User Interface for Three-Dimensional Imaging and Treatment

Abstract

The user interface presents a 3D view of the tissue and treatment plan. The 3D view includes multiple transverse images arranged along one or more longitudinal images. The user adjusts the treatment profile through inputs to the user interface, and the updated treatment profile is shown in the other views. The user overlays the treatment profile on the 3D view and one or more of zooming, panning, or rotating the 3D view, and the treatment profile moves with and maintains alignment with the 3D view. In some embodiments, the 3D treatment plan is generated according to multiple angles between the treatment probe and one or more tissue structures. AI algorithms can be used to identify tissue structures and plan treatment angles and energy delivery according to the tissue structures, thereby providing a more customized treatment.

Description

[Background technology]

[0001] Related Applications This application claims the benefit of the filing date of U.S. Patent Application No. 18 / 163,187, filed February 1, 2023, and U.S. Patent Application No. 18 / 163,197, filed February 1, 2023, the disclosures of which are incorporated by this reference in their entireties.

[0002] background Previous approaches to tissue planning and treatment using energy sources may be less than ideal in at least some respects. In at least some instances, the energy directed to the treated tissue may be inappropriate in at least some respects, potentially over- or under-treating the target tissue. Research related to the present disclosure suggests that, in at least some instances, the energy source may not be precisely directed to the target tissue. Also, some types of surgery treat tissue near delicate non-targeted tissue, and previous approaches may, in at least some instances, result in a greater amount of energy being delivered to the non-targeted tissue.

[0003] While image-guided procedures have been proposed that allow users to review treatment profiles overlaid on patient images prior to treatment, research relevant to the present disclosure suggests that previous user interfaces may be somewhat more complex or, at least in some instances, may provide gaps in the treatment area being reviewed. It would be useful to provide an improved user interface that allows users to quickly review the planned treatment with appropriate images. Also, at least some previous approaches for imaging tissue with a probe may be somewhat more complex than ideal and, at least in some instances, may be somewhat more sensitive to alignment between the treatment probe and the imaging probe than ideal.

[0004] Although artificial intelligence-based tissue recognition has been proposed, at least some of these previous approaches are not well suited for combination with surgical treatment planning. For at least some types of surgery, it would be useful to have an improved user interface that allows the user to review and verify the treatment plan before treating the patient.

[0005] In light of the above, there is a need for improved tissue treatment with energy and treatment regimens that ameliorate at least some of the aforementioned limitations of previous approaches. Summary of the Invention [Means for solving the problem]

[0006] overview In some embodiments, the user interface is configured to allow a user to review a treatment before treating a patient, facilitating treatment planning. In some embodiments, the user interface is configured to provide multiple images rotated relative to an axis of the treatment, such as the axis of an energy source on a probe, facilitating treatment planning. In some embodiments, the user interface is configured to present a 3D view of the tissue and a treatment plan, such as a treatment profile. In some embodiments, the 3D view includes multiple transverse images aligned along one or more longitudinal images, allowing the user an improved perspective of the treatment during treatment planning. In some embodiments, the one or more longitudinal images correspond to the longitudinal axis of the treatment probe. Alternatively, or in combination, the one or more longitudinal images may correspond to the longitudinal axis of an imaging probe acquiring the images. In some embodiments, the one or more longitudinal images may include images rotated such that at least one of the one or more longitudinal images extends substantially along the elongated axis of the treatment probe, and the multiple transverse images may include images rotated according to the rotation of the one or more longitudinal images.

[0007] In some embodiments, the user interface is configured to allow the user to select one or more views, such as multiple transverse views and one or more longitudinal views, in addition to the 3D view. The one or more longitudinal views may include one or more sagittal images, such as one or more sagittal or parasagittal images. In some embodiments, the user interface is configured to allow the user to adjust the treatment profile through input into the user interface, and the updated treatment profile is shown in the other views. In some embodiments, the user interface is configured to allow the user to overlay the treatment profile on the 3D view and one or more of zooming, panning, or rotating the 3D view, and the treatment profile moves with the 3D view to maintain alignment with the 3D view while the 3D view is zoomed, panned, or rotated. This approach allows the user to gain a better understanding of the location of the treatment and tissue structures relative to the planned treatment, such as the planned treatment profile.

[0008] In some embodiments, the 3D treatment plan is generated from multiple images, such as one or more longitudinal images and multiple transverse images. In some embodiments, the 3D treatment plan is generated according to multiple angles between the treatment probe and one or more tissue structures. While the treatment plan can be generated in many ways, in some embodiments, an AI algorithm is used to identify the tissue structures and plan the treatment angle and energy delivery according to the tissue structures, thereby providing a more customized treatment. In some embodiments, the AI-generated treatment plan is provided to the user on a user interface so that the user can verify the AI-generated treatment parameters. While this verification can be performed in many ways, in some embodiments, the AI-generated treatment plan is presented to the user in multiple views, which may allow the user to verify the AI-generated treatment plan. In some embodiments, the user interface is configured to allow the user to select multiple views and adjust the AI-generated treatment plan.

[0009] In some embodiments, a method for planning a treatment includes receiving a plurality of transverse images and one or more longitudinal images and generating an array of the plurality of transverse images along the one or more longitudinal images in a three-dimensional (3D) view. The one or more longitudinal images may include one or more sagittal or parasagittal images. The three-dimensional view may include a plurality of transverse images at a plurality of corresponding locations along the one or more longitudinal images, such as one or more sagittal or parasagittal images. A representation of the three-dimensional (3D) treatment profile is overlaid on the 3D view of the plurality of transverse images and the one or more longitudinal images, and the 3D view with the representation overlaid on one or more of the one or more longitudinal images and the plurality of transverse images is shown on a display of a user interface.

[0010] In some embodiments, a method for generating a treatment plan includes receiving a plurality of transverse images of tissue to be treated, for each of the plurality of transverse images, a position of a treatment probe and a tissue boundary are determined, and the boundary is used to define a tissue area to be treated.

[0011] In some embodiments, for each of the multiple transverse images, a first boundary angle from the treatment probe to a first location along a first side boundary of the area is determined, and a second boundary angle from the treatment probe to a second location along a second side boundary of the area is determined. The angle of the tissue boundary relative to the treatment probe can be used to determine the treatment angle. The treatment angle can be determined according to the boundary angle to provide one or more tissue margins near the treatment edge. Alternatively, or in combination, the treatment angle can be determined according to the tissue penetration depth of the energy source and the thickness of the tissue at an angle relative to the energy source to provide a depth margin. In some embodiments, the tissue margin includes a safety margin to reduce interaction with other tissue near the tissue margin, such as the verumontanum of the prostate or the trigone of the bladder.

[0012] Incorporation by Reference All patents, applications, and publications referred to and identified herein are incorporated herein by reference in their entirety and shall be considered to be incorporated by reference in their entirety even if referred to elsewhere in this application. [Brief explanation of the drawings]

[0013] BRIEF DESCRIPTION OF THE DRAWINGS A better understanding of the features, advantages, and principles of the present disclosure will be obtained by reference to the following detailed description that sets forth exemplary embodiments and the accompanying drawings.

[0014] [Figure 1] 1 illustrates a front view of a system for performing tissue ablation in a patient, according to some embodiments.

[0015] [Figure 2] 1 illustrates a schematic diagram of a system for performing tissue ablation in a patient, according to some embodiments.

[0016] [Figure 3A] 1 shows a top view of an array of probes, according to some embodiments.

[0017] [Figure 3B] 10A-10C illustrate longitudinal views, such as sagittal views, of an array of probes, according to some embodiments.

[0018] [Figure 3C] 1 shows a perspective view of an array of probes, according to some embodiments.

[0019] [Figure 3D] 10A-10C illustrate treatment and imaging probe axes skewed at an angle relative to one another such that the treatment and imaging probes do not extend along a common plane, according to some embodiments.

[0020] [Figure 4A]10 shows a top view of a transverse image plane relative to the axis of a treatment probe, according to some embodiments.

[0021] [Figure 4B] 1 illustrates a three-dimensional view of a transverse image plane for a treatment probe, according to some embodiments.

[0022] [Figure 4C] 1 illustrates a longitudinal view, such as a sagittal view, of a treatment probe, according to some embodiments.

[0023] [Figure 5] 10 illustrates a transverse image plane rotated relative to the elongated axis of the probe, according to some embodiments.

[0024] [Figure 6A] 10A-10C show a user interface and a transverse image showing movement of the probe location within the transverse image, according to some embodiments. [Figure 6B] 10A-10C show a user interface and a transverse image showing movement of the probe location within the transverse image, according to some embodiments. [Figure 6C] 10A-10C show a user interface and a transverse image showing movement of the probe location within the transverse image, according to some embodiments.

[0025] [Figure 7A] 1 illustrates a user interface with a three-dimensional view for three-dimensional treatment planning, according to some embodiments.

[0026] [Figure 7B] 10A-10C illustrate longitudinal images, such as sagittal images, for three-dimensional treatment planning, according to some embodiments.

[0027] [Figure 7C] 10 illustrates multiple rotation angles for a treatment probe that can be used to generate multiple longitudinal images, according to some embodiments. [Figure 7D] 10 illustrates multiple rotation angles for a treatment probe that can be used to generate multiple longitudinal images, according to some embodiments.

[0028] [Figure 8A] 10 illustrates a first transverse view of a three-dimensional treatment plan at a first depth of a three-dimensional treatment profile, according to some embodiments.

[0029] [Figure 8B] 10 illustrates a second transverse view of a three-dimensional treatment plan at a second depth, according to some embodiments.

[0030] [Figure 9A] 10A-10C illustrate a probe and rotation angles of an energy source on the probe for directing the energy source to tissue to treat the tissue to different depths, according to some embodiments.

[0031] [Figure 9B] 10 shows a treatment profile overlaid on an image of the probe and rotation angle and tissue, according to some embodiments.

[0032] [Figure 9C] 1 illustrates a treatment plan with one or more tissue margins, according to some embodiments. [Figure 9D] 1 illustrates a treatment plan with one or more tissue margins, according to some embodiments.

[0033] [Figure 10] 1 illustrates a method for planning a three-dimensional procedure (3D) using a user interface, according to some embodiments.

[0034] [Figure 11] 1 illustrates a method for planning a 3D procedure using automated tissue recognition, according to some embodiments.

[0035] [Figure 12] 1 illustrates a method for treating a first tissue using automated tissue recognition to reduce exposure to a second tissue, according to some embodiments.

[0036] [Figure 13] 1 illustrates a method for training an artificial intelligence (AI) algorithm, according to some embodiments.

[0037] [Figure 14] 1 illustrates a two-dimensional convolutional neural network, according to some embodiments. DETAILED DESCRIPTION OF THE INVENTION

[0038] Detailed Description The following detailed description provides a better understanding of the features and advantages of the invention described in this disclosure in accordance with the embodiments disclosed herein. While the detailed description includes many specific embodiments, these are provided by way of example only and should not be construed as limiting the scope of the invention disclosed herein.

[0039] The systems and methods of the present disclosure are well suited for use in many probes and diagnostic and surgical procedures. While reference is made to energy sources and treatment probes, including transrectal ultrasound ("TRUS") probes for prostate surgery, the present disclosure also applies to the brain, heart, lungs, intestines, eyes, skin, kidneys, liver, pancreas, stomach, uterus, ovaries, testes, bladder, ears, nose, mouth, tumors, cancers, bone marrow, adipose tissue, muscle, glandular and mucosal tissue, spinal cord and nerve tissue, soft tissue such as cartilage, teeth, hard biological tissue such as bone, as well as vascular cavities, nasal cavities and cavities, paranasal sinuses, colon, urethral cavity, gastric cavity, airway, esophageal cavity, transesophageal, intestinal cavities, It is highly suitable for use with many types of probes inserted into many types of tissues, organs, cavities and lumens such as anal cavity, vaginal cavity, transperitoneal cavity, abdominal cavity, lumen of throat, airway, lung passages etc. and for surgeries such as kidney surgery, ureter surgery, kidney stone, prostate surgery, tumor surgery, cancer surgery, brain surgery, heart surgery, eye surgery, conjunctival surgery, liver surgery, gallbladder surgery, bladder surgery, spine surgery, orthopedic surgery, arthroscopic surgery, liposuction, colonoscopy, tracheal intubation, minimally invasive incision, minimally invasive surgery etc.

[0040] The systems and methods of the present disclosure are well suited for combination with previous probes, such as imaging and treatment probes. Examples of such probes include, for example, laser treatment probes, water jet probes, RF treatment probes, radiation therapy probes, ultrasound treatment probes, phacoemulsification probes, imaging probes, endoscopic probes, resectoscope probes, ultrasound imaging probes, A-scan ultrasound probes, B-scan ultrasound probes, 3D ultrasound probes, Doppler ultrasound probes, transrectal ultrasound probes, transvaginal ultrasound probes, longitudinal plane ultrasound imaging probes, sagittal plane ultrasound imaging probes, transverse plane ultrasound imaging probes, and transverse and longitudinal plane (e.g., sagittal plane) ultrasound imaging probes.

[0041] The systems, methods and devices disclosed herein are well suited for combination with many previous surgical procedures, such as waterjet enucleation of the prostate, transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HOLEP), prostate brachytherapy, as well as surgical robotic systems and automated surgical procedures. The following patent applications describe examples of systems, methods, probes, and procedures suitable for incorporation according to the present disclosure: PCT / US2013 / 028441, filed February 28, 2013, entitled "AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT," published as WO 2013 / 130895; PCT / US2014 / 054412, filed September 5, 2014, entitled "AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT," published as WO 2015 / 035249; and PCT / US2015 / 048695, filed September 5, 2015, entitled "PHYSICIAN CONTROLLED TISSUE RESECTION INTEGRATED WITH TREATMENT MAPPING OF TARGET ORGAN "ARTIFICIAL INTELLIGENCE FOR ROBOTIC SURGERY," published on December 26, 2019 as WO2019246580A1; PCT / US2020 / 021756, filed on March 9, 2020, titled "ROBOTIC ARMS AND METHODS FOR TISSUE RESECTION AND IMAGING," published on November 4, 2020 as WO / 2020 / 181290; PCT / US2020 / 058884, filed on November 4, 2020, titled "SURGICAL PROBES FOR TISSUE RESECTION WITH ROBOTIC ARMS”, published as WO / 2021 / 096741;PCT / US2021 / 070760, filed June 23, 2021, entitled "INTEGRATION OF ROBOTIC ARMS WITH SURGICAL PROBES," published as WO / 2021 / 263276; PCT / US2021 / 038175, filed June 21, 2021, entitled "SYSTEMS AND METHODS FOR DEFINING AND MODIFYING RANGE OF MOTION OF PROBE USED IN PATIENT TREATMENT," published as WO / 2021 / 262565; and PCT / US2022 / 025617, filed April 20, 2022, entitled "SURGICAL PROBE WITH INDEPENDENT ENERGY SOURCES,” published on October 27, 2022 as WO / 2022 / 226103, the entire disclosure of which is incorporated herein by reference.

[0042] Some embodiments provide improved positional accuracy for the placement of energy sources and imaging probes. The energy source may include any suitable energy source, such as an electrode, a loop electrode, a laser source, a mechanical shear, a mechanical energy source, a radiation energy source, a thermal energy source, a vibration energy source, an ultrasound probe, a cavitation ultrasound probe, a water jet, a variable pressure water jet, a pressure-controlled water jet, a flow-controlled water jet, a variable pressure water jet, a fixed pressure water jet, a plasma, a steam, a morcellator, a transurethral needle, photoablation, or a water jet ejection. The energy source may be combined with other treatments and compounds, such as compounds for treatment, hemostasis, or photochemical treatment, or contrast agents for imaging. The imaging probe may include any suitable probe, such as an endoscopic probe, a resectoscope probe, an ultrasound imaging probe, an A-scan ultrasound probe, a B-scan ultrasound probe, a Doppler ultrasound probe, a transrectal ultrasound probe, a transvaginal ultrasound probe, a longitudinal plane (e.g., sagittal plane) ultrasound imaging probe, a transverse plane ultrasound imaging probe, and a transverse and longitudinal (e.g., sagittal) plane ultrasound imaging probe.

[0043] The probes, including the energy source and imaging probe, can be configured in many ways and each may include one or more reference points for determining the position and orientation of the respective probe.

[0044] Although this disclosure refers to treatment planning with a probe inserted into a patient, the systems and methods of this disclosure are well suited for pre-treatment planning. In some embodiments, treatment planning is performed without a probe inserted into the patient, for example, using images acquired before one or more of the treatment or imaging probes are inserted into the patient.

[0045] Although the present disclosure relates to an imaging probe separate from a treatment probe, the methods and apparatus of the present disclosure are well suited for use with treatment probes that include an imaging probe. In some embodiments, the imaging probe is located on the treatment probe, for example. Examples of imaging devices, such as imaging arrays, located on rotational and translational treatment probes are described in PCT / US2013 / 028441, filed February 28, 2013, entitled "AUTOMATED IMAGE-GUIDED TISSUE RESECTION AND TREATMENT," published as WO 2013 / 130895, the entire disclosure of which is incorporated herein by reference.

[0046] FIG. 1 illustrates an exemplary embodiment of a system 400 for performing a patient treatment. The system 400 may include a treatment probe 450 as described herein and an imaging probe 460 as described herein. The treatment probe 450 may be coupled to a first arm 442, and the imaging probe 460 may be coupled to a second arm 444. One or both of the first arm 442 and the second arm 444 may comprise a robotic arm, the movement of which may be controlled by one or more computing devices operably coupled to the arm. The treatment probe 450 may include a device for removing target tissue from a target site within a patient. The treatment probe 450 may be configured to deliver sufficient energy from the treatment probe 450 to the target tissue to remove the target tissue, and the energy from the energy source may include any suitable energy described herein. For example, the treatment probe 450 may include an electrosurgical ablation device, a laser ablation device, a transurethral needle ablation device, a water jet ablation device, a vapor ablation device, a high-intensity focused ultrasound (HIFU) device, or any combination thereof. The imaging probe 460 may be configured to deliver sufficient energy to the target tissue to image the target tissue. The imaging probe 460 may include, for example, an ultrasound probe, a magnetic resonance probe, an endoscope, or a fluoroscopy probe. The first arm 442 and the second arm 444 may be configured to be independently adjustable, adjustable according to a fixed relationship, adjustable according to a user-selected relationship, independently lockable, simultaneously lockable, or any combination thereof. The first arm 442 and the second arm 444 may have multiple degrees of freedom, e.g., six degrees of freedom, for manipulating the treatment probe 450 and the imaging probe 460, respectively. The treatment system 400 may be used to perform tissue ablation in a patient's organ, such as the patient's prostate. The patient may be positioned on a patient support 449, such as a bed, table, chair, or platform. The treatment probe 450 may be inserted into a target site on the patient along an entry axis coinciding with the treatment probe's elongated axis 451.For example, treatment probe 450 may be configured for insertion into the patient's urethra to position the treatment probe's energy delivery region within the patient's prostate. Imaging probe 460 may be inserted into the patient at a target site or adjacent to the patient's target site along an entry axis coincident with imaging probe's elongated axis 461. For example, imaging probe 460 may include a transrectal ultrasound (TRUS) probe configured for insertion into the patient's rectum to view the patient's prostate and surrounding tissue. As shown in FIG. 1 , first arm 442 and second arm 444 may be covered with sterile drapes to provide a sterile operating environment, keep the robotic arms clean, and reduce the risk of damaging the robotic arms. Further details regarding the various components of system 400 suitable for incorporation with the embodiments disclosed herein can be found in U.S. Pat. No. 7,882,841, U.S. Pat. No. 8,814,921, U.S. Pat. No. 9,364,251, and PCT Publication No. WO2013 / 130895, the entire disclosures of which are incorporated herein by reference.

[0047] FIG. 2 schematically illustrates an embodiment of a system 400 for performing tissue ablation on a patient. The system 400 may include a treatment probe 450 as described herein and, optionally, an imaging probe 460. The treatment probe 450 is coupled to a console 420 and a linkage 430. The linkage 430 may include one or more components of a robotic arm 442. The imaging probe 460 is coupled to an imaging console 490. The imaging probe may be coupled to a second robotic arm 444, for example. The patient treatment probe 450 and the imaging probe 460 can be coupled to a common base 440. The patient is supported by a patient support 449. The treatment probe 450 is coupled to the base 440 by a first arm 442. The imaging probe 460 is coupled to the base 440 by a second arm 444. As described in further detail herein, one or both of the first arm 442 and the second arm 444 may comprise a robotic arm whose movement may be controlled by one or more computing devices operably coupled to the arm.

[0048] Although a common base is referenced, the robotic arms may be coupled to a bed rail, a console, or any suitable support structure to support the base of the robotic arms.

[0049] In some embodiments, the system 400 includes a user input device 496 coupled to the processor 423 for a user to manipulate a surgical instrument on the robotic arm. The user input device 496 can be located in any suitable location, e.g., on a console, on the robotic arm, or on a mobile base, and there may be one, two, three, four, or more user input devices used with the system 400 to provide redundant means of input, unique input commands, or combinations. In some embodiments, the user input device comprises a controller for moving the end of a treatment or imaging probe in response to mechanical movement of the user input device. The end of the probe can be shown on the display 425, and the user can manipulate the end of the probe. For example, the user input device may comprise a six-degrees-of-freedom input controller, allowing the user to move the input device in six degrees of freedom, with the distal end of the probe moving in response to movement of the controller. In some embodiments, the six degrees of freedom include three translational degrees of freedom and three rotational degrees of freedom. The processor can be configured with instructions for probe control, for example, to switch between automated image-guided treatment with an energy source and treatment with an energy source via user movement of the user input device.

[0050] The patient is positioned on a patient support 449 so that the treatment probe 450 and the ultrasound probe 460 can be inserted into the patient. The patient can be positioned in one or more of a number of positions, such as prone, supine, upright, or inclined. In some embodiments, the patient is positioned in a lithotomy position, e.g., stirrups may be used. In some embodiments, the treatment probe 450 is inserted into the patient in a first direction on a first side of the patient, and the imaging probe is inserted into the patient in a second direction on a second side of the patient. For example, the treatment probe can be inserted into the patient's urethra from the anterior side of the patient, and the imaging probe can be inserted transrectally into the patient's intestine from the posterior side of the patient. The treatment probe and the imaging probe can be positioned on the patient with one or more of urethral tissue, urethral wall tissue, prostate tissue, intestinal tissue, or intestinal wall tissue extending between them.

[0051] The treatment probe 450 and the imaging probe 460 can be inserted into a patient in one or more of many ways. During insertion, each of the first and second arms can include a substantially unlocked configuration so that the treatment probe or imaging probe can be desirably rotated and translated to insert the treatment probe or imaging probe into the patient. Once the probe is inserted into the desired location, the arms can be locked. In the locked configuration, the probes can be oriented relative to each other in one or more of many ways, such as parallel, skewed, horizontal, oblique, or non-parallel. It can be useful to determine the orientation of the probe using an angle sensor described herein to map imaging probe image data to a treatment probe coordinate reference. Mapping tissue image data to the treatment probe coordinate reference space can enable precise targeting and treatment of tissue identified for treatment by an operator, such as a physician.

[0052] In some embodiments, the treatment probe 450 is coupled to the imaging probe 460 to align the treatment probe with the imaging probe 460 based on images from the imaging probe 460. Coupling can be achieved using a common base 440 as shown. Alternatively, or in combination, the treatment probe and / or the imaging probe may include magnets for aligning and holding the probe through the patient's tissue. In some embodiments, the first arm 442 is a movable and lockable arm so that the treatment probe 450 can be positioned at a desired location on the patient. Once the probe 450 is positioned at a desired location on the patient, the first arm 442 can be locked with an arm lock 427. The imaging probe can be coupled to the base 440 using a second arm 444 that can be used to adjust the alignment of the imaging probe when the treatment probe is locked in place. The second arm 444 may include a lockable and movable arm under the control of, for example, an imaging system or console and user interface. The movable arm 444 may be micro-actuable so that the imaging probe 460 may be adjusted relative to the treatment probe 450 in small movements, such as millimeters.

[0053] In some embodiments, the treatment probe 450 and the imaging probe 460 are coupled to angle sensors so that the treatment can be controlled based on the alignment of the imaging probe 460 and the treatment probe 450. A first angle sensor 495 may be coupled to the treatment probe 450 by a support 438. A second angle sensor 497 may be coupled to the imaging probe 460. The angle sensors can comprise one or more of many types of angle sensors. For example, the angle sensors can include goniometers, accelerometers, and combinations thereof. In some embodiments, the first angle sensor 495 comprises a three-dimensional accelerometer for determining the orientation of the treatment probe 450 in three dimensions. In some embodiments, the second angle sensor 497 comprises a three-dimensional accelerometer for determining the orientation of the imaging probe 460 in three dimensions. Alternatively, or in combination, the first angle sensor 495 may comprise a goniometer for determining the angle of the treatment probe 450 along the elongated axis 451 of the treatment probe. The second angle sensor 497 may comprise a goniometer for determining the angle of the imaging probe 460 along the elongated axis 461 of the imaging probe 460. The first angle sensor 495 is coupled to the controller 424 of the treatment console 420. The second angle sensor 497 of the imaging probe is coupled to the processor 492 of the imaging console 490. Alternatively or in combination, the second angle sensor 497 may be coupled to the controller 424 of the treatment console 420.

[0054] The console 420 includes a display 425 coupled to a processor system in components used to control the treatment probe 450. The console 420 includes a processor 423 having a memory 421. A communication circuit 422 is coupled to the processor 423 and a controller 424. The communication circuit 422 is coupled to the imaging console 490 via an imaging console communication circuit 494. An arm lock 427 of the console 420 may be coupled to the first arm 442 to lock the first arm or to allow the first arm to be freely movable for inserting the probe 450 into a patient.

[0055] Optionally, console 420 may include components of an endoscope 426 coupled to anchor 24 of treatment probe 450. Endoscope 426 may include components of console 420 and an endoscope through which treatment probe 450 can be inserted to treat a patient.

[0056] In some embodiments, the console 420 includes an impedance sensor circuit 220 coupled to the energy source to measure the impedance of tissue treated with energy from the energy source. In some embodiments, the energy source includes an electrode, and the electrode includes an impedance sensor. In some embodiments, the processor is configured with instructions for adjusting the amount of energy from the energy source in response to the amount of impedance. In some embodiments, the processor is configured with instructions for adjusting the amount of deflection of the extension and the offset of the energy source from the elongate shaft in response to the impedance.

[0057] In some embodiments, the console 420 includes a force sensor circuit 210 coupled to a force sensor on the treatment probe. The force sensor can be coupled to the extension, for example, to measure tissue resistance associated with deflection of the extension. In some embodiments, the force sensor is coupled to the link to measure tissue resistance associated with movement of the energy source away from the elongate shaft. In some embodiments, the force sensor is coupled to the energy source to measure tissue resistance associated with positioning distance of the energy source from the elongate shaft. In some embodiments, the force sensor is configured to measure tissue resistance associated with the amount of energy delivered from the energy source.

[0058] Optionally, console 420 may include one or more modules operably coupled with treatment probe 450 to control aspects of treatment by the treatment probe. For example, console 420 may include one or more of an energy source 22 for providing energy to the treatment probe, a balloon inflation control 26 for affecting inflation of a balloon used to secure the treatment probe to the target treatment site, an injection / irrigation control 28 for controlling injection and irrigation of the probe, an aspiration control 30 for controlling suction by the probe, an air insufflation control 32 for controlling insufflation of the target treatment site (e.g., the prostate), or a light source 33, such as an infrared, visible, or ultraviolet light source, for providing light energy to the treatment probe.

[0059] The processor, controller, and control electronics and circuitry may include one or more of many suitable components, such as one or more processors, one or more field programmable gate arrays (FPGAs), and one or more memory storage devices. In some embodiments, the control electronics controls a graphic user interface (hereinafter "GUI") control panel to provide pre-procedure planning according to user-specified treatment parameters and to provide user control over the surgical procedure.

[0060] The treatment probe 450 may include an anchor 24. The anchor 24 may secure the distal end of the probe 450 while energy is delivered by the probe 450 to the energy delivery region 20.

[0061] The probe 450 can include any suitable number and configuration of energy sources. In some embodiments, the probe includes an energy source 250 that can offset the probe from the elongated axis 451 by a distance 252 to treat tissue, for example, by deflection of an extension. Examples of suitable energy sources with deflection, translation, and rotation for treating and removing a volume of tissue are described in PCT / US2022 / 025617, filed April 20, 2022, entitled "SURGICAL PROBE WITH INDEPENDENT ENERGY SOURCES," published October 27, 2022 as WO / 2022 / 226103, the entire disclosure of which was previously incorporated herein by reference. Alternatively, or in combination, the probe 450 can include an energy source 200, such as a nozzle, which can include any suitable energy source described herein, such as a directed energy source that emits energy along a directional path for selective treatment of tissue. Examples of energy sources suitable for treating tissue with directed energy sources such as water jets are described in PCT / US2015 / 048695, filed September 5, 2015, entitled "PHYSICIAN CONTROLLED TISSUE RESECTION INTEGRATED WITH TREATMENT MAPPING OF TARGET ORGAN IMAGES," published as WO2016037137, the entire disclosure of which was previously incorporated herein by reference.

[0062] The treatment probe 450 may be coupled to the first arm 442 by a linkage 430. The linkage 430 may comprise components for moving the energy delivery region 20 to a desired target location on a patient, for example, based on an image of the patient. The linkage 430 may comprise a first portion 432, a second portion 434, and a third portion 436. The first portion 432 may include a substantially fixed anchor portion. The substantially fixed anchor portion 432 may be fixed to a support 438. The support 438 may comprise a reference frame for the linkage 430. The support 438 may include a rigid chassis or frame or housing for rigidly and rigidly coupling the first arm 442 to the treatment probe 450. The first portion 432 may remain substantially fixed, while the second portion 434 and the third portion 436 are movable to direct energy from the probe 450 to the patient. The first portion 432 may be fixed at a substantially constant distance 437 relative to the anchor 24. The substantially fixed distance 437 between the anchor 24 and the fixed first portion 432 of the linkage allows for precise placement of the treatment. The first portion 432 may include a linear actuator for precisely positioning a second energy source, such as the high-pressure nozzle 200, within the energy delivery region 20 at a desired axial location along the elongated axis 451 of the treatment probe 450. Additional actuators and linkages may be provided and operably coupled to the processor to offset, rotate, and translate the first energy source 250, as described herein.

[0063] The elongated axis 451 of the treatment probe 450 generally extends between a proximal portion of the probe 450 near the linkage 430 and a distal end having an anchor 24 attached thereto. The third portion 436 can control a rotation angle 453 about the elongated axis 451. During treatment of a patient, a distance 439 between the energy delivery region 20 and the first portion 432 of the linkage can change relative to the anchor 24. The distance 439 can be adjusted by probe translation 418 in response to computer control to set a target location along the elongated axis 451 of the treatment probe. In some embodiments, the first portion of the linkage remains fixed, and the second portion 434 adjusts the position of the energy delivery region 20 along the axis 451. The third portion 436 of the linkage adjusts the angle 453 about the axis in response to the controller 424 so that the distance along the axis in the treatment angle can be controlled very precisely relative to the anchor 24. The probe 450 may include a rigid member, such as a spine, extending between the support 438 and the anchor 24 so that the distance from the linkage 430 to the anchor 24 remains substantially constant during treatment. The treatment probe 450 is coupled to the treatment components described herein to enable treatment with one or more forms of energy, such as mechanical energy from a jet, electrical energy from an electrode, or light energy from a light source, such as a laser source. The light source may include infrared, visible, or ultraviolet light. The energy delivery region 20 can move under the control of the linkage 430 to deliver the intended form of energy to the patient's target tissue.

[0064] The imaging console 490 may include a memory 493, a communication circuit 494, and a processor 492. The processor 492 in corresponding circuitry is coupled to the imaging probe 460. An arm controller 491 is coupled to the arm 444 for accurately positioning the imaging probe 460. The imaging console may further include a display 425.

[0065] To facilitate precise control of the treatment probe and / or imaging probe during patient treatment, one or more treatment or imaging probes may be coupled to a robotic, computer-controllable arm. For example, with reference to the system 400 shown in FIG. 2 , one or both of the first arm 442 coupled to the treatment probe 450 and the second arm 444 coupled to the imaging probe 460 described herein may comprise a robotic, computer-controllable arm. The robotic arm may be operably coupled to one or more computing devices configured to control the movement of the robotic arm. For example, the first robotic arm 442 may be operably coupled to the processor 423 of the console 420, or the second robotic arm 444 may be operably coupled to the processor 492 of the imaging console 490 and / or the processor 423 of the console 420. One or more computing devices, such as the processors 423 and 492, may include computer-executable instructions for controlling the movement of one or more robotic arms. The first and second robotic arms may be substantially similar in structure and function, or may be different to accommodate particular functional requirements for controlling movement of the treatment probe relative to the imaging probe.

[0066] The robotic arm may include six or seven or more joints to allow the arm to move under computer control. Suitable robotic arms are commercially available from several manufacturers, such as RoboDK Inc., Kinova Inc., and several other manufacturers.

[0067] One or more computing devices operably coupled to the first and second robotic arms may be configured to automatically control the movement of the treatment probe and / or imaging probe. For example, the robotic arms may be configured to automatically adjust the position and / or orientation of the treatment probe and / or imaging probe during a patient treatment according to one or more preprogrammed parameters. The robotic arms may be configured to automatically move the treatment probe and / or imaging probe along a preplanned or programmed treatment or scan profile, which may be stored in the memory of the one or more computing devices. Instead of, or in addition to, automatic adjustment of the robotic arms, the one or more computing devices may be configured to control the movement of the treatment probe and / or imaging probe in response to user input, for example, via a graphical user interface of the treatment apparatus. Instead of, or in addition to, automatic adjustment of the robotic arms, the one or more computing devices may be configured to control the movement of the treatment probe and / or imaging probe in response to real-time positioning information, for example, anatomical structures recognized in one or more images captured by the imaging probe or other imaging source (from which a range of allowable movement of the treatment probe and / or imaging probe can be established) and / or position information of the treatment probe and / or imaging probe from one or more sensors coupled to the probe and / or robotic arm.

[0068] 3A, 3B, and 3C show top, longitudinal (e.g., sagittal), and oblique views, respectively, of a probe arrangement for use in treating tissue. In particular, FIGS. 3A, 3B, and 3C show a relative arrangement, including the position and orientation, of a treatment probe 450 relative to the position and orientation of an imaging probe 460 for treatment of tissue, such as prostate tissue. The imaging probe 460 can be configured to generate a transverse image, such as a transverse ultrasound image 310, and one or more longitudinal images, such as one or more longitudinal (e.g., sagittal) ultrasound images 320. In some embodiments, the energy source of the treatment probe 450 is moved through a rotational angle 453 and a translational 418 such that the treated tissue and the energy source are within the field of view of the imaging probe 460.

[0069] As shown in the top view of Figure 3A, the treatment probe axis 451 and the imaging probe axis 461 are positioned in a substantially coplanar configuration such that the imaging probe and the treatment probe extend along a common plane. As shown in the top view of Figure 3B and the perspective view of Figure 3C, the treatment probe axis 451 and the imaging probe axis 461 are positioned in a substantially coplanar but non-parallel configuration such that the imaging probe and the treatment probe extend substantially along a common plane, which allows the imaging probe to image the treatment probe along the length of translation 418 using one or more longitudinal images, such as real-time longitudinal images, e.g., real-time sagittal images. In some embodiments, the treatment probe and the imaging probe are arranged in a substantially coplanar configuration, and the ultrasound probe rotates to rotate the longitudinal (e.g., sagittal) field of view of the imaging probe to image the treatment probe along the length of the longitudinal field of view. Referring again to FIG. 3A, the imaging probe 460 can be rotated about the elongated axis 461 by an angle 336 to align the treatment probe 450 so that it is within the longitudinal field of view, for example, so that the longitudinal field of view of the imaging probe is aligned with the elongated axis 451 of the treatment probe.

[0070] One or more of the treatment probe or the imaging probe can be moved to adjust the alignment between the imaging probe and the treatment probe. In some embodiments, a proximal portion of the treatment probe is moved from a first position to a second position. Referring again to FIG. 3B , the treatment probe 450 can be moved from a first position 332 to a second position 334 to adjust the alignment between the probes, for example, based on data from one or more reference points described herein.

[0071] In some embodiments, the imaging probe 460 and the treatment probe 450 are aligned to be substantially coplanar with one another within an error margin, so that the imaging probe 460 can image the treatment probe 450 and the treatment probe's energy source during treatment, for example, with the treatment probe positioned within the imaging probe's field of view, such as a longitudinal (e.g., sagittal) image field of view. In some embodiments, the treatment probe is aligned with the imaging probe such that the treatment probe is visible along the length of the imaging probe's longitudinal (e.g., sagittal) view.

[0072] In some embodiments, the imaging probe 460 and the treatment probe 450 may be somewhat misaligned, e.g., beyond a margin of error, such that, for example, a portion of the imaging probe extends beyond the longitudinal (e.g., sagittal) field of view, causing the treatment probe to disappear from a portion of the longitudinal (e.g., sagittal) image. In some embodiments, this may result in the imaging probe 460 not imaging a portion of the treatment in the longitudinal (e.g., sagittal) image. In some embodiments, the treatment probe 450 and the imaging probe 460 may be arranged in a substantially skewed orientation as described herein, e.g., outside the margin of error, such that the treatment probe extends outside the longitudinal (e.g., sagittal) field of view of the imaging probe but is located within the field of view of the transverse image of the imaging probe. In such embodiments, the treatment can be monitored in real time using the transverse image, where the imaging probe moves to maintain the energy source and simultaneously the treated tissue within the transverse field of view of the imaging probe. In some embodiments, a transverse view of the tissue and energy source can reduce sensitivity to alignment between the two probes, and the imaging probe can move, for example synchronously, with the energy source to image the tissue and energy source during the procedure.

[0073] FIG. 3D shows treatment probe axis 451 and imaging probe axis 461 distorted relative to each other by angle 330 such that the treatment probe and imaging probe do not extend along a common plane. Adjusting the treatment probe, the imaging probe, or both can reduce this distortion angle. The amount of acceptable distortion can depend on several factors, such as the imaging probe's field of view and the length of tissue being treated with one or more of the rotational or translational energy sources. In some embodiments, the distortion angle error margin is, for example, 10 degrees or less, 5 degrees or less, 3 degrees or less, 2 degrees or less, or 1 degree or less. In some embodiments, the alignment error margin corresponds to the imaging probe's longitudinal (e.g., sagittal) field of view and the distortion angle between the imaging probe and the treatment probe. When the treatment probe and imaging probe are aligned within the error margin, the treatment probe is positioned within the longitudinal (e.g., sagittal) field of view along the translational length of the treatment and can be viewed in one or more real-time longitudinal (e.g., sagittal) images along the length of the longitudinal (e.g., sagittal) field of view. If the treatment probe and imaging probe are aligned outside the error margin, a portion of the treatment probe may lie outside the longitudinal (e.g., sagittal) field of view and disappear from a portion of the image along the length of the longitudinal (e.g., sagittal) field of view. In such embodiments, transverse imaging can be used to view the treatment in real time as described herein.

[0074] 4A shows a top view of a transverse image plane relative to the axis of the treatment probe. In some embodiments, the axis 451 of the imaging probe 450 includes a non-coplanar orientation relative to the elongated axis 461 of the imaging probe, e.g., having a skew angle 330. In some embodiments, the transverse image 310 includes multiple transverse images, such as a first transverse image 312, a second transverse image 314, and a third transverse image 316.

[0075] In some embodiments, the position of the treatment probe in the multiple transverse images varies. The degree to which the probe position varies may be related to a non-parallel angle, such as a distortion angle 330, between the treatment probe and the imaging probe. In some embodiments, the treatment probe 450 extends through the plane of the first transverse image 312 at a first location 313, through the plane of the second transverse image 314 at a second location 315, and through the plane of the third transverse image 316 at a third location 317. In some embodiments, the distortion angle 330 changes the lateral position of the treatment probe within the transverse image 330, such as the pixel column location of the transverse image.

[0076] FIG. 4B shows a three-dimensional view of the transverse image 310 and the corresponding plane of the transverse image relative to the treatment probe 450.

[0077] 4C shows a longitudinal (e.g., sagittal) image 320 of a treatment probe 450. In some embodiments, an axis 451 of the treatment probe 450 extends at an angle 335 relative to an elongated axis 461 of the imaging probe. In some embodiments, the angle 335 corresponds to the angle of the axis 451 of the treatment probe 450 along the longitudinal (e.g., sagittal) plane of the image. This angle causes the treatment probe to appear tilted in the longitudinal (e.g., sagittal) image, e.g., the position of the probe 450 changes in the transverse image 310. In some embodiments, the treatment probe is sufficiently coplanar with the imaging probe such that it lies within the longitudinal (e.g., sagittal) field of view of the imaging probe along the length of the longitudinal (e.g., sagittal) field of view, even as the position of the probe changes along the longitudinal (e.g., sagittal) image 320 and the corresponding transverse image 310. In some embodiments, the angle 335 causes the vertical position of the treatment probe to change in the transverse image 310, such as the pixel row location in the transverse image. In some embodiments, the treatment probe 450 shown in the longitudinal (e.g., sagittal) image extends through the plane of the first transverse image 312 at a first location 313, through the plane of the second transverse image 314 at a second location 315, and through the plane of the third transverse image 316 at a third location 317. While the treatment probe is referenced by a distortion angle relative to the imaging probe, in some embodiments, the angle 335 corresponds to, for example, a 3D vector projection of the treatment probe axis onto the longitudinal (e.g., sagittal) image plane of the field of view. In some embodiments, the distortion angle 330 corresponds to a 3D vector projection of the treatment probe axis onto a plane perpendicular to the longitudinal (e.g., sagittal) image plane field of view.

[0078] In some embodiments, the position of the probe in the transverse images can be used to determine one or more of the three-dimensional position or orientation of the treatment probe relative to the imaging probe. In some embodiments, a two-dimensional location of the probe 451 is determined in each of multiple transverse images, and these two-dimensional locations are used to determine the three-dimensional orientation of the treatment probe relative to the imaging probe. The two-dimensional location of the probe in each transverse image may include any suitable two-dimensional locations, such as, for example, X and Y locations, or pixel locations, such as pixel row locations and pixel column locations in each image. In some embodiments, the 3D orientation of the treatment probe relative to the imaging probe includes, for example, a 3D vector representation of the orientation.

[0079] The three-dimensional orientation of the treatment probe can be used to facilitate treatment planning, for example, by generating a rotated transverse image. Rotation of the image dataset can also be used to generate one or more rotated longitudinal images, for example, one or more rotated sagittal images. One or more longitudinal images can be rotated so that the position of the treatment probe remains substantially fixed along the one or more longitudinal images and the multiple transverse images. In some embodiments, the rotated longitudinal and transverse images are generated from a 3D tomographic image dataset, such as a Digital Imaging and Communications in Medicine (DICOM) image dataset, by selecting a plane of the multiple transverse images and one or more longitudinal images by generating images along a plane oriented at an angle relative to the X, Y, and Z planes of the 3D tomographic image dataset.

[0080] 5 shows a rotated transverse image 510 corresponding to the transverse image 310 rotated to compensate for the distortion angle 330 between the elongate axis of the treatment probe and the imaging probe. In some embodiments, the three-dimensional orientation of the treatment probe relative to the imaging probe can be used to rotate the transverse image so that the rotated transverse image plane is substantially perpendicular to the elongate axis 451 of the treatment probe 450, for example, to one or more of within 5 degrees of perpendicular, within 3 degrees of perpendicular, within 2 degrees of perpendicular, within 1 degree of perpendicular, within 0.5 degrees of perpendicular, or within 0.25 degrees of perpendicular. Similarly, one or more longitudinal images, such as one or more sagittal images, can be rotated to compensate for the angle 335. In some embodiments, the transverse image 310 and the one or more longitudinal images 320 comprise images of a 3D image dataset, such as Digital Imaging and Communications in Medicine (DICOM) images. The 3D vector orientation of the treatment probe relative to the imaging probe can be used to rotate the transverse and one or more longitudinal images so that the location of the treatment probe remains substantially fixed in the transverse images, facilitating treatment planning as described herein. In embodiments, the rotation of the 3D image dataset causes the probe to appear at a substantially fixed height in one or more longitudinal images, such as, for example, one or more sagittal images.

[0081] 6A-6C illustrate a user interface 600 and transverse images showing movement of the probe's location in the transverse images that may be related to the orientation of the treatment probe relative to the imaging probe. FIG. 6A shows a transverse image 312 and the location 313 of the treatment probe 450 within the image. FIG. 6B shows a transverse image 314 and the location 315 of the treatment probe within the image. FIG. 6C shows a transverse image 316 and the location 317 of the treatment probe within the image. As can be seen from the images, the location of the probe changes in the transverse images. The location of the probe in the transverse images can be used to determine the orientation of the treatment probe relative to the imaging probe as described herein.

[0082] In some embodiments, markers 650 are used to identify the location of the probe in one or more transverse images. In some embodiments, the markers are shown in each of the multiple transverse images. In some embodiments, a first marker 652 is shown at a first location in the first transverse image, such as location 353 in transverse image 312, a second marker 654 is shown at a second location in the second transverse image, such as location 355 in transverse image 314, and a third marker 656 is shown at a third location in the third transverse image, such as location 317 in transverse image 316.

[0083] In some embodiments, the artificial intelligence algorithm is configured to determine the location of the probe and identify the probe with a marker corresponding to the location of the probe. The marker may include any suitable marker, such as a line, a mark, a series of marks, a reticle, a cross, or a geometric shape such as a triangle or polygon, e.g., a box. In some embodiments, the user interface is configured to allow a user to adjust the position of the marker, for example, after reviewing the initial position determined by the algorithm described herein.

[0084] In some embodiments, user interface 600 is configured to present images on display 425 in response to user input. In some embodiments, user interface 600 is configured to display scan planes 610 with associated user inputs 612 for a user to select one or more longitudinal (e.g., sagittal) plane images and associated user inputs 614 for a user to select transverse images. In some embodiments, user interface 600 includes multiple user-selectable inputs 620 for a user to select transverse images for viewing on the display. Multiple user-selectable inputs 620 may include a separate input for each plane, such as, for example, a user-selectable button, tab, or pull-down menu. In some embodiments, the first user selectable input 622 corresponds to the first transverse image 312 along the first plane, the second user selectable input 624 corresponds to the second transverse image 314 along the second plane, the third user selectable input 626 corresponds to the third transverse image 316 along the third plane, the fourth user selectable input 628 corresponds to the fourth transverse image along the fourth plane, and the fifth user selectable input 629 corresponds to the fifth transverse image along the fifth plane.

[0085] In some embodiments, a first user input 622 corresponds to the intravesical prostatic protrusion (IPP), a second user input 624 corresponds to the bladder neck (BL), a third user input 626 corresponds to the mid-prostate (MID), a fourth user input 628 corresponds to the verumontanum (VERU), and a fifth user input 629 corresponds to the peripheral sphincter (P.SPH). Although anatomical landmarks of the prostate are referenced, the user-selectable inputs may correspond to any anatomical structure.

[0086] Although reference is made to five user inputs and five corresponding transverse images along corresponding planes, the number of inputs and corresponding images may include any suitable number, such as two user-selectable inputs corresponding to a first transverse image and a second transverse image, or more than five user-selectable inputs and transverse images may be used.

[0087] FIG. 7A shows a user interface 700 having a three-dimensional view 710 for three-dimensional treatment planning. In some embodiments, an animation of the treatment probe 450 is overlaid on multiple 2D images, such as 2D ultrasound images, arranged in a 3D digital environment, allowing the user to view the images from a 3D perspective. In some embodiments, the user interface is configured to allow a user to select an image from among the multiple images and maximize the selected image in a separate view. The multiple 2D images may include multiple transverse images 310, which are arranged along one or more longitudinal images, such as one or more sagittal images 320. In some embodiments, each of the multiple transverse images 310 is positioned along one or more longitudinal images, such as one or more sagittal images 320, at a location corresponding to an intersection of the transverse image and one or more longitudinal (e.g., sagittal) images, such as an intersection point of the 3D data set. In some embodiments, the user interface 700 is configured to allow a user to select an image, for example by clicking on the image, maximize the view of the image, and provide a magnified view of the image. For example, a user may select one or more of the longitudinal (eg, sagittal) or transverse images to view the selected images in a magnified view.

[0088] In some embodiments, AI algorithms are used to identify tissue structures and develop 3D treatment plans, such as the 3D treatment profiles described herein.

[0089] The treatment profile 730 may include, for example, an animated treatment profile that allows the user to view the treatment profile from different perspectives, angles, and images. In some embodiments, the user is provided with controls for one or more of zooming, panning, or rotating the perspective view. In some embodiments, the treatment profile 730 includes an animated treatment profile that matches one or more of zooming, panning, or rotating the perspective view so that alignment of the treatment profile with the multiple images is maintained. This approach can allow the user to view the treatment profile and its relationship to corresponding tissue from any suitable perspective. In some embodiments, the animated treatment profile is configured to generate a simulation of the treatment with movement of the energy source and increasing volumes of treated tissue, similar to a movie simulating the treatment.

[0090] In some embodiments, the user interface 700 is configured to allow a user to adjust a treatment profile, which is automatically updated and shown on the oblique views and other selected images, e.g., simultaneously updated in real time. The user interface may include inputs 755, such as visual icons that a user can drag to reposition the treatment profile. In some embodiments, the user interface 700 is configured with inputs 755, such as 3D inputs, for a user to adjust a treatment profile shown in a 3D view. In some embodiments, when a treatment profile is adjusted in one of the views using user input, the treatment profile is automatically updated, e.g., simultaneously updated, in the other views, allowing a user to assess changes in the treatment profile from more than one perspective. In some embodiments, the treatment profile includes multiple curves, such as splines, that are updated together and shown in different views.

[0091] 7B shows a longitudinal (e.g., sagittal) view 720 for three-dimensional treatment planning. In some embodiments, a longitudinal treatment profile, such as sagittal treatment profile 732, is overlaid on one of the one or more longitudinal images, such as one of the one or more sagittal images 320. While the user interface 700 can be configured in many ways, in some embodiments, the user is presented with, for example, the longitudinal view 720 and a 3D oblique view 710. In some embodiments, the user interface is configured so that the user selects an image from one or more longitudinal (e.g., sagittal) images 320 from the oblique view and provides a longitudinal (e.g., sagittal) view of the image, as shown in FIG.

[0092] In some embodiments, the 3D treatment profile 730 is updated in response to a user input, such as a 3D user input, and the corresponding sagittal treatment profile 732 and transverse treatment profile 734 of the 3D treatment profile are updated in corresponding views, such as the longitudinal view and transverse view described herein. For example, the longitudinal (e.g., sagittal) treatment profile 732 can be updated with a user input 755 on the 3D view 710 to move the longitudinal treatment profile 732 from a first longitudinal treatment profile to a second longitudinal treatment profile 782, and the updated treatment profile is shown in other views, such as the longitudinal (e.g., sagittal) view shown in FIG. 7B. Similarly, the 3D treatment profile 730 can be adjusted in the longitudinal (e.g., sagittal) view 720 from a first longitudinal treatment profile 732 to a second longitudinal (e.g., sagittal) treatment profile 782, and the updated treatment profile is shown in the 3D view 710. The treatment profile in the transverse view can be similarly adjusted and updated and shown, for example, in the 3D view and longitudinal (eg, sagittal) view.

[0093] The one or more longitudinal images 320 shown in the 3D view can be configured in many ways and may include any suitable number of longitudinal images, such as a single longitudinal image or multiple longitudinal images. The one or more longitudinal images may include, for example, one or more sagittal or parasagittal images. In some embodiments, the user interface 700 is configured to receive user input identifying a selected image from among the one or more longitudinal images 320 and multiple transverse images shown in the 3D view and display the selected image in the 2D view.

[0094] In some embodiments, the one or more longitudinal images include a plurality of longitudinal images. In some embodiments, the user interface 700 is configured for a user to select one or more longitudinal images 320 from the plurality of longitudinal images. In some embodiments, the user interface 700 is configured for a user to select a longitudinal image in a 3D view. For example, the user interface 700 can be configured for a user to select a longitudinal image with a pointing device or touch an image on a touchscreen display, as described herein. Alternatively or in combination, the plurality of inputs 620 may include a plurality of inputs corresponding to a plurality of longitudinal images. Alternatively or in combination, the user input 724 may include a plurality of inputs configured for a user to select a plurality of longitudinal images for display in a plurality of 2D views.

[0095] The multiple longitudinal images can be generated in many ways, but in some embodiments, the multiple longitudinal images are generated from a 3D volumetric image of tissue as described herein.

[0096] In some embodiments, the multiple longitudinal images are generated in response to multiple angles of an energy source for treating tissue. In some embodiments, the 3D treatment profile 730 corresponds to multiple rotations and translations of an energy source on a probe 450 described herein, and at least one of the multiple longitudinal angles corresponds to a rotation angle of the energy source.

[0097] 7C and 7D illustrate multiple rotation angles for the treatment probe that can be used to generate multiple longitudinal images. The multiple longitudinal images may include longitudinal images corresponding to rotation angles of the energy source of the treatment probe 450 about axis 451. For example, the 3D view may include a first longitudinal image 320a of one or more images 320 corresponding to a first rotation angle 770 of the energy source and a second longitudinal image 320b corresponding to a second rotation angle 772 of the energy source, as shown in FIG. 7B.

[0098] In some embodiments, the multiple longitudinal images include a first longitudinal image 320a along a first portion 732a of the treatment profile and a second longitudinal image 320b along a second portion 732b of the treatment profile.

[0099] In some embodiments, the arrangement in the 3D view shows a portion of a first longitudinal image along a first portion of the treatment profile and a portion of a second longitudinal image along a second portion of the treatment profile. In some embodiments, image 320b is positioned in the 3D view 710 at angle 772, and image 320a is also shown in the 3D view 710 at angle 770. A user can select the longitudinal image to show in the 3D view using a user interface described herein. The multiple longitudinal images may include any suitable number of images, and may include at least three longitudinal images, each at a different rotational angle relative to the elongated axis of the treatment probe.

[0100] In some embodiments, the first longitudinal image includes a first transparency along a first portion of the treatment profile and a second transparency along a second portion of the treatment profile that is greater than the first transparency to enhance visibility of the second longitudinal image along the second portion. In some embodiments, the second longitudinal image includes a first transparency along the first portion of the treatment profile and a second transparency along the second portion of the treatment profile, the first transparency being greater than the second transparency to enhance visibility of the first longitudinal image along the first portion of the treatment profile.

[0101] In some embodiments, an AI algorithm is used to process the image data, identify one or more anatomical structures, and provide marks for the one or more anatomical structures in one or more of the views shown on the user interface, such as a longitudinal (e.g., sagittal) view and a transverse view. In some embodiments, a mark, such as mark 750, is shown on one or more of the 3D oblique transverse images 310, and mark 750 may be shown on the corresponding transverse view. In some embodiments, a mark, such as mark 760, corresponding to the one or more anatomical structures is shown on one or more longitudinal views 720 of one or more longitudinal images, such as one or more sagittal images 320. Marks 750 and 760 may generally include any suitable modification to pixels overlaid on the image, such as one or more of highlighting, dashes, lines, icons, or other features, to indicate the profile identified by the AI ​​algorithm.

[0102] In some embodiments, multiple views are simultaneously shown on the user interface, e.g., the 3D oblique view of FIG. 7A and one or more longitudinal views of FIG. 7B. Alternatively, or in combination, the 3D oblique view can be shown with one or more transverse views. The multiple views can be arranged in any suitable manner, e.g., a side-by-side configuration or a view-inside-view configuration. In some embodiments, each user-selectable view is shown in a pop-up window that the user can move, resize, or close.

[0103] In some embodiments, user interface 700 includes an input 712 for a user to select a three-dimensional view and an input 724 for a user to select one or more longitudinal views, such as one or more sagittal views 720, to overlay a treatment profile, such as 3D treatment profile 730, on the image. In some embodiments, the 3D treatment profile includes multiple transverse treatment profiles 734 and one or more longitudinal (e.g., sagittal) profiles 732 that can be overlaid on corresponding images. User interface 700 may include, for example, one or more features of user interface 600.

[0104] In some embodiments, the images shown on the user interface 700 include rotated images, such as images from a rotated 3D image, where the images have been rotated according to the orientation between the imaging probe and the treatment probe described herein. Alternatively, the images may include non-rotated images, such as, for example, non-rotated 3D images.

[0105] 8A shows a first transverse view 742 of a three-dimensional treatment plan at a first depth of a three-dimensional treatment profile 730. The first transverse view 742 may include a view from among multiple user-selectable transverse views. In some embodiments, the first transverse view 742 corresponds to a transverse image of the IPP of the prostate, although the first view may include any transverse view of any suitable tissue at any suitable depth. The user interface 700 may include multiple inputs for a user to adjust the 3D treatment profile from the transverse view. The inputs may include a first two-dimensional input 812 for adjusting a first side of the transverse treatment profile 734 and a second user input 814 for adjusting a second side of the transverse treatment profile. The user interface may be configured to provide information related to the treatment profile, such as a depth 820 of the treatment profile 734 from the probe and an angle 822 of the treatment profile, which may correspond to an angular sweep angle of the scan of the energy source along the tissue. In some embodiments, the treatment profile includes a viewing angle, such as a line that forms the angle of the treatment profile relative to axis 451, which may correspond to the location of the energy source during treatment. Although angled treatment profiles with corresponding radii are referenced, the treatment profile may include other shapes as described herein.

[0106] In some embodiments, other views are updated in response to adjustments to the treatment profile described herein. For example, using input 814, the treatment profile 734 can be adjusted from a first position to a second position 816 or a third position 818, and other views, such as the 3D view, are automatically updated, e.g., substantially simultaneously in real time, e.g., within a few seconds.

[0107] 8B shows a second transverse view 744 of the three-dimensional treatment plan at a second depth of the three-dimensional treatment profile. In some embodiments, the first transverse view 742 and the second transverse view 744 include images from among a plurality of user-selectable views, such as the user-selectable transverse views described herein. In some embodiments, the second view corresponds to a transverse image of the MID prostate, although the second view may include any transverse view at any suitable depth. In some embodiments, the second view includes a different view from the first view at a different depth than the first depth. The second transverse view 744 may include a user interface similar to that shown in FIG. 8A for adjusting the treatment profile 734, with the other views automatically updated as described herein.

[0108] 9A shows a transverse view of a probe 450 and multiple rotation angles 932 of the energy source 200 on the probe for directing the energy source 200 to tissue 910 to treat the tissue to different depths according to a treatment plan. In some embodiments, a 3D treatment plan is determined from multiple transverse images, and the angle and treatment depth from each of the multiple transverse images are combined to generate the 3D treatment plan. The multiple rotation angles 932 can be referenced to a reference 930, which can include a fixed reference, such as a horizontal reference or a vertical reference. While the treatment plan can be determined in many ways, in some embodiments, the multiple rotation angles 932 can be evaluated with multiple projections 940 from the probe at the multiple angles 932. In some embodiments, the projections correspond to angles of the directed energy source 200, which can be rotated relative to the probe axis 451. The plurality of projections 420 may include any suitable number of projections, such as, for example, a first projection 942, a second projection 944, a third projection 946, a fourth projection 947, a fifth projection 968, and a sixth projection 969. Although projections are referenced to describe treatment plans and aspects of the plans, the treatment angles and depths described herein can be determined in many ways as will be understood by one of ordinary skill in the art.

[0109] In some embodiments, the angular width and thickness of the tissue is determined at multiple angles 932 of the treatment probe 450, multiple angles of a directed energy source, such as multiple angles of a nozzle, light beam, or other energy source described herein. In some embodiments, the thickness of the treated tissue is determined relative to the angular coordinate of the treatment probe. In some embodiments, the width of the tissue in the transverse view includes an angular width, such as an angular width between a first angle 934 and a second angle 936. In some embodiments, the first angle 932 corresponds to a projection, such as projection 944, and the second angle 936 corresponds to a projection, such as projection 948. In some embodiments, the treatment plan is configured to treat tissue between the first treatment angle 934 and the second treatment angle 936, and not treat tissue outside of these angles at translational positions corresponding to the images, e.g., to reduce interaction with the second tissue 420.

[0110] In some embodiments, the thickness profile includes a thickness at each of a plurality of angles, and the thickness profile can be used to develop a treatment plan. In some embodiments, the treatment plan is configured to selectively direct energy from the energy source to the tissue according to the depth of the tissue at the corresponding angle. In some embodiments, the treatment plan is configured to not direct energy to the tissue at an angle corresponding to zero thickness, which can reduce interaction of the energy source with a second tissue, such as second tissue 920.

[0111] In some embodiments, the thickness includes a distance through the tissue at a corresponding angle. For example, the thickness may include a distance between a first location 962 and a second location 964 at a corresponding angle, such as an angle corresponding to the second projection 944. In some embodiments, a first distance from the treatment probe 450 to the first location 962 and a second distance from the treatment probe 450 to the second location 964 are used to determine a treatment plan. In some embodiments, the first location 962 and the second location 964 include a first location of the boundary 912 having an outer surface facing toward the probe at a corresponding angle and a second location of the boundary 912 having an outer surface facing away from the probe at a corresponding angle. In some embodiments, the tissue 910 is positioned a distance from the probe, e.g., the first location 962 of the boundary 912 is positioned a distance from the probe. In some embodiments, a gap extends between the treatment probe and the boundary, and the gap may contain a bodily fluid as described herein, such as urine.

[0112] In some embodiments, data regarding the projections 940 of the energy source at multiple angles can be used to generate a treatment plan, which can be adjusted to more precisely treat the tissue, for example, removing tissue using tissue ablation. In some embodiments, a first margin 952 of the tissue boundary 910 is determined relative to the treatment probe 450, and a second margin 954 of the tissue 910 is determined relative to the treatment probe. In some embodiments, a first margin 952 of the tissue boundary 912 is determined relative to the treatment probe 450, and a second margin 954 of the boundary 912 is determined relative to the treatment probe. In some embodiments, the first margin 952 and the second margin 954 are located on opposite sides of the area 914 of the tissue 910. For example, the first margin 952 can be located on a first side 916 of the area 914, and the second margin 954 can be located on a second side 918 of the area 914.

[0113] In some embodiments, the treatment plan angle is determined according to the boundary angle. In some embodiments, the treatment plan angle is configured to provide a tissue margin near the boundary. In some embodiments, the treatment plan is configured to adjust the treatment angle to limit the treatment so that it does not extend beyond the first boundary margin 952 and the second boundary margin 954. In some embodiments, the user interface is configured to provide a notification to the user if the treatment plan extends beyond the angle boundary, for example, if the treated tissue is adjacent to untreated tissue. In some embodiments, the tissue margin is placed outside an outer portion of the area to be treated. Alternatively, or in combination, the treatment plan can be configured to treat tissue at the tissue boundary, for example, when it is beneficial to completely remove the treated tissue. In some embodiments, the treatment plan is configured to treat tissue up to the tissue boundary along a first portion of the treatment and provide a tissue margin along a second portion of the treatment.

[0114] While the first boundary margin 952 and the second boundary margin 954 can be determined in many ways, in some embodiments, the location of the first boundary margin 952 corresponds to a first projection, such as, for example, projection 942, that intersects the boundary 912 tangentially at a point defining the boundary margin 952, and the second boundary margin 954 corresponds to a second projection, such as, for example, projection 948, that intersects the boundary 912 tangentially at a point defining the boundary margin 954. In some embodiments, the first boundary margin is defined by, for example, a first angle where a projection of the first angle intersects the boundary 912 tangentially at a first side, and the second boundary margin is defined by a second angle where a projection of the second angle intersects the boundary 912 tangentially at a second side.

[0115] In some embodiments, the probe 450 can be seen on a corresponding image, such as the transverse image 312, which can be shown, for example, on the display 425 of the user interface 700. The view shown on the display can include any of the user-selectable views described herein, such as the IPP view 742.

[0116] In some embodiments, the image of the tissue 910 to be treated includes a boundary 912. The boundary 912 can be identified using an AI algorithm described herein, by a user, and combinations thereof. In some embodiments, the tissue 910 is placed near a second tissue 920, which may include a different anatomical structure than the tissue 910 or may include tissue of a different organ, for example, as described herein. The second tissue 920 may include an identifiable boundary 922 along a surface that may be oriented toward the first tissue, for example. The boundary 912 can be identified in many ways, as described herein, for example, using an AI algorithm, by a user of the system, and combinations thereof. In some embodiments, the boundary 912 defines an area 914 of tissue to be treated, and the area 914 may include a first side 916 and a second side 918 generally located on either side of the area 914 to be treated. In some embodiments, the boundary 912 surrounds the area 914 to be treated. Each of the aforementioned boundaries may be identified using an AI algorithm, and the identified boundary is shown on the display by overlaying the boundary on the image, for example by modifying pixels along the boundary with pixels of a different color, etc.

[0117] In some embodiments, the treatment plan is configured to treat the tissue 910 according to an angular tissue depth profile that includes multiple tissue depths at multiple angles. The treatment plan can be configured to adjust one or more of the intensity of energy from the energy source, the power of energy from the energy source, the translation of the probe along the treatment probe axis, the rotation of the probe about the treatment probe axis, the translational velocity of the treatment probe, the rotational velocity of the treatment probe, or the number of passes of the energy source along the tissue to treat the tissue to different depths according to the angular tissue depth profile. In some embodiments, the intensity of the energy source decreases as the depth decreases and increases in areas where the depth increases. Alternatively, the movement of the energy source can be adjusted in response to the tissue profile, with the energy from the energy source 200 remaining substantially fixed, for example, at a fixed flow rate from a pump, such as a pulsatile pump coupled to the nozzle. In some embodiments, the power of the energy source, such as the flow rate from the pump or the power from the laser, is adjusted in response to the tissue profile. In some embodiments, one or more of the translational velocity or rotational velocity of the energy source is adjusted in response to the angular tissue profile.

[0118] In some embodiments, the treatment plan is configured to scan the energy source more than once across a region of tissue so that energy can be delivered to the tissue in multiple passes of the energy source. In some embodiments, the treatment plan is configured to sequentially remove multiple tissue layers. In some embodiments, the treatment plan is configured to remove a first tissue layer, e.g., with one or more of removal, ablation, and / or resection, and treat a second tissue layer with the energy source to remove the second layer. In some embodiments, the treatment plan is configured to treat tissue to a first depth, e.g., along a first removal profile 970 extending from a first location 972 of the boundary 912 to a second location 964 of the boundary 912. The treatment plan is configured to remove the second tissue layer with another scan of the energy source to remove tissue between the first removal profile and the boundary 912. As many tissue layers as desired can be removed, and the depth of removal can be determined based on several factors, such as, for example, one or more of the type of energy from the energy source, the tissue type, the distance from the energy source to the tissue layer to be removed, the rotational speed of the energy source, or the translational speed of the energy source. In some embodiments, the treatment plan is configured to substantially fix the translational position of the treatment probe 450 along the axis 451 while the energy source is scanned across the tissue by angular rotation of the energy source at multiple angles 932. For example, a first tissue layer can be removed to the depth of the first removal profile 970 while the translational position of the energy source remains substantially fixed, and a second tissue layer can be removed from below the removal profile 970. Alternatively, the angle of the energy source 200 can remain substantially fixed while the energy source is translated and scanned along the elongated axis 451 to remove multiple layers.

[0119] In some embodiments, a treatment plan is developed for each of the multiple images, and the treatment plans are combined to generate a 3D treatment plan. In some embodiments, parameters from the treatment plan are interpolated, for example, for locations between the 3D images. Alternatively, or in combination, 3D angular depth profiles from each of the multiple images can be combined and interpolated to define a 3D angular depth treatment profile. In some embodiments, the images include, for example, 3D images where the spacing between transverse views is small enough that interpolation is not performed.

[0120] In some embodiments, each of the multiple transverse images is evaluated as described herein to determine multiple tissue removal profiles at multiple transverse image locations, and the removal profiles are combined to generate a 3D treatment plan. In some embodiments, multiple tissue profiles are combined from the multiple images and interpolated between the image locations.

[0121] FIG. 9B shows a treatment profile 980 overlaid on an image of the probe and rotation angle and tissue, such as one or more longitudinal or transverse images described herein. While a treatment plan can be generated in many ways, in some embodiments, the treatment profile 980 can be useful for determining the profile of the treatment plan and for allowing a user to review and modify the planned treatment. In some embodiments, the treatment profile 980 is configured to substantially match the boundary 912, for example, to be within 5% of the diameter of the boundary. In some embodiments, the treatment profile 980 is configured to provide one or more tissue margins as described herein. In some embodiments, an AI algorithm is configured to identify the boundary 912 and overlay the treatment profile on the boundary or use the boundary 912 as the treatment profile to generate the treatment plan, for example, as described in connection with FIG. 9A.

[0122] 9C and 9D show a treatment plan with one or more tissue margins 985. The one or more tissue margins may include, for example, one or more of an angular tissue margin 987 or a depth tissue margin 989. In some embodiments, the one or more tissue margins are referenced to the boundary 912 to reduce interaction with adjacent untreated tissue, such as the second tissue 920, while the first tissue 910 is being treated. In some embodiments, the angular tissue margin 987 corresponds to the angle between the boundary 912 and the first treatment angle 934 at the boundary of the removal profile 970. In some embodiments, the depth of the tissue margin 989 corresponds to a depth of tissue that exceeds the penetration depth of the energy source at the first treatment angle 934. In some embodiments, the first treatment angle corresponds to a projection of the energy source, such as projection 944.

[0123] In some embodiments, the removal profile 970 is configured to provide one or more tissue margins 990 on the second side 918. In some embodiments, the second angular tissue margin 992 corresponds to the angle between the boundary 912 at the boundary of the removal profile 970 and the second treatment angle 936. In some embodiments, the depth of the tissue margin 994 corresponds to a tissue depth that exceeds the depth of penetration of the energy source at the second treatment angle 936, e.g., a tissue depth at the second treatment angle that exceeds the depth of the removal profile 980.

[0124] In some embodiments, a treatment profile 980 corresponding to the removal profile 970 is overlaid on an image of the tissue described herein.

[0125] In some embodiments, the user interface is configured to allow the user to view the treatment profile 980 overlaid on the image of the tissue 910 and to allow the user to adjust the treatment profile. Alternatively, or in combination, the boundary 912 identified by the AI ​​algorithm can be marked on the display, for example with modified pixels, to allow the user to verify the location of the boundary determined by the AI ​​algorithm. In some embodiments, the user interface is configured to display the location of the boundary 912 determined by the AI ​​algorithm and to display the treatment profile 980, both overlaid on an image of the tissue, such as the transverse image 312. The user interface can be configured to allow the user to select different views and images to view and verify the treatment plan.

[0126] In some embodiments, the user interface is configured to allow a user to adjust the treatment profile in multiple views of the tissue described herein. In some embodiments, it may be useful for a user to adjust the treatment profile based on, for example, one or more of physician preference, previous patient outcomes, or patient preference. Referring again to FIG. 9B , a treatment profile 980 is shown slightly inside the boundary 912 near the first margin 952 and the second margin 954. Such user adjustment may be useful, for example, if the user wishes to reduce interaction between the energy source and the second tissue 980. Alternatively, or in combination, the user can adjust other regions of the treatment profile as needed. A portion of the treatment profile 980 oriented toward the nozzle is shown substantially overlapping the tissue boundary 910, and another portion of the treatment profile 980 oriented toward the second tissue 420 is shown substantially overlapping the boundary 912, which may be useful to ensure complete treatment of the tissue at these locations, for example, complete removal by one or more of ablation or resection. These regions of the treatment profile may similarly be adjusted by the user, for example, to extend outside of boundary 912 or to lie more completely within boundary 912.

[0127] The treatment profile 980 can be adjusted by the user in many ways, but in some embodiments, the user interface is configured to allow the user to select a location for the treatment profile and drag the location of the treatment profile to a desired position on the image. In some embodiments, the user interface is configured to, for example, drag a portion of the treatment profile to a desired location and perform a curve fit to the desired location so that the treatment profile remains smooth and continuous. Alternatively, or in combination, the user interface can be configured to allow the user to move the entire treatment profile relative to the tissue. The user interface can be configured to perform this selection and movement in many ways, such as using a pointing device, such as a trackpad or mouse, or a display, such as a touchscreen display.

[0128] Once the treatment profile is determined, a treatment plan can be constructed based on the treatment profile, similar to the determination of the treatment plan described herein in connection with boundary 912, such as the angular depth profile of the treatment profile relative to the energy source 200.

[0129] FIG. 10 illustrates a method 1000 for planning a three-dimensional procedure (3D) using a user interface.

[0130] In step 1010, one or more images are received. The one or more images may include any image or combination of images described herein, such as a 3D image, multiple transverse images, or one or more longitudinal (e.g., sagittal) images, and combinations thereof.

[0131] In step 1020, a 3D view of one or more images is generated. The 3D view may include an array of images, such as, for example, multiple transverse images arrayed along one or more longitudinal images along one or more sagittal images. In some embodiments, the 3D view includes multiple transverse images arrayed along one or more longitudinal images at multiple corresponding locations along the one or more longitudinal images. In some embodiments, the multiple transverse images intersect with one or more longitudinal images at multiple corresponding locations. In some embodiments, the multiple transverse images include volumetric pixels (voxels) that overlap with one or more longitudinal images at multiple corresponding locations, for example, when the received images include 3D volumetric images such as 3D ultrasound images. In some embodiments, the multiple transverse images and the one or more longitudinal images include images from 3D tomographic images. In some embodiments, each of the multiple transverse images appears substantially perpendicular to the one or more longitudinal images in the 3D view, for example, within 5 degrees of perpendicular. In some embodiments, the multiple transverse images and the one or more longitudinal images include ultrasound images, for example, the ultrasound images include images from an ultrasound probe inserted into the patient.

[0132] In some embodiments, the 3D view includes a perspective view, and the plurality of transverse images and one or more longitudinal images are arranged and shaped to provide a perspective view of the 3D view from a distance to the user.

[0133] In some embodiments, the plurality of transverse images includes a first portion on a first side of one or more longitudinal images and a second portion on a second side of one or more longitudinal images, the first portion being shown before the one or more longitudinal images and the second portion being shown after the one or more longitudinal images. In some embodiments, the one or more longitudinal images include a sufficient amount of transparency to allow the second portion of one or more of the transverse images to be viewed through the one or more longitudinal images.

[0134] In step 1025, a representation of the treatment probe is generated. The representation may include, for example, an image of the treatment probe from an image received from an imaging device, a computer-generated representation or animation of the treatment probe, and combinations thereof. In some embodiments, the representation of the treatment probe is shown in a 3D view extending in the sagittal direction. In some embodiments, the representation includes, for example, a computer-generated representation corresponding to multiple locations of the translational position and rotational angle of the energy source. In some embodiments, the representation includes, for example, an animation of the treatment probe. In some embodiments, the animation of the treatment probe is configured to move to show an animation of the treatment probe delivering energy from the energy source to tissue according to a 3D treatment plan, for example, according to a 3D treatment profile.

[0135] In step 1030, a 3D view is provided on a user interface. In some embodiments, the 3D view is provided on the user interface with a representation of the treatment profile overlaid on one or more of the one or more longitudinal images and the plurality of transverse images. While the representation can be shown in many ways, in some embodiments, the representation is shown where the representation of the 3D treatment profile intersects with the image.

[0136] In step 1035, the 3D view is adjusted. While the 3D view can be adjusted in any manner as described herein, in some embodiments, the 3D view is adjusted by user manipulation of a user input device, such as a pointing device or a touchscreen display. In some embodiments, the relative position and orientation of the images shown in the 3D view change in response to the user input. In some embodiments, the plurality of transverse images includes a first portion on a first side of one or more longitudinal images and a second portion on a second side of one or more longitudinal images, where the first portion is in front of the one or more longitudinal images and the second portion is behind the one or more longitudinal images.

[0137] In some embodiments, the array includes a three-dimensional (3D) array, and the user interface includes an input for a user to one or more of zoom, pan, or rotate the 3D array in the 3D view. In some embodiments, the user input is configured to rotate the one or more longitudinal images and the plurality of transverse images from a first orientation to a second orientation, where the first orientation shows a first portion of the plurality of transverse images before the one or more longitudinal images and a second portion of the plurality of transverse images after the one or more longitudinal images, and the second orientation shows a second portion of the plurality of transverse images before the one or more longitudinal images and a second portion of the transverse images after the one or more longitudinal images.

[0138] At step 1040, a user input is received to select a view to display. The selected view may include any suitable view described herein, such as a plurality of transverse views, a sagittal view, or a 3D view, and combinations thereof. In some embodiments, the user-selectable view includes, for example, one or more of a plurality of transverse images. In some embodiments, the user interface is configured to receive a user input selecting a transverse image from among a plurality of transverse images and, in response to the user input, provide a two-dimensional (2D) view of the transverse image with a representation overlaid on the 2D view of the transverse image. In some embodiments, the user interface is configured to receive a user input selecting one or more longitudinal images and, for example, in response to the user input, provide a 2D view of the one or more longitudinal images with a representation overlaid on the 2D view of the one or more longitudinal images.

[0139] In some embodiments, the user interface is configured to receive a user input identifying a selected image from among the one or more longitudinal images and the multiple transverse images shown in the 3D view and to display the selected image in the 2D view. In some embodiments, the user input corresponds to a user input at a location of the selected image in the 3D view and a location using a pointing device or a touchscreen display. Alternatively or in combination, the user interface includes a plurality of user-selectable inputs corresponding to the images to display, the plurality of user-selectable inputs including, for example, a first input for displaying the 3D view, a second input for displaying the sagittal view, and a third input for the user to select one or more of the transverse images.

[0140] In some embodiments, the plurality of transverse images correspond to a plurality of predetermined anatomical locations of an organ. In some embodiments, the plurality of predetermined anatomical locations include anatomical locations of a first organ and a second organ, the first organ and the second organ being visible in one or more of the one or more longitudinal images and the transverse images. In some embodiments, for example, the first organ includes a prostate and the second organ includes a bladder. In some embodiments, the plurality of predetermined anatomical locations include an intravesical prostatic protrusion (IPP), a bladder neck (BL), a prostate gland (MID), a verumontanum (VERU), and a peripheral sphincter (P.SPH).

[0141] In step 1045, the received images are processed with an AI algorithm. The AI ​​algorithm can be configured to identify one or more tissue structures as described herein. The AI ​​algorithm can include, for example, one or more of image enhancement, image segmentation, neural networks, convolutional neural networks, Transformers, Transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modality image fusion. The location of one or more tissue structures within the image can be used to identify images to present to a user, such as one or more transverse images corresponding to the locations of the tissue structures. In some embodiments, multiple predetermined anatomical locations are identified with the artificial intelligence algorithm. In some embodiments, the AI ​​algorithm is configured to process the received images and identify images corresponding to the predetermined anatomical locations, and selected images are presented to a user according to the identified locations and corresponding images. In some embodiments, the plurality of predetermined anatomical locations include the intravesical prostatic protrusion (IPP), bladder neck (BL), prostate (MID), verumontanum (VERU), and peripheral sphincter (P.SPH), and the transverse images shown to the user are based on the anatomical locations identified by the AI ​​algorithm.

[0142] In step 1050, a treatment profile is generated, which may be generated in any manner described herein. In some embodiments, the treatment profile comprises a 3D treatment profile.

[0143] In step 1060, the treatment profile is overlaid on one or more images. In some embodiments, the one or more images include one or more selected images, for example, where the images are selected in response to user input. In some embodiments, the representation of the 3D treatment profile includes a three-dimensional (3D) treatment volume overlaid on the array of images shown in the 3D view. In some embodiments, the 3D treatment volume extends longitudinally along one or more longitudinal images and transversely to one or more longitudinal images along one or more transverse images. In some embodiments, an outer boundary of the 3D treatment volume is shown extending along one or more longitudinal images transversely to one or more longitudinal images and longitudinally along the transverse images.

[0144] In some embodiments, the representation of the 3D treatment profile in the 3D view includes an intersection of the 3D treatment profile with one or more longitudinal images and one or more of the transverse images.

[0145] In some embodiments, the plurality of transverse images includes a first portion on a first side of one or more longitudinal images and a second portion on a second side of one or more longitudinal images, with the arrangement having a first portion in front of one or more longitudinal images and a second portion behind one or more longitudinal images in the 3D view. In some embodiments, a representation of a 3D treatment profile is overlaid in the 3D view on the first portion and one or more longitudinal images, the 3D representation extending along the first portion and one or more longitudinal images from a common location where the first portion intersects with the one or more longitudinal images. In some embodiments, the transverse view includes sufficient transparency to view the 3D representation of the treatment profile on the second portion of one or more of the transverse images. In some embodiments, the user interface is configured to display the treatment profile as multiple lines along the transverse images connected to one or more lines along the one or more longitudinal images. In some embodiments, the 3D representation is shown, for example, as a mesh overlaid on one or more images. In some embodiments, the image shown in the 3D view is user selectable while the 3D representation is shown in the 3D view. In some embodiments, the user interface is configured to allow the user to select the image shown in the 3D view, e.g., such that the user cannot select an image overlaid with the 3D representation of the treatment profile, or can select multiple images.

[0146] In some embodiments, the user interface is configured to adjust the 3D view with a treatment profile overlaid on the 3D view. In some embodiments, the array of images includes a 3D array, and the user interface is configured for a user to one or more of zoom, pan, or rotate the 3D array in the 3D view, and the treatment profile is correspondingly adjusted in the 3D view by input to one or more of zoom, pan, or rotate the 3D array. In some embodiments, a representation of the 3D treatment profile moves with the 3D array to maintain alignment of the 3D treatment profile with the 3D array in response to user input to one or more of zoom, pan, or rotate the 3D representation. In some embodiments, a representation of a treatment probe is shown extending along one or more longitudinal images, and the representation of the treatment probe moves with the 3D array and the 3D treatment profile to maintain alignment of the representation of the treatment probe with the 3D array and the 3D treatment profile.

[0147] In some embodiments, the user input is configured to rotate the one or more longitudinal images and the plurality of transverse images from a first orientation to a second orientation, the first orientation showing the 3D treatment profile before the first portion of the plurality of transverse images and the one or more longitudinal images and the 3D treatment profile after the second portion of the plurality of transverse images and the one or more longitudinal images, and the second orientation showing the 3D treatment profile before the second portion of the plurality of transverse images and the one or more longitudinal images and the 3D treatment profile after the first portion of the transverse images and the one or more longitudinal images.

[0148] User input to adjust the treatment profile is received at step 1070. In some embodiments, the user interface is configured to receive user input to adjust one or more images, for example, by moving boundaries of a treatment profile described herein.

[0149] The adjusted treatment profile is shown on the user interface display at step 1080. In some embodiments, the adjusted treatment profile is shown in real-time updates to the treatment profile shown in the view the user is adjusting, and in real-time updates to additional views described herein.

[0150] In step 1090, user input is received for the user to accept the adjusted treatment profile. The user input for accepting the treatment may include user input received before the treatment. Also, the user input described herein may include user input from a first user and user input from a second user. Alternatively, the user input may include, for example, input from a single user.

[0151] The patient is treated in step 1095. Treatment can be performed in a substantially automated manner, for example, by the user pressing a foot pedal or other device upon the user accepting treatment.

[0152] While treatment planning method 1000 has been shown and described in accordance with several embodiments, those skilled in the art will recognize numerous adaptations and variations of this disclosure. For example, steps may be performed in any order. Some steps may be repeated, some steps may be omitted, some steps may include sub-steps of other steps, and one or more of the steps of method 1000 may be combined with any step of any method described herein.

[0153] FIG. 11 illustrates a method 1100 for planning a 3D procedure using automated tissue recognition.

[0154] In step 1101, a plurality of images are received. The plurality of images may include any suitable images described herein, such as a plurality of transverse images, one or more longitudinal images, or 3D volumetric images such as 3D ultrasound images, and combinations thereof. In some embodiments, each of the plurality of images is received and evaluated, and the probe location and tissue boundaries are determined in each of the plurality of images to generate a 3D treatment plan. The following steps may be performed for each of the plurality of images:

[0155] In step 1103, the received images are processed with an AI algorithm. The AI ​​algorithm can be configured to identify tissue structures used in the treatment planning described herein. In some embodiments, the AI ​​algorithm is configured to identify the location of the probe within a plurality of images. The plurality of images may include any suitable images described herein, such as images from transverse images, one or more longitudinal images, or 3D volumetric images, and combinations thereof. The AI ​​algorithm may include, for example, one or more of image enhancement, image segmentation, neural networks, convolutional neural networks, Transformers, Transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modality image fusion.

[0156] In step 1105, the treatment probe position is determined. The probe position may include the elongated axis of the probe, which may correspond to the position of the energy source during treatment. In some embodiments, the energy source may not be offset from the elongated axis during treatment, and the treatment plan and angles and distances are determined according to the position of the energy source during treatment. In some embodiments, the probe position is determined using the AI ​​algorithms described herein. Alternatively or in combination, a user interface can be configured to allow the user to identify the probe position.

[0157] In step 1110, a tissue boundary is determined. In some embodiments, the boundary defines the area of ​​tissue to be treated. In some embodiments, the tissue boundary is determined using an AI algorithm described herein. Alternatively, or in combination, a user interface can be configured for the user to identify the boundary.

[0158] In some embodiments, the boundary may enclose the anatomical tissue structure and include a perimeter around the anatomical tissue structure in each of the multiple transverse images and boundary parameters related to the probe used to plan the treatment. In some embodiments, the boundary includes a margin relative to the treatment probe. In some embodiments, a first margin of the tissue boundary corresponds to a first line from the probe to a first location of the boundary that is tangent to the boundary at the first location, and a second margin of the tissue boundary corresponds to a second line from the probe that is tangent to the boundary at a second location of the boundary.

[0159] In some embodiments, the tissue boundaries are separated from the probe by a distance, and the distance and angle between the tissue boundaries can be used as inputs to determine the treatment profile and plan. In some embodiments, the probe is separated from the boundary by the closest distance at the boundary location closest to the probe and the farthest distance at the boundary location farthest from the probe.

[0160] In step 1115, a tissue profile is determined. In some embodiments, the tissue profile includes a variable thickness between a first angle of the boundary and a second angle of the boundary. In some embodiments, the variable thickness tissue profile includes multiple depths at multiple angles. In some embodiments, the tissue profile is separated from the probe with a gap between the probe and the treatment tissue profile. In some embodiments, the tissue profile includes a plurality of first radial distances from the probe to a first portion of the boundary at multiple corresponding angles and a second plurality of radial distances from the probe to a second portion of the boundary. In some embodiments, the first portion of the boundary is oriented toward the probe and the second portion of the boundary is oriented away from the treatment probe. In some embodiments, the variable thickness profile of the tissue is defined by the difference between the first plurality of radial distances and the second plurality of radial distances at the corresponding angles.

[0161] A treatment angle is determined in step 1120. In some embodiments, a first angle from the treatment probe to a first location along a first side boundary of the area is determined, and a second angle from the treatment probe to a second location along a second side boundary of the area is determined.

[0162] In some embodiments, the treatment plan is configured to provide one or more tissue margins. In some embodiments, a first treatment angle is oriented to provide a first tissue margin on a first side, and a second treatment angle is oriented to provide a second tissue margin on a second side of the treated tissue. In some embodiments, the first treatment angle is selected to provide a first tissue margin thickness at the first treatment angle that is greater than the penetration depth of the energy source at the first treatment angle, and the second treatment angle is selected to provide a second tissue margin thickness at the second treatment angle that is greater than the penetration depth of the energy source at the second treatment angle. In some embodiments, the first tissue margin corresponds to a first tissue margin angle between the first treatment angle and a first angle of a first margin on a boundary on a first side of the treated tissue, and the second tissue margin corresponds to a second tissue margin angle between the second treatment angle and a second angle of a second margin on a boundary on a second side of the treated tissue.

[0163] In some embodiments, the first tissue margin angle is in the range of about 1 degree to about 15 degrees, optionally in the range of about 1 degree to about 10 degrees, and further optionally in the range of about 2 degrees to about 10 degrees. In some embodiments, the second tissue margin angle is in the range of about 1 degree to about 15 degrees, optionally in the range of about 1 degree to about 10 degrees, and further optionally in the range of about 2 degrees to about 10 degrees.

[0164] In some embodiments, the treatment plan corresponds to a first penetration depth of the energy source at a first treatment angle, the first tissue margin including a first tissue margin thickness at the first treatment angle, the first margin thickness being greater than the first tissue penetration depth. In some embodiments, the first margin thickness is greater than the first penetration depth by an amount in the range of about 1% to about 15%, optionally in the range of about 1% to about 10%, and further optionally in the range of about 2% to about 10%. In some embodiments, the treatment plan corresponds to a second penetration depth of the energy source at a second treatment angle, the second tissue margin including a second tissue margin thickness at the second treatment angle, the second margin thickness being greater than the second tissue penetration depth. In some embodiments, the second margin thickness is greater than the second penetration depth by an amount in the range of about 1% to about 15%, optionally in the range of about 1% to about 10%, and further optionally in the range of about 2% to about 10%.

[0165] In some embodiments, the first treatment angle is determined according to a first boundary angle between the treatment probe and the tissue boundary on the first side, and the second treatment angle is determined according to a second boundary angle between the treatment probe and the tissue boundary on the second side. In some embodiments, the first treatment angle and the first boundary angle are arranged to provide a first tissue margin between the first treatment angle and the first boundary angle, and the second treatment angle and the second boundary angle are arranged to provide a second tissue margin between the second treatment angle and the second boundary angle. In some embodiments, the first boundary angle is determined from a first angle from the treatment probe to a first margin of the boundary on the first side, and the second boundary angle is determined from a second angle from the treatment probe to a second margin of the boundary on the second side. In some embodiments, the first boundary angle corresponds to a first projection line from the probe to the first boundary location that is tangent to the boundary on the first side, and the second boundary angle corresponds to a second projection line from the probe that is tangent to the boundary on the second side. In some embodiments, the first tissue margin extends between the first margin of the boundary and the first treatment location at the first treatment angle on the first side, and the second tissue margin extends between the second margin of the boundary and the second treatment location at the second treatment angle on the second side.

[0166] An ablation layer is determined in step 1125. In some embodiments, the ablation layer is determined to provide treatment with two or more sweeps of the energy source across the tissue.

[0167] Layer boundaries are determined in step 1130. In some embodiments, the boundaries of the ablation layers are determined to provide one or more tissue margins as described herein.

[0168] In step 1140, a treatment profile is generated for each of the plurality of images.

[0169] In some embodiments, the treatment profile may include a variable thickness between a first angle on the first side of the treatment area and a second angle on the second side of the treatment area, and may include multiple depths at multiple corresponding angles. In some embodiments, the treatment profile is separated from the probe by a gap between the probe and the treatment profile. In some embodiments, the treatment profile includes multiple thicknesses corresponding to multiple rotation angles of the energy source, each of the multiple thicknesses being determined for a corresponding angle of the multiple rotation angles. In some embodiments, each of the multiple thicknesses includes a distance between a first location of the tissue boundary and a second location of the tissue boundary at the corresponding angle. In some embodiments, for each of the multiple thicknesses of the treatment profile, the first location is a first distance away from the probe, and the second location is a second distance away from the probe.

[0170] A 3D treatment profile is generated in step 1145. In some embodiments, the 3D treatment profile is generated from multiple 2D treatment profiles. Alternatively, the 3D treatment profile can be generated from a 3D tissue profile where the 3D treatment tissue profile is generated from the boundaries of the tissue profiles in multiple images.

[0171] In step 1150, a 3D treatment plan is generated. In some embodiments, a 3D treatment plan is generated for each of the multiple images and combined. The 3D treatment plan can be generated from tissue boundaries, or from treatment profiles determined from tissue boundaries, and combinations thereof. Alternatively or in combination, the 3D treatment plan can be generated from the 3D tissue profile. In some embodiments, the 3D treatment plan is generated from the 3D treatment profile.

[0172] In some embodiments, the treatment plan is generated according to a first angle and a second angle of the probe relative to the tissue boundary for each of the plurality of transverse images. In some embodiments, the location of the probe corresponds to the location of the directed energy source during the treatment, the first angle corresponds to a first angle of the directed energy source during the treatment, and the second angle corresponds to a second angle of the energy source during the treatment. In some embodiments, the first angle and the second angle of each of the plurality of transverse images correspond to a plurality of treatment angles of the 3D treatment plan. For example, the first angle and the second angle from each of the plurality of transverse images are combined to generate the 3D treatment plan.

[0173] In some embodiments, the multiple transverse images are positioned along a treatment axis corresponding to axial translation of a directed energy source on the probe during treatment, with each of the multiple transverse images being positioned at a position along the treatment axis. In some embodiments, the treatment plan is configured to, for each of the multiple locations along the treatment axis, rotate the probe to direct energy from the energy source at a first angle to the first location and at a second angle to the second location. In some embodiments, the treatment plan is configured to rotate the energy source from the first angle to the second angle to scan the energy source across the tissue between the first angle and the second angle.

[0174] In some embodiments, the treatment plan includes machine-readable instructions for moving the probe to multiple axial locations along the treatment probe axis and rotating the probe to multiple angles to deliver energy from the energy source at the multiple axial locations and the multiple angles. In some embodiments, the treatment plan includes a first angle and a second angle for each of the multiple locations, and is configured to scan the energy source along the tissue between the first angle and the second angle at each of the multiple axial locations.

[0175] In some embodiments, the treatment plan is configured to treat tissue according to a treatment profile corresponding to a tissue boundary. In some embodiments, the boundary includes a boundary of an anatomical tissue structure a distance away from the probe. In some embodiments, the treatment plan is configured to adjust the delivery of energy from the energy source according to distance. In some embodiments, the directed energy source includes a cross-sectional area that increases with distance away from the energy source, and the distance can be used to adjust the energy delivered from the energy sources described herein.

[0176] In some embodiments, the treatment plan is configured to remove tissue at multiple thicknesses and multiple corresponding angles between a first angle and a second angle. In some embodiments, the treatment plan is configured to remove tissue to a first depth with a first pass of the energy source at a first angular subsense between the first angle and the second angle, and to remove tissue to a second depth with a second pass of the energy source corresponding to a second angular subsense that is smaller than the first angular subsense, the second depth being greater than the first depth. In some embodiments, the second angular subsense corresponds to a third location along a boundary on a first side of the area and a fourth location along a boundary on a second side of the area. In some embodiments, the third location of the boundary is located at or below the first removal depth, and the fourth location of the boundary is located at or below the first removal depth.

[0177] In some embodiments, each of the plurality of thicknesses comprises a distance from a proximal location of the boundary to a distal location of the boundary for a plurality of corresponding angles.

[0178] While treatment can be performed in many ways, in some embodiments, the treatment plan is configured to adjust one or more of the intensity of energy from the energy source, the power of energy from the energy source, the translational speed of the energy source, the rotational speed of the energy source, or the number of passes of the energy source at multiple corresponding angles to treat tissue according to multiple thicknesses. In some embodiments, the treatment plan is configured to fix the axial position of the treatment probe and rotate the treatment probe at the axial position to scan energy from the energy source along the tissue at a first pass between a first angle and a second pass between a second angle at the axial position. Alternatively or in combination, the treatment plan may be configured, for example, to fix the rotational angle of the treatment probe about the elongate probe axis and translate the treatment probe at the rotational angle to scan energy from the energy source along the tissue at a first pass between a first translational location at the rotational angle and a second pass between a second translational location at the rotational angle. In some embodiments, the treatment plan is configured to increase the translational speed of the energy source on the treatment probe to decrease the treatment depth and decrease the translational speed to increase the treatment depth. Alternatively or in combination, the treatment plan may be configured to, for example, increase the rotational speed of the energy source on the treatment probe to decrease the treatment depth and decrease the rotational speed to increase the treatment depth.

[0179] In step 1165, an image is presented to the user with the treatment profile overlaid on the image. The presented image may include any image or view described herein. This may be useful for the user to evaluate and verify the treatment plan. For example, with AI-based treatment planning, it may be useful to have a human review the treatment plan before treating the patient.

[0180] In step 1167, user input to adjust the treatment profile is received. This can be useful if the user wants to make changes to the treatment plan. The treatment profile can be adjusted in any manner described herein.

[0181] In step 1170, a second tissue boundary is determined. In some embodiments, the second tissue includes untreated tissue, but may also include, for example, a second treated tissue. In some embodiments, the boundary of the second tissue is determined using an AI algorithm described herein. In some embodiments, the first tissue includes a first anatomical tissue structure and the second tissue includes a second anatomical tissue structure that is different from the first anatomical tissue structure. The first anatomical tissue structure includes an anatomical tissue structure of a first organ and the second anatomical tissue structure includes a second anatomical tissue structure of a second organ that is different from the first organ.

[0182] In some embodiments, the anatomical structure of the first tissue structure includes, for example, one or more of a tissue wall, a vesicle, a lumen, a wall of a lumen, a bladder, a wall of the bladder, a bladder neck, a wall of the bladder neck, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a wall of a ureter, a prostate, a prostate lobe, an intravesical prostatic protrusion, a capsule of the prostate, an internal and external sphincter, an artery, a wall of an artery, a vein, a wall of a vein, or a lens of an eye. The second tissue structure may include any suitable tissue, such as one or more connective tissues, muscle tissues, epithelial tissues, muscle tissues, or anatomical structures associated with contrast in the image data.

[0183] In some embodiments, the second tissue structure includes a second type of tissue adjacent to a third type of tissue or fluid to provide contrast to the image data from the second tissue structure, which may include a liquid such as urine.

[0184] In some embodiments, the anatomical structure of the second tissue structure comprises, for example, one or more of a tissue wall, a vesicle, a lumen, a wall of a lumen, a bladder, a wall of the bladder, a bladder neck, a wall of the bladder neck, a trigone tissue, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a wall of a ureter, a prostate, a lobe of the prostate, an intravesical prostatic protrusion, a capsule of the prostate, a verumontanum of the prostate, an internal and external sphincter, an artery, a wall of an artery, a vein, a wall of a vein, or a retina of the eye.

[0185] In step 1180, the second tissue boundary is compared to the treatment plan. This comparison may include, for example, a comparison of the angle and distance of the second tissue relative to the probe. In some embodiments, the comparison is performed with respect to the boundary of the first tissue, for example, to determine whether the first tissue is interposed between the energy source and the second tissue. In some embodiments, the distance between the boundary of the first tissue and the boundary of the second tissue is compared, for example, to determine whether there is sufficient distance between the boundary of the first tissue and the boundary of the second tissue.

[0186] In step 1185, an output is generated to the user interface. While the output can be configured in many ways, in some embodiments, the output includes feedback to the user generated in response to the comparison in step 1180, where the feedback may include one or more of a notification or a warning to the user. In some embodiments, a first tissue boundary is interposed between a second tissue boundary, and the output is generated in response to, for example, a distance between the probe and the location of the second tissue boundary. In some embodiments, the treatment plan includes a rotation angle of the energy source beyond a margin of the first tissue boundary, and the output is generated in response to the rotation angle beyond the margin. In some embodiments, the treatment plan corresponds to a penetration depth of the energy source beyond a tissue thickness, and the output is generated in response to a penetration depth greater than the thickness. In some embodiments, the thickness includes multiple thicknesses at multiple rotation angles of the energy source, where each of the multiple thicknesses is determined for a corresponding angle of the multiple rotation angles, and a penetration depth is determined for each of the multiple angles. The output can be generated in response to, for example, a penetration depth that exceeds the tissue thickness.

[0187] Although reference is made to outputs such as notifications or alerts, in some embodiments the first tissue boundary, the second tissue boundary, and the treatment profile are shown in one or more views of the image, and the user interface is configured to adjust the treatment plan, for example, by moving the treatment profile as described herein. In some embodiments, the first tissue boundary, the second tissue boundary, and the treatment profile are shown in each of a plurality of transverse images, and the user interface is configured to adjust the treatment profile, for example, on the plurality of transverse images.

[0188] In step 1190, input is received from a user interface. The input may include any suitable input described herein, such as an input to modify a treatment profile. In some embodiments, the input includes an input indicating that the user accepts a treatment plan, such as a treatment profile.

[0189] In step 1195, the patient is treated.

[0190] While a method 1100 for 3D treatment planning using automated tissue recognition has been shown and described in accordance with several embodiments, those skilled in the art will recognize numerous adaptations and variations of this disclosure. For example, steps may be performed in any order. Some steps may be repeated, some steps may be omitted, some steps may include sub-steps of other steps, and one or more of the steps of method 1100 may be combined with any step of any method described herein.

[0191] FIG. 12 illustrates a method 1200 for treating a first tissue and reducing exposure to a second tissue using automated tissue recognition.

[0192] In step 1210, the AI ​​algorithm detects a first tissue, such as an IPP of the prostate, and a second tissue, such as a trigone tissue of the bladder. The AI ​​algorithm may include, for example, one or more of image enhancement, image segmentation, neural networks, convolutional neural networks, Transformers, Transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modality image fusion.

[0193] In step 1220, the AI ​​algorithm detects a first tissue and a second tissue in the multiple transverse images.

[0194] In step 1230, the AI ​​algorithm measures the distance from the energy source, such as a nozzle, to a second tissue, such as an IPP, and the angle of the IPP in multiple transverse images.

[0195] In step 1240, the AI ​​algorithm generates an output, such as a warning, indicating that the first tissue, such as the IPP, may have a penetration depth that exceeds the tissue thickness or a treatment angle that is outside the angle of the first tissue, such as the IPP.

[0196] In step 1250, the AI ​​algorithm determines the boundary of a first tissue, such as an IPP, and evaluates whether the treatment plan exceeds sufficient energy delivery to treat the first tissue. For example, the AI ​​algorithm can be configured to determine whether the penetration depth of the energy source exceeds the thickness of the first tissue. In some embodiments, the AI ​​algorithm is configured to determine whether the translational position of the energy source during treatment extends beyond the first tissue to impinge on a second tissue, such as an IPP.

[0197] The treatment plan is adjusted in step 1260. While the treatment plan can be adjusted in many ways, in some embodiments, the treatment profile is adjusted to limit the treatment to the first tissue, for example, by adjusting one or more treatment angles to appropriately limit the treatment angle, or by adjusting the tissue penetration depth to limit the tissue penetration depth to the tissue thickness.

[0198] While treatment planning method 1200 has been shown and described in accordance with several embodiments, those skilled in the art will recognize numerous adaptations and variations of this disclosure. For example, steps may be performed in any order. Some steps may be repeated, some steps may be omitted, some steps may include sub-steps of other steps, and one or more of the steps of method 1200 may be combined with any step of any method described herein.

[0199] FIG. 13 illustrates a method 1300 for training an AI algorithm.

[0200] In step 1310, images are collected and grouped. The images may include a collection of images acquired before and during treatment. The images may be categorized and grouped as appropriate, for example, with respect to tissue type. In some embodiments, the images are grouped according to tissue type, such as the prostate tissue types described herein.

[0201] In step 1320, the AI ​​model receives the grouped images from step 1310. Machine-assisted labeling (MAL) is used to label the grouped images according to each group of images. In some embodiments, each group of images may be segmented, classified, and labeled with MAL. In some embodiments, images are segmented and annotated with labels, for example, to identify tissue structures as described herein.

[0202] In step 1330, the MAL images are received by a user interface that allows an expert to review and clean up the MAL image data. An initial set of MAL images may be reviewed by an expert, such as a radiologist. The expert review and cleanup of the MAL images produces high-quality labeled image data. The high-quality labeled image data can be added to a pool of high-quality image data. This high-quality image data can be used as a ground state or true state for further training and refining the classifier and contains annotated data with appropriate labels that identify tissue types.

[0203] In step 1340, the high-quality labeled data is received by an AI algorithm described herein and used to train and validate a model. The annotated images can be used to train and validate the AI ​​algorithm and develop model parameters for the AI ​​algorithm. The AI ​​algorithm may include any suitable algorithm described herein, such as a neural network, e.g., a deep neural network.

[0204] In step 1350, the trained model parameters generated in step 1340 are received to refine and tune the model. This can be done in many ways, but in some embodiments, model inference speed improvements are performed on the model to increase the speed of the model without substantially compromising the model's output. This can be useful for increasing the model's throughput and reducing processing bottlenecks in the model.

[0205] The model is released and deployed in the field in step 1360. This field-deployed model can be used to process images and generate one or more tissue structures described herein.

[0206] In some embodiments, the model is further refined before field deployment in step 1360. For example, it may be useful to iterate and refine the model by repeating steps 1320, 1330, 1340, and 1350 to generate acceptable model parameters for field deployment in step 1360. In some embodiments, steps 1320, 1330, 1340, and 1350 comprise elements of a feedback loop. In some embodiments, the new model parameters developed in step 1350 are provided to the images grouped for MAL in step 1320, and the MAL images are then provided to an expert for review in step 1330. In some embodiments, additional images are provided for testing and validation in step 1320, and MAL images are generated and provided to an expert for review in step 1330, and these images are added to the pool of image data. In some embodiments, the new model parameters generated in step 1350 may be provided to an AI algorithm in step 1340, used to evaluate the image, and used to further refine and develop the AI ​​algorithm in step 1340. Once training and development of the AI ​​algorithm is completed in step 1340, this trained model may be refined in step 1350, for example, to improve model inference speed. Steps 1320, 1330, 1340, and 1350 may be performed as many times as appropriate to further refine and improve the model before field deployment in step 1360.

[0207] While method 1300 for training an AI algorithm has been shown and described according to several embodiments, those skilled in the art will recognize numerous adaptations and variations of this disclosure. For example, steps may be performed in any order. Some steps may be repeated, some steps may be omitted, some steps may include sub-steps of other steps, and one or more of the steps of method 1300 may be combined with any step of any method described herein.

[0208] The processors described herein may be configured to perform one or more steps of any of the methods disclosed herein, such as method 1000, method 1100, method 1200, or method 1300, for example.

[0209] 14 illustrates artificial intelligence ("AI") algorithms suitable for incorporation according to embodiments of the present disclosure. In some embodiments, the artificial intelligence algorithms include, for example, one or more of image enhancement, image segmentation, neural networks, convolutional neural networks, Transformers, Transformer machine learning models, supervised machine learning, unsupervised machine learning, edge detection, feature recognition, segmentation, 3D model reconstruction, or multi-modality image fusion.

[0210] In some embodiments, the AI ​​algorithm includes a two-dimensional convolutional neural network (CNN) 2100. In some embodiments, the AI, such as a CNN, is configured to identify one or more tissue structures of one or more tissues, process images to identify the tissue structures, and determine the tissue's response to treatment. The tissues may include a first tissue, a second tissue, or a combination thereof, as described herein. A dataset 2102 is first provided, which may include images from previous treatment data from previous patients and procedures. A convolution operation 2104 results in a second dataset 2106, which then has a pooling layer 2108 applied to result in a pooled layer 2110 of sub-sampled data to further condense the spatial size of the representation. The sub-sampled data may be convolved 2112 to produce a third dataset 2114, which may further have a pooling layer 2116 applied to provide sub-sampled data 2118. The subsampled data 2118 may be passed through a first fully connected layer 2120 and a second fully connected layer 2122 to generate a classification matrix output 2124. One or more filters may be applied to each convolutional layer to provide different types of feature extraction. After a model is defined, it may be compiled and feature recognition accuracy may be used as a performance metric. The model may be trained over time, such as by using past procedural data as training data, and validated according to the model's predictions until the model's predictions converge with the true data.

[0211] Although the trained model can be configured in many ways, in some embodiments the trained model is configured to identify tissue structure and output one or more metrics related to the tissue structure, such as one or more of the shape data or motion data described herein.

[0212] As described herein, the computing devices and systems described and / or illustrated herein broadly represent any type or form of computing device or system capable of executing computer-readable instructions, such as those contained within the modules described herein. In their most basic configurations, these computing devices may each include at least one memory device and at least one physical processor.

[0213] As used herein, the term "memory" or "memory device" generally refers to any type or form of volatile or non-volatile storage device or medium capable of storing data and / or computer-readable instructions. In one example, a memory device may store, load, and / or maintain one or more of the modules described herein. Examples of memory devices include, but are not limited to, random access memory (RAM), read-only memory (ROM), flash memory, hard disk drive (HDD), solid-state drive (SSD), optical disk drive, cache, one or more variations or combinations thereof, or any other suitable storage memory.

[0214] Furthermore, as used herein, the term "processor" or "physical processor" generally refers to any type or form of hardware-implemented processing unit capable of interpreting and / or executing computer-readable instructions. In one example, a physical processor may access and / or modify one or more modules stored in the memory devices described above. Examples of physical processors include, but are not limited to, a microprocessor, a microcontroller, a central processing unit (CPU), a field programmable gate array (FPGA) implementing a soft-core processor, an application-specific integrated circuit (ASIC), one or more portions thereof, one or more variations or combinations thereof, or any other suitable physical processor. A processor may include a distributed processor, such as a system running parallel processors, or a remote processor, such as a server, and combinations thereof.

[0215] Although illustrated as separate elements, the method steps described and / or illustrated herein may represent portions of a single application. Further, in some embodiments, one or more of these steps may represent or correspond to one or more software applications or programs that, when executed by a computing device, may cause the computing device to perform one or more tasks, such as method steps.

[0216] Further, one or more of the devices described herein may transform data, physical devices, and / or representations of physical devices from one form to another. Additionally or alternatively, one or more of the modules listed herein may execute on a computing device, store data on a computing device, and / or otherwise interact with a computing device, thereby transforming a processor, volatile memory, non-volatile memory, and / or any other portion of a physical computing device from one form of computing device to another form of computing device.

[0217] The term "computer-readable medium," as used herein, generally refers to any form of device, carrier, or medium capable of storing or carrying computer-readable instructions. Examples of computer-readable media include, but are not limited to, transmission-type media such as carrier waves, and non-transmission-type media such as magnetic storage media (e.g., hard disk drives, tape drives, and floppy disks), optical storage media (e.g., compact discs (CDs), digital video discs (DVDs), and BLU-RAY discs), electronic storage media (e.g., solid-state drives and flash media), and other distribution systems.

[0218] Those skilled in the art will recognize that any process or method disclosed herein can be modified in many ways. The process parameters and order of steps described and / or illustrated herein are given by way of example only and can be changed as desired. For example, although the steps illustrated and / or described herein may be shown or described in a particular order, these steps do not necessarily have to be performed in the order illustrated or described.

[0219] The various exemplary methods described and / or illustrated herein may also omit one or more of the steps described or illustrated herein or may include additional steps in addition to those disclosed. Furthermore, the steps of any method disclosed herein may be combined with any one or more steps of any other method disclosed herein.

[0220] The processors described herein can be configured to perform one or more steps of any of the methods disclosed herein. Alternatively, or in combination, the processors can be configured to combine one or more steps of one or more of the methods disclosed herein.

[0221] Unless otherwise stated, the terms "connected to" and "coupled to" (and their derivatives) as used in this specification and claims should be interpreted to allow both direct and indirect (i.e., via other elements or components) connections. Additionally, the terms "a" or "an" as used in this specification and claims should be interpreted to mean "at least one of." Finally, for ease of use, the terms "including" and "having" (and their derivatives) as used in this specification and claims are interchangeable with the term "comprising" and shall have the same meaning.

[0222] The processors disclosed herein may be configured with instructions to perform any one or more steps of any of the methods disclosed herein.

[0223] Terms such as "first," "second," and "third" may be used herein to describe various layers, elements, components, regions, or sections, but it will be understood that they do not refer to any order or sequence of events. These terms are used merely to distinguish one layer, element, component, region, or section from another layer, element, component, region, or section. A first layer, element, component, region, or section described herein could be referred to as a second layer, element, component, region, or section without departing from the teachings of the present disclosure.

[0224] As used herein, the term "or" is used inclusively to refer to items in the alternative and in combination.

[0225] As used herein, "eg" means for example.

[0226] As used herein, letters, such as numbers, refer to like elements.

[0227] This disclosure contains the following numbered clauses:

[0228] Clause 1. A method for planning a treatment, the method comprising: receiving a plurality of transverse images and one or more longitudinal images of a tissue; generating an array of the plurality of transverse images along the one or more longitudinal images in a three-dimensional (3D) view, the three-dimensional view including the plurality of transverse images at a plurality of corresponding locations along the one or more longitudinal images; overlaying a representation of a three-dimensional (3D) treatment profile on the 3D view of the plurality of transverse images and the one or more longitudinal images; and providing on a display of a user interface the 3D view having the representation overlaid on one or more of the one or more longitudinal images and the plurality of transverse images.

[0229] Clause 2. The method described in Clause 1, wherein in the 3D view, the multiple transverse images include a first portion on a first side of one or more longitudinal images and a second portion on a second side of one or more longitudinal images, the first portion being in front of the one or more longitudinal images and the second portion being behind the one or more longitudinal images.

[0230] Clause 3. A method according to any of clauses 1-2, wherein a representation of the 3D treatment profile is overlaid on the 3D view on the first portion and one or more longitudinal images, the 3D representation extending along the first portion and one or more longitudinal images from a common location where the first portion intersects with the one or more longitudinal images.

[0231] Clause 4. The method of any of clauses 1-3, wherein one or more longitudinal images include a sufficient amount of transparency to allow a second portion of one or more of the transverse images to be seen through the one or more longitudinal images.

[0232] Clause 5. A method according to any of clauses 1 to 4, wherein a representation of the 3D treatment profile is overlaid on the second portion of the second side, and the amount of transparency is sufficient to allow the representation of the 3D treatment profile of the second side to be seen through one or more longitudinal images.

[0233] Clause 6. The method of any of clauses 1 to 5, wherein the array comprises a three-dimensional (3D) array and the user interface comprises inputs for a user to one or more of zoom, pan, or rotate the 3D array in the 3D view.

[0234] Clause 7. The method of any of clauses 1 to 6, wherein the representation of the 3D treatment profile moves with the 3D array to maintain alignment of the 3D treatment profile with the 3D array in response to user input to one or more of zooming, panning, or rotating the 3D representation.

[0235] Clause 8. A method according to any of clauses 1 to 7, wherein user input is configured to rotate one or more longitudinal images and the plurality of transverse images from a first orientation to a second orientation, the first orientation representing a first portion of the plurality of transverse images before the one or more longitudinal images and a second portion of the plurality of transverse images after the one or more longitudinal images, and the second orientation representing a second portion of the plurality of transverse images before the one or more longitudinal images and a second portion of the transverse images after the one or more longitudinal images.

[0236] Clause 9. A method according to any of clauses 1 to 8, wherein a representation of a treatment probe is shown extending along one or more longitudinal images, and the representation of the treatment probe moves with the 3D array and the 3D treatment profile, and maintains alignment of the representation of the treatment probe with the 3D array and the 3D treatment profile.

[0237] Clause 10. The method of any of clauses 1-9, wherein the representation of the 3D treatment profile comprises a three-dimensional (3D) treatment volume overlaid on the array.

[0238] Clause 11. The method of any of clauses 1 to 10, wherein the 3D treatment volume extends longitudinally along one or more longitudinal images and transversely to one or more longitudinal images along one or more transverse images.

[0239] Clause 12. A method according to any of clauses 1 to 11, wherein the outer boundary of the 3D treatment volume is shown extending along one or more longitudinal images transverse to the one or more longitudinal images and longitudinally along the transverse images.

[0240] Clause 13. The method of any of clauses 1 to 12, wherein the representation of the treatment probe is shown in a longitudinally extending 3D view.

[0241] Clause 14. The method of any of clauses 1 to 13, wherein the representation includes an animation of the treatment probe.

[0242] Clause 15. The method of any of clauses 1-14, wherein the animation of the treatment probe is configured to move to show an animation of the treatment probe delivering energy from the energy source according to the 3D treatment plan.

[0243] Clause 16. The method of any of clauses 1 to 15, wherein the representation includes an image of the treatment probe from an imaging device.

[0244] Clause 17. The method of any of clauses 1 to 16, wherein the representation of the 3D treatment profile in the 3D view comprises an intersection of the 3D treatment profile with one or more longitudinal images and one or more of the plurality of transverse images.

[0245] Clause 18. The method of any of clauses 1 to 17, wherein the plurality of transverse images corresponds to a plurality of predetermined anatomical locations of the organ.

[0246] Clause 19. The method of any of clauses 1 to 18, wherein the plurality of predetermined anatomical locations includes anatomical locations of a first organ and a second organ, and the first organ and the second organ are visible in one or more of the one or more longitudinal images and the transverse images.

[0247] Clause 20. The method of any of clauses 1 to 20, wherein the plurality of predetermined anatomical locations is identified by an artificial intelligence algorithm.

[0248] Clause 21. The method of any of clauses 1 to 20, wherein the first organ comprises the prostate and the second organ comprises the bladder.

[0249] Clause 22. The method of any of clauses 1-21, wherein the plurality of predetermined anatomical locations comprises the intravesical prostatic protrusion (IPP), the bladder neck (BL), the prostate gland (MID), the verumontanum (VERU), and the peripheral sphincter (P.SPH).

[0250] Clause 23. The method of any of clauses 1 to 22, wherein the user interface is configured to receive user input identifying a selected image from among one or more longitudinal images and a plurality of transverse images to be shown in the 3D view, and to display the selected image in the 2D view.

[0251] Clause 24. The method of any of clauses 1 to 23, wherein the user input corresponds to a location of a selected image in the 3D view and a user input at the location using a pointing device or a touchscreen display.

[0252] Clause 25. A method according to any of clauses 1 to 24, wherein the user interface includes a plurality of user-selectable inputs corresponding to images to display, the plurality of user-selectable inputs including a first input for displaying a 3D view, a second input for displaying one or more longitudinal images, and a third input for the user to select one or more of the transverse images.

[0253] Clause 26. A method according to any of clauses 1 to 25, wherein the user interface is configured to receive a user input selecting a transverse image from among a plurality of transverse images, and in response to the user input, to provide a two-dimensional (2D) view of the transverse image having a representation overlaid on the 2D view of the transverse image.

[0254] Clause 27. A method according to any of clauses 1 to 26, wherein the user interface is configured to receive user input selecting one or more longitudinal images and, in response to the user input, provide a 2D view of the one or more longitudinal images with a representation overlaid on the 2D view of the one or more longitudinal images.

[0255] Clause 28. The method of any of clauses 1 to 27, wherein a plurality of transverse images intersect one or more longitudinal images at a plurality of corresponding locations.

[0256] Clause 29. The method of any of clauses 1 to 28, wherein the plurality of transverse images comprises volumetric pixels (voxels) that overlap with one or more longitudinal images at a plurality of corresponding locations.

[0257] Clause 30. The method of any of clauses 1 to 29, wherein each of the plurality of transverse images is viewed substantially perpendicular to the one or more longitudinal images in the 3D view, optionally within 5 degrees of perpendicular.

[0258] Clause 31. The method of any of clauses 1 to 30, wherein the 3D views include a plurality of transverse images and an oblique view of one or more longitudinal images.

[0259] Clause 32. The method of any of clauses 1 to 31, wherein the plurality of transverse images and one or more longitudinal images comprise images from a 3D tomographic image.

[0260] Clause 33. The method of any of clauses 1 to 32, wherein the plurality of transverse images and one or more longitudinal images comprise ultrasound images, and optionally the ultrasound images comprise images from an ultrasound probe inserted into the patient.

[0261] Clause 34. The method of any of clauses 1 to 33, wherein the one or more longitudinal images comprise a plurality of longitudinal images.

[0262] Clause 35. The method of any of clauses 1 to 34, wherein the plurality of longitudinal images are generated from a 3D volumetric image of the tissue.

[0263] Clause 36. The method of any of clauses 1 to 35, wherein a plurality of longitudinal images are generated in response to a plurality of angles of an energy source for treating tissue.

[0264] Clause 37. The method of any of clauses 1-36, wherein the plurality of longitudinal images includes a first longitudinal image along a first portion of the treatment profile and a second longitudinal image along a second portion of the treatment profile.

[0265] Clause 38. A method according to any of clauses 1 to 37, wherein the array represents a portion of a first longitudinal image along a first portion of the treatment profile and a portion of a second longitudinal image along a second portion of the treatment profile.

[0266] Clause 39. The method of any of clauses 1-38, wherein the first longitudinal image includes a first transparency along a first portion of the treatment profile and a second transparency along a second portion of the treatment profile that is greater than the first transparency to enhance visibility of the second longitudinal image along the second portion.

[0267] Clause 40. The method of any of clauses 1-39, wherein the second longitudinal image includes a first transparency along a first portion of the treatment profile and a second transparency along a second portion of the treatment profile, the first transparency being greater than the second transparency to enhance visibility of the first longitudinal image along the first portion of the treatment profile.

[0268] Clause 41. The method of any of clauses 1 to 40, wherein the plurality of longitudinal images includes a first longitudinal image at a first angle relative to the axis of rotation and a second longitudinal image at a second angle relative to the axis of translation.

[0269] Clause 42. The method of any of clauses 1 to 41, wherein the first angle corresponds to a first angle of rotation of the energy source about the axis and the second angle corresponds to a second angle of rotation of the energy source, and optionally the first angle and the second angle correspond to angles of rotation of the energy source inserted into the patient.

[0270] Clause 43. A method according to any of clauses 1 to 42, wherein the first longitudinal image extends along a first portion of the treatment profile at a first angle and the second portion of the longitudinal image extends along a second portion of the treatment profile at a second angle.

[0271] Clause 44. The method of any of clauses 1 to 43, wherein the plurality of longitudinal images comprises at least three longitudinal images, each at a different rotational angle relative to the elongated axis of the treatment probe.

[0272] Clause 45. A method of generating a treatment plan, the method comprising: receiving a plurality of transverse images of tissue to be treated; determining, for each of the plurality of transverse images, a position of a treatment probe and a boundary of the tissue, the boundary defining an area of ​​the tissue; determining, for each of the plurality of transverse images, a first treatment angle from the treatment probe to a first treatment location on a first side of the area responsive to the boundary, and a second treatment angle from the treatment probe to a second treatment location on a second side of the area responsive to the boundary; and generating a treatment plan responsive to the first treatment angle and the second treatment angle for each of the plurality of transverse images.

[0273] Clause 46. The method of clause 45, wherein the first treatment angle is oriented to provide a first tissue margin on a first side and the second treatment angle is oriented to provide a second tissue margin on a second side.

[0274] Clause 47. The method of any of clauses 45-46, wherein a first treatment angle is selected to provide a first tissue margin thickness at the first treatment angle that is greater than the penetration depth of the energy source at the first angle, and a second treatment angle is selected to provide a second tissue margin thickness at a second angle that is greater than the penetration depth of the energy source at the second angle.

[0275] Clause 48. The method of any of clauses 45-47, wherein the first tissue margin corresponds to a first tissue margin angle between the first treatment angle and a first angle of a first margin of the first side boundary, and the second tissue margin corresponds to a second tissue margin angle between the second treatment angle and a second angle of a second margin of the second side boundary.

[0276] Clause 49. The method of any of clauses 45 to 48, wherein the first tissue margin angle is in the range of about 1 degree to about 15 degrees, optionally in the range of about 1 degree to about 10 degrees, and further optionally in the range of about 2 degrees to about 10 degrees.

[0277] Clause 50. The method of any of clauses 45-49, wherein the second tissue margin angle is in the range of about 1 degree to about 15 degrees, optionally in the range of about 1 degree to about 10 degrees, and further optionally in the range of about 2 degrees to about 10 degrees.

[0278] Clause 51. The method of any of clauses 45-50, wherein the treatment plan corresponds to a first penetration depth of the energy source at a first treatment angle, the first tissue margin includes a first margin thickness at the first treatment angle, and the first margin thickness is greater than the first depth.

[0279] Clause 52. The method of any of clauses 45-51, wherein the first margin thickness is greater than the first penetration depth by an amount in the range of about 1% to about 15%, optionally in the range of about 1% to about 10%, and further optionally in the range of about 2% to about 10%.

[0280] Clause 53. The method of any of clauses 45-52, wherein the treatment plan corresponds to a second penetration depth of the energy source at a second treatment angle, the second tissue margin includes a second margin thickness corresponding to the first treatment angle, and the second margin thickness is greater than the second penetration depth.

[0281] Clause 54. The method of any of clauses 45-53, wherein the second margin thickness is greater than the second penetration depth by an amount in the range of about 1% to about 15%, optionally in the range of about 1% to about 10%, and further optionally in the range of about 2% to about 10%.

[0282] Clause 55. A method according to any of clauses 45 to 54, wherein the first treatment angle is determined according to a first boundary angle between the treatment probe and the tissue boundary on the first side, and the second treatment angle is determined according to a second boundary angle between the treatment probe and the tissue boundary on the second side.

[0283] Clause 56. The method of any of clauses 45-55, wherein the first treatment angle and the first boundary angle are arranged to provide a first tissue margin between the first treatment angle and the first boundary angle, and the second treatment angle and the second boundary angle are arranged to provide a second tissue margin between the second angle and the second boundary angle.

[0284] Clause 57. A method according to any of clauses 45 to 56, wherein a first boundary angle is determined from the treatment probe to a first margin of the boundary on a first side, and a second boundary angle is determined from the treatment probe to a second margin of the boundary on a second side.

[0285] Clause 58. The method of any of clauses 45 to 57, wherein the first boundary angle corresponds to a first projection line from the probe to the first boundary location that is tangent to the boundary on the first side, and the second margin of the tissue boundary corresponds to a second projection line from the probe that is tangent to the boundary on the second side.

[0286] Clause 59. A method according to any of clauses 45 to 58, wherein a first tissue margin extends between a first margin of the first lateral boundary and the first treatment location, and a second tissue margin extends between a second margin of the second lateral boundary and the second treatment location.

[0287] Clause 60. The method of any of clauses 45 to 59, wherein for each of the plurality of transverse images, the treatment plan is configured to treat tissue according to a treatment profile corresponding to a first treatment angle and a second treatment angle.

[0288] Clause 61. The method of any of clauses 45-60, wherein the treatment profile includes a variable thickness between the first treatment angle and the second treatment angle.

[0289] Clause 62. The method of any of clauses 45-61, wherein the treatment profile includes a substantially uniform thickness between the first treatment angle and the second treatment angle, and optionally, the substantially uniform thickness is uniform to within 20%.

[0290] Clause 63. The method of any of clauses 45 to 62, wherein the treatment profile is separated from the probe by a gap between the probe and the treatment profile.

[0291] Clause 64. The method of any of clauses 45 to 63, wherein the variable thickness includes a first thickness corresponding to a first treatment angle, a second thickness corresponding to a second treatment angle, and a central thickness at an angle between the first angle and the second angle, and the central thickness of the treatment profile is greater than the first thickness and the second thickness.

[0292] Clause 65. The method of any of clauses 45-64, wherein the treatment plan is configured to treat the first thickness and the second thickness with a first scan of energy from the energy source between the first treatment angle and the second treatment angle, and to treat the central thickness with the first scan and the second scan of energy from the energy source.

[0293] Clause 66. A method according to any of clauses 45 to 65, wherein the first scan comprises a first rotational scan of the energy source between a first treatment angle and a second treatment angle, and the second scan comprises a second rotational scan of the energy source, the second rotational scan comprising a smaller rotational angle than the first rotational scan.

[0294] Clause 67. The method of any of clauses 45-66, wherein the treatment plan is configured to remove tissue at multiple thicknesses and at multiple corresponding angles between the first treatment angle and the second treatment angle.

[0295] Clause 68. A method according to any of clauses 45 to 67, wherein the treatment plan is configured to remove tissue to a first depth with a first pass of the energy source at a first angular subsense between the first treatment angle and the second treatment angle, and to remove tissue to a second depth with a second pass of the energy source corresponding to a second angular subsense that is smaller than the first angular subsense, the second depth being greater than the first depth.

[0296] Clause 69. The method of any of clauses 45 to 68, wherein the second viewing angle corresponds to a third location on the first side of the area and a fourth location on the second side of the area.

[0297] Clause 70. The method of any of clauses 45 to 69, wherein the third location is located at or below the first removal depth, and the fourth location is located at or below the first removal depth.

[0298] Clause 71. The method of any of clauses 45-70, wherein each of the plurality of thicknesses comprises a distance from a proximal location of the boundary to a distal location of the boundary for a plurality of corresponding treatment angle angles.

[0299] Clause 72. The method of any of clauses 45-71, wherein the treatment plan is configured to adjust one or more of the intensity of energy from the energy source, the power of energy from the energy source, the translational speed of the energy source, the rotational speed of the energy source, or the number of passes of the energy source at multiple corresponding angles to treat tissue according to multiple thicknesses.

[0300] Clause 73. The method of any of clauses 45 to 72, wherein the treatment profile includes a plurality of thicknesses corresponding to a plurality of rotation angles of the energy source, each of the plurality of thicknesses being determined for a corresponding treatment angle of the plurality of rotation angles.

[0301] Clause 74. A method according to any one of clauses 45 to 73, wherein the probe is separated from the boundary by the closest distance at the location of the boundary closest to the probe and by the furthest distance at the location of the boundary farthest from the probe.

[0302] Clause 75. The method of any of clauses 45-74, wherein the first location of the first treatment angle is a first distance away from the probe and the second location of the second treatment angle is a second distance away from the probe.

[0303] Clause 76. The method of any of clauses 45 to 75, wherein the boundary includes a boundary of an anatomical tissue structure a distance away from the probe, and the treatment plan is configured to adjust the delivery of energy from the energy source according to the distance and the first treatment angle and the second angle from each of the plurality of transverse images.

[0304] Clause 77. The method of any of clauses 45 to 76, wherein the boundary surrounds the anatomical tissue structure and optionally includes a perimeter around the anatomical tissue structure in each of the plurality of transverse images.

[0305] Clause 78. A method according to any of clauses 45 to 77, wherein the boundary is determined for each of the plurality of transverse images by an artificial intelligence algorithm.

[0306] Clause 79. A method according to any of clauses 45 to 78, wherein the location of the probe corresponds to the location of the directed energy source during treatment for each of the plurality of transverse images, the first angle corresponds to a first angle of the directed energy source during treatment, and the second angle corresponds to a second angle of the energy source during treatment.

[0307] Clause 80. The method of any of clauses 45 to 79, wherein the first angle and the second angle of each of the plurality of transverse images correspond to a plurality of treatment angles of a three-dimensional (3D) treatment plan.

[0308] Clause 81. The method of any of clauses 45 to 80, wherein the first angle and the second angle from each of the plurality of transverse images are combined to generate a 3D treatment plan.

[0309] Clause 82. A method according to any of clauses 45 to 81, wherein the plurality of transverse images are positioned along a treatment axis corresponding to the axial translation of a directed energy source on the probe during treatment, and each of the plurality of transverse images is positioned at a position along the treatment axis.

[0310] Clause 83. The method of any of clauses 45-82, wherein the treatment plan is configured to, for each of a plurality of locations along the treatment axis, rotate the probe to direct energy from the energy source at a first angle to the first location and at a second angle to the second location.

[0311] Clause 84. The method of any of clauses 45 to 83, wherein the treatment plan is configured to rotate the energy source from a first angle to a second angle and scan the energy source across the tissue between the first angle and the second angle.

[0312] Clause 85. The method of any of clauses 45-84, wherein the treatment plan includes machine-readable instructions for moving the probe to multiple axial locations along the treatment probe axis and rotating the probe to multiple angles to deliver energy from the energy source at multiple axial locations and multiple angles.

[0313] Clause 86. The method of any of clauses 45-85, wherein the treatment plan includes a first angle and a second angle for each of the plurality of locations, and wherein the method is configured to scan the energy source along the tissue between the first angle and the second angle at each of the plurality of axial locations.

[0314] Clause 87. The method of any of clauses 45-86, wherein the treatment plan is configured to adjust one or more of the intensity of energy from the energy source, the power of energy from the energy source, the translation of the probe along the treatment probe axis, the rotation of the probe about the treatment probe axis, the translation speed of the treatment probe, the rotation speed of the treatment probe, or the number of passes of the energy source along the tissue to treat the tissue to different depths according to a treatment profile.

[0315] Clause 88. The method of any of clauses 45-87, wherein the treatment plan is configured to fix the axial position of the treatment probe, rotate the treatment probe in the axial position, and scan energy from the energy source along the tissue in a first pass between a first angle and a second pass between a second angle in the axial position.

[0316] Clause 89. A method according to any of clauses 45 to 88, wherein the first portion of tissue between the first angle does not overlap with the second angle to treat the tissue to a first depth in the first pass, and the second angle overlaps with the first angle to treat the tissue to a second depth in the first pass and the second pass.

[0317] Clause 90. The method of any of clauses 45-89, wherein the treatment plan is configured to fix a rotation angle of the treatment probe about the elongate probe axis, translate the treatment probe at the rotation angle, and scan energy from the energy source along the tissue in a first pass between first translation locations at the rotation angle and a second pass between second translation locations.

[0318] Clause 91. A method according to any of clauses 45 to 90, wherein the treatment plan is configured to increase the translational velocity of the energy source on the treatment probe to decrease the treatment depth and to decrease the translational velocity to increase the treatment depth.

[0319] Clause 92. A method according to any of clauses 45 to 91, wherein the treatment plan is configured to increase the rotational speed of the energy source on the treatment probe to decrease the treatment depth and to decrease the rotational speed to increase the treatment depth.

[0320] Clause 93. A method according to any of clauses 45 to 92, wherein each of the plurality of transverse images includes a second tissue, a boundary of the second tissue is determined, and an output to a user interface is generated in response to the location of the boundary of the second tissue.

[0321] Clause 94. The method of any of clauses 45-93, wherein the location of the second tissue boundary is between the first angle and the second angle, and the output is generated in response to the location of the second tissue boundary being between the first angle and the second angle.

[0322] Clause 95. The method of any of clauses 45-94, wherein a first tissue boundary is located between a second tissue boundary, and the output is generated as a function of the distance between the probe and the location of the second tissue boundary.

[0323] Clause 96. The method of any of clauses 45 to 95, wherein the treatment plan includes a rotation angle of the energy source beyond a margin of the first tissue boundary, and wherein the output is generated in response to the rotation angle beyond the margin.

[0324] Clause 97. The method of any of clauses 45-96, wherein the treatment plan corresponds to a penetration depth of the energy source that exceeds the thickness of the tissue, and the output is generated in response to a penetration depth that is greater than the thickness.

[0325] Clause 98. The method of any of clauses 45-97, wherein the thicknesses include a plurality of thicknesses at a plurality of rotation angles of the energy source, each of the plurality of thicknesses being determined for a corresponding angle of the plurality of rotation angles.

[0326] Clause 99. The method of any of clauses 45-98, wherein each of the plurality of thicknesses comprises a distance between a first location of the first tissue boundary and a second location of the first tissue boundary at a corresponding angle, and a penetration depth is determined for each of the plurality of thicknesses.

[0327] Clause 100. A method according to any of clauses 45 to 99, wherein the output to the user interface includes feedback to the user, and optionally the feedback includes one or more of a notification or a warning.

[0328] Clause 101. The method of any of clauses 45 to 100, wherein the output to the user interface is configured to allow the user to adjust the treatment profile shown in one or more of the plurality of transverse images in response to feedback.

[0329] Clause 102. A method according to any of clauses 45 to 101, wherein the treatment profile substantially surrounds an area and the user interface is configured to allow the user to adjust the treatment profile relative to the area by moving the treatment profile as shown on the display for each of the plurality of transverse images.

[0330] Clause 103. The method of any of clauses 45 to 102, wherein the user interface is configured to allow a user to adjust one or more of the angle of the treatment profile relative to the probe or the depth of the treatment profile relative to the probe.

[0331] Clause 104. A method according to any of clauses 45 to 103, wherein a boundary of the first tissue, a boundary of the second tissue, and a treatment profile are shown on each of the plurality of transverse images, and the user interface is configured to adjust the treatment profile on the plurality of transverse images.

[0332] Clause 105. The method of any of clauses 45 to 104, wherein the boundary of the first tissue and the boundary of the second tissue are determined by an AI algorithm.

[0333] Clause 106. The method of any of clauses 45 to 105, wherein the first tissue comprises a first anatomical tissue structure and the second tissue comprises a second anatomical tissue structure different from the first anatomical tissue structure.

[0334] Clause 107. The method of any of clauses 45 to 106, wherein the first anatomical tissue structure comprises an anatomical tissue structure of a first organ and the second anatomical tissue structure comprises a second anatomical tissue structure of a second organ different from the first organ.

[0335] Clause 108. The first anatomical tissue structure comprises one or more of the anatomical structures of the first tissue structure, including one or more of a tissue wall, a vesicle, a lumen, a wall of a lumen, a bladder, a wall of the bladder, a neck of the bladder, a wall of the bladder neck, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a wall of a ureter, a prostate, a lobe of the prostate, an intravesical prostatic protrusion, a capsule of the prostate, an internal and external sphincter, an artery, a wall of an artery, a vein, a wall of a vein, or a lens of an eye, and the second anatomical tissue structure comprises one or more of the anatomical structures of the first tissue structure, including one or more of a tissue wall, a vesicle, a lumen, a wall of a lumen, a bladder, a wall of the bladder, a neck of the bladder, a wall of the bladder neck, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a wall of a ureter, a prostate, a lobe of the prostate, an intravesical prostatic protrusion, a capsule of the prostate, an internal and external sphincter, an artery, a wall of an artery, a vein, a wall of a vein, or a lens of an eye. 108. The method of any of clauses 45-107, wherein the second tissue structure comprises one or more of the anatomical structures, including one or more of a tissue wall, a vesicle, a lumen, a wall of a lumen, a bladder, a wall of the bladder, a bladder neck, a wall of the bladder neck, a trigone tissue, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a wall of a ureter, a prostate, a prostate lobe, an intravesical prostatic protrusion, a capsule of the prostate, a verumontanum of the prostate, an internal and external sphincter, an artery, a wall of an artery, a vein, a wall of a vein, or a retina of an eye.

[0336] Clause 109. The method of any of clauses 45-108, wherein the first anatomical tissue structure comprises an intravesical prostatic protrusion of the prostate gland and the second anatomical tissue structure comprises the trigone of the bladder.

[0337] Clause 110. A method or apparatus according to any one of the preceding clauses, wherein the treatment comprises one or more of ablation, resection, or irradiation of tissue.

[0338] Clause 111. A method according to any of the preceding clauses, wherein the method comprises treating a patient.

[0339] Clause 112. An apparatus including a processor configured to perform the method of any of the preceding clauses.

[0340] Clause 113. A method or apparatus according to any preceding clause, wherein the one or more longitudinal images include one or more of a sagittal image or a parasagittal image.

[0341] Clause 114. A method or apparatus according to any of the preceding clauses, wherein the plurality of transverse images extend transversely to the one or more longitudinal images and, optionally, perpendicularly to the one or more longitudinal images.

[0342] Clause 115. The method or apparatus of any of the preceding clauses, wherein the plurality of transverse images and the one or more longitudinal images are rotated to align the one or more longitudinal images with the elongated axis of the treatment probe.

[0343] Clause 116. A method or apparatus according to any of the preceding clauses, wherein the processor comprises instructions for determining a 3D treatment profile of the tissue using an AI algorithm, and instructions for providing the 3D treatment profile on a display for a user to perform one or more of verifying or adjusting the 3D treatment profile.

[0344] The embodiments of the present disclosure have been shown and described herein and are provided by way of example only. Those skilled in the art will recognize numerous adaptations, modifications, variations, and substitutions without departing from the scope of the present disclosure. Several alternatives and combinations of the embodiments disclosed herein may be utilized without departing from the scope of the present disclosure and the invention(s) disclosed herein. Accordingly, the scope of the invention(s) of the present disclosure shall be defined solely by the scope of the appended claims and their equivalents.

Claims

1. 1. A method of planning a treatment, said method comprising: receiving a plurality of transverse images and one or more longitudinal images of the tissue; generating an array of the plurality of transverse images along the one or more longitudinal images in a three-dimensional (3D) view, the three-dimensional view including the plurality of transverse images at a plurality of corresponding locations along the one or more longitudinal images; overlaying a representation of a three-dimensional (3D) treatment profile onto the 3D view of the plurality of transverse images and the one or more longitudinal images; providing, on a display of a user interface, the 3D view having the representation overlaid on one or more of the one or more longitudinal images and the plurality of transverse images; A method comprising:

2. 2. The method of claim 1, wherein in the 3D view, the plurality of transverse images includes a first portion on a first side of the one or more longitudinal images and a second portion on a second side of the one or more longitudinal images, the first portion being in front of the one or more longitudinal images and the second portion being behind the one or more longitudinal images.

3. 3. The method of claim 2, wherein the representation of the 3D treatment profile is overlaid on the 3D view on the first portion and the one or more longitudinal images, the 3D representation extending along the first portion and the one or more longitudinal images from a common location where the first portion intersects with the one or more longitudinal images.

4. The method of claim 2 , wherein the one or more longitudinal images include a sufficient amount of transparency to allow the second portion of one or more of the transverse images to be viewed through the one or more longitudinal images.

5. 5. The method of claim 4, wherein the representation of the 3D treatment profile is overlaid on the second portion of the second side, and the amount of transparency is sufficient to allow the representation of the 3D treatment profile of the second side to be seen through the one or more longitudinal images.

6. 2. The method of claim 1, wherein the array comprises a three-dimensional (3D) array, and the user interface comprises inputs for a user to one or more of zoom, pan, or rotate the 3D array in the 3D view.

7. 7. The method of claim 6, wherein the representation of the 3D treatment profile moves with the 3D array to maintain alignment of the 3D treatment profile with the 3D array in response to the user input to one or more of zooming, panning, or rotating the 3D representation.

8. 8. The method of claim 7, wherein the user input is configured to rotate the one or more longitudinal images and the plurality of transverse images from a first orientation to a second orientation, the first orientation showing a first portion of the plurality of transverse images before the one or more longitudinal images and a second portion of the plurality of transverse images after the one or more longitudinal images, and the second orientation showing the second portion of the plurality of transverse images before the one or more longitudinal images and the second portion of the transverse images after the one or more longitudinal images.

9. 8. The method of claim 7, wherein a representation of a treatment probe is shown extending along the one or more longitudinal images, the representation of the treatment probe moving with the 3D array and the 3D treatment profile to maintain alignment of the representation of the treatment probe with the 3D array and the 3D treatment profile.

10. The method of claim 1 , wherein the representation of the 3D treatment profile includes a three-dimensional (3D) treatment volume overlaid on the array.

11. 11. The method of claim 10, wherein the 3D treatment volume extends longitudinally along the one or more longitudinal images and transversely to the one or more longitudinal images along one or more transverse images.

12. 12. The method of claim 11 , wherein an outer boundary of the 3D treatment volume is shown extending along the one or more longitudinal images transverse to the one or more longitudinal images and longitudinally along the transverse images.

13. The method of claim 1 , wherein a representation of a treatment probe is shown in the longitudinally extending 3D view.

14. The method of claim 13 , wherein the representation includes an animation of the treatment probe.

15. The method of claim 14 , wherein the animation of the treatment probe is configured to move to show an animation of the treatment probe delivering energy from an energy source according to a 3D treatment plan.

16. The method of claim 13 , wherein the representation includes an image of the treatment probe from an imaging device.

17. The method of claim 1 , wherein the representation of the 3D treatment profile in the 3D view includes an intersection of the 3D treatment profile with one or more of the one or more longitudinal images and the plurality of transverse images.

18. The method of claim 1 , wherein the plurality of transverse images correspond to a plurality of predetermined anatomical locations of an organ.

19. 20. The method of claim 18, wherein the plurality of predetermined anatomical locations include anatomical locations of a first organ and a second organ, the first organ and the second organ being visible in one or more of the one or more longitudinal images and the transverse images.

20. 20. The method of claim 19, wherein the plurality of predetermined anatomical locations are identified with an artificial intelligence algorithm.

21. 20. The method of claim 19, wherein the first organ comprises a prostate and the second organ comprises a bladder.

22. 22. The method of claim 21, wherein the plurality of predetermined anatomical locations include an intravesical prostatic protrusion (IPP), a bladder neck (BL), a prostate (MID), a verumontanum (VERU), and a peripheral sphincter (P.SPH).

23. 2. The method of claim 1, wherein the user interface is configured to receive user input identifying a selected image from among the one or more longitudinal images and the plurality of transverse images to be shown in the 3D view, and to display the selected image in a 2D view.

24. 24. The method of claim 23, wherein the user input corresponds to a location of the selected image in the 3D view and user input at the location using a pointing device or a touchscreen display.

25. 2. The method of claim 1, wherein the user interface includes a plurality of user-selectable inputs corresponding to images to display, the plurality of user-selectable inputs including a first input for displaying the 3D view, a second input for displaying the one or more longitudinal images, and a third input for the user to select one or more of the transverse images.

26. 2. The method of claim 1, wherein the user interface is configured to receive a user input selecting a transverse image from among the plurality of transverse images and, in response to the user input, provide a two-dimensional (2D) view of the transverse image with the representation overlaid on the 2D view of the transverse image.

27. The method of claim 1 , wherein the user interface is configured to receive user input selecting the one or more longitudinal images and, in response to the user input, provide a 2D view of the one or more longitudinal images with the representation overlaid on the 2D view of the one or more longitudinal images.

28. The method of claim 1 , wherein the plurality of transverse images intersect the one or more longitudinal images at the plurality of corresponding locations.

29. 30. The method of claim 28, wherein the plurality of transverse images includes volumetric pixels (voxels) that overlap with the one or more longitudinal images at the plurality of corresponding locations.

30. The method of claim 1 , wherein each of the plurality of transverse images is viewed substantially perpendicular to the one or more longitudinal images in the 3D view, optionally within 5 degrees of perpendicular.

31. The method of claim 1 , wherein the 3D views include perspective views of the plurality of transverse images and the one or more longitudinal images.

32. The method of claim 1 , wherein the plurality of transverse images and the one or more longitudinal images comprise images from a 3D tomographic image.

33. 10. The method of claim 1, wherein the plurality of transverse images and the one or more longitudinal images comprise ultrasound images, and optionally the ultrasound images comprise images from an ultrasound probe inserted into the patient.

34. The method of claim 1 , wherein the one or more longitudinal images comprises a plurality of longitudinal images.

35. 35. The method of claim 34, wherein the plurality of longitudinal images are generated from a 3D volumetric image of the tissue.

36. 36. The method of claim 35, wherein the plurality of longitudinal images are generated in response to a plurality of angles of an energy source for treating the tissue.

37. 35. The method of claim 34, wherein the plurality of longitudinal images includes a first longitudinal image along a first portion of the treatment profile and a second longitudinal image along a second portion of the treatment profile.

38. 38. The method of claim 37, wherein the array shows a portion of the first longitudinal image along the first portion of the treatment profile and a portion of the second longitudinal image along the second portion of the treatment profile.

39. 38. The method of claim 37, wherein the first longitudinal image includes a first transparency along the first portion of the treatment profile and a second transparency along the second portion of the treatment profile that is greater than the first transparency to enhance visibility of the second longitudinal image along the second portion.

40. 40. The method of claim 39, wherein the second longitudinal image includes a first transparency along the first portion of the treatment profile and a second transparency along the second portion of the treatment profile, the first transparency being greater than the second transparency to enhance visibility of the first longitudinal image along the first portion of the treatment profile.

41. 35. The method of claim 34, wherein the plurality of longitudinal images includes a first longitudinal image at a first angle relative to an axis of rotation and a second longitudinal image at a second angle relative to an axis of translation.

42. 42. The method of claim 41 , wherein the first angle corresponds to a first angle of rotation of an energy source about the axis and the second angle corresponds to a second angle of rotation of an energy source, optionally wherein the first angle and the second angle correspond to angles of rotation of an energy source inserted into the patient.

43. 42. The method of claim 41, wherein the first longitudinal image extends along a first portion of the treatment profile at the first angle and the second portion of the longitudinal image extends along a second portion of the treatment profile at the second angle.

44. 35. The method of claim 34, wherein the plurality of longitudinal images comprises at least three longitudinal images, each at a different rotational angle relative to the elongated axis of the treatment probe.

45. 1. A method for generating a treatment plan, the method comprising: receiving a plurality of transverse images of the tissue to be treated; determining a position of a treatment probe and a boundary of the tissue for each of the plurality of transverse images, the boundary defining an area of ​​the tissue; determining, for each of the plurality of transverse images, a first treatment angle from the treatment probe to a first treatment location on a first side of the area according to the boundary, and a second treatment angle from the treatment probe to a second treatment location on a second side of the area according to the boundary; generating the treatment plan in response to the first treatment angle and the second treatment angle for each of the plurality of transverse images; A method comprising:

46. 46. ​​The method of claim 45, wherein the first treatment angle is oriented to provide a first tissue margin on the first side and the second treatment angle is oriented to provide a second tissue margin on the second side.

47. 46. ​​The method of claim 45, wherein the first treatment angle is selected to provide a first tissue margin thickness at the first treatment angle that is greater than a penetration depth of the energy source at the first angle, and the second treatment angle is selected to provide a second tissue margin thickness at the second angle that is greater than a penetration depth of the energy source at the second angle.

48. 47. The method of claim 46, wherein the first tissue margin corresponds to a first tissue margin angle between the first treatment angle and a first angle of a first margin of the boundary on the first side, and the second tissue margin corresponds to a second tissue margin angle between the second treatment angle and a second angle of a second margin of the boundary on the second side.

49. 49. The method of claim 48, wherein the first tissue margin angle is in the range of about 1 degree to about 15 degrees, optionally in the range of about 1 degree to about 10 degrees, and further optionally in the range of about 2 degrees to about 10 degrees.

50. 49. The method of claim 48, wherein the second tissue margin angle is in the range of about 1 degree to about 15 degrees, optionally in the range of about 1 degree to about 10 degrees, and further optionally in the range of about 2 degrees to about 10 degrees.

51. 47. The method of claim 46, wherein the treatment plan corresponds to a first penetration depth of the energy source at the first treatment angle, and the first tissue margin includes a first margin thickness at the first treatment angle, the first margin thickness being greater than the first depth.

52. 51. The method of claim 50, wherein the first margin thickness is greater than the first penetration depth by an amount in the range of about 1% to about 15%, optionally in the range of about 1% to about 10%, and further optionally in the range of about 2% to about 10%.

53. 47. The method of claim 46, wherein the treatment plan corresponds to a second penetration depth of the energy source at the second treatment angle, the second tissue margin includes a second margin thickness corresponding to the first treatment angle, the second margin thickness being greater than the second penetration depth.

54. 54. The method of claim 53, wherein the second margin thickness is greater than the second penetration depth by an amount in the range of about 1% to about 15%, optionally in the range of about 1% to about 10%, and further optionally in the range of about 2% to about 10%.

55. 46. ​​The method of claim 45, wherein the first treatment angle is determined according to a first boundary angle between the treatment probe and the boundary of the tissue on the first side, and the second treatment angle is determined according to a second boundary angle between the treatment probe and the boundary of the tissue on the second side.

56. 56. The method of claim 55, wherein the first treatment angle and the first boundary angle are arranged to provide a first tissue margin between the first treatment angle and the first boundary angle, and the second treatment angle and the second boundary angle are arranged to provide a second tissue margin between the second angle and the second boundary angle.

57. 56. The method of claim 55, wherein the first boundary angle is determined from the treatment probe to a first margin of the boundary on the first side, and the second boundary angle is determined from the treatment probe to a second margin of the boundary on the second side.

58. 58. The method of claim 57, wherein the first boundary angle corresponds to a first projection line from the probe to a first boundary location that is tangent to the boundary on the first side, and the second margin of the tissue boundary corresponds to a second projection line from the probe that is tangent to the boundary on the second side.

59. 58. The method of claim 57, wherein the first tissue margin extends between the first margin of the boundary on the first side and the first treatment location, and the second tissue margin extends between the second margin of the boundary on the second side and the second treatment location.

60. 46. ​​The method of claim 45, wherein for each of the plurality of transverse images, the treatment plan is configured to treat tissue according to a treatment profile corresponding to the first treatment angle and the second treatment angle.

61. 61. The method of claim 60, wherein the treatment profile comprises a variable thickness between the first treatment angle and the second treatment angle.

62. 61. The method of claim 60, wherein the treatment profile comprises a substantially uniform thickness between the first treatment angle and the second treatment angle, optionally wherein the substantially uniform thickness is uniform to within 20%.

63. 61. The method of claim 60, wherein the treatment profile is separated from the probe with a gap between the probe and the treatment profile.

64. 62. The method of claim 61 , wherein the variable thickness includes a first thickness corresponding to the first treatment angle, a second thickness corresponding to the second treatment angle, and a central thickness at an angle between the first angle and the second angle, the central thickness of the treatment profile being greater than the first thickness and the second thickness.

65. 65. The method of claim 64, wherein the treatment plan is configured to treat the first thickness and the second thickness with a first scan of energy from the energy source between the first treatment angle and the second treatment angle, and to treat the central thickness with the first scan and second scan of energy from the energy source.

66. 66. The method of claim 65, wherein the first scan comprises a first rotational scan of the energy source between the first treatment angle and the second treatment angle, and the second scan comprises a second rotational scan of the energy source, the second rotational scan comprising a smaller rotation angle than the first rotational scan.

67. 61. The method of claim 60, wherein the treatment plan is configured to remove tissue at multiple thicknesses and at multiple corresponding angles between the first treatment angle and the second treatment angle.

68. 68. The method of claim 67, wherein the treatment plan is configured to remove tissue to a first depth with a first pass of the energy source at a first visual angle between the first treatment angle and the second treatment angle, and to remove tissue to a second depth with a second pass of the energy source corresponding to a second visual angle less than the first visual angle, the second depth being greater than the first depth.

69. 69. The method of claim 68, wherein the second viewing angle corresponds to a third location on the first side of the area and a fourth location on the second side of the area.

70. 70. The method of claim 69, wherein the third location is located at or below the first removal depth and the fourth location is located at or below the first removal depth.

71. 68. The method of claim 67, wherein each of the plurality of thicknesses comprises a distance from a proximal location of the boundary to a distal location of the boundary for a plurality of corresponding treatment angle angles.

72. 68. The method of claim 67, wherein the treatment plan is configured to adjust one or more of an intensity of energy from the energy source, a power of energy from the energy source, a translational speed of the energy source, a rotational speed of the energy source, or a number of passes of the energy source at the plurality of corresponding angles to treat the tissue according to the plurality of thicknesses.

73. 61. The method of claim 60, wherein the treatment profile includes a plurality of thicknesses corresponding to a plurality of rotation angles of the energy source, each of the plurality of thicknesses being determined for a corresponding treatment angle of the plurality of rotation angles.

74. 46. ​​The method of claim 45, wherein the probe is separated from the boundary by the closest distance at the boundary location closest to the probe and by the furthest distance at the boundary location furthest from the probe.

75. 46. ​​The method of claim 45, wherein the first location of the first treatment angle is a first distance away from the probe and the second location of the second treatment angle is a second distance away from the probe.

76. 46. ​​The method of claim 45, wherein the boundary includes a boundary of an anatomical tissue structure a distance away from the probe, and the treatment plan is configured to adjust the delivery of the energy from the energy source according to the distance and the first treatment angle and the second angle from each of the plurality of transverse images.

77. 77. The method of claim 76, wherein the boundary surrounds the anatomical structure and optionally includes a perimeter around the anatomical structure in each of the plurality of transverse images.

78. 46. ​​The method of claim 45, wherein the boundary is determined for each of the plurality of transverse images by an artificial intelligence algorithm.

79. 46. ​​The method of claim 45, wherein the location of the probe corresponds to a location of a directed energy source during treatment for each of the plurality of transverse images, the first angle corresponds to a first angle of the directed energy source during treatment, and the second angle corresponds to a second angle of the energy source during treatment.

80. 46. ​​The method of claim 45, wherein the first angle, the second angle of each of the plurality of transverse images correspond to a plurality of treatment angles of a three-dimensional (3D) treatment plan.

81. 81. The method of claim 80, wherein the first angle and the second angle from each of the plurality of transverse images are combined to generate the 3D treatment plan.

82. 81. The method of claim 80, wherein the plurality of transverse images are positioned along a treatment axis corresponding to axial translation of a directed energy source on the probe during treatment, and wherein each of the plurality of transverse images is positioned at a position along the treatment axis.

83. 83. The method of claim 82, wherein the treatment plan is configured to, for each of the plurality of locations along the treatment axis, rotate the probe to direct energy from an energy source at the first angle to the first location and at the second angle to the second location.

84. 84. The method of claim 83, wherein the treatment plan is configured to rotate the energy source from the first angle to the second angle and scan the energy source across the tissue between the first angle and the second angle.

85. 46. ​​The method of claim 45, wherein the treatment plan includes machine-readable instructions for moving the probe to multiple axial locations along a treatment probe axis, rotating the probe to multiple angles, and delivering energy from an energy source at the multiple axial locations and the multiple angles.

86. 86. The method of claim 85, wherein the treatment plan includes the first angle and the second angle for each of the plurality of locations, and is configured to scan the energy source along the tissue between the first angle and the second angle at each of the plurality of axial locations.

87. 86. The method of claim 85, wherein the treatment plan is configured to adjust one or more of the intensity of energy from the energy source, the power of energy from the energy source, the translation of the probe along the treatment probe axis, the rotation of the probe about the treatment probe axis, the translation speed of the treatment probe, the rotation speed of the treatment probe, or the number of passes of the energy source along the tissue to treat the tissue to different depths according to a treatment profile.

88. 88. The method of claim 87, wherein the treatment plan is configured to fix an axial position of the treatment probe and rotate the treatment probe at the axial position to scan energy from the energy source along the tissue in a first pass through a first angle and a second pass through a second angle at the axial position.

89. 90. The method of claim 88, wherein a first portion of tissue between the first angle does not overlap with the second angle to treat tissue to a first depth in the first pass, and the second angle overlaps with the first angle to treat tissue to a second depth in the first pass and the second pass.

90. 88. The method of claim 87, wherein the treatment plan is configured to fix a rotational angle of the treatment probe about the elongate probe axis, translate the treatment probe at the rotational angle, and scan energy from the energy source along the tissue in a first pass between a first translational location at the rotational angle and a second pass between a second translational location.

91. 86. The method of claim 85, wherein the treatment plan is configured to increase a translational velocity of the energy source on the treatment probe to decrease a treatment depth and to decrease the translational velocity to increase the treatment depth.

92. 86. The method of claim 85, wherein the treatment plan is configured to increase a rotational speed of the energy source on the treatment probe to decrease a treatment depth and to decrease the rotational speed to increase the treatment depth.

93. 46. ​​The method of claim 45, wherein each of the plurality of transverse images includes a second tissue, a boundary of the second tissue is determined, and an output to a user interface is generated in response to a location of the boundary of the second tissue.

94. 94. The method of claim 93, wherein the location of the second tissue boundary is between the first angle and the second angle, and the output is generated in response to the location of the second tissue boundary being between the first angle and the second angle.

95. 94. The method of claim 93, wherein the boundary of the first tissue is located between the boundary of the second tissue, and the output is generated as a function of the distance between the probe and the location of the second tissue boundary.

96. 94. The method of claim 93, wherein the treatment plan includes a rotation angle of an energy source beyond a margin of the boundary of the first tissue, and the output is generated in response to the rotation angle beyond the margin.

97. 94. The method of claim 93, wherein the treatment plan corresponds to a penetration depth of an energy source that exceeds a thickness of the tissue, and wherein the output is generated in response to the penetration depth being greater than the thickness.

98. 98. The method of claim 97, wherein the thickness comprises a plurality of thicknesses at a plurality of rotation angles of the energy source, each of the plurality of thicknesses being determined for a corresponding angle of the plurality of rotation angles.

99. 99. The method of claim 98, wherein each of the plurality of thicknesses comprises a distance between a first location of the first tissue boundary and a second location of the first tissue boundary at the corresponding angle, and wherein the penetration depth is determined for each of the plurality of thicknesses.

100. 94. The method of claim 93, wherein the output to the user interface includes feedback to the user, optionally the feedback including one or more of a notification or a warning.

101. 94. The method of claim 93, wherein the output to the user interface is configured for a user to adjust a treatment profile shown in one or more of the plurality of transverse images in response to the feedback.

102. 102. The method of claim 101, wherein the treatment profile substantially surrounds the area, and the user interface is configured for the user to adjust the treatment profile relative to the area by moving the treatment profile as shown on a display for each of the plurality of transverse images.

103. 102. The method of claim 101, wherein the user interface is configured to allow the user to adjust one or more of an angle of the treatment profile relative to the probe or a depth of the treatment profile relative to the probe.

104. 94. The method of claim 93, wherein the boundary of the first tissue, the boundary of the second tissue, and a treatment profile are shown on each of the plurality of transverse images, and the user interface is configured to adjust the treatment profile on the plurality of transverse images.

105. 94. The method of claim 93, wherein the boundary of the first tissue and the boundary of the second tissue are determined with an AI algorithm.

106. 94. The method of claim 93, wherein the first tissue comprises a first anatomical tissue structure and the second tissue comprises a second anatomical tissue structure that is different from the first anatomical tissue structure.

107. 107. The method of claim 106, wherein the first anatomical tissue structure comprises an anatomical tissue structure of a first organ and the second anatomical tissue structure comprises a second anatomical tissue structure of a second organ different from the first organ.

108. The first anatomical tissue structure includes one or more of the anatomical structures of the first tissue structure, including one or more of a tissue wall, a vesicle, a lumen, a wall of a lumen, a bladder, a wall of a bladder, a bladder neck, a wall of a bladder neck, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a wall of a ureter, a prostate, a prostate lobe, an intravesical prostatic protrusion, a capsule of the prostate, an internal and external sphincter, an artery, a wall of an artery, a vein, a wall of a vein, or a lens of an eye; and the second anatomical tissue structure includes one or more of the anatomical structures of the first tissue structure, including one or more of a tissue wall, a vesicle, a lumen, a wall of a lumen, a bladder, a wall of a bladder, a neck of the bladder, a wall of a bladder neck, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a wall of a ureter, a prostate, a lobe of the prostate, an intravesical prostatic protrusion, a capsule of the prostate, an internal and external sphincter, an artery, a wall of an artery, a vein, a wall of a vein, or a lens of an eye.

109. The method of claim 108, wherein the second tissue structure comprises one or more of the anatomical structures, including one or more of a tissue wall, a vesicle, a lumen, a wall of a lumen, a bladder, a wall of the bladder, a bladder neck, a wall of the bladder neck, a trigone tissue, a ureteral orifice, an internal urethral orifice, an external urethral sphincter, a ureter, a wall of a ureter, a prostate, a lobe of the prostate, an intravesical prostatic protrusion, a capsule of the prostate, a verumontanum of the prostate, an internal and external sphincter, an artery, a wall of an artery, a vein, a wall of a vein, or a retina of an eye.

109. 109. The method of claim 108, wherein the first anatomical structure comprises the intravesical prostatic prominence of the prostate gland and the second anatomical structure comprises the trigone of the bladder.

110. 10. The method or apparatus of any preceding claim, wherein treatment comprises one or more of ablation, ablation, or irradiation of the tissue.

111. 10. The method of any preceding claim, wherein the method comprises treating the patient.

112. 10. An apparatus comprising a processor configured to perform the method of any one of the preceding claims.

113. 10. The method or apparatus of any preceding claim, wherein the one or more longitudinal images include one or more of a sagittal image or a parasagittal image.

114. 10. A method or apparatus according to any preceding claim, wherein the plurality of transverse images extend transversely to the one or more longitudinal images, and optionally extend perpendicularly to the one or more longitudinal images.

115. 10. The method or apparatus of claim 1, wherein the plurality of transverse images and the one or more longitudinal images are rotated to align the one or more longitudinal images with an elongated axis of a treatment probe.

116. 10. The method or apparatus of any preceding claim, wherein the processor is configured with instructions for determining a 3D treatment profile of the tissue using an AI algorithm, and instructions for providing the 3D treatment profile on a display for a user to one or more of verify or adjust the 3D treatment profile.

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