Abstract
A medical ultrasound device is disclosed. The device comprises an elongated body having a proximal end, a distal end (10) and a distal end region (1). One or more ultrasound transducers (4) for generating acoustic radiation are positioned in the distal end region, inside the elongated body. A transmission element (5) which is substantially transparent to acoustic radiation is positioned in the radiation path of the acoustic radiation, and a controller unit is operatively connected to the ultrasound transducer. The controller unit detects the acoustic path length through the transmission element and determines the temperature at the distal end from the detected acoustic path length. In an embodiment, the medical device is an ultrasound RF ablation catheter.
Claims
1. An ultrasonic temperature determination device, comprising: a controller unit configured to be coupled to an ultrasound imaging device comprising an ultrasound transducer coupled to a distal region of an elongate body, the controller unit configured to: control the ultrasound transducer of the ultrasound imaging device to emit acoustic radiation through a transmission element coupled to the elongate body at a fixed position relative to the ultrasound transducer; receive an ultrasound signal from the ultrasound transducer, wherein the ultrasound signal is representative of reflections of the acoustic radiation from a surface of a backside and a surface of a front-side of the transmission element; determine, based on the ultrasound signal, an acoustic path length between the surface of the backside and the surface of the front-side of the transmission element; and determine a temperature of the transmission element based on the acoustic path length.
2. The device of claim 1, wherein the controller unit is configured to determine the acoustic path length by detecting a separation of reflection peaks from the surface of the backside and the surface of the front-side of the transmission element.
3. The device of claim 1, wherein the controller unit is configured to determine the temperature of the transmission element based on a look-up table or a functional relationship between a parameter related to the acoustic path length and temperatures of the transmission element.
4. The device of claim 1, wherein the controller unit is configured to: generate M-mode imaging data based on the ultrasound signal; and determine the acoustic path length based on the M-mode imaging data.
5. The device of claim 1, wherein the controller unit is further configured to control an ablation electrode of the ultrasound imaging device coupled to the distal region of the elongate body to emit ablation energy into a tissue of a patient.
6. The device of claim 5, wherein the controller unit is configured to simultaneously control the ablation electrode to emit the ablation energy and the ultrasound transducer to emit the acoustic radiation.
7. The device of claim 6, further comprising the ultrasound imaging device.
8. The device of claim 7, wherein the ablation electrode is disposed on a distal surface of the transmission element.
9. The device of claim 8, wherein the ablation electrode comprises a metallic layer.
10. The device of claim 7, wherein the transmission element comprises an acoustically transparent polymer-based body.
11. The device of claim 10, wherein the acoustically transparent polymer-based body is configured such that a velocity of the acoustic radiation changes more than 0.1% per degree Celsius.
12. The device of claim 7, wherein the transmission element is spaced from the ultrasound transducer.
13. The device of claim 12, wherein the elongate body includes fluid channels that allow delivery of a fluid to the distal region.
14. The device of claim 13, wherein the fluid channels are configured to deliver the fluid into a space between the ultrasound transducer and the transmission element.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
(1) Embodiments of the invention will be described, by way of example only, with reference to the drawings, in which
(2) FIG. 1 schematically illustrates the distal end region of an ablation catheter-based probe;
(3) FIG. 2 schematically illustrates an ablation electrode supported by a transmission element;
(4) FIG. 3 illustrates a screen shot of an M-mode ultrasound image of cardiac ablation in a sheep heart;
(5) FIG. 4 illustrates a zoom made of the first order TPX/Pt reflection peak of the M-mode image of FIG. 3;
(6) FIG. 5 shows a graph of peak separation as a function of time;
(7) FIG. 6 illustrates a graph correlating the peak separation, the speed of sound and the temperature;
(8) FIG. 7 further illustrates peak separations as a function of temperature;
(9) FIG. 8 illustrates a flow diagram of steps performed in connection operating a medical device; and
(10) FIG. 9 schematically illustrates a medical device connected to a controller unit and in connection with a computer program product.
DESCRIPTION OF EMBODIMENTS
(11) The present invention is disclosed in connection with a RF ablation catheter comprising a monitoring system in accordance with embodiments of the present invention. It is however to be understood that, while such an application is advantageous, the invention is not limited to this. In fact, the medical device may be applied in connection with any device which uses ultrasound transducers and which supports a structural configuration which enables to detect an acoustic path length through a transmission element.
(12) FIG. 1 schematically illustrates the distal end region 1 of an ablation catheter-based probe, hereafter also simply referred to as a catheter. The catheter comprises an elongated body 3, a proximal end (not shown), a distal end 10 and a distal end region 1. A length axis 9 runs along the elongation of the elongated body. The distal end region 1 is the extended end section of the elongated body 3 abutting the distal end itself 10. The catheter may at the proximal end comprise a controller unit or connection for a controller unit (cf. FIG. 9). The ultrasound transducer 4 is housed in the distal end region, where it is fixed by suitable means 6. The catheter comprises a transmission element 5 positioned in the radiation path of the acoustic radiation. The transmission element may be used as a transmission window for coupling the acoustic radiation out of the medical device. The transmission element has a backside generally facing the ultrasound transducer and an opposite facing front-side. The transmission element is substantially transparent to acoustic radiation, so that radiation generated by the ultrasound transducer will be transmitted through the transmission element to interact with tissue 2 under investigation or treatment. In an embodiment, the acoustic radiation is emitted along the length axis 9.
(13) As is illustrated in FIG. 1, the distal end region may further comprise fluid channels 7 which allow delivery of fluid through the elongated body to the distal end region so as to irrigate the treatment site during treatment if this is necessary or desirable, typically by use of saline fluid. The fluid channels may be holes into the side of the tube as in the illustrated embodiment, or made by other suitable means.
(14) In an embodiment the device may e.g. be an ultrasound catheter with an integrated ablation electrode. The ultrasound catheter supports monitoring of tissue properties by operating the ultrasound transducer in a monitoring mode, where ultrasound pulses are emitted and the reflected radiation is detected in order to generate an ultrasound image or scan. Operating an ultrasound transducer for detecting reflected radiation is known to the skilled person.
(15) The elongated body may be of a flexible material, such as a suitable polymer material for use in connection with a medical device. Such materials are known to the skilled person. A flexible device is thereby obtained. Alternatively may the elongated body be made of a rigid material, such as surgical steel or other suitable materials as are known to the skilled person. A rigid device may e.g. be implemented as a needle device.
(16) FIG. 2 schematically illustrates an ablation electrode 20 supported by a transmission element 5. The transmission element has a backside 21 and a front side 22. The ablation electrode may be formed by a thin conducting layer supported by the transmission element. In an embodiment, the transmission element comprises a polymer-based body and a conducting layer. The polymer-based body may be of the material poly-methylpentene (TPX) which is commonly used in connection with ultrasound, whereas the conducting layer may be a metallic layer, such as a platinum layer. Suitable thicknesses may be a few hundred micrometers thick TPX supporting a few hundred nanometer thick platinum layer, such as a 250 micrometer thick TPX element, supporting a 150 nanometer thick platinum layer. The thickness of the TPX element is the thickness at the central region. Other materials may also be used, as long as they are sufficiently transparent to acoustic radiation. The transmission element and supported electrode are illustrated in a rounded configuration which is the clinically relevant shape. In general any shape may be used.
(17) FIG. 3 illustrates a screen shot of an M-mode ultrasound image of cardiac ablation in a sheep heart as generated by an ablation catheter of the type schematically illustrated in FIG. 1. The vertical axis shows the distance from the transducer. The distance is given in pixels which can be converted into time or depth. The horizontal axis illustrates time, again given in pixels (increments of 20 pixels equals 1 second). The image shows the strong primary reflection 30 from the TPX/Pt ablation electrode, and in addition 2nd and 3rd order reflection peaks 31, 32.
(18) FIG. 4 illustrates a zoom made of the first TPX/Pt reflection peak 30, as indicated with reference numeral 33 on FIG. 3. In FIG. 4, it can be seen that the two peaks (maxima indicated by reference numerals 40, 41) are observed. The positions of these reflections are related to the time-of-flight of the ultrasound signal, and therefore the acoustic path length through the transmission element. The maxima of the two peaks are observed to be relatively constant with respect to time in the first half of the image, however as can be seen during the period indicated with reference numeral 42 where the ablation process is running, the distance 43, 44 between the two peaks increases. The first peak 40 corresponds to the transition of the acoustic radiation into the transmission element, and the second peak 41 corresponds to the transition of the acoustic radiation out of the transmission element. In the area between the two peaks, the ultrasound radiation is propagating inside the transmission element. Due to the ablative process, the temperature of the ablation electrode and the tissue increases and as a result, the acoustical path length through the transparent ablation electrode increases too. By monitoring the positioning of the two peaks, the acoustic path length can be monitored. From analysis of the monitored data, it is possible to obtain sub-pixel resolution. The main physical effect which gives rise to the changes in the acoustical path length is the change of the speed of sound in dependence upon the temperature changes. It can be mentioned that the material expansion of either the electrode or the transmission element over the relevant temperature ranges is nearly negligible. As the temperature rises, the speed of sound decreases, resulting in an increases acoustical path length, which is seen as an increase in the distance 43, 44 between the two peaks.
(19) FIG. 5 shows a graph of the peak separation 43, 44 as a function of time in the ablation period as indicated with reference numeral 42 in FIG. 4. The vertical axis is peak separation in pixels and the horizontal axis is time in seconds. The graph shows measuring points 50 as well as a calculated line 51 of the expected thermal effect. The calculation was obtained by assuming 4 mm thick cardiac tissue, cold surfaces and a 6 mm diameter ablation catheter. The vertical axis includes only a single fitting parameter in the form of the product of the ablation power and thermal conductivity. The horizontal axis does not contain fitting parameters. As can be seen, during the ablation process, the acoustical path length through the transmission element clearly increases. Subsequently, at the end of the ablation (at time=60 sec.) a rapid cooling is observed. The final jump at time=70 sec. is due to removal of the device from the heart wall.
(20) FIG. 6 illustrates a graph correlating the peak separation (left vertical axis), the speed of sound (right vertical axis) and the temperature in degree Celsius (horizontal axis). The measurement points are shown as solid bullets 60 (a line is drawn through the points to guide the eye), moreover, a line 61 is shown indicating 0.25% expansion per ° C. of the acoustic path length for comparison to the data. As can be seen the catheter is capable of accurately determining the temperature at the location of the point of contact between the ablation electrode and the tissue, which is the clinically interesting point.
(21) FIG. 7 further illustrates peak separations as a function of temperature. FIG. 7 illustrates a laboratory experiment, where the acoustical path length between the two peaks was measured for a medical device with the distal end region submerged in a water bath for a series of constant temperatures. A line 70 is shown which indicate 0.25% expansion per ° C. of the acoustic path length for comparison to the data. Point connected by the line with reference numeral 71 connect data points obtained during temperature rise 72, whereas point connected by the line with reference numeral 73 connect data points obtained during temperature decent 74. As can be seen, thermal resolution is of the order of 1° C. within the range of clinical relevant temperatures.
(22) In a situation of use, the temperature at the distal end may be determined based on a look-up table or a functional relationship between a parameter related to the acoustic path length and the temperature at the distal end, e.g. as deduced from a measurement as presented in FIG. 7. Look-up table, functional relationships etc. may be stored by and computed in the controller unit or a computing unit in or connected to the controller unit.
(23) FIG. 8 illustrates a flow diagram of some of the steps which may be performed in order to operate a medical device in accordance with embodiments of the present invention. Firstly, the medical device may be positioned 80 in the region of interest, for example in close proximity of cardiac tissue to undergo ablation treatment. The transducers are operated to generate 81 acoustic radiation and to detect 82 the reflected acoustic radiation. The transducers may be operated continuously 83 during the investigation and treatment. The reflected acoustic radiation is detected in order to monitor 84 the region of interest during the procedure, and from the reflected acoustic radiation also the acoustic path length is deduced to determine the temperature 85 at the distal end. Simultaneously with the monitoring and the temperature detection, the treatment modality may be operated 86 in order to perform medical treatment. For example, the tissue under treatment may undergo ablation.
(24) FIG. 9 schematically illustrates a medical device connected to a controller unit and in connection with a computer program product. The medical device comprises a catheter in accordance with embodiments of the present invention. The catheter comprises an elongated body 3 having a proximal end 90, a distal end 10, a distal end region 1 and a length axis 9 along the elongation. Moreover, the catheter comprises one or more ultrasound transducers positioned in the distal end region and a transmission element 5 positioned at the extremity of the elongated body to couple acoustic radiation in and out of the catheter.
(25) The catheter is at the proximal end 90 connected to a controller unit 91, such as a dedicated purpose or general purpose computing unit for control of at least the ultrasound transducer(s) and for dealing with the signal treatment and extraction of detection results. To this end, the detection of the acoustic path length through the transmission element and the determination of the temperature at the distal end are controlled by the controller unit 91.
(26) The controller unit may implement a computer system 92, such as a dedicated purpose or general purpose computing unit for controlling the device. The computer system may comprise storage means 93 for storing data which may be needed to operate the medical device or to store any acquired data, or for any other purpose where storage of data is desired. The computer system may be adapted to receive instructions from a computer program product 94 in order to operate the device. The computer program product may be comprised in a data carrier as illustrated in the Figure, however once loaded into the computer system it may be stored by, and run from, the storage means 93.
(27) In the foregoing, simultaneous operation of the monitoring, the ablation and the temperature sensing have been described. While it is an advantage of embodiments of the present invention that such simultaneous operation is feasible, also interleaved operation of one or more of the operation modalities is possible if this is desired.
(28) While the invention has been illustrated and described in detail in the drawings and foregoing description, such illustration and description are to be considered illustrative or exemplary and not restrictive; the invention is not limited to the disclosed embodiments. Other variations to the disclosed embodiments can be understood and effected by those skilled in the art in practicing the claimed invention, from a study of the drawings, the disclosure, and the appended claims. In the claims, the word “comprising” does not exclude other elements or steps, and the indefinite article “a” or “an” does not exclude a plurality. A single processor or other unit may fulfill the functions of several items recited in the claims. The mere fact that certain measures are recited in mutually different dependent claims does not indicate that a combination of these measured cannot be used to advantage. A computer program may be stored/distributed on a suitable medium, such as an optical storage medium or a solid-state medium supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems. Any reference signs in the claims should not be construed as limiting the scope.
