Apparatus and method for planning a stereotactic surgical procedure using coordinated fluoroscopy

Abstract

An apparatus and method is provided for coordinating two fluoroscope images, which permits accurate computer-based planning of the insertion point and angle of approach of a needle, drill, screw, nail, wire or other surgical instrumentation into the body of a patient, and subsequently guides the surgeon in performing the insertion in accordance with the plan.

1. A computer-aided method for planing a surgical procedure comprising:
 registering to a known coordinate frame a first two-dimensional, image of a body's anatomy taken at a first observation angle;  
 displaying the first image; and  
 drawing in the displayed first image a representation of a surgical object to be placed in the body based on the registration of the first image with the known coordinate frame.  
 
     
     
       2. The method of  claim 1  wherein drawing in the displayed first image the representation of the surgical object is in response to a user indicating at least one positioning parameter for the surgical object. 
     
     
       3. The method of  claim 2  wherein the at least one positioning parameter for the surgical object is defined in reference to the known coordinate frame. 
     
     
       4. The method of  claim 3  wherein the at least one parameter includes an approach angle of the surgical object. 
     
     
       5. The method of  claim 2  wherein the at least one parameter is defined in reference to the first image. 
     
     
       6. The method of  claim 5  wherein the at least one parameter includes a point in the body. 
     
     
       7. The method of  claim 5  wherein the user indicates the at least one parameter by positioning a cursor displayed within the first image. 
     
     
       8. The method of  claim 1  wherein a user indicates at least one parameter defining the surgical object. 
     
     
       9. The method of  claim 8  wherein the at least one parameter includes a dimension of the surgical object. 
     
     
       10. The method of  claim 1  further comprising:
 registering to the known coordinate frame a second two-dimensional, image of the body's anatomy taken at a second observation angle;  
 displaying the second image; and  
 drawing in the displayed second image the representation of the surgical object based on the registration of the second image with the known coordinate frame.  
 
     
     
       11. The method of  claim 10  wherein drawing the representation of the surgical object in the second image is in response to a user indicating on the displayed first image indicating a change in position of the representation of the surgical object in the first image. 
     
     
       12. The method of  claim 1 , wherein the representation of the surgical object is a virtual guidewire defining, at least in part, a trajectory of insertion of the surgical object into the body. 
     
     
       13. The method of  claim 1 , wherein the representation of the surgical object is a virtual guidewire having a length corresponding to a dimension of the surgical object to be inserted into the body. 
     
     
       14. The method of  claim 1  further comprising transmitting to a positioning mechanism coordinates for indicating the position of the surgical object represented in the first image. 
     
     
       15. The method of  claim 14  further comprising manipulating the positioning mechanism such that a guide coupled to the positioning mechanism is substantially aligned with the representation of the surgical object in the image. 
     
     
       16. The method of  claim 1  further comprising displaying information for indicating the position of the surgical object represented in the first image. 
     
     
       17. A computer readable storage medium encoded with instructions, which, when read by a computer, enable a computer to undertake a process comprising:
 registering to a known coordinate frame a first two-dimensional, image of a body's anatomy taken at a first observation angle;  
 displaying the first image; and  
 drawing in the displayed first image a representation of a surgical object to be placed in the body based on the registration of the first image with the known coordinate frame.  
 
     
     
       18. The computer readable storage medium of  claim 17  wherein drawing in the displayed first image the representation of the surgical object is in response to a user indicating at least one positioning parameter for the surgical object. 
     
     
       19. The computer readable storage medium of  claim 18  wherein the at lest one positioning parameter for the surgical object is defined in reference to the known coordinate frame. 
     
     
       20. The computer readable storage medium of  claim 19 , wherein the indication of the at lest one positioning parameter is a reference on the displayed first image controlled by a user. 
     
     
       21. The computer readable storage medium of  claim 17  wherein the process further comprises:
 registering to the known coordinate frame a second two-dimensional, image of the body's anatomy taken at a second observation angle;  
 displaying the second image; and  
 drawing in the displayed second image the representation of the surgical object based on the registration of the second image with the known coordinate frame.  
 
     
     
       22. The computer readable storage medium of  claim 21  wherein drawing the representation of the surgical object in the second image is in response to an input received from a user indicating a position of the surgical object. 
     
     
       23. The computer readable storage medium of  claim 21  wherein drawing the representation of the surgical object in the second image is in response to an input received from a user indicating a position of the representation of the surgical object in the displayed first image. 
     
     
       24. The computer readable storage medium of  claim 21  wherein drawing the representation of the surgical object in the second image is in response to an input indicating a change in position of the representation of the surgical object in the first image. 
     
     
       25. The computer readable storage medium of  claim 21  wherein registering to the known coordinate frame the first image and the second image includes registering known coordinates of a plurality of fiducials within the reference frame with positions of the plurality of fiducials in the first and second images. 
     
     
       26. A computer-aided method for planning a surgical procedure comprising:
 registering a first two-dimensional, image of a body's anatomy taken at a first observation angle with a second two-dimensional image of the body's anatomy taken at a second observation angle;  
 displaying the first image;  
 drawing within the displaying first image drawing within the displayed first image a representation of a surgical object to be placed in the body based on an input indicating a position of the surgical object;  
 displaying the second image; and  
 drawing in the displayed second image the representation of the surgical object.  
 
     
     
       27. The method of  claim 26  wherein drawing the representation of the surgical object in the second image is based, at least in part, on positioning in the displayed first image of the representation of the surgical object in the first image. 
     
     
       28. The method of  claim 26  wherein drawing in the first image and drawing second image the representation the surgical object is at least in part in response to a user indicating at least one positioning parameter for the surgical object. 
     
     
       29. The method of  claim 28  wherein the at least one positioning parameter for the surgical object is defined in reference to a known coordinate frame to which the first and the second images are registered. 
     
     
       30. The method of  claim 28  wherein the at least one parameter includes an approach angle of the surgical object. 
     
     
       31. The method of  claim 28  wherein the at least one parameter includes a point in the body. 
     
     
       32. The method of  claim 28  wherein the user indicates the at lest one parameter by positioning a reference displayed within the first or second images. 
     
     
       33. The method of  claim 26  wherein a user indicates at least one parameter defining the surgical object. 
     
     
       34. The method of  claim 26  further comprising transmitting to a positioning mechanism coordinates for indicating the position of the surgical object represented in the first image. 
     
     
       35. The method of  claim 34  further comprising manipulating the positioning mechanism such that a guide coupled to the positioning mechanism is substantially aligned with the representation of the surgical object in the image. 
     
     
       36. The method of  claim 26  further comprising displaying information for indicating the position within a known coordinate frame of reference for the surgical object for use in manually positioning a guide. 
     
     
       37. The method of  claim 26  wherein registering the first and second images includes registering a plurality of fiducials having known coordinates within a known coordinate frame of reference with images of the plurality of fiducials within in the respective first and second images. 
     
     
       38. A computer readable storage medium encoded with instructions, which, when read by a computer, enable a computer to undertake a process comprising:
 receiving a first two-dimensional, image taken of a patient's body and a plurality of radio-opaque fiducials placed adjacent the body at known positions; and  
 registering the image by optimizing parameters of a known geometric model such that projections of the plurality of fiducials into the first image best fit positions of the plurality of fiducials in the image.  
 
     
     
       39. The computer readable storage medium of  claim 38 , wherein the process further comprises:
 receiving a second, two-dimensional image taken of the patient'body and the plurality of fiducials from a position different from the first image; and  
 registering the second image by optimizing parameters of the known geometric model such that projections of the plurality of fiducials into the second image best fit positions of the plurality of fiducials in the second image.  
 
     
     
       40. The computer readable storage medium of  claim 39 , wherein the process further comprises:
 receiving input indicating on one of the first and second images a position of a representation of an imaginary object with respect to the body; and  
 drawing on the other of the first and second images a corresponding representation of the imaginary object projected into said other of the first and second images.  
 
     
     
       41. The computer readable storage medium of  claim 40  further comprising:
 receiving input indicating a change to a second position of the representation of the imaginary object within said one of the first and second image; and  
 redrawing within said other of the first and the second images the corresponding representation of imaginary object in the second position.  
 
     
     
       42. The computer readable storage medium of  claim 40  wherein the imaginary object is a representation of a surgical object and the corresponding representation is also of the same surgical object. 
     
     
       43. The computer readable storage medium of  claim 39 , wherein the process further comprises:
 receiving an input indicating a position of an imaginary object within the body; and  
 drawing on the first and the second images a representation of the imaginary object in the indicted position.  
 
     
     
       44. The computer readable storage medium of  claim 43 , wherein the process further comprises:
 receiving an input indicating a change in the position of the imaginary object to a second position; and  
 redrawing in the first and the second images the representation of imaginary object in the second position.  
 
     
     
       45. The computer readable storage medium of  claim 38 , wherein registering the image further comprises:
 displaying the image; and  
 receiving an input from a user indicating on the image the position of each of the plurality of fiducials within the image.  
 
     
     
       46. The computer readable storage medium of  claim 38 , wherein the process further comprises linearizing the image before registering the image. 
     
     
       47. A method comprising:
 receiving a first two-dimensional, image taken of a patient's body and a plurality of radio-opaque fiducials placed adjacent the body at known positions; and  
 registering the image by optimizing parameters of a known geometric model such that projections of the plurality of fiducials into the first image best fit positions of the plurality of fiducials in the image.  
 
     
     
       48. The method of  claim 47  further comprising:
 receiving a second, two dimensional image taken of the patient's body and the plurality of fiducials from a position different from the first image; and  
 registering the second image by optimizing parameters of the known geometric model such that projections of the plurality of fiducials into the second image best fit positions of the plurality of fiducials in the second image.  
 
     
     
       49. The method of  claim 48  further comprising:
 receiving input indicating on one of the first and second images a position of a representation of an imaginary object with respect to the body; and  
 drawing on the other of the first and second images a corresponding representation of the imaginary object projected into said other of the first and second images.  
 
     
     
       50. The method of  claim 49  further comprising:
 receiving input indicating a change to a second position of the representation of the imaginary object within said one of the first and second image; and  
 redrawing within said other of the first and the second images the corresponding representation of imaginary object in the second position.  
 
     
     
       51. The method of  claim 49  wherein the imaginary object is a representation of a surgical object and the corresponding representation is also of the same surgical object. 
     
     
       52. The method of  claim 48  further comprising:
 receiving an input indicating a position of an imaginary object within the body; and  
 drawing on the first and the second images a representation of the imaginary object in the indicated position.  
 
     
     
       53. The method of  claim 52  further comprising:
 receiving an input indicating a change in the position of the imaginary object to a second position; and  
 redrawing in the first and the second images the representation of imaginary object in the second position.  
 
     
     
       54. The method of  claim 47  further comprising:
 displaying the image; and  
 receiving an input from a user indicating on the image the position of each of the plurality of fiducials within the image.  
 
     
     
       55. The method of  claim 47  further comprising linearizing the image before registering the image. 
     
     
       56. A computer readable storage medium encoded with instructions, which, when read by a computer, enable a computer to undertake a process comprising:
   receiving a first two - dimensional image of a patient's body and a plurality of radio - opaque fiducials at known positions within a defined coordinate system; and        registering the image to the coordinate system by optimizing parameters of a known geometric model such that projections of the plurality of fiducials into the first image best fit positions of the plurality of fiducials in the image.     
     
     
       57. The computer readable storage medium of  claim 56 , wherein the process further comprises:
   receiving a second, two - dimensional image of the patient's body and the plurality of fiducials from a position different from the first image; and        registering the second image to the coordinate system by optimizing parameters of the known geometric model such that projections of the plurality of fiducials into the second image best fit positions of the plurality of fiducials in the second image.     
     
     
       58. The computer readable storage medium of  claim 57 , wherein the process further comprises:
   after receiving the first and second two - dimensional images, receiving an input indicating a position of an object near or in the patient's body; and        displaying on the first and second images a projection of the object into the first and second images.     
     
     
       59. The computer readable storage medium of  claim 58 , wherein the object comprises a representation of an aspect of a surgical object. 
     
     
       60. The computer readable storage medium of  claim 59 , wherein the aspect of the surgical object is a primary axis of the surgical object. 
     
     
       61. The computer readable storage medium of  claim 58  further comprising:
   receiving input indicating a change to a second position of the object; and        redisplaying an updated projection of the object in the second position in the first and second images.     
     
     
       62. The computer readable medium of  claim 59 , wherein the representation of the aspect of the surgical object comprises a virtual guidewire. 
     
     
       63. The computer readable storage medium of  claim 56 , wherein registering the image further comprises:
   displaying the first two - dimensional image; and        receiving an input from a user indicating on the first two - dimensional image the position of each of the plurality of fiducials within the image.     
     
     
       64. The computer readable storage medium of  claim 56 , wherein said first and second two- dimensional images comprise fluoroscopic images.   
     
     
       65. A method, comprising:
   receiving a first two - dimensional image of a patient's body and a plurality of radio - opaque fiducials at known positions within a defined coordinate system; and        registering the image to the coordinate system by optimizing parameters of a known geometric model such that projections of the plurality of fiducials into the first image best fit positions of the plurality of fiducials in the image.     
     
     
       66. The method of  claim 65 , further comprising:
   receiving a second, two - dimensional image of the patient's body and the plurality of fiducials from a position different from the first image; and        registering the second image to the coordinate system by optimizing parameters of the known geometric model such that projections of the plurality of fiducials into the second image best fit positions of the plurality of fiducials in the second image.     
     
     
       67. The method of  claim 66 , further comprising:
   receiving an input indicating a position of an object near or in the patient's body; and        displaying on the first and second images a projection of the object into the first and second images.     
     
     
       68. The method of  claim 67 , wherein the object comprises a representation of an aspect a surgical object. 
     
     
       69. The method of  claim 68 , wherein the aspect of the surgical object is a primary axis of the surgical object. 
     
     
       70. The method of  claim 67 , further comprising:
   receiving input indicating a change to a second position of the object; and        redisplaying an updated projection of the object in the second position in the first and second images.     
     
     
       71. The method of  claim 65 , further comprising:
   displaying the first two - dimensional image; and        receiving an input from a user indicating on the first two - dimensional image the position of each of the plurality of fiducials within the image.     
     
     
       72. A method, comprising:
   registering to a known three - dimensional coordinate frame a first two - dimensional, image of a body's anatomy taken at a first observation angle;       displaying the first image; and        displaying in the displayed first image a projection of a representation of a surgical object at a known position with respect to the coordinate frame based at least in part on the registration of the first image with the known - coordinate frame.     
     
     
       73. A computer readable storage medium encoded with instructions, which, when read by a computer, enable a computer to undertake a process, comprising:
   registering to a known three - dimensional coordinate frame a first two - dimensional, image of a body's anatomy taken at a first observation angle;        displaying the first image; and        displaying in the displayed first image a projection of a representation of a surgical object at a known position based at least in part on the registration of the first image with the coordinate frame.     
     
     
       74. A method for a surgical procedure, comprising:
   registering to a known three - dimensional coordinate frame a first two - dimensional diagnostic image of a patient's anatomy taken at a first observation angle and a second two - dimensional diagnostic image of a patient's anatomy taken at a second observation angle different than the first observation angle;        after receiving the first and second two - dimensional images, receiving an input indicating a position of an object with respect to the coordinate frame; and        displaying on the first and second images a projection of the object into the first and second images.     
     
     
       75. The method of  claim 74 , wherein the object comprises a representation of an aspect a surgical object. 
     
     
       76. The method of  claim 75 , wherein the aspect of the surgical object is a primary axis of the surgical object. 
     
     
       77. The method of  claim 75 , wherein the representation of the aspect of the surgical object includes a virtual guidewire. 
     
     
       78. An apparatus for a stereotactic surgical procedure using a fluoroscope for generating images of the body, the apparatus comprising:
   means for registering to a known three - dimensional coordinate frame a first two - dimensional diagnostic image of a patient's anatomy taken at a first observation angle and a second two - dimensional diagnostic image of a patient's anatomy taken at a second observation angle different than the first observation angle;        means for displaying on the first and second images a projection of an object at a known position within the coordinate frame into the first and second images.     
     
     
       79. The apparatus of  claim 78 , wherein the object comprises a representation of an aspect a surgical object. 
     
     
       80. The apparatus of  claim 79 , wherein the aspect of the surgical object is a primary axis of the surgical object. 
     
     
       81. The apparatus of  claim 79 , wherein the representation of the aspect of the surgical object includes a virtual guidewire. 
     
     
       82. An apparatus for a stereotactic surgical procedure for a linear trajectory insertion of a surgical instrument into a body using a fluoroscope for generating images of the body, the apparatus comprising:
   a registration artifact including a plurality of fiducials located at known three - dimensional coordinates relative a known coordinate frame;       means for displaying at least one image taken of the body and the fiducials on at least one computer monitor;        means for identifying two - dimensional coordinates of the fiducials in each image; and        means for numerically optimizing parameters of a geometric model, said model projecting three - dimensional coordinates into image points, such that the projections of the known three - dimensional coordinated of the fiducials best fit the identified two - dimensional coordinates in the image.     
     
     
       83. A computer readable storage medium encoded with instructions, which, when read by a computer, enable a computer to undertake a process, comprising:
   registering to a known three - dimensional coordinate frame a first two - dimensional diagnostic image of a patient's anatomy taken at a first observation angle and a second two - dimensional diagnostic image of a patient's anatomy taken at a second observation angle different than the first observation angle;        after receiving the first and second two - dimensional images, receiving the input indicating a position of an object with respect to the coordinate frame; and        displaying on the first and second images a projection of the object into the first and second images.     
     
     
       84. The computer readable storage medium of  claim 83 , wherein the object comprises a representation of an aspect of a surgical object. 
     
     
       85. The computer readable storage medium of  claim 84 , wherein the aspect of the surgical object is a primary axis of the surgical object.