1010, process 1000 may involve determining whether user-initiated or unintentional scope movement has occurred. If so, the generated mask may be adjusted to compensate for such movement such that such movement is not reflected in overlapping determinations and / or responsive actions.

[0146] For various embodiments disclosed herein, location information may be determined and / or generated using any suitable or desirable type of sensor, device, or combination thereof. For example, the location sensors / devices of the present disclosure may include any one or more of the following: electromagnetic sensors, impedance spectroscopy sensors, coaxial sensors, inertial measurement sensors, accelerometers, magnetometers, gyroscopes, and / or any other type of sensor that provides information indicative of position, distance, orientation, acceleration, alignment, or the like.

[0147] 3D target position estimation Three-dimensional (3D) position estimation for purposes of target anatomical feature tracking, according to aspects of the present disclosure, may be implemented according to any suitable or desirable technique or mechanism. For example, in some embodiments, the distance between an endoscopic camera and a target anatomical feature may be estimated based on a representative size of the anatomical feature in an image.

[0148] In some embodiments, information regarding the angle of movement of the scope and / or anatomical features may be used to determine 3D location. For example, electromagnetic sensors / beacons in the electromagnetic field / space may provide such movement angle information. By combining the electromagnetic sensor data with the image data, a mapping between the distance from the target anatomical feature and the size of the target anatomical feature in the resulting images captured after movement of such distance may be used to estimate the depth / distance of the feature in subsequent images. In some embodiments, the distance traveled may be registered using, for example, the electromagnetic sensor data when contacting the target anatomical feature (e.g., nipple), retracting the scope away from such feature, and parking the scope in a position that provides a desired field of view. Further, subsequent images provide information related to how large anatomical features appear in such images, and thus a relationship / mapping between feature size and distance may be determined and used for future location determination. In some implementations, machine learning may be utilized to classify images and determine location information based on the size of features in such images.

[0149] In some embodiments, machine learning may be utilized to train a neural network framework to interpret image data and generate an output indicative of the 3D depth of the image pixels. Such machine learning may be implemented according to any suitable or desirable process or mechanism described herein. In some embodiments, an external camera sensor associated with the medical instrument (e.g., a scope) may be utilized to obtain the 3D location of the target. For example, a structured illumination sensor and / or a time-of-flight sensor may be used in determining the 3D positioning.

[0150] According to some embodiments, a geometric translation approach may be implemented to detect the 3D position of the target anatomical feature. For example, as with certain other embodiments of the present disclosure, a potential image associated with a distinct timestamp may be captured. In association with such an image, rotational translation information regarding the camera, which may be determined based on sensor information from any suitable or desired sensor or device, may be used to triangulate and / or determine the position of such an image in 3D space, thereby providing information indicative of the 3D location of the target anatomical feature in 3D space. The rotational translation information may be based on robotic actuator movement and / or position sensor information, such as from an electromagnetic beacon device, associated with the camera and / or scope and indicative of the position of the camera in electromagnetic space.

[0151] FIG. 12 shows the time (C t and C t+1 FIG. 1 illustrates aspects of a 3D position estimation process involving a first image 91 and a second image 92 taken at a time t1 and t2 (referred to as t1 and t2).

[0152] Considering the intrinsic and extrinsic parameters of the camera (principal point, focal length and distortion coefficients, relative motion), the 3D location of the target anatomical feature can then be calculated based at least in part on the tracked target two-dimensional (2D) location on the image. For the intrinsic parameters, the camera principal point and focal length may be considered. Additional data that may be considered may include radial and tangential distortion coefficients. Based on sensor readings (e.g., either robotic or EM-based), extrinsic parameters may also be obtained, including the rotation R and translation T of the scope between where the two images were taken. For convenience, K may be expressed as a matrix containing the intrinsic parameters, and H may be expressed as a matrix containing the intrinsic parameters, C. t and C. t+1 The extrinsic rotations and translations between x and y can be represented as a 4x4 matrix.

[0153] C t For , the 3D and 2D projection relationship is x t=KX, where X is the 3D coordinate wrt. C t and x t is the 2D coordinate on image t (detected centroid of the target), where K is a 3×4 matrix that can be expressed as:

[0154]

number

[0155] Similarly, C t+1 About x t+1 = K'X,

[0156]

number

[0157] x t Since KX is a parallel vector, x t ×KX=0, and similarly, x t+1 ×K'X=0, where "×" is the cross product operator. Therefore,

[0158]

number

[0159] The above is i(v t K (3) XK (2) X)-j(u t K (3) XK (1) X)+k(u t K (2) Xv t K (1) X)=0, where u t and v t x t are the 2D coordinates of . Therefore,

[0160]

number

[0161] Here, only the first two equations may be needed since the third equation is a linear combination of the first two. Similarly, C t+1 For , we can obtain the following two equations:

[0162]

number

[0163] C t and C t+1 After stacking the equations, the following can be generated: AX=0 where A is a 4×4 matrix.

[0164]

number

[0165] Since the elements in A are known (detected 2D coordinates, intrinsic and extrinsic parameters), X can be computed by performing singular value decomposition (SVD) on A. A=UΣV T The last column of V is the solution for X.

[0166] Thus, in view of the foregoing disclosure, various inventive concepts disclosed herein may be utilized to perform automatic target detection, target tracking, and / or three-dimensional position estimation. In some embodiments, aspects of the present disclosure advantageously enable target anatomical feature tracking without requiring physical contact with the target anatomical feature, which may facilitate improved ergonomics of ureteroscope use.

[0167] A control circuit configured to implement the system of FIG. 12 can advantageously generate three-dimensional (3D) location information associated with targets present in two (e.g., temporally consecutive) images. In some implementations, the 3D information can be generated using a neural network framework, which may be similar in one or more respects to the framework 720 shown in FIG. 7 and described above, as an alternative to or in addition to the computational implementations described above. For example, inputs to the neural network can include images, labels, or other data indicating the 3D size, 3D location (e.g., xyz coordinates) of the target anatomical structure, or other data related to image parameters. Depth information can be determined from a CT or can be derived from other information. For example, depth and / or pixel coordinate information can be an output from the neural network.

[0168] Additional Embodiments Depending on the embodiment, certain acts, events, or functions of any of the processes or algorithms described herein may be performed in a different order, may be added, merged, or omitted entirely, and thus, in a particular embodiment, not all described acts or events may be required to practice a process.

[0169] In particular, hypothetical language used herein, such as "can," "could," "might," "may," "eg," and the like, is intended in its ordinary sense unless specifically stated otherwise or understood otherwise within the context in which it is used, and is intended to convey, generally, that certain embodiments include certain features, elements, and / or steps, while other embodiments do not. Thus, such hypothetical language is not intended to imply that features, elements, and / or steps are generally required in any way for one or more embodiments, or that one or more embodiments necessarily include logic for determining whether those features, elements, and / or steps are included or performed in any particular embodiment, with or without author input or prompting. Terms such as "comprising," "including," "having," and the like, are used in their ordinary sense and are used inclusively in a non-limiting manner and do not exclude additional elements, features, acts, operations, etc. Also, when the term "or" is used, for example, to connect a list of elements, the term "or" is used in its inclusive sense (and not its exclusive sense) to mean one, some, or all of the listed elements. Unless specifically stated otherwise, connective language such as the phrase "at least one of X, Y, and Z" is understood in the context as it is commonly used to convey that an item, term, element, etc. can be either X, Y, or Z. Thus, such connective language is generally not intended to imply that a particular embodiment requires that at least one of X, at least one of Y, and at least one of Z, respectively, be present.

[0170] In the above description of the embodiments, it should be understood that various features are sometimes grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure and aiding in the understanding of one or more of the various inventive aspects. However, the method of disclosure should not be interpreted as reflecting an intention that any claim requires more features than are expressly recited in that claim. Moreover, any component, feature, or step illustrated and / or described in a particular embodiment herein may be applied to or used in any other embodiment. Moreover, no component, feature, step, or group of components, features, or steps is necessary or essential for each embodiment. Thus, it is intended that the scope of the invention disclosed herein and claimed below should not be limited by the specific embodiments described above, but should be determined solely by a fair reading of the claims that follow.

[0171] It should be understood that certain ordinal terms (e.g., "first" or "second") may be provided for ease of reference and do not necessarily imply physical characteristics or ordering. Thus, as used herein, ordinal terms (e.g., "first," "second," "third," etc.) used to modify elements, such as structures, components, operations, etc., do not necessarily indicate a priority or order of the element relative to any other elements, but rather may generally distinguish an element from another element having a similar or identical name (apart from the use of the ordinal term). Furthermore, as used herein, the indefinite articles ("a" and "an") may indicate "one or more" rather than "one." Furthermore, an operation performed "based on" a condition or event may also be performed based on one or more other conditions or events not expressly recited.

[0172] Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the exemplary embodiments belong. It is further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning consistent with their meaning in the context of the relevant art, and should not be interpreted in an idealized or overly formal sense unless expressly so defined herein.

[0173] The spatially relative terms "outer", "inner", "upper", "lower", "below", "upper", "vertical", "horizontal", and similar terms may be used herein for ease of description to describe the relationship between one element or component and another element or component as illustrated in the drawings. It should be understood that the spatially relative terms are intended to encompass different orientations of the device during use or operation in addition to the orientation depicted in the drawings. For example, if the device shown in the drawings is inverted, a device positioned "below" or "under" another device may be positioned "above" the other device. Thus, the exemplary term "lower" may include both lower and upper positions. The device may also be oriented in other directions, and thus the spatially relative terms may be interpreted differently depending on the orientation.

[0174] Unless otherwise specified, comparative and / or quantitative terms such as "less," "more," "greater than," and the like are intended to encompass the notion of equality. For example, "less" can mean not only "less than" in the strict mathematical sense, but also "less than or equal to."

[0175] [Embodiment] (1) A method for positioning a surgical instrument, comprising: advancing a first medical instrument to a treatment site on a patient, the first medical instrument comprising a camera; recording a target location associated with a target anatomical feature at the treatment site; generating a first image of the treatment area using the camera of the first medical instrument; identifying the target anatomical feature in the first image using a pre-trained neural network; and adjusting the target position based at least in part on a position of the identified target anatomical feature in the first image. (2) The method of embodiment 1, further comprising adjusting an orientation of the first medical instrument based at least in part on the position of the identified target anatomical feature within the first image. (3) The method of embodiment 2, wherein the adjusting of the orientation of the first medical instrument involves centering the identified target anatomical feature within a field of view associated with the camera. (4) The recording of the target location comprises: contacting the target anatomical feature with a distal end of the first medical instrument; generating position data indicative of the target anatomical feature and a contact position of the distal end of the first medical instrument; 2. The method of embodiment 1, further comprising storing the location data in one or more data storage devices. (5) The method of embodiment 4, further comprising retracting the distal end of the first medical instrument away from the target anatomical feature prior to the generation of the first image.

[0176] (6) generating a second image of the treatment area using the camera of the first medical instrument after said generating the first image; and identifying anatomical features in the second image using the pre-trained neural network; and determining that the anatomical feature in the second image and the target anatomical feature in the first image represent the same feature; 2. The method of claim 1, further comprising: in response to the determination, adjusting the target position based at least in part on a position of the identified anatomical feature in the second image. (7) The said decision is determining an amount of overlap between at least a portion of the anatomical feature in the second image and at least a portion of the target anatomical feature in the first image; 7. The method of embodiment 6, further comprising determining that the amount of overlap is greater than a predetermined threshold. (8) generating a first mask of the first image that masks the at least a portion of the target anatomical feature in the first image; and generating a second mask of the second image that masks the at least a portion of the anatomical feature of the second image; 8. The method of claim 7, wherein the determining of the amount of overlap is performed using the first mask and the second mask. (9) The method of embodiment 6, wherein the determining involves tracking movement of a feature between the first image and the second image. (10) The method of embodiment 6, further comprising estimating a three-dimensional position of the anatomical feature in the second image based at least in part on the first image and the second image.

[0177] (11) The method of embodiment 10, wherein the estimation of the three-dimensional position of the anatomical feature is based on one or more of a camera focal length, a camera principal point, a relative motion of the first medical instrument, a rotation of the first medical instrument, and an electromagnetic sensor reading. (12) The method of embodiment 1, wherein the adjustment of the target position is further based at least in part on the determined movement of the first medical instrument. (13) The method of embodiment 1, further comprising percutaneously directing a second medical instrument through the patient's tissue toward the target location. (14) The method of embodiment 13, wherein the orientation is performed using sensor data provided by matching sensors of both the first medical instrument and the second medical instrument. (15) The method of embodiment 1, wherein the method is performed at least in part by a robotic system.

[0178] (16) A method for targeting an anatomical feature, comprising: receiving target location data indicative of a target location associated with a target anatomical feature of the patient; storing the target location data in one or more data storage devices; Receiving a first image of a surgical site within a patient; identifying a first morphology in the first image representative of the target anatomical feature using an artificial neural network; and storing updated target location data indicative of the target location based on the identified morphology in the first image. (17) The method of claim 16, further comprising articulating the medical instrument in response to the updated target position data. (18) The method is performed by a control circuit of a medical system; 17. The method of claim 16, wherein the target location data and the first image are received from an endoscope of the medical system. (19) The method of embodiment 16, wherein the target anatomical feature is an exposed portion of a papilla within the calyx of the patient's kidney. (20) The method of claim 16, wherein the artificial neural network is pre-trained based on known image and label data.

[0179] 21. The method of claim 20, wherein the artificial neural network comprises a multi-layer feature pyramid network. (22) The method of embodiment 16, wherein the updated target location data is based at least in part on known respiratory information associated with the patient. (23) receiving a second image of the surgical site; and identifying a second morphology in the second image representative of the target anatomical feature using the artificial neural network; and 17. The method of claim 16, further comprising determining a three-dimensional position of the target anatomical feature based at least in part on the first morphology and the second morphology. (24) The method of embodiment 23, wherein the determination of the three-dimensional position of the target anatomical feature is based at least in part on a relative size of the second morphology. (25) A health care system, comprising: an endoscope having a camera, the endoscope having an electromagnetic position sensor associated with a distal end thereof; a robotic medical subsystem including a plurality of articulating arms; a control circuit communicatively coupled to the endoscope and the robotic medical subsystem, advancing the endoscope to a treatment site on a patient in response to a user input; recording the position of the distal end of the endoscope within an electromagnetic field; generating user interface data indicating the location as a target anatomical location; receiving a first image from the camera of the endoscope; Identifying a target anatomical feature in the first image using a pre-trained neural network; and and control circuitry configured to adjust the target anatomical location based at least in part on a location of the identified target anatomical feature in the first image.

[0180] (26) The medical system of claim 25, wherein the control circuit is further configured to calibrate the distal end of the endoscope within the electromagnetic field. (27) The medical system of embodiment 25, further comprising a robotic nephroscope communicatively coupled to the control circuit. (28) A computing device comprising: An endoscope interface; 1. A control circuit comprising one or more processors and one or more data storage devices, receiving matching sensor data indicative of a position of a distal end of an endoscope coupled to the control circuitry on the endoscope interface; generating first user interface data indicating the position of the distal end of the endoscope as a target nephroscopy position; receiving a first image of a medical site on the endoscope interface; Identifying a first anatomical feature in the first image; receiving a second image of the medical site on the endoscope interface; identifying a second anatomical feature in the second image; determining that the first anatomical form and the second anatomical form represent the same target anatomical feature; and and control circuitry configured to update the target nephroscopy location based on the determination. (29) The computing device of embodiment 28, wherein the control circuitry is further configured to determine that an amount of overlap of the first feature and the second feature in the overlay of the first image and the second image is greater than a predetermined threshold. (30) The computing device of embodiment 28, wherein the control circuitry is configured to generate second user interface data in response to the updating of the target nephroscopy position, the second user interface data indicating the updated target nephroscopy position.

Claims

1. 1. A method of implementing a medical system for targeting an anatomical feature, comprising: an electromagnetic field generator of the medical system generating an electromagnetic field; receiving target location data indicative of a first location of a target anatomical feature in a three-dimensional (3D) space defined by the electromagnetic field; the control circuitry receiving a first image of a surgical site captured at a first time; the control circuitry identifying, based on an artificial neural network, a first morphology as a feature region representative of a shape or morphology of the surgical site in the first image; the control circuitry determining a mapping between the first feature in the first image and the first location in the 3D space; receiving a second image of the surgical site captured at a second time subsequent to the first time; the control circuitry identifying, based on the artificial neural network, a second morphology as a feature region representative of a shape or morphology of the surgical site in the second image; the control circuitry determining a mapping between a second morphology in the second image and a second location in the 3D space based at least in part on the mapping between the first morphology and the first location and a difference between the first image and the second image; the control circuitry comparing the entirety of the first image and the entirety of the second image when the second image is overlaid on the first image and determining an amount of overlap between the second feature and the first feature as a ratio of overlap to the entirety of the first image and the entirety of the second image; the control circuitry determining whether the amount of overlap is greater than a predetermined threshold amount of overlap between the first morphology and the second morphology; in response to the control circuitry determining that the amount of overlap is greater than the predetermined threshold amount, adjusting the target location data to move to the second location in the 3D space based at least in part on a position of the second morphology in the second image and a position of a distal end of an endoscope of the medical system at the first time and the second time; A method comprising:

2. The method of claim 1, further comprising: the control circuit articulating a medical instrument in response to adjusting the target position data.

3. The method described in claim 1, wherein the target location data and the first image are received from an endoscope of the medical system.

4. The method of claim 1 , wherein the target anatomical feature is an exposed portion of a papilla within a renal calyx.

5. The method of claim 1 , wherein the artificial neural network is pre-trained based on known image and label data.

6. The method of claim 5 , wherein the artificial neural network comprises a multi-layer feature pyramid network.

7. The method of claim 1, wherein the adjusted target position data is based at least in part on known respiratory information associated with the anatomical features.

8. The method of claim 1 , wherein mapping the second features to the second locations is based at least in part on a relative size of the second features.

9. 1. A health care system comprising: an electromagnetic field generator configured to generate an electromagnetic field; an endoscope having a camera and an electromagnetic position sensor associated with a distal end thereof for indicating a position within the electromagnetic field; a robotic medical subsystem including a plurality of articulating arms; a control circuit communicatively coupled to the endoscope and the robotic medical subsystem, advancing the endoscope to a treatment site in response to a user input; recording the position of the distal end of the endoscope within the electromagnetic field; generating user interface data indicating the location as a target anatomical location; receiving a first image of the treatment site captured at a first time from the camera of the endoscope; identifying a first anatomical feature in the first image as a feature region representative of a shape or morphology of the treatment site using a pre-trained neural network; receiving a second image from the camera of the endoscope captured at a second time subsequent to the first time; using the pre-trained neural network to identify second anatomical features in the second image as feature regions representative of the shape or morphology of the treatment site; determining, based at least in part on the first image and the second image, whether the second anatomical feature of the second image represents the same target anatomical feature as the first anatomical feature of the first image by overlaying the first image on the second image, and by comparing the entirety of the first image and the second image when the first image is overlayed on the second image, and determining an amount of overlap between the first anatomical feature and the second anatomical feature as an overlap ratio for the entirety of the first image and the second image; and and a control circuit configured, in response to determining that the first anatomical feature and the second anatomical feature represent a same target anatomical feature, to track the target anatomical location by compensating for dynamic relative movement of the target anatomical location based at least in part on a difference between the first anatomical feature in the first image and the second anatomical feature in the second image and a position of the distal end of the endoscope at the first time and the second time.

10. The medical system of claim 9 , wherein the control circuitry is further configured to align the distal end of the endoscope within the electromagnetic field with the target anatomical location.

11. 10. The medical system of claim 9, further comprising a robotic nephroscope communicatively coupled to the control circuitry.

12. A computing device in a medical system, comprising: An endoscope interface; 1. A control circuit comprising one or more processors and one or more data storage devices, receiving sensor data indicative of a position in three-dimensional (3D) space of a distal end of an endoscope coupled to the control circuitry on the endoscope interface, the 3D space being defined by an electromagnetic field generated by an electromagnetic field generator of the medical system; generating first user interface data indicating the position of the distal end of the endoscope as a first position relative to a target anatomical feature in the 3D space; receiving a first image of a medical site captured at a first time on the endoscope interface; identifying a first anatomical feature within the first image as a feature region representative of a shape or form of the medical site; determining a mapping between the first anatomical feature in the first image and the first location in the 3D space; receiving a second image of the medical site captured on the endoscope interface at a second time subsequent to the first time; identifying a second anatomical feature within the second image as a feature region representative of a shape or form of the medical site; determining a mapping between the second anatomical feature in the second image and a second location in the 3D space based at least in part on the mapping between the first anatomical feature and the first location and a difference between the first image and the second image; comparing the entirety of the first image and the entirety of the second image when the second image is overlaid on the first image, and determining an amount of overlap between the first anatomical feature and the second anatomical feature as a ratio of overlap between the entirety of the first image and the entirety of the second image; determining whether an amount of overlap of the first anatomical form and the second anatomical form is greater than a predetermined threshold amount of overlap for the first anatomical form and the second anatomical form; and control circuitry configured, in response to determining that the amount of overlap is greater than the predetermined threshold amount, to adjust the first user interface data to move to the second location in the 3D space based at least in part on a position of the second anatomical form in the second image, a position of the distal end of the endoscope at the first time and the second time.

Images