Medical program and system using an active implant

Abstract

Medical procedures, systems, and related methods are disclosed. In some examples, a system may include an instrument for delivering an active implant and at least one processor configured to receive information describing a pose of the active implant, determine a position of the active implant within an anatomical model based on the information describing the position of the active implant, and transmit the determined position to the anatomical model. And establishing the location of the active implant as a reference within the anatomical model. In some examples, a method may include obtaining an anatomical model of a subject anatomy, determining a pose of an active implant, and registering the anatomical model with a frame of reference of an instrument based on the pose of the active implant.

Description

Cross-referenced applications This application claims priority to and the benefit of U.S. Provisional Application No. 63 / 343,257, filed on May 18, 2022, and entitled “Medical Procedures and Systems Using Active Implants,” which is incorporated herein by reference in its entirety. Technical Field

[0001] Disclosed examples relate to medical procedures and systems using active implants. Background Art

[0002] Treatment of certain medical conditions may involve multiple sequential treatments and / or procedures. For example, an initial procedure may be performed to perform one or more diagnostic procedures on an anatomical target to determine whether medical intervention may be required. This may include procedures such as resection of a segment of a subject's lung, which may involve multiple sequential procedures (involving identification of the subject's lung and subsequent treatment). Other types of procedures that may involve multiple sequential procedures include radiation therapy and therapeutic injections that are applied to a specific anatomical target multiple times at different time points. Of course, while a few specific procedures are described above, there are any number of medical procedures that may involve interaction with a desired anatomical target during multiple sequential procedures. Summary of the invention

[0003] In some embodiments, a system for performing a medical procedure may include: an instrument for delivering an active implant within a subject's anatomy; and at least one processor configured to: receive an anatomical model of the subject's anatomy, wherein the anatomical model is based on data captured prior to delivery of the active implant; receive positional information of the active implant, wherein the positional information includes a posture of the active implant within the subject's anatomy; and establish the posture of the active implant as a reference within the anatomical model.

[0004] In some embodiments, a method for providing guidance using an anatomical model of a subject's anatomy may include: receiving the anatomical model; determining a pose of an active implant delivered to the subject's anatomy, wherein the anatomical model is based on data captured prior to delivering the active implant to the subject's anatomy; and updating the anatomical model based on the pose of the active implant to establish the active implant as a reference within the model.

[0005] In some embodiments, a non-transitory computer-readable storage medium may include processor-executable instructions encoded thereon that, when executed, perform the above-described method.

[0006] It should be understood that the above concepts and the additional concepts discussed below can be arranged in any suitable combination, as the present disclosure is not limited in this regard. In addition, other advantages and novel features of the present disclosure will become apparent from the following detailed description of various non-limiting examples when considered in conjunction with the accompanying drawings. BRIEF DESCRIPTION OF THE DRAWINGS

[0007] The drawings are not intended to be drawn to scale. In the drawings, each identical or nearly identical component shown in various figures may be represented by a like numeral. For clarity, not every component may be labeled in every drawing. In the drawings:

[0008] Figure 1 A medical device system according to an embodiment of the present disclosure is shown.

[0009] Figure 2 is a flow chart illustrating an exemplary process of using an exemplary system in an initial procedure according to an embodiment of the present disclosure.

[0010] Figure 3A A medical device system driven toward a target segment of a subject's anatomy is shown; Figure 3B Shows Figure 3A a medical device system interacting with a target segment of anatomy of a subject; Figure 3C Shows Figure 3A a medical device system that delivers an active implant into a desired location relative to a target segment of a subject's anatomy; Figure 4 is a flow chart illustrating an exemplary method performed by an exemplary system according to an embodiment of the present disclosure.

[0011] Figure 5 An exemplary bronchial anatomy is shown, illustrating the anatomical structure, target segments of the anatomy, and an exemplary system in accordance with an embodiment of the present disclosure.

[0012] Figure 6 According to the embodiment of the present disclosure Figure 5 A magnified view of .

[0013] Figure 7 An exemplary bronchial anatomy is shown showing anatomical structures, target segments of the anatomy, and visual guides (such as suture and / or cutting lines) and therapeutic instrument postures to assist the user in accordance with an embodiment of the present disclosure.

[0014] Figure 8 is another flow chart illustrating an exemplary method performed by an exemplary system according to an embodiment of the present disclosure.

[0015] Fig. 9 is a schematic diagram of an exemplary teleoperated medical system according to an embodiment of the present disclosure. DETAILED DESCRIPTION

[0016] In certain applications, it is necessary to locate a target segment of tissue, and this can be difficult due to the changing anatomy and the dynamic nature of certain organs (such as the lungs and gastrointestinal tract). In addition, preoperative imaging becomes inaccurate as the organ moves and / or the segments within the entire organ move (such as may occur if a lung tumor moves as the corresponding portion of the lung moves).

[0017] The above problems may become more apparent over a long period of time, which may often occur between an initial medical procedure where imaging occurs (such as a biopsy visit) and a subsequent medical procedure where surgery or other operations occur. For example, a suspected cancerous lesion is often biopsied during an initial medical procedure to confirm a positive or negative diagnosis (malignant or benign). Once confirmed positive, a subsequent medical procedure may be performed to treat the cancerous lesion. Depending on the specific medical diagnosis, a variety of treatments may be used. In some cases, the identified lesion may be treated by ablation or drug therapy. In other cases, removing a segment of tissue is the appropriate treatment. For example, in the case of lung cancer, removing a segment of the lung is called a segmentectomy or wedge resection. Treatments such as segmentectomies or wedge resections can be challenging (especially when performed on the anterior or posterior basal lobes). For example, the target segment may be difficult to locate due to variations in the anatomy of the lung airways and vessels, and / or because the tissue is difficult to distinguish from other non-target tissues (especially when too small for the surgeon to palpate or see). Critical sensitive associated structures within or near the target segment may also require a high degree of caution by the practitioner. Therefore, knowing the location of the target segment prior to such an operation makes the operation safer and more efficient.Of course, other types of procedures may also involve repeated positioning of a region of interest (including, for example, radiation therapy, repeated therapeutic injections, and other repeated procedures directed to a desired anatomical target, etc.).

[0018] When a medical treatment (such as a segmental resection) is completed in a series of separate medical procedures and / or when it is desired to relocate an area of ​​interest, various techniques can be used to help identify the target tissue during the sequential procedures. However, there are limitations associated with these various techniques. For example, dyes are often routinely used for surgical localization, but they only last for a few hours before they dissipate and become unusable, making it inappropriate when the initial procedure is a few days or weeks before the subsequent procedure (e.g., a common time period is 1 week-2 weeks).

[0019] In view of the foregoing, the inventor has recognized and realized the benefits associated with providing guidance when locating target tissue during a medical treatment procedure, wherein the target tissue has been identified in a separate initial diagnostic procedure. Therefore, an active implant configured to provide orientation information of an active implant to correspond to an anatomical model of the desired part of a subject can be used to relate the same anatomical model to the patient's anatomy at different times during different procedures. In some examples, the orientation information provides position, orientation, and implant state (including information for measuring the proportion, translation, and rotation of the active implant in the anatomical structure in which the active implant is implanted). Therefore, by adopting the active implant described in some embodiments of this invention, various improvements can be made to positioning, thereby leading to improvements to surgical operations. For example, in addition to providing a model for guiding subsequent procedures, the inventor also recognizes and realizes that a treatment positioning sensor of a medical device system for performing the desired subsequent procedures can be registered with the anatomical model, and real-time navigation guidance can be provided. Additionally, by using implant state information to identify deformation of the implant within the anatomy, any changes that the anatomy undergoes between an initial procedure to deploy the implant and a subsequent procedure can be used to update the anatomical model to reflect the changes in the anatomy, thereby providing a more accurate model. Thus, medical positioning can be accomplished faster and / or more accurately using an active implant than would be conventionally possible, the active implant being delivered to a desired location within the anatomy of a subject.

[0020] In some embodiments, a method for providing guidance during a medical procedure using an anatomical model (e.g., a three-dimensional anatomical model) may include obtaining an anatomical model of a subject's anatomy. This may include generating a model as described below and / or obtaining a previously generated model. The position information (e.g., position, orientation, implant state) of an active implant disposed in the subject's anatomy may then be determined. As further described below, this may include using various information sources (including but not limited to instrument positioning sensors during active implant deployment, user input, the position of target tissue relative to the active implant, implant positioning sensor information, the combination of the above and / or any other appropriate information source). The anatomical model of the subject may then be updated based on the position information of the determined active implant. For example, the posture of the active implant may be used to provide a reference within the three-dimensional model, which may be used to align the model with the reference system of the patient's anatomy during subsequent procedures, and the implant state may be used to update the three-dimensional model, as described below.

[0021] In one embodiment described above, an active implant can be delivered and anchored during an initial procedure. In one example, a robot or manual system including a positioning device (such as a robot intracavitary platform or a manually actuated device with position sensing) can be used to perform a biopsy or other medical procedures on a target tissue segment, and the positioning device can be used to deliver the active implant to a desired position in a subject's body to facilitate the registration between the model of the subject's anatomy captured during the initial procedure and the subject's anatomy during subsequent procedures. For example, an active implant can be delivered to a position corresponding to the closest protuberance to which the target tissue segment is close. In some embodiments, the three-dimensional model can be updated based on the determined position information of the active implant in the subject's body.

[0022] The orientation information of the active implant can be determined in a variety of ways. For example, in one embodiment, the position and orientation of the active implant can be determined based on the signal of the positioning sensor of the delivery device aligned with the three-dimensional model, and these positioning sensors can sense the position and orientation of at least the distal part of the device, and the active implant can be deployed from the distal part. Specifically, since the delivery device is positioned (for example, the device includes sensors, such as shape, electromagnetic sensors and / or other appropriate sensors configured to determine the real-time position and orientation of at least the distal part of the device), when the active implant is deployed in the desired position, its position and orientation (i.e., posture) relative to the device can be known. Based on the known relative positions of multiple sensors / references coupled or fixed to the active implant and / or determining the positions and orientations of multiple active implants relative to each other, the implant state information of the active implant (for example, the initial relative state of the active implant fixed in the patient's anatomy, which is used to measure the changes in scale, translation, bending and rotation) can be known.

[0023] In another example, a clinician can interact with the anatomical model and identify the position, orientation, or implant status information of an implant within the model. However, regardless of the method used to determine the position information of the active implant, the position information of the active implant can then be used to associate the anatomical model with the patient's anatomy and optionally update the anatomical model for use during the same or subsequent procedures.

[0024] As described above, in some embodiments, a subsequent subsequent medical procedure can be performed at a certain time after the initial medical procedure, during which the active implant can be deployed into the subject's anatomy. The subsequent medical procedure can be performed by a robot or manual system using the three-dimensional model generated during the initial medical procedure. The inventor has recognized and appreciated that, since the active implant is anchored at a known position with a known orientation (e.g., a known posture) in the subject's anatomy, the sensing posture of the active implant can facilitate the identification of the target tissue and / or the registration of the reference system of the model and the patient's anatomy in which the subsequent medical procedure is being performed. For example, from the initial procedure to the subsequent procedure, the relative positioning between the closest protuberance to which the active implant is deployed and the target tissue such as a lesion may be consistent. Therefore, using the posture of the active implant to register the three-dimensional anatomical model with the reference system of the patient's anatomy, the accurate position of the target tissue and other regions of interest in the model can be provided. Additionally, by registering the instrument used during the subsequent procedure with the active implant, real-time guidance in the anatomical model can be provided, which shows the relative position of the instrument and the target tissue.

[0025] In some embodiments, the subject's anatomy may change, shift or deform between the initial medical procedure and the subsequent medical procedure. Therefore, the active implant fixedly attached to the anatomy may deform in a similar manner. By comparing the implant ratio information recorded during the initial procedure with the implant ratio information determined during the subsequent procedure to measure the deformation of the active implant, similar deformations can be applied to the anatomical model reflecting the real deformation of the anatomy. For example. During the initial procedure, after the implant has been deployed in the anatomical structure, the baseline implant state of the active implant can be obtained. For example, when the anatomy is deformed, the active implant will stretch or compress, bend and twist. If the relative position and orientation of the fixed structure (such as multiple sensors fixed to the active implant) can be determined during the initial procedure and saved as a baseline, the relative position and orientation of the fixed structure can be measured or determined during the subsequent procedure, and compared with the baseline measurement to determine the deformation of the active implant (which can be used to determine the deformation of the anatomical model).

[0026] In one embodiment, a method for providing guidance during a subsequent procedure can include using a previously implanted active implant and a three-dimensional model disposed in the subject's anatomy, the three-dimensional model including a reference corresponding to the position and orientation of the previously determined active implant in the model. The three-dimensional model can be obtained in any appropriate manner (including calling from a memory, transmitting from a memory device, downloading from a remote server and / or any other appropriate method). In addition, the orientation information of the active implant in the subject's anatomy can be determined during a subsequent procedure. For example, the position and orientation (i.e., posture) of the active implant can be sensed by one or more treatment positioning sensors associated with an instrument for performing a desired medical procedure, as described below. Then, the anatomical model of the active implant and the determined posture can be used to align the model with the reference system of the instrument based on the posture of the active implant.

[0027] The inventors have recognized and appreciated that the disclosed active implants and related methods of use can reduce errors associated with subject and / or anatomical movement (e.g., lung inflation, deflation, rotation, stress, strain, deformation, etc.) (e.g., by real-time tracking and registration of active implants and anatomical models with the reference system of the patient's anatomy and optional instruments). This may lead to fewer medical complications in view of more accurate, subject-specific, and continuously reliable positioning of instruments during procedures. Additionally, in some cases, the disclosed methods and systems can provide more confidence in the subject-specific anatomy, guiding more efficient intraoperative decisions, such as guiding subsequent medical procedures via the use of preoperative planning to use the registration provided by the disclosed active implant. In other embodiments, the inventors also recognize that in some cases, when using the systems and techniques herein, additional imaging may not be required because the user can drive toward the target with more confidence than through other conventional systems, where the registration between the model of the conventional system and the reference system of the instrument being operated is not known.

[0028] While the disclosed systems and methods may be used for any number of applications, in some embodiments, the disclosed techniques may enable easy and repeatable access to a region of interest during a single operation including multiple procedures and / or during time-spaced procedures. For example, the disclosed techniques may enable serial drug / biologic delivery to the lumen of a tumor during sequential operations performed using the same or different instruments, as well as ablation using RF, microwave, cryotherapy, ultrasound therapy, laser, direct heat delivery, and / or other therapeutic procedures. The inventors have recognized and appreciated that the techniques disclosed herein may facilitate treatment of the lung, including segmental resections and wedge resections (e.g., marking the location of the tumor, finding the carina closest to the desired anatomical location, etc.), treatment of the gastrointestinal tract, bile duct, and / or any other lumen or appropriate anatomical structure in the body using any appropriate type of treatment, as described below.

[0029] The inventors have recognized and appreciated that the embodiments disclosed herein can provide improved positioning, which may also be helpful in other situations besides the above. For example, if the target area is found to be non-diseased (e.g., non-cancerous), the improved positioning may facilitate removal of the implant. Alternatively or additionally, the improved positioning may facilitate removal of the implant after treatment (such as during a subsequent procedure).

[0030] The embodiments disclosed herein may be used with any medical device. This may include robotic or manually operated endoscopes, catheters, and rigid instruments, as well as manually operated systems, robot-assisted surgical systems, remotely operated robotic surgical systems, and / or other desired applications. Of course, it should be understood that the disclosed technology is not limited to use with only these specific applications, as the present disclosure is not limited thereto.

[0031] As used herein, the term "orientation" refers to the position of an element or a portion of an element in three-dimensional space (e.g., three translational degrees of freedom along Cartesian x, y, and z coordinates). As used herein, the term "orientation" refers to the rotational placement of an element or a portion of an element (three rotational degrees of freedom - for example, roll, pitch, and yaw, angular axes, rotation matrices, quaternion representations, and / or the like). As used herein, the term "pose" refers to the multi-degree-of-freedom (DOF) spatial orientation and orientation of a coordinate system of interest attached to a rigid body. In general, a pose includes pose variables for each DOF in the pose. For example, a full 6-DOF pose will include 6 pose variables corresponding to 3 orientation DOFs (e.g., x, y, and z) and 3 orientation DOFs (such as roll, pitch, and yaw). In view of the above, it should be understood that a pose can be defined as a combination of the orientation and orientation of a subject. The pose information fully defines the spatial state of the subject in the coordinate system reference frame. For example, a separate subject and a kinematic chain of a subject may each have an associated pose, and it may be important to distinguish the meaning of a pose in this context.

[0032] Turning to the drawings, specific non-limiting examples are described in more detail. It should be understood that the various systems, components, features, and methods described with respect to these examples may be used alone and / or in any desired combination, as the present disclosure is not limited solely to the specific examples described herein.

[0033] Figure 1 An instrument system 200 is shown that can be used to remotely operate a medical system (e.g. Fig. 9 1600) using a medical instrument system in an image-guided medical procedure performed by a teleoperated component 233. Alternatively, the medical instrument system 200 can be used for non-teleoperated exploratory procedures or procedures involving traditional manually operated medical instruments (such as endoscopes). Additionally or alternatively, the medical instrument system 200 can be used to collect (i.e., measure) a set of data points corresponding to locations having anatomical passages of a subject.

[0034] The instrument system 200 includes a catheter system 202 coupled to an instrument body 204. The catheter system 202 includes an elongated flexible catheter body 216 having a proximal end 216 and a distal end or tip portion 218. The catheter system 202 may optionally include a positioning sensor (e.g., a shape sensor 222, an EM sensor 220, and / or a series of EM sensors) for determining the position, orientation, speed, velocity, posture, and / or shape of the catheter tip or other distal portion at the distal end 218 and / or along one or more segments 224 of the body 216. If the instrument system 200 is a medical instrument system (e.g., 1604) of a teleoperated medical system (e.g., 1600), the positioning sensor may be a component of the sensor system 108. If the instrument system 200 is manually operated or otherwise used for non-teleoperated procedures, the positioning sensor may be coupled to a tracking system 230 that receives sensor data and processes the received data to determine the position and optionally orientation of the distal end, section, or entire length of the instrument.

[0035] The positioning sensor may include a shape sensor 222, which may include an optical fiber aligned with the flexible catheter body 216 (e.g., provided within an internal channel (not shown) or mounted externally). Various systems and methods for monitoring the shape and relative orientation of an optical fiber in three dimensions are described in the following documents: U.S. Patent Application No. 11 / 180,389 (filed on July 13, 2005) (disclosing "Fiber optic position and shape sensing device and method relating thereto"); U.S. Patent Application No. 12 / 047,056 (filed on July 16, 2004) (disclosing "Fiber-optic shape and relative position sensing"); and U.S. Patent No. 6,389,187 (filed on June 17, 1998) (disclosing "Optical Fiber Bend Sensor"), all of which are incorporated herein by reference in their entirety. Additionally or alternatively, the positioning sensor may include an orientation sensor or a series of orientation sensors, such as an EM sensor. In some examples, the EM sensor may be positioned along the catheter for shape sensing. This type of EM sensor may additionally be used with an active implant, as previously described above. Further description of the EM sensor system is provided in U.S. Pat. No. 6,380,732 (filed Aug. 11, 1999), disclosing "Six-Degree of Freedom Tracking System Having a Passive Transponder on the Object Being Tracked," which is incorporated herein by reference in its entirety. In some embodiments, the shape sensor may also be used as an orientation sensor, because the shape of the sensor, together with information about the position of the base of the shape sensor (in the fixed coordinate system of the instrument), allows the position of various points along the shape sensor (including the distal tip) to be calculated.

[0036] The tracking system 230 may include a position sensor system 220 and / or a shape sensor system 222 for determining the position, orientation, velocity, posture, and / or shape of the distal end 218 and one or more segments 224 along the instrument 200. The tracking system 230 may be implemented as hardware, firmware, software, or a combination thereof interacting with or otherwise executed by one or more computer processors, which may include a processor of a control system.

[0037] The medical device 226 may house a cable, linkage, or other actuation control (not shown) extending between the proximal and distal ends of the device for controllably bending the distal end of the device. Steerable devices are described in detail in U.S. Patent No. 7,316,681 (filed October 4, 2005) (disclosing "Articulated Surgical Instrument for Performing Minimally Invasive Surgery with Enhanced Dexterity and Sensitivity") and U.S. Patent Application No. 12 / 286,644 (filed September 30, 2008) (disclosing "Passive Preload and Capstan Drive for Surgical Instruments"), which are incorporated herein by reference in their entirety.

[0038] In an embodiment where the instrument system 200 is actuated by a remotely operated assembly, the housing 204 may include a drive input that is removably coupled to an electrically driven element of the remotely operated assembly and receives power therefrom. In an embodiment where the instrument system 200 is manually operated, the housing 204 may include a gripping feature, a manual actuator, or other components for manually controlling the movement of the instrument system. The catheter system may be steerable, or, alternatively, the system may be non-steerable, without an integrated mechanism for operator-controlled instrument bending. Similarly or alternatively, one or more lumens are defined in the wall of the flexible body 216, through which medical devices can be deployed and used at the target surgical location. For example, the size and shape of the channel may be designed to receive a medical device (such as an image capture probe, a biopsy instrument, a laser ablation fiber, or other surgical, diagnostic, or therapeutic tool) or an active implant.

[0039] Information from the tracking system 230 can be sent to the navigation system 232, where it is combined with information from the visualization system 231 and / or the preoperatively acquired model to provide the surgeon or other operator with real-time position information on a display system (e.g., 1610 in FIG. 15 ) for controlling the instrument 200. The control system can use the position information as feedback to position the instrument 200. Various systems for registering and displaying surgical instruments with surgical images using fiber optic sensors are provided in U.S. patent application Ser. No. 13 / 107,562, filed May 13, 2011, disclosing “Medical System Providing Dynamic Registration of a Model of an Anatomical Structure for Image-Guided Surgery,” which is incorporated herein by reference in its entirety.

[0040] exist Figure 1 In an embodiment, the device 200 is used in a remotely operated medical system (e.g., Fig. 9 In an alternative embodiment, the remote operation component (e.g. Fig. 9 1602) may be replaced by direct operator control. In the direct operation alternative, various handles and operator interfaces may be included for handheld operation of the instrument.

[0041] Figure 2 1 is a flow chart illustrating one embodiment of an initial procedure during which an active implant may be implanted into a subject to facilitate registration of an anatomical model with an instrument's reference frame. In the depicted embodiment, process 1300 Figure 2 1300 is shown as a set of phases, blocks, steps, operations, or processes. Not all of the operations shown or listed may be performed in all embodiments of process 1300. Additionally, Figure 2 Some additional operations not explicitly shown may be included before, after, between, or as part of the enumerated stages.

[0042] Some embodiments of process 1300 may begin at stage 1310, where an anatomical model of a subject may be obtained. In one such embodiment, the subject's anatomy may be imaged by any suitable instrument prior to or during an operation to develop an anatomical model of at least a portion of the subject. In this embodiment, preoperative or intraoperative image data may be obtained from an imaging technique such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, or nanotube X-ray imaging. Computer software may then be used alone or in combination with manual input to convert the recorded images into a segmented two-dimensional or three-dimensional synthetic representation or model of a portion or entire anatomical organ or anatomical region. The synthetic representation and image data set describe various locations and shapes of the anatomy, such as airway passages and their connections.

[0043] The processor of the system can be configured to receive user input to determine or automatically determine an anatomical target and optionally generate a planned path to the anatomical target in the anatomical model. The processor can be configured to provide guidance, and / or can control the delivery instrument to navigate the delivery instrument to the anatomical target based on the planned path. The processor can be configured to identify or receive information identifying a position for deploying an active implant. For example, a position close to the anatomical target can be identified automatically, semi-automatically (e.g., the system determines and recommends a position) or by a user. In the case of automatic or semi-automatic selection of a position, the processor of the system can be configured to identify these positions based on appropriate considerations, such as relevant landmarks and anatomical structures close to the anatomical target within the anatomical model. In some embodiments, this may include positioning the anatomical target relative to the next carina on the proximal side of the procedure performed in the lungs of the subject.

[0044] After obtaining the anatomical model, process 1300 can then proceed to stage 1320, in which the delivery instrument (such as medical device system 200) and the subject anatomy can be registered with the three-dimensional anatomical model of the subject anatomy. Typically, registration involves matching measured points with points of the model using rigid and / or non-rigid transformations. The measured points can be generated using landmarks in the anatomy, electromagnetic coils that are scanned and tracked during the procedure, or a shape sensor system. The registration can be accomplished using any appropriate technique, including but not limited to landmark recognition, point cloud comparison, and / or other appropriate techniques. Other point set registration methods may also be used in the registration process within the scope of the present disclosure. Additionally, in some cases, because the anatomical model is generated by the instrument during the current procedure, the anatomical model may be registered with the reference frame of the instrument.

[0045] After registering the anatomical model with the instrument's reference frame, method 1300 may then proceed to stage 1330 where the delivery instrument may be driven to the location of the anatomical target, such as Figure 3A shown. Figure 3A An exemplary bronchial anatomy model 300 is shown showing different anatomical structures, target segments of the anatomy, and exemplary systems in accordance with an embodiment of the present disclosure. Specifically, the figure depicts a main carina 304 and a carina 306 at the junctions between different branches along the illustrated passageway as well as an anatomical passage. A delivery instrument 310 may be driven to an anatomical target 308 using any suitable method. For example, a user may manually control the delivery instrument, using the anatomical model for guidance, or a pre-planned path may be implemented to guide the delivery instrument to the anatomical target.

[0046] Once the delivery device 310 is properly positioned adjacent to the anatomical target 308, the delivery device 310 may be used at 1340 to Figure 3B Any suitable method shown is used to confirm the target site location of the anatomical target. This may include, for example: a biopsy needle 312 or other instrument delivered by a delivery instrument is used to obtain a sample of the anatomical target 308; visual identification of the anatomical target 308 using an endoscopic camera; imaging the anatomical target 308 using an ultrasound device delivered by or integrated into the delivery instrument; and / or any other suitable procedure capable of confirming the anatomical target 308.

[0047] After the target site location has been confirmed, method 1300 may then proceed to stage 1350 where delivery device 310 may be used to place active implant 314 at a desired location and orientation (i.e., posture) within the anatomy of the subject, such as Figure 3C 13 and as will be described in further detail below. In some examples, the desired position is determined during a planning phase, such as during phase 1310. In other examples, the desired position can be determined after confirming the target site location and selecting a position close to the current position of the delivery instrument at the anatomical target.

[0048] In some embodiments, after the active implant is placed in a desired posture relative to one or more anatomical structures of the subject, it may be desirable to update the subject's anatomical model (such as a three-dimensional anatomical model) to include references related to the position information of the active implant in the subject. The position information may include the position and orientation (posture) of the implant in the subject's anatomy, as well as implant state information, which can be used to determine the initial relative state of the active implant fixed in the patient's anatomy (for measuring changes in scale, translation, bending, and rotation). As previously described, information about the implant in the anatomy (which may include posture) can facilitate the use of the model in subsequent procedures by the ability to sense the posture of the active implant. The implant state information can be used to update the model during subsequent procedures to take into account changes and shifts in the subject's anatomy after the initial medical procedure.

[0049] This method is Figure 4 It is shown in Figure 4 is a flow chart illustrating one embodiment of a method 1400 for updating an anatomical model of a subject with positional information of an active implant within a portion of the subject's anatomy and, in some cases, optionally providing planning guidance to a clinician for use in an image-guided surgical procedure on the subject. Figure 4 1400 is shown as a set of phases, blocks, steps, operations or processes. Not all of the operations shown or listed may be performed in all embodiments of method 1400. Additionally, Figure 4 Some additional operations not explicitly shown in the method 1400 may be included before, after, between, or as part of the enumerated stages. Some embodiments of the method 1400 include instructions corresponding to the processes of the method 1400 stored in a memory. These instructions may be executed by a processor (such as a processor of a control system).

[0050] At 1420, an anatomical model may be obtained, such as in Figure 2The anatomical model generated during method 1300 of . After obtaining the anatomical model, position information of the active implant in the subject can be determined at 1430. The position information can include the position and orientation (posture) of the implant in the subject's anatomy, as well as implant state information, which can be used to later determine structural changes of the active implant for determining changes in the anatomy (in which the active implant is fixed). Including. Obtaining the position information can be done in real time using a system that delivers the active implant, or it can be performed by a separate system using previously recorded information, as the present disclosure is not limited to this. The position information of the active implant relative to the tissue in which it is implanted into the subject's anatomy can be determined in a variety of different ways, including receiving information from a delivery device at 1432, using known active implant sensor structure information, using imaging technology, and / or receiving information from a user at 1434, as described below.

[0051] In one embodiment, a delivery instrument positioning sensor, such as a shape sensor, an EM sensor, a plurality of EM sensors, or other suitable sensor, may be used to determine the pose of a distal portion of the delivery instrument from which the active implant is deployed at 1432. With the anatomical model registered with the reference frame of the delivery instrument, once the active implant has been deployed, the pose of the distal portion of the delivery instrument may be used to determine the pose of the active implant relative to the reference frame of the model, i.e., the delivery pose of the active implant that may be measured using the delivery instrument positioning sensor.

[0052] In another embodiment, the active implant may include multiple positioning sensors, each of which is embedded, coupled or otherwise fixed to the active implant in a known mechanical configuration that can be used to determine implant state information. In one example, the relative distances between multiple positioning sensors (including axial and rotational distances along the active implant) can be recorded as orientation information when deployed in the subject's anatomy. In another example, the relative distance of each positioning sensor can be measured. In other examples, the positioning sensor can be used as a reference visible in the image, and the relative distance can be visualized (e.g., visualized under fluoroscopy used during the implantation procedure or internal imaging provided by the instrument) and processed via image processing or visually identified by the user.

[0053] In yet another embodiment, multiple active implants may be used to determine implant state information, each of which includes one or more positioning sensors. In this embodiment, the method will include delivering multiple active implants in close proximity to each other within the subject's anatomy using a delivery device with positioning sensing (EM, optical fiber, shape, etc.) as previously described. The relative distance between each active implant can be determined by using data from a delivery device with positioning sensing, measurement of signals from each implant positioning sensor, and / or using imaging to visualize the implant positioning sensor as a reference, as described above.

[0054] In another embodiment, at 1434, the user can use any appropriate input device to input information related to the posture of the active implant. For example, the user can use a graphical user interface to select a posture corresponding to the position of the deployed active implant within the model, and select where the positioning sensor on the active implant is positioned. In other embodiments, both sensor data from the delivery device and user input can be used to determine the active implant posture, wherein the sensor data is initially used and the user input is provided to adjust the posture or the user input is provided for the initial posture and the sensor data is used to refine the position or orientation within the model.

[0055] Although specific methods for determining the posture of an active implant are described above, it should be understood that any suitable method for determining the posture of an active implant may be used, as the present disclosure is not limited in this regard.

[0056] After determining the posture of the active implant relative to the reference frame of the anatomical model and the implant state of the active implant, the method can proceed to stage 1440, in which the anatomical model can be updated based on the orientation information of the determined active implant. Specifically, a reference corresponding to the posture and implant state of the implant in the model can be incorporated into the model. Therefore, the posture and implant state of the reference in the model can substantially correspond to the posture and implant state of the active implant in the corresponding anatomical structure of the subject.

[0057] Figure 5An exemplary bronchial anatomical model according to an embodiment of the present disclosure is shown, which shows different anatomical structures, target segments of anatomical bodies, and exemplary systems. Specifically, the figure depicts an anatomical passage 910 and a main carina 920 and a carina 930 at the junctions between different branches along the passage shown. As previously described, an active implant 960 can be implanted in a desired position within the patient's anatomical structure with a given orientation, resulting in an overall posture of the active implant within the anatomical structure. As previously described, in the case of known position and orientation within the anatomical structure (based on active implant delivery by a registered delivery device or known by user input), the position and orientation within the anatomical model are known, and a virtual representation of the active implant can be added to the anatomical model.

[0058] In some embodiments, it may be desirable to provide treatment guidance to a user (such as a medical practitioner) after a model including information related to the active implant has been generated. For example, in some embodiments, method 1400 may optionally proceed to stage 1450, where treatment guidance may be planned. Depending on the embodiment, the treatment guidance may correspond to providing drug delivery guidance at 1452, providing tissue ablation guidance at 1454, providing tissue resection guidance at 1456, providing guidance for sequential treatments, combinations of the foregoing, and / or providing any other suitable type of treatment guidance.

[0059] In one embodiment of stage 1450, the processor may be configured to receive a three-dimensional model including anatomical targets and information associated with the active implant posture. The segments of the subject's anatomy for treatment may be identified based on the three-dimensional model. This may be an automatic step performed by the system, wherein the location of anastomosis, cutting or other treatments is identified. Alternatively, the system may implement this step semi-automatically, wherein the system defines the location and type of treatment, but the user may change the proposed treatment. In yet another embodiment, the user may manually input a plan in a pre-planning phase performed prior to a subsequent procedure. It should be understood that any medical device system for implementing the planned treatment may have appropriate therapeutic equipment to perform the removal of the identified anatomical targets, deliver therapeutics such as drugs to the identified anatomical targets, and / or provide any other desired type of treatment to the identified anatomical targets, because the present disclosure is not limited.

[0060] Figure 7 An example of graphical guidance for using an active implant 960 in a human body is shown in accordance with an embodiment of the present disclosure. Figure 7An exemplary target tissue segment 970 within a lumen of anatomical space is depicted. In the depicted example, the anatomical space corresponds to a lung of a subject. Although the target tissue segment is visible within the field of view of the instrument, it may still be difficult to identify other surrounding tissue. However, if the anatomical model of the subject is properly registered with the reference frame of the instrument, additional information may be displayed to the user. For example, Figure 7 As shown, information such as the location of one or more identified anatomical structures, including a target tissue segment (ie, an anatomical target), can be added to the anatomical model. Specifically, Figure 7 An exemplary target tissue segment 970 is depicted along with other structures such as identified veins (not depicted) and bronchial structures 974 and recommended surgical cuts or sutures 976. The surgical cuts / sutures 976 can be added by the user through a graphical user interface, or automatically determined by the system. In some embodiments, the position of the instrument 978 within the registered anatomical model and the corresponding position within the anatomical space can be superimposed on the image presented to the user. In another embodiment, additional information can be overlaid on the real-time fluoroscopic or endoscopic image after the imaging device is registered with the anatomical model. Thus, in some embodiments, the disclosed systems and methods can be used to facilitate augmented reality visualization during surgical procedures, which can accelerate procedural speed and success rates.

[0061] It should be noted that if multiple active implants are to be delivered into a subject's anatomy, the above model deployment and updating process may be repeated as many times as desired.

[0062] As previously described, an active implant (or multiple active implants) placed in a subject during an initial procedure can be used to facilitate registration between a previously generated model of a subject's anatomy associated with the active implant and the same subject's anatomy during a later, subsequent procedure. One such embodiment is shown in FIG. 13 , which is a flow chart showing an exemplary process 1500 for using an exemplary system in a subsequent procedure after a model containing references to the orientation information of the active implant has been generated. The method is shown as a set of stages, blocks, steps, operations, or processes. Not all of the operations shown and listed may be performed in all embodiments of method 1500. In addition, some additional operations not explicitly shown in FIG. 13 may be included before, after, between, or as part of the listed stages. Some embodiments of method 1500 include instructions corresponding to the processes of method 1500 stored in a memory. These instructions may be executed by a processor (such as a processor of a control system disclosed herein).

[0063] Some embodiments of process 1500 may begin at stage 1510, where a medical device system may obtain an anatomical model of a patient anatomy (such as in Figure 4 1440) for subsequent procedures. At 1520, the position information of (one or more) active implants in the current patient's anatomy can be determined. As previously described, the position information can include the active implant posture and implant state information in the anatomy. The posture is known in the implant positioning sensor reference system. Since the active implant is fixed and embedded in the subject's anatomy, the implant positioning reference system can be regarded as the same as the subject's anatomical reference system. In some embodiments, the desired position information includes the state of the active implant (including the relative positioning of each implant positioning sensor 962). In this embodiment, the active implant should be at least partially flexible and have a longitudinal length that can provide sufficient separation of multiple spaced apart sensors. The state of the active implant can include the relative positioning of the implant positioning sensors to each other (including the distance between each sensor along the longitudinal axis of the implant, the radial distance along the radius of the active implant, and / or the rotational distance between each sensor). Several potential embodiments for detecting the position information of the active implant are described in further detail below.

[0064] like Figure 6As best shown, in some embodiments, the active implant 960 may include one or more implant positioning sensors 962. It should be understood that any suitable type of active implant capable of measuring orientation information may be used. For example, the implant positioning sensor may be a passive system and / or it may be powered by an onboard power source (e.g., a battery), or it may be inductively powered by an externally located power source. In the case of a passive active implant, the active implant may include an inductive circuit having one or more inductive coils configured to couple with an electromagnetic field emitted by two or more than two, three or more than three, or any other suitable number of receivers (e.g., corresponding treatment positioning sensors) configured to be disposed at different locations relative to the active implant, such that the sensed signals may be used to determine the attitude of the active implant. In some embodiments, multiple inductive circuits may be included in the active implant, wherein different inductive circuits may be configured to be excited at different frequencies and or at different modulation frequencies. In other embodiments, a radiopaque reference included in the active implant may be imaged by an external X-ray imaging system to determine the attitude of the active implant. In the case of an electrically active implant, in some embodiments, the implant positioning sensor may include one or more transmitters configured to transmit a pulse signal that may be sensed by two or more, three or more, or any other appropriate number of receivers of a separate instrument configured to sense the transmitted pulse signal, which may then be used to determine the attitude of the active implant. Of course, other types of active implants having passive and / or active components that can be used to detect positional information associated with the active implant may be used, as the present disclosure is not limited thereto.

[0065] Depending on the particular application, the active implant may be anchored relative to the target location within the subject's anatomy in any suitable manner. For example, in certain embodiments, suitable attachment types may include, but are not limited to, stents, clips, adhesives, coil elements, baskets, and / or any other suitable method for attaching an active implant to an adjacent portion of tissue. Figure 3C As shown, active implant 314 may be an expandable stent that is delivered and deployed using delivery apparatus 310 .

[0066] In some embodiments, the active implant can be airtightly sealed or sealed in any other suitable manner to be placed in the human body. As previously mentioned, any suitable attachment method can be used to maintain the active implant in the desired posture in the anatomical structure. For example, the support 950 shown is engaged with the surrounding tissue of the passage of the lung so that the posture of the support and the corresponding posture of the active implant connected to the support are maintained relative to the surrounding tissue. The target tissue segmentation 970 spaced apart from the position of the active implant is also described.

[0067] In embodiments using powered active implants, the active implants may be powered by an onboard power source (such as a battery), or the active implants may be inductively powered by one or more externally located power sources (e.g., an inductive power source included in the medical device system 200 or the teleoperation system 1600). In either case, one or more implant positioning sensors of the active implants placed in a previous procedure may correspond to one or more transmitters configured to transmit wireless signals (such as one or more characteristic radio frequencies or modulations on a shared frequency) to enable differentiation between elements (such as multiple implants). The sensed transmissions emitted by the active implants may be used to determine the pose of the active implant relative to the sensors, thereby determining a reference frame of the associated system medical device system for performing the desired medical procedure.

[0068] In another embodiment, the active implant can be at least partially radiopaque and have physical features, such as size, shape, identity of markings, distances between elements, and / or any other features, that can be used to identify both the position and orientation of the active implant using multiple X-ray images (e.g., at least 2) taken at different postures relative to the subject. Thus, the X-ray images can be used to identify the posture of the active implant in the subject. In addition, the posture of the active implant relative to the medical device system can be determined when the reference frame of the X-ray imager is aligned with the reference frame of the medical device system.

[0069] Although specific methods for determining the posture of an active implant implanted within the anatomy of a subject are described in detail above, it should be understood that any appropriate method for determining the posture of the active implant relative to a reference frame of a medical device system used to perform one or more medical procedures on the subject may be used, as the present disclosure is not limited in this manner.

[0070] Return to reference Figure 8In the method 1500 of the embodiment of the present invention, at stage 1521, the anatomical model can be optionally updated. In some embodiments, the subject's anatomy can be deformed between the initial medical procedure and the subsequent medical procedure when the active implant is deployed. Therefore, the active implant fixedly attached to the anatomy can be deformed in a similar manner. By measuring the deformation of the active implant from the initial procedure to the subsequent procedure, similar deformations can be applied to the anatomical model reflecting the actual deformation of the anatomy. Since the anatomical model obtained during stage 1510 includes implant state information, a baseline measurement of the initial relative orientation of the implant positioning sensor 962 is provided, so the implant state information obtained from stage 1520 can be used to determine the deformation of the active implant. For example, measuring the change in longitudinal or radial distance can measure the proportional change indicating the stretching, compression or bending of the implant, and the rotational change can indicate the twisting of the implant, etc. Then, the change measured in the active implant can be converted into a change in the anatomical model, and the anatomical model can be updated to reflect this deformation. In another embodiment with multiple active implants, the change in the relative distance between each sensor can be determined in a similar manner, except that the sensor is embedded / coupled to a separate active implant deployed at different positions in the subject's anatomy.

[0071] In yet another embodiment, an instrument used during a subsequent procedure can include an imaging device that can be used to provide additional information to determine anatomical deformation. For example, an instrument with multiple endoscopic cameras can provide stereoscopic vision that can be used to extract surface features within the subject's anatomy that can be considered boundary conditions to deform the anatomical model to more accurately reflect the anatomy during subsequent procedures. By additionally visualizing the active implant, the expected position of the benchmark can be compared to the actual position of the benchmark to further update the model. Imaging analysis or artificial intelligence can be used to identify specific structures in the video stream, or the user can annotate the video using a GUI or other interactive input device as the video is displayed.

[0072] After determining the posture of the active implant and optionally updating the anatomical model, process 1500 can then proceed to stage 1522, in which the anatomical model is aligned with the subject's anatomy using the active implant. As previously described, the anatomical model from method 1440 includes the orientation information of the active implant (including the posture of the active implant in the model). Therefore, the known posture of the active implant in the anatomical model can be used to align the anatomical model with the subject's anatomy using the measured posture of the active implant obtained from stage 1520.

[0073] After registering the three-dimensional anatomical model with the patient anatomy, process 1500 can then proceed to stage 1530, in which the three-dimensional anatomical model of the subject anatomy can be registered with the following items: the reference frame of the medical device system, or other medical platform that can be used to perform medical procedures on the subject anatomy (e.g., tumor resection, segmental resection, wedge resection, ablation, drug delivery, radiation therapy treatment, lymphatic channel identification, etc.). For example, as previously described, the anatomical model can include references within the model related to the posture of the active implant relative to the anatomical model. Therefore, based at least in part on the registration of the active implant sensor reference frame with the medical device system treatment sensor reference frame, the anatomical model can be registered with the reference frame of the medical device system (which may include one or more treatment positioning sensors). Several potential embodiments for aligning implant positioning sensors with treatment positioning sensors are further described in detail below.

[0074] In one embodiment, one or more implant positioning sensors can be configured so that they can be actively or passively sensed by one or more corresponding treatment positioning sensors 964, which are configured to sense information related to the posture of the active implant. The treatment positioning sensor can be included in the medical device system and / or can be registered with the reference frame of the medical device system and can be disposed external to the subject.

[0075] In yet another embodiment, an implant positioning sensor and a corresponding treatment positioning sensor may be used as the EM sensors described in more detail above. In such an embodiment, the implant positioning sensor may correspond to one or more circuits including an inductive coil that may couple with an electromagnetic field emitted by one or more magnetic field transmitters (i.e., one or more treatment positioning sensors of a medical device system) disposed outside the subject. As previously described, the interaction between the (one or more) emitted electromagnetic fields and the inductive circuit of the active implant may be used to determine the posture of the active implant. In some embodiments, the reference frame for treatment positioning used to measure the posture of the active implant may be the same as the reference frame of the medical device system. Therefore, the posture of the active implant measured by the treatment positioning sensor may correspond to the posture of the active implant relative to the medical device system.

[0076] In another embodiment, a medical device can be used to contact a portion of an active implant, and the position and orientation of the medical device tip or distal portion of the medical device can be measured and associated with a known position on the active implant. Contacting multiple known points on the active implant can provide the data needed to align the active implant reference system with the medical device reference system.

[0077] It should be understood that the phases 1520 to 1530 corresponding to the detection of the orientation information of the active implant and the registration of the anatomical model with the reference system of the subject's anatomy and the medical device system can be performed in a single, continuous, real-time manner to account for the movement of the subject relative to the medical device system, and / or periodically at spaced intervals, as the present disclosure is not limited in this manner. In addition, the situation where these processes are performed on multiple active implants disposed within the subject's anatomy is also contemplated.

[0078] After registering the model with the reference frame of the medical instrument system, process 1500 may optionally proceed to stage 1540 where real-time guidance of a target anatomical segment (e.g., a target tissue such as a cancerous lesion) may be provided. For example, the anatomical target may represent a cancerous lesion or otherwise diseased or problematic tissue segment. The guidance may provide a graphical representation of the target tissue 970 to be treated or resected, as well as a graphical representation of the real-time position and orientation of the instrument 978 as it is positioned during the procedure, see Figure 7 The guidance provided can be implemented using pre-planned treatment guidance, which can be found in Figure 4 , and / or determined by the optional planning stage 1450 and / or a separate planning stage in the platform. Thus, the treatment guidance provided may include drug delivery guidance at 1542, tissue ablation guidance at 1544, tissue resection guidance at 1546, combinations of the foregoing, and / or any other appropriate type of treatment guidance, as the present disclosure is not limited in this regard. In addition, according to an embodiment, the treatment guidance provided may correspond to automatic control of a medical device, semi-automatic control of a medical device, and / or guidance provided to a user performing a manual procedure. In one such example, the model can be used with (one or more) rendered virtual images of a tool of the platform to provide real-time navigation guidance by displaying the relative positioning of the tool and the anatomical target to be treated within the registered anatomical model.

[0079] Depending on the type and number of procedures to be performed, process 1500 may end as indicated, or it may be repeated as necessary.

[0080] It should be understood that any of the methods described above in connection with FIGS. 11-13 and elsewhere in the present disclosure may be performed by at least one processor based on executable instructions encoded on at least one computer-readable storage medium. This may include implementations using processors such as those described with respect to the control systems of the various embodiments of the medical device systems disclosed herein. In addition, a method similar to Figure 1 and the following Fig. 9 The depicted system of systems performs operations including registration, confirming target tissue location, diagnosing or treating target tissue, and / or delivering active implants.

[0081] Fig. 9 One example of a system that may be used with some embodiments herein is shown, and an exemplary teleoperated medical system for, for example, surgical, diagnostic, therapeutic, or biopsy procedures is generally indicated by reference numeral 1600. Fig. 9 As shown, the teleoperation system 1600 generally includes a teleoperation manipulator assembly 1602 for operating medical instruments 1604 when performing various procedures on a subject. Assembly 1602 is mounted on or near an operating table O. A master assembly 1606 allows a clinician or surgeon S to view the intervention site and control the slave manipulator assembly 1602. The master assembly 1606 generally includes one or more control devices for controlling the manipulator assembly 1602. The control device may include any number of various input devices, such as a joystick, a trackball, a data glove, a trigger gun, a manually operated controller, a voice recognition device, a body motion or presence sensor, or the like.

[0082] Teleoperation assembly 1602 supports medical device system 1604 and may include one or more non-servo controlled linkages (e.g., one or more linkages that can be manually positioned and locked in place, often referred to as setup structures) and kinematic structures of a teleoperated manipulator. Teleoperation assembly 1602 includes a plurality of actuators or motors that drive inputs on medical device system 1604 in response to commands from a control system (e.g., control system 1612).

[0083] The teleoperated medical system 1600 also includes a sensor system 1608 having one or more subsystems for receiving information about the instrument of the teleoperated assembly. Such subsystems may include a position sensor system (e.g., an electromagnetic (EM) sensor system); a shape sensor system for determining the position, orientation, speed, velocity, posture, and / or shape of the catheter tip and / or one or more segments along the flexible body of the instrument system 1604; and / or a visualization system for capturing images from the distal end of the catheter system. The sensor system may also include one or more sensors configured to detect the posture of an implant positioning sensor of an active implant as described in detail above.

[0084] The teleoperated medical system 1600 also includes a display system 1610 for displaying images or representations of the surgical site and (one or more) medical device systems 1604 generated by the subsystems of the sensor system 1608. Alternatively or additionally, the display 1610 can present images of the surgical site recorded preoperatively or intraoperatively using image data from an imaging technique, such as computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound, optical coherence tomography (OCT), thermal imaging, impedance imaging, laser imaging, or nanotube X-ray imaging. The preoperative or intraoperative image data can be presented as a two-dimensional, three-dimensional, or four-dimensional (including, for example, time-based or rate-based information) image, or as an image from a model created from a preoperative or intraoperative image data set.

[0085] In some embodiments, typically for the purpose of imaging-guided surgical procedures, the display 1610 may display a virtual navigation image in which the actual position of the medical instrument 1604 is registered with the model described in detail above (i.e., the actual position of the medical instrument 1604 is dynamically referenced to the model described in detail above) to present a virtual image of the internal surgical site to the clinician or surgeon S from the viewpoint of the position of the tip of the instrument 1604. An image of the tip of the instrument 1604 or other graphical or alphanumeric indicator may be superimposed on the virtual image to assist the surgeon in controlling the medical instrument. Alternatively, the instrument 1604 may not be visible in the virtual image.

[0086] In other embodiments, the display 1610 may display a virtual navigation image in which the actual position of the medical instrument is registered with the preoperative or concurrent images to present a virtual image of the medical instrument within the surgical site from an external viewpoint to the clinician or surgeon S. An image of a portion of the medical instrument or other graphical or alphanumeric indicators may be superimposed on the virtual image to assist the surgeon in controlling the instrument 1604.

[0087] The remotely operated medical system 1600 also includes a control system 1612. The control system 1612 includes at least one memory and at least one computer processor (not shown), and typically multiple processors, for implementing control between the medical device system 1604, the operator input system 1606, the sensor system 1608, and the display system 1610.

[0088] During the virtual navigation procedure, the sensor system 1608 can be used to calculate the approximate position of the instrument relative to the subject's anatomy. Various systems can be used to register and display medical instruments together with preoperatively recorded surgical images (such as those from a virtual visualization system) using fiber optic sensors. For example, U.S. Patent Application No. 13 / 107,562 (filed on May 13, 2011) (disclosing "Medical System Providing Dynamic Registration of a Model of an Anatomical Structure for Image-Guided Surgery") discloses one such system, which is incorporated herein by reference in its entirety.

[0089] Although the systems and methods of the present disclosure have been described for use with the connected bronchial passages of the lung, they are also applicable for navigating and treating other tissues via natural or surgically created connected passages in any of a variety of anatomical systems, including the colon, intestines, kidneys, brain, heart, circulatory system, or the like.

[0090] One or more elements of the embodiments of the present invention may be implemented in software to be executed on a processor of a computer system such as the control system 1612. When implemented in software, the elements of the embodiments of the present invention are essentially code segments that perform the necessary tasks. The program or code segment may be stored in a processor-readable storage medium or device, which may have been downloaded via a computer data signal embodied in a carrier wave on a transmission medium or communication link. The processor-readable storage device may include any medium that can store information, including optical media, semiconductor media, and magnetic media. Examples of processor-readable storage devices include electronic circuits, semiconductor devices, semiconductor memory devices, read-only memories (ROMs), flash memories, erasable programmable read-only memories (EPROMs), floppy disks, CD-ROMs, optical disks, hard disks, or other storage devices. The code segments may be downloaded via a computer network (such as the Internet, an intranet, etc.).

[0091] Please note that the processes and displays presented may not be inherently related to any particular computer or other device. The structures required for various these systems will appear as elements in the claims. In addition, embodiments of the present invention are described without reference to any particular programming language. It should be understood that various programming languages ​​can be used to implement the teachings of the present invention described herein.

[0092] Although the present teaching has been described in conjunction with various examples, it is not intended that the present teaching be limited to these examples. On the contrary, it will be appreciated by those skilled in the art that the present teaching includes various alternatives, modifications and equivalents. Therefore, the above description and accompanying drawings are only intended to be examples.

Claims

1. A system for performing a medical procedure, the system comprising: Devices for delivering active implants within the anatomy of a subject; and At least one processor configured to: receiving an anatomical model of the subject's anatomy, wherein the anatomical model is based on data captured prior to delivering the active implant; receiving position information of the active implant, wherein the position information includes a posture of the active implant within the anatomy of the subject; and The pose of the active implant is established as a reference within the anatomical model.

2. The system of claim 1, wherein the at least one processor is further configured to update the anatomical model based on the position information of the active implant.

3. The system of claim 2, wherein the anatomical model is updated to reflect anatomical deformation of the subject's anatomy.

4. The system of any of the preceding claims, wherein the instrument comprises a delivery instrument positioning sensor, and the position information describing the posture of the active implant is received from the delivery instrument positioning sensor.

5. The system of claim 4, wherein the delivery instrument positioning sensor comprises a shape sensing optical fiber or at least one EM sensor, and wherein the delivery instrument positioning sensor is configured to provide the position and orientation of at least a distal segment of the instrument.

6. The system of claim 4 or 5, wherein establishing the pose of the active implant as the reference within the anatomical model comprises registering the instrument with the anatomical model based on data from a positioning sensor of the delivery instrument.

7. The system of any one of claims 4-6, wherein the position information from the delivery instrument positioning sensor is the delivery position of the instrument when the instrument delivers the active implant to the delivery position.

8. The system of claim 1, wherein the apparatus comprises an imaging system, wherein the imaging system is configured to provide data for updating the anatomical model to reflect anatomical deformation of the subject's anatomy.

9. The system of any of the preceding claims, wherein the position information describing the position of the active implant is based at least in part on input from a user.

10. The system of any of the preceding claims, further comprising the active implant, wherein the active implant comprises an implant positioning sensor.

11. The system of claim 10, wherein the at least one processor is further configured to register the subject anatomy with the anatomical model based on data from the implant positioning sensor of the active implant.

12. The system of claim 10 or 11, wherein the anatomical model comprises an anatomical target.

13. The system of claim 12, wherein the at least one processor is further configured to determine an implant position for delivering the active implant, wherein the implant position is based at least in part on a position of the anatomical target.

14. The system of claim 12 or 13, wherein the at least one processor is further configured to determine a portion of the subject's anatomy for treatment based on the anatomical target.

15. The system of claim 14, wherein the at least one processor is further configured to provide guidance for treatment of the segment of the subject's anatomy.

16. The system of claim 15, wherein the guidance comprises a graphical indicator on or within the anatomical model, wherein the graphical indicator represents the section of the subject's anatomy for treatment.

17. The system of any one of claims 141-16, wherein the treatment comprises resecting the segment.

18. The system of any one of claims 14-17, further comprising a treatment device configured to treat the segment, wherein the treatment device comprises a treatment positioning sensor.

19. The system of claim 18, wherein the at least one processor is further configured to register the therapeutic device with the anatomical model.

20. The system of claim 19, wherein the implant positioning sensor and the treatment positioning sensor are in the same reference frame.

21. The system of claim 15, wherein providing guidance for treatment of the segment comprises providing a representation of the treatment device within the anatomical model.

22. The system of any one of claims 12-21, wherein the at least one processor is further configured to generate a planned path to the anatomical target in the anatomical model.

23. The system of claim 22, wherein the at least one processor is further configured to provide guidance based on the planned path to navigate the instrument to the anatomical target.

24. The system of any of the preceding claims, wherein the instrument comprises a laparoscopic device, an endoscopic device, or a catheter.

25. A method for providing guidance using an anatomical model of a subject's anatomy, the method comprising: receiving the anatomical model; determining a pose of an active implant delivered to the subject's anatomy, wherein the anatomical model is based on data captured prior to delivering the active implant to the subject's anatomy; The anatomical model is updated based on the pose of the active implant to establish the active implant as a reference within the model.

26. The method according to claim 25, further comprising: receiving imaging data capturing the anatomy of the subject; as well as The anatomical model is generated based on the imaging data.

27. The method of claim 25, further comprising identifying an anatomical target within the anatomical model.

28. The method of claim 27, wherein identifying the anatomical target comprises segmenting the target from the imaging data.

29. The method of claim 27, wherein identifying the anatomical target comprises receiving user input.

30. The method of any one of claims 27-30, further comprising generating a planned path to the anatomical target in the anatomical model.

31. The method of claim 30, further comprising providing guidance based on the planned path to navigate to the anatomical target.

32. The method of any one of claims 29-31 further comprising determining a position of the implant proximate to the anatomical target.

33. The method of claim 32, wherein the active implant is delivered to the implant site via a delivery device.

34. The method of claim 33, further comprising registering a reference frame of the delivery instrument with the anatomical model.

35. The method of claim 33 or 34, wherein determining the pose of the active implant comprises receiving data from a delivery instrument positioning sensor coupled to the delivery instrument.

36. The method of claim 25, wherein determining the posture of the active implant comprises receiving user input.

37. The method of claim 25, wherein determining the pose of the active implant is based at least in part on a plurality of X-ray images of the active implant disposed in the subject's anatomy.

38. The method of any one of claims 27-37, further comprising identifying a treatment region including the anatomical target.

39. The method of claim 38, further comprising providing treatment guidance.

40. The method of claim 39, further comprising registering the subject anatomy with the anatomical model based on data from an implant positioning sensor of the active implant, wherein the registering is performed after delivering the active implant into the subject anatomy.

41. The method of claim 40, further comprising registering a therapeutic device positioning sensor of a therapeutic device with the implant positioning sensor.

42. The method of claim 41, wherein providing treatment guidance comprises providing a virtual representation of the treatment region and a virtual representation of the treatment positioning device within the anatomical model.

43. The method of any one of claims 39 or 42, wherein providing treatment guidance comprises providing drug delivery guidance.

44. The method of any one of claims 39 or 42, wherein providing treatment guidance comprises providing tissue ablation guidance.

45. The method of any one of claims 39 or 42, wherein providing treatment guidance comprises providing tissue resection guidance.

46. ​​The method of any one of claims 25-45, wherein the method is performed by at least one processor based on executable instructions encoded on at least one computer-readable storage medium.

47. A non-transitory computer-readable storage medium comprising processor-executable instructions encoded thereon that, when executed, perform the method of any one of claims 25-45.

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