The present invention relates generally to computer assisted image guided medical and surgical navigation systems that generate images during medical and surgical procedures indicating the relative position of various body parts, surgicalimplants, and instruments. In particular, the present invention relates to an instrument for use in an image guided surgery navigation system that enables the system to track both the depth and the trajectory of the instrument during surgery.
2. Background of Related Art
Computer assisted image guided medical and surgical navigation systems are known and used to generate images in order to guide a doctor during a surgical procedure. Such systems are disclosed, for example, in U.S. Pat. No. 5,383,454 toBucholz; PCT application Ser. No. PCT/US94/04530 (Publication No. WO 94/24933) to Bucholz; and PCT application Ser. No. PCT/US95/12984 (Publication No. WO 96/11624) to Bucholz et al., incorporated herein by reference.
In general, these image guided systems use images of a body part, such as CT scans, taken before surgery to generate images on a display, such as a CRT monitor screen, during surgery for representing the position of a surgical instrument withrespect to the body part. The systems typically include tracking devices such as, for example, an LED array mounted on a surgical instrument as well as a body part, a digitizer to track in real time the position of the body part and the instrument usedduring surgery, and a monitor screen to display images representing the body and the position of the instrument relative to the body part as the surgical procedure is performed.
There is a need in the art for a surgically navigable tool for use with these image guided systems that is simple to use and manipulate, that enables the computer tracking system to track both the trajectory of the instrument and the depth thatthe instrument is inserted into the body, and that is easily interchangeable with alternative drive sources such as a ratcheting handle or other instruments such as awls, taps, and screwdrivers.
SUMMARY OF THE INVENTION
It is therefore an object of the invention to provide an image guided medical instrument whose tip and trajectory can be simultaneously tracked.
It is a further object of the invention to provide an image guided medical instrument capable of generating a signal representing the trajectory and the depth of the tip of the instrument.
It is a still further object of the invention to provide an image guided medical instrument that may easily be used with any number of different tips and handles.
It is another object of the invention to provide an image guided medical instrument that is of relatively simple construction and relatively easy to use.
Additional objects and advantages of the invention will be set forth in the description which follows and, in part, will be obvious from the description or may be learned by practice of the invention. The objects and advantages of the inventionwill be realized and attained by means of the elements and combinations particularly pointed out in the appended claims.
To achieve the objects and in accordance with the purpose of the invention, as embodied and broadly described herein, the invention comprises a trackable medical instrument for use in a computer assisted image guided surgery system having adigitizer for tracking the position of the instrument in three dimensional space and a display providing an indication of the position of the instrument with respect to images of a body part taken preoperatively. The instrument includes a guide memberhaving an emitter array mounted thereon for being tracked by the digitizer, and a drive shaft contained within the guide member, the drive shaft having a proximal and a distal end, the drive shaft being rotatable within the guide member while beingfixable axially within the guide member, the proximal end of the drive shaft having a first connector for interchangeably receiving at least one drive source, and the distal end having a second connector for interchangeably receiving at least oneinstrument tip. The instrument may further include at least one instrument tip for connection to the distal end of the drive shaft and a drive handle for connection to the proximal end of the drive shaft for transmitting torque to the instrument tip tocause rotation of the instrument tip.
In another aspect of this invention, the instrument may further include a sensor which senses the removal and the connection of an instrument tip to the instrument. The sensor may be an electromechanical switch on the guide member.
It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory and are not restrictive of the invention as claimed.
BRIEF DESCRIPTION OF THE DRAWINGS
The accompanying drawings are included to provide a further understanding of the invention and are incorporated in and constitute a part of this specification. The drawings illustrate embodiments of the invention and, together with thedescription, serve to explain the principles of the invention.
FIG. 1 is a schematic front view of a computer assisted image guided surgery system used with an instrument according to the present invention.
FIG. 2 is a perspective view of an instrument according to the present invention.
FIG. 3 is an exploded view of the instrument shown in FIG. 2.
FIG. 4 is a view of a portion of the instrument shown in FIG. 2.
FIG. 5 is an exploded view of the portion of the instrument shown in FIG. 4.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Reference will now be made in detail to the present preferred embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers are used in the drawings and thedescription to refer to the same or like parts.
The medical instrument of the present invention is shown generally at 10 in FIG. 1. Instrument 100 can be used in many known computer assisted image guided surgical navigation systems such the system shown in FIG. 1 and disclosed in PCTapplication Ser. No. PCT/US95/12984 (Publication No. WO 96/11624) to Bucholz et al., incorporated herein by reference. A computer assisted image guided surgery system, shown at 10, generates an image for display on a monitor 106 representing the realtime position of a body part and the position of instrument 100 relative to the body part.
An image may be generated on monitor 106 from an image data set stored in a controller, such as computer 108, usually generated preoperatively by some scanning technique such as by a CAT scanner or by magnetic resonance imaging. The image dataset and the image generated have reference points for at least one body part. The reference points for the particularly body part have a fixed spatial relation to the particular body part.
System 10 also generally includes a processor for processing image data, shown as digitizer control unit 114. Digitizer control unit 114 is connected to monitor 106, under control of computer 108, and to instrument 100. Digitizer 114, inconjunction with a reference frame arc 120 and a sensor array 110 or other known position sensing unit, tracks the real time position of a body part, such as a cranium shown at 119 clamped in reference frame 120, and an instrument 100. Reference frame120 has emitters 122 or other tracking means that generate signals representing the position of the various body reference points. Reference frame 120 is fixed spatially in relation to a body part by a clamp assembly indicated generally at 124,125, and126. Instrument 100 also has a tracking device shown as an emitter array 40 which generates signals representing the position of the instrument during the procedure.
Sensor array 110, mounted on support 112, receives and triangulates the signals generated by emitters 122 and emitter array 40 in order to identify during the procedure the relative position of each of the reference points and the instrument. Digitizer 114 and computer 108 may then modify the image date set according to the identified relative position of each of the reference points during the procedure. Computer 108 may then generate an image data set representing the position of the bodyelements and the instrument during the procedure. System 10 may also include a foot switch 116 connected to instrument 100 and digitizer 114 for controlling operation of the system. The structure and operation of an image guided surgery system is wellknown in the art and need not be discussed further here.
Referring to FIGS. 2 and 3, an instrument according to the present invention is shown at 100. Instrument 100 includes a guide member 30, an interchangeable instrument tip 15, and an interchangeable driving handle 20.
A drive shaft 35 is housed within guide member 30 and is removably connected to an end, here the proximal end 37, to surgical instrument tip 15 and at the other end, here the distal end 38, to driving handle 20 such that torque applied manuallyor by motorized means to drive handle 20 is transmitted to drive shaft 35 which in turn is transmitted to tip 15. Drive shaft 35, while it could be extractable such as for service, is fixable axially in relation to guide member 30, but is rotatablewithin guide member 30. As shown in FIG. 5, bushings 33 may be provided at each end of guide member 30 to ensure smooth motion between drive shaft 35 and guide member 30. Guide member 30 is preferably made of stainless steel, but can also be made oftitanium, aluminum or plastic. Shaft 35 is preferably made from stainless steel, titanium, or aluminum.
Instrument 100 further includes a tracking device such as emitter array 40 attached to guide member 30 for tracking the location and trajectory of instrument 100. As shown in FIG. 4, array 40 is equipped with a plurality of emitters or trackingmeans 45, preferably four emitters, for generating a signal representing the trajectory of instrument 100 and the depth of instrument tip 15. Preferably emitters 45 are light emitting diodes; however, other tracking devices known in the art capable ofbeing tracked by a corresponding sensor array are within the scope of the invention. For purposes of illustration, not limitation, the tracking device may generate signals actively such as with acoustic, magnetic, electromagnetic, radiologic, andmicropulsed radar systems, or passively such as with reflective surfaces.
Drive handle 20 and instrument tip 15 are shown as modular units that can be attached to drive shaft 35 with corresponding and interlocking male and female socket joints. As shown in FIGS. 3 and 4, drive shaft 35 has a female socket joint 34for connection with a male socket 14 on tip 15, and drive shaft 35 has a male socket joint 36 for connection with a female socket joint 26 on drive handle 20. With the use of male and female socket joints, various instrument tips and various type andsized drive handles can be easily interchangeable. Instrument tip 15 could be any of a variety of instruments used in surgery such as taps, awls, and shaped tools for interacting with a work piece, such as a screwdriver for driving screws. Drive handle20 could be any number of existing or specially designed handles and could be ratcheting, nonratcheting or motorized. Instrument tip 15 and drive handle 20 could also be permanently attached to drive shaft 35. Other suitable connection means are withinthe scope of the invention as well.
In operation, torque applied to drive handle 20 is transmitted through drive shaft 35 to instrument tip 15. Because drive shaft 35 is fixed axially in relation to guide member 30, guide member 30 can remain stationary while drive shaft 35rotates without translating along the axis of drive shaft 35. The relationship between array 40 and the axis of drive shaft 35, therefore, remains constant. Instrument tip 15 is also fixed axially in relation guide member 30. As a result, therelationship between array 40 and instrument tip 15 also remains constant. Because the relationship between array 40 and tip 15 is constant, the signals emitted by emitters 45 can be used by the computer assisted image guided surgical navigation systemto inform the surgeon of the position of instrument 100, indicating both the trajectory or orientation in three dimensional space of instrument 100 and the length of travel along the trajectory, i.e., the depth instrument tip 15 has been inserted into abody part.
It should be recognized that other variations or modifications may be made to provide an instrument that has an emitter array fixed axially relative to the instrument tip while allowing the instrument tip to rotate relative to the emitter array. For example, guide member 30 may also be integral with instrument tip 15 and/or drive handle 20. The array could then be fixed axially relative to the instrument and means could be provided to allow rotation of the instrument relative to the array.
As discussed above, a variety of different instrument tips may be easily interchanged on instrument 100. To use these different instrument tips, information concerning the dimensions of the different tips may be entered into computer 108. As aresult, computer 108 can process the various image data for the specific instrument tip being used so that system 10 tracks the depth of the tip being used or, in the case of a screwdriver, so that system 10 tracks the depth of the screw being inserted.
System 10 may also be provided with a mechanism to prevent the system from operating after a new tip has been connected until computer 108 has been recalibrated. For example, an electromechanical switch, or other suitable sensors, could beprovided on instrument 100 to provide a signal to computer 108 indicating that instrument tip 15 has been removed from instrument 100 or that a new instrument tip 15 has been coupled to instrument 100. The switch is preferably a micro switch but can beembodied by any suitable electrical or electromechanical device or sensing device capable of providing a signal in response to attachment or detachment at a particular point on guide member 30 or tip 15.
The switch may be automatically actuated when tip 15 is removed or coupled to instrument 100. Computer 108 may be operably connected to the switch, such as through cable 161, and is responsive to the operation of the switch. Alternatively, ifa wireless instrument is used such as one with passive reflective surfaces in place of LED emitters, any suitable form of communication known in the art can be used. An alarm or other indication of some type, such as a message or display on monitor 106,may be generated by computer 108 indicating to the user that tip 15 has been changed. The computer 108 may further prevent the system from operating until the system has been recalibrated for the new instrument tip. Recalibration may be accomplished bytouching the instrument tip to a known reference point. Recalibration of the instrument tip can be positively confirmed by means of a light emission from the emitter array 40 detected by sensor array 110 and triangulated to determine the position of theinstrument tip. Alternatively, the dimensions of the instrument or tool type may be entered into computer 108 or selected from a pre-programmed list of tool dimensions or tool types. Further, recalibration could be accomplished by a fiber optic devicefor reading a bar code on the instrument tip, or by any other suitable recalibration technique.
It will also be apparent to those skilled in the art that various modifications and variations can be made to the structure and methodology of the present invention without departing from the scope or spirit of the invention. In view of theforegoing, it is intended that the present invention cover modifications and variations of this invention provided they fall within the scope of the following claims and their equivalents.
Richard D. Bucholz, M.D., et al., “Poster #1120, Use of an Intraoperative Optical Digitizer in a System for Free-Hand Stereotactic Surgery,” Scientific Program, Am. Assoc. of Neurological Surgeons 1992 Annual Meeting, pp. 284-285, Apr. 16, 1992.
“Alignment Procedure for the PixSys Two-Emitter Offset Probe for the SAC GP-8-3d Sonic Digitizer,” PixSys, Jul. 2, 1992, 4 pages.
Isabelle M. Germano, “The NeuroStation System for Image-Guided, Frameless Stereotaxy,” Neurosurgery, vol. 37, No. 2, Aug. 1995, pp. 348-350.
Kurt R. Smith, et al., “The Neurostation™—A Highly Accurate, Minimally Invasive Solution To Frameless Stereotactic Neurosurgery,” Computerized Medical Imaging and Graphics, Jul.-Aug. 1994, vol. 18, No. 4, pp. 247-256.
Kevin T. Foley, et al., “Image-guided Intraoperative Spinal Localization,” Intraoperative Neuroprotection: Monitoring, Ch. 19, pp. 325-340, 1996.
Richard D. Bucholz, et al., “Intraoperative localization using a three dimensional optical digitizer,” Proceedings of Clinical Applicatins of Modern Imaging Technology, vol. 1894, pp. 312-322, 1993.
Richard D. Bucholz, et al., “Clinical Applications of Modern Imaging Technology,” SPIE vol. 1894 pp. 312-322, Jan. 19, 1993.
Richard D. Bucholz, M.D., and Kurt R. Smith, “A Comparison of Sonic Digitizers Versus Light Emitting Diode-Based Localization,” Interactive Image-Guided Neurosurgery, pp. 179-200, 1993.
Skip Jacques, et al., “A Computerized Microstereotactic Method to Approach, 3-Dimensionally Reconstruct, Remove and Adjuvantly Treat Small CNS Lesions,” Meeting of the Amer. Soc. Stereotactic & Functional Neurosurgery, Houston 1980, Appl. Neurophysiol. 43: 176-182 (1980).
Hans F. Reinharts, M.D., et al., “Sonic Stereometry in Microsurgical Procedures for Deep-Seated Brain Tumors and Vascular Malformations,” Neurosurgery, vol. 32, No. 1, Jan. 1993 pp. 51-57.
L. Adams, et al., “Aide Au Reperage Tridimensionnel Pour La Chirurgie de la Base du Crane,” Innov. Tech. Biol. Med., vol. 13, No. 4, pp. 409-424, 1992.
Kurt R. Smith and Richard D. Bucholz, “Computer Methods for Improved Diagnostic Image Display Applied to Stereotactic Neurosurgery,” Stereotactic Neurosurgery Display, vol. 14, pp. 371-382, 1992.
W. Krybus, et al., “Navigation Support for Surgery by Means of Optical Position Detection,” p. 362-366, 1990.
Richard D. Bucholz, M.D. and K. Charles Cheung, M.D., “Halo vest versus spinal fusion for cervical injury: evidence from an outcome study,” J. Neurosurg 70:884-892, Jun. 1989.
M. Peter Heilbrun, M.D., “Computer Tomography—Guided Stereotactic Systems,” Computed Tomographic Stereotaxy, Ch.31 pp. 564-581, 1983.
C. Hunter Shelden, M.D, et al., “Development of a computerized microstereotaxic method for localization and removal of minute CNS lesions under direct 3-D vision,” J. Neurosurg 52: 21-27, 1980.
Bucholz et al., Richard D.; “Poster #1120, Use of An Intraoperative Optical Digitizer in A System for Free-Hand Stereotactic Surgery,” Scientific Program, Am. Assoc. of Neurological Surgeons 1992 Annual Meeting, pp. 284-285; Apr. 16, 1992.
Bucholz et al., Richard D.; “Clinical Applications of Modern Imaging Technology,” SPIE vol. 1894; pp. 312-322; Jan. 19, 1993.
Watanabe, E., M.D., et al., Open Surgery Assisted by the Neuronavigator, a Stereotactic, Articulated, Sensitive Arm, Neurosurgery, vol. 28, No. 6, pp. 792-800 (1991).
Wang, M.Y., et al., An Automatic Technique for Finding and Localizing Externally Attached Markers in CT and MR Volume Images of the Head, IEEE Trans. on Biomed. Eng., vol. 43, No. 6, pp. 627-637 (Jun. 1996).
Von Hanwhr et al., Foreword, Computerized Medical Imaging and Graphics, vol. 18, No. 4, pp. 225-228, (Jul.-Aug. 1994).
Trobraugh, J.W., et al., Frameless Stereotactic Ultrasonography: Method and Applications, Computerized Medical Imaging and Graphics, vol. 18, No. 4, pp. 235-246 (1994).
Thompson, et al., A System for Anatomical and Functional Mapping of the Human Thalamus, Computers and Biomedical Research, vol. 10, pp. 9-24 (1977).
Tan, K., Ph.D., et al., A frameless stereotactic approach to neurosurgical planning based on retrospective patient-image registration, J Neurosurgy, vol. 79, pp. 296-303 (Aug. 1993).
Smith, K.R., et al. Multimodality Image Analysis and Display Methods for Improved Tumor Localization in Stereotactic Neurosurgery, Annul Intl. Conf. of the IEEE Eng. in Med. and Biol. Soc., vol. 13, No. 1, p. 210 (1991).
Simon, D.A., Accuracy Validation in Image-Guided Orthopaedic Surgery, Second Annual Intl. Symp. on Med. Rob. an Comp-Assisted surgery, MRCAS '95, pp. 185-192 (undated).
Reinhardt, Hans. F., Neuronavigation: A Ten-Year Review, Neurosurgery, pp. 329-341 (undated).
Reinhardt, H.F., et al., Mikrochirugische Entfernung tiefliegender Gefäβmiβbildungen mit Hilfe der Sonar-Stereometrie (Microsurgical Removal of Deep-Seated Vascular Malformations Using Sonar Stereometry). Ultraschall in Med. 12, pp. 80-83 (1991).
Reinhardt, H.F. et al., Sonic Stereometry in Microsurgical Procedures for Deep-Seated Brain Tumors and Vascular Malformations, Neurosurgery, vol. 32, No. 1, pp. 51-57 (Jan. 1993).
Reinhardt, H., et al., A Computer-Assisted Device for Intraoperative CT-Correlated Localization of Brain Tumors, pp. 51-58 (1988).
Pixsys, 3-D Digitizing Accessories, by Pixsys (marketing brochure)(undated) (2 pages).
Penn, R.D., et al., Stereotactic Surgery with Image Processing of Computerized Tomographic Scans, Neurosurgery, vol. 3, No. 2, pp. 157-163 (Sep.-Oct. 1978).
Offset Probe for SAC GP8-3d Digitizer, 2 pages, not dated.
Ng, W.S. et al., Robotic Surgery—A First-Hand Experience in Transurethral Resection of the Prostate Surgery, IEEE Eng. in Med. and Biology, pp. 120-125 (Mar. 1993).
McGirr, S., M.D., et al., Stereotactic Resection of Juvenile Pilocytic Astrocytomas of the Thalamus and Basal Ganglia, Neurosurgery, vol. 20, No. 3, pp. 447-452, (1987).
Maurer, Jr., et al., Registration of Head CT Images to Physical Space Using a Weighted Combination of Points and Surfaces, IEEE Trans. on Med. Imaging, vol. 17, No. 5, pp. 753-761 (Oct. 1998).
Leavitt, D.D., et al., Dynamic Field Shaping to Optimize Stereotactic Radiosurgery, I.J. Rad. Onc. Biol. Physc., vol. 21, pp. 1247-1255 (1991).
Lavallee, S., et al., Computer Assisted Medical Interventions, NATO ASI Series, vol. F 60, 3d Imaging in Medic., pp. 301-312 (1990).
Lavallee, S., et al., Computer Assisted Knee Anterior Cruciate Ligament Reconstruction First Clinical Tests, Proceedings of the First International Symposium on Medical Robotics and Computer Assisted Surgery, pp. 11-16 (Sep. 1994).
Kwoh, Y.S., Ph.D., et al., A New Computerized Tomographic-Aided Robotic Stereotaxis System, Robotics Age, vol. 7, No. 6, pp. 17-22 (Jun. 1985).
Krybus, W., et al., Navigation Support for Surgery by Means of Optical Position Detection, Computer Assisted Radiology Proceed. of the Intl. Symp. CAR '91 Computed Assisted Radiology, pp. 362-366 (Jul. 3-6, 1991).
Kosugi, Y., et al., An Articulated Neurosurgical Navigation System Using MRI and CT Images, IEEE Trans. on Biomed, Eng. vol. 35, No. 2, pp. 147-152 (Feb. 1988).
Klimek, L., et al., Long-Term Experience with Different Types of Localization Systems in Skull-Base Surgery, Ear, Nose & Throat Surgery, Chapter 51, pp. 635-638 (undated).
Kim, W.S. et al., A Helmet Mounted Display for Telerobotics, IEEE, pp. 543-547 (1988).
Kelly, P.J., Stereotactic Imaging, Surgical Planning and Computer-Assisted Resection of Intracranial Lesions: Methods and Results, Advances and Technical Standards in Neurosurgery, vol. 17, pp. 78-118, (1990).
Kelly, P.J., et al., Results of Computed Tomography-based Computer-assisted Stereotactic Resection of Metastatic Intracranial Tumors, Neurosurgery, vol. 22, No. 1, Part 1, 1988, pp. 7-17 (Jan. 1988).
Kelly, P.J., Computer-Directed Stereotactic Resection of Brain Tumors, Neurologica Operative Atlas, vol. 1, No. 4, pp. 299-313 (1991).
Kelly, P.J., Computer Assisted Stereotactic Biopsy and Volumetric Resection of Pediatric Brain Tumors, Brain Tumors in Children, Neurologic Clinics, vol. 9, No. 2, pp. 317-336 (May 1991).
Kato, A., et al., A frameless, armless navigational system for computer-assisted neurosurgery, J. Neurosurg., vol. 74, pp. 845-849 (May 1991).
Kall, B., The Impact of Computer and Imgaging Technology on Stereotactic Surgery, Proceedings of the Meeting of the American Society for Stereotactic and Functional Neurosurgery, pp. 10-22 (1987).
Heilbrun, M.P., et al., Stereotactic Localization and Guidance Using a Machine Vision Technique, Sterotact & Funct. Neurosurg., Proceed. of the Mtg. of the Amer. Soc. for Sterot. and Funct. Neurosurg. (Pittsburgh, PA) vol. 58, pp. 94-98 (1992).
Heilbrun, M.D., Progressive Technology Applications, Neurosurgery for the Third Millenium, Chapter 15, J. Whitaker & Sons, Ltd., Amer. Assoc. of Neurol. Surgeons, pp. 191-198 (1992).
Hardy, T., M.D., et al., CASS: A Program for Computer Assisted Stereotaxic Surgery, The Fifth Annual Symposium on Comptuer Applications in Medical Care, Proceedings, Nov. 1-4, 1981, IEEE, pp. 1116-1126, (1981).
Guthrie, B.L., Graphic-Interactive Cranial Surgery: The Operating Arm System, Handbook of Stereotaxy Using the CRW Apparatus, Chapter 13, pp. 193-211 (undated.
Grimson, W.E.L., et al., Virtual-reality technology is giving surgeons the equivalent of x-ray vision helping them to remove tumors more effectively, to minimize surgical wounds and to avoid damaging critical tissues, Sci. Amer., vol. 280, No. 6, pp. 62-69 (Jun. 1999).
Grimson, W.E.L., An Automatic Registration Method for Frameless Stereotaxy, Image Guided Surgery, and enhanced Reality Visualization, IEEE, pp. 430-436 (1994).
Gomez, C.R., et al., Transcranial Doppler Ultrasound Following Closed Head Injury: Vasospasm or Vasoparalysis?, Surg. Neurol., vol. 35, pp. 30-35 (1991).
Germano, Isabelle M., “The NeuroStation System fir Unage-Guided, Frameless Stereotaxy,” Neurosurgery, vol. 37, No. 2 Aug. 1995, pp. 348-350.
Galloway, R.L., Jr. et al, Optical localization for interactive, image-guided neurosurgery, SPIE, vol. 2164, pp. 137-145 (undated.
Galloway, R.L., et al., Interactive Image-Guided Neurosurgery, IEEE Trans. on Biomed. Eng., vol. 89, No. 12, pp. 1226-1231 (1992).
Gallen, C.C., et al., Intracranial Neurosurgery Guided by Functional Imaging, Surg. Neurol., vol. 42, pp. 523-530 (1994).
Friets, E.M., et al. A Frameless Stereotaxic Operating Microscope for Neurosurgery, IEEE Trans. on Biomed. Eng., vol. 36, No. 6, pp. 608-617 (Jul. 1989).
Cutting M.D. et al., Optical Tracking of Bone Fragments During Craniofacial Surgery, Second Annual International Symposium on Medical Robotics and Computer Assisted Surgery, pp. 221-225, (Nov. 1995).
Bucholz, Richard, D., M.D., “A Comparison of Sonic Digitizers Versus Light Emitting Diode-Based Localization,” Interactive Image-Guided Neurosurgey, pp. 179-200, 1993.
Bucholz, Richard D., “Halo vest versus spinal fusion for cervical injury: evidence from an outcome study,” J. Neurosurg 70:884-892, Jun. 1989.
Bucholz, R.D., et al., The Correction of Stereotactic Inaccuracy Caused by Brain Shift Using an Intraoperative Ultrasound Device, First Joint Conference, Computer Vision, Virtual Reality and Robotics in Medicine and Medical Robotics and Computer-Assisted Surgery, Grenoble, France, pp. 459-466 (Mar. 19-22, 1997).
Bucholz, R.D., et al., Intraoperative Ultrasonic Brain Shift Monitor and Analysis, Stealth Station Marketing Brochure (2 pages) (undated).
Bucholz, R.D., et al., Intraoperative localization using a three dimensional optical digitizer, SPIE—The Intl. Soc. for Opt. Eng., vol. 1894, pp. 312-322 (Jan. 17-19, 1993).
Bucholz, R.D., et al., A Comparison of Sonic Digitizers Versus Light Emitting Diode-Based Localization, Interactive Image-Guided Neurosurgery, Chapter 16, pp. 179-200 (1993).
Bucholz, R.D., et al. Image-guided surgical techniques for infections and trauma of the central nervous system, Neurosurg. Clinics of N.A., vol. 7, No. 2, pp. 187-200 (1996).
Barrick et al., “Technical Difficulties with the Brooker-Wills Nail in Acute Fractures of the Femur,” Journal of Orthopaedic Trauma, vol. 6, No. 2, pp. 144-150 (1990).
Barrick et al., “Prophylactic Intramedullary Fixation of the Tibia for Stress Fracture in a Professional Athlete,” Journal of Orthopaedic Trauma, vol. 6, No. 2, pp. 241-244 (1992).
Adams et al., “Orientation Aid for Head and Neck Surgeons,” Innov. Tech. Biol. Med., vol. 13, No. 4, 1992, pp. 409-424.
“Prestige Cervical Disc System Surgical Technique”, 12 pgs.
Hatch, et al., “Reference-Display System for the Integration of CT Scanning and the Operating Microscope”, Proceedings of the Eleventh Annual Northeast Bioengineering Conference, Mar. 14-15, 1985, pp. 252-254.
Merloz, et al., “Computer Assisted Spine Surgery”, Clinical Assisted Spine Surgery, No. 337, pp. 86-96.
Germano, “Instrumentation, Technique and Technology”, Neurosurgery, vol. 37, No. 2, Aug. 1995, pp. 348-350.
Weese et al., “An Approach to 2D/3D Registration of a Vertebra in 2D X-ray Fluoroscopies with 3D CT Images,” pp. 119-128.
Watanabe, “Neuronavigator,” Igaku-no-Ayumi, vol. 137, No. 6, May 10, 1986, pp. 1-4.
Watanabe et al., “Three-Dimensional Digitizer (Neuronavigator): New Equipment for Computed Tomography-Guided Stereotaxic Surgery,” Surgical Neurology, vol. 27, No. 6, Jun. 1987, pp. 543-547.
Viant et al., “A Computer Assisted Orthopaedic System for Distal Locking of Intramedullary Nails,” Proc. of MediMEC '95, Bristol, 1995, pp. 86-91.
The Laitinen Stereotactic System, E2-E6.
Smith et al., “The Neurostation™—A Highly Accurate, Minimally Invasive Solution to Frameless Stereotactic Neurosurgery,” Computerized Medical Imaging and Graphics, vol. 18, Jul.-Aug. 1994, pp. 247-256.
Smith et al., “Computer Methods for Improved Diagnostic Image Display Applied to Stereotactic Neurosurgery,” Automedical, vol. 14, 1992, pp. 371-382 (4 unnumbered pages).
Shelden et al., “Development of a computerized microsteroetaxic method for localization and removal of minute CNS lesions under direct 3-D vision,” J. Neurosurg., vol. 52, 1980, pp. 21-27.
Selvik et al., “A Roentgen Stereophotogrammetric System,” Acta Radiologica Diagnosis, 1983, pp. 343-352.
Schueler et al., “Correction of Image Intensifier Distortion for Three-Dimensional X-Ray Angiography,” SPIE Medical Imaging 1995, vol. 2432, pp. 272-279.
Sautot, “Vissage Pediculaire Assiste Par Ordinateur,” Sep. 20, 1994.
Rosenbaum et al., “Computerized Tomography Guided Stereotaxis: A New Approach,” Applied Neurophysiology, vol. 43, No. 3-5, 1980, pp. 172-173.
Roberts et al., “A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope,” J. Neurosurg., vol. 65, Oct. 1986, pp. 545-549.
Reinhardt et al., “CT-Guided ‘Real Time’ Stereotaxy,” ACTA Neurochirurgica, 1989.
Potamianos et al., “Intra-Operative Imaging Guidance for Keyhole Surgery Methodology and Calibration,” First International Symposium on Medical Robotics and Computer Assisted Surgery, Sep. 22-24, 1994, pp. 98-104.
Phillips et al., “Image Guided Orthopaedic Surgery Design and Analysis,” Trans Inst. MC, vol. 17, No. 5, 1995, pp. 251-264.
Pelizzari et al., No. 528—“Three Dimensional Correlation of PET, CT and MRI Images,” The Journal of Nuclear Medicine, vol. 28, No. 4, Apr. 1987, p. 682.
Pelizzari et al., “Interactive 3D Patient-Image Registration,” Information Processing in Medical Imaging, 12th International Conference, IPMI '91, Jul. 7-12, 136-141 (A.C.F. Colchester et al. eds. 1991).
Pelizzari et al., “Accurate Three-Dimensional Registration of CT, PET, and/or MR Images of the Brain,” Journal of Computer Assisted Tomography, Jan./Feb. 1989, pp. 20-26.
Mazier et al., Chirurgie de la Colonne Vertebrale Assistee par Ordinateur: Appication au Vissage Pediculaire, Innov. Tech. Biol. Med., vol. 11, No. 5, 1990, pp. 559-566.
Mazier et al., “Computer-Assisted Interventionist Imaging: Application to the Vertebral Column Surgery,” Annual International Conference of the IEEE Engineering in Medicine and Biology Society, vol. 12, No. 1, 1990, pp. 0430-0431.
Levin et al., “The Brain: Integrated Three-dimensional Display of MR and PET Images,” Radiology, vol. 172, No. 3, Sep. 1989, pp. 783-789.
Lemieux et al., “A Patient-to-Computed-Tomography Image Registration Method Based on Digitally Reconstructed Radiographs,” Med. Phys. 21 (11), Nov. 1994, pp. 1749-1760.
Leksell et al., “Stereotaxis and Tomography—A Technical Note,” ACTA Neurochirurgica, vol. 52, 1980, pp. 1-7.
Lavallee, “VI Adaption de la Methodologie a Quelques Applications Cliniques,” Chapitre VI, pp. 133-148.
Lavallee, “A New System for Computer Assisted Neurosurgery,” IEEE Engineering in Medicine & Biology Society 11th Annual International Conference, 1989, pp. 0926-0927.
Lavallee et al., “Matching of Medical Images for Computed and Robot Assisted Surgery,” IEEE EMBS, Orlando, 1991.
Lavallee et al., “Image guided operating robot: a clinical application in stereotactic neurosurgery,” Proceedings of the 1992 IEEE Internation Conference on Robotics and Automation, May 1992, pp. 618-624.
Lavallee et al., “Computer Assisted Spine Surgery: A Technique For Accurate Transpedicular Screw Fixation Using CT Data and a 3-D Optical Localizer,” TIMC, Faculte de Medecine de Grenoble.
Lavallee et al., “Computer Assisted Interventionist Imaging: The Instance of Stereotactic Brain Surgery,” North-Holland MEDINFO 89, Part 1, 1989, pp. 613-617.
Lavallee et al., “Computer Assisted Driving of a Needle into the Brain,” Proceedings of the International Symposium CAR '89, Computer Assisted Radiology, 1989, pp. 416-420.
Lavallee et al, “Matching 3-D Smooth Surfaces with their 2-D Projections using 3-D Distance Maps,” SPIE, vol. 1570, Geometric Methods in Computer Vision, 1991, pp. 322-336.
Laitinen, “Noninvasive multipurpose stereoadapter,” Neurological Research, Jun. 1987, pp. 137-141.
Laitinen et al., “An Adapter for Computed Tomography-Guided, Stereotaxis,” Surg. Neurol., 1985, pp. 559-566.
Kelly et al., “Precision Resection of Intra-Axial CNS Lesions by CT-Based Stereotactic Craniotomy and Computer Monitored CO2 Laser,” Acta Neurochirurgica, vol. 68, 1983, pp. 1-9.
Kelly et al., “Computer-assisted stereotaxic laser resection of intra-axial brain neoplasms,” Journal of Neurosurgery, vol. 64, Mar. 1986, pp. 427-439.
Joskowicz et al., “Computer-Aided Image-Guided Bone Fracture Surgery: Concept and Implementation,” CAR '98, pp. 710-715.
Jacques et al., “Computerized three-dimensional stereotaxic removal of small central nervous system lesion in patients,” J. Neurosurg., vol. 53, Dec. 1980, pp. 816-820.
Jacques et al., “A Computerized Microstereotactic Method to Approach, 3-Dimensionally Reconstruct, Remove and Adjuvantly Treat Small CNS Lesions,” Applied Neurophysiology, vol. 43, 1980, pp. 176-182.
Hounsfield, “Computerized transverse axial scanning (tomography): Part 1. Description of system,” British Journal of Radiology, vol. 46, No. 552, Dec. 1973, pp. 1016-1022.
Horner et al., “A Comparison of CT-Stereotaxic Brain Biopsy Techniques,” Investigative Radiology, Sep.-Oct. 1984, pp. 367-373.
Hofstetter et al., “Fluoroscopy Based Surgical Navigation—Concept and Clinical Applications,” Computer Assisted Radiology and Surgery, 1997, pp. 956-960.
Hoerenz, “The Operating Microscope I. Optical Principles, Illumination Systems, and Support Systems,” Journal of Microsurgery, vol. 1, 1980, pp. 364-369.
Henderson et al., “An Accurate and Ergonomic Method of Registration for Image-guided Neurosurgery,” Computerized Medical Imaging and Graphics, vol. 18, No. 4, Jul.-Aug. 1994, pp. 273-277.
Heilbrun et al., “Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system,” Journal of Neurosurgery, vol. 59, Aug. 1983, pp. 217-222.
Hatch, “Reference-Display System for the Integration of CT Scanning and the Operating Microscope,” Thesis, Thayer School of Engineering, Oct. 1984, pp. 1-189.
Hamadeh et al., “Towards Automatic Registration Between CT and X-ray Images: Cooperation Between 3D/2D Registration and 2D Edge Detection,” MRCAS '95, pp. 39-46.
Hamadeh et al., “Automated 3-Dimensional Computed Tomographic and Fluorscopic Image Registration,” Computer Aided Surgery (1998), 3:11-19.
Hamadeh et al, “Kinematic Study of Lumbar Spine Using Functional Radiographies and 3D/2D Registration,” TIMC UMR 5525—IMAG.
Gueziec et al., “Registration of Computed Tomography Data to a Surgical Robot Using Fluoroscopy: A Feasibility Study,” Computer Science/Mathematics, Sep. 27, 1996, 6 pages.
Gottesfeld Brown et al., “Registration of Planar Film Radiographs with Computer Tomography,” Proceedings of MMBIA, Jun. 1996, pp. 42-51.
Gonzalez, “Digital Image Fundamentals,” Digital Image Processing, Second Edition, 1987, pp. 52-54.
Gildenberg et al., “Calculation of Stereotactic Coordinates from the Computed Tomographic Scan,” Neurosurgery, vol. 10, No. 5, May 1982, pp. 580-586.
Foley, “The StealthStation: Three-Dimensional Image-Interactive Guidance for the Spine Surgeon,” Spinal Frontiers, Apr. 1996, pp. 7-9.
Foley et al., “Image-guided Intraoperative Spinal Localization,” Intraoperative Neuroprotection, Chapter 19, 1996, pp. 325-340.
Foley et al., “Fundamentals of Interactive Computer Graphics,” The Systems Programming Series, Chapter 7, Jul. 1984, pp. 245-266.
Feldmar et al., “3D-2D Projective Registration of Free-Form Curves and Surfaces,” Rapport de recherche (Inria Sophia Antipolis), 1994, pp. 1-44.
Clarysse et al., “A Computer-Assisted System for 3-D Frameless Localization in Stereotaxic MRI,” IEEE Transactions on Medical Imaging, vol. 10, No. 4, Dec. 1991, pp. 523-529.
Cinquin et al., “Computer Assisted Medical Interventions,” International Advanced Robotics Programme, Sep. 1989, pp. 63-65.
Cinquin et al., “Computer Assisted Medical Interventions,” IEEE Engineering in Medicine and Biology, May/Jun. 1995, pp. 254-263.
Champleboux, “Utilisation de Fonctions Splines pour la Mise au Point D'un Capteur Tridimensionnel sans Contact,” Quelques Applications Medicales, Jul. 1991.
Champleboux et al., “Accurate Calibration of Cameras and Range Imaging Sensors: the NPBS Method,” IEEE International Conference on Robotics and Automation, Nice, France, May 1992.
Bucholz et al., “Variables affecting the accuracy of stereotactic localizationusing computerized tomography,” Journal of Neurosurgery, vol. 79, Nov. 1993, pp. 667-673.
Bryan, “Bryan Cervical Disc System Single Level Surgical Technique”, Spinal Dynamics, 2002, pp. 1-33.
Brack et al., “Accurate X-ray Based Navigation in Computer-Assisted Orthopedic Surgery,” CAR '98, pp. 716-722.
Bouazza-Marouf et al.; “Robotic-Assisted Internal Fixation of Femoral Fractures”, IMECHE., pp. 51-58 (1995).
Benzel et al., “Magnetic Source Imaging: a Review of the Magnes System of Biomagnetic Technologies Incorporated,” Neurosurgery, vol. 33, No. 2 (Aug. 1993), pp. 252-259.
Batnitzky et al., “Three-Dimensinal Computer Reconstructions of Brain Lesions from Surface Contours Provided by Computed Tomography: A Prospectus,” Neurosurgery, vol. 11, No. 1, Part 1, 1982, pp. 73-84.
Barrick, “Distal Locking Screw Insertion Using a Cannulated Drill Bit: Technical Note,” Journal of Orthopaedic Trauma, vol. 7, No. 3, 1993, pp. 248-251.