PT1321097E - Sensor de posição sem fios - Google Patents
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- PT1321097E PT1321097E PT02258820T PT02258820T PT1321097E PT 1321097 E PT1321097 E PT 1321097E PT 02258820 T PT02258820 T PT 02258820T PT 02258820 T PT02258820 T PT 02258820T PT 1321097 E PT1321097 E PT 1321097E
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0002—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
- A61B5/0031—Implanted circuitry
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
- A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
- A61B5/062—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/90—Identification means for patients or instruments, e.g. tags
- A61B90/98—Identification means for patients or instruments, e.g. tags using electromagnetic means, e.g. transponders
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2051—Electromagnetic tracking systems
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2072—Reference field transducer attached to an instrument or patient
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3904—Markers, e.g. radio-opaque or breast lesions markers specially adapted for marking specified tissue
- A61B2090/3916—Bone tissue
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/397—Markers, e.g. radio-opaque or breast lesions markers electromagnetic other than visible, e.g. microwave
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Description
DESCRIÇÃO "SENSOR DE POSIÇÃO SEM FIOS"
CAMPO DA INVENÇÃO A presente invenção refere-se geralmente a sistemas de rastreio intracorporais e, especificamente, a métodos e dispositivos sem fios para rastrear a posição e a orientação de um objecto no corpo.
ANTECEDENTES DA INVENÇÃO
Muitos processos médicos cirúrgicos, de diagnóstico, terapêuticos e profilácticos exigem a colocação de objectos tais como sensores, unidades de tratamento, tubos, cateteres, implantes e outros dispositivos dentro do corpo. Estes processos abrangem um largo espectro incluindo, por exemplo: inserção de eléctrodos para finalidades terapêuticas ou de diagnostico; colocação de tubos para facilitar a infusão de farmacos, fluidos nutricionais e outros no sistema circulatório ou no sistema digestivo de um doente; inserção de sondas ou dispositivos cirúrgicos para facilitar a cirurgia cardíaca ou de outro tipo; e 1 biopsias ou outros processos de diagnóstico.
Em muitos casos, a inserção de um dispositivo tem uma duração limitada no tempo, como durante uma cirurgia ou cateterização. Noutros casos, são inseridos dispositivos, tais como tubos de alimentação ou implantes ortopédicos, para utilização a longo prazo. Existe a necessidade de ser proporcionada informação em tempo real para a determinação precisa da localização e da orientação de objectos dentro do corpo do doente, de um modo preferido, sem a utilização de imagens de raio-X.
As patentes US 5391199 e 5443489 de Bem-Haim, descreve sistemas em que as coordenadas de uma sonda intracorporal são determinadas utilizando um ou mais sensores de campo, tal como um dispositivo de efeito de Hall, bobinas ou outras antenas transportadas na sonda. Tais sistemas são utilizados para gerar informação de localização tridimensional referente a uma sonda médica ou cateter. De um modo preferido, uma bobina de detecção é colocada no cateter e gera sinais em resposta a campos magnéticos aplicados externamente. Os campos magnéticos são gerados por três bobinas radiantes, fixas a uma estrutura de referência externa em locais mutuamente afastados conhecidos. As amplitudes dos sinais gerados em resposta a cada um dos campos magnéticos das bobinas radiantes são detectadas e utilizadas para calcular a localização da bobina de detecção. Cada bobina radiante é activada, de um modo preferido, através de um circuito de comando para gerar um campo com uma frequência conhecida, distinta da das outras bobinas radiantes, para que os sinais gerados pela bobina de detecção possam ser separados por frequência em componentes correspondendo a diferentes bobinas radiantes. 2 A patente US 6198963 de Bem-Haim et al., descreve um aparelho simplificado para a confirmação da localização de um tubo intracorporal que pode ser operado por não profissionais. A localização inicial do objecto é determinada como um ponto de referência, e as medições subsequentes são feitas para determinar se o objecto permaneceu na sua posição inicial. As medições são baseadas num ou mais sinais transmitidos para e/ou de um sensor fixo no corpo do objecto cuja localização está a ser determinada. 0 sinal pode ser de ondas ultra-sónicas, ondas ultravioletas, ondas de radiofrequência (RF) ou campos electromagnéticos estáticos ou rotativos. A publicação da patente PCT WO 96/05768 de Bem-Haim et al., descreve um sistema que gera informação de posição e de orientação em seis dimensões, relativamente à ponta de um cateter. Este sistema utiliza uma pluralidade de bobinas de detecção, adjacentes a um sitio localizável no cateter, por exemplo, próximo da sua extremidade distai, e uma pluralidade de bobinas radiantes fixas numa estrutura de referência externa. Estas bobinas geram sinais em resposta a campos magnéticos gerados pelas bobinas radiantes, permitindo estes sinais o cálculo de seis coordenadas de localização e de orientação. A patente US 6239724 de Doron et al., descreve um sistema de telemetria para fornecer informação de posicionamento espacial a partir do interior do corpo de um doente. O sistema inclui uma unidade de telemetria passível de ser implantada, tendo (a) um primeiro transdutor, para converter um sinal de alimentação recebido do exterior do corpo em energia eléctrica para alimentar a unidade de telemetria, (b) um segundo transdutor, para receber um sinal de campo de posicionamento que é recebido do exterior do corpo, e (c) um terceiro transdutor, 3 para transmitir um sinal de localização até um local no exterior do corpo, em resposta ao sinal de campo de posicionamento. A patente US 6172499 de Ashe, descreve um dispositivo para a medição da localização e da orientação em seis graus de liberdade de uma antena de recepção, relativamente a uma antena de transmissão utilizando sinais magnéticos de AC de multifrequências. 0 componente de transmissão consiste em duas ou mais antenas de transmissão de localização e orientação conhecidas relativamente uma à outra. As antenas de transmissão são accionadas em simultâneo por excitação de AC, com cada antena a ocupar uma ou mais posições únicas no espectro de frequências. As antenas de recepção medem o campo magnético de AC transmitido, mais as distorções provocadas por metais condutores. Um computador extrai depois a componente de distorção e remove-a dos sinais recebidos, proporcionando as saídas correctas de posição e de orientação. A patente US 4173228 de Van Steenwyck et al., descreve um dispositivo de localização de um cateter baseado na indução de um sinal numa bobina fixa ao cateter e a monitorização da amplitude e da fase do sinal induzido.
As patentes US 5099845 de Benz et al., e 5325873 de Hirschi et al., descrevem um aparelho e métodos em que um elemento radiante é fixo a um tubo médico, e. g., um cateter, e a posição do tubo é determinada em resposta à energia radiada do elemento. A patente US 5425382 de Golden et al., descreve um aparelho e métodos para a localização de um tubo médico no corpo de um doente, através da detecção do gradiente da intensidade do campo magnético estático, gerado por um íman fixo no tubo médico. 4
As patentes US 4905698 de Strohl et al. e 5425367 de Shapiro et al., descrevem um aparelho e métodos em que o campo magnético aplicado induz correntes dentro de uma bobina na ponta de um cateter. Baseado nestas correntes, é determinada a localização relativa do cateter. A patente US 5558091 de Acker et al., descreve um sistema magnético de determinação da posição e da orientação que utiliza campos uniformes criados por bobinas de Helmholtz, posicionadas em lados opostos de um volume de detecção, e campos de gradientes, gerados pelas mesmas bobinas. Através da monitorização dos componentes dos campos detectados numa sonda durante a aplicação destes campos, é deduzida a posição e a orientação da sonda. Uma representação da sonda é sobreposta a uma imagem do indivíduo obtida separadamente, para mostrar a posição e orientação da sonda relativamente ao indivíduo. A patente US 5913820 de Bladen et al., descreve um aparelho para a localização da posição de um sensor, de um modo preferido, em três dimensões, gerando campos magnéticos que são detectados no sensor. Os campos magnéticos são gerados a partir de uma pluralidade de locais e permitem a determinação tanto da orientação como da localização de um sensor de uma só bobina.
Estão actualmente disponíveis no mercado sistemas de mapeamento electrofisiológico e físico baseados na detecção da posição de uma sonda dentro do corpo. Entre eles, o CARTO™, desenvolvido e comercializado por Biosense Webster Inc., Diamond Bar, Califórnia, é um sistema para a associação e mapeamento automáticos da actividade eléctrica local com a localização do cateter. 5
Um artigo intitulado "Microtool Opens 3D Window into the Human Body" de Cleópatra Alfenito, Medicai Imaging 12(11), (Novembro de 1997), que é aqui incorporada por referência, descreve o dispositivo "miniBIRD", fabricado por Ascension Technology {Burlington, Vermont). Este dispositivo "... mede os órgãos internos e o seu movimento através da reconstrução da posição e da orientação de lâminas 2D para encher um volume 3D... Sensores - com uma dimensão de 5 mm - podem ser fixos em sondas, instrumentos ou mesmo na cabeça de um feto dentro do corpo humano. Estes mini-dispositivos de rastreio medem a localização espacial de sondas de ultra-sons ou outros instrumentos com seis graus de liberdade (posição e orientação, conforme dado por x, y, z, rotação, elevação e rolamento) em tempo real. 0 miniBIRD funciona medindo os campos magnéticos e convertendo os sinais em medições de 3D em tempo real. No inicio de cada ciclo de medição (existindo até 144 por segundo), o transmissor triaxial do sistema é comandado por um sinal de impulsos de DC. 0 sensor mede então o impulso do campo magnético transmitido. A unidade electrónica controla os elementos de transmissão e de recepção e converte os sinais recebidos em medições de posição e de orientação em tempo real, proporcionando a recolha de dados precisos. Estes dados podem então ser utilizados para a reconstrução em 3D de imagens internas do coração, vasos sanguíneos, estômago, pélvis e outras áreas, conforme proporcionado por ultra-sons ou um endoscópio". 0 documento US 6239724 divulga um dispositivo de acordo com o preâmbulo da reivindicação 1. 6
RESUMO DA INVENÇÃO
Um objectivo de alguns aspectos da presente invenção é o de proporcionar um aparelho melhorado para a determinação em tempo real da localização e da orientação de objectos intracorporais.
Um outro objectivo de alguns aspectos da presente invenção é o de proporcionar um aparelho melhorado de medição de posição baseado em sinais de radiofrequência.
Ainda outro objectivo de alguns aspectos da presente invenção é o de proporcionar um aparelho melhorado para a determinação da localização e da orientação de um objecto intracorporal que possa funcionar na ausência de outras tecnologias de localização, tais como o MRI ou a fluoroscopia.
Ainda outro objectivo de alguns aspectos da presente invenção é o de proporcionar um sensor para a localização de um objecto intracorporal que não necessite nem de cabos nem de uma fonte de energia interna.
Um objectivo adicional de alguns aspectos da presente invenção é o de proporcionar um aparelho para o mapeamento intracorporal que seja leve e pequeno.
Ainda outro objectivo adicional de alguns aspectos da presente invenção é o de proporcionar um aparelho de mapeamento intracorporal que possa ser facilmente integrado nos sistemas de suporte de mapeamento existentes.
Nas formas de realização preferidas da presente invenção, o aparelho de detecção da posição e da orientação de um objecto 7 colocado dentro do corpo de um doente compreende um transponder de localização sem fios contendo uma bobina de alimentação, uma bobina de detecção e um circuito integrado de processamento de sinais. Tipicamente, o transponder é fixo a um dispositivo inserido no corpo, como um cateter ou um implante. Uma unidade de accionamento localizada no exterior envia um sinal de radiofrequência (RF), de um modo preferido, tendo uma frequência na gama dos megahertz, para accionar a bobina de alimentação no transponder e assim alimentar o circuito integrado. De um modo adicional, um conjunto de geradores de campos magnéticos colocado em locais fixos no exterior do corpo, produz campos magnéticos com diferentes e respectivas frequências, tipicamente, na gama dos quilohertz. Estes campos provocam o fluxo de correntes na bobina de detecção, que dependem da posição e da orientação espacial da bobina de detecção relativamente aos geradores dos campos. 0 circuito integrado de processamento converte estas correntes em sinais de alta-frequência, que são transmitidos pela bobina de alimentação a uma unidade de processamento de sinais localizada no exterior. Esta unidade processa o sinal a fim de determinar as coordenadas de posição e de orientação do objecto para serem visualizadas e gravadas.
Deste modo, contrariamente aos actuais sistemas médicos de rastreio, tal como o sistema CARTO™ acima mencionado, o presente transponder permite a determinação da posição e da orientação de um objecto no corpo sem a necessidade de qualquer conexão de cabos entre a bobina de detecção e a unidade de processamento externa. Este tipo de funcionamento sem fios é particularmente vantajoso para a visualização da posição de dispositivos implantáveis, que não podem ser facilmente conectados à unidade de processamento através de cabos. É também útil na redução do número de cabos que têm de ser introduzidos através de uma sonda invasiva, tal como um cateter, a fim de accionar um sensor de posição na sua extremidade distai. Ao reduzir o número de cabos, torna-se possível, tipicamente, reduzir o diâmetro da sonda. Além disto, pelo facto de o actual transponder utilizar apenas duas bobinas, com uma única bobina a servir tanto para a entrada de energia como para o sinal de saída, e nenhuma fonte de energia interna, pode ser tornado substancialmente mais pequeno que os transponders sem fios conhecidos na técnica.
Um sincronizador de relógio é utilizado para sincronizar os sinais produzidos tanto pela unidade de comando externa como pelos geradores de campos magnéticos. De um modo mais preferido, a frequência do sinal de comando de RF é definida para ser um número inteiro, múltiplo das frequências dos campos magnéticos. Esta sincronização de relógio permite ao circuito integrado do transponder utilizar a detecção sensível à fase a fim de potenciar a relação sinal/ruído do sinal proveniente da bobina de detecção. A fase dos sinais do sensor é também, de um modo preferido, utilizada para resolver a ambiguidade que, de outro modo, ocorreria nos sinais durante uma inversão de 180° do eixo da bobina de detecção.
De um modo alternativo ou adicional, o transponder pode compreender múltiplas bobinas de detecção, de um modo preferido, três bobinas mutuamente ortogonais, conforme descrito na publicação PCT WO 96/05768 acima mencionada. Neste caso, todas as seis coordenadas de posição e de orientação podem ser determinadas sem ambiguidade.
Uma outra vantagem de algumas formas de realização preferidas da presente invenção é que elas podem ser facilmente 9 integradas nos actuais sistemas electromagnéticos de rastreio com cateter, tal como o sistema de mapeamento CARTO™ acima mencionado. Em tais formas de realização, a unidade de comando e um receptor que a acompanha, para comunicar através do ar com a bobina de alimentação do transponder sem fios, são conectados à unidade de processamento do sistema de rastreio em substituição dos cabos que habitualmente transportam sinais de posição vindos do cateter. 0 receptor processa previamente os sinais que recebe da bobina de alimentação, e depois passa os sinais ao processador de sinais existente no sistema de rastreio para determinar e visualizar a posição.
Consequentemente, de acordo com uma forma de realização preferida da presente invenção, é proporcionado um aparelho para o rastreio de um objecto, que inclui: circuitos de accionamento adaptados para accionar um ou mais geradores de campo, para gerar campos electromagnéticos com diferentes e respectivas frequências, na proximidade do objecto; um dispositivo de accionamento de radiofrequência (RF), adaptado para radiar um campo de accionamento de RF em direcção ao objecto; um circuito de sincronização de relógio acoplado aos circuitos de accionamento e ao dispositivo de accionamento de RF; um transponder sem fios, fixo ao objecto, o transponder incluindo: pelo menos, uma bobina de detecção, acoplada para que 10 uma corrente eléctrica flua na, pelo menos, uma bobina de detecção em resposta aos campos electromagnéticos; um circuito de controlo, acoplado à, pelo menos, uma bobina de detecção de modo a gerar um sinal de saida indicativo da corrente; e uma bobina de alimentação, acoplada para receber o campo de accionamento de RF e para transportar energia eléctrica do campo de accionamento para o circuito de controlo, e ainda acoplado para transmitir o sinal de saida gerado pelo circuito de controlo; e um receptor de sinal, adaptado para receber o sinal de saida transmitido pela bobina de alimentação e, em resposta a ele, determinar as coordenadas do objecto; em que os um ou mais geradores de campos estão adaptados para gerar os campos electromagnéticos nas respectivas frequências dos campos, e o dispositivo de accionamento de RF está adaptado para radiar o campo de accionamento de RF a uma frequência de accionamento, e os um ou mais geradores de campos e o dispositivo de accionamento de RF estão acoplados para operarem para que as frequências dos campos e a frequência de accionamento estejam mutuamente sincronizadas pelo circuito de sincronização de relógio; e em que o circuito de controlo está acoplado para receber um sinal de sincronização da frequência vindo da bobina de alimentação, em resposta ao campo de accionamento de RF sincronizado, e para aplicar o sinal de sincronização da frequência como sendo uma referência de frequência na geração do 11 sinal de saída.
De um modo preferido, a corrente eléctrica na, pelo menos, uma bobina de detecção tem componentes de frequência nas diferentes frequências dos um ou mais geradores de campos, e o sinal gerado pelo circuito de controlo é indicativo dos componentes de frequência da corrente.
De um modo mais adicional ou alternativo, o circuito de controlo está adaptado para gerar o sinal de saída de modo a indicar uma fase da corrente que flúi na, pelo menos, uma bobina de detecção, relativamente a uma fase dos campos electromagnéticos.
De um modo preferido, o circuito de controlo está adaptado para gerar o sinal de saída em resposta à sincronização das frequências dos campos com a frequência de accionamento.
De um modo ainda mais preferido, a frequência de accionamento do campo de accionamento de RF é um múltiplo de número inteiro das frequências dos campos dos campos electromagnéticos dos um ou mais geradores de campos.
De um modo ainda mais preferido, o circuito de controlo está ainda adaptado de modo a gerar um sinal de saída indicativo de uma amplitude da corrente, e o receptor do sinal está adaptado, em resposta à amplitude e à fase da corrente indicada pelo sinal de saída, para determinar uma orientação do objecto.
Numa forma de realização preferida, o circuito de controlo inclui um conversor de tensão para frequência (V/F) , que é acoplado para gerar o sinal de saída com uma frequência de saída 12 que varia em resposta à corrente eléctrica que flúi na, pelo menos, uma bobina de detecção.
Numa forma de realização preferida, o circuito de controlo compreende um conversor de tensão para frequência (V/F) , acoplado à, pelo menos, uma bobina de detecção de modo a gerar um sinal de saida com uma frequência de saida que varia em resposta a uma amplitude da corrente eléctrica que flúi na, pelo menos, uma bobina de detecção.
Em algumas formas de realização preferidas, o transponder está adaptado para ser inserido, juntamente com o objecto, no corpo de um doente, enquanto que os um ou mais geradores de campos e o dispositivo de accionamento de RF são colocados no exterior do corpo. De um modo preferido, o objecto inclui uma sonda alongada, para ser inserida no corpo, e o transponder é fixo na sonda de modo a permitir ao receptor determinar as coordenadas de uma extremidade distai da sonda. De um modo alternativo, o objecto inclui um implante, e o transponder está fixo no implante de modo a permitir ao receptor determinar as coordenadas do implante dentro do corpo. Numa forma de realização preferida, o implante inclui um implante dos ossos da anca, incluindo uma cabeça de fémur e um acetábulo, e o transponder inclui uma pluralidade de transponders fixos, respectivamente, na cabeça do fémur e no acetábulo, e o receptor de sinal está adaptado para determinar uma distância entre a cabeça do fémur e o acetábulo em resposta ao sinal de saida vindo dos transponders.
De um modo preferido, o circuito de controlo está adaptado para operar alimentado apenas pela energia eléctrica a ele transmitida pela bobina de alimentação. 13
Numa forma de realização preferida, a, pelo menos, uma bobina de detecção inclui uma única bobina de detecção, e o receptor de sinal está adaptado, em resposta à fase indicada da corrente, para determinar uma direcção da orientação do transponder.
BREVE DESCRIÇÃO DOS DESENHOS A presente invenção será melhor compreendida da descrição detalhada que se segue das suas formas de realização preferidas juntamente com os desenhos, nos quais: A Fig. 1 é uma ilustração pictural esquematizada de um sistema para fazer o rastreio da posição de um cateter dentro do coração, de acordo com uma forma de realização preferida da presente invenção; A Fig. 2 é uma vista lateral esquematizada de um cateter, mostrando pormenores de um transponder de localização sem fios dentro do cateter, de acordo com uma forma de realização preferida da presente invenção; A Fig. 3 é um diagrama de blocos que ilustra esquematicamente elementos de circuitos de accionamento e processamento utilizado num sistema de detecção de posição sem fios, de acordo com uma forma de realização preferida da presente invenção; e A Fig. 4 é uma ilustração pictural esquematizada que mostra a utilização de transponders de localização sem fios de um implante de uma articulação, de acordo com uma forma de 14 realização preferida da presente invenção.
DESCRIÇÃO DETALHADA DAS FORMAS DE REALIZAÇÃO PREFERIDAS A Fig. 1 é uma ilustração pictural esquematizada de um sistema 20 de mapeamento, para fazer o mapeamento de um coração 24 de um indivíduo 26, de acordo com uma forma de realização preferida da presente invenção. O sistema 20 compreende uma sonda alongada, de um modo preferido, um cateter 30, que é inserido por um utilizador 22 através de uma veia ou artéria do indivíduo para dentro de uma câmara do coração. O cateter 30 compreende um transponder 40 de posição sem fios, de um modo preferido, próximo da extremidade distai do cateter. O transponder 4 0 está mostrado em pormenor na Fig. 2. De um modo opcional, o cateter 30 compreende dois ou mais transponders deste tipo, mutuamente afastados ao longo do comprimento do cateter, a fim de proporcionar coordenadas de posição e de orientação em múltiplos pontos ao longo do cateter.
Para operar o transponder 40, o indivíduo 26 é colocado num campo magnético gerado, por exemplo, colocando sob o indivíduo uma placa contendo bobinas 28 geradoras de um campo para gerar um campo magnético. As bobinas 28 são accionadas por circuitos 32 de accionamento para gerar campos electromagnéticos com diferentes e respectivas frequências. As bobinas 28 geradoras estão localizadas no exterior do indivíduo (doente) 26. Um sensor electromagnético (não mostrado) de referência é fixado, de um modo preferido, relativamente ao doente, por exemplo, fixo com fita adesiva nas costas do doente, e o cateter 30 que contém o transponder 40 é introduzido até chegar ao coração do doente. Uma antena 54 adicional, de um modo preferido, na forma de uma 15 bobina, proporciona a energia de RF ao transponder e recebe sinais vindos dele, conforme será mais adiante descrito em pormenor. Os sinais recebidos pela antena 54 vindos do transponder 40 no coração são encaminhados para uma consola 34, que analisa os sinais e depois apresenta os resultados num ecrã 36. Com este método, a localização precisa do transponder 40 dentro do cateter 30, relativamente ao sensor de referência, pode ser determinada e apresentada visualmente. O transponder pode também detectar a deslocação do cateter que é provocada pela contracçâo do músculo do coração.
Algumas das caracteristicas do sistema 20 estão implementadas no sistema CARTO™ acima mencionado, incluindo a utilização do sistema para gerar mapas 38 da função eléctrica e mecânica do coração. Outros aspectos da concepção do cateter 30 e do sistema 20 estão geralmente descritos nas patentes US 5391199, 5443489 e 6198963 acima mencionadas. Todavia, a concepção do transponder 40 e do dispositivo de accionamento e dos circuitos de processamento do sinal associados utilizados na consola 34, conforme aqui descritos, são específicos da presente invenção.
Fazendo referência agora às Fig.s 2 e 3 que mostram esquematicamente pormenores do transponder 40 e dos circuitos de accionamento e de processamento na consola 34, de acordo com uma forma de realização preferida da presente invenção. Conforme mostrado na Fig. 2, o transponder 40 compreende uma bobina 42 de alimentação e uma bobina 46 de detecção, acopladas a um circuito integrado 44 de controlo. De um modo preferido, a bobina 42 está optimizada para receber e transmitir sinais de alta-frequência, na gama acima de 1 MHz. A bobina 4 6, por outro lado, está concebida, de um modo preferido, para um funcionamento na gama 16 de 1-3 kHz, as frequências a que as bobinas 28 geram os seus campos electromagnéticos. De um modo alternativo, podem ser utilizadas outras gamas de frequência, conforme exigido pelos requisitos da aplicação. 0 transponder 40 tem na sua totalidade, tipicamente, um comprimento de 2-5 mm e um diâmetro externo de 2-3 mm, permitindo a sua colocação conveniente dentro do cateter 30.
Conforme mostrado na Fig. 3, a consola 34 compreende um dispositivo 50 de accionamento de energia de RF que acciona a antena 54 para emitir um sinal de energia, de um modo preferido, na amplitude de 2-10 MHz. O sinal de energia provoca o fluxo de uma corrente na bobina 42 de alimentação, que é rectificada pelo circuito integrado 44 e utilizada para alimentar os seus circuitos internos. Ao mesmo tempo, os campos electromagnéticos produzidos pelas bobinas 28 geradoras de campos provoca o fluxo de uma corrente dentro da bobina 46 de detecção. Esta corrente tem componentes de frequência com as mesmas frequências que as das correntes de accionamento que fluem através das bobinas geradoras. Os componentes de corrente são proporcionais às intensidades dos componentes dos respectivos campos magnéticos produzidos pelas bobinas geradoras numa direcção paralela ao eixo da bobina de detecção. Consequentemente, as amplitudes das correntes indicam a posição e a orientação da bobina 46 relativamente às bobinas 28 geradoras fixas. O circuito integrado 44 mede as correntes que fluem na bobina 46 de detecção nas diferentes frequências do campo. Ele codifica esta medição formando um sinal de alta-frequência, que ele transmite então de bobina via a bobina 42 de alimentação até à antena 54. De um modo preferido, o circuito integrado 44 compreende um conversor 48 de tensão para frequência (V/F) , que 17 gera um sinal de RF cuja frequência é proporcional à tensão produzida pela corrente da bobina de detecção que flui através de uma carga. De um modo preferido, o sinal de RF produzido pelo circuito integrado 44 tem uma frequência de portadora na gama de 50-150 MHz. O sinal de RF produzido desta maneira é modulado com três diferentes componentes de modulação de frequência (FM) que variam com o tempo nas respectivas frequências dos campos gerados pelas bobinas 28. A magnitude da modulação é proporcional aos componentes de corrente nas três frequências. Uma vantagem da utilização de modulação de frequência, em vez de modulação de amplitude, para transmitir as medições da amplitude da bobina de detecção vindas do transponder 40 para a antena 54 é que a informação no sinal (i. e. a frequência) não é afectada pela atenuação variável dos tecidos do corpo através dos quais o sinal tem de passar.
De um modo alternativo, o circuito integrado 44 pode compreender um circuito de amostragem e um conversor analógico digital (A/D) (não mostrado nas figuras), que digitaliza a amplitude da corrente que flui na bobina 4 6 de detecção. Neste caso, o circuito integrado 44 gera um sinal modulado digitalmente, e faz a modulação em RF do sinal para a transmissão pela bobina 42 de alimentação. Qualquer método adequado de codificação e modulação digital pode ser utilizado para este fim. Outros métodos de processamento e de modulação de sinais serão evidentes para os peritos na técnica. O sinal FM ou modulado digitalmente transmitido pela bobina 42 de alimentação é captado pelo receptor 56, acoplado à antena 54. O receptor desmodula o sinal para gerar uma entrada adequada para os circuitos 58 de processamento de sinais na consola 34. Tipicamente, o receptor 56 amplifica, filtra e digitaliza os 18 sinais vindos do transponder 40. Os sinais digitalizados são recebidos e utilizados pelos circuitos 58 de processamento para calcular a posição e a orientação do cateter 30. Tipicamente, os circuitos 58 compreendem um computador de utilização geral, que é programado e equipado com circuitos de entrada apropriados para o processamento dos sinais vindos do receptor 56. A informação obtida pelos circuitos 58 é utilizada para gerar mapas 38, por exemplo, ou para proporcionar outra informação de diagnóstico ou de guia ao operador 22.
Numa forma de realização alternativa da presente invenção, o dispositivo 50 de accionamento, receptor 56 e antena 54 são colocados posteriormente num sistema de rastreio existente, como um sistema CARTO™. A consola 34 no sistema existente é concebida para receber e processar os sinais recebidos nos cabos de uma ou mais das bobinas de detecção no cateter 30, utilizando os circuitos 58 de processamento existentes para determinar a posição e a orientação do cateter. Consequentemente, nesta forma de realização alternativa, o receptor 56 desmodula os sinais gerados pelo transponder 40 de modo a reconstruir os sinais de corrente variáveis gerados pela bobina 46 de detecção. Os circuitos de processamento existentes utilizam esta informação para determinar a posição e a orientação do cateter, como se as correntes da bobina de detecção tivessem sido recebidas através de conexões de cabos. A consola 34 inclui um circuito 52 de sincronização de relógio que é utilizado para sincronizar os circuitos 32 de accionamento e o dispositivo 50 de accionamento da energia de RF. De um modo mais preferido, o dispositivo de accionamento da energia de RF funciona a uma frequência que é um múltiplo de número inteiro das frequências de accionamento dos geradores 28 19 de campos. 0 circuito integrado 44 pode então utilizar o sinal de RF recebido pela bobina 42 de alimentação não só como fonte de energia, como também como uma referência da frequência. Utilizando esta referência, o circuito integrado 44 é capaz de aplicar o processamento sensível à fase aos sinal de corrente gerados pela bobina 46 de detecção, para detectar a corrente da bobina de detecção em fase com os campos de accionamento gerados pelas bobinas 28. 0 receptor 56 pode aplicar métodos de processamento sensíveis à fase, conforme é conhecido na técnica, de uma maneira semelhante, utilizando a entrada proveniente do circuito 52 de sincronização de relógio. Tais métodos de detecção sensíveis à fase permitem ao transponder 40 alcançar uma relação sinal/ruído (S/N) melhorada, não obstante a baixa amplitude dos sinais de corrente na bobina 46 de detecção. A bobina 46 de detecção única mostrada na Fig. 2 é suficiente, juntamente com as bobinas 28 geradoras, para activar os circuitos 58 de processamento para gerar informação de posição em três dimensões e de orientação em duas dimensões. A terceira dimensão da orientação (tipicamente, a rotação do cateter 30 em torno do seu eixo longitudinal) pode ser inferida, se necessário, da informação mecânica ou, quando são utilizados dois ou mais transponders no cateter, a partir de uma comparação das suas respectivas coordenadas. De um modo alternativo, o transponder 40 pode compreender múltiplas bobinas de detecção, de um modo preferido, três bobinas mutuamente ortogonais, conforme descrito, por exemplo, na publicação PCT WO 96/05768 acima mencionada. Neste caso, os circuitos de processamento podem determinar todas as seis coordenadas de posição e de orientação do cateter 30, sem ambiguidade.
Outro ponto de possível ambiguidade na determinação das 20 coordenadas de orientação do transponder 40 é que a magnitude das correntes que flúem na bobina 46 de detecção é invariante aquando da inversão da direcção do eixo da bobina. Por outras palavras, a colocação do transponder 40 girado em 180° num plano perpendicular do eixo da bobina de detecção não tem qualquer efeito na amplitude da corrente. Nalgumas circunstâncias, esta resposta simétrica pode provocar um erro de 180° na determinação das coordenadas do transponder.
Embora a magnitude da corrente da bobina de detecção não seja afectada pela rotação do eixo da bobina, a inversão de 180° inverte a fase da corrente relativamente à fase dos campos electromagnéticos de accionamento gerados pelos geradores 28 de campos. 0 circuito 52 de sincronização de relógio pode ser utilizado para detectar esta inversão de fase e, consequentemente, ultrapassar a ambiguidade da orientação girada em 180°. A sincronização da modulação do sinal de RF devolvido pelo circuito integrado 44 ao receptor 56 com as correntes a accionar os geradores 28 de campos permite ao receptor 56 determinar a fase das correntes na bobina 46 de detecção relativamente às correntes de accionamento. Ao verificar se as correntes do sensor estão em fase com as correntes de accionamento ou se estão com um desfasamento de 180°, o circuito 58 de processamento é capaz de decidir em que sentido o transponder está direccionado. A Fig. 4 é uma ilustração pictural esquematizada que mostra a utilização de transponders de localização num processo ortopédico, de acordo com uma forma de realização preferida da presente invenção. Uma vantagem da utilização de transponders sem fios, como o transponder 40, sem uma fonte de energia incorporada, é que os transponders podem ser inseridos em ou 21 fixados nos dispositivos implantáveis, e depois deixados dentro do corpo do doente para referenciamento futuro. A forma de realização mostrada na Fig. 4 ilustra uma cirurgia de implante de anca, em que um cirurgião tem de posicionar a cabeça de um fémur 60 artificial num acetábulo 62 artificial. Tipicamente, antes de realizar o processo, o cirurgião obtém imagens de raio-X e de CT para visualizar a área da intervenção, mas depois tem de realizar efectivamente a cirurgia sem o beneficio de uma visualização tridimensional em tempo real.
Na forma de realização mostrada na Fig. 4, transponders 64 em miniatura são embutidos no fémur 60, e outros transponders 66 em miniatura são embutidos na pélvis na área do acetábulo 62. Os transponders 64 e 66 são, de um modo preferido, semelhantes ao transponder 40, conforme mostrado na Fig. 2. De um modo mais preferido, cada transponder é configurado para transmitir sinais de bobina à antena 54 numa frequência de portadora diferente, para que o receptor 56 possa diferenciar entre os transponders. No inicio da cirurgia, é obtida uma imagem de raio-X com a cabeça do fémur na proximidade do acetábulo. A imagem é captada pelo computador e apresentada num ecrã de computador. Os transponders 64 e 66 estão visiveis na imagem de raio-X, e as suas posições na imagem são registadas com as suas respectivas coordenadas de localização, conforme definido pelos circuitos 58 de processamento. Durante a cirurgia, o movimento dos transponders é seguido pelos circuitos 58, e este movimento é utilizado para actualizar as posições relativas do fémur e do acetábulo na imagem no ecrã, utilizando técnicas de processamento de imagens conhecidas na técnica. O cirurgião utiliza a imagem actualizada para conseguir uma correcta colocação da cabeça do fémur no acetábulo, sem a necessidade de repetidas exposições de raio-X no decorrer da cirurgia. 22
Terminada a cirurgia, as posições relativas dos transponders 64 e 66 (que permanecem no implante) são, de um modo preferido, verificadas periodicamente para ver se é mantida a relação correcta entre os ossos. Este tipo de monitorização de posição é útil tanto durante a recuperação, como para a monitorização do estado do implante a longo prazo. Por exemplo, tal monitorização pode ser utilizada para detectar a crescente separação do fémur em relação ao acetábulo que, em alguns casos, é conhecida por anteceder uma deterioração mais séria do osso.
Embora as Fig.s 1 e 4 mostrem apenas duas aplicações particulares dos transponders de posição sem fios de acordo com formas de realização preferidas da presente invenção, outras aplicações serão evidentes para os peritos na técnica e são consideradas como estando no âmbito da presente invenção. Por exemplo, e sem ser de todo limitativo, tais transponders podem ser fixos noutros tipos de instrumentos invasivos, tais como endoscópios e tubos de alimentação, assim como a outros dispositivos implantáveis, tais como implantes ortopédicos utilizados no joelho, na coluna e noutros locais.
Consequentemente, os peritos na técnica apreciarão que a presente invenção não está limitada ao que foi aqui particularmente mostrado e descrito. Pelo contrário, o âmbito da presente invenção inclui as combinações e as subcombinações das várias caracteristicas aqui descritas, assim como as suas variações e modificações que não estão na técnica anterior, e que poderão ocorrer aos peritos na técnica durante a leitura da presente descrição.
Lisboa, 28 de Agosto de 2007 23
Claims (14)
- REIVINDICAÇÕES 1. Aparelho (20) para o rastreio de um objecto (30), compreendendo: um ou mais geradores de campo; circuitos (32) de accionamento adaptados para accionar o um ou mais geradores (28) de campos para gerar campos electromagnéticos com diferentes e respectivas frequências na proximidade do objecto; um dispositivo (50) de accionamento de radiofrequência (RF) , adaptado para radiar um campo de accionamento de RF em direcção ao objecto; um transponder (40) sem fios, fixo no objecto (30), o transponder compreendendo: pelo menos, uma bobina (46) de detecção, acoplada para que uma corrente eléctrica flua na, pelo menos, uma bobina de detecção em resposta aos campos electromagnéticos; um circuito (44) de controlo, acoplado à, pelo menos, uma bobina (46) de detecção de modo a gerar um sinal de saída indicativo da corrente; e uma bobina (42) de alimentação, acoplada para receber o campo de accionamento de RF e para transportar energia eléctrica do campo de 1 accionamento para o circuito (44) de controlo, e ainda acoplado para transmitir o sinal de saida gerado pelo circuito de controlo; e um receptor (34) de sinal, adaptado para receber o sinal de saida transmitido pela bobina de alimentação e, em resposta a este, determinar as coordenadas do objecto (30); caracterizado por o aparelho compreender um circuito (52) de sincronização de relógio acoplado aos circuitos (32) de accionamento e ao dispositivo (50) de accionamento de RF, e por os um ou mais geradores (28) de campo estarem adaptados para gerar os campos electromagnéticos com a as respectivas frequências de campo, e o dispositivo (50) de accionamento de RF estar adaptado para radiar o campo de accionamento de RF com uma frequência de accionamento, e por os um ou mais geradores (28) de campo e o dispositivo (50) de accionamento de RF estarem acoplados para operar de modo a que as frequências de campo e a frequência de accionamento sejam mutuamente sincronizadas pelo circuito (52) de sincronização de relógio, e por o circuito (44) de controlo estar acoplado para receber um sinal de sincronização de frequência proveniente da bobina (42) de alimentação, em resposta ao campo de accionamento de RF sincronizado, e para aplicar o sinal de sincronização de frequência como uma referência de frequência ao gerar o sinal de saida.
- 2. Aparelho de acordo com a reivindicação 1, em que a corrente eléctrica na, pelo menos, uma bobina (42) de detecção tem 2 componentes de frequência em diferentes frequências dos um ou mais geradores (28) de campo, e em que o sinal gerado pelo circuito (44) de controlo é indicativo dos componentes de frequência da corrente.
- 3. Aparelho de acordo com a reivindicação 1, em que o circuito (4 4) de controlo está adaptado para gerar o sinal de saída de modo a indicar uma fase da corrente que flui na, pelo menos, uma bobina (46) de detecção, relativamente a uma fase dos campos electromagnéticos.
- 4. Aparelho de acordo com a reivindicação 3, em que o circuito (4 4) de controlo está adaptado para gerar o sinal de saída em resposta à sincronização das frequências dos campos com a frequência de accionamento.
- 5. Aparelho de acordo com qualquer reivindicação anterior, em que a frequência de accionamento do campo de accionamento de RF é um número inteiro múltiplo das frequências de campo dos campos electromagnéticos dos um ou mais geradores (28) de campos.
- 6. Aparelho de acordo com a reivindicação 3, em que o circuito (4 4) de controlo está ainda adaptado de modo a gerar um sinal de saída indicativo de uma amplitude da corrente, e em que o receptor (34) do sinal está adaptado, em resposta à amplitude e à fase da corrente indicada pelo sinal de saída, para determinar uma orientação do objecto (30).
- 7. Aparelho de acordo com a reivindicação 6, em que a, pelo menos, uma bobina de detecção compreende uma única bobina (46) de detecção e, em que o receptor do sinal está 3 adaptado, em resposta à fase indicada da corrente, para determinar a direcção da orientação do transponder (40).
- 8. Aparelho de acordo com a reivindicação 1 ou 6, em que o circuito (44) de controlo inclui um conversor (48) de tensão/frequência (V/F), que é acoplado para gerar o sinal de saída com uma frequência de saída que varia em resposta à corrente eléctrica que flui na, pelo menos, uma bobina (46) de detecção.
- 9. Aparelho de acordo com a reivindicação 1, em que o circuito (44) de controlo compreende um conversor (48) de tensão/frequência (V/F), acoplado à, pelo menos, uma bobina (4 6) de detecção de modo a gerar um sinal de saída com uma frequência de saída que varia, em resposta a uma amplitude da corrente eléctrica que flui na, pelo menos, uma bobina de detecção.
- 10. Aparelho de acordo com a reivindicação 1, 6 ou 9, em que o transponder (40) está adaptado para ser inserido, juntamente com o objecto (30), no corpo de um indivíduo (26), enquanto que os um ou mais geradores (28) de campo e o dispositivo (50) de accionamento de RF são colocados no exterior do corpo.
- 11. Aparelho de acordo com a reivindicação 10, em que o objecto compreende uma sonda (30) alongada, para inserção no corpo, e em que o transponder (40) é fixo na sonda (30) de modo a permitir ao receptor (34) determinar as coordenadas de uma extremidade distai da sonda. 4
- 12. Aparelho de acordo com a reivindicação 10, em que o objecto compreende um implante, e em que o transponder (40) é fixo ao implante de modo a permitir ao receptor determinar as coordenadas do implante dentro do corpo.
- 13. Aparelho de acordo com a reivindicação 12, em que o implante compreende um implante de articulação da anca, compreendendo uma cabeça (60) de fémur e um acetábulo (62), e em que o transponder compreende uma pluralidade de transponders (64, 66) fixos, respectivamente, na cabeça do fémur e no acetábulo, e em que o receptor de sinal está adaptado para determinar uma distância entre a cabeça (60) do fémur e o acetábulo (62) em resposta ao sinal de saida proveniente dos transponders (64, 66).
- 14. Aparelho de acordo com a reivindicação 1, em que o circuito (44) de controlo está adaptado para funcionar alimentado apenas pela energia eléctrica a ele transmitida pela bobina (42) de alimentação. Lisboa, 28 de Agosto de 2007 5
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EP1321097A3 (en) | 2003-12-10 |
JP2003299634A (ja) | 2003-10-21 |
DE60221781D1 (de) | 2007-09-27 |
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ATE369790T1 (de) | 2007-09-15 |
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EP1321097B1 (en) | 2007-08-15 |
JP4549624B2 (ja) | 2010-09-22 |
ES2291423T3 (es) | 2008-03-01 |
US7729742B2 (en) | 2010-06-01 |
CA2414914A1 (en) | 2003-06-21 |
SI1321097T1 (sl) | 2008-02-29 |
EP1321097A2 (en) | 2003-06-25 |
CA2414914C (en) | 2012-06-26 |
CY1106941T1 (el) | 2012-09-26 |
IL153437A (en) | 2009-02-11 |
US20030120150A1 (en) | 2003-06-26 |
KR20030053039A (ko) | 2003-06-27 |
IL153437A0 (en) | 2003-07-06 |
AU2002318895B2 (en) | 2007-10-04 |
HK1053599A1 (en) | 2003-10-31 |
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