JP5285270B2 - 自動ガイドワイヤ操作システム - Google Patents
自動ガイドワイヤ操作システム Download PDFInfo
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- JP5285270B2 JP5285270B2 JP2007502489A JP2007502489A JP5285270B2 JP 5285270 B2 JP5285270 B2 JP 5285270B2 JP 2007502489 A JP2007502489 A JP 2007502489A JP 2007502489 A JP2007502489 A JP 2007502489A JP 5285270 B2 JP5285270 B2 JP 5285270B2
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Description
本発明は一般に医療機器に関するものであり、特に患者の体の内腔内でカテーテルを操作する方法及びシステムに関するものである。
患者の体の内腔、例えば循環系、胃腸管、脳内の管、気管支樹、等に対する種々の診断及び手術が、内腔内にカテーテルを挿入することによって実行される。カテーテルは一般に大がかりな装置であるので、すべて自力で手術部位まで誘導(ガイド)することは困難である。この目的のために、その径がカテーテルの径よりも大幅に小さいガイドワイヤを、カテーテルを挿入する前に手術部位まで挿入し、そしてカテーテルをガイドワイヤ上に通して手術部位まで誘導する。
本発明の目的は、ワイヤ(またはカテーテル)の先端(チップ)上に配置した位置センサからのフィードバックを用いて、血管樹の構造的ロードマップに基づいて、カテーテルの先端を予め定めた指定位置まで自動的に操作して誘導(ガイド)する新規な方法及びシステムを提供することにある。
本発明は、患者の内腔内の所望位置へのカテーテルの移動を、内腔内の経路、及び内腔内のカテーテル先端の現在位置に応じて自動的に制御し、この現在位置をフィードバックとして用いつつ移動を制御するシステムを提供することによって、従来技術の欠点を克服する。カテーテルの先端が追従する経路は事前計画され、そして操作セッションに先立つ撮像セッションにおいて、動的な画像装置(イメージャ)を用いることによって決定される。あるいはまた、システムは患者の体の循環マップに従って、カテーテルを内腔内で所望位置に向けて操作する。オペレータはシステムの自動動作に優先して操作を行うことができ、即ち、内腔のリアルタイムの二次元画像に対するカテーテルの先端の(画像)表現を観測しながら、随時手動モードに復帰することができる。心電計(ECG:Electrocardiograph)のような、器官の器官タイミング信号を監視する器官モニター(監視装置)をこのシステムと共に用いて、器官(例えば心臓)の拍動によって生じる内腔の動きを考慮に入れることによって、血管樹の二次元画像、並びに三次元構造モデルを表示することができる。
Claims (25)
- 患者の体の内腔系を通るカテーテルを該内腔系内の所定位置まで誘導するシステムにおいて、
前記カテーテルの末端部分に配置されて強固に取り付けられた少なくとも1つの位置検出器であって、当該位置検出器の三次元位置を表現する信号を生成するように構成された位置検出器を具え、前記信号に応答して、前記少なくとも1つの位置検出器の現在位置を測定する医療用測位システムと;
前記カテーテルを前記内腔系に通して移動させるための、前記カテーテルに結合された移動機構と;
プロセッサ及び記憶装置を具え、前記医療用測位システム及び前記移動機構に結合されたコントローラとを具え、このコントローラは、
前記プロセッサを用いて、前記カテーテルの末端部分の前記内腔系に対する起点と前記所定位置との間に事前計画された経路上にある、前記カテーテルを移動させるべき新たな位置を、前記医療用測位システムから得られた前記現在位置、及び前記記憶装置に記憶されている前記内腔系の少なくとも一部分の二次元または三次元マッピングに応じて決定し、前記二次元または三次元マッピングは、少なくとも前記内腔系の三次元構造モデルを含み、
前記現在位置及び前記二次元または三次元マッピングに応じて、前記移動機構を動作させて、前記カテーテルを前記所定位置に向けて進めるように構成され、
前記事前計画された経路は、想定したカテーテル位置を含み、前記コントローラによって、前記プロセッサを用いて、前記内腔系の前記二次元または三次元マッピングからの位置情報から決定され、
前記コントローラはさらに、前記プロセッサを用いて、前記現在位置を、前記事前計画された経路に沿った前記想定したカテーテル位置と比較し、前記比較の結果により、前記カテーテルが前記事前計画された経路上で前記内腔系中の障害物に接触したことを前記コントローラが判定した際に、前記事前計画された経路とは異なる変更経路を決定し、前記移動機構を動作させて、前記カテーテルを前記変更経路に沿って移動させて、前記所定位置に向けて進めるように構成され、前記変更経路は、前記障害を乗り越えるように設定されることを特徴とするカテーテルの誘導システム。 - さらに、
前記内腔系の少なくとも一部分の画像を撮像する撮像システムと;
前記医療用測位システム及び前記撮像システムに結合された重ね表示プロセッサであって、前記末端部分を前記画像上に重ねて、前記重ね表示プロセッサに結合されたディスプレイ上に表示する重ね表示プロセッサと
を具えていることを特徴とする請求項1に記載のシステム。 - 前記重ね表示プロセッサが、前記二次元または三次元マッピングを前記画像上に重ねて、前記ディスプレイ上に表示することを特徴とする請求項2に記載のシステム。
- 前記ディスプレイが、前記末端部分の位置を表現する座標信号に応じて、前記末端部分の形状を表現する曲線を表示することを特徴とする請求項2に記載のシステム。
- 前記撮像システムが、
X線テーブル;
透視検査装置;
C型アーム撮像装置;
コンピュータ断層撮影装置;
陽電子放射型断層撮影装置;
超音波システム
から成るリストから選択したものであることを特徴とする請求項2に記載のシステム。 - さらに、前記患者の体の監視される器官、及び前記医療用測位システムに結合された器官モニターを具え、
前記監視される器官は前記内腔系に結合され、前記器官モニターは、前記内腔系の前記監視される器官の器官タイミング信号を監視し、前記コントローラは、前記器官タイミング信号に応じて、前記二次元または三次元マッピング及び前記現在位置を更新し、
前記コントローラは、更新された前記二次元または三次元マッピング及び更新された前記現在位置の少なくとも一方に応じて、前記移動機構の動作を制御することを特徴とする請求項1に記載のシステム。 - さらに、前記医療用測位システムに結合されたプロセッサを具え、
前記プロセッサは、前記器官タイミング信号に応じて、前記二次元又は三次元マッピング及び前記末端部分の表現を更新し;
前記プロセッサは、前記器官タイミング信号に応じて、前記内腔系の少なくとも一部分の再構成画像を生成し;
前記プロセッサは、更新された前記二次元または三次元マッピング及び更新された前記末端部分の表現の少なくとも一方を、前記再構成画像上に重ねて、前記プロセッサに結合されたディスプレイ上に表示する
ことを特徴とする請求項6に記載のシステム。 - 前記器官モニターは、
心電計;及び、
フィルタ付きMPS読み取り装置
から成るリストから選択したものであることを特徴とする請求項6に記載のシステム。 - 前記移動機構が使い捨て式であることを特徴とする請求項1に記載のシステム。
- 前記移動機構が、
少なくとも1つの運動要素と;
前記少なくとも1つの運動要素に結合され、前記カテーテルを、当該カテーテルの長軸を中心に選択した量だけ回転させる角度移動ローラーと;
前記少なくとも1つの運動要素に結合され、前記カテーテルを前記長軸に沿って移動させる線方向移動ローラーと
を具えていることを特徴とする請求項1に記載のシステム。 - さらに、前記運動要素に結合され、前記移動機構を手動で操作するためのジョイスティックを具えていることを特徴とする請求項1に記載のシステム。
- 前記医療用測位システムと前記少なくとも1つの位置検出器との間の結合が、
導線;及び、
無線
から成るリストから選択したものであることを特徴とする請求項1に記載のシステム。 - 前記二次元または三次元マッピングが、前記起点と前記所定位置との間に事前計画された経路であることを特徴とする請求項1に記載のシステム。
- 前記カテーテルがガイドワイヤで形成されることを特徴とする請求項1に記載のシステム。
- 前記カテーテルの少なくとも一部分が電場応答性ポリマー製であることを特徴とする請求項1に記載のシステム。
- 前記撮像システムが、前記画像をリアルタイムで生成することを特徴とする請求項2に記載のシステム。
- 前記コントローラがさらに、
前記医療用測位システムの三次元座標系を、前記画像の二次元座標系に変換して、前記現在位置または前記新たな位置の少なくとも一方を決定するように構成されていることを特徴とする請求項2に記載のシステム。 - 前記コントローラがさらに、前記内腔系の少なくとも一部分の画像上に示された、前記患者の体を表現する座標系における起点及び目的箇所に応じて、前記事前計画された経路を形成することを特徴とする請求項13に記載のシステム。
- 前記画像が、前記内腔系の少なくとも一部分を、少なくとも2つの非平行な画像平面において撮像することによって生成されることを特徴とする請求項18に記載のシステム。
- さらに、前記内腔系の少なくとも一部分を撮像する撮像システムを具え、この撮像システムは、前記画像を、複数の画像平面のうち前記事前計画された経路に最寄りの少なくとも1つの画像平面において撮像することを特徴とする請求項13に記載のシステム。
- 前記コントローラが、前記移動機構を動作させて、
前記カテーテルの長軸に沿った、前記内腔系の少なくとも一部分に対する線方向移動;
前記長軸を中心とした、前記内腔系の少なくとも一部分に対する回転移動
から成るリストから選択した移動を、前記カテーテルに行わせるように構成されていることを特徴とする請求項1に記載のシステム。 - 患者の体の内腔系内でカテーテルをリアルタイムで誘導するシステムにおいて、
前記カテーテルの末端部分に配置されて強固に取り付けられた少なくとも1つの位置検出器であって、当該位置検出器の三次元位置を表現する信号を生成するように構成された位置検出器を具え、前記信号に応答して、前記少なくとも1つの位置検出器の現在位置を測定する医療用測位システムと;
前記カテーテルに結合された移動機構と;
プロセッサ及び記憶装置を具え、指示装置、前記医療用測位システム、及び前記移動機構に結合されたコントローラとを具え、このコントローラは、
ユーザによる前記指示装置を用いた連続的な位置入力を受信し;
前記プロセッサを用いて、前記受信した連続的な位置入力の各々について、ユーザが規定した前記カテーテルの先端の位置を特定し;
前記医療用測位システムを用いて、前記カテーテルの先端のリアルタイム位置を規則的に検出し;
前記リアルタイム位置を検出する毎に、前記プロセッサを用いて、前記記憶装置に記憶されている前記内腔系の二次元または三次元マッピングに応じて、前記リアルタイム位置と、その前方に隣接する前記ユーザが規定した位置との間の増分的経路を、前記二次元または三次元マッピングからの位置情報から決定し、前記二次元または三次元マッピングは、少なくとも前記内腔系の三次元構造モデルを含み;
前記リアルタイム位置を検出する毎に、前記カテーテルを移動させる移動機構を動作させて、前記内腔系内で前記カテーテルの先端を、前記検出したリアルタイム位置から、その前方に隣接する前記ユーザが規定した位置に向かう前記決定した増分的経路に沿って増分的に移動させる
ように構成されていることを特徴とするカテーテルの誘導システム。 - さらに、ポインティング・デバイスを具え、このポインティング・デバイスから前記位置入力を受信することを特徴とする請求項22に記載のシステム。
- 前記ポインティング・デバイスは、
マウス;
タブレットとスタイラス;
サイバーグローブ;及び、
ジョイスティック
から成るリストから選択したものであることを特徴とする請求項23に記載のシステム。 - 前記コントローラがさらに、前記カテーテルの先端が、前記前方に隣接するユーザが規定した位置に到達し損なった際に、前記移動機構を動作させて、前記カテーテルを、所定の増分だけ前記内腔内で後ろ向きに後退させると共に、前記カテーテルの末端部分を所定量だけ回転させ、その後に、前記カテーテルを所定の変位増分だけ進めることをこと特徴とする請求項22に記載のシステム。
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US10/940,423 US8055327B2 (en) | 2004-03-08 | 2004-09-14 | Automatic guidewire maneuvering system and method |
US10/940,423 | 2004-09-14 | ||
PCT/IL2005/000227 WO2005084122A2 (en) | 2004-03-08 | 2005-02-23 | Automatic guidewire maneuvering system and method |
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EP (1) | EP1732437B1 (ja) |
JP (1) | JP5285270B2 (ja) |
AT (1) | ATE539790T1 (ja) |
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ATE539790T1 (de) | 2012-01-15 |
WO2005084122A3 (en) | 2006-08-03 |
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US20050197557A1 (en) | 2005-09-08 |
US7811294B2 (en) | 2010-10-12 |
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