WO2001080738A1 - Surgical targeting system - Google Patents
Surgical targeting system Download PDFInfo
- Publication number
- WO2001080738A1 WO2001080738A1 PCT/US2001/012691 US0112691W WO0180738A1 WO 2001080738 A1 WO2001080738 A1 WO 2001080738A1 US 0112691 W US0112691 W US 0112691W WO 0180738 A1 WO0180738 A1 WO 0180738A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- drape
- indicia
- radiographic image
- relative
- image
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/50—Clinical applications
- A61B6/502—Clinical applications involving diagnosis of breast, i.e. mammography
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/44—Constructional features of apparatus for radiation diagnosis
- A61B6/4423—Constructional features of apparatus for radiation diagnosis related to hygiene or sterilisation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/50—Clinical applications
- A61B6/505—Clinical applications involving diagnosis of bone
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
- A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
- A61B5/1076—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions inside body cavities, e.g. using catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
- A61B6/58—Testing, adjusting or calibrating apparatus or devices for radiation diagnosis
- A61B6/582—Calibration
- A61B6/583—Calibration using calibration phantoms
Definitions
- the surgical targeting system of the present invention is a device that allows the surgeon to intraoperatively pinpoint a location as well as the surgical corridor for accessing that location within the confines of the human body using fluoroscopy or other radiographic imaging modalities while maintaining and safeguarding a sterile surgical field. If there is a visible laser light beam (parallel to the beam of the X-ray) on the emitter and receiver tube of the C-arm fluoroscope, the device also enables the operator to obtain projections or fluoroscopic views or X-rays identical to one gotten earlier in a procedure during which multiple other intervening views have been taken.
- a desired target site may be transferred directly to the corresponding exterior location on the patient.
- the point of skin incision as well as the angle of incidence of the surgical corridor (for instrument or implant placement) are given by the locus on the grid and the direction of the radiographic/fluoroscopic beam (which can be altered in three dimensions).
- the operator may take advantage of a parallax effect for more precise targeting and the corridor can be "visualized" or determined by the surgeon in three dimensions.
- a specific locus which simultaneously resides between the imaged surgical targeting systems can be percutaneously accessed via the collinear corridor given by the direction of the fluoroscopic X- ray beam, and the near and far surgical targeting system grid coordinates.
- the depth of advancement of the surgical instrument or implant is given by a fluoroscopic/X-ray view (with overlying surgical targeting grid) taken at right angles to the first.
- the assessment of colinearity can be accomplished by applying the surgical targeting grid of the present invention so that it is collinear with the proximal femur on the lateral aspect (this may require C-arm fluoroscopic X-ray check during the act of grid placement, with extension of the placement cephalad as far as the buttock) as well placement of a second grid on the anterior aspect with extension cephalad as far as the buttock at which point it overlaps the first surgical targeting system.
- the start point on the skin is given by the intersection of these two rows on the surface of the buttock area. This is of special importance in percutaneous intramedullary nailing procedures, where the selection of an incision point which is not collinear with the proximal femur may cause tenting of a large cuff of soft tissue during the procedure and may necessitate extension of a small incision.
- Finding this point on the skin might otherwise entail multiple fluoroscopic X-ray views, each of which impart radiation exposure to the patient as well as the surgeon and other operating room personnel.
- An additional point is that accurate location of this point permits a small skin incision and this, with healing becomes a small scar which, if later extraction of the device is opted for, facilitates the accomplishment of the procedure, again, as a percutaneous one (with a limited incision whose locus is given by the existing scar).
- Another example of the utility of the system of the present invention is provided by the procedure of reamed femoral intramedullary nailing.
- Additional spot fluoroscopic views of the fracture with an overlying radiopaque object (such as a hemostat clamp, such as for clamping a blood vessel) gives the needed answer and prompts the surgeon to rotate the guidewire so that its tip is toward the intramedullary canal on the displaced fragment before advancing the wire down the fragment's canal.
- an overlying radiopaque object such as a hemostat clamp, such as for clamping a blood vessel
- obtaining additional fluoroscopic X-rays for this purpose are unnecessary.
- the added advantageous factor is that the surgeon need not place his hand near the radiation beam with the surgical instrument (this is an occupational hazzard for many surgeons).
- U.S. Patent 5,702,128 discloses a radiographic marker system and method of making it. The entire disclosure of U.S. Patent 5,702,128 is hereby incorporated by reference herein.
- U.S. Patent 5,052,035 (referred to herein as the '"035 patent") discloses image location marking devices for radiographs, a method of marking and methods of use. The entire disclosure of U.S. Patent
- the device disclosed in the '035 patent produces multiple parallel lines on an X-ray film bearing a radiographic image of a patient's body to facilitate the location of a part of the body or a retained foreign body or implant within that image.
- the device comprises a flexible substrate formed of a porous, translucent or transparent material having lines of a radiopaque material disposed thereon.
- CT computed tomography
- the device is used by applying it over a selected portion of the patient's body to be X-rayed or scanned using computed tomography (CT).
- CT computed tomography
- the resulting radiographic image of the selected portion of the person's body thus has indicator lines crossing it, which facilitates the demarcation of a desired portion of that image.
- a marking instrument i.e., a marking pen, can be applied to the substrate at predetermined locations thereon while the device is on the person to mark the body at the selected location.
- the device disclosed in the '035 patent is non-sterile and, therefore, can only be used in a non-sterile environment. Once the corresponding location has been marked on the patient's body, the device disclosed in the '035 patent is removed and discarded. The biopsy is then carried out normally using the mark placed on the skin as a reference point. If the surgeon would like to take another image with the device disclosed in the '035 patent in place, he would have to compromise the sterile field by replacing the device.
- the loban® drape is a thin, flexible, adhesive sheet of plastic designed for use during a surgical procedure.
- the loban® drape is 100% impervious to liquid and bacteria, but permeable to oxygen and moisture vapor. Accordingly, a drape that is impervious to liquid strike through or fluid flow through it is an important feature of this device of the present invention.
- a drape that allows fluid transfer, and thus bacterial transfer compromises the sterile field. This, in turn, potentially increases the risk of wound infection.
- active antimicrobial on the skin in the operative field is a desirable feature.
- the inclusion of an antiseptic coating on the drape of the present invention exposed to the skin provides an additional safeguard against infection.
- the sterile loban® drape of the present invention is stretched over the area to be incised.
- the designed function of the loban® drape is to provide an added sterile and antiseptic protective barrier within the surgical field placed on the patient's skin and the adjacent operating environment.
- the loban® drape's adhesive properties are often used as a means of securing the sterile drapes or towels to the margins of the surgical field.
- This invention consists of a thin radiolucent sheet of translucent or transparent material upon which is located a series of radiographically dense numbered and/or lettered lines or otherwise distinguishable markings.
- a series of radiographically dense numbered and/or lettered lines or otherwise distinguishable markings One possibility is to dispose a set of lines at regular intervals and a second set of similarly disposed radiographically dense numbered and/or lettered lines are at right angles to the first, so as to form a series of small distinguishable quadrants or intersecting points, i.e., a grid.
- Many patterns for the design of these patterns are possible, depending on the particular application. These lines as well as their labels are readily seen directly when applied to the patient's body and are also clearly visible when the area to which they are applied is imaged with fluoroscopic x-rays.
- the sheet is sterile and the side that is applied to the patient's skin has a uniform distribution of adhesive (although the amount of adhesive is contingent on the specific application). Additionally, the side of the drape applied to the patient's skin also may have a topical antiseptic.
- the sheet comes with a second layer on the adhesive side, which readily peels off and allows for application of the adherent portion of the targeting grid sheet to the skin of the patient.
- Application of the surgical targeting grid to the surface of the body permits a more accurate localization of radiodense structures or bodies within the zone of targeting by fluoroscopic or radiographic imaging.
- a surgical instrument or implant can be directed to the target tissue or target object by taking advantage of the surgical targeting system in several ways.
- the surgical targeting sheet around the portion of the body to be imaged in a hemicircumferential or circumferential manner, two grids (on opposite sides of the body or body part or in different planes from each other e.g., the lateral side and anterior surface of the thorax) can be simultaneously utilized to locate a lesion or a structure.
- Advantage can thus be taken of the parallax effect of two grids, with one being disposed on the near (to the receiver tube of fluoroscope
- Determination of depth and relative angle of passage can be ascertained by a grid and corresponding fluoroscopic image or X-ray of the target or passing instrument or implant at right angles to the parallel near and far grids.
- Overlapping near and far (located on opposite sides of the body or limb) grids can also be utilized in enabling the operator to exactly duplicate a fluoroscopic/X-ray view that was gotten earlier in a procedure. This can occur by making note of overlapping near and far grid coordinates on the view of interest gotten prior. Duplicating this angle of fluoroscopic incident beam can be done by fulfilling this same requirement getting the prior noted grid coordinates to overlap on each other on the hnage.
- Possible methodologies to assure consistent angle of incidence of the fluoroscopic beam can also be facilitated by having a visible laser light beam emanating from an adjustable position on the fluoroscopic emitter tube (X-ray tube) in a direction parallel to the fluoroscopic/X-ray beam. Co-locating the target, the grid marking and the incident visible laser from the emitter tube will allow for more accurate placement of instrument/implant. Once the co-location of the three has occurred (target, grid marking and incident laser light, the operator starts the passage of the mstrument/implant at the skin surface at the grid marking which overlies the target on the fluoroscopic view, and maintains the mstrument during the course of its passage in line with the incident laser beam.
- Additional accuracy can be gotten by way of the same technique, but utilizing two surgical targeting grids and having the laser light beam from the receiver tube (also parallel to the fluoroscopic/X-ray beam) centered at the overlapping far grid coordinate on the opposite side of the body/body part.
- the surgical targeting system of the present invention provides a series of coordinates/ lines within a sheet of sterile, flexible material with an adherent surface which is applied to the skin (after suitable surgical preparation).
- the sheet is non-porous and may have a topical antiseptic on the side which is applied to the skin.
- a fluoroscope or roentgenographic image of the portion of the body to which the adherent fihn is applied will show the underlying skeletal and radiopaque elements as well as the overlying surgical grid.
- the coordinates on the grid lines are clearly visible on the surface of the skin as well as on the fluoroscopic or radiographic image and by knowing the direction of the fluoroscopic or radiographic beam, the operator will be able to thereby correlate a specific locus on the skin with an underlying skeletal element or other underlying radiopaque structure.
- the directional pathway between the two points is given by the direction of the incident radiographic/ fluoroscopic beam.
- two loci-one on the set near the receiving tube of the fluoroscope (or the developing cassette or "film” of the roentgenograph), and one set of coordinates corresponding to the set on the opposite side of the body or imaged body part, e.g., a limb can be utilized.
- the targeted zone's relationship to the overlying near and far coordinates their colinearity can be taken advantage of by the operator for targeting, since both far and near grid coordinates are clearly visible on the surface of the patient's body.
- a third grid at right angles to the parallel far and near grids can be used to assess depth of advancement of the mstrument or probe or biopsy tool to assure the placement of the tip of the device in the target tissue (or implant or foreign body).
- the operator is not limited to one surgical corridor by this technique. Any number of potential surgical corridors can be located by varying the angle of the incident fluoroscopic or x-ray beam and then noting the overlying far and near grid coordinates.
- FIG. 1 is an anterior view of an embodiment of the surgical targeting system of the present invention applied to the torso of a body;
- Fig. 2 is a view of a radiographic image of the torso of Fig. 1 with the surgical targeting grid and skeletal elements visible;
- Figs. 3, 4 and 5 are views in the plane of Fig. 1 showing alternative rectangular coordinate configurations of the radiopaque elements of the surgical targeting system;
- Fig. 6 is an anterior view of the surgical targeting system of Fig. 1 applied to the torso;
- Fig. 7 is a lateral view of the surgical targeting system of Fig. 6 with the patient lying supme on the operating table
- Fig. 8 is an anterior view of the surgical targeting system of Fig. 6 with the patient lying supine on the operating table and viewed from above (anterior aspect);
- Fig. 9 is a superior view of the surgical targeting system of Fig. 6 with the patient lying on the operating room table from above with the emitter and receiving tubes of a C-arm fluoroscope depicted in position to obtain a lateral view of the targeted area;
- Fig. 10 is a view of a C-arm fluoroscopic image obtained from the apparatus depicted in Fig. 9;
- Fig. 11 is a superior view of the surgical targeting system of Fig. 6 with the patient lying on the operating room table from above with the emitter and receiving tubes of a C-arm fluoroscope depicted in position to obtain an anterior to posterior view of the targeted area;
- Fig. 12 is a view of a C-arm fluoroscopic image obtained from the apparatus depicted in Fig. 11;
- Fig. 13 is an anterior view of a lower trunk with the surgical targeting system of Fig. 1 applied to the anterior aspect as well as both sides, the emitter and receiving tubes of a C-arm fluoroscope being depicted in position for a lateral view of the targeted area;
- Fig. 14 is a lateral view of the surgical targeting system applied to the lower trunk of Fig. 13 from the lateral (side) aspect, the emitter and receiving tubes of a C-arm fluoroscope being depicted in position for an anteroposterior view of the targeted area;
- Fig. 15 is a view of the fluoroscopic image of the sacral elements and overlapping near and far surgical targeting grids obtained from the apparatus depicted in Fig. 13;
- Fig. 16 is a view of the fluoroscopic view of the skeletal elements and overlying surgical targeting grid obtained from the apparatus depicted in Fig. 14, the position of an iliosacral screw used to address an unstable sacroiliac joint also being shown;
- Fig. 17 is a medial (inner) aspect view of the surgical targeting system of
- Fig. 1 applied from the mid-thigh to mid-leg levels of a lower limb
- Fig. 18 is an anterior (front) aspect view of the surgical targeting system of Fig. 17 applied from the mid-thigh to mid-leg levels of the lower limb;
- Fig. 19 is a lateral (outer) aspect view of the surgical targeting system of Fig. 17 applied from the mid-thigh to mid-leg levels of the lower limb;
- Fig. 20 is a posterior (rear) aspect view of the surgical targeting system of Fig. 17 applied from the mid-thigh to mid-leg levels of the lower limb, the surgical targeting system not being applied to the central axial portion of this aspect of the limb;
- Fig. 21 is a view of a radiographic image of the skeletal elements and overlapping surgical targeting system of Fig. 17;
- Fig. 22 is a view of a radiographic image of the skeletal elements and overlapping surgical targeting system of Fig. 18;
- Fig. 23 is a view of a radiographic image of the skeletal elements and overlapping surgical targeting system of Fig. 19;
- Fig. 24 is a view of a radiographic image of the skeletal elements and overlapping surgical targeting system of Fig. 20;
- Fig. 25 is a C-arm fluoroscopic view of the distal femur from the lateral (or medial) aspect with the overlapping surgical targeting system of Fig. 23, targeting of the holes in the distal portion of a femoral intramedullary nail being facilitated by the near and far grid coordinates in the target nail hole such that with the grid properly positioned, these coordinates are directly read on the skin surface;
- Fig. 26 is a perspective view of an alternative embodiment of the surgical targeting system of Fig. 1 applied to a digit (finger depicted), the rolled closed tube being capable of being unrolled from the tip of the digit;
- Fig. 27 is a perspective view of the surgical targeting system of Fig. 26, the rolled closed tube being unrolled further toward the base of the digit;
- Fig. 28 is a view of a radiographic image of the digit and overlying surgical targeting system of Fig. 27 illustrating the skeletal elements of the digit;
- Fig. 29 is a perspective view of an alternative embodiment of the surgical targeting system of Fig. 26;
- Fig. 30 is a perspective view of the surgical targeting system of Fig. 29 illustrating the rolled closed tube unrolled fuiiher toward the base of the digit;
- Fig. 31 is a perspective view of an alternative embodiment of the surgical targeting system of Fig. 1 for application to a human breast, the surgical targeting system including a cone-shaped drape with a cutout having an aperture in the center corresponding to the nipple of the breast;
- Fig. 32 is an anterior view of the surgical targeting system of Fig. 31 showing the surgical grid as a polar coordinate system;
- Fig. 33 is a superior view of a patient to whom the surgical targeting system of Fig. 31 is applied, the patient undergoing mammographic imaging where the emitter tube is medial and the receiving tube is lateral;
- Fig. 34 is a view of the fluoroscopic mammographic image obtained from the apparatus depicted in Fig. 33 showing a lesion located cephalad, in line with the specific grid markings illustrated;
- Fig. 35 is a lateral view of a patient to whom the surgical targeting system of Fig. 31 is applied, the patient undergoing mammographic imaging where the emitter tube is cephalad (above) and the receiver tube is caudad (below); and
- Fig. 36 is a view of the fluoroscopic mammographic image obtained from the apparatus depicted in Fig. 35 showing a lesion located laterally, in line with the specific grid markings illustrated.
- the surgical targeting system of the present invention combines the advantages of both a marking device for radiograph and a plastic adhesive wound drape such as the loban® drape.
- the device is composed of a thin, sterile flexible, transparent or translucent sheet which has varying amounts of uniformly distributed adhesive and topical antiseptic such as iodophor on the side which is to be applied to the patient's skin.
- a removable and disposable layer on the adherent side (which is pealed off when applied) may be incorporated.
- a series of easily distinguishable radiopaque lines are incorporated either on or within the layers of the drape. One method of distinguishing the radiopaque lines is their being disposed in a pattern and labeled with radiopaque material.
- the pattern of the radiopaque elements and the labels/coordinates are easily visible on the drape as well as on a radiographic/fluoroscopic image of the drape.
- the radiopaque medium forms a distinctive pattern of lines on the drape, which allows for easy localization of the pathology or the targeting point within the radiographic image.
- the radiopaque medium may be, but is not limited to, fine steel wire (having a diameter of 0.003 inches) or a slurry of some radiopaque material such as barium or calcium sulfate.
- the material of the lines is radiopaque while the surgical drape material is radiolucent, which means only the lines of the drape and their corresponding coordinate markings are visible when a roentgenographic/fluoroscopic image of the drape is obtained.
- the drape material is transparent or translucent enough to allow the operator to directly read and distinguish the lines from one another when the drape is applied to the skin of a patient.
- One method of facilitating this distinction is to make the lines with discrete shapes, such as a zigzag, sine wave, square wave, or loops.
- Another method of distinction is straight lines with labels at each intersection that more readily facilitate the identification of the intersection of two of the lines.
- One possibility is to label the lines numerically along one axis and alphabetically along the other.
- a surgical targeting system of the present invention is designated generally by the reference numeral 1 in Fig. 1.
- the surgical targeting system 1 is used for adding an indicia image 2 to a radiographic image of a body 3 resulting from passage of image radiation through the body 4, as illustrated in Fig. 2.
- the surgical targeting system 1 comprises an antimicrobial drape 9 having an inner surface 11 of sufficient flexibility to conform to at least a portion of the outer surface 6 of the body 4.
- the drape 9 comprises a plastic impregnated with iodophor.
- a preferred embodiment of the drape 9 is disclosed in the publication
- the inner surface 11 of the drape may be coated with an antiseptic.
- the drape 9 has an outer surface 14, and longitudinal and lateral edges 16, 19. The drape 9 is puncturable to provide access to the outer surface 6 of the body 4.
- the drape 9 is transparent to the imaging radiation.
- the targeting system 1 further comprises an indicia 21 affixed to a portion of the drape 9.
- the indicia 21 are opaque to the imaging radiation resulting in the indicia image 2 co ⁇ esponding to the indicia 21.
- the targeting system further comprises a means for fixing the indicia 21 relative to the outer surface of the body 4 such that the indicia provide a reference on the body 4 for correlating portions of the body 4 to the radiographic body image 3.
- the fixing means may comprise adhesive 24 continuously applied to the entire inner surface 11 of the drape 9.
- Fig. 2 includes indicia images 2 (corresponding to the indicia 21), a body image 3 (corresponding to the body 4), and a skeleton image 26.
- the indicia 21 may be constituted by various coordinate or grid systems such as are illustrated in Figs. 3, 4 and 5.
- the radiopaque medium forms two sets of thin lines. Each set of lines is parallel and equidistant to one another. One set of the lines is oriented 90° to the other to form a grid. The result is a pattern of radiopaque squares of equal size. These squares may range in size from 1 millimeter to a few centimeters across depending on the grid pattern needed for a specific application.
- the material comprising the lines must be such that the loban® drape material retains its flexibility so that it stretches over the complex curves of the human body.
- each wire may be broken at every location where it crosses another wire as shown in Fig. 4.
- An alternative pattern which would fulfill this requirement would be the pattern shown in Fig. 5. In this manner, the segments of wire are free to move relative to each other, and the flexibility of the drape is not significantly compromised.
- Figs. 6, 7 and 8 illustrate an embodiment of the surgical targeting system 29 in which the surgical targeting system 1 is applied to anterior, lateral and posterior portions of the outer surface 34 of the chest or torso 31 of a body.
- the surgical targeting system 29 includes a drape 36 (corresponding to the drape 9), outer and inner surfaces 39, 41 (corresponding to the outer and inner surfaces 11, 14), and longitudinal and lateral edges 44, 46 (corresponding to the longitudinal and lateral edges 16, 19).
- the surgical targeting system 29 also includes indicia 56 (corresponding to the indicia 21) and adhesive 59 (corresponding to the adhesive 24).
- the drape 36 as applied to the torso 31, has anterior, lateral and posterior portions 49, 51, 54, as illustrated in Figs. 6, 7 and 8.
- An emitter 61 such as an X-ray tube, and. a receiver 64, such as an image intensifier, arranged as shown in Figs. 9 and 11, may be employed to produce the images illustrated in Figs. 10 and 12, respectively.
- Figs. 10 and 12 include indicia images 65 (corresponding to the indicia 56), a lesion image 66, rib images
- the term “lateral” refers to a location to the right or left sides of the body, relative to other locations. Alternatively, “lateral” refers to one or other side of the mid-line, with respect to the major axis of the body, or to a device lying in the major axis of the body.
- the term “medial” m refers to nearer to the mid-line.
- the left- and right-hand sides of the body are designated by the reference characters 1 and r, respectively.
- Figs. 13 and 14 illustrate an embodiment of the surgical targeting system 74 in which the surgical targeting system 1 is applied to anterior and lateral portions of the outer surface 79 of the lower trunk 76 of a body.
- the surgical targeting system 74 includes a drape 81 (corresponding to the drape 9), outer and inner surfaces 84, 86 (corresponding to the outer and inner surfaces 11, 14), and longitudinal and lateral edges 89, 91 (corresponding to the longitudinal and lateral edges 16, 19).
- the surgical targeting system 74 also includes indicia 99 (corresponding to the indicia 21) and adhesive 101 (corresponding to the adhesive 24).
- the drape 81 as applied to the lower trunk 76, has anterior and lateral portions 94, 96, as illustrated in Figs. 13 and 14.
- An emitter 104 such as an X-ray tube
- a receiver 106 such as an image intensifier, arranged as shown in Figs. 13 and 14, may be employed to produce the images illustrated in Figs. 15 and 16, respectively.
- Figs. 15 and 16 include indicia images 108 (corresponding to the indicia 99), an SI vertebrae image 109, an S2 vertebrae image 111, an S3 vertebrae image 114, an L4 vertebrae image 116, an L5 vertebrae image 119, a sacrum image 121, and a nail image 122.
- Figs. 17, 18, 19 and 20 illustrate an embodiment of the surgical targeting system 124 in which the surgical targeting system 1 is applied to the outer surface 129 of the lower limb 126 of a body.
- the surgical targeting system 124 includes a drape 131 (corresponding to the drape 9), outer and inner surfaces 134, 136 (corresponding to the outer and inner surfaces 11, 14), and longitudinal and lateral edges 139, 141 (corresponding to the longitudinal and lateral edges 16, 19).
- the surgical targeting system 124 also includes indicia 144 (corresponding to the indicia 21) and adhesive 146 (corresponding to the adhesive 24).
- An emitter such as an X-ray tube
- a receiver such as an image intensifier
- Figs. 21, 22, 23 and 24 include indicia images 147 (corresponding to the indicia 144), a lower limb image 148 (corresponding to the lower limb 126), and bone images 149.
- Fig. 25 is a view corresponding to Fig. 23. Accordingly, images in Fig.
- Fig. 25 contains a nail image 151 of a femoral intramedullary nail having hole images 154.
- the indicia images 144a labeled "3G" and "10G” are shown positioned such that an axis intersecting these indicia images extends through one of the hole images 154 to facilitate location of the one hole in the intramedullary nail.
- Figs. 26 and 27 illustrate an embodiment of the surgical targeting system 156 for application to the outer surface 161 of an elongate portion of a body such as finger 159.
- the surgical targeting system 156 includes a drape 164 of similar material as the drape 9.
- the drape 164 has an inner surface 169 which, like the inner surface 14 of the drape 9, may be coated with an antiseptic.
- the surgical targeting system 156 has indicia 179 similar to the indicia 21.
- the drape 164 has a cylindrical portion 174, one end of which is closed by a connected hemispherical end portion 176. The opposite end of the cylindrical portion 174 is defined by a rim 171.
- the drape 164 Prior to application to the finger 159, the drape 164 is rolled onto itself as shown in Fig. 26. The drape 164 is then applied to the end of the finger 159, as shown in Fig. 26, and unrolled to cover the finger as shown in Fig. 27.
- the surgical targeting system 156 includes means for fixing the indicia
- adhesive 181 may be continuously applied to the entire inner surface 169 of the drape 164.
- the drape 164 may be fixed to the outer surface 161 of the finger 159 by forming the drape of expandable material and sizing it to have an internal volume which is less than the volume of the finger such that the drape is srj-rink-fitted onto the finger.
- FIG. 28 includes indicia images 182 (corresponding to the indicia 179), a finger image 183 (corresponding to the finger 159), bone ⁇ nages 184, and a fragment image 186, such as may result from insertion of a foreign body into the finger.
- Figs. 29 and 30 illustrate a surgical targeting system 156a which is an alternative embodiment of the surgical targeting system depicted in Figs. 26 and 27. Accordingly, structures in Figs.
- the indicia 179a of the surgical targeting system 156a have the shape of "+" in contrast to the indicia 179 which are continuous.
- Figs. 31 and 32 illustrate an embodiment of the surgical targeting system 189 for application to the outer surface 194 of a right breast 191 of a body.
- the surgical targeting system 189 includes a right drape 196 of similar material as the drape 9.
- the right drape 196 has an inner surface 201 which, like the inner surface 14 of the drape 9, may be coated with an antiseptic.
- the right drape 196 also has an outer surface 199.
- the right drape 196 is conical and has a radial cutout 206.
- the cutout 206 has a base 209 which coincides with a peripheral edge 204 of the drape, and a central aperture 211.
- the surgical targeting system 189 has indicia 214 similar to the indicia 21.
- the indicia 214 are preferably a system of polar coordinates having a center coinciding with the apex of the right drape 196, as shown in Fig. 32.
- the indicia 214 of the polar coordinate system shown of Fig. 32 may include a radiopaque medium forming two sets of thin lines. The first set of lines radiates from a common center. The second set of lines forms concentric circles whose center is coincident with the intersection of the radial lines. The spacing between the radial lines and concentric circles varies from drape to drape depending on the specific application of the drape as well as the size of the tissue to be targeted.
- the lines may also have to be broken at the intersections, as described herein above for the rectangular coordinate system, to allow for optimal flexibility of the system.
- a "closed" wire system with thicker and stiffer wires may be preferred.
- Each line or intersection is also labeled in a manner analogous to the rectangular coordinate system.
- a common perceived use for a polar system is with radiographic images produced for a mammographic ex-u ⁇ ination and biopsy.
- the surgical targeting system 189 includes means for fixing the indicia
- FIG. 31 also illustrates a surgical targeting system 189a which is an alternative embodiment of the surgical targeting system 189. Accordingly, the structures of the surgical targeting system 189a corresponding to stracrures of the surgical targeting system 189 have the same reference numeral with the addition of the suffix a.
- the surgical targeting system 189a is for application to the outer surface 194a of a left breast 191a of the body.
- An emitter 219 such as an X-ray tube, and a receiver 221, such as an image intensifier, arranged as shown in Figs.
- Figs. 34 and 36 may be employed to produce the images illustrated in Figs. 34 and 36, respectively.
- Figs. 34 and 36 include an indicia image 222 (corresponding to the indicia 214), a right breast image 223 (corresponding to the right breast 191), and a lesion image 224.
- a tumor in the mediastinum may be localized and biopsied/resected (Depicted in the series of Figs. 6, 7, 8, 9, 10, 11 and 12).
- the sterile pack of the grid system is opened and the grid system is removed.
- the surgeon peels back the protective sheet of the grid system, exposing the adhesive backed sheet. This can then be applied to the area (now dry) for targeting as well as to secure the neighboring sterile towels and sheets. It is applied, adhesive side down, and pressed firmly in place.
- FIG. 6 shows a patient lying on a radiolucent operating room table with the surgical targetmg grid being applied to the sides and anterior aspect of the chest wall, covering the area where the lesion is known to be.
- Fig. 7 shows the view of the upper torso of this patient from the side view with the emitter and receiver tubes of the C-arm fluoroscope also depicted in position for an anteroposterior view of the targeted area.
- Fig. 8 shows the view of the upper torso of this same patient from the anterior (front) aspect with the surgical targeting system in place. The emitter and receiver tubes of the C-arm are depicted in position for a lateral view of the targeted area.
- Fig. 7 shows the view of the upper torso of this patient from the side view with the emitter and receiver tubes of the C-arm fluoroscope also depicted in position for an anteroposterior view of the targeted area.
- Fig. 8 shows the view of the upper torso of this same patient from the anterior (front) aspect with
- FIG. 9 shows the same patient from the cephalad aspect with the emitter and receiver tubes in position for the lateral X-ray/ fluoroscopic image which is depicted in Fig. 10.
- Fig. 11 shows the same patient from the cephalad aspect with the emitter and receiver tubes in position for the anteroposterior X- ray/fluoroscopic image which is shown in Fig. 12.
- Another example is as an aid in the accomplishment of accurate placement of an iliosacral screw for fixation of an unstable sacroiliac joint following trauma.
- Fig. 13 shows an oblique view of a patient lying on a radiolucent operating room table after suitable prepping and draping of the skin to create a sterile surgical field with the surgical targeting grid applied to the anterior and lateral aspects of the lower trunk (pelvic area).
- Fig. 14 shows this same patient from the lateral (side) view and emitter/receiving tubes as they would be positioned for an anteroposterior radiographic/fluoroscopic view.
- Fig. 15 is a view of the skeletal elements and overlapping near and far surgical targeting grids. Targeting in this instance can proceed from the near hatch mark which is superimposed on the center of the first sacral vertebral body to its nearly collocated counterpart on the far grid (See Fig. 15).
- Fig. 16 shows the skeletal elements on the anterior view.
- Targeting these points by way of instruments may be facilitated in several ways, including laser light beams from the emitting and receiving tubes on the C- arm fluoroscope directed parallel to the beam and targeted then at the specific target (near and far respectively) coordinates on the patient.
- Directionality of the pin or instrument or implant by keeping it exactly within beam of light would aid accurate placement.
- use may be made of a "C” guide (an instrument that directs the passage of a pin or drill from one point to emerge at a precise second point given by the instrument) where one point of the "C" is on the near target coordinate and the other point of the "C” on the far coordinate.
- the surgical targeting grid may also be utilized on the limb to facilitate percutaneous targeting.
- Figs.- 17, 18, 19 and 20 show the surgical targeting grid applied around three quarters of the circumference of the lower thigh, knee, and upper leg with only the posterior portion of the leg not covered)
- Figs. 21, 22, 23 and 24 show the corresponding skeletal elements and overlying surgical grids. Note that on the medial (Fig. 21) and lateral (Fig. 23) views, there are two grids seen, one near and the other on the far side.
- a locking intramedullary nail in place witi in the femoral intramedullary canal interlocking the nail (drilling a hole across the femur and through the hole in the nail, followed by the placement of a screw) can be facilitated by precise targeting utilizing the near and far hatch marks at the center of the target-in this case the circle which represents the hole in the intramedullary nail.
- Targeting the coordinates can be done by using the surface coordinates as described for the iliosacral screw fixation. Another example is provided by locating a retained foreign body in a finger.
- Figs. 26 and 27 show the adaptation of the surgical targeting grid for placement on a digit, with Fig. 26 showing the system partially and Fig. 27 showing the system fully unfurled.
- Fig. 28 shows the skeletal elements on a lateral roentgenograpliic/fluoroscopic view with a foreign body.
- Figs. 29 and 30 show an alternative construct of the surgical targeting grid for this application being applied to the digit.
- FIG. 32 Another example of the surgical targeting system would be for mammographic biopsy.
- the adaptation of the surgical grid system is shown in Fig. 32 where a polar coordinate system is used, i.e., a series of concentric lines at regular intervals are intersected by a series of lines perpendicular to them and converging on the center.
- the system is cone shaped, to conform to the shape of the breast with a slit and an open center to accommodate different sizes.
- Fig. 33 shows the patient from the cranial (top) view with the emitting and receiving tubes inside (medial) and outside (lateral) the breast which is to be imaged after the skin has been prepped appropriately and a surgical field created with appropriate draping, and the surgical targeting system applied.
- Fig. 32 shows a polar coordinate system, i.e., a series of concentric lines at regular intervals are intersected by a series of lines perpendicular to them and converging on the center.
- the system is cone shaped, to conform to
- Fig. 34 shows a roentgenographic/fluoroscopic view of the breast with the overlapping surgical targeting system in place and a lesion visible.
- Fig. 35 shows a side (from lateral) view of this same patient's breast with the emitter/receiving tubes cephalad (up or toward the head) and caudad (down or toward the feet) and
- Fig. 36 shows the corresponding roentgenographic/ fluoroscopic view with the lesion and overlapping surgical grid.
- the assessment of colinearity can be accomplished by applying the surgical targeting grid so that it is collinear with the proximal femur on the lateral aspect (this may require C-arm fluoroscopic X-ray check during the act of grid placement, with extension of the placement cephalad as far as the buttock) as well placement of a second grid on the anterior aspect with extension cephalad as far as the buttock-at which point it overlaps the first surgical targeting system.
- the start point on the skin is given by the intersection of these two rows on the surface of the buttock area. This is of special importance in percutaneous intramedullary nailing procedures, where the selection of an incision point which is not collinear with the proximal femur may cause tenting a large cuff of soft tissue during the procedure and may necessitate extension of a small incision.
- Finding this point on the skin might otlierwise entail multiple fluoroscopic X-ray views, each of which impart radiation exposure to the patient as well as the surgeon and other operating room personnel.
- An additional point is that accurate location of this point permits a small skin incision and this, with healing becomes a small scar which, if later extraction of the device is opted for, facilitates the accomplishment of the procedure, again, as a percutaneous one (with a limited incision whose locus is given by the existing scar).
- Another example of the utility of the system is provided by the procedure of reamed femoral intramedullary nailing.
- Additional spot fluoroscopic views of the fracture with an overlying radiopaque object gives the needed answer and prompts the surgeon to rotate the guidewire so that its tip is toward the intramedullary canal on the displaced fragment before advancing the wire down the fragment's canal.
- an overlying radiopaque object such as a hemostat
- obtaining additional fluoroscopic X-rays for this purpose are unnecessary.
- the added advantageous factor is that the surgeon need not place his hand near the radiation beam with the surgical instrument which is an occupational hazzard for many surgeons.
- minor directional adjustments in the passage of a radiopaque instrument or implant in the body can be subject to less guesswork because both the coordinates on the fluoroscopic screen and those directly readable on the patient can be correlated.
- Procedures which may utilize the surgical targeting system of the present invention include:
- Bone graft substitute trocar placement Localization of gantries for radiation therapy, and placement of radioactive sources for this purpose;
- sonic waves directed either singly at an individual target or from multiple projections at a single target; Locating a foreign object or foreign objects;
- Localization of tracts e.g., sinus tract infection
- the surgical targeting grid can be used to locate the tip of the endoscope, and thereupon direct the tip of a laparoscope to visualize the outside wall of the viscus for the purpose of staging/biopsy);
- Alternative embodiments of the invention are possible, in addition to integrating this grid system into a sterile drape.
- other methods of surgical targeting may be employed by combining a sterile radiopaque grid with a removable glove or sock or a condom for the extremity, finger or other appendage.
- a sterile radiopaque grid with a removable glove or sock or a condom for the extremity, finger or other appendage.
- Such a device is stretchable with enough friction to minimize any shearing between it and the skin and may not require adhesive backing or perhaps only minimal adhesive backing.
- This device would allow for surgical targeting of the upper and lower extremities.
- Another embodiment would be that applicable to the breast, i.e., a polar coordinate grid system on a conically shaped sterile plastic adhesive drape with the central portion for the nipple cut out and a slit to permit size adjustment.
- the surgical targeting system of the present invention includes a surgical adhesive drape (which is form-fit to a specific body part such as a digit, with no possibility for shearing between the skin and the overlying grid) which is transparent or translucent and radiolucent excepting the indicia of the surgical targeting system which are radiopaque and clearly visible both directly and on a radiographic/ fluoroscopic image.
- the drape is impervious to moisture and bacteria and has an option for inclusion of an uniformly distributed topical antiseptic on the surface of the drape which is applied to the body.
- the surgical targeting system includes one or several patterns of radiopaque lines disposed at right angles to each other and each with distinguishing radiopaque labels. Both the lines and the labels are easily readable both on fluoroscopic views as well as directly once the targeting systems have been applied to the surface of the body.
- This feature of parallax can also be utilized in the instance of overlapping (near and far) grids, disposed on opposite sides of the body or body part by assuring co-linearity of the target with far and near grid points. Subtle adjustments in the angle of the radiographic/fluoroscopic beam result in changes in the collinear near and far coordinates.
Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU2001253671A AU2001253671B2 (en) | 2000-04-21 | 2001-04-18 | Surgical targeting system |
EP01927195A EP1284652A4 (en) | 2000-04-21 | 2001-04-18 | Surgical targeting system |
AU5367101A AU5367101A (en) | 2000-04-21 | 2001-04-18 | Surgical targeting system |
CA002445105A CA2445105A1 (en) | 2000-04-21 | 2001-04-18 | Surgical targeting system |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/553,683 | 2000-04-21 | ||
US09/553,683 US7853311B1 (en) | 1999-04-23 | 2000-04-21 | Surgical targeting system |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2001080738A1 true WO2001080738A1 (en) | 2001-11-01 |
Family
ID=24210334
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2001/012691 WO2001080738A1 (en) | 2000-04-21 | 2001-04-18 | Surgical targeting system |
Country Status (5)
Country | Link |
---|---|
US (1) | US7853311B1 (en) |
EP (1) | EP1284652A4 (en) |
AU (2) | AU5367101A (en) |
CA (1) | CA2445105A1 (en) |
WO (1) | WO2001080738A1 (en) |
Cited By (13)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2006036248A1 (en) * | 2004-09-27 | 2006-04-06 | Kimberly-Clark Worldwide, Inc. | X-ray marker for medical drapes |
DE102008045405A1 (en) * | 2008-09-02 | 2010-03-04 | Siemens Aktiengesellschaft | Transparent film for applying markers or symbols on medical devices or body surfaces of patients and methods for their manufacture |
US7844397B2 (en) | 2005-03-29 | 2010-11-30 | Honeywell International Inc. | Method and apparatus for high accuracy relative motion determination using inertial sensors |
US7853311B1 (en) | 1999-04-23 | 2010-12-14 | 3M Innovative Properties Company | Surgical targeting system |
WO2011047517A1 (en) * | 2009-10-22 | 2011-04-28 | He Shisheng | Locating device for spinal surgery |
DE102010011589A1 (en) * | 2010-03-16 | 2011-09-22 | Siemens Aktiengesellschaft | Reference structure for implementation of medical procedure for patient based on two or three-dimensional x-ray images, has film provided with positioning arrangement with glue layer on flat side for fixation of film on skin of patient |
EP2744431A4 (en) * | 2011-08-19 | 2015-03-04 | Orthogrid Systems Llc | Alignment plate apparatus and method of use |
GB2527505A (en) * | 2014-06-20 | 2015-12-30 | Kirintec Ltd | X-ray imaging method and apparatus |
WO2016148968A1 (en) * | 2015-03-19 | 2016-09-22 | Medtronic Navigation, Inc. | Flexible skin-based patient tracker for optical navigation |
EP3125783A1 (en) * | 2014-04-03 | 2017-02-08 | Aesculap AG | Flexible medical reference device, medical navigation system, and method |
US10179014B1 (en) | 2012-06-01 | 2019-01-15 | Nuvasive, Inc. | Systems and methods for promoting sacroiliac joint fusion |
EP3760127A1 (en) * | 2017-09-25 | 2021-01-06 | Shanghai United Imaging Healthcare Co., Ltd. | System and method for locating a target subject |
WO2023057503A1 (en) * | 2021-10-06 | 2023-04-13 | InLine-Med GmbH | Device for covering an area of the body of a patient |
Families Citing this family (32)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20110051892A1 (en) * | 2009-09-01 | 2011-03-03 | Izi Medical Products, Llc | Radiation therapy skin marker |
US8424532B2 (en) | 2010-07-26 | 2013-04-23 | Medline Industries, Inc. | Cranial surgical drape |
CN102028550B (en) * | 2011-01-05 | 2012-10-31 | 武汉维斯第医用科技有限公司 | Clinical medicinal patch with developing coordinates |
US9278166B2 (en) | 2011-03-02 | 2016-03-08 | Medline Industries, Inc. | Method and apparatus pertaining to a medical drape having a suction port |
US8986315B2 (en) * | 2011-05-25 | 2015-03-24 | DePuy Synthes Products, LLC | Aiming device having radio-opaque markers |
JP6121406B2 (en) | 2011-06-16 | 2017-04-26 | スミス アンド ネフュー インコーポレイテッド | Surgical alignment using criteria |
US8690813B2 (en) * | 2011-07-22 | 2014-04-08 | Elizabeth Chabner Thompson | Radiation treatment garment—I |
EP2861175A2 (en) * | 2012-06-15 | 2015-04-22 | Koninklijke Philips N.V. | Guided incision planning for endoscopic minimally invasive surgery |
US9055915B2 (en) * | 2012-07-10 | 2015-06-16 | Ghansham D. Agarwal | Device for externally marking the location of organs on skin during a cat scan |
US20140064442A1 (en) * | 2012-08-31 | 2014-03-06 | Ghansham Das AGARWAL | Novel device for marking location of organs on skin as per cat scan |
CN103945769A (en) * | 2012-07-10 | 2014-07-23 | 甘沙姆·达斯·阿加瓦尔 | A novel device for extremely marking the location of organs on skin during a CAT scan |
US9456874B2 (en) | 2013-02-18 | 2016-10-04 | OrthoGrid Systems, Inc | Grid patterned alignment plate for imaging apparatus and method of providing implant placement |
US10070924B2 (en) | 2013-03-13 | 2018-09-11 | Medline Industries, Inc. | Apparatus and method pertaining to a multi-tier back-table drape |
TWI615131B (en) * | 2013-11-28 | 2018-02-21 | 財團法人國家實驗研究院 | Image based oxygen saturation measuring device and method thereof |
WO2015112570A1 (en) * | 2014-01-23 | 2015-07-30 | Conformis, Inc. | Skin-referencing surgical guides |
DE102014104800A1 (en) | 2014-04-03 | 2015-10-08 | Aesculap Ag | Medical fastening device and referencing device and medical instruments |
US10743960B2 (en) * | 2014-09-04 | 2020-08-18 | AtaCor Medical, Inc. | Cardiac arrhythmia treatment devices and delivery |
US10328268B2 (en) | 2014-09-04 | 2019-06-25 | AtaCor Medical, Inc. | Cardiac pacing |
CA2965683A1 (en) * | 2014-11-03 | 2016-05-12 | Arnold Herskovic | System for detecting stent slippage, method for detecting stent slippage |
US11097109B2 (en) | 2014-11-24 | 2021-08-24 | AtaCor Medical, Inc. | Cardiac pacing sensing and control |
US20160166322A1 (en) * | 2014-12-10 | 2016-06-16 | Matthew D. Lowrance | Incise drape for surgical applications and method of positioning the drape over a patient |
US9808549B2 (en) | 2014-12-24 | 2017-11-07 | University Of Central Florida Research Foundation, Inc. | System for detecting sterile field events and related methods |
US20180049715A1 (en) * | 2015-03-23 | 2018-02-22 | Straxcorp Pty Ltd | Automated Identification and Selection of a Region of Interest in Imaging |
WO2017030557A1 (en) * | 2015-08-17 | 2017-02-23 | Orthogrid Systems, Inc. | A surgical positioning system, apparatus and method of use |
EP3988027A1 (en) | 2016-03-13 | 2022-04-27 | Vuze Medical Ltd. | Apparatus and methods for use with skeletal procedures |
US11020199B2 (en) | 2016-03-14 | 2021-06-01 | Medline Industries, Inc. | Surgical drape |
WO2019012520A1 (en) | 2017-07-08 | 2019-01-17 | Vuze Medical Ltd. | Apparatus and methods for use with image-guided skeletal procedures |
KR102114089B1 (en) * | 2017-12-27 | 2020-05-22 | 경북대학교 산학협력단 | Laser projection apparatus and control method thereof, laser guidance system including the apparatus |
US11246675B2 (en) | 2018-01-18 | 2022-02-15 | Medline Industries, Lp | Surgical C-section drape with tunnel |
USD884905S1 (en) | 2018-01-18 | 2020-05-19 | Medline Industries, Inc. | Surgical C-section drape with tunnel |
US20200121271A1 (en) * | 2018-05-01 | 2020-04-23 | Randall Paul Davis | Medical Grid with Bar Codes |
WO2022128095A1 (en) * | 2020-12-17 | 2022-06-23 | Brainlab Ag | Patterned incision foil and method for determining a geometry of an anatomical surface |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4838265A (en) * | 1985-05-24 | 1989-06-13 | Cosman Eric R | Localization device for probe placement under CT scanner imaging |
US4938233A (en) * | 1987-08-03 | 1990-07-03 | Techton, Inc. | Radiation shield |
US5242985A (en) * | 1992-06-17 | 1993-09-07 | Isp Investments Inc. | Aqueous stable complex of a strongly swellable, moderately crosslinked polyvinylpyrrolidone and iodine |
US5260985A (en) * | 1992-08-14 | 1993-11-09 | Mosby Richard A | Conforming localization/biopsy grid and control apparatus |
Family Cites Families (49)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2344824A (en) | 1944-03-21 | Method and means of making x-ray | ||
US3171959A (en) | 1962-08-06 | 1965-03-02 | Oscar K Kozek | Apparatus for measuring objects within matter opaque to visible light |
US3547121A (en) * | 1968-03-04 | 1970-12-15 | Mount Sinai Hospital Research | Abdominal grid for intrauterine fetal transfusion |
US3968792A (en) | 1975-04-04 | 1976-07-13 | Hydro-Med Products, Inc. | Sterile tubular drape |
IT1082738B (en) | 1977-04-08 | 1985-05-21 | Vitalini Pier Luigi | DEVICE APPLICABLE TO FLEXIBLE RADIOGRAPHIC SHEETS TO OBTAIN A MILLIMETER RETICLE IN THE IMPRESSED SHEET |
US4187423A (en) | 1978-03-27 | 1980-02-05 | Larry C. Petersen | Article for measuring lower extremities comprising laminae of both PVC and acrylic |
US4319136A (en) * | 1979-11-09 | 1982-03-09 | Jinkins J Randolph | Computerized tomography radiograph data transfer cap |
US4349498A (en) | 1981-01-16 | 1982-09-14 | Carbomedics, Inc. | Radio-opaque markers for pyrolytic carbon prosthetic members |
US4506676A (en) | 1982-09-10 | 1985-03-26 | Duska Alois A | Radiographic localization technique |
US4899762A (en) * | 1982-11-26 | 1990-02-13 | Detroit Neurosurgical Foundation | Multi-purpose integrated surgical drape, dressing, and closure structure and method |
US4627427A (en) | 1984-10-17 | 1986-12-09 | Minnesota Mining And Manufacturing Company | Universal medical cover sheet and process for draping |
JPS62153229A (en) | 1985-12-27 | 1987-07-08 | Nippon Oil Co Ltd | Skin marker |
US4813062A (en) | 1986-08-13 | 1989-03-14 | Milliken Research Corporation | Radio-opaque marker and method |
US4985019A (en) | 1988-03-11 | 1991-01-15 | Michelson Gary K | X-ray marker |
US4860331A (en) | 1988-09-12 | 1989-08-22 | Williams John F | Image marker device |
GB8921300D0 (en) | 1989-03-13 | 1989-11-08 | Univ Sheffield | Improvements in the radiographic analysis of bones |
US4918715A (en) | 1989-05-01 | 1990-04-17 | Webb Research Ii Corporation | Image location marking devices for radiographs, method of making and methods of use |
US5052035A (en) | 1989-11-02 | 1991-09-24 | Webb Research Ii Corporation | Image location marking devices for radiographs, method of making and methods of use |
US5105457A (en) | 1990-04-19 | 1992-04-14 | Glassman Stuart L | Mammograph x-ray grid |
US5068886A (en) | 1990-06-28 | 1991-11-26 | Monica Lavia | Catheter or cannula position indicator for use in hemodynamic monitoring and the like |
GB9118062D0 (en) | 1991-08-21 | 1991-10-09 | Bulley John L | Improved tubular bandages |
US5285785A (en) | 1991-10-30 | 1994-02-15 | Meyer Seymour W | Apparatus and method for locating foreign bodies in humans and animals |
US5216700A (en) | 1992-02-18 | 1993-06-01 | George Cherian | Tape having graduated scale providing location indicia during x-ray processes |
US5306271A (en) | 1992-03-09 | 1994-04-26 | Izi Corporation | Radiation therapy skin markers |
US5522921A (en) | 1992-10-23 | 1996-06-04 | Custer; Peter | Invisible, x-ray opaque fluorescent printing medium for multiplex reading |
DE9422172U1 (en) | 1993-04-26 | 1998-08-06 | Univ St Louis | Specify the location of a surgical probe |
US6041094A (en) | 1993-05-07 | 2000-03-21 | Russell; Donald G. | Intermediate density marker and a method using such a marker for radiographic examination |
US5394456A (en) | 1993-05-27 | 1995-02-28 | Livinvston Products, Inc. | Identification system for X-ray sensitive film |
US6419680B1 (en) * | 1993-06-10 | 2002-07-16 | Sherwood Services Ag | CT and MRI visible index markers for stereotactic localization |
US5383234A (en) | 1993-09-03 | 1995-01-17 | Beekley Corporation | Radiographic system and a method for using the system for radiographic examination of tissue specimens |
US5444754A (en) | 1993-10-13 | 1995-08-22 | Instrumentarium Corp. | Method for localizing cross-sectional dental X-ray images |
US5476016A (en) | 1993-10-27 | 1995-12-19 | Board Of Regents Of The University Of Nebraska | Apparatus for annotating data on an assay medium |
US5419324A (en) | 1993-11-24 | 1995-05-30 | Endovascular Technologies, Inc. | Radiological marker board with movable indicators |
US5427099A (en) | 1994-03-17 | 1995-06-27 | Adams; Timothy L. | Marker for magnetic resonance imaging |
US5582189A (en) | 1994-10-24 | 1996-12-10 | Pannozzo; Anthony N. | Method for diagnosing the subluxation of a skeletal articulation |
US5628327A (en) | 1994-12-15 | 1997-05-13 | Imarx Pharmaceutical Corp. | Apparatus for performing biopsies and the like |
US5682890A (en) * | 1995-01-26 | 1997-11-04 | Picker International, Inc. | Magnetic resonance stereotactic surgery with exoskeleton tissue stabilization |
US5692519A (en) | 1995-02-23 | 1997-12-02 | Dianon Systems, Inc | Methods for determining suitable patients for prostate surgery incorporating a prostate needle biopsy |
US5908387A (en) | 1996-06-21 | 1999-06-01 | Quinton Instrument Company | Device and method for improved quantitative coronary artery analysis |
US5702128A (en) | 1996-07-18 | 1997-12-30 | Beekley Corporation | Radiographic marker system and method of making same |
US5799059A (en) | 1996-07-30 | 1998-08-25 | Stembridge; James H. | Phantom and method for accuracy and repeatability testing of positional mechanisms of computer assisted tomography and magnetic resonance imaging systems |
US5743899A (en) | 1997-03-04 | 1998-04-28 | Izi Medical Products | Method and apparatus for marking skin with ink |
US6041064A (en) | 1998-01-29 | 2000-03-21 | General Datacomm, Inc. | Voice server module for ATM switch |
US6173201B1 (en) * | 1999-02-22 | 2001-01-09 | V-Target Ltd. | Stereotactic diagnosis and treatment with reference to a combined image |
DE19911151C1 (en) | 1999-03-12 | 2000-11-23 | Hans Dallmeyr | Wound plasters for the tips of fingers and toes |
US7853311B1 (en) | 1999-04-23 | 2010-12-14 | 3M Innovative Properties Company | Surgical targeting system |
US6301495B1 (en) * | 1999-04-27 | 2001-10-09 | International Business Machines Corporation | System and method for intra-operative, image-based, interactive verification of a pre-operative surgical plan |
US6356621B1 (en) | 1999-07-14 | 2002-03-12 | Nitto Denko Corporation | Pressure-sensitive adhesive sheet for radiography |
US6333970B1 (en) | 2000-08-07 | 2001-12-25 | Lemaitre Vascular, Inc. | Single-use radiological imaging aid |
-
2000
- 2000-04-21 US US09/553,683 patent/US7853311B1/en not_active Expired - Fee Related
-
2001
- 2001-04-18 CA CA002445105A patent/CA2445105A1/en not_active Abandoned
- 2001-04-18 EP EP01927195A patent/EP1284652A4/en not_active Withdrawn
- 2001-04-18 WO PCT/US2001/012691 patent/WO2001080738A1/en active Application Filing
- 2001-04-18 AU AU5367101A patent/AU5367101A/en active Pending
- 2001-04-18 AU AU2001253671A patent/AU2001253671B2/en not_active Ceased
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4838265A (en) * | 1985-05-24 | 1989-06-13 | Cosman Eric R | Localization device for probe placement under CT scanner imaging |
US4938233A (en) * | 1987-08-03 | 1990-07-03 | Techton, Inc. | Radiation shield |
US5242985A (en) * | 1992-06-17 | 1993-09-07 | Isp Investments Inc. | Aqueous stable complex of a strongly swellable, moderately crosslinked polyvinylpyrrolidone and iodine |
US5260985A (en) * | 1992-08-14 | 1993-11-09 | Mosby Richard A | Conforming localization/biopsy grid and control apparatus |
Non-Patent Citations (1)
Title |
---|
See also references of EP1284652A4 * |
Cited By (21)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7853311B1 (en) | 1999-04-23 | 2010-12-14 | 3M Innovative Properties Company | Surgical targeting system |
WO2006036248A1 (en) * | 2004-09-27 | 2006-04-06 | Kimberly-Clark Worldwide, Inc. | X-ray marker for medical drapes |
US7844397B2 (en) | 2005-03-29 | 2010-11-30 | Honeywell International Inc. | Method and apparatus for high accuracy relative motion determination using inertial sensors |
DE102008045405A1 (en) * | 2008-09-02 | 2010-03-04 | Siemens Aktiengesellschaft | Transparent film for applying markers or symbols on medical devices or body surfaces of patients and methods for their manufacture |
WO2011047517A1 (en) * | 2009-10-22 | 2011-04-28 | He Shisheng | Locating device for spinal surgery |
DE102010011589A1 (en) * | 2010-03-16 | 2011-09-22 | Siemens Aktiengesellschaft | Reference structure for implementation of medical procedure for patient based on two or three-dimensional x-ray images, has film provided with positioning arrangement with glue layer on flat side for fixation of film on skin of patient |
EP2744431A4 (en) * | 2011-08-19 | 2015-03-04 | Orthogrid Systems Llc | Alignment plate apparatus and method of use |
US10179014B1 (en) | 2012-06-01 | 2019-01-15 | Nuvasive, Inc. | Systems and methods for promoting sacroiliac joint fusion |
US11253302B2 (en) | 2012-06-01 | 2022-02-22 | Nuvasive, Inc. | Systems and methods for promoting sacroiliac joint fusion |
EP3125783A1 (en) * | 2014-04-03 | 2017-02-08 | Aesculap AG | Flexible medical reference device, medical navigation system, and method |
GB2527505A (en) * | 2014-06-20 | 2015-12-30 | Kirintec Ltd | X-ray imaging method and apparatus |
US11432896B2 (en) | 2015-03-19 | 2022-09-06 | Medtronic Navigation, Inc. | Flexible skin based patient tracker for optical navigation |
US10413377B2 (en) | 2015-03-19 | 2019-09-17 | Medtronic Navigation, Inc. | Flexible skin based patient tracker for optical navigation |
WO2016148968A1 (en) * | 2015-03-19 | 2016-09-22 | Medtronic Navigation, Inc. | Flexible skin-based patient tracker for optical navigation |
EP3760127A1 (en) * | 2017-09-25 | 2021-01-06 | Shanghai United Imaging Healthcare Co., Ltd. | System and method for locating a target subject |
US11013486B2 (en) | 2017-09-25 | 2021-05-25 | Shanghai United Imaging Healthcare Co., Ltd. | System and method for locating a target subject |
US11058389B2 (en) | 2017-09-25 | 2021-07-13 | Shanghai United Imaging Healthcare Co., Ltd. | System and method for locating a target subject |
US11071512B2 (en) | 2017-09-25 | 2021-07-27 | Shanghai United Imaging Healthcare Co., Ltd. | System and method for locating a target subject |
US11583240B2 (en) | 2017-09-25 | 2023-02-21 | Shanghai United Imaging Healthcare Co., Ltd. | System and method for locating a target subject |
AU2022200948B2 (en) * | 2017-09-25 | 2023-07-13 | Shanghai United Imaging Healthcare Co., Ltd. | System and method for locating target subject |
WO2023057503A1 (en) * | 2021-10-06 | 2023-04-13 | InLine-Med GmbH | Device for covering an area of the body of a patient |
Also Published As
Publication number | Publication date |
---|---|
AU5367101A (en) | 2001-11-07 |
CA2445105A1 (en) | 2002-11-01 |
US7853311B1 (en) | 2010-12-14 |
AU2001253671B2 (en) | 2006-12-07 |
EP1284652A4 (en) | 2004-08-18 |
EP1284652A1 (en) | 2003-02-26 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US7853311B1 (en) | Surgical targeting system | |
AU2001253671A1 (en) | Surgical targeting system | |
US10952751B2 (en) | Surgical targeting systems and methods | |
US5203777A (en) | Radiopaque marker system for a tubular device | |
US7225012B1 (en) | Methods and systems for image-guided surgical interventions | |
US20160100911A1 (en) | Medical Procedure Localizing Aid | |
US20150223906A1 (en) | Medical Procedure Localizing Aid | |
CA2857183C (en) | A method and a device for computer assisted surgery | |
US20170296273A9 (en) | Surgical Targeting Systems and Methods | |
US20220031423A1 (en) | Marking device with metallic element for use in x-ray guided surgery | |
EP3072472B1 (en) | Stereotactic whole-body guide system for precisely positioning surgical instruments inside the body | |
US20210169504A1 (en) | Surgical targeting systems and methods | |
WO2016110086A1 (en) | Medical radiation positioning film and method for photographing lesion site, positioning of which is convenient and fast | |
JP6790000B2 (en) | Fiber Optic Real Shape Sensing for X-ray Fluoroscopic Surgery Navigation | |
JP2003180680A (en) | Navigation system | |
Begemann | CT-guided interventions: indications, technique, and pitfalls | |
WO2018226224A1 (en) | Surgical targeting systems and methods | |
US20230144552A1 (en) | Salvage device and method for localizing and removing a breast tissue marker clip at surgery after a failed specimen radiogram | |
Liebergall et al. | Navigation in orthopaedic trauma | |
Wingate et al. | Xeroradiographic Localization of Implanted 125l Seeds | |
Pishnamaz et al. | Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental | |
Lefkowitz et al. | Computer-assisted image-guided fluoroscopy (virtual fluoroscopy) |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AK | Designated states |
Kind code of ref document: A1 Designated state(s): AE AG AL AU BA BB BG BR BZ CA CN CR CU CZ DM DZ EE GD GE GH HR HU ID IL IN IS JP KP KR LC LK LR LT LV MA MK MN MX NO NZ PL PT RO SG SI SK TR TT UA UZ VN YU ZA |
|
AL | Designated countries for regional patents |
Kind code of ref document: A1 Designated state(s): GH GM KE LS MW MZ SD SL SZ TZ UG ZW AM AZ BY KG KZ MD RU TJ TM AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE TR BF BJ CF CG CI CM GA GN GW ML MR NE SN TD TG |
|
121 | Ep: the epo has been informed by wipo that ep was designated in this application | ||
DFPE | Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101) | ||
WWE | Wipo information: entry into national phase |
Ref document number: 522701 Country of ref document: NZ |
|
WWE | Wipo information: entry into national phase |
Ref document number: 2001927195 Country of ref document: EP Ref document number: 2001253671 Country of ref document: AU |
|
WWP | Wipo information: published in national office |
Ref document number: 2001927195 Country of ref document: EP |
|
WWE | Wipo information: entry into national phase |
Ref document number: 2445105 Country of ref document: CA |
|
NENP | Non-entry into the national phase |
Ref country code: JP |