System for registration between coordinate systems and navigation of selected components

Abstract

A system for assisting in guiding and performing surgery on an object is disclosed. The object may be any suitable object, such as an inanimate object and / or an animate object. The guide and system may include various manipulable or movable components and may be registered to a selected coordinate system.

Description

Technical Field

[0001] The present disclosure relates generally to tracking and navigation systems, and particularly to registering coordinate systems for various surgeries, such as for navigating one or more components during surgery. Background Art

[0002] This section provides background information related to the present disclosure which is not necessarily prior art.

[0003] Instruments may be navigated relative to a patient to perform various procedures. During a surgical procedure, instruments may be tracked in a navigation or tracking space, which may also be or include at least a portion of a patient space. The position of the tracked instrument may be displayed on a display device relative to an image of the patient.

[0004] The position of the patient can be determined using a tracking system. However, in order to track the patient relative to the image, the patient is typically registered to the image via a tracking instrument relative to the patient to generate a translation map between object or target space (e.g., patient space) and image space. This typically requires time during a surgical procedure for a user (e.g., a surgeon) to identify one or more points in object space and associate the typically same points in image space.

[0005] After registration, the position of the instrument can be appropriately displayed on a display device while the instrument is being tracked. The position of the instrument relative to the object can be displayed as a graphical representation, sometimes referred to as an icon, on the display device. Summary of the invention

[0006] This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.

[0007] A system that allows tracking of various components is disclosed. The system can simultaneously track multiple components in a navigation or tracking space. Each of the tracked components can be associated with a respective portion (such as a portion in an image). The image can be segmented to distinguish and depict the portion to allow for substantially real-time (e.g., minimal or no delay between real-space movement and image representation) navigation of multiple components in the space. The navigation system can operate multiple tracking systems or receive tracking information from multiple tracking systems, including a first tracking system operating in a first tracking modality (e.g., electromagnetic (EM)) and a second operating system operating in a second tracking modality (e.g., optical tracking).

[0008] To interpret or navigate with respect to an image, registration can occur between a selected physical space (e.g., an object space or a navigation space) and an image space (e.g., defined by the image). According to various embodiments, imageable fiducials can be used to perform the registration. For example, the fiducial objects can be imaged with an imaging system and can be identified or segmented in the image data and the image. The fiducial objects can be connected to a selected system, such as a robotic system. The robotic system can include a suitable robotic system, such as the Mazor X sold by Mazor Robotics, Inc., having a place of business in Israel, and / or Medtronic, Inc., having a place of business in Minnesota, USA. TM Robotic guidance system. Fiducial objects may also be attached to and / or located relative to the object during an imaging procedure. Additionally, naturally occurring or inherent features of an object may be identified as fiducial objects.

[0009] The fiducial target may include one or more targets, such as an array of discrete targets. Discrete targets may include spheres, objects of various shapes, continuous rods, and / or one or more rods that may all be within or intersecting a plane. The fiducial target may be modeled in three-dimensional (3D) space as a 3D model. Fiducial features may be extracted from the 3D model. The fiducial features may be compared or coordinated with image fiducial features generated by the imaged fiducial object or a portion thereof (e.g., an image fiducial feature may be a point relative to the center of a sphere or circle or a point relative to the intersection of a rod and a plane).

[0010] The tracking device may have one or more tracking members that may be positioned in the navigation space to be tracked using one or more tracking systems. For example, the tracking member may be connected to one or more members or parts of an object. The tracking member may be connected to a vertebra or a part of a vertebra of a patient. Similarly, the tracking device may be connected to one or more parts of any selected structure (such as a car, a fuselage, a cabinet system, etc.), such as a support beam. In any case, the tracking member is usually positioned relative to the member or part of the object in a fixed manner so that the relationship can be determined by tracking the tracking member and determining the position of the connected member in the navigation space and used to allow tracking of the member in the navigation space. Therefore, one or more members may be tracked in the navigation space during a selected tracking procedure. In addition, the instrument may be positioned or moved into a navigation space separate from the object (such as a drill, awl, implant member, fastener, etc.).

[0011] One or more tracking systems can be incorporated into or operated with a navigation system, which includes one or more instruments that can be tracked relative to an object. The navigation system can include one or more tracking systems that track various parts, such as tracking devices that can be associated with one or more components (such as skeletal parts, instruments, etc.). The tracking system can include a locator that is configured to determine the position of the tracking device in a navigation system coordinate system. The determination of the navigation system coordinate system can include those described in various references, including U.S. Patent No. 8,737,708, U.S. Patent No. 9,737,235, U.S. Patent No. 8,503,745, and U.S. Patent No. 8,175,681, all of which are incorporated herein by reference. Specifically, the locator can track an object in a volume relative to an object. The navigation volume in which the tracking device can be included or referred to as a navigation coordinate system or navigation space. The determination or correlation between the two coordinate systems can allow or also be referred to as the registration between the two coordinate systems.

[0012] In addition, an image of a selected portion of an object can be obtained. An image can be displayed for viewing by a user, such as a surgeon. The image may have been superimposed with a graphical representation of a tracked portion or member, such as an instrument, on a portion of the image. Moreover, the various parts of the image (e.g., a skeletal member) can be segmented. According to various embodiments, due to the registration of the image space (also referred to as the image coordinate system) to the object space, the graphical representation can be superimposed on the image at an appropriate position. The method of registering the object space defined by the object to the image space can be included in the method disclosed in U.S. Patent No. 8,737,708, U.S. Patent No. 9,737,235, U.S. Patent No. 8,503,745 and U.S. Patent No. 8,175,681, all of which are incorporated herein by reference in their entirety.

[0013] A graphical representation of a selected instrument that can be separated from the object can be superimposed on the displayed image. The superimposed graphical representation can illustrate the position of the instrument being tracked relative to the object due to the registration of the object or navigation space to the image space and the tracking of the instrument in the navigation space. Moreover, as described above, the tracking device can be connected to various parts of the object so that the tracking components are referenced relative to it and relative to each other. Segmented portions of the object can be illustrated as superimposed on the image and / or as part of the image. The segmented portions of the image or their graphical representations can also be moved due to the tracking device tracking on the various parts. Therefore, due to the tracking of the tracking device, the image can be updated to include a representation of the tracked portion (e.g., a skeletal portion) of the component.

[0014] During a selected procedure, due to a selected procedure, such as imaging of an object, the first coordinate system can be registered to the object space or object coordinate system. In various embodiments, the first coordinate system can be registered to the object by imaging the object using a reference point portion fixed relative to a first component or system, such as a robotic system. Due to the registration of the second coordinate system to the first coordinate system, additional elements that are not fixed to the first coordinate system or are not tracked in the first coordinate system can be allowed to be tracked to a position and / or an image of the object determined or tracked in the first coordinate system.

[0015] Tracking of instruments during an operation, such as a surgical procedure or a surgical treatment, allows navigation of the operation. When image data is used to define an image space, it can be associated or registered with a physical space defined by an object, such as a patient. Thus, according to various embodiments, the patient defines a patient space in which the instrument can be tracked and navigated. The image space defined by the image data can be registered to a patient space defined by the patient. Registration can be performed by using reference points that can be identified in the image data and the patient space.

[0016] Further areas of applicability will become apparent from the description provided herein.The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. BRIEF DESCRIPTION OF THE DRAWINGS

[0017] The drawings described herein are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure.

[0018] Figure 1 is a schematic diagram illustrating an overview of a robotic system and a navigation system according to various embodiments;

[0019] Figure 2 is a detailed environmental view of a tracking system according to various embodiments;

[0020] Figure 3 is a detailed environmental view of a tracking system according to various embodiments;

[0021] Figure 4 is a display device showing a first image;

[0022] Figure 5 is a display showing a second image;

[0023] Figure 6 is a flow chart of the method;

[0024] Figure 7 is a detailed environmental view of a tracking system according to various embodiments;

[0025] Figure 8is an illustration of an apparatus having a tracking device according to various embodiments;

[0026] Fig. 9 is an illustration of an apparatus having a tracking device according to various embodiments;

[0027] Fig.10 is a detailed environmental view of a tracking system according to various embodiments;

[0028] Fig.11A is a detailed environmental view of a tracking system according to various embodiments;

[0029] Fig. 11B is a display showing an image having a tracked portion therein according to various embodiments;

[0030] Fig. 12A is a display showing an image with a tracking portion therein in a first relative position according to various embodiments; and

[0031] Fig. 12B is a display showing an image with a tracking portion in a second relative position according to various embodiments.

[0032] Corresponding reference characters indicate corresponding parts throughout the several views of the drawings. DETAILED DESCRIPTION

[0033] Example embodiments will now be described more fully with reference to the accompanying drawings.

[0034] The subject disclosure relates to exemplary embodiments of surgical procedures on objects, such as human patients. However, it should be understood that the systems and methods described herein are merely exemplary and are not intended to limit the scope of the claims included herein. In various embodiments, it should be understood that the systems and methods can be incorporated into and / or used for non-living objects. For example, these systems can be used to align coordinate systems between two systems for use on manufacturing systems and maintenance systems, etc. For example, automobile assembly can use one or more robotic systems that include separate coordinate systems that can be aligned together for coordinated or joint actions. Therefore, the exemplary description of surgical procedures herein is not intended to limit the scope of the appended claims.

[0035] According to various embodiments, discussed herein are processes and systems for allowing registration between various coordinate systems. In various embodiments, a first coordinate system can be registered to a second coordinate system. The first coordinate system can be a first tracking space defined by a first tracking system with a first locator, and the second coordinate system can be a second tracking space defined by a second tracking system with a second locator. One or both of the first coordinate system and the second coordinate system can be registered to an additional coordinate system or space (e.g., a third coordinate system, a fourth coordinate system, etc.). Additional coordinate systems may include an image coordinate system or space and / or an object coordinate system or space. As discussed herein, a navigation space or coordinate system can be defined relative to an object space and at least in part by a tracking system space.

[0036] First reference Figure 1 , illustrating an operating room such as a surgical operating room. Positioned within the operating room may be various systems and components that are used during and / or assist in performing surgery relative to an object. For example, a navigation system 20 may be positioned within the operating room. Within the operating room, the navigation system 20 may include various elements or portions, such as an optical locator 88 and an electromagnetic (EM) locator 94, which define or are used to generate a navigation or tracking space in a selected first coordinate system and / or a second coordinate system, as further discussed herein. As further discussed herein, the respective locators 88, 94 may also be registered (also referred to as correlated) relative to each other to allow tracking of one or more instruments in either or both coordinate systems, and to associate the tracked position with an additional coordinate system. Thus, the user 72 may track one or more instruments, such as an instrument 68 relative to the object 30 and / or track multiple portions or components of the object 30.

[0037] The navigation system 20 can be used to track the position of one or more tracking devices, which may include an object tracking device 58, an imaging system tracking device 62, and / or a tool tracking device 66. The tool 68 can be any appropriate tool, such as a drill, tweezers, or other tool operated by a user 72. The tool 68 may also include an implant, such as a spinal implant or an orthopedic implant. It should be further noted that the navigation system 20 can be used to navigate any type of instrument, implant, or delivery system, including: guidewires, arthroscopic systems, orthopedic implants, spinal implants, deep brain stimulation (DBS) probes, etc. In addition, these instruments can be used to navigate or map any area of ​​the body. The navigation system 20 and various instruments can be used in any appropriate surgery, such as instruments for typically minimally invasive surgery or open surgery.

[0038] The imaging device 80 may be used to acquire preoperative, intraoperative, or postoperative or real-time image data of an object, such as the object 30. However, it should be understood that any suitable object may be imaged and any suitable procedure may be performed with respect to the object. In the illustrated example, the imaging system 80 comprises a Medtronic Navigation System sold by Medtronic Navigation, Inc. having a place of business in Louisville, Colorado, USA. Imaging device. The imaging device 80 may have a generally annular gantry housing 82 in which the image capture portion is movably placed. The imaging device 80 may utilize x-rays to acquire image data. The image capture portion may include an x-ray source or emitting portion, and the x-ray receiving portion or the image receiving portion may be positioned substantially or practically as far as possible 180 degrees from each other, and may be mounted on a rotor relative to a track or rail. The image capture portion may be used to rotate 360 ​​degrees during image acquisition. The image capture portion may rotate about a center point or axis, allowing image data of the patient 80 to be acquired from multiple directions or in multiple planes. The imaging device 80 may include an imaging system disclosed in: U.S. Pat. No. 7,188,998, U.S. Pat. No. 7,108,421, U.S. Pat. No. 7,106,825, U.S. Pat. No. 7,001,045, and U.S. Pat. No. 6,940,941, all of which are incorporated herein by reference or any appropriate portion thereof. In one example, imaging device 80 may utilize flat panel technology having a 1,720 x 1,024 pixel viewable area.

[0039] The position of the imaging device 80 and / or portions thereof, such as the image capture portion, may be precisely known relative to any other portion of the imaging device 80. According to various embodiments, the imaging device 80 may know and recall precise coordinates relative to a fixed coordinate system or a selected coordinate system. This may allow the imaging system 80 to know its position relative to the patient 30 or other reference. Additionally, as discussed herein, precise knowledge of the position of the image capture portion may be used in conjunction with a tracking system to determine the position of the image capture portion and image data relative to a tracked object, such as the patient 30, etc.

[0040] The imaging device 80 may also be tracked with the tracking device 62. According to various embodiments, the image data defining the acquired image space of the patient 30 may be inherently or automatically registered with respect to the target space. The target space may be a space defined by the patient 30 in the navigation system 20. Automatic registration may be achieved by including a determinable precise position of the tracking device 62 and / or the image capture portion on the imaging device 80. According to various embodiments, as discussed herein, imageable portions, virtual reference points, and other features may also be used to allow automatic or otherwise registration. However, it will be understood that image data of any object that will define the object space may be acquired. The patient space is an exemplary object space. Registration allows translation between the patient space and the image space.

[0041] As the patient moves, the patient 80 may also be tracked using a patient tracking device (also referred to as a dynamic reference frame (DRF)) or tracker 58. Alternatively or in addition, the patient 30 may be fixed within a navigation space defined by the navigation system 20 to allow for registration. As discussed further herein, registration of image space with patient space or object space allows for navigation of the instrument 68 using image data. As the instrument 68 is navigated, the position of the instrument 68 may be illustrated on the display device 84 relative to the acquired image data of the patient 30. Various tracking systems, such as a tracking system including an optical locator 88 or an electromagnetic (EM) locator 92, may be used to track the instrument 68.

[0042] More than one tracking system may be used to track the instrument 68 in the navigation system 20. According to various embodiments, these may include an electromagnetic tracking (EM) system with an EM locator 94 and / or an optical tracking system with an optical locator 88. As discussed herein, one or both of the tracking systems may be used to track a selected tracking device. It should be understood that, unless otherwise discussed, a tracking device may be a trackable portion with a selected tracking system. A tracking device does not necessarily refer to the entire member or structure to which the tracking device is attached or associated. It should also be understood that additional or alternative tracking systems such as radar, acoustic, ultrasonic and / or other tracking systems may also be used. Typically, a tracking system tracks a tracking device in a tracking or navigation space. The tracking system is capable of generating a signal based on the tracking (e.g., within a camera's field of view, an EM field, etc.), and the signal is used within the navigation system to determine the position of the tracked element. In various embodiments, the determined position may then be shown on a display device relative to another coordinate system (such as an image space).

[0043] It should also be understood that the imaging device 80 may be other than The imaging device of the imaging device may additionally or alternatively include a fluoroscope C-arm. Other exemplary imaging devices may include fluoroscopes, such as biplane fluoroscope systems, ceiling mounted fluoroscope systems, catheter laboratory fluoroscope systems, fixed C-arm fluoroscope systems, isocentric C-arm fluoroscope systems, 3D fluoroscope systems, etc. Other suitable imaging devices may also include MRI, CT, ultrasound, etc.

[0044] In various embodiments, the imaging device controller 96 can control the imaging device 80 and can receive image data generated in the image capture portion and store the image for later use. In various embodiments, the controller 96 can include a processor 97 and / or various memory portions. The controller 96 can also control the rotation of the image capture portion of the imaging device 80. It should be understood that the controller 96 does not need to be integrated with the frame housing 82, but can be separated from it. For example, the controller can be part of the navigation system 20, which can include a processing system and / or control system 98, which includes a processing unit or processing portion 102. However, the controller 96 can be integrated with the frame 82 and can include a second and separate processor 97 such as in a portable computer.

[0045] Patient 30 may be secured to operating table 104. According to one example, operating table 104 may be an Axis 104 sold by OSI, a division of Mizuho Ikakogyo Corporation, having a place of business in Tokyo, Japan, or Orthopedic Systems, Inc., having a place of business in California, USA. Operating table. The patient positioning device can be used with the operating table and includes The clamp or patient positioning device set forth in commonly assigned U.S. Patent Application No. 10 / 405,068, entitled "Integrated Electromagnetic Navigation and Patient Positioning Device," filed April 1, 2003, which is hereby incorporated herein by reference.

[0046] Thus, the position of the patient 30 relative to the imaging system 80 can be determined by the navigation system 20. The tracking device 62 can be used to track and position at least a portion of the imaging device 80, such as the gantry or housing 82. As further discussed herein, the patient 30 can be tracked with the dynamic reference frame 58. Thus, the position of the patient 30 relative to the imaging system 80 can be determined. In addition, due to the precise position of the imaging portion on the guide rails within the housing 82, the substantially inflexible rotors, etc., the position of the imaging portion can be determined relative to the housing 82. If the imaging device 80 is sold by Medtronic Navigation, Inc., having a place of business in Louisville, Colorado Imaging device, then imaging device 80 can include, for example, accuracy within 10 microns. Precise positioning of the imaging portion is further described in the following: U.S. Patent No. 7,188,998, U.S. Patent No. 7,108,421, U.S. Patent No. 7,106,825, U.S. Patent No. 7,001,045 and U.S. Patent No. 6,940,941, all of which are incorporated herein by reference.

[0047] According to various embodiments, the imaging device 80 can generate and / or emit X-rays from an X-ray source, which propagate through the patient 30 and are received by the X-ray imaging receiving portion. The image capture portion generates image data representing the intensity of the received X-rays. Typically, the image capture portion can include an image intensifier that first converts the X-rays into visible light and a camera (e.g., a charge coupled device) that converts the visible light into digital image data. The image capture portion can also be a digital device that directly converts the X-rays into digital image data to form an image, thereby potentially avoiding distortion caused by first converting to visible light.

[0048] Two-dimensional and / or three-dimensional fluoroscopic image data that may be taken by imaging device 80 may be captured and stored in imaging device controller 96. Multiple image data acquired by imaging device 80 may also be captured and combined to provide a larger view or image of an entire area of ​​patient 30, rather than just a portion of the area of ​​patient 30. For example, multiple image data of the spine of patient 30 may be appended together to provide a complete view or complete set of image data of the spine.

[0049] The image data may then be forwarded from the image device controller 96 to a navigation computer and / or processor system 102, which may be part of a controller or workstation 98 having a display 84 and a user interface 106. It will also be appreciated that the image data need not be first stored in the controller 96, but may also be directly transferred to the workstation 98. The workstation 98 may provide facilities for displaying the image data as an image 108 on the display 84 and for storing, digitally processing, or printing hard copy images of the received image data. The user interface 106, which may be a keyboard, mouse, stylus, touch screen, or other suitable device, allows the user 72 to provide input to control the imaging device 80 or adjust image settings of the display 84 via the image device controller 96. The workstation 98 may also instruct the image device controller 96 to adjust the image capture portion of the imaging device 80 to obtain various two-dimensional images along different planes, thereby generating representative two-dimensional image data and three-dimensional image data.

[0050] Continue to refer Figure 1, the navigation system 20 may also include a tracking system, which may be one or both of an electromagnetic (EM) locator 94 and / or an optical locator 88. However, as described above, additional or alternative tracking systems may also be provided or used. The tracking system may include a controller and an interface portion 110. The controller 110 may be connected to a processor portion 102, which may include a processor contained within a computer. The controller 110 may also be connected to one or more of the locators (such as the EM locator 94 and / or the optical locator 88). The connection may be wired or wireless and allow for one-way or two-way communication. The EM tracking system may include a system sold by Medtronic Navigation, Inc., having a place of business in Louisville, Colorado. AXIEM TM The navigation system 26 may be or include an EM tracking system as described in U.S. Pat. No. 7,751,865, entitled “Method and Apparatus for Surgical Navigation,” filed on July 6, 2010, U.S. Pat. No. 5,913,820, entitled “Position Positioning System,” issued on June 22, 1999, and U.S. Pat. No. 5,592,939, entitled “Method and System for Navigating Catheter Probe,” issued on January 14, 1997; all of which are incorporated herein by reference. It should be understood that the navigation system 26 may also be or include any suitable tracking system, including an EM tracking system having an optical positioner. or S7 TM A tracking system, which may be used as an optical locator 88, is sold by Medtronic Navigation, Inc., located in Louisville, Colorado. Other tracking systems include acoustic systems, radiation systems, radar systems, etc. The tracking system may be used according to techniques generally known or described in the references incorporated above. Details will not be included herein unless they clarify selected operations of the subject disclosure.

[0051] Wired or physical connections may interconnect the tracking system, imaging device 80, etc. Alternatively, rather than being directly coupled to the controller 110, various parts, such as the instrument 68, may employ wireless communication channels, such as disclosed in U.S. Pat. No. 6,474,341, entitled "Surgical Communication Power System," issued Nov. 5, 2002, which is incorporated herein by reference. In addition, the tracking devices 62, 66, 54 may generate fields and / or signals that are sensed by the localizers 88, 94.

[0052] Various portions of the navigation system 20, such as the instrument 68, and other portions described in detail below, may be equipped with at least one and typically a plurality of tracking devices 66. The instrument may also include more than one type or modality of tracking devices 66, such as an EM tracking device 66e and / or an optical tracking device 66o. The instrument 68 may include a graspable or manipulable portion at a proximal end, and the tracking device may be secured proximate to the manipulable portion of the instrument 68.

[0053] Additional representative or alternative positioning and tracking systems are described in US Pat. No. 5,983,126, entitled "Catheter Positioning System and Method," issued Nov. 9, 1999, which is hereby incorporated by reference. Thus, navigation system 20 may be a hybrid system including components from various tracking systems.

[0054] According to various embodiments, the navigation system 26 may be used to track the instrument 68 relative to the patient 30. As described above, the instrument 68 may be tracked with a tracking system. Image data of the patient 30 or a suitable object may be used to assist the user 72 in guiding the instrument 68. However, the image data is registered to the patient 30. The image data defines an image space that is registered to a patient space defined by the patient 30. The registration may be performed automatically, manually, or a combination thereof as discussed herein.

[0055] Generally, registration allows a translation map to generate a physical position of the instrument 68 relative to the image space of the image data. The translation map allows the tracked position of the instrument 68 to be displayed on the display device 84 relative to the image data 108. A graphical representation 68i, also referred to as an icon, can be used to illustrate the position of the instrument 68 relative to the image data 108.

[0056] As described above, the imaging system 80 or any suitable imaging system can acquire images of the object 30. The images can be automatically registered according to various procedures such as are known in the art, including tracking the imaging system 80 (e.g., using the image tracking device 62) and tracking the object 30 using the object tracker 58. Other registration processes may include identifying fiducials or related points in the image 108 and on the patient or object 30. The fiducials may include artificial fiducials that are imageable parts (e.g., radiopaque markers) that are positioned on the object 30 and / or implanted in the object during image acquisition using the imaging device 80 and appear on the image 108, such as the fiducial markers 113. The user 72 can identify the fiducial markers 113 in the image 108 and then also identify the fiducials on the object 30, such as the instrument 68 tracked with one or more tracking systems touching the fiducials in the object. The navigation system 20 can then determine the position of the tracked instrument 68 and associate it with the fiducials 113 identified in the image 108.

[0057] In various embodiments, when the fiducial portion 113 is imaged with the imaging device 80, image data including or identifying the fiducial portion 113 is generated. The fiducial portion 113 may be identified in the image data as an imaged fiducial portion 113i automatically (e.g., by a processor executing a program), manually (e.g., by selecting identification by a user 72), or a combination thereof (e.g., by identification by a user 72 selecting a seed point and segmentation performed by a processor executing a program). Methods of automatic imageable portion identification include methods disclosed in U.S. Pat. No. 8,150,494, issued on April 3, 2012, which is incorporated herein by reference. Manual identification may include selecting an element (e.g., pixel) or region in the image data where the imageable portion has been imaged. Regardless, the fiducial portion 120 identified in the image data may be used as a fiducial or fiducial location that may be used to register the image data or the image space of the image data with the patient space.

[0058] In various embodiments, to register the image space or coordinate system to another space or coordinate system, such as navigation space, the fiducial portion 120 identified in the image 108 may then be identified in an appropriate manner in the object space defined by the object 30. For example, if the fiducial portion was attached to the object 30 at the same location during acquisition of the image data to generate the image 108, the user 72 may move the instrument 68 relative to the object 30 to contact the fiducial portion 120. It should be understood that the fiducial portion 120 may be attached to the object 30 and / or may include an anatomical portion of the object 30, as discussed above in various embodiments.

[0059] In addition, tracking devices can be incorporated into the fiducial portion 113, and they can remain with the object 30 after the image is acquired. In this case, the registration or identification of the fiducial portion 120 can be performed in the object space. However, according to various embodiments, the user 72 can move the instrument 68 to contact the fiducial portion 113. Due to the tracking device 66 attached to the instrument 68, a tracking system such as an optical locator 88 can track the position of the instrument. This allows the user 72 to identify the position of the fiducial portion 120 identified in the image 108 in the navigation space. After identifying the position of the fiducial portion 120 in the navigation space, which may include the object space, a translation map can be made between the subject space defined by the object 30 and the image space defined by the image 108 in the navigation space. Therefore, as further discussed herein, the same or known position allows registration.

[0060] During registration, a translation map is determined between the image data coordinate system of the image data, such as image 108, and the patient space defined by patient 30. Once registration occurs, instrument 68 may be tracked with a tracking system registered to the image data to allow the position of the tracked instrument 68 to be identified and illustrated as an icon superimposed on the image data. Registration of image 108 (or any selected image data) to subject 30 may occur at any suitable time.

[0061] After registering the image space to the patient space, the instrument 68 can be tracked relative to the image 108. Figure 1 As shown, an icon 68i representing the position of the instrument 68 (which may include a 6-DOF position (including 3D position and orientation)) may be displayed on the display 84 relative to the image 108. Due to the registration of the image space to the patient space, the position of the icon 68i relative to the image 108 may substantially identify or simulate the position of the instrument 68 relative to the patient 30 in the patient space. As described above, this may allow the navigation process to occur.

[0062] Continue to refer Figure 1 and Figure 2 , the patient tracker or object tracker 58 may also include more than one tracking element or portion and / or may operate with one or more tracking systems. For example, the patient tracker 58 may include one or more optically trackable members or portions, such as a reflective member 58o. It should be understood that the optically trackable member may also be an active emitter (e.g., an LED) or passive, such as a reflector. In addition, the object tracker 58 may include an electromagnetic tracking member or portion 58e. The EM tracker 58e can be fixed relative to the optical tracker 58o so that the position (including the three-dimensional position and / or one or more degrees of freedom orientation) is fixed. Therefore, using at least two tracking systems, such as the optical positioner 88 and the EM positioner 94, the patient tracker 58 can be used as a registration or dynamic reference system relative to the patient 30.

[0063] The object tracker 58 may also be used for registration and / or calibration of an instrument including an instrument 68 having a selected fiducial or registration portion 150. The registration portion 150 may include a notch or indentation that the instrument 68 may contact to allow the navigation system 20 to determine the distal end or terminal end of the instrument 68 relative to the tracking device 66. As described above, the tracking device 66 may also be tracked in more than one tracking system including an optical tracking device 66o and an EM tracking device 66e.

[0064] It should be understood that multiple portions of the tracking device 66 may be secured together in a single unit, similar to the trackable member or assembly 154. Alternatively or in addition, two tracking devices, such as the optical tracking device 66o and the EM tracking device 66e, may be secured relative to each other on the instrument 68. Thus, regardless of the configuration, the position of the EM tracking device 66e relative to the optical tracking device 66o is fixed for a selected procedure, such as performing surgery on the subject 30.

[0065] In addition to the object tracker 58, additional tracking elements may be attached to the patient 30, including individual or separate component trackers 160, including a selected number (e.g., 3), including 160i, 160ii, and 160iii. Each of the individual trackers 160 may also be referred to as a tracking device and may be secured to a different bone portion that may move relative to one another, such as a different vertebra, including a first vertebra 166i, a second vertebra 166ii, and a third vertebra 166iii. Thus, each of the vertebrae 166 may move relative to one another, such as the first vertebra 166i and the second vertebra 166ii. The individual trackers 160 connected to the individual vertebrae may allow the individual vertebrae to be tracked relative to one another, as further discussed herein.

[0066] Additional references Figure 3 and Figure 4 , the patient tracker 58 can be fixed relative to the object 30, such as relative to a portion of the pelvis (including the iliac crest) or other suitable portion. In addition, the object 30 can be fixed relative to the operating table 104, and the patient tracker 58 is also fixed to the operating table 104, so that there is no movement between the patient 30 and the patient tracker 58. Regardless, the patient tracker 58 can be used to maintain the registration of the object 30 relative to the image 108 by measuring and tracking the movement of the object 30 to update the translation between the object 30 and the patient tracker 58 in the navigation space relative to the image space that defines the object space.

[0067] As described above, the patient tracker 58 may include an EM tracker 58e. The EM tracker 58e may communicate with the navigation system 20 in a suitable manner such as wireless, wired, or a combination thereof, such as through the controller 110. Similarly or in addition, the component tracker 160 such as the tracker 160i may also communicate with the navigation system 20 via wired communication, wireless communication, or a combination thereof. Figure 2 and Figure 3 As shown, the vertebrae including the first vertebra 166i and the second vertebra 166ii can each include or have a corresponding tracker or tracking device 160i, 160ii connected thereto, respectively. Thus, each of the tracking devices 160 can track a selected member or element, such as a bone portion including the vertebra 166.

[0068] As described above, the tracking system may track the skeletal portion or a tracking device connected to the skeletal portion in real time. The image 108 may include image data or images of vertebrae such as the first vertebra 166i' and the second vertebra 166ii'. The vertebrae (including each vertebra) may be segmented in the image in any suitable manner, such as in a substantially automatic process, a manual process, or a combination of a manual process and an automatic process. The segmentation of the vertebrae may include a method such as that performed by Mazor The robotic system is used to segment the vertebrae or other appropriate segmentation techniques. Manual segmentation may include the user 72 outlining or defining the image portion associated with the selected portion such as the first vertebra 166i and the second vertebra 166ii. Automatic segmentation may include a processor such as the processor 102, which executes an algorithm to segment the vertebrae in the image. Semi-manual segmentation may include the user 72 identifying a seed pixel or voxel or a plurality of seed pixels or voxels, and the processor may execute instructions to segment the image data associated with the identified seed portion. However, the image 108 may include segmented portions, such as the segmentation of the first vertebra, the second vertebra, and the third vertebra 166.

[0069] In addition to the segmentation of the vertebrae, various portions thereof may also be identified. In various embodiments, the upper and lower endplates of the vertebrae may be segmented or identified in the image 108, such as the endplates including a first endplate 170i of a first vertebra and a second endplate 170ii of a second vertebra 166ii. It should be understood that each of the vertebrae in the vertebrae typically includes two endplates, and the discussion of the first endplate 170 and the second endplate 174 herein is merely exemplary. In addition, other portions of the vertebrae may be identified and / or portions or portions of the endplates may be identified. The endplates may be identified automatically (e.g., based on the segmentation and angles determined therein) or may be identified based on an endplate determination made by a user (e.g., identifying the ends of the endplates).

[0070] The identification of the endplates 170, 174 may assist in identifying the endpoints or terminal portions of the vertebra 166 in the image 108. Additionally, the planes 178, 182 of the respective first and second endplates 170, 174 may be identified. The determination or identification of the planes 178, 182 may be used to measure respective distances between the planes 178, 182, such as an anterior distance 184 and a posterior distance 188. The difference in the distances 184, 188 may also be used to define or determine an angle 192 between the planes 178, 182. It should also be appreciated that the determination of the angle 192 may be made directly between the planes 178, 182. The planes 178, 182 may also be defined within the boundaries of the segmented vertebrae, rather than extending therefrom, such as Figure 4 shown.

[0071] As described above, separate or separate tracking devices 160 can be connected to separate vertebrae 166. Thus, the movement of one vertebra, such as the movement of the first vertebra 166i relative to the second vertebra 166ii, can be tracked using the respective tracking devices 160i and 160ii. The changes in tracking can then be shown on the display device 84 by changing the image 108 based on the tracked position of the tracking device 160, as discussed herein.

[0072] refer to Figure 5 , a vertebra, such as the second vertebra 166ii, can be moved relative to the first vertebra 166i for various purposes, such as attempting to achieve alignment, measuring the mobility of the vertebra, etc. Therefore, the display 84 can display the image 108 to illustrate the movement of the second vertebra 166ii as the image portion 166ii'. The end plates 170, 174 and the corresponding planes 178, 182 that have been previously identified can be shown and / or measured relative to each other on the display 84. In various embodiments, the user 72 can provide input to the navigation system 20, such as input commands, to determine the measurement results after the second vertebra 166ii is moved. The determination of the measurement results can also be performed and / or displayed substantially automatically during the operation. The navigation system 20 or an appropriate system can measure a distance or angle, such as a second angle 210 between the planes 178, 182. Therefore, the user 72 can determine or understand the movement or position between the two vertebrae 166i and 166ii.

[0073] In addition, after acquiring image data and showing the image 108 with the tracking device 160 positioned in the corresponding vertebra 166, the user 72 can also view the position of the vertebrae relative to each other and perform manual manipulation of the vertebrae 166. As discussed further herein, the user 72 can view the movement of the vertebrae 166 on the display device 84 without acquiring additional image data of the subject 30. Thus, in various embodiments, radiation exposure to the subject 30 and / or the user 72 or other users relative to the subject 30 can be reduced because the image 108 is changed based on the tracked position of the individual vertebrae 166 due to the corresponding tracking device 160. It should be understood that in addition to vertebrae, other suitable components and / or instruments can be individually tracked and their positions can be displayed using the display device 84.

[0074] In addition, as described above, the object 30 can be registered to the image 108 in an appropriate manner. Once the object 30 is registered to the image 108, the object tracking device 58 can be used to maintain the registration. As described above, the object tracking device 58 can include an EM tracking device and an optical tracking portion 58o. Therefore, the optical locator 88 and the EM locator 94 can track the patient tracker 58. In addition, because both the EM tracking device 58 and the optical tracking portion 58o are fixed in a single position relative to the patient 58 (such as via a connection or clamp 214), both the locators 88, 94 of the respective tracking systems can include a single origin or relative reference system for tracking additional elements or parts associated therewith. Therefore, as described above, the instrument 68 can include one or both of the tracking devices 66e and 66o to be tracked relative to the object 30 and have a representation 68i shown relative to the image 108.

[0075] Since each of the tracking devices 160, as well as other devices discussed herein, can be connected to a subject, they can also be used to maintain and / or confirm registration. The tracking devices 160 can include a single tracking modality (e.g., optical or EM), while the patient tracker 58 can include multiple tracking modalities (e.g., both optical and EM) to allow correlation between the two tracking modalities.

[0076] However, it should be understood that other tracking devices such as the object component tracking device 160 may include only a single tracking modality or type of tracker, such as an EM tracker. Therefore, according to various embodiments, the individual component tracker 160 may include only a single type of tracking device. In various embodiments, the EM tracking device may include one or more conductive material components formed as coils that can sense and / or transmit electromagnetic fields. The coils may be of a selected size and configuration to allow effective positioning relative to a selected object component. However, it should be understood that the individual tracking component 160 may also be formed or provided as other suitable components, as further discussed herein.

[0077] The movement of the vertebrae 166, such as the second vertebra 166ii, relative to the first vertebra 166i may be performed by any suitable mechanism. However, once the corresponding tracking device is identified relative to the corresponding vertebra, such as Figure 4 and Figure 5As shown, the movement can be shown on the display 84. For example, the user 72 can use the input 106 to identify the first vertebra 166i and the tracking device 160i associated therewith. Similarly, the user 72 can associate the image 166ii' with the vertebra 166ii and further associate the second tracking device 160ii with the vertebra 166ii. The user 72 or any appropriate person can identify the corresponding tracking device with the corresponding vertebra (or any appropriate separate or separate member). Therefore, the tracking system and / or the tracking system 88, 94 can track the corresponding tracking device separately. The signal from the corresponding separate tracking device 160 can then be used to identify the specific part or member that is moved or tracked as moving. The identified specific member is then associated with the graphical portion of the image to allow the image 108 to be updated to illustrate the movement of the corresponding member or part of the object 30.

[0078] Individual tracking devices may also be assigned to selected components substantially automatically. For example, it is known that the patient tracker 58 is located at a selected location, such as on the pelvis. The pelvis may be identified in the image (e.g., by selection or segmentation). Other components such as individual vertebrae may be segmented in the image 108. The navigation system may be determined or indicated with an input indicating that three vertebrae near the pelvis have tracking devices attached thereto. The navigation system may then sequentially identify the vertebrae based on the segmentation and sequentially assign to each tracked tracking device in accordance with the distance from the patient tracker 58 on the pelvis.

[0079] The tracked movement may be substantially real-time, such as with a delay of less than one second, including a delay of less than 10 milliseconds, between movement of a component portion (e.g., vertebra 166) and display of the movement on display 84 by changing image 108. Thus, user 72 may view image 108 with display device 84 to understand substantially real-time position and / or movement of the corresponding component of object 30.

[0080] Therefore, continue to refer to the various embodiments Figure 4 and Figure 5 , a surgery can be performed relative to the object 30 using the navigation system 20. Figure 6, a method 260 of performing surgery relative to an object 30 is shown, according to various embodiments. The method 260 is generally understood to include features or portions that can be performed using input from the user 72 or other appropriate user. Thus, according to various embodiments, in box 264, the object 30 can be positioned relative to the imaging system 80 at an appropriate time. It should be understood that the object 30 can be positioned relative to any appropriate imaging system and that the imaging system 80 is merely exemplary. In addition, in box 268, an individual component tracking device or a segmented component tracking device 160 can be connected to an appropriate component, such as an individual vertebra 166. These various steps can occur at any appropriate time, but allow the method 260 to occur or be performed as further discussed herein.

[0081] The method 260 may include acquiring image data in block 278. Acquiring image data in block 278 may include scanning the subject 30 with the imaging device 80 or any other suitable imaging device substantially at a selected time. Furthermore, the acquisition of image data in block 278 may be calling or accessing acquired image data at an appropriate time, such as before positioning the subject 30 in an operating room relative to the navigation system 20. Thus, in various embodiments, image data of the subject 30 may be acquired.

[0082] In block 282, the image data may then be segmented. As described above, the segmentation of the image data may be performed in any suitable manner. The segmentation may include segmenting individual vertebrae 166 in the image, such as the first vertebrae image 166i' and the second vertebrae image 166ii'. Various segmentation techniques including those discussed above may be used to segment the vertebrae. Additionally, if specific or detailed edge extraction or segmentation may not be required, the user 72 and / or the processor system 102 may identify various endpoints, such as the endpoints of the endplates 170, 174. Thus, for example, Figure 4 As shown, the user 72 can identify two endpoints 170i and 170ii on the first vertebra image 166i' and two separate endpoints 174i and 174ii relative to the second vertebra image 166ii'. These two points can be used to identify the corresponding endplates 170, 174 and / or planes 178, 182 and perform various functions and analyses related thereto. However, it should be understood that segmentation can be used to automatically determine the endplates and / or planes based on the geometry of the segmented parts, relative parts, etc. Therefore, the segmentation of the image data in box 282 can include segmenting all edges or boundaries of the corresponding parts and / or identifying appropriate or selected parts, such as identifying endpoints and determining lines or planes relative to the endpoints.

[0083] Registration of the image data to at least a first coordinate system occurs in block 286. The registration of the image data may be to the image data acquired from block 278 and / or the segmented image data in block 282. Regardless, the registration may be performed to a first coordinate system such as the coordinate system of the optical positioner 88. Thus, the image data may be registered in a first coordinate system that may be defined by the optical positioner 88. It should be understood that the first coordinate system may be any suitable coordinate system and that reference to the optical positioner 88 is merely exemplary.

[0084] However, once the registration of the image data is performed in block 286, the correlation between the first coordinate system and the second coordinate system may occur in block 290. For example, as described above, the EM localizer 94 may also be used to define a navigation or tracking space relative to the object 30. Since the patient tracker 58 includes both the EM tracking device 58e and the optical tracking device portion 58o, the correlation between the first coordinate system of the optical localizer 88 and the second coordinate system of the EM localizer 94 may be performed. As described above, the patient tracker 58 holds both the EM tracking device 58e and the optical tracking device 58o relative to a single fixed point (also referred to as a reference point). Therefore, the registration of either of these portions (such as the optical tracking portion 58o) with the image data may be used to associate the single point with the second coordinate system of the EM tracking system because the EM tracking device 58e is fixed relative to the same point. Therefore, it should be understood that additional tracking devices may also be associated with the patient tracker 58. For example, a radar tracking device may also be associated with the patient tracker 58 to allow for correlation with the radar tracking system that may define a third coordinate system.

[0085] At an appropriate time, such as after registering the image data to the first coordinate system and / or correlation between the first coordinate system and the second coordinate system, identification or determination of correspondence between the individual tracking devices and the segmented portions in the image is performed in block 294. The identification in block 294 may be understood as allowing association of a particular segmented portion in the image 108, such as the segmented image portion of the vertebra 166i', to be associated or correlated with a particular vertebra 166i of the subject. It should be understood that any other appropriate association of components may also be established.

[0086] As described above, individual portions of the image, such as individual vertebrae 166, may have a tracking device 160 attached thereto. Also as described above, the individual tracking devices may be tracked in any suitable tracking system. However, as described above, the individual tracking devices may be tracked in any suitable tracking system. Figure 2 and Figure 3As shown, the individual tracking device 160 may be tracked in a single manner, such as with the EM localizer 94. Other instruments, such as the instrument 68, may be tracked with a different tracking system, such as the optical tracking system 88. Thus, the registration of the first coordinate system may be with the optical tracking system, while the second coordinate system may be with the EM tracking system. Thus, the correlation between the first coordinate system and the second coordinate system may allow the tracking in the second tracking system to be correlated with the image data registered in block 286. Thus, if the individual tracking device 160 is tracked relative to the second coordinate system, the identification or determination of correspondence in block 294 may occur after the correlation in block 290.

[0087] The identification or determination of the individual tracking devices 160 relative to each of the vertebrae 166 may be performed as discussed above. For example, the user 72 may individually identify each tracking device relative to each of the vertebrae images 166i', 166ii', and 166iii'. Thus, the navigation system 20 may identify which of the graphical image portions or segmented portions is associated with each of the individual tracking devices. However, it should be understood that the individual tracking devices may also be automatically associated with the individual segmented portions. For example, the patient tracker 58 may be determined or known to be the lowest trackable portion, and the individual tracking devices may be attached to each of the vertebrae moving upward therefrom. Thus, the navigation system 20 may identify the patient tracker 58, and then sequentially identify each of the individual tracking devices at a distance from the patient tracker 58, wherein the closest tracking device is in the nearest vertebra, the next closest tracking device is in the next nearest vertebra, and so on. Thus, the navigation system 20 may also substantially automatically identify the segmented elements relative to each of the tracking devices in the operating room.

[0088] Individual tracking devices are tracked in block 298, including individual tracking devices 160 connected to a structure such as vertebra 166, instrument tracking device 66, and other tracking devices. Tracking the tracking devices in block 298 may include determining the position of the tracking devices in navigation space. Tracking the tracking devices in block 298 allows for the position of portions connected to the tracking devices (such as portions of individual structures including vertebra 166) to be determined. Thus, in block 304, image 108, including segmented image portions thereof, may be updated based on the tracked positions of the individual tracking devices. Figure 4 and Figure 5 As shown, image portions of vertebrae 166i' and 166ii' can be displayed based on the tracked position of the tracking device associated therewith. Thus, the tracking device 160 tracks the associated portion such as vertebrae 166 that can move, and can change or update the image portion 166' associated therewith on the image 108 displayed on the display device 64.

[0089] The user 72 may then move the vertebrae and / or instrument 68 relative to the object in block 308. As described above, the instrument 68 may include any suitable instrument, such as a tap and / or an implant to be positioned relative to the object 30. The user 72 may move the instrument 68 relative to the object and may display a graphical display or icon 68' on a display device, such as Figure 4 108. Alternatively, any suitable representation of the instrument 68 may be shown. In addition, as described above, the movement of the object 30 may be shown on the display device 84 by updating the image 108.

[0090] In various embodiments, measurements and / or presentation of selected measurements, such as angle 192, distance 184, 188, or other suitable measurements, may be performed in block 310. These measurements may be displayed on display device 84, such as in tiles relative to image 108, including discrete or small tiles 312 and / or ledges in 316. Thus, user 72 may view various measurements based on segmentation of image 108 and / or movement of various portions of object 30 and / or tracking of instrument 68.

[0091] In various embodiments, as described above, components or elements in the navigation domain can be tracked with a separate tracker connected thereto. In addition, multiple tracking devices can be used to track parts or components that move relative to the object 30. As described above, the instrument 68 can be tracked relative to the object 30 using the instrument tracking device 66.

[0092] Also as described above, the instrument 68 may represent multiple instruments, such as an instrument assembled from multiple components. Thus, in various embodiments, different parts of the instrument 68 may be connected together and each of the different parts or components may have a tracking device associated therewith. In this regard, reference is made to Figure 3 , instrument 68 may include instrument tracking device 66 and a second instrument tracking device 320. Second tracking device 320 may be of a type similar to EM tracking device 66e, or any suitable tracking device. However, second instrument tracking device 320 may be used to track portions or components of instrument 68 that are spaced apart or remote from the point of connection of instrument tracking device 66 to instrument 68. It should be understood that multiple tracking devices may also be associated with various other components, such as implants, particularly removable or adjustable implants, which may have portions that intentionally or unintentionally move relative to each other.

[0093] Turn to reference Figure 7, the patient tracker 58 can be connected to the subject 30 at a selected location, such as near the coccyx or iliac crest. Other trackers can be connected relative to the subject 30 at other appropriate locations, such as to the vertebra 166. The vertebra 166 can have different and separate tracking devices connected thereto, as can be provided in various embodiments. As discussed herein, each of the various tracking devices can vary in size, geometry, shape, color, tracking modality, etc.

[0094] In various embodiments, such as Figure 7 As shown, tracking devices are shown that may be provided or used in addition to or in place of tracking device 160. For example, a first tracking device 330 may be connected to the first vertebra 166i, a second tracking device 334 may be connected to the second vertebra 166ii and a third tracking device 338 may be connected to the third vertebra 166iii. Each of the tracking devices 330, 334, 338 may be within the field of view or navigation space of the optical locator 88. The optical locator 88 may include multiple cameras, such as a first camera 340 and a second camera 344. The cameras 340, 344 may view a field of view that may define all or a portion of the navigation space. Thus, the navigation system 20 may view the field of view or analyze the field of view to identify individual tracking devices 330-338.

[0095] Each of the tracking devices 330-338 may include a different shape or geometry, such as a triangle or other geometry that is different from each other. For example, the first tracking device 330 may have a tracking element or member 348 that is an acute triangle. The second tracking device 334 may have a trackable element 352 that is an obtuse triangle. Finally, the third tracking device 338 may include a trackable element 356 that is a parallelogram. Therefore, the navigation system 20 can identify each of the trackable elements 348, 352, 356 in the field of view. As described above, each of the trackable devices 330-338 can be associated with a corresponding vertebra 166. Therefore, the navigation system can track the tracking devices 330-338 substantially separately and individually, and associate or change the display device 84 to display an image 108 of the substantially real-time position of the corresponding vertebra 166 or the member to which the corresponding tracking device is connected. In addition to the changing or different shapes of each of the tracking portions 348-356, each tracking portion may include a different color, shade, etc. that may also be identified in the field of view. Thus, during a selected tracking procedure, each of the individual tracking devices may be identified by both shape and / or color.

[0096] Continue to refer Figure 7, the tracking devices may also include or alternatively include a fourth tracking device 360 ​​and a fifth tracking device 364. Each of the tracking devices 360, 364 may be connected to a selected individual vertebra or member, such as the fourth vertebra 166iv and the fifth vertebra 166v. It should also be understood that the tracking devices 360, 364 may be used in place of the tracking devices 330, 334, 356 or other suitable tracking devices as described above.

[0097] Tracking devices 360, 364 may include corresponding trackable elements or members 368 and 372. Trackable element 368 may include a known first pattern or light-changing characteristic. For example, navigation system 20 may include a database including patterns of trackable portion 368. In addition, trackable portions 348, 352, 356 as described above may also be included in the database. Second trackable portion 372 may include a different pattern or light-changing characteristic. Selected camera or lens features such as a plenoptic camera or when a structured light emitter is used can be used to identify differences in light reflected from trackable portions 368, 372. Trackable portions 368, 372 may include a three-dimensional pattern formed on trackable portions 368, 372 that may change the light emitted or reflected therefrom. Selected cameras 340, 344 may be used to identify the type of reflected light and identify specific tracking members 360, 364. For example, a plenoptic camera may include multiple lenses positioned away from a focal plane to analyze light encountering a photosensitive unit or a photoreceiver (e.g., a complementary metal oxide semiconductor sensor). By analyzing the reflected light, the navigation system 20 may be able to identify a specific tracking device 360, 364. As described above, each of the individual tracking devices may be associated with an individual vertebra, such as the fourth vertebra 166iv and the fifth vertebra 166v. Thus, the navigation system 20 may identify the specific vertebra and update the image 108 based on the tracked position of the tracking device 360, 364.

[0098] Continue to refer Figure 7, further or alternative tracking devices may include tracking device 380 and tracking device 384. Each of tracking devices 380, 384 may have a trackable portion 386, 388, respectively. Each of trackable portions 386, 388 may be substantially three-dimensional or have depth to change or transform the direction of reflected light. Therefore, each of trackable portions 386, 388 may be identified based on the direction of the reflected light or the type of change or prediction. For example, trackable portion 386 may reflect light from a light source along a first ray 392. A second trackable portion 388 may reflect light along a second ray 396. As indicated by the two rays, the trackable portion may reflect light in different directions. The light may come from a single light source 398, and the cameras 340, 344 of the locator 88 may identify specific light reflections to identify the corresponding tracking devices 380, 384. As described above, individual portions of the trackable portions 386, 388 may also be changed or distinguished by color, reflective characteristics, etc.

[0099] Thus, the respective and separate tracking devices 380, 384 that may be connected to the different and separate vertebrae 166vi and 166vii may be used to identify the respective vertebrae during the tracking procedure. As described above, the navigation system 20 may then update the image 108 to identify the movement of the position of the respective member of the subject 30, such as the vertebra 166. The updated image may be based on the tracked positions of the respective and separate tracking devices 380, 384.

[0100] It should be understood that a suitable type of tracking device may be associated with the vertebra 166 in any suitable manner and may include an electromagnetic or convection coil (EM) that may be used to sense the field and transmit a signal thereon. Identification of the individual tracking devices may include a signal regarding each of the individual tracking devices. In a wired transmission, the individual signals may relate to a specific tracking device that is transmitted with a wired connection or a physical connection. In a wireless transmission system, a selected identification feature may be added to the transmitted signal to identify the specific tracking device that transmitted the signal. Examples include a tracking device serial number or a hard-coded universal unique identifier (UUID). Other possible tracking devices may also include radar tracking devices, radio frequency tracking devices, ultrasonic tracking devices, and the like.

[0101] In addition to tracking each of the corresponding vertebrae relative to a selected reference (such as the patient tracker 58), each of the corresponding tracking devices can be used as a reference marker for tracking other elements relative to them. For example, once both the first tracking device 330 and the second tracking device 334 are registered within the navigation coordinate system, the first tracking device can be tracked relative to the second tracking device. As described above, the patient tracker 58 can be registered to the image 108 and can include multiple trackers so that selected types of trackers connected to the individual's tracking devices can be tracked relative to the patient tracking device 58 and / or other tracking devices in the navigation field, including Figure 7 The trackers shown and discussed above.

[0102] In various embodiments, multiple types of trackers may be divided into tracking devices associated with object 30 to assist in tracking multiple types of procedures. Figure 7 As shown in the above figures, the trackable portion can be connected to a member that is directly fixed to a bone portion, such as a vertebra. Each of these tracking devices can include a pin, screw, etc. that is fixed to the bone portion, and the tracking device can extend through the subject's soft tissue, such as its dermis or muscle. Thus, as Figure 7 As shown in dashed lines, the dermis layer 30d can cover a portion of the vertebra 166, so that the trackable portion 358 extends through the dermis and the pin or connecting member 367 extends into the vertebra 166iii. It should be understood that other tracking devices can include similar connecting mechanisms so that the trackable portion extends above the dermis layer 30d. However, in various embodiments, the trackable portion of the tracking device can be connected to the vertebra in an alternative and / or additional manner.

[0103] In various embodiments, such as Figure 8 As shown, the implant can be positioned relative to the object 30. As described above, the implant is the instrument 68. However, in various embodiments, the implant can include a fastener, such as a pedicle screw 410. The pedicle screw can include various parts, such as a handle 414 and a head 418. The pedicle screw 410 can be any suitable pedicle screw, such as the pedicle screw sold by Medtronic, Inc., having a place of business in Minnesota, USA. Spinal System. The pedicle screw may allow the head 418 to move relative to the stem 414.

[0104] The pedicle screw 410 may include tracking members, such as a first or head tracking member 422 and a second or stem tracking member 424. The tracking members may be tracked by a tracking system in the navigation system 20. In various embodiments, the tracking members 422, 424 may be EM tracking members.

[0105] Other trackable devices may include intervertebral devices such as Disc replacement or disc implant and / or Intervertebral disc replacement or intervertebral disc implant, both sold by Medtronic, Inc. The intervertebral device 430 can be positioned between two vertebrae, such as positioned between and / or in contact with the endplates 170, 174, as discussed. It should be understood that various intervertebral implants can include surgical implants, lumbar implants, etc. Generally, the intervertebral implant 430 can include a first endplate or contact side 434 and a second implant or contact side 436. Positioned near or adjacent to the two sides 434, 436 can be tracking devices, such as a first tracking device 438 and a second tracking device 442. Likewise, the tracking devices 438, 442 can be EM tracking devices tracked with the navigation system 20.

[0106] In either case, the tracking devices 422, 424, 438, 442 can be used to track the position or relative position of different parts of the respective components 410, 430. For example, the two tracking devices 422, 424 can be used to track the relative position of the head 418 and the shaft 414. The tracking devices 438, 442 of the intervertebral implant 430 can be used to display the distance between the two surfaces 434, 436 or their relative angle, etc.

[0107] In addition, tracking devices associated with implants 410, 430 can be used during surgery. For example, pedicle screws 410 can be positioned in vertebrae such as vertebra 166i. When screw 410 is positioned in vertebra 166i, a tracking device in the screw can be used to track the screw. Once screw 410 is positioned in vertebra 166i, in addition to or in place of the tracking device described above (e.g., 160 described above), the tracking device on screw 410 or a selected one of the tracking devices can then be used as a tracking device for a particular vertebra. Similarly, tracking devices 438, 442 of intervertebral device 430 can be used to track the intervertebral device 430 being positioned, and then tracked relative to the vertebra once positioned. It should be understood that other suitable implants may also include tracking devices and can be used as separate component tracking devices once positioned in the object.

[0108] Turn to reference Fig. 9, showing the vertebra 166i. In various embodiments, as described above, a pilot aperture or hole 450 can be formed in the vertebra 166i for various purposes, such as positioning a pedicle screw 410 therein. A drilling instrument or drill bit 454 can be used to form the aperture 450. The drilling instrument 454 can be formed to include a trackable portion 458 to track drilling during the formation of the aperture 450. After the aperture 450 is formed, the trackable portion 458 can be disengaged or removed from the drill bit 454 and retained in the aperture 450. Thus, the tracking device 458 can remain in the aperture 450 during selected portions of the procedure and / or after implantation of other components. In various embodiments, the tracking device 458 is a tracking device tracked by the EM locator 94. The tracking device 458 may include one or more coils of conductive material.

[0109] The trackable portion 458 disengaged from the drill bit 454 can be used as a tracking device to track individual vertebrae 166i. It should be understood that other suitable instruments can be used to perform the first portion of the procedure on the selected member, and the drill bit and vertebrae are merely exemplary. However, the tracking portion included in the first instrument portion can be disengaged and retained in the selected member, such as a vertebra, for use in other portions of the procedure. The remaining tracking portion can be used alone or in addition to other tracking devices that can be externally connected to the vertebrae or other members as a tracking device for additional portions of the procedure.

[0110] It should be understood that other suitable components may also include tracking portions that can be used to track instruments relative to the object 30 and / or specific components thereof, such as the vertebrae 166 or other implants. For example, a retractor, tap, awl, etc. may engage a selected portion of an anatomical structure temporarily or for an extended period of time during surgery. The tracked portion may be identified with a corresponding portion of the anatomical structure and may be used to track a specific portion of the object during the selected portion of the surgery. By tracking individual portions during surgery, the image 108 may be updated to show the tracked real-time position of the selected component to which the tracking device is connected or associated.

[0111] Turn to reference Fig.10 As described above, one or more elements or parts, such as bone members including vertebrae, may have tracking devices associated therewith. The tracking device may also be used as a patient tracker or reference frame for tracking with another instrument relative thereto. As described above, the instrument 68 may be moved relative to the subject 30 during a selected procedure.

[0112] like Fig.10 Shown and referenced Figure 1 and Figure 3, a first tracking device 160i can be connected to a first vertebra 166i and a second tracking device 160ii can be connected to a second vertebra 166ii. During a selected procedure, the instrument 68 can be tracked relative to the subject 30. Fig.10 As shown, the instrument 68 can be moved relative to the subject 10, such as being positioned near the first vertebra 166i. When positioned near the first vertebra 166i, the nearest tracking device 160i can be used as a reference system for tracking the instrument 68 relative to the first vertebra 166i. The instrument 68 and / or a separate instrument such as the instrument 470 can be positioned near the second vertebra 166ii. The instrument 470 can be the same as or different from the first instrument 68. However, the second tracking device 160ii can be the tracking device closest to the instrument 470, and therefore can be used as a reference system to track the instrument 470 relative to the second vertebra 166i.

[0113] However, it should be understood that in various embodiments, only a single instrument 68 may be tracked and moved between the first vertebra 166i and the second vertebra 166ii for a selected portion of the procedure or for the procedure. Thus, selecting a tracking device to use as a reference system may be based on determining that the tracking device is closest to the instrument 68 during a portion of the procedure. Selecting the closest tracking device for reference may increase the accuracy of tracking the instrument relative to the selected member, such as the vertebra 166.

[0114] In various embodiments, a single patient tracker 58 may be used as a reference system. As described above, the individual tracking devices 160 are provided on separate parts so that once the individual tracking devices are registered in the navigation space, each of the individual tracking devices can be used as a reference device. Thus, the selection of the reference device can be switched between the patient tracker 58, the first tracking device 160i, the second tracking device 160ii, or other appropriate tracking devices.

[0115] In addition and / or alternatively to selecting the tracking device closest to the instrument being tracked, the assumed fixed tracking device may be selected based on the highest measurement quality. Fig.10In addition to tracking the instrument 68, the first tracking device 160i, the second tracking device 160ii, or the patient tracker 58 can be used as a reference tracking device for tracking the instrument 68. The selection of the tracking device for reference when tracking the instrument 68 can be based on the tracking quality of the selected tracking device connected to the object 30. The tracking quality can be based on errors in geometry, signal strength, etc. For example, as described above, the tracking device 160i can be provided as any suitable tracking device, such as tracking devices 330, 334, 338. Each of the tracking devices has a known geometry that can be used to identify the tracking device in the navigation space. The lowest error in geometry can be used to determine the tracking device that is best used as a reference for tracking the instrument 68 relative to the object 30. In addition, the determination of signal interference (e.g., vortex EM fields) can be used to determine the tracking device as the selected reference device.

[0116] In various embodiments, greater confidence or quality can be obtained based on tracking devices with minimal errors (including geometric errors). Errors can be measured as the average or root mean square of the difference between the measured tracking device position and the expected tracking device position. For example, in an EM tracking device, the coils are in known and fixed positions relative to each other. Therefore, each coil can be tracked and the entire information can be used to determine the position of the tracking device. However, each coil position can be tracked relative to each other, and therefore the known and tracked positions can be used to determine the quality of the tracking information. Noise or pseudo-spectral components can also be used to weight the measurements according to the signal quality or the presence of interference. The measured signal phase can also be used to assess the individual quality.

[0117] Thus, providing multiple tracking devices (such as the first tracking device 160i and the second tracking device 160ii) in the object 30 allows different tracking devices to be selected for tracking of the instrument 68 relative to it. The selection can be made substantially automatically and / or manually (e.g., by a user) during a selected procedure. For example, the navigation system 20 can receive tracking signals of each of the tracking devices during the selected procedure. When the instrument 68 is tracked relative to the object 30, the navigation system 20 can determine the lowest error relative to the multiple tracking devices connected to the object 30. The error can be determined by comparing the measured fiducial characteristics with the expected fiducial characteristics, which fiducial characteristics include physical size and geometry, color, texture, signal spectral composition and phase, etc. Therefore, the tracking system 20 can automatically select the tracking device with the lowest error to navigate or track the instrument 68 relative to the object 30. Similarly, the tracking system 20 can measure the distance between the instrument 68 and other tracking devices in the navigation space, and select the tracking device closest to the instrument 68 as the tracking device to track the instrument 68 with reference. Alternatively and / or in combination therewith, the user 72 may select and / or verify or confirm the selection of a tracking device for use in the navigation instrument 68 .

[0118] As mentioned above, continue to refer to Fig.10 And further reference Figure 7 , multiple tracking devices may be connected to each of the parts of object 30. For example, Fig.10 As shown, vertebra 166i can be connected to a first tracking device 160i and a tracking device 330. Similarly, a second vertebra 166ii can be connected to a tracking device 160ii and a tracking device 334. Each of the respective tracking devices can be connected at the same point, such as a tracking device or reference point 480 on the first vertebra 166i and a second tracking or reference point 484 on the second vertebra 166ii. Thus, the two tracking devices 330 and 160i are connected at a single tracking point 480. Similarly, the two tracking devices 334 and 160ii are connected at a second tracking point 484.

[0119] Two different tracking devices, such as the EM tracking devices 160i and 160ii, can track in different tracking modalities, and the second tracking portion can be the optical tracking device portion 330, 334. Thus, two different tracking systems, including the optical localizer 88 and the EM localizer 94, can be used to track the same point 480, 484. It should be understood that multiple types of tracking devices can be connected together and connected to the same tracking point, such as including radar tracking devices, acoustic tracking devices, etc. Instruments such as the instrument 68 may only include one or more tracking device modalities associated therewith. Regardless, due to the multiple types of tracking devices at a single tracking point or tracking points 480, 484, the navigation system 20 can be co-registered relative to a selected portion, such as an individual vertebra 166.

[0120] It should be understood that each of these vertebrae or each appropriate member or portion of the object can have a tracking device connected to it. Therefore, during surgery, selection of the best tracking device for reference can also be made based on the tracking system having the greatest confidence in the tracking data of the reference device. The maximum confidence can be based on a comparison of the confidence levels of the tracking positions of various different tracking devices. The confidence can be based on geometric errors of the tracking portions individually and / or relative to each other, predicted light (visible or invisible (e.g., infrared)) shaping or diffraction, signal strength or signal-to-noise ratio, or other considerations. As discussed herein, the confidence of each tracking device can be determined at a selected rate during surgery and used for various purposes.

[0121] During navigation of the instrument 68, the instrument 68 may be tracked with an optical system that tracks the optical tracking device 66o, while the vertebra 166i is tracked with an EM tracking device, such as the tracking device 160i. The two tracking systems may be co-registered or correlated due to pre-registration of the tracking device with respect to the vertebra 166i, either alone and / or with the patient tracker 58. The EM localizer 94 may be used to track the vertebra 166i with the EM tracking device 160i, and the optical tracking system with the localizer 88 may track the instrument 68 with the optical tracking device portion 66o. The position of the vertebra 166i and the position of the instrument 68 may be illustrated as a graphical representation, superimposed on the segmented image 108 or illustrated by changing the segmented image, as described above.

[0122] The multiple tracking portions of the tracking device allow the instrument 68 to be tracked relative to the vertebra 166i based on one or more tracking devices in the navigation system 20. It should be understood that multiple instruments may also be tracked, and the particular type of tracking system may be selected based on the selection of the user 78 or other appropriate selection, and the above is merely exemplary. However, the vertebra 166i may be tracked with a first tracking modality (e.g., EM tracking) and the instrument 68 may be tracked with a second tracking modality (e.g., optical tracking). As described above, the two tracking systems may be co-registered and allow the respective positions of the vertebra 166i and the instrument 68 to be displayed on the display device 84, as described above.

[0123] Correlation of the tracking systems can allow the tracking device portion 66o to be tracked by the optical tracking system relative to the vertebra 166i tracked by the tracking device 160i (which can be an electromagnetic tracking device tracked by the EM localizer 94). Although the two tracking systems may include different localizers operating in different modalities (e.g., optical and different from electromagnetic), the tracked position of the instrument 68 relative to the vertebra 166i can be known due to the correlation between the EM tracking system and the optical tracking system and the related coordinate systems. The relationship can be attributed to the tracking devices connected to a single point 480 on the vertebra 166i, including the tracking device 160i, which can be an EM tracking device, and the tracking device 330, which can be an optical system tracking device. In addition, the tracking device 58 discussed above can include both an EM tracking portion and an optical tracking portion, which allows for co-registration or correlation between the two tracking systems. The correlation can be performed at any appropriate time, such as initially or during surgery. The correlation can be performed in the case where the two tracking systems (or any appropriate number of tracking systems) can track or determine a single position to allow for correlation between the coordinate systems of all tracking systems.

[0124] As described above, the instrument 68 includes a tracking device 66, which may include one or more tracking portions, such as an optical tracking portion 66o and an EM tracking portion 66e. Thus, the instrument 68 may be tracked substantially simultaneously with two localizers 88, 94. As described above, the two localizers having two corresponding coordinate systems may be correlated.

[0125] Tracking instrument 68 in two coordinate systems can be used to help increase confidence in the tracked position of instrument 68. The tracked position of instrument 68 can be tracked with two tracking systems, and the tracked position can be confirmed and / or the confidence in the tracked position can be increased by tracking with the two tracking systems and / or selecting the tracking system with the smallest amount of error. In addition, instrument 68 can be tracked substantially continuously regardless of interference with either of the tracking systems. In addition, moving instrument 68 through space and keeping track of the instrument with two tracking systems can allow for determination of possible interference with either or both of the tracking systems in different spatial regions. It should be understood that any appropriate number of tracking systems can simultaneously track instrument 68, and that the two tracking systems are merely exemplary.

[0126] Additionally, the tracking information from the two or more tracking systems can be combined in various ways. In various embodiments, combining the tracking information can include a sensor fusion approach by applying the central limit theorem or Kalman filtering to the tracking data to determine the tracked position of the instrument 68. Regardless, the tracked position of the instrument 68, or any suitable portion of the two or more tracked portions that allow the two or more tracking systems to track, can be tracked substantially simultaneously with the two or more tracking systems in an attempt to increase the confidence and / or accuracy of the tracked position to which the tracking device is attached.

[0127] Additionally, by positioning the instrument 68 relative to a known point, such as the patient tracker 58, it can be positioned within a tracking coordinate system. The patient tracker 58 can include a reference point or portion 500 similar to the reference point 150 that can be contacted by the instrument 68. Once the instrument 68 contacts the point 500, the corresponding tracking system can register or coordinate the instrument 68 within the navigation space. For example, if the patient tracker 58 includes both an optical tracking system and an EM tracking system, once the instrument 68 contacts the instrument portion at point 500, a correlation between the tracking systems can be determined. Even if the position of the instrument 68 is tracked using an optical tracking system (with only the optical tracking portion 66o), this correlation allows the instrument 68 to be tracked in an optical tracking system with the optical localizer 88 and associated with the EM coordinate system.

[0128] Additionally, a tracking device on the instrument 68 may be registered or determined by positioning or contacting the instrument 68 with point 500. A patient reference 58 may be determined in navigation space, and once the instrument 68 contacts the reference point 500, the tracked position of a tracking portion, such as the optical tracking portion 66o, may be determined relative to the reference point 500. This may allow the position of the tracking portion 66o relative to a selected portion of the instrument 68, such as a distal point or endpoint thereof, to be determined. It should be understood that a tracking portion in any suitable component may be determined in a similar manner or by contacting any suitable reference point, such as an implant (e.g., a pedicle screw). Alternatively or in addition, the tracking device 66o or any suitable tracking device may be manufactured or mounted to the instrument 68 at a known or predetermined location. The navigation system 20 may then call upon the known and predetermined location to determine a point of the instrument or a portion or geometry of the instrument relative to the tracking portion 66o.

[0129] The position of various tracking devices, such as tracking device 160i, relative to components of object 30 may also be determined by imaging object 30 and identifying the tracked portion in the image. The tracked portion may be identified in the image automatically (e.g., by segmentation of known geometry), semi-automatically (e.g., a user selects selected pixels or voxels in a segmentation based thereon), or by manual selection by a user. Regardless, identification of the position of tracking portion 160i (or any appropriate tracking device) may be determined in the image. Thus, when updating image 108, the known position of the tracking device may be used to help determine an appropriate position in the image (e.g., a three-dimensional position and an appropriate number of degrees of freedom for orientation).

[0130] Turning to FIG. 11 , the object 30 may include multiple parts, such as multiple vertebrae 166 that may be of interest for a selected surgery. During the selected surgery, various tracking devices such as the patient tracker 58 may be connected relative to the object 30 along with other appropriate tracking devices such as the third tracking device portion 160iii and the first tracking device portion 160i. Fig.11A As shown, the first tracking device portion 160i is connected to the first vertebra 166i. The third tracking device 160iii is connected to the third vertebra 166iii. However, the second vertebra 166ii may not have a tracking device connected thereto. As described above, the identification of the selected portion of the object 30 to which the tracking device is connected can be performed in various ways, such as by automatic identification, manual identification, etc. However, the navigation system 20 can directly show the position of the first vertebra 166i and the position of the third vertebra 166iii, either alone or relative to other portions of the anatomical structure in the image 108. As described above, tracking the movement or position of the respective tracking devices 160i and 160ii can allow the current position or tracked position of the respective vertebrae to which they are attached to be directly determined.

[0131] However, the second vertebra 166ii may also be tracked indirectly or have its position estimated relative to either or both of the first vertebra 166i and the second vertebra 166iii. Fig. 11B As shown, the image 108 displays all vertebrae as images including segmented portions of the vertebrae and / or graphical representations thereof. Thus, the first vertebra is shown as a first vertebra image portion 166i', a second vertebra image portion 166ii', and a third vertebra image portion 166iii'. Since the tracking devices are associated with different vertebrae, the navigation system 20 can measure the distances between the selected portions, such as the center of mass 520 of the first vertebra image 166i', the second center of mass 524 of the second vertebra image 166ii', and the third center of mass 528 of the third vertebra image 166iii'. Each center of mass can be measured relative to each other to allow the closest paired positions between the tracked vertebrae 166i and 166iii and the second vertebra 166ii to be determined. It should be understood that other appropriate portions, such as pedicles, spinous processes, or other appropriate determined or identified portions in the image, can be measured between the image portions. In addition, as described above, the end plates of the vertebrae and / or geometric shapes associated therewith, such as lines or planes, can be determined and illustrated. These may also be used to display and / or determine the position and movement of the vertebrae in the image 108. The navigation system may include appropriate instructions to segment and / or identify selected portions of the vertebral anatomy in the image 108 and / or other appropriate portions for measuring comparative distances between image portions.

[0132] The navigation system 20 may also include information about which parts are directly tracked, such as automatically input or manually input as described above. Therefore, the part or tracked part that is closest to the untracked part can be determined. For example, the navigation system can measure the distance between the first center of mass 520 and the second center of mass 524 and determine that it is the shortest distance. Therefore, the position of the second vertebra 166ii relative to the first vertebra 166i can be inferred based on the directly tracked position of the first vertebra 166i.

[0133] The image 108 can thus be updated with the selected position of the second vertebra 166ii based on the direct tracking of the nearest vertebra. For example, the position of the second vertebra 166ii can be assumed to move from an initial or original segmented position within a selected threshold of the directly tracked position of the closest vertebra, such as with a translational movement (e.g., increment) of about 70% to about 90% of the directly tracked portion. In various embodiments, the selected portion can be assumed to move or have an incremental translation of exactly the same amount as the selected tracked portion. Thus, the second vertebra 166ii can be illustrated as moving by the same amount and manner as a selected vertebra, such as vertebra 166i.

[0134] Additionally, the determined position of the untracked vertebra 166ii may be based on an interpolation between two directly tracked vertebrae. For example, the position of the first vertebra 166i is known directly from the first tracking device 160i, and the precise position of the third vertebra 166iii is known directly from the tracked position of the third tracking device 160iii. The position of the untracked vertebra 166ii may be based on a selected function of the known positions of the two vertebrae on either side of the untracked vertebra 166ii.

[0135] The interpolation function may be any suitable function and may be determined by the user during a selected procedure and / or predetermined based on a biomechanical model of known or suspected movement of vertebrae between two adjacent vertebrae, particularly in a selected portion of the anatomy. For example, the interpolation may be a direct interpolation, such as in a line or plane between the first vertebra image 166i' and the third vertebra image 166iii'. Thus, if the first vertebra 166ii is tracked to a first angular orientation 540 and the third vertebra 166iii is tracked to a second angular position 544, the interpolated angular position of the second vertebra 166i may be determined to be approximately equal distances between the first angular position 540 and the second angular position 544, and may be approximately determined to be at an angular position 548. The angular position 548 may be a first distance 552 and a second distance 554 from the second angular position 544. Thus, the third angular position 548 may be substantially between the first angular position 544 and the second angular position or line 544. According to various embodiments, spherical linear interpolation may be a particular method that may be used to interpolate the rotational components of two different transformations.

[0136] Alternatively or in addition, a biomechanical model may be used to determine and / or update or refine the interpolated or estimated position, such as a model based on known muscle or soft tissue interactions, motion limits or determined ranges, or other appropriate known or determined biomechanical features. In various embodiments, the biomechanical features may include rigid body dynamics, collision response, Hooke's law, or more advanced interaction models based on empirically determined material properties (general or patient-specific), finite element modeling, and any combination of the above.

[0137] As mentioned above, reference Fig.11A and Fig. 11B, an element or portion that is not tracked in the navigation space can be interpolated or its position determined between two tracking portions and / or relative to a single tracking portion. Similarly, an instrument can have multiple parts that can be positioned or moved relative to each other. In addition, an implant can include more than one part, such as a pedicle screw and interconnecting rod, a multi-piece ventricular disc, a femoral implant and a tibial implant for a total knee replacement, or other implant systems. The position of the untracked portion can be determined based on tracking of the nearest portion, interpolation between two tracking portions, and determination based on a selected or known mobility of one component relative to another component. Therefore, when interpolated with a tracking system, the untracked portion of the instrument can also be tracked.

[0138] With reference to the above drawings, and for example with reference to Fig.11A and Fig. 11B , the tracked portion of the navigation domain may be used to update the display 84 of the image 108. It should be understood that any suitable portion may be viewed on the display, which may include a vertebral portion, such as a first vertebra 166i displayed as vertebra 166'. As the vertebra 166i moves in the navigation space, its position may be updated on the display 84 so that the image 108 will change to show the movement of the displayed portion 166i' of the vertebra. The movement may be determined based on tracking the first tracking device 160i relative to a selected reference, such as the third tracking device 160iii and / or the patient tracker 58.

[0139] The movement of vertebra 166i can be in any suitable translation or rotation position, for example comprises that angle moves to exemplary position, comprises 166i'a.When display 84 is updated and image 108 is changed, the previous position of implant part 166i' may not occur, thereby only shows the current tracking position of vertebra 166i.Should be appreciated that other positions are also updated on display 84, and the position such as tracking instrument 68 can be presented on the display as graphical representation 68'.

[0140] like Fig.11A As shown, such changes may occur when an implant or component is positioned in the object 30, such as an intervertebral body 600. The intervertebral body can be moved or positioned between the first vertebra 166i and the second vertebra 166ii. The intervertebral body 600 can be displayed on the display device 84 as a graphical representation 600' relative to the image 108. The graphical representation 600' of the intervertebral body 600 can be directly displayed based on the tracked position of the intervertebral body 600, such as using a tracking element 604 positioned in the intervertebral body similar to that discussed above. In addition, when adjacent or contacting vertebrae and / or other appropriate parts are also tracked to the position of the vertebrae, the position of the vertebrae can also be shown on the display device 84.

[0141] Continue to refer to Fig.11A and Fig. 11B And also refer to Fig. 12A and Fig. 12B , the display 84 may also be updated with the selected image. For example, the image 108 may be updated over time, such as to illustrate or display a first image 108i and a second image 108ii. The second image 108ii may include changes in the displayed position of the vertebrae 166i' and 166ii' to show the movement of the vertebrae relative to each other, the implant positioned relative to the vertebrae, and other appropriate information.

[0142] For example, Fig. 12A As shown, lines 610 and 612 may represent respective endplates 616 and 618 of respective vertebrae 166i' and 166ii'. As described above, endplates and / or planes or lines may be determined as a result of segmentation, and lines 610, 612 may also be determined and then displayed in image 108i. A first angle 622 may be displayed as determined between lines 610, 612. Following manipulation of object 30, such as movement of vertebrae 166i and 166ii, the image may be updated to Fig. 12B 108ii shown in FIG. 108ii. The movement of vertebra 166 may be due to an implant (such as Fig.11A The intervertebral implant 600 shown may be positioned, manually manipulated, implanted, or otherwise appropriately positioned. However, the image 108i may include lines 610 and 612 relative to the respective vertebrae 166i' and 166ii'.

[0143] A second angle 630 may be displayed between the two lines 610, 612. The second angle 613 may be analyzed to determine a selected angle or compared to a planned angle, a priori angle, or other appropriate determination. For example, the user 72 may determine a desired or selected angle between two vertebrae 166i and 166ii, and the user may view the display 84 to determine whether the second angle 630 is the selected angle. If not, further manipulation of the vertebrae may be performed to attempt to reach the selected angle.

[0144] However, due to the tracking of the individual vertebrae, the display 84 may display an image 108ii updated in substantially real time to view the positions of the vertebrae 166i, 166ii as representations 166i' and 166ii'. As described above, the representations of the vertebrae on the display may include segmented images updated with the tracking devices associated therewith.

[0145] In addition, if Fig.11AAs shown in , the intervertebral body 600 can be positioned relative to a selected portion of the anatomy, such as the second vertebra 166i. The intervertebral implant 600 may include a tracking device 604. Thus, once implanted, the implant 600 may be determined to be positioned adjacent to the endplate vertebra 166ii. Thus, a display such as displays 11B and / or 12B may be updated to illustrate the vertebral image 166ii as being in contact with the intervertebral body 600. Fig. 11B As shown, the graphical representation of implant 600' can be displayed in contact with vertebrae representation 166ii', and image 108 can be updated to show the same situation, even if the second vertebra 166ii is not directly tracked. Due to the positioning of implant 600 in contact with vertebrae 166ii, image 108 can be updated to show the position of the vertebra relative to the implant, such as by showing that vertebrae display 166ii' in the image is in contact with the graphical representation of implant 600. Similarly, Fig. 12B The second image 108ii in the can be updated due to the implant being positioned between the vertebra 166i and the second vertebra 166ii. Therefore, the updated image can show a selected portion (e.g., a graphical representation of an instrument and / or image portion) in a different or changed position relative to the first image.

[0146] In various embodiments, implant 600 can be an adjustable or expandable implant. It should be understood that any suitable implant can be an adjustable implant and intervertebral body 600 is merely exemplary. However, intervertebral body 600 can be positioned between two vertebrae that can be directly tracked, such as first vertebra 166i and second vertebra 166ii. Although in Fig.11A It is not specified in the , but as mentioned above, all vertebrae of interest can be used Figure 2 The tracking device shown tracks directly. Thus, the intervertebral body 600 can be adjusted, such as to a maximum distance or size.

[0147] Tracking the position of the first vertebra 166i to the second vertebra 166ii can be used to determine the efficacy of the implant 600 by measuring the amount of movement between the two vertebrae. Fig. 12AAs shown, the intervertebral body can be positioned between two vertebrae 166i and 166ii. The angle or distance between the two lines 610,612 representing the corresponding implant 616,618 can be measured. The intervertebral body can be adjusted then, and the distance between the two lines 610,612 can be measured then and the image can be updated in the image 108ii. The user 72 can assess and / or the navigation system 20 can assess the position between the two vertebrae 166i and 166ii in the image 108ii and / or the difference of the final position to determine the efficacy of the implant. For example, if the movement is not parallel, does not reach a selected angle or does not reach other appropriate changes due to the change of the implant 600, the user can assess the efficacy of the implant and / or select a new implant during the trial.

[0148] Thus, tracking multiple elements in the navigation domain (such as multiple elements in object 30) can be used to perform surgery or any appropriate surgery relative to object 30. The tracking of the multiple elements can be used to update the display 108 to confirm the efficacy of the selected portion of the surgery, locate the implant, or other appropriate information. Thus, tracking the multiple portions in the navigation space can be used to confirm the surgery and / or help plan additional portions of the surgery, including the tracking stage when selecting an appropriate or selected implant.

[0149] In addition, by tracking all or multiple components in the navigation space. The image 108 can be updated with the substantially real-time position of all elements (e.g., vertebrae) in the region of interest for surgery. Therefore, a more accurate position of unconnected components such as instruments 68 can be navigated relative to components in the region of interest such as vertebrae. The display 84 showing the image 108 may include substantially real-time and accurate positioning of the elements therein (e.g., segmentation components, instruments, etc.) for performing the selected surgery. In addition, the image 108 can be a direct image or an image generated (such as based on x-ray image data). Portions of the image can be segmented therefrom, such as individual vertebrae. The image 108 can be updated by moving the segmented portion. The image 108 can also be updated by displaying and / or moving graphical representations of the imaging portion or other components (e.g., instruments).

[0150] The foregoing description of the embodiments is provided for the purpose of illustration and description. The above description is not intended to be exhaustive or to limit the present invention. The individual elements or features of a particular embodiment are generally not limited to the particular embodiment, but are interchangeable in applicable cases and can be used in selected embodiments, even if not specifically shown or described. The individual elements or features of a particular embodiment can also be changed in many ways. Such variations will not be considered as departing from the present invention, and all such modifications are intended to be included within the scope of the present invention.

[0151] It should be understood that the various aspects disclosed herein may be combined in combinations different from those specifically presented in the specification and drawings. It should also be understood that, depending on the instance, certain actions or events in any of the processes or methods described herein may be performed in a different order, may be added, combined, or omitted entirely (e.g., all described actions or events may not be necessary to perform these techniques). In addition, although certain aspects of the present disclosure are described as being performed by a single module or unit for purposes of clarity, it should be understood that the techniques of the present disclosure may be performed by a combination of units or modules associated with, for example, a medical device.

[0152] In one or more embodiments, the described techniques may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored in the form of one or more instructions or codes on a computer-readable medium and may be executed by a hardware-based processing unit. A computer-readable medium may include a non-transitory computer-readable medium, which corresponds to a tangible medium, such as a data storage medium (e.g., RAM, ROM, EEPROM, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and can be accessed by a computer).

[0153] The instructions (also referred to as computer programs) that may be generated or derived from the above algorithms may be executed by one or more processors, such as one or more digital signal processors (DSPs), general purpose microprocessors, application specific integrated circuits (ASICs), field programmable logic arrays (FPGAs), or other equivalent integrated or discrete logic circuits. Thus, the term "processor" as used herein may refer to any of the foregoing structures or any other physical structure suitable for implementing the described techniques. Moreover, the techniques may be fully implemented in one or more circuits or logic elements.

Claims

1. A system for navigating surgery relative to an object, comprising: a display device for displaying a first image having a first segmented portion corresponding to the first portion of the object, a second segmented portion corresponding to the second portion of the object, and a third segmented portion corresponding to the third portion of the object; a first tracking system, the first tracking system defining a first tracking space using a first coordinate system; a first tracking device trackable in the first coordinate system, wherein the first tracking device is associated with the first segmented portion in the first image data and connected to the first portion of the object; a second tracking device trackable in the first coordinate system, wherein the second tracking device is associated with the second segmented portion in the first image data and is connected to the second portion of the object; as well as A navigation processor system operable to: registering a first image data coordinate system of the first image data to the first coordinate system; associating the first tracking device with the first segmented portion of the first image data; associating the second tracking device with the second segmented portion of the first image data; determining a position of the third segment relative to the first segment and the second segment; updating the first image based on tracking the first tracking device and tracking the second tracking device and the determined position of the third segmented portion, including changing the position of the first segmented portion, the second segmented portion, or the third segmented portion, and An updated first image is generated for display with the display device.

2. The system of claim 1, wherein the navigation processor system associates the first tracking device with the first segmented portion in the first image data and associates the second tracking device with the second segmented portion in the first image data based at least on user input.

3. The system according to any one of claims 1 or 2, further comprising: an instrument, the instrument being tracked by the first tracking system; Wherein the navigation processor system is further operable to: determining a greater tracking confidence between the first tracking device and the second tracking device; as well as The determined greater tracking confidence between the first tracking device and the second tracking device is selected as a reference for tracking the instrument.

4. The system according to any one of claims 1 or 2, further comprising: an instrument configured to perform a portion of a procedure; The first tracking device is detachable from the apparatus; wherein after performing said portion of said procedure, said first tracking device remains secured to a first portion of said subject; Wherein the first part of the object is represented in the first image as the first segmented part in the first image data.

5. A navigation method, comprising: accessing first image data of at least a region of interest, wherein the first image data comprises at least a first segmented portion corresponding to a first portion of an object, a second segmented portion corresponding to a second portion of the object, and a third segmented portion corresponding to a third portion of the object; tracking a first tracking device, wherein the first tracking device is coupled to the first portion of the object; tracking a second tracking device, wherein the second tracking device is coupled to the second portion of the object; associating the first tracking device with the first segmented portion of the first image data; associating the second tracking device with the second segmented portion of the first image data; determining a position of the third segment relative to the first segment and the second segment; displaying the first image using a display device; as well as Updating the first image based on tracking the first tracking device connected to the first portion and tracking the second tracking device connected to the second portion and the determined position of the third segmented portion includes changing the position of the first segmented portion, the second segmented portion, or the third segmented portion.

6. The method according to claim 5, further comprising: The image data is segmented to determine a boundary of at least the first segmented portion and the second segmented portion.

7. The method of any one of claims 5 or 6, wherein associating the first tracking device with the first segmented portion in the first image data and associating the second tracking device with the second segmented portion in the first image data comprises: inputting into a navigation system an identification of the first tracking device having the first segmented portion; as well as An identification of the second tracking device having the second segmented portion is input into the navigation system.

8. The method of any one of claims 5 or 6, wherein associating the first tracking device with the first segmented portion in the first image data and associating the second tracking device with the second segmented portion in the first image data comprises: determining a position of the first tracking device relative to a known reference device and the first segmented portion by executing instructions using a navigation system; as well as A position of the second tracking device relative to a known reference device and the second segment is determined by executing instructions using the navigation system.

9. The method according to claim 5, further comprising: determining a greater tracking confidence between the first tracking device and the second tracking device; Tracking devices; as well as The determined greater tracking confidence between the first tracking device and the second tracking device is selected as a reference for tracking the instrument.

10. The method according to any one of claims 5 or 6, further comprising: Determine the real-time location of the third part; The first image is updated to include the real-time position of the third portion.

11. The method of claim 10, wherein determining the real-time location of the third portion comprises: Based on the tracking by the first tracking device and the second tracking device, interpolating between the first portion and the second portion.

12. The method of claim 11, wherein determining the real-time location of the third portion comprises: accessing a biomechanical model of the third portion relative to at least one of the first portion or the second portion; The real-time position of the third portion in the image is updated based on the tracking by the first tracking device and the second tracking device.

13. The method according to any one of claims 5 or 6, further comprising: Either the first tracking device or the second tracking device is selected as a reference to maintain registration of the first image to space based on tracking of the first tracking device and the second tracking device.

14. The method according to claim 13, further comprising: tracking a reference point by at least (i) tracking a first tracking device in a first coordinate system and (ii) tracking a second tracking device in a second coordinate system; Wherein both the first tracking device and the second tracking device are fixed relative to the reference point.

15. A non-transitory computer-readable medium comprising one or more instructions stored thereon, which when executed by a processor cause the processor to perform the method of any one of claims 5-8.

16. The non-transitory computer readable medium of claim 15, further comprising one or more instructions that, when executed by the processor, cause the processor to: forming an orifice in the first portion using an instrument; and The first tracking device is disengaged from the instrument within the aperture to connect the first tracking device to the first portion.

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