Techniques for supporting a user in an operating tool by

Abstract

A method of supporting a user in an operating room is provided. The method is performed by a processing system and includes obtaining spatial information indicating a plurality of spatial regions in an operating room, each spatial region of the plurality of spatial regions being associated with one or more feedback parameters; and obtaining tracking information indicating the tracked poses of the plurality of medical instruments in the operating room. The method further includes associating each of the medical instruments with at least one of the spatial regions based on the spatial information and the tracking information, and triggering, for each of the medical instruments, feedback according to one or more feedback parameters of the associated at least one spatial region. A system, computer program and carrier are also provided.

Description

Technical Field

[0001] The present disclosure generally relates to a method of supporting a user in an operating room by triggering feedback about one or more medical instruments. Related systems, computer programs, and carriers are also disclosed herein. Background Art

[0002] In many clinical scenarios, clinical personnel (such as surgeons) wish to be provided with feedback about the tracked position of medical instruments. For example, a surgeon may wish to know the current position of a handheld drill relative to the patient's body, or the alignment of a pedicle screw driver relative to a robotically manipulated medical tool (such as a trocar).

[0003] Some surgical navigation systems can provide a single navigation view to the surgeon that visualizes the tracked pose of a handheld medical instrument relative to the patient's body. Where multiple medical instruments are used, the tracked poses of the multiple medical instruments can be simultaneously visualized in a single navigation view. In particular, if the tracked medical instruments are far apart from one another (e.g., at different vertebral levels of the patient's spine), or if the multiple medical instruments are manipulated simultaneously by different surgeons, a single navigation view may not be optimal for navigating each medical instrument.

[0004] Some surgical navigation systems enable users to select one of multiple tracked medical instruments and then generate a single navigation view customized for the selected medical instrument. This approach requires the user to interact with the navigation system and only provides feedback for the selected medical instrument. Summary of the invention

[0005] What is needed is a technique for supporting users in an operating room that addresses one or more of the above issues or other issues.

[0006] According to a first aspect, a method for supporting a user in an operating room by triggering feedback about one or more medical instruments is provided. The method is performed by at least one processor. The method comprises: obtaining spatial information, the spatial information indicating a plurality of spatial regions in the operating room, each of the plurality of spatial regions being associated with one or more feedback parameters. The method further comprises obtaining tracking information, the tracking information indicating tracked postures of a plurality of medical instruments in the operating room. The method comprises: associating each of the plurality of medical instruments with a corresponding at least one spatial region of the plurality of spatial regions based on the spatial information and the tracking information. The method comprises triggering feedback for each of the plurality of medical instruments according to one or more feedback parameters of the associated corresponding at least one spatial region of the plurality of spatial regions.

[0007] The one or more feedback parameters may be region specific.The one or more feedback parameters may differ between two or more spatial regions (eg, all spatial regions) of the plurality of spatial regions.

[0008] The plurality of spatial regions may be defined based on a pose of at least one reference object in the operating room.

[0009] The at least one reference object may include at least a portion of a patient's body. The at least one reference object may include at least one anatomical element of a patient's body (e.g., a bone, such as a vertebra). The at least one reference object may include at least a portion of a medical tool (e.g., a distal tool tip). The at least one reference object may include at least a portion of a medical instrument (e.g., a distal tip of a medical instrument).

[0010] In one example, different ones of the plurality of spatial regions include different parts of the patient's body.

[0011] At least some of the plurality of spatial regions may be separated from one another by one or more virtual planes.The virtual planes may be defined relative to the patient's body (eg, relative to one or more anatomical elements of the patient's body).

[0012] The one or more virtual planes may include at least one anatomical plane, at least one user-defined plane, and / or at least one plane associated with an anatomical element of the patient's body.

[0013] In one example, a medical tool is manipulated by a robot in an operating room.

[0014] At least one of the spatial information and the tracking information may be obtained for a plurality of time points. Feedback may be iteratively triggered for two or more time points (eg, each time point) of the plurality of time points.

[0015] One or more of the associated corresponding at least one of the plurality of spatial regions may be updated based on movement of one or more of the plurality of medical instruments as indicated by the tracking information obtained for the plurality of time points.

[0016] The associated corresponding at least one of the plurality of spatial regions may be updated so that a medical instrument associated with the corresponding at least one of the plurality of spatial regions remains within the at least one of the plurality of spatial regions. Alternatively or additionally, the associated corresponding at least one of the plurality of spatial regions may be updated so that a medical instrument not associated with the corresponding at least one of the plurality of spatial regions remains outside the at least one of the plurality of spatial regions.

[0017] In one variation, the plurality of medical instruments comprises instruments that are manipulated simultaneously.

[0018] Instruments being manipulated simultaneously may be manipulated by different surgeons.

[0019] In one example, different subsets of the plurality of spatial regions are associated with different surgeons.

[0020] The one or more feedback parameters may define at least one of auditory feedback, tactile feedback, and visual feedback.

[0021] The visual feedback may include displaying a navigation view that visualizes the pose of the corresponding medical instrument.

[0022] In one example, the one or more feedback parameters define at least one setting of the navigation view, the at least one setting including: the type of medical image data used to present the navigation view; criteria for highlighting structures in the navigation view; criteria for indicating planned objects in the navigation view; the orientation of the navigation view; and / or the viewing angle of the navigation view.

[0023] According to a second aspect, a system is provided. The system includes at least one processor, which is configured to: obtain spatial information, the spatial information indicating multiple spatial regions in the operating room, each of the multiple spatial regions being associated with one or more feedback parameters; obtain tracking information, the tracking information indicating the tracked positions of multiple medical instruments in the operating room; based on the spatial information and the tracking information, associate each of the multiple medical instruments with at least one corresponding spatial region in the multiple spatial regions; and for each of the multiple medical instruments, trigger feedback according to one or more feedback parameters of the associated corresponding at least one spatial region in the multiple spatial regions. The at least one processor can be configured to perform the method according to the first aspect.

[0024] The system may further include a tracking system configured to track the positions of the plurality of medical instruments in the operating room. Alternatively or additionally, the system may include a feedback unit configured to provide the feedback to at least one user in the operating room. The system may include a robot configured to manipulate a medical tool.

[0025] According to a third aspect, a computer program is provided. The computer program includes instructions, which, when executed on at least one processor, cause the at least one processor to: obtain spatial information, the spatial information indicating multiple spatial regions in the operating room, each of the multiple spatial regions being associated with one or more feedback parameters; obtain tracking information, the tracking information indicating the tracked positions of multiple medical instruments in the operating room; based on the spatial information and the tracking information, associate each of the multiple medical instruments with at least one of the multiple spatial regions; and for each of the multiple medical instruments, trigger feedback according to one or more feedback parameters of at least one of the multiple spatial regions associated with the medical instruments. The computer program may include instructions, which, when executed on the at least one processor, cause the at least one processor to perform the method according to the first aspect.

[0026] According to the fourth aspect, a carrier is provided. The carrier carries the computer program according to the third aspect. The carrier may carry a computer program including instructions, which, when executed on the at least one processor, causes the at least one processor to perform the method according to the first aspect. For example, a carrier (e.g., a non-transitory computer storage medium) carrying (e.g., storing) a computer program is provided, the computer program including instructions, which, when executed on at least one processor, causes the at least one processor to: obtain spatial information, the spatial information indicating multiple spatial regions in the operating room, each of the multiple spatial regions being associated with one or more feedback parameters; obtain tracking information, the tracking information indicating the tracked postures of multiple medical instruments in the operating room; based on the spatial information and the tracking information, associate each of the multiple medical instruments with at least one of the multiple spatial regions; and for each of the multiple medical instruments, trigger feedback according to one or more feedback parameters of at least one of the multiple spatial regions associated with the medical instruments. BRIEF DESCRIPTION OF THE DRAWINGS

[0027] Other details, advantages and aspects of the present disclosure will become apparent from the following embodiments in conjunction with the accompanying drawings, in which:

[0028] Figure 1 A schematic diagram of a system according to the present disclosure is shown;

[0029] Figure 2 A flow chart of a method according to the present disclosure is shown;

[0030] Figure 3a-3f schematically illustrates a spatial region according to the present disclosure; and

[0031] Figures 4a-4f Different scenarios and corresponding spatial areas according to the present disclosure are schematically illustrated. DETAILED DESCRIPTION

[0032] In the following description, exemplary embodiments will be explained with reference to the accompanying drawings. The same reference numerals will be used to represent the same or similar structural features.

[0033] Figure 1 A schematic diagram of a system 2 according to the present disclosure is shown. The system 2 may be referred to as a surgical navigation system and includes a computing system 4. The system 2 may also include a tracking system 6, a display unit 8, and / or a robot 10. The computing system 4 includes at least one processor 12 communicatively connected to at least one memory 14 and at least one interface 16. The at least one interface may be communicatively connected to the tracking system 6, the display unit 8, and / or the robot 10 via one or more wired or wireless connections.

[0034] Also shown is a patient's body 18 of a patient lying on a treatment couch 20 in an operating room 22, two medical instruments 24, 26, and a medical tool 28. In this example, each of the medical instruments 24, 26 is a handheld instrument, such as a pointer, a drill, a chisel, or a screwdriver. The medical instruments 24, 26 can be manipulated simultaneously, for example, by different surgeons. The medical instrument 24 includes a shaft 25 extending longitudinally along an axis 27 of the shaft. The medical instrument 26 includes a distal instrument end 29. The medical tool 28 in the illustrated example is manipulated by the robot 10 (e.g., simultaneously) and includes a distal tool end 31.

[0035] The tracking system 6 is configured to track the pose of the medical instruments 24, 26 by positioning (e.g., optical or electromagnetic) trackers 30, 32 attached to the medical instruments 24, 26. The tracking system 6 can also track the pose of the medical tool 28 by positioning a tracker 34 attached to the medical tool 28. The tracking system 6 can be configured as an optical tracking system and can include a (e.g., stereoscopic) tracking camera for positioning the optical tracker. Alternatively, the tracking system 6 can be configured as an electromagnetic tracking system and can include an electromagnetic field generator.

[0036] As an alternative to tracking the medical tool 28 with the tracking system 6, the pose of the medical tool 28 may be determined (e.g., by at least one processor 12) based on the pose of the robot 10, such as based on the rotation and / or translation of actuators of the robot 10. In the illustrated example, the pose of the medical tool 28 may be determined based on the angular orientation of the arm segments 36, 38, 40 of the robot 10 defined by the joints 42, 44 between the arm segments 36, 38, 40 of the robot 10.

[0037] The tracking system 6 can also be configured to track the pose of the patient's body 18 by positioning a patient tracker 33 arranged in a fixed spatial relationship relative to the patient's body 18 (e.g., a patient tracker 33 adhesively attached to the patient's skin or clamped to an anatomical element of the patient's body). A transformation (also referred to as a registration) between (e.g., pre-operative) patient image data of at least a portion of the patient's body 18 on the one hand and the patient's body 18 on the other hand can be used to convert a (e.g., pre-planned) position defined relative to the patient image data into a (e.g., real-world) position in the operating room 22. Various techniques for determining such a transformation or registration are known to those skilled in the art. For example, points acquired on the surface of the patient's body 18 using a tracked registration probe can be matched with the surface of the patient's body 18 represented by the patient image data to obtain a transformation.

[0038] The display unit 8 is an example of a feedback unit configured to provide feedback to at least one user, in particular feedback regarding the medical instrument(s) 30, 32. Other examples of such feedback units include a tactile feedback unit (e.g., included in one or more of the instruments 30, 32), another type of visual feedback unit such as an indicator light (e.g., included in one or more of the instruments 30, 32), and an auditory feedback unit such as a speaker.

[0039] The patient's body 18 includes a plurality of anatomical elements, such as organs or bones. In the illustrated example, vertebrae 46-58 of the patient's spine 60 are indicated as examples of anatomical elements of the patient's body 18. It should be noted that although the patient's spine 60 generally includes a total of 33 vertebrae, Figure 1 Only seven vertebrae 46-58 are shown in the figure in order to provide a better overview. Figure 1 Also indicated are a plurality of spatial regions 60-68.

[0040] Figure 21 shows a flow chart of a method according to the present disclosure. The method may be performed by at least one processor 12 of the system 2. To this end, at least one memory 14 may store a computer program including instructions that, when executed by at least one processor 12, cause the at least one processor to perform the method disclosed herein. At least one memory 14 is an example of a carrier that carries a computer program. Alternatively, the computer program may be carried by at least one processor 12 via an interface 16, for example, from a server. Although the following will use Figure 1 However, these reference numerals should not be construed as limiting the method to Figure 1 Specific details shown.

[0041] The method may be referred to as a computer-implemented method. In a particular variant, the method is not a method of treating the human or animal body by surgery or therapy, and / or the method does not comprise a surgical step.

[0042] In step 202 , spatial information indicative of a plurality of spatial regions 62 - 70 in operating room 22 is obtained.

[0043] For at least two or all of the spatial regions, the spatial information may indicate at least one property selected from size, shape, contour, boundary, position and orientation. The spatial information may be obtained from at least one memory 14. The spatial information may be predefined and / or preplanned, in particular predefined and / or preplanned before the start of the surgical procedure. The spatial information may be determined by at least one processor 12 or defined by a user.

[0044] The spatial information may be determined or defined based on (e.g., pre-operative) patient image data, the patient image data including one or more medical images of at least a portion of the patient's body 18, such as a computed tomography (CT) image and / or a magnetic resonance (MR) image. The spatial information may indicate a spatial region 62-70 in a real-world coordinate system (e.g., a coordinate system of the patient's body 18 and / or a patient tracker 33). The method may include obtaining (e.g., pre-defined and / or pre-planned) information indicating the spatial region 62-70 in a coordinate system of the patient image data (e.g., a spatial region defined based on or relative to one or more anatomical elements of the patient's body represented by the patient image data), obtaining a transformation between the coordinate system of the patient image data and (e.g.) a real-world coordinate system, and determining the spatial information by transforming the information indicating the spatial region 62-70 from the coordinate system of the patient image data to the real-world coordinate system based on the obtained transformation. As explained above, there are various techniques for determining such a transformation, which is also referred to as registration between the patient image data and the patient's body 18.

[0045] One or more of the plurality of spatial regions 62-70 (e.g., all of the spatial regions) can be defined based on a pose of at least one reference object in the operating room 22 (e.g., defined in a real-world coordinate system). For example, one or more of the plurality of spatial regions 62-70 (e.g., all of the spatial regions) can be defined relative to a pose of at least one reference object in the operating room 22 (e.g., in a real-world coordinate system). The at least one reference object can include at least a portion of the patient's body 18 (e.g., one or more anatomical elements of the patient's body 18, such as one of the vertebrae 46-58) and / or at least a portion of the medical tool 28 (e.g., the distal tip 31 of the medical tool 28) and / or at least a portion of the medical instrument 24, 26.

[0046] A plurality of spatial regions 62-70 may differ from each other in at least one property selected from size, shape, contour, boundary, position, and orientation. A plurality of spatial regions 62-70 may differ from each other in one or more anatomical elements of the patient's body 18 included in the corresponding spatial regions. In other words, different spatial regions in the plurality of spatial regions 62-70 may include different parts of the patient's body (e.g., different anatomical elements, such as different vertebrae 46-58). Each spatial region in the spatial regions 62-70 may be a three-dimensional region. Two or more spatial regions (e.g., all spatial regions) in the spatial regions 62-70 may not be connected in space. Two or more spatial regions in the spatial regions 62-70 may overlap each other (e.g., at least partially overlap).

[0047] At least some of the plurality of spatial regions 62-70 (e.g., two or more spatial regions) may be separated from one another by one or more virtual planes 65, 37. The one or more virtual planes 65, 67 may be defined relative to the patient body 18, for example, relative to one or more anatomical elements (e.g., one or more vertebrae 46-58) of the patient body 18. The one or more virtual planes 65, 67 may include at least one anatomical plane (e.g., a coronal plane, a sagittal plane, or a transverse plane), at least one user-defined plane, and / or at least one plane associated with an anatomical element (e.g., one of the vertebrae 46-58) of the patient body 18. The method may include obtaining (e.g., from a DICOM header in the patient image data) information indicating an orientation of the at least one virtual plane 65, 67 in a coordinate system of the patient image data, and converting the orientation to a real-world coordinate system using a known registration between the two coordinate systems to obtain two or more spatial regions 62-70 separated by the at least one virtual plane 65, 67 in the real-world coordinate system.

[0048] Different subsets of the plurality of spatial regions may be associated with different surgeons. That is, different spatial regions may be defined for different surgeons prior to surgery. Each subset of the plurality of spatial regions may correspond to a different side of the patient's spine 60, such as a different side relative to a dissecting plane. A subset may consist of subset-specific spatial regions. That is, no one of the plurality of spatial regions may be associated with more than one surgeon.

[0049] Each spatial region in the plurality of spatial regions 62 - 70 is associated with one or more feedback parameters.

[0050] The one or more feedback parameters may be predefined and / or obtained from at least one memory 14. The one or more feedback parameters may be defined by a user. The one or more feedback parameters may be different between two or more of the plurality of spatial regions. In one example, the one or more feedback parameters are region-specific. The one or more feedback parameters may be specific to the anatomical elements of the patient's body included in the respective spatial region. This may enable feedback specifically tailored to the respective spatial regions.

[0051] In step 204 , tracking information indicating tracked poses of a plurality of medical instruments in an operating room (eg, tracked poses of instruments 24 , 26 in a real-world coordinate system) is obtained.

[0052] The tracking information may be obtained by the at least one processor 12 from the tracking system 6, for example via the at least one interface 16. Alternatively, the tracking information may be loaded from the at least one memory 14. The tracking information may indicate exactly one pose of each medical instrument 24, 26 being tracked, for example at the same point in time. Thus, the tracking information may indicate the pose of the tracked medical instruments 24, 26 relative to each other.

[0053] Compared to Figure 2 , the order of steps 202 and 204 may be reversed. In another variation, the spatial information and the tracking information are obtained simultaneously (eg, obtained as part of a single data set), so that steps 202 and 204 are performed together.

[0054] In step 206 , each of the plurality of medical instruments (eg, 24 , 26 ) is associated with a corresponding at least one spatial region of the plurality of spatial regions (eg, 62 - 70 ) based on the spatial information and the tracking information.

[0055] Each of the medical instruments 24, 26 may be associated with a subset of the spatial regions 62-70, or with exactly one of the spatial regions 62-70. For example, a medical instrument may be associated with a spatial region 62-70 if one or more predefined spatial constraints of the spatial region 62-40 are satisfied. The one or more predefined spatial constraints may be obtained from at least one memory 16. The method (e.g., step 206) may include obtaining one or more predefined spatial constraints for one or more of the plurality of spatial regions 62-70, and determining whether the one or more predefined spatial constraints are satisfied based on the spatial data and the tracking data. The one or more predefined spatial constraints may include at least one of: (i) a maximum distance between an instrument (e.g., at least a portion of the instrument) (e.g., a distal tip of the instrument) and a spatial region, (ii) a maximum distance between an instrument (e.g., at least a portion of the instrument) (e.g., a distal tip of the instrument) and an anatomical element enclosed by and / or defining the spatial region, (iii) a maximum deviation of an instrument main axis (e.g., longitudinal axis 27) from the spatial region, and (iv) a maximum deviation of an instrument main axis (e.g., longitudinal axis 27) from an anatomical element enclosed by and / or defining the spatial region. A spatial region that is closest to a medical instrument and / or a spatial region pointed at by a medical instrument may be associated with the medical instrument, and vice versa.

[0056] exist Figure 1 In the example of , the medical instrument 24 can be associated with the spatial region 64 because the longitudinal axis 27 intersects the spatial region 64, which means that the predefined spatial constraint of the maximum deviation of the longitudinal axis 27 from the spatial region 64 is satisfied. The medical instrument 26 can be associated with the spatial region 70 because the distal end 29 is located within the spatial region 70, which means that the predefined spatial constraint of the maximum distance of the distal end 29 from the spatial region 70 is satisfied.

[0057] In one variation, predefined association information is obtained that indicates an association of each of the plurality of medical instruments (e.g., 24, 26) with a corresponding at least one of the plurality of spatial regions (e.g., 62-70). The association may be defined by a user. The association may be determined based on a priority associated with each of the plurality of medical instruments.

[0058] In step 208 , for each of the plurality of medical instruments, feedback is triggered according to one or more feedback parameters of an associated respective at least one spatial region of the plurality of spatial regions.

[0059] The triggered feedback may be based on at least one of the tracking information and the spatial information. The feedback triggered for the medical instrument may be based on the tracked pose of the medical instrument (e.g., as indicated by the tracking information), and based on at least one associated (e.g., corresponding) spatial region of the plurality of spatial regions. The feedback triggered for the medical instrument may indicate the tracked pose of the medical instrument, for example, relative to the tracked pose of at least one associated (e.g., corresponding) spatial region of the plurality of spatial regions. One or more feedback parameters associated with the spatial region may define how the tracked pose of the medical instrument associated with the spatial region is indicated by the feedback triggered for the medical instrument.

[0060] The one or more feedback parameters may define at least one of an auditory feedback (e.g., a warning sound), a tactile feedback (e.g., a vibration), and a visual feedback (e.g., displaying an image on the display unit 8 or activating a warning light). The visual feedback may include the display of a navigation view 72, 74 that visualizes the pose of the corresponding medical instrument 24, 26 indicated by the tracking information. In this case, the one or more feedback parameters may define at least one setting of the navigation view 72, 74, the at least one setting including: the type of medical image data for presenting the navigation view 72, 74; the criteria for highlighting structures in the navigation view 72, 74; the criteria for indicating a planned object in the navigation view 72, 74; the orientation of the navigation view 72, 74; and / or the viewing angle of the navigation view 72, 74.

[0061] exist Figure 1 In the example of , the navigation view 72 can indicate the position of the medical instrument 24 by visualizing the longitudinal axis 27 relative to the anatomical elements (i.e., the vertebra 48) enclosed by the spatial region 64. In this example, one or more feedback parameters associated with the spatial region 64 can define visual feedback including the display of the navigation view 72, and the viewing angle of the navigation view can be limited to a lateral viewing angle. The navigation view 74 can indicate the position of the medical instrument 26 by visualizing the position of the end 29 in the form of a crosshair relative to the position of the tool end 31, and by further visualizing the spatial region 70. In this example, one or more feedback parameters associated with the spatial region 70 can define visual feedback including the display of the navigation view 74, and the viewing angle of the navigation view can be limited to a viewing angle along the main axis of the shaft of the instrument 26.

[0062] At least one of the spatial information and the tracking information may be obtained for a plurality of time points, and feedback may be iteratively triggered for two or more of the plurality of time points (e.g., each time point). The method may be at least partially repeated by updating at least one of the spatial information and the tracking information and performing subsequent steps 206-208 using the updated information, such as Figure 2 This can ensure that the navigation views 72, 74 indicate the current pose of the medical instruments 24, 26 and can therefore be particularly helpful in guiding the user.

[0063] One or more of the associated corresponding at least one of the plurality of spatial regions 62-70 may be updated based on the movement of one or more of the plurality of medical instruments 24, 26 indicated by the tracking information obtained for a plurality of time points. For example, the associated corresponding at least one of the plurality of spatial regions (e.g., 70) may be updated so that a medical instrument (e.g., 26) associated with the corresponding at least one of the plurality of spatial regions remains within the at least one of the plurality of spatial regions. Alternatively or additionally, the associated corresponding at least one of the plurality of spatial regions (e.g., 70) may be updated so that a medical instrument (e.g., 24) not associated with the corresponding at least one of the plurality of spatial regions remains outside the at least one of the plurality of spatial regions. Thus, the spatial regions may be updated based on the movement of the medical instruments 24, 26 associated or not associated with these spatial regions. This may ensure that the association between the spatial regions and the medical instruments is maintained over time.

[0064] Figure 3a-3f Examples of spatial regions according to the present disclosure are schematically illustrated.

[0065] exist Figure 3a In the example of FIG. 6 , a virtual plane 65 defines a boundary between two adjacent spatial regions 62, 64. In this example, the virtual plane 65 is defined based on an anatomical element of the patient's body 18 (i.e., a vertebra 46 of the patient's spine 60). The surface of the anatomical element (i.e., the end plate 76 of the vertebra 46) is located in the virtual plane 65.

[0066] exist Figure 3b In the example of FIG. 6 , a virtual plane 78 defines a boundary of the spatial region 69. In this example, the virtual plane 78 is defined relative to an anatomical element of the patient's body 18, i.e., a vertebra 58 of the patient's spine 60. The virtual plane 78 extends axially along the middle of the spinous process 81 of the vertebra 58. The virtual plane 81 can be perpendicular to the end plate 80 of the vertebra 58 and intersect the center 82 of the vertebra 58.

[0067] exist Figure 3c In the example of FIG. 1 , a virtual plane 65 defines a boundary between two adjacent spatial regions 62, 64. In this example, the virtual plane 65 is defined based on two anatomical elements of the patient's body 18, i.e., two vertebrae 46, 48 of the patient's spine 60. The virtual plane 65 extends (e.g., equidistantly) between the two anatomical elements and, in the illustrated example, is parallel to the end plates 76, 84 of each vertebra 46, 48.

[0068] exist Figure 3d In the example of , the spatial region 64 is defined as a bounding box surrounding an anatomical element (e.g., vertebra 48) of the patient's body 18. The bounding box may have a predefined shape (such as a square or a sphere), or may define an area with a predefined thickness around the enclosed anatomical element, thereby representing an enlarged version of the anatomical element.

[0069] exist Figure 3e In the example of FIG. 1 , multiple virtual planes 86, 88, 90 are illustrated. The virtual planes 86, 88, 90 correspond to different anatomical planes of the patient's body 18. Each of the virtual planes 86, 88, 90 may be a boundary of one or more spatial regions and / or may separate adjacent regions from each other. Figure 3e In the example of FIG. 8 , the virtual planes 86 , 88 , 90 may define a maximum of 8 spatial regions.

[0070] exist Figure 3f In the example of FIG. 4 , a spherical spatial region 70 is illustrated, which has a predefined radius (eg, several centimeters) around the tool tip 31 of the medical tool 28 .

[0071] Other variations of the spatial region are possible. For example, the spatial region may be defined by the user (e.g., defined in an arbitrary position relative to the patient's body). Figure 3d ) in the example of , one or more spatial regions are determined by segmenting at least one anatomical element enclosed by one or more spatial regions.

[0072] Figures 4a-4f Different scenarios and corresponding spatial areas according to the present disclosure are schematically illustrated.

[0073] Figure 4a Two navigation views 92, 94 are shown, which can be displayed on the same display unit 8 or on different display units 8. The medical image of the patient's body 18 is also shown. Figure 4aAs shown, on the medical image, the spatial regions 96, 98 are indicated as being separated from each other by a virtual plane 100. In this example, the virtual plane 100 defining the spatial regions 96, 98 may correspond to the sagittal plane of the patient's body 18. Therefore, the virtual plane 100 is static, Figure 4a The spatial regions 96, 98 shown in FIG. 1 may be referred to as static or initial spatial regions. One surgeon may operate in spatial region 96, while another surgeon may operate in spatial region 98. Figure 4a In the scenario, the tracked instruments are not visible to the tracking system 6 and therefore such instruments are not visualized in the navigation views 92 , 94 .

[0074] exist Figure 4b In the scenario of FIG. 1 , a surgeon positions the tip of a medical instrument (e.g., 26) at a position 102 relative to the patient's body 18. The tracking system 6 allows the relative pose between the medical instrument and the spatial regions 96, 98 to be determined. The tracked instrument is associated with the spatial region 96 in which the instrument is located, and a corresponding navigation view 92 is displayed, indicating the pose of the medical instrument relative to the patient's body 18.

[0075] exist Figure 4c In the scenario of FIG. 1 , another surgeon positions the end of another medical instrument (e.g., 26) at a position 104 relative to the patient's body 18. The tracking system 6 allows the relative pose between the medical instrument and the spatial regions 96, 98 to be determined. The instrument at position 104 is associated with the spatial region 98 in which the end of the instrument is located, and a corresponding navigation view 94 is displayed, indicating the pose of the medical instrument relative to the patient's body 18. Figure 4c As can be seen in FIG. 1 , the navigation views 92 are displayed simultaneously. This allows two instruments being operated on by different surgeons on different spatial regions to be navigated simultaneously relative to the patient's body 18 .

[0076] Figure 4d The diagram illustrates a scenario in which an instrument associated with a spatial region 96 moves from a position 102 to a position 108 relative to a patient's body 18. Such movement of the instrument may affect or trigger an update of the initial spatial regions 96 and / or 98. In the example shown, the initial spatial regions 96, 98 are updated by using a virtual plane 106 instead of a virtual plane 100. The virtual plane 106 is perpendicular to the straight line connecting the position 104 with the position 108 and intersects the straight line in the middle of the straight line. This ensures that each of the positions 104, 108 is at a similar distance from the edge of the corresponding spatial region 96, 98. The association between the instrument and the updated spatial regions 96, 98 may be maintained, and the navigation views may be displayed continuously in the scene.

[0077] Figure 4e The diagram shows a scenario where an instrument associated with the spatial region 96 moves from position 102 to position 110 relative to the patient's body 18. Position 110 is located such as Figure 4a 104 and 110. In the example shown in FIG. 104 , the initial spatial region 98 is defined based on the virtual plane 100. In order to prevent the instrument from moving from the spatial region 96 to the spatial region 98 between the positions 102 and 110, the initial spatial regions 96 and 98 can be updated based on the movement of the instrument. Similarly, the updated spatial regions 96 and 98 can be defined by a virtual plane 109, which is perpendicular to the straight line connecting the position 104 and the position 110 and intersects the straight line in the middle of the straight line. In this case as well, the association between the instrument and the spatial region 96 and 98 can be maintained, and the navigation views 92 and 94 can be continuously displayed.

[0078] exist Figure 4f In the scenario of FIG. 1 , the medical instrument previously located at position 104 is removed from spatial region 98 and is no longer within the tracking range of interest of tracking system 6. Therefore, navigation view 94 may be left blank or stopped from being displayed. Navigation view 92 based on the instrument located at position 108 may not be affected by the removal of the instrument previously located at position 104. That is, navigation view 92 may be continuously displayed regardless of the presence or absence of other medical instruments, as long as the medical instrument associated with spatial region 96 is within the tracking range of interest of tracking system 6.

[0079] from Figure 4f Starting with the scenario of FIG. 1 , if another medical instrument is positioned relative to the patient body 18, then if the medical instrument is located within the (e.g., initial or updated) spatial region 98, then the medical instrument may be associated with the spatial region 98. This may result in the following: Figure 4e The same situation shown. The initial spatial region defined by the virtual plane 100 can be used as a fixed region for associating a medical instrument with one of the spatial regions, and the spatial region can then be (e.g., continuously) updated based on the (e.g., changed) tracking pose of the associated medical instrument.

[0080] The details of the present invention will now be described in other words to provide a better understanding of the present invention. Figure 1-4f Reference numerals may be used hereinafter, but these should not be construed as limiting the inventive technology to the specific details shown in these drawings.

[0081] Complications during surgery (e.g., surgical site infection or blood loss) may increase with the duration of the surgical intervention. More than one surgeon performing navigation surgery at the same time can reduce the operation time, thereby reducing the overall complication rate. Allowing multiple medical instruments 24, 26 to be navigated simultaneously allows each surgeon to operate on different spinal levels or spinal segments at the same time, which can benefit in reducing operation time, reducing blood loss, and coordinating complex cases. For example, in the case of scoliosis, where the spine 60 has a side-to-side curvature estimated to be 10 degrees or greater, spinal fusion may be required. The basic motivation is to realign and fuse together some vertebrae 46-58 of the patient's spine 60 through the additional support of the rod, so that they heal as a single solid bone. In such an operation, more than one surgeon can operate on the patient's body 18 at the same time. For example, one surgeon can implant a pedicle screw on the right side of the patient's spine, and another surgeon can implant a pedicle screw on the left side of the patient's spine. This can reduce turnaround time and reduce blood loss.

[0082] Some 3D navigation systems do not support simultaneous visualization of multiple navigated medical instruments. Such navigation systems can only provide views of a single medical instrument. For example, in some systems, the tracked position of the distal end 29 of a single medical instrument 26 is used as a reference for these views to determine the views to be displayed (e.g., axial views, sagittal views, coronal views, views along the tool axis). If another medical instrument 24 is brought into the surgical area and positioned closer to the patient's body 18 than a single instrument 26, the single instrument 26 may no longer be considered the primary medical instrument, and the other medical instrument 24 may become the new primary medical instrument for determining (multiple) views. In these cases, only one surgeon can navigate the patient's anatomy at a given time.

[0083] Some 2D navigation systems can visually indicate views of multiple medical instruments 24, 26 at the same time. For example, a static view of a portion of a patient's body 18 (e.g., anterior-posterior (AP), and lateral x-ray images) is shown on a display unit. The navigated medical instrument 24 is displayed as an overlay on two x-ray images. In this case, multiple instruments 24, 26 can be overlapped in the x-ray image at the same time. If the position of the medical instrument 24 affects the change of the view by changing a portion of the x-ray image to be displayed as a portion of the view (e.g., where the view corresponds to a zoomed version of the x-ray image near the distal end of the instrument), it may be necessary to provide a separate view for each navigated instrument 24, 26. In a 3D navigation system, intersecting 2D planes of 3D patient image data can be shown on a display unit. The intersecting planes can be derived from the tracked position of the distal end 29 of the medical instrument 26. In such a view, for example, sagittal and / or coronal intersecting planes including the instrument end 29 can be shown. The sagittal plane can be parallel to the y-axis and z-axis of the DICOM coordinate system of the 3D patient image data, and the coronal plane can be parallel to the x-axis and t-axis of the DICOM coordinate system of the 3D patient image data. In another view (also referred to as an instrument-oriented view), the instrument tip 29 can be shown as superimposed on the intersection plane, but in this case, the intersection plane can be defined by the coordinate system of the instrument tip 29 rather than the 3D patient image data. In this example, it can be said that the instrument tip 29 scrolls through the 3D data set. In the case where the instrument tip 29 controls the displayed view, it can be desired to display a different view for each of multiple medical instruments 24, 26 being used simultaneously.

[0084] In a navigated spinal surgery, it may be necessary for two or more surgeons to perform surgery on several spinal levels or portions of a patient's spine 60 simultaneously. The technology disclosed herein allows for, for example, providing a separate navigation view 72, 74 for each of the instruments 24, 26 while providing feedback for multiple tracked medical instruments 24, 26 associated with a surgeon-specific spatial region. This can allow for simultaneous navigation of multiple medical instruments 24, 26 so that each surgeon can perform surgery on a different spinal level or portion of the spine 60 of the patient's body 18 at a given time. For example, one surgeon can perform spinal decompression on the right side of a patient's spine 60 while another surgeon can implant pedicle screws on the left side of the patient's spine 60, or two surgeons can implant pedicle screws on corresponding sides of the spine of the patient's spine 60. The navigation views 72, 74 can be displayed on a screen such as a computer program product. Figure 1 The display units 8 are shown on a single screen, or on their separate screens.

[0085] As another example of visual feedback, a flashing pattern and / or light intensity of an indicator light can indicate the distance and / or alignment of the tracked medical instrument 26 relative to the associated spatial region 70. Alternatively, or as a supplement to providing visual feedback (such as a navigation view or light signals of an indicator light) as feedback on the tracked poses of multiple medical instruments 24, 26, tactile feedback and / or auditory feedback can also be output to (multiple) users in the operating room 22. For example, a vibration pattern and / or intensity of a tactile feedback unit worn by a surgeon can indicate the distance of the tracked medical instrument 24 relative to the associated spatial region 64. A warning sound can be output via a speaker to indicate that the distal tip 29 of the tracked medical instrument 26 is currently located outside the associated spatial region 70.

[0086] The surgeon may wish to use multiple tracked medical instruments sequentially during surgery. The medical instruments that are actively used by the surgeon for surgical navigation and will be used to provide feedback to the surgeon may be referred to as primary instruments 24, 26. The proposed technology allows for providing feedback for multiple primary medical instruments 24, 26 being manipulated simultaneously, for example by displaying navigation views 72, 74 of the multiple primary medical instruments 24, 26, while other medical instruments may or may not be visualized in these navigation views.

[0087] The primary medical instrument 24, 26 can be selected by a user from a plurality of tracked medical instruments, for example by pressing a button on the primary medical instrument 24, 26 or on a graphical user interface. Alternatively, the primary medical instrument 24, 26 can be determined based on the tracking data and the spatial data, for example, the primary medical instrument 24, 26 is determined if the tracked pose of the primary instrument 24, 26 satisfies one or more predefined spatial constraints. In a specific example, the medical instrument 26 can be selected as the primary medical instrument if the distal tip 29 of the medical instrument 26 is located in the associated spatial region 70. If more than one medical instrument is located in the same spatial region 62-70, other criteria can be used to select the primary instrument from the more than one medical instrument, for example, the tool that is closest to the patient tracker 33 or closest to the center of the same spatial region 62-70 can be selected as the primary medical instrument. As another option, each medical instrument can have an associated priority, which can be pre-defined (e.g., based on the type of medical instrument) or can be based on tracking information (e.g., based on the direction of movement or speed of movement of the medical instrument), and a primary instrument can be selected from multiple tracked medical instruments based on the priorities of these medical instruments.

[0088] The present technology can achieve simultaneous navigation of multiple medical instruments 24, 26, for example, by providing corresponding navigation views 72, 74 to the surgeon. One concept is to provide multiple spatial regions 62-70. A main medical instrument can be associated with each spatial region 62-70 or a subset of the spatial regions 62-70. The patient's body 18 can be divided into multiple surgical areas as spatial regions 62-70, for example, by using separate virtual planes 65, 67, 78, 68, 88, 90 that define the spatial regions 62-70, and the spatial regions 62-70 are operated on by different surgeons. The spatial regions 62-70 can be defined based on one or more of the following methods (A) to (D).

[0089] (A) Virtual plane based on anatomical plane

[0090] A sagittal plane derived from the coordinate system of the patient image data (e.g., a DICOM image data set) can be used as a virtual plane for dividing the patient's body 18 into a left region and a right region. Several planes can be combined to form more spatial regions. For example, additional transverse planes can be added to divide the left and right regions into a head sub-region and a tail sub-region, resulting in a total of four spatial regions. Instead of using an anatomical plane as a virtual plane for defining a spatial region, a plane that is parallel to the anatomical plane and, for example, contains (e.g., predefined) points of interest can be used. Examples of such virtual planes 86, 88, 90 corresponding to or parallel to the anatomical planes are shown in Figure 3d middle.

[0091] (B) Virtual plane based on (multiple) anatomical elements

[0092] The orientation of the virtual planes need not necessarily correspond to anatomical axes defined by the coordinate system of the patient image data. In another variation, the orientation of the virtual planes is defined relative to an anatomical element of the patient's body 18, such as a bone (e.g., vertebrae 46-58), an organ, or a tumor. The orientation of the virtual planes may be derived from a segmentation of the anatomical element. One or more virtual planes may be determined based on a segmentation of the patient's spine 60. As an example, the virtual planes may approximate the end plates of a vertebra of the patient's body, such as Figure 3a In this case, one surgeon can operate on an upper horizontal plane relative to the virtual plane, while another surgeon can operate on a lower horizontal plane relative to the virtual plane. A plurality of virtual planes can be defined in a similar manner, thereby dividing the patient's spine 60 into different spatial regions. Another example of a virtual plane defined based on an anatomical element of the patient's body is a virtual plane that approximates the spinous process of a vertebra and divides the patient's body 18 into left and right sides, such as Figure 3b As shown in the figure as an example.

[0093] (C) Virtual plane defined by the user

[0094] A user may define a spatial region and / or one or more virtual planes. For example, one or more virtual planes may be defined by a user via a graphical user interface (GUI) based on patient image data. In one example, a user defines two points in the patient image data to define an axis, and defines a point on the axis. A virtual plane may then be determined to have a user-defined axis as a normal, and a user-defined point as an intersection with the user-defined axis. As another example, a user may draw a free-form shape in multiple views of a patient's body 18 represented by the patient image data, and a spatial region having a corresponding free-form shape as an outline may be determined. Other variations of user-defined virtual planes or spatial regions are also possible.

[0095] (D) General geometric objects

[0096] The discriminative geometric objects used to define spatial regions are not limited to virtual planes. General geometric (e.g., virtual) objects (such as mesh-based surface models) can be used to define one or more spatial regions. For example, anatomical elements in patient image data can be segmented, and convex shells around the segmented anatomical elements can be defined as spatial regions, such as Figure 3d Thus, the spatial region may have a subvolume of the patient body 18 as an inner volume or internal volume, and the patient body 18 and the patient image data representing the patient body 18 may be divided into an inner volume and an outer volume.

[0097] In all cases (A) through (D), the spatial region may also be constrained by a bounding volume (eg, a bounding box surrounding the patient body 18 ) and / or patient image data.

[0098] When the anatomical structure is divided into n different spatial regions, the number of primary medical instruments may range from 0 to n. A medical instrument 26 having its distal tip 29 located in one of the defined spatial regions may be associated with that spatial region of the spatial regions and thus become a primary medical instrument for that associated spatial region of the spatial regions.

[0099] A navigation view 74 may be provided as visual feedback associated with the primary medical instrument 26, the navigation view indicating the pose of the primary instrument 26 relative to the portion of the patient's body 18 represented by the patient image data that is contained in the spatial region 70 associated with the primary instrument 24. Each spatial region 62-70 may be simultaneously and independently navigated using the respective primary instrument 24, 26. During navigation, the spatial regions 64, 70 associated with the primary instruments 24, 26 may be displayed on a single screen (e.g., as Figure 1 The anatomical navigation views 72, 74 can be visualized on different windows of the same display unit 8 or on different display units. Each main instrument 24, 26 can be visualized in its own (multiple) navigation views 72, 74. In the anatomical navigation view, this can be, for example, a 2D sagittal view and a 2D coronal view containing the tips of the main instruments. This can enable surgeons to collaborate and operate together.

[0100] Each tracked medical instrument can be classified into a surgeon-specific medical instrument set (e.g., by a tracking system). Different surgeons can use different instrument sets. These sets can be pre-defined or defined by a user (e.g., surgeon(s)). In one example, one instrument in each instrument set is used as a primary instrument. This means that only one instrument in each instrument set can be associated with a spatial region 62-70 or a subset of spatial regions 62-70, and feedback can be triggered using one or more feedback parameters in the spatial region(s) 62-70 associated with the primary instrument.

[0101] As described above, one concept is to divide the patient's anatomical structure into two or more spatial regions 62-70 and associate a primarily navigated medical instrument 24, 26 with the spatial regions. A fixed association between the medical instruments 24, 26 and the spatial regions 62-70 can be used. A displayed navigation view indicating the posture of the associated medical instrument 24, 26 can be determined for each associated spatial region 62-70 to provide a dedicated visualization to each surgeon (e.g., providing a dedicated visualization on a surgeon-specific display unit). Compared to this region-based approach for identifying which part of the patient's body is displayed in the navigation view, the direct association of the medical instrument with the display unit will make it impossible to visualize the same medical instrument on different display units of the surgeon without processing additional information, such as tracking the surgeon to identify which instrument belongs to whom, or manually adjusting which tool should be used for navigation for each display unit.

[0102] If the distal end of surgeon A's medical instrument enters a spatial region defined for another surgeon B, there may no longer be a primary medical instrument in surgeon A's spatial region, but two medical instruments may be located in surgeon B's spatial region at the same time. Only one medical instrument can be the primary medical instrument that controls the navigation view. Therefore, in this case, one surgeon may "release" his navigation view. For example, surgeon B may no longer be provided with a navigation view. This means that A takes over control and B no longer sees his instrument being visualized. To avoid this situation, once multiple surgeons navigate simultaneously, the spatial region can be dynamically updated. The separation between spatial regions can be based on the current position of the end of the tracked medical instrument. That is, a static region (e.g., defined relative to the patient's body) can be used initially, and then the static region can be updated based on the movement of the tracked medical instrument to specifically avoid the tracked medical instrument from moving into another spatial region. That is, a static region can be used as a trigger for visualizing a medical instrument on a surgeon's specific display unit.

[0103] Once multiple surgeons navigate the tracked medical instrument simultaneously and display the navigation view (e.g., on a dedicated display unit for each surgeon), each associated spatial region can be anchored to the distal tip of the tracked medical instrument. In other words, the in-situ separation can be derived from the position of the medical instrument.

[0104] For example, a virtual plane separating two adjacent spatial regions from each other can be defined as a plane perpendicular to a line connecting the distal ends of two tracked medical instruments (e.g., primary medical instruments), the plane being at the same distance from the two distal ends. The concept of dividing space into spatial regions can be known from the Voronoi diagram. That is, each of the multiple spatial regions (e.g., updated) can correspond to a Voronoi cell defined based on a point (e.g., distal end) of the tracked medical instrument. For a given set of points {p1, ..., p n}, the space is divided into so-called Voronoi cells. i The Voronoi cell is from p i The distance to each point is less than the distance to any other point in the given set of points. Thus, for n surgeons, n separating virtual planes can be defined, thereby defining n Voronoi cells, one for each instrument end. i, i = 1, ..., n. Through this concept of dynamically partitioning the space into Voronoi cells for each instrument tip, a fixed navigation view can be provided to each surgeon even if the tip of the primary instrument associated with that surgeon enters a region of space originally provided for another surgeon.

[0105] If multiple surgeons are operating and one surgeon removes a medical instrument from situ, the associated navigation view may be left blank while the other surgeons still display the ends of their navigated instruments. If the surgeon selects another medical instrument and inserts the end of the instrument into the spatial region defined for the surgeon, the instrument may be visualized again in the previously blank navigation view. If at least one instrument already exists in the spatial region, a separation (e.g., a re-segmentation of the spatial region) may be performed using the new instrument and the other (multiple) instruments in the region. The end of the new instrument may be shown on the display unit associated with the surgeon, and all other instruments may still be visualized in their navigation views and / or on their display units.

[0106] Various modifications to the technology disclosed herein are possible. For example, the technology presented herein is not limited to spinal surgery and is applicable to other navigated surgical procedures (e.g., hip, knee, skull or shoulder surgery).

[0107] The present technology can allow more than one surgeon to navigate his primary medical instruments 24, 26 simultaneously during the surgical navigation process. Simultaneous navigation of multiple medical instruments 24, 26 reduces the duration of intervention and improves the efficiency and effectiveness of intervention. When feedback is provided based on the spatial region associated with the tracked instrument, instead of providing the same feedback for all tracked instruments, the user can distinguish feedback between the spatial regions 62-70, thereby more easily associating each primary instrument with the associated spatial region. Region-specific feedback parameters can achieve feedback specifically customized for each spatial region, which may be particularly advantageous compared to a solution in which the feedback on the tracked instrument posture is the same regardless of the instrument's posture relative to the spatial region. When spatial regions are associated with different surgeons, one or more feedback parameters can be customized according to the needs and preferences of different surgeons. In view of the present disclosure, other advantages may become apparent to those skilled in the art.

Claims

1. A method for supporting a user in an operating room by triggering feedback about one or more medical instruments, the method being executed by at least one processor and comprising: obtaining spatial information indicating a plurality of spatial regions in the operating room, each of the plurality of spatial regions being associated with one or more feedback parameters; obtaining tracking information indicating tracked positions of a plurality of medical instruments in the operating room; associating each of the plurality of medical instruments with a corresponding at least one spatial region of the plurality of spatial regions based on the spatial information and the tracking information; as well as For each of the medical instruments, feedback is triggered according to one or more feedback parameters of an associated respective at least one spatial region of the plurality of spatial regions.

2. The method according to claim 1, wherein The one or more feedback parameters are region-specific and / or differ between two or more spatial regions of the plurality of spatial regions.

3. The method according to claim 1, wherein The plurality of spatial regions are defined based on a pose of at least one reference object in the operating room.

4. The method according to claim 3, wherein The at least one reference object comprises at least a part of a patient's body and / or at least a part of a medical tool and / or at least a part of a medical instrument.

5. The method according to claim 4, wherein Different ones of the plurality of spatial regions include different parts of the patient's body.

6. The method according to claim 5, wherein At least some of the plurality of spatial regions are separated from one another by one or more virtual planes, which are optionally defined relative to the patient body.

7. The method according to claim 6, wherein The one or more virtual planes include at least one anatomical plane, at least one user-defined plane, and / or at least one plane associated with an anatomical element of the patient's body.

8. The method according to claim 1, wherein: The spatial information is determined or defined based on patient image data, the patient image data comprising one or more medical images of at least a portion of a patient's body.

9. The method according to claim 8, further comprising: obtaining information indicative of the spatial region in a coordinate system of the patient image data; Obtaining a transformation between the coordinate system of the patient image data and a real-world coordinate system; as well as The spatial information is determined by transforming information indicative of the spatial region from the coordinate system of the patient image data to the real-world coordinate system based on the obtained transformation.

10. The method according to claim 1, wherein At least one of the spatial information and the tracking information is obtained for a plurality of time points, and the feedback is iteratively triggered for two or more time points among the plurality of time points.

11. The method according to claim 10, wherein One or more of the associated respective at least one of the plurality of spatial regions are updated based on movement of one or more of the plurality of medical instruments as indicated by the tracking information obtained for a plurality of time points.

12. The method according to claim 11, wherein The associated corresponding at least one spatial area of ​​the plurality of spatial areas is updated so that the medical instrument associated with the corresponding at least one spatial area of ​​the plurality of spatial areas remains within the at least one spatial area of ​​the plurality of spatial areas; and / or The associated respective at least one of the plurality of spatial regions is updated such that a medical instrument not associated with the respective at least one of the plurality of spatial regions remains outside the at least one of the plurality of spatial regions.

13. The method according to claim 1, wherein: The plurality of medical instruments includes instruments that are manipulated simultaneously.

14. The method according to claim 1, wherein: Different subsets of the plurality of spatial regions are associated with different surgeons.

15. The method according to claim 1, wherein: The one or more feedback parameters define at least one of auditory feedback, tactile feedback, and visual feedback.

16. The method according to claim 15, wherein: The visual feedback includes displaying a navigation view that visualizes the posture of the corresponding medical instrument.

17. The method according to claim 16, wherein: The one or more feedback parameters define at least one setting of the navigation view, the at least one setting including: the type of medical image data used to present the navigation view; criteria for highlighting structures in the navigation view; criteria for indicating planned objects in the navigation view; the orientation of the navigation view; and / or the viewing angle of the navigation view.

18. A system comprising at least one processor, the at least one processor being configured to: obtaining spatial information indicating a plurality of spatial regions in the operating room, each of the plurality of spatial regions being associated with one or more feedback parameters; obtaining tracking information indicating tracked positions of a plurality of medical instruments in the operating room; associating each of the plurality of medical instruments with a corresponding at least one spatial region of the plurality of spatial regions based on the spatial information and the tracking information; as well as For each of the plurality of medical instruments, feedback is triggered according to one or more feedback parameters of an associated respective at least one spatial region of the plurality of spatial regions.

19. The system of claim 18, further comprising at least one of the following components: A tracking system configured to track the positions of the plurality of medical instruments in the operating room; a feedback unit configured to provide the feedback to at least one user in the operating room; A robot is configured to manipulate a medical tool.

20. A computer program comprising instructions which, when executed on at least one processor, cause the at least one processor to: obtaining spatial information indicating a plurality of spatial regions in the operating room, each of the plurality of spatial regions being associated with one or more feedback parameters; obtaining tracking information indicating tracked positions of a plurality of medical instruments in the operating room; associating each of the plurality of medical instruments with a corresponding at least one spatial region of the plurality of spatial regions based on the spatial information and the tracking information; as well as For each of the plurality of medical instruments, feedback is triggered according to one or more feedback parameters of an associated respective at least one spatial region of the plurality of spatial regions.

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