Systems and methods for registration compensation in image-guided surgery

Abstract

A system and method for registration compensation in image-guided surgery. A method performed by a computing system includes receiving shape information for an elongated flexible portion of a medical instrument. The medical instrument includes a reference portion movably coupled to a fixture having a known pose in a surgical reference coordinate system. The fixture includes a constraint structure having a known constraint structure location in the surgical reference coordinate system. The elongated flexible portion is coupled to the reference portion and is sized to pass through the constraint structure. The method further includes receiving reference portion position information in the surgical reference coordinate system; determining an estimated constraint structure location in the surgical reference coordinate system from the reference portion position information and the shape information; determining a correction factor by comparing the estimated constraint structure location to the known constraint structure location; and modifying the shape information based on the correction factor.

Description

[0001] This application is a divisional application of Chinese Patent Application 2019112568850, filed April 4, 2016, entitled "Systems and Methods of Registration Compensation in Image Guided Surgery," which is a divisional application of Chinese Patent Application 2016800327330, filed April 4, 2016, entitled "Systems and Methods of Registration Compensation in Image Guided Surgery."

[0002] Related Applications

[0003] This patent application claims priority to and the benefit of the filing date of U.S. Provisional Patent Application 62 / 143,405, entitled "SYSTEMS AND METHODS OF REGISTRATION COMPENSATION IN IMAGE GUIDED SURGERY," filed April 6, 2015, which is incorporated by reference in its entirety. TECHNICAL FIELD

[0004] The present disclosure relates to systems and methods for performing image guided procedures, and more particularly, to systems and methods for compensating for registration errors during image guided procedures. BACKGROUND

[0005] Minimally invasive medical techniques are intended to reduce the amount of tissue that is damaged during a medical procedure, thereby reducing patient recovery time, discomfort, and harmful side effects. Such minimally invasive techniques can be performed through natural orifices in a patient's anatomy, or through one or more surgical incisions. Through these natural orifices or incisions, a clinician can insert a minimally invasive medical instrument, including a surgical instrument, a diagnostic instrument, a therapeutic instrument, or a biopsy instrument, to reach a target tissue location. To assist in reaching the target tissue location, the position and movement of the medical instrument can be registered with pre-operative or intra-operative images of the patient's anatomy. With an image guided instrument registered to the images, the instrument can navigate natural or surgically created passageways in the anatomical system, such as the lungs, colon, intestines, kidneys, heart, circulatory system, etc. Some image guided instruments can include a fiber optic shape sensor that provides information about the shape of the elongated flexible instrument and about the pose of the distal end of the instrument. Systems and techniques are needed for minimizing errors associated with registering the proximal end of the instrument to the pre-operative or intra-operative images to maintain the accuracy of the pose estimate for the distal end of the instrument. SUMMARY

[0006] Embodiments of the invention are summarized by the claims appended to the specification.

[0007] In one embodiment, a method performed by a computing system includes receiving shape information of an elongated flexible portion of a medical instrument. The medical instrument includes a reference portion movably coupled to a fixture having a known pose in a surgical reference frame. The fixture includes a constraining structure having a known constraining structure position in the surgical reference frame. The elongated flexible portion is coupled to the reference portion and is sized to pass through the constraining structure. The method further includes receiving reference portion position information in the surgical reference frame; determining an estimated constraining structure position in the surgical reference frame from the reference portion position information and the shape information; determining a correction factor by comparing the estimated constraining structure position to the known constraining structure position; and modifying the shape information based on the correction factor.

[0008] In another embodiment, a method performed by a computing system includes receiving instrument shape information from a medical instrument. The medical instrument includes a reference portion movably coupled to a fixture having a known pose in a surgical reference frame. The fixture includes a constraining structure and an elongated flexible portion coupled to the reference portion. The elongated flexible portion is sized to pass through the constraining structure of the fixture at a known position in the surgical reference frame. The method further includes receiving anatomical model information and registering the instrument shape information to the anatomical model information. The registering includes adjusting the instrument shape information to pass through the known position in the surgical reference frame.

[0009] It is to be understood that the foregoing general description and the following detailed description are exemplary and explanatory only and are intended to provide a description of the disclosure as claimed. In that regard, additional aspects, features, and advantages of the present disclosure will be apparent to one of ordinary skill in the art from the following detailed description. BRIEF DESCRIPTION OF DRAWINGS

[0010] When read with the accompanying Figure One Aspects of the disclosure are best understood from the following detailed description when read with the accompanying drawings. It is emphasized that various features are not to scale. In fact, the dimensions can be arbitrarily increased or decreased for the sake of discussion. Moreover, the disclosure can repeat reference numerals and / or letters in various examples. This repetition is for the sake of simplicity and clarity and does not in itself dictate a relationship between the various embodiments and / or configurations discussed.

[0011] Figure 1 is a teleoperated medical system in accordance with an embodiment of the disclosure.

[0012] Figure 2 A medical instrument system utilizing aspects of the disclosure is shown.

[0013] Figure 3 A medical instrument system having an extended medical tool is shown. Figure 2 A distal end of a medical instrument system.

[0014] Figure 4 is a flowchart showing a method for providing guidance in an image-guided surgical procedure according to embodiments of the present disclosure.

[0015] Figure 5 A registration display station showing a registration technique according to embodiments of the present disclosure.

[0016] Figure 6 A side view showing a surgical coordinate space including a medical instrument mounted on an insertion assembly.

[0017] Figure 7a A portion of an insertion assembly of Figure 6 is shown according to alternative embodiments, wherein a two degree of freedom constraint structure is mounted on the insertion assembly.

[0018] Figure 7b A cross-sectional view of Figure 7a a constraint structure is shown.

[0019] Figure 8a A portion of an insertion assembly of Figure 6 is shown according to alternative embodiments, wherein a four degree of freedom constraint structure is mounted on the insertion assembly.

[0020] Figure 8b A cross-sectional view of Figure 8a a constraint structure is shown.

[0021] Figure 9a is a flowchart showing a method for correcting registration of a medical instrument with a set of anatomical model information.

[0022] Figure 9b is a flowchart showing a method for correcting shape information from a shape sensor.

[0023] Figure 10 An initial registration of anatomical model information with shape sensor information is shown.

[0024] Figure 11 A final registration corrected based on a shape sensor passing through a constraint structure is shown. DETAILED DESCRIPTION

[0025] In the following detailed description of the aspects of the application, numerous specific details are set forth in order to provide a thorough understanding of the embodiments of the present disclosure. However, it will be apparent to one skilled in the art that the embodiments of the present disclosure can be practiced without these specific details. In other instances, well-known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the embodiments of the present application. Also, for the purpose of clarity, one or more components or acts can be described as being performed by one or more components or acts that are not explicitly described in order to avoid unnecessarily obscuring the aspects of the embodiments of the present application. It is also noted that the embodiments of the present application can be described as a process, which is depicted as a flowchart, with one or more operations. While the process described above can be implemented by one or more computing devices, the process can also be implemented as instructions stored on a computer-readable medium that, when executed by one or more computing devices, perform the process. The order in which each operation of the process is performed can be changed, and very

[0026] The following embodiments will describe various instruments and portions of instruments in terms of their state in three-dimensional space. As used herein, the term "position" refers to the location of an object or portion of an object in three-dimensional space (e.g., three translational degrees of freedom along Cartesian X, Y, Z coordinates). As used herein, the term "orientation" refers to the rotational placement of an object or portion of an object (three rotational degrees of freedom, e.g., roll, pitch, and yaw). As used herein, the term "pose" refers to the position of an object or portion of an object in at least one translational degree of freedom and the orientation of the object or portion of the object in at least one rotational degree of freedom (up to six total degrees of freedom). As used herein, the term "shape" refers to a set of poses, positions, or orientations measured along an object.

[0027] Referring to the drawings Figure 1 A teleoperated medical system for use in, for example, a surgical procedure, a diagnostic procedure, a therapeutic procedure, or a biopsy procedure is generally indicated by the reference numeral 100. As shown in Figure 1 The teleoperated system 100 generally includes a teleoperational manipulator assembly 102 for operating a medical instrument 104 in performing various procedures on a patient P, as shown in

[0028] The master assembly 106 can be located at a surgeon's console, which is typically in the same room as the operating table O. However, it should be understood that the surgeon S can be in a different room or a completely different building from the patient P. The master assembly 106 typically includes one or more control devices for controlling the manipulator assembly 102. The control devices can include any number of various input devices such as joysticks, trackballs, data gloves, trigger-guns, hand-operated controllers, voice recognition devices, body motion or presence sensors, etc. In some embodiments, the control devices will be provided with the same degrees of freedom as the associated medical instrument 104, providing the surgeon with telepresence, or the control devices are integral with the instrument 104 so that the surgeon has the perception of a strong feeling of directly controlling the instrument 104. In other embodiments, the control devices can have more or fewer degrees of freedom than the associated medical instrument 104, and still provide the surgeon with telepresence. In some embodiments, the control devices are hand input devices that move in six degrees of freedom, and can also include actuatable handles for actuating the instrument (e.g., for closing grasping jaws, applying an electrical potential to an electrode, delivering a medical treatment, or the like).

[0029] The teleoperational assembly 102 supports the medical instrument system 104 and can include a kinematic structure of one or more servo-controlled links (e.g., one or more links that can be manually positioned and locked into place, often referred to as a set-up structure) and a teleoperational manipulator. The teleoperational assembly 102 includes a plurality of actuators or motors that drive input devices on the medical instrument system 104 in response to commands from a control system (e.g., control system 112). The motors include a drive system that, when coupled to the medical instrument system 104, can advance the medical instrument into a naturally or surgically occurring anatomical orifice. Other motorized drive systems can move the distal end of the medical instrument in multiple degrees of freedom, which can include three degrees of linear motion (e.g., linear motion along X, Y, Z Cartesian axes) and three degrees of rotational motion (e.g., rotation about X, Y, Z Cartesian axes). In addition, the motors can be used to actuate articulatable end effectors of the instrument in order to grasp tissue in a biopsy device or the like. Motor position sensors such as resolvers, encoders, potentiometers, and other mechanisms can provide sensor data describing the rotation and orientation of the motor shafts to the teleoperational assembly. This position sensor data can be used to determine the motion of objects manipulated by the motors.

[0030] The teleoperational medical system 100 also includes a sensor system 108 having one or more subsystems for receiving information about the instruments of the teleoperational assembly. Such subsystems can include: an orientation sensor system (e.g., an electromagnetic (EM) sensor system); a shape sensor system for determining the orientation, orientation, velocity, rate, pose, and / or shape of the tip of the catheter and / or one or more segments along the flexible body of the instrument system 104; an optical tracking system that uses a video camera to monitor external optical markers on the instrument system and / or the patient; and / or a visualization system for capturing images from the distal end of the catheter system. One or more of these systems can be used to position the instrument relative to a reference coordinate system, such as a patient reference coordinate system and / or a surgical environment reference coordinate system.

[0031] The visualization system (e.g., the visualization system 231 of Figure 2 The visualization system can include a viewing scope assembly that records a simultaneous or real-time image of the surgical site and provides the image to the clinician or surgeon S. The simultaneous image can be, for example, a two-dimensional or three-dimensional image captured by an endoscope disposed within the surgical site. In this embodiment, the visualization system includes an endoscope assembly that can be integrally or removably coupled to the medical instrument 104. However, in alternative embodiments, a separate endoscope attached to a separate manipulator assembly can be used with the medical instrument to image the surgical site. The visualization system can be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which can include the processors of the control system 112 (described below).

[0032] The teleoperational medical system 100 also includes a display system 110 for displaying images or representations of the surgical site and the medical instrument system(s) 104 produced by the subsystems of the sensor system 108. The display 110 and the operator input system 106 can be oriented so that the operator can control the medical instrument system 104 and the operator input system 106 through a perception of telepresence.

[0033] The display system 110 can also display images of the surgical site and medical instruments captured by the visualization system. The display 110 and the control device can be oriented so that the relative orientation of the imaging device in the scope assembly and the medical instrument is similar to the relative orientation of the surgeon's eyes and hands, so that the operator can manipulate the medical instrument 104 and the hand control as if viewing the work space in substantial true presence. By true presence, it is meant that the presentation of the image is a realistic perspective image that simulates the point of view of the operator who is actually manipulating the instrument 104.

[0034] Alternatively or in addition, the display 110 can present images of the surgical site recorded preoperatively or intraoperatively by using image data from imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, or nanotube X-ray imaging, among others. The preoperative or intraoperative image information can be presented as two-dimensional, three-dimensional, or four-dimensional (including, for example, time-based or velocity-based information) images, or as images from models generated from the preoperative or intraoperative image data sets.

[0035] In some embodiments, the display 110 can display a virtual navigation image in which the actual position of the medical instrument 104 is registered with a preoperative or synchronous image / model (i.e., the actual position of the medical instrument 104 is dynamically referenced to the preoperative or synchronous image / model) often for the purpose of image-guided surgical procedures, to present to the clinician or surgeon S a virtual image of the internal surgical site from the viewpoint of the position of the tip of the instrument 104. An image or other graphical or alphabetic indicator of the tip of the instrument 104 can be superimposed on the virtual image to assist the surgeon in controlling the medical instrument. Alternatively, the instrument 104 can not be visible in the virtual image.

[0036] In other embodiments, the display 110 can display a virtual navigation image in which the actual position of the medical instrument is registered with a preoperative or synchronous image to present to the clinician or surgeon S a virtual image of the medical instrument within the surgical site from an external viewpoint. An image of a portion of the medical instrument or other graphical or alphabetic indicator can be superimposed on the virtual image to assist the surgeon in controlling the instrument 104.

[0037] The teleoperational medical system 100 also includes a control system 112. The control system 112 includes at least one memory and at least one computer processor (not shown), and typically includes multiple processors, for effecting control between the medical instrument system 104, the operator input system 106, the sensor system 108, and the display system 110. The control system 112 also includes programmed instructions (e.g., a computer-readable medium storing instructions) to implement some or all of the methods described in accordance with aspects disclosed herein, including instructions for providing disease information to the display system 110. When the control system 112 is in communication with the display system 110, the control system 112 can provide the disease information to the display system 110. Figure 1The system, when shown as a single block in a simplified schematic, can include two or more data processing circuits, with one portion of the processing optionally performed on or near the teleoperational assembly 102, another portion of the processing performed at the operator input system 106, and the like. Any of a variety of centralized or distributed data processing architectures can be employed. Similarly, the programmed instructions can be implemented as many separate programs or subroutines, or they can be integrated into many other aspects of the teleoperational system as described herein. In one embodiment, the control system 112 supports a wireless communication protocol, such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and wireless telemetry.

[0038] In some embodiments, the control system 112 can include one or more servo controllers that receive force and / or torque feedback from the medical instrument system 104. In response to the feedback, the servo controllers transmit signals to the operator input system 106. The servo controller(s) can also transmit signals instructing the teleoperational assembly 102 to move the medical instrument system 104, which extends into an internal surgical site within a patient's body via an opening in the body. Any suitable conventional or specialized servo controller can be used. The servo controllers can be separate from or integrated with the teleoperational assembly 102. In some embodiments, the servo controllers and teleoperational assembly are provided as part of a teleoperational arms cart that is positioned near the patient's body.

[0039] The control system 112 can further include a virtual visualization system for providing navigation assistance to the medical instrument system(s) 104 when used in an image-guided surgical procedure. Virtual navigation using the virtual visualization system is based on a reference to a preoperative or intraoperative data set of the acquired anatomical passageway. More specifically, the virtual visualization system processes images of a surgical site imaged using imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, or nanotube X-ray imaging, among others. Software, alone or in combination with manual input, is used to convert the recorded images into a segmented two- or three-dimensional composite representation of a portion or an entire anatomical organ or anatomical region. The image data set is associated with the composite representation. The composite representation and the image data set describe various locations and shapes of the passageway and its connectivity. The images used to produce the composite representation can be recorded preoperatively or intraoperatively during a clinical procedure. In alternative embodiments, the virtual visualization system can use a standard representation (i.e., not patient-specific) or a mixture of a standard representation and patient-specific data. The composite representation and any virtual images generated from the composite representation can represent a static pose of a deformable anatomical region during one or more motion phases (e.g., during the inhalation / exhalation cycle of a lung).

[0040] During a virtual navigation procedure, the sensor system 108 can be used to calculate the proper position of the instrument relative to the patient's anatomy. This position can be used to produce both macro-level (external) tracking images of the patient's anatomy and virtual internal images of the patient's anatomy. Various systems that use fiber optic sensors to register a medical instrument with preoperatively recorded surgical images, such as those from a virtual visualization system, and display the medical instrument with the preoperatively recorded surgical images are known. For example, U.S. Patent Application No. 13 / 107,562 ("Medical System Providing Dynamic Registration of a Model of an Anatomical Structure for Image-Guided Surgery," filed May 13, 2011), which is incorporated by reference herein in its entirety, discloses one such system.

[0041] The teleoperated medical system 100 can further include optional operating and support systems (not shown), such as illumination systems, steering control systems, irrigation systems, and / or suction systems. In alternative embodiments, the teleoperated system can include more than one teleoperational assembly and / or more than one operator input system. The exact number of manipulator assemblies will depend on the surgical procedure and other factors such as space limitations within the operating room. The operator input systems can be collocated, or they can be disposed in separate locations. Multiple operator input systems allow more than one operator to control one or more manipulator assemblies in various combinations.

[0042] Figure 2 A medical instrument system 200 is shown, which can be used as the medical instrument system 104 in an image-guided medical procedure performed with the teleoperated medical system 100. Alternatively, the medical instrument system 200 can be used in a non-teleoperational exploratory procedure or in a procedure involving a conventionally manually operated medical instrument, such as an endoscope. Additionally or alternatively, the medical instrument system 200 can be used to collect a set of data points corresponding to a location within a patient's anatomical passageway.

[0043] The instrument system 200 includes a catheter system 202 coupled to an instrument body 204. The catheter system 202 includes an elongate flexible catheter body 216 having a proximal end 217 and a distal or tip portion 218. In one embodiment, the flexible body 216 has an outer diameter of about 3 mm. Other flexible body outer diameters can be larger or smaller. The catheter system 202 can optionally include a shape sensor 222 for determining the position, orientation, velocity, rate, pose, and / or shape of the catheter tip at the distal end 218 and / or of one or more segments 224 along the body 216. The entire length of the body 216 between the distal end 218 and the proximal end 217 can effectively be divided into segments 224. If the instrument system 200 is the medical instrument system 104 of the teleoperated medical system 100, the shape sensor 222 can be a component of the sensor system 108. If the instrument system 200 is manually operated or otherwise used in a non-teleoperational procedure, the shape sensor 222 can be coupled to a tracking system 230 that interrogates the shape sensor and processes the received shape data.

[0044] The shape sensor 222 can include an optical fiber aligned with the flexible catheter body 216 (e.g., provided within an internal channel (not shown) or mounted externally). In one embodiment, the optical fiber has a diameter of approximately 200 pm. In other embodiments, the dimensions can be larger or smaller. The optical fiber of the shape sensor system 222 forms an optical fiber bend sensor for determining the shape of the catheter system 202. In an alternative example, an optical fiber including fiber Bragg gratings (FBGs) is used to provide strain measurements in one or more dimensions of structure. Various systems and methods for monitoring the shape and relative orientation of an optical fiber in three dimensions are described in U.S. Patent Application No. 11 / 180,389 (filed July 13, 2005) (which discloses “Fiber optic position and shape sensing device and method relating thereto”); U.S. Patent Application No. 12 / 047,056 (filed July 16, 2004) (which discloses “Fiber-optic shape and relative position sensing”); and U.S. Patent No. 6,389,187 (filed June 17, 1998) (which discloses “Optical Fibre Bend Sensor”), all of which are incorporated by reference herein in their entireties. Sensors in alternative embodiments can employ any suitable strain sensing technology, such as Rayleigh scattering, Raman scattering, Brillouin scattering, and fluorescence scattering. In other alternative embodiments, the shape of the catheter can be determined using other techniques. For example, a history of catheter distal tip poses can be used to reconstruct the shape of the device over an interval of time. As another example, historical pose, position, or orientation data can be stored for known points of the instrument system along a cycle of alternating motion, such as respiration. This stored data can be used to develop shape information about the catheter. Alternatively, a series of position sensors, such as EM sensors, placed along the catheter can be used for shape sensing. Alternatively, a history of data from position sensors, such as EM sensors, on the instrument system during a procedure can be used to represent the shape of the instrument, particularly if the anatomical passageway is generally static. Alternatively, wireless devices with position or orientation controlled by an external magnetic field can be used for shape sensing. A history of the position of the wireless devices can be used to determine the shape of the navigated passageway.

[0045] The medical instrument system can optionally include a position sensor system 220. The position sensor system 220 can be a component of an EM sensor system having a sensor 220 that includes one or more electrically conductive coils that can be subjected to an externally generated electromagnetic field. Each coil of the EM sensor system 220 then generates an induced electrical signal having characteristics that depend on the position and orientation of that coil relative to the externally generated electromagnetic field. In one embodiment, the EM sensor system can be configured and disposed to measure six degrees of freedom, e.g., three positional coordinates X, Y, Z and three orientation angles indicative of pitch, yaw, and roll of a base point, or five degrees of freedom, e.g., three positional coordinates X, Y, Z and two orientation angles indicative of pitch and yaw of a base point. Further description of EM sensor systems is provided in U.S. Patent No. 6,380,732 (filed August 11, 1999), which discloses a "Six-Degree of Freedom Tracking System Having a Passive Transponder on the Object Being Tracked," which is incorporated by reference herein in its entirety. In some embodiments, the shape sensor can also function as a position sensor, as the shape of the sensor, along with information about the location of the base of the shape sensor (in a fixed coordinate system of the patient) allows the calculation of the location of various points along the shape sensor, including the distal tip.

[0046] The medical instrument system can optionally include an optical tracking system 227. The optical tracking system includes a plurality of markers located on the instrument system 200. The markers can be located on the instrument body 204 outside of the patient anatomy during surgical use, or can be located on the catheter system 202 inside of the patient anatomy during surgical use. The markers can be tracked during the surgical procedure by a stereo camera system.

[0047] The tracking system 230 can include the position sensor system 220, the optical tracking system 227, and / or the shape sensor system 222 to determine the position, orientation, velocity, pose, and / or shape of the distal end 218, as well as the position, orientation, velocity, pose, and / or shape along one or more segments 224 of the instrument 200. The tracking system 230 can be implemented as hardware, firmware, software, or a combination thereof that interacts with or otherwise executes in connection with one or more computer processors, which can include the processors of the control system 112.

[0048] The flexible catheter body 216 includes a passageway 221 sized and shaped to receive a medical instrument 226. The medical instrument can include, for example, an image capture probe, a biopsy instrument, a laser ablation fiber or other surgical tool, diagnostic tool or therapeutic tool. The medical tool can include an end effector having a single working member, such as a scalpel, a blunt blade, an optical fiber or an electrode. Other end effectors can include, for example, forceps, graspers, scissors or clip appliers. Examples of electrically activated end effectors include electrosurgical electrodes, transducers, sensors and the like. In different embodiments, the medical tool 226 can be an image capture probe (e.g., a component of the visualization system 231) that includes a stereo or monoscopic camera at or near the distal end 218 of the flexible catheter body 216 for capturing images (including video images) that are processed for display. The image capture probe can include a cable coupled to the camera for transmitting captured image data. Alternatively, the image capture instrument can be a fiber optic bundle coupled to the visualization system, such as a fiber optic endoscope. The image capture instrument can be a single or multiple spectrums that capture image data in one or more of the visible spectrum, infrared spectrum or ultraviolet spectrum, for example.

[0049] The medical instrument 226 can house a cable, a linkage or other actuation control (not shown) that extends between the proximal and distal ends of the instrument to controllably bend the distal end of the instrument. Steerable instruments are described in detail in U.S. Patent No. 7,316,681 (entitled "Articulated Surgical Instrument for Performing Minimally Invasive Surgery with Enhanced Dexterity and Sensitivity," filed October 4, 2005) and U.S. Patent Application No. 12 / 286,644 (entitled "Passive Preload and Capstan Drive for Surgical Instruments," filed September 30, 2008), which are incorporated by reference herein in their entireties.

[0050] The flexible catheter body 216 can also house a cable, link, or other steering control (not shown) that extends between the housing 204 and the distal end 218 to controllably bend the distal end 218, as indicated by the dashed lines representing the distal end 219. Steerable catheters are described in detail in U.S. Patent Application No. 13 / 274,208 (entitled "Catheter with Removable Vision Probe"), filed October 14, 2011, which is incorporated by reference herein in its entirety. In embodiments in which the instrument system 200 is actuated by a teleoperational assembly, the housing 204 can include a drive input that is removably coupled to and receives power from motorized drive elements of the teleoperational assembly. In embodiments in which the instrument system 200 is manually operated, the housing 204 can include clamping features, manual actuators, or other components for manually controlling the motion of the instrument system. The catheter system can be steerable, or alternatively, the system can be non-steerable, in which there is no integrated mechanism for operator-controlled bending of the instrument. Also or alternatively, one or more lumens are defined in the walls of the flexible body 216, in which a medical instrument can be deployed through the one or more lumens and used at a target surgical site.

[0051] In various embodiments, the medical instrument system 200 can include a flexible bronchial instrument, such as a bronchoscope or bronchial catheter, for use in the examination, diagnosis, biopsy, or treatment of the lungs. The system 200 is also suitable for navigation and treatment of other tissues via naturally or surgically created connecting passageways in various anatomical systems, including the colon, intestines, kidneys, brain, heart, respiratory system, and the like.

[0052] Information from the tracking system 230 can be sent to a navigation system 232, where it is combined with information from the visualization system 231 and / or preoperatively obtained models to provide real-time positional information to the surgeon or other operator on the display system 110 for use in the control of the instrument 200. The control system 112 can utilize the positional information as feedback for positioning the instrument 200. Various systems for registering and displaying surgical instruments with surgical images using fiber optic sensors are provided in U.S. Patent Application No. 13 / 107,562, filed May 13, 2011, entitled "Medical System Providing Dynamic Registration of a Model of an Anatomical Structure for Image-Guided Surgery," which is incorporated by reference herein in its entirety.

[0053] InFigure 2 In one embodiment, the device 200 is remotely operated within the remote-operated medical system 100. In an alternative embodiment, the remote-operation component 102 can be replaced by a direct operator control. In direct-operation alternatives, various handles and operator interfaces can be included for handheld operation of the device.

[0054] In alternative embodiments, the remote operating system may include one or more slave manipulator components and / or one or more master control components. The exact number of manipulator components will depend on other factors such as the medical procedure and space constraints within the operating room. Master control components may be juxtaposed or may be located in separate positions. Multiple master control components allow more than one operator to control one or more slave manipulator components in various combinations.

[0055] like Figure 3 As shown in more detail, one or more medical instruments 228 for procedures such as surgery, biopsy, ablation, illumination, irrigation, or aspiration can be deployed through channels 221 of the flexible body 216 and used at a target location within the anatomy. If, for example, the instrument 228 is a biopsy instrument, it can be used to remove sample tissue or sample cells from the target anatomical location. The medical instrument 228 can also be used in conjunction with an image-capturing probe within the flexible body 216. Alternatively, the instrument 228 itself can be the image-capturing probe. The instrument 228 can be advanced from the opening of the channel 221 to perform the procedure and then retracted into the channel when the procedure is complete. The medical instrument 228 can be removed from the proximal end 217 of the catheter flexible body or from another optional instrument port (not shown) along the flexible body.

[0056] Figure 4is a flowchart showing a general method 450 for use in performing image-guided surgical procedures. At process 452, preoperative or intraoperative image data is obtained from imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, or nanotube X-ray imaging. The preoperative or intraoperative image data can correspond to two-dimensional, three-dimensional, or four-dimensional (including, for example, time-based or velocity-based information) images. At process 454, computer software, alone or in combination with manual input, is used to convert the recorded images into segmented two- or three-dimensional composite representations or models of the partial or entire anatomical organ or anatomical region. The composite representations and image data sets describe the various locations and shapes of the passageways and their connectivity. More specifically, during the segmentation process, the images are divided into segments or elements (e.g., pixels or voxels) that share certain features or computed properties such as color, density, intensity, and texture. This segmentation process results in a two- or three-dimensional reconstruction that forms a model of the target anatomical body based on the obtained images. To represent the model, the segmentation process can describe groups of voxels that represent the target anatomical body and then apply a function such as a marching cube function to obtain a 3D (three-dimensional) surface that encloses the voxels. Additionally or alternatively, the model can include a centerline model that includes a set of interconnected line segments or points that extend through the center of the modeled passageways. At process 456, the anatomical model data is registered to the patient anatomy prior to and / or during the course of the patient's image-guided surgical procedure. Typically, the registration involves measuring the match of points to points of the model using rigid and / or non-rigid transformations. The measured points can be generated by using, for example, landmarks in the anatomical body, optical markers, and / or electromagnetic coils that are scanned during imaging and tracked during the procedure. Additionally or alternatively, the measured points can be generated by using shape sensor information and iterative closest point (ICP) techniques.

[0057] Figure 5 A display system 500 is shown displaying a rendering of an anatomical passageway 502 of a human lung 504 based on anatomical model information. In the case where the surgical environment reference coordinate system is registered to the model reference coordinate system, the current shape of the catheter 510 and the location of the distal end 518 can be positioned and displayed in synchronization with the rendering of the model passageway 502. As the catheter moves within the passageway 502, the movement of the catheter 510 is tracked and displayed, providing guidance to a user controlling the movement of the catheter.

[0058] As noted above, various positioning systems can be used to position an instrument to a surgical reference coordinate system (which is the same as or approximately the same as the patient reference coordinate system for a static patient) during an image-guided surgical procedure. Such positioning systems include the use of EM sensors, impedance-based sensors, ultrasonic-based sensors, fiber-optic based sensors, and / or optical tracker based sensors. These sensors can be located on components of an instrument that are located within the patient anatomy during a medical procedure, or can be located on components of an instrument that remain outside of the patient anatomy during a medical procedure. Some positioning systems have features that can limit their utility for positioning instruments in a surgical environment. For example, in the case of EM sensing or impedance-based sensing, metal objects or certain electronics used in the surgical environment can create interference that compromises the quality of the sensed data. In the case of optical tracker based systems, the tracking camera system can be too large to view markers within the anatomy, or can obstruct the clinician workflow if viewing markers outside of the anatomy.

[0059] Fiber-optic shape sensors can be used in particular as positioning sensors because they provide data about the overall shape of the instrument, including the pose of the distal tip, without being sensitive to metal objects in the region or requiring obstructive imaging equipment. However, when using fiber-optic shape sensors, small errors in position and orientation at the proximal end of the fiber-optic can create large cumulative errors in position and orientation for the distal end of the sensor due to the length of the sensor (e.g., about one meter). Systems and methods to correct for these errors are described below, and can be used to produce more accurate registration of the fiber-optic to the anatomical model information.

[0060] Figure 6 A surgical coordinate system X S , Y S , Z Ssurgery environment 600, where a patient P is positioned on a platform 602. From the perspective of the patient being sedated, restrained, or otherwise limited from gross movement, the patient P can be static within the surgery environment. Thus, the patient reference frame can be considered the same as or fixed relative to the surgery environment reference frame. Cyclic anatomical motion, including respiration and cardiac motion of the patient P, will continue. Within the surgery environment 600, a medical instrument 604 is coupled to an instrument carriage 606. The instrument carriage 606 is mounted to an insertion table 608. The insertion table 608 itself can be fixed within the surgery environment 600. Alternatively, the insertion table can be coupled to a manipulator arm of a teleoperational system. Movement of the manipulator arm and thus the insertion table can be tracked within the surgery environment 600 by using, for example, kinematically-based joint sensors for the manipulator arm, optical tracking, EM tracking, or other known tracking systems. Thus, even if the insertion table itself is not fixed, the position of the insertion table within the environment can be known. The insertion table can be a linear table as shown in this embodiment, or can have another predetermined and known shape in the surgery environment.

[0061] The instrument carriage 606 can be a component of a teleoperational manipulator assembly (e.g., assembly 102) that is coupled to the instrument 604 to control insertion motion (i.e., motion in the Xs direction) and optionally to control motion of a distal end of the instrument in multiple directions including yaw, pitch, roll. The instrument carriage 606 or the insertion table 608 can include servo motors (not shown) that control motion of the instrument carriage along the insertion table.

[0062] The medical instrument 604 can include a flexible catheter 610 coupled to a proximal rigid instrument body 612. The rigid instrument body 612 is coupled and fixed relative to the instrument carriage 606, and thus is movably coupled to the insertion table 608 via the carriage. An optical fiber shape sensor 614 is fixed at a reference portion 616 of the rigid instrument body 612. In alternative embodiments, the reference portion 616 of the sensor 614 can be movable along the body 612, but the position of the reference portion can be known (e.g., via a tracking sensor or other tracking means). A reference frame for the reference portion 616 has coordinate system X T , Y T , Z T . The shape sensor 614 measures a shape from the reference portion 616 to another point, such as a distal end 618 of the catheter 610. The medical instrument 604 can be substantially similar to the medical instrument system 200.

[0063] Orientation measuring device 620 provides information about the orientation of the rigid instrument body 612 as it moves along insertion axis A on insertion stage 608. Orientation measuring device 620 may include a resolver, encoder, potentiometer, and other mechanisms that determine the rotation and orientation of the motor shaft controlling the movement of instrument carrier 606 and thus provide an indirect measurement of the movement of the rigidly attached instrument body 612. Alternatively, orientation measuring device 620 may directly measure the movement of instrument body 612 using, for example, mechanical belt measurement, laser distance sensor, or electromagnetic or optical tracker. In this embodiment, insertion stage 608 is linear, but in alternative embodiments it may be curved or have a combination of curved and linear segments. Optionally, the linear tracker may be foldable, for example, as described in U.S. Provisional Patent Application No. 62 / 029,917 (filed July 28, 2014) (disclosing “Guide Apparatus For Delivery Of A Flexible Instrument And Methods Of Use”), which is incorporated herein by reference in its entirety. Figure 6 The instrument body 612 and bracket 606 are shown in the retracted position along the insertion stage 608. In this retracted position, the reference portion 616 is positioned at orientation L0 along axis A. The X-axis of the position of the reference portion 616 in this orientation along the insertion stage 608 is shown. S The component can be set to zero or its original value. With the instrument body 612 and the bracket 606 in this retracted position, the distal end 618 of the catheter can be positioned precisely inside the inlet port of the patient P.

[0064] like Figure 6 As shown, the constraint structure 622 is rigidly coupled to the insertion stage 608. In an alternative embodiment, the constraint structure may be movable, but its position in the surgical reference coordinate system may be known (e.g., via a tracking sensor or other tracking device). Because the position of the constraint structure 622 is fixed or known in the surgical coordinate system 600, the portion of the catheter 610 passing through the constraint structure 622 also passes through the same fixed or known position. This information about the fixed or known position of the constraint structure can be used to determine or correct the orientation of the shape information from the sensor 614 in the surgical coordinate system, and thus also produce a more accurate estimate of the position of the distal end of the sensor and the catheter.

[0065] like Figure 7a As shown, the constraint structure 622a can be a ring-shaped member, the dimensions of which are designed to receive the conduit 610 in the sliding channel along axis A, and in +X S -X SIn one embodiment, the ring has a length LI of approximately 2 mm. Other relatively short lengths that constrain translation in the Y S , Z S directions while allowing pivotal motion about the point of constraint can be suitable. As shown in Figure 7b , the catheter 610 is constrained because it must pass through the ring constraint structure 622a and thus the Y S and Z S coordinates of one point of the catheter are constrained to equal the Y S and Z S coordinates of the center of the constraint structure. In other words, at the location of the constraint structure 622a, the translational movement of the catheter 610 is limited in the + / - Y S and + / - Z S directions. Because the length LI is relatively short, the segment of the shaft that passes through the constraint structure 622a is not constrained in orientation and can still pivot about the point of constraint. Alternatively, as shown in Figure 8a , the constraint structure 622b can be a tube-shaped member that is sized to receive the catheter 610 in a sliding passageway in the + / - X S , -X S directions and has a length L2 that is longer than LI, thereby constraining the movement of the catheter in four degrees of freedom. In one embodiment, the tube-shaped member has a length L2 of approximately 2 cm. Other lengths that constrain the translational degrees of freedom in the Y S and Z S directions and the rotational degrees of freedom in the pitch and yaw directions can be suitable. As shown in Figure 8b , the constraint structure 622b constrains the segment of the shaft of the catheter not only in its Y S and Z S coordinates equal to the Y S and Z S coordinates of the centerline of the constraint structure, but also the pitch orientation angle and the yaw orientation angle are constrained to be aligned with the X S direction. The two azimuth and two orientation constraints are added to the constraint structure to constrain four degrees of freedom.

[0066] Figure 9a is a flowchart illustrating a method 700 for providing guidance to a clinician in an image-guided surgical procedure on a patient P in a surgical environment 600 according to an embodiment of the present disclosure. At process 702, shape information is received from a fiber optic shape sensor 614 extending within an instrument 604. The shape information describes a shape of the instrument 604 between a proximal reference portion 616 and a distal end 618. The cumulative shape information also describes a position of the distal end 618 relative to the proximal reference portion 616 (i.e. in the XT , Y T , Z T orientation (in the coordinate system). Shape information 800 from sensor 614 can be illustrated as shown in FIG. 8B. Shape information also provides information about the position of the constraints relative to proximal reference portion 616. As shape sensor moves along axis A, the observed shape information from the fixed or known position of the constraints will be the same for different positions of proximal reference portion 616 (i.e., will present the same known constraints). Figure 10

[0067] At process 704, anatomical model information is received. As described above, anatomical model information can be generated from preoperative or intraoperative image data obtained from imaging techniques including CT, MRI, and / or fluoroscopy. The preoperative or intraoperative image data can correspond to two-dimensional, three-dimensional, or four-dimensional images. A segmentation process produces a two- or three-dimensional reconstruction that forms a model of the anatomical body based on the obtained images. The model can be represented, for example, as a centerline model comprising a set of interconnected line segments or points that extend through the center of the modeled passageway, or can be represented as a surface model that describes the surface of the modeled passageway. Figure 10 Anatomical model information 802 is shown representing a centerline model of a set of anatomical passageways.

[0068] At process 706, instrument shape information 800 is registered to anatomical model information 802. To perform the registration between the shape information and the anatomical model information, both sets of information are registered to a surgical reference coordinate system (which is the same as the patient reference coordinate system for a static patient). Proximal reference portion 616 of sensor 614 is fixed or known relative to rigid instrument body 612 that is coupled to instrument carriage 606. The instrument carriage moves along insertion table 608 that has a fixed or known position in the surgical reference coordinate system. By tracking the movement of the instrument carriage using, for example, sensor 620, the position and orientation of proximal reference portion 616 relative to the surgical reference coordinate system can be determined and tracked, and thus the position and orientation of the proximal reference portion reference coordinate system relative to the surgical reference coordinate system can be determined and tracked.

[0069] ​Registration of the anatomic model information 802 to the surgical reference frame can be performed according to any of a variety of methods. For example, registration can be accomplished by using markers 624 held on the patient during a surgical procedure, attached to the patient during pre-operative or intra-operative imaging, and markers 626 attached to the instrument at the reference portion 616 of the sensor 614. In one embodiment, the markers 624 can be optical trackers with a distinctive configuration of two-dimensional or three-dimensional markers. Another optical tracker can be disposed on the reference portion 616 of the sensor 614. Optical tracking based registration is described in

Attorney Docket No. ISRG06890

Attorney Docket No. ISRG06880

[0070] As shown in Figure 10 Due to errors associated with the registration orientation of the shape sensor proximal reference portion reference frame to the model reference frame, the initial registration of the instrument shape information 800 to the anatomic model information 802 can be incorrect. When small errors associated with the orientation and / or position of the opposing reference portion reference frames form the basis for determining the pose of the distal end 804 of the sensor, these small errors can be compounded and magnified. Thus, as shown in Figure 10 The small orientation errors associated with the proximal reference portion 616 of the shape information 800 can result in significant errors in the positioning of the distal end 804 of the shape sensor, as shown in

[0071] At process 708, the instrument shape information 800 is corrected by compensating for errors associated with the orientation or position of the sensor reference portion reference frame. The constraint structure 622 provides a known location in the surgical reference frame that the instrument must pass through. Thus, the shape sensor information 800 must pass through the known location with the degrees of freedom constraint enforced by the constraint structure 622. An initial registration that does not observe the known constraint imposed by the constraint structure can be corrected by rotating the orientation and / or translating the position of the shape sensor information 800 to pass through the known location with a known pose, where the known pose is indicated by the constraint structure 622. As shown in FIG. 8, the orientation of the shape information 800 has been adjusted to cause the shape information 800 to pass through the location of the constraint structure 622. Figure 11

[0072] Figure 9b is a flowchart showing a method 710 for correcting shape information from a shape sensor. At process 712, shape information is received from a fiber optic shape sensor 614 extending within an instrument 604. The shape information describes the shape of the instrument 604 between a proximal reference portion 616 and a distal end 618. The accumulated shape information also describes the position and orientation of the distal end 618 relative to the proximal reference portion 616 (i.e., in the X T , Y T , and Z T coordinate system). The shape information also provides information about the location of the constraint relative to the proximal reference portion 616. As the shape sensor moves along the axis A, the shape information at the location of the fixed or known constraint will be the same for different positions of the proximal reference portion.

[0073] ​At process 714, proximal reference portion 616 position information in the surgical reference coordinate system is received or determined. In one embodiment, a calibration procedure is performed to calibrate the relative position and / or orientation of proximal reference portion 616 along the insertion path. For example, as carriage 606 is moved from a retracted position of portion 616 at location L0 to an advanced position of portion 616 at location LI, the position and orientation of portion 616 is measured. The calibration procedure determines the direction of movement of portion 616 for each change in position measurement device 620. In this embodiment, where insertion table 608 restricts movement of carriage 606 to a linear path, the calibration procedure determines the direction of the straight line. From the slope of the insertion table tracking, the position and orientation of portion 616 in the surgical environment 600 can be determined for each corresponding measurement of position measurement device 620. In alternative embodiments, if the insertion table has a curved shape or otherwise has a non-linear shape, the calibration procedure can determine the non-linear shape such that for each measurement of the position device, the position and orientation of portion 616 in the surgical environment can be determined. For example, the distal tip of the catheter can be held in a fixed position while the instrument body travels along a non-linear insertion table. As the instrument body travels along the insertion table, the position and orientation data collected from portion 616 by the shape sensor is cross-correlated with the position measurement device data, thereby calibrating the movement of portion 616 along the axis A of insertion table 608.

[0074] At process 716, the position and orientation of constraint structure 622 in the surgical reference coordinate system can be predicted based on the instrument shape information and the proximal reference portion 616 position information. More specifically, for any given measurement of position measurement device 620, the position of proximal reference portion 616 in the surgical reference coordinate system is known based on the calibration. From the shape information, the position and orientation of constraint structure 622 relative to reference portion 616 is also known. Thus, for each position of reference portion 616, the position and orientation of constraint structure 622 in the surgical reference coordinate system can be predicted by combining the calibrated insertion position information and the shape information.

[0075] At process 718, the predicted position and orientation of constraint structure 622 in the surgical reference coordinate system is compared to the known position and orientation of constraint structure 622 in the surgical reference coordinate system. A correction factor is determined that includes the position and orientation components between the predicted position and the known position of the constraint structure. This correction factor is applied to the shape sensor information to correct the position and orientation of the distal end of the shape sensor information in the surgical reference coordinate system. Optionally, this corrected shape sensor information can be used to register with the anatomic model information to perform an image-guided surgical procedure. Optionally, the positioning instrument can be displayed with the anatomic model to assist the clinician in the image-guided surgical procedure.

[0076] While the systems and methods of the present disclosure have been described for use in the connected bronchial passageways of the lungs, they are also suitable for navigating and treating other tissues via naturally occurring or surgically created connected passageways in any of a variety of anatomical systems including the colon, intestines, kidneys, brain, heart, respiratory system, etc.

[0077] One or more elements in embodiments of the present application can be implemented in software to execute on a processor of a computer system such as the control system 112. When implemented in software, the elements of the embodiments of the present application are essentially the code segments to perform the necessary tasks. The program or code segments can be stored in a processor readable storage medium or device, which can be downloaded via a computer data signal embodied in a carrier wave over a transmission medium or a communication link. The processor readable storage device can include any medium that can store information including optical, semiconductor, magnetic, or any other medium. Examples of processor readable storage devices include an electronic circuit; a semiconductor memory device, a memory device, a read-only memory (ROM), a flash memory, an erasable programmable read-only memory (EPROM); a floppy diskette, a CD-ROM, an optical disk, a hard disk, or other storage device. The code segments can be downloaded via computer networks such as the Internet, Intranet, etc.

[0078] It is noted that the processes presented and displays can not inherently be related to any particular computer or other apparatus. An apparatus constructed according to the present application is primarily a means for accomplishing each of the functions, steps and operations enclosed in the claims. In addition, the embodiments of the present application are not described with reference to any particular programming language. It will be appreciated that a variety of programming languages can be used to implement the teachings of the application as described herein.

[0079] While certain example embodiments of the application have been described and shown herein, it is understood that such embodiments are merely illustrative and not restrictive of the broad application, and that modifications can be made by those skilled in the art with the object of the application in mind which do not depart from the scope of the present application. Therefore, it is understood that all such modifications and changes that come within the meaning and range of equivalents of the appended claims are to be included.

Claims

1. A system comprising: A fixation device having a known pose in a surgical reference coordinate system, the fixation device including a constraint structure having a known position in the surgical reference coordinate system; Medical devices, including: A rigid instrument body having a reference portion, said reference portion being movably coupled to the fixing device; and An elongated flexible portion is coupled to the rigid instrument body and is sized to pass through the constraint structure at the known location in the surgical reference coordinate system, with the rigid instrument body located at the proximal end of the elongated flexible portion. An optical tracker configured to optically track an optical mark on the rigid instrument body; and The computing system is configured as follows: Receive shape information of the medical device from the medical device; Receive anatomical model information; Receive medical device location information from the optical tracker; and The shape information of the medical device is registered to the anatomical model information, wherein the registration includes adjusting the shape information of the medical device to pass through the known position in the surgical reference coordinate system.

2. The system of claim 1, wherein the medical device further comprises an optical fiber shape sensor, and wherein the computing system receives the shape information from the optical fiber shape sensor.

3. The system of claim 2, wherein the fiber optic shape sensor includes a proximal end located in the reference portion of the medical device.

4. The system of claim 1, wherein the shape information includes the pose of the distal tip of the medical device.

5. The system of claim 1, further comprising a remote manipulator fixed in the surgical reference coordinate system, wherein the fixing device is a component of the remote manipulator.

6. The system of claim 1, wherein the constraint structure is configured to constrain at least two degrees of freedom of motion of the elongated flexible portion of the medical device at the known position in the surgical reference coordinate system.

7. The system of claim 6, wherein the constraint structure comprises a rigid ring.

8. The system of claim 1, wherein the constraint structure is configured to constrain at least four degrees of freedom of motion of the elongated flexible portion of the medical device at the known position in the surgical reference coordinate system.

9. The system of claim 8, wherein the constraint structure comprises an elongated sleeve.

10. The system of claim 1, wherein the optical tracker is further configured to optically track an optical marker located on the patient's anatomy.

11. The system of claim 1, further comprising electromagnetic markers located on the reference portion of the medical device and on the patient's anatomy for registering the shape information of the medical device to the anatomical model information.

12. The system of claim 1, wherein the computing system is further configured to correct the orientation of the shape information of the medical device to extend through the known position in the surgical reference coordinate system to adjust the shape information of the medical device.

13. The system of claim 1, wherein the known position is a fixed position in the surgical reference coordinate system.

14. The system of claim 1, wherein the computing system is further configured to display a first image of the medical device registered to a second image generated from the anatomical model information.

15. A system comprising: A fixation device having a known fixation device position in a surgical reference coordinate system, the fixation device including a constraint structure having a known constraint position in the surgical reference coordinate system; Medical devices, including: A rigid instrument body having a reference portion, the reference portion being movably coupled to the fixing device; An elongated flexible portion coupled to the rigid instrument body, wherein the elongated flexible portion is dimensioned to pass through the constraint structure at the known constraint location, and the rigid instrument body is located at the proximal end of the elongated flexible portion; and A shape sensor that extends within the medical device; A orientation measuring device that measures the motion of the reference portion relative to the known position of the fixed device as the reference portion moves along the fixed device; and The computing system is configured as follows: The shape information of the medical device in the reference coordinate system of the reference portion is received from the shape sensor; Receive anatomical model information; Receive the reference portion orientation information in the surgical reference coordinate system from the orientation measuring device; and The shape information of the medical device is registered to the anatomical model information, wherein the registration includes: Register the reference coordinate system of the reference portion to the surgical reference coordinate system; Register the anatomical model information to the surgical reference coordinate system; and The shape information of the medical device is adjusted to pass through the known constraint position in the surgical reference coordinate system.

16. The system of claim 15, wherein the shape sensor is an optical fiber shape sensor.

17. The system of claim 15, wherein the constraint structure is in a fixed position relative to the fixing device.

18. The system of claim 15, further comprising a tracking sensor configured to track the position of the constraint structure, wherein the constraint structure is movable relative to the fixing device.

19. The system of claim 15, wherein the orientation measuring device includes a motor orientation sensor configured to determine the rotation or orientation of a motor shaft that controls the movement of the reference portion when the reference portion moves along the insertion axis of the fixing device.

20. The system of claim 19, wherein the motor orientation sensor comprises a resolver, an encoder, or a potentiometer.

21. The system of claim 15, wherein the orientation measuring device includes a direct measuring device.

22. The system of claim 21, wherein the direct measurement device comprises a mechanical belt measurement, a laser distance sensor, an electromagnetic tracker, or an optical tracker.

23. A method performed by a computing system, comprising: The medical device receives shape information of an elongated flexible portion of a medical device in a reference coordinate system, the medical device including a rigid device body located at the proximal end of the elongated flexible portion, the rigid device body having a reference portion coupled to the elongated flexible portion, wherein the reference portion is movably coupled to a fixation device having a known fixation device position in a surgical reference coordinate system. Receive anatomical model information; The orientation measurement device receives orientation information of the reference part, and the orientation measurement device measures the movement of the reference part relative to the known position of the fixation device in the surgical reference coordinate system as the reference part moves along the fixation device; The shape information of the slender flexible portion is registered to the anatomical model information; and Correcting the shape information of the elongated flexible portion includes correcting the shape information to pass through a constraint structure, wherein the constraint structure is coupled to the fixation device at a known constraint structure location in the surgical reference coordinate system, and the elongated flexible portion is sized to pass through the constraint structure.

24. The method of claim 23, wherein registering the shape information of the elongated flexible portion to the anatomical model information comprises: The reference coordinate system relative to the surgical reference coordinate system is determined based on the orientation information of the reference portion; and The anatomical model information is registered to the surgical reference coordinate system.

25. The method of claim 23, wherein correcting the shape information of the elongated flexible portion comprises at least one of: translating the orientation of the shape information of the medical device or rotating the orientation of the shape information to extend through the constraint structure at the known constraint structure location in the surgical reference coordinate system.

26. The method of claim 23, wherein the position of the known constraint structure is fixed in the surgical reference coordinate system.

27. The method of claim 23, wherein the position of the known constraint structure is movable in the surgical reference coordinate system and is tracked by a tracking sensor.

28. The method of claim 23, wherein the anatomical model information is a centerline model or a surface model.

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