METHODS AND SYSTEMS FOR REDUCING ULTRASOUND ARTIFACTS

Abstract

Methods of and systems for monitoringvia an ultrasonic imaging devicethe delivery of radio-frequency energy are described herein. The articles may be ultrasonically echogenic to assist with guidance.

Claims

1. A method of using ultrasound imaging to guide the use of an ablation device, the method comprising providing an ultrasound imaging device; providing an ablation device configured to deliver radio-frequency (RF) energy to a target tissue, the device comprising: a shaft having a distal end, a proximal end, one or more delivery lumens, and one or more aspiration lumens; a fluid control apparatus fluidly coupled to the one or more delivery lumens and the one or more aspiration lumens; an RF probe extending through the shaft; an RF energy source operatively coupled to the probe to deliver RF energy; and a system controller configured to coordinate the operation of the fluid control apparatus and the RF energy source so as to deliver and remove fluid to reduce ultrasound imaging artifacts to allow for continued monitoring of the ablation procedure; positioning the distal end of the shaft proximate an ablation site using the ultrasound imaging device; delivering fluid to the ablation site through the one or more delivery lumens; removing at least a portion of the fluid from the ablation site through the one or more aspiration lumens; and selectively delivering RF energy to the ablation site to remove tissue at the ablation site; and continuing to monitor the ablation procedure using the ultrasound imaging device.

2. The method of claim 1, wherein the fluid is delivered to the ablation site at the same time as or for a selected period of time before RF energy is delivered to ablation site, and wherein the fluid is delivered to the ablation site for a selected period of time after the delivery of RF energy to the ablation site is terminated.

3. The method of claim 1, wherein the RF probe is a coblation probe.

4. The method of claim 1, wherein the ultrasound imaging artifacts comprise gas bubbles formed by the delivery of the RF energy to the ablation site.

5. The method of claim 1, wherein reducing ultrasound imaging artifacts comprises reducing the formation of ultrasound imaging artifacts.

6. The method of claim 1, wherein the fluid control apparatus is further configured to monitor and control the temperature of the fluid.

7. The method of claim 1, wherein the fluid control apparatus is further configured to monitor the temperature of the fluid.

8. The method of claim 1, wherein the RF probe is held at a fixed position relative to the shaft.

9. The method of claim 1, wherein the RF probe is movable within the shaft such that the RF probe comprises a retracted position in which a tip of the RF probe is proximate the distal end of the shaft and an extended position in which the tip of the RF probe is spaced from the distal end of the shaft.

10. The method according to claim 1, further comprising delivering the fluid to the ablation site at a temperature below 20 C.

11. A method of monitoring an ablation procedure using an ultrasound imaging device, the method comprising: positioning the ultrasound imaging device near a portion of a patient's body that contains an ablation site; providing an ablation device configured to deliver radio-frequency (RF) energy to the ablation site, the device comprising: a shaft having a distal end, a proximal end, one or more delivery lumens, and one or more aspiration lumens; a fluid control apparatus fluidly coupled to the one or more delivery lumens and the one or more aspiration lumens; an RF probe extending through the shaft; an RF energy source operatively coupled to the probe to deliver RF energy; and a system controller configured to coordinate the operation of the fluid control apparatus and the RF energy source so as to deliver and remove fluid to reduce ultrasound imaging artifacts to allow for continued monitoring of the ablation procedure; positioning the distal end of the shaft proximate an ablation site using the ultrasound imaging device; delivering fluid to the ablation site through the one or more delivery lumens; removing at least a portion of the fluid from the ablation site through the one or more aspiration lumens; and selectively delivering RF energy to the ablation site to remove tissue at the ablation site; and monitoring the ablation procedure using the ultrasound imaging device.

12. The method of claim 11, wherein the fluid is delivered to the ablation site at the same time as or for a selected period of time before RF energy is delivered to ablation site, and wherein the fluid is delivered to the ablation site for a selected period of time after the delivery of RF energy to the ablation site is terminated.

13. The method of claim 11, wherein the RF probe is a coblation probe.

14. The method of claim 13, wherein the ultrasound imaging artifacts comprise gas bubbles formed by the delivery of the RF energy to the ablation site.

15. The method of claim 14, wherein reducing ultrasound imaging artifacts comprises reducing the formation of ultrasound imaging artifacts.

16. The method of claim 11, wherein the fluid control apparatus is further configured to monitor and control the temperature of the fluid.

17. The method of claim 16, wherein the temperature of the fluid is kept below about 20 C.

18. The method of claim 11, wherein the RF probe is held at a fixed position relative to the shaft.

19. The method of claim 11, wherein the RF probe is movable within the shaft such that the RF probe comprises a retracted position in which a tip of the RF probe is proximate the distal end of the shaft and an extended position in which the tip of the RF probe is spaced from the distal end of the shaft.

20. The method according to claim 11, wherein the fluid delivered via the delivery lumens has a temperature below 20 C.

Description

BRIEF DESCRIPTION OF DRAWINGS

[0029] FIGS. 1A & 1B depict the distal end of one embodiment of a coblation device which includes a coblation probe extending through a shaft.

[0030] FIGS. 2 A & 2B depict an alternate embodiment of a coblation device including a coblation probe extending through a shaft.

[0031] FIG. 3 depicts a coblation probe movable between an extended position and a retracted position as depicted by the bidirectional arrows in FIG. 3.

[0032] FIG. 4 is a block diagram of one exemplary coblation system including a coblation device, fluid control apparatus, coblation energy source, and a system controller that may be operably connected to both the fluid control apparatus and the coblation energy source.

[0033] FIG. 5 is a side view of one tissue dilation apparatus with an expansion device in the collapsed configuration.

[0034] FIG. 6 is a side view of the tissue dilation apparatus of FIG. 5 with the expansion device in an expanded configuration.

[0035] FIG. 7 is an end view taken along the longitudinal axis of the shaft of the tissue dilation apparatus of FIG. 6.

[0036] FIG. 8 is a cross-sectional view of another exemplary embodiment of a tissue dilation apparatus that may be used with the devices and systems described herein.

[0037] Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

[0038] In the following detailed description of illustrative embodiments, reference is made to the accompanying figures of the drawing which form a part hereof, and in which are shown, by way of illustration, specific embodiments of this disclosure. It is to be understood that other embodiments may be utilized and structural changes may be made without departing from the scope of the present disclosure.

[0039] FIGS. 1A & 1B depict the distal end of one embodiment of a coblation device which includes a coblation probe 111 that extends through the shaft 110. The shaft 110 also incorporates two or more lumens 112 and 113. Of the two or more lumens, one or more lumens will be used to deliver fluid to the ablation site (referred to as a delivery lumen) and one or more of the lumens will be used to remove fluid from the ablation site (referred to as an aspiration lumen). As depicted in FIG. IA, lumen 112 operates as the delivery lumen to deliver fluid as depicted by arrow 102, while lumen 113 operates as the aspiration lumen to remove fluid and/or tissue from the ablation site as depicted by arrow 103.

[0040] The channel 114 in the shaft 110, within which the coblation probe 111 is located, may preferably extend to the distal end of the shaft 110 as depicted in FIG. 1A. The coblation probe 111 may extend past the distal end of the shaft 110 such that the tip 101 of the coblation probe 111 is spaced from the distal end of the shaft as seen in FIG. 1A.

[0041] FIGS. 2 A & 2B depict an alternate embodiment of a coblation device including a coblation probe 211 that extends through the shaft 210. The shaft 210 also incorporates two or more lumens 212 and 213. Of the two or more lumens, one or more lumens will be used to deliver fluid to the ablation site (referred to as a delivery lumen) and one or more of the lumens will be used to remove fluid from the ablation site (referred to as an aspiration lumen). As depicted in FIG. 2A, lumen 212 operates as the delivery lumen to deliver fluid as depicted by arrow 202, while lumen 213 operates as the aspiration lumen to remove fluid from the ablation site as depicted by arrow 203.

[0042] The channel 214 in the shaft 210, from which the coblation probe 211 extends, may preferably terminate short of the distal end of the shaft 210 as depicted in FIG. 2A. As a result, the outer wall of the shaft 210 may form a shroud over a portion of the coblation probe 211. The tip 201 of the coblation probe 211 may still preferably be located past the distal end of the shaft 210 as depicted in FIG. 2A.

[0043] Although the coblation probes of coblation systems described herein may have stationary positions relative to the shafts in which they are located such that the coblation probe is held at a fixed position relative to the shaft, in some embodiments, the coblation probe may be capable of moving relative to the shaft. FIG. 3 depicts one embodiment of this optional feature, with the coblation probe 311 being movable between an extended position and a retracted position as depicted by the bidirectional arrows in FIG. 3. In the extended position, the tip of the probe 311 is advanced in the distal direction out of the shaft 310 (see shaded portion of figure and reference number 301a) such that the tip of the probe is spaced from the distal end of the shaft 310. In the retracted position as depicted in FIG. 3, the tip 301 of the probe 311 is closer to the distal end of the shaft 310, and may, in some embodiments, be withdrawn into the shaft 310.

[0044] Withdrawal of the probe 311 from the extended position towards the proximal end of the shaft 310 may preferably create a void that will be filled by the fluid delivered through the delivery lumen. This movement and subsequent filling may enhance aspiration through lumen 313 of the fluid delivered to the ablation site through lumen 312.

[0045] FIG. 4 is a block diagram of one exemplary coblation system, wherein the system includes a coblation device 410, fluid control apparatus 420 that may be fluidly connected to the coblation device 410, coblation energy source 430 that may be operably connected to a coblation probe (not shown) provided as a part of the coblation device 410, and a system controller 440 that may be operably connected to both the fluid control apparatus 420 and the coblation energy source 430.

[0046] The fluid control apparatus 420 may optionally include a temperature control mechanism 422 capable of controlling the temperature of the fluid delivered to the coblation device 410 from the fluid control apparatus 420. The temperature control mechanism may be in the form of a refrigeration unit or a thermal sink capable of reducing the temperature of the fluid delivered to the coblation device to a temperature below 20 degrees Celsius (or any other selected temperature).

[0047] In addition to the coblation systems described herein, the present disclosure also encompasses tissue dilation apparatus that may potentially be used to provide access for a coblation probe and/or may be used alone to provide tissue dilation.

[0048] In one exemplary embodiment, the tissue dilation apparatus may include a shaft with a pointed or tapered tip at one end a fluid connection fitting at the opposite end. An expansion device (in the form of, e.g., an inflatable balloon) may preferably be attached to the shaft proximate the distal end of the shaft.

[0049] The shaft may be hollow such that fluids can be delivered through the shaft as discussed herein and/or the shaft may be sized to operate as a cannula with one or more lumens that can be used to deliver one or more working instruments, fluids, etc. to targeted body tissue. For example, the shaft may be used to deliver a coblation probe.

[0050] The shaft may be of any desired thickness, although it may be preferred that the shaft be in the range of 10 gauge to 30 gauge. It may be preferred that the shaft be substantially rigid such that it does not deflect significantly under normal use (e.g., the shaft may be made of metals or other materials capable of providing the desired rigidity).

[0051] Although stainless steel may preferably be used to construct the shaft, many other materials could be substituted. In general, however, it may be preferred that at least some material used in the shaft be ultrasonically echogenic where echogenic materials are materials may be visualized or otherwise guided using ultrasonic energy. In some instances, the shaft may be, e.g., coated or otherwise treated (e.g., etched, etc.) to improve its ability to be ultrasonically detected.

[0052] The shaft may, in some embodiments, have a solid tip (as opposed to the open tips of, e.g., Quincke-type needles) and the lumen defined in the hollow shaft may terminate at one or more openings through the sidewall of the shaft. Those openings may preferably be in fluid communication with the interior of an inflatable balloon attached to the shaft. The openings may, in some instances, improve the echogenicity to improve conspicuity of the apparatus when using ultrasonic energy. The use of multiple openings into the interior of the expansion device may be useful for more accurately determining the location of the expansion device.

[0053] The proximal end of the shaft may include a fluid connection such as, e.g., a Luer lock fitting, etc. to permit fluid-tight attachment to a source of fluid to be delivered through the lumen of the shaft. In use, the fitting may be attached to a syringe or other fluid delivery device. In embodiments to be used an access cannula to deliver one or more working instruments to targeted body tissue, the proximal end of the shaft may include one or more connectors that connect to, e.g., a working instrument, coblation probe, etc. as described herein.

[0054] The length of the shaft may vary depending on the needs of the user, although in some embodiments the length of the shaft may be, e.g., 200 millimeters (mm) or less (where the shaft length is measured from the proximal end to the distal end). In some embodiments, the length may preferably be 100 mm or less. It may be preferred that the expansion device (e.g., inflatable balloon) occupy a distance of about 10% or more of the length of the shaft, hi other embodiments, the expansion device may occupy 25% or more of the length of the shaft. In terms of actual dimensions, the expansion device may have a length of, e.g., 5 mm or more, 10 mm or more, 20 mm or more, or even 50 mm or more.

[0055] The expansion device located near the distal end of the apparatus may be in the form of one or more inflatable balloons. Materials used for the balloons may preferably be flexible such that the expansion device is capable of taking a collapsed configuration for delivery to a desired location where the expansion device can be expended to an expanded configuration. Suitable materials may include, e.g., polyethylenes, etc. It may be preferred that the balloon material allow for the transmission of ultrasonic energy such that the portion of the shaft located within the balloon can be detected using ultrasonic energy.

[0056] The expansion device may preferably have a profile or shape that is relatively small, e.g., similar to the dimensions of the shaft on or to which the expansion device is mounted. The expansion device may take on a variety of shapes when in the expanded configuration. Examples of some potential shapes in the expanded configuration may include, but are not limited to narrow oblong shapes, near spherical shapes, spherical shapes, two or more lobes, etc.

[0057] When deploying the tissue dilation apparatus, ultrasound guidance may be used to guide the shaft to a desired internal body location with the expansion device is preferably in the collapsed configuration. This process may be similar to that used in an ultrasound-guided injection and/or other procedures as described herein. The shaft may, for example, be passed through the area in which the stenosis is located until the expansion device (e.g., balloon) is positioned in the region to be dilated.

[0058] With the expansion device in position, the expansion device is then expanded from the collapsed configuration to the expanded configuration. When the expansion device is in the form of an inflatable balloon, the expansion may preferably be caused by passing a fluid such as, e.g., distilled sterile water, degassed sterile ultrasound gel, etc. It may be preferred that the fluid used be non-echogenic such that ultrasonic visualization of the expansion site is not significantly impaired during the expansion process. It may further preferred that the distention caused by the expansion device be monitored (e.g., visualized) using concomitant ultrasound imaging or any other suitable visualization technology. The expansion device may be maintained in its expanded configuration for any selected period of time, e.g., from a few seconds to minutes. Further, the expansion device may be expanded and collapsed only once or it may be repeatedly expanded and collapsed as need to provide the desired tissue distention. If the expansion device is repeatedly expanded and collapsed, the amount of expansion may be varied, e.g., the size of the expansion device may be progressively increased with each expansion, etc.

[0059] FIG. 5 is a side view of one illustrative embodiment of a tissue dilation apparatus 510, with the expansion device 502 in the collapsed configuration. FIG. 6 is a side view of the tissue dilation apparatus 510 of FIG. 5 with the expansion device 502 in an expanded configuration. FIG. 7 is an end view taken along the longitudinal axis of the shaft of the tissue dilation apparatus of FIG. 5.

[0060] The tissue dilation apparatus 510 of FIGS. 5-7 includes a shaft 504 that has a lumen 503 extending therethrough. The shaft 504 includes an optional beveled opening 501 at its distal end that may preferably be closed or sealed to permit expansion of the expansion device 502. The shaft 504 may also include a fitting 505 at its proximal end to facilitate attachment of a fluid delivery device (e.g., syringe, pump, etc.) or other connector to adapt to a working instrument as discussed herein.

[0061] Although both lobes of the expansion device 502 are expanded (as depicted in FIGS. 6-7), in some embodiments, the different lobes may be selectively expandable (by, e.g., delivering fluids thought separate lumens, etc.). Also, although the expansion device 502 is depicted as being contained within the shaft 504 in the collapsed configuration, the expansion device 502 may alternatively be wrapped around the exterior of the shaft 504 (in a manner similar to cardiac balloon dilators).

[0062] Although the expansion device 502 may be filled by delivering a fluid through the main channel of the shaft 504 (where, e.g., the distal end of the shaft 504 is sealed), an auxiliary channel located within the shaft 504 (if hollow) or positioned external to the shaft 504 (whether the shaft 504 is solid or hollow) may be used to deliver fluids to and/or remove fluids from the expansion device 502. If the shaft 504 is hollow and an auxiliary channel is used to dilate the expansion device 502, the hollow shaft 504 can potentially be used to deliver other fluids (e.g., therapeutic substances, etc.) or other devices such as the coblation probes described herein to an internal body location.

[0063] FIG. 8 is a cross-sectional view of another exemplary embodiment of a tissue dilation apparatus 610 in which the expansion device 602 is in the form of a hollow balloon located on the exterior of a primary shaft 604. The expansion device 602 is in fluid communication with a lumen 612 passing through an auxiliary shaft 606 that is separate from the main channel 605 extending through the primary shaft 604. As a result, fluids can be delivered to and/or removed from the expansion device 602 through the lumen 612. Although the auxiliary shaft 606 is depicted as attached to the primary shaft 604, this attachment is optional.

[0064] With the expansion device 602 in a selected position, the expansion device 602 can be dilated to the expanded configuration (as depicted in FIG. 8). The main channel 605 of the primary shaft 604 can then be used to introduce other devices (e.g., coblation probes, etc.), fluids (e.g., therapeutic substances, etc.) to a location proximate the dilated expansion device 602.

[0065] In some instances, the primary shaft 604 may be flexible, with the primary shaft 604 and collapsed expansion device 602 being introduced to a selected body site while a support structure (e.g., a solid or hollow needle, etc.) is located within the main channel 605 (to give the primary shaft 604 sufficient stiffness to facilitate advancement to a selected location). After the expansion device 602 is in the selected position (and possibly dilated), the support structure may be removed from the main channel 605, with the primary shaft 604 and its main channel 605 serving as a defined path through which other devices, fluids, etc. can be delivered. For example, the main channel 605 may be sized to allow a coblation device (such as, e.g., the coblation devices described herein) to be advanced through the main channel 605.

[0066] Although the primary shaft 604 may itself be echogenic, in some embodiments, the echogenicity may be provided by the support structure (if used) while the primary shaft 604 and the expansion device 602 are substantially transparent to the ultrasonic energy used for guiding the tissue dilation apparatus. In such an embodiment, the echogenic support structure may be removed to allow unobstructed ultrasonic visualization of the body site at which the expansion device 602 is deployed (in those embodiments in which the primary shaft 604 and the expansion device 602 are non-echogenic). hi still another variation, the auxiliary shaft 606 may be echogenic while the primary shaft 606 is not, such that ultrasonic guidance can be used to position the expansion device 602, with the primary shaft 604 obscuring less of the field of interest.

[0067] Also, in some embodiments, a pressure sensor may be provided to monitor fluid pressure within the expansion device.

[0068] The systems, apparatus and methods described herein may advantageously be used in connection with the systems, devices and methods described in, e.g., PCT Patent Application No. PCT/US09/34659, titled SYSTEMS, DEVICES AND METHODS FOR ACCESSING BODY TISSUE, filed on even date herewith and/or U.S. Provisional Patent Application Ser. No. 61/030,009, titled ACCESSING AND TREATING BODY TISSUE, filed on February 20, 2008.

[0069] The words preferred and preferably as used herein refer to embodiments that may afford certain benefits, under certain circumstances. However, other embodiments may also be preferred, under the same or other circumstances. Furthermore, the recitation of one or more preferred embodiments does not imply that other embodiments are not useful, and is not intended to exclude other embodiments from the scope of the invention.

[0070] As used herein, a, an, the, at least one, and one or more are used interchangeably. Thus, for example, a coblation probe may refer to one, two or more coblation probes.

[0071] The term and/or means one or all of the listed elements or a combination of any two or more of the listed elements.

[0072] The complete disclosure of the patents, patent documents, and publications identified herein are incorporated by reference in their entirety as if each were individually incorporated.

[0073] Illustrative embodiments are discussed and reference has been made to possible variations within the scope of this disclosure. These and other variations and modifications will be apparent to those skilled in the art without departing from the scope of the invention, and it should be understood that this invention is not limited to the illustrative embodiments set forth herein. Accordingly, the invention is to be limited only by the claims provided below and equivalents thereof.