# US 9,433,390 B2 · System for measuring the true dimensions and orientation of objects in a two dimensional image > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 9,433,390 B2 - Document ID: US9433390B2 - Status: Granted - Kind: B2 - Application number: 14/106,771 - Filed: 2013-12-15 - Published: 2014-06-26 - Granted: 2016-09-06 - Earliest claimed: 2007-06-21 - Assignees: Surgix Ltd. - Applicants: Orthopedic Navigation Ltd. - Inventors: Ram Nathaniel; Dan Rappaport; Oren Drori - Web page: https://patentgrep.com/patent/US9433390B2 ## CPC - A61B 6/12: Arrangements for detecting or locating foreign bodies - A61B 6/461: {Displaying means of special interest} - A61B 6/5211: {involving processing of medical diagnostic data} - A61B 90/39: {Markers, e.g. radio-opaque or breast lesions markers} - G06T 7/0012: {Biomedical image inspection} - G06T 7/73: using feature-based methods - G06T 11/00: Two-dimensional [2D] image generation - G06T 19/00: Manipulating three-dimensional [3D] models or images for computer graphics - A61B 2090/3966: {Radiopaque markers visible in an X-ray image} - G06T 2200/04: involving 3D image data - G06T 2207/10116: X-ray image - G06T 2207/10121: Fluoroscopy - G06T 2207/30008: Bone - G06T 2207/30021: Catheter; Guide wire - G06T 2207/30052: Implant; Prosthesis - G06T 2207/30204: Marker - G06T 2219/012: Dimensioning, tolerancing - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - G06T: IMAGE DATA PROCESSING OR GENERATION, IN GENERAL ## Abstract The invention is a system for measuring the true dimensions and orientation of objects in a two dimensional image. The system is comprised of a ruler comprising at least one set of features each comprised of two or more markers that are identifiable in the image and having a known spatial relationship between them and a software package comprising programs that allow extension of the ruler and other objects in the two dimensional image beyond their physical dimensions or shape. The system can be used together with radiographic imagery means, processing means, and display means to take x-ray images and to measure the true dimensions and orientation of objects and to aid in the identification and location of a surgery tool vs. anatomy in those x-ray images. The invention provides a method of drawing and displaying on a two dimensional x-ray image measurements of objects visible in said image, graphical information, or templates of surgical devices. ## Claims ### Claim 1 A system for measuring the true dimension and orientation of objects in a two dimensional(2D) medical image, said system comprising: a set of markers visible in the 2D medical images, which markers are located upon a surgical tool and have known spatial relationships between them; receiving circuitry adapted to receive a given 2D medical image, which given 2D medical image includes the surgical tool and an organ of a subject; image processing circuitry adapted to calculate distance within the given 2D image based on the appearance of said markers in the 2D image, characterized in that said processing circuitry include programs adapted to: (a) identify said markers in the given 2D medical image and determine their location; (b) calculate from the determined locations of the identified markers in the given medical image a three dimensional position and orientation of the surgical tool, in relation to the organ, thereby providing 3D positional information of the tool from the appearance of the markers in the given 2D medical image; and (c) calculate a dimension of a spatial relationship between the surgical tool, or a point on the surgical tool, and the organ, based on the locations of the identified markers in the given medical image and the calculated relative 3D position and orientation of the surgical tool. ### Claim 2 (depends on 1) The system according to claim 1, wherein the organ is a femur. ### Claim 3 (depends on 1) The system according to claim 1, wherein the given 2D medical image is a radiographic image. ### Claim 4 (depends on 1) The system according to claim 1, wherein the dimension is a tip-apex distance. ### Claim 5 (depends on 1) The system according to claim 1, wherein the image processing circuitry is further adapted to identify a contour of the organ in the given 2D medical image. ### Claim 6 (depends on 2) The system according to claim 2, wherein the image processing circuitry is further adapted to identify a contour of a head of the femur in the given medical image. ### Claim 7 (depends on 5) The system according to claim 5, wherein the dimension is a distance between a point on the surgical tool and a point on the identified contour of the organ. ### Claim 8 (depends on 1) The system according to claim 1, further comprising a rendering module adapted to render upon the given medical image an overlay of an implant, positioned in relation to the organ based on a prediction of an expected location of the implant considering the current determined 3D position and orientation of the surgical tool. ### Claim 9 A system for measuring the true dimensions and orientation of objects in a two dimensional (2D) medical image, said system comprising: a set of markers visible in the medical images and having known spatial relationships between them, which markers are located upon a penetrating surgical tool, wherein the penetrating surgical tool has a penetrating tip for penetrating human tissue; receiving circuitry adapted to receive a given 2D medical image, which given 2D medical image includes the surgical tool and an organ of a subject; image processing circuitry adapted to render an extension of the penetrating tip upon the given 2D medical image; characterized in that said image processing circuitry comprises image processing logic that allows said image processing circuitry to identify the markers in the given 2D medical image and use said identified markers to create a virtual extension of the penetrating tip of the penetrating surgical tool, thereby enabling a user to accurately predict a trajectory of the penetrating tip and to draw the virtual extension of the penetrating tip, on the 2D medical image, as an overlay. ### Claim 10 (depends on 9) The system according to claim 9, wherein the organ is a femur. ### Claim 11 (depends on 9) The system according to claim 9, wherein said image processing circuitry is further adapted to determine a distance between the penetrating point and a point on the organ. ### Claim 12 (depends on 11) The system according to claim 11, wherein the distance is a tip-apex distance. ### Claim 13 (depends on 9) The system according to claim 9, further comprising automatically identifying, by the processing circuitry, a contour of the organ in the given 2D medical image. ### Claim 14 (depends on 10) The system according to claim 10, further comprising automatically identifying, by the processing circuitry, a contour of a head of the femur in the given 2D medical image. ### Claim 15 (depends on 13) The system according to claim 13, wherein said image processing circuitry is further adapted to determine a distance between the penetrating point and a point on the identified contour of the organ. ### Claim 16 (depends on 9) The system according to claim 9, wherein said image processing circuitry is further adapted to render upon the given 2D medical image an overlay of an implant, positioned in relation to the organ based on a prediction of an expected location of the implant considering the current determined 3D position and orientation of the surgical tool. ### Claim 17 A system for measuring the true dimension and orientation of objects in a two dimensional (2D) medical image, said system comprising: a set of markers visible in the 2D medical images and having known spatial relationships between them; receiving circuitry adapted to receive a given 2D medical image, which 2D medical image includes the markers, a surgical tool and an organ of a subject; image processing circuitry adapted to calculate distance within the given 2D image based on the appearances of said markers in the 2D image; characterized in that said processing circuitry includes programs adapted to: (a) identify said markers in the given 2D medical image and determine their location; (b) calculate from the determined location of the identified markers in the given medical image a three dimensional position and orientation of the surgical tool, in relation to the organ, thereby providing 3D positional information of the tool from the appearance of the markers in the given 2D medical image; and (c) calculate a dimension of a spatial relationship between the surgical tool, or a point on the surgical tool, and the organ, based on the locations of the identified markers in the given medical image and the calculated relative 3D position and orientation of the surgical tool. ### Claim 18 (depends on 17) The system according to claim 17, wherein said image processing circuitry is further adapted to determine a trajectory of the surgical tool and render the trajectory upon the given 2D medical image. ### Claim 19 (depends on 17) The system according to claim 17, wherein the dimension is a tip-apex distance. ### Claim 20 (depends on 17) The system according to claim 17, further comprising a rendering module adapted to render upon the given 2D medical image an overlay of an implant, positioned in relation to the organ based on a prediction of an expected location of the implant considering the current determined 3D position and orientation of the surgical tool. ### Claim 21 A system for measuring the true dimensions and orientation of objects in a two dimensional (2D) medical image, said system comprising: a set of markers visible in the 2D medical images, which markers are located upon a surgical tool and have known spatial relationships between them; receiving circuitry adapted to receive a given 2D medical images, which given 2D medical image includes the markers and an organ of a subject; image processing circuitry adapted to calculate distances with the given 2D image based on the appearances of said markers in the 2D image; characterized in that said processing circuitry includes programs adapted to: (a) identify said markers in the given 2D medical image and determine their location; (b) calculate from the determined location of the identified markers in the given medical image a three dimensional position and orientation of the surgical too, in relation to the organ, thereby providing 3D positional information of the tool from the appearance of the markers in the given 2D medical image; and (c) calculate a dimension of a spatial relationship between two points on the organ, based on the locations of the identified markers in the given 2D medical image. ### Claim 22 (depends on 21) The system according to claim 21, further comprising a rendering module adapted to render upon the given 2D medical image an overlay of an implant, positioned in relation to the organ based on a prediction of an expected location of the implant considering the current determined 3D position and orientation of the surgical tool. ### Claim 23 (depends on 21) The system according to claim 21, wherein the given 2D medical image is a radiographic image. ### Claim 24 (depends on 21) The system according to claim 21, further comprising a rendering module adapted to render, intra-operatively, upon a display, the given 2D medical image along with the calculated dimension, wherein the given 2D medical image was acquired intra-operatively.