The present technology generally relates to a system and method for positioning a emitter and a receiver of an electro-magnetic imaging device in an ideal position relative to a patient supported on a surgical frame to limit the number of doses of electro-magnetic radiation necessary to provide a desired image or images at an area of interest of the patient.
Common imaging techniques can employ electromagnetic radiation to facilitate imaging of anatomical structures of a patient before, during, and after surgery. For example, fluoroscopy is one of these common imaging techniques. Typically, the apparatus facilitating fluoroscopy includes an emitter for emitting X-rays directed towards a patient, and a receiver for receiving the emitted X-rays directed towards the patient after passing through the patient. The fluoroscopy apparatus can be used to image specific portions of the patient's body during surgery. However, capturing a desired image or images of an area of interest of the patient's body typically relies on trial and error to obtain the desired image or images. As such, capturing the desired image or images may require a multiplicity of uses of the fluoroscopy apparatus until the desired image or images are captured. Such use of the fluoroscopy apparatus can lead to exposure of the patient to a multitude of undesirable doses of electro-magnetic radiation, and to exposure of personnel in an area around the patient to scattering from the multitude of doses. The undesirable exposure can be harmful. Therefore, there is a need to limit the use of the fluoroscopy apparatus while still capturing the desired image or images of the patient's body. As discussed below, a system and method can be used for facilitating positioning of the emitter and the receiver in an ideal position relative to the patient's body to capture the desired image or images of the area of interest to limit the need for a multitude of uses of the fluoroscopy apparatus.
The techniques of this disclosure generally relate to a surgical frame incorporating an electro-magnetic imaging device.
In one aspect, the present disclosure provides a method of positioning an emitter and a receiver of an imaging device relative to an area of interest of a patient supported on a surgical frame, the method including identifying the area of interest using images of the patient generated prior to surgery; prior to the surgery, placing at least one optical navigation marker on skin of the patient adjacent the area of interest; measuring a physical distance between two reference points on the surgical frame; positioning the patient on the surgical frame; capturing images of the patient positioned on the surgical frame using an optical camera system; determining a location of the optical navigation marker adjacent the area of interest in an X, Y, and Z coordinate system using the captured images of the patient and at least one ratio to the measured physical distance; moving the emitter and the receiver into position relative to the optical navigation marker adjacent the area of interest using the determined location thereof in the X, Y, and Z coordinate system; and initiating use of an electromagnetic imaging technique using the emitter and the receiver to produce a desired image of the area of interest.
In one aspect, the present disclosure provides a method of positioning an emitter and a receiver of an imaging device relative to an area of interest of a patient supported on a surgical frame, the method including identifying the area of interest using images of the patient generated prior to surgery; prior to the surgery, placing at least one optical navigation marker on skin of the patient adjacent the area of interest; measuring a physical distance between two reference points on the surgical frame; positioning the patient on the surgical frame; capturing images of the patient positioned on the surgical frame using an optical camera system in at least one of a side elevational view and a top plan view; determining a first one of at least one ratio via a comparison of at least one of the measured physical distances between the two reference points with a dimension between the two reference points in the at least one of the side elevational view and the top plan view; determining a location of the optical navigation marker adjacent the area of interest in at least one of an X-direction, a Y-direction, and a Z-direction of an X, Y, and Z coordinate system using the captured images of the patient and the determined first one of the at least one ratio; moving the emitter and the receiver into position relative to the optical navigation marker adjacent the area of interest using the determined location thereof in the at least one of X-direction, the Y-direction, and the Z-direction of the X, Y, and Z coordinate system; and initiating use of an electromagnetic imaging technique using the emitter and the receiver to produce a desired image of the area of interest.
In one aspect, the present disclosure provides a method of positioning an emitter and a receiver of an imaging device relative to an area of interest of a patient supported on a surgical frame, the method including placing at least one optical navigation marker on skin of the patient adjacent an area of interest; measuring a physical distance between two reference points on the surgical frame; positioning the patient on the surgical frame; capturing images of the patient positioned on the surgical frame using an optical camera system in at least one of a side elevational view and a top plan view; determining a first one of at least one ratio via a comparison of at least one of the measured physical distances between the two reference points with a dimension between the two reference points in the at least one of the side elevational view and the top plan view; determining a location of the optical navigation marker adjacent the area of interest in at least one of an X-direction, a Y-direction, and a Z-direction of an X, Y, and Z coordinate system using the captured images of the patient and the determined first one of the at least one ratio; moving the emitter and the receiver into position relative to the optical navigation marker adjacent the area of interest using the determined location thereof in the at least one of X-direction, the Y-direction, and the Z-direction of the X, Y, and Z coordinate system; and initiating use of an electromagnetic imaging technique using the emitter and the receiver to produce a desired image of the area of interest, where the surgical frame includes a first vertical support portion and a second vertical support portion, a translating beam is moveably attached relative the first vertical support portion and the second vertical support portion, the emitter and the receiver are moveably attached relative to portions of the C-arm assembly, and the C-arm assembly is moveably attached relative to the translating beam, movement of the of the C-arm assembly relative to the translating beam facilitates movement of the emitter and the receiver in the X-direction, movement of the emitter and the receiver relative to the portion of the C-arm assembly facilitates movement of the emitter and the receiver in the Y-direction, and movement of the translating beam relative to the first vertical support portion and the second vertical support portion facilitates movement of the emitter and the receiver in the Z-direction.
The details of one or more aspects of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims.
The details of one or more aspects of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims.
As discussed below, the surgical frame 10 serves as an exoskeleton to support the body of the patient P as the patient's body is manipulated thereby, and, in doing so, serves to support the patient P such that the patient's spine does not experience unnecessary torsion.
The surgical frame 10 is configured to provide a relatively minimal amount of structure adjacent the patient's spine to facilitate access thereto and to improve the quality of imaging available before and during surgery. Thus, the surgeon's workspace and imaging access are thereby increased. Furthermore, radiolucent or low magnetic susceptibility materials can be used in constructing the structural components adjacent the patient's spine in order to further enhance imaging quality.
The surgical frame 10 has a longitudinal axis and a length therealong. As depicted in
The offset main beam 12 is used to facilitate rotation of the patient P. The offset main beam 12 can be rotated a full 360° before and during surgery to facilitate various positions of the patient P to afford various surgical pathways to the patient's spine depending on the surgery to be performed. For example, the offset main beam 12 can be positioned to place the patient P in a prone position (e.g.,
As depicted in
The vertical support posts 48 can be adjustable to facilitate expansion and contraction of the heights thereof. Expansion and contraction of the vertical support posts 48 facilitates raising and lowering, respectively, of the offset main beam 12. As such, the vertical support posts 48 can be adjusted to have equal or different heights. For example, the vertical support posts 48 can be adjusted such that the vertical support post 48 of the second support portion 42 is raised 12 inches higher than the vertical support post 48 of the first support portion 40 to place the patient P in a reverse Trendelenburg position.
Furthermore, cross member 44 can be adjustable to facilitate expansion and contraction of the length thereof. Expansion and contraction of the cross member 44 facilitates lengthening and shortening, respectively, of the distance between the first and second support portions 40 and 42.
The vertical support post 48 of the first and second support portions 40 and 42 have heights at least affording rotation of the offset main beam 12 and the patient P positioned thereon. Each of the vertical support posts 48 include a clevis 60, a support block 62 positioned in the clevis 60, and a pin 64 pinning the clevis 60 to the support block 62. The support blocks 62 are capable of pivotal movement relative to the clevises 60 to accommodate different heights of the vertical support posts 48. Furthermore, axles 66 extending outwardly from the offset main beam 12 are received in apertures 68 formed on the support blocks 62. The axles 66 define an axis of rotation of the offset main beam 12, and the interaction of the axles 66 with the support blocks 62 facilitate rotation of the offset main beam 12.
Furthermore, a servomotor 70 can be interconnected with the axle 66 received in the support block 62 of the first support portion 40. The servomotor 70 can be computer controlled and/or operated by the operator of the surgical frame 10 to facilitate controlled rotation of the offset main beam 12. Thus, by controlling actuation of the servomotor 70, the offset main beam 12 and the patient P supported thereon can be rotated to afford the various surgical pathways to the patient's spine.
As depicted in
The axles 66 are attached to the first portion 80 of the forward portion 72 and to the third portion 94 of the rear portion 74. The lengths of the first portion 80 of the forward portion 72 and the second portion 92 of the rear portion 74 serve in offsetting portions of the forward and rear portions 72 and 74 from the axis of rotation of the offset main beam 12. This offset affords positioning of the cranial-caudal axis of patient P approximately aligned with the axis of rotation of the offset main beam 12.
Programmable settings controlled by a computer controller (not shown) can be used to maintain an ideal patient height for a working position of the surgical frame 10 at a near-constant position through rotation cycles, for example, between the patient positions depicted in
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An alternative preferred embodiment of a torso-lift support is generally indicated by the numeral 160 in
As discussed below, the torso-lift support 160 depicted in
As discussed above, the chest support lift mechanism 166 includes the actuators 170A, 170B, and 170C to position and reposition the support plate 164 (and hence, the chest support plate 100). As depicted in
The second actuator 170B is interconnected with the support plate 164 via first links 182, and the third actuator 170C is interconnected with the support plate 164 via second links 184. First ends 190 of the first links 182 are pinned to the second actuator 170B and elongated slots 192 formed in the offset main beam 162 using a pin 194, and first ends 200 of the second links 184 are pinned to the third actuator 170C and elongated slots 202 formed in the offset main beam 162 using a pin 204. The pins 194 and 204 are moveable within the elongated slots 192 and 202. Furthermore, second ends 210 of the first links 182 are pinned to the support plate 164 using the pin 176, and second ends 212 of the second links 184 are pinned to the support plate 164 using a pin 214. To limit interference therebetween, as depicted in
Actuation of the actuators 170A, 170B, and 170C facilitates movement of the support plate 164. Furthermore, the amount of actuation of the actuators 170A, 170B, and 170C can be varied to affect different positions of the support plate 164. As such, by varying the amount of actuation of the actuators 170A, 1706, and 170C, the COR 172 thereof can be controlled. As discussed above, the COR 172 can be predetermined, and can be either fixed or varied. Furthermore, the actuation of the actuators 170A, 170B, and 170C can be computer controlled and/or operated by the operator of the surgical frame 10, such that the COR 172 can be programmed by the operator. As such, an algorithm can be used to determine the rates of extension of the actuators 170A, 1706, and 170C to control the COR 172, and the computer controls can handle implementation of the algorithm to provide the predetermined COR. A safety feature can be provided, enabling the operator to read and limit a lifting force applied by the actuators 170A, 170B, and 170C in order to prevent injury to the patient P. Moreover, the torso-lift support 160 can also include safety stops (not shown) to prevent over-extension or compression of the patient P, and sensors (not shown) programmed to send patient position feedback to the safety stops.
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To accommodate patients with different torso lengths, the position of the thigh cradle 220 can be adjustable by moving the support plate 230 along the offset main beam 12. Furthermore, to accommodate patients with different thigh and lower leg lengths, the lengths of the second and third support struts 226 and 228 can be adjusted.
To control the pivotal angle between the second and third support struts 226 and 228 (and hence, the pivotal angle between the thigh cradle 220 and lower leg cradle 222), a link 240 is pivotally connected to a captured rack 242 via a pin 244. The captured rack 242 includes an elongated slot 246, through which is inserted a worm gear shaft 248 of a worm gear assembly 250. The worm gear shaft 248 is attached to a gear 252 provided on the interior of the captured rack 242. The gear 252 contacts teeth 254 provided inside the captured rack 242, and rotation of the gear 252 (via contact with the teeth 254) causes motion of the captured rack 242 upwardly and downwardly. The worm gear assembly 250, as depicted in
The worm gear assembly 250 also is configured to function as a brake, which prevents unintentional movement of the sagittal adjustment assembly 28. Rotation of the drive shaft 258 causes rotation of the worm gears 256, thereby causing reciprocal vertical motion of the captured rack 242. The vertical reciprocal motion of the captured rack 242 causes corresponding motion of the link 240, which in turn pivots the second and third support struts 226 and 228 to correspondingly pivot the thigh cradle 220 and lower leg cradle 222. A servomotor (not shown) interconnected with the drive shaft 258 can be computer controlled and/or operated by the operator of the surgical frame 10 to facilitate controlled reciprocal motion of the captured rack 242.
The sagittal adjustment assembly 28 also includes the leg adjustment mechanism 32 facilitating articulation of the thigh cradle 220 and the lower leg cradle 222 with respect to one another. In doing so, the leg adjustment mechanism 32 accommodates the lengthening and shortening of the patient's legs during bending thereof. As depicted in
The pelvic-tilt mechanism 30 is movable between a flexed position and a fully extended position. As depicted in
The sagittal adjustment assembly 28, having the configuration described above, further includes an ability to compress and distract the spine dynamically while in the lordosed or flexed positions. The sagittal adjustment assembly 28 also includes safety stops (not shown) to prevent over-extension or compression of the patient, and sensors (not shown) programmed to send patient position feedback to the safety stops.
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A preferred embodiment of a surgical frame incorporating a translating beam is generally indicated by the numeral 300 in
The surgical frame 300 includes translating beam 302 that is generally indicated by the numeral 302 in
As discussed below, by affording greater access to the patient receiving area A, the surgical frame 300 affords transfer of the patient P from and to a surgical table/gurney. Using the surgical frame 300, the surgical table/gurney can be conventional, and there is no need to lift the surgical table/gurney over portions of the surgical frame 300 to afford transfer of the patient P thereto.
The surgical frame 300 is configured to provide a relatively minimal amount of structure adjacent the patient's spine to facilitate access thereto and to improve the quality of imaging available before, during, and even after surgery. Thus, the workspace of a surgeon and/or a surgical assistant and imaging access are thereby increased. The workspace, as discussed below, can be further increased by positioning and repositioning the translating beam 302. Furthermore, radiolucent or low magnetic susceptibility materials can be used in constructing the structural components adjacent the patient's spine in order to further enhance imaging quality.
The surgical frame 300, as depicted in
Rather than including the cross member 44, and the horizontal portions 46 and the vertical portions 48 of the first and second support portions 40 and 42, the support structure 304 includes the support platform 306, a first vertical support post 308A, and a second vertical support post 308B. As depicted in
As depicted in
The translating beam 302 is interconnected with the first and second end members 310 and 312 of the support platform 306, and as depicted in
The translating beam 302, as discussed above, is capable of being positioned and repositioned with respect to portions of the remainder of the surgical frame 300. To that end, the support platform 306 includes a first translation mechanism 340 and a second translation mechanism 342. The first translation mechanism 340 facilitates attachment between the first end members 310 and 330, and the second translation mechanism 342 facilitates attachment between the second end members 312 and 332. The first and second translation mechanism 340 and 342 also facilitate movement of the translating beam 302 relative to the first end member 310 and the second end member 312.
The first and second translation mechanisms 340 and 342 can each include a transmission 350 and a track 352 for facilitating movement of the translating beam 302. The tracks 352 are provided on the upper surface 320 of the first and second end members 310 and 312, and the transmissions 350 are interoperable with the tracks 352. The first and second transmission mechanisms 340 and 342 can each include an electrical motor 354 or a hand crank (not shown) for driving the transmissions 350. Furthermore, the transmissions 350 can include, for example, gears or wheels driven thereby for contacting the tracks 352. The interoperability of the transmissions 350, the tracks 352, and the motors 354 or hand cranks form a drive train for moving the translating beam 302. The movement afforded by the first and second translation mechanism 340 and 342 allows the translating beam 302 to be positioned and repositioned relative to the remainder of the surgical frame 300.
The surgical frame 300 can be configured such that operation of the first and second translation mechanism 340 and 342 can be controlled by an operator such as a surgeon and/or a surgical assistant. As such, movement of the translating beam 302 can be effectuated by controlled automation. Furthermore, the surgical frame 300 can be configured such that movement of the translating beam 302 automatically coincides with the rotation of the offset main beam 12. By tying the position of the translating beam 302 to the rotational position of the offset main beam 12, the center of gravity of the surgical frame 300 can be maintained in positions advantageous to the stability thereof.
During use of the surgical frame 300, access to the patient receiving area A and the patient P can be increased or decreased by moving the translating beam 302 between the lateral sides L1 and L2 of the surgical frame 300. Affording greater access to the patient receiving area A facilitates transfer of the patient P between the surgical table/gurney and the surgical frame 300. Furthermore, affording greater access to the patient P facilitates ease of access by a surgeon and/or a surgical assistant to the surgical site on the patient P.
The translating beam 302 is moveable using the first and second translation mechanisms 340 and 342 between a first terminal position (
With the translating beam 302 and its cross member 338 moved to be positioned at the lateral side L1, the surgical table/gurney and the patient P positioned thereon can be positioned under the offset main beam 12 in the patient receiving area A to facilitate transfer of the patient P to or from the offset main beam 12. As such, the position of the translating beam 302 at the lateral side L1 enlarges the patient receiving area A so that the surgical table/gurney can be received therein to allow such transfer to or from the offset main beam 12.
Furthermore, with the translating beam 302 and its cross member 338 moved to be in the middle of the surgical frame 300 (
The position of the translating beam 302 and its cross member 338 can also be changed according to the rotational position of the offset main beam 12. To illustrate, the offset main beam 12 can be rotated a full 360° before, during, and even after surgery to facilitate various positions of the patient to afford various surgical pathways to the patient's spine depending on the surgery to be performed. For example, the offset main beam 12 can be positioned by the surgical frame 300 to place the patient P in a prone position (e.g.,
A radiation-scatter mitigating system 400 is depicted in
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The at least one radiation shield 416 is attached to and supported by the bar portion 414. Although only one radiation shield 416 is depicted in
As depicted in
The expansion and contraction of the radiation shield 416, in similar fashion to use of curtains/drapes with a window, can close off (via expansion) or provide access (via contraction) to areas underneath the main beam 12. To illustrate, when the radiation shield 416 is expanded, the radiation shield 416 serves to intercept/block and mitigate at least some of the scatter of the electromagnetic radiation from the emitter E, and when the radiation shield 416 is contracted, the radiation shield 416 affords access underneath the main beam 12.
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The at least one first radiation shield 456 and the second radiation shield 458 are each attached to and supported by the bar portion 454. Although only one first radiation shield 456 is depicted in
As depicted in
The expansion and contraction of the first radiation shield 456, in similar fashion to use of curtains/drapes with a window, can close off (via expansion) or provide access (via contraction) to areas underneath the main beam 12. To illustrate, when the first radiation shield 456 is expanded, the first radiation shield 456 serves to intercept/block and mitigate at least some of the scatter of the electromagnetic radiation from the emitter E, and when the first radiation shield 456 is contracted, the first radiation shield 456 affords access underneath the main beam 12.
Although only one second radiation shield 458 is depicted in
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The expansion and contraction of the second radiation shield 458, in similar fashion to use of curtains/drapes with a window, can close off (via expansion) or provide access (via contraction) to areas underneath the main beam 12. To illustrate, when the second radiation shield 458 is expanded, the second radiation shield 458 serves to intercept/block and mitigate at least some of the scatter of the electromagnetic radiation from the emitter E, and when the second radiation shield 458 is contracted, the second radiation shield 458 affords access underneath the main beam 12.
Additional radiation shields (not shown) can be used with the radiation-scatter mitigating system 400 and be provided at either end of the surgical frame 300 to further intercept/block radiation scatter, and these additional radiation shields can have configurations and be supported in similar fashion to the radiation shield 416, the first radiation shield 456, and/or the second radiation shield 458.
The expansion of the radiation shield 416, the first radiation shield 456, the second radiation shield 458, and the additional radiation shields can serve to at least partially enclose the emitter E therebetween. Thus, during operation of the emitter E, radiation therefrom can be at least partially blocked/intercepted from escaping through the radiation shield 416, the first radiation shield 456, the second radiation shield 458, and the additional radiation shields.
Furthermore, as depicted in
The emitter E and the receiver R could be moveable upwardly and downwardly toward or away from one another and the patient P using a modified C-arm portion 508 and/or a modified base portion 512. The receiver R could be moveable upwardly and downwardly relative to the modified C-arm, and the modified base portion 512 can be configured to be telescopically expandable and contractable. The modified C-arm and the modified base portion 512 can facilitate movement of the emitter E and/or the receiver R relative to one another and the patient P.
Rather than being attached to the translating beam 302, the C-arm portion 508, the base portion 512, the modified C-arm portion 508, or the modified base portion 512 could be attached to a slide bar (not shown) that is attached to the translating beam 302. The slide bar could be arranged transversely to and extend on either or both of the lateral sides of the translating beam 302. To facilitate positioning of the emitter E, the slide bar could be moveable along the translating beam 302 using a track (not shown) from between a location at least adjacent the first end member 310 and at least adjacent the second end member 312, and the C-arm portion 508, the base portion 512, the modified C-arm portion 508, or the modified base portion 512 could be moveable along the slide bar using a track (not shown) from between a location adjacent a first end of the slide bar and a location adjacent a second end of the slide bar.
Furthermore, a fixed beam (rather the translating beam 302) that extends between, for example, the first end member 310 and the second end member 312 could be used with the slide bar. Movement of the slide bar on the fixed beam from between a location at least adjacent the first end member 310 and at least adjacent the second end member 312, and movement of the C-arm portion 508, the base portion 512, the modified C-arm portion 508, or the modified base portion 512 on the slide bar from between a location adjacent a first end of the slide bar and a location adjacent a second end of the slide bar can afford similar positioning of the emitter E as with the translating beam 302 and the track provided thereon.
The cart portion 502 can be unattached or attached to the surgical frame 300, and can include various casters 514 facilitating movement thereof relative to the ground. When the cart portion 502 is unattached to the surgical frame 300, a user can position and reposition the cart portion 502 (and the componentry supported by the cart portion 502) relative to the patient P and/or the surgical frame 300. For example, the C-arm portion 508 (supporting the receiver R) and/or the base portion 512 (supporting the emitter E) can be attached relative to the cart portion 502, and thus, the user can position and reposition the emitter E and the receiver R relative to the patient P and/or the surgical frame 300 by moving the cart portion 502.
Alternatively, the cart portion 502 can be attached relative to the translating beam 302. To illustrate, the extension portion 510 can be attached to the cart portion 502, the base portion 512 can be attached to the extension portion 510, and the extension portion 510 and/or the base portion 512 can be attached relative to the translating beam 302. As such, when the translating beam 302 moves, the cart portion 502 moves with the movement of the translating beam 302. Additionally, the extension portion 510 and/or the base portion 512 can be interconnected with a track (not shown) extending along the translating beam 302 that affords movement of the extension portion 510 and/or the base portion 512 along the length of the translating beam 302. As such, when the extension portion 510 and/or the base portion 512 move along the track, the cart portion 502 moves with the movement of the extension portion 510 and/or the base portion 512.
Movement of the translating beam 302 and/or movement of the extension portion 510 and/or the base portion 512 along the track can serve in positioning and repositioning the cart portion 502 (and the componentry supported by the cart portion 502). As discussed above, the C-arm portion 508 (supporting the receiver R) and/or the base portion 512 (supporting the emitter E) can be attached relative to the cart portion 502, and thus, movement of the cart portion 502 serves to position and reposition the emitter E and the receiver R relative to the patient P and/or the surgical frame 300.
The C-arm portion 508 can be attached at different locations relative to the cart portion 502. For example, the C-arm portion 508 can be attached to the head portion 506, and the head portion 506 can be attached to the post portion 504. The post portion 504 can be telescoping to facilitate raising and lowering of the head portion 506 (and the C-arm 508 attached thereto) relative to the cart portion 502. Furthermore, the base portion 512 can be attached to the C-arm portion 508 instead of being attached to the cart portion 502 via the extension portion 510. As such, movement of the head portion 506 via the telescoping post portion 504 can serve in positioning and repositioning the emitter E and the receiver R upwardly and downwardly relative to the patient P and main beam 12. Alternatively, the C-arm 508 can be attached to the extension portion 510 and/or the base portion 512, rather than the head portion 506 or even the post portion 504. Either way, the C-arm portion 508 can correspondingly move with movement of the cart portion 502. Furthermore, the C-arm portion 508 and the base portion 512 can be rotatable relative to the cart portion 502 to facilitate rotation of the emitter E and the receiver R with respect to the patient P.
The C-arm portion 508 and/or the base portion 512 alternatively can be attached relative to the translating beam 302 without use of the cart portion 502. Such attachment is described in U.S. application Ser. No. 16/108,669, which is herein incorporated by reference. Furthermore, the C-arm portion 508 and the base portion 512 can be rotatable relative to the translating beam 302 to facilitate rotation of the emitter E and the receiver R with respect to the patient P. As such, movement of the translating beam 302 and/or movement of the C-arm portion 508 and/or the base portion 512 relative to the translating beam 302 can serve in positioning and repositioning the receiver R (attached to the C-arm portion 508) and/or the emitter E (attached to the base portion 512) without use of the cart portion 502.
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Furthermore, as depicted in
The expansion and contraction of the radiation shield 416 (used in association with the first side portion 522), and the expansion and contraction of the first radiation shield 456 and the second radiation shield 458, in similar fashion to use of curtains/drapes with a window, can close off (via expansion) or provide access (via contraction) to areas underneath the main beam 12. To illustrate, as discussed above, when the radiation shield 416 is expanded, the radiation shield 416 serves to intercept/block and mitigate at least some of the scatter of the electromagnetic radiation from the emitter E, and when the radiation shield 416 is contracted, the radiation shield 416 affords access underneath the main beam 12. Furthermore, as discussed above, when the first radiation shield 456 and the second radiation shield 458 are expanded, the first radiation shield 456 and the second radiation shield 458 serve to intercept/block and mitigate at least some of the scatter of the electromagnetic radiation from the emitter E, and when the first radiation shield 456 and the second radiation shield 458 are contracted, the first radiation shield 456 and the second radiation shield 458 afford access underneath the main beam 12.
Additional radiation shields (not shown) can be used with the radiation-scatter mitigating system 520 and be provided at either end of the surgical frame 300 to further intercept/block radiation scatter, and these additional radiation shields have configurations and be supported in similar fashion to the radiation shield 416, the first radiation shield 456, and/or the second radiation shield 458.
Rather than using the cart portion 502, the post portion 504, the head portion 506, the C-arm portion 508, the extension portion 510, and/or the base portion 512 to position the emitter E and receiver R with respect to one another, the emitter E can be attached to and positioned relative to the surgical frame 300, and the receiver R can be attached to and positioned relative to a receiver-support structure 550 in a radiation-scatter mitigating system 540 (
The receiver-support structure 550, as depicted in
The receiver R is attached to the transom 556 using a truck 558. The transom 556 can serve as a track, and the truck 558 can be moveable along the track formed by the transom 556 to facilitate movement of the receiver R along the length of the transom 556. Using the movement of the truck 558 relative to the transom 556, the receiver R can be moved between adjacent the first support post 552 and adjacent the second support post 554.
Furthermore, the emitter E can be attached to the translating beam 302. As depicted in
The locations of the emitter E and the receiver R can be synchronized to facilitate the imaging techniques applied to the patient P. The synchronization of the emitter E and the receiver R can be facilitated via movement of the translating beam 302, movement of the emitter E along the track portion attached to the translating beam 302, and movement of the receiver R via movement of the truck 558 along the transom 556.
Furthermore, the emitter E and/or the receiver R could be moveable upwardly and downwardly toward or away from one another and the patient P using a modified first support portion 552, a modified second support post 554, a modified truck 558, and/or a modified base portion 560. The modified first support portion 552, the modified second support post 554, the modified truck 558, and/or the modified base portion 560 can be configured to be telescopically expandable and contractable to facilitate movement of the emitter E and/or the receiver R relative to one another and the patient P.
Rather than being attached to the translating beam 302, the base portion 560 or the modified base portion 560 could be attached to a slide bar (not shown) that is attached to the translating beam 302. The slide bar could be arranged transversely to and extend on either or both of the lateral sides of the translating beam 302. To facilitate positioning of the emitter E, the slide bar could be moveable along the translating beam 302 using a track (not shown) from between a location at least adjacent the first end member 310 and at least adjacent the second end member 312, and the base portion 560 or the modified base portion 560 could be moveable along the slide bar using a track (not shown) from between a location adjacent a first end of the slide bar and a location adjacent a second end of the slide bar.
Furthermore, a fixed beam (rather the translating beam 302) that extends between, for example, the first end member 310 and the second end member 312 could be used with the slide bar. Movement of the slide bar on the fixed beam from between a location at least adjacent the first end member 310 and at least adjacent the second end member 312, and movement of the base portion 560 and the modified base portion 560 on the slide bar from between a location adjacent a first end of the slide bar and a location adjacent a second end of the slide bar can afford similar positioning of the emitter E as with the translating beam 302 and the track provided thereon.
The radiation shield 416, the first radiation shield 456, and/or the second radiation shield 458, along with the first support post portions 410, 450, 530, 534, and the second support post portions 412, 452, 532, and 536 of the radiation-scatter mitigating systems 400 and 520 can be used with the radiation-scatter mitigating system 540 to intercept/block and mitigate, as discussed above, at least some of the scatter of the electromagnetic radiation from the emitter E. As depicted in
Rather that being attached relative to the ground, a modified receiver-support structure 550′ could be attached to the surgical frame 300 in a radiation-scatter mitigating system 540′. The modified receiver-support structure 550′ can include some of the componentry of the receiver-support structure 550 and similar element numbering is applied to indicate similar features of the modified receiver-support structure 550′.
As depicted in
The emitter E and/or the receiver R could be moveable upwardly and downwardly toward or away from one another and the patient P using a modified first support post 570, a modified second support post 572, a modified truck 558, and/or a modified base portion 560 that are telescopically expandable and contractable to facilitate movement of the emitter E and/or the receiver R relative to one another and the patient P. Furthermore, the modified receiver-support structure 550′ also can be used to support various surgical lights 580 thereon, and the above-discussed slide bar and/or the fixed main beam could be used with the modified-receiver support structure 550′.
The above-discussed movement of the emitter E and the receiver R with respect to the patient P, and/or the rotation of the main beam 12 (and the patient P supported by the main beam 12) afford positioning of the emitter E and the receiver R in position relative to the patient P. Such movement and rotation facilitates the imaging of certain portions of the patient's body, and the above-discussed radiation shields serve in intercepting/blocking and mitigating radiation scatter from the emitter E directed toward the patient P.
Furthermore, the attachment locations of the emitter E and the receiver R can be reversed in their positions on the C-arm assembly 500, the translating beam 302, and the receiver-support structures 550 and 550′. The positioning and repositioning of the relocated emitter E and the relocated receiver R can then be effectuated as described above. Also, one or more robotic arms (not shown) could be attached in locations on the C-arm assembly 500, the translating beam 302, and/or the receiver-support structures 550 and 550′ in place of or in addition to the emitter E and the receiver R. The one or more robotic arms could also be moveably attached to the main beam 12 to facilitate movement thereof from at least adjacent one end of the main beam 12 to at least adjacent the other end of the main beam 12. The robotic arms can be used in manipulating instruments, supporting the patient P, and/or supporting the emitter E and/or the receiver R.
Manual adjustment and controlled automation can be used to facilitate movement of the translating beam 302, movement of the cart portion 502 relative to the translating beam 302, raising and lowering of the telescoping post portion 504 to facilitate movement of the head portion 506, movement of the extension portion 510 and/or the base portion 512 (supporting the emitter E, the receiver R, and/or the one or more robotic arms) relative to the translating beam 302, movement of the emitter E and/or the receiver R relative to the transoms 556 and 574, and/or movement of the base portion 560 (supporting emitter E, the receiver R, and/or the one or more robotic arms) relative to the translating beam 302. The expansion and contraction of the radiation shield 416, the first radiation shield 456, the second radiation shield 458, and/or the other additional radiation shields discussed herein can also be effectuated using manual adjustment and controlled automation. When using controlled automation, actuators, such as servomotors, can be used to facilitate the mechanical articulations and movements described above.
In addition to or in place of the above-discussed radiation shields, a shield or shields can be positioned around the emitter E. The shield or shields can create an area that increases in size further and further from emitter E to facilitate unblocked radiation emission from the emitter E to the patient P, but that shields areas around the shield or shields. For example, the shield or shields can define a first cross-sectional area adjacent to the emitter E in a first plane perpendicular to the direction of radiation emission from the emitter E, and a second cross-sectional area removed from the emitter E in a second plane perpendicular to the direction of the radiation emission from the emitter E, where the first cross-sectional area is smaller than the second cross-sectional area. For example, the shield or shields could be frusto-conical or truncated-pyramidal shaped.
A preferred embodiment of the system and method of the present disclosure is used for limiting exposure of the patient P and operating room personnel to doses of the electromagnetic radiation of common imaging techniques (including, for example, fluoroscopy), and is depicted in
The system and method of the present disclosure relies on a surgical frame 300′ (
As discussed below, the surgical frame 300′ relies on some of the features of the surgical frame 300 and the C-arm assembly 500 incorporated into the surgical frame 300′ to facilitate adjustment of the emitter E and the receiver R relative to the patient P. As discussed below, the emitter E and the receiver R can be moved into an ideal position via movement thereof in the X, Y, and Z directions using the surgical frame 300′, and the patient P and/or the emitter E and the receiver R can be rotated with respect to one another to further position the emitter E and the receiver R using the surgical frame 300′.
The system and method of present disclosure also relies on a pre-surgical procedure applied to the patient P before surgery. By determining location(s) of one or more anatomical features of the patient P prior to surgery, the optical navigation marker(s) can be placed on the patient P signifying the location(s) of these anatomical feature(s). For example, as depicted in
Although shown as a pin extending upwardly from the skin of the patient, the optical navigation markers M1 (and the other optical navigation marker(s) described herein) are not limited to such a configuration. For example, the optical navigation marker(s) also can be other structures that are attached relative to the skin of the patient. These other structures can extend upwardly from the body of the patient P, can extend downwardly into the body of the patient P, and/or cover portions of the skin of the patient. For example, the optical navigation marker M1 (and similar optical navigation marker(s)) could extend from the skin of the patient P into portions of the epidermis, the dermis, and hypodermis layers of the patient P and could be attached to bony features at and adjacent the area of interest A. Furthermore, the optical navigation marker M1 (and similar optical navigation marker(s)) could be stickers, temporary ink markings, or permanent or semi-permanent tattoos applied to and covering the skin or penetrating the skin of the patient at and adjacent the area of interest A. The optical navigation marker M1 (and similar optical navigation marker(s)) can be metallic, polymeric, or combinations thereof, and can be radio-opaque, radio-translucent, semi-radio-opaque, semi-radio-translucent, or combinations thereof. Furthermore, besides being positioned on the patient P, the optical navigation markers(s), as discussed below, can be provided on or as part of a surgical frame 300′.
Dimension(s) of the patient P can be measured and recorded before surgery, and the dimension(s) of the patient P can aid such positioning of the optical navigation marker M1. Using the optical camera apparatus C, the dimensions of the patient P and/or the location of the optical navigation marker M1 can determined within the X, Y, and Z coordinate system, and the emitter E and the receiver R ultimately can be moved into an ideal position relative to the area of interest A using some of the features of the surgical frame 300 and the C-arm assembly 500 incorporated into the surgical frame 300′.
The surgical frame 300′, as depicted in
In addition to being positioned on the patient P, the optical navigation marker(s) can be provided on the first arm portion 592, the second arm portion 594, and/or the elongated portion 596. These optical navigation marker(s) can be any of the above-discussed configurations of the optical navigation marker M1. For example, as depicted in
The optical camera apparatus C, as depicted in
The patient P, as depicted in
Many different angles of captured images can be generated using the optical camera apparatus C. Images of the many different angles can be captured using the optical camera apparatus C, or the captured images can be manipulated to generate additional images of many different angles by the optical camera apparatus C. One or more computers and machine learning can be incorporated in the optical camera apparatus C to facilitate the capturing of the images and manipulation of the capture images. The captured images can include images of the patient P, the surgical frame 300′, and the locations of the optical navigation marker(s) in X, Y, and Z directions of the X, Y, and Z coordinate system that is depicted in
The captured/converted images are used by the system and method of the present disclosure in determining the dimensions of the patient P and/or the locations of the optical navigation marker(s) (such as the optical navigation marker M1) positioned on the patient P in the X, Y, and Z coordinate. For example, the system and method of the present disclosure can employ the one or more computers and machine learning to facilitate calculations of these dimensions and locations. Furthermore, points of fixed reference such as dimension(s) of the surgical frame 300′ and/or distance(s) between the optical navigation marker(s) provided on or as part of portions of the surgical frame 300′ can be inputted into the one or more computers to facilitate such calculations.
For example, the points of fixed reference can be provided by distances between optical navigation markers (such as, for example, the optical navigation markers M2/M3, M4/M5, and M6/M7), dimensions of the surgical frame 300′, and/or distances between optical navigation markers (such as, for example, the optical navigation markers M2, M3, M4, M5, M6, and M7) and features of the surgical frame 300′, can be inputted into the one or more computers, and be correlated using machine learning to information in the captured/converted images to determine the dimensions of the patient P and/or the locations of the optical navigation marker(s) positioned on the patient P.
To illustrate, the distances between the optical navigation marker(s) provided on or as part of portions of the surgical frame 300′ can be physically measured in the X, Y, and Z directions and are thus known, and the dimensions of the surgical frame 300′ can be physically measured in the X, Y, and Z directions and are thus known. Additionally or alternatively, the positions of the optical camera apparatus C relative to the surgical frame 300′ also can be physically measured in the X, Y, and Z directions and are thus known. The known distances between the optical navigation marker(s) provided on or as part of portions of the surgical frame 300′, the known dimensions of the surgical frame 300′, and/or known geometries of the surgical frame 300′ relative to the optical camera apparatus C can be inputted into the one or more computers of the present disclosure.
As discussed below, these known distances, these known dimensions, and/or known geometries in the X, Y, and Z directions can be used as frame of references for determining the dimensions of the patient P and/or the locations of the optical navigation marker M1, so that the emitter E and the receiver R ultimately can be moved into an ideal position relative to the area of interest A.
For example, using the captured/converted images, the system and method of the present disclosure can via ratios of the known distances, known dimensions, and/or known geometries determine the dimensions of the patient P and/or the relative locations of the optical navigation marker(s) provided on the patient in the X, Y, and Z directions to a frame of reference such as, for example, an optical navigation marker M8 (
As depicted in
Similarly, as depicted in
And similarly, as depicted in
The ratios affording the determination of the distances X2, Y2, and Z2 also afford determination of the dimensions of the patient P in the X, Y, and Z directions. For example, the length of the patient P positioned on the surgical frame 300′ in the X-direction can be determined using ratios of the dimension X1 in the X-direction, and the determined length can be compared against a physically measured length to determine (if necessary) the accuracy of the determinations of the dimensions X2, Y2, and Z2.
Rather than using distances between the optical navigation markers M2/M3, M4/M5, and M6/M7, and the distances therebetween as the basis for ratios for determining the location of the optical navigation marker M1 at the area of interest, the features of the surgical frame 300′ by themselves or in combination with optical navigation markers (such as, for example, the optical navigation markers M2, M3, M4, M5, M6, and M7) can be used instead. For example, the dimensions between the first arm portion 592 and the second arm portion 594 in the X-direction, the dimensions between opposite ends of the first vertical support post 308A in the Y-direction, and the dimensions between opposite ends of the first end member 310 in the Z-direction can be used instead.
Whether using the using the optical navigation markers M2/M3, M4/M5, and M6/M7 and/or features of the surgical frame 300′ to provide the basis for the ratios used to determine the location of the optical navigation marker M1, the location of the optical navigation marker M1 can be determined in the X, Y, and Z directions relative to a frame of reference such as, for example, the optical navigation marker M8. The relative location of the optical navigation marker M1 can then be calibrated to movement of portions of the surgical frame 300′.
To facilitate proper positioning of the emitter E and the receiver R relative to the patient P, the emitter E and the receiver R are moveable in the X, Y, and Z directions using the surgical frame 300′. The X-direction is aligned with a longitudinal axis of the cross member 338 of the translating beam 302, the Y-direction is a vertical direction perpendicular to the X-direction, and the Z-direction is a horizontal direction perpendicular to the X and Y directions.
The surgical frame 300′, as depicted in
The C-arm assembly 600 can be configured to be docked and undocked from the surgical frame 300′ from either lateral side thereof. When docked, the C-arm assembly 600 is attached relative to one of the lateral sides of the surgical frame 300′, and when undocked, the C-arm assembly 600 can be repositioned away from the surgical frame 300′. The docking process can provide attachment of the C-arm assembly 600 to portions of the surgical frame 300′ in consistent locations. Furthermore, although the C-arm assembly 600 is not shown in
As depicted in
The C-arm assembly 600, like the C-arm assembly 500, includes a cart portion 602, a post portion 604, a head portion 606, a C-arm portion 608, an extension portion 610, a base portion 612, and casters 614. As depicted in
As depicted in
Additionally, the C-arm assembly 600 can be modified so that the C-arm portion 608 is separate from base portion 612, modified so that both the emitter E and the receiver R are attached to the C-arm portion 612, modified so that the C-arm portion 612 (with the emitter E and the receiver R attached thereto) is moveably attached upwardly and downwardly in the Y-direction relative to head portion 606 and/or the head portion 606 is moveably attached upwardly and downwardly in the Y-direction relative to the cart portion 602, and/or modified so that the C-arm portion 608 (and the emitter E and the receiver R attached thereto) is rotatable relative to the head portion 606 and/or the base portion 612.
The translating beam 302 is moveable in the Z-direction relative to the first end member 310 and the second end member 312 using the first translation mechanism 340 and the second translation mechanism 342. The first translation mechanism 340 facilitates moveable attachment between the first end member 310 and the first end member 330 (of the translating beam 302), and the second translation mechanism 342 facilitates moveable attachment between the second end member 312 and second end member 332 (of the translating beam 302). The first and second translation mechanisms 340 and 342 also facilitate movement of the translating beam 302 relative to the first end member 310 and the second end member 312 in the Z-direction. Because the C-arm assembly 600 is attached relative to the translating beam 302, the movement of the translating beam 302 (and the C-arm assembly 600 attached thereto) relative to the first end member 310 and the second end member 312 can be used to move the C-arm assembly 600 in the Z-direction.
The above-discussed movement in the X, Y, and Z directions can be calibrated to facilitate positioning of the emitter E and the receiver R adjacent the optical navigation marker M1 and the area of interest A. For example, the location of the C-arm assembly 600 relative to the translating beam 302 is known, the locations of the emitter E and the receiver R relative to the C-arm assembly 600 are known, and the location of the translating beam 302 relative to the first end member 310 and the second end member 312 are known. These locations, like the location of the optical navigation marker M1, can be determined relative to the optical navigation marker M8, or other optical navigation marker(s) or portion of the surgical frame 300′. As such, these locations can be correlated with the same frame of reference (e.g., the optical navigation marker M8) used for determining the location of the optical navigation marker M1. With the use of the same frame of reference, and given that the amount of corresponding movement of the C-arm assembly 500 in the X-direction, the amount of movement of the emitter E and the receiver R in the Y-direction, and the amount of movement of the translating beam 302 in the Z-direction according to the operation of the above-discussed motors controlled by the one or more computers is known, operation of the motors can be calibrated to move the emitter E and the receiver R adjacent a desired location (such as the optical navigation marker M1 and the area of interest A) in the X, Y, and Z coordinate system relative to the frame of reference. Furthermore, before, during, or after such movement of the emitter E and the receiver R in the X, Y, and Z directions, the patient P can be rotated relative to the emitter E and the receiver R via rotation of the main beam 590, and the emitter E and the receiver R can be rotated relative to the patient P via rotation of the C-arm portion 608 to further position the emitter E and the receiver R relative to the patient P.
The known geometries of, for example, the optical navigation markers M2 and M3 and/or the surgical frame 300′, allow a relative location of the optical navigation marker M1 and the area of interest A to be determined using the optical camera apparatus C. Then, given the calibration to the same frame of reference, the relative location of the optical navigation marker M1 and the area of interest A can be used as a guide to ideally position the emitter E and the receiver R relative thereto in the X, Y, and Z directions. The dimensions of the body cavity, as discussed below, can be used to fine tune the positioning of the emitter E and the receiver R in the X, Y, and Z directions. Before, during, or after ideally positioning the emitter E and the receiver R in the X, Y, and Z directions, the patient P and/or the emitter E and the receiver R can be rotated with respect to another to further position the emitter E and the receiver R relative to the patient P. Thereafter, the common imaging techniques can be applied to facilitate production of a desired image or images at the area of interest A without need for repeated uses thereof.
Prior to surgery, at 632, the results of the common imaging techniques can be used to identify the area of interest A in the patient P for treatment, and at 634, the optical navigation marker M1 (and additional optical navigation marker(s), if needed) can be placed on or subcutaneous to the skin of the patient P adjacent the area of interest A. For example, the area of interest A could be identified as one or more vertebrae (e.g., L2 and L3), and the results of the common imaging techniques can allow placement of the optical navigation marker M1 on the skin of the patient P in locations corresponding to L2 and L3. The dimensions of the patient P can be measured and recorded before surgery, and the dimensions of the patient P can aid placement of the optical navigation marker M1. Furthermore, markings (from, for example, a permanent or a semi-permanent marker) corresponding to the locations L2 and L3 can be placed on the skin of the patient P prior to surgery. Then, before or after the patient P is positioned on the surgical frame 300′, the optical navigation marker M1 can be positioned on the skin of the patient P at or adjacent the markings applied at or adjacent the area of interest A.
If not already measured and/or entered, distances in the X, Y, or Z directions between optical navigation markers (such as, for example, the optical navigation markers M2/M3, M4/M5, and M6/M7), dimensions in the X, Y, or Z directions of the surgical frame 300′, and/or distances in the X, Y, or Z directions between optical navigation markers (such as, for example, the optical navigation markers M2, M3, M4, M5, M6, and M7) and features of the surgical frame 300′ can be measured and entered into the one or more computers at 636. These distances, dimensions, and/or geometries are used by the one or more computers as the basis for ratios that afford determination of the dimensions of the patient P and/or the relative locations of the optical navigation marker(s) provided on the patient in the X, Y, and Z directions.
At 638, the patient P is positioned on the surgical frame 300′. Thereafter, at 640, the optical camera apparatus C is activated to capture images of the patient P, the surgical frame 300′, and/or the locations of the optical navigation marker(s). For example, the elevational view (
Thereafter, at 642, the relative location in the X, Y, and Z directions of the optical navigation marker M1 relative to the optical navigation marker M8 can be determined by the one or more computers and machine learning by using the elevational view (
It should be understood that various aspects disclosed herein may be combined in different combinations than the combinations specifically presented in the description and the accompanying drawings. It should also be understood that, depending on the example, certain acts or events of any of the processes of methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques). In addition, while certain aspect of this disclosure are described as being performed by a single module or unit for purposes of clarity, it should be understood that the techniques of this disclosure may be performed by a combination of units or modules associated with, for example, a medical device.