Patent Application
20070043596
Embodiments of the present invention generally relate to a physiology network and a workstation configured to operate with a hospital/medical network. More particularly, embodiments relate to a physiology workstation that operates to co-display images and physiology information acquired during a physiology procedure as well as pre-recorded patient information obtained from a patient information database.
Various types of physiology workstations have been proposed such as electrophysiology (EP) workstations, hemo-dynamic (HD) workstations, and the like. Heretofore, physiology workstations operate independent and distinct from other equipment and systems utilized during the physiology study, such as a fluoroscopy system, an ultrasound system, an ablation system, a cardiac mapping system and the like. Generally, EP, HD and ablation procedures are carried out in a procedure room including, among other things, EP catheters, HD catheters and patient sensors joined to an EP or HD workstation. The procedure room also includes a fluoroscopy system, a diagnostic ultrasound system, a patient monitoring device and an ablation system. A monitoring room and a control room may be located adjacent to the procedure room.
Also, conventional physiology workstations operate independent and distinct from other equipment and systems distributed through a medical or hospital network. Conventional physiology workstations do not present, and do not afford access to, historic patient information, such as patient records. Instead, while a hospital/medical system may locally store different types of patient records, today such patient records are not accessible at a physiology workstation.
Numerous hospital/medical systems exist around the United States and around the world. These hospital/medical systems range in the degree that equipment and systems store patient records and are connected to one another. For example, local databases may exist within different functional areas of a hospital/medical network, such as the emergency room, patient recovery rooms, laboratories, diagnostic imaging facilities, operating rooms and the like. The functional areas collect certain overlapping patient information and certain unique patient information. Examples of patient information include patient demographic information, interventional medical procedure history, physician/lab reports, past measured physiologic performance, diagnostic image information, prior physiology studies and the like.
However, conventional physiology workstations operate independent and distinct from other equipment and systems distributed throughout the medical or hospital network. Conventional physiology workstations do not present, and do not afford access to, historic patient information, such as patient records. Instead, while a hospital/medical system may locally store different types of patient records, today such patient records are not accessible at a physiology workstation.
Conventional physiology workstations and diagnostic systems suffer from various disadvantages that are addressed by various embodiments of the present invention.
A physiology network is provided that is configured to operate with a medical network. The physiology network includes a physiology workstation that receives, processes and display's physiology signals obtained from a subject during a physiology procedure carried out on the subject. The physiology workstation has a network interface that is configured to be joined to the network. A database is provided that store's patient records associated with the subject undergoing the physiology procedure. A server is joined to the network and to the database. The server manages and controls access to the database. The server provides, to the physiology workstation, a patient record associated with the subject in order that the physiology workstation may co-display the physiology signals and information from the patient record to an operator of the physiology workstation.
The patient records may include at least one of patient demographic information, interventional medical procedure history, prior physician/lab reports, past measured physiologic performance, diagnostic image information, prior physiologic studies and the like. The physiology workstation may co-display one or more prerecorded stored ECG traces and real-time ECG traces, prerecorded prior physiology studies and case logs, a real-time physiology study and case log, previously obtained diagnostic images and the like.
In at least one embodiment, a method is provided for managing and distributing patient and physiology information over a network joined to a database. The method includes obtaining physiology signals from the subject and processing the physiology signals at a physiology workstation in real-time during a physiology procedure. The method includes requesting from the database prerecorded patient records associated with the subject, where the prerecorded patient records were generated and stored prior to the physiology procedure. The method further includes accessing the database to obtain the prerecorded patient record associated with the subject, providing the patient record to the physiology workstation, and displaying the physiology signals in real-time with information from the patient record to an operator of the physiology workstation during the physiology procedure.
In at least one embodiment, monitoring workstations are provided remote from the physiology workstation. The monitoring workstation co-displays the same information as the physiology workstation and permits an operator of the monitoring workstation to update patient information, patient logs and the like during the procedure. The physiology network stores the new physiology study and case log in the patient database, along with any updates entered at monitoring workstations. The information displayed at the physiology workstation may also be displayed real-time on any personal computer, personal digital assistant, cell phone and the like joined to the network. For instance, computers located in individual doctors offices, or in an administrative office may be utilized to view and, based upon network privileges or permissions, may update the patient information during the study. The physiology workstation, monitoring workstations and office computers support “same time” text and/or audio communication with one another, such as to support remote consultations and the like.
The physiology workstation 302 is joined over the network link 314 to a server 316 that coordinates and manages data transfer and data communication over at least a portion the network 300. The server 316 includes a processor module 318 that stores and retrieves patient records to and from a database 320. The databas with the subject undergoing the physiology procedure. The server 316 manages and controls access to the database 320 to, among other things, provide to e 320 stores patient records that may include one or more records associated the physiology workstation, patient records and/or files associated with the subject. The physiology workstation co-displays the physiology signals and the patient information from the patient records/files for viewing and analysis by an operator at monitors 304.
The medical/hospital system includes numerous functional areas, such as an emergency room, patient recover rooms, laboratories, physician's offices, operating rooms, diagnostic examination rooms, administrative offices and the like. The emergency room includes, for example, patient monitoring equipment 342, a monitoring/control workstation 344 and diagnostic equipment 346. The patient monitoring equipment 342 and diagnostic equipment 346 obtain patient information, while the workstation 344 coordinates and controls transfer of patient information to/from the monitoring equipment 342 and diagnostic equipment 346. The workstation 344 also allows an operator to enter other patient information, including basic demographic information. Optionally, the workstation 344 may transfer the patient information over link 348 to a hospital information system manager 354 which directs the patient information to database 356 and/or server 316. Alternatively, the workstation 344 may be directly joined to the network 300 and have a unique internet protocol (IP) address within the network 300 in order to transfer directly patient information onto the network 300 from the diagnostic equipment 346 and patient monitoring equipment 342.
The patient rooms also include patient monitoring equipment 350 joined with workstations 352 that are in turn joined to the hospital information system manager 354 over link 348, and/or directly to the network 300. Workstations 356 are also provided in the labs to facilitate entry of patient information associated with lab reports. The lab reports are conveyed over link 348 to the hospital information system manager 354 and/or directly over the network 300 to the server 316. When directly joined to the network 300, the workstations 352 and 356 are statically or dynamically assigned unique internet protocol (IP) address within the network 300 and control direct transfer of patient information onto the network 300. Optionally, the hospital information system manager 354 may store the patient information from the emergency room, patient rooms and the labs in the local database 358. In addition or alternatively, the hospital information system manager 354 may communicate with the server 316 to store the patient information in database 320.
The physician's offices are also provided with computers 360 and the hospital administrator's offices are provided with computers 362. Computers 360 and 362 are joined to the network 300 to retrieve, modify and enter patient information through the server 316 and database 320. The computers 360 and 362 permit real-time monitoring of, and consultation in connection with, procedures being conducted throughout the network 300, including the physiology procedure. The consultation may be provided through textual and/or audio messages exchanged between the physiology workstation or remote monitoring workstation 312, and one of computers 360 and 362. The text consultation may be provided through a “same time” text messaging format. The audio consultation may be provided through a Voice Over IP Protocol supported by the network 300, hospital information system manager 354 and server 316.
Optionally, the network 300 may include local wireless transmitters 315 distributed throughout the medical/hospital system. The transmitters 315 support bidirectional local transmission, throughout the medical/hospital facility, of physiology signals, diagnostic images and other patient information. Physicians and other personnel may be provided with wireless portable hand-held devices 317 having text and graphic display and entry capabilities (such as personal digital assistants, cell phones, laptop computers and the like). The hand-held devices 317 enable the physicians and other personnel to monitor patients (e.g., during a physiology procedure) while roaming about the medical/hospital facility. The wireless hand-held devices 317 may include a transmitter and microphone and/or keypad supporting audio and/or text entry to enable the physician or other personnel to provide feedback, consultation and the like, such as to the operator of the physiology workstation and the team conducting a physiology procedure.
The patient records are not limited to the specific types of data discussed herein, but instead may vary. By way of example only, the patient records may include at least one of patient demographic information, interventional medical procedure history, physician/lab reports, past measured physiologic performance, and diagnostic image information, and prior physiology studies. The interventional medical procedure history may include, among other things, an interventional medical history of the patient representing a radiology report, cardiology report, implanted device report and the like. The implanted device report identifies, among other things, implanted device parameters and settings. The physician/lab reports may include, among other things, a physician office report, a lab-work report, medication subscribed to the subject and the like. The patient record may include pre-recorded stored ECG traces recorded prior to the physiology procedure.
The physiology workstation 302, monitoring workstations 312,344,352,356, computers 360,362, and hand-held devices 317 may co-display the pre-recorded stored ECG traces and real-time ECG traces, wherein the real-time ECG traces are obtained from the physiology signals obtained from the subject during the physiology procedure. Also, the patient record may include a pre-recorded prior physiology study and/or case log. The physiology workstation 302, monitoring workstations 312,344,352,356, computers 360,362, and hand-held devices 317 may co-display the pre-recorded prior physiology study and a real-time physiology study obtained from the subject during the physiology procedure. Alternatively, physiology workstation 302, monitoring workstations 312,344,352,356, computers 360,362, and hand-held devices 317 may provide co-display by presenting, on one monitor, prerecorded patient information, and on another monitor, real-time information (e.g. ECG and EP signals, live diagnostic images, earlier diagnostic images recorded during the procedure).
The patient record may be generated and periodically updated throughout the life of the patient as the patient undergoes various examinations, procedures, studies and the like. For example, the patient record may be updated with patient monitoring information such as obtained while in an ambulance or while obtained in the emergency room of a hospital. The patient record may include prerecorded diagnostic images, such as obtained from a CT system 322, an ultrasound system 323 and an MR system 324 located within the hospital network 300. Other examples of diagnostic images may be obtained from PET and SPECT systems. The CT, ultrasound and MR systems 322-324 also include network interfaces having IP addresses for each system to facilitate transfer of images and other data over the network 300. Further, the patient records may include patient monitoring information that is recorded prior to the procedure (e.g. prerecorded), such as by patient monitoring equipment. The patient monitoring equipment may be located anywhere throughout the medical network, such as in an ambulance, and emergency room, a patient recovery room, in operating room, a physician's office and the like.
The server 316 also includes a manufacturer specific format converter 326 that facilitates conversion of images and other patient information between formats specific to different manufacturers of diagnostic imaging equipment. For example, CT system 322 may be manufactured by one company, while ultrasound system 323 and the physiology workstation 302 are manufactured by a different second manufacturer. In certain instances, the images generated by the CT system 322 are formatted in a manner different from the formats supported by the ultrasound system 323 and physiology workstation 302. In this instance, the processor 318 may be configured to identify potential formatting compatibility problems. When a formatting incompatibility arises, the converter 326 may be utilized to transform the data (e.g. image files and the like) from one manufacturer specific format to a format known to be compatible with the physiology workstation 302.
The physiology workstation 302 generates a physiology study file(s) (including case log, physiology signals, EP mapping information and the like) throughout the procedure and, upon the completion of the procedure, exports the physiology study file(s) over the hospital network 300. The completed physiology study file(s) may be stored in the database 320 by the server 316 and/or remotely conveyed to a third-party application, such as to build graphic reports from the physiology study. The completed physiology study file(s) may be later viewed at the physiology workstation 302, monitoring workstations 312,344,352,356, computers 360,362, and hand-held devices 317.
A separate monitoring room may be provided, in which a remote monitoring workstation 312 is located. The remote monitoring workstation 312 permits the operator to view all or at least a portion of the information displayed at the monitors 304 and at each of systems 306, 308 and 310. The remote monitoring workstation 312 may co-display information from a patient record and physiology signals obtained from a subject during a physiology procedure, such that the remote monitor 312 presents the same information as displayed on the monitors 304 of the physiology workstation 302. The monitoring workstation 312 also supports data entry by the operator, such as to permit a case log associated with the particular physiology procedure to be updated during the procedure by the operator. The monitoring workstation 312 may communicate directly with the physiology workstation 302 over a link 311. In addition or alternatively, the monitoring workstation 312 may include a network interface 313 (such as used to define a static or dynamic IP address for the workstation) through which images, records, data and the like are conveyed over the network 300 and/or to/from the physiology workstation 302.
As shown in
Optionally, to reduce the bandwidth needs of the network, the monitoring workstations 312,344,352,356, computers 360,362, and hand-held devices 317 may be configured to receive and display a streaming video of all or a portion of the information or windows displayed on the monitors 304 of the physiology workstation 302. For example, the monitoring workstation 312 may include three monitors and the operator may choose to display the complete content of the three monitors 304 provided at the physiology workstation. For example, the operator of monitoring workstation 312 may choose to order the windows in a different layout than the window layout on monitors 304. For example, the operator of workstations 344,352,356 may designate particular windows of interest, such as only the real-time physiology signals, and/or the real-time fluoroscopy or ultrasound images. For example, the operators of computers 360,362 and hand-held devices 317 may choose to only view a single window. Optionally, the operators of any workstation, computer or hand-held devices 317 may choose only to be notified when certain parameters of the patient undergoing the procedure exceed or fall below certain predetermined thresholds (set by the procedure team or the operator of the particular workstation, computer or hand-held device).
The physician/lab reports 412-414 include information such as the date of a physician examination, type of examination and results, or the date of lab work, type of lab work and conclusions. In the event that blood samples and other biologic samples are analyzed, the physician/lab reports may also be joined with video or image files 415 the examined tissue, blood sample and the like. The video or image may be captured by sophisticated diagnostic equipment. The physiologic test files 416-418 may correspond to stress tests and the like. The diagnostic image files 420-423 may correspond to CT, ultrasound, MR, PET, SPECT images (2D, 3D, 4D) and the like.
The patient may be identified may be based on the patient ID, as well as an identification of one or more patient files of interest. For example, the operator may enter the patient's social security number and request the patient demographic information. The physiology workstation would then automatically populate the fields of the physiology study contained within the patient demographic information. For example, the physiology study may include a patient name field, patient age field, insurance carrier information field, billing address field and the like. To the extent that the above fields are completed within the patient's demographic information, the physiology workstation automatically populate such fields in the current physiology study, thereby reducing the study data entry time of the operator. As another example, the operator may request any prior physiology studies conducted upon the present patient, as well as any pre-existing diagnostic images of the patient's cardiac system. The physiology workstation may then present the prior physiology study on one monitor next to a second monitor displaying the real-time physiology study.
At 708, the server 316 receives the request and accesses the database 320 to retrieve the requested record or files. The server 316 performs the request based upon the patient ID and record/filed designators. The server 316 also determines whether formatting incompatibilities exist between the stored patient record format and the formats supported by the physiology workstation 302. When formatting incompatibilities exist, the data from the database 320 is passed through the converter 326 to be reformatted prior to being transmitted to the physiology workstation 302. By way of example, the patient record may be formatted in data packets associated with an Internet protocol (for example TCP/IP). The server 316 records within the stream of data packets the IP address of the intended receiver, as well as the patient identifier and record/file types.
At 710, the network interface 305 receives data packets and determines that the data packets are intended for the physiology workstation 302 (based on the IP address header information within the data packets). At 712, the workstation 302 validates and unpacks the incoming patient record/file (such as by comparing the patient ID and filed designators to the patient ID of the subject of the physiology study and of the requested files). At 714 the physiology workstation 302 processes and merges the past patient information with the real-time physiology signals for co-display.
The physiology workstation 802 displays, on monitor 820, various windows such as real-time diagnostic images 822 from the ultrasound system 812 (surface, IVUS and the like) and x-ray system 816 during the procedure. The monitor 820 may also include a window that displays prerecorded diagnostic images 823 which are obtained prior to the physiology procedure. The monitor 820 also may include a window that displays EP mapped images 824 which represent virtual representations developed based upon the data points taken by the EP mapping system 814. The monitor 820 also includes a window that displays text consultation messages 825 that may be conveyed to the physiology workstation 802 over the network link 805. The text consultation messages 825 may be sent during the physiology procedure from a physician located remote from the procedure room, such as from a personal computer of a physician specialist and the like.
The physiology workstation 802 displays in discrete windows, on monitor 830, real-time physiology traces 832 (EP or HD), a real-time case log 834, prerecorded physiology traces 833 and a prerecorded case log 835. The real-time physiology traces 832 and real-time case log 834 are generated by the physiology workstation 802 during the physiology procedure based on signals from physiology catheters 850 (EP or HD) and ECG electrodes 852. The prerecorded physiology traces and case log 833 and 835 are generated during a prior physiology procedure by the physiology workstation 802 or by a different physiology workstation.
In the exemplary embodiment of
The physiology workstation 802 communicates over link 803 with a remote monitoring workstation 804. The monitoring workstation 804 includes one or more monitors 840 configured to display all or at least a portion of the windows displayed on monitors 820 and 830. In the example of
In the example of
Alternatively, the files may be formatted utilizing local area network protocols, wide area network protocols, the TCP/IP protocol, and the like.
As shown in
The beamformer 33 is responsible for transmit and receive beam forming operations. The beamformer 33 controls the phase and amplitude of each transmit signal delivered over the link to induce a transmit or firing operation by the ultrasound catheter 25. Reflected echoes are received at the ultrasound catheter 25 and delivered to the beamformer 33 as analog signals representative of the detected echo information at each individual transducer element. Optionally, the beamformer 33 may also control transmission and reception in connection with non-catheter type U/S probes, such as a transesophageal probe 47, a surface cardiac probe 49, an intravenous, intraarterial probes and the like. The beamformer 33 includes a demodulator and filters to demodulate and filter the received analog RF signals and produce therefrom digital base-band I and Q data pairs formed from acquired data samples. The I,Q data pairs are derived from the reflected ultrasound signals from respective focal zones of the transmitted beams. The I,Q data pairs corresponds to each data samples within the region of interest. The beamformer 33 may pass the I,Q data pairs to a FIFO buffer 37 which then passes the I,Q data pairs over the communications interface 24 under the control of the controller 39. Alternatively, the beamformer 33 may directly stream the I,Q data pairs over the communications interface 24 as generated without buffering. Optionally, the beamformer 33 may store the I,Q data pairs in memory 7 in the ultrasound system 11. An ultrasound processor module 9 may be provided in the ultrasound system 11 to process the I, Q data pairs to form ultrasound images that are passed over communications interface 24 and/or stored in memory 7.
A real-time monitor 41, a review monitor 43 and documentation monitor 45 are located proximately the patient bed 13 for viewing by the procedure team and physician during the procedure monitors 41, 43 and 45 and are remotely controlled to present the same information as presented on the real-time monitor 48, operation monitor 50 and documentation monitor 52, respectively, located at the workstation 10.
The workstation 10 includes a signal management module 12 which is configured to receive and transmit a variety of signals and data that are conveyed to and from the patient over leads, cables, catheters and the like. Examples of signals that may be received by the signal management module 12 include intercardiac (IC) signals 14 from EP catheters, patient monitoring signals 15 (e.g., from a blood pressure cuff, SPO2 monitor, temperature monitor, CO2 levels and the like), ECG signals 16 from surface ECG leads 27, pressure signals 18 from an open lumen catheter, and intracardiac signals. The signal management module 12 also receives fluoroscopic imaging data 20 from the fluoroscopic system 17, ultrasound imaging data 21 from the beamformer 33, and ablation data 22 (e.g., power, temperature, impedance) from the ablation source and controller 31. The fluoroscopic system 17 is an x-ray apparatus located in the procedure room. The ultrasound data 21 also may be collected at a transesphageal ultrasound probe, an intraoperative ultrasound probe, a transthoracic probe and/or a cardiac ultrasound probe. Optionally, the ultrasound system 11 may be operated in an acoustic radiation force imaging (ARFI) mode.
The communications interface 24 extends from the workstation 10 to the various equipment located proximate the patient bed. When different rooms are provided the interface 24 extends through the wall or other divider separating the control and procedure rooms, into the procedure room. The communications interface 24 conveys, among other things, IC signals 14, patient monitoring signals 15, surface ECG signals 16, pressure signals 18, fluoroscopic imaging data 20, ultrasound imaging data 21 and ablation data 22. The content and nature of the information conveyed over the communications interface 24 is explained below in more detail. In one embodiment, the communications interface 24 is comprised of physical connections (e.g. analog lines, digital lines, coaxial cables, Ethernet data cables and the like or any combination thereof).
Optionally, the communications interface 24 may include, in whole or in part, a wireless link between the workstation 10 in the control room and one or more of the ultrasound, fluoroscopic, ablation, and EP instruments, devices, apparatus and systems in the procedure room 11. For example, ultrasound data 21 may be communicated wirelessly from a transmitter that is located within the procedure room 11 at the beamformer 33 to a receiver that communicates with the workstation 10 in the control room. The receiver would then convey the imaging data 21 to the signal management module 12.
The signal management module 12 selectively controls access of signals and data onto the communications interface 24. The signal management module 12 may comprise a simple configuration of switches that are manually operated by the user via the user interface 26. Alternatively, switches in the signal management module 12 may be automatically controlled by the processor 28 based upon various criteria including, among other things, the type of procedure currently being conducted. The signal management module 12 may include processing capabilities (e.g. a CPU, DSP and the like) to internally and automatically decide certain switching operations. The signal management module 12 may include memory, such as to temporarily buffer incoming and/or outgoing signals and/or data from/to the communications interface 24. The communications interface 24 conveys analog and digital signals. In the event that the communications interface 24 conveys analog signals, the signal management module 12 may include analog to digital converters to convert the analog signals to digital data and vise versa.
The signal management module 12 may communicate directly with an external stimulator 30. The stimulator 30 may deliver electrical signals (such as for pacing) directly over interface 24, or through the signal management module 12 and the IC leads 14, to one or more catheters 19 positioned within the patient. Examples of stimulators are the Micropace by Micropace Pty Ltd and the Bloom offered by Fisher Imaging. Optionally, the signal management module 12 may process or otherwise interact with the signals to/from the leads 14 and catheters 19. The signal management module 12 may receive the signals fro mthe leads 14, catheters 19 and otherwise, digitize and process such signals, store the signals in internal memory and send on the signals. The pacing signal may or may not go through the signal management module 12, and may not go through the amplifier.
The workstation 10 is used in an EP study to provide a detailed evaluation of the hearts electrical system. During an EP study, typically 3-5 catheters 19 are used. Each EP catheter 19 includes platinum electrodes spaced near the tip of the catheter, where such electrodes have the ability to record electrical signals from inside the heart as well as deliver stimulus pulses to the heart from different locations, such as to pace the heart. The workstation 10 evaluates normal and abnormal conductions and rhythms. The protocol used during the EP study may vary from site to site or procedure to procedure (e.g. corrected sinus node recovery time, AV Wenckebach and the like).
The incoming signals from the patient over the communications interface 24 are passed from the signal management module 12 to a signal conditioning circuit 38 which performs various signal processing operations upon the incoming signals. The signal conditioning circuit 38 passes conditioned signals to the processor module 28 and optionally may pass the conditioned signals to a frame grabber 40 or directly to memory 42 or a database 44. The processor module 28 manages overall control and operation of the workstation 10. The processor module 28 receives user inputs through the user interface 26. The processor module 28 stores data, images and other information in the memory 42 and/or in the database 44. The frame grabber 40 also accesses memory 42 and database 44 in order to obtain and store various data, images and the like. While the memory 42 and database 44 are shown as part of the workstation 10, it is understood that one or both of the memory 42 and database 44 may be part of the workstation 10, separate from, but located locally to the workstation 10 (e.g. in the control room) or remote from the workstation 10 and the control room (e.g. in another part of the facility or at an entirely separate geographic location (e.g. a different hospital, university, state, country and the like)).
The memory 42 and database 44 may store diagnostic images, such as CT and MR images acquired prior to the procedure, and ultrasound images acquired prior to, during, or after the procedure. The stored images facilitate pre- and post-procedure analysis for image optimization, manipulation and analysis. The ultrasound images may represent intracardiac ultrasound images obtained from the ultrasound catheter 25. Optionally, the ultrasound images may be obtained utilizing a transesophageal probe 47, an interoperative probe, and an external cardiac probe 49.
In each of the workstation 10 and U/S system 11, the timing information may be derived from the time of day, or from a reference clock. Alternatively, the various processors may have synchronized clocks which result in all the various systems being synchronized to the identical spot in the cardiac cycle. Alternatively, the timing information may be associated with the cardiac cycle of the patient which is determined by the EP signals.
The processor module 28 communicates uni-directionally or bi-directionally with the display controller 46 which controls monitors 48, 50 and 52. The monitors 48, 50 and 52 may simply present displayed information as explained hereafter. Optionally, the monitors 48, 50 and 52 may include input buttons for operation by the user to directly enter certain commands and instructions at the monitor 48, 50 and 52. Optionally, the monitors 48, 50 and 52 may represent touch sensitive screens that enable the user to enter information directly by touching active areas of a corresponding monitor 48, 50 and 52.
In the example of
In the example of
The workstation 10 integrates the display of ultrasound images with other EP or HD study information and/or ablation procedure information by utilizing one or more of monitors 48, 50 and 52. For example, real-time image window 60 may present ultrasound images obtained from an ultrasound catheter, while planning window 62 presents previously acquired CT or MR images. Integrating the ultrasound images into the workstation affords, among other things, an improved standard of care, increased user confidence and shorter procedure time.
Optionally, the real-time image window 60 may present ultrasound images as a cine loop, in which a sequence of ultrasound frames is acquired and associated with one or more cardiac cycles. The cine loop of ultrasound images may be repeatedly displayed or frozen. While the real-time image window 60 presents the ultrasound images, the real-time EP/HD window 58 simultaneously displays real-time EP signals corresponding to the ultrasound cine loop. Optionally, one screen may be static while the other screen updates with live images, where the user select which screen is live. The planning window 62 may present associated mapping data acquired earlier during the EP or HD study.
The signal management module 12 also communicates directly with an ablation control device 32 which is used to control various ablation procedures. The ablation control device 32 may constitute RF catheter ablation, laser catheter ablation, cryogenic ablation and the like. The ablation device 32 is attached to a generator 34 that produces the energy utilized to achieve ablation. Optionally, the ablation device may be a single module or unit that both controls and delivers the energy. For example, in an RF ablation or laser ablation system, the generator 34 represents a RF generator or a laser source. During RF catheter ablation, energy is delivered from a RF generator through an RF catheter having a tip located proximate anatomy that is desired to undergo ablation. Ablation is generally performed in order to locally destroy tissue deemed responsible for inducing an arrhythmia. The RF energy represents a low-voltage high-frequency form of electrical energy that produces small, homogeneous, lesions approximately 5-7 millimeters in diameter and 3-5 millimeters in depth.
Memory 212 stores various information explained below in more detail. A stimulator 214 is provided to generate stimulus signals delivered to the patient in the procedure room 204. A physiology video processor module 216 communicates with the control module 208 and controls monitors 218 and 220. An external video processor module 222 is also provided within the workstation 206. The external video processor module 222 communicates with control module 208 and controls a real-time imaging monitor 224. Optionally, the physiology and external video processor modules may be combined as a single module and/or may implemented utilizing a single or parallel processors.
A physiology mapping device 207 is provided in the procedure room 204 and is joined to the workstation 206 over link B and to the sensor module 244 over link A. The physiology mapping device 207 communicates with catheter position sensors 205 to monitor the position of EP, HD and/or mapping catheters, while being positioned within the heart. The workstation 206 integrates, among other things, real-time EP and HD information, real-time intracardiac (IC) echography, transesophageal ultrasound, transthoracic ultrasound, fluoroscopic images, EP mapping data and pre-surgery planning CT & MR images. The workstation 206 offers integrated monitoring and review of EP, HD, patient, and mapping information as well as stored and real-time diagnostic images, ECG signals and IC signals.
The procedure room 204 includes a patient bed 214 to hold the patient during pre-procedure intracardiac mapping and during EP, HD and ablation procedures. A fluoroscopy system 232 is provided proximate patient bed 214 to obtain fluoroscopic images of the region of interest while the doctor is conducting mapping or a procedure. EP or HD catheters 234, ultrasound probes 236, 238 and an ultrasound probe 240 are provided for use throughout the procedure. The ultrasound catheter 240 and ultrasound probes 236, 238 are configured to obtain ultrasound images of the region of interest, as well as images that indicate directly the position and placement of other instruments, devices and catheters, such as a defibrillator or pacemaker lead, catheter 234, an ablation catheter and the like relative to the region of interest. Surface ECG leads 212 are provided and attached to the patient to obtain surface ECG information.
An ultrasound system 250 and an intravascular ultrasound (IVUS) system 252 are joined to, and control, the ultrasound probes 236, 238 and catheter 240. The ultrasound catheter 240 may generally represent an intravascular ultrasound (IVUS) catheter, in that the catheter 240 and IVUS system 252 may be used to perform diagnostic ultrasound examination of any and all portions of a subjects vascular structure, including but not limited to, the cardiac structure, peripheral veins, peripheral arteries and the like. One exemplary application of an IVUS system 252 is to perform intracardiac echocardiography (ICE), in which the catheter 240 is utilized in an intra-cardiac examination. A user interface 257 permits an operator to control operation of the IVUS system 252, and to enter modes, parameters and settings for the IVUS system 252. The IVUS system 252 includes a beamformer 254 that is responsible for transmit and receive beamforming operations. The beamformer 254 controls the phase and amplitude of each transmit signal delivered over the link to induce transmit or firing operations by the ultrasound catheter 240.
The beamformer 254 may include a demodulator and filter (or a processor programmed) to demodulate and filter the received echo signals. The beamformer 254 generates RF signals from echo signals and performs RF processing to produce digital base-band I and Q data pairs formed from the RF signals associated with acquired data samples. An I,Q data pair corresponds to each data sample within the region of interest. The beamformer 254 may pass the I,Q data pairs to memory 256, or directly to processor module 258.
The I,Q data pairs are processed by mode-related modules (e.g., B-mode, color Doppler, power Doppler, M-mode, spectral Doppler anatomical M-mode, strain, strain rate, and the like) of the processor module 258 to form 2D or 3D data sets of image frames, volumetric data sets and the like. The image frames are stored in memory 256. The processor module 258 may record, with each image frame, timing information indicating a time at which the image frame was acquired. The processor module 258 may also include a scan conversion module to perform scan conversion operations to convert the image frames from Polar to Cartesian coordinates. A video processor module 260 reads the image frames from memory 256 and displays the image frames on the IVUS monitor 262 in real time during the procedure is being carried out on the patient. Optionally, the video processor module 260 may store the image frames in an image memory 263, from which the images are read and displayed on IVUS monitor 262.
A video link 259 is maintained between the video processor 260, image memory 263 and IVUS monitor 262. The IVUS system 252 includes a video output (e.g., a VGA output) that is connected to a video link 227 (e.g., a VGA cable). The ultrasound system 250 includes a transmitter (within beamformer 264) which drives ultrasound probes 236, 238. A user interface 267 permits an operator to control the operation of, and enter modes, parameters and settings for, the ultrasound (U/S) system 250. The beamformer 264 processes the signals for steering, focusing, amplification, and the like. The beamformer 264 also filters and demodulates the RF signals to form in-phase and quadrature (I/Q) data pairs representative of the echo signals from data samples. The RF or I/Q signal data may then be routed to the memory 266 for storage or directly to the processor module 268. The processor module 268 acquires ultrasound information (i.e., the RF signal data or IQ data pairs) from memory 266 and prepares frames of ultrasound information (e.g., graphical images) for storage or display. The processor module 268 provides the ultrasound information to the video processor 270. The video processor 270 stores image frame data in the image memory 265 and outputs the video signals that drive the monitor 272. A video link 269 is maintained between video processor module 270, image memory 265 and U/S monitor 272. The video link 225 conveys to the physiology workstation 206 the identical video signals as presented to the U/S monitor 272.
The processor module 258 in the IVUS system 252 and the processor module 268 in the ultrasound system 250 may also receive hemodynamic, intercardiac and/or surface ECG signals from the sensor module 244, surface leads 242 and catheter 234. Optionally, the processor modules 258 and 268 may receive respiratory signals corresponding to the breathing cycle of the patient. The processor modules 258 and 268 utilize the IC signals, HD signals, ECG signals and/or respiratory signals to derive timing information that is tagged to each ultrasound image frame generated by the scanned converter 326 (
The procedure room 204 may include various equipment and systems, such as an x-ray system 232 that controls a rotating support arm 280. The modes, parameters and other settings of the x-ray system 232 are entered and controlled from the user interface 287. The support arm 280 includes a x-ray source and a x-ray detector on opposite ends thereof. The x-ray detector may represent an image intensifier, a flat panel detector, a change coupled device and the like. The x-ray detector provides fluoroscopy data to a data acquisition system 282 which stores the x-ray data in memory 284. A processor module 286 processes the x-ray data to generate x-ray images that may be stored in memory 284 or passed directly to video processor module 288.
In each of the x-ray system 232, IVUS system 252 and U/S system 250, the timing information may be derived from the time of day, or from a reference clock. Alternatively, the various processors may have synchronized clocks which result in all the various systems being synchronized to the identical spot in the cardiac cycle. Alternatively, the timing information may be associated with the cardiac cycle of the patient which is determined by the EP signals provided from the sensor module 244.
The workstation 206 includes a physiology control module 208 which is configured to receive and transmit a variety of signals and data that are conveyed to and from the patient over leads, cables, catheters and the like. Examples of signals that may be received by the control module 208 include intercardiac (IC) signals and/or hemodynamic signals from catheters 234, patient monitoring signals (e.g., from a blood pressure cuff, SPO2 monitor, temperature monitor, CO2 levels and the like), ECG signals from surface ECG leads 212. The control module 208 manages overall control and operation of the workstation 206. The EP control module 208 receives user inputs through the user interface 210. The EP control module 208 stores data, images and other information in the memory 212. The EP video processor module 216 accesses memory 212 in order to obtain and store various data, signal traces, images and the like. The memory 212 may store diagnostic images, such as ultrasound CT and MR images acquired prior to the procedure. The stored images facilitate pre- and post-procedure analysis for image optimization, manipulation and analysis. The control module 208 communicates uni-directionally or bi-directionally with video processor module 216 which controls monitors 218 and 220. The monitors 218 and 220 may simply present displayed information as explained hereafter. Optionally, the monitors 218 and 220 may include input buttons for operation by the user to directly enter certain commands and instructions at the monitor 218 and 220. Optionally, the monitors 218 and 220 may represent touch sensitive screens that enable the user to enter information directly by touching active areas of a corresponding monitor 218 and 220.
The workstation 206 integrates the display of real-time ultrasound and fluoroscopy images with other EP/HD study information and/or ablation procedure information by utilizing one or more of monitors 218, 220 and 224. For example, the real-time image monitor 224 may present ultrasound images obtained from an ultrasound catheter, while the planning window presents previously acquired CT or MR images. Integrating the ultrasound images into the workstation affords, among other things, an improved standard of care, increased user confidence and shorter procedure time.
The real-time image monitor 224 may present ultrasound images as a cine loop, in which a sequence of ultrasound frames is acquired and associated with one or more cardiac cycles. The cine loop of ultrasound images may be repeatedly displayed or frozen. While the real-time image monitor 224 presents the ultrasound Optionally, the various images may be displayed on any of the screens. images, the monitor 218 simultaneously displays real-time EP or HD signals corresponding to the ultrasound cine loop. The workstation 206 includes an external video processor module 222 that has access to memory 212 and communicates with the control module 208. The external video processor module 222 controls a separate monitor 224 provided as part of the workstation 206. Monitor 224 is positioned immediately adjacent monitors 218 and 220 in order that all 3 monitors may be reviewed simultaneously by an operator of the workstation 206.
The external video processor module 222 receives video input signals 223, 225, and 227 from the x-ray system 232, the ultrasound system 250 and the IVUS system 252, respectively. The video signals 223, 225 and 227 are directly attached to the video signals used to drive the fluoroscopy monitor 290, ultrasound monitor 272, and IVUS monitor 262, respectively. The external video processor module 222, under direction of the control module 208, affords a comprehensive image management system under which fluoroscopy and ultrasound images may be viewed in real-time at the workstation 206. The external video processor module 222 includes additional video input signals (e.g., such as signal 229) from any standard video source.
In at least one embodiment, monitoring workstations are provided remote from the physiology workstation. The monitoring workstation co-display's the same information as the physiology workstation and permits an operator of the monitoring workstation to update patient information, patient logs and the like during the procedure. The physiology network stores the new physiology study and case log in the patient database, along with any updates entered at monitoring workstations. The information displayed at the physiology workstation may also be displayed real-time on any personal computer, personal digital assistant, cell phone and the like joined to the network. For instance, computers located in individual doctors offices, or in an administrative office may be utilized to view and, based upon network privileges or permissions, may update the patient information during the study. The physiology workstation, monitoring workstations and office computers support “same time” text and/or audio communication with one another, such as to support remote consultations and the like.
The term “co-displays” is not limited to displaying information on a common CRT or monitor, but instead refers also to the use of multiple monitors located in immediately adjacent one another to facilitate substantially simultaneous viewing by a single individual.
The figures illustrate diagrams of the functional blocks of various. The functional blocks are not necessarily indicative of the division between hardware circuitry. Thus, for example, one or more of the functional blocks (e.g., processors or memories) may be implemented in a single piece of hardware (e.g., a general purpose signal processor or a block or random access memory, hard disk, or the like). Similarly, the programs may be stand alone programs, may be incorporated as subroutines in an operating system, may be functions in an installed imaging software package, and the like.
