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Description  |
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FIELD OF THE INVENTION
The present invention relates to an arrangement for the puncturing of
internal body organs, vessels or the like, through the utilization of a
puncturing cannula or hollow needle which will well reflect an ultrasound,
as well as an ultrasound-echo sectional view apparatus having an
ultrasonic applicator with an ultrasound scanning system for the
surface-wide ultrasonic scanning of the body region which is to be
punctured, and a display or viewing apparatus for rendering visible the
echo-section images.
DISCUSSION OF THE PRIOR ART
It is presently known that one can remove tissues or body fluids from
internal body organs for example, the liver or kidney, for diagnostic
purposes by means of suitable puncturing needles. Just as well, for the
same purpose there may be removed amniotic fluid from the uterus during a
pregnancy or, for example, blood or a medication may be injected into the
fetal body.
In all of these instances it is of extreme importance to know the precise
position of the puncturing cannula or needle with regard to the organs or
vessels which are to be punctured so as to avoid any unnecessary injuries
of endangered areas, for example, the placenta during uterus punctuation
or the like; and also to prevent an erroneous tissue withdrawal from
undesired body regions or, respectively, in an injection to avoid
misplaced injections.
An arrangement of the above-mentioned type permits for continuous
puncturing control through the assistance of ultrasound, in particular,
through rapid ultrasound-section image recording pursuant to the B-scan
procedure. Hereby, through the rapid linewise displacement of the
ultrasound beam of a known ultrasound-echo sectional view apparatus (for
example, German Published Patent Specification 1,928,367 or 1,948,463)
there is selected, in the body region which is to be punctured, a
sectional plane which is preferred for the puncture target or aim
direction, and then rendered visible as an echo-sectional view, for
example, on the picture screen of an oscillograph tube. The puncturing
cannula or needle which is conveyed in the plane is also easily visible on
the picture screen, since the cannula material stands in a good
distinguishable ultrasound contrast to the surrounding biological tissue.
Notwithstanding good visual control in the scanning region there are,
however, encountered further aiming problems. Thus, the movement of the
cannula in the tissue may be directly followed by eye on the picture
screen of the viewing apparatus, however only then, when the cannula
actually reaches into the region of the ultrasound-scanning waves in the
scanning sectional plane. Up to reaching of the aimed at scanning area,
the puncturing sequence is carried out blindly, the penetration or
entering of the cannula must thereby be corrected more or less frequently
in dependence upon the skill of the person carrying out the puncture.
However, frequent directional corrections of the puncturing cannula or
needle lead to undesired tissue injuries and, in general, delay the
puncturing procedure.
SUMMARY OF THE INVENTION
Accordingly, it is an object of the present invention to provide an
arrangement of the above-mentioned type which allows for the assuredly
aimed penetration of the puncturing cannula into the body region which is
to be punctured essentially independent of the skill of the particular
operating personnel.
The foregoing object is inventively achieved in that there is provided, at
the viewing apparatus, a targeting aid for the aiming of a suitable
punctuating point in the echo sectional view, and on the ultrasound
applicator a guide aide adjustable at least in the targeting direction of
the aiming aside for the introduction of the puncturing cannula into the
body region which is to be punctured.
The inventive combination of a targeting or aiming aide on the viewing
apparatus, including a guide aide for the puncturing cannula on the
ultrasonic applicator which is adjustable to the aiming direction of the
aiming aide, facilitates an exact presetting of the desired penetrating
direction of the puncturing cannula in the direction towards the body
region which is to be punctured. This presetting thereby also faciitates a
relatively aim assured bridging over that invisible tissue region which is
not detected by the ultrasound beam of the ultrasonic scanning system in
the ultrasonic applicator, and which heretofore has been punctured through
by the puncturing cannula merely in a blind aiming procedure. The
increased accuracy in aim in the arrangement pursuant to the invention
affords that the one-time selected penetrating direction of the puncturing
cannula practically need not be any more corrected. This puncture may thus
be carried out hereby, depending upon circumstances, also by somewhat
lesser practiced aides or assistants.
In a preferred embodiment of the invention, the aiming or targeting aide
should encompass an aiming pin which is pivotable over the picture screen
of the viewing apparatus pivotable in desired aiming directions, as well
as being displaceable along the present aiming direction. For reading off
the pivoting angle obtained for the current aiming direction, an angle
scale should hereby be associated with the aiming pin. Furthermore, there
should also be suitably provided on the aiming pin a displacement scale
for detection of the imaginary penetrating depth for the puncturing
cannula. The guide aide for the puncturing cannula, for example, should be
a guide sleeve which, in conformance with the aiming pin on the picture
screen of the viewing apparatus, is pivotable in desired aiming diections,
and which incorporates a corresponding angle scale for the setting of the
pivoting angle of the aiming pin. For monitoring of the imaginary
penetrating depth which is read off on the displacement scale of the
aiming pin, the puncturing cannula or needle should also be provided with
a corresponding displacement scale.
Brief Description of the Drawing
Further advantages and details of the invention may now be ascertained from
the following description of an exemplary embodiment thereof, taken in
conjunction with the accompanying single FIGURE of the drawing which
schematically shows a puncturing arrangement of the above-mentioned type.
DETAILED DESCRIPTION
In the single FIGURE of the drawing, an ultrasonic applicator is identified
by reference numeral 1, which interiorly thereof includes a cylindrical
parabola reflector 2, in whose focal line an ultrasonic
transmitter-receiver head 3 is positioned so as to be rotatable in the
direction of the rotational arrow, about the focal line serving as the
axis and which is displaceable along the focal line. The applicator 1,
which additionally encompasses a coupling medium 4, for example, a
precedent water section, is mounted on the body surface of a patient 5 in
the elevation of an organ 6 or the like which is to be punctured, for
example, the liver or the uterus of a pregnant woman. At a rapid rotation
of the ultrasonic head 3, due to the reflective properties of the
reflector 2, the ultrasonic transmitting beam 7, 7' etc. which is radiated
in the direction onto the reflector and from there reflected into the body
region 5, 6, is displaced in parallel with itself within this body region.
The reflected ultrasonic beam 7, 7', or the like, thereby scans this body
region and, in particular, the organ 6 which is to be punctured, in a
rapid linewise sequence.
Through the corresponding linewise reproduction of the ultrasound echo
impulses emanatng from each ultrasound line in the examination region, for
example, on the picture screen 8 of an oscillograph 9, there is finally
obtained a visual image of the plane of the object 6 which has been
presently scanned by the ultrasonic beam 7, 7', etc. This picture is then
schematically indicated through luminous points 10 on the picture screen 8
of the oscillograph 9. The sectional view 10 again merely provides a
single selected sectional plane of the object 6. Through displacement of
the ultrasonic head 3 along the focal line of the reflector 2, there may,
however, be selected further suitable sectional planes and represented in
the visual picture.
For the aiming of a desired puncturing point, for example point 11, in the
visual picture 10, the viewing apparatus encompasses a needle-shaped
aiming pin 12. This aiming pin 12 is supported in a guide sleeve 13 so as
to be displaceable along the longitudinal direction thereof. In turn, the
sleeve 13 supported in a fixed point so as to be rotatable about a
horizontal axis 14. For effectuating rotation of the sleeve 13 about the
rotational point 14, there is provided an adjustable locking knob 15. The
axis 14 is a component of an angle piece 16 which, with an elbow thereof,
is located in the groove of a support member 18 fastened on the housing of
the viewing apparatus 9 so as to be displaceable in the longitudinal
direction of the groove. The support member 18, on occasion, may also be
displaceable, for example, horizontally in a horizontal slot guide formed
in the housing of the viewing apparatus. For effecting th clamping fast of
the angle piece 16 in a predetermined elevational position, there is
provided a clamping screw 19. Furthermore, an angle scale 20 is provided
on which there may be read off the set pivot angle of the aiming pin 12
(aiming direction of the aiming pin) after the aiming of a predetermined
puncture point, for example, point 11. For detection of the depth position
of the imaginary puncture point 11, a displacement scale 21 is
additionally located along the aiming pin 12. The current depth position
is provided, for example, through the distance of the tip of the aiming
pin 12 which is directed towards the puncturing point selectively from one
of the two edges of the guide sleeve 13, or from a special reference aide.
Serving as the guide aide for the actual puncturing cannula 22, which, for
example, consists of metal, is also a sleeve 23 which has preferably the
same length as the guide sleeve 13 for the aiming pin 12. In equivalence
to the guide sleeve 13 of the aiming pin 12, the guide sleeve 23 for the
puncturing cannula 22 is also pivotably supported in a pivot point 24. For
effecting pivoting there also provided an adjustable locking knob 25, as
well as an angle piece 26 for the setting of predetermined elevational
positions, which again is vertically displaceable in the groove 27 of a
support member 28 fastened onto the applicator, and for the arresting
thereof is provided with a clamping screw 29. The support 28 may also have
a horizontal slot guide on the applicator associated therewith. For
pivoting of the puncturing cannula 22 into the pivot angle of the aiming
pin 12, there is again provided an angle scale 30 as a setting aide. For
the setting of the depth value which is read off on the displacement scale
21 on the aiming pin 12, a corresponding displacement scale 31 serves on
the puncturing cannula 22, for example, with an associated adjustable
contact.
The entire guide unit for the puncturing cannula 22 is easily removable by
means of the angle piece 26 from the applicator (through pushing out from
the groove of the support member). In case of need, the guide portion or,
upon occasion, also the guide sleeve, may alone be rapidly detached from
the ultrasonic applicator and, for example, after sterilizing, be again
easily adapted onto the applicator. Through vertical and, as occasioned,
also horizontal displacement of the angle carrier 16, respectively 26 for
the aiming pin 12, on the one hand, the puncturing cannula 22 and, on the
other hand, the rotational points 24 for the puncturing cannula 22, as
well as 14 for the aiming pin 12, may be correlated in a spatial position
with respect to each other whereby, with reference to the object which is
to be punctured, for example, organ 6, there are obtained the same
geomtrical relationships.
The manner of function of the arrangement pursuant to the drawing is
obtained to be as follows:
Prior to effectuating the actual puncturing, by means of the ultrasonic
applicator 1 there is selected a predetermined sectional plane from the
object 6 which is to be punctured and reproduced as a sectional view 10 on
the picture screen 8 of the oscillograph 9. Thereafter, through pivoting
and longitudinal displacement of the aiming pin 12, the tip thereof is
positioned on a desired puncture point, for example, point 11. The
puncturing cannula 22 is then adjusted through suitable pivoting, as well
as through corresponding longitudinal displacement, to the pivot angle and
elevational lift of the aiming pin 12. The cannula 22 is thereby directed
precisely onto the targeted puncturing point 11 and, consequently, without
any great difficulties and practically without correction, may be
penetrated up to the aiming point.
The arrangement according to the exemplary embodiment, specially employed
for the ultrasonic scanning is an ultrasonic applicator with a reflector
and rapidly rotating ultrasonic transitter-receiver. In lieu of that type
of construction for the applicator there may naturally be also used a
so-called lamellar applicator, for example, in conformance with the German
Published Patent Specification 1,948,463, meaning, such an applicator
which possesses a plurality of adjacently located ultrasonic
transitter-receiver oscillators, which may be excited timewise
individually or in groups for the corresponding linewise displacement of
the ultrasonic transmitting beam. In the described embodiment there are
further employed specialized angle-and displacement scales for the setting
and reading off of the pivot angle and the penetration depth. These
readoff-, respectively, setting elements, naturally may be replaced also
by means of corresponding electronic equivalents, for example, through
resistance potentiometers, opto-electrical installations, such as
photoscanners or the like, which convert the rotational or longitudinal
changes of the aiming pin into corresponding electrical signals. With the
aid of these signals, as well as suitable control elements, there may then
be automatically effected on the puncturing cannula the correct setting of
the aiming direction and, as required, also the penetration path, for
example in a motor driven manner. All of these possible potential
embodiments fall within the scope and purview of the present invention.
While there has been shown what is considered to be the preferred
embodiment of the invention, it will be obvious that modifications may be
made which come within the scope of the disclosure of the specification.
What is claimed is:
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