Control of intravascular robotic devices

Abstract

A control device 100 for controlling the movement of a medical instrument is presented. The control device comprises a limit indication providing unit 101 configured to provide an indication 12 of a limit position of the instrument 10, beyond which the position of the instrument is considered to be out of limit, and a position providing unit 102 configured to provide a position 11 of the instrument from a received image comprising a portion of the instrument and / or an acquired movement of the instrument. The control device further comprises a controller 103 configured to control the movement of the instrument based on the indication of the limit position and the position of the instrument, such that the position of the instrument maintains a predefined relationship to the limit position. This allows for improved movement control of medical and other instruments.

Description

[Technical field]

[0001] The present invention relates to a control device, a method and a computer program for controlling the movement of a medical instrument, as well as to an apparatus, a method and a computer program for moving a medical instrument. [Background technology]

[0002] Navigating a medical device during or in preparation for a medical intervention can be a difficult and time-consuming task. The complexity of this task is further increased by the fact that after navigating the medical device to a desired target location, an unexpected situation may cause the medical device to move away from the desired target location, thus necessitating time-consuming re-navigation of the medical device. In fact, poor motion control of the medical device not only requires additional navigation measures, thus lengthening the overall intervention duration, but also causes other medical complications that may be harmful to the patient. Therefore, there is a need to improve the motion control of the medical device. Summary of the Invention [Problem to be solved by the invention]

[0003] It is an object of the present invention to allow improved motion control of medical instruments. [Means for solving the problem]

[0004] In a first aspect, the present invention relates to a control device for controlling movement of a medical instrument, the control device comprising a non-transitory memory storing instructions and a processor for executing instructions, the instructions, when executed by the processor, causing the control device to: - providing indications of limit positions of the device, beyond which the position of the device is considered to be out of limit; - providing a location of the device from received images including a portion of the device and / or from an acquired movement of the device; - controlling movement of the equipment based on the indication of the limit position and the position of the equipment such that the position of the equipment maintains a predetermined relationship with respect to the limit position; Execute the command.

[0005] The above-mentioned "instructions" are defined or depicted as, or are performed by, "units" or "controllers" as used in the next section of this document.

[0006] for example, The "limit indication providing unit" is (in this case) configured to provide an indication of a limit position of the instrument, preferably beyond which the position of the instrument is considered to be out of limit. The "position providing unit" is configured to provide the position of the device from received images (in this case) including a portion of the device and / or captured movements of the device. The "controller" is configured to control movement of the instrument based on the indication of the limit positions and the position of the instrument (in this case) such that the position of the instrument maintains a predetermined relationship to the limit positions.

[0007] An indication of the limit position of the instrument and also the position of the instrument are provided, the position of the instrument being provided from a received image including a portion of the instrument and / or from an acquired movement of the instrument, and preferably beyond the limit position the position of the instrument is considered to be out of limit, and for this reason information about the position of the instrument relative to the limit is available. Based on the indication of the limit position and the position of the instrument the movement of the instrument is controlled such that the position of the instrument maintains a predefined relationship to the limit position, so that undesirable movements of the instrument can be limited. The control device thus enables improved movement control of the medical instrument.

[0008] The limit indication providing unit may be configured to determine an indication of the limit position itself and provide the determined indication, or to receive an indication from a corresponding determining unit, instruction, processor or user interface and provide the indication for further processing (or the corresponding instruction may further cause the control device to execute these). Additionally or alternatively, the limit indication providing unit is optionally configured to provide a representation of an indication in an image to graphically represent the limit position (or the corresponding instruction may optionally cause the control device to execute this). The image is the image from which the position of the equipment is provided. The representation of the indication in the image may or may not be determined based on a user input. If determined based on a user input, the user input specifically indicates the image position where the representation of the indication is to be located.

[0009] The position providing unit is preferably configured to determine (or preferably causes the control device to perform) a position of the device itself based on an image including a portion of the device and / or an acquired movement of the device, and to provide the determined position. To determine the device's position based on the image, the position providing unit is configured to apply image segmentation (or preferably causes the control device to perform this). Known image segmentation tools may be used, including, for example, the U-Net convolutional neural network model.

[0010] The device for which the limit position indicator is provided may be a device in which motion is induced. In that case, the indicator is also called an induced motion limit indicator, since the limit position indicates the limit of the motion induced to the device. Induced motion specifically refers to accidental or unintended motion, i.e., motion that does not match the motion expected based on or corresponding to the motion control signal of the controller. Induced motion may refer to the induced motion of the device relative to a static environment or reference system, and is called absolute induced motion. More generally, induced motion may also refer to relative motion, in which case the induced motion is measured relative to the environment or reference system that moves itself. For example, the induced motion is measured relative to a potentially moving anatomical structure, such as the vascular structure of a living patient. In this case, changes in the relationship between the position of the device and the limit positions may result, for example, from a) movement of the anatomical structures relative to which the limit positions are fixed, when the device is moved variously or held in a fixed absolute position, b) movement induced to the device by movement of the anatomical structures, when the limit positions are fixed absolute positions, and / or c) movement induced to the device by movement of other devices that interact with the device.

[0011] In the implementation example in which the medical device is navigated to a desired target position, the limit position, i.e. the limit position of the medical device indicated by the limit indicator, corresponds in particular to the desired target position. The desired target position corresponds to the last known position, for example determined by a user input or the last known position after the user triggers the control of the device. The limit position corresponds to the desired target position itself, i.e. exactly or approximately equal to the desired target position. However, the limit position can also correspond to the desired target position only within a predefined tolerance range. In this case, a motion induced to the medical device is allowed as long as the medical device does not deviate from the target position to such an extent that the motion causes the position of the medical device to deviate from the desired target position beyond the tolerance range. On the other hand, an initial navigation of the medical device may already have been performed such that the medical device does not finally reach the desired target position itself, but a position corresponding to the desired target position only up to a certain safety margin, which already predicts a potential induced motion of the medical device. In this latter case, the limit position indicated by the limit indicator still corresponds exactly or approximately to the desired target position. This example shows in particular that the given relationship of the position of the device to the limit positions should be understood broadly, including both the case where the device is held in a fixed position and the case where the device is allowed to move as long as given conditions regarding the relative position of the device to the limit positions are met. In this sense, through the limit indicators, the tolerance range for induced movements of the device, possibly all movements, becomes quantifiable. Thus, in one embodiment, the indicated limit positions are understood as implying or defining the limits for induced movements of the device. However, the limit positions and their indicators are defined independently of the movements induced to the device. More generally, for example, the indicated limit positions are understood as implying or defining the limits for all movements of the device.

[0012] The position of the device refers to the location and / or orientation of the device. In particular, the position of the device refers to the location and / or orientation of a predefined part of the device. However, the position of the device may also refer to or be determined based on the locations and / or orientations of multiple parts of the device, such as by averaging. The position of the device may be determined based on at least one of a) a received image including a part of the device, and b) an acquired movement of the device. Thus, for example, the position of the device may be determined based on an analysis of an image showing the device, in particular based on predefined image features thereof. As mentioned above, known segmentation techniques are used for this purpose. In addition to or as an alternative to an image-based device position determination, the acquired movement of the device is used to determine the device position. The acquired movement of the device refers to motion control information recovered from previous motion control signals sent by the controller, and / or current control or movement parameters indicative of the device position. The acquired, previous or current movement is preferably obtained from information measured or collected from tools, robots and / or motors driving the motion of the device. This is preferred for tracking and sensing systems, which usually imply embedding sensors in the device. It should be understood that the location of the equipment provided by the position providing unit (or by corresponding instructions causing the control device to provide this location) as the basis for control by the controller is preferably the current location of the equipment.

[0013] As already indicated above, an indication of the limit position of the device, and therefore also implicitly the limit position itself, is determined, for example, based on a user input. The indication may also indicate multiple limit positions, such as limit areas. For example, if the position of the device is determined based on an image of the device, the limit position or limit area is indicated together with the image. In this case, the movement control for the device is based on the image.

[0014] The type of input the controller receives to control the movement of the instrument will vary depending on the type of indicator used and how the position of the instrument is determined, and the type of output the controller will vary depending, among other things, on the type of input the controller receives.

[0015] Preferably, the position and the limit position of the equipment refer to a position in two or three spatial dimensions. Usually, at least the position of the equipment moves over time. The position providing unit is therefore configured to track the position of the equipment, i.e. its movement, in time (or a corresponding instruction causes the control device to execute this). While tracking the movement of the equipment, the controller is configured to repeatedly, in particular continuously, check whether the position of the equipment still satisfies a predetermined relationship with respect to the limit position. As already indicated above, this check is performed using a tolerance range. That is, the controller is configured to control the movement of the equipment such that the equipment maintains a predetermined relationship with respect to the limit position within a tolerance range. For example, if it is determined that the position of the equipment exceeds the indicated limit position by less than a predefined tolerance distance, this is acceptable and therefore does not trigger a control signal indicating a countermeasure. The controller also takes into account a time tolerance range for determining the control signal. The time tolerance range is, for example, if it is determined that the position of the equipment exceeds the indicated limit position for less than a predefined tolerance period, this is acceptable and therefore does not trigger a control signal indicating a countermeasure. The acceptable period can be predefined, for example, to correspond to an integer number N seconds.

[0016] Control of the movement of the device by the controller refers to the controller providing a control signal according to which the device may be physically moved. The control signal preferably includes a movement command for the position of the device, possibly provided continuously or repeatedly in time. The physical movement of the device may be based on the control signal provided by the controller, for example realized by a drive. In other embodiments, the controller comprises a physical movement means such as a drive, in which case the controller is configured to physically move the device itself. It should be noted that the control signal preferably refers to the position of the device, which refers to the location and / or orientation of the device in two or three spatial dimensions, as well as in time, but the degrees of freedom of the device that can be controlled by the controller are limited. For example, the controller is configured to control only a single translational and a single rotational degree of freedom of the device, such as the translation of the device along the longitudinal axis of the device and the rotation around this axis.

[0017] Regardless of the type of inputs and / or outputs of the controller, the controller is configured to control the movement of the instrument such that the position of the instrument maintains a predetermined relationship with respect to the limit positions. The predetermined relationship refers to a relationship between the position of the instrument and the limit positions, i.e. the limit positions with respect to the instrument. The predetermined relationship is considered as a condition to be satisfied by the position of the instrument with respect to a given limit position, as already indicated above. The controller is configured to determine how the instrument should or can be moved from this condition and the position of the instrument to ensure that the condition is maintained satisfied. The predetermined relationship can be mathematically expressed in terms of inequalities involving the position of the instrument and its limit positions, or respective indicators such as images or acquired movement characteristics related to the instrument and corresponding limit values ​​defined by the indicator of the limit positions. For example, the predetermined relationship mathematically corresponds to the condition that the distance between a certain part of the medical instrument and a certain anatomical position should not decrease below a predefined threshold. However, controlling the movement of the instrument such that the position of the instrument maintains a predetermined relationship with respect to the limit positions does not necessarily require the control to be position-based, in particular the control to be purely position-based. Additionally or alternatively, the controller controls the equipment based on signals or other control quantities, for example, indicative of the speed of the equipment or the force on the equipment, possibly at a position provided for the equipment. Limit values ​​are also defined for such other control quantities, which translate or correspond to specific limit positions. Meeting a certain position-based condition implies that a corresponding condition based on the other control quantity, such as speed or force, is met, and vice versa. Thus, control "such that the position of the equipment maintains a predetermined relationship to the limit positions" includes control mechanisms that are not position-based. In this sense, the position of the equipment referred to in this specification is understood as not necessarily referring to the spatial position of the equipment, but rather, possibly, to a position in the space of other control quantities, such as speed or force. The space of control quantities is also understood as a configuration space, i.e., a space of configurations of the respective equipment.

[0018] It is understood that the predefined relationship or corresponding state that is maintained is "valid" only over a predefined time window, possibly beginning after navigation of the medical device is completed or deemed completed. Outside of this time window, it is acceptable that the conditions corresponding to the predefined relationship are not met. For example, the medical device may initially be navigated past a critical anatomical point, but then induced motion of the medical device should not cause the medical device to approach this critical anatomical point again.

[0019] An induced motion of an instrument is understood as a passive motion caused by an active motion of another object or by the environment in which the instrument is located. For example, a motion is induced to the instrument by a patient undergoing a medical procedure performed with the instrument or by the use of a further instrument in combination with the instrument in which the motion is induced. An induced motion of an instrument does not exclude an active motion of the instrument. In contrast, an instrument may undergo an induced motion at the same time that the instrument itself moves, i.e., moves actively. In other words, active and passive motions of a medical instrument may overlap. In particular, the instrument is actively moved to balance a passive motion such as an induced motion. More particularly, the active motion of the instrument is summarized as compensating for a passive motion that causes the position of the instrument not to maintain a predetermined relationship to a limit position. It is the active motion of the instrument that is the subject of the control signal provided by the controller. The controller is also configured to suppress or even block the induced motion instead of providing an active motion that compensates for the induced motion corresponding to the passive motion of the instrument.

[0020] As indicated earlier, when a medical device is inserted into a patient's body during a medical procedure, the patient's body movements affect the position of the medical device relative to the body, e.g. relative to certain anatomical landmarks. Thus, the controller is configured to, for example, control the movement of the medical device such that the medical device at least partially follows the body movements. However, as also indicated earlier, another source of induced movement of a device, in particular a medical device used in a medical procedure, may be a further device. Thus, in one embodiment, the device is a first device of two devices, and a second device of the two devices induces a movement relative to the first device, i.e. when the second device is moved. The second device induces a movement relative to the first device, in particular by its own movement. In other words, the induced movement of the first device may be induced in particular by the movement of the second device. This is particularly applicable when the first device and the second device are both medical devices inserted into the patient's body.

[0021] When two devices are present, the device on which motion is induced is also referred to hereinafter as the first device, and the device that induces motion relative to the first device is also referred to hereinafter as the second device. Similarly, the position of the first device is also referred to hereinafter as the first position, and the position of the second device is also referred to hereinafter as the second position.

[0022] These instructions for the control device further include causing the control device to: - providing a target indicator indicating a target position of a second device to be moved; - providing a second location, the second location being a location of the device; Execute the command.

[0023] The above-mentioned "instructions" are defined or illustrated as or are performed by a "unit" or "controller" as used in the next section of this document.

[0024] for example, The "target indicator providing unit" is configured to provide a target indicator indicating a target position of the second device to be moved (in this case); The "second position providing unit" is configured to provide a second position, which in this case is the position of the second device. The controller is configured to control a movement of the second device based on the target indicator and the second position such that the second position approaches the target position.

[0025] Thus, the controller primarily controls the movement of the second instrument (or the instructions further cause the control device to primarily do this), and since this movement of the second instrument inadvertently induces movement relative to the first instrument, the controller secondarily controls the movement of the first instrument, i.e. partially or fully compensates for or controls or blocks the induced movement (or the instructions further cause the control device to secondarily do this).

[0026] The target indicator can be of the same type as the indicator of the limit position of the first device, i.e. it corresponds to the indicator of the limit position of the first device, with the difference that the target indicator indicates the target position of the second device instead of the limit position of the first device. In the two images, for example, the two indicators are represented in the same manner, just in different image locations and possibly with different orientations.

[0027] Similarly, the second location is determined like the first location, only for the second device and not for the first device. In particular, it should be understood that the location of the device is preferably the current location of the device, possibly determined based on image analysis or based on acquired movements of the second device.

[0028] The controller is configured to control the movement of the second device based on a user input, for example a user input received via a user interface. Apart from relying on such a user input, the controller is configured to automatically control the movement of the second device. In more advanced embodiments, a fully automatic control of the movement of the second device can also be performed, i.e. without user input. Conversely, it is also possible in principle for the second device to be primarily moved by the user, i.e. manually. In an exemplary embodiment, the device whose operation is controlled by the controller is a first device of two devices, and the second device of the two devices is manually driven to induce a movement relative to the first device, and thus the control device allows the first device to automatically maintain a predetermined relationship with respect to the limit position while the second device is manually driven. In that case, the controller is configured to provide haptic feedback to the user. For example, the controller is configured to not allow the user to move the second device beyond the target position and / or to support any movement of the second device by the user that brings the second device closer to the target position. Because the controller is controlling the second device to push back, the user is "not allowed" to move the second device beyond the target position. Indeed, even in semi-automatic embodiments in which the user provides user input based on which the controller controls the movement of the second device, the user is "not allowed" to move the second device beyond the target position. In this case, "not allowed" refers to the controller ignoring the respective user input.

[0029] Thus, in addition to or as an alternative to a) the controller being configured to control movement of the second instrument based on the target indicator and the second position such that the second position approaches the target position, the controller is configured to b) trigger a warning to a user when the second instrument approaches the target position beyond a warning limit, c) control movement of the second instrument based on the target indicator and the second position such that movement of the second instrument slows down when the second position exceeds an approach limit, and / or d) control a reaction force applied to the second instrument, or a tool driving the second instrument, such force opposing a manual force applied by a user manually driving the second instrument, such reaction force being applied when the second position exceeds an approach limit, optionally the approach limit being the target position, and the reaction force being sufficient to prevent the user from manually driving the second instrument beyond the target position, and further optionally the reaction force gradually increasing between the approach limit and the target position.

[0030] The controller is preferably configured to control the movement of the first device further based on the movement of the second device, for example based on the speed at which the second device moves. This allows for better compensation of induced or other undesired movements. Furthermore, the controller is configured to restrict the movement of the first device and / or the second device to predefined degrees of freedom. This allows for simplified control. The complexity of user inputs that may be required may also be reduced in this way. In one example, the movement of the first device and / or the second device is limited to translational movements, i.e., rotational movements are excluded. By excluding rotational movements, movement control may be easier, since it has been observed that rotational movements induce more complex movements on other devices.

[0031] A target indicator is also provided to the first device. In fact, the indicator of the limit position provided to the first device may itself at least temporarily function as a target indicator for the first device. For example, the controller is configured to initially control the first device so that it approaches or extends beyond the indicated target position, and subsequently control the first device so that it maintains a predetermined relationship, such as a maximum distance, to the target position, especially even if potential movements are induced for the first device. In such a scenario, the target indicator changes over time into an indicator of the limit position.

[0032] Either of the two instruments refers to a flexible, elongated, guided instrument, and the respective other instrument refers to an instrument guided along the elongated guided instrument. Thus, in one embodiment, a) the first instrument refers to a flexible, elongated, guided instrument, and the second instrument refers to an instrument guided along the first instrument, and / or b) the second instrument refers to a flexible, elongated, guided instrument, and the first instrument refers to an instrument guided along the first instrument.

[0033] In addition to or as an alternative to being flexible, the reflex guidance devices are articulated, i.e., equipped with one or more joints through which a controller can control the movement of each device. Cases where one of the two devices is elongated and guides the other of the two devices by physical contact have been found to be particularly relevant, since the induced movements are likely to be relatively short movements observed over a long period of time, i.e. corresponding to events such as collisions.

[0034] Preferably, both instruments are elongate instruments, in particular flexible and / or articulated elongate instruments. Furthermore, the first instrument and the second instrument preferably form an articulated instrument, i.e. a compound instrument, in which the first and second instruments are coaxially arrangable, the second instrument forming an outer instrument part configured to slide along the first instrument forming an inner instrument part.

[0035] The first instrument location (hereinafter also referred to as the first location) refers to the distal tip of the first instrument and the second location refers to the distal tip of the second instrument. If any of the instruments is not elongated, then instead of the distal tip of the respective instrument, the other distal portion of the respective instrument is considered.

[0036] "Non-elongated" should be understood to refer to a device characterized by a relatively compact shape and, in some cases, being of relatively equal size in all dimensions, whereas an "elongated" device should be understood as a device in which the size in one dimension is relatively small or, for all practical purposes, insignificant in relation to each of the other two dimensions.

[0037] The term "distal" preferably refers to the relatively farthest or most distant part of the respective instrument when measured in the longitudinal direction of the instrument away from the motion means of the instrument, while "proximal" has the opposite meaning. The motion means may correspond for example to a motor or a drive, or to a device mediating a manual motion action by a user. Regardless of whether they refer to the distal tip or other distal part of the respective instrument, the first and second positions are determined by a detectable element of the respective instrument. The detectable element may refer for example to a metallic bead, ring or other shape, and / or an electromagnetic sensor.

[0038] The first and second instruments are both medical instruments, and the controller is configured to control movement of the first instrument along a tubular anatomical structure. Optionally, the controller is configured to control movement of the first and second instruments along a tubular anatomical structure within a patient. For example, the first instrument is robotically driven along the tubular anatomical structure, possibly based on user input, while the second instrument is also robotically driven or manually driven.

[0039] The movement of the first and / or second instruments is not necessarily limited to remaining within the tubular anatomical structure. Instead, for example, the first and second instruments are moved to leave the tubular anatomical structure to reach the tumor or the body cavity where the treatment is applied. The location limit indicator is other than the tubular location, and the exit location can be considered as an ostium. Also, such movement of the first and / or second instruments away from the anatomical structure is brought about by a controller and / or manual operation. According to a specific example, the second instrument refers to a catheter, and the first instrument refers to a guidewire of the catheter. In a typical workflow, the guidewire is first extended into the tubular anatomical structure. Typically, the guidewire is easier to navigate than the catheter. Following the guidewire, a catheter with a hollow body that radially surrounds the guidewire around the axis of the catheter is extended into the tubular anatomical structure by using the guidewire as a physical guide. In case of catheter exchange, which is often necessary due to the limited functionality of the catheter, the guidewire should normally remain in place as much as possible while retracting the catheter. Both during guidewire extension and catheter retraction, each device can accidentally drag the other with it. To prevent undesired movements in both situations, i.e. during guidewire extension and catheter retraction, both options a) and b) above may be applicable.

[0040] More generally, the controller of the control device is configured to determine a first distance based on a first position, i.e. the position of the first instrument, and an indication of a limit position, the first distance indicating the distance between the position of the first instrument and the limit position of the first instrument, and to control the movement of the first instrument based on the first distance. Similarly, the controller is configured to determine a second distance based on a position of the second instrument and a target indication, the second distance indicating the distance between the target position and the position of the second instrument, and to control the movement of the second instrument based on the second distance. Controlling the movement of the instruments based on the first and second distances, respectively, may refer, for example, to proportional control. That is, the controller is configured to determine a control signal leading to a drive force or a movement speed proportional to the respective distance.

[0041] Both the first distance and the second distance can be determined according to a predefined distance measure, such as, for example, a geometric distance measure, in particular a Euclidean distance measure, or a physical distance measure. These distance measures are preferably three-dimensional, i.e., measuring distances in three-dimensional space. If complete three-dimensional information is not available initially, the complete three-dimensional information can be compensated for from two-dimensional information through calibration. For example, if one or both of the positions of the first and second devices are initially measurable only in two spatial dimensions, as is the case when determining the respective positions based on X-ray images, the positions of the respective devices in three-dimensional space can be determined based on the respective two-dimensional measured positions and calibration coefficients determined based on the calibration measurements.

[0042] An exemplary distance measure is a measure of the length of a path or passage, also called an arc length. For example, for a first device, the controller is configured to determine a distance between a position of the device and a limit position indicated for the device by a corresponding indicator, and to control the movement of the device based on the distance, the distance being optionally defined along a path or passage. The same control can be applied to a second device, where instead of the first position and limit position, a second position and a target position are considered.

[0043] Thus, for example, the first distance and the second distance are determined based on respective paths determined from the respective positions and the respective indicators. Specifically, the first path is defined between the position of the first instrument and the limit position of the first instrument, and the first distance is determined along the first path. Similarly, the second path is defined between the position of the second instrument and the target position of the second instrument, and the second distance is measured along the second path. The first path is the path followed by the first instrument, and the second path is the path followed by the second instrument. In a more specific embodiment, the paths are predefined to be located along a tubular anatomical structure. In such an embodiment, the controller of the control device is configured to: a) determine a first anatomical distance based on the first position, the indicator of the limit position of the first instrument, and the tubular anatomical structure, where the first anatomical distance indicates a distance between the first position along the tubular anatomical structure and the limit position of the first instrument, and control movement of the first instrument based on the first anatomical distance; and / or b) determine a second anatomical distance based on the second position, the target indicator, and the tubular anatomical structure, where the second anatomical distance indicates a distance between the second position along the tubular anatomical structure and the target position of the second instrument, and control movement of the second instrument based on the second anatomical distance.

[0044] To determine the first and / or second distances, in particular the first and / or second anatomical distances, the control device comprises (or corresponding instructions executed by the processor cause the control device to execute) a structural representation providing unit configured to provide a representation of the tubular anatomical structure and / or the first and second instruments, in which the first position, i.e. the position of the first instrument, the limit position of the first instrument, the second position, i.e. the position of the second instrument, and the target position of the second instrument are identifiable. The structural representation is preferably determined based on data used for the position determination of the instruments, i.e. on received images including the respective parts of one or more instruments and / or the movement of the respective instruments. The structural representation of the tubular anatomical structure and / or the first and second instruments is an image, for example optionally an image on the basis of which the structural representation itself is determined, or possibly a more schematic version of the image consisting of line segments only. However, the structural representation can also be another representation, i.e. a non-image-based representation. For example, a non-image based representation may refer to numerical data, parametric data, or any other data that may, but is not necessarily, be used to generate an image, where the data indicates line segments corresponding to the tubular anatomical structure and / or the first and second instruments, or pixel locations in an image of the tubular anatomical structure and / or the first and second instruments. The structural representation may preferably be three-dimensional, i.e., a volumetric representation, regardless of the dimensionality of the image or motion data on which the structural representation is determined.

[0045] The limit indicator providing unit is configured to provide the indicator of the limit position as a line segment perpendicular to a portion of the axial cross section of the tubular anatomical structure (or a corresponding instruction causes the control device to execute this). Similarly, the target indicator providing unit is configured to provide the target indicator as a line segment perpendicular to a portion of the axial cross section of the tubular anatomical structure (or, optionally, a corresponding instruction causes the control device to execute this). In particular, the provided indicators can be line segments oriented perpendicular to a center line of the tubular anatomical structure at each longitudinal position of the tubular anatomical structure, and the line segments are provided with a length that is shorter than or equal to the lateral extent of the tubular anatomical structure at each longitudinal position, i.e., such that the length remains inside the tubular anatomical structure. Instead of a line segment, each of the indicator of the limit position and the target indicator can correspond to, for example, any of a point, a circular arc, an area, a set of line segments, a three-dimensional volume, a circle, or a rectangle.

[0046] Thus, in one embodiment, for example, the first instrument is a medical instrument whose position is determined from a received image including a portion of the instrument, the controller is configured to control movement of the instrument along a tubular anatomical structure, the portion of the tubular anatomical structure being included in the image, and a representation of the indicia is provided to traverse the imaged tubular structure. Optionally, the controller is configured to dynamically change a size of the representation of the indicia provided to traverse the imaged tubular structure in response to potential changes in width of the imaged tubular structure.

[0047] The position of the moved instrument is preferably provided based on image data. For example, the control device further comprises an image data providing unit configured to provide image data of at least one of the first and second instruments (or corresponding instructions cause the control device to execute this), and if the image is an image of the first instrument, the first position providing unit is configured to determine the first position based on the image (or corresponding instructions cause the control device to execute this), and if the image is an image of the second instrument, the second position providing unit is configured to determine the second position based on the image (or corresponding instructions cause the control device to execute this). The image data may in particular be fluoroscopy data or other X-ray data, magnetic resonance imaging (MRI) data, ultrasound data, or other medical imaging data. Other medical image data include, for example, image data acquired by electrophysiological dielectric (EPD) imaging, which image data allows each instrument to be tracked in three-dimensional space with respect to the anatomical environment through which it moves. The imaging modality is selected depending on the first and / or second device so that the first and / or second device can be imaged, i.e. visible in the respective images, and vice versa. This depends for example on the material of the respective devices. Optionally, markers can be attached to the devices for visibility in the images of the selected imaging modality. The position of the respective device then corresponds to the position of the marker. Image processing measures can also be taken to increase the visibility of the first and / or second device. For example, any of the devices can be identified in the image and further highlighted in the image to the user. This identification can be achieved for example by segmentation, and the highlighting can correspond to superimposing a visual marker on the respective device, in particular the position of the device taken as a basis for the movement control. In an embodiment in which the position of the first device is provided based on a received image of a portion of the first device and the movement of the first device is controlled based on the distance indicated above, the limit position indicated for the first device refers to a position in the received image, the distance being determined based on the image.

[0048] Meanwhile, at least one of the first position and the second position is provided based on non-image-based data. For example, when moving each device by the robot, robot data is used as non-image data. Based on past robot data, such as past user inputs and / or control signals sent by the controller, information regarding previous movements of each device can be obtained, and based on this information, the current location of the device can be determined.

[0049] Additionally, a combination of image-based and non-image-based data is also used to determine either or both of the first and second locations. When image data is used to determine one of the first and second locations and non-image data is used to determine the other of the first and second locations, the image data and non-image data are registered with each other. Registration is also performed when both the first and second locations are determined based on image data, for example, when the image data used to determine one of the locations is from a different imaging modality than the image data used to determine the other location.

[0050] Further as indicated above, if a path is taken as a reference for determining a distance on the basis of which the movement of the respective instruments is controlled, this path is determined based on the provided image data and / or non-image data. It is preferable to determine the path in the image. Thus, for example, the indicated limit position can refer to an image corresponding to the image data, and the path, i.e. the path determined for controlling the first instrument, can be determined based on the image data. Similarly, for controlling the second instrument, the target position indicated by the target indicator can refer to an image corresponding to the image data, and the path, i.e. the path determined for controlling the second instrument, can be determined based on the image data. In a particular embodiment, the control device comprises (or the corresponding instructions executed by the processor cause the control device to execute) an image data providing unit configured to provide image data of an image of the tubular anatomical structure including the first instrument and the second instrument inside the tubular anatomical structure, and the first position, the limit position of the first instrument, the second position, and the target position of the second instrument refer to positions in the image, and the controller is configured to determine the first anatomical distance and / or the second anatomical distance, respectively, as a distance along the tubular anatomical structure visible in the image.

[0051] Further, the limit indication providing unit is configured (or corresponding instructions executed by the processor cause the control device to do this) to provide an indication of the limit position based on anatomical information and / or based on user input, such as user input provided via a user interface.

[0052] The anatomical information indicates a risk associated with a first position, i.e., a position of the first device, that does not maintain a predetermined relationship to the limit position. For example, an indication of the limit position is provided in such a manner that the risk of the first device moving away from a predefined vessel or vessel section, which may be the vessel or vessel section in which the first device is currently located, is minimized. An exemplary risk measure for this purpose considers the distance from the position of the first device to the proximal, in particular the nearest proximal ostium or bifurcation, of the current vessel in which the first device is located, the diameter of the vessel, the ratio of diameters between the first device and the current vessel, a heuristically determined quantity, and / or the radius of gyration of the current vessel, including the radius of gyration of the current vessel relative to the previous vessel from which the first device entered the current vessel. Instead of the radius of gyration, other quantities indicative of the curvature of the current vessel may also be considered.

[0053] Providing a limit indicator based on a user input can refer to the selection of a limit position by the user. If the user wants to "pin" the position of the first instrument, the user does not need to actually select a position. Instead, the user only activates a dedicated mode in which the limit position is automatically set to the current position of the first instrument. In a further control mode, which is also activated and / or deactivated by the user, the limit indicator providing unit is configured to adapt the indicator over time (or corresponding instructions executed by the processor cause the control device to do this). For example, when the first instrument is moving through a branched tubular anatomical structure, the limit position of the first instrument is adapted each time the first instrument enters a new branch of the tubular anatomical structure, for example to the proximal position of each new branch or each previous branching point.

[0054] Thus, the limit indication providing unit is configured to provide an indication of the limit position (or corresponding instructions executed by the processor cause the control device to do this) based on imaged anatomical features when the instrument is moved along the tubular anatomical structure, in particular the new branch into which the instrument enters, user input through a user interface configured to associate the user input with a location within the image, and / or stored default setting parameters.

[0055] Furthermore, the limit indicator providing unit is configured (or the corresponding instructions executed by the processor cause the control device to execute this) to provide the limit position indicator further based on the position of each instrument for which the limit position indicator is provided, i.e. specifically based on the first position, which is the position of the first instrument. For example, the limit position indicator indicates the limit position of the first instrument as being at the nearest but preferably further proximal bifurcation of the anatomical structure or just distal thereto, relative to the first position. In this way, the possibility of needing to reintubate the first instrument into the branch of the anatomical structure after the first instrument is accidentally pulled out of the branch of the anatomical structure can be eliminated. Navigating the instrument to the correct branch of several branches branching off from the bifurcation, called intubation, can be the most challenging part of the navigation process performed with the instrument.

[0056] The controller is preferably configured to control the movement of the first device based on the first position, i.e. the change in the position of the first device. In particular, the movement of the first device is adapted based on the change in the first position. For example, the controller is configured to detect that the first device is controlled to move beyond a threshold distance but the first position does not change, and in this case to modify, in particular slow down, the movement of the first device or to trigger a warning to the user. This makes it possible to avoid harmful jumping of the first device due to a spring effect caused by a temporary blockage. Similarly, the controller is configured to detect that the second device is controlled to move beyond a threshold distance but the second position does not change, and in this case to modify, in particular slow down, the movement of the second device or to trigger a warning to the user. More generally, i.e. for any number of controlled devices, the controller is configured to detect that the moved device, i.e. the position of the respective device is controlled to move but the device does not change, and in this case to slow down the movement of the device.

[0057] Both the limit position indicator and the target indicator are graphic indicators, possibly displayed in an image, such as an image of a tubular anatomical structure, together with the first and / or second instruments, or at the first and / or second positions only. Optionally, each indicator is a section across the imaged vessel, possibly moving with the vessel's movement. The width of the indicator changes with changes in the vessel's width, which may physically change, for example, due to changes in blood pressure caused by blood pulsation and vasospasm, or substantially, for example, due to changes in image magnification.

[0058] Furthermore, the controller is configured to increase the degree of control over the first position as the distance between the first position and the limit position decreases. For example, the degree of control increases monotonically as the distance between the first position and the limit position decreases. In particular, when the first position is determined to coincide with the limit position, the degree of control can be maximized to prevent any movement of the first instrument, particularly any movement induced on the first instrument by the movement of the second instrument. In certain embodiments, the controller controls the movement of the first instrument to prevent the first position from crossing the limit position.

[0059] In an exemplary embodiment, the first device is an inner device and the second device is an outer device, the received images include images of portions of the first device and the second device and a branched intersection of multiple branches of the anatomical structure including a main branch and a target branch branching off from the main branch, and the controller is further configured to maintain the inner device at the target point within the target branch of the tubular anatomical structure by further advancing the inner device an amount that compensates for the retraction of the outer device when the controller causes retraction of the outer device.

[0060] In a further aspect, the invention relates to an apparatus for moving a medical instrument, the apparatus comprising a control device and additionally a drive controllable by a controller of the control device for driving the movement of the instrument to be moved, i.e. in particular a first instrument, and the movement of a second instrument is driven by the drive under the control of the controller of the control device.

[0061] The apparatus further comprises an imaging device configured to capture images of the first and second devices. These images are used to determine the first and second positions. The apparatus further comprises a display device configured to display the first and second devices. The display device is used for the user to use his / her expertise and visual judgment to determine to provide user input to the controller via a user interface. The display device itself also functions as a user interface. For this purpose, the display device comprises, for example, a touch screen.

[0062] In another aspect, the present invention relates to a method for controlling movement of a medical device comprising the steps of: a) providing an indication of a limit position of the device, beyond which the position of the device is considered to be out of limit; b) providing a position of the device from a received image including a portion of the device and / or an acquired movement of the device; and c) controlling movement of the device based on the indication of the limit position and the position of the device, such that the position of the device maintains a predetermined relationship to the limit position.

[0063] Further, an aspect of the present invention relates to a method for moving a medical device, the method comprising the steps of controlling the device in accordance with the aforementioned method for controlling the movement of the medical device and driving the movement of a first device accordingly.

[0064] Further aspects of the invention relate to a computer program for controlling the movement of a medical device, the program comprising instructions for causing a control device to carry out a method for controlling the movement of a medical device, and a computer program for moving a medical device, the program comprising instructions for moving the device from above according to the above method for moving a medical device, when the program is executed on a computer controlling the device.

[0065] It is to be understood that the control device according to claim 1, the apparatus according to claim 17, the method according to claim 18 and the computer program according to claim 19 have similar and / or identical preferred embodiments, in particular as defined in the dependent claims.

[0066] It shall be understood that a preferred embodiment of the invention can also be any combination of the dependent claims or the above embodiments with the respective independent claim.

[0067] These and other aspects of the invention will be apparent from and elucidated with reference to the embodiment(s) described hereinafter. [Brief description of the drawings]

[0068] [Figure 1] FIG. 2 shows a schematic and exemplary control device for controlling the movement of a medical instrument. [Diagram 2] FIG. 2C is a diagram illustrating, diagrammatically and exemplarily, different stages during a catheter exchange in four parts given by FIGS. 2A to 2D. [Diagram 3] FIG. 1 shows a schematic and exemplary diagram of an apparatus for moving a medical device. [Figure 4] FIG. 2 shows a schematic and exemplary display including a user interface for controlling the movement of a medical device. [Diagram 5] 1 illustrates, diagrammatically and exemplarily, a method for controlling the movement of a medical device. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0069] 1 shows, in a schematic and exemplary manner, a control device 100 for controlling a movement of a medical instrument. The control device 100 comprises a limit indicator providing unit 101 configured to provide an indication 12 of a limit position of the instrument 10. The indication 12 may also be referred to as a limit indicator. Beyond the limit position, the position of the instrument 10 is considered to be out of limit. Furthermore, the control device 100 comprises a position providing unit 102 configured to provide a position 11 of the instrument 10 from a received image including a portion of the instrument and / or an acquired movement of the instrument, and a controller 103 configured to control the movement of the instrument 10 based on the indication 12 of the limit position and the position of the instrument, such that the position of the instrument maintains a predetermined relationship to the limit position.

[0070] 2A to 2D show the control mechanism implemented by the control device according to a particular embodiment applied to the context of catheter exchange. In this embodiment, the device 10 is a guidewire for a medical catheter. The guidewire is considered as the first medical device and the catheter is considered as the second medical device 20. FIG. 2A shows the guidewire and the catheter reaching the target location in the vasculature of a patient in an intravascular procedure. To reach the target location, the guidewire is first inserted into the patient's body through the vasculature, and then the catheter is inserted with the aid of the guidewire, i.e. by sliding along it. As is often the case in intravascular procedures, once the target location is reached, an exchange of the device is required. In the illustrated case, the catheter needs to be exchanged for a new one, which means that the current catheter needs to be removed from the body and the new catheter needs to be inserted over the guidewire. Since the catheter is in physical contact with the guidewire, retraction or pulling back of the catheter along the guidewire can cause accidental withdrawal or other induced movement of the guidewire. If the induced motion becomes too large, i.e., if the guidewire is accidentally repositioned too far from its initial position before the exchange process begins, the new catheter to be attached may not be able to reach the target location. The guidewire then needs to be repositioned again to the appropriate position, which may result in longer than expected procedure times and / or other medical complications. Delays or other procedural complications may have a significant impact on the patient's health, especially in emergency situations such as stroke. In fact, the induced motion itself may be dangerous to the patient. For example, a snapping motion of the elastic guidewire is triggered when the distal end of the elastic guidewire is accidentally pulled out of the branch vessel.

[0071] In the illustrated embodiment, the control device 100 comprises a target indicator providing unit configured to provide a target indicator 22 indicating a target position of the second instrument 20, in this case a catheter, and a second position providing unit configured to provide a second position 21, which is the position of the second instrument 20, i.e. the catheter. Furthermore, in this case the controller 103 is configured not only to control the movement of the first instrument 10, i.e. the guidewire in this case, but also to control the movement of the second instrument 20, i.e. the catheter, and the movement of the second instrument 20, i.e. the catheter, is controlled based on the target indicator 22 and the second position 21 such that the second position 21 approaches the target position.

[0072] 2A to 2D, the catheter is retracted from an initial position towards a target position, the latter being indicated by the intersection of the target indicator 22 with the line appearing as the catheter in the image. The tip 21 of the catheter is assumed as the relevant position of the catheter based on which the movement is controlled. During the movement of the tip 21 of the catheter 20 along the guidewire 10 from the initial position towards the target position, the tip 11 of the guidewire 10 is accidentally pulled out, which can be considered as an induced movement. This induced movement is recognized by the controller 103 by the position providing unit 102 providing the tip position 11 of the guidewire, which uses an artificial neural network assisted image segmentation for this purpose. Furthermore, the limit indicator 12 provided by the limit indicator providing unit 101 is, in the illustrated embodiment, a line segment 12 similar to the line segment 22 corresponding to the catheter's target indicator 22, but the line segment corresponding to the limit indicator 12 is located distal to the target indicator 22. The predetermined relationship that the position of the first device, the guidewire 10, is maintained relative to the limit position indicated by the indicator 12 is in this case formulated as a condition that the distance between the guidewire tip position 11 and any position on the line segment 12 should remain greater than zero, preferably greater than zero by a predetermined margin. In this way, as can be seen from Figures 2C and 2D, when the controller 103 recognizes that the predetermined relationship may not be maintained, i.e., when it is determined that the guidewire tip is about to cross the line segment corresponding to the indicator 12, the controller 103 can balance or prevent the withdrawal of the guidewire due to the retracting movement of the catheter.

[0073] A guidewire as shown in Figures 2A to 2D may be understood as an example of a flexible elongated guiding device that can guide a second device, such as a catheter also illustrated by Figures 2A to 2D. In this case, the guidance is facilitated by physical contact between the guidewire and the catheter, meaning that the catheter slides along the guidewire. Typically, the catheter, also understood as a flexible elongated device itself, is designed in the shape of a tube or sleeve with a diameter sufficient to allow the catheter to slide axially over the guidewire while radially surrounding the guidewire. The guidewire is specifically designed to be easily navigable. This allows the catheter to be navigated to a treatment site within the patient's body by pushing the catheter along the guidewire, even if the catheter itself is not as easily navigable as the guidewire. The guidewire may be considered an inner device relative to the catheter, and the catheter may be considered an outer device relative to the guidewire, which is the inner device.

[0074] It is understood that while the movement of the catheter may induce the movement of the guidewire, the opposite situation may also occur, i.e. the movement of the guidewire induces the movement of the catheter. The former situation occurs, for example, during the retraction of the catheter for catheter exchange, and the latter situation occurs, for example, when the guidewire is further extended or when the guidewire is retracted while the catheter has already partially or completely slid over the guidewire. Moreover, both of the two instruments are moved simultaneously, in which case their respective movements induce each other's movements. In particular in such cases, indicators and target indicators for limiting the position are defined for each of the two instruments.

[0075] Although guidewires and catheters are examples of medical devices, it will be understood that the control mechanisms described with respect to the illustrated embodiments are applicable to other devices as well. In particular, devices controllable by controller 103 need not necessarily be moved along tubular anatomical structures within a patient's body, such as the blood vessels illustrated by Figures 2A-2D. Instead, controller 103 is configured to control the movement of devices in other environments as well.

[0076] The movement of the one or more devices is controlled by the controller 103 based on their respective positions and their respective limit position indicators and / or target indicators. In the illustrated embodiment illustrating the case where the guidewire should remain in place while the catheter 20 is retracted, the controller 103 is configured to determine a first distance based on the guidewire tip position 11 in the image provided by the position providing unit 102 and an indicator 12 corresponding to a distal line segment visible in the image and provided by the limit indicator providing unit 101, the determined distance indicating the distance between the position 11 of the tip of the guidewire 10 and the limit position of the guidewire 10. In this case, the latter is given by the axial position along the branch vessel, at which the line segment 12 appears in the image.

[0077] In principle, many distance measures can be selected for the distance determination. For example, the shortest two-dimensional Euclidean distance between the tip of the guidewire appearing in the image and a point on the line segment 12 or an intersection with the vascular structure can be considered. However, an anatomical distance measure is preferably applied so that the controller 103 can determine the anatomical distance between the position 11 of the tip of the guidewire and the position of the indicator 12. The anatomical distance is understood as the distance along the anatomical structure in which the device or devices are moved, such as the vascular structure in the illustrated embodiment. The determination of the anatomical distance should therefore be further based on the respective anatomical structure. The anatomical distance reflects more accurately the physically possible path of the device in the anatomical structure. For example, in the case of a highly curved vessel, the tip of the guidewire may be located "around the bend" as seen from the limit indicator such as the line segment 12, and in such a case the Euclidean distance will correspond to a path in which the catheter tip "omits the bend", i.e. exits from the vessel.

[0078] According to one particular anatomical distance measure applicable to the illustrated embodiment, when the guidewire 10 appears as a curve in the image, the arc length of the curve is taken as the basis for controlling the movement of the guidewire 10, and the arc length is measured between the guidewire tip position 11 and the intersection point of the curve and the line segment 12 corresponding to the indicator of the limit position of the guidewire 10 when the guidewire 10 appears as a curve in the image. Thus, in this particular case, the only position indicated by the indicator of the limit position and subject to the movement control is the position of the intersection point, i.e., the location of the intersection point. It should be understood that this particular distance measure results in an approach to the Euclidean distance measure the straighter and / or shorter the portion of the guidewire extending beyond the line segment 12. Applicable distance measures, whether anatomical or not, include three-dimensional distance measures. The three-dimensional distance may be determined, for example, based on three-dimensional image data.

[0079] In the illustrated embodiment, to retract the catheter 20, the controller 103 is configured to determine a second distance based on the position of the catheter tip 21 provided by the second position providing unit based on the image and the target indicator 22 corresponding to the larger proximal line segment seen in Figures 2B-2D. The second distance may be determined based on the same or a different distance measure when compared to the first distance, i.e., the catheter and the line segment 22. The second distance is used as a basis for controlling the movement of the catheter 20.

[0080] Images such as those shown in Figures 2A to 2D can be acquired by an image modality and then provided as image data to the control device 100, in particular to the controller 103. For this purpose, the control device 100 comprises an image data providing unit arranged to provide image data. One or more images are acquired and then provided as image data by the image data providing unit of only the instrument moved by the controller 103 or by the image data providing unit of one or more further instruments whose movement induces a movement to the instrument moved. In the illustrated embodiment, both instruments, i.e. the guidewire 10 and the catheter 20, are imaged in a single common image. In this case, spatially two-dimensional X-ray images are collected over time, with each of Figures 2A to 2D showing a certain moment in time. Apart from X-ray, various imaging modalities are used, such as for example MRI or ultrasound.

[0081] For any device being imaged, the device's position is determined at least in part based on the image, i.e., image data corresponding to the image. Specifically, for example, the positions of the guidewire and catheter tips in the images shown in Figures 2A-2D are determined to exactly correspond to the pixel positions of the tips in the images. Device position determination is also performed by controller 103 based on non-image data, such as past control data from which past motion can be retrieved. However, in many cases, device position determination based only on images, as in the illustrated embodiment, is already accurate enough to provide reliable motion control.

[0082] As explained above, in Figs. 2A to 2D, the first and second distances, i.e., the distances on the basis of which the movement of the guidewire 10 and the catheter 20 is controlled, are each approximately equal to the length of the portion of the respective device that extends beyond the respective line segments 12, 22 when viewed from the proximal to the distal side. These lengths are understood as anatomical distances since they necessarily connect along the vasculature and can be measured based on the image data, for example, by integration along the respective devices visible in the image. Thus, while such integration is necessarily performed along the vasculature, no explicit reference to the anatomical structure is necessary in these length formulas. For example, if the guidewire 10 is represented internally as a set of consecutive segments, the underlying arc length used to control its movement can be measured as the sum of the lengths of the segments that extend distally beyond the limit indicator 12. If the guidewire 10 is withdrawn until it no longer intersects the indicator 12, the closest distance between the guidewire tip position and any point on the indicator 12 is used to control the guidewire so that the tip of the guidewire returns past the indicator 12 again. Thus, the distance measure used to determine the distance based on which each instrument is controlled depends on the position of the instrument relative to its respective limit and / or target positions.

[0083] The indicator 12 is provided by the limit indicator providing unit 101 based on anatomical information. The anatomical information is again derived from image data, in particular image data on the basis of which the position of one or more of the instruments is determined. For example, as illustrated by Fig. 2A to Fig. 2D, the indicator 12 indicates a limit position for a part of the anatomical structure in which the first instrument is moved. Furthermore, the indicator 12 is adapted to the geometry of the anatomical structure. For example, when considering a tentative limit position for the first instrument such as the guidewire 10, which is indicated by the user or corresponds to a predefined fixed position, the indicator 12 is determined by the limit indicator providing unit 101 to be roughly at this tentative position, but to indicate limit positions for all physically possible passages of the first instrument through the rough tentative position. For example, in the illustrated case of an index 12 corresponding to a line segment in an image, the user can select a rough location in the image where he or she wants to place the index 12, and then the limit index providing unit 101 can fix the corresponding line segment to have a location range that completely blocks the blood vessel in the area closest to where the user previously intended the index 12 to be.

[0084] Furthermore, the limit indicator providing unit 101 is configured to provide the indicator 12 further based on the position of the first device 10. In this case, the anatomical information and the position of the first device 10 uniquely determine where the indicator 12 should be placed, possibly according to predefined criteria, so that no user input is required. For example, as can be seen from Figures 2A and 2B, the line segment 12 is substantially fixed by requiring that the indicator 12 corresponds to a line segment located between the current tip position 11 of the guidewire and the nearest branch of the vascular structure proximal to the current tip position 11, and further that the indicator 12 is perpendicular to the longitudinal axis of the vascular segment in which the guidewire tip 11 is located.

[0085] Optionally, the length of any line segments corresponding to the indicators 12 and the target indicators 22 are selected to fit the dimensions of the anatomical structure at the location of the respective indicators, the dimensions being preferably selected to be measured in a direction perpendicular to the direction of movement of the respective instruments. The lines are then displayed as superpositions on the image, in which one or more instruments are also displayed within the anatomical structure. For example, in Figs. 2A-2D, the indicator lines 12, 22 extend across the respective vessel portions such that any movement of the respective instruments 10, 20 is likely or almost certain to intersect with the respective line segments 12, 22 at some point. In the case of the line segment 22 corresponding to the target indicator of the retracting catheter 20, the diameter of the vessel portion proximal to the location of the target indicator is extrapolated to some extent so that the line segment 22 closes off an imaginary extension of the proximal vessel portion in the distal direction. The lines 12, 22 are also moved and / or resized according to temporal changes in the anatomical structure. For example, the line segments 12, 22 may be moved with the movement of the vasculature and / or modified in length to match the time-varying width of the vasculature caused, for example, by blood pulsation.

[0086] The limit positions indicated by the indicators 12 can be considered as "pinning" positions, and the indicators 12 themselves are considered as "virtual anchors" that "anchor" or "pin" the guidewire 10 at a predefined position, at least when the first instrument, i.e., in the illustrated embodiment, the guidewire 10, approaches the predefined position, for example from its distal side. As indicated above, the indicators 12 can be determined automatically or semi-automatically, i.e., automatically, up to, for example, based on user input. The indicators 12 are defined in relation to anatomical information derived from images, preferably images acquired while the instrument is being moved, such as during a medical procedure, although the indicators 12 can also be generated from a preoperative model of the anatomical structure in which the instrument is to be moved.

[0087] In some other embodiments, the guidewire is actively anchored to a location. For example, if the guidewire is in a side branch and the catheter is in a proximal large branch, catheter motion will begin to retract the guidewire. This is difficult for a skilled professional to do manually, since it requires both hands to simultaneously manipulate both interventional devices in four degrees of freedom. The robotic device counters this by using the location of the interventional device in the image to advance the guidewire relative to the catheter so that it maintains its depth within the side branch. This is accomplished by active guidewire servo control, with the location of the guidewire tip in the side vessel as a feedback metric. If an external force, such as catheter motion, causes the guidewire tip to retract, the guidewire will automatically advance from its initial position in proportion to the amount of retraction. This minimizes the movement of the guidewire out of the cannulated side branch. In other embodiments, the guidewire extends further into the side branch to provide additional stabilization.

[0088] The controller 103 also advances the inner device a fixed distance over the outer device while keeping the outer device stationary. The controller 103 servo controls the robotic device to retract the outer device a fixed distance relative to the inner device to keep the inner device stationary. The controller can also retract the inner device relative to the outer device. The controller 103 actively advances and retracts the inner device relative to an initial position of the tip of the inner device in conjunction with the image. In this way, the controller 103 anchors the inner device to the vessel / branch vessel. Advancing the inner device over the outer device is performed while the controller 103 is retracting or rotating the outer device.

[0089] In some other embodiments, the guidewire is misaligned in the cannulated vessel and, upon recognition, the catheter movement is automatically stopped and a new maneuver is suggested. Additionally, if the catheter is not rotated to the correct orientation so that it faces away from the cannulated vessel, the orientation error is detected and the user is notified with a suggested correction. Alternatively, when an orientation error is detected, the correction is performed automatically. As a result, the guidewire is actively anchored in the vessel by automatically correcting the catheter orientation.

[0090] Furthermore, the indicia 12 and the target indicia 22 are graphically represented for display to the user in terms of line segments, but may be variously graphically represented, for example, by circles, dashed line segments, rectangles, areas, or volumes. More complex forms, such as circles, areas, or volumes, may be constructed from line segments. The graphical representations of the indicia 12, 22 may correspond to their internal representations provided as input to the controller 103. The indicia 12, 22 may also include text labels, glyphs, and / or animations, some of which dynamically represent a distance measure, or generally a respective metric, based on which the movement of the first and second devices is controlled, i.e., actively taken into account for the robot motion.

[0091] However, the graphical representation selected for the indicia 12, 22 can also be a simplified version of a more complex representation defined only internally by the control device 100. For example, to keep an instrument such as a guidewire pinned, a rectangular area can be used to define the desired area, which is more accurately defined as bounded by the vessel wall and also by two lines that cross the vessel at an axial distance from each other, i.e. in the vessel axis direction. It is understood that such latter examples can be generalized to three-dimensional graphical representations, for example by generalizing the rectangle to a cube or cylinder, or the line segment to a square or disk.

[0092] The controller 103 is configured to control the movement of one or more instruments by providing control signals as output, which are interpreted by the drives, which may also be considered as motors and may comprise, for example, servos, to realize the respective movements. In such a configuration, due in particular to the respective environment in which the one or more instruments are moved, the actual movements realized may not correspond to the intended movements corresponding to the control signals provided as output by the controller 103. Such discrepancies between the intended movements and the actually realized movements may be identified in the images of the instruments acquired during the movement, and preventive measures may be taken to mitigate the risks associated with such discrepancies. For example, if the controller 103 controls the instrument to move, but the movement of the instrument is not observed in the acquired images, the controller 103 reduces the speed at which the movement of the instrument is realized, such as by the drives. This may mitigate the risk that spring effects may potentially cause large undesirable displacements of the instrument. More generally, the control algorithm executed by the controller 103 takes into account the slack observed in the instrument to be moved. In other words, the control device 103 is configured to detect when the guidewire tip position 11 does not change even though the guidewire 10 is controlled to move, and in this case to slow the movement of the guidewire 10. Additionally, the controller 103 is configured to detect when the catheter tip position 21 does not change even though the catheter 20 is controlled to move, and in this case to slow the movement of the catheter 20.

[0093] 3 shows, in a schematic and exemplary manner, an apparatus 200 for moving one or more medical instruments, such as a guidewire 10 and a catheter 20, from above. The apparatus 200 comprises a control device 100 and a drive 210 controllable by the controller 103 of the control device 100 to drive the movement of the one or more medical instruments. As shown, the apparatus 200 further comprises an imaging device 220 configured to capture images of the one or more instruments. The apparatus 200 also comprises a display device 230 configured to display the one or more instruments. In particular, images are acquired by the imaging device 220 during an ongoing medical procedure performed using the one or more instruments 10, 20, and the images are displayed on the display 230 to a user of the one or more instruments. The user provides a user input, such as via a user interface of the control device corresponding to the display 230 itself, based on the displayed images and possibly further graphic elements on the display 230 determined by the control device 100, and the control of the instruments mediated by the drive 210 is performed based on the user input. In the example of FIG. 3, the medical procedure is, for example, an intravascular procedure on a patient 30 .

[0094] Fig. 4 shows, in a schematic and exemplary manner, a display screen that can be displayed on the display device 230 of the apparatus 200 illustrated by Fig. 3. In the left part of the display screen, an image of the guidewire 10 and the catheter 20 representing the two medical devices inside, i.e. inserted into, a tubular test structure can be seen, with a line segment corresponding to the limit position indicator 12 being placed on the left arm of the test structure of the guidewire 10. The image shows the catheter 20 being rotated while being withdrawn in order to perturb the guidewire 10 for testing purposes. Attempts to perturb the guidewire are unsuccessful, since the controller 103 controls the movement of the guidewire so that it maintains a predetermined relationship to the limit position indicated by the line segment 12, thereby virtually "anchoring" the tip of the guidewire.

[0095] The right part of the display screen shown in FIG. 4 displays a user interface through which the user provides control inputs for the guidewire 10 and the catheter. For each of the two instruments, the user is asked to move the respective instrument forward or backward, i.e. to extend or retract at one of two predefined speeds (single or double arrows), and to rotate clockwise or counterclockwise about its longitudinal axis at one of two predefined speeds (single or double arrows). For each instrument, a distance is displayed indicating how far the instrument has been inserted into the tubular structure, and an angle is displayed indicating the instrument's rotational state. Moving the instruments using the arrow buttons to explicitly perform a particular translational and / or rotational movement is considered semi-automatic control. In contrast, the user can initiate a fully automatic movement of each instrument by pressing the "Auto" button shown in FIG. 4, which may correspond in particular to the movement of each instrument to a previously indicated target position while limiting the movement of the respective other instrument to the indicated limit positions. For safety reasons, the user must keep the respective "Auto" button pressed to continue the movement. At the top of the display screen, the user interface shown in Figure 4 includes a button (represented by two connected chain elements) for linking the movements of the two instruments being controlled. If this button is clicked, clicking either of the "Auto" buttons will trigger automatic movements of both instruments.

[0096] 5 shows, diagrammatically and exemplarily, a method 300 for controlling a movement of a medical device, the method comprising, in step 301, providing an indication 12 of a limit position of the device 10, preferably beyond which the position of the device 10 is considered to be out of limit. In step 302 of the method 300, a position 11 of the device 10 is provided from a received image comprising a part of the device and / or an acquired movement of the device. Furthermore, the method 303 comprises a step of controlling 303 the movement of the device 10 based on the indication 12 of the limit position and the position 11 of the device 10, such that the position 11 of the device 10 maintains a predefined relationship to the limit position.

[0097] Navigating intravascular devices under fluoroscopic guidance is inherently difficult, and delays and complications can have a significant impact on patient health in emergency situations such as stroke. Once the target location within the vasculature is reached, device exchange is often required. During the exchange process (e.g., while removing the current catheter and attaching a new catheter over the guidewire), one or more devices may accidentally move out of the target location (e.g., the guidewire accidentally retracts), requiring the navigation process to be repeated, leading to increased procedure time and / or complications. In particular, it has been found that robotically controlled instruments and image interpretation can be utilized in a closed-loop controller to provide a reliable and automated means for moving or exchanging instruments while maintaining one or more of the instruments at a desired target location within the vessel, effectively pinning the device to the vessel location.

[0098] In a preferred embodiment, the following system (device or apparatus) for controlling a coaxial elongate instrument allows the tip of the instrument to be actively stabilized at a desired target location within a blood vessel even when another instrument is retracted. The system comprises: a) an imaging unit arranged to provide a 2D X-ray image including an imaged coaxial elongated device, the coaxially movable elongated device including an inner device (guidewire) and an outer device (catheter); b) a unit for providing limits configured to provide a line ("limit line") superimposed on and intersecting the imaged inner device (or imaged outer device) so that the tip of the inner device (or outer device) exceeds the limit line (this is also called "virtual anchoring"); c) a unit for image analysis configured to identify in the image during movement of the inner and / or outer device whether the tip of the inner device (or outer device) crosses or approaches the limit line and to provide corresponding output information; and d) a (robotic) controller arranged to drive the inner device (or outer device) and configured to adapt the movement of the inner device (or outer device) based on the output information so that the tip of the inner device (or outer device) remains beyond the limit line as much as possible. As described in more detail above, the limit lines may be adapted in length to the imaged vasculature, superimposed across the width of the vasculature, and moved with the motion of the vasculature detected in the image. Additionally, the limit lines may be provided through a user interface or automatically by the system based on anatomical features (e.g., vessel openings).

[0099] Optionally, the limit providing unit is configured to provide a second limit line superimposed on and intersecting the imaged outer device (or the imaged inner device) so that the tip of the outer device (or the inner device) exceeds the limit line, and the image analysis unit is configured to identify whether the tip of the outer device (or the inner device) crosses or approaches the second limit line in the image during the movement of the inner device and / or the outer device and provide corresponding second output information. The controller is then arranged to drive the outer device (or the inner device) and adapt the movement of the outer device (or the inner device) based on the second output information so that the tip of the outer device (or the inner device) stays as far beyond the limit line as possible. This is particularly useful when a (robotically controlled) movement is required to retract the catheter to the second limit line while keeping the guidewire at the first limit line. In particular, the limit line of the retracted device can also be considered as a target line, since it is desired to retract to this line at most.

[0100] In a particular example, the system is a robotic system for instrument navigation in neurovascular procedures. In that case, a particular target location is, for example, the patient's left vertebral artery. The controller of the system is also considered a control device, and in one embodiment follows the following control flow: A.) The user selects "catheter exchange" on the user interface, and an x-ray image is taken. B.) The system automatically creates target locations represented by line segments in the x-ray image from the device tracking information: one for the catheter target location (distal to where the catheter exits the image) and one for the guidewire target location (perpendicular to the distal part, at the current guidewire tip location). The user can adjust these through the GUI. The user presses a button or display area represented by "x-ray / robot enable" and the robot automatically and independently servos the two devices to their respective targets, using live fluoroscopy for feedback control. C.) The robot continues to servo the catheter by retracting it to the catheter target, and D.) the catheter retraction is completed. During catheter retraction, the guidewire tip retracts to its own target. Throughout all or part of the workflow, the physician is able to clearly monitor the location of the guidewire tip within the catheter by incorporating respective visual cues on the corresponding fluoroscopic images.

[0101] In the image-based case, the feedback control method for moving the instruments can use Euclidean geometry in the image space. For example, the instruments in the image can be represented as line segments that are segmented and ordered similar to their respective limit or target lines. The control objective is then to move one of the instruments as close as possible to the target line. The target line corresponds to the distal end (tip) of the other instrument. However, any part of the instrument can be used to calculate, for example, the 2D Euclidean distance between the closest point on the target line and the closest point on the instrument being moved. This distance can then be used to extend the instrument to reach the line. If the instrument intersects with the target line segment, the length of the instrument beyond the intersection point is preferably used as a metric for retracting the instrument. A dead zone tolerance can be used to minimize dithering around the target line.

[0102] For the guidewire stabilization use case, the distance to the target may be relatively short, and therefore the servo motion may be relatively small, resulting in the device appearing stationary or "pinned." However, for the catheter retraction use case, the target line may be relatively far from the catheter tip, and therefore the motion to reach the target may be fast.

[0103] In a preferred embodiment, the controller or controlled robot "pins" the guidewire while simultaneously retracting the catheter being exchanged. However, alternative combinations are possible, such as the catheter being pinned, the guidewire being retracted, or other combinations, for example when more than two instruments are involved. Fully automatic control of all instruments is possible, but the user can also be included in the control loop. For example, the user manually controls one or more instruments while the robot controls the other instruments. In one example, once the guidewire target is defined, the user can retract the catheter (manually or robotically) while the robot actively "pins" the guidewire to the target location in the image. For robotically controlled catheters, the catheter degrees of freedom are limited to retraction or rotation only, or both. If the guidewire is moving away from the target location quickly, the catheter controller can be slowed down to increase the stability of the guidewire target. An extension of this is to take into account the type of motion applied by the user and compensate for potential large changes in guidewire length / position, such as fast rotation of a curved catheter.

[0104] Although the above embodiments are primarily directed to medical applications, it will be appreciated that these embodiments generalize to the control of non-medical devices, particularly in environments other than tubular structures such as a patient's vascular system.

[0105] Furthermore, although the above embodiments mainly refer to the case where one or two devices are controlled, any other number of devices may be controlled. That is, limit and / or target position indicators are provided for the multiple devices, and the device controller is configured to control the multiple devices based on the indicators. In particular, movements induced on the two or more devices by the environment and / or two or more other devices are balanced or suppressed by providing corresponding indicators, called induced movement limit indicators, for the two or more devices. Also, target indicators are provided for the multiple devices in addition to the induced movement limit indicators, so that the multiple devices can be controlled to move towards their respective target positions.

[0106] In fact, the control of one or more appliances is not limited to being position-based, in particular not only position-based. Additionally or alternatively, for example the speed of the appliance and / or the force acting on the appliance are taken into account. Thus, in particular, the limit position indicator provided for each appliance can also indirectly indicate the limit position of this appliance via other quantities. For example, the limit position is indirectly defined as a position where the appliance has a predefined limit speed or where a predefined limit force acts on the appliance. Similarly, the target indicator of each appliance indicates the target position of this appliance only indirectly via other quantities, such as the speed of the appliance or the force acting on the appliance, just as the target position is indirectly defined as a position where the appliance has a predefined target speed or where a predefined target force acts on the appliance. Corresponding to the position providing unit for providing the position of each appliance, additionally or alternatively, a respective speed and / or force providing unit is included in the control device. The predetermined relationship maintained by each controlled appliance is also indirectly defined, i.e. via other quantities in terms of limit force or speed, or target force or speed, etc.

[0107] Other variations to the disclosed embodiments can be understood and effected by those skilled in the art in practicing the claimed invention, from a study of the drawings, the disclosure, and the appended claims.

[0108] In the claims, the word "comprising" does not exclude other elements or steps and the word "a" or "an" does not exclude a plurality.

[0109] A single unit or device may fulfill the functions of several items recited in the claims. The mere fact that certain measures are recited in mutually different dependent claims does not indicate that a combination of these measures cannot be used to advantage.

[0110] As used herein, a providing unit may be a receiving unit configured to receive a respective portion from another unit or device and provide the received portion. However, a providing unit may also be a storage in which previously measured or otherwise obtained portions are stored and from which a portion is provided. A providing unit may also be or include a unit or device that previously measured or otherwise received a portion. Before providing a previously received or stored portion, the portion is processed by the respective providing unit.

[0111] Procedures such as providing the indications and positions, controlling the movements, which are performed by one or several units or devices, may be performed by any number of other units or devices. These procedures may be implemented as program code means of a computer program and / or as dedicated hardware.

[0112] The computer program may be stored / distributed on a suitable medium, such as an optical storage medium or a solid-state medium, supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless communication systems.

[0113] Any reference signs in the claims should not be construed as limiting the scope.

[0114] A control device for controlling a movement of a medical instrument is presented. The control device comprises a limit indication providing unit configured to provide an indication of a limit position of the instrument beyond which the position of the instrument is considered to be out of limit, and a position providing unit configured to provide a position of the instrument from a received image including a portion of the instrument and / or an acquired movement of the instrument. The control device further comprises a controller configured to control the movement of the instrument based on the indication of the limit position and the position of the instrument such that the position of the instrument maintains a predetermined relationship to the limit position. This allows for improved movement control of medical and other instruments.

[0115] One and / or the other of the "units" (e.g., "limit indication providing unit", "position providing unit", "target indication providing unit", "second position providing unit") and / or "controllers" used in this specification are hardware and / or software based components. In particular, these units and / or controllers can be found as computer programs or codes of instructions, stored in a non-transitory memory and arranged to be executed by a processor that causes the control device to implement the control according to various embodiments of the present invention.

[0116] A control device is a computer system, computer device, or computer unit that includes at least one memory, and if there are multiple memories, the memories in the computer system communicate with each other and with the processor via a bus. Any or more of the memories are considered representative examples of "its" memory of the control device, storing instructions used to implement some or all aspects of the methods and processes described herein. The memory according to the invention described herein is a tangible storage medium for storing data and executable software instructions, and is non-transient while the software instructions are stored. As used herein, the term "non-transient" should not be interpreted as a permanent characteristic of a state, but as a characteristic of a state that continues for a period of time. The term "non-transient" specifically negates transitory characteristics such as carrier waves or signals or other forms of characteristics that exist only temporarily at any time and place. A memory is an article of manufacture and / or a machine component. It is a computer-readable medium from which the data and executable software instructions are read by a computer (or a processor). The memory may be implemented as one or more of random access memory (RAM), read only memory (ROM), flash memory, electrically programmable read only memory (EPROM), electrically erasable programmable read only memory (EEPROM), registers, hard disk, removable disk, tape, compact disk read only memory (CD-ROM), digital versatile disk (DVD), floppy disk, Blu-ray disk, or any other form of storage medium known in the art. The memory may be volatile or non-volatile, and may be secured and / or encrypted or non-secured and / or unencrypted.

[0117] "Memory" is an example of a computer-readable storage medium. Computer memory is any memory that is directly accessible to a processor. Examples of computer memory include, but are not limited to, RAM memory, registers, and register files. References to "computer memory" or "memory" should be interpreted as possibly being multiple memories. A memory may be, for example, multiple memories in the same computer system. A memory may also be multiple memories distributed among multiple computer systems or computing devices.

[0118] The computer system, computer device, or computer unit further includes a video display unit, such as, for example, a liquid crystal display (LCD), an organic light emitting diode (OLED), a flat panel display, a solid state display, or a cathode ray tube (CRT). In addition, the computer system, computer device, or computer unit includes input devices, such as a keyboard / virtual keyboard, a touch-sensitive input screen, or a voice input with voice recognition, and a cursor control device, such as a mouse or a touch-sensitive input screen or pad. The computer system, computer device, or computer unit also optionally includes a disk drive unit, a signal generating device, such as a speaker or a remote control, and / or a network interface device.

[0119] The disk drive unit includes a computer readable medium having one or more software instruction sets (software) embedded therein. The software instruction sets are read from the computer readable medium and executed by the processor. Furthermore, the software instructions, when executed by the processor, perform one or more steps of the methods and processes described herein. In one embodiment, the software instructions reside in whole or in part in a memory (e.g., main memory or static memory) and / or in the processor during execution by the computer system, computer device, or computer unit. Furthermore, the computer readable medium includes the software instructions or receives and executes the software instructions in response to a propagated signal, such that network-connected devices can communicate audio, video, or data over the network. The software instructions are transmitted or received over the network via a network interface device.

[0120] In one embodiment, dedicated hardware implementations such as application specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), programmable logic arrays, and other hardware components are constructed to implement one or more of the methods described herein. One or more embodiments described herein use two or more specific interconnected hardware modules or devices to implement functions with associated control and data signals that can be communicated between and through the modules. Thus, the present disclosure encompasses software, firmware, and hardware implementations. Nothing in this application should be interpreted as being implemented or capable of being implemented solely in software rather than hardware such as tangible non-transitory processors and / or memories.

[0121] According to various embodiments of the present disclosure, the methods described herein are implemented using a hardware computer system executing a software program. Further, in exemplary non-limiting embodiments, implementations may include distributed processing, component / object distributed processing, and parallel processing. A virtual computer system process implements one or more of the methods or functions described herein, and a processor described herein is used to support a virtual processing environment.

Claims

1. 1. A control device for controlling movement of a medical device, said control device comprising: a non-transitory memory for storing instructions; a processor for executing said instructions; wherein the instructions, when executed by the processor, cause the control device to: providing an indication of a limit position of the device, beyond which the position of the device is considered to be out of limit; providing a position of the device from received images including a portion of the device and / or from acquired movements of the device; controlling movement of the device based on the indication of the limit position and the position of the device such that the position of the device maintains a predetermined relationship with respect to the limit position; A control device that causes the

2. The control device of claim 1 , wherein the instructions further cause the control device to provide a representation of the indicator within the image to graphically represent the limit position.

3. The control device of claim 2, wherein the instrument is a medical instrument, the instructions further cause the control device to control movement of the instrument along a tubular anatomical structure, a portion of the tubular anatomical structure being included in the image, and the representation of the indicator being provided to traverse the imaged tubular structure.

4. The control device of claim 3 , wherein the instructions further cause the control device to provide a representation of the indicator provided across the imaged tubular structure such that the size of the representation of the indicator dynamically changes in response to potential changes in width of the imaged tubular structure.

5. 10. The control device of claim 1, wherein the instrument is a first of two instruments, a second of the two instruments inducing motion relative to the first instrument when the second instrument is moved.

6. 6. The control device of claim 5, wherein the second of the two devices is manually driven to induce motion relative to the first device, and the instructions further cause the control device to control the first device to automatically maintain the predetermined relationship with respect to the limit position while the second device is manually driven.

7. The instructions may further include causing the control device to: providing a target indicator indicating a target position of the second device to be moved; providing the second location, the second location being the location of the second device; The control device according to claim 5 ,

8. The instructions may further include causing the control device to: controlling a movement of the second device based on the target indicator and the second position so that the second position approaches the target position; triggering a warning to a user when the second device approaches the target location beyond a warning limit; controlling the movement of the second device based on the target indicator and the second position such that the movement of the second device is slowed when the second position exceeds an approach limit; and / or controlling a reaction force applied to the second instrument or a tool driving the second instrument, such force opposing a manual force applied by a user manually driving the second instrument, such reaction force being applied when the second position exceeds an approach limit, optionally the approach limit being the target position, the reaction force being large enough to prevent the user from manually driving the second instrument beyond the target position, and further optionally the reaction force gradually increasing between the approach limit and the target position. The control device according to claim 7, wherein the control device causes the following to be executed:

9. The control device of claim 5 , wherein the first and second devices are medical devices, and the instructions further cause the control device to control movement of the first and second devices along a tubular anatomical structure.

10. The control device of claim 9, wherein the first device is an inner device, the second device is an outer device, the received images include images of portions of the first device and the second device and a branched intersection of multiple branches of the tubular anatomical structure including a main branch and a target branch branching from the main branch, and the instructions further cause the control device to maintain the inner device at a target point within the target branch of the tubular anatomical structure by further advancing the inner device by an amount that compensates for the retraction of the outer device when the controller causes the outer device to retract.

11. The control device of claim 1 , wherein the instructions further cause the control device to determine a distance between the position of the equipment for which the indication of the limit position is provided and the limit position, and control the movement of the equipment based on the distance.

12. 12. The control device of claim 11, wherein the location of the equipment for which the indication of the limit location is provided is provided from a received image of a portion of the equipment, the limit location referring to a position within the received image, and the distance determined based on the image.

13. The control device of claim 1, wherein the instructions further cause the control device to provide the indication of the limit position based on imaged anatomical features as the instrument is moved along a tubular anatomical structure, in particular new branches into which the instrument enters, user input through a user interface relating user input to locations within the image, and / or stored default setting parameters.

14. The control device of claim 13 , wherein the instructions further cause the control device to provide the indication of the limit position further based on the position of the equipment for which the indication is provided.

15. The control device of claim 1, wherein the instructions further cause the control device to detect when the position of the equipment being moved does not change despite the equipment being controlled to move beyond a threshold distance, and in such a case, to modify the movement of the equipment or trigger a warning to a user.

16. 1. An apparatus for operating a medical device, the apparatus comprising: A control device according to any one of claims 1 to 15; a drive controllable by a controller of the control device to drive the movement of the equipment to be moved; An apparatus comprising:

17. the device being a first device of two devices, and a second device of the two devices; a) the first device refers to a flexible, elongated, guided device, and the second device refers to a device that is guided along the first device; and / or 17. The apparatus of claim 16, wherein the second device refers to a flexible, elongated, guided device and the first device refers to a device guided along the first device.

18. 1. A method for controlling movement of a medical device, the method comprising: providing an indication of a limit position of the device beyond which the device position is considered to be out of limit; providing a position of the device from received images including a portion of the device and / or from captured movements of the device; providing a control signal to control movement of the device based on the indication of the limit position and the position of the device such that the position of the device maintains a predetermined relationship with respect to the limit position; A method comprising:

19. 19. A computer program for controlling the movement of a medical instrument, said computer program comprising instructions for causing a control device according to any one of claims 1 to 15 to carry out the method according to claim 18.

Images