Method and device for processing medical image data in conjunction with a trepanation

Abstract

A method for processing medical image data in conjunction with a trepanation comprises the following steps: - providing 3D data obtained by computed tomography, which comprise a skull image and marker positions, wherein a geometric association exists between the marker positions and structures which are recorded in the form of the 3D data, - automatically sensing the marker positions independently of the computed tomographic imaging by means of a surgical navigation system (6), - associating structures detected by computed tomography in the first step with the marker positions that exist in the second step, - using the association obtained in the previous step to control a trepanning robot (7) using the above-mentioned navigation system (6).

Description

[0001] Method and device for processing medical image data in connection with trepanation

[0002] The invention relates to a method for processing medical image data, which is applicable in connection with trepanation. Furthermore, the invention relates to a device for processing and using medical image data in this context.

[0003] A method for processing medical image data is disclosed, for example, in US 2021 / 0338342 A1. It proposes using a navigation system to obtain feedback on the position and orientation of an object during surgery. This involves using 3D data acquired by computed tomography, which includes a skull image and marker positions. The marker positions can also be acquired independently of the computed tomography using the navigation system. The system described in US 2021 / 0338342 A1 is said to be particularly suitable for brain surgery.

[0004] Trepanation is known to be performed for cranial pressure relief. Documents US 2012 / 0271223 Al, US 2021 / 0059720 Al, and CN 107348933 A, for example, address this topic.

[0005] A robot for intracranial surgery is the subject of the following publication:

[0006] D. Glauser, H. Frankhauser, M. Epitaux, J.-L. Hefti & A. Jaccottet (1995) Neurosurgical Robot Minerva: First Results and Current Developments, Journal of Image Guided Surgery, 1:5, 266- 272, DOI: https: / / doi.org / 10.3109 / 10929089509106332.

[0007] Various variants of cranial drills, i.e., medical devices suitable for trepanation, are described, for example, in documents WO 2021 / 011795 A1, US 2020 / 0367915 A1, US 2015 / 0202011 A1, EP 3 206 595 B1, EP 2 022 414 B1, WO 2004 / 014223 A2, and US 2008 / 0183173 A1. The device described in the latter document comprises an ultrasound generator. EP 1 528 892 B1 concerns a drill bit for medical devices.

[0008] For the scientific background, please refer to the following document:

[0009] Guidelines for diagnostics and therapy in neurology: Intracranial pressure (ICP) - Development stage: Sl, published by the Guidelines Commission of the German Society of Neurology, lead author: Prof. Dr. Hagen B. Hüttner, Erlangen, published by AWMF online, 2018, AWMF registration number 020 / 105

[0010] Various variants of robots designed as medical devices are described, for example, in the documents US 2020 / 0297357 A1 and DE 100 35 487 B4.

[0011] Intracranial pressure, i.e., the pressure inside the skull, is also colloquially referred to as "cranial pressure." Intracranial pressure counteracts the pressure with which blood is pumped into the brain and thus has a decisive influence on blood flow and brain function. In cases of brain injury such as a stroke, intracranial pressure can increase exponentially, almost suddenly. In such a situation, opening the skull, i.e., trepanation, can be a measure to counteract the increase in intracranial pressure.

[0012] The invention is based on the object of providing means that are more advanced than the cited prior art and can be used for trepanations performed under extreme time pressure. Ideally, the trepanation should be possible without the presence of highly specialized medical personnel.

[0013] The processing of medical image data plays a central role in solving this problem. According to the invention, a method for processing medical image data as specified in claim 1 is proposed, which comprises the following steps:

[0014] Provision of 3D data obtained by computer tomography, which includes a skull image and marker positions, whereby a geometric correlation is given between the marker positions, i.e. the positions of the markers on the patient, and anatomical structures recorded in the form of the 3D data, and whereby the patient is typically relocated after the 3D data has been acquired,

[0015] Automatic detection of marker positions in the current position of the patient independently of the computed tomographic imaging using a surgical navigation system,

[0016] Assigning structures detected by computer tomography in the first step, in particular brain structures, to the marker positions given in the second step,

[0017] Use of the assignment obtained in the previous step, i.e. third step, to control a trepanation robot using the navigation system mentioned.

[0018] The device used to acquire the 3D computed tomography data can, in particular, be a computed tomography scanner specifically designed for examining the head. This is preferably a computed tomography scanner without a rotating source-detector arrangement. For example, computed tomography scanners such as those described in documents EP 3 537 978 B1 or EP 4031009 B1 are suitable.

[0019] The 3D data obtained by computed tomography and the data provided by the navigation system can be used to automatically determine the position, orientation and feed rate of a drilling device associated with the trepanation robot.

[0020] In an alternative, less automated procedure, the 3D data acquired using a CT scanner is transmitted via a wireless communication system to enable remote instructions to be received and thus operate the trepanation robot. It is also conceivable to integrate an AI system, i.e., an artificial intelligence system, directly into the trepanation robot or to connect it to it via a communication system to control the trepanation robot in a partially or fully automated manner using AI support. The AI ​​system can access data based on a large number of similar cases.

[0021] Safety aspects are particularly important in highly automated variants of the method according to the application. An advantageous safety concept that can be implemented without significant time loss provides that, before the trepanation robot is activated, i.e., before the trepanation begins, a comparison is made between location information provided by the navigation system and further location information originating from the trepanation robot. Each location information relates to the position of a drill provided by the drilling device, in particular the drill tip. Independently of the navigation system, the trepanation robot is capable of determining the position of the drill.

[0022] For this purpose, the trepanation robot comprises several geometric measuring devices, including at least one angle measuring device and at least one length measuring device. The geometric information obtained in this way is compared with the information provided by the navigation system. Only if the location information obtained in the various ways matches is the trepanation to be performed by the robot authorized. These geometric measuring devices can be components of a drive and measuring system of the trepanation robot, which is linked to the navigation system via data technology.

[0023] According to claim 6, within the framework of processing medical image data, 3D data comprising a skull image are simultaneously acquired by computed tomography and, using this data, a trepanation robot can be controlled. At the same time, all features of method claims 1 to 5 can be implemented, also in combination with the device features listed in the present text. In particular, the 3D data can be acquired by computed tomography while the gantry of the computed tomography scanner is tilted relative to the patient's skull and its longitudinal axis. A tilt axis of the gantry can lie in a horizontal plane.During computed tomographic imaging, the central axis of the gantry is inclined relative to an axis lying in the horizontal plane, which is parallel to the longitudinal axis, for example by an angle of at least 15 degrees and at most 75 degrees, in particular by an angle of at least 30 degrees and at most 60 degrees, which provides good conditions for the simultaneous use of the trepanation robot.

[0024] Thanks to simultaneous 3D imaging and control of the trepanation robot, an end effector of the trepanation robot, which includes a drill bit, can track any patient movements in real time. One or more components of the CT scanner used to acquire the 3D data can be moved while controlling the trepanation robot, continuously capturing an observed volume (ROI, region of interest). When tracking the gantry, geometric precision in the submillimeter range can be achieved. The same applies to the positioning movements of the trepanation robot.

[0025] The device according to the application for processing and using medical image data comprises the following components according to claim 10:

[0026] A data processing unit which is designed to acquire 3D data obtained by computer tomography, which includes at least one skull image and information on the position of markers attached to the patient's skull, a surgical navigation system which is provided for establishing a coordinate system on the basis of the position of the markers detected by the navigation system, a trepanation robot which is designed to drill a trepanation hole in cooperation with the data processing unit and the navigation system.

[0027] According to the independent claim 19, the device for processing and using medical image data comprises a data processing unit which is designed to acquire 3D data obtained by computer tomography, which includes at least one image of the skull, a surgical navigation system, a trepanation robot which is designed to use the 3D data in real time and thus, even with varying positions of the skull, to set a trepanation bore in cooperation with the data processing unit and the navigation system.

[0028] The following statements apply, as applicable, to both the device according to claim 10 and the device according to claim 19.

[0029] In a preferred embodiment, the trepanation robot is designed as a multi-axis surgical robot with multiple degrees of freedom. Rotational and / or linear degrees of freedom can be provided.

[0030] All features and advantages explained in this text with reference to the device intended for processing and using medical image data also apply mutatis mutandis to the method according to the application, with which image data is processed and used to control a trepanation robot, i.e. a surgical robot, and vice versa.

[0031] According to an advantageous development, the aforementioned drive and measuring system of the trepanation robot is coupled not only to the navigation system but also to an optical monitoring device. In this case, the trepanation robot is activated, i.e., the trepanation process begins, only when three different systems—namely, the navigation system, the drive and measuring system, and the optical monitoring device—provide consistent geometric data.

[0032] The CT scan images, which are primarily available in the form of cross-sectional images and / or segmented three-dimensional images, do not represent real-time data when controlling the trepanation robot. A higher degree of timeliness can be achieved with the help of elastic fusion of image data. Regarding the elastic fusion of image data in medical technology, reference is made to documents US 11,382,603 ​​B2 and DE 102013 200898 A1 as examples.

[0033] In this case, various options exist for optimizing and / or updating 3D image data generated by computed tomography and used to control the trepanation robot using elastic fusion. For this purpose, data provided by the trepanation robot, including any monitoring devices integrated into or linked to the robot, can be accessed. The function of a monitoring device can be performed by an ultrasound system or an optical system, for example. Elastic fusion means that the original 3D image data is updated by incorporating more recent data, which generally occurs as a distortion of the data. Such distortion, which is associated with an actual change in the shape of the tissue under consideration, can be attributed, for example, to an enlargement of a hematoma.

[0034] If this enlargement or other change in shape only occurs after the computed tomography images have been acquired, the 3D image data – which is then no longer current – ​​can, for example, be drawn into the correct shape, figuratively speaking, by using reference points or structures that are automatically identifiable in both the 3D image data acquired by computed tomography and the current ultrasound images. These points or structures are used to align the entire 3D image data with the current geometry of the tissue under consideration. In this way, the precision and richness of the data from the initial X-ray imaging, i.e., computed tomography, is combined with the less information-rich data acquisition performed in real time, particularly ultrasound imaging.

[0035] In addition to or as an alternative to ultrasound data acquisition, elastic fusion can access optical systems or other data sources, such as measurements performed on the patient. Finally, it is also possible to predict changes in the condition of the tissue under consideration using simulations. Non-geometric, currently measured data can also be incorporated into such a simulation. In extreme cases, a simulation or AI-based prediction leading to elastically fused image data can even be performed solely on the basis of data already available at the time of the computed tomography scan.

[0036] In a compact yet mechanically well-protected design, the trepanation robot can have a helmet-like shape. This is particularly suitable in cases where the personnel operating the trepanation robot do not need to be able to see the location on the skull where the trepanation hole is to be drilled. This means that the helmet-like design of the trepanation robot—as far as visible from the outside—is particularly suitable when the trepanation is performed fully automatically. The patient's head can be fixed to the helmet-like trepanation robot or in some other way. In any case, the previously applied markers have a defined geometric relationship to the trepanation robot.

[0037] The navigation system of the device according to the application is designed, in particular, as an electromagnetic position determination system. Regarding possible configurations of navigation systems for medical technology purposes, reference is made to documents US Pat. No. 9,192,446 B2, DE 10 2006 037 604 A1, and DE 10 2005 051 102 B4 as examples. In the present case, data from the navigation system are to be merged with data from the previously used medical imaging device, namely a computer tomography scanner. Regarding the fusion of data, in particular image data, in medical technology, background information can be found, for example, in documents DE 198 46 687 A1 and DE 202015 100224 U1.

[0038] According to an advantageous further development, the trepanation robot is used as part of a mobile medical technology system, which, in a preferred design, also includes the CT scanner, which contributes the 3D data. In particular, the CT scanner and the trepanation robot, which is linked to it for data purposes, are housed in one and the same vehicle, i.e., an ambulance. Especially in such a case, the compact design of both the trepanation robot and the CT scanner, which preferably works with a fixed, i.e., non-rotating, radiation source-detector arrangement, is particularly advantageous. The greatest advantage, however, is that the patient does not have to be transported to a hospital to have the immediately effective trepanation drilled. The highly automated, mobile trepanation device thus provides an invaluable time advantage.

[0039] Several embodiments of the invention are explained in more detail below with reference to a drawing. These show, schematically:

[0040] Fig. 1 shows a first embodiment of a device for processing and using medical image data that can be used in a trepanation,

[0041] Fig. 2 shows a computer tomograph which provides usable 3D data by the device according to Fig. 1,

[0042] Fig. 3 shows a mobile medical system comprising the devices according to Figures 1 and 2,

[0043] Fig. 4 Components of a trepanation robot attributable to the device according to Fig. 1 including several measuring and monitoring devices, Fig. 5 in a flowchart steps of a method that can be carried out with the device according to Fig. 1,

[0044] Fig. 6 shows in a diagram the elastic fusion of image data in the course of the method that can be carried out with the device according to Fig. 1,

[0045] Fig. 7 shows a second embodiment of a device for processing and using medical image data that can be used in a trepanation,

[0046] Fig. 8 shows in a flowchart steps of a method that can be carried out with the device according to Fig. 1.

[0047] The following explanations apply, where applicable, to both exemplary embodiments. Structures or components that correspond to one another or have essentially the same function are identified by the same reference numerals in all figures.

[0048] A device for processing and using medical image data, designated overall by reference numeral 1, is part of a medical system 10 that enables the rapid insertion of a trepanation hole in emergencies. The core information technology component of the device 1 is a data processing unit 2, which is linked to both a CT scanner 3 and a trepanation robot 7 associated with the device 1. The data processing unit 2 can be configured centrally or decentrally in any desired manner, and access to data stored in a cloud can also be provided.

[0049] If increased intracranial pressure is detected in a patient, necessitating trepanation, 3D data obtained with the aid of the CT scanner 3 must be used for the corresponding procedure. Figure 2, as well as Figure 7, shows the patient's head supported on a patient couch 4. In both cases, the patient's longitudinal axis lies in a horizontal plane parallel to the patient couch 4.

[0050] Before the computed tomography examination, in the exemplary embodiment according to Figures 1 to 6, markers 5 are applied to the patient's head in a conventional manner, as is not shown to scale in Figures 1 and 2. The markers 5, which are clearly visible under X-ray conditions, appear in the 3D data supplied by the computed tomography scanner 3. A line 13 is provided as a data connection for transmitting the data between the computed tomography scanner 3 and the data processing unit 2. Similarly, a data connection exists between the data processing unit 2 and the trepanation robot 7. A navigation system 6, which represents a component of the device 1 and which will be discussed in more detail below, is also linked to the data processing unit 2 in a corresponding manner; data connections can also be implemented wirelessly.

[0051] The computed tomography scan indicated in Figure 2 is used to obtain information about the most suitable location for opening the skull. Depending on various process variants, the corresponding determination can be made either automatically, mechanically assisted, or solely by operating personnel or remotely connected personnel. In any case, after the computed tomography scan, a geometric relationship is established between the computed tomography-captured structures and the positions of the markers 5.

[0052] Once the computed tomography examination is complete, the trepanation robot 7 is deployed. As shown in Figure 1, the trepanation robot 7 comprises a supporting component, which is referred to as a helmet 8 due to its external shape. The patient's head is positioned in the helmet 8, whereby the head can be supported, in a manner not shown, either directly on the helmet 8 and / or in some other way. While the patient is positioned in this way, the position of the markers 5 is detected with the aid of the aforementioned navigation system 6, which is an electromagnetic navigation system. Thus, even in this configuration, the spatial position of the patient's structures previously detected by the computed tomography scanner 3 is known.

[0053] The trepanation robot 7 comprises a drilling device 11, which, in the case sketched in Figure 1, is arranged entirely within the supporting structure of the trepanation robot 7, designed as a helmet 8. The drilling device 11 can be adjusted in a variety of ways, with a first adjustment direction VI and a second adjustment direction V2 being shown as examples in Figure 1. For movement in the first adjustment direction VI, a linear guide 9 can be provided, as sketched in Figure 1. A curved rail of the linear guide 9 ensures that the entire drilling device 11, which includes a drill 12, can be moved along the surface of the skull. The drilling device 11 and the drill 12 represent components of an end effector 11, 12 of the trepanation robot 7.

[0054] A further adjustment mechanism, not shown in Figure 1, enables the pivoting of the linear guide 9 about a pivot axis located in the image plane and tangent to both ends of the linear guide 9. An additional linear guide with the same functionality can be provided, which can be used to move the drilling device 11 out of the image plane shown in Figure 1. The adjustment direction V2 indicates an adjustment of the drill 12 in its longitudinal direction, i.e., a feed of the drill 12. Adjustment of the angle at which the drill 12 strikes the skull can also be provided. In any case, the trepanation is monitored using the navigation system 6. This also applies to the embodiment according to Figures 7 and 8.

[0055] Figure 3 illustrates the mobile use of the computer tomography scanner 3 and the trepanation robot 7. This figure also applies to all embodiments. The aforementioned medical devices 3, 7 are located on board a vehicle, i.e., an ambulance. The trepanation robot 7, like the computer tomography scanner 3, is suitable for mobile use, which in the case of the computer tomography scanner 3 is primarily due to the fact that it is a computer tomography scanner 3 with a fixed emitter-detector arrangement. Regarding possible configurations of such a

[0056] As regards computer tomograph 3, reference is made to the cited prior art.

[0057] As further illustrated in Figure 3, the mobile medical technology system 10 is connected to a stationary facility 14, for example, a specialized clinic, via a wireless communication system 15. This provides the possibility of influencing the trepanation to be performed by the robot 7 via a remote connection. Extremely valuable time is gained by the fact that the trepanation can be performed even before the patient arrives at the clinic.

[0058] Especially in cases where no highly specialized medical personnel are present with the patient, safety aspects are particularly important during trepanation performed with the robot 7. Elements of a safety system used in the present case are outlined in Figure 4. According to this, the trepanation robot 7 has a drive and measuring system 17, which includes several measuring devices 18, 19, indicated by way of example in Figure 4, including at least one angle measuring device 18 and at least one length measuring device 19. A control unit 16 is provided for controlling the drive and measuring system 17, which—deviating from the symbolic representation in Figure 4—can also be implemented as a component of the data processing unit 2.In any case, the drive and measuring system 17 is configured to determine the position of the drill 12 unambiguously and independently of the navigation system 6. In addition, there is an optical monitoring device 20, also shown in Figure 4, which is capable of detecting the position of the drill 12, including its tip, before the start of the trepanation.

[0059] Preparatory steps to be performed prior to trepanation, which the device 1 according to Figure 1, including the components according to Figure 4, performs automatically, are explained below with reference to Figure 5. In step S1, the position of the drill 12 is detected by means of the navigation system 6. Parallel to this, in step S2, the position of the drill 12 is determined with the aid of the drive and measuring system 17 in the manner explained with reference to Figure 4. In addition, additional monitoring is performed with the aid of the optical monitoring system 20.

[0060] In step S3, the data provided by the various measuring and monitoring systems 6, 17, and 20, each of which indicates the position of the drill 12, are compared. If discrepancies are detected, the process is aborted in step S4. Otherwise, the trepanation, which is performed automatically by the trepanation robot 7, is started in step S5.

[0061] Further features of the method that can be performed with the device shown in Figure 1 are shown in Figure 6. In this schematic figure, the time axis is illustrated by a broad arrow pointing from top to bottom. First, image data DG, i.e., geometric data, are generated using the CT scanner 3. Strictly speaking, these data DG are only current at the time of the CT scan. In Figure 6, B1 denotes the image data relating to this time that have not been further processed.

[0062] In the period between the computed tomography scan and the intervention using the trepanation robot 7, even if all components of the medical technology system 10 are spatially consolidated, changes can occur in the patient's tissue being examined. Such a change is shown in Figure 6 in an exaggerated form. During the preparation of the intervention using the trepanation robot 7 and also during this intervention, the trepanation robot 7 itself and / or devices coupled to it, including the optical monitoring device 20, provide data generally referred to as measurement data DM. This is not necessarily optical data.

[0063] In any case, the measurement data DM is used to update the image data Bl via elastic image fusion and, as a result, to provide fused image data B2 for controlling the trepanation robot 7. The further processing of the original image data Bl into the elastically fused image data B2 is to be understood as a distortion of the original image data Bl. In this case, the richness of the original image data Bl is retained, insofar as it is relevant for the operation of the trepanation robot 7. The measurement data DM represent, either literally or figuratively, reference points based on which the image data Bl is rearranged, which may include compressions and expansions.

[0064] The fused image data B2 obtained in the manner described represents the relevant data for controlling the trepanation robot 7. If, deviating from this procedure, no relevant changes in the structures under consideration are to be expected, it is also possible to directly use the image data B1 generated by the computer tomograph 3 to control the trepanation robot 7.

[0065] The embodiment shown in Figures 7 and 8 differs from the embodiment shown in Figures 1 to 7 in that the acquisition of 3D data by computed tomography and the use of the trepanation robot 7 occur simultaneously. The gantry of the computed tomography scanner 3, designated 21, is tilted in this case to the longitudinal axis of the patient and to the patient's skull. A region of interest (ROI) can be continuously captured, even if the position of the skull changes, while—within wide limits—the trepanation robot 7 remains operational.

[0066] In Figure 8, which relates to the arrangement according to Figure 7, step S11 denotes the acquisition of geometric data by means of the computer tomography scanner 3. At the same time, in step S12, the state of the trepanation robot 7 is acquired in the manner already explained in connection with the exemplary embodiment according to Figures 1 to 6. In steps S13 and S14, which are also carried out simultaneously or without a technically relevant time offset, a check is carried out to determine whether the data acquired with the computer tomography scanner 3 and the determined state of the trepanation robot 7 fundamentally permit its use. If this is the case, corrections to the device 1 are made in step S15, if necessary. Such corrections can include adjusting the trepanation robot 7, in particular its end effector 11, 12, which comprises the drilling device 11 and the drill 12, as well as adjusting the gantry 21.Step S16 denotes a processing step performed by the trepanation robot 7. During this process, the position of the end effector 11, 12 changes only slightly. Subsequently, in step S17, it is determined whether the trepanation is complete. If so, the method ends with step S18. Otherwise, the method continues with steps S11, S12, with the trepanation robot 7 continuing to be used in real time using the computer tomography scanner 3. A particular advantage is the fact that not only can a high degree of precision be achieved during the procedure, but any relocation of the patient between imaging and trepanation is also eliminated. In particular, the compact device according to Figure 7 is suitable for use in a mobile medical system 10, as already explained with reference to Figure 3.

[0067] List of reference symbols

[0068] 1 Device for processing and using medical image data

[0069] 2 Data processing unit

[0070] 3 computer tomography

[0071] 4 patient beds

[0072] 5 markers

[0073] 6 Navigation system

[0074] 7 trepanation robots

[0075] 8 Helmet

[0076] 9 Linear guide

[0077] 10 medical technology system

[0078] 11 Drilling device

[0079] 12 drills

[0080] 13 Line, data connection

[0081] 14 inpatient facilities

[0082] 15 Communication system

[0083] 16 Control unit of the trepanation robot

[0084] 17 Drive and measuring system

[0085] 18 Angle measuring device

[0086] 19 Length measuring device

[0087] 20 optical monitoring device

[0088] Bl image data, from the computer tomograph

[0089] B2 image data, fused

[0090] DG geometric data

[0091] DM measurement data

[0092] S1...S5 process step

[0093] VI first adjustment direction, degree of freedom

[0094] V2 second adjustment direction, degree of freedom

Claims

Patent claims 1. Method for processing medical image data, comprising the following steps: Providing 3D data acquired by computer tomography, which comprises a skull image and marker positions, wherein a geometric assignment is given between the marker positions and structures recorded in the form of the 3D data, Automatic detection of the marker positions independently of the computer tomography imaging by means of a surgical navigation system (6), Assigning structures detected by computer tomography in the first step to the marker positions given in the second step, Using the assignment obtained in the previous step to control a trepanation robot (7) using said navigation system (6).

2. Method according to claim 1, characterized in that the 3D data obtained by computer tomography and the data supplied by the navigation system (6) are used to automatically determine the position, orientation and feed of a drilling device (11) assigned to the trepanation robot (7).

3. Method according to claim 2, characterized in that before the trepanation robot (7) is started, a comparison is carried out between location information supplied by the navigation system (6) concerning the position of a drill (12) to be assigned to the drilling device (11) and the associated location information which the trepanation robot (7) supplies by means of several geometric measuring devices (18, 19), which include at least one angle measuring device (18) and at least one length measuring device (19) of the trepanation robot (7), and the action of the trepanation robot (7) is carried out exclusively at Agreement between location information obtained in different ways is released.

4. Method according to one of claims 1 to 3, characterized in that the 3D data obtained by computer tomography are transmitted remotely via a communication system (15).

5. Method according to one of claims 1 to 4, characterized in that elastically fused image data (B2), which represent a modification of image data (B1) obtained by computer tomography with the inclusion of further, more recent measurement data (DM), are used to control the trepanation robot (7).

6. Method for processing medical image data, wherein 3D data comprising a skull image are simultaneously acquired by computer tomography and a trepanation robot (7) is controlled using this data.

7. Method according to claim 6, characterized in that the 3D data are acquired with the gantry (21) inclined relative to the patient's skull.

8. Method according to claim 6 or 7, characterized in that an end effector (11, 12) of the trepanation robot (7) tracks movements of the patient in real time.

9. Method according to one of claims 6 to 8, characterized in that at least one component of the computer tomograph (3) used to acquire the 3D data is moved during the control of the trepanation robot (7) with permanent detection of an observed volume region (ROI).

10. Device (1) for processing and using medical image data, comprising a data processing unit (2) which is designed to acquire 3D data obtained by computer tomography, which includes at least one skull image and information on the position of markers (5) attached to the skull, a surgical navigation system (6) which is provided for defining a coordinate system on the basis of the position of the markers (5) detected by the navigation system (6), a trepanation robot (7) which is designed to set a trepanation bore in cooperation with the data processing unit (2) and the navigation system (6).

11. Device (1) according to claim 6, characterized in that the trepanation robot (7) is designed as a multi-axis surgical robot having several degrees of freedom (VI, V2).

12. Device (1) according to claim 7, characterized in that the trepanation robot (7) comprises a drive and measuring system (17) with at least one angle measuring device (18) and at least one length measuring device (19), wherein the measuring devices (18, 19) are data-technically coupled to the navigation system (6) via a control unit (16) of the trepanation robot (7).

13. Device (1) according to claim 8, characterized in that the navigation system (6) is further coupled to an optical monitoring device (20), wherein the control unit (16) of the trepanation robot (7) is designed to enable its start-up only when the geometric information supplied by three different systems (6, 17, 20), namely the navigation system (6), the drive and measuring system (17), and the optical monitoring device (20), agree.

14. Device (1) according to one of claims 6 to 9, characterized in that the data processing unit (2) is set up to process image data (B1) obtained by computer tomography in the sense of an elastic fusion by including further, more recent measurement data (DM) and / or simulation data and to control a drilling device (11) of the trepanation robot (7) on the basis of the fused image data (B2) thus obtained.

15. Device (1) according to one of claims 6 to 10, characterized in that the trepanation robot (7) has a helmet-like shape.

16. Device (1) according to one of claims 6 to 11, characterized in that the navigation system (6) is designed as an electromagnetic position determination system.

17. Device (1) according to one of claims 6 to 12, characterized in that the trepanation robot (7) is part of a mobile medical system (10).

18. Device (1) according to claim 13, characterized in that the mobile medical system (10) further comprises the computer tomography device (3) which is provided for obtaining the said 3D data.

19. Device (1) for processing and using medical image data, comprising a data processing unit (2) which is designed to acquire 3D data obtained by computer tomography, which includes at least one image of the skull, a surgical navigation system (6), a trepanation robot (7) which is designed to use the 3D data in real time and thus, even with varying positions of the skull, in cooperation with the data processing unit (2) and the navigation system (6), to set a trepanation bore.

Images