# US 11,443,441 B2 · Deep inspiration breath-hold setup using x-ray imaging > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 11,443,441 B2 - Document ID: US11443441B2 - Status: Granted - Kind: B2 - Application number: 16/476,941 - Filed: 2017-02-24 - Published: 2019-12-05 - Granted: 2022-09-13 - Earliest claimed: 2017-02-24 - Assignees: Brainlab AG - Applicants: Brainlab AG - Inventors: Kajetan Berlinger - Web page: https://patentgrep.com/patent/US11443441B2 ## CPC - G06T 7/33: using feature-based methods - A61B 5/0077: {Devices for viewing the surface of the body, e.g. camera, magnifying lens} - A61B 5/7292: {Prospective gating, i.e. predicting the occurrence of a physiological event for use as a synchronisation signal} - A61B 34/10: Computer-aided planning, simulation or modelling of surgical operations - A61N 5/1037: {taking into account the movement of the target, e.g. 4D-image based planning} - A61N 5/1039: {using functional images, e.g. PET or MRI} - A61N 5/1049: {for verifying the position of the patient with respect to the radiation beam} - G06T 7/0014: {using an image reference approach} - G06T 7/248: {involving reference images or patches} - G06T 7/251: {involving models} - G06T 7/30: Determination of transform parameters for the alignment of images, i.e. image registration - G06T 7/74: {involving reference images or patches} - G06T 7/75: {involving models} - G06T 12/00: Tomographic reconstruction from projections - G16H 30/40: for processing medical images, e.g. editing - A61B 2034/107: {Visualisation of planned trajectories or target regions} - A61B 2090/3762: {using computed tomography systems [CT]} - A61N 2005/1059: {using cameras imaging the patient} - G06T 2207/10072: Tomographic images - G06T 2207/10081: Computed x-ray tomography [CT] - G06T 2207/10116: X-ray image - G06T 2207/20128: Atlas-based segmentation - G06T 2207/20221: Image fusion; Image merging - G06T 2207/30008: Bone - G06T 2207/30081: Prostate - G06T 2207/30096: Tumor; Lesion - G06T 2207/30196: Human being; Person - G06T: IMAGE DATA PROCESSING OR GENERATION, IN GENERAL - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B) - G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA ## Abstract A computer-implemented medical data processing method for determining a difference in position of an imaged anatomical body part of a patient, the method comprising executing, on at least one processor of at least one computer, steps of: acquiring, at the at least one processor, first patient image data describing a digital image of a first anatomical body part during a first phase of inspiration and the position of the first anatomical body part during the first phase of inspiration in a first reference system associated with the first image data; acquiring, at the at least one processor, second patient image data different from the first patient image data and describing a digital image of the first anatomical body part during a second phase of inspiration and the position of the first anatomical body part during the second phase of inspiration in a second reference system associated with the second image data; acquiring, at the at least one processor, position transformation data describing a transformation between the first reference system and the second reference system; and determining, by the at least one processor and based on the first patient image data and the second patient image data and the position transformation data, position difference data describing a relative position between the position of the first anatomical body part during the first phase of inspiration and the position of the first anatomical body part during the second phase of inspiration. ## Claims ### Claim 1 A computer-implemented medical data processing method for determining a difference in position of an imaged anatomical body part of a patient, the method comprising executing, on at least one processor of at least one computer, steps of: acquiring, at the at least one processor, first patient image data describing a digital image of a first anatomical body part and a second anatomical body part during a first phase of inspiration and the position of the first anatomical body part and the position of the second anatomical body part during the first phase of inspiration in a first reference system associated with the first image data; acquiring, at the at least one processor, second patient image data different from the first patient image data describing a digital image of the first anatomical body part during a second phase of inspiration and the position of the first anatomical body part during the second phase of inspiration in a second reference system; acquiring, at the at least one processor, third patient image data different from the first patient image data and the second patient image data describing a digital image of the second anatomical body part during a third phase of inspiration and the position of the second anatomical body part during the third phase of inspiration in the second reference system; determining, by the at least one processor, position transformation data describing a transformation between the first reference system and the second reference system, the position transformation data being determined based on the first patient image data and the third patient image data; and determining, by the at least one processor and based on the first patient image data and the second patient image data and the position transformation data, position difference data describing a relative position between the position of the first anatomical body part during the first phase of inspiration and the position of the first anatomical body part during the second phase of inspiration, wherein the first patient image data is three-dimensional image data, the second patient image data is two-dimensional image data, the first anatomical body part is a body part moving during inspiration, the second anatomical body part is a body part not moving during inspiration, the first phase of inspiration is a phase of deep inspiration breath hold at a first point in time, and the second phase of inspiration is a phase of deep inspiration breath hold at a second point in time, which is later than the first point in time. ### Claim 2 (depends on 1) The method of claim 1, wherein the method further comprises, before determining the position transformation data, acquiring, at the at least one processor, atlas data describing a model of the second anatomical body part in a reference body, wherein determining the position transformation data, by the at least one processor, is based on the first patient image data, the third patient image data and the atlas data. ### Claim 3 (depends on 1) The method according to claim 1, wherein the method further comprises the following step performed after determining the position transformation data: determining, by the at least one processor and based on the position transformation data, control data describing a control command for controlling a patient support device to be moved according to the transformation. ### Claim 4 (depends on 1) The method according to claim 1, wherein the second patient image data describes a digital image of the first anatomical body part and the second anatomical body part during the second phase of inspiration and the position of the first anatomical body part and the position of the second anatomical body part during the second phase of inspiration in the second reference system and wherein the method comprises the following step performed after acquiring the second patient image data and before determining the position transformation data: acquiring, at the at least one processor, atlas data describing a model of the second anatomical body part in a reference body, wherein the position transformation data is determined, by the at least one processor, is based on the first patient image data and the second patient image data and the atlas data. ### Claim 5 (depends on 1) The method according to claim 1, wherein the method further comprises the following steps performed before acquiring the second patient image data: acquiring, at the at least one processor, patient surface data describing the position of a surface of the patient in a third reference system associated with an optical position tracking system; acquiring, at the at least one processor, surface offset data describing a value of an offset between the position of the patient surface described by the acquired patient surface data and a second position of the patient surface; determining, by the at least one processor and based on the patient surface data and the surface offset data, corrected patient surface data describing the corrected position of the surface of the patient; acquiring, at the at least one processor, the position transformation data; acquiring, at the at least one processor, first camera position transformation data describing a transformation between the third reference system and the second reference system; determining, by the at least one processor and based on the first camera position transformation data and the position transformation data, second camera position transformation data describing a transformation between the first reference system and the third reference system; determining, by the at least one processor and based on the corrected patient surface data and the first patient image data and the second camera position transformation data, surface transformation data describing a transformation between the corrected position of the surface of the patient and an outer contour of the first patient image data. ### Claim 6 (depends on 5) The method of claim 5, further comprising after determining the surface transformation data and before acquiring the second patient image data, determining, by the at least one processor and based on the surface transformation data, inspiration phase data describing a phase of inspiration of the patient, wherein the patient surface data is acquired based on using an optical position tracking system by tracking a predetermined region of the surface of the patient which moves during inspiration, and wherein the optical position tracking system uses at least one of patterned light, infrared light, one or more optical markers or multiple cameras. ### Claim 7 (depends on 6) The method according to claim 6, wherein the method further comprises, after determining the inspiration phase data and before acquiring the second patient image data, determining, by the at least one processor and based on the inspiration phase data, control data describing a control signal for controlling a medical imaging device to acquire the second patient image data. ### Claim 8 (depends on 5) The method of claim 5, wherein the first patient image data further describes a digital image of a third anatomical body part during the first phase of inspiration and the position of the third anatomical body part during the first phase of inspiration in the first reference system and wherein the method comprises the following steps performed after acquiring the surface transformation data: acquiring, at the at least one processor, planning data describing the position of the third anatomical body part in the first reference system; determining, by the at least one processor and based on the corrected patient surface data and the surface transformation data and the planning data, target position data describing the relative position between the third anatomical body part and the corrected position of the surface of the patient. ### Claim 9 (depends on 8) The method according to claim 8, wherein the method further comprises the following steps performed after determining the position difference data: acquiring, at the at least one processor, difference threshold data describing thresholds of the position difference data; determining, by the at least one processor and based on the difference threshold data and the position difference data, first condition data describing whether the position difference data exceeds a first predetermined difference threshold; if the first condition data describes that the position difference data exceeds the first predetermined difference threshold, determining, by the at least one processor and based on the position difference data, the surface offset data; and repeating the method starting at one of acquiring the patient surface data or acquiring the second patient image data. ### Claim 10 (depends on 9) The method of claim 9, further comprising, if the first condition data describes that the position difference data does not exceed the first predetermined difference threshold, continuing with a step of determining, by the at least one processor and based on the target position data and the corrected patient surface data and the inspiration phase data, treatment parameter data describing at least one treatment parameter of a treatment device. ### Claim 11 (depends on 9) The method of claim 9, further comprising determining, after acquiring the difference threshold data, by the at least one processor and based on the difference threshold data and the position difference data, second condition data describing whether the position difference data exceeds a second predetermined difference threshold; and if the second condition data describes that the position difference data exceeds the second predetermined difference threshold, determining, by the at least one processor and based on the position difference data, control data describing a control command for controlling a patient support device and/or a treatment device to be moved according to the position difference data. ### Claim 12 (depends on 11) The method of claim 11, further comprising, if the second condition data describes that the position difference data does not exceed the second predetermined difference threshold and if the first condition data describes that the position difference data does not exceed the first predetermined difference threshold, continuing with a step of determining, by the at least one processor and based on the target position data and the corrected patient surface data and the inspiration phase data, treatment parameter data describing at least one treatment parameter of a treatment device. ### Claim 13 (depends on 10) The method of claim 10, further comprising a step of outputting, by the at least one processor, the treatment parameter data to a treatment device, wherein the at least one treatment parameter describes deactivation of the treatment device in case at least one of the inspiration phase data indicates a predetermined inspiration phase not intended for treatment, or the patient surface data indicates a predetermined position of the surface of the patient not intended for treatment. ### Claim 14 (depends on 10) The method according to claim 10, wherein the method comprises the following step performed after determining the treatment parameter data: repeating the method starting at one of acquiring the patient surface data or acquiring the second patient image data. ### Claim 15 (depends on 1) The method according to claim 1, wherein the third phase of inspiration is a phase of inspiration at a third point in time, which is later than the first point in time and earlier than the second point in time. ### Claim 16 A non-transitory, computer-readable storage medium having stored thereon computer-executable instructions for a computer program which, when running on at least one processor of at least one computer or when loaded into a memory of at least one computer, causes the at least one computer to: acquire first patient image data describing a digital image of a first anatomical body part and a second anatomical body part during a first phase of inspiration and the position of the first anatomical body part and the position of the second anatomical body part during the first phase of inspiration in a first reference system associated with the first image data; acquire second patient image data different from the first patient image data describing a digital image of the first anatomical body part during a second phase of inspiration and the position of the first anatomical body part during the second phase of inspiration in a second reference system; acquire third patient image data different from the first patient image data and the second patient image data describing a digital image of the second anatomical body part during a third phase of inspiration and the position of the second anatomical body part during the third phase of inspiration in the second reference system; determine position transformation data describing a transformation between the first reference system and the second reference system, the position transformation data being determined based on the first patient image data and the third patient image data; and determine, based on the first patient image data and the second patient image data and the position transformation data, position difference data describing a relative position between the position of the first anatomical body part during the first phase of inspiration and the position of the first anatomical body part during the second phase of inspiration, wherein the first patient image data is three-dimensional image data, the second patient image data is two-dimensional image data, the first anatomical body part is a body part moving during inspiration, the second anatomical body part is a body part not moving during inspiration, the first phase of inspiration is a phase of deep inspiration breath hold at a first point in time, and the second phase of inspiration is a phase of deep inspiration breath hold at a second point in time, which is later than the first point in time. ### Claim 17 A system for supporting determining a difference in position of an imaged anatomical body part of a patient, the system comprising: a computer having computer-executable instructions that, when executed, configure the computer to: acquire first patient image data describing a digital image of a first anatomical body part and a second anatomical body part during a first phase of inspiration and the position of the first anatomical body part and the position of the second anatomical body part during the first phase of inspiration in a first reference system associated with the first image data: acquire second patient image data different from the first patient image data describing a digital image of the first anatomical body part during a second phase of inspiration and the position of the first anatomical body part during the second phase of inspiration in a second reference system; acquire third patient image data different from the first patient image data and the second patient image data describing a digital image of the second anatomical body part during a third phase of inspiration and the position of the second anatomical body part during the third phase of inspiration in the second reference system; determine position transformation data describing a transformation between the first reference system and the second reference system, the position transformation data being determined based on the first patient image data and the third patient image data; and determine, based on the first patient image data and the second patient image data and the position transformation data, position difference data describing a relative position between the position of the first anatomical body part during the first phase of inspiration and the position of the first anatomical body part during the second phase of inspiration; and a medical imaging device for acquiring patient image data, the medical imaging device being operably coupled to the computer for transmitting a signal to the computer corresponding to the patient image data, wherein the patient image data is at least one of the first patient image data, the second patient image data and third patient image data. ### Claim 18 (depends on 17) The system according to claim 17, further comprising an optical position tracking system for acquiring patient surface data describing the position of the surface of the patient, the optical position tracking system being operably coupled to the computer for transmitting a signal to the computer corresponding to the patient surface data. ### Claim 19 (depends on 17) The system according to claim 17, further comprising a treatment device operably coupled to the computer for receiving a signal from the computer corresponding to treatment parameter data describing at least one of activation or deactivation of a treatment device. ### Claim 20 (depends on 17) The system according to claim 17, further comprising a patient support device operably coupled to the computer for receiving a signal from the computer corresponding to control data describing a control command for controlling the patient support device to be moved.