Method for position determination, method for controlling an x-ray device and medical system

Abstract

In order to particularly quickly and precisely image a VOI during monitoring of a robotically assisted movement of a medical object through the body by means of a robot system, a method for controlling an X-ray apparatus having an imaging system is specified, which has the following steps: receiving a user input for imaging a region of interest, providing a previously imaged three-dimensional volume image of at least one body part, determining a length of a path moved through by the object from measurement and / or control data of the robot system, determining and / or calculating a current position of the object on the basis of the three-dimensional volume image by using the determined length of the path moved through and the original position of the object, automatically moving the imaging system of the imaging apparatus in order to center and / or visualize the region of interest comprising the current position of the object, and imaging the region of interest, in particular in the form of a VOI volume image.

Description

Technical Field

[0001] The present invention relates to a method for determining the current position of an object introduced into a body, a method for controlling an X-ray device by using the method for determining the current position of the object, a method for controlling an X-ray device, and an apparatus. Background Technology

[0002] Interventional medical procedures in the vascular systems of hollow organs, such as the human body or a phantom, require the introduction of a medical object, such as a device or instrument, through a percutaneous vascular inlet and its guidance toward the target area to be treated. Traditionally, the operator, under imaging conditions such as X-ray fluoroscopy, introduces the object, such as a guiding catheter, microcatheter, or guidewire, into the vascular system via an inlet sheath and then guides the object to the target area by injecting a contrast agent to make the blood vessels visible. In many cases, the operator, assisted by an assistant, stands directly at the patient table to perform the procedure.

[0003] An extended design of this medical procedure connects a robotic system between the operator's hand and the patient. The advantage is that the operator no longer needs to stand directly on the patient support table, but can remotely adjust the object (rotate, move forward and backward). Such robotic systems are known in principle to enable (semi-)automatic movement of objects, such as catheters and / or guidewires, within the patient's hollow organs using robotic assistance, as known, for example, by EP 3406291B1. A corresponding user interface is provided for the operator for this remote-controlled movement. Furthermore, it is advantageous to capture, transmit, and display fluoroscopic images from an imaging device to the operator for necessary visual feedback. The advantages of this robotic guidance of the medical object lie primarily in the operator's comfortable working position, the possibility of being completely away from the radiation area at the patient table, and the resulting enhanced safety through radiation avoidance.

[0004] Especially in demanding vascular situations, such as chronic or acute complete obstruction, it is reasonable to image and display the medical subject moving within the blood vessel and its surrounding environment in 3D for optimal therapeutic effect. However, for such volumetric imaging (e.g., DynaCT imaging), a very high X-ray dose is used within the fully open (collimator) X-ray window. High-resolution so-called VOI (Volume of Interest) displays, known in the prior art, are based on the significant limitation of the X-ray window during 3D operation, i.e., the visualization of the object and its immediate surroundings. Therefore, the imaging device and / or stage must be positioned such that the object is as centrally located as possible within the isocenter of the imaging system (e.g., a C-arm). Manually performing this positioning of the imaging device is extremely time-consuming. Summary of the Invention

[0005] The technical problem to be solved by this invention is to provide a method for controlling a medical system with an imaging device and a robotic system for moving a medical object, said method achieving isocentering to the VOI as quickly and accurately as possible; furthermore, the technical problem to be solved by this invention is to provide a medical system suitable for implementing said method. Additionally, the technical problem to be solved by this invention is to provide a method as simple as possible for determining the current position of an object introduced into the body.

[0006] The technical problem is solved according to the present invention by a method for determining the current position of an object introduced into the body, a method for controlling an X-ray device by using the method for determining the current position of the object, a method for controlling an X-ray device, and an apparatus for implementing the above methods.

[0007] The method for determining the current position of an object introduced into a body according to the present invention can determine the position of the object very accurately and quickly without the need for additional X-ray radiation, wherein the object can move within the body with the aid of a robotic system. To this end, the following steps are performed: providing a previously captured three-dimensional volumetric image of at least one body part; determining the distance traveled by the object using measurement and / or control data from the robotic system; and determining and / or calculating the current position of the object based on the three-dimensional volumetric image using the determined distance traveled and the object's original position. No other position determination system, such as a navigation system, is required in this method. The method provides a very simple possibility for position determination because only the distance traveled by the object along its longitudinal direction and the starting point are used to determine the current position.

[0008] The body can be a human or animal body, a body phantom, or a test sample. The object can be, for example, imported into the hollow organs of a human / animal body or a phantom, or into a channel system for detecting samples.

[0009] In principle, robotic systems are known, for example, by EP 3406291 B1, which enable robotic-assisted actions to (semi-)automatically move objects, such as catheters and / or guidewires, within a patient's hollow organs.

[0010] According to one embodiment of the invention, the robot system has a drive system with a driver that causes the object to be fed, or in other words, generates the feed of the object, and uses measurement and / or control data from the drive system to determine the distance traveled by the object. The drive system, such as a stepper motor, can, for example, indicate, based on its control data or by means of measurement, that the feed, and therefore the distance traveled by the object, includes millimeters or centimeters.

[0011] According to one embodiment of the invention, path planning data previously generated, particularly based on the three-dimensional volumetric image, can be used to determine the position of an object. Specifically, the determined distance traveled is associated with the previously planned path for the object's movement to determine the current position. Therefore, for example, assuming the object follows the planned path, the accurate current position can be displayed in the path planning data. Because the path planning data is typically registered in the patient's coordinate system, the object's current absolute position can also be easily determined.

[0012] Furthermore, the present invention includes a method for controlling an X-ray device with an imaging system, the method using a method according to the invention for determining the current position of an object introduced into the body, wherein the object is robotically movable within the body by means of a robotic system, the method comprising the additional steps of: automatically moving the imaging system of the X-ray device to isocenter and / or image the imaging area including the current position of the object, and particularly image the imaging area in the form of a collimated volumetric image, such as a VOI. Relatedly, based on the determination of the current position of the object, the imaging system of the X-ray device is controlled and moved such that the current position of the object is at the isocenter of the imaging system and additional image is implemented when necessary. The resulting VOI is then automatically imaged using 3D imaging, such as DynaCT. The method according to the invention can be implemented automatically, particularly quickly, simply, and with a low X-ray dose. High-quality imaging of the desired imaging area can thus be achieved without, for example, subjecting the body to unnecessary additional radiation load. High-quality imaging enables particularly good diagnosis and improved therapeutic effects.

[0013] In a manner advantageous for the particularly smooth operation of the method, the X-ray device is pre-registered with at least one previously acquired three-dimensional volumetric image and / or path planning data.

[0014] According to another design of the invention, user input can be received, which triggers the method for control. The user input can serve as a trigger for the method; for example, a doctor can activate the method when needed.

[0015] According to another embodiment of the invention, the X-ray device has a patient table, and the patient table is additionally moved in order to make the imaging area isocentric and / or visible.

[0016] Furthermore, the present invention includes a method for controlling an X-ray device with an imaging system during monitoring of robot-assisted movement of a medical object through a body via a robotic system. The method comprises the following steps: receiving user input for imaging an area; providing a previously captured three-dimensional volumetric image of at least one body part; determining the distance traveled by the object using measurement and / or control data from the robotic system; determining and / or calculating the object's current position based on the three-dimensional volumetric image using the determined distance traveled and the object's original position; automatically moving the imaging system of the X-ray device to center and / or visualize the imaging area including the object's current position; and, in particular, imaging the imaging area in the form of a collimated volumetric image, such as a VOI. This method enables the rapid and highly accurate determination of the object's position without the need for additional X-ray radiation.

[0017] The method provides a very simple possibility for location determination, as only the distance traveled by the object along its longitudinal direction and the starting point are used to determine the current position. Based on the location determination, the X-ray imaging system is then controlled and moved such that the object's current position is at the isocenter of the imaging system, and additional imaging is performed if necessary. The resulting VOI is then automatically captured using 3D imaging, such as DynaCT. The method according to the invention can be performed automatically, particularly quickly, simply, and with a low X-ray dose. This allows for high-quality imaging of the desired area without unnecessarily subjecting the body to additional radiation load. High-quality imaging enables particularly good diagnosis and improved treatment outcomes.

[0018] Furthermore, the present invention includes a medical system comprising a robotic system having at least one robot control unit and a robot-assisted drive system having a driver and a drive mechanism, wherein the drive system is designed to move a medical object within a body based on path planning data using control signals from the robot control unit; the medical system has a computing unit designed to determine the distance traveled by the object using measurement and / or control data from the drive system and to determine and / or calculate the current position of the object based on a three-dimensional volumetric image using the determined distance traveled and the object's original position; and the medical system includes an X-ray device having a system control unit and a movable imaging system for capturing images of an imageable area, wherein the system control unit is designed to control the imaging system to move and capture images such that the imaging system moves automatically to center and / or visualize the image area including the object's current position, and particularly to capture images of the image area in the form of enlarged volumetric images; the medical system also includes an input unit for receiving user input. The imaging system is particularly formed by a C-arm. The medical system may also have a movable patient station. Attached Figure Description

[0019] The invention and other advantageous designs are described in detail below with reference to the schematic embodiments illustrated in the accompanying drawings. The invention is not limited to these embodiments. In the drawings:

[0020] Figure 1 This illustrates the flow of a method for determining the current position of an object imported into the body;

[0021] Figure 2 A flowchart is shown for a method of controlling an X-ray device during monitoring of a robot-assisted movement of a medical object through a patient's hollow organ;

[0022] Figure 3 A view showing the current position of an object calculated based on a volumetric image;

[0023] Figure 4 A view of the medical system according to the invention is shown; and

[0024] Figure 5 A view showing a VOI volume image captured using the method according to the present invention. Detailed Implementation

[0025] exist Figure 1The diagram illustrates steps for determining the current position of an object introduced into the body, the object being robotically assisted in movement through a hollow organ by a robotic system. In principle, robotic systems are known, for example, by EP 3406291B1, by means of which robotic assistance enables (semi-)automatic movement of objects, such as catheters, stents, and / or guidewires, within, for example, a patient's hollow organ. After the object has moved for a period of time, an operator (e.g., a physician) now needs to verify the position or determine the current location.

[0026] The body can be a human or animal body, a phantom, or a test sample. The object can be, for example, inserted into a hollow organ (i.e., a vascular system, vascular tree structure, bronchial system, etc.) of a human / animal body or phantom, or into the channel system of a test sample.

[0027] In the first step 30, a previously acquired three-dimensional volumetric image (“Pre-OP”) of at least one body part, such as a hollow organ or channel system, is provided. This volumetric image is typically generated to obtain an overview of the entire treatment area and to enable path planning, for example, for movement of the object. The previously acquired volumetric image has been previously registered or aligned to a coordinate system, for example, for the patient or phantom. This volumetric image may be generated, for example, by a CT (computed tomography) scanner, an MR (magnetic resonance) scanner, or angiographic X-ray equipment.

[0028] In the second step 31, the distance traveled by the object with robot-assisted feeding is determined using measurement and / or control data from the robot system. This can be achieved, for example, by querying and using data from the stepper motor that generates the feed. The data can be processed or converted accordingly to obtain the distance traveled. However, the distance traveled typically only determines the distance, not the exact path or precise location.

[0029] Therefore, in the third step 32, the current position of the object is now determined or calculated based on the three-dimensional volume image using the determined distance traveled by the object and its original position. For illustration, in Figure 3 The previously generated volumetric image V is shown in the figure. pre The hollow organ H is imaged on the volumetric image. In the previously generated volumetric image V pre The diagram shows a previously planned path G for the journey of object O. Starting from the original position A of object O, the distance L traversed is now laid out on the planned path G, thereby obtaining the current position P of object O with very high accuracy. This can also be achieved without a planned path, based solely on a previously generated volumetric image V. preImplementation. In order to determine the actual selected path for branching processes in hollow organs or channel systems, and for rough orientation, information from fluoroscopic imaging (or fluorescein imaging) or data from other navigation systems may be additionally used.

[0030] exist Figure 2 The diagram illustrates a flow chart of a method for controlling an X-ray device, the X-ray device being used in accordance with the method and proportions of the present invention. Figure 1 Location determination methods. For example, using methods such as... Figure 5 The medical system 1 shown is a robotic system and an X-ray device 10. The robotic system is designed to move a medical object 0, such as an instrument, stent, guidewire, or catheter, semi-automatically or automatically, for example, within a hollow organ of a patient 15 or a phantom, or within a sample access system. Here, semi-automatic control is understood, for example, as control that can be transmitted from an operator to a robotic control unit 8 via an input unit 17 (e.g., joystick, touchpad, rotary adjuster, etc.). The robotic system has at least one robotic control unit 8 and a robot-assisted drive system 7. The drive system 7 is designed to move the medical object, for example, within a hollow organ of a patient 15 or a phantom, based on control signals from the robotic control unit 8 after it has been introduced at an entry point. The drive system 7 includes at least one actuator and a drive mechanism (not shown, but known, for example, from EP 3406291 B1), which is detachably coupled, for example, to the guidewire 5. The guidewire 5 can be longitudinally pushed forward and pulled back and / or additionally rotated by means of the drive mechanism and actuator. The longitudinal feed distance can be determined by measurement or control data from the drive system (e.g., a stepper motor). The robot control unit 8 is connected to an input unit 17 (e.g., remotely positioned from the patient), which can be operated by an operator, such as an interventional cardiologist or radiologist. Control signals are transmitted from the input unit 17 (e.g., one or more joysticks, touchpads, control buttons, etc.) to the robot control unit 8, thereby semi-automatically controlling the movement of the object. Alternatively, the operator can also perform path planning for the object or allow path planning to be generated automatically. This path plan is transmitted to the robot control unit 8, thereby enabling fully automatic movement. The path plan can also be used as a reference during semi-automatic movement.

[0031] To obtain an overview of the intervention and movement, an X-ray device 10 is provided. The X-ray device 10, for example, has a C-arm 13 that holds the X-ray source 12 and the X-ray detector 11 and is connected to a system control unit 16. The C-arm 13 can be movably positioned relative to the patient or phantom body or the sample being examined; in the case of a mobile X-ray device, the entire X-ray device can also be moved. Alternatively or supplementarily, a patient table 19 can also be moved relative to the X-ray device or the imaging system. An image of the imageable area can be generated using the X-ray device 10 and displayed on a display unit 18. The robot control unit 8 of the imaging device and the system control unit 16 can exchange data bidirectionally and communicate with each other. A common control unit, comprising the robot control unit 8 and the system control unit 16, can also be provided. Furthermore, the medical system 1 includes a computing unit 20 designed to determine the distance traveled by the object using measurement and / or control data from the drive system and to determine and / or calculate the object's current position based on a previously generated volumetric image using the determined distance traveled and the object's original position. Registration can already be performed between the robotic system and the X-ray equipment, for example, using previously generated 3D image data.

[0032] If the operator requires an accurate 3D view of the object and its surroundings, such as near a vascular branch of a hollow organ or channel system, in the form of a VOI photograph, the operator makes user input. This user input can be received, for example, by system control device 16 (step 33) and the receipt triggers the method (see [link to documentation]). Figure 2 Next, in the first step 30, a previously captured three-dimensional volumetric image (“Pre-OP”) of at least one body part, such as a hollow organ or channel system, is provided. preThe previously captured volumetric image has been previously registered or aligned with the coordinate system of the X-ray device (or has been generated directly by the X-ray device). In the second step 31, the distance traveled by the object with robot-assisted feeding is determined by measurement and / or control data from the robot system. For this purpose, data from the stepper motor that generates the feed can be queried and used, for example. This data can be processed or converted accordingly to obtain the distance traveled. However, the distance traveled can usually only determine the distance, but not the exact path. Therefore, in the third step 32, the current position of the object is now determined or calculated based on the three-dimensional volumetric image using the determined distance traveled by the object and its original position. If the current position of the object is determined, it is transmitted to the system control device 16 of the X-ray device 10 for control, and in the fifth step 34, the imaging system (and / or patient table 19) of the X-ray device is moved automatically such that the current position of the object is isocenter. The object, in particular, becomes the center of the imaging area. Furthermore, additional display is implemented (e.g., using a collimator), so that only the object and its immediate surroundings, i.e., the VOI, are displayed. The precise size of the VOI can be preset or automatically selected. The VOI can, for example, be one-quarter or less of the volume of the full image. Next, in step 35, a volumetric image V of the displayed image area, showing the object O and its immediate surroundings, is captured. VOI See Figure 5 Based on such VOI volumetric images, critical situations can be better identified, for example, when the object is moving (e.g., at vascular branches or vascular closures), thus enabling improved diagnosis and treatment. The method allows for rapid and costless image acquisition through automation.

[0033] The method can be made more robust by using sensor devices, such as navigation systems, targeting the tip or center of the object (for vascular stents), for example, EM-Tracking.

[0034] The advantage of this method is that it automates the costly positioning of the imaging system (and potentially the patient table). In this way, a VOI volumetric image can be generated, which is a volumetric image of the desired imaging area, namely the object and its immediate surroundings, significantly limited in terms of the X-ray window. With this limited image area, the X-ray dose is significantly reduced compared to a full-format 3D photograph, thus minimizing the risk to the body.

[0035] The present invention can be briefly summarized as follows: To enable particularly rapid and accurate imaging of VOI (void of movement) during monitoring of robotically assisted movement of a medical object through a body (e.g., a hollow organ of a patient or phantom, or a channel system for detecting samples) implemented by a robotic system, a method is provided for controlling an X-ray device with an imaging system, the method comprising the steps of: receiving user input for imaging an area; providing a previously captured three-dimensional volumetric image of at least one body part; determining the length of the path traveled by the object by measurement and / or control data from the robotic system; determining and / or calculating the current position of the object based on the three-dimensional volumetric image using the determined length of the path traveled and the object's original position; automatically moving the imaging system of the imaging device to center and / or visualize the imaging area including the object's current position, and, in particular, imaging the imaging area in the form of a VOI volumetric image.

Claims

1. A method for determining the current position (P) of an object (O) in an imported body, wherein, The object (O) is capable of moving within the body with the aid of a robotic system, and the method comprises the following steps: • Acquire previously captured three-dimensional volumetric images (V) of at least one body part. pre (), including at least the original location of the object, • Acquire three-dimensional volumetric images (V) based on previously captured images. pre Previously generated route plan data, • The distance (L) traveled by the object (O) in the previously captured 3D volumetric image is determined by measurement and / or control data from the robot system, and • By using the determined distance traveled (L) by the object (O), path planning data, and original position (A), the current position (P) of the object (O) is determined and / or calculated, and • The imaging system of the automatically moving X-ray device (10) is such that the imaging area, including the current position (P) of the object (O), is centered and / or displayed, and • Capture images of the area being photographed.

2. The method according to claim 1, wherein, The robot system has a drive system (7) with a driver that causes the object (O) to feed, and wherein the measurement and / or control data of the drive system (7) are used to determine the distance (L) traveled by the object (O).

3. The method according to claim 1, wherein, The X-ray device (10) uses at least one previously captured three-dimensional volumetric image (V) pre ) and / or route planning data pre-registration.

4. The method according to claim 1, wherein, The method receives user input, which triggers the control function.

5. The method according to claim 1, wherein, The X-ray device (10) has a patient table (19), and wherein the patient table (19) is additionally moved in order to center and / or visualize the imaging area.

6. A medical system (1) for implementing the method according to any one of claims 1 to 5, the medical system comprising a robotic system having at least one robot control unit (8) and a robot-assisted drive system (7), the drive system having an actuator and a drive mechanism, wherein, The drive system (7) is designed to move a medical object within a body based on path planning data using control signals from a robot control unit (8). The medical system has a computing unit (20) designed to determine the distance traveled by the object using measurement and / or control data from the drive system and to determine and / or calculate the current position of the object based on a three-dimensional volume image using the determined distance traveled and the object's original position. The medical system also has an imaging device with a system control unit (16) and a movable imaging system (11; 12; 13) for capturing images of an imageable area. The system control unit (16) is designed to control the imaging system (11; 12; 13) to move and capture images, such that the imaging system moves automatically to center and / or display the image area including the object's current position and to capture images of the image area. The medical system also has an input unit for receiving user input.

7. The medical system according to claim 6, wherein, The imaging system is formed by a C-arm.

8. The medical system according to claim 6, wherein the medical system has a movable patient table.

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