Assembly with an OCT device for verifying a 3D reconstruction of a volume of a region of interest, computer program, and computer-implemented method therefor

Abstract

To simplify surgical intervention for a surgeon in an operation area an access to which is difficult.SOLUTION: The current invention includes: an OCT device (20) for scanning an object domain volume (22) disposed in an object domain (18) by using an OCT scanning beam (21); and a calculation unit (60) which is connected to the OCT device (20) and includes a computer program for confirming a 3D reconfiguration of the object domain volume (22) and a section position of an object (24) in the object domain volume (22) by using the OCT device (20). The computer program determines a reference variation for the object (24) with respect to a target area and calculates an optimal route of the object (24) to a space target position by using a reference. The reference is shade measures that quantifies presence of shadows generated by the object (24) in the calculated 3D reconfiguration.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention provides a method for scanning a volume of interest within a region of interest with an OCT scanning beam. and a tunable optical coherence tomography (OCT) device positioned within the volume of interest, where the OCT device and an item having a section locatable by the OCT device, connected to the OCT device. The image is acquired by the OCT device by scanning the volume of interest. determining a 3-D reconstruction of the region of interest volume by processing the scanned information; A computer program for determining the relative location of a section of an item within a region volume. The present invention also relates to an arrangement comprising a computer unit including a target area box. Computer program and computer implementation for determining 3-D reconstruction of a volume It also relates to methods. [Background technology]

[0002] Optical coherence tomography (OCT) uses a sample beam path and a reference beam path. from the guided, temporally incoherent but spatially coherent laser light. By scanning the tissue with an OCT scanning beam, the volume of biological tissue can be measured. OCT is a method of acquiring data. OCT is used to determine the position of an object, such as a surgical subject, within a surgical field. This allows for location confirmation.

[0003] International Publication No. 2016 / 055422A1 and U.S. Patent Application Publication No. 201 7 / 0209042A1 each discloses an arrangement of the type mentioned at the outset. These documents describe a method for detecting an OCT device and a valid sensor that can be located by the OCT device. The present invention describes a surgical system that includes surgical instruments with a target The area should be determined for the surgical instrument from the reference data and compared to the target area. The offset of the surgical instrument should be used as the reference for triggering the instrument function. It states that

[0004] US Patent Application Publication No. 2019 / 0000563A1 discloses a method for detecting the tip of an instrument during ophthalmic surgery. In this case, the eye tissue is In particular, the relative position and orientation of the instrument tip, as detected by OCT, can be determined by the Based on the marker, the image capture generates a magnetic field in a coordinate system relative to the detected tissue. It may be determined by an air sensor, by an ultrasonic sensor, or by an inertial sensor.

[0005] US Patent Application Publication No. 2016 / 0249989A1 describes a method for treating a patient's body by We have developed a visualization system that can render visible virtual structures referenced in relation to It shows.

[0006] EP 3461411 A1 discloses OCT data for different regions of interest. OCT data across various regions of interest are used to form a model based on the reference data. The patent discloses the processing of data.

[0007] US Patent Application Publication No. 2018 / 0263706A1 discloses a method for manufacturing a transparent optical fiber comprising a shadow structure. The processing of patient images captured with illumination is taught.

[0008] US Patent Application Publication No. 2012 / 0190976A1 discloses a method for treating a pulmonary artery disease by using a pulmonary artery disease (PAD) in an active substance reservoir. The pressure is determined by a pressure sensor and the outflow of the active substance from the active substance reservoir is monitored by a micro A microcatheter introduced into the patient's blood circuit is controlled by a valve. The controlled release of active substances using teres is described. Summary of the Invention [Problem to be solved by the invention]

[0009] The object of the present invention is to simplify surgical intervention for surgeons in difficult to access surgical areas. The purpose is to transform it into something more. [Means for solving the problem]

[0010] This object is achieved by the arrangement defined in claim 1, the computer program defined in claim 14, This is achieved by the method defined in claim 15. , as defined in the dependent claims.

[0011] The arrangement defined in claim 1 is an arrangement of an object placed in a target region using an OCT scanning beam. an OCT device for scanning a volume of a region, the OCT device being positionable within the region of interest and configured to perform the OCT; A section of the target volume that can be located by the device is called a target area. Furthermore, the arrangement includes an item having an optical coherence tomography (OCT) device. and acquired by the OCT device by scanning the volume of interest. By processing the OCT scan information obtained, a 3-D reconstruction of the volume of interest is determined. and computer program to determine the relative location of sections of items within the area volume. In this case, the computer program includes a computer unit containing the The system is designed to determine the target area in a 3-D reconstruction of the volume of interest. a calculation routine for calculating a guide for the item with respect to the target area; The computer program determines the target location in space based on the criteria. a path planning routine for calculating an optimal path for the items, where the criteria are Shadow size quantifies the presence of shadows caused by items in the generated 3-D reconstruction. be.

[0012] The OCT device in the arrangement according to the invention has a sample beam path and a reference beam path. The coherence length I c is incoherent in time and in space with A source of coherent laser light is provided. The sample beam path to be inspected is is directed towards the tissue and is emitted back into the sample beam path due to scattering centers in the tissue. The laser light coming from the optical coherence tomography (OCT) device is superimposed on top of the laser light from the reference beam path. The interference signal results from this superposition. The location of the scattering center for the radiation may be determined from this interference signal. The OCT device in the surgical system is "time domain OCT" or "Fourier The domain OCT may be designated as "OCT".

[0013] Path planning routines facilitate automation of surgical procedures and improvements in the accuracy of item guidance. while at the same time increasing the degrees of freedom for the surgeon.

[0014] By minimizing the size of the shadow on an item or exceeding a specified threshold. By not including shadows in the data, it is possible to avoid them from the start. If the light source position and the position and orientation of the item within the object area are known, The size is the area in the data that is shadowed by the item and the target in the target area. It is possible to pre-calculate the shadow size for a particular path of the item to the target location. can.

[0015] In this case, a computer program visualizes the optimal path of the item for the surgeon. It would be advantageous if the system included a visualization routine for performing the procedure. Item paths can be verified even before movement and corrective interventions can be implemented if necessary It is possible.

[0016] In an advantageous embodiment of the present invention, the surgeon can determine the surgical procedure by selecting the criteria. The basis for the path planning routines so that you can directly influence their automatic implementation. A standard can be specified.

[0017] In this case, the criteria also include, in particular, minimizing the path length of the path along which the item is displaced. and observe the minimum distance of items from these regions when planning paths. This can protect sensitive areas of the target volume or This avoids shadowing in the data as a result of the item. As a result of formulating the optimization problem using a get function, multiple bases are available within the scope of path planning. It is also possible to consider the criteria simultaneously. In this case, these criteria shall be considered in each case. These can be weighted by their relevance and included in the target function.

[0018] In particular, to retinal tissue to treat what is known as dry macular degeneration (AMD). Stem cell injection promotes the reduction of drusen regeneration and repairs the already damaged retinal pigment epithelium and damaged This allows damaged photoreceptors to heal again. However, the important thing here is that the retinal tissue The key is to ensure that the stem cells injected into the body are released in the correct location and in the correct amount by the surgeon. Accurate positioning is also important for the placement of implants on the retina, e.g. nano-retinal implants and It is also important for the placement of what is known as the It is important to remove the vitreous humor as accurately as possible during these steps.

[0019] In particular, items such as surgical instruments, implants, etc., as well as tissues, should be identified as accurately as possible. Accurate localization is therefore desirable for the success of such procedures.

[0020] In this case, the term 3-D reconstruction refers to the shape and appearance of a real object or part of it. As an example, 3-D reconstruction is a process that captures the view of a scene. Processes can be available as either active or passive. Active techniques can be implemented using distance measuring devices. actively interact with the object to be reconstructed mechanically or radiometrically. Passive techniques measure radiation reflected or emitted by the surface of an object. This is used to estimate the 3-D structure of the object through image understanding. Just use

[0021] The present invention is realized by the function of an item being performed or by the item being placed thereon. in a 3-D reconstruction of the volume of interest, where the item should be supported by To achieve this goal, this area is part of the target area. The get location can be included.

[0022] A target area is determined in a 3-D reconstruction of the region of interest volume, and the computer Programmatically determining guide variables for items allows for the use of surgical instruments and This facilitates automation of the routing of further items.

[0023] The present invention relates to a method for determining the guide variables by a computer program and using the algorithm to determine the location of the objects in the target area. Here, such variables are understood to be variables that guide the item. A guide variable indicates a quantitatively determinable characteristic of a procedure or state when guiding an item. The guidance of the system can be directly described, for example, in the form of direction, speed, position, or time range. The guide variable is used to indicate the guide of the item, e.g., the object area that is radiated by the item. Indirectly described in the form of the amount, volume, or spatial extent of the medium to be delivered or removed from Here, the guide variables are used to process the data in the target area. is decided in favor of the

[0024] The items may in particular be surgical instruments, and the section on items may include information on the availability of surgical instruments. It can be an effective section.

[0025] Markers locatable by the OCT scanning beam are placed on sections and / or It is advantageous if the image is placed within the region of interest. This is because the image is This facilitates determining the relative position of the system and / or determining a 3-D reconstruction, This contributes to the automation of surgical procedures.

[0026] Preferably, the computer program is adapted to generate control signals for items, in particular surgical instruments. Alternatively, a computer program may be used to generate guide variables in the form The program determines the control for the item based on the guide variables determined for the target area. These means allow for the automation of the guidance of items. Moreover, it can improve the accuracy of item guidance, increasing the chances of successful surgery. For example, reducing the risk of complications as a result of damage to blood vessels or tremors in the surgeon's hands .

[0027] In a preferred embodiment, the item comprises a capillary tube having an opening for the release of the medium. In one example, the surgical instrument may be a surgical instrument for the treatment of AMD. an injection needle for injecting stem cells into a patient, which is configured and computer programmed according to the present invention; It can be carried out in a maximally automated manner based on the program.

[0028] More preferably, the calculation routine of the computer program calculates three dimensions of the region of interest volume. -D reconstruction by processing the target area and / or determined pre-operatively By processing the data and / or scanning the region of interest volume. By processing the OCT scan information acquired by the OCT device, / or by input of a target value by the surgeon for the volume of released medium It serves as a guide variable to determine the target value. The target value can be, for example, a value that is calculated from specific data or a combination of these data for image processing. This means that the target value can be determined by a computer program. 3-D reconstruction or OC When T-scan information is used, this additionally determines whether the target value currently exists in the patient's region of interest. This has the advantage that it is adapted to existing conditions and not to previously recorded data.

[0029] Advantageously, the calculation routine of the computer program generates a 3-D reconstruction of the region of interest volume. Data on the target area in the configuration and / or target area before and during the release of the medium A target area acquired by an OCT device by scanning a volume By comparing the scanned information of In this case, the volume of the medium released into the target area The actual value of the volume can be determined by image processing. may be obtained from OCT data acquired at different times and / or 3-D reconstructions determined at different times. This can be determined by evaluating the difference image that results from the difference in composition. Based on this it is also possible to estimate the location of any leaks that may be present.

[0030] The calculation routine of the computer program advantageously calculates the volume of the emitted medium. The volume of medium released in the target area is used as a guide variable for the readjustment. It is designed to determine the difference between the target value and the actual value. The volume of the amount of media to be further released into the target area is automatically determined. Automatically calculates the volume of the emitted medium based on the target area data present. These measures take into account any leaks that may exist and are Ensure that the media in the selected volume is actually applied to the target area. If so, the target area or target location within the target area is You can adjust it while you're there.

[0031] Based on the determined guide variables for readjusting the volume of the released medium, The computer program may include a control signal for the surgical instrument to eject the medium and / or an external A volume indication signal can be generated for the physician.

[0032] A further preferred embodiment of the present invention is to provide a 3-D reconstruction of the region of interest using the determined time. - Removal of material from a target area. By way of example, the material may be tissue, water, or the vitreous. In this case, the calculation routine of the computer program by processing the target area in a 3-D reconstruction of the volume; and / or By processing the data, and / or determining the region of interest volume, determined pre-operatively By processing the scan information acquired by the OCT device through scanning and / or by inputting target values ​​by the surgeon to determine the location and / or location of material to be removed. or serves as a guiding variable in determining the amount of material removed. The locations within the region of interest volume where the target material is still present are determined by the target Alternatively, the area that has not yet been removed can be determined by image processing. The volume of the material can also be determined for a given location. Then, based on the calculated distance, the items in the target area are automatically displaced relative to the material that has not yet been removed. It is possible to generate a control signal for

[0033] To allow complete removal of the material to be removed, this material must be free of markers, especially tria. This allows for greater accuracy in detecting the disease. This increases the chances of success and preserves the surrounding blood vessels. Protect.

[0034] Advantageously, the computer program determines the location of the material to be removed within the region of interest volume. and / or a visualization routine to visualize the amount of material being removed. To achieve this, for example, augmenting the 3-D reconstruction by marking the location Alternatively, the amount of material to be removed can be specified as heights at various locations. It is also possible to provide a contour map of the target area of ​​the region of interest volume. Alternatively, the items not yet removed relative to the item's current position within the region of interest volume are It is possible to provide an indicator bar showing the amount of material that has not been removed.

[0035] By way of example, the substance can be a material of the vitreous humor. Precise vitrectomy without residue is improved by using items such as vitrectomy devices. This is important for the success of retinal implant surgery, as it facilitates a high signal-to-noise ratio. In this case, the vitreous humor to be removed is located at each point on the retina. The surgeon visualizes the amount of vitreous humor in the eye based on a contour map. The vitrectomy program advantageously comprises a vitreous humor rinse and a surgical area rinse. The device is designed to continuously determine the boundary between the solution and the patient and / or display said boundary to the surgeon. This means that the boundary between the vitreous humor and the solution for rinsing the surgical area is clear of the optics of the surgical area. This is advantageous in that it allows for clear emphasis in visualization. Automatic detection of vitreous humor residue facilitates measurement of the remaining thickness of the layer. Each visualization of the surgical field is displayed to the surgeon, simplifying the performance of the surgery and providing a better experience for the patient. This can reduce the risk of

[0036] In a further advantageous embodiment, the item is in the form of an implant.

[0037] Furthermore, the computer program may include the items and / or further items and / or objects. Considering the characteristics of the target area in a 3-D reconstruction of the regional volume, and / or Considering the geometric relationship between them, especially the offset information, we Determine the spatial target position within the target area in D reconstruction as a guide variable In this case, the properties are in particular, for example, the properties of the implant or The dimensions of the implant part as well as the dimensions of further items, for example in the form of surgical instruments or The dimensions of the area of ​​the target area are also indicated. The characteristics also include the structure, e.g., the shape of the implant. Describe the path of 3-D electrodes on the back of the item in the form or blood vessels within the volume of interest. The geometric relationship may in particular be the relative positions of the regions with respect to each other, e.g. Describes the distance of items from blood vessels in the room. Considering the properties and / or geometric relationships when determining the guide variables is crucial for the target area volume. The placement of items in the volume is done automatically and with greater precision, whenever possible. Advantageously, the seat of the item is , verified after attaching the item, e.g., implant, to its target area. do.

[0038] Preferably, the OCT angiographic data of the region of interest volume is , scanning information acquired by the OCT device by scanning the region of interest volume; OCT angiography is a noninvasive, three-dimensional visualization of the retinal and choroidal vasculature. From a technical point of view, OCT-A is an optical coherence tomography (OCT-A) imaging technique. The development of optical coherence tomography (OCT) is a result of more powerful software and hardware. OCT-A facilitates not only morphological analysis but also three-dimensional retinal and choroidal perfusion analysis. In this case, the computer program advantageously performs a calculation based on the OCT angiography data. Designed to determine the location and / or size of blood vessels in a target area. The representation and / or measurement of blood vessels within the target area by the TA is used to guide and place the item. When to place the target, and when to determine the target area or target position within the target area. If the target area is large, the computer determines the guide variables for the item. The calculation routines of the data program take into account the location and / or dimensions of the vessels. This is advantageous in avoiding complications as a result of damage to larger vessels during the intervention. do.

[0039] In particular, here, a computer program is provided to a position calculation routine for determining a spatial target position in the The goal of this method is to minimize the number of blood vessels that are punctured when placing an item at a spatial target location. This procedure is also advantageous when relatively large vessels or Minimize the chance of damaging more blood vessels than necessary.

[0040] An advantageous embodiment of the present invention provides a method for detecting the location of an item in a 3-D reconstruction of a region of interest volume. relative position of the section and / or data determined preoperatively and / or target area The guide variables to be determined for the As a result, the surgeon can obtain a 3-D image of the target volume. Permanently monitoring the relative position of items within the reconstruction, e.g., implants or surgical instruments. The data determined before surgery can be, for example, a target area determined before surgery. Visualization can also be performed to provide the surgeon with further information prior to surgery or planning. The identified guide variables, such as control signals for displacing items, and the The volume to be removed or the amount of material to be removed can also be visualized for the surgeon. This can be a variable derived from the guide variable, e.g., a target for the amount to be released. The volume to be readjusted is determined from the previously determined guide variables in the form of values. The computer program also applies the guideline determined for the target area. and / or derived variables for the surgeon. can generate tactile indicator signals.

[0041] An advantageous development of the invention is that the computer program calculates the corrected image of the region of interest volume. a shadowing routine for determining the 3-D reconstruction, the shadowing routine comprising: Recognize the areas shaded by the items (24, 24') and select the target area for these areas. Specifies the compensation rules for the 3-D reconstruction of the region volume. As a result, the individual regions Corrected 3-dimensional volume of the target area without shadowing, which reduces the visibility of fine details in the It is possible to determine an improved 3-D reconstruction of the region of interest volume. As a result of the impression, there is better control of the placement for the surgeon and the target to be determined. This also ensures greater accuracy of the data for the target location and / or target area. This reduces the risk of complications during surgery as critical areas in the data are not obscured by shadows. do.

[0042] In this case, the area shadowed by the item is identified and / or the 3-D reconstruction is performed. The shadowing routine for specifying compensation rules for As explained in the A1 specification, OCT data from different recording times may be used. Alternatively, specify rules for recognizing and / or compensating for shadowed areas. Shadowing routines for data from other modalities, e.g. optical data, MRI data, For example, the shadows may be more accurately represented by OCT data. may be more easily recognizable in these data than in the In addition, the data 92 determined before the operation can be used for the purpose of this Alternatively, the shadowing routine for shadow recognition and replacement may also be used. Considering the currently calculated 3-D reconstruction 94 and / or the currently recorded OCT data, This may be taken into consideration.

[0043] To recognize the shadowed areas, for example, the grayscale values ​​of the acquired OCT data It is possible to analyze the grayscale values ​​and compare them with the surrounding or different time periods. By defining a threshold, points with a grayscale value below the threshold are shaded. To recognize shadows, it is possible to identify them by analyzing the edge profile in the image. It is also possible to consider that long straight edges do not normally occur in body tissues. The long straight edges in this case represent the shadows of the man-made items. If the position of the microscope is known intraoperatively, the shadow position can be calculated by ray tracing. is also possible.

[0044] Alternatively, the shadowing routine may use a shadow region obtained at the same time as the shadow of the element, but at a distance from the element. Using the data on the area, the items are analyzed in a 3-D reconstruction of the area volume. Alternatively, the shadowing routine can use, for example, The entire disclosure of which is incorporated herein by reference in its entirety into the description of the present invention. Jie and Shu,Chang,A comparison of image inp ainting techniques,Proceedings of SPIE-T he International Society for Optical Eng By using the inpainting method as explained in "Ineering, 2015" The area shadowed by the item is treated as data generated by a computer program. These methods represent the information in the shadowed area as realistically as possible. This is advantageous in that it contributes to patient safety. This facilitates the representation of 3-D reconstructions without shading, and this representation is easy to implement and almost No calculation time is required.

[0045] An advantageous development of the invention is that the computer program generates a 3-D image of the region of interest volume. It is proposed that the method be designed to determine spatial target locations for items in the reconstruction. Preferably, the spatial target location for the item is provided here as a region of interest volume. This means that the surgical procedure can be automated and Contributes to greater accuracy when navigating items.

[0046] The computer program spatially maps the section of the item from the spatial target location. Advantageously, it is designed to determine offset information relating to the offset. Based on the information provided by the computer program, this method allows for the automation and implementation of the surgical procedure. Automatically generates control signals to guide items, helping to improve item guidance accuracy. It is possible to do this.

[0047] An advantageous embodiment of the invention is characterized in that the computer program is adapted to image the area of ​​interest using the imaging method. By inspecting the volume, it is possible to measure the volume, especially the volume, which is measured by the OCT scanning beam of the OCT device. Obtained by scanning the volume of the area of ​​interest and / or determined preoperatively Determine the location of a section of data and / or items within the region of interest volume A 3-D reconstruction of the volume of interest is performed from the data, which is data about the sensor signals for In this case, a person skilled in the art can determine the volume of interest. To calculate the 3D reconstruction of the image, see, for example, the publication "Justin A. Eichel, Kostadinka K. Bizheva, David A. Clausi, Paul W.Fieguth,Automated 3D Reconstruction a nd Segmentation from Optical Coherence T omography, Proceedings of the European Co. nference on Computer Vision (ECCV),2010, pp. 44-57, or, for example, as described in the publication "Hugh Durrant-Whyte, Tim Bailey, Simultaneous L localization and Mapping(SLAM):Part I The Essential Algorithms,Robotics and Autom Simultaneous location and mapping as described in "Area Information Magazine, 2006" Both of the above publications are incorporated herein in their entirety. The disclosure of which is incorporated herein by reference. This means allows for the computation of 3-D reconstructions. It can be performed with the highest possible accuracy, so that the results are as realistic as possible. This has the advantage of increasing patient safety.

[0048] The computer program also determines the relative position of the data relative to each other by an alignment method. The data is designed to determine the spatial location of the target area, the data comprising the following groups: Scanning information acquired by the OCT device by scanning the target region volume , data from further imaging methods, in particular optical image representations, MRI data, CT data, ultrasound data, Wave images, endoscopic images, position of the section of the item, data determined before surgery, position sensor It is also advantageous to have data from a sensor signal. Thus, taking into account different aspects of the target area within the region of interest volume and Moreover, redundant information in data from different modalities can be represented. The use of leads to a higher accuracy of the results of the registration method.

[0049] The alignment method may be any method known to those skilled in the art, in particular, for example, the method described in the publication "F. Oli veira, J. Tavares Medical Image Registrati on:a Review,Computer Methods in Biomecha nics and Biomedical Engineering, 2014 Any method for registering medical data may be used, all of which are described in the present invention. No. 6,299,999, the disclosure of which is incorporated into the description of the present invention.

[0050] If the computer program is designed for continuous alignment of data, further As a result, the alignment result always corresponds to the currently existing conditions, ensuring patient safety. Enhance safety.

[0051] Preferably, the OCT data generation, the calculation of the 3-D reconstruction, and the alignment of the various data are performed. In this case, the surgeon will be able to see the progress of the surgery in real time. To facilitate visualization of items within the current volume of interest, This measure also improves patient safety.

[0052] In an advantageous development of the method, the OCT device is adapted to image the area of ​​interest by an OCT scanning beam. The OCT device is designed for subsequent sequential scanning of the area volume, and / or Subsequent scanning of the area of ​​interest volume containing the section of the item by the CT scanning beam A computer program is designed for continuous scanning of the 3-D image of the target volume. For subsequent sequential determination of the reconstruction and / or the location of the items in the volume of interest. It is also advantageous if the system is designed for subsequent continuous determination of the relative positions of the sections. OCT scan information and a 3-D reconstruction of the region of interest volume generated from these data. , the relative position of the items in the area of ​​interest, and the resulting position are always adapted to the currently existing conditions. This is to improve the manageability of the system and patient safety. T scan information and determination of 3-D reconstruction and section of items within the region of interest volume It is advantageous if the determination of the relative position is performed in real time.

[0053] A computer program scans the region of interest volume and / or or for scanning sections of an item and / or for locating sections of an item A scanning speed adjustment for scanning the region of interest volume at a slower speed compared to the scanning speed adjustment. This is advantageous in areas where items are changing rapidly, especially when , which is usually guaranteed to be scanned at a higher rate than the slowly changing areas. The measure saves computation time and leads to a higher accuracy of the determined relative positions of the items.

[0054] During surgery, data determined before surgery is stored in a memory connected to the computer unit. In this case, the data determined before the operation can be used to determine the location of the target area, in particular the location of the target area. Sections for further area images, target area images or data, distance, target position, geometric data of the item, in particular its dimensions or material properties, e.g. reflective properties, sensors biometric patient data, especially biometrics such as pupil size or distance between the eyes The computer program may be derived from a group of patients with preoperatively determined Target areas and / or target locations for items in the specified data Routine and preoperative determination of data for 3-D reconstruction of the target area volume The alignment routine aligns the configuration and position, and the target data is determined preoperatively. to transfer the target area and / or target location to a 3-D reconstruction of the region of interest volume. As a result, the target end from the data determined before surgery is Automatically transfer information items such as rear and / or target positions to existing 3-D reconstructions. This is possible through comprehensive automation of surgical procedures and 3D modeling based on preoperative data. -Facilitates accurate localization of target area and / or target location in D reconstruction To do so.

[0055] Additionally, a computer program may be used to segment tissue structures and / or tissue layers. In the data determined preoperatively by the application of the method for the region of interest volume In the 3-D reconstruction of the target area and / or spatial target location, This approach would be advantageous if it were designed to allow for a greater degree of automation of surgical procedures. .

[0056] A method for a computer program to calculate a 3-D reconstruction based on a criterion, and and / or a method for calculating the relative position of sections of an item within a region of interest volume. It is advantageous if the method is designed to be adaptive, in which case the method can be adapted continuously during surgery. It is further advantageous if the criteria are based on the data and / or the area of ​​interest. and / or items, and / or placement, and / or alignment method, and / or current of the 3-D reconstruction being calculated and / or of the section of the item currently being calculated The characteristics of the relative position are taken into account during this adaptation. In particular, the criteria in this case are the availability of data. Possibility and / or measurement accuracy of data and / or amount of data and / or type of data , and / or the type or amount of different modalities of data, and / or the organization within the target area. or the characteristics of the area of ​​interest in the form of type or characteristics of material, and / or its dimensions or materials Item characteristics in the form of material characteristics and / or individual components or lighting settings The properties of the device in the form of settings or properties and / or their adaptation to the current data the speed, accuracy or quality of the combined or currently computed 3-D reconstruction and / or or characteristics of the method in the form of the quality of the currently calculated relative position of sections of the item. These measures include the 3-D reconstruction of the region of interest volume and / or the Higher accuracy and / or sectioning of items in the 3-D reconstruction of the region of interest volume This leads to a higher accuracy of the relative position of the sections, which facilitates a more comprehensive automation of the method. do.

[0057] In the following, advantageous exemplary embodiments of the invention are explained on the basis of schematic drawings. [Brief explanation of the drawings]

[0058] [Figure 1] 1 shows a first arrangement having a surgical microscope, having an OCT device for scanning an area of ​​interest, and having an item in the form of a surgical instrument in the form of an injection needle. [Figure 2] A close-up view of the surgical instruments is shown. [Figure 3] 1 shows a cross section of a portion of the retina. [Figure 4] 1 shows the transfer of the target area onto a 3-D reconstruction of the region of interest volume based on data determined preoperatively. [Figure 5A] 10 shows image data for an OCT-B scan of a region of interest volume with heterogeneity during stem cell injection. [Figure 5B] 10 shows image data for an OCT-B scan of a region of interest volume with heterogeneity during stem cell injection. [Figure 6] A second arrangement is shown having a surgical microscope, having an OCT device for scanning an area of ​​interest, having an item in the form of a surgical instrument, and having an image providing device. [Figure 7] A third arrangement is shown having a surgical microscope, having an OCT device for scanning an area of ​​interest, having items in the form of surgical tools, and having a robotics unit. [Figure 8] A fourth arrangement is shown having a surgical microscope, having an OCT device for scanning an area of ​​interest, having an item in the form of a surgical tool, having an image providing device, and having a robotics unit. [Figure 9]1 shows an item in the form of an applicator for a further item in the form of a retinal pin. [Figure 10A] 1 shows the front of an item in the form of an implant for the retina. [Figure 10B] 1 shows the rear of an item in the form of an implant for the retina. [Figure 10C] 1 shows an enlarged partial view of an item in the form of an implant with 3-D electrodes. [Figure 11] 1 shows a first image of a surgical area inside the patient's eye captured by a camera, with an applicator for a retinal pin and with an implant. [Figure 12] 10 shows a further image of the surgical area inside the patient's eye captured by the camera, with an applicator for a retinal pin and with an implant. [Figure 13] 1 shows an image of a surgical area inside a patient's eye captured by a camera with a vitrectomy device for vitrectomy that generates a shadowed area. [Figure 14] 1 shows an image of the fundus of a patient's eye based on OCT angiography data for visualization of blood vessels. [Figure 15] 1 shows an image of the surgical area inside the patient's eye captured by a camera, with the implant and blood leaking from damaged blood vessels on the retina of the patient's eye. DETAILED DESCRIPTION OF THE INVENTION

[0059] The arrangement 10 shown in FIG. 1 includes a surgical microscope 16 for magnifying and visualizing an area of ​​interest 18. As an example, the surgical microscope 16 may be manufactured by Carl Zeiss Meditec AG OPMI® Lumera 660 Rescan Surgical Microscope The layout 10 can be seen, for example, in A. Ehnes's "Entwicklung ei nes Schichtsegmentierungsalgorithmus zur automated analysis von indiceruelen Netzhautschichten in optischen Kohaerenz tomographie-B-Scans”, Dissertation, Univer City of Giessen (2013), Chapter 3, pp. 45-82. As shown, the patient's eye 14 is scanned by A-, B-, and C-scans to obtain a volume of interest. The OCT device 20 provides an OCT scanning beam 21 for scanning a beam 22. are.

[0060] The arrangement 10 can be positioned within the region of interest 18 and can be detected by the OCT device based on the markers 78. a section 84 locatable within the region of interest volume 22 by the sensor 20; Item 24 in the form of a surgical instrument is provided.

[0061] The surgical microscope 16 views the patient's eye 14 through the microscope main objective 42 within the region of interest 18. The surgical microscope 16 includes stereoscopic viewing beam paths 38, 40 that facilitate inspection of the It further comprises a zoom system 44 and an eyepiece 46. The object is viewed through the microscope main objective 42 for the purpose of stereoscopically visualizing the patient's eye 14. An illumination device 48 is provided to illuminate the area 18 with illumination light.

[0062] The OCT device 20 includes adjustable scanning mirrors 50, 52 and a beam splitter 54. and 56, the object area within the object area volume 22 is observed through the microscope main objective 42. The OCT scanning beam 21 has short coherent light guided into the region 18. The light of the OCT scanning beam 21 scattered within the region volume 22 is at least partially the same The optical path of the scanning light then returns to the OCT device 20. This is used to determine the exact location of the scattering center within the region of interest 18. In particular, the position of the optically active area is determined by the coherence of the short coherent light in the OCT scanning beam 21. Lens length I c It is possible to detect with an accuracy corresponding to

[0063] The surgical microscope 16 includes a control unit for controlling an OCT scanning beam 21 to perform OCT imaging in the region of interest 18. A device for positioning the target volume 22 scanned by the scanning beam 21. There is a device 58. The device 58 includes a computer unit 60. The computer unit 60 has an input interface as a means for inputting the target value. 61, which controls the OCT scanning beam 21 and scans with the OCT scanning beam 21. To adjust the spatial extent and location of the region of interest volume 22, i.e., the relative position and orientation, A device 5 for controlling an OCT scanning beam 21 includes a computer program for 8, in this case, by an OCT scanning beam 21, a target area volume 22 and an item For continuous sequential scanning of a region of interest volume 22 including 24 sections 84 In this case, the OCT scanning beam 21 allows the surgeon to have rapid hand-eye coordination. To enable this, the frame rate is 10 ms to 20 ms.

[0064] The device 58 for controlling the OCT scanning beam 21 displays a user interface. a display connected to the computing unit 60 in the form of a display for displaying the a spray unit 28 on which the OCT scanning beam 21 scans the patient's eye 14 The region of interest volume 22 having the section 84 of the item 24 scanned in image 6 4. Furthermore, in the arrangement 10, the OCT device 20 The OCT scan information for the surgical procedure is then transferred to a device 34 for overlaying data. It may be visualized for the surgeon in the eyepiece 46 of the microscope 16 .

[0065] The computer unit 60 connected to the OCT device 20 additionally includes a signal generator 3 In the case of stem cell injection, when the injection position is reached, an acoustic signal and The indicator signal is generated by the signal generator 30. The derived variable in the form of the amount of stem cells not yet injected is based on a visual indicator signal. It is generated by

[0066] Furthermore, the computer program in the program memory of the computing unit 60 The system includes a reference length for the OCT scanning beam 21 and a target area within the target area at the patient's eye 14. and controls specifying the settings of the adjustable scanning mirrors 50, 52 for scanning the volume 22. routine to define the region of interest volume 22 to be scanned by the OCT scanning beam 21. The device 58 for determining the position of the object is provided in the form of an operating unit that can be operated by an operator. There is a control member 62. The control routine also determines the area of ​​interest using a particular scanning pattern. Included are scanning routines for scanning the area volume 22 and the section 84 of the item 24. In the process, the area of ​​interest volume 22 is reduced to the smallest possible amount of data. To keep the calculation time as short as possible, and therefore to keep the calculation time as short as possible, from item 24, section 84: are also scanned at a lower rate.

[0067] The computer program in the program memory of the computer unit 60 is further , acquired by the OCT device 20 by scanning the region of interest volume 22 By processing the scan information, a 3-D reconstruction 94 of the region of interest volume 22 and a corresponding The relative position of the section 84 of the item 24 within the image area volume 22 is determined by the In this case, the OCT scan information, the 3-D reconstruction 94, and the region of interest volume 22 are used. The relative positions of the sections 84 of the items 24 are determined in real time. The computer program generates a target image in a 3-D reconstruction 94 of the region of interest volume 22. The guide variables in item 24 include a calculation routine for determining the target area 90. The guide variables are determined relative to the target area 90. determined by the data program and serves to guide items 24 within the area of ​​interest 18 It is understood to be a variable.

[0068] The shading of the region within the region of interest volume 22 is based on the criteria. Calculate the optimal path of item 24 to spatial target location 91 within target area 90. This is avoided by computer programs that include path planning routines that The tract planning routine calculates the magnitude of the shadow in the form of a value that quantifies the presence of the shadow in the OCT data. Make a decision.

[0069] If the light source position is known, the area shadowed by item 24 in the OCT data is , for a particular path of item 24, based on the calculated relative position of item 24 , are calculated in advance. In this case, the size of the shadow represents the scale of the shadow. Based on the shadow size, the path planning routine then selects targets that do not exceed a shadow size threshold. Determine the shortest path for item 24 to location 91. Alternatively, the path planning routine may To determine a route that minimizes both the path length and the magnitude of the shadow to the greatest extent possible, , the path length and the weighted sum of the magnitude of the shadow are minimized. The program uses a display unit 28 to display the optimal path of the item 24 for the surgeon. In this case, the target area 9 of item 24 Planning a path to 0 represents a guide variable.

[0070] The computer program may include a program for preventing shadowing of regions within the region of interest volume 22. The shadowing routine may include a shadowing routine that is performed by the item 24. and for a 3-D reconstruction 94 of the region of interest volume 22 with respect to these regions. Note that the compensation rules are specified for the shaded area. Provides a replacement for the domain.

[0071] OCT data of the same area at other recording times, especially the OCT data of the shadowed area just before shadowing. The T data is used to identify and place shadowed regions in the 3-D reconstruction 94. It can be used both to replace

[0072] When injecting stem cells into the retina 15, a medium in the form of stem cells to be released by an injection needle is used. A target value for the volume of the body 88 mass is determined as a guide variable.

[0073] FIG. 2 is an enlarged view of item 24 in the form of a surgical instrument.

[0074] The surgical instrument is an injection needle for injecting stem cells into the retina 15 of the patient's eye 14. Section 84 acts as an operative part and the and a handle section 76 that can be held by the microrobot 70. The injection needle includes a capillary tube 86 and an opening for discharging a medium 88 into a target area 90. The injection needle has a tip 80 with a scanning beam 82. There are 78 recognizable markers.

[0075] The surgical instruments also include retinal pins for positioning the implant on the retina 15 of the patient's eye 14. or may be in the form of an applicator for removing vitreous humor from the patient's eye 14. It should be noted that the device may also be used as a vitrectomy device for the purpose of The arrangement 10 may also be used for surgery on other body parts than the patient's eye 14. Please pay close attention to this.

[0076] FIG. 3 shows a patient's eye 101 with blood vessels 108 as well as photoreceptors 112 and drusen 114. 4 shows the structure of the retina 15.

[0077] FIG. 4 shows a computer-generated image of a target area 90' based on pre-operatively determined data 92. 1 illustrates the transfer of the region of interest volume 22 to a 3-D reconstruction 94 in the data unit 60. The target area 90 and target region 22 are shown in a 3-D reconstruction 94 of the region of interest volume 22. In order to determine the target position 91, the data 92 of the target region 18 determined before the operation is The target position in the target area 90' is calculated by the 3-D reconstruction. 91', where target location 91' is the location of the particular location where item 24 is located. within preoperatively determined data 92 relating to the region of interest volume 22 on which the function is to be performed. When injecting stem cells, the target location in the data 92 is determined before surgery. Intended location 91' within area 90' is envisioned for stem cell injection into retina 15. corresponds to the position.

[0078] The method for segmenting tissue structures and tissue layers is based on pre-operatively determined data 92 91' and / or target area 90' within the Alternatively, the target location 91' and / or the target area 90' may also be , can also be marked by the surgeon in pre-operatively determined data 92.

[0079] The target location 91' and / or the target area 90' may be determined by a computer program The target region volume 22 is determined before surgery from the data 92. from the scan information obtained by scanning the film 22, and optionally from further data. The image is transferred to a 3-D reconstruction 94 of the determined region of interest volume 22. The registration method aids in the transcription, and the registration method is based on the time in the data 92 determined before the operation. The target location 91' within the target area 90' is defined as a target location in the region of interest volume 22. 3. Alternatively, the surgeon may also The target location 91 and / or target The net area 90 can also be marked directly.

[0080] The guide variables are then determined based on the target area 90' in the pre-operatively determined data 92. , or determined by processing the data of the 3-D reconstruction 94 of the region of interest volume 22 When injecting stem cells, the guiding variable is in the form of the amount of stem cells still being released. It is decided.

[0081] In this regard, FIGS. 5A and 5B each show a target within target area 90. OCT-B scanning of the region of interest volume 22 with stem cells released at location 91. The OCT-B scan shows implantation inhomogeneity.

[0082] To monitor and control the amount of stem cells injected, the target area of ​​interest volume 22 is The actual volume of stem cells released at the target location 91 within the target area 90 The OC value is determined by scanning the target volume 22 before and during the release of stem cells. By comparing the OCT scan information of the target area 90 acquired by the T device 20 In this case, the amount of stem cells injected is determined by image processing. To determine volume changes, for example, OCT scans acquired at different times can be used. Difference images appearing as differences in items and / or 3-D reconstructions 94 determined at different times It is possible to evaluate the injected amount of stem cells as they are visible to OCT scanning radiation. If the difference image contains particles, the difference image is used to identify the particles in the target area volume 22 by image processing. Leak locations can also be determined. Any leaks that may exist can be detected by these means. This is taken into consideration to ensure that a specific amount of stem cells is actually injected into the injection site. Thus, the injection location, i.e., the target position of the injection needle, may be adjusted during stem cell injection.

[0083] Based on the target amount of stem cells to be injected specified by the surgeon, The guiding variable in the form of the amount of unreleased stem cells is the target amount of stem cells released. The difference between the target value and the actual value is determined. The computer program then directs the specified amount of stem cells to target locations within the target area 90. The needle may be inserted into the cavity of the implanted implantation needle, or the implantation needle may be inserted into the implantation needle. Generates a control signal for the injection needle that is sent to the control unit 72 of the microrobot 70 .

[0084] In this case, an instruction signal is generated for the surgeon by a signal generator 30, said instruction signal The number designates the amount of stem cells that have not yet been released or the amount of stem cells that have already been released. The signal is represented in the form of a bar on the display of the display unit 28. Based on this, the surgeon can either perform the stem cell injection himself or have it performed by the microrobot 70. The injection procedure can be monitored.

[0085] FIG. 6 illustrates a surgical microscope 16 with an OCT device 20 for scanning an area of ​​interest 18. a second surgical instrument having an item 24 in the form of a surgical instrument and an image-providing device 65; The components and elements of the second arrangement 10' shown in FIG. To the extent that it corresponds to the components and elements of the first arrangement 10 seen in FIG. These are identified by the same numbers as the reference numbers.

[0086] The image providing device 65 is capable of capturing images of the patient's eye 14 in real time. Additionally or alternatively, the image providing device 65 includes: The patient's memory 63 is provided with pre-operatively determined data 92 relating to the region of interest. Images of the eye 14 and pre-operatively determined data 92 provide greater accuracy in the process. 3-D reconstruction 94. 21 in addition to the data obtained by scanning the region of interest volume 22. In principle, biometric patient data, e.g., eye length, eye diameter, angle The white-to-white diameter, corneal thickness, anterior chamber depth, or anterior chamber angle is It should be noted that the present invention may be used to create a 3-D reconstruction 94 of the area volume 22. I want to be.

[0087] The registration method determines the relative spatial position of different data with respect to each other, and and to combine different data sources, said registration method being Scanning information acquired by the OCT device 20 by scanning the area volume 22 information, pre-operatively determined data 92, and target locations for items 24, 24'. 91 and, if present, further data of the region of interest volume 22. Allows simultaneous use of all acquired data in each visualization of the region of interest volume 22 do.

[0088] FIG. 7 illustrates a surgical microscope 16 with an OCT device 20 for scanning an area of ​​interest 18. and a robotics unit 68. 8 shows the third arrangement 10'. Components and configuration of the third arrangement 10'' shown in FIG. The elements may be the components and elements of the first arrangement 10 seen in FIG. 1 or the components and elements of the first arrangement 10 seen in FIG. To the extent that they correspond to the components and elements of the second arrangement 10', they are They are identified by the same number as the reference number.

[0089] The robotics unit 68 includes a microrobot 70 having a control unit 72. As an example, the MicroRobot 70 is being developed for the ophthalmology For surgical instruments with motor drives, such as those provided in the surgical system R1.1 The device can be in the form of a manipulator for this purpose.

[0090] To ensure the most comprehensive automation of the operation possible, a surgical instrument in the form of an injection needle was used. The movement of the item 24 embodied in this case is set by the microrobot 70. The microrobot 70 of the robotics unit 68 is, in this case, a computer unit. The control is based on the information item processed by unit 60.

[0091] A computer unit is used to coordinate the microrobots 70 in the robotics unit 68. The control signal generated by the unit 60 controls the shape of the injection needle in the third configuration 10'''. The guide variables are for item 24 embodied as a surgical instrument in the surgical state.

[0092] Instead of item 24 being embodied as a surgical instrument in the form of an injection needle, a microrobot The target area 90 in the region of interest volume 22 is generally a target area 90. It can be used as an applicator, a retinal pin, or a vitrectomy device to It should be noted that items in the form of surgical instruments may also be moved. Specifies the spatial offset of section 84 of item 24 from spatial target position 91. To this end, offset information is also determined within the region of interest volume 22. Based on the determined relative positions of the target area 90 and the item 24, the computer The calculation can then be performed by the program. A control signal is generated from the offset information and sent to the control unit 72 of the microrobot 70. It is believed.

[0093] FIG. 8 illustrates a surgical microscope 16 with an OCT device 20 for scanning an area of ​​interest 18. having an item 24 in the form of a surgical instrument; having a robotics unit 68; A fourth arrangement 10''' is shown with an image providing device 65. The fourth arrangement shown in FIG. The components and elements of 10''' can be seen in Figures 1, 6, and 7, For the components and elements of the arrangements 10, 10', 10'' described on the basis of the figures To the extent that they are applicable, they are identified by the same reference numerals. The image providing device 65 having the device 66 is in turn provided by the OCT device 20. 3-D reconstruction of the patient's eye 14 with greater accuracy than a 3-D reconstruction based solely on the scan information obtained. This makes it easier to calculate the product 94.

[0094] During vitrectomy with a surgical instrument, also in the form of a vitrectomy device, The amount of vitreous humor removed from the point is also specified as a guiding variable in the configuration described above. Please pay attention to the good things.

[0095] Moreover, if the surgical instrument is also in the form of a vitrectomy device, it may be removed from the patient's eye 14. The amount of vitreous humor present is also shown in the configurations 10, 10', 10'', and 10''' described above. Note that the signal can be displayed as an indicator.

[0096] FIG. 9 shows a meshwork that serves to anchor further items in the form of implants to the retina 15. a surgical instrument in the form of an applicator for placing a further item 24' in the form of a membrane pin; 2 shows an item 24 embodied as a tool.

[0097] 10A and 10B show an image of an implant for the retina 15 of the patient's eye 14 as item 24. 1 shows an implant comprising a photovoltaic assembly and an image capture assembly. 10A includes a power supply 116 having a power supply 118 on the side facing away from the retina. 10B is a perspective view of the implant when the gaze direction is directed toward the patient's eye 14. FIG. 10C is a perspective view of the implant with the gaze direction facing the retina. The implant penetrates into the retina 15 where it connects to the nerve tracts. It has 3-D electrodes 120 that interact with the network of pathways.

[0098] In the above-described devices 10, 10', 10'', 10''', the retina 15 of the patient's eye is Target locations 91 for the intended attachment locations of the retinal pins to the retina 15, and the location of the impingement on the retina 15. The actual location of the item 24 in the form of a implant is determined by the placement of the implant in the patient's eye 14. For this purpose, the information can be displayed on the display unit 28.

[0099] FIG. 11 shows a first image of the surgical area inside the patient's eye 14 captured by the camera. 1, wherein the image shows a first item 2 in the form of an applicator for retinal pins. 4, and a further item 24 in the form of an implant immediately prior to its placement on the retina 15. 12 shows a corresponding image of the surgical area after the implant has been placed on the retina 15. After the implant is attached to the retina, the implant seat is For example, the surgeon can test whether the implant performs its intended physiological function. When the implant is attached to the retina 15 of the patient's eye 14, Displacement of the applicator for attaching the retinal pins to fix the implant A guide variable in the form of a control signal is generated by a computer program and is transmitted to the surgeon or is transmitted to the control unit 72 of the microrobot 70.

[0100] Figure 13 shows the fundus of patient's eye 14 based on OCT angiography data for vessel visualization. 106. In the arrangements 10, 10', 10'', and 10'' described above, and corresponding OCT angiography data is obtained by scanning the region of interest volume 22. A display may be generated from the scanning information acquired by the OCT device 20. The image 106 can be displayed on the unit 28. The location and / or dimensions, such as diameter or length, of the blood vessel 108 are shown in FIG. Based on the OCT angiography data, the computer program This information is then used to calculate the 3-dimensional image of the region of interest volume 22. D. Target locations of items 24, 24′ within target area 90 in reconstruction 94 91. In particular, items 24, 24 within the target area 90 ', the number of blood vessels 108 to be punctured is minimized when determining the spatial target location 91 for It will be transformed.

[0101] FIG. 14 illustrates a patient's eye 14 having an implant, which is configured to remove blood from damaged blood vessels 108 on the retina 15. A surgical area inside the patient's eye 14 captured by a camera, with blood flowing out. The image shows:

[0102] acquired by the OCT device 20 by scanning the region of interest volume 22 OCT angiography data from scans taken from the ophthalmic graft is useful for the visualization of relatively large blood vessels10 in ophthalmic surgery. This allows for prevention of bleeding 110 as a result of damaging the ligament 8.

[0103] FIG. 15 is a camera-captured image of the surgical area inside the patient's eye 14. Here, an item 24 in the form of a vitrectomy device for vitrectomy is positioned. As a result, the area 104 of the patient's eye 14 is shadowed. Corpectomy is crucial for the success of retinal implant surgery, as it facilitates an improved signal-to-noise ratio. It is very important.

[0104] Therefore, for vitrectomy within the scope of ophthalmic surgery using a vitrectomy device, The latter target location 91 within the get area 90 is the target area from which vitreous humor is to be removed. The above-described devices 10, 10' ... 0'', 10''' can be displayed on the display unit 28.

[0105] Thus, the computer units of the arrangements 10, 10', 10'', 10'''' described above The calculation routine of the computer program in Figure 60 calculates the amount of vitreous humor removed as follows: Processing the target area 90 in a 3-D reconstruction 94 of the region of interest volume 22 and for vitrectomy with a vitrectomy device, as determined as a guide variable by Alternatively, the amount of vitreous humor to be removed may also be determined preoperatively. This may be determined by processing the data 92 or by inputting a target value by the surgeon. In this case, as is clear from FIG. 15, the vitreous humor is more positively charged than the vitreous humor. To facilitate accurate identification and therefore removal, preferably without residue, It is identified by injecting a dialysis marker. In this case, the vitreous The fluid indicates the amount of vitreous humor removed from each point on the retina 15. Furthermore, during vitrectomy, the surgeon visualizes the vitreous tissue using a computer program. The system continuously separates the boundary between the vitreous humor and the solution (BSS) for rinsing the target area 18. The resulting volume of vitreous humor removed is automatically determined by image processing. and displaying the surgical field visualisation by the display unit. can be done.

[0106] in the form of a control signal for displacing a surgical instrument in the form of an injection needle or a vitrectomy device. Further guiding variables are both when injecting stem cells and when removing vitreous humor. The further guide variables are generated by the surgeon or the control unit 7 of the microrobot 70. 2.

[0107] FIG. 15 further illustrates a target area box shadowed by item 24 in the form of a vitrectomy device. The computer program shows a region 104 within volume 22. It includes a shadowing routine that prevents shadowing of areas within the image area 22. It is implemented by item 24. Identifying the regions 104 to be shaded and calculating the 3-D image of the region of interest volume 22 for these regions. Specify a compensation rule for the reconstruction 94. In this case, the compensation rule is Provides replacement of OCT data of the same area at other recording times, especially the shadowed area 1 The OCT data immediately before shadowing of 04 is the shadowed area in the 3-D reconstruction 94 shown in Figure 15. It can be used both to identify regions 104 and to replace them. Alternatively, for recognizing the shadowed area and / or specifying the compensation rules The shadowing routine uses the current 3-D reconstruction 94 and / or the currently recorded OCT data and and / or data from other modalities relating to the same region, e.g., optical data, MRI data. Data, ultrasound images, or CT data may also be used. Data determined before surgery9 Alternatively, the shadowed region 104 may be detected in the 3-D reconstruction 94. may be generated by data acquired from other areas outside the shaded area 104. Alternatively, the shadowed region 104 may be added to the data or the 3-D reconstruction 94. The detection may be performed in a computer program, for example by inpainting methods. It may be replaced by data generated by the RAM.

[0108] The region shading is based on a criterion and is performed within the target area 90 of the region of interest volume 22. Includes a path planning routine that calculates the optimal path of item 24 to a spatial target location 91 This can be avoided by a computer program, in which case the path planning routine , determining the size of the shadow in the form of a value that quantifies the presence of the shadow in the OCT data. If the location is known, the area 104 shadowed by the item 24 in the OCT data is For a particular path of the item 24, based on the calculated relative position of the item 24, It is calculated in advance. In this case, the size of the shadow represents the scale of the shadow. Based on this, the path planning routine then selects a target position that does not exceed a threshold shadow size. Alternatively, the path planning routine may determine the shortest path for item 24 to location 91. To determine a path that minimizes both the length and the magnitude of the shadow to the greatest extent possible, The criteria of path length and sum of weighted magnitude of shadows are minimized. The display unit 28 is used to visualize the optimal path of the item 24 for the surgeon. In this case, the target area 90 of item 24 Planning a route to represents a guide variable.

[0109] Both the input data for the 3-D reconstruction method and the input data for the registration method should be For example, during surgery, greater accuracy can be achieved for the 3-D reconstruction 94 of the region of interest volume 22. Please note that this will be adjusted for the availability of data provided and the accuracy of the measurements. If the measurement precision of individual data points is too low, these are taken into account by the respective method. do not have.

[0110] In summary, it should be noted in particular that: the present invention is Regarding ''', the OCT scanning beam 21 scans the target area 18. The OCT device 20 is positionable within the region of interest 18 for scanning the volume 22. and localizable in the region of interest volume 22 by OCT device 20. 2. An OCT image sensor comprising: an item 24 having a section 84 within a region of interest volume 22; The OCT device 20 is connected to the OCT device 20 and scans the region of interest volume 22. The OCT scan information acquired by the device 20 is processed to obtain a volume of the region of interest. determining a 3-D reconstruction 94 of the area 22 and segmenting the items 24 within the area of ​​interest volume 22; a computer unit including a computer program for determining the relative position of the 60, and a computer program for generating a 3-D reconstruction 9 of the region of interest volume 22. 4, a calculation routine for determining the target area 90, The program determines guide variables for the item 24 relative to the target area 90.

[0111] In particular, the present invention relates to the following aspects specified in the following clauses: 1. A target region volume (22) within the target region (18) by an OCT scanning beam (21). an OCT device (20) for scanning the The OCT device (20) can be positioned within the region of interest volume (22) and can then an item (24, 24') having a section (84) locatable by The OCT device (20) is connected to the imaging system and is configured to scan a volume of interest (22). and processing the OCT scan information acquired by the OCT device (20) by Thus, a 3-D reconstruction (94) of the region of interest volume (22) is determined, and the region of interest volume is Determine the relative position of the section (84) of the items (24, 24') within the room (22) The arrangement ( 10, 10', 10'', 10'''), The computer program performs a 3-D reconstruction (94) of the region of interest volume (22). a calculation routine for determining a target area (90) in accordance with the defines the guide variables for item (24, 24') with respect to the target area (90). The present invention is characterized by determining 2. Arrangement according to clause 1 (10, 10', 10'', 10'''), The computer program examines the region of interest volume (22) using an imaging method. In particular, the OCT scanning beam (21) of the OCT device (20) The region volume (22) may be acquired by scanning and / or pre-operatively. The data (92) to be determined and / or the items within the region of interest volume (22) A data signal is provided for determining the position of the section (84) of the frame (24, 24'). From the data, a 3-D reconstruction (94) of the region of interest volume (22) is determined. Designed to and / or The computer program determines the relative spacing of the data with respect to each other by a registration method. The data is designed to determine the inter-position of the target area, and the data is collected from the following groups: a region of interest volume (22); Scanning information acquired by the OCT device (20) by scanning the target area Volume (22), data from further imaging methods, in particular optical image representation, MRI data , CT data, ultrasound images, endoscopic images, location of section (84) of item (24) , data determined preoperatively (92), comprising data from the position sensor signal; and / or The OCT device (20) scans a region of interest volume (2) with an OCT scanning beam (21). 2) is designed for subsequent continuous scanning, and / or the OCT device (20) , including a section (84) of an item (24, 24') by an OCT scanning beam (21). designed for subsequent sequential scanning of a region of the target volume (22) including and / or The computer program generates a 3-D reconstruction (94) of the region of interest volume (22). For subsequent sequential determinations, and / or items ( 24, 24') section (84) is designed for subsequent sequential determination of the relative position of the section (84), and / or The computer program performs a 3-D reconstruction (94) of the region of interest volume (22). designed to determine a spatial target location (91) for an item (24, 24') And, and / or The computer unit (60) provides intraoperative data (92) determined before surgery. connected to a memory (63) for and / or The computer program may be used to segment tissue structures and / or tissue layers. The application of the method allows the target area (9 0') and / or spatial target location (91') and / or area of ​​interest volume Target area (90) and / or is designed to determine the spatial target location (91), and / or The computer program generates guidance signals in the form of control signals for the items (24, 24'). a routine for generating an id variable; and / or The computer program may include item (24) and / or further items (24' ) and / or a target in a 3-D reconstruction (94) of the region of interest volume (22). Considering the characteristics of the area (90) and / or the geometric relationship between them, especially 3-D reconstruction (94) of the volume of interest (22) taking into account offset information Determine the spatial target position (91) within the target area (90) as a guide variable. Designed to and / or The placement is performed by placing the items (24) in a 3-D reconstruction (94) of the volume of interest (22). ) for visualizing the relative positions of the sections (84) of the graft and / or for determining preoperatively. for visualizing the data (92) to be displayed and / or related to the target area (90) for visualizing guide variables determined by and / or derived from the guide variables equipped with a device for visualizing the variables involved, and / or The computer program determines guide variables relative to the target area (90). and / or based on the parameters derived therefrom, acoustic, optical, and generating a tactile or tactile indicator signal; and / or The computer program generates a corrected 3-D reconstruction ( 94), the shadowing routine including: 4') and calculates the target area volume for these areas. Specifying compensation rules for the 3-D reconstruction (94) of the volume (22), and / or A marker (78) locatable by the OCT scanning beam (21) is positioned on the item (2 4, 24') section (84) and / or within the target area (18); and / or The computer program scans the region of interest volume (22) using a specific scanning pattern. and / or for scanning a section (84) of the item (24, 24'), and and / or a lower speed compared to the location of the section (84) of the item (24, 24'). a scanning routine for adjusting a scanning speed for scanning the region of interest volume (22) at , and / or The computer program generates decision rules for 3-D reconstruction (94) based on criteria. Sections of items (24, 24') within the volume of interest (22) and / or designed to adjust the decision rule for the relative position of the sine wave (84), It is characterized by: 3. The OCT angiography data (106) of the region of interest volume (22) is A scan obtained by the OCT device (20) by scanning the image (22). Arrangements according to clauses 1 or 2 (10, 10', 10') characterized in that they are generated from information ',10'''). 4. The computer program generates targets based on the OCT angiography data (106). designed to determine the location and / or size of a blood vessel (108) within the vein area (90), The target area (90) is then placed in a 3-D reconstruction (94) of the target area volume (22). The calculation routine of the computer program for determining The method is characterized in that it takes into account the path and / or location and / or size of the blood vessel (108). Arrangement by term 3 (10, 10', 10'', 10''). 5. The computer program directs the eye to a spatial target location (91) based on the criteria. a path planning routine for calculating an optimal path for the system (24, 24'), Arrangement according to any one of clauses 1 to 4 (10, 10', 10'', 10'''). 6. The criteria are based on the occurrence of item (24, 24') in the calculated 3-D reconstruction (94). 5. The arrangement according to clause 5, characterized in that the size of the shadow quantifies the presence of a shadow due to the (10, 10', 10'', 10''). 7. The computer program will determine the preoperative outcome based on the provided data (92). A target area (90') and / or target location (90') for the item (24) to be 1') and the data (92) determined before surgery are used to determine the area of ​​interest. A registration routine to align the volume (22) with a 3-D reconstruction (94) and a manual The target area (90') and / or target area in the preoperatively determined data (92) To transfer the bit positions (91') to a 3-D reconstruction (94) of the region of interest volume (22), and a transcription routine for the arrangement according to any one of clauses 1 to 6. 10, 10', 10'', 10'''). 8. The items (24, 24') have openings (82) for the release of the medium (88). Any of clauses 1 to 7, characterized in that it is in the form of a surgical instrument comprising a capillary (86) through which Arrangement by single term (10, 10', 10'', 10''). 9. The computational routine of the computer program calculates the 3-D volume of the region of interest (22). by processing the target area (90) in a reconstruction (94); and / or By processing the data (92) determined preoperatively, and / or by creating a volume of the region of interest, The OCT image is acquired by the OCT device (20) by scanning the beam (22). By processing the scan information and / or by inputting target values ​​by the surgeon , determining a target value for the volume of the released medium (88) as a guide variable. The arrangement according to Article 8 (10, 10', 10'', 10' ''). 10. The calculation routine of the computer program calculates the 3-dimensional volume of the region of interest (22). D. Reconstruction (94) of data from the target area (90) and / or the medium (88) The OCT device scans the region of interest volume (22) before and during the release of the By comparing the scan information of the target area (90) acquired by the This determines the actual volume of the medium (88) released into the target area (90). Arrangements according to clauses 8 or 9 (10, 10', 10') characterized in that they serve to determine ',10'''). 11. The calculation routine of the computer program calculates the volume of the emitted medium (88). The amount of media ( ) released into the target area (90) is used as a guide variable for the readjustment of the system. 88) is designed to determine the difference between the target and actual volume values. An arrangement according to any one of clauses 8 to 10, characterized in that 12. The calculation routine of the computer program calculates the 3-dimensional volume of the region of interest (22). by processing the target area (90) in the D reconstruction (94), and / or by processing data (92) determined preoperatively and / or by the surgeon. Entering a target value determines the location of the material to be removed and / or the amount of material to be removed. According to any one of clauses 1 to 7, the function of the id variable is to determine Arrangement. 13. Location of material to be removed within the region of interest volume (22) and / or object to be removed Arrangement according to clause 12, characterized by a visualization routine for visualizing the quantity of quality (10, 1 0', 10'', 10'''). 14. Scanning the OCT device (20) through the volume of interest (22) By processing the OCT scan information acquired by the for determining a 3-D reconstruction (94) of the region of interest volume (22) and Determine the relative position of the section (84) of the item (24) in the volume (22) A computer program for: The target area (90) in the 3-D reconstruction (94) of the region of interest volume (22) ) and guide variables for items (24) related to the target area (90). A computer program comprising: 15. By means of a computer program pursuant to Article 14, the target area within the target area (18) for determining a 3-D reconstruction (94) of the region of interest volume (22) and To determine the relative position of the section (84) of the item (24) in the room (22). How to do it. [Explanation of symbols]

[0112] 10, 10', 10'', 10''' arrangement / equipment 12 Cornea 14 Patient's eye 15 Retina 16. Surgical microscope 18 Target Areas 20 OCT devices 21 OCT scanning beam 22 Volume of interest 24, 24' items 26 Optical axis 28 Display Unit 30 Signal Generator 34 Data overlay 38, 40 Stereoscopic observation beam path 42 Microscope main objective lens 44 Zoom System 46 Eyepiece 48 Lighting Equipment 50, 52 Scanning mirror 54, 56 Beam splitter 58 devices 60 Computer Unit 61 Input Interface 62 Control member 63 memory 64 images 65 Image Providing Device 66 Image Capture Device 68 Robotics Unit 70 Microrobot 72 Control Unit 76 Handle Section 78 Markers 80 Tip 82 Opening 84 Section 86 Capillary 88 Medium 90 Target Area 90' Target area based on preoperative data 91 Target Position 91' Target position in data determined before surgery 92 Data to be determined before surgery 94 3-D reconstruction 104 Shaded Area Images based on 106 OCT angiography data 108 Blood vessels 110 Bleeding 112 Photoreceptors 114 Drusen 116 Power supply 118 Image Capture Assembly 120 3-D electrode

Claims

1. an OCT device (20) for scanning a region of interest (18) volume of interest (22) with an OCT scanning beam (21); an item (24, 24') positionable within the region of interest volume (22) and having a section (84) locatable therein by the OCT device (20); 1. An arrangement (10, 10', 10'', 10''') comprising a computer unit (60) connected to the OCT device (20) and including a computer program for determining a 3-D reconstruction (94) of the area of ​​interest volume (22) by processing OCT scan information acquired by the OCT device (20) by scanning the area of ​​interest volume (22) and for determining relative positions of the sections (84) of the items (24, 24') within the area of ​​interest volume (22), the computer program has a calculation routine for determining a target area (90) in the 3-D reconstruction (94) of the region of interest (22), the calculation routine including a routine for determining guide variables for the items (24, 24') with respect to the target area (90); The computer program is designed to adjust decision rules for the 3-D reconstruction (94) and / or decision rules for the location of the section (84) of the item (24, 24') within the region of interest volume (22) based on a criterion, the criterion being a shadow magnitude that quantifies the presence of a shadow due to the item (24, 24') in the calculated 3-D reconstruction (94).

2. The arrangement (10, 10', 10'', 10''') of claim 1, wherein the computer program includes a path planning routine that calculates an optimal path for the items (24, 24') to a spatial target location (91) based on the criteria.

3. 3. The arrangement (10, 10', 10'', 10''') according to claim 1 or 2, wherein the computer program is designed to determine a 3-D reconstruction (94) of the region of interest volume (22) from data that is obtained by examining the region of interest volume (22) using an imaging method, in particular by scanning the region of interest volume (22) with the OCT scanning beam (21) of the OCT device (20) and / or that is determined preoperatively and / or that is data related to sensor signals for determining the position of the section (84) of the item (24, 24') within the region of interest volume (22).

4. 4. The arrangement (10, 10', 10'', 10''') according to claim 1, characterized in that the computer program is designed to determine the relative spatial position of data with respect to one another by a registration method, the data comprising the following group: scanning information acquired by the OCT device (20) by scanning the region of interest volume (22), the region of interest volume (22), data from further imaging methods, in particular optical image representations, MRI data, CT data, ultrasound images, endoscopic images, the position of the section (84) of the item (24), data determined pre-operatively (92), data from position sensor signals.

5. the OCT device (20) is designed for subsequent continuous scanning of the region of interest volume (22) by the OCT scanning beam (21), and / or the OCT device (20) is designed for subsequent continuous scanning of an area of ​​the region of interest volume (22) including the section (84) of the item (24, 24') by the OCT scanning beam (21); and / or the computer program is designed for subsequent successive determinations of the 3-D reconstructions of the region of interest volume and / or for subsequent successive determinations of the relative positions of the sections of the items in the region of interest volume, and / or the computer program is designed to determine a spatial target position (91) for the item (24, 24') in the 3-D reconstruction (94) of the region of interest volume (22); and / or said computer unit (60) being connected to a memory (63) for intraoperative provision of preoperatively determined data (92); and / or the computer program is designed to determine a target area (90') and / or a spatial target position (91') in the pre-operatively determined data (92) and / or a target area (90) and / or a spatial target position (91) in the 3-D reconstruction (94) of the region of interest (22) by applying a method for segmenting tissue structures and / or tissue layers; and / or the computer program includes a routine for generating a guide variable in the form of a control signal for the item (24, 24'); and / or the computer program is designed to determine, as a guide variable, a spatial target position (91) within the target area (90) in the 3-D reconstruction (94) of the region of interest (22) taking into account characteristics of the item (24) and / or the further item (24') and / or the target area (90) in the 3-D reconstruction (94) of the region of interest (22) and / or taking into account geometric relationships therebetween, in particular offset information; and / or the arrangement comprises a device for visualizing the relative position of the section (84) of the item (24) in the 3-D reconstruction (94) of the region of interest (22), and / or for visualizing pre-operatively determined data (92), and / or for visualizing the guide variables determined with respect to the target area (90), and / or for visualizing variables derived from the guide variables; and / or the computer program includes a routine for generating acoustic, optical, or tactile indicator signals for the surgeon based on the guide variables and / or variables derived therefrom determined with respect to the target area; and / or the computer program includes a shadowing routine for determining a corrected 3-D reconstruction (94) of the region of interest volume (22), the shadowing routine including a routine for recognizing regions (104) shadowed by the items (24, 24') and specifying compensation rules for the 3-D reconstruction (94) of the region of interest volume (22) with respect to these regions; and / or a marker (78) locatable by the OCT scanning beam (21) is positioned within the section (84) and / or the region of interest (18) of the item (24, 24'); and / or The arrangement (10, 10', 10'', 10''') according to any one of claims 1 to 4, characterized in that the computer program comprises a scanning routine for scanning the area of ​​interest volume (22) and / or the section (84) of the item (24, 24') with a specific scanning pattern and / or for adjusting a scanning speed to scan the area of ​​interest volume (22) at a slower speed compared to the location of the section (84) of the item (24, 24').

6. The arrangement (10, 10', 10'', 10''' according to claim 4 or claim 5 depending on claim 4, characterized in that the OCT angiography data of the region of interest (22) is generated from the scan information acquired by the OCT device (20) by scanning the region of interest (22).

7. The arrangement (10, 10', 10'', 10''') according to claim 6, characterized in that the computer program is designed to determine the position and / or dimensions of a blood vessel (108) in the target area (90) based on the OCT angiography data, and the calculation routines of the computer program for determining the target area (90) in the 3-D reconstruction (94) of the region of interest (22) take into account the path and / or position and / or dimensions of the blood vessel (108) in the target area (90).

8. 8. The arrangement (10, 10', 10'', 10''') according to any one of claims 1 to 7, characterized in that the computer program comprises a routine for determining a target area (90') and / or a target position (91') for the item (24) in provided data (92) determined preoperatively, a registration routine for registering the preoperatively determined data (92) with the 3-D reconstruction (94) of the region of interest volume (22), and a transfer routine for transferring the target area (90') and / or the target position (91') in the preoperatively determined data (92) to the 3-D reconstruction (94) of the region of interest volume (22).

9. The arrangement (10, 10', 10'', 10''') according to any one of claims 1 to 8, characterized in that the item (24, 24') is in the form of a surgical tool comprising a capillary (86) having an opening (82) for the release of a medium (88).

10. 10. The arrangement (10, 10', 10'', 10''') according to claim 9, characterized in that the calculation routine of the computer program serves to determine target values ​​for the volume of the emitted medium (88) as guide variables by processing the target area (90) in the 3-D reconstruction (94) of the region of interest volume (22), and / or by processing pre-operatively determined data (92), and / or by processing OCT scan information acquired by the OCT device (20) by scanning the region of interest volume (22), and / or by input of target values ​​by a surgeon.

11. 11. The arrangement (10, 10', 10'', 10''') according to claim 10, characterized in that the calculation routine of the computer program serves to determine the actual value of the volume of the medium (88) released in the target area (90) by comparing data of the target area (90) in the 3-D reconstruction (94) of the region of interest volume (22) and / or scanning information of the target area (90) acquired by the OCT device (20) by scanning the region of interest volume (22) before and during the release of the medium (88).

12. 12. The arrangement according to claim 10 or 11, characterized in that the calculation routine of the computer program is designed to determine the difference between a target value and an actual value of the volume of the medium (88) emitted in the target area (90) as a guide variable for readjustment of the volume of the emitted medium (88).

13. 9. The arrangement according to claim 1, wherein the calculation routine of the computer program serves to determine the location of material to be removed and / or the amount of material to be removed as guide variables by processing the target area (90) in the 3-D reconstruction (94) of the region of interest volume (22) and / or by processing pre-operatively determined data (92) and / or by input of target values ​​by the surgeon.

14. 14. The arrangement (10, 10', 10'', 10''') according to claim 13, characterized by a visualization routine for visualizing the location of the material to be removed and / or the amount of material to be removed within the region of interest volume (22).

15. 1. A computer program for determining a 3-D reconstruction (94) of a region of interest volume (22) within a region of interest (18) by processing OCT scan information acquired by an OCT device (20) by scanning the region of interest volume (22), and for determining relative positions of sections (84) of items (24, 24') in the region of interest volume (22), the computer program comprising: a calculation routine for determining a target area (90) in the 3-D reconstruction (94) of the region of interest (22) and guide variables for the items (24, 24') relative to the target area (90); and an adjustment routine for adjusting a decision rule for the 3-D reconstruction (94) and / or a decision rule for the location of the section (84) of the item (24, 24') within the region of interest volume (22) based on a criterion, wherein the criterion is a shadow magnitude that quantifies the presence of a shadow caused by the item (24, 24') in the calculated 3-D reconstruction (94).

16. The computer program of claim 15, characterized by a path planning routine that calculates an optimal path for the items (24, 24') to a spatial target location (91) based on the criteria.

17. A method of operating a medical device, comprising: a computer unit for determining a 3-D reconstruction (94) of a region of interest volume (22) within a region of interest (18) by processing OCT scan information acquired by an OCT device (20) by scanning said region of interest volume (22), and for determining relative positions of sections (84) of items (24, 24') in said region of interest volume (22), comprising:

1. A method for operating a medical device, comprising: a computer unit adjusting a decision rule for the 3-D reconstruction and / or a decision rule for the position of the section of the item within the region of interest volume based on a criterion, the criterion being a shadow magnitude that quantifies the presence of a shadow caused by the item in the calculated 3-D reconstruction. a computer unit determining a target area (90) in the 3-D reconstruction (94) of the region of interest (22) and guide variables for the items (24, 24') relative to the target area (90); a computer unit calculating an optimal path for said items (24, 24') to a spatial target location (91); 18. The method of claim 17, wherein:

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