CA2110857C - Radiation responsive laparoscopic instrument - Google Patents

Radiation responsive laparoscopic instrument

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Publication number
CA2110857C
CA2110857C CA002110857A CA2110857A CA2110857C CA 2110857 C CA2110857 C CA 2110857C CA 002110857 A CA002110857 A CA 002110857A CA 2110857 A CA2110857 A CA 2110857A CA 2110857 C CA2110857 C CA 2110857C
Authority
CA
Canada
Prior art keywords
crystal
radiation
electrically conductive
instrument
window
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
CA002110857A
Other languages
French (fr)
Other versions
CA2110857A1 (en
Inventor
Marlin O. Thurston
Dale A. Slifko
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Navidea Biopharmaceuticals Inc
Original Assignee
Neoprobe Corp
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Filing date
Publication date
Application filed by Neoprobe Corp filed Critical Neoprobe Corp
Publication of CA2110857A1 publication Critical patent/CA2110857A1/en
Application granted granted Critical
Publication of CA2110857C publication Critical patent/CA2110857C/en
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M37/00Other apparatus for introducing media into the body; Percutany, i.e. introducing medicines into the body by diffusion through the skin
    • A61M37/0069Devices for implanting pellets, e.g. markers or solid medicaments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/42Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis
    • A61B6/4208Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector
    • A61B6/425Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector using detectors specially adapted to be used in the interior of the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/42Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis
    • A61B6/4208Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector
    • A61B6/4258Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector for detecting non x-ray radiation, e.g. gamma radiation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00Radiation therapy
    • A61N5/10X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048Monitoring, verifying, controlling systems and methods
    • GPHYSICS
    • G01MEASURING; TESTING
    • G01TMEASUREMENT OF NUCLEAR OR X-RADIATION
    • G01T1/00Measuring X-radiation, gamma radiation, corpuscular radiation, or cosmic radiation
    • G01T1/16Measuring radiation intensity
    • G01T1/161Applications in the field of nuclear medicine, e.g. in vivo counting

Abstract

A laparoscopic instrument is provided having a hand-grippable base to which an elongate accessing tube is connected which extends to a tip. Extending inwardly from the tip is a detection support region within which is formed a radiation transmissive window. Immediately spaced from and behind the window there is positioned a detecting crystal such as cadmium telluride which is retained in a crystal mountstructure having an architecture designed for minimizing noise generation occasioned from microphonic (piezoelectric) phenomena and the like.

Description

2 ~

RADL~TION RESPONSIVE LAPAROSCOPIC INSTRUMENT

Background of the Invention Current and his~orical procedures for the treatment of colon and rectal cancer have been based, for staging purposes, upon the natural history of tumor spread, and thence, upon operative and non-operative options. Operative options generally have looked to the physical location and surgical resection of tumor. A variety Gf techniques have been brought to bear in the art with the purpose of aiding the surgeon in detecting and localizing neoplastic tissue as part of this surgical procedure. ("Neoplastic tissue", for present purposes, often is referred to as cancerous tissue, though malignant tumor and malignant tumor cells also are found in the terrninology of the art. The term 10 "neoplastic tissue" includes all of these.) A substantial amount of eff~rt in aiding the surgeon in locating neoplastic tissue has been through the utilization of radiolabeled antibody for detection purposes. For exarnple, one technique includes the scintillation scanning of patien~s injected with relatively high energy, e.g. 131I labeled antibodies.
Such photoscanning or scintillation scanning provides scintigrams difficult to interpret because of blood pool background radioactivity. Computer subtraction of radioactive blood pool agents and the use of two labeled antibodies (one specific for the tumor and one non-specific) have been attempted to enhance imaging. Nevertheless, such techniques haYe been found to provide little, if any, useful information to the surgeon, especially over and aboYe CAT scans, magnetic resonance imagings, and like 20 traditional techniques. Typically, large tumor is readily located by the surgeon by vi~u~li7~tion at the ope~ating theater and, in particular, through palpation, i.e. the feel of a tumor as opposed to ~hat of normal tissue. To achieve operative success, however, it is necessary for the surgeon to somehow locate "occult" tumor, i.e. tumor which cannot be found by the conventional surgical procedure of sight and feel. Failure to locate and rcmove such occult tumor generally will result in the continued growth of cancer in the patient, a condition often rnisidentifled as "recurrent" cancer. In general, conventional diagnostic techniques as, for example, use of the classic gamrna camera and the like, fail to find or locate occult tumor. As tumor sites become smaller, the radionucleide concentrations at a given tumor site will tend to be lost, from an imaging 30 standpoint, in the background where blood pool radiation necessarily is present in the patient.
U S. Pat. No. 4,782,840, by Martin, M.D. and Thurston, Ph.D., entitled "Method for Locating, Dirrel enliating, and Removing Neoplasms, issued Nov. 8, 1988 reviews such scintillation sc~nning technique and discloses a much improvedmethod for locating, differenti~ting, and removing neoplasms. Such technique utilizes a radiolabeled ,~.

antibody and a portable radiation detection probe which the surgeon may use intraoperatively in order to detect sites of radioactivity. Because of the proximity of the detection probe to the labeled antibody, the faint radiation em~n~ting from neoplastic tissue at occult sites becomes detectable, for example, in part because of the inherent 5 application of the approximate inverse square law of radiation propagation. The procedure is known as the Radioimmunoguided Surgery~ system (Radioiml~ oguided Surgery being a trademark of Neoprobe Corporation, Columbus, Ohio) and is successful additionally because of a recognition that tumor detection should be delayed until the blood pool background of circulating radiolabeled antibody 10 has had an opportunity to be cleared from the body. As a consequence, the photon emiSsions or radiation emitted by minor tumors compared to surrounding tissue beco...es detect~ble in view of the proximity of the probe device to it. r~ ui~ously, the '840 patent discloses the ability of the radiolabeled antibody to remain bound to or ~csoci~teA with neoplastic tissue for extended periods of time with the radio tag still bound thereto. Moreover, even though the accretion of radioactivity at the tumor site decreases over time, the blood pool background and surrounding tissue (relative to the tumor sites) decrease at a much greater rate so that the radioactive sites can be determined readily uhli7ing a hand held probe positioned in close p~ y with the tissue under investigation.
Somewhat recently, laparoscopic surgery has become popular as an alternative to traditional operative procedures. Particularly with the development of video-based visual s,yslems, laparoscopic surgical techniques have been employed with more complic~teA gastr~intes~in~l procedures. Such procedures offer savings in total health care costs as a result of shorter hospital stays and a more rapid patient return to normal activity. However, these procedures require ins~-ulllelltation and technique supplanting conventional three-flim.oncional viewing and tactile feedback to the surgeon. Improved instrumentation particularly is called for where these newer surgical techniques are applied to the detection and removal of neoplastic tissue.
While a variety of laparoscopic instruments have been developed, such equipment falls into two broad categories: those major pieces of e~lui~ ent that enable the surgeon to perform laparoscopy and those instruments related to the performance of specific tasks or procedures, e.g. electrocautery and laser. Generally, visualization within peritoneal cavity requires "space" in which to shine light and maneuver. In a standard surgical approach or la~arotoll~y this space is created by opening the abdomen and allowing room light and air into the cavity to accommodate three-dimensionalviewing. In laparoscopic procedures, this is accomplished by filling the peritoneal cavity with a gas that distends the abdominal wall and provides an area for light and manipulation, a process termed "pneumoperitoneum". Carbon dioxide is the standard 21lO~
gas used for pneumoperitoneum. Pneumoperitoneum currently is carried out utilizing an i~lsll~l~nt referred to as an incuffl~tor.
Laparoscopic surgery generally features the establishment of one or more portals of entry into the abdominal cavity. Mech~nismc for inserting and removing 5 various instruments through these portals without loss of pneumoperitoneum arenecess~. ~. These ports are established by the insertion of a trochar tip through the skin of the patient in conjunction with a port defining cannula or sheath. The trocar is inserted through the lumen of the c~nn~ as an obturator. Typically, the c~nnul~c have a spring-loaded trumpet valve to permit the introduction of instruments into the10 abdom~n and prevent gas from escaping. Conventionally, the size of the cannula sleeve is 1 mm larger in ~ meter than the cc~lle~lJonding instrument that will traverse it.
Di~ for such ir~Llu~nts may reach, for example, 15 mm or larger in extent.
Employment of the laparoscopic surgical technique in conjunction with the surgical staging and resection of neoplastic tissue poses limitations heretofore not 15 encoul~tel-,d by the surgeon. As noted above, when engaged in treating colon and rectal cancer, the surgeon, in addition to such aids as the radioimmunoguided systems, also relies upon sight and palpation or feel to locate tumor. With laparoscopic surgical pl~lul~,s, sight is constrained to the two ~lim~oncions available at a video screen and palpation or feel essentially is lost. In effect, the surgeon is maneuvering along or 20 _anipulating tissue through elongate in~l,..,..e,.~ ;on from a distance of about 18 inches away. Thus, the detection and localization of neoplastic tissue calls for laparoscopic in~ ...el t~tion which effectively replaces palpation and three-dimensional viewing.
With such sup~l~ g in~ n~tion, the surgeon or surgical oncologist may not only seek to resect neoplastic tissue but properly stage cancer patients so that an ~pr~pliate 25 mode of therapy can be a~lminictered. The latter staging is particularly important in view of the National Institute of Health (NIH) consensus report concerning the aclminictration of adjuvant chemotherapy to appropriately staged patients. "NIH
Con~ ..c Conrel~l ce: Adjuvant Therapy for Patients with Colon and Rectal Cancer", JAMA, 1990, 264:1444-50.
Su~
The present invention is addressed to instruments for detecting and localizing sources of radiation emission and, particularly, to radiation detecting instruments employed for laparoscopic surgical procedures. Requisite response to locator retained 35 radioactive emissions at tumor sites is achieved with the instruments, while the constraints otherwise associated with the limited size of cannula port are accolll,l,odated. Because elongated instruments usually are inserted and maneuvered generally parallel with the body plane, a more effective utilization of the radiation emission detection technique has been developed through employment of a "side 2110~55~
looking" detector crystal mounting. With such mounting, the forward surface of thedetecting crystal is oriented generally transversely to the lengthwise extent of the in~ll u~ nt. Thus oriented, the detector may be of rectangular configuration, having a widthwise extent limited by the colrespondingly limited rli~m~ter of the instrument, but 5 a lengthwise extent selecteA to provide a raAi~tion conr,~ g surface of sufficient area.
Where c~Amillm telluride detectors are employed with the instrument, their noisegenerating microphonic attributes are controlled through an improved crystal mounting a~ it~~
Another feature of the invention is to provide a laparoscopic instrument 10 extensible through a cannula having a port of predetermined (iiameter for insertion within a body region for locating tissue from which locator based radiation is emitteA
The insl~ument includes a hand grippable base portion and an elongate ~cces.sing tube fixed to the base portion and ~ Pns;oned for slidable movement through the port. The accessing tube extends along a central axis to a tip with a length selected for accessing 15 the tissue and has a passageway extending thel~l}llvugh as well as a detector support portion including a window through which radiation may be I ~ d which extends inwardly from the tip. A crystal mount is provided having a crystal receiving portion positioned at the detector support portion to locate the receiving portion in adjacency with the window. A crystal having a lea~war~ surface is supported upon the crystal 20 receiving portion to position a fol ~ surface thereof in closely spaced ~dj~cen~y with the window and is responsive to radiation tr~n~mitted through the window generally transversely to the axis to derive a charge categorized output. An eleclTic~lly conductive contact arrangement is provided for applying an electrical bias to the crystal rearward surface and for conveying the charge categorized output, and at least one 25 preamplification stage is mounted within the accessing tube in adjacency with the crystal which has an input for receiving the conveyed charge categorized output and which derives an amplified output. An electrical tr~n~mi~cion arrangement is provided having one end coupled with the ~lealllplification stage for receiving the amplified output and applying the noted bias, and which extends along the passageway to an30 opposite end region at the base. Signal treatment and control then is provided which is connect~ble with the electrical tr~ncmicsiQn arrangement opposite end for providing the electrical bias and for receiving and electrically treating the amplified output to provided output signals.
Another feature of the invention provides an instrument for detecting and 35 locating sources of radiation emission. The insllument includes a cylindrical housing with an internally disposed chamber extending to a window region through which the radiation emission is tr~nsmissible. A crystal mount is provided which is positioned within the chamber and has a crystal receiving cavity with an interior surface and which is located in spaced adjacency with the window portion. An electrically insulative 211118~ 7 polymeric layer is positioned over the receiving cavity interior surface and an electrically conductive, deformable cushion layer with an upwardly disposed surface additionally having a lower disposed surface which is located in abutment with the electrically incul~tive layer and adhered thereto with an elastomeric adhesive. A
radiation responsive crystal is provided having a rearward surface freely abuttably positioned against the upwardly disposed surface of the electrically conductive,deformable cushion layer and which has an oppositely disposed forward surface located in closely spaced ~ cen~y with the window portion and which is responsive to the radiation tr~nsmitted through the window to derive a charge output. An electrically conductive contact arrangement is provided having a forward portion located intern~Ai~te the ele~trir~lly insulative polymeric layer and the lower disposed surface of the elect-rically conductive deformable cushion layer and which is adhesively retained in electrical contact with the lower disposed s~lrface. The contact arrangement applies electrical bias to the crystal l~wald surface and receives the charge output thel~rlvm.
A letailler arrangement is m-~mt~ upon the crystal mount in spaced ~rlj~ency with the window portion for co~ ~ssibly ret~ining the crystal against the upw~dly disposed surface of the electrically con~lctive deformable layer and a circuit arrangement is provided for applying the electrical bias through the contact arrangement and for receiving and electri~lly treating the charge OUtpUL
As a further feature, the invention provides a laparoscopic in~llulllent ext~ncible through a c~nnul~ having a port of ps~ele~ ,ninell diameter for insertion within a body region for detecting tissue at which a radiadon emitting locator is positioned. The instrument includes a hand grippable base portion and an elongate accessing tube~iim.oncioned for slidable movement through the port and which is fixed to the base pordon. The tube extends along an axis to a tip a length selected for accessing the tissue and has a detector support region including a substantially planar windowthrough which the radiation may be tr~ncmit~e~ and which extends inwardly from Lhe tip. A crystal mount is provided which is formed of radiation attenuating material and which is positioned within the detector support region and has a receiving cavity with an interior surface, the cavity being located in spaced adjacency with respect to the window. A c~minm telluride crystal having a rearward surface is mounted within the receiving cavity and has a forward surface which is positioned in spaced adjacency with the window and which is responsive to radiation transmitted therethrough generally transversely to the axis to derive an output. An electrically conductive contactarrangement is provided for applying electrical biac to the crystal rearward surface and for conveying the output. A grounding aTrangement is provided for applying electrical ground to the crystal forward surface and a signal tre~tment and control arrangement is provided for generating the electrical bias and ground and for receiving and electrically treating the output.
_5_ 2110857' Other objects of the invention will, in part, be obvious and will, in part, appear hereinafter.
The invention, accordingly, comprises the apparatus possessing the construction, combination of elements, and arrangement of parts which are exemplified S in the following det~ilerl disclosure.
For a fuller understanding of the nature and objects of the invention, referenceshould be had to the following detailed description taken in connection with theaccompanying drawings.

10 Brief Description of the Drawings Fig. 1 is a perspective view of a laparoscopic instrument according to the invention;
Fig. 2 is a side view of the instrument of Fig. 1 showing components therein in pl~nlo.--.
Fig. 3 is a partial sectional view of the in~l~u~ nt of Fig. l;
Fig. 4 is an exploded perspective view of a crystal and associated crystal mountemployed with the insl ull~nt of Fig. l;
Fig. 5 is a sectional view taken through the plane 5-5 shown in Fig. 3;
Fig. 6 is a graph showing the sensitivity of the instrument of Fig. 1 in counts per second with a ~list~nce of its detector com~ollent from a source of radiation;
Fig. 7 is a schcllJalic representation of a human body showing a laparoscopic utili7~ion of the ins~ ent of the invention;
Fig. 8 is a schematic representation of a human body showing another utili7~tion of the instrument of the invention;
Fig. 9 is a schematic representation of the instrument of Fig. 1 with the accesstube thereof in broken fashion showing an opposite side thereof;
Fig. 10 is a chart showing the sensitivity of the instrument of the invention when employed for longill-(lin~l and transverse sc~nning movement;
Figs. llA and llB combine as labeled to form a block diagram of the functional components of a signal treatment and control system associated with the ins~ "~"t of the invention;
Fig. 12 is an electrical schematic diagram of a preamplification function employed with the instrument of the invention;
Fig. 13 is a partial sectional view of an instrument according to the invention which is configured for detecting beta radiation emissions; and Fig. 14 is a sectional view of the instrument of Fig. 13 taken through the plane14-14 shown therein.

211~83 ~
Detailed Description The general RIGS procedure commences with the a lminictration to the patient of an effective amount of a radiolabelled locator which specifically binds a marker produced or associated with neoplastic tissue. A "locator" includes a substance which 5 ~l~,re.~nlially concentrates at tumor sites by binding with a marker (the cancer cell or product of the cancer, for example) produced by or associated with neoplastic tissue or neoplasms. Apl,rol,liate locators today primarily include antibodies (whole and monoclonal), antibody fragmentc, chimeric versions of whole antibodies and antibody fr~gm~nts, hnm~ni7~d versions thereof, as well as other tumor specific carriers, i.e.
10 locators. It should be appreciated, however, that single chain antibodies (SCAs such as disclosed in U.S. Pat. No. 4,946,778) and like substances have been developed and they pli~ily prove efficacious. Biochemistry and genetic engineering may yet produce sub~ces which mimic the function of antibodies in selectively concentrating at sites of neoplastic tissue, though such substances may not be subsumed within the 15 traditional definition of "antibody". "Locator" is a term chosen to include present day antibodies and equivalents thereof, as well as those substances yet to be determined which mimic antibodies in the method of the RIGS system.
An adaptation of radioimmunoguided surgical techniques (RIGS) to laparoscopic procedures involves a need to accommodate a variety of aspects associated 20 with each. The hand-held radiation detecting probe employed conventionally with the RIGS system is described in U.S. Pat. No. 5,070,878 by Denen, issued December 10, 1991, and assigned in common herewith. This probe utilizes a cadmium telluride crystal of adequate surface area which is mounted in a "forward looking" manner.Thus, as the probe is held by the surgeon, the window component thereof at the tip is 25 moved transversely along tissue being evaluated. Because the RIGS surgical approach is one wherein the extent of radiation em~n~ting from a carrier located at neoplastic tissue is quite faint, it becomes necessary that the crystal be of adequate surface area to capture s~lfficient radiation emissions. Of similar importance, because of the rapid fall-off of radiation as the crystal surface is moved away from that tissue region in30 consequence of the inverse square law of radiation propagation, it is essential that the surgeon m~int~in a close proximity between the crystal surface behind the probe window and the radioactive tissue. In effect, this application of the inverse square law of radiation propagation aids in sharply delineating the extent or boundaries ofneoplastic tissue. Collim~tors obviously are not employed with such a system where 35 low energy radiation is involved inasmuch as they would not sharpen the location of radiation but would lessen the number of received emissions from the faint radiation source at the tumor site. From the laparoscopic surgical standpoint, it is necessary that the laparoscopic instrument be maneuverable, having an access tube or the like of diameter limited by the port of a cannula, for example, less than 12 mm. In the development of the instant invention, it was determined that the latter diametricconstraint imposed u~lwallted limitations on the available surface area of a radiation detecting crystal such as cadmium telluride. As a folwar~ looking laparoscopic adaptation of the r~ tion ~etecting probe was employed, in addition to the low count S rates available with smaller diameter crystals, as the source of radiation wasapproached, usually in a longitudinal direction along the body cavity, instrument çesl)onse ~imini.ches as the crystal moves across the radiation source because of the shiel~ling positioned about the crystal itsel~ Transverse movement of the instrument within the body cavity, for example, from a vertical oriçnt~tion, represents a procedure 10 with serious limit~tions to the extent it is not desirable. Thus, the laparoscopic insl~ u~.lt iS l~Ui~ to be configured within the ~ metric constraints associated with its insGl~n through a c~nn~ and its solllGwllat hori70nt~l maneuvering within the body cavity. Next, the device must be capable of ret~ining a crystal such as cadmium-_inc-telluride for ~etection which has adequate surface area to achieve operationally effective radiation detecting sensitivity. This insllulllent then is called upon to locate neoplastic tissue through faint radiation emissions while being observed two-ncil?n~lly with a television camera which also is inserted through a c~nn~ into that same body cavity. In effect, the in~ll u~llellt is called upon to replace the su~geon's sense of touch and to support the surgeon's vision which now is restricted to two ~ ;o~s~
Referring to Fig. 1, a laparoscopic insllulllent incorporating the features of the invention is revealed in general at 10. In~l,ullRnt 10 includes a hand-grippablecylin-lric-~l base portion 12 to which an elongate accessing tube 14 is fixed. Accessing tube 14 is of a length convenient to the surgeon for accessing those regions of the abdomin~l cavity int~n~ed for neoplastic tissue detection and loc~li7~tion. This length may, for example, be about 14 inches (36 cm) and extends to a tip 16. Inwardly from this tip 16 there is a dct~clor support portion represented generally at 18 which extends to a union or joint l-,p~sented at line 20. Tube 14 is cylindrical, having an outer meter, for example, of 11 mm such that it is suitable for insertion through a conventional 12 mm diameter cannula port. This cylindrical configuration extendsthrough to the tip 16, however, the detector crystal mounted within the instrument 10 provides for "side looking" evaluation of impinging radiation. This is through a planar or flat window 22 located at the detector support portion 18 and which is seen to have a sol~ what elongate rectangular peripheral shape. The crystal detector which will be seen to be spaced but closely proximate the window n is operated in conjunction with signal tre~tmen~ and control circuitry which nltim~tely is coupled through a console mounted connector (not shown) to the in~llument 10 via a shielded flexible cable 24 e~le.ul;l-g from the hand-grippable base 12. In general, the control and signal treatment components are contained within a console to which the cable 24 leads and which is located out of the sterile surgical field. However, some signal treatment componentsare neceSSilA~e~ at the instrument 10 itself. Looking additionally to Fig. 2, a crystal mount arrangement is shown in general in phantom at 26 located within the accessing tube 14 at the detector support portion 18. T ~te~ in adjacency with the crystal mount 5 26 is a pre~mplifiration stage represented generally at 28. Depending upon theco~ nts of the size of the passageway within tube 14, it may be found apl)lvpliate to split the preamplification function of the instrument 10 into two components.
Accordingly, a fol~d stage 28 is positioned in proximity to crystal mount 26 andstage 28 then co.. ~ni~AIes, for exAmple, with shi~lde~l cable as represented by dashed 10 line 30 with a second or final preAmplifir~tio~ stage shown in phantom at 32 which is uunt~ within the hand-grippable base 12. Cable 24 is electrically connected with this last Amplific~~ion stage l~ led at 32.
Looking to Flgs. 3 and 4, the ~lluct~ing of the crystal mounting arrangement 26 is revealed at an enh~nce~ level of detail. In the figure, a crystal mount 34 which is 15 formed of a mAteriAl selected to ~ttennAte gamma radiation such as lead is provided which is ins~lt~d within the passageway of rod 14 at the detector ~UppOl~ portion 18.
This mount 34 is seen to be generally cylin~lricAl in shape with a flattened or truncated upwardly disposed surface 36 and a stepped down surface portion 38. Formed inwar~ly from the flat surface 36 is a rectangular crystal receiving and :>Up~JOl Lillg cavity 20 40. The mount 34 is seen to be positioned within a separate or discrete cylindrical tip co,ll~onenl 42 of the tube 14. In this regard, the ~~ onent 42 is seen to be flattened to define the window surface 22 and is slidably n~ leA over a stepped down surface 44 (Flg. 3) turned within tube 14. P~etçntio~l of this tip component 42 upon the stepped down surface 44, for example, is provided using an electrically conductive epoxy25 ce-m~nt. In this regard. the connection must be such as to assure no leakage of body fluids within the passageway 46 formed within tube 14. Note that the upwardly disl,osed flat surface 36 of the mount 34 is spaced in close A(lj~cency with the underside of the window com~nent 22 of tip co~ )onel-t 42. This permits the positioning of a radiation responsive crystal as close as possible to that surface window 22. Fig. 3 30 shows an opening or conduit 48 formed within the mount 34 which extends from an opening 50 within the f~dl ~d surface of mount 34 to a corresponding opening 54 at the bottom surface of cavity 40.
The confi~ ion thus depicted in connection with Figs. 3-5 is one intended for use in ~etecting locators labeled with gamma emitting radiation, and, particularly, 35 emitted from 125I which, for the surgical pelr ,. " ,~n- e contell~lated will be of very low energy level. Ca~minm-zinc-telluride detecting crystals are employed for this purpose.
Such crystals are ~IA~keted by Aurora Technologies, Inc., San Diego, California. For the present lal)alosc~ic instrument, it is desirable that the crystal used for detection have as large a surface area as is practical to improve counting efficiency. Preferably, g 211085~
that active surface area will be equivalent to the surface area of fc,~ looking crystal mounts as are used in conventional RIGS surgery. To achieve this requisite active surface area while m~int~ining necess~rily l~sn ;~ile~ in~ll u~ "t ~ meters, a rectangular cfl~lmillm-zinc-telluride crystal 60 is employed having a principal lengthwise (1im~nsion S in parallel with the central axis 62 of the tube 14. Because cfl-lminm telluride crystals exhibit microphonic (piezoelectric) effects, their mounting for the instant use requires a rigid avoidance of noise generated by rubbing or by the tr~n~micsion of acoustical noise or the like into the crystal 60 from its mou~ g environment. To achieve this requisite mounting with an avoidance of microphonic induced noise, the cavity 40 is initially 10 covered with an electrically insulative polymeric layer 64. Preferably, the layer 64 is formed of silicone, generally referred to as silicone rubber which is an elastomer in which the C linkages of a polymerized hydrocarbon are replaced by Si--O linkages. It is sold, for example, under the tr~(iem~rk "SILASTIC". In this regard, the layer 64 can be developed as a rect~ngul~r receptacle with a rectangular mold carFying a conve-ntion~l 15 mold release. A necessary electrical bias, for example at 60 v, is asserted at the rearward surface 66 of the crystal 60 by an electrical contact arrangement including multi-strand wire 68 seen extending from connecdon with a circuit board 70 in Fig. 3 and through the opening 50 of passageway 48 to opening 54 within the cavity 40.
From this opening 54, the plurality of strands of this wire are "spread out" over the 20 polymeric layer 64 as seen in general at 72 in Fig. 4. Additionally, positioned over the electrically insulative polymeric layer 64 at the bottom of the cavity 40 is an electrically conductive cushion layer 74 having a lower disposed surface 76 positioned over the strands 72 and upon the forwardly facing surface of layer 64. To avoid microphonically induced noise, this lower disposed surface 76 of the cushion layer 74 25 is adhered to the upper surface of the heat-stable silicone rubber. Additional amounts of the "SILASTIC" material may be used for this purpose. Advantagouesly, the electrically insulative elastomeric adhesive retains its elastic properties over time and high temperature conditions. With the arrangement thus shown, electrical bias, as well as electrical communication with respect to charge transfer is asserted from the contact 30 strands 72 into this electrically conductive cushion layer to its upwardly disposed surface 78. Preferably, the electrically conductive cushion layer 74 is provided as a non-woven TEFLON cloth which is carbon filled to the extent rendering it an effective conductor of electricity. In general, the m~t~ri~l iS a carbon CO~ g stretched, highly crystalline, -lnsintered polytetrafluoroethylene marketed under the trademark "Gore-35 Tex".
The lower or rearward surface 82 of the cadmium-zinc-telluride crystal 60 is freely abuttably positioned over the upwardly disposed surface 78 of electrically conductive cushion layer 74. No adhesive is employed in this union other than some of the silicone adhesive may migrate about the edge of the crystal 60 with beneficial effect.

.
21108~7 This positions the upwardly disposed surface of crystal 60 as at 84 in close adjacency with the underside of the window 22. To retain the assemblage of crystal 60 and associated mount in position, a thin elastomerically deformable sheet 86 is stretched over the assembly including the upwardly disposed surface 84 of crystal 60. ThisS co,ll~s~ibly urges the crystal downwardly to improve device perform~nce The thin sheet 86 may be provided as a carbon-filled rubber and thus serves the second purpose of asserting necessary ground at the surface 84 of crystal 60. Note in this regard, that in sln,~cl~ g the sheet 86 over the crystal 60, it is fastened by machine screw and washer combination 88 at the fol w~d or tip portion 90 of mount 34 seen in Fig. 3.
The opposite end of the sheet 86 is similarly fastened to surface 38 of mount 34 by a machine screw and washer aTrangement shown at 92 in Figs. 3 and 4. Ground is conveyed to the sheet 86 from the lead mount 34 which, in turn, is coupled to ground through the rOl wald stage 28 of the preamplifier function. Note that the circuit board 70 is seen a~he~ to surface 38 of mount 34 with a screw 94.
Thus mounted within the detector support region 18 of instrument 10, the upwardly disposed surface 84 of crystal 60 is spaced from the underside of window 22 by a very small gap 96 to avoid acoustic or vibrationally induced noise. However, the rli~t~n~e from the oulwardly disposed surface of window 22 to that upwardly disposed surface of crystal 60 is quite small, being, for example, less than 2 mm. This permits the upwardly disposed surface 84 of crystal 60 to be positioned in very close proximity to the tissue under investigation. It is the flatness of the window 22 within the generally cylin-lrir~l ins~lu~nt 10 which additionally permits this close positioning of the crystal to the tissue under investigation. Such distancing for the purpose of the operation of in~l,ument 10 is quite important in view of the low level of radiation involved and the noted approximate inverse square relationship of radiation propagation. Looking momentarily to Fig. 6, the sensitivity of instrument 10 with respect to ~ t~nce from a Mdiation source as may be encountered is revealed. Thefigure shows a curve 100 generated employing a 1 microcurie source (129I). That source gradually is positioned further and further away from the upward surface 84 of crystal 60. Note that at a 2 mm distance, ~ senting the equivalent of positioning the source right at the top surface of window 22, a count of about 3,000 counts per second is recognized. However, that initial count at the closest pl~ ity to window 22 is seen by curve 100 to drop to 2,000 counts per second at the close distance of about 4 mm from the source. This rapid fall-off demonstrates the importance of the flatness of window 22 and its close positioning in adjacency with the top surface 84 of crystal 60.
The effectiveness of the "side-looking" orientation of the crystal 60, i.e.
generally in parallel with axis 62 of instrument 10 may be recognized in connection with conventional laparoscopic procedures. Looking to Fig. 7, a schematic lepl~sel-tation of the human anatomy is provided.

- ~ilU8~

In Fig. 7, the holi~ontal body 110 is depicted having a liver region 112 in the vicinity of the rib cage. In this region is the gastrohepatic ligament with associated lymph nodes about the portal region of liver 112. These nodes are currently the subject of subst~nti~l interest on the part of those employing the RIGS system. Below the liver S region 112 is the colon. The colon is 12~200 cm long. The ascending colon is shown at 114 eYten-ling from the iliac fossa to the inferior surface of the liver 112. Then, the transverse colon 116 extends to the descending colon 118 thence to the sigmoid colon 120, the latter being suspended by its mesentery. In the figure, the instrument 10 is reproduced having been inserted through a cannula 122 located below the umbilicus.
The detector support portion 18 of instrument 10 is seen scanning somewhat horizontally both transversely and lon ihlclin~lly a tumor region 124 while being observed by a laparoscope or video camera 126 which has been inserted through cannula 128 above the llmb~ ruc~ Other ports typically will be opened within the body 110 following pnellmo~l ;IO!~e~J~ Thus, as the surgeon grasps the instrument 10 at its base 12, it is maneuvered about the region of interest while being observed in two-on~l color television at a video "- >nilo, po~itionF~l adjacent the surgical theater.
Fig. 8 shows a similar procedure in conjunction with a body representation utili7in~ the same null~ela~ion for identifir,~tion as shown in Fig.7. For this procedure, the in~llu~ nt 10 has been inserted through a c~nnnl~ 140 below the umbilicus but positioned so as to permit scanning of the descending colon 118, particularly with respect to a tumor region ~ sented at 142. To observe this sc~nning operation through a television monitor, the laparoscopic camera 126 is inserted through a cannula 144 such that it may be positioned to observe the detector support portion 18 ofi..sllu~ent 10 as it scans about the region of interest 142. It has been found desirable 25 to provide a visual televisedreadout of the rotational orientation of the in~llument 10 during such procedures. Looking momF nt~rily to Fig. 9, a thin line 146 may be seen to be engraved along the back surface of the ~cces.sing tube 14 including its detector support portion 18. This line may be observed by the video camera 126 and is seen to extend to the base portion 12 such that it may be observed also by the surgeon outside 30 of the body cavity. The line 146 is positioned along the instrument opposite the center of planar window 22.
Referring to Fig. 10, the output of the instrument 10 with respect to the noted transverse scanning and longitu~in~l sc~nning is revealed at respective curves 148 and 150. The same source and general set-up as described in connection with Fig. 6 was 35 used in a laboratory setting. The cadmium telluride crystal 60 employed with the instrument 10 had dimensions of 7 mm x 14 mm. To derive the curve 148 for a transverse scan, the source was moved from the center position of the window 22 and lw~dly therefrom. This center position, located at distance "0" shows a somewhatsharp peak in the resultant output in counts per second which may be expected from the shorter widthwise ~lim-~n~ion of the crystal. To derive curve 150, the outer tip 16 of the probe was established as a 0 position, thus the curve 150 is shifted with respect to curve 148 and exhibit~ a wider peak response which is in keeping with the greater principal longitudinal ,1;,~ ;on of the c~q.~lminm tellllri~e crystal 60.
Referring to Fig. llA and llB, a block diagr.qmmqtic representation of the signal lleaLu~ellt and control circuitry employed with instrument 10 is revealed. In Fig.
1 lA, that crystal which is being employed, for example crystal 60 as labelled, is shown having one face coupled to ground through line 157, while the opposite, biased face thereof is coupled via lines 158 and 159 to a bias filter represented at block 160. Bias filter 160 is part of the earlier-described Çolwd~ preamplification stage 28 herein identified in Fig. 1 lA by a dashed boundary with the same numeration. The input to the filta 160 is derived nltimqtely from cable 24 (~lg. 1) and is represented in Fig. 1 lA
at line 161 as being applied through that cable again represented by numeral 24. Line 158 collGsponds with line 68 earlier described in connection with Fig. 3 and supplies an appr~pliate bias, for exqmple, 60v to the le~ d surface of crystal 60. This bias emqnqtes from a power supply shown at block 162 in Fig. 1 lB and represented at line 163.
Line 158 from crystal 60 is shown e~ d;.~g to an integrator stage 164 of the first pre-qmplifier stage 28. The inte~ted vqll~qtion of a detected radiation disturbance or charge categorized signal then is shown dir~l~ as represented by line 165a to a driver-amplification network shown at block 166. Line 165a additionally is a part of the shielded cable 30 eyten~ing through the passageway 46 of access tube 14 to the second preamplificatiol- stage 32 within base 12 as described in connection with Fig. 2.
Cable 30 also may carry ground and +12v supply as shown, respectively, at lines 165b and 165c. The noted 12v power supply as l~resented at line 165c is derived for the driver amplifier stage 166 from the power supply 162 (Fig. 1 lB) as represented at line 167 which, as shown in Fig. 1 lA, is directed to a probe current network represented by block 168. Under microcolllpu~er control as represented by line 169, the network 168 develops signals, for example, detennining whether the probe instrument 10 has been properly connected to a console based control system described in detail in U.S.
Patent No. 4,801,803 (not shown). Delivery of the 12v power supply for the preamplifier stage 32 is l~lGsGIl~ed at line 170 as eYt~n-1ing to the driver-amplifier 166 via cable 24 and line 171.
Ground to the instrument 10 also is developed from the power supply block 162 as lGplesellted at line 172 shown in Fig. 1 lA as extending to cable 24 and via line 173 to the driver-amplification stage 166.
The output of the driver-amplification stage 166 is represented at line 174 extending through the cable 24 and then being represented as line 175 to the input of a nonn~ ing arnplifier l~lGsGIlted at block 176. The network represented by block 176 211~)85~

functions to amplify or attenuate, i.e. scale the noise characteristic of any given instrument 10 and normalize the value thereof or render it consistent for later comparison stages. Generally, for example, the 27 kev energy level gamma ray generated pulses in a system employing 125I will be about five times higher than noise S levels. Norm~li7ing amplifier network 176 will establish those noise levels at some predetermined level, for example, 200 millivolts, and the resultant proportional valid gamma related pulses will become about lv high for purposes of ensuing comparison functions. It may be observed that the amplifier network at block 176 is controlled from a digital-to-analog converter network represented at block 177 via line 178.
Network 177, in turn, is controlled from line 179 e~cten~ling, as shown in Fig. 1 lB, to block 180 representing a microcomputer network. The norm~li7ç~ output developed from network 176 is presented along lines 181 and 182 to a noise averager circuit as Sel~ at block 183. This network 183 determines an average amplitude value for the noise of a given system with a given instrument 10 and provides a corresponding signal as represented at line 184 (noise amp) which is employed as above described as information used by the microco~llpu~er 180. This information, in addition to being employed with the normali_ing amplifier network represented at block 176, may beused to develop a low window valuation for the comp~ison function.
Line 182 also extends via line 186 to a pulse acquire network represented at block 188. This network functions, when activated, by the microcc"l,~uler le~,csented at block 180, to acquire the value of the highest pulse amplitude witnessed at line 186.
Periodically, this information then is tr~n~mitte~ to the microco~llputer at block 180 as represented by line 190. Representing a form of peak detector, the network is sometim-o.s referred to as a "snapshot circuit". Also produced from line 182, as at line 192 and block 194, is a buffer amplif1er which will provide at line 196 an output representing received pulses which may be made available to the system, for example, at a console (not shown).
Line 181 extends, as shown at Fig. llB, at line 198, to one input of an upper window comparator represented at block 200 and a lower window comparator illustrated at block 202. The threshold level for comparative purposes employed by the network at block 202 is shown asserted from line 204 and, preferably, is developed by the logic of microcomputer network 180 at a level just above the noise amplitudesignals generated from line 184. Of course, manual setting of such windows can be carried out. In similar fashion, the upper window of acceptance for valid radiation interaction is established from a corresponding line 206. This threshold setting may be made from the information taken from pulse acquire network 188.
Returning to Fig. llA, the upper window and lower window threshold selections are made under the control of the microcomputer network at block 180 which controls the digital-to-analog network shown at block 177. It is the characteristic of 21108~7 such networks as at block 177 to provide an output which is comprised, for example, of 256 steps of varying amplitude. The percentage of increment~tion from step to step will vary somewhat over a range of voltage values provided. Accordingly, the outputs from this conversion network at block 177, as shown at lines 208 and 210 are directed to squarer networks shown, respectively, at blocks 212 and 214. These networks function to square the current outputs at lines 208 and 210 and thus achieve a uniform .cenlage incre~m~nt~tion of the threshold defining outputs at lines 204 and 206.Returning to Fig. 1 lB, the outputs of the com~aldtor networks shown at blocks 200 and 202 represent candidate pulses which may be above or below the given thresholds and are identified as being presented as "UW pulse" and "LW pulse" along respective lines 216 and 218. These lines are shown directed to a real time pulse c~ tor network represented at block 220 which carries out Boolean logic to ~etermine the presence or absence of valid pulses. Valid pulses are introduced to the miCrOCO~ Ut~l netWOlk 180 as represented by line 222.
The microco~ )uler l~lwolk represented at block 180 perforrns under a number of operational modes to provide both audio and visual outputs to aid the surgeon in loc.~ting and di~e,~ ting tumorous tissue. In the former regard, as lG~lGsellted at line 224 and block 226, a volume control function may be asserted with amplitude v~ri~tion~ controlled from a solid-state form of potentiometer represented at line 228 and block 230. Control to potentiometer 230 is represented at line 229. Further, a "siren" type of frequency variation may be asserted as represented at line 232 to an audio ~mplifi~tion circuit represented at block 234 for driving a speaker as represented at 236 and line 238. With the noted siren arrangement, the frequency output fromspeaker 236 increases as the insl,ulllellt 10 is moved closer to the situs of concentrated ra~ tion Of course, conventional clicks and beeps can be provided at the option of the operator.
The microcol~ule~ nelwolk 180, as represented by bus defining alTow 240 and block 242 also addresses an input-output network which, as represented at bus arrow 244, functions to provide a pulse count output of varying types as well as outputs representing volume levels, pulse height, noise levels, and battery status. These outputs are provided in visual format at a visual display represented at block 245.
Similarly, the input-output function represented at block 242 provides appropriate scanning of switches or the like may be employed with the control system and arel~)reSÇnte~1 by block 241 and bus input arrow 243. During a given counting operation, the microcomputer network at block 180 functions to control a light emitting diode drive network represented by block 246 from line 248. The drive network represented at block 246 is shown providing an input, as represented by line 250, to a light emitting diode (LED) display as represented by block 251. A serial output port of conventional variety also may be provided with the system, such ports being l~;plesellted at block 21108~7 252 being addressed from the microcolnpulcr represented at block 180 from line 254 and having output and input components lepl~ ser.led by arrow 256. A real time clock-c~lend~r having a non-volatile memory also may be provided in conjunction with the functions of the microcoll.puter network 180 as repl.,sellted by block 258 and bus-S arrow 260. Further, the microcompuLer may be employed to monitor the performance of the power supply represented at block 162. This is shown being carried out by the interaction of the microco--ll~ulel network with a multiplexer represented at block 262 and having an association represented by arrows 264 and 266. It may be observed that the power supply also provides a +Sv source for the logic level components of the circuit as lGp~se-nte~ by line 268; a -Sv source at line 270, as well as a -9v source at line 272 for purposes of display drive, and finally, a 2.5v reference as represented at line 274 to provide reference input for the pre~rnplifi~ation analog cilcuilly.
Returning to Fig. 1 lA, the microcollll,ul~ nelwo,h as represented at block 180 also provides an input to the digital-to-analog collvc;l~ion network represented at block 177 which corresponds with the instantaneous pulse rate and this information is conveyed to a pulse rate and this information is conveyed to a pulse rate amplifier network represented at block 276 via line 278. The res~llt~nt output, as represented at line 280, may be provided, for example, at a convenient location upon a console. This circuit l~l~,s~,.lt~d at block 276 also may be employed to ge.l~ate a calibrating pulse for testing the downstream components of the system. Thus, the microcomputer represented at block 180 applies a predetermined pulse level through the digital-to-analog conversion network at block 177 for plcselllation to the amplifier network r~lcsel led at block 276. The resultant output at line 282 is selectively switched, as l~lesented by block 284, to define pulse width from the microcolllpuler input at line 286 to the calibrating pulse at line 288.
Referring to Fig. 12, the dual stage preamplification function employed with theinstrument 10 is represented generally at 290. The preamplification function 290includes the earlier-described forward stage 28 which is coupled by a shielded connector 30 to a second stage again represented in general at 32. The circuit 290 is seen performing in conjunction with a radiation detecting crystal herein again represented at 60 and is seen to include a bias filtering com~nent as earlier described and again represented in general at 160 as well as an integrator component 164 again represented by that numeration. The components of the cable 30 are represented as described in conjunction with Fig. llA at lines 165a-165c. Bias, as before, is shown being provided from line 161. This bias is seen to be asserted through one side of crystal 30 through the bias filter 160 comprised of resistors R1, R2, and a capacitor C1. Capacitor C1 provides a local filter to remove any spurious noise which may be engendered in the line tr~nsmitting bias. The opposite face of crystal 60 is coupled to ground as represented by earlier-described line 165b. Crystal bias resistor R2 is ~11085i7 provided having a large resistance value, for example, about 50 megohms, a levelsel~cte~ to avoid absorbing current disturbances from the crystal. The input signal to the integration stage 164 is asserted through coupling capacitor C2 and line 292 to the gate input termin~l of a N-channel junction field effect transistor (JFET) Ql. Line 292 also is coupled via line 294 and bias resistor R3 to ground at line 165b. The resistance value at resistor R3 is selected co,--"un~ ately with the selection of resistance for resistor R2, preferably about 200 mrgaohmc to avoid signal absorption. Generally, the resi ct~nce for this CO~ )OI ellt will be selected between about 10 to 10,000 megaohms.
As an integrator component, the tr~ncistor Ql performs with stray capacitance and, additionally, in effect, o~l~les as a source follower charge amplifier, its purpose being to achieve an impeA~nce transÇo. ~ ;on from a very high impedance gate suited to low current and low noise. In general, the lFET structure exhibits lowest current noise at the room temperature operating condidons contemplated for the present instrument.
Further, these exhibit high frequency response (wide band width) as well as a high ~mplification factor or high transcon-luct~nr,e. In view of the latter aspect, the device tends to create a large current di~ b~lce at its source terminal at line 296. Line 296 e~ten~lc through a source load resistor R4 to ground line 165b. The resistor R4 functions as a d.c. current return device. The drain trrmin~l of transistor Ql is coupled to +12v supply at line 165c while the same terminal is decoupled or isolated by a filter compri~e~l of capacitor C4 and resistor R5.
The charge categorized output of stage 28 at line 165a is tr~ncmitte~ along the cable 30 and line 165a to the base of NPN, bipolar transistor Q2. Transistor Q2 performs a voltage amplification and a singular bipolar component is elected for this function in~cmllch as such devices exhibit low voltage noise characteristics at room t~,~l~ture. Additionally, the devices have a higher amplification factor availability than collGs~nding field effect transistors.
The degree of ~mp!ifir,~tion achievable with stage Q2 is related to the impedance exhibited with respect to its emitter and collector, i.e. the value of the collector load impedance divided by the emitter ;"~ nce. In the alTangement shown, the emitter of transistor Q2 is coupled via line 298 to ground through resistor R6 and is by-passed to ground via lines 298 and 300 through capacitor C5. The latter component exhibitsrelatively low impe~l~nce on the order of 25 ohms at the frequencies of interest. The collector of transistor Q2 is coupled with +12v supply via line 302. Line 302, in turn, is associated with a relatively high reci~t~nr,e value resistor R7 which is in series with a resistor R8. To enhance gain, an NPN transistor Q3 is coupled in a "bootstrap" circuit arrangement to raise its effective collector impedance to transistor Q2. In this regard, the base of transistor Q3 is coupled via line 304 to line 302, while the collector thereof at line 306 is couple;d to supply line 171 in conjunction with a decoupling filter comprised of resistor R9 and capacitor C7. The emitter of tr~n~i~tor Q3 is coupled to line 308 to ground through resistor R10 as well as via line 310 incorporating resistor Rl l and capacitor C6. This line 310 extends to a position int~.rrne~li~te resistors R7 and R8. Transistor Q3 functions as an emitter follower, feeding the noted junction between resistors R7 and R8 through resistor Rl l and capacitor C6 in bootsllappi-lg fashion.
S Resistor Rl l is incorporated in the cireuit to damp the positive feeclb~ lr and lower gain otherwise elevated due to the stage separation of the preamplification function 290.
Transistors Q2 and Q3 may be considered to partieipate in the integration function 164, however, for the instant description, they are ineorporated within what has beenreferred to as a driver amplifier function 166. The signal at line 308 is applied through resistor R12 and eapacitor C9 to the base of an NPN transistor Q4 whieh forms one eomponent of an amplification stage in conjunction with PNP tr~n~i~tor Q5. This A.C.
voltage amplifier comprises few components and exhibits high gain and broad bandwidth charaeteristies. Beeause the gamma ray interaction at erystal 60 will exhibit a frequency disturbance spectrum ranging from about 50 KHz to 200 KHz, the frequency response of this amplification component is tailored accordingly. For example, the high end roll-off of the response is est~ he~l by resistor R10 within line 308 and capacitor C8 within line 310.
A voltage bias to the base of tr~n~istor Q4 is provided via line 312 from supplyfollowing its division by divider resistors R13 and R14. This bias input, amounting to about 1/4 of the supply voltage is treated by the filter combination of resistor R9 and capaeitor C7.
The 12v power supply additionally is filtered by a pi filter comprised of capacitors C10 and C12 along with resistor R15 as coupled within line 314. Line 314, in turn, is seen to extend via line 316 to the emitter of transistor Q5 and through resistor R16 to the base thereof as well as to the eollector of transistor Q4. Correspondingly, the emitter of transistor Q4 extends via lines 318, 320, and 322 to resistor R17 and the eolleetor of transistor Q5 as well as to resistor R18. The output of the preamplifier funetion 290 is provided at earlier-described line 174 ineorporating resistor R19. The gain of this output stage is set by resistor R20 in eonjunction with resistor R17, while capacitor C11 aids in the setting of low frequency roll-off for the amplifier component.
The high frequency roll-off characteristic is further aided by the combination of resistor R12 and capaeitor C13, the latter component being coupled between line 324 and ground via line 326. Low end roll-off characteristics for the amplification stage further are aided by the combination of capaeitor C5 and resistor R6.
For the RIGS surgical procedure, in addition to the Utili7~hon of radioisotope tags emitting gamma radiation, radioisotopes emitting beta radiation additionally can be used in conjunction with the laparoscopie instrument of the invention. However, the in~ll u~l~nt will employ a crystal semi-eonductor responsive to beta radiation emissions ~llO~

or positrons. Beta radiation responsive devices intended for interoperative use are disclosed, for example, in U.S. Pat. No. 5,008,546.
In the discourse to follow, instrument components common to figures 1-5 are identified with the same numeration in Figs. 13 and 14. While the surgical technique 5 utili7ing a laparoscopic probe instrument remains the same, the beta responsive device will be altered; however, it will be able to perform with the same ~u~vllillg circuitry.
Referring to Fig. 13 and 14, the insllument 10 is revealed having an access tube14 as before incorporating a passageway 46 and at least one initial stage of a pre-amplification function as represented at 28 in conjunction with a thin elongate circuit board 340. The detector support portion 18 of the instrument 10 now is configured som.,~. l.at differently, having an outer cylindrical support housing 342 which may be formed of aluminum or plastic and which is attached to a surface 344 of reduced m~ot~r at the end of tube 14. In general, the housing 342 is attached by an epoxy adhesive which, for the present embodiment, should be electrically conductive.
Housing 342 forms a tip 346 and extending inwardly from that tip in generally parallel relationship with the central axis 348 of the instrument is a rectangular opening 350 defined by the peripheral edges as at 352. Over this opening 350 there is positioned a thin polymeric cover 354 having a thickness, for example, of 4 mils and being vapor coated with aluminum to provide opacity within the interior of the housing 342 while 20 l~ ini~g substantially tr~n~rni~sive to beta radiation to define a window at opening 350. The cover 354 may be p~vided as a thin polyester, for example, such as that sold under the tr~dem~rk "Mylar". Preferably, a detector or crystal component is selected which is responsive to beta or positron emissions while remaining non-responsive to gamma radiation. Such a component may be provided as a silicon crystal configured 25 with a PN junction, the latter being reverse biased to evoke a depletion layer. Such a crystal is represented in the figure at 356 positioned within a rectangular cavity 358 formed within a crystal mount 360. Mount 360 is fashioned of a material which attenuates beta radiation without the generation of secondary X-rays. Accordingly, the device is made of a plastic or the like and specifically not a heavy metal such as lead. A
30 polyc~l~onate may be used for the purpose of device 360. Mount 360 appears quite similar to that described at 34 having a flat upper surface 362 which is again stepped down at 364 for the purpose of supporting elongate circuit board 340 through a screw connection 366. As before, a conduit 368 extends through mount 360 from an opening 370 within the passageway 46 to an opening 372 at the bottom center of cavity 358.
35 Silicon device 356 will not exhibit the microphonic noise effects of a cadmium telluride device, consequently, its mounting is somewhat simplified. In this regard, a silicone or silicone rubber layer 374 is formed along the walls of cavity 358, for example, as before, utilizing a mold and mold release. Connection of the lower crystal surface 380 of silicon crystal 356 with a biasing lead as at 376 may be provided through an electrically conductive adhesive or by thermal compressive bonding. In similar fashion, the ground connection to the upper surface 382 of crystal 356 may be provided by an ~ min~lm wire as at 378. Aluminum is used for this purpose to avoid X-ray generation and may be coupled into surface 382 by thermal compression bonding.
Sinee eertain ehanges may be made in the above-deseribed apparatus without departing from the scope of the invention herein involved, it is intended that all matter contained in the deseription thereof or shown in the accolllpanying drawings shall be int~ ed as illustrative and not in a limitin~ sense.

Claims (22)

1. An instrument for detecting and locating sources of radiation emission, comprising:
a cylindrical housing with an internally disposed chamber extending to a window portion through which said radiation emission is transmissible;
a crystal mount positioned with said chamber and having a crystal receiving cavity with an interior surface and located in spaced adjacency with said window portion;
an electrically insulative polymeric layer positioned over said receiving cavity interior surface;
an electrically conductive deformable cushion layer with an upwardly disposed surface, said layer having a lower disposed surface which is located in abutment with said electrically insulative layer;
a radiation responsive crystal having a rearward surface freely abuttably positioned upon said upwardly disposed surface of said electrically conductive, deformable cushion layer, and having an oppositely disposed forward surface located in closely spaced adjacency with said window portion and responsive to said radiation transmitted therethrough to derive a charge output;
electrically conductive contact means having a forward portion located intermediate said electrically insulative polymeric layer and said lower disposed surface of said electrically conductive deformable cushion layer and retained in electrical contact with said lower disposed surface, for applying electrical bias to said crystal rearward surface and for receiving said charge output;
retainer means mounted upon said crystal mount in spaced adjacency with said window portion for compressibly retaining said crystal against said upwardly disposed surface of said electrically conductive deformable layer; and circuit means for applying said electrical bias through said contact means and for receiving and electrically treating said charge output.
2. The instrument of claim 1 in which said retainer means is a thin, elastomeric retainer mounted in tension over said crystal forward surface.
3. The instrument of claim 2 in which said elastomeric retainer is a thin, electrically conductive elastomeric sheet configured for asserting electrical ground.
4. The instrument of claim 1 in which said cylindrical housing extends along a longitudinal axis to a tip and said window region is planar and extends rearwardly from said tip in parallel relationship with said axis.
5. The instrument of claim 1 in which said electrically insulative elastomeric layer is silicone rubber.
6. The instrument of claim 1 in which said electrically conductive deformable cushion layer is a carbon-filled non-woven polytetrafluoroethylene cloth.
7. The instrument of claim 1 in which said thin, elastomeric retainer is an electrically conductive carbon filled rubber sheet configured for asserting electrical ground.
8. A laparoscopic instrument extensible through a cannula having a port of predetermined diameter for insertion within a body region for detecting tissue at which a radiation emitting locator is positioned, comprising:
a hand grippable base portion;
an elongate accessing tube dimensioned for slidable movement through said port, fixed to said base portion, extending along an axis to a tip a length selected for accessing said tissue, having a detector support region including a substantially planar window through which said radiation may be transmitted extending inwardlyfrom said tip;
a crystal mount formed of radiation attenuating material positioned within said detector support region having a receiving cavity with an interior surface, said cavity being located in spaced adjacency with said window;
a cadmium telluride crystal having a rearward surface mounted within said receiving cavity a forward surface positioned in spaced adjacency with saidwindow and responsive to radiation transmitted therethrough generally transversely to said axis to derive an output;
electrically conductive contact means for applying electrical bias to said crystal rearward surface and for conveying said output;
grounding means for applying electrical ground to said crystal forward surface; and signal treatment and control means for providing said electrical bias and ground and for receiving and electrically treating said output.
9. The laparoscopic instrument of claim 8 including:
an electrically insulative polymeric layer positioned over said receiving cavity interior surface; and an electrically conductive deformable cushion layer with an upwardly disposed surface and having a lower disposed surface located in abutment with said electrically insulative layer and said electrically conductive contact means, said upwardly disposed surface being in freely abutting contact with said crystal rearward surface and conveying said electrical bias thereto.
10. The laparoscopic instrument of claim 9 in which said electrically conductive deformable cushion layer lower disposed surface is adhered to said contact means and said electrically insulative polymeric layer with an elastomeric adhesive.
11. The laparoscopic instrument of claim 10 including a thin, elastomeric retainer mounted in tension over said crystal forward surface for compressibly retaining said crystal against said upwardly disposed surface of said electrically conductive deformable cushion layer.
12. The laparoscopic instrument of claim 11 in which said elastomeric retainer is a component of said grounding means and comprises a thin, electrically conductive elastomeric sheet asserting ground at said crystal forward surface.
13. The laparoscopic instrument of claim 9 in which said crystal is of generally elongate rectangular shape having a longitudinal principal dimension parallel with said axis.
14. A laparoscopic instrument extensible through a cannula having a port of predetermined diameter for insertion within a body region for locating tissue from which locator based radiation is emitted, comprising:
a hand grippable base portion;
an elongate accessing tube fixed to said base portion, dimensioned for slideable movement through said port, extending along a central axis to a tip a length selected for accessing said tissue, having a passageway extending therethrough, and a detector support portion, including a window through which said radiation may betransmitted, extending inwardly from said tip;
a crystal mount having a crystal receiving portion positioned at said detector support portion to locate said receiving portion in adjacency with said window;
a crystal, having a rearward surface supported upon said crystal receiving portion to position a forward surface thereof in closely spaced adjacency with said window and responsive to said radiation transmitted therethrough generally transversely to said axis to derive a charge categorized output;
electrically conductive contact means for applying an electrical bias to said crystal rearward surface and for conveying said charge categorized output;

at least one pre-amplification stage mounted within said accessing tube in adjacency with said crystal, having an input for receiving said conveyed charge categorized output and deriving an amplified output;
electrical transmission means having one end coupled with said pre-amplification stage for receiving said amplified output and applying said bias and which extends along said passageway to an opposite end region at said base; and signal treatment and control means connectable with said electrical transmission means opposite end for providing said electrical bias and for receiving and electrically treating said amplified output to provide output signals.
15. The laparoscopic instrument of claim 14 in which said window is flat, having an inwardly disposed surface located in closely spaced adjacency with said crystal forward surface so as to permit a positioning of said forward surface in close proximity with said tissue to enhance the detection of said emitted radiation.
16. The laparoscopic instrument of claim 14 in which:
said pre-amplification stage is mounted within said tube passageway and effects a filtering of said electrical bias applied to said crystal from said contact means and in integration of said charge categorized output; and said signal treatment and control means includes a second pre-amplification stage positioned in the vicinity of said base and coupled with said transmission means opposite end for effecting supplementary amplification of said amplified output.
17. The laparoscopic instrument of claim 16 in which said second pre-amplification stage is mounted within said hand graspable base.
18. The laparoscopic instrument of claim 14 in which:
said crystal is formed of cadmium telluride;
said crystal mount is formed of a gamma radiation attenuating material said receiving portion of said crystal mount includes a cavity having an interior surface, an electrically insulative polymeric layer positioned over said interior surface an electrically conductive deformable cushion layer with an upwardly disposed surface and having a lower disposed surface located in abutment with said electrically insulative elastomeric layer and adhered thereto with an elastomeric adhesive;
said electrically conductive contact means having a forward portion located intermediate said electrically insulative deformable elastomeric layer and said lower disposed surface of said electrically conductive deformable cushion layer and adhesively retained in electrical contact with said lower disposed surface by said elastomleric adhesive;
said crystal rearward surface is located in abutting relationship upon said electrically insulative deformable cushion layer upwardly disposed surface; and including a thin, elastomeric retainer mounted in tension over said crystal forward surface for compressibly retaining said crystal against said upwardly disposed surface of said electrically conductive deformable cushion layer.
19. The laparoscopic instrument of claim 18 in which said elastomeric retainer is a thin electrically conductive elastomeric sheet configured for asserting electrical ground at said crystal forward surface.
20. The laparoscopic instrument of claim 14 in which said crystal is of generally elongate rectangular shape having a longitudinal principal dimension parallel with said axis.
21. The laparoscopic instrument of claim 14 in which:
said crystal is formed to respond to Beta radiation emission to produce said charge categorized output;
said crystal mount is formed of a polymeric material selected for attenuating Beta radiation without a propagation of X-rays.
22. The laparoscopic instrument of claim 21 in which said window is thin, flat material substantially transmissive of Beta radiation, having an inwardly disposed surface located in close adjacency with said crystal forward surface so as to permit a positioning of said forward surface in close proximity with said tissue to enhance the detection of said emitted radiation.
CA002110857A 1992-12-18 1993-12-07 Radiation responsive laparoscopic instrument Expired - Lifetime CA2110857C (en)

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US07/992,617 US5429133A (en) 1992-12-18 1992-12-18 Radiation responsive laparoscopic instrument
US07/992,617 1992-12-18
US08/214,814 US5383456A (en) 1992-12-18 1994-03-17 Radiation-based laparoscopic method for determining treatment modality

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DE69323166T2 (en) 1999-06-24
EP0603110A2 (en) 1994-06-22
IL112902A0 (en) 1995-06-29
EP0603110B1 (en) 1999-01-20
DE69323166D1 (en) 1999-03-04
AU5259493A (en) 1994-06-30
MX9400056A (en) 1994-07-29
KR100186784B1 (en) 1999-04-01
EP0603110A3 (en) 1995-02-01
US5383456A (en) 1995-01-24
ES2128408T3 (en) 1999-05-16
AU678334B2 (en) 1997-05-22
AU669236B2 (en) 1996-05-30
IL112902A (en) 1998-02-22
CA2110857A1 (en) 1994-06-19
KR940013458A (en) 1994-07-15
IL107920A (en) 1998-02-22
ATE175855T1 (en) 1999-02-15
US5429133A (en) 1995-07-04
IL107920A0 (en) 1994-04-12
JP2816642B2 (en) 1998-10-27
CA2144821A1 (en) 1995-09-18
AU1488195A (en) 1995-05-25
JPH06258440A (en) 1994-09-16

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