Interactive navigation system for shock wave applications

The latest generation of shock wave lithotripters, with therapy heads mounted on articulated arms, have found widespread application in the treatment of orthopedic diseases. Currently, integration of an ultrasound probe in the therapy head is the dominant modality for positioning the shock wave focus on the treatment area. For orthopedic applications, however, X-ray imaging is often preferred. This article describes a new method to locate the therapy head of a lithotripter. In the first step, the surgeon positions the tissue to be treated at the isocenter of a C-arc. This is achieved using AP and 30-degree lateral projections, with corresponding horizontal and vertical movements of the patient under fluoroscopic guidance. These movements register the anatomic location in the coordinate system of the C-arc. In the second step, the therapy head is navigated to align the shock wave focus with the isocenter. Position data are reported from an optical tracker mounted on the X-ray system, which tracks an array of infrared LEDs on the therapy head. The accuracy of the tracking system was determined on a test bench, and was calculated to be 1.55 mm (RMS) for an angular movement of +/-15 degrees around a calibrated position. Free-hand navigation and precise alignment are performed with a single virtual reality display. The display is calculated by a computer system in real time, and uses graphical symbols to represent the shock wave path and isocenter. In an interactive process, the physician observes the display while navigating the therapy head towards the isocenter. Precise alignment is achieved by displaying an enlarged view of the intersecting graphical symbols. Results from the first tests on 100 patients demonstrate the feasibility of this approach in a clinical environment.