Method, a graphic user interface, a system and a computer program for optimizing workflow of a medical intervention

Abstract

The invention relates to a method of optimizing workflow for an intervention, comprising the steps of reconstruction of an image of a target area representative of an envisaged intervention based on imaging dataset; automatically selecting an optimal viewing direction for enabling a pre-operative quantitative analysis of intervention features. The invention further relates to a computer program and a system for optimizing a workflow of an intervention.

Claims

1. An apparatus for computer-assisted medical intervention of a patient comprising: a graphical user interface operating on a processor, wherein the graphical user interface comprises a display window showing a simulated X-ray angiographic image of a target area of a patient; wherein the simulated X-ray angiographic image is based on a three-dimensional or four-dimensional imaging data set of the target area of the patient; and wherein the display window is configured to provide for interactive viewing and analysis of the simulated X-ray angiographic image at varying view directions corresponding to different positions of a C-arm of an X-ray imaging unit and recording a position of the C-arm that provides an optimal view direction of the simulated X-ray angiographic image.

2. An apparatus according to claim 1, wherein the simulated X-ray angiographic image is derived from reconstructed data of the target area of the patient.

3. An apparatus according to claim 1, wherein the recorded position of the C-arm that provides the optimal view of the simulated X-ray angiographic is automatically installed by the X-ray imaging unit under certain circumstances.

4. An apparatus according to claim 3, wherein the certain circumstances involve the X-ray imaging unit uploading saved data.

5. An apparatus according to claim 1, wherein the position of the C-arm that provides the optimal view of the simulated X-ray angiographic image is established automatically.

6. An apparatus according to claim 1, wherein the position of the C-arm that provides the optimal view of the simulated X-ray angiographic image is established interactively.

7. An apparatus according to claim 1, wherein the processor controls the C-arm.

8. An apparatus according to claim 7, wherein the processor directly controls the C-arm.

9. An apparatus according to claim 7, wherein the processor indirectly controls the C-arm.

10. A non-transitory computer program loadable onto a processor for computer-assisted medical intervention of a patient, the computer program comprising instructions for causing the processor to operate a graphical user interface, wherein the graphical user interface comprises a display window showing a simulated X-ray angiographic image of a target area of the patient; wherein the simulated X-ray angiographic image is based on a three-dimensional or four-dimensional imaging data set of the target area of the patient; and wherein the display window is configured to provide for interactive viewing and analysis of the simulated X-ray angiographic image at varying view directions corresponding to different positions of a C-arm of an X-ray imaging unit and recording a position of the C-arm that provides an optimal view direction of the simulated X-ray angiographic image.

11. A non-transitory computer program according to claim 10, wherein the simulated X-ray angiographic image is derived from reconstructed data of the target area of the patient.

12. A non-transitory computer program according to claim 10, wherein the recorded position of the C-arm that provides the optimal view of the simulated X-ray angiographic is automatically installed by the X-ray imaging unit under certain circumstances.

13. A system for computer-assisted medical intervention of a patient, the system comprising: an X-ray imaging unit with a C-arm; and a graphical user interface operating on a processor, wherein the graphical user interface comprises a display window showing a simulated X-ray angiographic image of a target area of the patient based on a three-dimensional or four-dimensional imaging data set of the target area of the patient, wherein the display window is configured to allow for interactive viewing and analysis of the simulated X-ray angiographic image at varying view directions corresponding to different positions of a C-arm of an X-ray imaging unit and recording a position of the C-arm that provides an optimal view direction of the simulated X-ray angiographic image.

14. A system according to claim 13, wherein the simulated X-ray angiographic image is derived from reconstructed data of the target area of the patient.

15. A system according to claim 13, wherein the recorded position of the C-arm that provides the optimal view of the simulated X-ray angiographic is automatically installed by the X-ray imaging unit under certain circumstances.

16. A system according to claim 15, wherein the certain circumstances involve the X-ray imaging unit uploading saved data.

17. A system according to claim 13, wherein the position of the C-arm that provides the optimal view of the simulated X-ray angiographic image is established automatically and/or interactively.

18. A system according to claim 13, wherein the processor controls the C-arm.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 presents an embodiment of a graphical user interface according to a first aspect of the invention.

(2) FIG. 2 presents an embodiment of a graphical user interface according to a second aspect of the invention.

(3) FIG. 3 presents an embodiment of a graphical user interface according to a third aspect of the invention.

(4) FIG. 4 presents an embodiment of a graphical user interface according to a fourth aspect of the invention.

(5) FIG. 5 presents an embodiment of a graphical user interface according to a fifth aspect of the invention.

(6) FIG. 6 presents an embodiment of a graphical user interface according to a sixth aspect of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

(7) FIG. 1 presents an embodiment of a graphical user interface according to a first aspect of the invention. In the present embodiment of a graphic user interface 10 four sub-windows 10a, 10b, 10c and 10d are provided. It will be appreciated that a number of suitable rendered optimal projections may be customized tailoring demands of a particular situation.

(8) Sub-window 10a presents a reconstructed image of a plane of aortic valve of a human heart, wherein a centerline of the lumen (aorta) is given by reference number 4. Along the curved center line 4 a number of reference points may be provided in an automatic, semi-automatic or manual way.

(9) For example, points 1 and 3 may correspond to begin and end of a relevant trajectory along the vessel 6 (aorta). The point 2 corresponds to the annulus point position, which may be determined automatically during image reconstruction and analysis, or, it may be determined semi-automatically or manually. It will be appreciated that it may be possible to readjust a position of the annulus point position after it is seeded in an automatic way. Besides the annulus position, the annulus plane orientation may be also determined automatically or manually.

(10) Due to the fact that for optimal imaging of heart valves reconstruction of oblique images may be required, the sub-window 10a may comprise an orientation indicator animated in a suitable way.

(11) Sub-windows 10b, 10c present a second oblique image and a further oblique image, respectively, which may be rendered together with the image in sub-window in 10a using an MPR reconstruction.

(12) Window 10d may be used for presenting 3D reconstruction of anatomy in the imaging dataset, wherein the current plane shown in projection 10a, 10b, 10c may be indicated by a frame 7.

(13) Accordingly, due to the fact that the heart valve 6 shown in the sub-window 10c is depicted in the optimal projection, accurate analysis of the heart valve parameters and features, such as leaflets is enabled. In addition, due to the fact that the graphic user interface 10 may be used as a tool for planning a medical intervention (in this casereplacement of a heart valve) the workflow may be improved as the clinician has a clear and easy understanding of the otherwise complicated geometry.

(14) It will be appreciated that the graphic user interface 10 may comprise a number of supplementary regions, which may be used for input/output operations with respect to data or commands as well as for feedbacking patient ID data. Preferably, the graphic user interface is used for accessing hospital information system (HIS) or any other suitable database for selecting patient data. It will be appreciated that in the context of the present application the image data may refer to raw image data, or to processed image data. For example, initial analysis of the image data may be carried out automatically as a batch job beforehand.

(15) The graphic user interface 10 may comprise a number of modules, like Valve Analysis, Apex Analysis, Femoral Analysis, Subclavian Analysis or the like, which may be used in an alternative fashion if the context of the casus allows it. It may be advantageous to subject the same patient imaging dataset for analysis for different intervention approaches, like a transapical approach or transfemoral approach for deducing an optimal strategy for the medical intervention. Due to this feature the workflow is further improved and the accuracy of the intervention (heart valve replacement or stent placement) may be improved.

(16) The graphic user interface 10 may further comprise suitable tools for enabling distance measurements, angle measurement or measurements of other type, which may be carried out automatically or in a manual mode.

(17) FIG. 2 presents an embodiment of a graphical user interface according to a second aspect of the invention. In the present embodiment a Valve Analysis screen is presented, which may be used for obtaining quantitative information about the vessel and its spatial position.

(18) For example, the Valve Analysis screen 20 may comprise a suitable plurality of sub-windows, for example sub-windows 20a, 20b, 20c, 20d, 20e. The sub-window 20a may be used as a compass viewer for assisting the user in orientation of two sub-windows 20d, 20e. The sub-window 20b may relate to a MinIP view for assessing valve anatomy, for example relating to number and condition of the leaflets. The sub-window 20c may be used for visualizing results of the MIP or volume rendered image about the lumen center line. This view is particularly useful for assessing calcifications as well as for establishing an optimal imaging angle of a C-arm. The sub-windows 20d, 20e relate to stretched curved MPR views enabling quantitative determination of the lumen length along the lumen center line.

(19) Preferably, the sub-windows 20d, 20e may be toggled between the MPR view and the double oblique view, the latter enabling diameter measurement of the lumen.

(20) It will be appreciated that the view 20a may relate to the optimal viewing direction according to the invention.

(21) The image presented in view 20c may be referred to as a hockey puck view. The hockey puck view is a cylindrical area with a configurable diameter and a configurable height. The view is used to focus the user on the heart valve itself by removing any surrounding voxels that are outside the hockey puck confines that may obstruct a clear view of the heart valve.

(22) Different render methods (MIP/MinIP/Volume Rendering) may be used to show calcifications of the heart valve, the dynamics of the heart valve itself using 4D data, as well as the anatomy of the heart valve.

(23) It will be appreciated that data rendering may be carried out either starting from a 3D imaging data set or a 4D imaging dataset, the latter allowing for a dynamic study as a function of time. For example, dynamics in leaflets behavior as a function of heartbeat and the phase therein may be studied.

(24) FIG. 3 presents an embodiment of a graphical user interface according to a third aspect of the invention. In this exemplary embodiment an Apex Analysis screen 30 is presented. In this case, for example, the sub-windows may relate to sub-windows 30a, 30b, 30c depicting regular orthogonal reconstruction slices and a relatively larger sub-window 30d presenting an oblique slice through the heart, which runs through the annulus point 2. This projection is particularly useful, as an optimum line of approach for transapical interventions may be determined. It will be appreciated that the method according to the invention enables the user to study a suitable plurality of line of approaches and to compare them quantitatively for making an educated selection of a preferred intervention route. Suitable reporting may be envisaged as well, like a length on the route, or other clinically relevant parameters, like angles, vicinity to critical organs or regions and the like.

(25) The optimal line of approach 32 may run between the annular point 2 and the apex point 3. Preferably, the graphic user interface supports a real-time changing of point positions for analysis and optimization. It is also possible that some regions are organs are virtually dimmed out or otherwise highlighted or de-highlighted for enabling an easy comprehension of the anatomy and the planned intervention by the clinician.

(26) It may be also possible to suitably rotate around line of MPR view for path analysis, for example a virtual catheter size viewing may be envisaged, wherein thickness of the catheter may be adapted.

(27) In addition the sub-window 30d may be used for analyzing the entry angle for the catheter. The entry angle may be of a crucial importance, for example for checking whether induced catheter bending do not supersede allowable tolerances. In order to work around corners or the like, it may be possible to define additional points between the point 2, 3.

(28) In addition, the sub-window 30d may be used for enabling measurement of lengths of myocardium and septal wall thickness for planning the intervention.

(29) Accordingly, due to one or more above features workflow of the heart valve replacement intervention may be substantially optimized, wherein probability of a human error may be reduced.

(30) FIG. 4 presents an embodiment of a graphical user interface according to a fourth aspect of the invention. In this exemplary embodiment a Femoral Analysis screen 40 is discussed. The screen 40 may also comprise a suitable plurality of windows, some of which may be used for reference, like windows 40a, 40b, 40c. A central portion of the screen 40 may be used for the sub-windows 40e, 40f for depicting suitable vessels, in casu, left and right stretched curved MPR views.

(31) Advantageously quantitative supplementary information is provided in sub-windows 40e, 40f For example, graphs representing a running value of a lumen diameter, wherein, advantageously regions of particular attention, like narrowings may be highlighted. For example, a critical value of 23 F (about 8 mm) may be indicated throughout the graph for immediate perception whether a particular catheter fits into the lumen. The sub-window 40a, depicting a running lumen diameter may be synchronized with the area along the window 40d, 40e so that when a cursor falls within the image of 40e a cross-sectional image of the lumen 402 together with a fitted coin 401 corresponding to the same longitudinal level may be shown. In this way the user may easily check whether the automated algorithm did not fail while calculating a running value of the lumen diameter.

(32) In addition, regions having particular properties, like tortuosity data, may be suitably indicated along the graph. It will be appreciated that such indication may be carried out using color-code or by implementing other illustrative means.

(33) It will be appreciated that the view 40a may relate to the optimal viewing direction according to the insights of the invention.

(34) FIG. 5 presents an embodiment of a graphical user interface according to a fifth aspect of the invention. In the present exemplary embodiment an Angiographic View screen 50 is presented, which may be a separate data analysis package, or, it may be a part of the data analysis package discussed with reference to FIG. 1. Image 50 shows reconstructed data enabling interactive viewing and analysis of position angles for the C-arm for optimal viewing of patient anatomy during intervention.

(35) Also in this case it is preferable that panning, zooming and windowing of this view is rendered along the center line of the lumen. The segmented vessels may be highlighted using per se known thresholding methods. When the optimal projection is established automatically or interactively, the corresponding position of the C-arm for generating such image may be recorded.

(36) As a result, workflow in the operation room is improved. In case when the C-arm is controllable (directly or indirectly) by the processor operating the graphic user interface, the position of the C-arm may be automatically installed upon uploading saved data.

(37) It will be appreciated that the functionality discussed with reference to angiography may also be applied for analyzing valve leaflets, as it may be important to understand the structure and the spatial position of the leaflets prior to replacing the heart valve.

(38) In addition, it is possible that vessel anatomy is studied in more detail using a graphics tool. For example, a clock position overlay may be used to determine the angle in which a vessel branches off another vessel. In particular such tool may be used to determine the angles under which the renal arteries branch off the aorta. The angle is measured either in degrees or the position on the clock where 12 o'clock is defined as pointing towards the posterior side of the patient and looked at from above. For fenestrated stents theses angles provide valuable information for guiding the intervention.

(39) FIG. 6 presents an embodiment of a graphical user interface according to a sixth aspect of the invention. In this exemplary embodiment a Stent Form Templates screen 60 is presented. The screen 60 may comprise a number of sub-windows, like a transversal view, a first longitudinal view 60b (right iliac) and a second longitudinal view 60c (left iliac).

(40) In accordance with aspects of the invention discussed earlier, the windows 60b, 60c may relate to a stretched curved MPR views. Preferably, the views 60b, 60c are linked with an automatic measuring tool, for determining a running value of the lumen diameter of the vessels under consideration.

(41) Preferably, results of the automatic measurement of the lumen diameter are automatically recorded in a Stent Form Template, comprising a number of assigned characteristic areas 610, 612, 614, 620, 616 for enabling an educated selection of a suitable stent for treating the aneurism 601. It will be appreciated that due to the automatic data log the workflow may further be improved and human errors may be avoided.

(42) It will be further appreciated that a similar template may be used to enabling the user to analyze multiple implant devices and to quantitatively compare the results. For example, for the heart valve replacement module the software may be adapted to add form templates that can be tied to the different measurements carried out on the rendered image

(43) It will be appreciated that while specific embodiments of the invention have been described above, that the invention may be practiced otherwise than as described. In addition, isolated features discussed with reference to different figures may be combined.