Registration system and method for image guided surgery

Abstract

The invention relates to a registration system and method for image guided surgery. A method is disclosed that includes accessing a set of model points of a model of one or more pathways of a patient; detecting a point collection condition in data obtained from the catheter; initiating collection of a measurement point set; executing a point set registration algorithm using the model point set and the measurement point set to produce a registered model point set; and displaying a visual representation of the registered set of model points in a user interface provided by a display.

Description

[0001] This application is a divisional application of Chinese patent application No. 2020108544165, whose application date is August 11, 2016 and whose name is “Registration system and method for image-guided surgery”. This Chinese patent application is a divisional application of Chinese patent application No. 2016800475296 (PCT / US2016 / 046633), whose international application date is August 11, 2016 and whose national phase entry date is February 12, 2018 and whose name is “Registration system and method for image-guided surgery”.

[0002] Related patent applications

[0003] This patent application claims the benefit of priority and filing date to U.S. Provisional Patent Application No. 62 / 205,440, filed on August 14, 2015, entitled “SYSTEMS AND METHODS OF REGISTRATION FOR IMAGE-GUIDED SURGERY,” which is incorporated herein by reference in its entirety. Technical Field

[0004] The present disclosure relates to systems and methods for performing image-guided surgery, and more particularly to systems and methods for displaying pathology data of tissue sampled during image-guided surgery. Background Art

[0005] Minimally invasive medical technology aims to reduce the amount of tissue damaged during the medical process, thereby reducing patient recovery time, discomfort and harmful side effects. Such minimally invasive techniques can be performed through natural orifices in the patient's anatomical structure or through one or more surgical incisions. Clinicians can insert minimally invasive medical instruments (including surgical instruments, diagnostic instruments, therapeutic instruments or biopsy instruments) through these natural orifices or incisions to reach the target tissue position. In order to assist in reaching the target tissue position, the position and movement of the medical instrument can be related to the preoperative image or intraoperative image of the patient's anatomical structure. In the case where the image-guided instrument is related to the image, the instrument can navigate the natural or surgically created pathways in the anatomical system (such as the lungs, colon, intestines, kidneys, heart, circulatory system, etc.). Traditional instrument tracking and reference systems may require the use of patient pads during preoperative and surgical imaging, and may interfere with the clinical environment or workflow. Systems and methods for performing image-guided surgery with minimal clinical interference are needed. Summary of the invention

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

[0007] However, an exemplary method may include: segmenting a set of first modality image data representing a model of one or more pathways in a patient; and generating a first point set based on the set of segmented first modality image data representing the model of the one or more pathways. The method may also include: determining a matching set between a second point set and the first point set, wherein the second point set is obtained by a second modality; and discarding a subset of the matching set based on the first heuristic to generate a modified matching set.

[0008] Another exemplary method may include: receiving a model point set of a model of one or more pathways of a patient; and receiving a set of measurement points collected from within the patient pathway, each point comprising coordinates within a surgical environment occupied by the patient. A weight may be assigned to one or more measurement points. The method may also include: matching each measurement point with a model point to produce a set of matches, the value of each match depending on the assigned weight of the measurement point in the match; and moving the set of measurement points relative to the set of model points based on the match set.

[0009] Another exemplary method may include: receiving a set of measurement points collected from within a patient pathway, each point comprising coordinates within a surgical environment occupied by a patient; and identifying features of the patient pathway based on the set of measurement points. The method may also include the following steps or operations: identifying features corresponding to the identified features in a model of the patient pathway obtained prior to receiving the set of measurement points; and performing an initial registration of the set of measurement points with a set of modeling points obtained from the model.

[0010] Additional exemplary methods may include: accessing a model point set of a model of one or more pathways of a patient; detecting a point collection condition in data obtained from a catheter; initiating collection of a measurement point set; and performing a point set registration algorithm using the model point set and the measurement point set.

[0011] Another additional exemplary method may include: receiving a model point set of a model of one or more pathways of a patient; and receiving a first set of measured points collected from within the pathway of the patient, each point including coordinates within a surgical environment occupied by the patient. The method may also include the following operations: generating a first registration between the set of measured points and the set of model points; generating a second registration between the second set of measured points and the set of model points; and then determining whether to implement the second registration to replace the first registration.

[0012] Another exemplary method may include: receiving a model point set of a model of one or more pathways of a patient; and determining a state of a catheter located within the one or more pathways of the patient. When the state of the catheter satisfies a condition, the method may further include: collecting a set of measured points from within the patient pathway, each point including coordinates within a surgical environment occupied by the patient; and then generating a registration between the set of measured points and the set of model points.

[0013] Yet another exemplary method may include: receiving a model point set of a model of one or more pathways of a patient; and receiving a first set of measured points collected from within the pathway of the patient, each point comprising coordinates within a surgical environment occupied by the patient. The method may also include: generating a first registration between the set of measured points and the set of model points; detecting movement of the patient; and generating a second registration between a second set of measured points and the set of model points.

[0014] It should be understood that the foregoing general description and the following detailed description are exemplary and explanatory in nature, and are intended to provide an understanding of the present disclosure without limiting the scope of the present disclosure. In this regard, other aspects, features and advantages of the present disclosure will be apparent to those skilled in the art based on the following detailed description. BRIEF DESCRIPTION OF THE DRAWINGS

[0015] Various aspects of the present disclosure are best understood in light of the following detailed description when read in conjunction with the accompanying drawings. It should be emphasized that, in accordance with standard practice in the industry, the various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or decreased for discussion. In addition, the present disclosure may repeat reference numerals and / or letters in the various examples. Such repetition is for simplicity and clarity and does not in itself indicate a relationship between the various embodiments and / or configurations discussed.

[0016] Figure 1 A remotely operated medical system according to an embodiment of the present disclosure.

[0017] Figure 2A A medical instrument system utilizing aspects of the present disclosure is shown.

[0018] Figure 2B A medical tool having an extension according to an embodiment of the present disclosure is shown. Figure 2A The remote end of the medical instrument system.

[0019] Figure 3 Shown is the location of the human lung Figure 2A The remote end of the medical instrument system.

[0020] Figure 4 is a flow chart illustrating a method for providing guidance in image-guided surgery according to an embodiment of the present disclosure.

[0021] Figure 5A , Figure 5B and Figure 5C Steps in a segmentation process for generating a human lung model for registration according to an embodiment of the present disclosure are shown.

[0022] Fig. 6A and Figure 6Bis a side view of a patient coordinate space including a medical instrument mounted on an insertion assembly according to an embodiment of the present disclosure.

[0023] Figure 6C is a side view of a patient in patient coordinate space including an endotracheal tube according to an embodiment of the present disclosure.

[0024] Fig.6D Including according to various aspects of the present disclosure Figure 6C Illustration of the interior surface of an endotracheal tube.

[0025] Figure 7 A flow chart illustrating a portion of an image-guided surgical procedure according to an embodiment of the present disclosure is shown.

[0026] Figure 8 Shown are two point sets representing anatomical structures that are to be registered as part of an image-guided surgical procedure in accordance with an embodiment of the present disclosure.

[0027] Fig. 9 The seeding process of image-guided surgery according to an embodiment of the present disclosure is shown.

[0028] Fig.10 The registration of two point sets resulting from a registration technique according to an embodiment of the present disclosure is shown.

[0029] Fig.11A , Fig. 11B , Fig. 11C , Fig.11D , Fig.11E , Fig.11F , Fig.11G and Fig.11H Various methods for registering two point sets representing a patient's anatomy are shown in accordance with embodiments of the present disclosure.

[0030] Fig.12 The display stage of the registration technique according to an embodiment of the present disclosure is shown.

[0031] Fig.13 A point pool stored in a memory according to an embodiment of the present disclosure is shown.

[0032] Fig.14 A flow chart illustrating a portion of an image-guided surgical procedure according to an embodiment of the present disclosure is shown. DETAILED DESCRIPTION

[0033] Many specific details are set forth in the following specific embodiments of various aspects of the present invention, so as to provide a full understanding of the disclosed embodiments. However, it will be appreciated by those skilled in the art that embodiments of the present disclosure may be implemented without these specific details. In other cases, well-known methods, procedures, components and circuits are not described in detail to avoid unnecessarily obscuring various aspects of embodiments of the present invention. Also, in order to avoid unnecessary descriptive repetition, one or more components or actions described according to an illustrative embodiment may be used or omitted when applicable according to other illustrative embodiments.

[0034] The following embodiments will describe the instrument and the instrument part according to the state of various instruments and instrument parts in three-dimensional space. As used herein, the term "position" refers to the position of an object or a part of an object in three-dimensional space (e.g., along the three translational degrees of freedom of Cartesian x-coordinates, y-coordinates and z-coordinates). As used herein, the term "orientation" refers to the rotational placement of an object or a part of an object (three rotational degrees of freedom-e.g., roll, pitch and yaw). As used herein, the term "attitude" refers to the position of an object or a part of an object in at least one translational degree of freedom and the orientation of an object or a part of an object in at least one rotational degree of freedom (up to a total of six degrees of freedom). As used herein, the term "shape" refers to a group of attitudes, positions or orientations measured along an object.

[0035] Refer to the attached figure Figure 1 A remotely operated medical system, such as for a surgical procedure, a diagnostic procedure, a therapeutic procedure, or a biopsy procedure, is generally indicated by reference numeral 100. Figure 1 As shown, teleoperation system 100 generally includes a teleoperation manipulator assembly 102 for operating medical instruments 104 while performing various procedures on a patient P. Assembly 102 is mounted to or near an operating table O. A master assembly 106 allows a clinician or surgeon S to observe the intervention site and control the slave manipulator assembly 102.

[0036] The main assembly 106 may be located at a surgeon's console, which is typically located in the same room as the operating table O. However, it should be understood that the surgeon S may be located in a different room or a completely different building from the patient P. The main assembly 106 typically includes one or more control devices for controlling the manipulator assembly 102. The control device may include any number of various input devices, such as a joystick, a trackball, a data glove, a trigger gun, a manual controller, a voice recognition device, a body motion or presence sensor, etc. In some embodiments, the control device will be provided with the same degrees of freedom as the associated medical instrument 104, so as to provide the surgeon with a sense of telepresence, or the sense that the control device is integrated with the instrument 104, so that the surgeon has a strong sense of directly controlling the instrument 104. In other embodiments, the control device may have more or less degrees of freedom than the associated medical instrument 104, and still provide telepresence to the surgeon. In some embodiments, the control device is a manual input device that moves with six degrees of freedom and may also include an actuatable handle for actuating the instrument (e.g., for closing the grasping jaws, applying an electric potential to an electrode, delivering a drug treatment, etc.).

[0037] The teleoperation assembly 102 supports the medical instrument system 104 and may include a kinematic structure of one or more non-servo-controlled links (e.g., one or more links that can be manually positioned and locked in place, generally referred to as a setup structure) and a teleoperation manipulator. The teleoperation assembly 102 includes a plurality of actuators or motors that drive inputs on the medical instrument system 104 in response to commands from a control system (e.g., the 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 natural or surgically created anatomical orifice. Other motorized drive systems may move the distal end of the medical instrument with multiple degrees of freedom, which may include three linear motions (e.g., linear motion along the X, Y, Z Cartesian axes) and three rotational motions (e.g., rotation around the X, Y, Z Cartesian axes). Additionally, the motors may be used to actuate an articulated end effector of the instrument for grasping tissue in the jaws of a biopsy device, etc. Motor position sensors (such as resolvers, encoders, potentiometers, and other mechanisms) can provide sensor data describing the rotation and orientation of the motor shaft to the remote operation assembly. This position sensor data can be used to determine the motion of an object manipulated by the motor.

[0038] The teleoperated medical system 100 also includes a sensor system 108 having one or more subsystems for receiving information about the instruments of the teleoperated assembly. Such subsystems may include: a positioning / position sensor system (e.g., an electromagnetic (EM) sensor system); a shape sensor system for determining the position, orientation, speed, velocity, posture, and / or shape of the catheter tip and / or one or more sections along the flexible body of the instrument system 104; and / or a visualization system for capturing images from the distal end of the catheter system.

[0039] Visualization systems (e.g. Figure 2A The visualization system 231) may include a viewing scope component that records simultaneous or real-time images of the surgical site and provides the images to the clinician or surgeon S. For example, the simultaneous images may be two-dimensional or three-dimensional images captured by an endoscope located within the surgical site. In this embodiment, the visualization system includes an endoscope assembly that may be integrally or removably coupled to the medical instrument 104. However, in alternative embodiments, a separate endoscope attached to a separate manipulator assembly may be used with the medical instrument to image the surgical site. The visualization system may be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which may include a processor of the control system 112 (described below). Instructions executable by the processor of the control system 112 include instructions corresponding to the processes disclosed herein.

[0040] The teleoperated 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 generated by the subsystems of the sensor system 108. The display 110 and the operator input system 106 may be oriented so that an operator may control the medical instrument system 104 and the operator input system 106 using the perception of the telepresentation.

[0041] The display system 110 may also display images of the surgical site and medical instruments captured by the visualization system. The display 110 and controls may be oriented so that the relative positions of the imaging device and medical instruments in the scope assembly are similar to the relative positions of the surgeon's eyes and hands, so the operator can manipulate the medical instruments 104 and manual controls as if viewing the workspace in a substantially realistic rendering. Realistic rendering means that the rendering of the image is a realistic perspective image that simulates the viewpoint of the operator physically manipulating the instrument 104.

[0042] Alternatively or additionally, the display 110 can present an image of the surgical site recorded preoperatively or intraoperatively using image data from an imaging technique such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermography, impedance imaging, laser imaging, or nanotube x-ray imaging. The preoperative or intraoperative image data can be presented as a two-dimensional, three-dimensional, or four-dimensional (e.g., including time-based or velocity-based information) image, or as an image from a model created from a preoperative or intraoperative image data set.

[0043] In some embodiments, which are generally used for image-guided surgery, the display 110 can display a virtual navigation image in which the actual position of the medical instrument 104 is registered (i.e., dynamically referenced) with a preoperative or concurrently generated image / model so as to present a virtual image of the internal surgical site to the clinician or surgeon S from the viewpoint of the tip position of the instrument 104. An image of the tip of the instrument 104 or other graphical or alphanumeric indicators can be superimposed on the virtual image to assist the surgeon in controlling the medical instrument. Alternatively, the instrument 104 may not be visible in the virtual image.

[0044] In other embodiments, the display 110 can display a virtual navigation image in which the actual position of the medical instrument is registered with the preoperative or concurrently generated image so as to present a virtual image of the medical instrument within the surgical site to the clinician or surgeon S from an external viewpoint. An image of a portion of the medical instrument or other graphical or alphanumeric indicators can be superimposed on the virtual image to assist the surgeon in controlling the instrument 104. As described herein, a visual representation of the data points can be presented to the display 110. For example, measured data points, moved data points, registered data points, and other data points described herein may be displayed on the display 110 in a visual representation. The data points can be visually represented in the user interface by a plurality of points or dots on the display, or represented as a rendered model (such as a grid or line model created based on a set of data points). In some embodiments, after each processing operation has been implemented, the visual representation can be refreshed in the display 110 to change the data points.

[0045] The remotely operated 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 implementing 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 programming instructions (e.g., a computer-readable medium storing instructions) for implementing some or all of the methods described according to the various aspects disclosed herein, including instructions for providing pathology information to the display system 110. Although the control system 112 is Figure 1 102 is shown as a single block in the simplified schematic diagram of , but the system may include two or more data processing circuits, with one portion of the processing optionally performed on or near the remote operation component 102, another portion of the processing performed at the operator input system 106, and so on. Any of a variety of centralized or distributed data processing architectures may be employed. Similarly, the programming instructions may be implemented as multiple separate programs or subroutines, or they may be integrated into multiple other aspects of the remote operation system described herein. In one embodiment, the control system 112 supports wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and wireless telemetry.

[0046] In some embodiments, the control system 112 may 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 controller transmits a signal to the operator input system 106. The servo controller(s) may also transmit signals that direct the teleoperation assembly 102 to move the medical instrument system(s) 104, which extend through an opening in the body to an internal surgical site in the patient's body. Any suitable conventional or application specific servo controller may be used. The servo controller may be separate from the teleoperation assembly 102 or integrated with the teleoperation assembly 102. In some embodiments, the servo controller and teleoperation assembly are configured as part of a teleoperation arm cart positioned near the patient's body.

[0047] The control system 112 may also include a virtual visualization system for providing navigation assistance to (one or more) medical instrument systems 104 when used in image-guided surgery. Virtual navigation using the virtual visualization system is based on reference to the preoperative or intraoperative data set of the acquired anatomical pathway. More specifically, the virtual visualization system processes images of the surgical site imaged using imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, temperature recording, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-ray imaging, etc. Software alone or in combination with manual input is used to convert the recorded images into a segmented two-dimensional or three-dimensional synthetic representation of a portion or entire anatomical organ or anatomical region. The image data set is associated with the synthetic representation. The synthetic representation and the image data set describe the various positions and shapes of the pathway and its connectivity. During clinical surgery, images used to generate the synthetic representation may be recorded preoperatively or intraoperatively. In alternative embodiments, the virtual visualization system may 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 produced by the composite representation may represent the static pose of the deformable anatomical region during one or more phases of motion (eg, during the inspiration / expiration cycle of the lungs).

[0048] During the virtual navigation process, the sensor system 108 can be used to calculate the approximate position of the instrument relative to the patient's anatomy. This position can be used to generate a macroscopic (external) tracking image of the patient's anatomy and a virtual internal image of the patient's anatomy. Various systems for using electromagnetic (EM) sensors, fiber optic sensors, or other sensors to align and display medical instruments and preoperatively recorded surgical images (such as surgical images from a virtual visualization system) are known. For example, U.S. Patent Application No. 13 / 107,562 (filed on May 13, 2011) (disclosing "Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery") discloses such a system, and the patent application is incorporated herein by reference in its entirety.

[0049] The remote operation medical system 100 may also include optional operation and support systems (not shown), such as lighting systems, steering control systems, irrigation systems and / or suction systems. In alternative embodiments, the remote operation system may include more than one remote operation assembly and / or more than one operator input system. The exact number of manipulator assemblies will depend on factors such as the space limitations in the surgical operation and the operating room. The operator input systems may be arranged in parallel or they may be located in separate locations. Multiple operator input systems allow more than one operator to control one or more manipulator assemblies in various combinations.

[0050] Figure 2A A medical instrument system 200 is shown that can be used as the medical instrument system 104 in an image-guided medical procedure performed using the teleoperated medical system 100. Alternatively, the medical instrument system 200 can be used in a non-teleoperated exploratory procedure or a procedure involving a traditional manually operated medical instrument (such as an endoscope). Additionally or alternatively, the medical instrument system 200 can be used to collect (i.e., measure) a set of data points corresponding to locations having anatomical pathways of a patient.

[0051] The instrument system 200 includes a catheter system 202 coupled to an instrument body 204. The catheter system 202 includes an elongated flexible catheter body 216 having a proximal end 217 and a distal end or tip portion 218. In one embodiment, the flexible body 216 has an outer diameter of about 3 mm. Other flexible body outer diameters may be larger or smaller. The catheter system 202 may optionally include a shape sensor 222 for determining the position, orientation, speed, velocity, posture, and / or shape of the catheter tip at the distal end 218 and / or 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) may be effectively divided into segments 224. If the instrument system 200 is a medical instrument system 104 of a remotely operated medical system 100, the shape sensor 222 may be a component of the sensor system 108. If instrument system 200 is manually operated or otherwise used in a non-remotely operated procedure, shape sensor 222 may be coupled to tracking system 230 , which interrogates the shape sensor and processes the received shape data.

[0052] The shape sensor 222 may include an optical fiber aligned with the flexible catheter body 216 (e.g., disposed within an internal passage (not shown) or mounted externally). In one embodiment, the optical fiber has a diameter of approximately 200 μm. In other embodiments, the size may be larger or smaller. The optical fiber of the shape sensor system 222 forms a fiber optic bend sensor for determining the shape of the catheter system 202. In an alternative, an optical fiber including a fiber Bragg grating (FBG) is used to provide stress measurements in a structure in one or more dimensions. Various systems and methods for monitoring the three-dimensional shape and relative position of an optical fiber are described in U.S. Patent Application No. 11 / 180,389 (filed July 13, 2005) (disclosing "Fiber optic position and shape sensing device and method relating thereto"); U.S. Patent Application No. 12 / 047,056 (filed July 16, 2004) (disclosing "Fiber-optic shape and relative position sensing"); and U.S. Patent No. 6,389,187 (filed June 17, 1998) (disclosing "Optical Fiber Bend Sensor"), which are incorporated herein by reference in their entirety. In alternative embodiments, the sensor may employ other suitable stress sensing techniques, such as Rayleigh scattering, Raman scattering, Brillouin scattering, and fluorescence scattering. In other alternative embodiments, other techniques may be used to determine the shape of the catheter. For example, a history of the distal tip attitude of the catheter may be used to reconstruct the shape of the device over a time interval. As another example, historical posture, position or orientation data of known points of the instrument system along an alternating motion (such as breathing) cycle can be stored. This stored data can be used to develop shape information about the catheter. Alternatively, a series of position sensors (such as electromagnetic (EM) sensors) positioned along the catheter can be used for shape sensing. Alternatively, a historical record of data from position sensors (such as EM sensors) on the instrument system during surgery can be used to represent the shape of the instrument, especially if the anatomical pathway is generally static. Alternatively, a wireless device whose position or orientation is controlled by an external magnetic field can be used for shape sensing. The historical record of the position of the wireless device can be used to determine the shape of the navigation pathway.

[0053] Optionally, the medical instrument system may include a position sensor system 220. The position sensor system 220 may be a component of an EM sensor system, wherein the sensor 220 includes one or more conductive coils that may be subjected to an externally generated electromagnetic field. Each coil of the EM sensor system 220 then generates an induced electrical signal, the characteristics of which depend on the position and orientation of the coil relative to the externally generated electromagnetic field. In one embodiment, the EM sensor system may be configured and positioned to measure six degrees of freedom (e.g., three position coordinates X, Y, Z and three orientation angles of pitch, yaw and roll indicating a base point) or five degrees of freedom (e.g., three position coordinates X, Y, Z and two orientation angles of pitch and yaw indicating a base point). Further description of the EM sensor system is provided in U.S. Patent No. 6,380,732 (filed on August 11, 1999) (disclosing "Six-Degree of Freedom Tracking System Having a Passive Transponder on the Object Being Tracked"), which patent application is incorporated herein by reference in its entirety. In some embodiments, the shape sensor can also be used as a position sensor because the shape of the sensor and information about the position of the base of the shape sensor (in the patient's fixed coordinate system) allow the position of various points along the shape sensor (including the distal tip) to be calculated.

[0054] The tracking system 230 may include a position sensor system 220 and a shape sensor system 222 for determining the position, orientation, velocity, posture, and / or shape of the distal end 218 and one or more segments 224 along the instrument 200. The tracking system 230 may be implemented as hardware, firmware, software, or a combination thereof that interacts with or is otherwise executed by one or more computer processors, which may include a processor of the control system 116.

[0055] The flexible catheter body 216 includes a channel 221 sized and shaped to receive a medical instrument 226. For example, the medical instrument may include an image capture probe, a biopsy instrument, a laser ablation fiber, or other surgical tools, diagnostic tools, or therapeutic tools. The medical tool may include an end effector (such as a scalpel, a blunt blade, an optical fiber, or an electrode) having a single working member. For example, other end effectors may include forceps, graspers, scissors, or clip applicators. Examples of electrically activated end effectors include electrosurgical electrodes, transducers, sensors, and the like. In various embodiments, the medical tool 226 may be an image capture probe including a distal portion having a stereoscopic or monoscopic camera at or near the distal end 218 of the flexible catheter body 216 for capturing images (including video images) processed by the visualization system 231 for display. The image capture probe may include a cable connected to the camera for transmitting the captured image data. Alternatively, the image capture instrument may be a fiber bundle (such as a fiberscope) connected to the visualization system. The image capture instrument may be monospectral or multispectral, for example capturing image data within one or more of the visible, infrared, or ultraviolet spectrum.

[0056] The medical instrument 226 may accommodate cables, linkages, or other actuation controls (not shown) extending 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 (filed on October 4, 2005) (disclosing "Articulated Surgical Instrument for Performing Minimally Invasive Surgery with Enhanced Dexterity and Sensitivity"), and U.S. Patent Application No. 12 / 286,644 (filed on September 30, 2008) (disclosing "Passive Preload and Capstan Drive for Surgical Instruments"), which are incorporated herein by reference in their entirety.

[0057] The flexible catheter body 216 may also house a cable, a linkage, or other steering control device (not shown) extending between the housing 204 and the distal end 218, so as to controllably bend the distal end 218, for example, as shown by the dashed line depiction 219 of the distal end. A steerable catheter is described in detail in U.S. Patent Application No. 13 / 274,208 (filed on October 14, 2011) (disclosing "Catheter with Removable Vision Probe"), which is incorporated herein by reference in its entirety. In embodiments where the instrument system 200 is actuated by a remotely operated assembly, the housing 204 may include a drive input that is removably coupled to a motorized drive element of the remotely operated assembly and receives power from it. In embodiments where the instrument system 200 is manually operated, the housing 204 may include a gripping feature, a manual actuator, or other components for manually controlling the movement of the instrument system. The catheter system may be steerable, or alternatively, the system may be non-steerable, where there is no integrated mechanism for operator control of instrument bending. Additionally or alternatively, one or more lumens are defined in the wall of the flexible body 216 through which medical instruments may be deployed and used at the target surgical site.

[0058] In various embodiments, the medical instrument system 200 may include a flexible bronchial instrument (such as a bronchoscope or bronchial catheter) for inspection, diagnosis, biopsy, or treatment of the lungs. The system 200 is also suitable for navigating and treating other tissues through natural or surgically created connected pathways in any of a variety of anatomical systems, including the colon, intestines, kidneys and calyces, brain, heart, circulatory system including blood vessels, etc.

[0059] Information from the tracking system 230 may be sent to the navigation system 232 where it is combined with information from the visualization system 231 and / or preoperatively acquired models to provide real-time position information to the surgeon or other operator on the display system 110 for controlling the instrument 200. The control system 116 may utilize the position 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 and published, “Medical System Providing Dynamic Registration of a Model of an Anatomic Structure for Image-Guided Surgery,” which is incorporated herein by reference in its entirety.

[0060] exist Figure 2A In the embodiment of the present invention, the instrument 200 is remotely operated within the teleoperation medical system 100. In alternative embodiments, the remote operation assembly 102 can be replaced by a direct operator control device. In the direct operation alternative, various handles and operator interfaces can be included for handheld operation of the instrument.

[0061] In alternative embodiments, the teleoperation system may include more than one slave manipulator assembly and / or more than one master assembly. The exact number of manipulator assemblies will depend on factors such as the medical procedure and space limitations within the operating room. The master assemblies may be arranged side by side or they may be positioned in separate locations. Multiple master assemblies allow more than one operator to control one or more slave manipulator assemblies in various combinations.

[0062] like Figure 2B As shown in more detail in FIG, (one or more) medical tools 228 for processes such as surgery, biopsy, ablation, illumination, irrigation or aspiration can be deployed through the channel 221 of the flexible body 216 and used at the target location within the anatomical structure. For example, if the tool 228 is a biopsy instrument, it can be used to remove sample tissue or cell sampling from the target anatomical location. The medical tool 228 can also be used with an image capture probe within the flexible body 216. Alternatively, the tool 228 itself can be an image capture probe. The tool 228 can be advanced from the opening of the channel 221 to perform the process and then retracted into the channel when the process is completed. The medical tool 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.

[0063] Figure 3 A catheter system 202 is shown positioned within an anatomical passage of a patient's anatomy. In this embodiment, the anatomical passage is an airway of a human lung 201. In alternative embodiments, the catheter system 202 may be used in other passages of the anatomy.

[0064] Figure 4 4 is a flow chart illustrating a general method 450 for image-guided surgery. At process 452, preoperative or intraoperative image data is obtained from an imaging technique such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermography, impedance imaging, laser imaging, or nanotube x-ray imaging. The preoperative or intraoperative image data may correspond to a two-dimensional, three-dimensional, or four-dimensional (e.g., including time-based or velocity-based information) image. For example, the image data may represent Figure 3 201 of a human lung. At process 454, computer software, either alone or in combination with manual input, is used to convert the recorded image into a segmented two-dimensional or three-dimensional synthetic representation or model of a portion or entire anatomical organ or anatomical region. The synthetic representation and image data set describe the various locations and shapes of the pathway and its connectivity. More specifically, during the segmentation process, the image is divided into segments or elements (e.g., pixels or voxels) that share certain characteristics or computational properties (such as color, density, intensity, and texture). The segmentation process results in a two-dimensional or three-dimensional reconstruction that forms a model of the target anatomical structure based on the acquired image. In order to represent the model, the segmentation process can depict a set of voxels representing the target anatomical structure, and then apply a function (such as a marching cube function) to generate a 3D surface of closed voxels. The model can be made by generating a grid, volume, or voxel map. Additionally or alternatively, the model can include a centerline model that includes a collection of interconnected line segments or points extending through the center of the modeled pathway. In the case where the model includes a centerline model containing a set of interconnected line segments, those line segments can be converted into a point cloud or point set. By converting the line segments, the points corresponding to the interconnected line segments can be selected manually or automatically. At process 456, the anatomical model data is registered with the patient's anatomical structure before and / or during the image-guided surgical procedure on the patient. Generally, registration involves matching the measured points with the points of the model using rigid and / or non-rigid transformations. The measured points can be generated using landmarks in the anatomical structure, electromagnetic coils scanned and tracked during surgery, or shape sensor systems. The measured points can be generated for the iterative closest point (ICP) technique described in detail elsewhere in FIG. 6 and in the present disclosure. Other point set registration methods can also be used in the registration process within the scope of the present disclosure.

[0065] Other registration methods for use with image-guided surgery typically involve the use of techniques based on electromagnetic or impedance sensing. Metal objects or certain electronic devices used in the surgical environment may produce interference that impairs the quality of the sensed data. Other registration methods may hinder clinical workflow. The systems and methods described below perform ICP-based registration, or another point set registration algorithm, and calibration movement of a point collection instrument with a fiber optic shape sensor, thereby eliminating or minimizing interruptions in the surgical environment. Other registration techniques can be used to align the measured point set with a preoperative model or a model obtained using another modality. In the embodiments described below, EM sensors on the patient and the instrument and the optical tracking system of the instrument can be eliminated.

[0066] Figure 5A , Figure 5B and Figure 5C Shows Figure 4 Some steps of the general method 450 are shown. Figure 5A A segmented model 502 of a set of anatomical pathways created from preoperative or intraoperative imaging data is shown. In this embodiment, the pathways are airways of a human lung. The segmented model 502 may not include all pathways present within a human lung due to naturally occurring limitations or limitations set by an operator. For example, relatively narrow and / or distal pathways of a lung may not be fully included in the segmented model 502. The segmented model 502 may be a three-dimensional model (such as a mesh model) that includes walls defining lumens or pathways of the lung.

[0067] Based on the segmentation model 502, such as Figure 5B As shown, a centerline segmented model 504 can be generated. The centerline segmented model 504 can include a set of three-dimensional straight lines or a set of curves that correspond to the approximate center of the passage contained in the segmented model 502. The higher the resolution of the model, the more accurately the set of straight lines or curves correspond to the center of the passage. Representing the lungs with the centerline segmented model 504 can provide a smaller data set that can be more efficiently processed by one or more processors or processing cores compared to the data set representing the segmented model 502 of the passage wall. In this way, the operation of the control system 112 can be improved. As shown in FIG. Figure 5B As shown, the centerline segment model 504 includes several branch points, some of which are Figure 5B504. The trachea in the model is highlighted for viewing. Branch points A, B, C, D and E are shown at each of the branch points. Branch point A can represent the point where the trachea in the model is divided into left and right main bronchi. The right main bronchus can be identified in the centerline model 504 as being located between branch points A and B. Similarly, the secondary bronchus is identified by branch points B and C and is identified between branch points B and E. Another generation can be defined between branch points C and D. Each of these generation can be associated with a representation of the lumen diameter of the corresponding passage. In some embodiments, the centerline model 504 can include an average diameter value for each segmented generation. The average diameter value can be a patient-specific value or a more general value derived from multiple patients.

[0068] In other embodiments, the segmented model 502 may be used to generate the centerline segment 504 or another suitable model including a point cloud, point set, or point collection as follows. When the segmented model 502 includes a mesh representing the interior surface of one or more passages, a subset of the vertices of the mesh represented in the stored data file including the model 502 may be used. Alternatively, the geometric centers of the voxels representing the volumes or passages in the segmented model 502 may be used. Additionally, a combination of various methods may be used to generate the first point set (such as the centerline segment model 504). For example, a subset of the vertices of the mesh may be used together with the geometric centers of the voxels from the model.

[0069] In some embodiments, the centerline segment model 504 is represented in data as a point cloud, point set, or collection of points in three-dimensional space, rather than as a continuous line. Figure 5C The centerline segment model 504 is shown as a point set 506. In the data, each point in the model point set may include a set of coordinates such as M , Y M and Z M , or other coordinates identifying the location of each point in three-dimensional space. In some embodiments, each point may include a generation identifier that identifies which pathway generation the point is associated with and / or a diameter value or radius value associated with that portion of the centerline segment model 504. In some embodiments, information describing the radius or diameter associated with a given point may be provided as part of a separate data set.

[0070] The centerline segment model is generated 504 and stored in the data as Figure 5C After the point set 506 is shown, the centerline segmented model 504 can be retrieved from the data storage device for use in image-guided surgery. In order to use the centerline segmented model 504 in image-guided surgery, the model 504 can be registered to associate the modeled pathways in the model 504 with the actual anatomy of the patient present in the surgical environment. Using the model 504 in point set registration includes using the point set 506 from the model 504.

[0071] Fig. 6A and Figure 6B An exemplary surgical environment 600 is shown, according to some embodiments, where the surgical coordinate system is X S , Y S , Z S , where the patient P is located on the platform 602. The patient P may be stationary within the surgical environment in the sense that large-scale patient movement is limited by sedation, restraint or other means. Cyclic anatomical movements including breathing and cardiac movement of the patient P can continue unless the patient is required to hold his or her breath to temporarily suspend respiratory movement. Therefore, in some embodiments, data can be collected at a specific direction stage in breathing, and the stage is used to mark and identify the data. In other embodiments, the stage of collecting data can be inferred based on physiological information collected from the patient. Within the surgical environment 600, the point collection instrument 604 is connected to the instrument bracket 606. In various embodiments, the point collection instrument 604 can use EM sensors, shape sensors and / or other sensor modalities. The instrument bracket 606 is mounted to an insertion table 608 fixed within the surgical environment 600. Alternatively, the insertion table 608 can be movable, but has a known position in the surgical coordinate system (e.g., by tracking sensors or other tracking devices). The instrument carriage 606 may be a component of a teleoperated manipulator assembly (eg, assembly 102) that is coupled to the instrument 604 to control insertion motion (ie, movement along the X axis). S The instrument carriage 606 or insertion stage 608 may include a servo motor (not shown) that controls the movement of the instrument carriage along the insertion stage.

[0072] The point collection instrument 604 can include a flexible catheter 610 coupled to a proximal rigid instrument body 612. The rigid instrument body 612 is coupled to and fixed relative to the instrument bracket 606. In the illustrated embodiment, a fiber optic shape sensor 614 is fixed at a proximal point 616 on the rigid instrument body 612. In alternative embodiments, the point 616 of the sensor 614 can be moved along the body 612, but the location of the point can be known (e.g., by a tracking sensor or other tracking device). The shape sensor 614 measures the shape from the point 616 to another point (such as the distal end 618 of the catheter 610). The point collection instrument 604 can be substantially similar to the medical instrument system 200.

[0073] When the rigid instrument body 612 moves on the insertion stage 608 along the insertion axis A, the position measurement device 620 provides information about the position of the rigid instrument body 612. The position measurement device 620 may include resolvers, encoders, potentiometers and other mechanisms that determine the rotation and orientation of the motor shaft that controls the movement of the instrument bracket 606 and thus determines the movement of the rigidly attached instrument body 612. In this embodiment, the insertion stage 608 is linear, but in alternative embodiments, it can be curved or have a combination of curved and linear portions. Optionally, the linear track can be foldable, such as described in U.S. Provisional Patent Application No. 62 / 029,917 (filed on 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. Fig. 6A The instrument body 612 and the bracket 606 are shown in a retracted position along the insertion stage 608. In this retracted position, the proximal point 616 is at a position L0 on the axis A. In this position along the insertion stage 608, the X coordinate of the position of the point 616 is S The component can be set to zero or an initial value. In this retracted position of the instrument body 612 and the bracket 606, the distal end 618 of the catheter can be located just inside the access port of the patient P. Also in this position, the position measurement device can be set to zero or an initial value (e.g., I=0). Figure 6B , the instrument body 612 and the carriage 606 have been advanced along the linear track of the insertion table 608, and the distal end of the catheter 610 has been advanced into the patient P. In this advanced position, the proximal point 616 is at position L1 on the axis A.

[0074] Embodiments of the point collection instrument 604 may use any number of modalities, including EM sensing and shape sensing, to collect measurement points. When the measurement points are collected from inside the patient pathway, the points are stored in a data storage device, such as a memory. The set of measurement points may be stored in a database that includes at least some of the measurement points obtained during or immediately before surgery, but may also include all of the measurement points. When stored in the memory, each point may be represented by data including the coordinates of the point, a timestamp, and a relative sensor position or a separate sensor ID (when multiple sensors distributed along the length of the point collection instrument 604 are used to simultaneously determine the positions of several points). In some embodiments, the data representing each point may also include a respiratory phase flag that indicates the patient's respiratory phase when the point was collected.

[0075] Figure 77 is a flow chart illustrating a method 700 for providing guidance to a clinician during an image-guided surgical procedure on a patient P in a surgical environment 600 according to an embodiment of the present disclosure. Figure 7 700 is shown as a set of boxes, steps, operations or processes. Not all of the operations shown or enumerated may be performed in all embodiments of method 700. Additionally, Figure 7 Some additional operations not explicitly shown in the method 700 may be included before, after, between, or as part of the enumerated processes. Some embodiments of the method 700 include instructions corresponding to the processes of the method 700 stored in a memory. These instructions may be executed by a processor (similar to the processor of the control system 112).

[0076] Thus, some embodiments of method 700 may begin at process 702, where a calibration process is performed to calibrate the relative position and / or orientation of sensor reference points along the insertion path using a position measurement device such as point collection instrument 604 or another suitable device. For example, when carriage 606 moves from a retracted position at point 616 at position L0 to an advanced position at point 616 at position L1, a calibration process may be performed using a position measurement device such as point collection instrument 604 or another suitable device. Fig. 6A and Figure 6B The point collection instrument 604 determines the position and orientation of point 616. The calibration process determines the direction of movement of point 616 for each change in the position measurement device 620. In this embodiment, the calibration process determines the direction of the straight line in the case where the insertion table 608 limits the movement of the bracket 606 to a linear path. According to the inclination of the insertion table track, the position and orientation of point 616 in the surgical environment 600 can be determined for each corresponding measurement of the position measurement device 620. In an alternative embodiment, if the insertion table has a curved or nonlinear shape, the calibration process can determine the nonlinear shape so that the position and orientation of point 616 in the surgical environment can be determined for each measurement of the position device. For example, when the instrument body is moved along the nonlinear insertion table, the distal tip of the catheter can remain in a fixed position. When the instrument body is routed along the insertion table, the position and orientation data collected by the shape sensor from the fixed point 616 is correlated with the position measurement device data, thereby calibrating the movement of point 616 along the axis A of the insertion table 608.

[0077] At process 704, the distal end 618 of the catheter 610 passes through the anatomical passage of the patient P (e.g., the airway of the patient's lungs), thereby recording the position data of the distal end of the catheter and / or other points along the shape of the shape sensor through data from the shape sensor 614 or another sensor (such as an EM sensor or a sensor disposed on the catheter 610). As described herein, the position data may include a set of measurement points or be processed to obtain a set of measurement points. More specifically, the movement of the distal tip of the catheter 610 may be controlled by remote operation control, manual control, or automatic control (e.g., by the main component 106) to survey / survey a portion of the anatomical passage.

[0078] For example, the remote operation control signal can cause carriage 606 to move along axis A, thereby causing the distal tip 618 of conduit to advance or retract in anatomical passage. In addition or alternatively, the remote operation control signal can cause the control member extending in the surgical instrument to actuate so as to move the distal tip 618 in a series of movements (including deflection, pitch and roll). When conduit moves in multiple passages, shape sensor data (and / or other position data are collected in other embodiments that do not include sensor) are collected for multiple positions of the distal tip. In certain embodiments, conduit can extend to various passages up to about three inches. In certain embodiments, conduit can extend through or enter the generation of about three branches on each side of the lung. When the diameter of flexible conduit 610 is reduced and / or the flexibility of flexible conduit 610 is increased, the number of generation that can be entered by conduit 610 can be increased.

[0079] refer to Figure 8 In some embodiments, shape sensor data is collected for a set of measurement data points D. Fig.13 As discussed, these measurement points can be stored in memory as a data set or point pool with coordinates, timestamps, sensor IDs, respiratory phase information, etc. for each collection point. As the distal end 618 of the catheter 610 is moved to a plurality of locations within the surgical space 600, a collection of spatial information provided by data points D collected from a shape sensor or other point collection device can be collected. By placing the distal end of the catheter at point D X The information from the position measuring device 620 at the time of X The shape data from the shape sensor at the time is combined to determine the given collected data point D X The position in the surgical environment space 600. Points can also be collected along the length of the catheter. In both cases, data from the position measurement device 620 and the calibrated path of the fixed sensor point 616 provide a position at the distal end 618 of the catheter at point D XThe location of sensor point 616 in the patient surgical environment 600 when the catheter distal end is at D. For example, encoder data from one or more motors controlling the movement of carriage 606 along track 608 and calibration data from the movement of the carriage along the track provide a position of sensor point 616 in the patient surgical environment 600 when the catheter distal end is at D. X The shape sensor provides the shape of the instrument between the fixed sensor point 616 and the distal end 618. X The calibration position measurement data and shape sensor data recorded at the time are used to determine point D X The position in the surgical environment space 600 (where the distal end 618 is located) is determined, and one or more points along the length of the shape sensor may also be used to determine other points D. For all data points D in the collected data point set (i.e., the combination of the calibrated position of the proximal point 616 and the shape sensor data of the position of the distal end 618 relative to the point 616), the position in the surgical environment 600 coordinate space is a reference set of spatial information for the instrument that can be registered with the anatomical model information.

[0080] Reference again Figure 7 , at process 706, one or more of the collected data points D may correspond to a landmark location in the patient's anatomy. In some embodiments, the collected data points D corresponding to the landmarks may be used in a scattering registration process (such as an ICP process). In some embodiments of method 700, process 706 may not be performed, and an automatic seed generation algorithm may be used in place of process 706. Additionally, some embodiments of the ICP process may not include a scattering process. This subset of collected data points D corresponding to one or more landmarks may be referred to as seed points. When stored in a memory, data representing a subset of collected data points D corresponding to a landmark may include a landmark indicator. Reference Fig. 9 , a set of anatomical pathways 900 includes main carinas C1, C2, C3 where the pathways 900 bifurcate. By moving the distal end of the catheter to the corresponding carina position, data points D can be collected for the position of each carina. For example, data point D can be collected at carina C1 L1 Data point D can be collected at carina C2 L2 Data point D can be collected at carina C3 L3 As above for point D X As described, a carina or other suitable landmark may be located in the patient surgical environment 600 .

[0081] Reference again Figure 7In method 700, anatomical model information is received at process 708. The anatomical model information may be Figure 5C The segmented centerline model 504. Again referring to Fig. 9 , the anatomical model information may be represented as a centerline model 550 of a branched anatomical pathway. In some embodiments, the model may include one or more landmark points to correspond to the seed point D L1 , D L2 and D L3 In some embodiments, included in the model to match the seed point D L1 , D L2 and D L3 These points may not be centerline points, but may be included in the centerline model 550 to facilitate the diffusion of the subsequent registration process. In some embodiments, the centerline model 550 may include more than M L1 、M L2 and M L3 More model landmark points.

[0082] Reference again Figure 7 At process 712, registration of the anatomical model information 550 with the collected data point set D from the surgical environment 600 is performed. The registration can be accomplished using a point set registration algorithm (such as the iterative closest point (ICP) technique described in processes 512-520), or by implementing another registration algorithm. Prior to process 712, at process 710, ICP registration is propagated through known information about the displacement and orientation relationship between the patient's surgical environment and the anatomical model. In this embodiment ( Fig. 9 ), for example, in the anatomical model information, the carina landmarks C1, C2, and C3 are identified as points M L1 、M L2 、M L3 In alternative embodiments, the anatomical model information may be represented in other ways, for example, as centerline segments or axes of a 3D mesh model. L1 , D L2 and D L3 Respectively with the corresponding model point M L1 、M L2 and M L3 Match (ie D L1 With M L1 In the case of point matching, at process 711, the landmark data point D is applied. L1 , D L2 and D L3 With model point M L1 、M L2 and M L3Based on the landmark data point D L1 , D L2 , D L3 and model landmark point M L1 、M L2 、M L3 This determined initial transformation may be applied to all collected data points D. The propagation process provides an initial rough registration of the collected data points D to the anatomical model information 550 based on several landmark points.

[0083] The initial transformation may be a rigid transformation in which all landmark data points are transformed by the same change in position and orientation, or may be a non-rigid transformation in which landmark data points are transformed by different changes in position and orientation. In some embodiments in which the set of measured data points D undergoes rotation about at least one axis, the motion of each individual point may vary due to the arrangement of one or more axes of rotation of the set of data points D.

[0084] The initial transformation performed in the seed phase can be performed based on many different model points and many different measurement points. Similarly, the measurement points used in the seed phase may be provided in many different ways. In some embodiments, a variety of diffusion methods for providing the initial transformation are performed, and the error of each method is checked. The method that provides the minimum error between the anatomical information model 550 and the point set D can be used to start the registration process.

[0085] For example, as described herein, one can use Fig. 9 The main "Y" configuration provided by the trachea and left and right main bronchi is shown. Each of the first three major bifurcation points or carinae C1, C2, and C3 can be identified in the model and in the data point set D. In some embodiments, the process of collecting data points D can cause an identifier to be included as part of the recorded data for certain points for the dissemination process to be included in the data for that point. The identifier can be automatically included as part of the workflow, or the clinician controlling the point collection instrument 604 can use an interface to manually indicate (e.g., by clicking a button) a point defined by the distal end 618 of the catheter 610 that the point collection instrument 604 will use for the dissemination process (i.e., a landmark data point) at a particular time. For example, after inserting the catheter, the clinician can position the distal end 618 at the carina C2 and click a button to capture the location as data point D. L2 In some embodiments using an image sensor located within the passageway of the patient P, the clinician can then navigate to the carina C1 and click a button to capture the location as a data point D L1 The clinician can then navigate to the carina C3 and click a button to capture the location as a data point D L3In some embodiments, the interface of the medical system can guide the clinician to navigate to a specific location, and then confirm by manipulating the interface elements that the distal end 618 is at the specific location, at which point a corresponding data point is collected. The data points collected in this manner can include the coordinates and other information described herein, and can also include an indication that the data point is a seed point or landmark point that can be used in the seeding process to perform an initial coarse transformation.

[0086] Other user interface interactions may be used to trigger one or more data points D X For example, where the medical system includes a speech recognition component, the clinician can speak aloud to identify the current location of the remote end 618 as a seed point, or confirm the collection point as a seed point corresponding to a specific location requested by the workflow. Although in the above example, the medical system provides a workflow to collect data points D for use in the diffusion process L1 , D L2 , D L3 , but in other embodiments, the user may select a preferred landmark (including in addition to Fig. 9 Through the user interface, the clinician can identify the anatomical location of the selected landmark so that the corresponding location in the anatomical model information can be accessed.

[0087] In some embodiments, a sensor disposed at the distal or proximal end of the catheter 610 may be used to trigger data points (including data point D L1 , D L2 and D L3 ) for the dissemination process. For example, as part of the workflow, a medical system can use the first three collected data points D X1 , D X2 and D X3 In such an embodiment, the clinician can navigate to the main carina C1 and cause physical contact between the main carina C1 and the distal end 618. A torque sensor or encoder controlling an actuator at the distal end of the catheter can register the resistance or force against the distal end and trigger a data point D L1 of collection in response.

[0088] In some embodiments, touch sensors (such as capacitive sensors or Hall effect sensors) can be positioned along the flexible instrument to provide an indication when the instrument is close to or in contact with the wall of the anatomical passage. Thus, the touch sensors can provide information about the shape and size of the passage that can be used to identify corresponding features in the model data.

[0089] Although for some embodiments the main carina may be used for the diffusion process, other embodiments may rely on other anatomical features to perform the initial registration. For example, when the distal end 618 of the catheter 610 is passed through an endotracheal (ET) tube used to guide the catheter 610 through the mouth of the patient P, the catheter 610 may conform to a known bend or curve corresponding to the ET tube. Figure 6C and Fig.6D An exemplary ET tube 622 is shown in . Even though the bend 621 in the tube is not precisely known, the curvature may be significant enough to be identified as corresponding to the upper airway and trachea because the portion of the catheter 610 at the proximal end of the ET tube 622 forms a nearly 90° angle relative to the portion of the catheter 610 at the distal end of the ET tube 622. Due to the sensors in the connector of the remote operation assembly 102, the pose of the proximal end of the point collection instrument may be known. Based on this pose information and the curve of the endotracheal tube, which can be easily identified using the shape sensor data, the trachea of ​​the patient P can be identified and used to spread the initial transformation. Although the orientation of the patient P with respect to the point collection instrument 604 may already be known, by navigating the distal end 618 into the left or right mainstem bronchus (e.g., Figure 6C ), additional information that can be used to spread the initial transformation can be collected. For example, by using shape sensor or EM sensor data, information representing a first approximately right angle can be collected between the length of the trachea where the ET tube enters the patient P and the length of the trachea where the ET tube leaves the patient P. The first angle can identify a plane that can be expected to bisect the anatomical model information 550. When the distal end 618 transitions from the trachea to the left mainstem bronchus or the right mainstem bronchus, a second angle defining a second plane can be identified. The first location and the second location are approximately orthogonal. By using the first angle and the second angle, the medical system can identify a right-left orientation of the patient that can be used to spread the alignment process by roughly orienting the data point D with the anatomical model information 550.

[0090] Reference again Figure 6C , which shows Fig. 6A and Figure 6B A close-up view of patient P is shown. Figure 6C An ET tube 622 is shown positioned within a patient P to guide a catheter 610 into the lungs of the patient P. The ET tube 622 includes an inner surface 623, which may include a different color and / or a different pattern.

[0091] In embodiments where an endoscopic camera is incorporated into or used in conjunction with the point collection instrument 604, image information may also be used to provide a seed. For example, the medical system may use image data to determine whether the catheter 610 is in the trachea or another pathway of the patient P. This may be accomplished, for example, by using a camera to monitor changes in anatomical color, texture, or anatomical features associated with changes in anatomical regions (e.g., the tracheal entrance). Alternatively, a camera may be used to monitor changes in color or pattern of the inner surface 623 of the ET tube 622 or movement of the camera past the distal end of the ET tube terminating in the trachea.

[0092] To aid in detecting entry and / or exit of the ET tube by the catheter 610, the ET tube can include a distinguishing color, marking, and / or pattern. For example, the ET tube can be bright green, orange, or another color. In some embodiments, the ET tube can include markings (such as symbols or alphanumeric characters). In some embodiments, the ET tube can include a pattern (such as a striped pattern that alternates between light and dark colors). Additionally, in some embodiments, the ET tube 622 can be coated with a reflective coating. Based on the color, marking, and / or pattern of the ET tube, the medical system can use images obtained by the camera to determine whether the distal end 618 is within the ET tube or has exited into the trachea. Fig.6D An example of an inner surface 623 is shown in . Colors, markings, and / or patterns may also be captured in pre-operative or intra-operative imaging data and thus used as fiducial landmarks during the diffusion process.

[0093] like Fig.6D As shown, inner surface 623A has a solid color. The solid color can be hunter orange, fluorescent green, or any color that is significantly different from machine vision when compared to the naturally existing color of the passage of the patient P. Inner surface 623B shows a pattern of alternating stripes including at least two colors. For example, black and white stripes can be used in some embodiments. Although the stripes of inner surface 623B are all equal, the stripes of inner surface 623C can include stripes of different widths. As shown, the width of the light stripes increases, while the width of the dark stripes is the same. In some embodiments, the width of the light stripes and the dark stripes can vary along the length of the ET tube 622. Although the stripes of inner surfaces 623B and 623C are arranged to be orthogonal to the central axis of the ET tube 622, the inner surface 623D includes stripes that are not orthogonal to the central axis. Surface 623D includes alternating stripes tilted relative to the central axis. In alternative embodiments, the color, mark or pattern can change along the length of surface 623 to provide an indication of the camera insertion depth.

[0094] In other embodiments, the posture of the catheter 610 can be estimated based on the endoscopic image by comparing the expected position with the actual image. For example, during the insertion of a medical instrument (such as an endoscope), a camera image of the main carina can be compared with a virtual segmented representation of the main carina and used to estimate the insertion depth and the roll / roll angle of the endoscope. The roll angle can have two possible solutions 180° apart corresponding to the left and right main bronchus of the patient. In this case, two alignment processes can be initiated, one for each possible solution. The alignment that provides the better result can be maintained and continued, while the other alignment can be discarded.

[0095] Reference again Figure 7 In the method 700, at process 714, after performing an initial rough transformation to start the registration process, the set of measured data points D collected from the interior of the patient P is matched with the anatomical model information 550 ( Fig.10 ). For example, each measurement data point D can be matched to the nearest point in the anatomical model information 550. In this embodiment, the anatomical model information 550 is a set of points along the center line generated from a three-dimensional anatomical model, similar to Figure 5C The segmented model 502 produces a segmented centerline model 504. The registration algorithm identifies matches between the closest points in the collected data points D and the anatomical model point set. In various alternatives, matching can be achieved by using brute force techniques, KD tree techniques, etc. Some matches can be discarded based on maximum distance threshold calculations, maximum angle threshold calculations, or other metrics for filtering out matches that are not considered reliable enough to be included in the model. The anatomical model points can be represented by any of several different types of points (including centerline points, grid points, and / or volume points). In some embodiments, only a subset of the measured data points D matches the point set in the anatomical model. Multiple heuristics can be implemented to determine which points in the measured data points D are included in the subset of measured points.

[0096] At process 716, the motion required to move the collected data point set D to the position and orientation of the matching anatomical model points of the anatomical model information 550 is determined. More specifically, for the collected data point set D, the overall calculated offset of the position and orientation is determined. For example, Figure 8An initial offset of approximately 20° in orientation and approximately 40 mm in displacement between the collected data point D and the anatomical model information 550 is shown. In some embodiments, the calculated corrective motion may be limited so that only a certain degree of rotation may be applied for a certain number of millimeters of displacement in a single iteration of process 712. In some embodiments, while calculating a 20° rotation or reorientation of the anatomical model information 550, the medical system may limit the change in orientation to 10°, 5°, or less. Similarly, in some embodiments, while calculating a 40 mm displacement, the medical system may also limit the displacement available in a single iteration to 20 mm, 10 mm, 5 mm, or less. In some embodiments, the limits may be changed based on the number of iterations performed so that the movement allowed in a later iteration is less than the movement allowed in an earlier iteration.

[0097] At process 718, the collected data point set D is transformed using a rigid transformation or a non-rigid transformation, the transformation applying a calculated offset of displacement and orientation so as to move each point in the collected data point set D. If the calculated offset is greater than the established limit, a limited calculated offset can be applied. In an alternative embodiment, the modeled data points can be transformed by using a rigid or non-rigid transformation, the transformation applying a calculated offset of displacement and orientation so as to move each point in the modeled data point set 550 toward the collected data point D. Therefore, some embodiments of the present disclosure may involve aligning the measured points with the model points, and moving (including translating and / or changing its orientation) the measured points to better align with the model points. These embodiments also include aligning the measured points with the model points, and reorienting the model points to better align with the measured points. In yet another alternative embodiment, the calculated offset can be applied partially to the collected data point set D and partially to the modeled data points 550, so that both point sets are transformed to converge to a common reference system that is different from the coordinate system of the collected data points or the coordinate system of the modeled data points.

[0098] At process 720, the convergence of the collected data points D and the matched anatomical model points 550 is evaluated. In other words, the error factors for orientation and displacement can be determined for each set of matched points. If the total error factor is greater than a threshold, additional iterations of processes 714-720 can be repeated until the overall position and orientation error factor falls below the threshold. Fig.10 The result of this process is shown in . Fig.10The results shown may represent the results of repeating process 712 for multiple iterations. For example, more than 50 iterations may be performed to converge on a satisfactory registration. However, in some embodiments, less than 30 iterations may be required to achieve a satisfactory registration. The registration process including the diffusion process and process 712 may be understood as: directing a set of anatomical model information 550 to a point set D existing in a space defined by a surgical environment; directing point set D to a set of anatomical model information 550 in an anatomical model space; or directing both point set D and a set of anatomical model points 550 to a common space different from the surgical environment or model space.

[0099] The sum of the calculated motions required to minimize the error between the set of measured points D and the anatomical model information 550 may be applied to a model having more details than are present in the anatomical model information 550. Figure 5C After the segmented centerline model 504, the same transformation can be applied to another model, such as Figure 5A Thereafter, a user interface may be presented to the clinician that displays the segmented model 502 or portions thereof along with live information, such as the current position of the catheter within the long passageway of the patient P. The segmented model 502 and live information may be presented in separate windows or screens, or may be overlaid and presented together in a single window.

[0100] The registration process 712 can be recalculated multiple times during the surgical procedure periodically (e.g., once every ten seconds, once every minute, once every five minutes, etc.), and / or in response to pathway deformations caused by cyclic anatomical motion, instrument forces, and / or other changes in the patient's environment or changes in the patient's orientation with respect to the environment (such as through patient movement).

[0101] After registering the anatomical model with the surgical environment, image-guided surgery can optionally be performed. The anatomical model may include details previously captured from the modality that are difficult to use during surgery and are therefore typically captured preoperatively. Figure 8At process 722, during the surgical procedure, the current position of the surgical instrument in the surgical environment is determined. For example, a position sensor (such as an EM sensor) can be used to determine the position of the surgical instrument (and in particular the distal end 618) in the surgical environment 600. Alternatively, data from the position measurement device 620 and the calibrated path of the fixed sensor point 616 provide the position of the sensor point 616 in the patient surgical environment 600 when the catheter is in the current position. The shape sensor or multiple discrete sensors provide the shape of the instrument between the fixed sensor point 616 and the distal end 618. Therefore, the current position of the catheter 610 (and in particular the distal end 618 of the catheter) in the surgical environment space 600 can be determined based on the calibrated position measurement data and shape sensor data.

[0102] At process 724, the previously determined registration transformation is applied to the current instrument position and shape data to localize the current instrument to the anatomical model. For example, the distal end of the instrument (i.e., data point D) is transformed using one or more transformation iterations determined at process 712. current )'s current position and orientation. Therefore, the data point D in the surgical environment 600 is current Transformation to Anatomical Model Space Alternatively, if the model data points have already been transformed to the surgical environment 600 and the catheter 610 is localized in the surgical environment, process 724 may be omitted.

[0103] Optionally, registration allows one or more images to be presented to assist in the image-guided process. For example, an image of a catheter superimposed on a segmented model pathway may be presented. Additionally or alternatively, an internal image of an anatomical pathway within the model may be presented from the perspective of a local distal end of the catheter (i.e., a view just distal to the distal end 618).

[0104] Reference now Fig.11A -H, in which several different rules or heuristics are shown that may be used to select a subset of measurement data points D that are then used to match the anatomical model to calculate corrective motion. By identifying points containing high-quality information and ignoring points that include low-quality information, the control system performing the registration may operate more efficiently. The improved efficiency may allow the registration or re-registration to be updated periodically or in an event-driven manner and minimize delays in the presentation of images used for surgical navigation. In some embodiments, only a subset of the measurement data points are used in the matching process 714. The set of measurement data points 1102 is shown as they relate to the anatomical model 1104 (shown as a collection of segments 1104A-G). Although the segments 1104A-G of the anatomical model 1104 are Fig.11A-H are shown as lines, but these segments 1104A-G may also correspond to a collection of model points (including points 1106A-F) extending along the center of a pathway of a lung or other organ having a pathway.

[0105] like Fig.11A As shown, the set of measurement data points 1102 exhibits a general correlation with the segments of the anatomical model 1104. This correlation may be the result of a registration process or a previous iteration of such a registration process propagation. When calculating the corrective motion by which the measurement points 1102 are transformed to better align with the anatomical model 1104, a plurality of error values ​​may be obtained as part of the process of calculating the motion. In some embodiments, these error values ​​may be distances between matching points. Typically, the minimum error value associated with a particular measurement data point may be a match.

[0106] like Fig.11A As shown, measured data point 1102A matches model point 1106A. Distance 1107 represents the distance or error value associated with the matched pair of measured data point 1102A and model point 1106A. These points can be matched because distance 1107 is the shortest distance between measured data point 1102A and any other model point in anatomical model 1104. Fig.11A Other matches shown include: a match between measured point 1102B and model point 1106B, another match between measured point 1102C and model point 1106C, and another match between measured point 1102D and model point 1106D. Measured point 1102D also matches model point 1106E. The distance between measured point 1102D and model point 1106D and the distance between measured point 1102D and model point 1106E can be the same, or can be substantially similar to be considered the same. For example, when the distance between a measured point and two model points differs by less than a threshold percentage (e.g., 10%, 5%, 3%, etc.), the distances can be considered the same for some purposes. In some embodiments, the distance between model points 1106D and 1106E can be calculated, and as a heuristic, two matches can be discarded when the distance between the model points is greater than the distance between either model point and measured point 1102D, as this can indicate that the two matches are associated with different airways. When the distance between model points is less than the distance between any one model point and a measured point, the matches can be averaged or a single match can be selected. When multiple measured points match a single model point, the measured points can be averaged to create a single average point.

[0107] In order to more effectively and / or more accurately align the measurement data points 1102 with the anatomical model 1104, the influence of some points can be ignored based on one or more heuristics during the calculation of the corrective motion. Matching significance can be the basis for ignoring or discarding measurement points. For example, because measurement point 1102D effectively matches model points 1106D and 1106E, the match can be ignored when calculating the corrective motion. This can be done by ignoring measurement point 1102D. When measurement points are ignored in various algorithms disclosed herein, the measurement points can be temporarily ignored. For example, measurement point 1102D and its associated match with model points 1106D and 1106E may not be factored into the corrective motion determined in one iteration, but may be factored into the corrective motion determined in subsequent iterations. Alternatively, measurement points can be permanently deleted instead of temporarily deleted.

[0108] Measured data point 1102C matches model point 1106C. Model point 1106C is the "end point" because it is the most distal point in segment 1104G (i.e., a segment that is not connected to a subsequent segment at its distal end). In some embodiments, the heuristic provides for ignoring measured points that match the end point of the model for at least one iteration. Fig.11A As shown, the match between point 1102C and point 1106C can be ignored so that it is not factored into the calculation of determining the corrective motion applied to the measurement data point set 1102 (or to the model 1104, depending on which point set is moved relative to the other point set). Measurement points that match the endpoints of the model can be excluded in order to avoid pulling the model toward unsegmented branches, because if the more distal pathways are segmented to generate the model, those measurement points may match the more distal pathways. In some embodiments, all measurement points that match the endpoints on the anatomical model 1104 can be ignored. The anatomical model 1104 used for registration may not represent all pathways of the lung or other anatomical structure. Therefore, measurement points 1102 can be obtained from portions of the lung that are not included in the anatomical model 1104. By selectively ignoring a subset of measurement points that do not correspond well to any point of the anatomical model 1104, the control system 112 can perform the registration of the measurement points 1102 with the anatomical model 1104 more efficiently and accurately. While in some embodiments points ignored for one or more iterations may be considered in subsequent iterations, in other embodiments measured points that match more than one model point or match a terminal model point may be deleted from the set of measured points.

[0109] Additionally, in some cases, the "end point" may be the most proximal point in the segment. For example, assuming segment 1104A is a segment of the model associated with the trachea, the most proximal point would correspond to the beginning of the trachea. For one or more iterations, the point corresponding to the beginning of the trachea may be ignored.

[0110] As another heuristic, the timestamp associated with each measurement point can be used to determine which segment the measurement point is associated with. For example, the timestamp associated with measurement point 1102D, when considered together with the timestamps of other measurement points recorded at approximately the same time, can indicate that the catheter is located in the passage associated with segment 1104D, and may not be located in passage 1104E at this time. Thus, the temporal order of the measurement points can be used to determine whether a given measurement point can be matched to a model point.

[0111] Fig. 11B The set of measurement points 1102 and the anatomical model 1104 are shown after applying a correction motion to transform the measurement point 1102 for the first iteration of the registration process. For subsequent iterations of the registration process, the measurement point 1102A is now matched with the model point 1106F to which it is now closer. After the first iteration, the measurement point 1102E is further away from the segment 1104A. For the first iteration, the measurement point 1102C is matched with the terminal model point 1106C. For subsequent iterations, the measurement point 1102C is matched with a different terminal model point (point 1106G).

[0112] Fig. 11C Another heuristic is shown by which the process 714 of matching measured data points to model points may be optimized to provide a more accurate and efficient registration by the control system 112. Fig. 11C As shown, measurement point 1102F matches model point 1106H. Additional points of measurement point 1102 shown near measurement point 1102F will also match points on model segment 1104G. However, because no measurement point 1102 matches segment 1104C, the match between measurement point 1102F and model point 1106H can be ignored when calculating the correction movement. This can be done based on the following assumption: in order to associate a point with a more distal pathway (a higher generated pathway), a measurement point that matches the pathway immediately preceding (more distal) should be obtained. The pathway immediately preceding can be referred to as the "parent", and the immediately adjacent distal pathway can be referred to as the "child". Here, because no measurement point matches segment 1104C of the anatomical model 1104, the match with the connected but more distal segment 1104G is questionable. In some embodiments, for a specified number of iterations (eg, one or more times), measurement point 1102F may be ignored or may be permanently deleted from measurement point set 1102 .

[0113] And if Fig. 11CAs shown, two measurement points 1102G and 1102H are shown as matching with model points 1106I and 1106J, respectively. Model points 1106I and 1106J are part of model segment 1104E. In some embodiments, another heuristic method can provide that a threshold number of measurement points is required to match a specific model segment before considering matching in calculating the corrective motion. For example, when a threshold of three measurement points is required to match the segment, the matching between measurement points 1102G and 1102H and model points 1106I and 1106J can be ignored respectively. If alternatively, the threshold is one or two measurement points, these matches can be included in the calculation. In various embodiments, the threshold can be 2, 3, 5, 10 or more points, and can depend on the generation of the path modeled by the segment. For example, the threshold associated with segment 1104G can be lower or higher than the threshold associated with segment 1104C because these segments are associated with different generated paths in the anatomical model 1104.

[0114] Reference now Fig.11D , where two associated anatomical models are shown: model 1108 (solid line model) and model 1110 (dashed line model). Anatomical model 1108 is associated with a first breathing phase, while anatomical model 1110 is associated with a second breathing phase. For example, when patient P breathes, the first breathing phase may be a maximum degree of inspiration, and the second breathing phase may be a maximum degree of exhalation. During natural processes in the body, organs (such as lungs) may deform. To compensate for such processes, multiple models may be generated, such as Fig.11D As shown. Fig.11D In FIG. 1 , a set of measurement points 1102 includes points represented by data containing respiratory phase markers. As depicted, point 1102 includes Fig.11D 1102. The points shown as circles in FIG. 1104 and the points shown as crosses in FIG. 1105. The points shown as circles 1106 include a respiratory phase marker indicating inspiration. The points shown as crosses 1107 include a respiratory phase marker indicating exhalation. In some embodiments, there may be a separate set of measurement points stored in memory.

[0115] When point 1102 includes a respiratory phase marker, another heuristic may be to provide that the point is matched to the anatomical model of the corresponding phase. Fig.11DAs shown, although measurement point 1102I is closer to segment 1110B, the medical system matches measurement point 1102I with point 1112A on segment 1108B of anatomical model 1108. This is because measurement point 1102I includes a respiratory phase marker for inspiration, and anatomical model 1108 is a phase model associated with the inspiration phase of breathing. Measurement point 1102J is matched with model point 1114A, which is part of segment 1110B of anatomical model 1110, because point 1102J is an exhalation point (e.g., the data representing point 1102J includes a respiratory phase marker indicating that the data was obtained during exhalation), and anatomical model 1110 is a phase model associated with the exhalation phase. Similarly, because measurement point 1102L is an exhalation point, point 1102L is matched with model point 1114B. Point 1102K is matched with model point 1112B because they are both associated with the inspiration phase.

[0116] In an embodiment where two phases are represented in two models and the measurement points each have a binary phase flag, the Figure 7 Process 712 is performed to align the first stage measurement points with the first stage model and the second stage measurement points with the second stage model. Alternatively, a separate set of measurement points may be aligned with corresponding model points. In the case where the measurement point sets are stored separately in the memory, the data representing the points may not include phase markers. In some embodiments, the phase marker of a given measurement point can be determined by measuring the patient's respiratory phase over time and comparing this information with the timestamp associated with each measurement point. When the timestamp of a given measurement point indicates that the injured point was collected at peak inspiration, the data representing the measurement point can be updated to include appropriate phase markers. Additionally, in some embodiments where the catheter 610 includes a shape sensor, the temporal shape data can be used to determine the respiratory phase and include appropriate markers and measurement data points.

[0117] Reference now Fig.11E and Fig.11F Some embodiments of the medical system may implement a maximum distance threshold heuristic such that measurement points that match model points but whose separation distance is greater than the maximum distance threshold are excluded from the calculation of the iterative correction motion. Fig.11E As shown, the measurement points 1102 have been at least initially registered with the anatomical model 1104 by a scattering process. One or more earlier iterations may also have been performed. In some embodiments, a maximum distance threshold that is generally applied to the anatomical model 1104 can be established. Alternatively, as shown, a different maximum distance threshold is associated with each generation of a pathway in the anatomical model 1104. The maximum distance threshold for each generation can be determined based on features (such as pathway diameter and / or deformability) that affect the likelihood that a point at a given distance from the centerline is a legitimate point rather than an anomaly.

[0118] like Fig.11E As shown, the first maximum distance threshold 1116A is associated with model segment 1104A, the second maximum distance threshold 1116B is associated with model segment 1104B, and the third maximum distance threshold 1116C is associated with model segment 1104D. Because the path represented by model segment 1104C is generated identically to the path represented by model segment 1104B, the second maximum distance threshold 1116B may also be associated with segment 1104C. Similarly, all the paths associated with segments 1104E, 1104F, and 1104G are generated identically to the path associated with segment 1104D. Therefore, the third maximum distance threshold 1116C may also be associated with segments 1104D, 1104F, and 1104G. These maximum distance thresholds 1116A, 1116B, and 1116C may correspond to average path radii obtained from multiple patients, or they may be obtained from a model of a specific patient P.

[0119] In some embodiments, the maximum distance thresholds 1116A, 1116B, and 1116C may be related to an average path radius specifically obtained from the patient P. For example, the maximum distance thresholds 1116A, 1116B, and 1116C may be related to an average path radius specifically obtained from the patient P. Figure 5A The maximum distance threshold is calculated by the passage radius of the segmented model 502 shown. Because the radius of the more distal passage may be less than the radius of the more proximal passage, the maximum distance threshold of the more distal passage can be generally less than the maximum distance threshold of the more proximal passage. In certain embodiments, the maximum distance threshold can be approximately greater than the diameter of the passage (that is, greater than about twice the radius). In certain embodiments, the maximum distance threshold can be approximately one and a half times the passage radius. In certain embodiments, for the trachea, the maximum distance threshold can be approximately 20mm, and for the distal passage, the maximum distance threshold can be as small as about 2mm. In certain embodiments, the maximum distance threshold can decline from the trachea in one or two generations, and then increase again to explain the possibility of increased deformation in the more distal passage.

[0120] like Fig.11E As shown, measurement point 1102M matches a point on segment 1104A. However, the separation distance between measurement point 1102M and segment 1104A is greater than maximum distance threshold 1116A, and thus the match may be ignored when calculating the corrective motion to be applied to measurement point set 1102. Similarly, measurement point 1102N is at a distance greater than maximum distance threshold 1116B from segment 1104C and thus may also be ignored.

[0121] Reference now Fig.11F , which shows the Fig.11EThe results of the corrective motion calculated for the set of measured points 1102 and the anatomical model 1104 are shown. Due to the corrective motion, the measured points 1102M and 1102N are within the maximum distance thresholds 1116A and 1116B, respectively. Therefore, the maximum distance heuristic can include the matches between the measured points 1102M and 1102N and the closest points in the segments 1104A and 1104C, respectively, as a factor in calculating the corrective motion for subsequent iterations.

[0122] The maximum distance threshold may be applied in other ways. For example, the maximum distance threshold may be set depending on generation, or may be set depending on the distance from a particular feature, such as the main carina. The maximum distance threshold may also be calculated depending on the depth of entry into the passage. Thus, the maximum distance threshold at the proximal end of a model segment, such as model segment 1116B, may be greater than the maximum distance threshold at the distal end of the model segment.

[0123] Reference now Fig.11G In some embodiments, if the point collection instrument has not moved for a period of time, multiple points can be measured at a single location or in close proximity. Fig.11G As shown, there is a cluster 1118 of measurement points 1102. Since the cluster includes so many points, the collection of measurement points at the location of cluster 1118 may skew the calculation results so as to determine the corrective motion by including multiple matches. In order to filter out this result, the distance between the measurement points 1102 can be compared to identify the cluster. Alternatively or additionally, a cluster (similar to cluster 1118) can be identified by determining the distance between the points measured in sequence according to the timestamp. This can allow identification of clusters caused by the suspension of the movement of the catheter 610 rather than clusters caused by the narrowing of the passage. As another heuristic, the measurement points and / or associated matches in the cluster 1118 can be ignored. In some embodiments, cluster 1118 can be permanently deleted to avoid having to screen out cluster 1118 in subsequent iterations of the registration process 712.

[0124] Reference now Fig.11H , which shows another heuristic that can be used to match measurement points 1102 to an anatomical model 1104. Fig.11H A plurality of artificial model points 1120 generated based on the anatomical model 1104 are included. For one or more iterations, the artificial model points 1120 may be incorporated into the anatomical model 1104 and then discarded in subsequent iterations. In some embodiments, new artificial model points may be calculated for each iteration. When performing the matching process, one or more artificial points 1120 may be generated based on the measured points and the radius of the matching path. For example, an artificial point 1120A may be generated based on the measured point 1102P. Fig.11HAs shown, the distance between the measured point 1102P and its closest point (point 1106k) on the model segment 1104A is greater than the radius 1122A. Along the line between the model point 1106k and the measured point 1102P, an artificial point 1120A is created at a location that is no more than the radius 112A away from the model point 1106k. Then, for the next iteration, the artificial point 1102A can be added to the model point set. For this iteration, the measured point 1102P is matched with the artificial point 1120A, and the resulting match is used to calculate the corrective motion to be applied to the measured point set 1102.

[0125] like Fig.11H As shown, another artificial model point 1120B is generated along the line connecting the measured point 1102Q to the nearest model point 1106L. Artificial point 1120B is defined along this line at a distance from model segment 1104C equal to radius 112B. Fig.11H As shown, segments 1104A, 1104B, and 1104C include artificial points of artificial model points 1120. Artificial model points 1120 proximate segment 1104A are positioned up to a radial distance 1122A from segment 1104A. Fig.11H 1106k, but the artificial model point 1120 may simulate a two-dimensional plane or volume. For example, when the distance between the measured point 1102P and the model point 1106k is less than the radius 1122A, the distance between the artificial point 1120A and the model point 1106k may be less than the radius 1122A. In such cases, the artificial point 1120A may be located at the same position as the measured point 1102P itself. Other heuristics may then be applied to determine whether the matches between the measured point 1102P and the artificial point 1120A and between the measured point 1102Q and the artificial point 1120B are included in the calculation of the corrective motion. For example, if the distance between the artificial point 1120B and the measured point 1102Q is greater than the maximum threshold distance, the match may be discarded for that iteration.

[0126] In some embodiments, the above heuristics and other heuristics may be used in combination to prevent matching one or more measurement points or to prevent one or more matches from being factored into the calculation of the corrective motion. Thus, the control system 112 may employ heuristics serially (e.g., one heuristic per iteration) or in parallel (e.g., running multiple heuristics in a single iteration).

[0127] In some embodiments, other heuristics can be used to assign weights to the measurement points. Additionally, in some embodiments, the control system 112 can guide the clinician to obtain the measurement points and anatomical models to be used for registration. For example, certain pathways in the upper lobe of each lung can provide particularly reliable and useful information and anatomical models for registration for patients undergoing surgery. Therefore, in some embodiments, the control system 112 can display a user interface to the clinician in the display system 110. The user interface can guide the clinician to turn the catheter to a high information position in the upper lobe of the lung. In some embodiments, one or more measurement points can be ignored so that the measurement points do not match the model points during the matching process. In some embodiments, one or more matches can be ignored so that the match is not included in the calculation of the correction movement. Therefore, heuristics can be applied to points and matches.

[0128] Reference again Figure 7 At process 724, local instruments may be displayed along with the anatomical model to assist the clinician in performing image-guided surgery. Fig.12 A display system 1200 is shown that displays a representation of an anatomical pathway 1202 of a human lung 1204 in a user interface based on anatomical model information. Fig.10 As described in, with the patient's surgical space registered with the model space, the current shape of the catheter 610 and the position of the distal end 618 can be positioned and displayed while presenting the passage 1202. Anatomical model information can be obtained from measurement data points, movement data points, registration data points, and other data points described herein that may be displayed on the display 110 in a visual representation. The data points can be visually represented in the user interface by multiple points or dots on the display, or represented as a rendered model (such as a grid or line model created based on a set of data points). In some embodiments, after each processing operation has been implemented, the visual representation can be refreshed in the display 110 to change the data points.

[0129] like Fig.13 As shown, in some embodiments, the control system 112 can adjust the weights associated with one or more points to change their effect as a factor in the corrective motion calculation. The weights can be adjusted based on one or more factors. Fig.13 1 shows a set of measurement points in a point pool 1300 stored in the memory of the control system 112. The exemplary point pool 1300 contains data representing measurement points obtained from the body of the patient P. In the point pool 1300, each point includes a point identifier, a set of coordinates, a timestamp, a sensor ID, a phase flag, and a weight. Some embodiments may include a timestamp as a point identifier instead of including a separate point identifier. This data may be formatted in many different ways. For example, Fig.13As shown, the phase flag is a binary value, 0 or 1 depending on whether the phase is inspiration or expiration, respectively. In other embodiments, other phase flags may be used. The weights shown in the exemplary point pool 1300 are normalized weights. Some embodiments (such as embodiments using shape sensing catheters) may not include a sensor ID, which may be used by a catheter having multiple EM sensors or multiple other discrete sensors that can be identified to determine the approximate location of the measured data point on the catheter.

[0130] exist Figure 7 In some embodiments of the method 700, the registration process 712 may include an additional process in which the weights of the measurement points are changed according to a parameter or rule. The weights may be changed by adding weights where they did not previously exist or by changing the weights associated with a given measurement point. For example, in some embodiments, relatively high weights may be assigned to recently acquired points. Relatively high weights may be provided by incrementally reducing the weights assigned to points that are not recently acquired as more time passes. Due to movement of the patient, recently measured points may be more accurate, so by weighting recently measured points greater than weights for points that are not recently measured, the registration process 712 may be biased to reflect the latest information. The weights may be normalized weights or non-normalized weights.

[0131] In some embodiments, the weight of a given measurement point may be based on the generation of the path in which the point was obtained. Fig.11A As shown, anatomical model 1104 includes several sections 1104A, 1104B and 1104C and other sections associated with the passage of specific generation. Because trachea is a wider passage, and therefore provides less information for aligning the measurement point with the modeling point, the measurement point matched with section 1104A has a relatively reduced weight. Similarly, the measurement point matched with section 1104C and other measurement points of the same more distal generation can also be assigned a relatively reduced weight. The measurement points associated with the more distal generation can be assigned a smaller weight, because these more distal passages are more likely to be deformed due to the force applied on the passage by the point collection instrument. Section 1104B is associated with a more central passage, which is narrower than section 1104A and is more easily deformed by conduit 610 compared with section 1104C.

[0132] In order to compensate for the deformation that the point collection instrument for obtaining the points in the point pool 1300 can cause, the weight of each point can be based on the state of the catheter. For example, the catheter can include a torque sensor, and when indicating a high torque, a lower weight can be assigned, because the high torque can indicate a significant deformation. Similarly, if the catheter is in a controlled state so that the catheter distal end is actively positioned in the central part of the passage through which the catheter is passing, the measurement point can have a relatively high weight compared to when the catheter is in a relaxed state. In some embodiments, only when the catheter is actively turned and controlled so as to collect points from the center of the passage, the measurement points can be collected in the point pool 1300. When in a relaxed state, compared with being in an actively controlled state, the catheter is more likely to pass along the bottom of the passage. In some embodiments, the measurement points collected in a relaxed or passive state can be compensated by adjustment, so that it seems to be closer to the collection point of the passage center. This can be done by changing the collection point coordinates so that the point is moved to the center. Additionally, in order to minimize the deformation caused by further inserting the catheter into the passage, some embodiments can limit the point collection to when the catheter is in a passive state and retracted from the passage. When the camera is disposed on the distal end of the catheter, the control system can determine whether the catheter is in the middle of the passage based on the acquired image using image recognition techniques. As indicated by the image recognition, the control system can limit point collection to when the catheter is in the middle.

[0133] The weights may be assigned based on the respiratory phase in which the measurement points were collected. Thus, when a single anatomical model is used, measurement points that are similar in phase to the single anatomical model (e.g. Fig.11D The anatomical model 1108) may be assigned a weight that is greater than the weights of measurement points associated with different phases.

[0134] When the catheter can collect measurement points at multiple locations along its length, whether or not due to including a shape sensor or multiple discrete sensing / transmission devices, the history of the catheter can be used to assign weights. When the catheter advances through the path of the patient's anatomical structure, multiple points are collected along its length. The less distal part of the catheter can collect points whose coordinates are identical or substantially similar to the coordinates of the points previously collected by the more distal part of the catheter. Alternatively, if the catheter is being taken out of the blood vessel instead of advancing the catheter, the coordinates of the points obtained by the distal end of the catheter can be identical or substantially similar to the coordinates of the points previously obtained by the less distal part of the catheter. In some embodiments, only when the catheter is taken out from the patient's path, the catheter is used to collect measurement points. This history record can indicate that the recurrence point is particularly reliable, and the weight of either or both of the earlier obtained points and the later obtained points can be adjusted to relatively high. In some embodiments, the weight of the point measured by the more distal part of the catheter can be higher than the less distal part of the catheter, because the diameter of the less distal part of the catheter may be thicker and more likely to cause tissue deformation. Other configurations of the catheter can also be used as factors of the basis of the weight of the measurement point.

[0135] In some embodiments, machine learning can be used to identify the quality of the most reliable points. The control system can then apply weights accordingly. Each of the factors described can be used to determine the weight of a single point. Therefore, although in some embodiments a single factor can be used to determine the weight of a given point, in other embodiments, the control system can use multiple factors to adjust the weight of one or more of the points in the point pool 1300.

[0136] Reference again Fig. 6A and Figure 6B , which shows a tracking device 624 temporarily attached to a patient P. The control system can determine whether the patient P moves by monitoring the tracking device 624. The tracking device 624 can be a device capable of generating position and / or motion data, such as a set of EM sensors / transmitters, accelerometers, etc. In some embodiments, the tracking device 624 can be a passive device monitored by the monitoring device. For example, the tracking device 624 can be a pad that is easily identified by a visual tracking system. For example, the pad can have a known size and can include a unique pattern and / or color to allow machine vision to monitor its position. When the tracking device 624 moves, the visual tracking system can provide an indication to the control system that the patient P has moved.

[0137] Due to the movement of the patient P, the previous registration between the anatomical model and the measurement points may become less accurate. Therefore, the information (such as damage or tumor) obtained from the anatomical model and / or displayed in conjunction with the anatomical model may not be accurately transmitted to the clinician. In some embodiments, after satisfactory registration has been obtained and the movement of the patient P is detected, the registration process can be started again. In some embodiments, the displacement and / or orientation change measured by the tracking device 624 can be used to update the registration. In some embodiments, the registration process 712 can be performed again starting from the scattering process. In other embodiments, the registration process 712 can be performed without performing a new scattering process. For example, if the movement of the patient P is determined to be small, the older measurement points from the point pool 1300 are discarded (or their relative weighting is substantially reduced to facilitate the points obtained after the movement of the patient P is detected) and the catheter is used to collect new measurement points. Therefore, in some embodiments, a new set of points is collected and used to align the model with the moving patient P, or a mixed weighting of new and old points can be used. In some embodiments, a notification is provided to the user so that the registration is initiated due to the movement of the patient. In other embodiments, registration may be initiated by the control system 112 after motion in the tracking device 624 is detected.

[0138] In some embodiments, the catheter shape after movement of the patient P can be used to compensate for errors in rigid registration due to motion. In some embodiments, the shape sensor data can be used to provide new measurement points after movement of the patient P, which can be used to perform further registration processes (similar to those in method 700).

[0139] In some embodiments, the point collection instrument is connected to a remotely operated robot arm. The remotely operated arm can be moved according to the command from the operator input system. In some embodiments, the insertion stage 608 can be installed on the remotely operated arm. When the arm or the insertion stage 608 moves, the movement can be transmitted to the control system from the encoder incorporated into the setting joint of the arm and / or the stage 608. When the insertion stage 608 and / or the remotely operated arm moves (as indicated by the encoder), the registration process can be performed again. The comparison between the command movement and the measured movement (by the shape sensor) can indicate that uncommanded movement has occurred. If the comparison value between the command movement and the measured movement exceeds a threshold value, the registration process in whole or in part can be re-initiated. For example, if the distal tip is ordered to enter the opening of the passage, but the distal tip is forcibly removed from the entrance to the opening due to anatomical movement, tissue texture or other anatomical forces, this may occur.

[0140] Reference now Fig.14 , wherein a flow chart of method 700A is shown. Method 700A shares the same principles as described herein and as Figure 7Many processes are included in the method 700 shown. Shared processes include the same reference numbers. Method 700A also includes a set of processes that provide a method for initiating the collection of measurement points within a patient pathway. Method 700A can be implemented as part of a workflow managed by a control system 112 to enable clinicians to treat patients (similar to patient P) more effectively and efficiently.

[0141] When a point collection instrument (e.g., catheter 610) is introduced into a patient passage, collection of position and / or shape data may be automatically initiated to generate a set of measurement points describing the passage of the anatomical structure of the patient P. This may be performed at process 1402, where the control system 112 detects one or more point collection conditions that trigger the collection of measurement points. For example, when the catheter 610 includes a camera or image sensor, images may be collected and processed to determine when the distal end 618 enters the patient passage. For example, the control system 112 or another component of the system 100 may identify the appearance of the main carina obtained by the image sensor system, or may identify the trachea based on the color of the image obtained therein.

[0142] Moreover, as this article combines Figure 6C and Fig.6D As described, the ET tube 622 can include a color and / or pattern on its inner surface 623. This can provide a point collection condition when images obtained from the catheter 610 during introduction into the patient pathway do not include the color and / or pattern of the inner surface 623. A point collection condition can be detected when information obtained from the image indicates that the transition from the interior of the ET tube 622 to the interior of the trachea (or other anatomical pathway) is complete.

[0143] Additionally, if combined Fig. 6A and Figure 6BAs described, when the rigid instrument body 612 moves on the insertion stage 608 along the insertion axis A, the position measurement device 620 provides information about the position of the rigid instrument body 612. The movement of the rigid instrument body 612 can provide an indication of the movement of the distal end 618 of the catheter 610. This kinematic information can be used to infer that after a certain amount of insertion movement, the catheter 610 may have entered the patient passage. Therefore, the kinematic information can provide a collection condition that can trigger the process 1404 when detected, and the process 1404 initiates the collection of position information in order to collect a set of measurement points describing the patient passage. Similarly, in the case where the catheter 610 is connected to another robotic device (such as a robotic arm), the kinematic information provided by the encoder in the arm of the device can be used to detect point collection conditions, such as the amount of movement in a specific direction. In some embodiments, the movement command provided to the robotic device or arm can also be used to identify the point collection condition that triggers the point collection at the process 1404, rather than relying on the encoder to relay the actual movement. In some embodiments, the command movement and measurement movement of the robotic device can be used. When sufficient motion is detected and / or commanded, the control system 122 may detect the motion and determine whether it meets the requirements of the point collection conditions.

[0144] Although the systems and methods of the present disclosure have been described for use with connected bronchial pathways of the lungs, they are also applicable for navigating and treating other tissues through natural or surgically created connected pathways in any of a variety of anatomical systems, including the colon, intestines, kidneys, brain, heart, circulatory system, and the like.

[0145] At process 1404, data representing a point may be added to point pool 1300, stored in memory, such as Fig.13As shown. This position information represented by the measurement point can be collected only at the distal end 618 of the catheter 610, collected from multiple discrete points along the length of the catheter, or continuously obtained from the shape sensor information along the length of the catheter 610. When the shape sensor information continuously provides position information along the length of the catheter 610, in some embodiments, the shape sensor information can be sampled to produce discrete points. Depending on how the points are obtained from the catheter (and the type of catheter used for point collection), the detection of the point collection condition for collecting points from a specific part of the catheter may not be sufficient to trigger the point collection at another part of the catheter. For example, when the distal end 618 transitions from the ET tube 622 to the trachea, the condition can be met to trigger the point collection at the distal end 618, but not to trigger the point collection at the part of the catheter that is still in the ET tube 622. Therefore, in some embodiments, after the distal end 618 leaves the tube (as identified by the visual information provided to the control system 112), kinematic information can be used to determine when to start point collection from the less distal part of the catheter. When the catheter 610 includes multiple EM sensors distributed along its length, the insertion distance can be used to determine when to start collecting information. For example, if the second EM sensor is positioned 2 cm from the first EM sensor at the distal end of the catheter, the point collection condition for the second EM sensor may be that the first EM sensor must have left the ET tube 622 and the catheter must have moved 2 cm or another predetermined distance. The movement is obtained from the kinematic information described herein.

[0146] In some embodiments, the registration process can be repeated during the surgical procedure (similar to Figure 7 712 of the process 712 described in). As described, the movement of the patient P can trigger a new registration process. In some embodiments, the control system 112 periodically executes the registration algorithm during surgery, such as every minute or every five minutes. In other embodiments, the registration process can be continuously run and continuously updated on the control system 112 as a background process. For example, even after the registration process is completed, as long as there is a catheter in the patient's passage that can obtain the measurement point (from any suitable modality), the collection of the measurement points in the point pool 1300 can continue. In some embodiments where the registration process is operated as a background process, the registration can be updated only when the new registration is better than the old registration as determined by the accuracy metric. The accuracy metric can be the percentage of measurement points that are successfully matched with the model, or it can be the average distance between the measurement point and the matching model point. Other accuracy metrics can be implemented in other embodiments. Therefore, when a closer registration has a higher percentage of successfully matched measurement points, a closer registration can be used instead of an earlier registration. Consistency is maintained by requiring that an accuracy metric be satisfied in order to replace one registration with another if a superior registration is not obtained.

[0147] In some embodiments, when a later registration replaces an earlier registration, or an earlier registration is considered by the control system 112 to be replaceable with a later registration, an alert may be provided to the clinician through the user interface to indicate that there is a registration change or that there is an available superior registration. In some embodiments, the control system 112 may require the clinician to approve through the user interface before achieving a superior registration. For example, when a superior registration is identified, an alert may be provided to the display system 110 and a button or other user interface element by which the clinician may approve or disapprove the new registration. Whether to then perform the new registration will depend on the clinician's decision.

[0148] One or more elements in an embodiment of the present invention may be implemented in software for execution on a processor of a computer system (such as control system 112). When implemented in software, the elements of an embodiment of the present invention are essentially code segments for performing necessary tasks. The program or code segment may be stored in a non-temporary processor-readable storage medium or device, which includes any medium (including optical media, semiconductor media, and magnetic media) that can store information. Examples of processor-readable storage devices include: electronic circuits; semiconductor devices, semiconductor memory devices, read-only memories (ROMs), flash memories, erasable programmable read-only memories (EPROMs); floppy disks, CD-ROMs, optical disks, hard disks, or other storage devices. Code segments can be downloaded via a computer network (such as the Internet, an intranet, etc.). As described herein, operations such as accessing, detecting, initiating, aligning, displaying, receiving, generating, determining, moving data points, segmenting, matching, etc. can be performed at least in part by the control system 112 or its processor.

[0149] It should be noted that the processes and displays presented may not inherently involve any particular computer or other device. The structures required for various such systems will appear as elements in the claims. In addition, embodiments of the present invention are described without reference to any particular programming language. It should be understood that various programming languages ​​can be used to implement the teachings of the present invention as described herein.

[0150] Although certain exemplary embodiments of the present invention have been described and shown in the accompanying drawings, it should be understood that such embodiments are merely illustrative of the broad invention and not restrictive, and that the embodiments of the present invention are not limited to the specific construction and arrangements shown and described, since various other modifications may occur to those skilled in the art.

Claims

1. A non-transitory computer readable medium storing instructions that, when executed by one or more processors, cause the one or more processors to perform a method for navigating an endoscope through an anatomical passage of a patient, the method include: commanding a distal tip of the endoscope to move along a path through the anatomical passage; collecting position sensor data and kinematic information as the endoscope moves along the path; as well as Based on the position sensor data and the kinematic information, a roll angle of the distal tip is determined.

2. The non-transitory computer readable medium of claim 1, wherein an insertion path of a portion of the endoscope comprises a linear path.

3. The non-transitory computer readable medium of claim 1, wherein an insertion path of a portion of the endoscope comprises a non-linear path. 4 . The non-transitory computer readable medium of claim 1 , wherein the position sensor data is collected by an electromagnetic sensor (EM sensor). The non-transitory computer readable medium of claim 1 , wherein the position sensor data is obtained by an imaging modality. 6 . The non-transitory computer readable medium of claim 1 , wherein determining the roll angle comprises applying a registration algorithm to the position sensor data and kinematic information. 7 . The non-transitory computer readable medium of claim 1 , further comprising storing instructions that, when executed by the one or more processors, cause the one or more processors to evaluate the accuracy of the determined roll angle.

8. A system, include: catheter; as well as a control system in communication with the catheter, the control system comprising one or more processors configured to: receiving a set of model points of a model of one or more pathways of a patient; determining a state of the catheter while the catheter is within the one or more passageways of the patient; when the state of the catheter satisfies a condition, collecting a set of measurement points from within the one or more pathways, each point comprising coordinates within a surgical environment occupied by the patient; as well as A registration between the measurement point set and the model point set is generated.

9. The system of claim 8, wherein determining the state of the catheter comprises determining whether the catheter is in a passive state or an actively controlled state.

10. The system of claim 9, wherein the condition comprises the catheter being in the passive state.

11. The system of claim 8, wherein determining the status of the catheter comprises determining whether the catheter is being inserted into or removed from the one or more passageways.

12. The system of claim 11, wherein the state of the catheter is determined based on image data from the catheter.

13. The system of claim 12, wherein the condition comprises identification of a main carina in the image data.

14. The system of claim 12, wherein the condition comprises identification of a transition of the catheter from an endotracheal tube to an external one.

15. The system of claim 11, wherein the condition comprises the catheter being withdrawn from the one or more passages.

16. The system of claim 8, wherein determining the state of the catheter comprises determining whether a distal end of the catheter is located within a center of one of the one or more passageways.

17. The system of claim 16, wherein the condition includes the distal end of the catheter being located within the center of one of the one or more passageways.

18. The system of claim 8, wherein the one or more processors are further configured to perform: The collected measurement points are discarded when the state of the catheter does not satisfy the condition.

19. The system of claim 8, wherein the state of the catheter is determined based at least in part on kinematic information associated with movement of a proximal portion of the catheter.

20. The system of claim 8, wherein the state of the conduit satisfying the condition triggers collecting the set of measurement points along a first portion of the conduit.

21. The system of claim 20, wherein the state of the conduit satisfying a second condition triggers collecting the set of measurement points along a second portion of the conduit.

22. The system of claim 8, wherein the one or more processors are further configured to perform: determining movement of the patient; collecting a second set of measurement points from within the one or more pathways, each point in the second set of measurement points comprising coordinates within the surgical environment; and A second registration between the second set of measured points and the set of model points is generated.

23. A system, include: catheter; as well as a control system in communication with the catheter, the control system comprising one or more processors configured to: receiving a set of model points of a model of one or more pathways of a patient; receiving a first set of measurement points collected from within the patient pathway, each point comprising coordinates within a surgical environment occupied by the patient; generating a first registration between the set of measured points and the set of model points; detecting movement of the patient; as well as A second registration between a second set of measured points and the set of model points is generated.

24. The system of claim 23, wherein detecting the movement of the patient comprises detecting relative movement between the patient and a proximal end of the catheter used to collect the first set of measurement points.

25. The system of claim 24, wherein the catheter includes a shape sensor extending the length of the catheter.

26. The system of claim 23, wherein the second set of measurement points includes points measured within the patient pathway after the motion of the patient is detected.

27. The system of claim 23, wherein tracking markers are temporarily attached to the patient to monitor the patient's movement.

28. The system of claim 23, wherein the second registration is used to compensate for errors in the first registration attributable to the motion of the patient.

29. The system of claim 23, wherein the motion is detected in shape data obtained by the catheter.

30. The system of claim 29, wherein the catheter is robotically controlled, and wherein the motion is detected in the shape data when the control system is not directing the motion of the catheter.

31. The system of claim 23, wherein generating the second registration comprises registering at least some of the first set of measurement points and the second set of measurement points to the model point set.

32. The system of claim 31, wherein a relatively low weight is assigned to the at least some of the first set of measurement points, and a relatively high weight is assigned to the second set of measurement points.

33. The system of claim 23, wherein the catheter is used to collect the first set of measurement points and the second set of measurement points.

34. The system of claim 33, further comprising a robotic medical system configured to at least partially control movement of the catheter, wherein the robotic medical system comprises a joint.

35. The system of claim 34, wherein an encoder is configured to monitor the position of the joint to provide kinematic information to the robotic medical system.

36. The system of claim 35, wherein the second registration is performed in response to an indication in the kinematic information that the robotic medical system has moved relative to the patient.

37. The system of claim 35, wherein the kinematic information is compared to one or more motion commands issued by the robotic medical system to filter out physiologically induced motion.

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