TWI501749B - Instrument guiding method of surgical navigation system - Google Patents

Description

Instrument guiding method for surgical guiding system

The invention relates to a device guiding method for a surgical guiding system, in particular to a device guiding method for providing a surgical guiding system for a doctor to visually guide.

In orthopedic surgery, doctors usually use C-arm X-ray machine (hereinafter referred to as C-arm) to repeatedly capture imaging information including surgical instruments and bones in the body, and then determine the surgical position in the body based on personal clinical experience. Using the spatial relationship between the surgical instrument and the surgical position in these image information, slowly adjust and move the surgical instrument to the surgical position. In this way, in addition to relying on the physician's clinical surgical experience, the patient and medical staff receive a large amount of radiation dose.

Figure 1 is a schematic diagram of a surgical guidance scenario. As shown in FIG. 1 , in order to solve the problem that the physician needs to repeatedly capture image information to obtain the spatial relationship between the surgical instrument 130 and the surgical position, the patient and the medical personnel receive a large amount of radiation dose, and the surgical guidance system has been developed in recent years. The surgical guidance system can display the position of the dynamic surgical instrument 130 in the image to provide guidance information. The surgical guiding system respectively sets a dynamic reference frame (DRF) 140 near the corrector 120 installed on the C-arm receiving end 110, the surgical instrument 130, and the surgical site of the patient, and uses the optical locator 150 to detect The position of the DRF 140 is measured such that the position of the surgical instrument 130 and the position of the C-arm receiving end 110 can correspond to the DRF coordinate system of the surgical site, and the position of the surgical instrument 130 is projected and displayed at the C-arm receiving end 110. The image captured.

In this way, only two images including the surgical instrument 130 and the bones in the body (such as the coronal section and the sagittal section) are taken, and the image information is used to plan the operation position, and the operation position can be integrated through the DRF coordinate system. And the dynamic position of the surgical instrument 130 is in the two image information, and then the physician can adjust the surgical instrument 130 to refer to the surgical instrument 130 to place the surgical instrument 130 into the surgical position without reference to the relationship between the surgical position and the dynamic position of the surgical instrument 130. The image capture is used to significantly reduce the radiation dose received by patients and medical staff.

However, the physician needs to simultaneously adjust the relationship between the surgical position and the dynamic position of the surgical instrument 130 in the two image information (for example, the coronal section and the sagittal section) in order to properly adjust the surgical instrument 130, so that the surgical guidance system is not fully used. Experienced new physicians will need a period of study and adaptation. If a more visual and intuitive device guidance method can be developed to directly guide the physician how to adjust the surgical instrument 130, the doctor's learning history and surgery can be greatly reduced. The time it takes.

The invention relates to a device guiding method for a surgical guiding system, comprising the steps of: obtaining a predetermined instrument path 3D vector; obtaining a predetermined tangent plane; displaying a target mark on a display; reading a dynamic 3D vector; A projection vector is generated; two dynamic markers are displayed on the display and the instrument is guided to produce an overlay image. The invention can enable the doctor to more intuitively and intuitively understand the relationship between the instrument and the predetermined instrument path during the surgical guidance to accelerate the operation.

The invention provides a device guiding method for a surgical guiding system, which is In a computer system, the instrument guiding method comprises the steps of: obtaining a predetermined device path 3D vector, which is to plan a predetermined instrument path 3D vector according to an image frame; obtaining a predetermined tangent plane, wherein the predetermined tangent plane is a processing The unit calculates a spatial plane perpendicular to the predetermined instrument path 3D vector and through the end of the predetermined instrument path 3D vector; displays a target marker on a display, the target marker being the end of the predetermined instrument path 3D vector on the predetermined tangent plane; Taking a dynamic 3D vector, the dynamic 3D vector is a direction vector of an instrument; generating a projection vector, which is generated by projecting a dynamic 3D vector onto a predetermined tangent plane; displaying two dynamic markers on the display, wherein the dynamic markers are projections Two marker points of the vector; and a guiding device to create an overlay image that guides the instrument such that the center of the dynamic markers overlaps the center of the target marker.

With the implementation of the present invention, at least the following advancements can be achieved:

First, the physician can more intuitively understand the relationship between the instrument and the predetermined instrument path during the surgical guidance.

Second, it can speed up the operation.

Third, it can reduce the radiation dose received by patients and medical personnel.

Fourth, can reduce the time for physicians to learn.

In order to make those skilled in the art understand the technical content of the present invention and implement it, and according to the disclosure, the patent scope and the drawings, the related objects and advantages of the present invention can be easily understood by those skilled in the art. The detailed features and advantages of the present invention will be described in detail in the embodiments.

FIG. 2 is a schematic diagram of a surgical guiding situation according to an embodiment of the present invention. FIG. 3 is a flow chart of a device guiding method of a surgical guiding system according to an embodiment of the present invention. 4A and 4B are schematic diagrams showing the steps of obtaining a predetermined device path 3D vector according to an embodiment of the present invention. FIG. 5A and FIG. 5B are schematic diagrams showing steps of obtaining a predetermined tangential plane according to an embodiment of the present invention. FIG. 6A is a schematic diagram showing the steps of displaying a target mark on a display according to an embodiment of the present invention. FIG. 6B is a schematic diagram showing the steps of displaying two dynamic marks on the display according to an embodiment of the present invention. 7A, 8A, 9A, 10A, and 11A are diagrams showing the position of the surgical instrument at various points in the surgical guide according to an embodiment of the present invention. 7B, 8B, 9B, 10B, and 11B are schematic diagrams of the guidance display screens corresponding to the 7A, 8A, 9A, 10A, and 11A. FIG. 12 is a schematic diagram of a comprehensive guide display screen according to an embodiment of the present invention.

As shown in FIG. 2 and FIG. 3, the embodiment of the present invention is a device guiding method S100 for a surgical guiding system, which is implemented in a computer system 70. The instrument guiding method S100 comprises the steps of: obtaining a predetermined instrument path 3D vector (step S10); obtaining a predetermined tangent plane (step S20); displaying a target mark on a display (step S30); reading a dynamic 3D vector (Step S40); generating a projection vector (step S50); displaying two dynamic marks on the display (step S60) and guiding the apparatus to generate an overlapping image (step S70).

When the surgical guide is used, if the imaging device used by the physician is a C-arm 10, the corrector 20 mounted on the receiving end of the C-arm 10, the surgical site 60 of the patient, and the surgical instrument 30 are each equipped with DRF 40, optical locator 50 for receiving signals from these DRFs 40 to position the surgical instrument 30 The position of the surgical site 60 can be integrated into the DRF coordinate system and displayed in the C-arm 10 captured image, wherein the image can be a sagittal section image and a coronal section image including the surgical instrument 30 and the surgical site 60. The imaging device may be other imaging devices and is not limited to the C-arms listed in the examples.

Referring to FIG. 4A and FIG. 4B simultaneously, a predetermined device path 3D vector is obtained (step S10), wherein the physician can obtain a predetermined instrument path in one of the image frames or two image frames captured by the C-arm 10 3D vector 72. If the predetermined instrument path 3D vector 72 is obtained according to the two image screens, the two image screens are respectively a sagittal section image screen (such as FIG. 4A) and a coronal section image image (such as FIG. 4B), thereby planning The predetermined instrument path 3D vector 72 can be obtained by the surgical position 30 on which the surgical instrument 30 is intended to be placed and the predetermined path required to reach the surgical position 71, and then the surgical position 71 and the predetermined path are read and calculated via the processing unit. In addition, the physician may perform step S10 on an X-ray image, a computed tomography image, a nuclear magnetic resonance image, or an ultrasound image.

Referring to FIGS. 5A and 5B simultaneously, a predetermined tangent plane is obtained (step S20), which is calculated by the processing unit as a spatial plane perpendicular to the predetermined instrument path 3D vector 72 and passing through the end point 74 of the predetermined instrument path 3D vector. This spatial plane is the predetermined tangent plane 73. That is, the projection of the predetermined instrument path 3D vector 72 on the predetermined tangent plane 73 will form a point. When the projection of the surgical instrument 30 on the predetermined tangential plane 73 is a point, the representative surgical instrument 30 is parallel to the predetermined instrument path 3D vector 72, and when this point is located just at the end 74 of the predetermined instrument path 3D vector, the surgical instrument 30 is represented. That is, it is located on the predetermined instrument path 3D vector 72.

Referring to FIG. 6A and FIG. 6B simultaneously, a target mark is displayed on a display (step S30), wherein the target mark 81 displayed on the display is the end point 74 of the predetermined instrument path 3D vector on the predetermined tangent plane 73. A cross-sectional view 85 can be displayed on the display and the target mark 81 is marked on the cross-sectional view 85. The cross-sectional view 85 can be obtained by re-cutting the section of the computed tomography (CT) image or magnetic resonance imaging (MRI) image taken by the patient before the operation. Since the device guiding method S100 of the embodiment of the present invention is a visual and intuitive guide, the physician only needs to refer to the marking point of the method without referring to the actual anatomical image, so that no background image can be displayed on the display. on.

Referring to FIG. 7A and FIG. 7B simultaneously, a dynamic 3D vector is read (step S40), wherein the dynamic 3D vector 75 is a direction vector of a surgical instrument 30, and the direction vector of the surgical instrument 30 can be tracked by a spatial locator. Obtained, for example, an optical positioner 50. By arranging the DRF 40 on the surgical instrument 30, the optical positioner 50 can receive the signal of the DRF 40 to obtain the direction vector of the surgical instrument 30.

In order to provide a visual guiding effect, the target mark 81 can be a cross line 812 or a dot, or both, and the user's convenience is mainly considered, so that the guide picture can be concise and clear. The target mark 81 may further include a circle 813 centered on the target mark 81, wherein the radius of the circle 813 may be a fixed value or may be proportional to the distance from the end of the dynamic 3D vector 75 to the end point 74 of the predetermined instrument path 3D vector. That is, as the surgical instrument 30 approaches the target end point, the radius of the circle 813 becomes smaller. In addition, the target mark 81 may further include a number 814 displayed beside the target mark 81, and the numerical value of the number 814 represents the end point of the dynamic 3D vector 75 to the predetermined device. The unit distance of the end point 74 of the path 3D vector, where the endpoint of the dynamic 3D vector 75 can be the start or end of the dynamic 3D vector 75.

A projection vector is generated (step S50), wherein the projection of the dynamic 3D vector 75 to the predetermined tangent plane 73 can produce a projection vector having two marked points, such as a first marker point and a second marker point. When the first marker point is the vector start point of the projection vector and the second marker point is the vector endpoint of the projection vector, the first marker point is the posterior end of the surgical instrument 30 and the second marker point is the front end of the surgical instrument 30.

Please refer to FIG. 6B at the same time, and display two dynamic marks on the display (step S60), wherein the dynamic marks are two mark points displayed on the display and representing the above-mentioned projection vector, and the first dynamic mark 82 corresponds to the first mark. Point, and the second dynamic mark 83 corresponds to the second mark point. In order to provide a visual guiding effect, the dynamic markers may be a circle 832, a dot 831 or both, wherein the radius of the circle 832 may be a fixed value or may be connected to the end of the dynamic 3D vector 75. The distance of the end point 74 of the predetermined instrument path 3D vector is proportional. It is worth noting that in a navigation display, usually only one dynamic marker or the radius of the target marker is adjusted with the distance from the endpoint of the dynamic 3D vector 75 to the end 74 of the predetermined instrument path 3D vector to avoid Confuse users.

In addition, each circle 832 may further have a cross line 821, and the intersection of the cross lines 821 is the center of the circle 832. In order to facilitate the physician to quickly identify the front end and the rear end of the surgical instrument 30, the first dynamic mark 82 representing the rear end of the surgical instrument 30 may be marked with a different color from the second dynamic mark 83 representing the front end of the surgical instrument 30, or The projection vector described above is displayed on the display and the position representing the front end of the surgical instrument 30 is marked on the displayed projection vector.

Guiding the device to generate an overlay image (step S70), according to the visualized and intuitive guidance display displayed on the display, the physician can adjust the surgical instrument 30 correspondingly until the dynamic markers are displayed in the display The center overlaps the center of the target mark 81 to produce an overlay image in which the target mark 81 and the centers of the dynamic marks are overlapped.

As shown in Figures 2 and 7A, at the beginning of the surgical guide, the surgical instrument 30 is still at a distance from the predetermined instrument path 3D vector 72. In the conventional surgical guidance method, the physician is required to refer to both slices simultaneously. The surgical instrument position map of the screen determines how the surgical instrument 30 is to be adjusted. For example, when the physician sees the coronal section of the left hand side, it is decided to move the surgical instrument 30 to the right, and then the surgical instrument 30 is moved to the head side of the patient according to the sagittal section of the right hand side.

Please refer to FIG. 7B at the same time. However, in the guiding method of the embodiment of the present invention, in order to facilitate the doctor to determine the relative position of the image and the patient, the guiding display screen may also be set according to the doctor's habit, for example, in the spinal surgery, the setting may be set. The upper part of the guidance display screen represents the head side of the patient, the lower side represents the side of the patient's foot, and the left and right sides are the same as the left and right sides of the doctor. In order to facilitate the interpretation of the doctor, the head side, the foot side, the right side and the left side can be displayed in the guidance display screen. The direction guide sign 90. When the doctor sees the corresponding guiding display screen, it is not necessary to first determine the position of the surgical instrument 30 in the body, and the marking points displayed on the guiding display screen, such as the target mark 81 and the two dynamic markers 82, can be directly used. 83, indirectly, the two dynamic markers 82, 83 are superimposed on the target mark 81 in accordance with the guide display screen. For example, if the physician sees the guidance display screen, it can be known that the second dynamic marker 83 can be directly moved to the upper right to overlap the target marker 81, that is, the front end of the surgical instrument 30 is moved to the right and the head side of the patient.

Please refer to Figure 8A at the same time. When the doctor sees the coronal section of the left hand side, it is impossible to determine with certainty how to move. Referring to the sagittal section of the right hand side, the front end of the surgical instrument 30 is determined to be toward the patient's head side. Moving, the rear end of the surgical instrument 30 moves toward the patient's foot side.

Please refer to FIG. 8B at the same time, but in the guiding method of the embodiment of the present invention, when the doctor sees the corresponding guiding display screen, the doctor can directly visually understand that the first dynamic marker 82 is to be moved directly to the lower left side. It is possible to overlap with the target mark 81, that is, to move the rear end of the surgical instrument 30 to the left side of the patient and to the left side, wherein the front end and the rear end of the surgical instrument 30 can also be easily judged by the displayed projection vector 84. come out.

Please refer to FIG. 9A and FIG. 9B at the same time. Similarly, the front end of the surgical instrument 30 is adjusted to the right side and the head side of the patient according to the guide display screen, and the rear end of the surgical instrument 30 is directed to the left of the patient. Adjusting the square and the foot side a little bit can produce an overlapping image.

Referring to FIG. 10A and FIG. 10B simultaneously, when the overlay image is generated, it represents that the surgical instrument 30 is already on the predetermined instrument path 3D vector 72. At this time, for example, when the second dynamic marker 83 includes a circle 832, the circle 832 is included. The radius will be proportional to the distance from the endpoint of the dynamic 3D vector 75 to the end 74 of the predetermined instrument path 3D vector, so the physician can drill the surgical instrument 30 a little further into the ventral side of the patient.

Please refer to FIG. 4A, FIG. 11A and FIG. 11B at the same time. When the doctor goes deep into the ventral side of the patient, the radius of the dynamic mark can be seen to be small, for example, the first dynamic mark 82, when the dynamic mark is small To a certain extent, it represents the surgical position 71 that has reached the beginning of planning.

As shown in FIG. 12, the device guiding method S100 may further include a combined medical image step S65 after step S60, which displays a medical image together with the dynamic mark and the target mark 81 on the display, and the medical image may be one. X-ray image, computer tomography image, nuclear magnetic resonance image or a supersonic image. That is, the medical image may be a section image of the patient's anatomy, and an X-ray image, a computerized tomography, a nuclear magnetic resonance or a superficial slice image may be used, and the medical image and the dynamic mark and the target mark 81 are displayed as the present invention. The guide picture of the two slice pictures in Fig. 11A in the embodiment.

In addition, the guide picture of the two slice images of FIG. 11A can be combined with the instrument guide picture of FIG. 11B to form a sagittal slice guide picture A and a coronal slice guide picture B as shown in FIG. The integrated guide display screen of the device guide screen C is provided to provide the user with accurate surgical instrument position information and quick guidance. According to the device guiding method S100 of the embodiment of the present invention, in addition to the guiding method (C-arm, computer tomography, nuclear magnetic resonance or ultrasonic wave) which can be used for various imaging systems, the physician can also More visualization and more intuitive reference to a guide display to adjust the surgical instrument 30 without having to rethink how the surgical instrument 30 is to be adjusted can speed up the procedure. In addition, it can also reduce the learning time of novice physicians.

The embodiments are described to illustrate the features of the present invention, and the purpose of the present invention is to enable those skilled in the art to understand the present invention and to implement the present invention without limiting the scope of the present invention. Equivalent modifications or modifications made by the spirit of the disclosure should still be included in the scope of the claims described below.

110‧‧‧C-arm receiver

120, 20‧‧‧ Corrector

130, 30‧‧‧Surgical instruments

140, 40‧‧‧DRF

150, 50‧ ‧ optical locator

10‧‧‧C-arm

60‧‧‧Surgical site

70‧‧‧ computer system

71‧‧‧Surgical position

72‧‧‧Scheduled instrument path 3D vector

73‧‧‧Predetermined cut plane

74‧‧‧The end point of the 3D vector of the intended instrument path

75‧‧‧Dynamic 3D Vectors

81‧‧‧Target mark

812, 821‧‧ ‧ crosshairs

813, 832‧‧ ‧ circle

814‧‧‧ figures

82‧‧‧First dynamic mark

83‧‧‧Second dynamic mark

831‧‧‧ dots

84‧‧‧ Display projection vector

85‧‧‧ Sectional view

90‧‧‧ Directional Signs

A‧‧‧sagittal section guide screen

B‧‧‧ Coronal section guide screen

C‧‧‧Device guidance screen

Figure 1 is a schematic diagram of a surgical guidance scenario.

FIG. 2 is a schematic diagram of a surgical guiding situation according to an embodiment of the present invention.

FIG. 3 is a flow chart of a device guiding method of a surgical guiding system according to an embodiment of the present invention.

4A and 4B are schematic diagrams showing the steps of obtaining a predetermined device path 3D vector according to an embodiment of the present invention.

FIG. 5A and FIG. 5B are schematic diagrams showing steps of obtaining a predetermined tangential plane according to an embodiment of the present invention.

FIG. 6A is a schematic diagram showing the steps of displaying a target mark on a display according to an embodiment of the present invention.

FIG. 6B is a schematic diagram showing the steps of displaying two dynamic marks on the display according to an embodiment of the present invention.

7A, 8A, 9A, 10A, and 11A are diagrams showing the position of the surgical instrument at various points in the surgical guide according to an embodiment of the present invention.

7B, 8B, 9B, 10B, and 11B are schematic diagrams of the guidance display screens corresponding to the 7A, 8A, 9A, 10A, and 11A.

FIG. 12 is a schematic diagram of a comprehensive guide display screen according to an embodiment of the present invention.

S100‧‧‧Surgical guidance system instrument guidance method

S10‧‧‧Get a predetermined instrument path 3D vector

S20‧‧‧Get a predetermined cut plane

S30‧‧‧ shows a target mark on a display

S40‧‧‧Read a dynamic 3D vector

S50‧‧‧ produces a projection vector

S60‧‧‧ shows two dynamic markers on the display

S65‧‧‧ combined with medical imaging

S70‧‧‧ Guidance device to create an overlay image

Claims (10)

A device guiding method for a surgical guiding system, which is implemented in a computer system, the instrument guiding method comprising the steps of: obtaining a predetermined device path 3D vector, which is to plan the predetermined instrument path 3D vector according to an image frame. Obtaining a predetermined tangent plane, wherein the predetermined tangent plane is a spatial plane calculated by a processing unit perpendicular to the predetermined instrument path 3D vector and passing through the predetermined instrument path 3D vector; displaying a target mark on a display The target is marked as an end point of the predetermined instrument path 3D vector on the predetermined tangent plane; a dynamic 3D vector is read, the dynamic 3D vector is a direction vector of the instrument; and a projection vector is generated, which is the dynamic 3D vector Projecting to the predetermined tangent plane; displaying two dynamic markers on the display, wherein the dynamic markers are two points of the projection vector; and guiding the device to generate an overlay image that guides the device The centers of the dynamic markers overlap at the center of the target marker. The device guiding method according to claim 1, wherein the device guiding method further comprises a combined medical image step of simultaneously displaying a medical image with the dynamic markers and the target marker on the display The medical image is an X-ray image, a computed tomography image, a nuclear magnetic resonance image or an ultrasound image. The method of guiding a device according to claim 1, wherein the target Mark as a crosshair or a dot. The device guiding method of claim 3, further comprising a circle marked with the target as a center. The instrument guiding method of claim 3, further comprising a number displayed next to the target mark, the numerical value of the number representing the end of the dynamic 3D vector to the predetermined instrument path 3D vector The distance from the end point. The device guiding method according to claim 1, wherein the direction vector of the device is obtained by tracking by a spatial locator. The device guiding method of claim 1, wherein the marking points are a first marking point and a second marking point, and the first marking point corresponds to a first dynamic marking and the second marking The point corresponds to a second dynamic marker, the first marker point being a vector start point of the projection vector and the second marker point being a vector end point of the projection vector. The device guiding method according to claim 1, wherein the dynamic markings are a circle or a dot. The instrument guiding method of claim 4, wherein the radius of the circle is proportional to a distance from an end of the dynamic 3D vector to an end of the predetermined instrument path 3D vector. The instrument guiding method according to claim 8, wherein each of the circles further has a cross line, and the intersection of the cross lines is the center of the circle.