Patent Application
20170065353
The present invention relates generally to medical imaging, and specifically to a method for color-coding ablation locations by their respective registrations.
A wide range of medical procedures involves placing objects, such as sensors, tubes, catheters, dispensing devices, and implants, within the body. Real-time imaging methods are often used to assist doctors in visualizing the object and its surroundings during these procedures. In most situations, however, real-time three-dimensional imaging is not possible or desirable. Instead, systems for obtaining real-time spatial coordinates of the internal object are often utilized.
U.S. Patent Application 2007/0016007, to Govari et al., whose disclosure is incorporated herein by reference, describes a hybrid field-based and impedance-based location sensing system. The system includes a probe adapted to be introduced into a body cavity of a subject.
U.S. Pat. No. 6,574,498, to Gilboa, whose disclosure is incorporated herein by reference, describes a system for determining the position of a work piece within a cavity of an opaque body. The system claims to use a transducer that interacts with a primary field, and several transducers that interact with a secondary field.
U.S. Pat. No. 5,899,860, to Pfeiffer, et al., whose disclosure is incorporated herein by reference, describes a system for determining the position of a catheter inside the body of a patient. A correction function is determined from the difference between calibration positions derived from received location signals and known, true calibration positions, whereupon catheter positions, derived from received position signals, are corrected in subsequent measurement stages according to the correction function.
Documents incorporated by reference in the present patent application are to be considered an integral part of the application except that to the extent any terms are defined in these incorporated documents in a manner that conflicts with the definitions made explicitly or implicitly in the present specification, only the definitions in the present specification should be considered.
The description above is presented as a general overview of related art in this field and should not be construed as an admission that any of the information it contains constitutes prior art against the present patent application.
There is provided, in accordance with an embodiment of the present invention a method, including performing a first registration of a tracking system, which is configured to track a location of a probe within an organ of a human body, with a baseline coordinate system, measuring first locations of the probe within the organ following the first registration, presenting, on an image of the organ, first indicators marking the first locations with a first visual effect, at positions on the image that are determined in accordance with the first registration, after measuring the first locations, performing a second registration of the tracking system with the baseline coordinate system, measuring second locations of the probe within the organ following the second registration, and presenting, on the image of the organ, second indicators marking the second locations with a second visual effect, which is visually distinct from the first visual effect, at positions on the image that are determined in accordance with the second registration.
In embodiments of the present invention, the tracking system and the baseline system are each selected from a group consisting of a field-based location tracking system, an impedance-based location tracking system and a medical imaging system. In some embodiments, the image includes a simulated surface of the organ. In additional embodiments, the first visual effect includes a first color and the second visual effect includes a second color different from the first color.
In further embodiments, performing the first registration includes identifying a relationship between the tracking system and the baseline coordinate system, and the second registration is performed upon detecting a change in the relationship. In supplementary embodiments, the probe includes a catheter, and the organ includes a heart. In some embodiments, the locations include ablation locations.
There is also provided, in accordance with an embodiment of the present invention an apparatus, including a tracking system configured to track a location of a probe within an organ of a human body, a baseline coordinate system, a display, and a processor configured to perform a first registration of the tracking system with the baseline coordinate system, to measure first locations of the probe within the organ following the first registration, to present, on the display, first indicators on the organ marking the first locations with a first visual effect, at positions on the image that are determined in accordance with the first registration, after measuring the first locations, to perform a second registration of the tracking system with the baseline coordinate system, to measure second locations of the probe within the organ following the second registration, and to present, on the image of the organ, second indicators marking the second locations with a second visual effect, which is visually distinct from the first visual effect, at positions on the image that are determined in accordance with the second registration.
There is further provided, in accordance with an embodiment of the present invention, a computer software product for sensing, using a baseline coordinate system and a tracking system configured to track a location of a probe within an organ of a human body, the product including a non-transitory computer-readable medium, in which program instructions are stored, which instructions, when read by a computer, cause the computer to perform a first registration of the tracking system, with the baseline coordinate system, to measure first locations of the probe within the organ following the first registration, to present, on an image of the organ, first indicators marking the first locations with a first visual effect, at positions on the image that are determined in accordance with the first registration, after measuring the first locations, to perform a second registration of the tracking system with the baseline coordinate system, to measure second locations of the probe within the organ following the second registration, and to present, on the image of the organ, second indicators marking the second locations with a second visual effect, which is visually distinct from the first visual effect, at positions on the image that are determined in accordance with the second registration.
The disclosure is herein described, by way of example only, with reference to the accompanying drawings, wherein:
Various diagnostic and therapeutic procedures involve mapping of the electrical potential on the inner surface of a cardiac chamber. Electrical mapping can be performed, for example, by inserting a medical probe (e.g., a catheter), whose distal end is fitted with a position sensor and a mapping electrode (also referred to herein as a probe electrode), into the cardiac chamber. The cardiac chamber is mapped by positioning the probe at multiple points on the inner chamber surface. At each point, the electrical potential is measured using the mapping electrode, and the distal end position is measured using the position sensor. The measurements are typically presented as a map of the electrical potential distribution over the cardiac chamber surface.
While positioning the medical probe within the cardiac chamber, impedance-based and/or magnetic field-based (also referred to herein as field-based) position sensing systems can be used to determine a location of the probe within the cardiac chamber. In impedance-based location sensing systems, such as those described in U.S. Pat. No. 8,456,182, whose disclosure is incorporated herein by reference, a set of adhesive skin patches is affixed to a subject's body, and a distal end of a medical probe (e.g., a catheter) is inserted into a body cavity of the subject.
The patches include respective electrodes in contact with a surface of the subject. Typically the set of patches comprises three or more patches. A control console delivers a current to an electrode (also referred to herein as an impedance-based location sensor) positioned at the distal end of the probe. Each of the patches receives a portion of the current, and conveys its respective received current back to the control console. From the received currents the control console can determine a respective impedance between each of the patches and the mapping electrode, and compute, based on the impedances, impedance-based location coordinates for the distal end. The impedance-based location coordinates are three-dimensional coordinates measured with respect to a frame of reference defined by the patches, herein assumed to have impedance-based coordinates, and enable the distal end to be tracked in this frame of reference in the body cavity.
In field-based position sensing systems, multiple magnetic field generators may be positioned in the vicinity of the subject. A field-based position sensor, also herein termed a magnetic tracking sensor, is positioned at the distal end of the probe, and the sensor conveys a probe signal to the control console in response to the magnetic fields received from the field generators. Upon receiving the probe signal from the tracking sensor, the control console can compute, based on the probe signal, field-based probe location coordinates for the distal end. The field-based probe location coordinates are three-dimensional coordinates with respect to a frame of reference defined by field-based location coordinates of the magnetic field generators, and also enable the distal end to be tracked in the field-based frame of reference.
Field-based position sensing systems are typically more accurate than impedance-based location sensing systems. For example, field-based position sensing systems may be accurate to within one millimeter while impedance-based position systems may be accurate to within three millimeters. However, field-based systems are typically more costly than the impedance-based systems.
Medical systems, typically those using multiple probes during a medical procedure, may incorporate into at least one of the probes an electrode and a field-based position sensor. Such a probe, herein termed a reference probe, may be used to map the volume of the body cavity in both systems, and a correlation between the two mappings may then be applied to other probes having only mapping electrodes, the mapping electrodes being used for tracking the probes in an impedance-based system. In order that the impedance-based location coordinates of the reference probe correspond to its field-based location coordinates, the frames of reference of the two systems are registered, so generating a relation between the two frames of reference. Using the relation, inter alia, typically increases the accuracy of the impedance-based system, as well as allowing the electrode-only probes to be tracked in the field-based system.
During a medical procedure such as an ablation of tissue in a heart, the heart may move due to the patient breathing even though the patient is immobile. While breathing is overall a cyclic process, the amplitude and period of the breathing typically vary during a procedure. Such motions, including motions of the “complete” patient, may be allowed for, for example by positioning the reference probe in a fixed position within the heart, and tracking location changes of the heart with this probe.
Upon detecting motion of the patient during the procedure, the multiple coordinate systems may need to be re-registered. However, each re-registration may introduce errors into locations that were measured prior to the re-registration. In instances where there are multiple re-registrations, errors in values of earlier measured positions that were registered with earlier registrations may be more significant than errors of recently measured positions that were registered with more recent registrations.
Embodiments of the present invention provide methods and systems for identifying one or more locations that may be more liable to error, by presenting each of the locations using a respective visual effect that is associated with its respective registration. In embodiments of the present invention, the locations are measured by a control console comprising a tracking system that is configured to track a location of a probe within an organ of a human body.
As explained hereinbelow, a first registration is performed between the tracking system and a baseline coordinate system. Examples of tracking and baseline coordinate systems include, but are not limited to, field-based location tracking systems, impedance-based location tracking systems and medical imaging systems.
Subsequent to the first registration, the control console measures first locations of the probe within the organ, and presents, on an image of the organ, first indicators marking the first locations with a first visual effect, at positions on the image that are determined in accordance with the first registration. After measuring the first locations, a second registration is performed between the tracking system and the baseline coordinate system, and upon measuring second locations of the probe within the organ, the control console presents, on the image of the organ, second indicators marking the second locations with a second visual effect, which is visually distinct from the first visual effect, at positions on the image that are determined in accordance with the second registration.
In embodiments where the visual effects comprise different colors, the locations can be “color-coded” by presenting the first locations measured using a first color, and presenting the second locations using a second color. By color-coding the locations, systems implementing embodiments of the present invention enable a physician to decide whether or not to re-measure any particular location.
An operator 28 inserts probe 22 through the vascular system of a patient 30 so that a distal end 32 (
Control console 24 comprises a processor 44 that converts the signals from fluoroscopy unit 34 and probe 22 into an electroanatomical map 46 (also referred to herein as image 46), which comprises information regarding the procedure that the processor presents on a display 48. Display 48 is assumed, by way of example, to comprise a cathode ray tube (CRT) display or a flat panel display such as a liquid crystal display (LCD), light emitting diode (LED) display or a plasma display. However other display devices can also be employed to implement embodiments of the present invention. In some embodiments, display 48 may comprise a touchscreen configured to accept inputs from operator 28, in addition to presenting electroanatomical map 46.
System 20 can use field-based position sensing to determine position coordinates of distal end 32 inside heart 26. In configurations where system 20 uses field-based based position sensing, console 24 comprises a driver circuit 50 which drives field generators 52 to generate magnetic fields within the body of patient 30. Typically, field generators 52 comprise coils, which are placed below the patient at known positions external to patient 30. These coils generate magnetic fields in a predefined working volume that contains heart 26. A magnetic field sensor 54 (also referred to herein as position sensor 54) within distal end 32 of probe 22 generates electrical signals in response to the magnetic fields from the coils, thereby enabling processor 44 to determine the position of distal end 32 within the cardiac chamber. Magnetic field-based position tracking techniques are described, for example, in U.S. Pat. Nos. 5,391,199, 6,690,963, 5,443,489, 6,788,967, 5,558,091, 6,172,499 and 6,177,792, whose disclosures are incorporated herein by reference.
In an alternative embodiment, the roles of location sensor 54 and magnetic field generators 52 may be reversed. In other words, driver circuit 50 may drive a magnetic field generator in distal end 32 to generate one or more magnetic fields. The coils in ach field generator 52 may be configured to sense the fields and generate signals indicative of the amplitudes of the components of these magnetic fields. Processor 44 can receive and process these signals in order to determine the position coordinates of distal end 32 within heart 26.
During a medical procedure, an array of adhesive skin patches 56 are affixed to patient 30. In other words, each of the skin patches in the array is affixed to a surface of the body of patient 30. At least one of the patches comprises one or more magnetic field sensors (e.g., coils) that can measure the magnetic fields produced by field generators 52, and responsively convey the magnetic field measurements to console 24. Based on the magnetic measurements received from the magnetic field sensors (also referred to herein as patch sensors) in a given patch 56, processor 44 can determine a current field-based position, relative to the field generators, of the given skin patch.
Each patch 56 also comprises a body surface electrode in contact with the surface of the body, and console 24 is connected by a cable 58 to the body surface electrodes. In the configuration shown in
In operation, processor 44 can determine impedance-based location coordinates of distal end 32 inside heart 26 based on the impedances measured between patches 56 and probe electrode 62. Impedance-based position tracking techniques are described, for example, in U.S. Pat. Nos. 5,983,126, 6,456,864 and 5,944,022, whose disclosures are incorporated herein by reference. In embodiments of the present invention, processor 44 can use a distance 66 between position sensor 54 and electrode 62 when performing a registration between the position-dependent magnetic signals received from the magnetic field sensor and position-dependent electrical signals (i.e., impedance measurements) received from patches 56.
In some embodiments, system 20 can use electrode 62 for both impedance-based location sensing and for other activities such as potential acquisition for electrical mapping of the heart, or ablation. Console 24 also comprises a radio frequency (RF) ablation module 68 that delivers electrical power to electrode 62. Processor 44 uses ablation module 68 to monitor and control ablation parameters such as the level of ablation power applied via electrode 62. Ablation module 68 may also monitor and control the duration of the ablation that is provided.
Processor 44 receives and processes the signals generated by position sensor 54 in order to determine field-based position coordinates of distal end 32, typically including both field-based location and field-based orientation coordinates. In addition to determining the field-based coordinates of distal end 32, processor 44 can also receive and process impedances from patches 56 in order to determine impedance-based location coordinates of the distal end. The method of position sensing described hereinabove is implemented in the above-mentioned CARTO® system and is described in detail in the patents and patent application cited above.
Based on the signals received from probe 22 and other components of system 20, processor 44 drives display 48 to update map 46, so as to present a current position of distal end in the patient's body, as well as to present status information and guidance regarding the procedure that is in progress. Processor 44 stores data representing map 46 in a memory 70. In some embodiments, operator 28 can manipulate map 46 using one or more input devices 72. In embodiments, where display 48 comprises a touchscreen display, operator 28 can manipulate map 46 via the touchscreen display.
In the configuration shown in
In one embodiment, force sensor 74 may comprise a magnetic field transmitter and receiver connected by a spring in distal tip 64, and may generate an indication of the force based on measuring the deflection of the spring. Further details of this sort of probe and force sensor are described in U.S. Patent Application Publications 2009/0093806 and 2009/0138007, whose disclosures are incorporated herein by reference. Alternatively, distal end 32 may comprise another type of force sensor.
Processor 44 typically comprises a general-purpose computer, with suitable front end and interface circuits for receiving signals from probe 22 and controlling the other components of console 24. Processor 44 may be programmed in software to carry out the functions that are described herein. The software may be downloaded to console 24 in electronic form, over a network, for example, or it may be provided on non-transitory tangible media, such as optical, magnetic or electronic memory media. Alternatively, some or all of the functions of processor 44 may be carried out by dedicated or programmable digital hardware components.
The following description assumes, by way of example, that an ablation procedure is performed on patient 30. Those having ordinary skill in the art will be able to adapt the description, mutatis mutandis, for other procedures such as a cardiac chamber mapping procedure. In the ablation procedure, processor 44 can generate electroanatomical map 46 comprising map points comprising ablation locations collected from probe 22. Each map point may comprise a respective coordinate within a body cavity, and possibly a physiological property collected by probe 22 at the respective coordinate. While the description referencing
In a construction step 80, processor 44 constructs a simulated surface of the cardiac chamber. In some embodiments, processor 44 constructs the simulated surface based on additional map points (not shown), typically three-dimensional mapping points of the surface, previously collected from probe 22. In a presentation step 82, the processor presents, on display 48, electroanatomical map 46 comprising the simulated surface.
In an insertion step 84, operator 28 inserts distal end 32 of probe 22 into the cardiac chamber. As operator 28 maneuvers probe 22, processor 44 determines current impedance based location coordinates for distal end 32 based on an impedance between patches 56 and electrode 62, and determines field-based location coordinates for the distal end 32 based on signals received from position sensor 54. In an initial registration step 86, processor identifies a relationship between the impedance-based location coordinates and the field-based location coordinates, and uses the relationship to register the impedance-based location coordinates to the field-based location coordinates. A method for determining a relationship such as that referred to above is provided in U.S. Pat. No. 8,456,182, to Bar-Tal et al., which is incorporated herein by reference.
During the medical procedure, as processor 44 collects map points 110, the processor may detect a change in the current relationship between the impedance-based location coordinates and the field-based location coordinates of distal end 32. Such a change may be caused, for example, by movement of patient 30. Upon detecting the change in the relationship, processor 44 can re-register the impedance-based location coordinates to the field-based location coordinates. In embodiments of the present invention, upon re-registering the impedance-based location coordinates to the field-based location coordinates, processor changes the color used to present ablation locations collected subsequent to the re-registration. Therefore, when initializing system 20, processor 44 can define a set of colors that can be used to present the ablation locations on display 48.
In a first assignment step 88, processor 44 assigns, from the set of colors, an initial color to a display color. As operator 28 uses probe 22 to perform an ablation on intracardiac tissue 76, in a receive step 90, processor 44 receives, from probe 22, measurements indicating a given ablation location marked by a given map point 110. In some embodiments, the measurements comprise impedances between patches 56 and electrode 62, and processor 44 can use the registration to determine or measure (i.e., find coordinates for) the given map point.
In a presentation step 92, processor 44 presents, on display 48, electroanatomical map 46 comprising a fusion of the simulated surface and the given ablation location. In embodiments of the present invention, processor 44 calculates the given ablation location using the (current) registration, and presents the given ablation location in heart 26 using the assigned display color. In a first comparison step 94, if the ablation procedure is not complete, then in a second comparison step 96, processor 44 checks to see if the current registration is still valid.
If processor 44 detects a change in the relationship between the impedance-based location coordinates and the field-based location coordinates, then the current registration is not valid, and in a re-registration step 98, the processor uses the changed relationship to re-register the impedance-based location coordinates to the field-based location coordinates. In a second assignment step 100, processor 44 processor 44 assigns, from the set of colors, a previously unassigned color to the display color, and the method continues with step 92.
Returning to step 96, if the current registration is still valid then the method continues with step 90. Returning to step 94, if the ablation procedure is complete, then the method ends.
In embodiments of the present invention, as described in the description referencing
The example in the description referencing
It will be appreciated that the embodiments described above are cited by way of example, and that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art.
This application claims the benefit of U.S. Provisional Patent Application 62/214,262, filed Sep. 4, 2015, which is incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| 62214262 | Sep 2015 | US |
