CN101627411A - 手术前的手术模拟 - Google Patents
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Abstract
用于模拟图像导引过程的设备。该系统包括：输入，用于接收描述病人器官的三维(3D)医学图像；模型产生单元，用于根据该3D医学图像产生该器官的3D解剖模型；以及模拟单元，用于根据该3D解剖模型模拟计划对病人进行的图像导引过程。
Description
技术领域及背景技术
本发明涉及用于执行模拟的图像导引医疗过程的设备和方法，并且更具体但非排它地，涉及根据基于三维(3D)医学图像的器官3D模型来执行模拟的图像导引过程。
一般认为医学成像对于以改善治疗结果为目的的诊断和病人护理来说是重要的。近年来，由于例如X射线、计算机断层成像(CT)、磁共振成像(MRI)和超声的成像模式的发展，医学成像经历了爆炸性的增长。这些模式提供用于研究活体内脏器官的非侵入式方法，但是数据量相对较大并且当作为二维(2D)图像显示时，通常需要解剖学家/放射学专科医生对其进行解释。遗憾的是，对该数据进行人工解释带来的成本对于常规数据分析来说是昂贵的。可以将2D切片(slice)结合以产生3D体模型。
这种医学成像系统允许执行微创治疗过程。通常在导管室(CathLab)中执行这些过程，其中医生希望评估例如心脏和冠状动脉的内脏器官的功能或者执行例如冠状动脉成形术的过程。
大多数的放射学产生例如2D X射线胶片或例如CT和MRI扫描的3D医学图像的记录图像。低剂量交互控制X射线也被称为透视，其允许医生动态地监控进行中的手术。介入放射学是放射科医生和心脏专科医生利用实时放射医学图像执行治疗和诊断过程的专科。介入放射科医生通常依靠实时透视2D图像，其可以作为模拟图像或数字信息在视频监视器上观看。
然而，这些过程包括精细和协同的手部移动，其与遥控的手术器具在视频监视器上的视图空间不相关。在平面视频显示器上缺少深度感并且因此不容易学习通过空间上任意的联系来控制工具。在这种困难的环境下发生的错误可能是危险的。因此，需要高水平的技巧，并且对这些专科医生的现实训练是一项复杂的任务。另外，通常没有关于放射科医生深度感觉的直接约定，放射科医生必须作出关于病人解剖学结构的假设以便进行治疗和评估结果。
可以用于训练这种专科医生的医学模拟器在通过改进的训练降低医疗成本、更好的治疗前计划以及更经济和快速的开发新型医疗设备方面具有很大的潜力。在可能带有很大风险的直接的病人介入之前，实际动手经验在训练中成为可能。
例如血管导管术、成形术和支架置入术的图像导引过程特别适于模拟，因为它们通常将医生置于距操纵手术器具的手术位置一定距离之外并且在视频监视器上察看该过程。
例如，2000年5月16日公布的美国专利6062866号描述一种用于教学和演示例如血管成形术的侵入式医疗过程的医学模型。该模型为塑料的、透明三维的至少部分血管系统的解剖学上的正确表示，并且在优选实施例中该至少部分血管系统可以包括大动脉、冠状动脉、锁骨下动脉、肺动脉和肾动脉，其中每个定义一个通路或内腔。提供进入口使得可以将例如导引器和导管的实际医疗设备插入到位置模拟的阻塞(Blockage)。也可以引入流体以真实地模拟活体条件。也可以将相似结构的模拟心室附连到主动脉瓣以进一步提高对侵入式过程的表示。
2003年4月10日公布的美国专利申请2003/0069719号描述一种接口设备和方法，用于将器械接口连接到血管通路模拟系统，用作将模拟或实际医疗器械形式的外围设备接口连接到模拟系统以使得能够进行医疗过程的模拟，其中公开了提供更加准确的、在训练期间结合了视觉和触觉反馈的更为复杂的模拟系统。该接口设备包括用于接纳导管针组件的导管单元组件，以及为执行医疗过程将皮肤放入牵引或操纵其它解剖部位的皮肤牵引机构。在医疗过程期间由使用者操纵导管针组件和皮肤牵引机构。导管单元组件包括基座、外壳、轴承组件和接纳导管针组件的轴。轴承组件使得导管针组件能够平移，并且包括使轴能够根据导管针组件的操控而平移的轴承。轴通常包括编码器以测量导管针组件的针的平移运动，而接口设备还包括编码器以测量各种自由度内的导管针组件的操控以及皮肤牵引机构的操控。该模拟系统从接口设备编码器接收测量并更新模拟和显示，同时向力反馈设备提供控制信号以使得能够向导管针组件提供力反馈。
2003年3月25日公布的美国专利6538634号中公开了模拟系统的另一个例子，其目的是根据预定义的和固定的模块来模拟图像导引过程。
这些模拟系统以及其它已知的模拟系统基于预定义的模型，这些模型在系统开始运行之前或者在例如更新系统的维护过程中被获得并增强。通常，将包括存储在相关数据库中的虚拟模型的库(Library)连接到模拟系统。在操作模式期间，系统根据由系统使用者选择的虚拟模型之一来模拟图像导引过程。
虽然这种系统允许医生和受训者模拟图像导引过程，所模拟的图像导引过程根据器官、人体系统或其一部分的预定义或随机改变的模型来建模。因此，使用与医生或受训者所要执行手术图像导引过程的器官不相同的虚拟器官模型来对其进行训练。
另外，当使用虚拟模型时，模拟系统不能用于准确模拟已经在真实的病人身上执行过的手术。因此，当前所使用的模拟系统不能用于追溯出错的手术或者用于教学目的。
因此，广泛地认为需要一种避免了上述局限的、能够以更加真实的方式模拟医生所要执行的图像导引过程的用于模拟图像导引过程的系统，并且拥有这种系统将会是非常有益的。
发明内容
根据本发明的一个方面，提供一种用于模拟图像导引过程的设备。该设备包括：输入，用于接收描述病人器官的三维(3D)医学图像；模型产生单元，配置为根据该3D医学图像产生该器官的3D解剖模型；以及模拟单元，配置为根据该3D解剖模型模拟为病人计划的图像导引过程。
优选地，该设备还包括操作连接到模型产生单元的分割单元，该分割单元配置为将3D医学图像中的器官分割为多个区域，所分割的图像用于产生3D解剖模型。
优选地，3D解剖模型为管道的模型。
更优选地，该管道为下述的组中的一种：血管管道、泌尿道、肠胃道和瘘管道。
优选地，3D医学图像为下述的组中的一种：计算机断层成像(CT)扫描图像、磁共振成像器(MRI)扫描图像、超声扫描图像和正电子发射断层成像(PET)-CT扫描图像。
优选地，所计划的图像导引过程为血管成形术过程。
优选地，该设备还包括操作连接到模型产生单元的用户接口，该用户接口允许使用者在3D解剖模型的产生期间指示模型产生单元。
优选地，所模拟的计划图像导引过程用作学习过程中的学习案例。
优选地，所模拟的计划图像导引过程用来向病人演示相应的图像导引过程。
优选地，所模拟的计划图像导引过程用于为手术进行文件准备。
优选地，输入配置为接收描述某时间段内器官的四维(4D)医学图像，模型产生单元配置为根据该4D医学图像产生4D器官模型，模拟单元配置为根据该4D器官模型模拟为病人计划的图像导引过程。
优选地，器官为下述的组中的一种：解剖区域、人体系统、器官的区域、器官的若干区域、器官的部分、人体系统的部分。
根据本发明的一个方面，提供一种用于执行模拟的图像导引过程的方法。该方法包括以下步骤：a)获得描述病人器官的三维(3D)医学图像；b)根据该3D医学图像产生3D解剖模型；以及c)根据该3D模型模拟为病人计划的图像导引过程。
优选地，该方法在步骤a)和b)之间还包括步骤a1)将3D医学图像中的器官分割为多个区域，根据所分割的3D医学图像执行步骤b)中的产生。
优选地，所计划的图像导引过程为血管成形术过程。
优选地，该产生包括从系统使用者接收产生指令的步骤，该产生指令用于定义3D模型。
优选地，该模拟包括显示器官。
更优选地，该方法还包括允许系统使用者根据显示为所计划的图像导引过程标记标签的步骤。
优选地，所计划的图像导引过程为血管成形术过程。
优选地，该模拟为手术前的手术模拟。
优选地，3D解剖模型为管道的模型。
优选地，3D解剖模型为管道模型。
更优选地，该管道模型定义下述的组中的一种：血管管道、泌尿道、肠胃道和瘘管道。
优选地，该获得包括获得描述某时间段内器官的四维(4D)医学图像的步骤，该产生包括根据该4D医学图像产生器官的4D模型的步骤，根据该4D模型执行模拟。
优选地，该器官为下述的组中的一种：解剖区域、人体系统、器官的区域、器官的若干区域、器官的部分、人体系统的部分。
除非另外定义，这里使用的所有技术和科学术语具有与本发明所属领域技术人员的通常理解相同的含义。这里所提供的材料、方法和例子只是说明性的，而不是要进行限定。
本发明的方法和系统的实现包括手动地、自动地或以其结合的方式执行或完成某些所选择的任务或步骤。另外，根据本发明的方法和系统的优选实施例的实际器械和设备，可以通过硬件、或通过在任何固件上的任何操作系统上的软件、或其结合来实现若干所选择的步骤。例如，作为硬件，本发明的所选择的步骤可以作为芯片或电路实现。作为软件，本发明的所选择的步骤可以作为由计算机使用适合的操作系统执行的多个软件指令来实现。在任何情况下，可以将本发明的方法和系统的所选择的步骤描述为由例如用于执行多个指令的计算平台的数据处理器来执行。
附图说明
这里参考附图通过单纯的例子描述本发明。现在具体参考详细附图，应强调，所示出的细节为举例说明并且只是为了本发明优选实施例的说明性讨论的目的，并且将其示出为了提供被认为是本发明的原理和概念方面最为有用和易于理解的描述。因此，并非试图比本发明的基本理解所必要程度更为详细地示出本发明的结构细节，描述与附图一起使得本领域技术人员明白如何在实践中实施本发明的若干形式。
在图中：
图1为根据本发明的一个优选实施例的用于模拟图像导引过程的手术前模拟器的示意图；
图2A为Hounsfield标度的图示，该标度衡量介质对X射线辐射的衰减。标记了不同人体器官的Hounsfield值；
图2B和2C分别示意地图解股骨的两个三角曲面模型，其直接从扫描数据产生，以及图2B中的部分的粗化变型(Coarsened variant)，其根据本发明的一个优选实施例产生；
图3为根据本发明的一个实施例的带有对模拟单元详细描述的图1的手术前模拟器的示意图；
图4为根据本发明的一个实施例的图3的手术前模拟器的示例性图解；
图5为根据本发明的一个实施例在图像导引过程模拟期间进行的屏幕显示的示例性图解；
图6为根据本发明的一个优选实施例的用于执行图像导引过程的手术前模拟的方法的流程图。
具体实施方式
本实施例包括用于模拟图像导引过程的设备和方法。根据本发明的一个实施例，该设备和方法允许医生设置图像导引过程的手术前模拟。该手术前模拟模拟要在某病人身上执行的图像导引过程。为了允许这种特定病例模拟，获取描述将要进行手术的某病人的解剖区域的3D医学图像并且基于该3D医学图像产生3D解剖模型。优选地，3D解剖模型定义例如血管管道(Vascular tract)的某解剖结构或器官的边界。在手术前模拟期间，3D解剖模型用于模拟该区域上的图像导引过程。
参考附图及其描述可以更好地理解根据本发明的设备和方法的原理和操作。
在详细解释本发明的至少一个实施例之前，应该理解，本发明在应用中不限于下面的描述中提出的或在图中图解的结构细节和部件设置。本发明可以具有其它实施例或者能够以各种方式实践或实现。另外，应该理解，这里使用的措辞和术语是为了描述的目的，而不应该被认为是限定。
可以将3D医学图像理解为一系列CT扫描图像、一系列MRI扫描图像、一系列PET-CT扫描图像、空间图像等。
可以将医学成像系统理解为MRI成像系统、CT成像系统、PET-CT成像系统等。
可以将器官或解剖区域理解为人体器官、人体系统、器官的区域、器官的若干区域、器官的部分、人体系统的部分等。
现在参考图1，图1为根据本发明的一个优选实施例的用于模拟图像导引过程的手术前模拟器1的示意图。手术前模拟器1包括：输入单元2，用于获得描述病人解剖区域的3D医学图像；以及解剖模型产生单元3，设计用于根据所接收的3D医学图像产生器官的3D解剖模型。如下面所描述的，手术前模拟器1还包括模拟单元4，用于根据三维模型模拟图像导引过程。
优选地，输入单元2允许用于模拟图像导引过程的系统1在由医生使用3D医学图像之前从例如图像存档与传输系统(PACS)的医学图像服务器提取该3D医学图像。PACS服务器包括专用于存储、检索、分配和显示所存储的3D医学图像的若干计算机。以若干格式存储3D医学图像。最常见的图像存储格式为医学数字成像和通信(DICOM)。优选地，以优选为512·512·150体素的3D数组来表示所提取的3D医学图像。
在一个实施例中，输入单元2接收作为输入的原始3D数据数组，由提取前和解析前的DICOM图像组成。分割不限于特定的模式。优选地，3D医学图像为CT扫描。在这种实施例中，每个体素由单个测量值表示，该测量值物理上与所描述器官相应位置的X射线衰减程度相应。优选地，数据获取模式为CT血管造影术(CTA)。
输入单元2可以适合于从PACS工作站、计算机网络或便携式存储设备(例如DVD、CD、存储卡等)接收3D医学图像。
如上所述，将所接收的3D医学图像发送到设计用于产生3D解剖模型的解剖模型产生单元3。优选地，解剖模型产生单元3包括用于将所接收的3D医学图像分割为解剖结构的3D图像分割单元。或自动或半自动地执行分割。在一个实施例中，使用标准的自动分割过程分割图像。
优选地，分割基于将所接收的原始3D数据数组的相关体素隔离的过程。例如，如果原始3D数据数组基于CT扫描，以HU标度物理衰减，其中数值-1000HU与空气相关而数值0HU与水相关，如图2A所示。在这种标度下，不同的组织类型具有不同的典型HU范围。使用特定组织的典型衰减将其在CT数据的3D数组中隔离。例如，描述肺的体素值通常在-550HU到-450HU之间，而描述骨骼的体素值大约在450HU到1000HU之间。
在这种实施例中，3D医学图像的体素的HU值用于隔离所感兴趣的组织内的体素。优选地，为了提高分割过程的精确度，在取得3D医学图像时应用例如钡、碘或任何其它放射性药物成分的静脉对比度增强(ICE)成分。ICE成分将血管的HU值增加到、并且有时超过骨骼的HU值。这种增加导致能够改善分割过程的脉管体素与周围体素之间的更高的对比度。优选地，分割过程适合于从3D医学图像分割被扫描体素的子集，其中该子集中的体素的存储值在预定义的范围内。在一个实施例中，分割并标记所有具有血管范围内的存储值的体素。
在本发明的一个实施例中，根据HU值的原始3D数据数组计算三角形网格。优选地，使用行进立方体(Marching cubes)算法的变型来初步产生三角形网格，参见“Marching Cubes：A High Resolution 3D SurfaceConstruction Algorithm”，William E.Lorensen and Harvey E.Cline，Computer Graphics(Proceedings of SIGGRAPH‘87)，Vol.21，No.4，pp.163-169。三角形网格用于3D医学图像中的部分的表面构造。通过行进立方体算法的变型获得的网格将该部分的预期体积划界。由于以3D医学图像的分辨率获得该部分，因此它可能是极为精细的。因此，优选地，执行附加的消减处理过程，在该过程中将网格粗化并降低该部分的表面近似水平。
优选地，将边折叠(Edge-Collapse)操作用于粗化，参见Hoppe，H.Progressive meshes.In Proc，SIGGRAPH’96，pages 99-108，August 1996以及Hussain，M.，Okada，Y.and Niijima，K.Fast，simple，feature-preserving and memory efficient simplification of triangle meshes.International Journal of Image and Graphics，3(4)：1-18，2003。在图2B和2C中描述了这种消减的例子，图2B和2C分别描述被分割的股骨以及通过应用上述消减处理而产生的被分割股骨的粗化变型。优选地，以512×512×150的3D数组表示3D医学图像，其中优选地由具有下列各式之一的值来表示每个体素：8位(1字节存储)、12位(2字节存储)、16位(2字节存储)以及单精度浮点(4字节存储)。
优选地，分割过程适合于分割在所接收的3D医学图像中描述的解剖结构。不同的解剖部分具有影响分割的不同的特性。
在图像导引过程期间，由医生经由某管道输送导管或类似物。因此，分割过程的目的是识别这种管道并且将其分割或者分割划定该管道界限的所有区域。
例如，如果所接收的3D医学图像描述人体脊椎的颈部部分并且图像导引过程为血管成形术过程，例如颈动脉支架，则颈动脉为传输导管或相似物所通过的管道。在这种情况下，应该分割颈动脉。动脉网具有先验已知的特征，可以利用该特征提高并验证分割过程的精确度。例如，如果该区域为颈部并且该过程是颈动脉支架，则利用以下解剖结构：胸主动脉、头臂动脉干、锁骨下动脉、颈动脉以及椎动脉。
优选地，在分割过程期间识别并分割器官的图像中的血管。优选地，在分割期间识别并记录图像中每个主要血管的中心线、半径以及相互连接。
优选地，将解剖模型产生单元3连接到用户接口(未示出)。在这种实施例中，可以要求模拟器使用者例如在所描述的管道上标记一个或更多的点。例如，如果所接收的3D医学图像描述人体脊椎的颈部并且图像导引过程是血管成形术过程，则可以要求模拟器使用者将左侧颈动脉标记为自动分割的开始点。
当分割处理完成时，产生了经分割版本的3D图像或表示所分割区域和管道的数组。可以以若干格式和数据组表示所分割的区域。优选地，使用下列数据组中的一个或更多个来表示所分割的3D图像：
a.每个动脉或任何其它管道部分的中心曲线的立方体Catmull-Rom3D样条(Spline)描述；
b.描述动脉或任何其它管道部分之间的连接的树描述、图形描述或任何其它描述。例如，这种描述描述动脉X在哪一点分离出动脉Y；
c.每个动脉在其中心曲线上每一点的半径的立方体Catmull-Rom 2D样条描述；
d.描述血管系统解剖结构的表面的三角曲面网格；
e.描述在扫描中获取的其它器官-肺、心脏、肾等的多边形网格；以及
f.每个原始数据体素就其指定的解剖学部分(脉管体素、肾体素等)的分类。
将所分割的3D医学图像或表示3D医学图像中的分割部分的数组发送到模拟单元4。
应该注意到，手术前模拟器1还可以用来根据四维(4D)图像模拟图像导引过程，该4D图像为描述某时间段内某器官的一组3D医学图像。在这种实施例中，由输入2接收4D图像。将所接收的4D医学图像发送到设计用于产生4D模型的解剖模型产生单元3。优选地，解剖模型产生单元3包括用于将所接收的4D医学图像分割为解剖结构的4D图像分割单元。或自动或半自动地执行分割。如下面所述，在一个实施例中，单独地分割每个组成所接收的4D医学图像的3D医学图像。
根据本发明的一个实施例，现在参考图3，图3为表示图1中描述的手术前模拟器1、模拟单元4的部件以及计划模块51的框图。
优选地，模拟单元4包括两个子系统。第一子系统为介入模拟器设备50，由虚拟介入性器械52、运动检测器53、运动计算单元57、图像显示设备58以及力反馈机构54组成。第二子系统为模拟模块55，其具有以下功能：从运动检测器53接收输入、使用运动计算单元57分析该输入、将结果转化为视觉和触觉输出并将其传递到显示设备58和力反馈机构54。模拟模块55也具有从解剖模型产生单元3接收分割的3D医学图像的功能，其中所接收的分割的3D医学图像已经被转化为3D模型，该3D模型模拟分割的3D医学图像中所描述的器官。如上所述，分割的3D医学图像基于从要进行手术的实际病人接收的3D医学图像。
现在参考图4，图4为前面所述的根据本发明的一个实施例用于模拟图像导引过程的手术前模拟器1的示例性图解。虚拟介入器械52和图像显示设备如图3，而图4还描述外壳62、计算机处理器64和用户输入接口65。在使用中，医生通过操控优选为虚拟导管的虚拟介入器械52来为手术的图像导引过程做准备。将虚拟介入器械52插入外壳62中的腔体66内，外壳62包括运动检测器和力反馈机构(未示出)的力反馈部件(未示出)，其中力反馈部件例如阻力产生器。当医生操控虚拟介入器械52时，根据外壳62内的虚拟介入器械52就上述被模拟器官的3D模型而言的位置来确定触觉和视觉反馈。以在图像显示设备58上显示的形式提供视觉反馈，并且从外壳62内的力反馈部件提供触觉反馈。分别在图像显示设备58上显示和在虚拟介入器械52上传递的视觉和触觉反馈的目的是用来提高医生的技术和操作技能。由显示一系列连续图像的显示设备58提供视觉反馈，该一系列连续图像基于以所接收的3D医学图像为基础的3D模型。关于基于所接收的3D医学图像的3D模型，通过根据从成像模拟模块接收的运动信号在虚拟介入器械上传递不同的压力来提供触觉反馈。不同的压力模拟医生在真实图像导引过程期间所感受的实际触觉感觉并且反映病人组织对虚拟介入器械52操作的实际反应。
图像显示设备58显示从模拟模块(未示出)传递的实时反馈图像。该实时反馈图像表现如果将介入器械插入所要进行手术的病人的器官时所看到的视觉图像。该视觉图像是对将要从相关器官接收的视觉数据的准确和真实的模拟。
优选地，模拟模块和解剖模型产生单元3由例如带有nVidiaGeForce-6+(6600onwards)GPU的Intel Pentium Core-Duo的处理器支持。
现在再次参考图3。通过处理器，利用模拟模块55准备在手术的图像导引过程期间在屏幕上显示的被模拟器官的视觉图像。提供视觉反馈以用于在模拟的图像导引过程期间模拟器官的视觉显示，如图5所示，图5为颈动脉支架的模拟透视图。优选地，模拟模块55根据接收的3D医学图像模拟若干血管管道。同时，模拟模块55从沿外壳腔体安置的运动检测器53接收导航信号。模拟模块55使用处理器根据导航信号计算虚拟介入器械52在外壳腔体内的位置，并且以虚拟介入器械52的瞬时的相应位置更新如上所述的器官视觉图像。另外，模拟模块55模拟例如导管的模拟器械与被模拟解剖结构之间的实际相互作用，其包括但不限于导管扭曲和弯曲、脉管弯曲以及可选地脉管破裂。
另外，与视觉信息相应，模拟模块55还指示力反馈54的部件以模拟该过程的瞬时触觉反馈的方式在虚拟介入器械52上传递压力。这种视觉图像和触觉反馈模拟在实际对象上执行实际医疗过程期间所接收的实际反馈，并且因此向医生反映介入器械沿被模拟器官的当前位置和弯曲情况。显然，手术前模拟器1并不只限于例如血管管道的特定器官的模拟，而能够关于介入器械的瞬时位置反映各种单元和器官的视觉显示。这里不对图像导引过程的模拟器作更加详细的描述，因为它们已经被普遍地了解并且已经在所并入的专利以及本领域技术人员已知的出版物中进行了可理解的描述。
手术前模拟器1的目的在于允许医生为其要在某病人身上执行的图像导引过程进行手术前的手术模拟。在这种实施例中，医生将病人交至医学成像系统，以获取要进行手术的器官的3D医学图像。然后将所获取的3D医学图像发送到PACS服务器。然后，由手术前模拟器1从PACS服务器获得所获取的3D医学图像。将该3D医学图像作为器官的3D解剖模型的基础。如上面更加详细描述的，由用于将器官分割为若干区域的分割单元产生3D解剖模型。
应该注意到，这种手术前模拟器1还可以用于向病人解释并演示其病状以及其所要经历的手术的细节。
在本发明的一个实施例中，还可以将手术前模拟器用作学习工具。已知的模拟器被设计用来模拟虚拟器官的预定义模型上的图像导引过程。由于所模拟的器官为虚拟器官，训练者不能以允许其接收相关病例更广泛概况的方式获得诊断真实病人的经验。与之相对地，如上所述，手术前模拟器1允许执行真实解剖结构的病人特异性模拟。因此，手术前模拟器1可以用于教学非常真实的病例，其具有真实的解剖结构、病变、问题、矛盾和解决。医生可以经历更加真实的图像导引过程，并且可以在模拟的图像导引过程期间基于病人本身的总体病历和治疗状况作出决定。
在本发明的一个实施例中，手术前模拟器1还可以被用作计划工具。图3中描述的计划模块51优选地连接到图像显示设备58或任何其它显示设备并连接到用户接口。计划模块51支持用于允许医生根据上述特定病例模拟来计划手术的图像导引过程的工具。该模块优选地允许医生在影像导引过程模拟期间画草图和做记录。优选地，图像显示设备58为触摸屏，该触摸屏允许医生画出描述在手术的图像导引医疗过程中所要使用的手法(Maneuver)的轨迹。另外，在这种实施例中，医生可以标记所描述器官的有问题的区域。在一个优选实施例中，图像导引过程模拟为血管成形术过程模拟。医生可以使用触摸屏画出管道的边界，医生要通过该管道执行该过程或其一部分。
在本发明的一个实施例中，手术前模拟器1还可以被用作用于追溯已执行手术的分析工具。如上所述，根据要进行手术的器官的医学图像产生进行手术的器官的模型。在本发明的一个实施例中，手术前模拟器1用于执行对已经在病人身上执行的图像导引过程的重演(Reenactment)。将这种重演作为如上所述的图像导引过程模拟来执行。由于手术前模拟器1使用的模型模拟已进行过手术的器官，重演是真实的并且允许医生对于手术有更好的准备。
现在参考图6，图6为根据本发明的一个实施例执行模拟的图像导引过程的方法的流程图。
图6中描述的方法允许医生对其所要执行的图像导引过程进行临床手术前模拟。这种模拟允许医生基于要进行手术的病人的3D医学图像作出安全且不贸然的临床决定。
在如201所示的第一步骤中，获得了描述病人器官的3D医学图像。使用医学成像系统获取该3D医学图像，并如上所述例如经由PACS服务器或便携式存储设备获得该3D医学图像。该3D医学图像描述要进行手术的病人的器官。在如202所示的接下来步骤中，根据所接收的3D医学图像产生该解剖结构的3D模型。该3D模型定义例如某管道的解剖结构中的区域的边界。在如203所示的接下来步骤中，根据先前步骤中已经建立的3D模型进行病人身上的图像导引过程的模拟。该图像导引过程的模拟允许医生为手术的图像导引过程做准备。基于该模拟，医生可以选择最为适合的角度和工具。另外，使用者可以事先标记隐患(Pitfall)，例如难以导航的区域或误导性的视角。
例如，如果所模拟的图像导引过程为血管成形术过程，医生可以事先选择其在手术中所要使用的导管、球囊(Balloon)和支架的尺寸和类型。另外，事先获得对病人的特定器官的了解可以导致显影注射和X射线曝光的减少。例如在血管成形术过程中，X射线曝光期的持续时间取决于医生将导管操作进入相关解剖区域所用的时间。如果医生已经使用上述系统模拟了血管成形术过程，他已经熟悉了特定区域并且因此在实际的血管成形术过程期间能够容易地操作导管。
预期在本专利有效期内许多相关设备和系统将开发出来，并且这里的术语的范围，特别是3D模型、成像设备、模拟单元、运动检测器、3D医学图像和图像导引过程的范围旨在包扩所有这种演化出的新技术。
应当理解，为了清楚，在分开的实施例中描述本发明的某些特征，也可以将其相互结合地提供于单个实施例中。相反地，为了简练，在单个实施例中描述本法明的各种特征，也可以将其分别提供或者以任意适合的子组合提供。
虽然已经结合其具体实施例对本发明进行了描述，显然，许多替换、修改和变化对于本领域技术人员是明显的。因此，旨在包含所附权利要求的精神和广泛范围之内的所有这种替换、修改和改变。在此将本说明书中提到的所有出版物、专利和专利申请通过引用完整地结合到本说明书中，以达到与特定地和分别地指示将每个单独出版物、专利或专利申请通过引用结合于此相同的程度。另外，不应将本申请中任何参考的引用和确认解释为承认这种参考可以作为对于本发明的现有技术。
Claims (25)
1.一种用于模拟图像导引过程的设备，该设备包括：
输入，用于接收描述病人器官的三维(3D)医学图像；
模型产生单元，配置为根据所述3D医学图像产生所述器官的3D解剖模型；以及
模拟单元，配置为根据所述3D解剖模型模拟为所述病人计划的图像导引过程。
2.根据权利要求1所述的设备，还包括操作连接到所述模型产生单元的分割单元，所述分割单元配置为将所述3D医学图像中的所述器官分割为多个区域，所述经分割的器官图像用于产生所述3D解剖模型。
3.根据权利要求1所述的设备，其中所述3D解剖模型为管道的模型。
4.根据权利要求3所述的设备，其中所述管道为下述的组中的一种：血管管道、泌尿道、胃肠道和瘘管道。
5.根据权利要求1所述的设备，其中所述3D医学图像为下述的组中的一种：计算机断层成像(CT)扫描图像、磁共振成像器(MRI)扫描图像、超声扫描图像和正电子发射断层成像(PET)-CT扫描图像。
6.根据权利要求1所述的设备，其中所述计划的图像导引过程为血管成形术过程。
7.根据权利要求1所述的设备，还包括操作连接到所述模型产生单元的用户接口，所述用户接口允许使用者在所述3D解剖模型的产生期间指示所述模型产生单元。
8.根据权利要求1所述的设备，其中，将所述模拟的计划的图像导引过程用作学习过程期间的学习案例。
9.根据权利要求1所述的设备，其中，将所述模拟的计划的图像导引过程用来向所述病人演示相应的图像导引过程。
10.根据权利要求1所述的设备，其中，将所述模拟的计划的图像导引过程用于手术的文件准备。
11.根据权利要求1所述的设备，其中所述输入配置为接收描述某时间段内所述器官的四维(4D)医学图像，所述模型产生单元配置为根据所述4D医学图像产生所述器官的4D器官模型，所述模拟单元配置为根据所述4D器官模型模拟为所述病人计划的图像导引过程。
12.根据权利要求1所述的设备，其中所述器官为下述的组中的一种：解剖区域、人体系统、器官的区域、器官的若干区域、器官的部分和人体系统的部分。
13.一种用于执行模拟的图像导引过程的方法，所述方法包括：
a)获得描述病人器官的三维(3D)医学图像；
b)根据所述3D医学图像产生所述器官的3D解剖模型；以及
c)根据所述3D模型模拟为所述病人计划的图像导引过程。
14.根据权利要求13所述的方法，在步骤a)和步骤b)之间还包括步骤a1)将所述3D医学图像中的所述器官分割为多个区域，根据所述经分割的3D医学图像执行步骤b)的所述产生。
15.根据权利要求13所述的方法，其中所述计划的图像导引过程为血管成形术过程。
16.根据权利要求13所述的方法，其中所述产生包括从系统使用者接收产生指令的步骤，所述产生指令用于定义所述3D模型。
17.根据权利要求13所述的方法，其中所述模拟包括显示所述器官。
18.根据权利要求17所述的方法，还包括允许系统使用者根据所述显示为所述计划的图像导引过程标上标签。
19.根据权利要求13所述的方法，其中所述计划的图像导引过程为血管成形术过程。
20.根据权利要求13所述的方法，其中所述模拟为手术前的手术模拟。
21.根据权利要求13所述的方法，其中所述3D解剖模型为管道的模型。
22.根据权利要求13所述的方法，其中所述3D解剖模型为管道模型。
23.根据权利要求22所述的方法，所述管道模型定义下述的组中的一种：血管管道、泌尿道、肠胃道和瘘管道。
24.根据权利要求13所述的方法，其中所述获得包括获得描述某时间段内所述器官的四维(4D)医学图像，所述产生包括根据所述4D医学图像产生所述器官的4D模型的步骤，根据所述4D模型执行所述模拟。
25.根据权利要求13所述的方法，其中所述器官为下述的组中的一种：解剖区域、人体系统、器官的区域、器官的若干区域、器官的部分以及人体系统的部分。
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- 2008-01-13 CN CN200880005220.6A patent/CN101627411B/zh active Active
- 2008-01-13 US US12/224,314 patent/US8500451B2/en active Active
- 2008-01-13 GB GB0914278A patent/GB2459225B/en active Active
- 2008-01-13 WO PCT/IL2008/000056 patent/WO2008087629A2/en active Application Filing
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2013
- 2013-08-05 US US13/958,954 patent/US20140129200A1/en not_active Abandoned
Cited By (14)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US9622820B2 (en) | 2012-05-03 | 2017-04-18 | Siemens Product Lifecycle Management Software Inc. | Feature-driven rule-based framework for orthopedic surgical planning |
| CN104271067A (zh) * | 2012-05-03 | 2015-01-07 | 西门子产品生命周期管理软件公司 | 用于整形外科手术计划的特征驱动的基于规则的构架 |
| CN103700139A (zh) * | 2013-12-02 | 2014-04-02 | 北京像素软件科技股份有限公司 | 一种3d网络游戏中创建河流模型的方法和装置 |
| CN106164978A (zh) * | 2014-01-28 | 2016-11-23 | 西门子保健有限责任公司 | 使用参数化可变形网状物来构造个性化具体化的方法和系统 |
| CN106164978B (zh) * | 2014-01-28 | 2019-11-01 | 西门子保健有限责任公司 | 使用参数化可变形网状物来构造个性化具体化的方法和系统 |
| CN104978872A (zh) * | 2014-04-04 | 2015-10-14 | 上海橘井泉网络科技有限公司 | 手术演示方法、装置和系统 |
| CN105992996A (zh) * | 2014-04-04 | 2016-10-05 | 外科手术室公司 | 外科手术环境中的动态和交互式导航 |
| CN105992996B (zh) * | 2014-04-04 | 2019-11-26 | 外科手术室公司 | 外科手术环境中的动态和交互式导航 |
| CN106446504A (zh) * | 2015-07-31 | 2017-02-22 | 富士通株式会社 | 用于生物医学模拟的系统和方法 |
| CN106446504B (zh) * | 2015-07-31 | 2019-04-09 | 富士通株式会社 | 用于生物医学模拟的系统和方法 |
| WO2017036027A1 (zh) * | 2015-09-01 | 2017-03-09 | 深圳先进技术研究院 | 血管内介入手术模拟系统 |
| CN106295189B (zh) * | 2016-08-12 | 2019-06-28 | 上海鸿巍企业管理咨询有限公司 | 一种可视化手术全流程一体化系统 |
| CN106295189A (zh) * | 2016-08-12 | 2017-01-04 | 上海鸿巍企业管理咨询有限公司 | 一种可视化手术全流程一体化系统 |
| CN114072088A (zh) * | 2019-05-09 | 2022-02-18 | 物化股份有限公司 | 具有自动化缺损定量的手术计划系统 |
Also Published As
| Publication number | Publication date |
|---|---|
| WO2008087629A2 (en) | 2008-07-24 |
| US8500451B2 (en) | 2013-08-06 |
| GB0914278D0 (en) | 2009-09-30 |
| CN101627411B (zh) | 2014-03-19 |
| GB2459225B (en) | 2011-07-20 |
| US20090018808A1 (en) | 2009-01-15 |
| WO2008087629A3 (en) | 2009-03-26 |
| GB2459225A (en) | 2009-10-21 |
| US20140129200A1 (en) | 2014-05-08 |
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