View-based robotic intracardiac catheter guidance

Abstract

The invention relates to view-based robotic intracardiac catheter guidance. For view-dependent control, different desired imaging catheter views are defined. The robotic catheter system may be modified from one view to another based on activation, but in other cases, manually free by an operator. This pre-definition of views and exchange of intra-operative views provide procedure monitoring information while avoiding radiation and minimizing interruption of the procedure (e.g., needle placement and puncture).

Description

Background Art

[0001] This embodiment relates to robotic control of medical catheters. An example of a medical catheter is an intracardiac echocardiography (ICE) catheter, which is used for imaging in cardiac interventional and diagnostic procedures. ICE can provide close feedback of anatomy and tools during surgical procedures. Other imaging catheters include optical imaging or guide catheters.

[0002] Due to the anatomy of the coronary arteries, it is difficult to access the left atrium for interventional procedures. Transseptal puncture is a technique used to create a small surgical channel through the atrial septum from the right atrium into the left atrium via a catheter. Transseptal catheterization is routinely used for many ablation procedures, occlusion of left atrial appendages, and mitral valve repair, among other things.

[0003] Only using biplane fluoroscopy for indirect anatomical landmark guidance has been shown to lead to safe and successful transseptal puncture procedures. Radiation exposure from fluoroscopy is a major concern for both physicians and patients. By replacing fluoroscopy guidance with ICE guidance, zero fluoroscopy transseptal puncture is now possible. Direct visualization of the correct puncture site using ICE can be successfully applied to minimize the risk of cardiac injury. Typical ICE for electrophysiology provides a two-dimensional echocardiogram (i.e., one image sector), and therefore provides limited information about the atrial septum (3D surface). Therefore, it is necessary to constantly adjust the position of the ICE catheter during the transseptal puncture procedure to ensure that the angle of incidence of the transseptal needle is correct. This is inefficient and time-consuming because it requires the physician to move their hands away from the transseptal needle to manipulate the ICE catheter to obtain a new imaging perspective. In addition, and for the same reason, the ICE catheter cannot be effectively used to track the dynamic movement of the transseptal needle assembly, thereby preventing visualization of the needle tip at a critical moment. In its current state, while ICE does offer a clear path toward zero-fluoroscopic transseptal puncture, limitations of ICE in terms of control and real-time image adjustments have hampered its application for zero-fluoroscopic or reduced-fluoroscopic transseptal puncture. Summary of the invention

[0004] By way of introduction, the preferred embodiments described below include methods, systems, and robots for view-dependent control. Different desired imaging catheter views are defined. The robotic catheter system can change from one view to another based on activation, but otherwise hands-free by the operator. This pre-definition of views and the exchange of intraoperative views provides procedural monitoring information while avoiding radiation and minimizing procedural interruptions (e.g., needle placement and puncture).

[0005] In a first aspect, a method for robotic control of an imaging catheter is provided. A plurality of views of an imaging catheter in a heart are determined for transseptal puncture. A trajectory for movement of the imaging catheter between the plurality of views is defined. A robotic catheter system moves the imaging catheter between the plurality of views along the trajectory. Images from the imaging catheter at the plurality of views are displayed.

[0006] In a second aspect, a catheter control system is provided. A memory is configured to store instructions. The instructions configure a processor to control a catheter robot to manipulate an intracardiac echocardiography catheter to exchange an intraoperative view of the intracardiac echocardiography catheter based on a preoperative selection of a view.

[0007] In a third aspect, a control system for a steerable catheter is provided. A robotic system for operation of a steerable catheter is provided. A memory is configured to store a first view of a heart and a second view of the heart. The first view is different from the position and / or orientation of the first view within the heart. The first and second views are views of anatomical structures and / or devices used for a medical procedure. The processor is configured to cause the robotic system to navigate the steerable catheter from the first view to the second view in response to activation by a user. The display is configured to display an image of the first view and an image of the second view.

[0008] Other implementations of any of Aspects 1-3 are summarized below as examples.

[0009] The present invention is defined by the following claims, and nothing in this section should be considered a limitation on those claims. Features of one aspect or type of claim (e.g., method or system) may be used in other aspects or types of claims. Additional aspects and advantages of the present invention will be discussed below in conjunction with the preferred embodiments, and may be claimed later, either independently or in combination. BRIEF DESCRIPTION OF THE DRAWINGS

[0010] Components and the various figures are not necessarily drawn to scale, instead emphasis is placed upon illustrating the principles of the present invention. Moreover, in the various figures, like reference numerals designate corresponding parts throughout the different views.

[0011] Figure 1 is a flow chart of one implementation of a method for robotically operating a catheter with exchange views;

[0012] Figure 2 is a flow chart of another implementation of a method for robotically operating a catheter with exchange views;

[0013] Figure 3 illustrates example segments and corresponding boundaries for navigation and / or view placement;

[0014] Figure 4 illustrates two-dimensionally view positions and trajectory formation according to one example; and

[0015] Figure 5 is a block diagram of one embodiment of a system for view control of a robotic catheter system. DETAILED DESCRIPTION

[0016] A workflow for a robotic intracardiac echocardiography-guided transseptal puncture or another procedure is provided. ICE imaging for a transseptal puncture workflow for a catheter-based left heart procedure is at least partially automated. ICE catheter views (e.g., position and orientation) are specified preoperatively based on diagnostic imaging. The position of the ICE catheter within the patient's anatomy is then located intraoperatively. Movement of the catheter to a pre-specified target view is automated intraoperatively. In addition, the physician-user can then iterate between target ICE catheter views manually as desired.

[0017] The software framework relies on a robotic system to steer the ICE catheter. The robotic controller software automatically steers the ICE catheter to the target. Automated view selection (e.g., preoperatively) and switching of views (e.g., intraoperatively) creates a clinical workflow mechanism for ICE-guided zero-fluoroscopy in transseptal punctures. By providing a consistent process for reduced or zero-fluoroscopy transseptal punctures, fluoroscopy dose to physicians and patients can be reduced. By enabling a simple, automated ICE imaging workflow, better anatomical information can be provided for intraoperative guidance.

[0018] Predetermination of desired views and automated switching of views for imaging catheters can be used in other ICE-guided procedures. By selecting different sets of key views preoperatively, the catheter robot can navigate to views or navigate between views in any ICE procedure. As a specific example, by preselecting views of key nearby anatomical structures for procedures such as transcatheter valve replacement, the framework can be applied to hands-free real-time complication monitoring during the procedure. Common complications in transcatheter valve replacement include annular rupture, myocardial perforation, coronary ostial occlusion, aortic perforation or dissection, poor valve positioning, valve displacement, paravalvular leak, thrombosis, and paracardiac effusion. Views to monitor any of these complications in different anatomical structures are set and then exchanged by the catheter robot during the procedure. In this or other procedures, one or more views of the device can be provided.

[0019] Figure 1is a flow chart of one embodiment of a method for robotic control of an imaging catheter, such as an ICE catheter. Different views are identified for the procedure. The catheter robot navigates the catheter to the position and orientation of the view with little or no user control, thereby allowing the surgeon to focus on the procedure and control of other equipment. By automatically or semi-automatically switching between views, the imaging catheter provides monitoring, thereby reducing the need for fluoroscopy, while placing little navigation burden on the operator.

[0020] Figure 2 Shows Figure 1 An implementation of the method. Figure 2 is a flow chart of another approach for a robotic control method of an imaging catheter.

[0021] Figure 1 and / or Figure 2 The method by Figure 5 The system and / or robotic system or another system is implemented. The processor receives and / or the memory stores different views (e.g., the position and orientation of the transducer). The processor defines a trajectory and causes the catheter robot to move the catheter from one view to another along the trajectory. The imaging catheter and imaging system (e.g., ultrasound system) generate images displayed on a display screen to monitor the patient, device and / or procedure from different views.

[0022] Additional, different, or fewer actions may be provided. For example, where the trajectory is pre-established or known, action 110 is not provided. As another example, such as where a recording of the image is stored rather than displayed, action 130 is not provided. In yet another example, actions 200, 210, and / or 220 are not provided. Figure 2 , or in Figure 1 In other examples, actions for preoperative planning and / or preoperative, during-procedure, and / or post-procedure imaging are provided. As another example, actions for puncture, ablation, stent placement, or another procedural operation on the heart are provided.

[0023] The actions are performed in the order shown (from top to bottom or numerically) or in a different order. For example, action 220 occurs before action 210 and / or after action 110.

[0024] In act 100, a processor determines a plurality of views for a procedure such as transseptal puncture through an imaging catheter in the heart. The views are determined by input using a user interface, by artificial intelligence, from an atlas, from a program guide, and / or loaded from memory.

[0025] The view can be a standard view and / or a view desired by a particular surgeon. The view can be about a heart model, or about the heart of a particular patient. For example, ICE is used to view one or more puncture locations, such as the primary and any secondary selections for the heart wall puncture location. One or more views are provided for each puncture location of the anatomical structure, such as from different angles, orientations and / or distances. In another example, ICE is additionally or alternatively used to view the needle or other equipment used in the procedure. One or more views are provided for each desired position of the equipment, such as viewing the needle from different directions when the needle is placed adjacent to the puncture location. Any number of views of any object can be provided in any part of the procedure. These views are determined for monitoring the procedure using ICE.

[0026] This determination occurs in preoperative planning. A three-dimensional (3D) map of the patient's heart can be used to define the position and orientation of the ultrasound transducer of the imaging catheter. The 3D map can form boundaries within which the views must be located and / or be used to determine where the views are desired. The views are defined relative to the heart in the preoperative images. Alternatively, one or more views can be added or determined during the procedure and / or intraoperatively.

[0027] In one approach, ICE view positions are determined based on preoperative imaging. Precise treatment planning on computed tomography (CT) or magnetic resonance (MR) scans (images) is typical for electrophysiology and structural heart procedures. During the preoperative planning, the best ICE view to be used during the transseptal puncture procedure is identified. The user accurately plans the positioning of the ICE catheter and the associated anatomical view. This determination of the view can be performed manually. The user directly enters the view in the CT imaging or from the imaged heart segment. This determination of the view can be performed using an ICE simulator that simulates the ICE in the preoperative image. In manual input or simulated input, the user specifies the ICE catheter position and image orientation (view) for different parts of the procedure. The predicted ICE view synthesized from CT / MR data can be used to confirm that the desired view is selected. In another approach, the determination of one or more views is performed automatically, such as by an artificial intelligence trained for the view determination of the procedure. In yet another approach, the determination is performed semi-automatically, such as a view set output by a trained artificial intelligence, with manual changes and / or selections to adjust or define the view to be used. Simulation can be used to assist in selection or change.

[0028] In act 110, the processor defines a trajectory for movement of the imaging catheter between views. A sequence of views and corresponding movement of the imaging catheter from one view to another is defined. The trajectory is defined by a path optimization selected or input by the processor and / or a user. For example, a simulation is used to define the path, where the trajectory is the path that the user follows in the simulation to go from one view to another. As another example, the processor uses the boundaries of the 3D map or segmentation from the heart and any other blocked or impassable locations (e.g., where the needle is located) to find the shortest path between views.

[0029] The trajectory may be along a sequence of views. The imaging catheter will advance along the trajectory from one view to another. Alternatively, different trajectories are provided between different, any or all pairs of views. The imaging catheter will move from any one view to a different selected view. Different views and corresponding trajectories may be used during surgery. In another approach, different trajectories are provided for different pairs or groups of views.

[0030] The trajectory is the path of movement along the catheter's degrees of freedom. For example, four degrees of freedom are provided: translation along the catheter's longitudinal axis, rotation around the longitudinal axis, front-to-back bending, and left-to-right bending. In other examples, six degrees of freedom in a patient-centered space are provided. The trajectory path is continuous, or a series of two or more samples or points. The trajectory has a starting point and an end point, with no, one, two or more waypoints or samples in between. The trajectory can be defined relative to any movement within the degrees of freedom, such as rotation, translation, bending in one plane, bending in another plane, or a combination thereof. For example, the trajectory has a translation along a curve in three dimensions, wherein the rotation and / or bending are different or the same at different points or samples along the path or curve. A straight trajectory or a trajectory without translation (e.g., only rotation and / or bending) can be provided.

[0031] The generation of a path from a current position (e.g., a view or manually positioned position) to a predetermined or desired view of action 110 occurs preoperatively, during a procedure (e.g., real-time processing and / or intraoperatively), or a combination of both. For example, a processor defines a trajectory during surgery based on the current position, the desired view (e.g., a predetermined view), and the 3D map. As another example, the trajectory is defined preoperatively, such as using manual, automatic (e.g., artificial intelligence), and / or semi-automatic input in planning with view determination.

[0032] Figure 2 Another approach is shown. During the procedure, the planned views are loaded into the robotic controller, which can intraoperatively self-position and automatically drive the ICE catheter to each of these views. Prior to the procedure, actions 200 and 210 are performed.

[0033] Obtain the physical 3D boundaries of the ventricle. Figure 3 An example is shown where a mesh defines the heart boundary in 3D and a two-dimensional (2D) cross section of the heart with ventricle boundaries. This boundary defines the overall possible workspace for ICE catheter manipulation (ie, provides a safe use boundary for robotic motion).

[0034] In act 200, the processor constructs a roadmap having motions moving between locations within the boundaries. Figure 4 The left side of shows an example roadmap as multiple locations (points) and links between the locations. A link is a route or track between adjacent locations within a boundary.

[0035] A path within a cardiac volume is generated. Optimal robotic control inputs capable of maneuvering a catheter from a current position within the heart to a desired predetermined view can be derived from the roadmap of the path. Desired ICE view pose information and a 3D ventricular safe passage volume (i.e., an occlusion map) are used to form a roadmap, such as including views within the boundary as part of the roadmap. A discrete grid within the occlusion map is generated, some of which include locations of desired views. Other locations are between desired views, such as along the grid. Robot kinematic modeling determines a set of robotic controls to move between any two points in the grid, such as between desired views. In a preprocessing step, a kinematic model for catheter manipulation is used as a set of possible motions. Catheter state X = (x, y, z, xθ, yθ, zθ) where ∈χ has (x, y, z) as the tip of the catheter / guidewire at R, respectively. 3 (robot system coordinates) and θ (robot system rotation) as orientation. The manipulation system can be viewed as a transfer function F. Using control u∈U, F makes the transition from X(k) to another state X(k+1): X(k+1)=X(k)+ω, ω~N(Xp,Σp), where X p and Σp are the mean and variance of the catheter state transitions via u. The transition error is minimized using hysteresis compensation. The result is a 3D occlusion map and motion model.

[0036] A roadmap is constructed from a 3D occlusion map (boundary) and a motion model. A probabilistic roadmap (PRM) constructs a single roadmap that aims to cover a good portion of the collision-free spatial region in the 3D occlusion map, e.g. Figure 4 The left side is shown in two dimensions. The probabilistic roadmap covers the maximum space within the boundary. Other approaches can be used, such as forming trajectories without a roadmap.

[0037] exist Figure 2 In act 210, the processor registers the preoperative plan (eg, boundaries, views, trajectories, and / or roadmaps) to the patient. Registration occurs during the procedure, such as after patient positioning and before surgery.

[0038] Landmarks, fiducials, imaging of catheters within the patient, position sensing, or other approaches can be used to register the desired view to the patient's heart. In one approach, preoperative image data and plans are fused with patient imaging during the procedure. If a sufficiently large ICE 3D volume is available, CT to x-ray registration (2D / 3D), CT to DynaCT (3D / 3D), or CT to ultrasound can be used to complete the co-registration procedure. Several methods can be used for co-registration (including rigid and deformable) based on image-based registration or deep learning algorithms.

[0039] If done by CT to x-ray or CT to DynaCT, the robotic ICE controller will then be registered to the scene or patient. For example, the user positions the ICE catheter at a series of standard anatomical views that have been previously identified within the CT data, such as the views expected for the procedure or other views. Alternatively, two x-ray images can be acquired to estimate the pose of the ICE catheter. As another approach, sensors embedded directly within the ICE catheter are used for registration.

[0040] If registration is done by CT to ultrasound, no additional co-registration step is required. It may be useful to co-register x-ray or DynaCT into the scene. CT to x-ray and CT to DynaCT fusion are beneficial but not necessary. CT to ultrasound fusion aligns the preoperative plan with the patient during treatment.

[0041] exist Figure 2 In the approach of , the selection or generation of one or more trajectories of act 110 is performed in real time during the procedure using the registered roadmap. The processor selects the trajectory from the motion roadmap defined by the heart boundary.

[0042] For example, select one or more paths from the current position to a predetermined position. Given a roadmap, find the best path from one pose to another (e.g., between predetermined views). Maneuver the catheter from the current pose to the target pose, performing all state transitions via the robot actuators, and find the best motion sequence π that minimizes ζ(π) * , which is described as π * =argminζ(π). Discrete search (eg, A*) algorithms find the best sequential path from one position to another. Figure 4 (Right) shows the selection of paths in the roadmap. Paths are shown as thick lines from the current position to another position, such as a desired view. Kinematics and planning for the robotic ICE controller can be applied by traditional optimization methods or by deep learning algorithms.

[0043] In act 120, the processor moves the imaging catheter. The processor controls the robotic catheter system to move the imaging catheter. The processor controls the robotic catheter system to move the catheter. For example, when a portion of the catheter is in the patient, the processor causes the robotic catheter system to translate, rotate, and / or bend the catheter.

[0044] The movement is along a trajectory. The trajectory defines translation, rotation and / or bending. The processor causes the robotic catheter system to translate, rotate and / or bend the catheter to move the catheter along the trajectory. The movement is from a current position, such as one desired view, to another desired view. The movement swaps between views. The trajectory is followed to change between desired views of the procedure.

[0045] Movement of the imaging catheter occurs intraoperatively or during a procedure. Preoperative determination of desired views is used to move the imaging catheter during surgery to show or image at different views at different times for monitoring.

[0046] Movement is automatic or semi-automatic. The user can set the robotic catheter system to automatically move between desired views (e.g., continuously swap or jump), or have more in-depth control through semi-automatic view-by-view movement (e.g., the pressing or activation of one button at a time causes the robotic catheter system to move the catheter to the next desired or specific desired view). In action 220, the processor receives user input for swapping views. The trajectory of the desired view for view swapping is defined or found and used to move the imaging catheter in response to the user input to provide the next desired view. After each activation, the robotic catheter system pauses movement at the desired view. Automatic navigation occurs in response to user activation input, and there is no need for user control of movement along the trajectory. Hands-free movement of the imaging catheter is provided. Some user control of movement, such as override, can be provided.

[0047] The user input may be an indication of activation, or may be a selection of a desired view. For example, the movement is in response to a user input of a selection of one of the determined views. Figure 2 In some examples, robot control, routing, and view positions are determined preoperatively. The user simply enters an identification of which view is desired at that time. For other method examples, the view order is predetermined, thus activating a cycle to the next view. Routing and movement occur during the procedure of swapping views. Alternatively, routing occurs prior to surgery.

[0048] User input is provided through a graphical user interface, voice command, foot pedal, table mounted buttons, gestures, controllers, or other inputs. The desired view may be selected from a list, selected from a roadmap, indicated on a 3D rendering, or provided as the next view in a list. For example, during surgery, when the user inputs, the user presses a button to cause movement to the next view of a determined view without a specific view indication.

[0049] After making a decision and controlling for the next view, the catheter robot performs a move of action 120. The move is from the current position to the view, such as swapping between different views in a predetermined view. The catheter robot precisely manipulates each of the 4 DOFs of the ICE catheter, and by extension, the tip of the catheter or the imaging transducer. The robot controller applies the motor control sequence. Since the catheter robot is co-registered with the patient, the control sequence moves the ICE catheter from the current position to the desired position and orientation (i.e., the desired view).

[0050] In one implementation, the processor causes the robotic catheter system to repeat the movement of the imaging catheter from the desired view to the desired view multiple times. The back and forth swap occurs when the imaging catheter is used for periodic or continuous monitoring. The navigation of the imaging catheter is performed without the operator performing the navigation. The user can start or activate the swap, but the robotic catheter system navigates the catheter along the trajectory with or without pauses at the midpoint without further input or control from the user.

[0051] Physicians often utilize ICE to survey anatomy to see how devices interact or are deployed on an area. By swapping between defined views, hands-free repeated image surveys of anatomy and device deployment are provided. Users are free to focus more on the images and controls of other devices.

[0052] In another approach, a processor causes a robotic catheter system to move the catheter synchronously with the heart motion. Using ECG or image processing, the cardiac cycle or trajectory is input to a processor or trigger device. The robotic catheter system moves the catheter during specific points or portions of the cardiac cycle.

[0053] To move, the processor controls the motor of the robotic catheter system. The robotic catheter system manipulates the catheter by motor actuation. Manipulation can include steering (e.g., bending in one or more planes), overall rotation (e.g., rotation of the handle and corresponding catheter), overall translation (e.g., pulling the catheter further out or pushing it further into the patient), imaging, ablation, puncture, expansion, suturing, clamping, cutting, drug deposition, stent expansion, balloon expansion, stent release and / or another operation. The robot operates the catheter under the control of the processor. Similarly, the user interface (e.g., display and input device) of the robotic catheter system provides manual control of the robotic catheter system. The processor can receive input and / or generate output for the user interface and provide control to the motor.

[0054] In act 130, the display shows one or more images from the imaging catheter. For ICE, the image is ultrasound. For an endoscope or catheter with an optical camera, the image is optical. The image has a desired view such as the anatomy and / or device (e.g., needle) of interest in the procedure. A single image or a sequence of images from one view may be provided. The image may also be displayed as the imaging catheter is moved.

[0055] Due to the swapping during the procedure, images from different views are displayed in sequence. The surgeon can monitor the procedure by imaging from different viewing angles as needed.

[0056] Figure 5 is a block diagram of one embodiment of a catheter control system. A control system using a robotic catheter system (catheter robot) 500 is provided for a steerable catheter 550. The control system switches between views from the catheter 550 using different views, freeing the user to focus on imaging information and / or other operations rather than navigating the catheter 550.

[0057] The control system includes a robotic catheter system 500 formed by a base 540 and an adapter 542. The processor 510, memory 520, and / or display 530 are part of a separate computer, workstation, or server and / or part of the robotic catheter system 500. Additional, different, or fewer components may be provided. For example, the base 540 and adapter 542 are combined into a housing for a motor and a gripper to manipulate the catheter 550.

[0058] The robotic catheter system 500 is configured for robotically controlling the catheter 450. In the example used herein, the robotic catheter system 500 is configured to control an ICE catheter 550. Other types of steerable catheters may be used, such as controlling an ablation catheter or other imaging catheter. Other catheter-like devices (e.g., a fiberoptic endoscope or a needle) may be controlled. These different catheters may have the same or different arrangements of control knobs, steering, degrees of freedom, and / or manipulation, so the robotic catheter system 500 is configured to manipulate or control the arrangement of the catheter 550 used.

[0059] Any type or design of robotic catheter system 500 can be used. In the example herein, the robotic catheter system 500 includes a base 540 and an adapter 542. The base 540 includes a motor for steering and / or manipulating a catheter 550, and the adapter 542 is configured to cooperate with, hold, and / or manipulate the catheter 550. For example, the adapter 542 allows the robotic catheter system 500 to operate a steerable ICE catheter 550 designed for manual control by a physician. Various embodiments of such a robotic catheter system are disclosed in U.S. Pat. No. 11,590,319, the disclosure of which is incorporated herein by reference. Other designs can be used, such as a robotic catheter system designed as a robotically controlled catheter that is specifically designed for or with and controlled by a robot (e.g., without an adapter 542).

[0060] The base 540 includes motors to manipulate the steerable catheter 550 in any number of degrees of freedom, such as 4 or more degrees of freedom (e.g., overall translation, overall rotation, and bending or steering the catheter 550 in two or more directions or planes). Transmissions, motors, clamps (clamps), connectors, and / or other robotic components are in the base 540 for generating and transmitting forces to operate the catheter 550. The robotic catheter system 500 applies thrust and / or pull to the steering wires 556, 558 (e.g., three or four steering wires per catheter 550) to operate the catheter 550. The tip is steered for catheter operation. Electrical signals, translational and / or rotational forces can be generated in the base 540. Overall translational and / or rotational forces can be applied similarly, such as by a handle of the catheter 550.

[0061] The adapter 542 connects or plugs into the base 540 and manipulates the catheter 550. In one embodiment, the adapter 542 is a clamshell or other arrangement of housings, actuators, connectors, clamps, and / or other robotic components to transfer forces from the base 540 to the catheter 550 to steer and / or otherwise manipulate the catheter 550. In one approach, the adapter 542 fits around the handle and / or body of the catheter 550 to allow manipulation of the actuators (e.g., knobs) of the catheter 550, such as the AP / LR knobs of an ICE catheter and / or a handle of the catheter 550 for overall translation and / or rotation (e.g., a push-pull knob of an ablation catheter, etc.). Other adapters 542 that support other (e.g., 2, 3, 4, or more) degrees of freedom may be used, such as for control of a needle or ablation catheter.

[0062] In the case where the steerable catheter 550 is an ICE catheter, the robotic catheter system 500 can be configured to control the ICE catheter. The robotic catheter system 500 or imaging system can control imaging using an imaging catheter. The element array 552 is controlled by beamforming to generate ultrasound images. A field of view 554, imaging type, and / or other imaging controls can be provided.

[0063] The memory 520 is a non-transitory memory, such as a removable storage medium, a random access memory, a read-only memory, a field programmable gate array memory, a cache, and / or other memory. The memory 520 is configured by a processor, such as the processor 510, to store views (positions and orientations), roadmaps (movement options), motion controls, trajectories, images, waypoints, control signals, boundaries, registrations, information, control software, instructions executable by the processor 510, instructions executable by the robotic catheter system 500, interface software, and / or other information.

[0064] In one implementation, the memory 520 stores the determined views registered to the patient's heart. For example, the memory 520 is configured to store two or more views of the heart, where the coordinate system is transformed or transformable to the robotic catheter system 500 and / or the patient. One view is in a different position and / or orientation than another view within the heart. The different views are views of the anatomical structures and / or devices used for the medical procedure. The different views are stored in the memory as a selection of preoperative images from the heart or other sources.

[0065] The processor 510 is a general purpose processor, an application specific integrated circuit, an integrated circuit, a digital signal processor, a field programmable gate array, an artificial intelligence processor, a tensor processor, and / or another controller for docking or controlling the robotic catheter system 500, the user interface / display 530, and / or the catheter 550. The processor 510 is configured by design, hardware, firmware, and / or software to dock between a user and the robotic catheter system 500 and / or control the robotic catheter system 500. Multiple processors can be used as processors 510 for sequential and / or parallel processing. The instructions from the memory 520, when executed by the processor 510, cause the processor 510 to operate the robotic catheter system 500 and / or the steerable catheter 550, and to dock between various components and / or with a user or operator.

[0066] The processor 510 is in the same room as the robotic catheter system 500. For example, a computer or workstation is connected with a wired or wireless connection for interacting with the robotic catheter system 500. In one implementation, the processor 510 is the processor of the robotic catheter system 500. Alternatively, the processor 510 is in a different room than the robotic catheter system 500, such as a room in the same building, a different building, a different facility, or a different area. A computer network is used to communicate between the processor 510 and the robotic catheter system 500. Control of the robotic catheter system 500 by the processor 510 allows the processor 510 to be completely remote from the procedure, the patient, and / or the robotic catheter system 500, because the processor 510 provides a catheter 550 for robotic manipulation.

[0067] The desired view is stored in the memory 520. When the operator controls the robotic system 500 to move the catheter 550 and / or the user interface 530 to input the selection of the desired view, the trajectory is created and stored in the memory 520 or selected from the memory 520. The processor 510 is configured to cause the robotic system 500 to navigate the steerable catheter 550 using the trajectory so that the desired view is provided. The processor 510 is configured by instructions to control the catheter robot 500 to manipulate the ICE catheter so as to exchange the view of the ICE catheter intraoperatively based on the preoperative selection of the view.

[0068] Processor 510 is configured to receive a selection of a view in a preoperative image. Each selected view defines a position and an orientation. The views are stored in memory 520. A different processor may be used to receive the selected view.

[0069] The processor 510 is configured to enable hands-free manipulation of the ICE catheter by the user in response to user activation of the swap. Using the selected view, the processor 510 causes the catheter robot 500 to navigate the ICE catheter to the desired view. Navigation occurs in response to input from the user, such as activation or view selection. The navigation itself, moving from the current position to the selected position, is either hands-free by the user or requires less than full navigation control by the user (e.g., one or more degrees of freedom are handled automatically).

[0070] Processor 510 is configured to perform a swap from one view to another. The ICE catheter follows a trajectory that is pre-planned or optimized in real time between views. For example, the trajectory that implements the swap is based on an optimization of the path length from one view to another. Processor 510 causes a swap from one view to another during a procedure, such as for a transseptal puncture. Imaging from imaging catheter 550 is provided for different views to monitor a transseptal puncture or other cardiac procedure. The swap occurs in response to user activation, but may alternatively be triggered by a procedural event and / or be periodic.

[0071] Display / user interface 530 is a display screen such as an LCD or monitor, and user inputs such as a keyboard, knob, slider, touch pad, mouse, and / or track pad. Display / user interface 530 may include icons, graphics, or other images such as from an operating system or application for user interaction (selection, activation, and / or output).

[0072] Display 530 is configured to display images, such as ultrasound images, from imaging catheter 550. The images are of the desired view. Since the views are swapped during the procedure, the images of the views are provided in sequence. Images from different viewing angles (positions and / or orientations) assist in monitoring the procedure.

[0073] Various examples and corresponding combinations are provided below.

[0074] In Example 1, a method for robotic control of an imaging catheter is provided. Multiple views of an imaging catheter in a heart for transseptal puncture are determined. A trajectory for movement of the imaging catheter between the multiple views is defined. A robotic catheter system moves the imaging catheter between the multiple views along the trajectory. Images from the imaging catheter at the multiple views are displayed.

[0075] Example 2 is the method of Example 1, wherein the moving and displaying are performed intraoperatively based on the determined preoperative performance.

[0076] Example 3 is the method of Example 1 or 2, wherein the movement includes automatic navigation in response to a user activation input and no user control of the movement along the trajectory is required.

[0077] Example 4 is the method of any of Examples 1-3, wherein determining includes determining the plurality of views as one or more views of one or more locations for a transseptal puncture and / or one or more views of a needle for performing a transseptal puncture.

[0078] Example 5 is the method of any of Examples 1-4, wherein determining includes defining a position and an orientation of an ultrasound transducer of the imaging catheter in the pre-operative image.

[0079] Example 6 is the method of any of Examples 1-5, wherein defining comprises selecting the trajectory from a motion roadmap defined by a heart boundary.

[0080] Example 7 is the method of any of Examples 1-6, wherein the moving comprises moving from a first view to a second view.

[0081] Example 8 is the method of any of Examples 1-7, wherein moving comprises moving in response to user input selecting one of the views.

[0082] Example 9 is the method of any of Examples 1-8, wherein moving comprises hands-free movement of the imaging catheter.

[0083] Example 10 is the method of any of Examples 1-9, wherein moving comprises swapping between different ones of the views.

[0084] Example 11 is a catheter control system comprising: a memory configured to store instructions; and a processor configured by the instructions to control a catheter robot to manipulate an intracardiac echocardiography catheter based on a preoperative selection of a view, thereby exchanging views of the intracardiac echocardiography catheter during surgery.

[0085] Example 12 is the catheter control system of Example 11, further comprising a catheter robot.

[0086] Example 13 is the catheter control system of any of Examples 11-12, wherein the processor is configured for hands-free manipulation of the intracardiac echocardiography catheter by a user in response to activation of the exchange by the user.

[0087] Example 14 is the catheter control system of any of Examples 11-13, wherein the processor is configured to receive a selection of views in the pre-operative image, the selection defining a position and an orientation of each view.

[0088] Example 15 is the catheter control system of any of Examples 11-14, wherein the processor is configured to perform a swap from a first view to a second view, wherein the intracardiac echocardiography catheter follows an optimized trajectory based on a path length from the first view to the second view.

[0089] Example 16 is the catheter control system of any of Examples 11-15, wherein the processor is configured to perform a swap from a first view for transseptal puncture to a second view for transseptal puncture.

[0090] Example 17 is the catheter control system of any of Examples 11-16, further comprising a display configured to display an ultrasound image from the view in the exchanged sequence.

[0091] Example 18 is a control system for a steerable catheter. The control system includes: a robotic system for operation of a steerable catheter; a memory configured to store a first view of a heart and a second view of the heart, the first view being different in position and / or orientation from the first view from within the heart, the first and second views being views of anatomical structures and / or devices used for a medical procedure; a processor configured to respond to user activation so that the robotic system navigates the steerable catheter from the first view to the second view; and a display configured to display an image of the first view and an image of the second view.

[0092] Example 19 is the control system of Example 18, wherein the processor is configured to cause navigation in response to input from a user, the navigation being user hands-free.

[0093] Example 20 is the control system of Example 18 or 19, wherein the first view and the second view are stored in the memory as selections from pre-cardiac surgical images.

[0094] Although the present invention has been described above with reference to various embodiments, it should be understood that many changes and modifications may be made without departing from the scope of the present invention. Therefore, the foregoing detailed description is intended to be considered illustrative rather than restrictive, and it should be understood that the following claims, including all equivalents, are intended to define the spirit and scope of the present invention.

Claims

1. A method for robotic control of an imaging catheter, the method comprising: identifying multiple views of an imaging catheter in the heart for transseptal puncture; defining a trajectory of movement of the imaging catheter between the plurality of views; The imaging catheter is moved along the trajectory between the multiple views by a robotic catheter system; and Images from the imaging catheter are displayed at multiple views.

2. The method according to claim 1, wherein: The movement and display are performed intraoperatively based on the determined preoperative execution.

3. The method according to claim 1, wherein: The movement includes automatic navigation in response to user activation input and does not require user control of movement along the track.

4. The method according to claim 1, wherein: Determining includes determining the plurality of views as one or more views of one or more locations for a transseptal puncture and / or one or more views of a needle for performing a transseptal puncture.

5. The method according to claim 1, wherein: Determining includes defining a position and orientation of an ultrasound transducer of an imaging catheter in a pre-operative image.

6. The method according to claim 1, wherein: The definition includes selecting a trajectory from a motion roadmap bounded by the heart boundaries.

7. The method according to claim 1, wherein: The movement includes moving from a first view to a second view.

8. The method according to claim 1, wherein: The movement includes moving in response to user input selecting one of the views.

9. The method according to claim 1, wherein: Movement includes hands-free movement of the imaging catheter.

10. The method according to claim 1, wherein: Moving includes swapping between different ones of the views.

11. A catheter control system, comprising: a memory configured to store instructions; and A processor configured by the instructions to control a catheter robot to manipulate an intracardiac echocardiography catheter based on a pre-procedural selection of a view to intra-procedurally exchange views of the intracardiac echocardiography catheter.

12. The catheter control system of claim 11, further comprising a catheter robot.

13. The catheter control system according to claim 11, wherein: The processor is configured to enable hands-free manipulation of the intracardiac echocardiography catheter by a user in response to activation of the exchange by the user.

14. The catheter control system according to claim 11, wherein: The processor is configured to receive a selection of views in the pre-operative image, the selection defining a position and orientation of each view.

15. The catheter control system according to claim 11, wherein: The processor is configured to perform a swap from a first view to a second view, wherein the intracardiac echocardiography catheter follows an optimized trajectory based on a path length from the first view to the second view.

16. The catheter control system according to claim 11, wherein: The processor is configured to perform a swap from a first view for transseptal puncture to a second view for transseptal puncture. 17 . The catheter control system of claim 11 , further comprising a display configured to display ultrasound images from the views in the exchanged sequence.

18. A control system for a steerable catheter, the control system comprising: Robotic systems for manipulation of steerable catheters; a memory configured to store a first view of the heart and a second view of the heart, the first view being at a different location and / or orientation than the first view from within the heart, the first and second views being views of anatomical structures and / or devices used for a medical procedure; a processor configured to, in response to activation by a user, cause the robotic system to navigate the steerable catheter from the first view to the second view; and The display is configured to display an image of the first view and an image of the second view.

19. The control system according to claim 18, wherein: The processor is configured to cause navigation in response to input from a user, the navigation being user hands-free.

20. The control system of claim 18, wherein: The first view and the second view are stored in a memory as a selection from cardiac pre-operative images.

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