Fiducial marker devices, tools, and methods

A divot assembly for use with an instrument that is remotely detectable by a positioning system, the divot assembly comprising:

• an anchoring base;
• and
• a bracket that is rotatably coupled to the base;
• and
• a divot that is tiltably coupled to the bracket such that when the instrument is inserted into the divot an orientation of the instrument varies as at least one of:
• (1) the bracket is rotated with respect to the base;
• and (2) the divot is tilted with respect to the bracket.

A locator assembly that is remotely detectable by a positioning system, the locator assembly comprising:

• an anchoring base;
• and
• a bracket that is rotatably coupled to the base;
• and
• a reflector, including a reflective surface, the reflector tiltably coupled to the bracket such that an orientation of the reflective surface varies as at least one of:
• (1) the bracket is rotated with respect to the base;
• and (2) the reflector is tilted with respect to the bracket.

An apparatus comprising:

• a frame, including a hub and a plurality of legs extending from the hub, each leg carrying at least one locator;
• and
• a keyed anchoring base, the base including:
• external threads that permit the base to be secured to a bone at a single location;
• and
• a first key that fixedly defines an orientation of the frame with respect to the base.

A method including:

• affixing to a patient a device including both an imagable locator and an integral male or female receptacle sized and shaped for mating to an instrument detectable by a positioning system;
• obtaining, using an imaging system, an image of the patient, the image including the imagable locator;
• and
• mating the instrument to the receptacle to register an actual position of the patient to the image of the patient.

A patient registration method including:

• securing to a patient a base and an imagable locator coupled to the base;
• obtaining, using an imaging system, an image of the patient including an image of the imagable locator;
• replacing the imagable locator coupled to the base with an assembly that includes multiple receptacles for mating to an instrument locatable by a positioning system;
• mating the instrument to a first one of the receptacles;
• and
• if the instrument is oriented such that it is outside a field of view of the positioning system, then mating the instrument to a second one of the receptacles that is different from the first one of the receptacles to reorient the instrument.

A patient registration method including:

• securing to a patient a base and an imagable locator coupled to the base;
• obtaining, using an imaging system, an image of the patient, the image of the patient including an image of the imagable locator;
• replacing the imagable locator coupled to the base with an assembly that includes a positionable receptacle for mating to an instrument locatable by a positioning system;
• mating the instrument to the positionable receptacle;
• and
• if the instrument is oriented such that it is outside a field of view of the positioning system, then repositioning the positionable receptacle to reorient the instrument.

A patient registration method including:

• securing to a patient a base and an imagable locator coupled to the base;
• obtaining, using an imaging system, an image of the patient, the image of the patient including an image of the imagable locator;
• replacing the imagable locator coupled to the base with an assembly that includes a positionable reflector locatable by a remote positioning system;
• if the reflector is not suitably aimed within a field of view of the positioning system, then repositioning the positionable reflector to reorient the reflector.

A method including:

• securing a plurality of reflective imagable locators to a patient;
• obtaining, using an imaging system, an image of the patient that includes images of the locators;
• and
• registering the patient's location in the operating room to the images, including using energy reflected from the locators that are secured to the patient to locate the locators for correlation to the images of the locators.