System and method for a medical procedure using computed tomography

Abstract

A system and method for planning and performing a percutaneous medical procedure is described. A three dimensional data set of a patient is registered with respect to a patient position and an interventional apparatus, which may be a C-arm X-ray device. A target within the patient is identified in the image data, and a skin entry point chosen for planning the procedure. The image data set is processed so as to compute a two dimensional fluoroscopic overlay image upon which the target and the skin entry point are displayed. The angulation of the volumetric representation of the C-arm is controlled so as to plan the guiding path for an interventional device, and the planning attempts to achieve one of a bull's eye orientation or a generalized bull's orientation. The interventional device is aligned with the guiding axis to perform the procedure, which may be monitored using X-ray progression views.

1 . A method for planning a percutaneous medical procedure, the method comprising:
 obtaining three-dimensional image data of a patient;   orienting a representation of the patient, or the patient, with respect to a trackable patient support table of an interventional apparatus;   registering the three-dimensional image data with respect to the patient; and   planning the percutaneous medical procedure using the three dimensional image data,   wherein an intervention path is planned so that an intervention device is alignable along a guiding axis passing through a skin entry point and a target and one of a bull's eye or a generalized bull's eye image is obtained in an X-ray projection image view.   
   
   
       2 . The method of  claim 1  wherein the interventional apparatus is a C-arm X-ray apparatus. 
   
   
       3 . The method of  claim 1 , wherein the interventional device is a biopsy needle. 
   
   
       4 . The method of  claim 1 , wherein a bull's eye view is obtained when the skin entry point and the target are aligned along the central axis of the interventional apparatus. 
   
   
       5 . The method of  claim 4 , wherein the interventional device is aligned with the optical axis using one of a laser pointer or a plurality of laser fan beams. 
   
   
       6 . The method of  claim 5 , wherein the aligned device is maintained in position using a mechanical fixture. 
   
   
       7 . The method of  claim 1 , wherein a generalized bull's eye view is obtained when the interventional path does not lie along an optical axis of the interventional apparatus. 
   
   
       8 . The method of  claim 7 , wherein, when a generalized bull's eye view is obtained, re-reorienting the patient to plan an intervention path lying closer to the interventional apparatus optical axis. 
   
   
       9 . The method of  claim 8 , wherein the step of re-orienting includes re-positioning the patient support table. 
   
   
       10 . The method of  claim 1 , wherein a first planned angulation of the interventional apparatus is associated with the interventional path. 
   
   
       11 . The method of  claim 1 , further comprising:
 comparing a volumetric location of the interventional apparatus for a first planned angulation of the interventional apparatus with a volumetric location of the patient, and the patient table and determining that a collision does not result.   
   
   
       12 . The method of  claim 1 , wherein a second planned angulation of the interventional apparatus is associated with a progression view of the interventional path. 
   
   
       13 . The method of  claim 1 , wherein a second planned angulation of the interventional axis is associated with a progression view of the interventional path and the target. 
   
   
       14 . The method of  claim 1 , wherein orienting a representation of the patient comprises:
 generating two-dimensional image data from the three dimensional image data of the patient and registering the coordinates of the patient with respect to coordinates of interventional apparatus.   
   
   
       15 . The method of  claim 14 , further comprising:
 positioning the patient so that the patient coincides with a registered skin surface image, at least within the field of view of an image to be obtained by the interventional apparatus.   
   
   
       16 . The method of  claim 1 , further comprising:
 positioning a tip of the interventional device such that a skin penetration is made at the skin entry point, and an axis of the interventional device passes through the target.   
   
   
       17 . The method of  claim 1 , further comprising:
 performing the planned medical procedure.   
   
   
       18 . The method of  claim 17 , wherein the step of performing the planned interventional procedure further comprises:
 advancing the intervention device along the guiding axis through the skin entry point;   adjusting an angulation of the interventional apparatus so as to obtain a progression image of the interventional device; and
 determining that the interventional device is aligned along the guiding axis; or, 
 determining that the interventional device is not aligned along the guiding axis and correcting an alignment of the interventional device. 
   
   
   
       19 . The method of  claim 18 , further comprising:
 repeating the steps of advancing, adjusting and determining until a tip of the interventional device is positioned in a planned position with respect to the target.   
   
   
       20 . The method of  claim 18 , further comprising:
 using the interventional device to perform a procedure on the target.   
   
   
       21 . The method of  claim 1 , wherein the target is identified in the three-dimensional image data. 
   
   
       22 . The method of  claim 21 , wherein the target is displayed as a synthetic image in a two-dimensional image derived from the three-dimensional image data. 
   
   
       23 . The method of  claim 21 , wherein the target is displayed as a synthetic image in a fluoroscopic image obtained by the interventional apparatus. 
   
   
       24 . The method of  claim 1 , wherein an endoscopic view along the guiding path is produced from the three-dimensional image data. 
   
   
       25 . A computer program product for planning a medical procedure, the product being stored on a computer readable medium, comprising:
 instructions for configuring a computer to:
 accept three-dimensional image data of a patient; 
 register the three dimensional data image with respect to the patient; 
 produce images suitable for planning a guiding path between a skin entry point and a target in the patient; 
 determine the axis of the guiding path and a corresponding angulation of an interventional apparatus having imaging capability; 
 determine the volumetric relationship between the interventional apparatus when oriented at the angulation with respect to a patient support; 
 determine whether there is an collision between the interventional apparatus and the patient support. 
   
   
   
       26 . The computer program product of  claim 25 , wherein, when the guiding path does not lie on an optical axis of the interventional apparatus, re-determining re-planning the procedure by changing at least one of the angulation or the position of the patient support table to bring the guiding path into closer angular alignment with the optical axis. 
   
   
       27 . The computer program of  claim 25 , wherein a synthetic image of the target is superimposed on an image of the images used for planning. 
   
   
       28 . The computer program of  claim 25 , wherein an icon representing a skin entry point is superimposed on the image. 
   
   
       29 . The computer program of  claim 28 , wherein when the planned angulation of the interventional apparatus is adjusted, a relative position of the icon and the synthetic image of the target is compared so as to determine whether a bull's eye or generalized bull's eye alignment has been achieved. 
   
   
       30 . The computer program of  claim 29 , wherein an operator input device controls the computed angulation of the interventional apparatus, and the corresponding image.