# US 10,307,061 B2 · Automatic tracking of a tool upon a vascular roadmap

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- Number: US 10,307,061 B2
- Document ID: US10307061B2
- Status: Granted
- Kind: B2
- Application number: 12/650,152
- Filed: 2009-12-30
- Published: 2010-06-24
- Granted: 2019-06-04
- Earliest claimed: 2007-03-08
- Assignees: Sync-Rx, Ltd.
- Applicants: Ran Cohen; David Tolkowsky
- Inventors: Ran Cohen; David Tolkowsky
- Web page: https://patentgrep.com/patent/US10307061B2

## CPC

- A61B 6/12: Arrangements for detecting or locating foreign bodies
- A61B 5/0044: {for the heart}
- A61B 6/469: {for selecting a region of interest [ROI]}
- A61B 6/481: {involving the use of contrast agents}
- A61B 6/501: {for diagnosis of the head, e.g. neuroimaging or craniography}
- A61B 6/504: {for diagnosis of blood vessels, e.g. by angiography}
- A61B 6/5217: {extracting a diagnostic or physiological parameter from medical diagnostic data}
- A61B 6/541: {involving acquisition triggered by a physiological signal}
- A61B 17/12036: {partial occlusion}
- A61B 17/1204: {temporary occlusion}
- A61B 17/12136: {Balloons}
- A61B 34/10: Computer-aided planning, simulation or modelling of surgical operations
- A61B 34/20: Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- G06T 7/0012: {Biomedical image inspection}
- G06T 7/0014: {using an image reference approach}
- G06T 7/13: Edge detection
- G06T 7/246: using feature-based methods, e.g. the tracking of corners or segments
- G06T 7/62: of area, perimeter, diameter or volume
- G06T 11/60: Creating or editing images; Combining images with text
- G06V 40/103: {Static body considered as a whole, e.g. static pedestrian or occupant recognition}
- G16H 50/30: for calculating health indices; for individual health risk assessment
- A61B 5/7285: {for synchronizing or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal}
- A61B 5/7289: {Retrospective gating, i.e. associating measured signals or images with a physiological event after the actual measurement or image acquisition, e.g. by simultaneously recording an additional physiological signal during the measurement or image acquisition}
- A61B 6/503: {for diagnosis of the heart}
- A61B 6/5247: {combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound}
- A61B 8/0883: {for diagnosis of the heart}
- A61B 8/0891: {for diagnosis of blood vessels}
- A61B 8/543: {involving acquisition triggered by a physiological signal}
- A61B 18/02: by cooling, e.g. cryogenic techniques
- A61B 18/1492: {having a flexible, catheter-like structure, e.g. for heart ablation (A61B18/1477 takes precedence)}
- A61B 18/24: with a catheter (A61B18/26, A61B18/28 take precedence)
- A61B 34/25: {User interfaces for surgical systems}
- A61B 2017/00252: {for by-pass connections, i.e. connections from heart chamber to blood vessel or from blood vessel to blood vessel}
- A61B 2017/00694: {with means correcting for movement of or for synchronisation with the body}
- A61B 2017/00703: {correcting for movement of heart, e.g. ECG-triggered}
- A61B 2017/1205: {Introduction devices}
- A61B 2017/22044: {with a pointed tip}
- A61B 2017/22094: {for crossing total occlusions, i.e. piercing}
- A61B 2034/105: {Modelling of the patient, e.g. for ligaments or bones}
- A61B 2034/107: {Visualisation of planned trajectories or target regions}
- A61B 2034/254: {being adapted depending on the stage of the surgical procedure}
- A61B 2090/365: {augmented reality, i.e. correlating a live optical image with another image}
- A61F 2/958: Inflatable balloons for placing stents or stent-grafts
- G06T 2207/10121: Fluoroscopy
- G06T 2207/30048: Heart; Cardiac
- G06T 2207/30101: Blood vessel; Artery; Vein; Vascular
- G06V 2201/034: of medical instruments
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- G06T: IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
- G06V: IMAGE OR VIDEO RECOGNITION OR UNDERSTANDING
- G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- A61F: FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS (dental prosthetics A61C)

## Abstract

Apparatus and methods are described including generating a road map of a blood vessel in a portion of a subject's body. A given feature that is within the portion of the subject's body is identified in the road map, the given feature being visible even in images of the portion the generation of which does not include use of a contrast agent. A tool is inserted into the blood vessel, and a current location of a portion of the tool is determined with respect to the given feature, by imaging the tool and the feature. In response to the determined current location, a current position of the tool within the road map is determined. In response to determining the current position of the tool within the road map, the current position of the tool with respect to the road map is displayed. Other embodiments are also described.

## Claims

### Claim 1

A method for use with an endoluminal tool that is inserted into a blood vessel in a portion of a subject's vasculature, and with an extraluminal image-acquisition device that acquires images of the endoluminal tool and the portion of the subject's vasculature, the method comprising:
using a first image acquired by the image-acquisition device when there was contrast agent within the portion of the subject's vasculature, generating a road map of the blood vessel, and identifying in the first image a feature that is within the portion of the subject's vasculature;
determining, by a processor, a distance between a portion of the endoluminal tool and the feature within a second image that shows the endoluminal tool and the feature, the second image having been acquired by the extraluminal image-acquisition device in an absence of contrast agent within the portion of the subject's vasculature, wherein the feature is visible and in the same position with respect to the portion of the subject's vasculature in both the first image and the second image;
based on the determined distance between the portion of the endoluminal tool and the feature in the second image, determining, by the processor, a position of the endoluminal tool within the road map; and
in response, driving, by the processor, a display to display an output representative of the determined position of the endoluminal tool within the road map.

### Claim 2 (depends on 1)

The method according to claim 1, wherein the endoluminal tool includes a balloon, and wherein determining the distance between the portion of the endoluminal tool and the feature comprises determining a distance between at least a portion of the balloon and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 3 (depends on 1)

The method according to claim 1, wherein the endoluminal tool includes a replacement valve, and wherein determining the distance between the portion of the endoluminal tool and the feature comprises determining a distance between at least a portion of the replacement valve and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 4 (depends on 1)

The method according to claim 1, wherein the endoluminal tool includes a stent, and wherein determining the distance between the portion of the endoluminal tool and the feature comprises determining a distance between at least a portion of the stent and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 5 (depends on 1)

The method according to claim 1, wherein the endoluminal tool includes a wire, and wherein determining the distance between the portion of the endoluminal tool and the feature comprises determining a distance between at least a portion of the wire and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 6 (depends on 1)

The method according to claim 1, wherein the endoluminal tool includes a catheter, and wherein determining the distance between the portion of the endoluminal tool and the feature comprises determining a distance between at least a portion of the catheter and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 7 (depends on 1)

The method according to claim 1, wherein generating the road map comprises generating a road map based upon a given phase of a motion cycle of the blood vessel, and wherein determining the distance between the portion of the endoluminal tool and the feature, within the second image that was acquired in the absence of contrast agent comprises determining a distance between the portion of the endoluminal tool and the feature, within at least one image that was acquired during the given phase, in the absence of contrast agent.

### Claim 8

Apparatus for use with an endoluminal tool that is inserted into a blood vessel in a portion of a subject's vasculature, the apparatus comprising:
an extraluminal image-acquisition device that is configured to acquire images of the endoluminal tool and the portion of the subject's vasculature;
a display; and
at least one processor configured to:
generate a road map of the blood vessel in the portion of the subject's body using a first image, the first image having been acquired by the extraluminal image-acquisition device when there was contrast agent within the portion of the subject's vasculature,
identify a feature that is within the portion of the subject's vasculature within the first image acquired when there was contrast agent within the portion of the subject's vasculature, wherein the feature is visible and in the same position with respect to the portion of the subject's vasculature in both the first image and a second image acquired by the extraluminal image-acquisition device in an absence of contrast agent within the portion of the subject's vasculature;
determine a distance between at least a portion of the endoluminal tool and the feature within the second image of the endoluminal tool and the feature,
based on the determined distance between the endoluminal tool and the feature in the second image, determine a position of the endoluminal tool within the road map, and
in response to determining the position of the endoluminal tool within the road map, drive the display to display an output representative of the determined position of the endoluminal tool within the road map.

### Claim 9 (depends on 8)

The apparatus according to claim 8, wherein the endoluminal tool includes a balloon, and wherein the processor is configured to determine the distance between the portion of the endoluminal tool and the feature, by determining a distance between at least a portion of the balloon and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 10 (depends on 8)

The apparatus according to claim 8, wherein the endoluminal tool includes a replacement valve, and wherein the processor is configured to determine the distance between the portion of the endoluminal tool and the feature, by determining a distance between at least a portion of the replacement valve and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 11 (depends on 8)

The apparatus according to claim 8, wherein the endoluminal tool includes a stent, and wherein the processor is configured to determine the distance between the portion of the endoluminal tool and the feature, by determining a distance between at least a portion of the stent and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 12 (depends on 8)

The apparatus according to claim 8, wherein the endoluminal tool includes a wire, and wherein the processor is configured to determine the distance between the portion of the endoluminal tool and the feature, by determining a distance between at least a portion of the wire and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 13 (depends on 8)

The apparatus according to claim 8, wherein the endoluminal tool includes a catheter, and wherein the processor is configured to determine the distance between the portion of the endoluminal tool and the feature, by determining a distance between at least a portion of the catheter and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 14 (depends on 8)

The apparatus according to claim 8, wherein the processor is configured to generate a road map based upon a given phase of a motion cycle of the blood vessel, and wherein the processor is configured to determine the distance between the portion of the endoluminal tool and the feature within the second image that was acquired during the given phase in the absence of contrast agent.

### Claim 15

A method for use with an extraluminal image-acquisition device that acquires two-dimensional images of a blood vessel in a portion of a subject's vasculature, the method comprising:
using a first two-dimensional image, the first image having been acquired by the extraluminal image-acquisition device when there was contrast agent within the portion of the subject's vasculature, generating a two-dimensional road map of the blood vessel;
identifying, by a processor, a feature that is within the portion of the subject's vasculature within the first image acquired when there was contrast agent within the portion of the subject's vasculature;
identifying, by the processor, the feature in a second two-dimensional image acquired by the extraluminal image-acquisition device in an absence of contrast agent within the portion of the subject's vasculature, wherein the feature is in the same position with respect to the portion of the subject's vasculature in both the first image and the second image;
coregistering, by the processor, the two-dimensional road map and the second image acquired in the absence of contrast agent, using the identified feature; and
driving, by the processor, a display to display an output in response to the coregistering of the road map and the second image acquired in the absence of contrast agent.

### Claim 16 (depends on 15)

The method according to claim 15, wherein coregistering the road map and the second image acquired in the absence of contrast agent comprises automatically coregistering the road map and the second image acquired in the absence of contrast agent.

### Claim 17 (depends on 15)

The method according to claim 15, wherein coregistering the road map and the second image acquired in the absence of contrast agent comprises coregistering the road map and the second image acquired in the absence of contrast agent in real time, with respect to acquisition of the second image acquired in the absence of contrast agent.

### Claim 18 (depends on 15)

The method according to claim 15, wherein coregistering the road map and the second image acquired in the absence of contrast agent comprises coregistering the road map and the second image acquired in the absence of contrast agent in near real time, with respect to acquisition of the second image acquired in the absence of contrast agent.

### Claim 19

Apparatus comprising:
an extraluminal image-acquisition device that is configured to acquire two-dimensional images of a blood vessel of a portion of a subject's vasculature;
a display; and
at least one processor configured to:
receive the images from the extraluminal image-acquisition device,
generate a two-dimensional road map of the blood vessel in the portion of the subject's vasculature, using a first two-dimensional image, the first image having been acquired by the extraluminal image-acquisition device when there was contrast agent within the portion of the subject's vasculature,
identify a feature that is within the portion of the subject's vasculature within the first image that was acquired when there was contrast agent within the portion of the subject's vasculature,
identify the feature in a second two-dimensional image that was acquired by the extraluminal image-acquisition device in an absence of contrast agent within the portion of the subject's vasculature, wherein the feature is in the same position with respect to the portion of the subject's vasculature in both the first image and the second image,
coregister the two-dimensional road map and the second image acquired in the absence of contrast agent, using the identified feature, and
in response to the coregistering of the road map and the second image acquired in the absence of contrast agent, drive the display to display an output.

### Claim 20 (depends on 19)

The apparatus according to claim 19, wherein the processor is configured to automatically coregister the road map and the second image acquired in the absence of contrast agent.

### Claim 21 (depends on 19)

The apparatus according to claim 19, wherein the processor is configured to coregister the road map and the second image acquired in the absence of contrast agent in real time, with respect to acquisition of the second image acquired in the absence of contrast agent.

### Claim 22 (depends on 19)

The apparatus according to claim 19, wherein the processor is configured to coregister the road map and the second image acquired in the absence of contrast agent in near real time, with respect to acquisition of the second image acquired in the absence of contrast agent.

### Claim 23 (depends on 1)

The method according to claim 1, wherein the endoluminal tool includes a tool that is inserted into the blood vessel via a guiding catheter, wherein the feature includes a portion of the guiding catheter, and wherein the identifying the feature in the first image that was acquired when there was contrast agent within the portion of the subject's vasculature comprises identifying the portion of the guiding catheter in the first image that was acquired when there was contrast agent within the portion of the subject's vasculature.

### Claim 24 (depends on 1)

The method according to claim 1, wherein the endoluminal tool includes an endoluminal imaging catheter that is inserted into the blood vessel, and wherein determining the distance between the portion of the endoluminal tool and the feature comprises determining a distance between at least a portion of the endoluminal imaging catheter and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 25 (depends on 1)

The method according to claim 1, wherein the endoluminal tool includes an endoluminal measurement catheter that is inserted into the blood vessel, and wherein determining the distance between the portion of the endoluminal tool and the feature comprises determining a distance between at least a portion of the endoluminal measurement catheter and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 26 (depends on 1)

The method according to claim 1, wherein:
the endoluminal tool includes an endoluminal catheter that is inserted into the blood vessel via a guiding catheter, the endoluminal catheter being selected from the group consisting of: an endoluminal imaging catheter and an endoluminal measurement catheter,
the feature includes a portion of the guiding catheter,
identifying the feature in the first image that was acquired when there was contrast agent within the portion of the subject's vasculature comprises identifying the portion of the guiding catheter in the first image that was acquired when there was contrast agent within the portion of the subject's vasculature, and
determining the distance between the portion of the endoluminal tool and the feature comprises determining a distance between a portion of the endoluminal catheter and the portion of the guiding catheter.

### Claim 27 (depends on 8)

The apparatus according to claim 8, wherein the endoluminal tool includes a tool that is inserted into the blood vessel via a guiding catheter, wherein the feature includes a portion of the guiding catheter, and wherein the processor is configured to identify the feature in the first image that was acquired when there was contrast agent within the portion of the subject's vasculature by identifying a portion of the guiding catheter in the first image that was acquired when there was contrast agent within the portion of the subject's vasculature.

### Claim 28 (depends on 8)

The apparatus according to claim 8, wherein the endoluminal tool includes an endoluminal imaging catheter that is inserted into the blood vessel, and wherein the processor is configured to determine the distance between the portion of the endoluminal tool and the feature, by determining a distance between at least a portion of the endoluminal imaging catheter and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 29 (depends on 8)

The apparatus according to claim 8, wherein the endoluminal tool includes an endoluminal measurement catheter that is inserted into the blood vessel, and wherein the processor is configured to determine the distance between the portion of the endoluminal tool and the feature, by determining a distance between at least a portion of the endoluminal measurement catheter and the feature within the second image that was acquired in the absence of contrast agent.

### Claim 30 (depends on 8)

The apparatus according to claim 8, wherein:
the endoluminal tool includes an endoluminal catheter that is inserted into the blood vessel via a guiding catheter, the endoluminal catheter being selected from the group consisting of: an endoluminal imaging catheter and an endoluminal measurement catheter,
the feature includes a portion of the guiding catheter,
the processor is configured to identify the feature in the first image that was acquired when there was contrast agent within the portion of the subject's vasculature by identifying the portion of the guiding catheter in the first image that was acquired when there was contrast agent within the portion of the subject's vasculature, and
the processor is configured to determine the distance between the portion of the endoluminal tool and the feature by determining a distance between a portion of the endoluminal catheter and the portion of the guiding catheter within the second image acquired in the absence of contrast agent.

### Claim 31 (depends on 15)

The method according to claim 15, further comprising, in response to the registration of the road map to the second image acquired in the absence of contrast agent, overlaying the road map and the second image acquired in the absence of contrast agent, wherein driving the display to display the output comprises driving the display to display the overlay of the road map and the second image acquired in the absence of contrast agent.

### Claim 32 (depends on 19)

The apparatus according to claim 19, wherein the processor is configured, in response to the coregistering of the road map and the second image acquired in the absence of contrast agent, to drive the display to display an overlay of the road map and the second image acquired in the absence of contrast agent.

### Claim 33

A method for use with an endoluminal catheter selected from the group consisting of: an endoluminal imaging catheter and an endoluminal measurement catheter, the endoluminal catheter being configured to be inserted into a blood vessel in a portion of a subject's vasculature via a guiding catheter, and for use with an extraluminal image-acquisition device that acquires extraluminal images of the endoluminal catheter and the portion of the subject's vasculature, the method comprising:
using a first extraluminal image, the first image having been acquired by the extraluminal image-acquisition device when there was contrast agent within the portion of the subject's vasculature, generating a road map of the blood vessel;
identifying a distal portion of the guiding catheter within the first image that was acquired when there was contrast agent within the portion of the subject's vasculature;
determining, by a processor, a distance between a portion of the endoluminal catheter and the distal portion of the guiding catheter within a second extraluminal image that shows the endoluminal catheter and the distal portion of the guiding catheter, the second image having been acquired in an absence of contrast agent within the portion of the subject's vasculature, wherein the distal portion of the guiding catheter is visible and in the same position with respect to the portion of the subject's vasculature in both the first image and the second image;
based on the determined distance between the portion of the endoluminal catheter and the distal portion of the guiding catheter in the second image, determining, by the processor, a position of the endoluminal catheter with respect to the road map; and
in response to determining the position of the endoluminal catheter within the road map, driving, by the processor, a display to display an output representative of the determined position of the endoluminal tool within the road map.

### Claim 34

Apparatus for use with an endoluminal catheter selected from the group consisting of: an endoluminal imaging catheter and an endoluminal measurement catheter, the endoluminal catheter being configured to be inserted into a blood vessel in a portion of a subject's vasculature via a guiding catheter, the apparatus comprising:
an extraluminal image-acquisition device that acquires images of the endoluminal catheter and the portion of the subject's vasculature; and
at least one processor configured to:
generate a road map of the blood vessel, using a first extraluminal image, the first image having been acquired by the extraluminal image-acquisition device when there was contrast agent within the portion of the subject's vasculature,
identify a distal portion of the guiding catheter within the first image acquired when there was contrast agent within the portion of the subject's vasculature,
determine a distance between a portion of the endoluminal catheter and the distal portion of the guiding catheter within a second extraluminal image of the endoluminal catheter and the guiding catheter, the second extraluminal image having been acquired in an absence of contrast agent within the portion of the subject's vasculature, wherein the distal portion of the guiding catheter is visible and in the same position with respect to the portion of the subject's vasculature in both the first image and the second image,
based on the determined distance between the portion of the endoluminal catheter and the distal portion of the guiding catheter in the second image, determine a position of the endoluminal catheter with respect to the road map, and
in response to determining the position of the endoluminal catheter with respect to the road map, drive the display to display an output representative of the determined position of the endoluminal catheter within the road map.

### Claim 35 (depends on 1)

The method according to claim 1, wherein determining, by the processor, the distance between the portion of the endoluminal tool and the feature comprises determining a distance between the portion of the endoluminal tool and the feature, the distance being measured along the blood vessel.

### Claim 36 (depends on 8)

The apparatus according to claim 8, wherein the processor is configured to determine the distance between the portion of the endoluminal tool and the feature by determining a distance between the portion of the endoluminal tool and the feature, the distance being measured along the blood vessel.