THAI MAITINT A DE ALTAAO MA WA MATAI MATATU US 20180008290A1

( 19) United States

(12 ) JiPatent Application Publication ( 10) Pub . No.: US 2018 /0008290 A1
et al. (43) Pub . Date: Jan . 11, 2018
(54 ) LASER GUIDANCE SYSTEM FOR A61B 5700 ( 2006 .01)
INTRA -OPERATIVE ORTHOPEDIC A61B 6/00 (2006 .01 )
SURGERY
(52) U .S. CI.
(71) Applicant: Whale Imaging, Inc., Waltham , MA CPC .......... A61B 17 / 1703 ( 2013 .01); A61B 6/ 547
(US ) ( 2013.01 ); A61B 5 / 061 ( 2013 .01 ); A61B
5/ 0059 (2013.01); A61B 2034 / 107 (2016 .02 )
( 72 ) Inventors : Changguo Ji , Lexington , MA (US);
Xinbai He, Belmont, MA (US ); Xun
Zhu, Waltham , MA (US) (57) ABSTRACT
(21) Appl. No.: 15 /631,208
(22 ) Filed : Jun . 23, 2017 A system and method are provided for performing fluoro
Related U .S . Application Data scopic procedures with assistance of guiding laser beam

co podia polisin ka,czasie

(60 ) Provisional application No. 62/358, 759 , filed on Jul.
6 , 2016 .
Publication Classification
projections to reduce a reliance on harmful radiation emit
ting fluoroscopic imaging devices during the procedure. The
system and method reduce an amount of radiation exposure
to patients and medical personnel during procedures that
require assistive real-time imaging. Specifically , an auto
(51) Int . Cl. mated laser guidance system and method of use is provided
A61B 17 / 17 (2006 .01) to reduce fluoroscopic radiation, reduce operation time, and
A61B 5 / 06 (2006 .01) increase operative accuracy .

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Patent Application Publication Jan. 11 , 2018 Sheet 7 of 8 US 2018 /0008290 A1

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US 2018 /0008290 A1 Jan . 11, 2018

LASER GUIDANCE SYSTEM FOR SUMMARY

INTRA -OPERATIVE ORTHOPEDIC
SURGERY [0005 ] There is a need for improved methods and systems
to reduce fluoroscopic radiation exposure to patients, reduce
procedure time, and increase operative accuracy . The pres
CROSS -REFERENCE TO RELATED ent invention is directed toward further solutions to address
APPLICATION (S ) this need , in addition to having other desirable characteris
[0001 ] This application claims priority to , and the benefit tics . Specifically, a medical imaging and guidance system is
of, co - pending U . S . Provisional Application No. 62/ 358 , provided to produce guiding laser beam projections on a
759, filed Jul. 6 , 2016 , for all subjectmatter common to both patient to assist a surgeon in a fluoroscopic imaging proce
applications . The disclosure of said provisional application dure in lieu of active imaging processes (e . g ., X - ray ). The
guiding laser beam projections are generated by a fixed array
is hereby incorporated by reference in its entirety . of laser diodes and through their use , less radiation -based
imaging is required during an operation , therefore reducing
FIELD OF THE INVENTION radiation exposure time and increasing operative accuracy
over alternative non - fluoroscopic methodologies. In particu
[ 0002 ] The present invention relates to a laser guidance lar, the present invention provides a system and method for
system for use in intra -operative orthopedic surgery or a laser guidance system to be used in connection with
fluoroscopy . In particular, the present invention relates to a intra - operative fluoroscopic imaging, but in a manner that
system and corresponding method of use implementing a reduces activation periods of the imaging devices because
diode array configured to create an improved laser guidance laser diode generated guiding laser beam projections are
system for use with a fluoroscopic medical imaging system used to facilitate positioning on the patient' s body.
to produce guiding laser beam projections on a patient to [0006 ] In accordance with example embodiments of the
assist a surgeon in a real- time fluoroscopic imaging during present invention , a medical imaging and guidance system is
procedures. provided . The system includes a fluoroscopic imaging sys
tem . The fluoroscopic imaging system includes a support
BACKGROUND gantry having a generally arc shape about an interior center
focus point with a first terminal end and a second terminal
[0003] Generally , fluoroscopy is considered indispensable end . The fluoroscopic imaging system also includes a first
during orthopedic surgery. However, there is increasing imaging assembly that is positioned on the support gantry
concern regarding occupational safety in the operating room and comprising a first imaging energy emitter that is posi
(OR ). Orthopedic surgeons are increasingly using X -ray tioned opposite a first imaging receptor, wherein one of the
based fluoroscopic techniques in the operation theatre or in first imaging energy emitter or the first imaging receptor is
the fluoroscopy room . Procedures such as kyphoplasty , positioned at the first terminal end of the support gantry. The
vertebroplasty , deformity correction , pelvic fixation , fluoroscopic imaging system further includes a plurality of
intramedullary inter - locking nails and computerized tomog laser-diodes fixedly attached to at least one of the first
raphy (CT) guided biopsies require radiation exposure . imaging receptor or the second imaging receptor around half
Vertebroplasty and kyphoplasty are similar medical spinal of a circumference of the first imaging receptor or the second
procedures . Such procedures rely on X -ray based fluoro imaging receptor,respectively, at intervals ofno greater than
scopic techniques to improve surgery success and efficiency . 15 radial degrees of spacing between each laser -diode of the
For example , these spinal procedures includemethodologies plurality of laser-diodes. The plurality of laser-diodes emits
in which bone cement is injected through a small hole in the guiding laser beam projections onto a subject to provide
skin percutaneously into a fractured vertebra with the goal of guidance to medical personnel during a procedure without
relieving back pain caused by vertebral compression frac radiation energy being emitted by the first imaging assem
tures . In practice , using an X - ray, a surgeon inserts a bly.
dedicated guide wire to confirm position under image inten 10007 ] In accordance with aspects of the present inven
sification multiple times before drilling and tapping . Utili tion , the fluoroscopic imaging system further includes a
zation of such processes can inevitably introduce additional second imaging assembly that is positioned on the support
radiation doses to both surgeons and patients. gantry and comprising a second imaging energy emitter
[ 0004 ] The general philosophy followed by most health positioned that is opposite a second imaging receptor,
care facilities is to minimize radiation dosages and require wherein one of the second imaging energy emitter or the
all radiation exposures to be justified . In particular, industry second imaging receptor is positioned at the second terminal
practice is to keep exposure levels " as low as reasonably end of the support gantry and a control unit that directs
achievable” (ALARA ). Even in following ALARA , there is movement and positioning of the support gantry. The s
increasing concern regarding occupational safety in the fluoroscopic imaging system can further include a process
operating room (OR ). In particular, during a course of a ing and display device in communication with the first
career, an orthopedic surgeon and their OR staff could be imaging assembly, the second imaging assembly, and the
exposed to potentially dangerous cumulative levels of radia plurality of laser-diodes . The fluoroscopic imaging system
tion . This long term exposure can cause substantial cytoge obtains raw image data of a subject patient located proxi
netic and chromosomal damage , potentially increasing can mate the interior center focus point between the first imaging
cer risk . Even relatively small doses of radiation should be assembly and the second imaging assembly and communi
considered dangerous over the long -term . Additionally , pro cates the raw image data to the processing and display
tective measures, including observance of safe working device . The processing and display device receives the raw
distance from the radiation source and the routine use of image data and transforms the raw image data for display as
protective garments , have been established . a preview image and receives at least one plan line that is
US 2018 /0008290 A1 Jan . 11, 2018

overlaid onto the preview image and electronically selects [0010 ] In accordance with aspects of the present inven
one or more of the plurality of laser -diodes to activate to tion , the at least one plan line is generated in response to
project one or more guiding laser beam projections onto the receiving user input to create the at least one plan line at a
subject patient at locations corresponding to the at least one particular orientation and location on the preview image of
plan line. The plurality of laser-diodes can be mechanically the subject patient.
positioned with an angular coverage or linear translation [0011] In accordance with aspects of the present invention ,
around the fluoroscopic imaging system . The at least one the method further includes determining a positioning of the
plan line can be generated with any position and line one or more laser- diode of the plurality of laser - diodes to
direction through the preview image. The at least one plan generate the one or more guiding laser beam projections.
line can provide input information and imaging geometry to The method can also include performing a fluoroscopic
determine power state of each of the plurality of laser procedure relying on the one or more guiding laser beam
diodes . The first imaging assembly can be positioned and projections.
oriented to emit imaging energy in an LT plane and the
second imaging assembly is positioned and oriented to emit [0012 ] In accordance with aspects of the present inven
imaging energy in an AP plane, perpendicular to the LT tion , the imaging device further includes a first imaging
plane . The first imaging assembly can be positioned and energy emitter, which is positioned opposite a first imaging
oriented to emit imaging energy in an AP plane and the receptor. One of the first imaging energy emitter or the first
second imaging assembly is positioned and oriented to emit imaging receptor is positioned at a first terminal end of a
imaging energy in an LT plane, perpendicular to the AP support gantry . The second imaging assembly is positioned
plane. The first imaging receptor and the second imaging on the support gantry , the second imaging assembly includ
receptor can be one of an image intensifier, a flat panel ing a second imaging energy emitter positioned opposite a
detector , or a thin film transistor ( TFT) flat-panel detector second imaging receptor. One of the second imaging energy
with a scintillation material layer configured to readout a emitter or the second imaging receptor is positioned at a
voltage data value to the processing and display device . The second terminal end of the support gantry . The imaging
TFT flat -panel detector can be configured to receive energy device also includes a control unit that directs movement
from visible photons that charge capacitors of pixel cells and positioning of the support gantry and the plurality of
within the TFT flat- panel detector and charges from each of laser - diodes are fixedly attached to at least one of the first
the pixel cells are readout as a voltage data value to the imaging receptor or the second imaging receptor around half
processing and display device . The first imaging energy of a circumference of the first imaging receptor or the second
emitter and the second imaging energy emitter can be X - ray imaging receptor.
sources configured to produce X -ray beams.
[0008 ] In accordance with aspects of the present inven BRIEF DESCRIPTION OF THE FIGURES
tion , the plurality of laser- diodes is mechanically aligned to [0013] These and other characteristics of the present
produce guiding laser beam projections to pass through the invention will be more fully understood by reference to the
interior center focus point of the support gantry. The plu following detailed description in conjunction with the
rality of laser - diodes further can include at least three attached drawings, in which :
laser -diodes uniformly spaced around the half of the cir
cumference of the first imaging receptor or the second [0014 ] FIG . 1 is diagrammatic illustration of a conven
imaging receptor. An angle of convergence for each the tional fluoroscopic imaging device known in the art;
plurality of laser -diodes can be provided to focus each of the [0015 ] FIG . 2 is an illustrative example of a conventional
plurality of laser - diodes to a center of a front input plane of two - diode laser guidance system known in the art for use
an imaging receptor that the plurality of laser-diodes is with a fluoroscopic imaging device ;
attached thereto . Each of the plurality of laser- diodes can be [00161 FIG . 3 is diagrammatic illustration of a fluoro
independently operable according to a user specification . scopic imaging device in accordance with the present inven
[0009 ] In accordance with example embodiments of the tion ;
present invention , a method for utilization of a medical [0017 ) FIG . 4 is an illustrative example configuration of a
procedure guidance system is provided . The method plurality of laser diodes for implementation on an imaging
includes activating an imaging device including a first device in accordance with the present invention ;
imaging assembly and a second imaging assembly config [0018 ] FIG . 5A is a fluoroscopic image with a plan line , in
ured and arranged to receive a subject patient therebetween .
The method also includes obtaining , by imaging receptors, accordance with aspects of the present invention ;
a raw image data of the subject patient, communicating the [0019 ] FIG . 5B is an image of guiding laser beam projec
raw image data to a processing and display device , and tions generated by the laser diodes in accordance with the
transforming the raw image data, by the processing and present invention ;
display device, into a preview image of the subject patient. [0020 ] FIGS. 6A and 6B are illustrative examples of
The method further includes displaying the preview image guiding laser beam projections generated by the laser diodes
on a display with at least one plan line, generated by the in accordance with the present invention ;
processing and display device , overlaid onto the preview
image and instructing, by the processing and display device , [0021] FIG . 7 is a flowchart depicting a method of utiliz
one or more laser-diode of a plurality of laser- diodes in a ing the laser diode array laser guidance system in accor
laser -diode array to project one or more guiding laser beam dance with the present invention ; and
projections onto the subject patient at locations correspond [0022 ] FIG . 8 is a diagrammatic illustration of a high level
ing to the at least one plan line , which is overlaid onto the architecture for implementing processes in accordance with
preview image . aspects of the invention.
US 2018 /0008290 A1 Jan . 11, 2018

DETAILED DESCRIPTION view , and a patient table 112 configured to hold a patient
[0023] An illustrative embodiment of the present inven between the imaging energy emitters 104 , 108 and the
tion relates to a fluoroscopic imaging device configured with imaging receptor 106 , 110 . As would be appreciated by one
a plurality of laser diodes , or laser diode array, installed on skilled in the art, the imaging energy emitters 104 , 108 can
at least one of the imaging receptors of the fluoroscopic include any kind of suitable imaging energy emitters utilized
imaging device . The plurality of laser diodes is distributed in for imaging a patient. For example , the imaging energy
a semi-circular pattern on the imaging receptor(s ) at station emitters 104 , 108 can be electromagnetic radiation or x - im
ary locations. The plurality of laser diodes is utilized to aging energy emitters configured to produce X -rays . The
create a guiding laser beam projections on a subject for use combination of elements in the G -arm medical imaging
during a fluoroscopic procedure. A surgeon can rely upon the system 100 includes a gantry 114 that supports all of the
guiding laser beam projections produced by the plurality of components /machinery . The gantry 114 of the G - arm medi
laser diodes instead of requiring an imaging device to be cal imaging system 100 is configured to enable two bi- planar
images to be captured simultaneously or without movement
active for the entirety of the fluoroscopic procedure (unnec of the equipment and/or the patient. In some instances, the
essarily exposing the surgeon , patient, and staff to radiation ). gantry 114 is adjustable to change angles of the imaging
In other words , the guiding laser beam projections provide machinery (e . g ., the imaging energy emitters 104, 108 and
guidance during the procedure in lieu of an active imaging imaging receptor 106 , 110 ) .
device (e. g., X -ray ). [0027 ] FIG . 2 depicts a conventional imaging receptor 110
[ 0024 ] To generate the guiding laser beam projections, one
or more of the plurality of laser diodes is activated based on ( or imaging receptor 106 ) with two laser diodes 120
a positioning and orientation of a user-provided plan line installed thereon. The laser diodes 120 are installed on the
input that is overlaid on a fluoroscopic preview image . Upon imaging receptor 110 in a configuration in which the diodes
activation , the one or more laser diodes produce the guiding can rotate around a circular position on the imaging receptor
laser beam projections on a subject which correspond to the surface . Additionally, the laser diodes 120 are configured to
location and orientation of the user -provided plan line. The project a laser guide beam on a surface of subject ( e. g .,
plurality of laser diodes are spaced, oriented , and positioned patient ) positioned within the G -arm medical imaging sys
in a manner to provide 360 degree coverage of guiding laser tem 100 . An example of such a laser guidance system and
beam projections to facilitate coverage of all requisite angels methodology is discussed with respect to U .S . patent appli
and areas, and enable production of a guiding laser beam cation Ser. No. 15 /426 , 791, incorporated herein by refer
projections matching any provided plan line. The use of ence . In short, a user can lay out a plan line or guiding laser
laser diodes generating guiding laser beam projections beam on an image preview ( e .g ., an X -ray ) to be projected
directly on the patient and corresponding to plan lines in a on the patient as a guiding laser beam projections to assist
fluoroscopic image make it possible for the fluoroscopic in performing a fluoroscopic image supported surgical or
imaging radiation to be shut off and still have guiding laser medical procedure . Based on the plan line laid out by the
beam projections displayed to the medical professionals to user, the G -arm medical imaging system 100 instructs the
rely upon during a procedure . laser diodes 120 to position and rotate in a configuration to
[ 0025 ] FIGS. 3 through 8 , wherein like parts are desig project the guiding laser beam projections on the subject at
nated by like reference numerals throughout, illustrate an a location corresponding to the plan line on the preview
example embodiment or embodiments of improved opera image.
tion for the medical imaging and laser guidance system , [0028 ] Continuing with FIG . 2 , the laser diodes 120 are
according to the present invention . Although the present positioned at two separate locations separated by 90 degrees
invention will be described with reference to the example on the imaging receptor 110 . In particular, the laser diodes
embodiment or embodiments illustrated in the figures, it 120 are positioned at the six and nine o 'clock positions of a
should be understood that many alternative forms can circular area within the imaging receptor 110 . As would be
embody the present invention . One of skill in the art will appreciated by one skilled in the art, the laser diodes 120 can
additionally appreciate differentways to alter the parameters be positioned at any locations on an imaging receptor that
of the embodiment( s ) disclosed , such as the size , shape , or enables them to be rotated and positioned in a manner to
type of elements or materials, in a manner still in keeping create a guiding laser beam projection on a subject at various
with the spirit and scope of the present invention . locations and orientations. However, the utilization of two
[0026 ] Imaging systems are commonly utilized in the laser diodes adds complexity to the imaging receptor 110
medical field for use during fluoroscopic procedures and and adds configuration time during a procedure . In particu
come in a variety of configurations for a variety of appli lar, the utilizing of two laser diodes requires mechanisms to
cations (e . g ., C - arm single plane imager, G - arm bi-plane enable the ability to rotate and position the diodes in a
imager, etc .). An example of an imaging system configured position necessary to provide the laser beam projections .
for capturing bi-planar medical images (e .g ., X - rays ) of a Additionally , the rotation and positioning takes additional
patient is depicted in FIGS. 1 and 2 . In particular, FIG . 1 time during a procedure whenever the diodes need to be
depicts a conventional G -arm medical imaging system 100 repositioned for creating the guiding laser beam projection .
and the main components that make up the G - arm medical As such , the two diode configuration is more complex and
imaging system 100. The main components of the G -arm more time consuming to operate .
medical imaging system 100 system include a movable [0029 ] FIG . 3 depicts example illustrations of a medical
stand 102 , a imaging energy emitter 104 ( e. g., an X -ray imaging and guidance system including an imaging appa
source , X -ray tube, etc .) and imaging receptor 106 (e. g., an ratus 200 for use in accordance with the present invention .
image intensifier, flat panel detector, etc .) configured for a The apparatus 200 of the present invention shares similar
frontal view (or anteroposterior view ), an imaging energy components and functionality with the components dis
emitter 108 and imaging receptor 110 configured for a lateral cussed with respect to the G - arm medical imaging system
US 2018 /0008290 A1 Jan . 11, 2018

100 in FIG . 1 . The apparatus 200 also includes additional art, the second imaging energy emitter 212 could be posi
components and functionality in combination with the tra tioned at the second terminal end 204b with the second
ditional components of the G -arm medical imaging system imaging receptor 214 positioned on the opposite side of the
100. In particular, FIG . 3 depicts an imaging apparatus 200 support gantry 204 without influencing the imaging process.
configured with a plurality of laser diodes 202 , or diode In other words, the second imaging receptor 214 (shown in
array, including a plurality of diodes 202 configured to FIG . 3 ) can also be switched with the second imaging energy
generate one or more guiding laser beam projections on a emitter 212 (shown in FIG . 3 ) in an optional arrangement.
target location ( e . g., a patient). In accordance with an The second imaging assembly is positioned and oriented to
example embodiment of the present invention , the plurality emit imaging energy in an AP plane , perpendicular to the LT
of laser diodes 202 are configured at fixed locations on one plane created by the first imaging assembly, as depicted in
of the image receptors (210 , 214 ) in a semi-circular pattern , FIG . 3. Additionally , as would be appreciated by one skilled
as depicted in FIG . 4. in the art, the second imaging assembly can be positioned
[0030 ] The apparatus 200 includes a support gantry 204 and oriented to emit imaging energy in an LT plane , per
having a generally arc shape, about an interior center focus pendicular to the AP plane from the first imaging assembly .
point 206 , with a first terminal end 204a and a second
terminal end 204b. The apparatus 200 also includes a first [0033 ] The apparatus 200 also includes a control unit 216
imaging assembly positioned on the support gantry 204 , the configured to move and position the support gantry 204 at a
first imaging assembly includes a first imaging energy desired location . Additionally , the support gantry 204
emitter 208 (e . g ., X - ray source ) positioned opposite a first includes a plurality of wheels 218 to enable a user to push ,
imaging receptor 210. As would be appreciated by one pull, and pivot the apparatus 200 into a desired position via
skilled in the art, the first imaging receptor 210 is configured the control unit 216 . In accordance with an example embodi
to receive the energy format produced by the first imaging ment of the present invention, the apparatus 200 includes or
energy emitter 208 . For example , the first imaging energy is otherwise in communication with a processing and display
emitter 208 is an X -ray source and the first imaging receptor device 220 ( such as the imaging control device discussed in
210 is a flat- panel detector configured to receive X -ray U .S . Patent Application Publication No. 2016 /0262712
energy . One of the first imaging energy emitter 208 and the incorporated herein by reference ). The processing and dis
first imaging receptor 210 is located proximate the first play device 220 is configured to receive raw image readouts
terminal end 204a. (of a subject located proximate the interior center focus
[ 0031] In accordance with an example embodiment of the point 206 ) from the imaging receptors 210 , 214 and convert
present invention , as depicted in FIG . 3 , the first imaging the readouts signal into a displayable format. The imaging
receptor 210 is located at the first terminal end 204a of the receptors 210 , 214 can include any combination of image
support gantry 204 . As would be appreciated by one skilled receptors known in the art configured to provide readable
in the art, the first imaging energy emitter 208 could be signals to the processing and display device 220 for display .
positioned at the first terminal end 2040 with the first For example , the imaging receptors 210 , 214 can be thin film
imaging receptor 210 positioned on the opposite side of the transistor ( TFT) panels with a scintillation material layer
support gantry 204 without influencing the imaging process . configured to receive energy from visible photons to charge
In other words, the first imaging receptor 210 ( shown in FIG . capacitors of pixel cells within the TFT panel. The charges
3 ) can be swapped with the first imaging energy emitter 208 for each of the pixel cells are readout as a voltage data value
positionally ( shown in FIG . 3 ) and be an equivalent con to the processing and display device 220 . The signals
figuration . The first imaging assembly is positioned and received by the processing and display device 220 can be
oriented to emit imaging energy ( e . g., from the first imaging configured into two dimensional or three dimensional
energy emitter 208 ) in an LT plane , as depicted in FIG . 3. images utilizing any combination ofmethodologies known
Additionally , as would be appreciated by one skilled in the in the art.
art, the first imaging assembly can alternatively be posi [0034 ] In accordance with an example embodiment of the
tioned and oriented to emit imaging energy (e .g ., from the present invention , the processing and display device 220 is
energy emitter 212 ) in an AP plane. configured to provide a user with a planning tool to create
[0032 ] Continuing with FIG . 3 , the apparatus 200 further one or more plan lines 222 on a preview image 224 for the
includes a second imaging assembly positioned on the generation of a guiding laser beam projection 226 , by one or
support gantry 204 ; the second imaging assembly including more laser diodes 202, on a subject 228 , as depicted in FIGS.
a second imaging energy emitter 212 ( e.g ., X -ray source ) 5A and 5B and discussed in greater detail with respect to
positioned opposite a second imaging receptor 214 . As U . S . patent application Ser. No. 15 /426 , 791 (as it relates to
would be appreciated by one skilled in the art, the second the plan lines 222 ). In an example , a surgeon can create the
imaging receptor 214 is configured to receive the energy one or more plan lines 222 on a fluoroscopic preview image
format produced by the second imaging energy emitter 212 . 224 through a software interface provided by the processing
For example , the second imaging energy emitter 212 is an and display device 220 by drawing the one or more plan
X -ray source and the second imaging receptor 214 is a lines 222 on the preview image 224 using a computer
flat-panel detector configured to read X - ray energy. One of mouse , a touch screen input, drawing tablet, or other input
the second imaging energy emitter 212 or the second imag device known in the art. The one or more plan lines 222 on
ing receptor 214 is positioned at the second terminal end the preview image 224 can be planned with any position and
204b of the support gantry 204 . In accordance with an line direction that the user desires. As would be appreciated
example embodimentof the present invention , as depicted in by one skilled in the art, the fluoroscopic preview image 224
FIG . 3, the second imaging receptor 214 is positioned is provided by the imaging provided by the apparatus 200 .
proximate to the second terminal end 204b of the support As shown in FIG . 5B , the guiding laser beam projection 226
gantry 204 . As would be appreciated by one skilled in the by one or more laser diodes 202 is projected on a target
US 2018 /0008290 A1 Jan . 11 , 2018

location 228 corresponding to the same location as that of specified plan line will dictate , via the processing and
the plan lines 222 depicted in the preview image 224 . display device 220 , the power state of each of the plurality
[0035 ] FIG . 4 depicts an example configuration of the of laser diodes 202 such that the one or more laser diodes
plurality of laser diodes 202 fixedly attached to stationary that will produce a guiding laser beam projection corre
positions within or on the first imaging receptor 210 . The sponding to the plan line will be powered /activated .
plurality of laser diodes 202 are oriented such that they [0038] The one or more plan lines 222 created on the
generate laser beams focused to the field of view at the preview image 224 are utilized by the processing and
interior center focus point 206 . As depicted in FIG . 4 , in display device 220 to determine which diodes within the
accordance with an example embodiment of the present plurality of laser diodes 202 for display should be activated
invention , the plurality of laser diodes 202 is uniformly to generate the guiding laser beam projections 226 on the
installed in a semi- circular pattern on the first imaging subject 228 . As would be appreciated by one skilled in the
receptor 210 and /or the second imaging receptor 214 . As art , the number and locations of the diodes that are activated
would be appreciated by one skilled in the art, the laser is based on the desired guiding laser beam projections 226
diodes 202 can be adapted to fit on different shaped imaging ( e . g ., based on the one or more plan lines 222 ). In accor
receptors . For example , for an image intensifier imaging dance with an example embodiment of the present inven
receptor, the plurality of laser diodes 202 can be mounted tion , the one or more plan lines 222 are prescribed on the
around the input window of the image intensifier. Addition preview image 224 through a graphical user interface (GUI)
ally , the laser diodes 202 can be positioned and spaced in any and the geometrical input data from the one or more plan
shape and distribution which will allow guiding laser beam lines 222 is used to determine which laser diodes of the
projections to be projected on a subject (e. g., a patient) at plurality of laser diodes 202 to activate . In particular, the
any position and configuration . For example , the plurality of processing and display device 220 receives the raw image
laser diodes 202 can be spaced in a 180 degree distribution data from the imaging receptors 210 , 214 and transforms the
at intervals of no greater than 15 radial degrees of spacing raw image data for display as a preview image 224 and
between each laser-diode of the plurality of laser - diodes to subsequently receives at least one plan line that is overlaid
form a semi-circular design . The 180 degree distribution onto the preview image 224 from a user. Thereafter , the
enables the plurality of laser diodes 202 to create guiding processing and display device 220 electronically selects one
laser beam projection coverage in a 360 degree radius. or more of the plurality of laser-diodes 202 to activate in
Furthermore , any number of laser diodes 202 can be utilized order to project one or more guiding laser beam projections
to make up the desired shape . Continuing the previous onto the subject patient at locations corresponding to the at
example , the plurality of laser diodes 202 can include at least least one plan line . In other words, based on the received
three , and preferably more , laser - diodes uniformly spaced plan line( s ), the processing and display device 220 selects
around the half of the circumference of each of the first one or more laser diodes 202 (to provide an activation
imaging receptor 210 and/or the second imaging receptor signal/instruction ) at positions required to generate corre
214 . For example , the plurality of laser diodes 202 can sponding guiding laser beam projections 226 to be displayed
include about twenty laser - diodes uniformly spaced around onto the subject 228 in the same locations corresponding to
the half of the circumference of the first imaging receptor the one ormore plan lines 222 created on the preview image
210 , as depicted in FIG . 4 . As would be appreciated by one 224 , as depicted in FIGS. 5A and 5B . In response to the
skilled in the art, the number of laser diodes 202 is restricted activation , the activated laser diode( s ) 202 produce the
due to a size of the diodes and mounting spacing of the guiding laser beam projections 226 corresponding to the
diodes around the imaging receiver. positioning of the one or more plan lines 222 on the preview
[0036 ] In operation , in accordance with an example image 224, while the first and /or second imaging assemblies
embodiment of the present invention , each of the laser are not actively emitting radiation and providing real-time
diodes 202 is configured to generate a guiding laser beam imaging. As such there is no requirement that first and /or
projection 226 to be properly aligned to focus on the interior second imaging assemblies emit radiation and provide real
center focus point 206 of the apparatus 200 . In particular , the time imaging for the entirety of a procedure because at
plurality of laser diodes 202 are mechanically aligned to moments during the procedure the guiding laser beam
produce guiding laser beam projection 226 to pass through projections can take the place of the necessary functionality
the interior center focus point 206 of the support gantry 204 . of the plan lines of the first and/ or section imaging assem
The mechanical positioning of the plurality of laser diodes blies , thereby reducing overall radiation emission and expo
202 provides an angular coverage or linear translation sure to the patient and medical personnel. In accordance
around the apparatus 200 (e . g ., fluoroscopic imaging sys with an example embodiment of the present invention , the
tem ). In particular, the plurality of laser diodes 202 are activation is performed by transmitting a power signal to the
positioned at an angle of convergence to provide an angular corresponding laser diode ( s ). This methodology is per
focus directed to a center of a front input plane of the formed without requiring any movement of any of the
imaging receptor 210 , 214 that the plurality of laser-diodes plurality of laser diodes 202 and the surgeon can rely on the
are attached thereto . guiding laser beam projections 226 produced by the acti
[0037 ] In accordance with an example embodiment of the vated laser diode( s ) from the plurality of laser diodes 202
present invention , each of the plurality of laser diodes 202 during the intra -operative surgery without exposing the
is independently operable according to a user specification . subject 228 to additional radiation beyond that which was
In particular, a user will specify a plan line to be generated experienced during the brief snapshot of the fluoroscopic
by one or more of the plurality of laser diodes 202 . For preview image 224 .
example , surgeons can plan line on a preview image, as [0039 ] FIGS. 6A and 6B depict illustrative examples of
discussed with respect to FIGS. 2 , 5A , 5B , 6A , and 6C , to the functionality provided by the plurality of laser diodes
be generated by the plurality of laser diodes 202 . The user 202. In particular, FIG . 6A depicts a plan line 222 or surgical
US 2018 /0008290 A1 Jan . 11, 2018

guide direction line, which passes through an image center time the imaging energy emitters 208 , 212 can be powered
230 on preview image 224 . The plan line 222 is generated off to stop any continued radiation exposure .
with any position and line direction through the preview [0045 ] At step 710 the processing and display device 220
image 224 . Additionally , the plan line 222 provides the input displays a preview image 224 on a display device (e .g ., a
information and imaging geometry to determine power state monitor ) for interpretation and pre -planning by a user. The
of each of the plurality of laser diodes 202. In particular, the preview image 224 displayed to the user is an image of the
plurality of laser -diodes 202 are electronically selected subject 228 (e.g., X -ray image).
according to a direction of the plan line 222 overlaid on the [0046 ] At step 712 the processing and display device 220
preview fluoroscopic image 224 . FIG . 6B depicts a guiding receives one or more plan lines 222 from a user overlaid on
laser beam projections 226 or surgical laser guide beam the displayed preview image 224 , as depicted in FIGS . 5A
generated by the electronically selected diodes according to and 6A .
the plan line 222 created on the preview image 224 . The [0047 ] At step 714 the processing and display device 220
guiding laser beam projection 226 generated by the activated determines which diode (s ) of the plurality of laser diodes
laser diode(s ) ( as depicted in FIG . 6B ) correspond to the 202 to activate to produce guiding laser beam projections
plan line 222 created on the preview image 224 (as depicted 226 corresponding to the one or more plan lines 222 . In
in FIG . 6A ). particular, the processing and display device 220 determines
[0040 ] FIG . 7 depicts an example process 700 of operation to direct guiding laser beam projections 226 which diode (s )
for the imaging apparatus 200 discussed with respect to of the plurality of laser diodes 202 to activate to produce the
FIGS. 3 -6B . In particular, FIG . 7 depicts an example imple guiding laser beam projections 226 at the same location on
mentation of the process 700 to pre -plan one or more plan the subject 228 in the real world as the one or more plan lines
lines 222 on a fluoroscopic preview image 224 to be directed 222 overlaid on the preview image 224 of the subject 228 .
as a guiding laser beam projections 226 (as produced by one [0048 ] At step 716 processing and display device 220
or more of the plurality of laser diodes 202 ) onto a subject transmits a signal to activate the selected the laser diode (s )
228 . The utilization of the guiding laser beam projections from step 714 .
226 , as provided in process 700 , enable a medical profes [0049 ] At step 718 the activated laser diode (s ) directs one
sional to perform a fluoroscopic procedure without having to or more guiding laser beam projections 226 in the direction
constantly expose the subject and other personnel to radia of the subject 228 , as depicted in FIGS . 5B and 6B . The one
tion from the imaging device . In particular, the plurality of or more guiding laser beam projections 226 create visible
laser- diodes 202 emit guiding laser beam projections 226 light lines on a surface of the subject 228. Additionally , the
onto a subject 228 to provide guidance to medical personnel guiding laser beam projections 226 correspond to the loca
during a procedure without radiation energy being emitted tion and angle of the one or more plan lines 222 created by
by either imaging assembly 208 , 212 . Although , with respect the user on the preview image 224 as they related to the
to FIG . 7 , the process 700 is discussed with respect to the locations on the subject 228 .
operation for the apparatus 200 depicted in FIG . 3 , as would [0050 ] At step 720 the user (e.g ., a surgeon ) can being
be appreciated by one skilled in the art, the process 700 performing a fluoroscopic procedure based on the guiding
could be implemented utilizing any other combination of laser beam projections 226 displayed on the subject 228 . As
imaging methods and systems. a result of the process 700, the apparatus 200 provides
[0041 ] At step 702 the subject 228 is positioned proximal improved surgical precision while significantly reducing
to the interior center focus point 206 of the apparatus dependence on intra -operative fluoroscopy ( e . g ., reducing
between the first imaging assembly and the second imaging exposure to radiation ). By relying on the guiding laser beam
assembly . In particular, the subject 228 is positioned in projections 226 at different times during the fluoroscopic
within the apparatus at a location to capture the desired area procedure instead of an active real time preview image 224
of the subject 228 . created through the first and second imaging assemblies, the
[0042] At step 704 the imaging energy emitters 208 , 212 process reduces an amount of radiation exposure to the
are activated . In particular, the imaging energy emitters 208 , subject 228 and any medical professionals within a given
212 (e. g., X -ray sources) are activated in response to receiv proximity to the imaging apparatus 200 .
ing a user instruction input into the processing and display [0051 ] Any suitable computing device can be used to
device 220 and transmitted to the x imaging energy emitters implement the computing devices 220 and methods/ func
208 , 212 via the control logic . Upon activation , the imaging tionality described herein and be converted to a specific
energy emitters 208, 212 generate energy (e . g ., X - ray pho system for performing the operations and features described
tons ) in a direction of the subject 228 located within the herein through modification of hardware, software, and
apparatus 200. firmware , in a manner significantly more than mere execu
[0043] At step 706 the energy emissions (e.g., X -ray tion of software on a generic computing device, as would be
photons) from the imaging energy emitters 208 , 212 are appreciated by those of skill in the art. One illustrative
absorbed as energy charges at the the imaging receptors 210 , example of such a computing device 800 is depicted in FIG .
214 . In particular, the imaging receptors 210, 214 receive the 8 . The computing device 800 is merely an illustrative
energy as raw image data to be transmitted to the processing example of a suitable computing environment and in no way
and display device 220 for conversion . limits the scope of the present invention . A “ computing
[0044 ] At step 708 the raw image data received by the device ,” as represented by FIG . 8 , can include a " worksta
imaging receptors 210 , 214 transmitted to the processing tion ,” a “ server,” a “ laptop,” a “ desktop ,” a “ hand -held
and display device 220. Thereafter, the processing and device ," a " mobile device ," a " tablet computer,” or other
display device 220 receives the raw image data and converts computing devices , as would be understood by those of skill
the raw image data into a format for display, utilizing any in the art. Given that the computing device 800 is depicted
system or method known in the art . During this period of for illustrative purposes, embodiments of the present inven
US 2018 /0008290 A1 Jan . 11 , 2018

tion may utilize any number of computing devices 800 in subjective or objective values, such as variations in proper
any number of different ways to implement a single embodi ties
O ,, parameters, sizes, and dimensions. In one non - limiting
mentof the present invention . Accordingly , embodiments of example , the terms “ about” , “ generally ” , and “ approxi
the present invention are not limited to a single computing mately ” mean at, or plus 10 percent or less , or minus 10
device 800, as would be appreciated by one with skill in the percent or less . In one non - limiting example, the terms
art, nor are they limited to a single type of implementation " about" , " generally ” , and “ approximately ” mean sufficiently
or configuration of the example computing device 800 . close to be deemed by one of skill in the art in the relevant
[0052 ] The computing device 800 can include a bus 810 field to be included. As utilized herein , the term “ substan
that can be coupled to one or more of the following tially ” refers to the complete or nearly complete extend or
illustrative components , directly or indirectly : a memory degree of an action , characteristic , property , state , structure,
812 , one or more processors 814 , one or more presentation item , or result, as would be appreciated by one of skill in the
components 816 , input/ output ports 818 , input/output com art. For example, an object that is “ substantially ” circular
ponents 820 , and a power supply 824 . One of skill in the art would mean that the object is either completely a circle to
will appreciate that the bus 810 can include one or more mathematically determinable limits, or nearly a circle as
busses, such as an address bus, a data bus, or any combi would be recognized or understood by one of skill in the art.
nation thereof. One of skill in the art additionally will The exact allowable degree of deviation from absolute
appreciate that, depending on the intended applications and completeness may in some instances depend on the specific
uses of a particular embodiment, multiple of these compo context . However , in general, the nearness of completion
nents can be implemented by a single device . Similarly , in will be so as to have the sameoverall result as if absolute and
some instances, a single component can be implemented by total completion were achieved or obtained . The use of
multiple devices. As such , FIG . 8 is merely illustrative of an " substantially ” is equally applicable when utilized in a
exemplary computing device that can be used to implement negative connotation to refer to the complete or near com
one or more embodiments of the present invention , and in no plete lack of an action , characteristic , property , state , struc
way limits the invention . ture, item , or result, as would be appreciated by one of skill
[0053] The computing device 800 can include or interact in the art.
with a variety of computer-readable media . For example , [0057] Numerous modifications and alternative embodi
computer -readable media can include Random Access ments of the present invention will be apparent to those
Memory (RAM ); Read Only Memory (ROM ); Electroni skilled in the art in view of the foregoing description .
cally Erasable Programmable Read Only Memory (EE Accordingly, this description is to be construed as illustra
PROM ) ; flash memory or other memory technologies ; tive only and is for the purpose of teaching those skilled in
CDROM , digital versatile disks (DVD ) or other optical or the art the best mode for carrying out the present invention .
holographic media ; magnetic cassettes, magnetic tape , mag Details of the structure may vary substantially without
netic disk storage or other magnetic storage devices that can departing from the spirit of the present invention , and
be used to encode information and can be accessed by the exclusive use of allmodifications that comewithin the scope
computing device 800 . of the appended claims is reserved . Within this specification
[ 00541 The memory 812 can include computer -storage embodiments have been described in a way which enables a
media in the form of volatile and /or nonvolatile memory . clear and concise specification to be written , but it is
Thememory 812 may be removable , non -removable , or any intended and will be appreciated that embodiments may be
combination thereof. Exemplary hardware devices are variously combined or separated without parting from the
devices such as hard drives, solid - state memory, optical- disc invention . It is intended that the present invention be limited
drives, and the like. The computing device 800 can include only to the extent required by the appended claims and the
one or more processors that read data from components such applicable rules of law .
as the memory 812 , the various I/ O components 816 , etc . [0058] It is also to be understood that the following claims
Presentation component(s ) 816 present data indications to a are to cover all generic and specific features of the invention
user or other device . Exemplary presentation components described herein , and all statements of the scope of the
include a display device , speaker, printing component, invention which , as a matter of language, might be said to
vibrating component, etc . fall therebetween .
[ 0055 ] The I/ O ports 818 can enable the computing device What is claimed is:
800 to be logically coupled to other devices, such as I/O 1 . A medical imaging and guidance system , comprising:
components 820 . Some of the I/ O components 820 can be a fluoroscopic imaging system , comprising :
built into the computing device 800 . Examples of such I/O a support gantry having a generally arc shape about an
components 820 include a microphone, joystick , recording interior center focus point with a first terminal end
device, game pad , satellite dish , scanner , printer , wireless and a second terminal end ;
device , networking device , and the like. a first imaging assembly that is positioned on the
[0056 ] As utilized herein , the terms “ comprises” and support gantry and comprising a first imaging energy
" comprising ” are intended to be construed as being inclu emitter that is positioned opposite a first imaging
sive, not exclusive . As utilized herein , the terms “ exem receptor, wherein one of the first imaging energy
plary ” , “ example” , and “ illustrative” , are intended to mean emitter or the first imaging receptor is positioned at
" serving as an example , instance , or illustration ” and should the first terminal end of the support gantry ; and
not be construed as indicating, or not indicating, a preferred a plurality of laser-diodes fixedly attached to at least
or advantageous configuration relative to other configura one of the first imaging receptor or the second
tions . As utilized herein , the terms “ about” , “ generally” , and imaging receptor around half of a circumference
" approximately ” are intended to cover variations that may of the first imaging receptor or the second imaging
existing in the upper and lower limits of the ranges of receptor, respectively , at intervals of no greater
US 2018 /0008290 A1 Jan . 11, 2018

than 15 radial degrees of spacing between each detector and charges from each of the pixel cells are readout
laser -diode of the plurality of laser- diodes; as a voltage data value to the processing and display device .
wherein the plurality of laser- diodes emit guiding laser 11 . The system of claim 2, wherein the first imaging
beam projections onto a subject to provide guidance to energy emitter and the second imaging energy emitter are
medical personnel during a procedure without radiation X - ray sources configured to produce X -ray beams.
energy being emitted by the first imaging assembly . 12 . The system of claim 1, wherein the plurality of
2 . The system of claim 1, further comprising: laser-diodes is mechanically aligned to produce guiding
a second imaging assembly that is positioned on the laser beam projections to pass through the interior center
support gantry and comprising a second imaging focus point of the support gantry .
energy emitter positioned that is opposite a second 13 . The system of claim 1 , wherein the plurality of
imaging receptor, wherein one of the second imaging laser - diodes further comprise at least three laser -diodes
energy emitter or the second imaging receptor is posi uniformly spaced around the half of the circumference of the
tioned at the second terminal end of the support gantry ; first imaging receptor or the second imaging receptor.
and 14 . The system of claim 1 , wherein an angle of conver
a control unit that directs movement and positioning of gence for each the plurality of laser-diodes is provided to
the support gantry. focus each of the plurality of laser- diodes to a center of a
3. The system of claim 2 , further comprising: front input plane of an imaging receptor that the plurality of
a processing and display device in communication with laser -diodes is attached thereto .
the first imaging assembly, the second imaging assem 15 . The system of claim 1 , each of the plurality of
bly, and the plurality of laser-diodes ; laser -diodes is independently operable according to a user
wherein the fluoroscopic imaging system obtains raw specification .
image data of a subject patient located proximate the 16 . A method for utilization of a medical procedure
interior center focus point between the first imaging guidance system , the method comprising:
assembly and the second imaging assembly and com activating an imaging device comprising a first imaging
municates the raw image data to the processing and assembly and a second imaging assembly configured
display device; and arranged to receive a subject patient therebetween ;
wherein the processing and display device receives the obtaining , by imaging receptors , a raw image data of the
raw image data and transforms the raw image data for subject patient;
display as a preview image and receives at least one communicating the raw image data to a processing and
plan line that is overlaid onto the preview image; and display device ;
wherein the processing and display device electronically transforming the raw image data , by the processing and
selects one or more of the plurality of laser -diodes to display device, into a preview image of the subject
activate to project one or more guiding laser beam patient ;
projections onto the subject patient at locations corre
sponding to the at least one plan line. displaying the preview image on a display with at least
4 . The system of claim 3 , wherein the plurality of laser one plan line, generated by the processing and display
diodes are mechanically positioned with an angular cover device, overlaid onto the preview image; and
age or linear translation around the fluoroscopic imaging instructing, by the processing and display device, one or
system . more laser- diode of a plurality of laser- diodes in a
5 . The system of claim 3 , wherein the at least one plan line laser -diode array to project one or more guiding laser
is generated with any position and line direction through the beam projections onto the subject patient at locations
preview image . corresponding to the at least one plan line , which is
6 . The system ofclaim 5 , wherein the at least one plan line overlaid onto the preview image .
provides input information and imaging geometry to deter 17 . The method of claim 16 , wherein the at least one plan
mine power state of each of the plurality of laser-diodes . line is generated in response to receiving user input to create
7 . The system of claim 2, wherein the first imaging the at least one plan line at a particular orientation and
assembly is positioned and oriented to emit imaging energy location on the preview image of the subject patient.
in an LT plane and the second imaging assembly is posi 18 . The method of claim 16 , further comprising deter
tioned and oriented to emit imaging energy in an AP plane , mining a positioning of the one or more laser - diode of the
perpendicular to the LT plane . plurality of laser -diodes to generate the one or more guiding
8 . The system of claim 2 , wherein the first imaging laser beam proj ections.
assembly is positioned and oriented to emit imaging energy 19 . The method of claim 16 , further comprising perform
in an AP plane and the second imaging assembly is posi ing a fluoroscopic procedure relying on the one or more
tioned and oriented to emit imaging energy in an LT plane , guiding laser beam projections.
perpendicular to the AP plane . 20 . The method of claim 16 , wherein the imaging device
9 . The system of claim 2 , wherein the first imaging further comprises:
receptor and the second imaging receptor are one of an a first imaging energy emitter, which is positioned oppo
image intensifier, a flat panel detector, or a thin film tran site a first imaging receptor, wherein one of the first
sistor ( TFT ) flat -panel detector with a scintillation material imaging energy emitter or the first imaging receptor is
layer configured to readout a voltage data value to the positioned at a first terminal end of a support gantry;
processing and display device. the second imaging assembly positioned on the support
10 . The system of claim 9 , wherein the TFT flat -panel gantry , the second imaging assembly comprising a
detector is configured to receive energy from visible photons second imaging energy emitter positioned opposite a
that charge capacitors of pixel cells within the TFT flat -panel second imaging receptor, wherein one of the second
US 2018 /0008290 A1 Jan . 11, 2018

imaging energy emitter or the second imaging receptor

is positioned at a second terminal end of the support
gantry ;
a control unit that directs movement and positioning of
the support gantry ; and
the plurality of laser-diodes being fixedly attached to at
least one of the first imaging receptor or the second
imaging receptor around half of a circumference of the
first imaging receptor or the second imaging receptor.
* * * * *