Surgical Instrument Wearable Display System

Abstract

A C-arm or mobile augmentation device is an example of a medical imaging device based on X-ray technology. C-arm devices can display high-resolution X-ray images in real time, allowing physicians to monitor progress at any time during surgery and therefore take appropriate action based on the displayed images. However, monitoring images is often difficult during certain procedures, such as procedures that require attention to the patient's anatomy as well as the medical imaging device display. In one example, a surgical instrument assembly includes a processor, a surgical instrument configured to act on the anatomy, and a display coupled to the processor and attached to the surgical instrument. The display can be configured to display visual information including X-ray images generated by the medical imaging device, depth gauge information generated by a depth gauge coupled to the surgical instrument, and trajectory information associated with various intramedullary nailing operations.

Description

[Technical field]

[0001] The present invention relates to a system that may be used in conjunction with medical imaging. [Background technology]

[0002] A C-arm or mobile intensifier is an example of a medical imaging device based on X-ray technology. The name C-arm comes from the C-shaped arm used to connect the X-ray source and the X-ray detector together. Various medical imaging devices, such as C-arm devices, can perform fluoroscopy, a type of medical imaging that shows continuous X-ray images on a monitor. During a fluoroscopy procedure, an X-ray source or transmitter emits X-rays that penetrate the patient's body. An X-ray detector or image intensifier converts the X-rays that pass through the body into a visible image that is displayed on the monitor of the medical imaging device. Medical imaging devices, such as C-arm devices, can display high-resolution X-ray images in real time, allowing the physician to monitor the progress at any time during the procedure and therefore take appropriate action based on the displayed images. However, monitoring the images is often difficult during certain procedures, such as those that require attention to not only the patient's anatomy but also the display of the medical imaging device. For example, if a medical professional is required to operate a drill while looking at the display of the medical imaging device, it can be difficult to align the drill bit with the distal locking hole. Summary of the Invention [Means for solving the problem]

[0003] In an example, a surgical instrument assembly includes a processor, a surgical instrument configured to act on an anatomical structure, and a display coupled to the processor and attached to the surgical instrument. The display may be configured to display fluoroscopic data, e.g., x-ray images or video data, of the anatomical structure. The fluoroscopic data is generated by an imaging device. The surgical instrument assembly may further include a memory in communication with the processor. The memory may have instructions stored therein that, when executed by the processor, cause the surgical instrument assembly to receive fluoroscopic data in real time from the imaging device, e.g., via a wireless communication channel. Additionally, the surgical instrument may include a proximal end and a working end opposite the proximal end. The working end may be configured to act on the anatomical structure, and the display may be positioned to provide a line of sight from a proximal location of the surgical instrument to both the working end and the display. Additionally, the display may be configured to provide a visual indication of alignment of a cutting tool of the surgical instrument relative to a direction of travel of x-rays from an x-ray transmitter of the imaging device to an x-ray receiver of the imaging device.

[0004] In another example, the accelerometer of the surgical instrument assembly is calibrated using a direction of travel of the x-rays from an x-ray generator to an x-ray receiver of the medical imaging device. The surgical instrument assembly can include a drill having a drill bit. The surgical instrument assembly can display an x-ray image of the anatomical structure generated by the medical imaging device. The x-ray image can include a target site. The tip of the drill bit can be positioned on the anatomical structure, and the surgical instrument assembly can display a representation of the position of the tip of the drill bit along with the target site. The surgical instrument assembly can further display an orientation image including a stationary region and a movable indicator representing an orientation of the drill bit, the drill being oriented in a direction of travel of the x-rays when the movable indicator has a predetermined spatial relationship to the stationary region. The anatomical structure can be drilled while the tip of the drill bit is aligned with the target site and while the movable indicator has a predetermined spatial relationship to the stationary region.

[0005] In yet another example, a surgical instrument assembly includes a surgical instrument configured to act on an anatomical structure, a display, and a processor configured to: 1) determine an axis of the anatomical structure; and 2) determine a representation of a trajectory defining an entry point into the anatomical structure based on the axis. The display may be configured to display x-ray data of the anatomical structure generated by the imaging device. The display may be further configured to overlay the representation of the trajectory on the x-ray data of the anatomical structure to display the representation of the trajectory. The display may also be further configured to overlay a boundary on the x-ray data of the anatomical structure to display a boundary of the anatomical structure. In one example, the anatomical structure is a bone including an intramedullary (IM) canal, and the surgical instrument assembly is configured to drill a hole in the bone, and the representation of the trajectory further defines a line along which the hole may be drilled to meet with the IM canal.

[0006] The foregoing summarizes several aspects of the disclosure and does not reflect the complete scope of the disclosure. Additional features and advantages of the disclosure will be set forth in or will be obvious from the following description, or may be learned by the practice of the invention. Moreover, both the foregoing general description and the following detailed description are exemplary and explanatory and are intended to provide further explanation of the disclosure. [Brief description of the drawings]

[0007] The foregoing summary, as well as the following detailed description of example embodiments of the present disclosure, will be better understood when read in conjunction with the accompanying drawings. For purposes of illustrating example embodiments of the present disclosure, reference is made to the drawings. It should be understood, however, that the application is not limited to the precise arrangements and instrumentalities shown. The drawings are as follows: [Figure 1] FIG. 1 illustrates an exemplary imaging system according to an exemplary embodiment, the exemplary imaging system including an imaging device in electrical communication with a surgical instrument assembly. [Figure 2A] FIG. 2 is a perspective view of the exemplary surgical instrument assembly shown in FIG. 1 including a display attached to the surgical instrument. [Figure 2B] FIG. 2 is a perspective view of the exemplary surgical instrument assembly shown in FIG. 1 including a display attached to the surgical instrument. [Figure 2C] FIG. 1 is a rear view of an exemplary surgical instrument assembly. [Figure 2D] FIG. 1 is a side view of an exemplary surgical instrument assembly. [Diagram 3] 2 is a block diagram of an exemplary computing device for use in the imaging system shown in FIG. 1. [Figure 4A] 2A-2D show exemplary x-ray images of anatomical structures that may be displayed by the surgical instrument assembly shown in FIG. 2A-2D, the x-ray images including the target site. [Figure 4B] FIG. 13 illustrates another exemplary x-ray image of the anatomical structure, showing the position of a cutting instrument of a surgical instrument assembly relative to a target portion of the anatomical structure. [Figure 4C] FIG. 13 illustrates another exemplary x-ray image of the anatomical structure with the tip of the cutting instrument positioned above the target site. [Figure 5A] 11 is an exemplary screenshot of a display of a surgical instrument assembly showing a visual indication of alignment of a cutting instrument relative to the direction of travel of X-rays from an X-ray transmitter to an X-ray receiver of an imaging device, where the cutting instrument is not aligned relative to a first direction. [Figure 5B] 11 is another exemplary screenshot of a display of a surgical instrument assembly showing a visual indication of alignment of the cutting instrument relative to the direction of travel of the x-ray, where the cutting instrument is not aligned relative to a second direction that is substantially perpendicular to the first direction. [Figure 5C] FIG. 11 is another exemplary screenshot of a display of a surgical instrument assembly showing a visual indication of the alignment of the cutting instrument with respect to the X-ray travel direction, where the cutting instrument is aligned with the X-ray travel direction, such that the cutting instrument and the X-ray travel direction have the same orientation. [Figure 6A] 2 illustrates the exemplary imaging system shown in FIG. 1 showing exemplary anatomical structures and an exemplary orientation of a surgical instrument assembly. [Figure 6B] 6B illustrates another exemplary orientation of the surgical instrument assembly in the imaging system shown in FIG. 6A. [Figure 7A] FIG. 13 is a perspective view of a surgical instrument assembly according to another embodiment, wherein the surgical instrument assembly includes one display and a depth gauge affixed to the surgical instrument. [Figure 7B] FIG. 13 is a perspective view of a surgical instrument assembly according to another embodiment, wherein the surgical instrument assembly includes one display and a depth gauge affixed to the surgical instrument. [Figure 8] FIG. 7C is a perspective view of the depth gauge and display shown in FIGS. 7A and 7B. [Figure 9] 1A-1C are cross-sectional views of exemplary anatomical structures with a cutting instrument advancing through the anatomical structure along a perforation direction. [Figure 10A]13 is an exemplary screenshot of a display of a surgical instrument assembly showing a visual indication of the depth of the tip of a cutting instrument relative to a portion of an anatomical structure. [Figure 10B] 13 is an exemplary screenshot of a display of a surgical instrument assembly showing a visual indication of the depth of the tip of a cutting instrument relative to a portion of an anatomical structure. [Figure 11] 1 is an exemplary split screenshot of a display of a surgical instrument assembly showing simultaneously a visual indication of the alignment of the cutting instrument and a visual indication of the depth of the tip of the cutting instrument. [Figure 12] 13 is another exemplary screenshot of a display of a surgical instrument assembly showing simultaneously a visual indication of the alignment of the cutting instrument and a visual indication of the depth of the tip of the cutting instrument, and a visual indication of the depth of the tip of the cutting instrument and the cutting instrument on an x-ray image of an anatomical structure. [Figure 13] FIG. 7B is a perspective view of the surgical instrument assembly shown in FIG. 7A, showing an exemplary X-ray image displayed on a display of the surgical instrument assembly. [Figure 14A] FIG. 1 is an exemplary screenshot of a display of a surgical instrument assembly showing an x-ray image of an anatomical structure from a first or anteroposterior (AP) view, where the x-ray image includes a cutting instrument positioned to enter the anatomical structure for a particular intramedullary (IM) nailing procedure. [Figure 14B] 14B is an exemplary screenshot of a display of a surgical instrument assembly, the screenshot including the x-ray image of FIG. 14A with the AP boundary and an AP representation of the trajectory of a particular IM nailing procedure overlaid on the x-ray image. [Figure 15] FIG. 14C is an exemplary screenshot of a display of a surgical instrument assembly, the screenshot including the x-ray image of FIG. 14B with the position of the cutting instrument adjusted according to an AP representation of the trajectory. [Figure 16]FIG. 16 is an exemplary screenshot of a display of a surgical instrument assembly showing an x-ray image of the anatomical structures and cutting instrument shown in FIG. 15, but from a second or lateral view instead of an AP view, the screenshot including an x-ray image with the lateral boundaries and a lateral representation of the trajectory of a particular IM nailing procedure overlaid on the x-ray image. [Figure 17] FIG. 17 is an exemplary screenshot of a display of a surgical instrument assembly, the screenshot including the X-ray image of FIG. 16 with the position of the cutting instrument adjusted according to a lateral representation of the trajectory. [Figure 18] FIG. 2 is another exemplary screenshot of a display of a surgical instrument assembly, the screenshot including 1) an x-ray image of an anatomical structure, and 2) a representation of an axis of the anatomical structure overlaid on the x-ray image and a trajectory overlaid on the x-ray image, the representation of the trajectory being offset at an angle relative to the axis according to an exemplary embodiment. [Figure 19] 13 is another exemplary screenshot of a display of a surgical instrument assembly showing exemplary technical information related to an IM nailing process. [Figure 20] FIG. 7B is a perspective view of the surgical instrument assembly shown in FIG. 7A showing first and second exemplary x-ray images displayed on a display of the surgical instrument assembly, with a first representation of the trajectory overlaid on the first x-ray image and a second representation of the trajectory overlaid on the second x-ray image. [Figure 21] 13 is another exemplary screenshot of a display of a surgical instrument assembly, the screenshot including options for performing various procedures. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0008] A medical professional may use a medical imaging device, such as a C-arm device, to perform various medical procedures on a patient. For example, a medical professional may use an imaging device to determine a fracture, guide a surgical procedure, or verify the results of a surgical repair. The C-arm device provides, for example, spot imaging and fluoroscopic imaging that allows for the generation of continuous, real-time moving images. Such images are provided on a display of the C-arm device. It is recognized herein that in some cases, the display of a C-arm system is not positioned in a manner that adequately assists a medical professional. In various embodiments described herein, images provided by the imaging device are transmitted in real time to a display that may be attached to a surgical instrument, such that fluoroscopic imaging provided by the imaging device may be viewed by the medical professional as the medical professional manipulates and views the working end of the surgical instrument. The display may receive images in real time, such that the images are displayed by the display at the same time that the images are generated by the imaging device. In one example, a display is attached to a surgical drill such that fluoroscopic images provided by the imaging device may be viewed during an intramedullary (IM) nailing procedure. In one embodiment, the application of alignment may also be performed by a display mounted on the surgical drill to guide the medical professional during the IM nailing procedure. The display may be interactive and may assist in various aspects of the IM nailing process. For example, the display may assist in determining and validating the proper entry point trajectory for a given IM nail, as well as determining and validating the proper placement and orientation of the distal locking screw for the IM nail.

[0009] First, because fluoroscopy is a type of medical imaging in which continuous x-ray images are shown on a monitor, the terms fluoroscopic data, fluoroscopic image, video data, and x-ray image may be used interchangeably herein, unless otherwise specified, but are not limited thereto. Thus, an x-ray image may refer to an image produced during a fluoroscopy procedure in which an x-ray beam passes through a patient's anatomy. Furthermore, it will be understood that fluoroscopic data may include x-ray images, video data, or computer-generated visual representations. Thus, fluoroscopic data may include still or moving images.

[0010] 1, the medical imaging system 102 may include a medical imaging device 104 and a surgical instrument assembly 202 in electrical communication with the imaging device 104. The medical imaging device 104, which may be a C-arm device, may include an X-ray generator or transmitter 106 configured to transmit X-rays through a body (e.g., bones) and an X-ray detector or receiver 108 configured to receive the X-rays from the X-ray transmitter 106. Thus, the medical imaging device 104 may define a direction of travel 128 of the X-rays from the X-ray transmitter 106 to the X-ray receiver 108. The X-ray transmitter 106 may define a flat surface 106a facing the X-ray receiver 108. The medical imaging device 104 may further include an arm 110 that physically connects the X-ray transmitter 106 to the X-ray receiver 108. The medical imaging device 104 may further communicate with a medical imaging device display 112 configured to display the x-ray image from the x-ray detector 108. In some cases, the medical imaging device display 112 may be physically integrated into the x-ray detector 108 such that the display 112 may be located in a fixed position relative to the arm 110.

[0011] The medical imaging device 104 is presented as a C-arm device to facilitate description of the disclosed subject matter and is not intended to limit the scope of the present disclosure. Additionally, the imaging system 102 and the imaging device 104 are presented as a medical imaging system and a medical imaging device, respectively, to facilitate description of the disclosed subject matter and are not intended to limit the scope of the present disclosure. Thus, it will be understood that other devices, systems, and configurations may be used in addition to or in place of a system such as the system 102 to implement the embodiments disclosed herein, and all such embodiments are contemplated within the scope of the present disclosure. It is recognized herein that the location of the display 112 may create problems for medical professionals. For example, in some cases, a medical professional may need to view images or data rendered by the display 112 while viewing a patient positioned between the x-ray generator 106 and the x-ray detector 108. In one example, a medical professional may face challenges placing a distal locking screw during an IM nailing procedure due to insufficient auxiliary instruments or guidance systems, such as an aiming arm, used to place the proximal screw. Distal screws are typically inserted with a freehand technique under fluoroscopic guidance. The freehand technique is commonly referred to as the perfect circle technique. For example, once a perfect circle is established during an IM nailing procedure, it may be difficult to properly align the drill bit with the axis of the distal locking hole due to lack of visibility while using radiographic images. Improper alignment may cause the implant to break or crack during drilling of the pilot hole, which may result in implant breakage, poor reduction / fixation, delayed surgery, etc. It is further recognized herein that the orientation of the x-ray image rendered by the display 112 may not match the orientation of the patient's anatomy, thereby creating additional challenges for medical professionals.

[0012] As another example of a technical problem addressed by the embodiments described herein, a medical professional may face challenges placing an IM nail due to insufficient auxiliary instruments or guidance systems before the distal locking screw is placed. IM nails are typically inserted with a freehand technique under fluoroscopic guidance. However, improper placement may cause pain to the patient. For example, different bones and different IM nails require the IM nail to be inserted into the bone at different entry points and different trajectories to minimize pain. Furthermore, current approaches to determining the appropriate entry point and trajectory for a particular bone, for example by consulting a technical guide, may result in errors or delays. In various examples described herein, a surgical instrument assembly may be configured to guide and assist a medical professional during various operations, such as an IM nailing procedure.

[0013] 21, a user may select one or more operations by activating an option on an exemplary user interface 2100, which may be displayed by the display 112. For example, a user may select an IM trajectory option 2104 to perform an IM drilling operation. A user may select a plating option 2103 to perform an operation associated with securing a plate to a bone. A user may select a nailing option 2102 to perform an operation associated with securing a nail with a distal locking screw. It will be appreciated that alternative or additional options may be rendered by the user interface 2100 as desired. It will further be appreciated that activation of an option may cause further displays to be rendered to guide the user through a particular operation.

[0014] 3, in one embodiment, the data provided by the medical imaging device 104 (e.g., video or still images) may be received by an instrument application, e.g., a fluoroscope application, which may be a program such as software or hardware or a combination of both that may be run on any suitable computing device. A user may use the instrument application to view images generated by the medical imaging device 104. The instrument application may receive and display fluoroscopic images at various locations, e.g., at locations aligned with the patient's field of view.

[0015] 2 and 3, any suitable computing device 204 may be configured to host the instrument application. It will be appreciated that the computing device 204 may include any suitable device, examples of which include a portable computing device such as a laptop, tablet, or smartphone. In another example, the computing device 204 may be internal to the surgical instrument 203.

[0016] In an exemplary configuration, the computing device 204 includes a processing unit or unit 206, a power supply 208, an input unit 210, a display 212, a memory unit 214, a user interface unit 216, and an accelerometer 215. It is emphasized that the block diagram depiction of the computing device 204 is an example and is not intended to suggest a particular implementation and / or configuration. The processing unit 206, the input unit 210, the display 212, the memory 214, the user interface 216, and the accelerometer 215 may be coupled together to enable communication therebetween. The accelerometer 215 may be configured to generate accelerometer information corresponding to an orientation of the computing device 204. As will be appreciated, any of the above-mentioned components may be distributed across one or more separate devices and / or locations.

[0017] In various embodiments, the input 210 includes a receiver in the computing device 204, a transmitter in the computing device 204, or a combination thereof. The input 210 is capable of receiving information, such as fluoroscopic data, in real time from the medical imaging device 104. It should be understood that the transmitting and receiving functionality may also be provided by one or more devices external to the computing device 204, and thus to the surgical tool assembly 202.

[0018] Depending on the exact configuration and type of processor, memory portion 214 may be volatile (such as some types of RAM), non-volatile (such as ROM, flash memory, etc.), or a combination thereof. Computing device 204 may include additional storage (e.g., removable and / or non-removable storage) including, but not limited to, tape, flash memory, smart cards, CD-ROMs, digital versatile disks (DVDs) or other optical storage devices, magnetic cassettes, magnetic tape, magnetic disk storage devices or other magnetic storage devices, Universal Serial Bus (USB) compatible memory, or any other medium that can be used to store information and that can be accessed by computing device 204.

[0019] The computing device 204 may also include a user interface portion 216 that allows for user communication with the computing device 204. The user interface portion 216 may include inputs that provide the ability to control the computing device 204, for example, by buttons, soft keys, a mouse, voice-activated controls, a touch screen, movement of the computing device 204, visual cues (e.g., moving a hand in front of a camera on the computing device 204), and the like. The user interface portion 216 may provide outputs that include visual information (e.g., via a display), audible information (e.g., via a speaker), mechanical (e.g., via a vibration mechanism), or combinations thereof. In various configurations, the user interface portion 216 may include a display, a touch screen, a keyboard, a mouse, an accelerometer, a motion detector, a speaker, a microphone, a camera, a tilt sensor, or any combination thereof. The user interface portion 216 may further include any suitable device for inputting biometric information, such as, for example, fingerprint information, retinal information, voice information, and / or facial feature information. Thus, a computer system, such as computing device 204, may include a processor, a display coupled to the processor, and a memory in communication with the processor. The memory may have instructions stored therein that, when executed by the processor, cause the computer system to perform operations, such as those described herein. The display 212 may be configured to display visual information, such as those described with reference to Figures 4A-4C, 5A-5C, and 10A-18.

[0020] 1 and 3, the transmitter unit 114 may be electrically coupled to the medical imaging device 104 or may be part of the medical imaging device. The transmitter unit 114 may be any suitable computing device configured to receive and transmit video signals including images, e.g., fluoroscopic images. It will be appreciated that the transmitter unit 114 may include any suitable device, examples of which include portable computing devices such as laptops, tablets, or smartphones.

[0021] 3, in an exemplary configuration, the transmitter unit 114 may include a processing unit or unit 116, a power supply 118, an input 120, and an output 122. It is emphasized that the block diagram depiction of the transmitter unit 114 is an example and is not intended to suggest a particular implementation and / or configuration. The processing unit 116, the input 120, and the output 122 may be coupled together to enable communication therebetween. As will be appreciated, any of the above-mentioned components may be distributed across one or more separate devices and / or locations.

[0022] In various embodiments, the input 120 includes a receiver of the transmitter unit 114, and the output 122 includes a transmitter of the transmitter unit 114. The input 120 is capable of receiving information, such as fluoroscopic image or video data, from the medical imaging device 104, in particular from the output interface 105 of the medical imaging device 104. The output interface 105 may include a coaxial output, a USB output, a component output, a wireless output, and the like. It should be understood that the transmission and reception functions may also be provided by the medical imaging device 104. In one example, the transmitter unit 114 is electrically coupled to the output interface 105 of the medical imaging device 104 to establish a wired or wireless electrical connection between the transmitter unit 114 and the display 112. The output interface 105 may include more video output connectors using matching input modules. In one example, the processing unit 116, which may include a processor running on an embedded operating system, may detect the presence of a signal, for example a video signal including a fluoroscopic image, from the medical imaging device 104. The processing unit 116 may process the signal as necessary for transmission to the surgical instrument assembly 202. For example, the processing unit 116 may compress the signal to reduce the bandwidth used to transmit the signal.

[0023] After the processing unit 116 performs processing on the video signal as required, the video signal, which may include a fluoroscopic image, may be transmitted by the output 122 of the transmitter unit 114 to the input 210 of the computing device 204. The output 122 of the transmitter unit 114 may be configured to transmit the fluoroscopic image according to any communication protocol as desired. For example, the output 122 may include a ZigBee module connected to the processing unit 206 via a Universal Serial Bus (USB) so that the output 122 can transmit data wirelessly (via a wireless communication channel) according to any ZigBee protocol. The output 122 may transmit the video signal, e.g., the fluoroscopic image, via Wi-Fi, Bluetooth, broadcast, or any other wireless communication channel as desired.

[0024] Thus, the input 210 of the device 204 can receive data or video signals, e.g., fluoroscopic images, in real time, transmitted from the medical imaging device 104 over a wireless communication channel. The input 210 can be configured to receive ZigBee messages, Wi-Fi messages, Bluetooth messages, broadcast messages, or messages formatted according to any wireless protocol, as desired. In one example, when the input 210 of the device 204 receives a fluoroscopic image from the medical imaging device 104, the image can be acquired and verified by the processing unit 206 of the computing device 204. For example, the processing unit 206 can verify that the received image is from the appropriate medical imaging device. The image can be transferred to the display 212, for example, when the image is verified. The processing unit 206 can also ensure that valid data is displayed. For example, if there is an interruption in the wireless communication channel or connection between the computing device 204 and the medical imaging device 104, the processing unit 206 can identify the interruption and send a message to the display 212 so that the interruption is communicated to a medical professional viewing the display 212. In some cases, the processor 206 may cause the surgical tool assembly 202 to display an indication of an error on the display 212 when the quality of the communication link between the imaging device 104 and the surgical tool assembly 202 falls below a predetermined threshold. Thus, a wireless point-to-point communication channel or connection between the transmitter unit 114 and the computing device 204 may be established, which may be managed by the input 210 and output 122 on the physical layer and the processing units 116 and 206 at the application layer.

[0025] 2A-2D, 7A-7B, and 13, the medical imaging system 102 may include a surgical tool assembly 202 that may include a computing device 204 mounted to a surgical tool 203. The surgical tool 203 may be configured to act on an anatomical structure, such as the anatomical structure 124. The surgical tool 203 may define a body 205, and the computing device 204 may be attached to the body 205 at any location as desired. In one example, with reference to FIGS. 2A-2D, the computing device 204, and thus the display 212, may be supported by a mount 228. The mount 228 may include a support surface 230 that supports the computing device 204, and thus the display 212. The mount 228 may further include an arm 232 attached to the support surface 230 and body 205 of the surgical instrument 203 such that the display 212 is located in a fixed position relative to the body 205 of the surgical instrument 203. The arm 232 or support surface 230 may be configured to rotate to adjust the viewing angle of the display 212. The mount 228 may be positioned such that the display does not interfere with the operation of the surgical instrument 203. It will be appreciated that the computing device 204 may alternatively be attached to the surgical instrument 205 if desired.

[0026] 7A, 7B, and 8, for example, the surgical instrument assembly 202 may further include a depth gauge 250. The depth gauge 250 may include one or more processors configured to measure, determine, and transmit data related to the depth of a drilling operation performed on an anatomical structure, as described further herein. In some examples, the depth gauge 250 is embodied in accordance with a measurement device suitable for determining the length of a bone screw as described in WO 2017 / 083992, the disclosure of which is incorporated by reference as if set forth in its entirety herein. It will be understood that the depth gauge 250 may be embodied alternatively. The depth gauge 250 may be in communication with the display 212. The depth gauge 250 may be configured to measure the drilling depth of the surgical instrument 203 when the surgical instrument 203 operates as a drill. The depth gauge 250 may be secured to the surgical instrument 203 at a fixed position relative to the surgical instrument 203. The depth gauge 250 may be removably attached or secured to the body 205 of the surgical instrument 203 such that it is fixed in a fixed position relative to the body 205. The depth gauge 250 may be supported by an adapter 252, which may be secured to the body 205 and the depth gauge 250. The adapter 252 may be of a desired size to clamp to the body 205 such that the adapter 252, and therefore the depth gauge 250, remains in a fixed position relative to the body 250 when the surgical instrument 203 is operated. In one example, the adapter 252 may be adjusted, for example, by moving an actuator 255. The actuator 255 may be configured as a knob or the like. For example, the actuator 255 may be rotated in a clockwise direction to tighten the adapter 252 and the actuator may be rotated in a counterclockwise direction to loosen the adapter 252.

[0027] The depth gauge 250 may define a depth gauge body 254 defining a first or front end 254a and a second or rear end 254b opposite the first end 254a along a longitudinal direction L. The depth gauge body 254 may further define a third or top end 254c and a fourth or bottom end 254d opposite the third end 254c along a transverse direction T substantially perpendicular to the longitudinal direction L. The adapter 252 may be secured to the fourth end 254d of the depth gauge 250, although it will be understood that the depth gauge 250 may alternatively be secured to the adapter 252 if desired. The adapter 252 may be press fit into the body 205 of the surgical instrument 203. The adapter 252 may define a clamping collar that is secured to the body 205 of the surgical instrument 203, although it will be understood that the adapter 252 may alternatively be secured to the surgical instrument 203. In another example, the depth gauge 250 may be secured directly to the surgical instrument 203 without the use of the adapter 252.

[0028] 7A, 7B, and 8, the depth gauge 250 may further include a depth gauge member 256 extending from the depth gauge body 254, for example at the second end 254b of the depth gauge body 254. The computing device 204 may further define a computing device body 204a and a computing device member 258 extending from the body 204a to be attached to the depth gauge member 256. The computing device member 258 may be integrated such that the computing device member 258 may be in a fixed position relative to the computing device body 204a, or may be otherwise attached to the computing device body 204a. Additionally, the display 212 may be in a fixed position relative to the computing device body 204a. Thus, the display 212 may be in a fixed position relative to the computing device member 258. The computing device member 258 may be configured to rotate relative to the depth gauge member 256. In one example, the computing device member is configured to rotate about an axis 260 that is substantially parallel to the transverse direction T. Thus, the display 212 may be configured to rotate about an axis 260 that is substantially parallel to the transverse direction T. For example, the display 212 may be configured to rotate about the axis 260 to adjust the viewing angle of the display 212 while an operation is being performed. The axis 260 may be centered relative to a width of the display 212 defined along a lateral direction A that is substantially perpendicular to both the longitudinal direction L and the transverse direction T. It will be understood that the display 212 may be configured to rotate about alternate axes as desired. One or more processors of the depth gauge 250 may be communicatively coupled to the computing device 204 and thus to the display 212. In one example, the depth gauge 250 is configured to wirelessly transmit data to the computing device 204. For example, the depth gauge 250 may provide real-time data to the computing device 204 via a Wi-Fi network.

[0029] It will also be appreciated that the computing device 204 may alternatively be integrated with the surgical instrument 203. Additionally, while the surgical instrument 203 is shown as a surgical drill for illustrative purposes, it will be appreciated that the computing device 204 and depth gauge 250 may be attached to or integrated with a number of suitable alternative devices or instruments. For example, the surgical instrument assembly 202 may include an instrument or device configured to target an area of ​​bone or other portion of an anatomical structure, remove a medical implant, perform an osteotomy or any other procedure, such as any other procedure using fluoroscopy, as desired. Thus, while the anatomical structure 124 is presented as a bone, it will be appreciated that the structures on which the surgical instrument assembly may be configured to operate are not limited to bones.

[0030] The computing device 204, and thus the surgical instrument assembly 202, may include a display 212 that may be attached to the surgical instrument. The display 212 may be configured to display a fluoroscopic image of the anatomical structure 124 generated by the imaging device 104. In an exemplary configuration, the display 212 may display a fluoroscopic image of the anatomical structure 124 in real time, with the image of the anatomical structure 124 being displayed by the display 212 at the same time the image is generated by the imaging device 104. In some cases, the display 212, and thus the surgical instrument assembly 202, may include multiple displays, for example, a first display 212a and a second display 212b having a different orientation compared to the orientation of the first display 212a. In another exemplary configuration, the display 212, and thus the surgical instrument assembly 202, includes only one display, as shown, for example, in Figures 7A, 7B, 8, and 13.

[0031] 2A-2D, 7A-7B, and 13, the surgical instrument 203 may define a proximal end 203b and a working end 203a opposite the proximal end 203b. The working end 203a may be configured to, for example, cut, pierce, or otherwise target, a structure, for example, an anatomical structure 124, of a patient receiving medical care. The display 212 may face the proximal end 203b. The displays 212, particularly the first display 212a and the second display 212b, may be positioned to provide a line of sight to both the working end 203a and the display 212 from a location proximal to the surgical instrument 203. Thus, in some cases, for example, a medical professional may be able to see both the display 212 and the working end 203a of the surgical instrument 203 while manipulating the surgical instrument 203.

[0032] In one example, the surgical instrument 203 includes a cutting instrument 226 including a proximal end 226b adjacent the body 205 of the surgical instrument 203 and a cutting tip 226a opposite the proximal end 226b of the cutting instrument 226. The cutting tip 226a can define an end of the cutting instrument opposite the proximal end 226b of the cutting instrument 226. The cutting instrument 226 can have the cutting tip 226a, which can be configured to extract anatomical material from an anatomical structure, such as the anatomical structure 124. In the illustrated example, the cutting instrument 226 is a drill bit and the cutting tip 226a is a tip of a drill bit, however, it should be understood that other instruments and configurations in addition to or in place of instruments such as the cutting instrument 226 may be used to achieve the embodiments disclosed herein, and all such embodiments are contemplated as falling within the scope of the present disclosure.

[0033] The surgical instrument assembly 202 may include an alignment tool 218, such as, for example, an axial alignment tool, mounted to the body 205 of the surgical instrument 203. It will be appreciated that the alignment tool 218 may alternatively be integral with the surgical instrument 203. The alignment tool 218 may be rigidly attached to the body 205 of the surgical instrument 203. In one example, the cutting instrument 226 is located at the working end 203a of the surgical instrument 203 and the alignment tool 218 is located at the proximal end 203b of the surgical instrument, although it will be appreciated that the alignment tool 218 may alternatively be located as desired. The alignment tool 218 may define a first surface 218a proximal to the surgical instrument 203 and a second surface 218b opposite the first surface 218a. The second surface 218b may define a flat surface, and thus the alignment tool 218 may define a flat surface. Thus, the second surface 218b of the alignment tool 218 can define a plane. The cutting instrument 226 (e.g., a drill bit) can be oriented perpendicular to the plane defined by the second surface 218b of the alignment tool 218. In one example, the alignment tool 218 includes a pin oriented perpendicular to the plane defined by the second surface 218b of the alignment tool. The pin can be configured to be received in a hole defined by the proximal end 203b of the surgical instrument 203. The hole defined by the proximal end 203b of the surgical instrument 203 can have an orientation parallel to the cutting instrument 226, such that when the pin of the alignment tool 218 is received in the hole defined by the proximal end 203b of the alignment tool 218, the second surface 218b of the alignment tool defines a plane perpendicular to the orientation of the cutting instrument 226.

[0034] 4A-4C, the fluoroscopic image of the anatomical structure 124 may include one or more target sites 126. The target sites 126 may represent sites on the anatomical structure 124 at which the surgical instrument 203 may drill, cut, or otherwise target. According to the illustrated example, the target sites 126 may be defined by an intrabone implant 125, such as an IM nail or rod. While the exemplary operation performed by the surgical instrument assembly is presented as an IM nailing operation to facilitate explanation of the disclosed subject matter, it will be understood that this exemplary IM operation is not intended to limit the scope of the present disclosure. Thus, it will be understood that the surgical instrument assembly 202 may be used to perform other operations in addition to or in place of operations such as the exemplary IM nailing operation, and all such embodiments are contemplated within the scope of the present disclosure.

[0035] The display 212 may display, among other things, fluoroscopic images related to the IM nailing operation. Additionally, the display 212 may display images or data related to the depth gauge 250. Additionally, the display 212 may display images or data related to the depth gauge 250 at the same time the display 212 renders the fluoroscopic images. The display 212 may be configured to display fluoroscopic images, e.g., exemplary fluoroscopic images 400a-400c of the anatomical structure 124 generated by and received from the medical imaging device 104. With particular reference to FIG. 4A , the display 212, e.g., the first display 212a, may display an exemplary fluoroscopic image 400a of the implant 125 within the anatomical structure 124. The implant 125 may define one or more target sites 126 from which material may be removed from the anatomical structure 124. In an exemplary IM nailing operation, by viewing a display 212 displaying a fluoroscopic image from the imaging device 104, a medical professional can manipulate the patient or the imaging device 104 while simultaneously viewing both the patient and the display 212 until the target site 126 defines a perfect circle, as shown in Figure 4A. In an example of IM nailing, when one or more target sites 126 define a perfect circle, holes for locking screws may be drilled in the target sites 126.

[0036] 4B, the display 212 can display an exemplary fluoroscopic image 400b. Accordingly, the display 212 can be configured to display the position of the cutting tip 226a of the cutting instrument 226 relative to the target site 126 on the fluoroscopic image of the anatomical structure 124. The fluoroscopic image 400b can, for example, show the position of the cutting tip 226a shown in FIG. 6B. The cutting tip 226a can be configured to extract anatomical material from one or more target sites 126 of the anatomical structure 124. Additionally, as shown in FIG. 4C, the tip 226a of the cutting instrument 226 (e.g., a drill bit) can be positioned on the anatomical structure 124, for example, at the center of the target site 126. The display 212 may be positioned to provide a line of sight from a location proximal to the surgical instrument 203 to both the tip 226a and the display 212, allowing a medical professional to view both the fluoroscopic images 400b and 400c, and thus the tip 226a, and the anatomical structure 124, in order to center the tip 226a at the target site 126. The display 212 of the surgical instrument 203 may mirror the display 112 of the medical imaging device 104, such that the display 212 of the surgical instrument assembly 202 can simultaneously render the same image as the display 112 of the imaging device 104 renders, displaying the image in real time.

[0037] In some cases, for example, based on a user selection via the user interface 216, the surgical instrument assembly 202 can rotate the fluoroscopic image displayed on the display 212 to a rotational orientation such that a vertical or horizontal direction on the display 212 corresponds to a vertical or horizontal direction, respectively, of movement of the surgical instrument 203 relative to the anatomical structure 124. Thus, in some cases, the rotationally oriented fluoroscopic image displayed by the display 212 can be rotated compared to a fluoroscopic image displayed on a medical imaging device display 112 that is separate from the display 212 coupled to the surgical instrument 203.

[0038] 5A-5C, the display 212 may also be configured to provide a visual indication, such as an orientation image 129 of the alignment of the cutting tip 226a relative to the direction of travel 128 of the x-rays from the x-ray transmitter 106 to the x-ray receiver 108. In one example, the display 212 includes a first display 212a and a second display 212b, where the first display 212a is configured to display fluoroscopic images (e.g., fluoroscopic images 400a-400c) from the imaging device 104, and the second display 212b is configured to display an orientation screen (e.g., orientation screens 500a-500c) that includes a visual indication of the orientation of the cutting instrument 226. It will be appreciated that the first display 212a may also or alternatively display the orientation screen and the second display 212b may also or alternatively display the fluoroscopic images. Further, the display 212 may, in some cases, include only one display that may simultaneously display both the fluoroscopic image and the orientation screen. Further, with reference to FIGS. 11 and 12, the display 212 may, in some cases, include only one display that may simultaneously display any combination of the fluoroscopic image, the orientation screen, and the depth gauge data. In one example, a user may select an option via the user interface 216 to select the fluoroscopic image, the orientation screen, or the depth gauge data to be displayed by the display 212. In another example, the display 212 may be split, for example, in half or split into three, such that any combination of the fluoroscopic image, the orientation screen, and the depth gauge data may be simultaneously displayed by the display 212. It will be understood that the images that may be displayed by the display 212 described herein (e.g., FIGS. 4A-4C, 5A-5C, 10A-20) are not exhaustive. The display 212 may provide various information to the user through various configurations or alternative visual depictions.

[0039] The visual indication of alignment, e.g., orientation image 129, may be based on the x-ray travel direction 128 and may further be based on accelerometer information corresponding to the orientation of the cutting instrument 226. For example, the accelerometer 215 of the surgical instrument assembly 202 may be calibrated using the x-ray travel direction 128 from the x-ray generator 106 to the x-ray receiver 108 of the medical imaging device 104. In an exemplary calibration, an alignment tool 218 attached to the surgical instrument 203 is configured to be registered with a surface of the medical imaging device 104 having a predetermined orientation to align the cutting instrument 226 (e.g., a drill bit) with the x-ray travel direction 128. In one example, the alignment tool 218 is configured to be registered with the x-ray transmitter flat surface 106a, although it will be understood that the alignment tool 218 may be configured to be registered with other surfaces of the medical imaging device 104 as needed. In particular, the second surface 218b of the alignment tool 218 may be a flat surface that may abut against the flat surface 106a of the medical imaging device 104 when the cutting tool 226 is aligned with the x-ray travel direction 128. Continuing with this example, to calibrate the accelerometer 215 with the direction of the x-ray beam generated by the medical imaging device 104, and in particular, the medical imaging device 104, a zero value may be set when the surface 218b of the alignment tool 218 abuts against the flat surface 106a of the x-ray generator 106. In one example, to set the zero value and thereby calibrate the accelerometer 215 with the x-ray travel direction 128, a user may activate a calibration option 134 on the display 212 when the surface 218b of the alignment tool is flat against the flat surface 106a of the x-ray generator 106 such that a zero value is set when the cutting tool 226 is oriented along the x-ray travel direction 128.

[0040] In another example, the calibration tool may be part of or attached to the medical imaging device 104. When the medical imaging device 104, and in particular the x-ray travel direction 128, is oriented in a desired position to perform an operation, the calibration tool of the medical imaging device 104 may identify a zero value for gravity such that the zero value corresponds to the desired x-ray travel direction 128. The calibration tool 128 of the medical imaging device 104 may send the zero value for gravity to the accelerometer 215. Thus, the surgical tool assembly 202 may receive from the medical imaging device 104 a zero value representing the x-ray travel direction 128 from the x-ray generator 106 to the x-ray receiver 108 of the medical imaging device 104 to calibrate the accelerometer 215 of the surgical tool assembly 202 with the x-ray travel direction 128 defined by the medical imaging device 104. The accelerometer 215 can set a zero value for gravity to a zero value received from a calibration tool of the medical imaging device 104 such that the accelerometer 215 is calibrated with the x-ray travel direction 128. Thus, the accelerometer 215 can indicate a zero value when the cutting tool 226 is oriented along the x-ray travel direction 128.

[0041] In one example, the accelerometer 215 corresponds to the orientation of the display 212. Thus, in some cases, when the orientation of the display 212 relative to the cutting tool 226 is adjusted, the zero value is reset to recalibrate the accelerometer 215 with the x-ray travel direction 128. In some examples, the display 212 has one or more pre-set orientations (e.g., 90 degrees, 75 degrees, etc.) relative to the cutting tool 226. Thus, in some cases, after calibration in a first pre-set orientation, the display 212 can be moved to a second pre-set orientation. In one example, a user can use the user interface 216 to select a pre-set orientation in which the display 212 is placed. The accelerometer 215 can receive the second pre-set orientation and adjust the zero value accordingly, thereby adjusting the display 212 without the accelerometer being recalibrated. In yet another example, the medical imaging device 104 includes an accelerometer that can identify a change in the orientation of the x-ray travel direction. In this example, the accelerometer of the medical imaging device can transmit changes in the orientation of the x-ray travel direction to the surgical tool assembly 202, which can reset the zero value without recalibrating the accelerometer 215. Thus, the zero value can be adjusted according to changes in the orientation of the x-ray generator 106 and the x-ray receiver 108.

[0042] For example, when the accelerometer 215 of the surgical instrument assembly 202 is calibrated with the x-ray travel direction, the accelerometer can generate accelerometer information that indicates the orientation of the cutting instrument 226 relative to the x-ray travel direction 128. The accelerometer information can be displayed by the display 212 in various orientation views, such as orientation views 500a-500c, which can include an orientation image 129. As an example of IM nailing, by viewing the orientation image 129 while using the surgical instrument assembly 202, the cutting instrument 226 can be maintained in the proper orientation during drilling. That is, a hole defining a perfect circle can be drilled in the target site 126.

[0043] For example, referring to FIGS. 5A-5C, the orientation screens 500a-500c may include an orientation image 129 that may include a stationary region 130 and a movable indicator 132. The movable indicator 132 may represent an orientation of the cutting instrument 226. In one example, when the movable indicator 132 has a predetermined spatial relationship to the stationary region 130, the cutting instrument 226 is oriented in the direction of travel 128 of the x-rays. In one example, the tip 226a (e.g., a drill bit) of the cutting instrument 226 is aligned with the target site 126, and a hole is drilled in the anatomical structure 124 while the movable indicator 132 has a predetermined spatial relationship to the stationary region 130. It will be appreciated that the predetermined spatial relationship may vary as desired. In some examples, when the movable indicator 132 overlies the stationary region 130, the cutting instrument 226 is oriented in the direction of travel 128 of the x-rays. In some examples, as shown in FIG. 5C, when the movable indicator 132 is within the boundary defined by the stationary region 130, the cutting instrument 226 is oriented in the direction of travel 128 of the x-rays.

[0044] As described above with reference to Figures 4A-4C, the display 212 can display fluoroscopic images and user interfaces related to placing a locking screw to secure the IM nail. Now referring to Figures 13-20, the display 212 can additionally or alternatively display x-ray or fluoroscopic images and user interfaces related to placing an implant 125, such as an IM nail. The display 212 can be configured to display x-ray images, such as x-ray data or image 602 (Figures 13, 14A, 14B), x-ray image 604 (Figure 15), x-ray image 606 (Figure 16), x-ray image 608 (Figure 17), x-ray image 610 (Figure 18), and x-ray images 630a and 630b (Figure 20). As used herein, unless otherwise specified, x-ray data and x-ray images may be used interchangeably, without limitation. With particular reference to FIG. 14A , the display 212 can display x-ray data 602 of the anatomical structure 124. According to the illustrated example, the x-ray data 602 includes a cutting instrument 226 positioned to drill a hole in the anatomical structure 224 for the implant 125. The x-ray data 602 further includes a clamp 612 positioned to move soft tissue for the drilling operation. In an example, a hole can be drilled to meet the IM canal of the anatomical structure or bone 124. Thus, the hole can define an entry point into the bone and a trajectory between the entry point and the IM canal, and the implant 125 (e.g., an IM nail or rod) can be inserted into the hole sized to receive the implant 125. It is recognized herein that the appropriate trajectory and entry point of the drilling operation (e.g., to minimize pain) can vary depending on the bone and / or type of implant being inserted. It is further recognized herein that the proper trajectory and entry point may not be readily accessible in a given operating room, and thus a given medical professional may rely on personal knowledge to estimate the proper trajectory and entry point. Furthermore, even if the proper trajectory and entry point are known, the drilling operation is typically performed freehand, and thus the actual trajectory and entry point may differ from the proper trajectory and entry point.

[0045] In an exemplary embodiment, with reference to Figures 14B and 17, the processor of the surgical instrument assembly 202 may identify or determine a boundary 614 of the anatomical structure 124, such as a first or anterior-posterior (AP) boundary 615 (Figures 14B and 15) or a second or lateral boundary 617 (Figures 16 and 17). The boundary 614 may define a first outermost edge 614a of the anatomical structure 124 and a second outermost edge 614b of the anatomical structure 124 opposite the first outermost edge 614a. In some examples, the processor may determine the boundary 614 by implementing an edge detection process as described in U.S. Patent Application Publication No. 2007 / 0274584, the disclosure of which is incorporated by reference in its entirety as if set forth herein. It will be understood that other edge detection algorithms may be implemented as desired, and the above-described edge detection process is presented for illustrative purposes. In some cases, the processor may identify the boundary 614 based on a user selection via the user interface 216. For example, the display 212 may display an option such as a manual alignment option 646. A user, e.g., a medical professional, may activate the manual alignment option 646, e.g., by touch. When the manual alignment option 646 is activated, the user may manually overlay one or more images on the x-ray data, causing the display 212 to display one or more images on the x-ray data. An example of an image that the user may manually overlay is the boundary 614. By way of example, the user may manually overlay an image on the x-ray data using a stylus, finger, or the like. In an example, the user may activate the manual alignment option 646 to adjust the boundary 614 determined by the processor of the surgical instrument assembly 202. For example, the processor may perform an edge detection process to determine the boundary 614, but in some cases, the edge detection process may result in a portion of the boundary 614 that is offset from the actual outermost edge of the anatomical structure 124. For example, the edge detection process may erroneously identify a fracture in the anatomy 124 as part of the boundary 614.In this example, the user may, via the user interface 216, adjust the portion of the boundary 614 that is incorrectly identified as representing the outermost edge of the anatomical structure 124. Thus, the surgical instrument assembly 202 may adjust at least a portion, such as all, of the boundary 614 in response to the user activating at least one of the options of the user interface 216.

[0046] As shown in Figures 14B, 15, 16, and 17, the display 212 can overlay a boundary 614 on an x-ray image of the anatomical structure 124 to display the boundary 614 of the anatomical structure 124. With reference to Figures 18 and 20, a processor of the surgical instrument assembly 202 can determine an axis 616 of the anatomical structure 124. The processor of the surgical instrument assembly 202 can determine a representation of a trajectory 618 that defines an entry point 620 into the anatomical structure. With reference to Figures 14B-18 and 20, the display 212 can overlay a representation of the trajectory 618 on an x-ray image of the anatomical structure 124 to display the representation of the trajectory 618. The representation of the trajectory 618 can define a line along which a hole can be drilled to meet with the IM canal of the anatomical structure 124. The representation of the trajectory 618 can be determined based on the axis 616. Further, with reference to FIGS. 18 and 20, the display 212 can overlay a boundary 616 onto the x-ray image of the anatomy to display the axis 616 of the anatomy 124.

[0047] In some examples, the axis 616 may define a centerline along the length of the anatomical structure. With reference to FIGS. 14B-17, the trajectory may coincide with the axis 616 such that the representation of the trajectory 618 and the axis 616 may overlap one another. For example, the first outermost edge 614a may be spaced from the second outermost edge 614b to define a width of the anatomical structure substantially perpendicular to the length of the anatomical structure. Thus, the axis 616 may be equidistant from the first outermost edge 614a and the second outermost edge 614b along the length of the anatomical structure 124. In some cases, the processor may identify the axis 616 based on a user selection via the user interface 216. As an example, a user, e.g., a medical professional, may activate a manual alignment option 646, e.g., by touch. When the manual alignment option 646 is activated, the user may manually overlay one or more images on the x-ray data, causing the display 212 to display one or more images on the x-ray data. An example of an image that the user may manually overlay is an axis line 616. As shown, the axis line 616 is represented as a dashed line, but it will be understood that the axis line 616 may alternatively be represented as desired, for example, by a solid line. By way of example, the user may manually overlay an image on the x-ray data using a stylus, finger, or the like. In one example, the user may activate the manual alignment option 646 to adjust the axis line 616 determined by the processor of the surgical instrument assembly 202 based on the boundary 614, specifically the first outermost edge 614a and the second outermost edge 614b. Thus, the surgical instrument assembly 202 may adjust or determine at least a portion, for example, all, of the axis line 616 in response to the user activating at least one of the options of the user interface 216. Furthermore, the surgical instrument assembly 202 can determine the axis 616 of the anatomical structure 124 based on the boundary 614 of the anatomical structure 124, such that if the boundary 614 of the anatomical structure changes, the axis 616 of the anatomical structure 124 changes in accordance with the change to the boundary 614.For example, the second outermost edge 614b may be adjusted away from the first outermost edge 614a and the surgical instrument assembly 202 may move the axis line 616 toward the second outermost edge 614b such that the axis line 616 may be displayed further away from the first outermost edge 614a compared to when the axis line 616 was displayed before the boundary 614 was adjusted.

[0048] Without being bound by theory, it is recognized that the embodiments described herein may reduce the number of x-ray images taken in an operating room, thereby reducing the time it takes to perform a given procedure. In one example, referring to x-ray image 630a in FIGS. 14A-15 and 20, the display 212 may display an x-ray image of the anatomical structure 124 from a first view or an anterior-posterior (AP) view. The surgical instrument assembly may determine a representation of a trajectory 618 that defines an entry point 620 into the anatomical structure 124. The display 212 may overlay the representation of the trajectory 618 on the x-ray image of the anatomical structure 124 to display the representation of the trajectory 618.

[0049] In some cases, the processor may determine a representation of the trajectory 618 in response to a user selection via the user interface 216. For example, the display 212 may display an option such as an auto-align option 622. A user, e.g., a medical professional, may activate the auto-align option 622, e.g., by touch. When the auto-align option 622 is activated, the processor of the surgical instrument assembly 202 may determine a representation of the trajectory 618 that defines an entry point 620 into the anatomical structure 124. The surgical instrument assembly may also determine the axis 616 or the boundary 614, or both the axis 616 and the boundary 614, in response to the auto-align option 622 being selected or activated. Further, in response to the automatic alignment option 622 being activated, the display 212 may overlay at least one of the representation of the trajectory 618, the axis line 616, and the boundary 614, e.g., only one of them, e.g., any combination thereof, onto the X-ray image of the anatomical structure 124 to display the representation of the trajectory 618, the axis line 616, and / or the boundary 614.

[0050] In some examples, the surgical instrument assembly 202 can determine a representation of the trajectory 618 based on technical information, for example, technical information stored in the memory 214. Such technical information can include suitable trajectories for drilling holes in various bones for placement of the IM nail. Based on this technical information, the surgical instrument assembly 202 can determine a representation of the trajectory. By way of example, the technical information may specify that the trajectory for a given bone from an AP view is 5 degrees lateral from an axis measured from a point just below the lesser trochanter. Continuing with this example, the technical information may specify that the trajectory for a given bone from a lateral view is centered on the greater trochanter and aligned with the medullary canal. In one example, the bone and nail type may be input to the processor via the user interface 216, and a view (e.g., lateral or AP) corresponding to an x-ray image may be input to the processor via the user interface 216. In response, the processor can obtain technical information corresponding to the view of the x-ray image, the bone type, and the nail. Based on the obtained technical information, a trajectory may be determined. In some cases, the processor first determines the boundary 614 and then determines the axis 616 based on the boundary. A representation of the trajectory 618 may be determined based on the axis 616 and the technique information. For example, the technique information may indicate that the trajectory is coincident with the axis 616 in a first view and is angularly offset from the axis by a particular angle in a second view that is substantially perpendicular to the first view (see FIG. 19 ).

[0051] 19, a given user may obtain technical information from the surgical instrument assembly actuating a user selection via the user interface 216. For example, a user selection may cause the display 212 to display technical information 650a and 650b. The technical information 650a may include a graphical depiction of a proper trajectory 652a from an AP view. The technical information 650b may include a graphical depiction of a proper trajectory 652b from a lateral view. The technical information that may be displayed may include textual instructions 654 for placing an IM nail, among other operations. In one example, in response to a user selection, the user interface 216 may render audible instructions associated with, among other operations, an IM nailing operation.

[0052] In some cases, a given user, e.g., a medical professional, may utilize technical information rendered by the surgical instrument assembly 202 to manually overlay a representation of the trajectory 618 on a given x-ray image. For example, a user may activate a manual alignment option 646, e.g., by touch. When the manual alignment option 646 is activated, the user may manually overlay a representation of the trajectory 618 such that the display 212 displays the trajectory 618 on the x-ray data. The representation of the trajectory 618 may define a solid line, a dashed line, or the like. In an example, a user may activate the manual alignment option 646 to adjust the boundary 616 determined by the processor of the surgical instrument assembly 202 after the automatic alignment option 622 is selected. The surgical instrument assembly 202 may adjust or determine at least a portion, e.g., all, of the representation of the trajectory in response to a user activating at least one of the options of the user interface 216. Thus, the processor of the surgical instrument assembly 202 can adjust the representation of the trajectory to define a new representation of the trajectory, and the display 212 can overlay the new representation of the trajectory on the x-ray image of the anatomical structure to display the new representation of the trajectory. In one example, the processor can adjust the representation of the trajectory in response to a user activating at least one of the options of the user interface 216.

[0053] 14B, by viewing the representation of the trajectory 618 and the cutting instrument 226 visible on the X-ray image 602, the user can move the cutting instrument 226 to align with the representation of the trajectory, as shown in the X-ray image 604 of FIG. 15. Alternatively, in an automated scenario, the cutting instrument 226 can be automatically moved to align with the representation of the trajectory 618. In one example, once the cutting instrument 226 is aligned with the representation of the trajectory 618, the medical imaging device 104 can be adjusted to define a new direction of the X-ray movement 128 from the X-ray transmitter 106 to the X-ray receiver 108 that is different from the direction of the X-ray movement that generated the X-ray images 602 and 604 to generate the X-ray images 606 and 608. For example, the medical imaging device 104 can be adjusted to generate a second or lateral view that is approximately perpendicular to the first or AP view shown in FIG. 14B and FIG. 15.

[0054] 14B, 15, and 20, the representation of the trajectory 618 may be referred to as a first representation 618a of the trajectory from a first perspective, e.g., from an AP perspective. In an example, with reference to FIGS. 16, 17, and 20, the surgical instrument assembly 202 may determine a second representation 618b of the trajectory that defines an entry point 620 into the anatomical structure 124. The second representation 618b may be from a second perspective. By way of example, the second perspective may be approximately periorbital relative to the first perspective, such that the first perspective may define an AP view and the second perspective may define a lateral view. The second representation 618b of the trajectory may be determined and displayed according to any of the embodiments described herein for determining and displaying a representation of the trajectory 618.

[0055] 14B-18, the display 212 can display the position of the cutting tip 226a relative to an entry point 620 of the anatomical structure. By viewing the second representation 618b of the trajectory and the cutting instrument 226 visible on the x-ray images 606 and 608, the user can move the cutting instrument 226, and thus the cutting tip 226a, to align with the second representation 618b of the trajectory. Alternatively, in an automated scenario, the cutting instrument 226 can be automatically moved to align with the second representation 618b of the trajectory.

[0056] In some cases, once the cutting instrument 226, and thus the cutting tip 226a, is aligned with the first representation of the trajectory 618a and the second representation of the trajectory 618b, the drilling operation may begin when the cutting instrument 226 is aligned with the appropriate entry point and trajectory, which may be determined from the technical information described herein. The display 212 may be positioned to provide a line of sight from a proximal location of the surgical instrument 203 to both the tip 226a and the display 212, thereby allowing the medical professional to view both the x-ray images, and thus the tip 226a and the anatomical structure 124, in order to center the tip 226a at the entry point 620.

[0057] 18, the display 212 may also be configured to provide a visual indication of alignment, e.g., an orientation image 629, of the cutting instrument 226 relative to the first representation 618a of the trajectory and the second representation 618b of the trajectory. The visual indication of alignment, e.g., an orientation image 629, may be based on the x-ray travel direction 128 and may further be based on accelerometer information corresponding to the orientation of the cutting instrument 226. For example, the accelerometer 215 of the surgical instrument assembly 202 may be calibrated with the direction 128 of x-ray movement from the x-ray generator 106 to the x-ray receiver 108 of the medical imaging device 104 when the x-ray image 604 is taken from a first perspective, and with the direction 128 of x-ray movement when the x-ray image 608 is taken from a second perspective that is substantially perpendicular to the first perspective.

[0058] For example, referring to FIG. 18 , the orientation image 629 may include a stationary region 130 and a movable indicator 132. The movable indicator 132 may represent an orientation of the cutting instrument 226. In some examples, the cutting instrument 226 is oriented using the first and second representations 618a and 618b of the trajectory when the movable indicator 132 has a predetermined spatial relationship to the stationary region 130. In some examples, the cutting instrument 226 (e.g., a drill bit) is aligned with the first and second representations of the trajectory and a hole is drilled into the anatomical structure 124 while the movable indicator 132 has a predetermined spatial relationship to the stationary region 130. It will be appreciated that the predetermined spatial relationship may vary as desired. In some examples, the cutting instrument 226 is oriented using the first and second representations of the trajectory when the movable indicator 132 is overlaid on the stationary region 130. In some examples, when the movable indicator 132 is within the boundary defined by the stationary region 130, the cutting instrument 226 is oriented using the first and second representations of the trajectory.

[0059] 10A-12, the display 212 may also be configured to provide a visual indication of the depth of the cutting tip 226a relative to one or more portions of the anatomical structure 124, such as a depth gauge image 262. In one example, with reference to FIG. 9, the anatomical structure 124 defines a first or proximal cortex 123 and a second or distal cortex 127 opposite the first cortex 123 along a first direction D1, i.e., direction of travel 128 of the x-ray, which may be the direction of perforation. The first cortex 123 may define a first or proximal surface 123a and a second or distal surface 123b opposite the first surface 123a along the first direction D1. Similarly, the second cortex 127 may define a first surface, or proximal surface 127a, and a second surface, or distal surface 127b, opposite the first surface 127a along a first direction D1, which may be along a direction of travel 128 of the x-rays. The anatomical structure 124 may define a hollow portion 131. For example, the hollow portion 131 may be defined between the second surface 123b of the first cortex 123 and the first surface 127b of the second cortex 127. A visual indication of depth, such as a depth gauge image 262, may change as the cutting instrument 226, and in particular the cutting tip 226a, enters the anatomical structure 124. In particular, the depth gauge image 262 may include data that may change as the cutting instrument tip 226a contacts the first and second surfaces of the first and second cortices 123 and 127, respectively.

[0060] In an exemplary operation, referring first to FIGS. 10A and 12, which show an exemplary depth gauge screen 1000a and an exemplary split screen 1200, respectively, the depth gauge image 262 is configured to measure a first distance of a reference position relative to a portion of the anatomical structure 124, and the display 212 is configured to indicate a second distance of the cutting tip 226a relative to the portion of the anatomical structure 124. The depth gauge 250 may be configured to measure the first distance as the surgical instrument 203 penetrates. The display 212 may be configured to indicate the second distance as the surgical instrument penetrates to indicate the second distance in real time. The first cortex 123 may define a portion of the anatomical structure 124. In one example, the first cortex 123, and in particular the first surface 123a of the first cortex 123, defines a reference position whose distance from the reference position is measured by the depth gauge 250. In one example, the cutting tip 226a defines a reference position such that the first distance is equal to the second distance.

[0061] In an alternative example, the surgical instrument 203 may include a drill sleeve that defines a reference position where a distance from a portion of the anatomical structure 124 is measured by the depth gauge 250 such that the first distance is greater than the second distance. The cutting instrument 226 may be positioned within the sleeve to protect the soft tissue surrounding the bone, among other reasons. During drilling, the depth gauge 250 may determine a distance from the distal end of the drill sleeve to the first surface 123a of the first cortex 123. The distance from the distal end of the drill sleeve to the first surface 123a of the first cortex 123 may be greater than the distance from the cutting tip 226a to the first surface 123a of the first cortex 123. Thus, the depth gauge 250 may measure a real-time drill depth distance that is greater than the real-time drill depth distance displayed by the display 212. The difference between the first distance and the second distance may be determined by calibrating the display 212 to account for the distance between the cutting tip 226a and the distal end of the drill sleeve (which may be referred to as an offset distance), and the display 212 provides a total drill depth indication 264 indicating the distance from the cutting instrument tip to the first surface 123a of the first cortex 123. In one example, a user may input the offset distance by selecting a calibration option in the user interface 216. In another example, the depth gauge 250 may determine the offset distance during a calibration mode.

[0062] The display 212 can display a depth gauge screen 1000a and an exemplary split screen 1000. In the illustrated example, when the cutting instrument tip 226a abuts the first surface 123a of the first cortex 123, the total drill depth indication 264 indicates zero (0). Alternatively, the depth gauge can be calibrated such that when the drill sleeve abuts the first surface 123a of the first cortex 123, the total drill depth indication 264 can indicate zero (0). The surgical instrument 203 can be configured to drill in a first direction D1 from the first cortex 123 toward the second cortex 127. Thus, the total drill depth indication 264 can indicate zero (0) prior to the drilling operation, whereby the cutting instrument tip 226a enters the anatomical structure 124 during the drilling operation. 10B and 11 , which respectively show an example depth gauge screen 1000b and an example split screen 1100 as the drilling operation progresses and the cutting instrument tip 226a moves through the first cortex 123, the total drill depth display 264 may increase to indicate the real-time distance the cutting instrument tip 226a has advanced relative to the first surface 123a of the first cortex 123. As shown, the display of the depth gauge image 262 is rendered in millimeters, although it will be understood that the display may be rendered in any alternate units.

[0063] The depth gauge image 262 may further include a nearest cortical exit point indication 266 indicating a distance from the cutting instrument tip 226a to the distal surface of the most recently pierced cortex. Thus, the display 212 may be configured to indicate a third distance as the cutting tip 226a exits the first cortex 123, which may represent a width of the first cortex 123 along the first direction D1. As an example, the nearest cortical exit point indication 266 indicates a distance from the first surface 123a of the first cortex 123 to the second surface 123b of the first cortex 123 as the cutting instrument tip 226a travels along the first direction D1, which may be the x-ray travel direction 128, to exit the second surface 123b of the first cortex 123. Thus, in one example, at the moment the cutting instrument tip 226a advances through the second surface 123b of the first cortex 123, the nearest cortical exit point indication 266 may show the same value as the total perforation depth indication 264.

[0064] Continuing with the example of the drilling operation, as the cutting instrument tip 226a advances along the first direction D1 to exit the second surface 127b of the second cortex 127, the most recent cortical exit point indication 266 displays the distance from the first surface 123a of the first cortex 123 to the second surface 127b of the second cortex 127. Thus, the display 212 may be configured to display a fourth distance as the cutting tip 226a exits the second cortex 127, the fourth distance representing the bone width of the bone along the first direction D1. The display 212 may be configured to simultaneously display the second distance, the third distance, and the fourth distance. Furthermore, at the moment the cutting instrument tip 226a advances through the second surface 127b of the second cortex 127, the most recent cortical exit point indication 266 may display the same value as the total drill depth indication 264. The depth gauge image 262 may further include a previous cortical exit point indication 268 that displays an indication or value associated with a previous, but not most recent, cortical exit point. Thus, continuing with this example, as the cutting instrument tip 226a exits the second surface 127b of the second cortex 127, the previous cortical exit point 268 displays the distance from the first surface 123a of the first cortex 123 to the second surface 123b of the first cortex 123. Thus, the value displayed in the most recent cortical exit point indication 266 transfers to the previous cortical exit point indication 268. As the cutting instrument tip 226a advances away from the second surface 127b of the second cortex 127, the total drill depth indication 264 may increase to indicate the real-time distance the cutting instrument tip 226a has advanced relative to the first surface 123a of the first cortex 123, as illustrated in FIG. 10B and FIG. 11.

[0065] Without being bound by theory, the user may view the depth gauge image 262 while the surgical instrument 203 is operating, either under the user's control or autonomously, to better perform the drilling operation. For example, the user may view the total drill depth indication 264 while the drilling operation is being performed to control the surgical instrument based on the total drill depth indication 264. The surgical instrument 203 may be controlled based on the information in the depth gauge image 262 to prevent the cutting instrument 203 from entering unwanted portions of the anatomy, such as soft tissue or the far cortex, where full or partial drilling is not intended. In some cases, the user may view the depth gauge image 262, particularly the total drill depth indication 264 or the most recent cortical exit point indication 266, to match the screw length with each drilled hole, rather than having to measure the hole after the drilling operation is performed. In one example, the computing device 204 stores an inventory of available screws so that the screw is automatically matched to the hole to be drilled based on the hole's depth in the anatomy 124. In one example, the user can activate a screw selection option in the user interface 216 such that a screw corresponding to one of the indications on the depth gauge image 262, such as the nearest cortical exit point indication 266 or the total drilling depth indication 262, is selected.

[0066] Thus, during operation, the display 212 can receive and display multiple x-ray images in real time, and the display 212 can display the orientation image 129 and the depth gauge image 262, particularly the total drilling depth indication 262, during manipulation of the surgical instrument 203. Specifically, the depth gauge image 262 can represent the distance traveled by the cutting instrument 203. The x-ray fluoroscopic image, the orientation image, and the depth gauge image can be displayed simultaneously by the display 212. The distance displayed by the display 212 as the cutting instrument 203 moves along the drilling direction can change to update the distance in real time.

[0067] In one example, referring to FIG. 6A, the surgical instrument 203 may be manipulated to drill along a first direction D1 that is parallel to the x-ray travel direction 128. During drilling, for example, when the orientation of the cutting instrument 226 moves away from a zero value, the movable indicator 132 may move away from the stationary region 130. The movable indicator 132 may move relative to the stationary region 130 at the same time that the orientation of the cutting instrument 226 moves relative to the zero value, thereby providing a real-time representation of the orientation of the cutting instrument 226. For example, when the proximal end 226b of the cutting instrument 226 moves along a second direction D2 relative to the cutting tip 226a of the cutting instrument 226, the movable indicator 132 may move along the second direction D2 (see, for example, FIG. 5A). The second direction D2 may be perpendicular to the first direction D1. Similarly, when the proximal end 226b of the cutting instrument 226 moves along the third direction D3 relative to the cutting tip 226a of the cutting instrument 226, the movable indicator 132 may move along the third direction D3 (see, for example, FIG. 5B). The third direction D3 may be perpendicular to both the first and second directions D1 and D2, respectively. It will be further understood that when the proximal end 226b of the cutting instrument 226 moves along both the second and third directions relative to the cutting tip 226a of the cutting instrument 226, the movable indicator 132 may move along both the second and third directions D3. Additionally, the orientation screens 500a-500c may include a numerical representation 136 of the orientation of the cutting instrument 226 along the second and third directions D2 and D3.

[0068] 5C, when the cutting instrument 226 is oriented according to a zero value, the movable indicator 132 may be positioned within a boundary defined by the stationary region 130. Further, in some cases, when the cutting instrument 226 is precisely aligned with the x-ray travel direction 128, the numerical representation 136 may indicate a zero value associated with both the second and third directions. As an IM nailing example, a medical professional may maintain the orientation image 129 shown in FIG. 5C during drilling in order to drill a hole with a proper orientation at the target site 126.

[0069] Although example embodiments of apparatus for carrying out the disclosed techniques are described herein, the underlying concepts may be applied to any computing device, processor, or system capable of communicating and presenting information as described herein. The various techniques described herein may be implemented in connection with hardware or software, or, where appropriate, a combination of both. Thus, the methods and apparatus described herein may be implemented, or certain aspects or portions thereof, may take the form of program code (i.e., instructions) embodied in a tangible, non-transitory storage medium, such as a floppy diskette, CD-ROM, hard drive, or any other machine-readable storage medium (computer-readable storage medium), which when loaded into and executed by a machine, such as a computer, becomes an apparatus for carrying out the techniques described herein. In the case of program code executed on a programmable computer, a computing device generally includes a processor, a processor-readable storage medium (including volatile and non-volatile memory and / or storage elements), at least one input device, and at least one output device, such as a display. The display may be configured to display visual information. For example, the displayed visual information may include fluoroscopic data, such as an x-ray image, a fluoroscopic image, an orientation screen, or a computer-generated visual representation.

[0070] The program(s) may be implemented in assembly or machine language, if desired, which may be a compiled or interpreted language, and combined with hardware implementations.

[0071] The techniques described herein may also be implemented via communication embodied in the form of program code transmitted over some transmission medium, such as over electrical or cabling wiring, through optical fiber, or over any other form of transmission. When implemented on a general-purpose processor, the program code combines with the processor to provide a unique apparatus that operates to provide the functionality described herein. In addition, any storage techniques used in connection with the techniques described herein may invariably be a combination of hardware and software.

[0072] While the technology described herein may be implemented in connection with and described in various embodiments in the various figures, it should be understood that other similar embodiments may be used, or modifications and additions may be made to the described embodiments without departing from them. For example, it should be understood that the steps disclosed above may be performed in the order shown above, or in any other order as desired. Furthermore, those skilled in the art will recognize that the technology described in this application may be applied to any environment, whether wired or wireless, and to any number of such devices connected via a communication network and exchanging information across the network. Thus, the technology described herein should not be limited to any single embodiment, but rather should be construed in breadth and scope in accordance with the appended claims.

[0073] [Embodiment] (1) A surgical instrument assembly comprising: A processor; a surgical instrument configured to act on an anatomical structure; a display coupled to the processor and attached to the surgical instrument, the display configured to display x-ray data of the anatomical structure, the x-ray data generated by an imaging device; and a memory in communication with the processor having stored thereon instructions that, when executed by the processor, cause the processor to 1) determine an axis of the anatomical structure; and 2) determine a representation of a trajectory based on the axis, the trajectory defining an entry point into the anatomical structure; The surgical instrument assembly, wherein the display is further configured to overlay the representation of the trajectory onto the x-ray data of the anatomical structure to display the representation of the trajectory. (2) The surgical instrument assembly of claim 1, wherein the display is further configured to overlay the axis on the X-ray data of the anatomical structure to display the axis of the anatomical structure. (3) The surgical instrument assembly of claim 1, wherein the memory further stores technical information specific to the anatomical structure and further instructions that, when executed by the processor, cause the processor to also determine the representation of the trajectory based on the technical information. (4) A surgical instrument assembly as described in embodiment 3, wherein the technical information is specific to a particular implant. (5) the memory further storing instructions that, when executed by the processor, cause the processor to identify a boundary of the anatomical structure; 2. The surgical instrument assembly of claim 1, wherein the display is further configured to overlay the boundary on the X-ray data of the anatomical structure to display the boundary of the anatomical structure.

[0074] (6) The surgical instrument assembly of claim 5, wherein the memory further stores instructions that, when executed by the processor, cause the processor to determine the axis of the anatomical structure based on the boundary of the anatomical structure, such that the axis of the anatomical structure changes when the boundary of the anatomical structure changes. (7) The anatomical structure is a bone including an intramedullary canal; the surgical instrument assembly is configured to drill a hole in the bone; 2. The surgical instrument assembly of claim 1, wherein the representation of the trajectory further defines a line along which the hole may be drilled to meet the intramedullary canal. (8) the memory further storing instructions that, when executed by the processor, cause the processor to adjust the representation of the trajectory to define a new representation of a new trajectory; 2. The surgical instrument assembly of claim 1, wherein the display is further configured to overlay the new representation of the new trajectory on the X-ray data of the anatomical structure to display the new representation of the new trajectory. (9) The surgical instrument assembly of embodiment 8, wherein the display defines a user interface configured to display options for a user of the surgical instrument assembly, and the memory further stores instructions that, when executed by the processor, cause the processor to adjust the representation of the trajectory in response to the user activating at least one of the options of the user interface. (10) The representation of the trajectory is a first representation of the trajectory from a first perspective, and the memory, when executed by the processor, provides to the processor: 2. The surgical instrument assembly of claim 1, further storing instructions for determining a second representation of the trajectory defining the entry point into the anatomical structure, the second representation being from a second perspective.

[0075] (11) The surgical instrument assembly of embodiment 10, wherein the first viewpoint is substantially perpendicular to the second viewpoint. (12) The surgical instrument assembly of claim 10, further comprising a cutting instrument having a cutting tip configured to remove anatomical material from the entry point of the anatomical structure, and wherein the display is further configured to display a position of the cutting tip relative to the entry point of the anatomical structure. (13) The surgical instrument assembly of claim 10, wherein the display is further configured to provide a visual indication of alignment of the cutting instrument relative to the first representation of the trajectory and the second representation of the trajectory. (14) A method comprising the steps of: receiving, via a wireless communication channel, a first x-ray image of an anatomical structure, the first x-ray image being generated by a medical imaging device; displaying the first x-ray image on a display attached to a surgical instrument having a cutting instrument; determining a first representation of a trajectory defining an entry point into the anatomical structure; and displaying the first representation of the trajectory on the first x-ray image of the anatomical structure. (15) receiving, via the wireless communication channel, a second x-ray image of the anatomical structure, the second x-ray image generated by the medical imaging device to provide a perspective of the anatomical structure that is substantially perpendicular to a perspective provided by the first x-ray image; displaying, by the display, the second x-ray image of the anatomical structure; determining a second representation of the trajectory defining the entry point in the anatomical structure; 15. The method of claim 14, further comprising: displaying, by the display, the second representation of the trajectory on the second x-ray image of the anatomical structure.

[0076] (16) The method of claim 15, further comprising the step of displaying a position of the cutting instrument relative to the first representation of the trajectory and the second representation of the trajectory.

Claims

1. 1. A surgical instrument assembly comprising: A processor; a surgical instrument configured to act on an anatomical structure, the surgical instrument comprising a cutting instrument having a cutting tip configured to extract anatomical material from an entry point into the anatomical structure; a display coupled to the processor and attached to the surgical instrument, the display configured to display x-ray data of the anatomical structure, the x-ray data generated by an imaging device; and a memory in communication with the processor having stored thereon instructions, which, when executed by the processor, cause the processor to: 1) determine an axis along a length of the anatomical structure based on an edge of the anatomical structure; and 2) determine a representation of a trajectory defining the entry point into the anatomical structure such that the axis and a representation of the trajectory are superimposed on one another; The surgical instrument assembly, wherein the display is further configured to overlay the representation of the trajectory onto the x-ray data of the anatomical structure to display the representation of the trajectory.

2. The surgical instrument assembly of claim 1 , wherein the display is further configured to overlay the axis on the x-ray data of the anatomical structure to display the axis of the anatomical structure.

3. 2. The surgical instrument assembly of claim 1, wherein the memory further stores technical information specific to the anatomical structure and further instructions that, when executed by the processor, cause the processor to also determine the representation of the trajectory based on the technical information.

4. The surgical instrument assembly of claim 3 , wherein the technical information is specific to a particular implant.

5. the memory further storing instructions that, when executed by the processor, cause the processor to identify boundaries of the anatomical structure; The surgical instrument assembly of claim 1 , wherein the display is further configured to overlay the boundary on the x-ray data of the anatomical structure to display the boundary of the anatomical structure.

6. 6. The surgical instrument assembly of claim 5, wherein the memory further stores instructions that, when executed by the processor, cause the processor to determine the axis of the anatomical structure based on a boundary of the anatomical structure, such that the axis of the anatomical structure changes if the boundary of the anatomical structure changes.

7. the anatomical structure is a bone that includes an intramedullary canal; the surgical instrument assembly is configured to drill a hole in the bone; The surgical instrument assembly of claim 1 , wherein the representation of the trajectory further defines a line along which the hole may be drilled to meet the intramedullary canal.

8. the memory further storing instructions that, when executed by the processor, cause the processor to adjust the representation of the trajectory to define a new representation of a new trajectory; The surgical instrument assembly of claim 1 , wherein the display is further configured to overlay the new representation of the new trajectory onto the x-ray data of the anatomical structure to display the new representation of the new trajectory.

9. 9. The surgical instrument assembly of claim 8, wherein the display defines a user interface configured to display options for a user of the surgical instrument assembly, and the memory further storing instructions that, when executed by the processor, cause the processor to adjust the representation of the trajectory in response to the user activating at least one of the options of the user interface.

10. The representation of the trajectory is a first representation of the trajectory from a first perspective, and the memory, when executed by the processor, provides to the processor: The surgical instrument assembly of claim 1 , further storing instructions to determine a second representation of the trajectory defining the entry point into the anatomical structure, the second representation being from a second perspective.

11. The surgical instrument assembly of claim 10 , wherein the first perspective is substantially perpendicular to the second perspective.

12. The surgical instrument assembly of claim 10, wherein the display is further configured to display a position of the cutting tip relative to the entry point of the anatomical structure.

13. The surgical instrument assembly of claim 10, wherein the display is further configured to provide a visual indication of alignment of the cutting instrument relative to the first representation of the trajectory and the second representation of the trajectory.

Images