ABLATION PLANNING SYSTEM

Abstract

Disclosed herein is a method of operating a medical instrument (100, 200, 400, 500). The medical instrument comprises a user interface (108) with a display. The method comprises receiving (300) an anatomical segmentation (122) identifying a location of an anatomical structure (416) and receiving (302) a target zone segmentation (124) identifying a location of a volume (416) at least partially within the anatomical segmentation. The method further comprises displaying (304) a planning graphical user interface (112) using the display. The planning graphical user interface comprises a first panel (130) configured for rendering a cross sectional view of the anatomical segmentation (136) and the target zone segmentation (138). The planning graphical user interface comprises a second panel (132) configured for displaying a first three-dimensional model (140) of the anatomical segmentation and the target zone segmentation. The planning graphical user interface further comprises a third panel (134) configured for displaying a second three-dimensional model (142) of a remaining portion of the target zone segmentation. The planning graphical user interface further comprises an ablation selector (144, 144′, 146) configured for providing an ablation zone. The method further comprises repeatedly: receiving (306) the ablation zone from the ablation selector; and updating (308) the remaining portion by removing the ablation zone from the remaining portion.

Claims

1. A medical instrument comprising: a user interface comprising a display; a memory storing machine executable instructions; a computational system configured for controlling the medical instrument, wherein execution of the machine executable instructions causes the computational system to: receive an anatomical segmentation identifying a location of an anatomical structure; receive a target zone segmentation identifying a location of a volume at least partially within the anatomical segmentation; and display planning graphical user interface using the display; wherein the planning graphical user interface comprises a first panel configured for rendering a cross sectional view of the anatomical segmentation and the target zone segmentation; wherein the planning graphical user interface further comprises a second panel configured for displaying a rendering of a first three-dimensional model (140) of the anatomical segmentation and the target zone segmentation; wherein the planning graphical user interface further comprises a third panel configured for rendering a second three-dimensional model of a remaining portion of the target zone segmentation; wherein the planning graphical user interface further comprises an ablation selector configured for providing a user-selectable ablation zone descriptive of a volume at least partially within the remaining portion; wherein execution of the machine executable instructions further causes the computational system to repeatedly: receive the ablation zone from the ablation selector; and update the remaining portion by removing the ablation zone from the remaining portion.

2. The medical instrument of claim 1, wherein the ablation selector is configured to receive a selection of a volume within the remaining portion, wherein execution of the machine executable instructions further causes the processor to generate the ablation zone in response to receiving the selection of the volume from the ablation selector.

3. The medical instrument of claim 1, wherein the ablation selector is configured to receive a selection of a trajectory that intersects the remaining portion, wherein execution of the machine executable instructions further causes the processor to generate the ablation zone in response to receiving the selection of the trajectory from the ablation selector.

4. The medical instrument of claim 1, wherein the memory further comprises an automated planning module configured for outputting the ablation zone in response to inputting the remaining portion, wherein the ablation selector is configured to receive an automated planning request, wherein execution of the machine executable instructions further causes the processor to generate the ablation zone by inputting the remaining portion into the automated planning module in response to receiving the automated planning request.

5. The medical instrument of claim 1, wherein execution of the machine executable instructions further causes the processor to generate insertion instructions for inserting the ablation probe in response to receiving the ablation zone from the ablation selector.

6. The medical instrument of claim 1, wherein the medical instrument comprises an ablation probe system comprising an ablation probe, wherein the medical instrument further comprises an ablation probe tracking system registered to the anatomical segmentation, wherein execution of the machine executable instructions further causes the computational system to: receive probe tracking data from the ablation probe; and update the remaining portion using the probe tracking data.

7. The medical instrument of claim 6, wherein the ablation probe is any one of the following: a radio frequency ablation probe, a microwave ablation probe, a high-intensity focused ultrasound ablation probe, a focal laser ablation probe, an irreversible electroporation probe, and a cryo-ablation probe.

8. The medical instrument of claim 6, wherein the medical instrument further comprises a guidance medical imaging system, wherein execution of the machine executable instructions further causes the computational system to: control the guidance medical imaging system to acquire real-time guidance medical image data during acquisition of tracking data from the ablation probe; and display the real-time guidance medical image data on the user interface in real time.

9. The medical instrument of claim 8, wherein the guidance medical imaging system is any one of the following: a computed tomography system, an ultrasound imaging system, a magnetic resonance imaging system, and an X-ray fluoroscope.

10. The medical instrument of claim 1, wherein execution of the machine executable instructions causes the computational system to receive a planning magnetic resonance image descriptive of a region of interest of a subject, wherein the anatomical segmentation identifies a location of the anatomical structure within the planning magnetic resonance image, wherein the first panel is further configured for rendering a cross sectional view of the planning magnetic resonance image.

11. The medical instrument of claim 10, wherein the memory further stores an automated segmentation algorithm configured for generating the anatomical segmentation and/or the target zone segmentation in response to inputting the planning magnetic resonance image, wherein execution of the machine executable instructions further causes the processor to generate the anatomical segmentation and/or the target zone segmentation by inputting the planning magnetic resonance image into the automated segmentation algorithm.

12. The medical instrument of claim 10, wherein the medical instrument further comprises a planning magnetic resonance imaging system configured for acquiring planning k-space data descriptive of the subject, wherein the memory further comprises planning pulse sequence commands configured for controlling the magnetic resonance imaging system to acquire the planning k-space data, wherein execution of the machine executable instructions further causes the computational system to: control the planning magnetic resonance imaging system with the planning pulse sequence commands to acquire the planning k-space data; and reconstruct the planning magnetic resonance image from the planning k-space data.

13. The medical instrument of claim 1, wherein the display is a three-dimensional display, wherein execution of the machine executable instructions further causes the processor to render the first three-dimensional model and the second three-dimensional model three-dimensionally using the three-dimensional display.

14. A computer program comprising machine executable instructions for execution by a computational system controlling a medical instrument, wherein the medical instrument comprises a user interface comprising a display; wherein execution of the machine executable instructions causes the computational system to: receive an anatomical segmentation identifying a location of an anatomical structure; receive a target zone segmentation identifying a location of a volume at least partially within the anatomical segmentation; and display planning graphical user interface using the display; wherein the planning graphical user interface comprises a first panel configured for rendering a cross sectional view of the anatomical segmentation and a cross sectional view of the target zone segmentation; wherein the planning graphical user interface further comprises a second panel configured for displaying a rendering of a first three-dimensional model of the anatomical segmentation and the target zone segmentation; wherein the planning graphical user interface further comprises a third panel configured for rendering a second three-dimensional model of a remaining portion of the target zone segmentation; wherein the planning graphical user interface further comprises an ablation selector configured for providing a user-selectable ablation zone descriptive of a volume at least partially within the remaining portion; wherein execution of the machine executable instructions further causes the computational system to repeatedly: receive the ablation zone from the ablation selector; and update the remaining portion by removing the ablation zone from the remaining portion.

15. A method of operating a medical instrument, wherein the medical instrument comprises a user interface, wherein the user interface comprises a display, wherein the method comprises: receiving an anatomical segmentation identifying a location of an anatomical structure; receiving a target zone segmentation identifying a location of a volume at least partially within the anatomical segmentation; and displaying a planning graphical user interface using the display; wherein the planning graphical user interface comprises a first panel configured for rendering a cross sectional view of the anatomical segmentation and the target zone segmentation; wherein the planning graphical user interface further comprises a second panel configured for displaying a rendering of a first three-dimensional model of the anatomical segmentation and the target zone segmentation; wherein the planning graphical user interface further comprises a third panel configured for rendering a second three-dimensional model of a remaining portion of the target zone segmentation; wherein the planning graphical user interface further comprises an ablation selector configured for providing a user-selectable ablation zone descriptive of a volume at least partially within the remaining portion; wherein the method comprises repeatedly: receiving the ablation zone from the ablation selector; and updating the remaining portion by removing the ablation zone from the remaining portion.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0055] In the following preferred embodiments of the invention will be described, by way of example only, and with reference to the drawings in which:

[0056] FIG. 1 illustrates an example of a medical instrument;

[0057] FIG. 2 illustrates a further example of a medical instrument;

[0058] FIG. 3 shows a flow chart which illustrates a method of operating the medical instrument of FIG. 1 or FIG. 2;

[0059] FIG. 4 illustrates a further example of a medical instrument;

[0060] FIG. 5 illustrates a further example of a medical instrument;

[0061] FIG. 6 illustrates an example of a planning magnetic resonance image;

[0062] FIG. 7 shows a ultrasound image with the segmentations of FIG. 6;

[0063] FIG. 8 shows a rendering of the second three-dimensional model;

[0064] FIG. 9 shows a further rendering of the second three-dimensional model; and

[0065] FIG. 10 shows a rendering of a transperineal grid template.

DETAILED DESCRIPTION OF THE EMBODIMENTS

[0066] Like numbered elements in these figures are either equivalent elements or perform the same function. Elements which have been discussed previously will not necessarily be discussed in later figures if the function is equivalent.

[0067] FIG. 1 illustrates an example of a medical instrument 100. The medical instrument 100 is shown as comprising in this particular example a computer 102. The computer 102 is shown as comprising an optional hardware interface 104. The hardware interface 104 may for example be used to control other components of the medical instrument 100 if they are present. The medical instrument 100 is further shown as comprising a computational system 106. The computational system 106 is intended to represent one or more computational systems or devices such as processors of other computers. The computational system 106 may be distributed also in multiple locations. The medical instrument 100 is further shown as comprising a user interface 108. The user interface comprises a planning graphical user interface 112. The medical instrument 100 is further shown as comprising a memory 110. The memory 110 represents any memory that is accessible to the computational system 106.

[0068] The medical instrument 100 illustrated in FIG. 1 may be a component or part of a variety of different types of systems. In one example the medical instrument 100 is a workstation or a computing device which is used for planning. In another example the medical instrument 100 may be integrated with an ablation probe or ablation probe system. In another example the medical instrument 100 may be integrated with a magnetic resonance imaging or other medical imaging system.

[0069] The memory 110 is further shown as comprising an optional automated planning module 126. The automated planning module may be configured for outputting a selected ablation zone in response to inputting the remaining portion. The memory 128 is further shown as comprising insertion instructions 128 which may be presented on an optional display for insertion instructions 148. For example, the insertion instructions 128 may comprise instructions on where and how far to insert an ablation probe.

[0070] The planning graphical user interface 112 is shown as comprising a first panel 130, a second panel 132, and a third panel 134. The first panel is configured for rendering a cross-sectional view of the anatomical segmentation 136 and a cross-sectional view of the target zone segmentation 138. The first panel 130 may also be configured for displaying a cross-sectional of a medical image such as a magnetic resonance image with these two cross-sectional views of the segmentations 136, 138.

[0071] The second panel 132 is configured for displaying a rendering of a first three-dimensional model 140. The first three-dimensional model 140 is a three-dimensional model of the anatomical segmentation 122 and the target zone segmentation 124. The second panel 132 may be useful because it may display the three-dimensional models of the segmentations 122 and 124 without any other medical imaging data and also in the three-dimensional means.

[0072] The third panel 134 displays a second three-dimensional model 142 that shows a remaining portion of the target zone segmentation 124. Shown within the panel 134 are a number of ablation zone selectors 144 that are volumes. These correspond to volumes that the operator can select to further ablate the target zone 124. After an ablation zone selector 144 has been removed a variety of actions may take place. For example, this area may be removed from the target zone segmentation 124 to show a smaller volume or region that still needs to be ablated. It may also cause the insertion instructions 128 to be generated. In some examples this medical instrument 100 may be used purely for planning purposes. For example, the insertion instructions 128 could be followed at a later time. In other examples the medical instrument 100 could be integrated with an ablation probe and/or medical imaging system for tracking and real-time updating of the remaining portion 142.

[0073] Also shown on the planning graphical user interface 112 is an optional automated planning request control 146. For example, when this button 146 is activated by the operator the automated planning module 126 may for example choose one of the ablation zone selectors 144 automatically.

[0074] FIG. 2 illustrates a further example of a medical instrument 200. The medical instrument 200 in FIG. 2 is similar to the medical instrument 100 in FIG. 1 except in this example instead of the ablation zone selector selecting volumes the ablation zone selector instead selects trajectories 144′. These for example may be a choice of different insertion points for an ablation probe. Once a trajectory 144′ is selected the ablation zone that will be ablated may be determined and this may be removed or subtracted from the remaining portion 142.

[0075] FIG. 3 shows a flowchart which illustrates a method of operating the medical instrument 100 of FIG. 1 or 200 of FIG. 2. First in step 300 the anatomical segmentation 122 identifying a location of an anatomical structure is received. Next in step 302 the target zone segmentation 124 is received and this identifies the location of a volume at least partially within the anatomical segmentation. Next in step 304 the planning graphical user interface 112 is displayed. The planning graphical user interface 112 comprises a first panel 130 that is configured for rendering a cross-sectional view of the anatomical segmentation 136 and a cross-sectional view of the target zone segmentation 138. The planning graphical user interface 112 further comprises a second panel 132 that is configured for displaying a rendering of a first three-dimensional model 140 of the anatomical segmentation 122 and the target zone segmentation 124.

[0076] The planning graphical user interface 112 further comprises a third panel 134 which is configured for rendering a second three-dimensional model 142 of a remaining portion of the target zone segmentation. The planning graphical user interface further comprises an ablation selector 144, 144′ configured for providing an ablation zone descriptive of a volume at least partially within the remaining portion. The method then proceeds to step 306. In step 306 the ablation zone is received from the ablation zone selector 144, 144′. Then in step 308 the remaining portion 142 is updated by removing the ablation zone from the remaining portion. This causes the remaining portion to become smaller. The method then proceeds to decision box 310. In this step it asks are the iterations finished. If the answer is no then the method returns back to step 306 and another ablation zone is selected. If the answer is yes then the method proceeds to step 312 and the method illustrated in FIG. 3 ends.

[0077] FIG. 4 shows a further example of a medical instrument 400. The medical instrument 400 in FIG. 4 is similar to the medical instruments 100 and 200 depicted in FIGS. 1 and 2. The medical instrument 400 additionally comprises a guidance medical image system 402 and an ablation probe tracking system 412. There is also an ablation probe system 406 displayed. The guidance medical image system 402 may represent any number of different modalities of medical imaging that may be used for tracking the insertion of the ablation probe 406. The guidance medical imaging system 402 has an imaging zone 404 from which guidance medical image data 422 can be acquired. A subject 408 is shown as on a subject support 410 and is supported such that the anatomical structure 416 and the target zone 418 are within the imaging zone 404.

[0078] The planning graphical user interface 112 is further shown as having a real-time rendering 424 of the guidance medical image data 422 acquired by the guidance medical imaging system 402. It clearly displays the position of the ablation probe 406. The medical instrument 400 is also shown as comprising an ablation probe tracking system 412. This may for example comprise electronics which are able to localize the position and orientation of the ablation probe 406 so that is can be better determined what region of the subject 408 is actually ablated by the probe 406. This can be used to update or correct the remaining portion 142.

[0079] FIG. 5 illustrates a further example of a medical instrument 500. The medical instrument 500 in FIG. 5 is similar to the medical instruments 100 and 200 except that the medical instrument 500 further comprises a planning magnetic resonance imaging system 502. The planning magnetic resonance imaging system 502 is a magnetic resonance imaging system. The term planning in the planning magnetic resonance imaging system is simply a label. Likewise, the planning label is used for pulse sequence commands, k-space data and images from this planning magnetic resonance imaging system 502. The features of FIG. 5 may be freely combined with the features of FIG. 4. In some instances, the planning magnetic resonance imaging system 502 may be identical with the guidance medical imaging system 402.

[0080] The planning magnetic resonance imaging system 502 comprises a magnet 504. The magnet 504 is a superconducting cylindrical type magnet with a bore 506 through it. The use of different types of magnets is also possible; for instance it is also possible to use both a split cylindrical magnet and a so called open magnet. A split cylindrical magnet is similar to a standard cylindrical magnet, except that the cryostat has been split into two sections to allow access to the iso-plane of the magnet, such magnets may for instance be used in conjunction with charged particle beam therapy. An open magnet has two magnet sections, one above the other with a space in-between that is large enough to receive a subject: the arrangement of the two sections area similar to that of a Helmholtz coil. Open magnets are popular, because the subject is less confined. Inside the cryostat of the cylindrical magnet there is a collection of superconducting coils.

[0081] Within the bore 506 of the cylindrical magnet 504 there is an imaging zone 508 where the magnetic field is strong and uniform enough to perform magnetic resonance imaging. A region of interest 509 is shown within the imaging zone 508. The k-space data that is acquired typically acquired for the region of interest. The subject 408 is shown as being supported by a subject support 520 such that at least a portion of the subject 408 is within the imaging zone 508 and the region of interest 509. The anatomical structure 416 and the target zone 418 are within the field of view 509 which is also inside of the imaging zone 508.

[0082] Within the bore 506 of the magnet there is also a set of magnetic field gradient coils 510 which is used for acquisition of preliminary magnetic resonance data to spatially encode magnetic spins within the imaging zone 508 of the magnet 504. The magnetic field gradient coils 510 connected to a magnetic field gradient coil power supply 512. The magnetic field gradient coils 510 are intended to be representative. Typically magnetic field gradient coils 510 comprise three separate sets of coils for spatially encoding in three orthogonal spatial directions. A magnetic field gradient power supply supplies current to the magnetic field gradient coils. The current supplied to the magnetic field gradient coils 510 is controlled as a function of time and may be ramped or pulsed.

[0083] Adjacent to the imaging zone 508 is a radio-frequency coil 514 for manipulating the orientations of magnetic spins within the imaging zone 508 and for receiving radio transmissions from spins also within the imaging zone 508. The radio frequency antenna may comprise multiple coil elements. The radio frequency antenna may also be referred to as a channel or antenna. The radio-frequency coil 514 is connected to a radio frequency transceiver 516. The radio-frequency coil 514 and radio frequency transceiver 516 may be replaced by separate transmit and receive coils and a separate transmitter and receiver. It is understood that the radio-frequency coil 514 and the radio frequency transceiver 516 are representative. The radio-frequency coil 514 is intended to also represent a dedicated transmit antenna and a dedicated receive antenna. Likewise the transceiver 516 may also represent a separate transmitter and receivers. The radio-frequency coil 514 may also have multiple receive/transmit elements and the radio frequency transceiver 516 may have multiple receive/transmit channels. For example if a parallel imaging technique such as SENSE is performed, the radio-frequency could 514 will have multiple coil elements.

[0084] The transceiver 516 and the gradient controller 512 are shown as being connected to the hardware interface 104 of a computer system 102.

[0085] The memory 110 is further shown as comprising planning pulse sequence commands 530. The planning pulse sequence commands 530 are pulse sequence commands. The planning pulse sequence commands 530 are data or commands which may be converted into commands that control the planning magnetic resonance imaging system 502 to acquire the planning k-space data 532. The planning k-space data 532 is k-space data. The memory 110 is further shown as comprising a planning magnetic resonance image 534. The planning magnetic resonance image was reconstructed from the planning k-space data 532 and may be segmented. The memory 110 is further shown as comprising an automated segmentation algorithm 536 that is able to automatically generate the anatomical segmentation 122 and/or the target zone segmentation 124 using the planning magnetic resonance image 534 as input. In some cases, these segmentations may also be provided manually using the planning graphical user interface 112.

[0086] In thermal tumor ablation procedures (and may other types of ablations), it is beneficial to fully cover the tumor to eradicate the disease, without ablating surrounding critical structures. For this purpose, it is possible to create a plan upfront, yet real-time feedback mechanisms while placing the ablation applicators and performing the ablation are missing.

[0087] Examples may provide a feedback mechanism to help clinicians in assessing coverage of the tumor, and especially in identifying areas that are not treated within the tumor. The system includes visualization of the untreated area in 2D and 3D including associated interaction mechanisms.

[0088] Examples may be particularly relevant to the field of thermal ablation in general, and specifically addresses the need to support identification of areas that are not treated. Although the disclosure below is also relevant to many other types of ablation.

[0089] Percutaneous thermal ablation is an interventional cancer treatment option that has seen significant increase in adoption in the past decade, and is predicted to continue to grow at a CAGR of 8-10% through 2024. Thermal ablation can be delivered using various ablation modalities, including radiofrequency (RF), microwave (MW), high-intensity focused ultrasound (HIFU), focal laser ablation (FLA), irreversible electroporation (IRE), cryo-ablation, etc.

[0090] In clinical practice, these ablation procedures consist of placing one or more ablation applicators (ablation probe 406) inside or near the target region (target zone 418) with the help of image guidance. Typically, physicians place these needle-like applicators while inspecting real-time ultrasound or interventional radiology images (CT/MR), based on information provided from the manufacturer, results in clinical trials and personal experience. The use of more advanced ablation therapy planning systems (ATPS) to plan the ablation and guide needle placement, akin to the radiation therapy planning systems (RTPS) used in brachytherapy procedures, is not wide spread due to their limited availability.

[0091] In current ablation procedures, quality assurance is limited. Most procedures are performed without a plan, and if a plan is defined, it is visualized by displaying the covered/treated area, without direct feedback on the presence of small untreated areas (“gaps”) between individual ablations inside the target.

[0092] Examples may provide for an ablation therapy guidance system, capable displaying the untreated area within the target (the remaining portion 142). This display (planning graphical user interface 112) is interactive, 3D rendering that allows the user to determine where to place additional applicators to cover the untreated areas.

[0093] Given discrete binary representations of a lesion L (target zone 418) to be treated and the ablation zone Z (600), the untreated area U (the remaining portion 142) can be computed by the following equation:

U=L\Z={x∈L|x.Math.Z}  (1)

[0094] For the purpose of visualization, the binary region U may need to be converted in a mesh or contour structure. For this purpose, the calculation may include marching squares or marching cubes as a post-processing step.

[0095] The untreated area may be visualized in 2D, e.g. on top of multi-planar reformat (MPR) visualizations of 3D image volume covering the area to be treated, or on top of live US images that are registered to the applicator plan through real-time tracking.

[0096] FIGS. 6 and 7 below provide example of 2D untreated area visualizations. FIG. 6 shows an example of a planning magnetic resonance image 534. There is visible an anatomical segmentation 122 with a target zone segmentation 124 and an ablation zone 600.

[0097] FIG. 7 shows the same segmentations 122, 124 and the location of the ablation zone 600 in an ultrasound image 700. The location of a suggested position for the ablation probe 702 is also displayed.

[0098] The untreated area (the remaining portion 142) may be visualized in 3D, e.g. by shaded surface in combination with other anatomical parts to reveal the relative location of the untreated area with respect to surrounding tissue.

[0099] FIGS. 8 and 9 show two views of the third panel 134. In FIG. 8 the remaining portion 142 is the entire target zone segmentation 124. An ablation zone 144 has been selected. After this is selected the volume of the ablation zone is removed from the remaining portion 142. FIG. 9 shows the remaining portion 142 after the ablation zone 144 has been removed.

[0100] In transperineal prostate procedures, the visualization may include a visualization of the transperineal grid template (a needle guidance device) through which applicators are being inserted. This enables the users to decide on the correct approach to cover the untreated area.

[0101] FIG. 10 shows an alternative means of visualization. Illustrated in FIG. 10 is a rendering of a transperineal grid template that lays a matrix of circles labeled A-M and 1-13. These represent different locations where an ablation probe may be inserted. Underneath this grid 1000 the ablation zone 600 is illustrated as well as the remaining portion 124. Superimposing 600 in 124 on the grid 1000 may help an operator visualize the proper location to insert an ablation probe.

[0102] When including more regions for healthy tissue and organs at risk, these 3D surface renderings may possibly be generated with the help of advanced techniques, such as glass rendering.

[0103] When the untreated area is visualized in 3D renderings, alongside MPR visualizations of a 3D image volume of the area to be treated, the system may incorporate a navigation aid that positions the MPR viewers based on a clicked untreated area as visualized in a 3D rendering.

[0104] In some examples, when the untreated area is visualized, the user may be able to plan an ablation within the untreated area:

[0105] by clicking a location in the untreated area (in MPR view or 3D rendering),

[0106] by clicking a needle trajectory that passes through the untreated area (e.g. .clicking a grid hole in prostate procedures), and

[0107] by clicking a button to initiate automated planning.

[0108] The visualization of the untreated areas plays an important role during two decision moments in an ablation procedure that is guided by an ATPS.

[0109] The first moment is the review and approval of the plan that is to be implanted by the user. Before starting to do so, the user can inspect his plan to assess whether there are no remaining uncovered areas in the target lesion.

[0110] The second moment is after placement of the applicators, where small deviations from the plan are inevitable. Such deviations may introduce small untreated areas in between the applicators, which can now easily be visualized. If there are gaps, the user can decide to plan further ablations, to place an applicator in the untreated area, or to accept the gap as is.

[0111] Examples may possibly provide for medical instruments with one or more of the following features:

[0112] A medical instrument cable of computing and displaying the untreated area within a target for an ablation treatment.

[0113] A medical instrument capable of visualizing the untreated area relative to needle guidance device.

[0114] A medical instrument capable of calculating a new ablation plan that will cover the untreated area.

[0115] A medical instrument in which the display of the untreated area is achieved using 2D rendering techniques.

[0116] A medical instrument in which the display of the untreated area is achieved using 3D rendering techniques.

[0117] 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.

[0118] 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.

LIST OF REFERENCE NUMERALS

[0119] 100 medical instrument [0120] 102 computer [0121] 104 hardware interface [0122] 106 computational system [0123] 108 user interface [0124] 110 memory [0125] 112 planning graphical user interface [0126] 120 machine executable instructions [0127] 122 anatomical segmentation [0128] 124 target zone segmentation [0129] 126 automated planning module [0130] 128 insertion instructions [0131] 130 first panel [0132] 132 second panel [0133] 134 third panel [0134] 136 cross sectional view of anatomical segmentation [0135] 138 cross sectional view of target zone segmentation [0136] 140 first three-dimensional model [0137] 142 second three-dimensional model of the remaining portion [0138] 144 ablation zone selector (volume selector) [0139] 144′ ablation zone selector (trajectory selector) [0140] 146 automated planning request control [0141] 148 display for insertion instructions [0142] 200 medical instrument [0143] 300 receive an anatomical segmentation identifying a location of an anatomical structure [0144] 302 receive a target zone segmentation identifying a location of a volume at least partially within the anatomical segmentation [0145] 304 display a planning graphical user interface using the display [0146] 306 receive the ablation zone from the ablation selector [0147] 308 update the remaining portion by removing the ablation zone from the remaining portion [0148] 310 Iterations finished? [0149] 312 end [0150] 400 medical instrument [0151] 402 guidance medical imaging system [0152] 404 imaging zone [0153] 406 ablation probe system [0154] 408 subject [0155] 410 support [0156] 412 ablation probe tracking system [0157] 416 anatomical structure [0158] 418 target zone [0159] 420 probe tracking data [0160] 422 guidance medical image data [0161] 424 real time rendering of guidance medical image data [0162] 500 medical instrument [0163] 502 planning magnetic resonance imaging system [0164] 504 magnet [0165] 506 bore of magnet [0166] 508 imaging zone [0167] 509 region of interest [0168] 510 magnetic field gradient coils [0169] 512 magnetic field gradient coil power supply [0170] 514 radio-frequency coil [0171] 516 transceiver [0172] 520 subject support [0173] 530 planning pulse sequence commands [0174] 532 planning k-space data [0175] 534 planning magnetic resonance image [0176] 536 automated segmentation algorithm [0177] 600 ablation zone [0178] 700 ultrasound image [0179] 702 location of ablation probe [0180] 1000 transperineal grid template