Adapter for attaching electromagnetic image guidance components to a medical device

[0001] The present invention relates generally to medical devices, systems and methods and more particularly to methods and apparatus for attaching electromagnetic image guidance components to guide catheters and other medical devices that are useable in performing therapeutic or diagnostic procedures.

[0002] Image guided surgery (IGS) procedures (sometimes referred to as “computer assisted surgery”) were first developed for use in neurosurgery and have now been adapted for use in certain ENT surgeries, including sinus surgeries. See, Kingdom T. T., Orlandi R. R., Image-Guided Surgery of the Sinuses: Current Technology and Applications, Otolaryngol. Clin. North Am. 37(2):381-400 (April 2004). Generally speaking, in a typical IGS procedure, a digital tomographic scan (e.g., a CT or MRI scan) of the operative field (e.g., the nasal cavities and paranasal sinuses) is obtained prior to surgery. A specially programmed computer is then used to convert the digital tomographic scan data into a digital map. During surgery, sensors or markers mounted on the surgical instruments send data to the computer indicating the position of each surgical instrument. The computer correlates the data received from the instrument-mounted sensors with the digital map that was created from the preoperative tomographic scan. One or more image(s) is/are then displayed on a monitor showing the tomographic scan along with an indicator (e.g., cross hairs or an illuminated dot) of the real time position of the surgical instrument. In this manner, the surgeon is able to view the precise position of each sensor-equipped instrument relative to the surrounding anatomical structures shown on the tomographic scan.

[0003] The currently available IGS systems fall into two main categories, namely, optical systems and electromagnetic systems. In electromagnetic IGS systems, electromagnetic sensors (e.g., electromagnetic coils) are attached to the surgical instrument and the computer determines the position of the instrument within the body on the basis of signals received from those electromagnetic sensors. Examples of commercially available electromagnetic IGS systems that have been used in ENT and sinus surgery include the ENTrak Plus™ and InstaTrak ENT™ systems available from GE Medical Systems, Salt Lake City, Utah. Other examples of electromagnetic image guidance systems that may be modified for use in accordance with the present invention include but are not limited to those available from Surgical Navigation Technologies, Inc., Louiville, Colo., Biosense-Webster, Inc., Diamond Bar, Calif. and Calypso Medical Technologies, Inc., Seattle, Wash.

[0004] The electromagnetic sensors must be attached to the instrument in a manner that maintains the sensors in specific, fixed spatial relationships to the portion of the instrument that is to be tracked within the body. In some cases, the sensor(s) may be built into the instruments at the time of manufacture. In other instances, it may be desirable to attach one or more electromagnetic sensors (or a module containing the sensor(s)) to an instrument immediately prior to or during use of that instrument in a therapeutic procedure.

[0005] In the ENT field, one particular area in which it is desirable to attach electromagnetic sensors to instruments is in the performance of procedures where rigid and/or flexible catheters and other devices are inserted through the nose and used to perform sinus surgery or other sinus treatment procedures. One such procedure is balloon dilation of sinus cavity ostia. In such procedure, a guide catheter having a substantially fixed shape is inserted through the nose and advanced to a position where the distal end of the guide catheter is adjacent to the ostium of a paranasal sinus. A guidewire is then advanced through the guide catheter (e.g., Relieva™ Guide Catheter, Acclarent, Inc., Menlo Park, Calif.) and into the paranasal sinus. Thereafter, a balloon catheter (e.g., Relieva™ Balloon Catheter, Acclarent, Inc., Menlo Park, Calif.) is advanced over the guidewire and is used to dilate the ostium of the paranasal sinus, thereby improving drainage from and/or ventilation of that paranasal sinus. Since the guide catheter has a substantially fixed shape, electromagnetic sensors may be mounted on the proximal portion of the guide catheter in positions that bear known spatial relation to the distal end of the guide catheter. In this manner, those proximally mounted sensors may be used in conjunction with an electromagnetic IGS system to track the position of the distal end of the guide catheter within the subject's body. However, to accomplish this, the sensors must be firmly mounted and maintained in specific positions on the proximal end of the guide catheter.

[0006] Thus, there remains a need in the art for the development of new adapter devices that may be used to securely attach electromagnetic sensors (or receiver modules that contain the sensor(s)) to guide catheters and/or other devices useable in the performance of balloon dilation procedures as well as other instruments used in ENT and other surgical procedures.

[0007] In accordance with the invention, there is provided an adapter device useable for attaching an electromagnetic image guidance element (the electromagnetic image guidance element can be either a receiver or a transmitter) to a medical device, such as a guide catheter or other device, for example a guide catheter having a balloon, having a distal portion that becomes inserted into the body of a human or animal subject and a proximal portion that remains outside of the subject's body. This adapter device generally comprises (a) a medical device holding fixture constructed to be firmly attached to the proximal portion of the medical device and (b) a element holding fixture constructed to firmly hold the image guidance element in substantially fixed spatial relation to at least one location on the distal portion of the medical device while allowing the distal portion of the medical device to be inserted into the subject's body for purposes of the procedure with a high degree of accuracy.

[0008] Further in accordance with the invention, there is provided a method for performing an image guided therapeutic or diagnostic procedure within the body of a human or animal subject. In general this method includes the steps of (a) providing a medical device having a distal portion that is inserted into the subject's body and a proximal portion that remains outside of the subject's body, said medical device being useable to perform or facilitate the performance of at least part of the procedure, (b) providing an IGS system that includes a element which communicates signals to a computing device which uses said signals to determine the location of a device within the body of a human or animal subject, (c) providing an adapter device that includes i) a medical device holding fixture constructed to be firmly attached to the proximal portion of the medical device and ii) a element holding fixture constructed to firmly hold the image guidance element in substantially fixed spatial relation to the distal portion of the medical device while allowing the distal portion of the medical device to be inserted into the subject's body and allowing the medical device to be used to perform or facilitate the performance of at least part of the procedure, (d) attaching the proximal portion of the medical device to the adapter device by way of the medical device holding fixture, (e) attaching the element to the adapter device by way of the element holding fixture, (f) inserting the distal end of the medical device into the subject's body, (g) using the IGS system to guide the positioning of at least one location on the distal portion of the medical device within the subject's body and (h) using the medical device to perform or facilitate the performance of at least part of the procedure. In some embodiments, the IGS system can be used in conjunction with an endoscope and/or a fluoroscope system. In some embodiments of the invention, the medical device may be a guidewire or guide catheter that has a substantially fixed shape and Step H of the method may be carried out by advancing another device over the guidewire or through the guide catheter.

[0009] Still further in accordance with the invention there is provided a calibration tool for use in calibrating an IGS system to an elongate medical device that has a substantially fixed shape and a distal end. In general, such calibration tool comprises a substantially rigid body having a receiving groove, a first calibration tip and may include a second calibration tip. In a preferred embodiment, first and second calibration tips extend in 180 degree opposite directions from one another. The elongate medical device (e.g., a curved guide catheter) is insertable into the receiving groove with its distal end positioned in a known position relative to the first and second calibration tips. The first and second calibration tips are alternately placeable in a known location relative to an electromagnetic transmitter such that readings may be taken by the IGS system and used to calibrate the IGS system to the shape of that medical device.

[0010] Still further in accordance with the invention there is provided a method for calibrating an image guided surgery system for use with an elongate medical device that has a substantially fixed shape and a distal end. In general, this method comprises the steps of (a) providing a calibration tool comprising a substantially rigid body having a receiving groove, a first calibration tip and a second calibration tip formed therein, said first and second calibration tips extending is 180 degree opposite directions from one another, (b) inserting the medical device into the receiving groove with the distal end of the medical device positioned in a known position within one of said first and second calibration tips, (c) positioning the first calibration tip in a known position relative to an electromagnetic transmitter while obtaining at least one reading using the image guided surgery system, (d) positioning the second calibration tip in a known position in relation to the electromagnetic transmitter while obtaining at least one additional reading using the image guided surgery system and (e) calibrating the image guided surgery system to the substantially fixed shape of the medical device on the basis of the readings obtained in Steps C and D. In some embodiments, multiple readings may be taken in Steps C and D wile maintaining the first and second calibration tips in the known position relative to the electromagnetic transmitter. In some instances, a receiving location (e.g., a well, notch, cavity or other depression) may be formed in the electromagnetic transmitter and the calibrations tips may be maintained in the known location relative to the transmitter by inserting those calibration tips into the receiving location.

[0011] Further aspects, details and embodiments of the present invention will be understood by those of skill in the art upon reading the following detailed description of the invention and the accompanying drawings.

[0021] The following detailed description and the accompanying drawings are intended to describe some, but not necessarily all, examples or embodiments of the invention. The contents of this detailed description and the accompanying drawings do not in any way limit the scope of the invention disclosed herein.

[0022] FIGS. 1-3 show an adapter device 10 of the present invention that is designed to facilitate attachment of an electromagnetic image guidance element 12 to a medical device which, in this example, comprises a guide catheter 14. In another embodiment, the medical device can be a stiff member with a dilatation balloon on the distal end. The stiff member can be hollow to allow passage of other medical devices therethrough or to allow suction and/or irrigation therethrough. The guide catheter 14 comprises a tubular shaft 16 having a lumen, an optional curve 18 and an open distal end DE. A Luer hub 15 which may optionally include radially opposing projections 40 is mounted or formed on the proximal end PE of the guide catheter 14. The guide catheter shaft 16 is of substantially fixed size and shape such that the spatial relationship of the distal end DE to the proximal end PE is known. The image guidance element 12 contains electromagnetic sensors that provide signals useable by an IGS system. In typical useage, a distal portion DP of the guide catheter 14 becomes inserted into the subject's body while a proximal portion PP remains outside of the subject's body. The adapter device 10 firmly holds the guide catheter 14 and element 12 such that the electromagnetic sensors located in the element are in substantially fixed spatial relation to the distal end DE of the guide catheter 10. As explained more fully herebelow, this enables the IGS system to track the location of the distal end DE of the guide catheter 10 within the body of a human or animal subject.

[0023] One example of a commercially available embodiment of the guide catheter 10 is the Relieva™ Sinus Guide Catheter available from Acclarent, Inc. of Menlo Park, Calif. One example of a commercially available embodiment of an IGS element 12 useable in this invention is the InstaTrak® Receiver available from GE Healthcare, Inc. of Schenectady, N.Y.

[0024] With reference to the showings of FIGS. 1-3, one embodiment of the adapter 10 comprises an adapter body 20 having a element holding fixture 22 and a guide catheter holding fixture 24. In this example, the element holding fixture 22 comprises first and second clamping members 26 which are useable to clamp and hold the element 12 in fixed position on the underside of the adapter device body 20, as shown. Also, in this example, the guide catheter holding fixture 24 comprises a guide catheter receiving channel 28 which comprises first guide catheter fixture member 28a and a second guide catheter fixture member 28b. As explained in more detail herebelow, a tightening mechanism 30 which tightens the guide catheter receiving channel 28 about the proximal portion PP of the guide catheter shaft 16, thereby firmly holding the guide catheter 14 in place. In order to facilitate ease of use of the system including creating less interference with an endoscope used by the physician and a comfortable angle for the Physician's hand preferably the guide catheter receiving channel is at an angle between 0 and 45 degrees relative to the element holding fixture, and most preferably at an angle of 20 degrees.

[0025] The exploded view of FIG. 2 shows specific components of which this embodiment of the adapter device 10 is assembled. It is to be appreciated that this is merely an example, and various other components/modes of construction may be employed as alternatives to that seen in these figures. As shown, this embodiment of the adapter device 10 comprises an upper body portion 20a that is attached to a lower body portion 20b. Element clamping members 26a, 26b are attached to the lower body portion 20b. A first guide catheter fixture member 28a is formed integrally of the upper body portion 20a and a second guide catheter fixture member 28b is pivotally attached to the upper body portion 20a by way of a hinge which pivots about a pin 30. A screw 32 having a screw head 36 thereon is received within threaded bore 34. Turning of the screw head 36 in a first direction causes the second guide catheter fixture member 28b to pivot toward the second guide catheter fixture member 28a, thereby tightening the guide catheter receiving channel 28 so as to firmly grasp the guide catheter shaft 16. Turning of the screw head 36 in a second direction causes the second guide catheter fixture member 28b to pivot away from the second guide catheter fixture member 28a, thereby widening the guide catheter receiving channel 28 so as to allow the guide catheter shaft 16 to be inserted into or removed from the guide catheter holding fixture 24 or to allow adjustment of the longitudinal position or rotational orientation of the guide catheter 14 relative to the adapter device 10.

[0026] The components of the adapter device 20 may be formed of any suitable materials. In some embodiments, the components of the adapter body 20 may be molded from acrylonitrile butadiene styrene (ABS) or other polymeric material having suitable properties. In other embodiments, the components of the adapter body 20 can be metal so as to be resterilizable.

[0027] The upper body portion 20a may be attached to the lower body portion 20b in a number of ways including mechanical or frictional connections or, as shown in the example of FIG. 2, by way of adhesive pads 38 using suitable adhesive. In embodiments where the upper and lower body portions 20a, 20b are formed of ABS, a suitable adhesive would be epoxy or cyanoacrylate.

[0028] In one embodiment of a method for attaching the guide catheter 14 to the adapter device 10, the screw head 36 is initially turned in a counter-clockwise direction to widen the guide catheter receiving channel 28 to a width wider than the outer diameter of the guide catheter shaft 16. The guide catheter shaft 16 is then inserted through the channel 28 and positioned such that the proximal portion PP if the guide catheter shaft 16 is within the channel 28 and the guide catheter 14 is in the desired rotational orientation. Thereafter, the screw head 36 is turned in the clockwise direction, causing the channel 28 to narrow until sufficient clamping force is exerted on the guide catheter shaft 16 to hold the guide catheter 14 in substantially fixed longitudinal position and to substantially prevent subsequent rotational movement of the guide catheter shaft 16 relative to the adapter device 10. Optionally, in embodiments where opposing radial projections 40 are formed on the Luer hub 15 or elsewhere on the proximal portion PP of the guide catheter 14, corresponding receiving notches 42 may be formed within the guide catheter receiving channel 28, as shown in FIG. 2. The opposing radial projections 40 with be firmly held within notches 42 thereby defining and maintaining the rotational orientation of the guide catheter 14 relative to the adapter device 10. The clamping force of the present invention on the shaft 16 and/or the Luer hub 15 is important to eliminate relative motion between the guide catheter and adapter device 10 and correspondingly the element 12 resulting in very good accuracy in identifying the location of the distal tip of the guide catheter in the patient using the IGS system. In embodiments where the guide catheter shaft 16 includes a curve, the opposing radial projections 40 may extend on a transverse axis TA that is parallel to the direction in which the catheter shaft 16 curves, referred to herein as the “curve direction” CD. In illustration of this concept, in the embodiment of FIG. 1, the catheter shaft 16 has a 90 curve which extends in a particular curve direction CD that is parallel to the transverse axis TA of the opposing radial projections 40. The notches 42 are formed at 12 o'clock and 6 o'clock positions within the guide catheter receiving channel 28. Thus, when the opposing radial projections 40 are held within notches 42 as described, the curve direction CD will be straight up (or straight down) and in this manner the surgeon and the IGS system will at all times be apprised of the rotational orientation of the guide catheter 14.

[0029] FIG. 3 shows the underside of the adapter body 20. Indicia indicating specific information on the adapter device 10 (e.g., the size and type of medical device that is to be attached, etc.) may be formed on the underside of the adapter body 20 such that when the element 12 is positioned in the element holding fixture 24, it will recognize or read the indicia provided, and the IGS system may be programmed to make adjustments (e.g., software or computational adjustments) in response to such indicia. In this example, such indicia are in the form of unique magnetic field(s). To create such magnetic field(s), one or more of the magnet receiving slots 42 hold identifying magnet(s) 44 in a manner that creates the desired unique magnetic field(s). The unique identifying magnetic field is sensed by the electromagnetic navigation element 12 and communicated to the IGS system which is programmed to determine, on the basis of such information, the particular type of guide catheter 14 (or other medical device) that is (or will be) attached to the adapter device 10. For example, three identifying magnets 42 fixed to the second, third and fourth magnet slots 42 as shown in FIG. 2 may indicate that the particular curved guide catheter 14 shown in FIG. 1 is attached (or will be attached) to the adapter device 10.

[0030] The position and/or the trajectory of the distal end DE of the guide catheter 14 may be calibrated to an IGS system such as the InstaTrak® surgical image guidance system (available from GE Healthcare, Inc., Schenectady, N.Y.) using a suitable calibration tool. FIGS. 4A-4C show a calibration tool 50 of the present invention which may be used for this purpose. This calibration tool 50 comprises a rigid body having a catheter shaft receiving groove 51 which extends into a first calibration tip 52 on one side and a second calibration tip 54 on the other side. The shaft 16 of guide catheter 14 snap fits into the shaft receiving groove 51 with its distal end DE positioned in second calibration tip 54. An important embodiment of the calibration tool invention of the present application is the use of two calibration tips. The calibration tool in this important embodiment is constructed such that the axis that runs through the two calibration tips is coincident with the axis of the distal opening of the guide device. With this construction when the image guidance system is calibrated to both tips, it is also calibrated to the trajectory extending out from the distal opening of the guide device. Therefore, it is also calibrated to the axis along which a medical device would travel as it exits the distal end of the guide device which prospective trajectory can be displayed on the monitor of the image guidance system. Thus a variety of calibration tools 50 may be designed, each adapted to be used with a particular guide catheter 14 as a result the calibration tool may accommodate a device with only one angle or it may a variety of angled devices. If trajectory is not desired, a calibration tool with only one calibration tip can be used. Alternatively, the system can calibrate trajectory using a single tip calibration tool and a hole of known size and orientation in the headset attached to the patient. Calibration tool 50 may also have one or more guide markings 56 indicating the type of guide catheter 14 that can be used with that calibration tool 50. In a preferred embodiment, guide markings 56 are etched into calibration tool 50.

[0031] In the particular embodiment shown in FIGS. 4A-4C, calibration tool 50 is designed to accommodate either of two Relieva™ Sinus Guide Catheters (available from Acclarent, Inc., Menlo Park, Calif.) with curved distal tips curved at 70° and 110° respectively. In typical use with the InstaTrak® IGS system (available from GE Healthcare, Inc., Schenectady, N.Y.) the Relieva™ Sinus Guide Catheter is attached to the adapter device 10 as described above and as shown in FIG. 4C. The catheter shaft 16 is snap fit into the catheter shaft receiving groove 51 such that the distal end DE of the guide catheter shaft 16 is positioned within a tip receiving recess in second calibration tip 54. An imageable headset is attached to the subject's body and an imaging scan is performed to image the headset along with the subject's body using a tomographic imaging modality such as CT, MRI, etc. In a preferred embodiment, the headset is placed on the bridge of the nose and on the external ear canals of the patient. After the imaging scan is completed, the image data is transferred to the InstaTrak® IGS system. Thereafter, at the time of a later medical or surgical procedure, the guide catheter guide 14 and element 12 are attached to the adapter device 10 as described above. Identifying magnets 44 are positioned in the appropriate magnet slots 42 to type of guide catheter 14 being used. The shaft 16 of the guide catheter 14 is snap fit within shaft receiving groove 52 such that the distal end DE of the catheter shaft 16 is positioned within the tip receiving recess of second calibration tip 54. The headset is placed on the patient in the precise location as that used during the tomographic imaging scan. The electromagnetic transmitter 58 is attached to the patient headset. The first calibration tip 52 is then inserted into a tip receiving location, such as a well, cavity, notch or other depression 60 formed on the electromagnetic transmitter 58. Several readings may be taken using the IGS system with varying orientations of guide catheter 14 while keeping first calibration tip 52 within the depression 60 of the transmitter 58. Thereafter, the second calibration tip 54 is fitted into depression 60 of transmitter 58 and several more readings are taken using the IGS system with varying orientations of guide catheter 14 while keeping second calibration tip 54 inside calibration depression 60. In this way, the specific orientation of the curve formed in the catheter shaft 16 is calibrated to the IGS system's computing device. Also, the position of the distal tip of guide device 14 is located at a fixed offset with respect to the position of either calibration tip 52 or 54. The offset is used to calibrate the position of the distal end DE of guide catheter 14 relative to the electromagnetic IGS system. The offset may be programmed into the IGS system or may be manually entered by the IGS system via a user interface such as a keyboard, keypad, touch screen, etc. The IGS system will be programmed to automatically calculate the position and/or the orientation of the distal end DE of the guide catheter 14.

[0032] After the calibration process is complete, the guide catheter 14 is removed from the calibration tool 50 and the medical or surgical procedure is conducted.

[0033] It is to be understood that the particular design and construction of the adapter device 10 shown in FIGS. 1-4C is not limiting. Various other modes of design and construction may be used within the scope of the invention claimed herein. One of many such examples is shown in FIGS. 5A-5C.

[0034] With reference to FIGS. 5A-5C, there is shown an alternative adapter device 10a which comprises an adapter body 70 having a element holding fixture 72 and a guide catheter holding fixture 74. In this example, the element holding fixture 72 comprises element clamping members 24a similar to those of the embodiment shown in FIGS. 1-4C for clamping and holding the element 12 in substantially fixed position relative to the adapter device 10a. Also in this example, the guide catheter holding fixture 74 comprises a male Luer connector 76 and a catheter shaft support member 78. As seen in FIGS. 5B and 5C, the proximal portion PP of the guide catheter shaft 16 is inserted into the catheter shaft support fixture 78 and the male Luer connector 76 is connected to the female Luer connector hub 15 on the proximal end of the guide catheter 14. This arrangement firmly holds the guide catheter 14 in substantially fixed position relative to the adapter device 10A. Optionally, a constraining groove 80 may be formed in the adapter body 70 to receive one of the opposing radial projections 40 on the proximal Luer hub 15 of the guide catheter 14, thereby defining and maintaining the rotational orientation of the guide catheter 14 in the same manner as described above with respect to the other embodiment of the adapter device 10. In a further embodiment, the guide catheter 14 can be fixed at any rotational orientation the physician chooses by turning the guide catheter to the desired orientation and then tightening and locking the rotating Luer connector 76 to the proximal Luer hub 15 of the guide catheter 14. In another embodiment, the proximal hub of the guide catheter 14 can have a hexagonal shape or other shape that fits into a matching shaped opening in the adapter device.

[0035] The adapter devices of this invention, including the embodiments of the device 10, 10a shown in these drawings, can be used as accessories to the Relieva™ Sinus Guides (Acclarent, Inc., Menlo Park, Calif.) and the InstaTrak™ 3500 Plus and ENTrak™ Plus IGS systems (GE Healthcare, Inc., Schenectady, N.Y.). The combination of the adapter device 10, 10a and the InstaTrak™ 3500 Plus or ENTrak™ Plus IGS system can be used to provide image guidance capabilities to the Relieva™ Sinus Guide for navigation in the paranasal sinus anatomy. This combination can be used to track the distal end DE of the Relieva™ Sinus Guide and/or display its trajectory on a monitor. Specific uses of the adapter device 10, 10a include image guided balloon dilation procedures as well as other ear, nose or throat procedures and procedures elsewhere in the body.

[0036] It is to be further appreciated that the invention has been described hereabove with reference to certain examples or embodiments of the invention but that various additions, deletions, alterations and modifications may be made to those examples and embodiments without departing from the intended spirit and scope of the invention. For example, any element or attribute of one embodiment or example may be incorporated into or used with another embodiment or example, unless to do so would render the embodiment or example unsuitable for its intended use. All reasonable additions, deletions, modifications and alterations are to be considered equivalents of the described examples and embodiments and are to be included within the scope of the following claims.