APPARATUS AND METHOD FOR POSITIONING A PATIENT'S BODY AND TRACKING THE PATIENT'S POSITION DURING SURGERY

Abstract

The disclosed system uses a body shape capturing device for acquiring a patient's body shape and a 3D shape generating device for additively manufacturing a patient receiving device that is at least partially adapted to the patient's body shape or at least partially deviates from the patient's body shape bringing the patient's body into a desired shape so that the outer shape of the patient's body during surgery is identical to the outer shape of the body during shape capturing. The patient receiving device comprises at least one tracker element that is detectable by a detection system. The detection system captures data indicating the at least one tracker element's position and/or orientation during surgery enabling, particularly for surgical operations on or in soft tissues with high flexibly and with no specific natural or artificial landmarks, the surgeon to orientate/navigate in live images from the surgical site.

Claims

1. An arrangement for positioning a patient's body and tracking the patient's position during surgery comprising: a body shape capturing device (11) adapted to acquire an outer contour shape (S) of at least a part of the patient's body (13); a processing unit (12) adapted to generate based on the outer contour shape (S) a data representation (M) for a patient receiving device (14) adapted to at least partially receive the patient's body (13); a 3D shape generating device (15) adapted to additively manufacture based on the data representation (M) at least parts of the patient receiving device (14), the patient receiving device (14) comprising at least one tracker element (16) that is connected to the patient receiving device (14) and adapted to indicate a position and orientation of the patient receiving device (14); and a detection system (29) for capturing data indicating the at least one tracker element's position during surgery.

2. The arrangement of claim 1, further comprising: a medical imaging system (21) adapted to acquire at least one at least two-dimensional medical image of a patient's region of interest in relation to the at least one tracker element; a live imaging device (33) for acquiring live images of a surgical site; and a computation unit (24) adapted to register and blend the at least one at least two-dimensional medical image and the live images according to the captured data of the tracker element's position during surgery.

3. The arrangement of claim 2, wherein the processing unit (12) is further adapted to compute the outer contour shape (S) using the at least one medical image (25).

4. The arrangement of claim 1, wherein the patient receiving device (14) includes a movable table (23) and an additively manufactured structure (31) that is configured to be placed on the movable table (23).

5. The arrangement of claim 4, wherein the 3D shape generating device (15) is adapted to additively build the additively manufactured structure (31) as one part.

6. The arrangement of claim 4, wherein an inner shape of the additively manufactured structure (31) is at least partly conformed to the outer contour shape (S) of the patient's body (13).

7. The arrangement of claim 4, wherein an inner shape of the additively manufactured structure (31) at least partly deviates from the outer contour shape (S) for bringing the patient's body into a desired position, orientation and/or shape (D).

8. The arrangement of claim 4, wherein the additively manufactured structure (31) comprises at least two parts (48, 49, 50, 51) that are configured to be assembled, disassembled and/or reassembled.

9. The arrangement of claim 1, wherein the receiving device (14) comprises an opening (40) for exposing a region the surgery is to be performed on.

10. The arrangement of claim 1, wherein the at least one tracker element (16) is adapted to indicate the position and the orientation of the patient receiving device (14) in space.

11. The arrangement of claim 4, wherein the 3D shape generating device (14) is adapted to additively build the at least one tracker element (16), wherein the at least one tracker element is configured to be connected to a surface of the movable table (23) and/or a surface of the additively manufactured structure (31).

12. The arrangement of claim 1, wherein the at least one tracker element (16) comprises spaced apart reflector elements detectable by the detection system (29).

13. The arrangement of claim 1, wherein the detection system comprises at least two cameras (37, 38) for trigonometrically determining the position and the orientation of the at least one tracker element (21) in space.

14. A method for positioning a patient's body and tracking the patient's position during surgery comprising: acquiring an outer contour shape (S) of at least a part of the patient's body (13); generating a data representation (M) of a patient receiving device (14) for at least partially receiving the patient's body (13) based on the outer contour shape (S); additively manufacturing at least parts of the patient receiving device (14) based on the data representation (M); connecting at least one tracker element (16) to the patient receiving device (14) that indicates the position and orientation of the patient receiving device (14); and capturing data indicating the at least one tracker element's position during surgery.

15. The method of claim 14, wherein additively manufacturing at least parts of the patient receiving device (14) comprises additively building a structure (31) comprising an inner shape that is at least partly conformed to the outer contour shape (S) of the patient's body (13) and/or partly deviates from the outer contour shape (S) for bringing the patient's body (13) into a desired position, orientation, and/or shape (D).

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0046] FIG. 1 is a schematic representation of a patient receiving device with a patient placed therein in the body shape capturing device;

[0047] FIG. 2 is the schematic representation of a patient receiving device with the patient placed therein, a medical imaging device and a 3D shape generating device;

[0048] FIG. 3 is the schematic representation of a patient receiving device with the patient placed therein, a medical imaging device and a 3D shape generating device;

[0049] FIG. 4 is a schematic representation of the patient placed in a patient receiving device at the surgical site for the inventive arrangement including a detection system for localizing or detecting the patient during surgery;

[0050] FIG. 5 is a schematic representation of scan images provided by the medical imaging device;

[0051] FIG. 6 illustrates the scan image a live image and a blended image provided to the surgeon;

[0052] FIG. 7 is a schematic representation of the camera for acquiring live images;

[0053] FIG. 8 illustrates the scan images, a volume model of a patient's tissue structure obtained from the scan images, and the live image registered into the spatial representation of the tissue structure;

[0054] FIG. 9 is a cross-sectional view of patient receiving device and the patient placed therein; and

[0055] FIG. 10 is a longitudinal-section view of the receiving device.

DETAILED DESCRIPTION

[0056] FIG. 1 illustrates an arrangement for body shape capturing 10 comprising a body shape capturing device 11 adapted to acquire a shape S of at least a part of the patient's body 13. The patient 22 is placed on a movable table 23. In FIG. 1, the body shape capturing device 11 is a 3D camera that acquires image and simultaneously depth information. The body shape capturing device 11 is rotated around a patient's body length axis B which is indicated by the arrow R. The body shape capturing device 11 is communicatively connected to a processing unit 12 adapted to generate a data representation (model) M of a patient receiving device 14 based on the patient's body shape S. The patient receiving device 14 is adapted to at least partially receive the patient's body 13. A 3D shape generating device 15 is communicatively connected to the processing unit 12. In the present example, the 3D shape generating device 15 is a 3D printing device 15 that receives the model M of the patient receiving device 14 from the processing unit 12. The 3D printing device 15 is adapted to additively manufacture the patient receiving device 14 based on the received model M.

[0057] The patient receiving device 14 comprises at least one tracker element 16 that is firmly connected to the patient receiving device 14. The tracker element 16 is adapted to indicate the positon and orientation of the patient receiving device 14. In the present example there are three tracker elements 17, 18, 19, which in the present case are balls fixed at the ends of a tree 20 in known distances one from another. Balls 17a, 18a, 19a may be light reflecting or light absorbing balls visible ball the imaging system 21. In the present case three tracking elements 17, 18, 19 are provided for unambiguously indicating the location and orientation of the patient. However, while three balls 17a, 18a, 19a placed on the ends of the tree 20 give a fairly good indication of the location and orientation of the patient it is also possible to place three different balls independent from one another at different places of the patient receiving device 14.

[0058] If the tracker elements 17, 18, 19 will be optically detected they will be placed at a visible side of the patient receiving device 14. Furthermore, it is possible to use only one item as a tracker element 16 e.g. one cube firmly connected to the receiving device 14. Other tracker elements having different designs are also well applicable.

[0059] After manufacturing, the patient receiving device 14 can be put on or around the desired region of the patient's body so that the patient's body is brought into a desired position, orientation and/or shape. For instance, the desired region of the patient's body 13 may be marked before the shape scan with reference markers 27 that are affixed and/or painted on the patient's body 13. The desired region of the patient's body is the torso of the patient in FIG. 1.

[0060] In FIG. 2 of the patient receiving device 14 with a torso of patient 22 placed therein and a medical imaging device 21. The medical imaging device 21 can be any type of medical imaging system for acquiring a pre-operative medical scan as there is a MRI system or a CT system. A CT system may comprise an x-ray source and an x-ray detector adapted to receive x-ray from source and deliver data to a computation unit (an image processing unit) 24 producing scan images 25 (25a to 25z) as illustrated in FIG. 5. The image processing unit 24 may be any type of computer adapted processing signals supplied by the x-ray detector. The image processing unit 24 is connected to storage 26 for storing the scan images 25 therein. Alternatively or additionally, an intraoperative scan apparatus 24a may be provided in example a CR system, an ultrasonic imaging apparatus 24b or any other system suited for providing medical scan images 25 during operation.

[0061] A medical imaging system 24 may additionally be used as a means for capturing data indicating the portions of the tracker elements 17, 18, 19 during operation of the imaging system in example during the scanning of the patient's body 13. Alternatively, a separate detection system may be provided for detecting and locating the tracking elements 17, 18, 19 and bringing the images 25 into special relation to the tracking elements 17, 18, 19.

[0062] FIG. 3 shows the example of FIG. 2, except that no shape scan (as illustrated in FIG. 1) has been performed before the medical scan. The shape S of the patient's body extracted from the scan images 25 in the image processing unit 24. The shape S is provided to the processing unit 12 which generates a (three-dimensional) model M of a patient receiving device 14 that is sent to the 3D printing device 15. The 3D printing device 15 additively manufactures at least parts of the patient receiving device 14. Again, after manufacturing, the patient receiving device 14 can be put on or around the desired region of the patient's body so that the patient's body is brought into a desired position, orientation and/or shape as described above in the context of FIG. 1.

[0063] Part of the arrangement may be an operation site 28 illustrated in FIG. 4. The patient again is placed on a table, which may be identical with the movable table 23 of the scanning/imaging sites illustrated in FIGS. 1, 2, 3. However, typically table 23a will be a different table as typical used in a regular operating room. No matter whether tables 23, 23a are identical or not, an additively manufactured structure 31 will be used for bringing the patient's body in the same shape as it has had during medical imaging as illustrated in FIGS. 1, 2, 3. Moreover, the tracking elements 17, 18, 19 will be in the same position relative to the patient's body 13 during imaging/scanning and during surgery as well.

[0064] At the operation site 28, a localization or detection system 29 is provided for capturing data fed into a localization or detection processing unit 30 connected to the storage 26. The localization or detection processing unit 30 may be identical with the image processing unit 24 of FIGS. 2, 3 or alternatively it may be a different or separate processing unit. Processing units 24, 30 may be any type of computer or processor adapted to receive data from the detection system 29 and determine the position and orientation of the tracker elements 17, 18, 19 and hence the positioning and orientation of the patient's body 13. The detection system 29 may comprise at least two cameras 32 oriented such that the tracking elements 17, 18, 19 are within the combined field of view of the cameras 32. Processing units 30 or 24 are adapted to locate the tracker elements 17, 18, 19 by triangulation before the surgery starts if the table 23a is kept at rest. If table 23a is moved the detection system 29 may repeat determining the position and orientation of the patient's body 13. Alternatively, the detection may continuously be performed by the detection system 29 during surgery.

[0065] Part of the arrangement is a live imaging device 33 which can be another camera for acquiring live images as separately illustrated in FIGS. 4 and 7. The field of view 34 of the camera 33 is a region of interest 35 of the patient's body 13 and at which surgery is to be performed. FIG. 8 illustrates the region of interest 35 covered by the field of view 4. The camera 33 may be a laparoscopic camera and endoscopic camera or any other type of cameras suitable and adapted to produce a live image 36 of the region of interest 35.

[0066] The live image 36 may be fed to the processing units 24, 30 as illustrated in FIG. 4. The processing unit 24, 30 may process any live image 36 which is shown in FIG. 6, right upper illustration. The live image 36 may contain a real tissue structure 37 and the tip of an instrument 38. Any type of detection system may be used for detecting location and/or orientation of the instrument 38 and/or the camera 33. The localization or detection system 39 for localizing the camera 33 may comprise at least one tracker 44 element in example three tracker elements 45, 46, 47 as illustrated in FIG. 7. Similar to the tracker elements 17, 18, 19. Other types of tracking systems may be used as well.

[0067] In FIG. 9 displays a cross-sectional view of patient receiving device 14 and the patient 22 placed therein. The patient receiving device 14 in the example of FIG. 9 comprises an additively manufactured structure 31 that is connected to a movable table 23. The additively manufactured structure 31 for example comprises four parts 48, 49, 50, 51 that can be individually manufactured by additively manufacturing, i.e., 3D printed. The parts 48, 49, 50, 51 can be removably assembled, for instance with locking and/or latching mechanisms at the junctions of the individual parts. The at least one tracker element 16 is firmly connected to an outer surface of the additively manufactured structure 31. As depicted in FIG. 9, the tracker element 16 is connected to one part 48 of the additively manufactured structure 31. The tracker element 16 comprises three balls 17, 18, 19 that are mechanically connected via a tree with the part 48. Alternatively, the additively manufactured structure 31 can be monolithically formed in one part. In this alternative, flaps, joints and/or locking and/or latching mechanisms can be provided to simplify taking on the patient receiving device.

[0068] FIG. 10 illustrates a longitudinal-section view of the patient receiving device 14 cut along the dashed line in FIG. 9. FIG. 10 shows the outer contour shape S acquired by a body shape capturing device 11. In order to put the patient 22 into a desired shape D, the inner shape of the additively manufactured structure 31 diverges from the scanned shape S. In the example of FIG. 10, mainly the inner shape of part 51 diverges from the patient's shape S.

[0069] The so far described arrangement operates as follows:

[0070] Before surgery the patient will be placed on the table 23 and the body shape capturing device 11 acquires a shape S of the patient's body 13 as illustrated in FIG. 1. The processing unit 12 computes a model M for a patient receiving device 14, which is sent to the 3D printing device 15. The 3D printing device 15 prints the patient receiving device 14 based on the received model M. The printed receiving device 14 is then put on the patient and the medical imaging scan such as illustrated in FIG. 2 can be performed. If the processing unit 4 is able to extract the shape S of the patient's body from the medical image the patient receiving device 14 is built by the 3D printing device 15 based on the model M that is extracted from the medical images as illustrated in FIG. 3.

[0071] After the patient receiving device 14 is manufactured and put on or around the patient, the imaging system 21 may acquire scan images 25a to 25z, which images are stored by processing unit 24 in the storage 26. Afterwards the patient may leave the receiving device 14 and prepare for surgery, which may follow within a short period of time and sometimes within hours or days.

[0072] For surgery the patient reenters the patient receiving device 14 as illustrated in FIG. 4 by placing his or her body at the table 23 with the receiving device placed on or around the body 13 as illustrated in FIG. 4. The patient receiving device 14 may comprise an opening (window) 40 that the surgeon may open before or during surgery. The window 40 may exclusively be designed according to the needs of the surgery or the surgeon. Alternatively, the surgeon may have to cut a window 40 in one or more pieces of the additively manufactured structure elements so that he or she has access to the body through the window 40.

[0073] At the beginning or before the beginning of the surgery the detection system 29 will be activated which captures position of the tracking elements 17, 18, 19. So the processing unit 24, 30 will be registered the position of the patient's body to the scan images 25a to 25z as illustrated in FIG. 8. Moreover, the processing unit 24 or the processing unit 30 may produce a volume model 41 of at least a portion of the patient's body in example of the region of interest 35.

[0074] The detection system 29 or any other tracking system for determining the position and orientation of the camera 33 continuously processes data from which a processing unit 24, 30 determines the place and orientation of the field 34 of the camera 33 and hence the place of the live image 36 and the viewing direction to the live image. As illustrated in FIG. 8 the live image 36 may intersect the volume model 41 in a different way as the scan images 25a to 25z. However, the processing unit 24, 30 may produce a synthetic image of the volume model 41 as illustrated in FIG. 8, upper left illustration, at least of the region of interest 35. For doing so, the processing unit may intersect the volume model 41 in the same plane as the live image 25.

[0075] The processing unit 24, 30 will then merge and blend the live image 42 (FIG. 6, upper right illustration) with the volume model illustration derived by intersecting the volume model 41 at the same place and with the same orientation as has the live image 42. FIG. 6 illustrates the blended image 51 with the tissue structures 43 seen by camera 39 and the specific tissue structure 43 found by the imaging and to be treated by instrument 44.

[0076] Furthermore, the processing unit 24 or 30 may alternatively or additionally use graphical presentations 48 of tissue structures and blend those graphic representations 48 into the live image. Any of the scan images 25 the image obtained by intersecting the volume model 41, and a graphic representation 48 obtained from at least one of the scan images or from the volume model 41 are considered being a “scan image” for blending with the “live image”. The arrangement further comprises an image display 49 for reproducing the blended image. The display 49 may be a screen, a virtual reality head set or another means for showing the blended image.

[0077] The inventive system uses a body shape capturing device for acquiring a patient's body shape and a 3D shape generating device for additively manufacturing a patient receiving device that is at least partially adapted to the patient's body shape or at least partially deviates from the patient's body shape bringing the patient's body into a desired shape so that the outer shape of the patient's body during surgery is identical to the outer shape of the body during shape capturing. The patient receiving device comprises at least one tracker element that is detectable by a detection system. The detection system is adapted to capture data indicating the at least one tracker element's position and/or orientation during surgery enabling in particular important for surgical operations on or in soft tissues with high flexibly and with no specific natural or artificial landmarks the surgeon to orientate/navigate in live images from the surgical site.

REFERENCE NUMERALS

[0078] 10 arrangement for body shape capturing [0079] 11 body shape capturing device [0080] 12 processing unit [0081] 13 patient's body [0082] 14 patient receiving device [0083] 15 3D shape generating device (3D printing device) [0084] 16 tracker elements [0085] 17 to 19 individual tracker elements (balls) [0086] 20 tracker tree [0087] 21 imaging system [0088] 22 patient [0089] 23 movable table [0090] 23a table for surgery [0091] 24 image processing unit [0092] 25 scan images [0093] 26 storage [0094] 27 reference markers [0095] 28 operational site [0096] 29 localization or detection system [0097] 30 localization or detection processing unit [0098] 31 additively manufactured structure [0099] 32 cameras [0100] 33 live imaging device (camera) [0101] 34 field of view [0102] 35 region of interest [0103] 36 live image [0104] 37 real tissue structure [0105] 38 (surgical) instrument [0106] 39 localization or detection system for camera 33 [0107] 40 opening (window) [0108] 41 volume model [0109] 42 blended image [0110] 43 further tissue structure [0111] 44 at least one tracker element of camera 33 [0112] 45 to 47 individual tracker elements (balls) [0113] 48 graphical representations [0114] 49 image display [0115] B length axis of the patient's body [0116] M data representation (model) [0117] R arrow (direction of scanning) [0118] D desired shape [0119] S outer contour shape of the patient's body