WO1993017527A1 - Medical monitor system and method - Google Patents

Medical monitor system and method Download PDF

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Publication number
WO1993017527A1
WO1993017527A1 PCT/US1993/001713 US9301713W WO9317527A1 WO 1993017527 A1 WO1993017527 A1 WO 1993017527A1 US 9301713 W US9301713 W US 9301713W WO 9317527 A1 WO9317527 A1 WO 9317527A1
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WO
WIPO (PCT)
Prior art keywords
monitor
mirror
patient
medical
display
Prior art date
Application number
PCT/US1993/001713
Other languages
French (fr)
Inventor
Peter Ebner
Original Assignee
Peter Ebner
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Peter Ebner filed Critical Peter Ebner
Publication of WO1993017527A1 publication Critical patent/WO1993017527A1/en

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Classifications

    • H—ELECTRICITY
    • H04—ELECTRIC COMMUNICATION TECHNIQUE
    • H04N—PICTORIAL COMMUNICATION, e.g. TELEVISION
    • H04N7/00—Television systems
    • H04N7/18—Closed-circuit television [CCTV] systems, i.e. systems in which the video signal is not broadcast
    • H04N7/183—Closed-circuit television [CCTV] systems, i.e. systems in which the video signal is not broadcast for receiving images from a single remote source

Definitions

  • This invention relates to medical monitor systems and methods, and particularly to systems and methods for displaying images of the internal portions of a patient's body for use in performing medical procedures.
  • monitors usually is located at some distance from the patient, at one or more locations in which all medical personnel (doctors, nurses, etc.) who must see a monitor can do so, wherever they are located around the operating table.
  • monitors usually are located relatively high, above the heads of the operating room personnel, or lower and to one side, so that the personnel normally involved in an operation will not block the view of the monitor.
  • the medical personnel need to look down towards the patient and the medical instruments they -are manipulating, they usually must look up and/or turn their heads frequently to see the monitor and see what they are doing. Because the monitor is relatively far from the patient, and from the line of sight to the patient, it can take a considerable amount of time for the person to shift the focus of his or her eyes from the near object to the far object, or vice-versa. Movement of the head or eyes ' can increase the time required for the shift. This can slow the reaction time of the personnel to changes of conditions requiring fast action to save the patient from damage or death. Also, it can cause fatigue of the medical personnel. In either event, the health and safety of the patient may be compromised by the display of images far from the patient and/or the line of sight to the patient.
  • An additional object of the invention is to permit the ' lowering of ambient lighting to minimize "wash-out" of displayed 1 images, while providing more than adequate illumination of the operating area on the patient.
  • Another object of the invention is to provide such a monitor system which is strong, stable and enduring in construction, relatively simple and economical to make and use, and as compact as possible to minimize the usage of valuable hospital or medical office space.
  • the foregoing objects are met by the provision of supporting means for supporting a medical image display device near the lines of sight of medical personnel to the area where medical procedures are to be performed.
  • the display is located above and near the patient's body.
  • the display is low enough to be seen quickly by medical personnel looking at the patient, and is high enough to avoid interfering with the medical procedures being performed. Means of adjustment is provided to allow for optimal utilization of the medical personnels' field of view.
  • a video monitor is supported face-down above the operating area on the patient, and mirrors are suspended beneath the monitor in a position to display the image to each of several persons located around the patient.
  • the height of the display and the positions of the individual mirrors can be adjusted.
  • each doctor, nurse and s other person needing to see the display can see it at a location very near the operating area on the patient.
  • the device have a high- intensity lamp located beneath the image display to shine downwardly towards the operating area on the patient. This prevents shadows from dimming the illumination of the patient, and permits the ambient lighting to be reduced to minimize "wash ⁇ out" of the images on the display screen.
  • the display means comprises at least one, and preferably two or more flat panel displays rather than a conventional video monitor.
  • two back-to-back flat panel displays are located near and above the patient, and are positioned so that medical personnel on both sides of an operating table can see one of the panels.
  • a support structure in which a base structure supports an arm to which a display device is secured.
  • the arm and the display device preferably are movable relative to one another, and the arm is movably mounted on the base structure.
  • the support structure is mounted on a floor stand and can be moved relatively easily.
  • the support structure is_mounted on the ceiling or wall of a room so as to cause the display to be located above and near the surface of an operating table located near the support structure.
  • Fig. 1 is a perspective view of a medical monitor system constructed in accordance with the present invention, together with one of the operating personnel using it;
  • Fig. 1A is a schematic diagram of a portion of the system of Fig. 1;
  • Fig. 2 is an enlarged, partially broken-away perspective view of a portion of the system of Fig. 1;
  • Figs. 2A, 2B, 2C, 2D and 2E are perspective views of parts of the structure of Fig. 2;
  • FIGs. 3, 3A, 3B, 3C, 4 and 5 are further views of portions of the system of Figure 1;
  • Fig. 6 is a perspective view of another embodiment of the invention.
  • Fig. 7 is a top plan view of a portion of the embodiment shown in Figure 6; and Each of Figs. 8 through 17 is & schematic perspective view of another embodiment of the supporting structure of the invention.
  • Figure l shows a preferred embodiment 20 of the medical monitor system of the invention.
  • the system includes a support structure having a base portion 22, a vertical post 24, and a support arm structure 26 to the end of which a video monitor 28 is secured. As it is shown in Fig. 1A, the screen 29 of the monitor 28 faces downwardly.
  • a mirror support structure 30 is suspended below the monitor and supports a plurality of mirrors 74, 76, 78 and 80 just above the operating area 81 on a patient 84 lying on an operating table 86.
  • Each of the mirrors is supported at an acute angle to horizontal so as to present an image of the monitor screen which is near and above the patient. This makes the image easy to see by medical personnel such as the doctor 40 shown in Figure 1, as well as other doctors, nurses and other medical personnel (not shown) standing at the operating table. Four to six or more such personnel often are present.
  • An endoscope 32 has been inserted into the patient's body.
  • the endoscope is a fiber-optic or other device. . which illuminates and conveys images of internal body parts upwardly from the lower internal end to the upper external end.
  • a miniature video camera 34 is mounted at the upper end of the endoscope to convert the images from the endoscope into video signals. The video signals are sent through a cable 36 to the monitor 28 where they are displayed.
  • One or more instruments also are inserted into the patient's body through devices called trocars.
  • the instruments used include laparoscopes, forceps, lasers, hemostats, cauterizers, and other well known medical instruments.
  • the instruments are inserted through relatively small holes, rather than into a large incision, thus "invading" the patient's body only minimally.
  • the lines of sight from the eyes 41 of the doctor 40 to the mirror 74, the instrument 38, and the opposite side of the table are shown in Fig. 1A, as well as in Fig. 1.
  • the line of sight to the mirror is 94; the line to the instrument is 92, and the line of sight to the opposite side of the table is shown as the horizontal line 88.
  • the sight line 94 to the mirror 74 can be below horizontal, and very close to the sight line 92 to the instrument.
  • the angle ⁇ (Fig. 1A) between the two sight lines can be relatively small to facilitate rapid shifting of the line of sight by the medical "personnel.
  • the line of sight 88 to the opposite side of the operating table is unobstructed.
  • the doctor can readily " keep eye contact with other personnel on the opposite side of the table.
  • the distance from the eye 41 to the instrument 38 or the operating area on the patient is close to the effective distance of the monitor images seen by the eye 41. This minimizes the amount of re-focusing required in shifting the line of sight between the two objects.
  • the monitor 28 has two control panels 91 with indicator lights and control switches to control the contrast, brightness, etc. of the video picture on the monitor.
  • the sight line 90 to the panel 91 also is unobstructed, and is similar in length to the paths to the other objects the medical personnel must watch.
  • each panel 91 is close enough to the personnel to enable them to operate the controls easily, without walking away from the operating table.
  • the control panels may be of the "touch" type with a disposable sterile cover 93 made of flexible transparent material.
  • the images appearing on the screen of the video monitor 28 are reversed so as to give the mirror images seen by the medical personnel the right orientation. This is done quite /0 simply by reversing the connections to the vertical deflection coil of the T.V. monitor.
  • the base portion 22 includes two L-shaped legs 42 and 44, one end of which adjustably fits inside of one end of a
  • T-shaped hollow member consisting of a horizontal bottom portion
  • Each of the L-shaped legs 42 and 44 of the base has a pair of casters 45 and 47. Each of the casters 47 can be locked to prevent undesired movement.
  • a weight 50 is located in the bottom of the vertical portion 48 in order to counter-balance the weight of the monitor 28 acting upon its mounting arm. This tends to stabilize the unit and prevent it from tipping over.
  • a compression spring 52 pushing upwardly on the bottom edge of a square tube 54 which slides vertically within the tube 48.
  • the tube 54 has a series of holes 51 and a pin 49 which can be inserted into one of the holes to adjust the height of the structure.
  • the coil spring pushes upwardly on the tube 54 to assist in increasing the monitor height. If preferred, a lead- screw motorized drive can be provided for power-assisted lowering and raising of the monitor. //
  • the support arm 26 consists of a first square tube 60 with a smaller square tube 62 slidably mounted within the tube 60.
  • the tubs 60 is rotatably mounted on the vertical post 24 by means of a mounting structure 46 whose details are not shown in Fig. 1, but will be shown and described below.
  • the arm 62 slides inwardly and outwardly in the tube 60 to shorten or lengthen the arm 26 to best position the monitor 28 and the mirror support structure 30.
  • the monitor 28 is pivotably mounted on a vertical post (not shown in Fig. 1) which fits into a receptacle 64 secured to one side of the monitor housing.
  • a vertical post not shown in Fig. 1
  • the monitor 28 also can be rotated about a vertical axis to adjust its angular position within a horizontal plane.
  • the cable 36 from the video camera 34 is connected to a unit 58 of known construction which contains a power supply, a video processor for sizing, adding text and image enhancement for the video monitor 28, and contains circuitry for color balancing, color correction, etc.
  • the cable then leaves the box 58 and passes through a hole in the metal tubing and passes through the hollow interior of the arms 60 and 62.
  • the cable exits the tube 62 and is connected to the input terminals 65 on the monitor 28.
  • Electric power is supplied to the components in the box ' 58 from an ordinary 60 H z , 120 volt outlet through a cord 37. /I
  • MIRROR SUPPORT Fig. 2 is a partially cross-sectional view of the mirror support structure 30.
  • the mirrors are supported on a metal housing 72 which is shaped to be a light reflector and which is secured to a mounting member 98 (see Fig. 1 as well as Fig. 2) which is connected through a hollow vertical shaft and a tube 68 to a height adjustment unit 66, to be described in detail below.
  • the unit 66 operates in conjunction with a handle 82 to raise and lower the mirror mounting assembly 30 to provide for optimum spacing of the assembly 30 from the tops of the medical instruments being manipulated so as to provide adequate space for manipulating the instruments.
  • movement of the mirror support structure 30 can be used to optimize its position for ease of viewing images, and to ensure open lines of sight between personnel on opposite sides of the operating table.
  • the mirror is a first-surfaced mirror made out of acrylic material.
  • a first-surfaced mirror made out of acrylic material.
  • Such a mirror does not shatter like glass mirrors, and can be made at prices sufficiently low to enable the mirrors to be discarded after use in order to maintain operating room sterility with a minimum of labor.
  • conventional " glass mirrors also can be used, if preferred.
  • Each of the mirrors 74, 76, 78 and 80 is attached to the housing--72 by means of a ring 100 made out of stainless steel and secured to the housing by means of a bolt 102 and a bushing 104.
  • Each of the mirrors is clipped onto the ring 100 by means of a plastic clip 108 which is attached by adhesive to the rear surface of the mirror.
  • the clip 108 can be any of a number of readily- available commercial plastic clips such as those used for anchoring electric cable.
  • One suitable type of clip is sold .under the brand name "Kwik-Klip".
  • the angle of the mirror can be adjusted by rotating it in the direction shown by the arrow 75 in Fig. 2.
  • the friction between the clip and the ring 100 will hold the mirror at any position to which it is moved.
  • Each mirror can be moved along the length of the ring to change its position in that direction too.
  • the size and shape of the mirrors should be such that the entire monitor screen can be seen at. a glance from a single viewing point near the operating table 86 so that medical personnel need not move their heads to see the images. A round mirror of a size a little smaller than the monitor screen has been found to be satisfactory. LAMP
  • the housing 72 also serves as a reflector and protector for.a lamp module 109 having four high-intensity halogen lamp bulbs 112, only one of which is shown in Fig. 2.
  • the bottom of the housing 72 is covered by a transparent window 110 made out of polycarbonate plastic material.
  • the window 110 is held in place by means of a centrally-located bolt 118 with a stop member 114 and a nut 116 on the lower end.
  • the power for-the lamp comes through a cord 111 which passes-through the.hollow interior of the member 98, the shaft 7Q, the box,66, and- is connected to receive power through the cable 36.
  • the lamp built into the unit 30 is highly advantageous in that it is relatively close to the patient and the instruments immediately below it, and thus is highly efficient. Furthermore, it eliminates any shadow which might be created by the monitor 28 or the unit 30. It also allows the overhead lighting to be less intense, and this minimizes the "wash-out" effect of such light on the images on the monitor screen or other display.
  • the monitor 28 faces downwardly and is shaded from overhead lights by its housing. These features make the images easier to see. S
  • FIGS. 2C, 2D and 2E show the lamp module 109 and the details of its construction.
  • Th module 109 includes a central hub 113 preferably made of a high-temperature-resistant plastic material such as a high-temperature cross-linked polyvinylchloride (“PVC”) material.
  • PVC polyvinylchloride
  • each arm 115 Extending radially outwardly from the hub 113 are four aluminum arms 115 spaced at 90° from one another. At the end of each arm is a bulb-holding bracket 119 which grips the bulb 112 in the seal region 127 (Fig. 2D) of the bulb.
  • This arm construction serves as a heat sink to keep the seal area 127 at temperatures below 350°c, -while not cooling the bulb wall 125 (Fig. 2D) to temperatures below 250°c. These temperatures are required by some tungsten halogen bulbs for proper operation.
  • Each arm 115 is formed by one end of an aluminum bar which is bent at two points 117 to form a central recessed portion which fits into the hollow interior of the hub 113.
  • the bolt 118 passes through a hole in each bar, and the bars are secured to the hub by means of a nut 133 threaded onto the bolt 118.
  • the module 109 is mounted in the housing 72 ( Figure 2) by means of a pair of nuts 135 and 137 threaded onto the bolt 118.
  • the bulbs 112 are spaced from the housing 72 by a pre ⁇ determined distance.
  • the hub 113 has a recess 123 in one edge with electrical contacts adapted to mate with similar contacts on a contact block 121 ( Figure 2E) secured to the housing 72.
  • the block 121 is shaped to fit into the recess 123 when the module 109 has the correct angular orientation.
  • the pressure of forcing the hub 113 against the housing 72 forces the contacts on block 121 and in recess 123 together to make good electrical contact.
  • Each bulb 112 has a pair of conductive pins 129 (Fig. 2D) each of which is inserted into one of the tubes 131, and the end of the tube crimped and/or onto soldered the pin.
  • the module 109 has several advantages. First, the bulbs 112 can be replaced when they burn out simply by replacing the module 109.
  • the bulbs 112 are made of quartz and should not be touched with the bare hand, either when hot or when they are cold.
  • each of a relatively low (e.g. 50 watts) wattage has the advantage over providing a single bulb of high wattage in that the light distribution can be spread more evenly over a wide area. Also, when one of the four bulbs burns out, the other three can be used until the module can be replaced, thus allowing an operation to continue to completion.
  • the bulbs 112 are positioned accurately in the housing 72, both as to angular position as well as spacing from the wall of the housing 72.
  • the use of the aluminium tubes 131 as conductors eliminates the need for more expensive hollow conduits for wires, and eliminates the potential problem of deterioration of insulation on the wires, due to the high temperatures in the housing 72.
  • a utility ring 96 Suspended below the lamp housing by means of a mounting bracket 106 is a utility ring 96. This ring is used as a convenient attachment member to hold instruments or other objects used by the medical personnel. This frees the hands of the medical personnel who otherwise might have to hold the instruments.
  • a ball-joint holding structure 120 is shown in Fig. 2 as it is used to attach the upper end of the endoscope 32,to the utility ring 96.
  • the structure 120 includes a pair of links 122 and 124, each having a ball 128 at each end. /8
  • the clip can be clipped around the ring 96 or any similar object such as the upper end of the endoscope 32, by loosening a knurled thumbscrew 130, inserting the ring between the open jaws, and then tightening the thumbscrew.
  • the structure 120 provides a flexible support for holding up the upper end of the endoscope 32.
  • Figs. 3, 3A, 3B, and 3C show details of the construction of the telescoping arm 26.
  • a vertical spindle 136 Secured at the right end of the square tube 62 is a vertical spindle 136 which extends upwardly from the tube.
  • a high-density polyethylene thrust washer which provides a certain amount of resistance to rotation of the monitor 28 on the spindle, thus holding the monitor in any position to which it is rotated.
  • Attached to the inside walls of the tube 60 are three longitudinal bars 132 and 134. (also see Fig. 3C) .
  • the bar 132 extends upwardly, and the two bars 134 extend horizontally.
  • the bars are held in place by means of screws 140 which pass through the wall of the outer tube 60 and into threaded holes in the bars ' 134 and 132. _.
  • the tube 62 rolls inwardly and outwardly smoothly in the larger tube 60 on a set of ball-bearing " rollers mounted on axles 148, 150, 153 and 157 in the inner tube 62 (see Fig. 3C) .
  • the rollers consist of two lower side rollers 154, and two upper side rollers 156 which are located considerably to the right of the rollers 154, as it is shown in Fig. 3.
  • the rollers 156 bear downwardly against the upper surfaces of the bars 134, and the rollers 154 are urged upwardly by the weight of the arm 62.
  • rollers 158 and 160 which bear against opposite sides of the upper bar 132 (see Fig. 3) to guide its movement smoothly inwardly and outwardly in the larger tube 60 (the rollers 160 do not appear in Fig. 3C) .
  • a pair of drag brakes 162 consisting of a housing with a high-density polyethylene friction plunger 164 urged outwardly from the housing by an internal spring 166.
  • the spring forces the friction plungers against the bar 132 to give a controlled amount of friction to cause the arm to stay in one place until someone applies enough force to overcome the friction of the plungers. This serves as a friction lock to hold the section 62 in a desired position.
  • Fig. 3A shows the construction of a wiper 142 which is used to seal the end of the tube 60 into which the tube 62 extends.
  • the wiper 142 consists of a metal support plate 144, and a high-density polyethylene wiper sheet 146 which is attached by adhesive to the plate 144.
  • the plate 144 is secured inside the right end of the larger tube 60 by means of a pair of screws 152.
  • Each of the plate 144 and the wiper sheet 146 has a central hole which is square to fit around of the metal tube 62.
  • the hole in the sheet 146 is dimensioned so that the sheet rubs with some force against the surfaces it meets so as to form a seal for the end of the tube 160. This prevents any debris which might accumulate in the tube due to flaking of metal from the rollers 154 etc. from falling downwardly into the operating table area below it. Caps (not shown) are placed on the right end of the tube 62, and on the left end of the tube 60 for the same purpose.
  • Fig. 4 shows the rotatable mounting of the arm 60 on the vertical post structure.
  • a round shaft 168 is mounted in bearings (not shown) inside the square tube 54 and is attached to a mounting plate 174 which is secured to the under side of the metal tube 60.
  • the arm structure can be rotated to move the "monitor at the end of the arm forwardly and backwardly towards or away from operating personnel at the sides of the operating table.
  • A--stop member 170 is secured to the shaft 168.
  • a pair of stop screws 172 and 173 mate with threaded holes in opposite sides of the tube 54. The ends of the screws 172 and 173 can be adjusted inwardly or outwardly to provide variable stop positions for the member 170 to limit the degree of rotation of the arm structure to prevent it from being moved so far that it unbalances the unit 20.
  • the cable 36 is coiled inside of the tube 60 to allow for the lengthening and shortening of its path through the arm 26 as the tube 62 is moved inwardly and outwardly inside of the tube 60.
  • Fig. 5 is a partially broken-way perspective view of the structure used to adjust the height of the mirrors.
  • the handle 82 is secured to a rotatable horizontal shaft (not shown) which has a bevel gear 178 at one end meshing with another bevel gear 179 which is attached at the end of a vertical shaft 180 which extends upwardly through the tube 70.
  • the tube 70 moves up and down in a linear bearing 69 which is mounted in a large tube 68 which is secured to the housing of the unit 66. 21
  • the upper end 182 of the shaft 180 is threaded at 182 and mates with a threaded block 184 mounted on the inside of the housing 66. ⁇ By rotation of the handle 82, the rod 180 is rotated in the threaded block 184, thus raising and lowering the mirror mounting unit.
  • Two vertical guides 188 and 186 are mounted in the housing 66.
  • a horizontal cross bar 190 is attached to the tube 70 and slides on a linear bearing 196 around the shaft 188.
  • the arms formed by the slot 192 at the other end of the member 190 ride on shaft 186. This structure serves to stabilize and hold the tube 70 against unwanted movement.
  • a "Negator" brand constant force spring 194 is attached between the member 190 and the housing to provide a constant lifting force to assist in moving the structure upwardly.
  • the wire 111 passes through a hole in the center of the shaft 70 and into the"lighting fixture as shown in Fig. 2.
  • a disposable sterile transparent plastic cover 81 shaped to fit on the handle preferably is fitted over the handle 82 during use.
  • Fig. 6 shows an embodiment of the invention which is essentially the same as that shown in Fig. 1, except that two vertical flat display panels 220 and 222 are provided instead of a video monitor and mirrors. Also, for the sake of illustration, the support " structure is different. It should be understood, however, that either support structure, or any other disclosed herein, is usable with the devices shown in Figs 1 and 6. Parts of the embodiment shown in Fig. 6 which are the same as in Fig. 1 are given the same reference numerals as in Fig. 1.
  • the support base consists of two arms 226 and 228 attached perpendicularly to one another at the base of the square tube 48.
  • Three locking casters 232, 230 and 234 are provided.
  • the support arm 200 for the monitor system also is different.
  • the support arm consists of three hollow cylindrical tubular sections 202, 210 and 212 hinged together by two hinges 204 and 206 with bellows 208 and 214 providing flexible closures for the tubes at the hinges.
  • a control unit 216 for the display panels 220 and 222 is provided.
  • the unit 216 has two control panels 218 on opposite sides, similar to the panels 91 shown in Fig. 1.
  • the control unit contains computer hardware and software to control the operation of the display panels.
  • a disposable tranparent cover 219, shaped to fit over the end of the unit 216, is provided to cover the control panels 218, for the same purpose as the covers 9? in Fig. 1. _ .
  • the mechanism used to raise and lower the panels 220 and 222 is substantially the same as that shown in Fig. 5.
  • the display panels are any of a number of high- resolution color LCD flat display panels which are now available for the display of video pictures, graphics or computer information.
  • Flat panel displays using active-matrix TFT (thin- film transistor) color technology which can produce pictures of photographic quality, are being used in laptop computers.
  • active-matrix TFT thin- film transistor
  • computors is the "Colorstar” by Sharp.
  • Another suitable flat display is a TFT LCD color display with touch ⁇ screen operation, sold by Computer Dynamics of Greer, South Carolina.
  • the touch screen can be used, with a sterile protective cover, to control various parameters such as color balance, contrast, etc.
  • adapters such displays can be used to display video pictures produced by the video camera 34.
  • the first section 202 of the arm 200 is pivotably mounted on the tube 54 in the same manner as the arm 60 is mounted in the tube 54 as shown in Fig. 4.
  • the arm shown in Fig. 6 has the advantage that it can be flexed readily to move the position of the monitor equipment in the horizontal plane.
  • the cable delivering •power- and video signal to the units 216, 220, 222 and the lamps pass through the hollow interior of the arms.
  • section 212 of the flexible arm is connected to the unit 216 by means of an angular mounting block 236.
  • Fig. 7 Also shown in Fig. 7 is the pivot member 203 about which the arm pivots with respect to the metal tube 54.
  • FIGs. 8 through 17 show ten different alternative • support structure for use in the invention. Each of the figures is schematic and omits details unnecessary to the basic understanding of the embodiment.
  • Fig. 8 shows the use of a pair of vertical cylindrical columns 242 and 244 for use in supporting a single arm 238.
  • the arm is pivotably connected to the member 242 at 240.
  • the monitor 28 hangs downwardly from an attachment 246 which slides in a slot on the underside of the arm 238, Rollers inside the arm 238 allow the monitor to be moved in the direction of the arrow 248 along the arm.
  • the arm also can be swung in a arc indicated by the arrow 251, and the monitor 28 can be rotated as indicated by the arrow 250 because the attachment at 246 is ' pivotable.
  • Fig. 9 shows an embodiment like the one shown in Fig. 8, except that, instead of the monitor 28 sliding in a slot in the arm 238, it is attached at one point to the end of the arm 253, which slides in a square tube guide 254 pivotably mounted' on the post 242.
  • Fig. 10 The embodiment shown in Fig. 10 is similar to the telescoping arm embodiment shown in Fig. 1, except that it has three telescoping parts 256, 258 and 260.
  • Fig. 11 shows a wall-mounted device like that shown in Fig. l.
  • the wall is shown at 262.
  • the end of the tube 60 is pivotably mounted to a wall mounting plate 264. Otherwise, the operation of the device shown in Fig. 11 is the same as that shown in Fig. l.
  • Fig. 12 shows a device like that of Fig. 1, except that it is mounted to hang down from the ceiling 166 of a room in which it is located instead of standing on a floor stand.
  • the square tube 48 is secured to a mounting plate 264 which is fastened to the ceiling of the room.
  • Fig. 13 is a device like that shown in Fig. 6, except that it is mounted to the ceiling. Again, a mounting plate 264 is used.
  • the ceiling and wall mounted units shown in Figs. 11 ' through 13 have advantages in certain installations. There is no mechanism to get in the way of operating personnel, and there is no possibility of tipping the equipment over.
  • Fig. 14 shows another embodiment, similar to that of Fig. 6, except that two sections 268 are hinged together at 272.
  • the section 268 is pivotably mounted on the post 242, and the monitor 28 is pivotably mounted at the end of section 270.
  • Fig. 15 shows an embodiment in which a single arm 274 is fixedly secured at 276 to the post 242.
  • a bearing member 278 can slide along the arm 274 in the direction 286.
  • the monitor 28 is attached to a shaft 282 which can slide on the bearing member 278 in the direction 284.
  • a counter-weight is provided at 280 to balance or partially counterbalance the structure.
  • the embodiment in Fig. 15 thus provides movement of the monitor in mutually perpendicular directions.
  • Fig. 16 shows a support structure with two post formations 294 and 296, each consisting of sections 242 and 244.
  • a guide rail 288 is connected between the posts 242, and the bearing member 278 moves along the guide rail 288 in the direction shown by the arrows 292.
  • the monitor 28 can move on the guide member in the direction indicated by the arrow 290, as in the embodiment shown in Fig. 15.
  • Fig. 16 has the advantage of great stability in its structure. It will not easily tip over and gives solid support for the equipment it holds. 99
  • the embodiment shown in Fig. 17 also has two mounting support structures, consisting of horizontal members 298, which are attached to vertical members 48, with lockable casters 300.
  • a horizontal bar 302 connects the bars 298 together rigidly.
  • the structures -which are attached to the monitor 28 are the same as those shown in Fig. 1.
  • the monitor can be pulled forwardly or backwardly and the arms 62 will move inwardly and outwardly in the arms 60 to accommodate the forward and backward movement.
  • the monitor can be moved to the left and the right as shown in Fig. 17.
  • the base structure consisting of the members 298 and 302 is generally C-shaped so as to fit around an operating table.
  • the Fig. 17 structure is very solid and stable and provides greater supporting strength for the monitor and the other equipment which support it.
  • the preferred material for the support structure of the invention is stainless steel.
  • a satisfactory material is steel coated electrostatically with an epoxy power and heated to give a smooth, tough surface at a cost lower than for stainless steel.
  • Other materials have been mentioned for specific elements of the ' structure. 21
  • the display system can be of the three-dimensional variety in which the medical personnel wear special glasses for three-dimensional viewing.
  • FIG. 1A Another such variant is one in which a flat panel display replaces the monitor 28 in Figure 1A.
  • the use of a single flat panel and several mirrors may improve image sharpness, while reducing costs.
  • Text matter can be displayed with the body images, and, because the images are so close to the viewers, the text can be read easily.
  • the text matter can contain vital statistics for the patient, and other such information.

Abstract

A medical monitor system for viewing internal portions of a patient's body (84) through an endoscope (32) and displaying the internal images on a video monitor (28), suspended face-down above and near the patient, to assist medical personnel (40) when performing medical procedures. The medical monitor system includes a support structure (22, 24, 26) for supporting the monitor just above the patient and a plurality of mirrors (74, 76, 78, 80) to reflect the images, from the monitor, to medical personnel positioned on all sides of the patient such that the medical personnel need not shift their line of sight very much from the patient to the monitor when performing medical procedures.

Description

MEDICAL MONITOR SYSTEM AND METHOD
This invention relates to medical monitor systems and methods, and particularly to systems and methods for displaying images of the internal portions of a patient's body for use in performing medical procedures.
The use of displays of images of internal portions of the bodies of medical patients has engendered a revolution in many medical procedures.
For example, in some medical procedures, traditional surgery is replaced by the use of an endoscope to view the internal body portions, and a video camera and a video monitor to display images of those portions. The medical personnel then can use externally-manipulated medical instruments to remove the gall bladder, or appendix, and to perform many other internal medical procedures without making large incisions. This sometimes is referred to as "minimally invasive surgery", and also is called "endoscopic" or "laparoscopic" surgery. Surgery on knees and other joints using similar techniques is called "arthroscopy".
The benefits of such procedures are very substantial. The recovery time for the patient usually is substantially reduced. The chances of infection are reduced, and the cost of the procedures, including hospital costs, are reduced. Pain and suffering often are dramatically reduced. Despite the foregoing benefits from such procedures, they suffer from certain problems. It is the object of this invention to-recognize and alleviate such problems.
One problem recognized by the inventor of this patent application is that the usual location of the video monitor makes it relatively difficult for medical personnel to perform medical procedures. One or more monitors usually is located at some distance from the patient, at one or more locations in which all medical personnel (doctors, nurses, etc.) who must see a monitor can do so, wherever they are located around the operating table. Thus, monitors usually are located relatively high, above the heads of the operating room personnel, or lower and to one side, so that the personnel normally involved in an operation will not block the view of the monitor.
Since the medical personnel need to look down towards the patient and the medical instruments they -are manipulating, they usually must look up and/or turn their heads frequently to see the monitor and see what they are doing. Because the monitor is relatively far from the patient, and from the line of sight to the patient, it can take a considerable amount of time for the person to shift the focus of his or her eyes from the near object to the far object, or vice-versa. Movement of the head or eyes 'can increase the time required for the shift. This can slow the reaction time of the personnel to changes of conditions requiring fast action to save the patient from damage or death. Also, it can cause fatigue of the medical personnel. In either event, the health and safety of the patient may be compromised by the display of images far from the patient and/or the line of sight to the patient.
Another problem is the "wash out" of pictures displayed on the monitors by the high level of ambient lighting in the operating room. This makes the images more difficult to see.
It is an object of the present invention to alleviate the foregoing problems; more particularly, it is an object of the invention to provide a medical monitor system and method in which images of internal portions of patients' bodies are displayed near the site of the operation so as to be easily and quickly seen by medical personnel, with a minimum of re-focusing, eye or head movement, and delay.
It is a further object of the invention to provide such a system and method in which the positions at which images are displayed can be adjusted easily by the medical personnel, for the most convenient operation of monitor controls, and for best viewing,' regardless of which portion of the patient's body is being displayed.
An additional object of the invention is to permit the 'lowering of ambient lighting to minimize "wash-out" of displayed 1 images, while providing more than adequate illumination of the operating area on the patient.
Another object of the invention is to provide such a monitor system which is strong, stable and enduring in construction, relatively simple and economical to make and use, and as compact as possible to minimize the usage of valuable hospital or medical office space.
In accordance with the present invention, the foregoing objects are met by the provision of supporting means for supporting a medical image display device near the lines of sight of medical personnel to the area where medical procedures are to be performed.
Preferably, the display is located above and near the patient's body. The display is low enough to be seen quickly by medical personnel looking at the patient, and is high enough to avoid interfering with the medical procedures being performed. Means of adjustment is provided to allow for optimal utilization of the medical personnels' field of view.
In one embodiment of the invention, a video monitor is supported face-down above the operating area on the patient, and mirrors are suspended beneath the monitor in a position to display the image to each of several persons located around the patient. The height of the display and the positions of the individual mirrors can be adjusted. Thus, each doctor, nurse and s other person needing to see the display can see it at a location very near the operating area on the patient.
It"also is preferred that the device have a high- intensity lamp located beneath the image display to shine downwardly towards the operating area on the patient. This prevents shadows from dimming the illumination of the patient, and permits the ambient lighting to be reduced to minimize "wash¬ out" of the images on the display screen.
It also is advantageous to provide the display with holding means to which an endoscope or other instruments can be secured in order to free the hands of the operating personnel for other tasks.
In another embodiment, the display means comprises at least one, and preferably two or more flat panel displays rather than a conventional video monitor. Preferably, two back-to-back flat panel displays are located near and above the patient, and are positioned so that medical personnel on both sides of an operating table can see one of the panels.
A support structure is provided in which a base structure supports an arm to which a display device is secured. The arm and the display device preferably are movable relative to one another, and the arm is movably mounted on the base structure. IP
The support structure is mounted on a floor stand and can be moved relatively easily. Alternatively, the support structure is_mounted on the ceiling or wall of a room so as to cause the display to be located above and near the surface of an operating table located near the support structure.
The foregoing and various other features of the invention are described more fully in the drawings and description which follow.
IN THE DRAWINGS:
Fig. 1 is a perspective view of a medical monitor system constructed in accordance with the present invention, together with one of the operating personnel using it;
Fig. 1A is a schematic diagram of a portion of the system of Fig. 1;
Fig. 2 is an enlarged, partially broken-away perspective view of a portion of the system of Fig. 1;
Figs. 2A, 2B, 2C, 2D and 2E are perspective views of parts of the structure of Fig. 2;
Figs. 3, 3A, 3B, 3C, 4 and 5 are further views of portions of the system of Figure 1;
Fig. 6 is a perspective view of another embodiment of the invention;
Fig. 7 is a top plan view of a portion of the embodiment shown in Figure 6; and Each of Figs. 8 through 17 is & schematic perspective view of another embodiment of the supporting structure of the invention.
GENERAL DESCRIPTION
Figure l shows a preferred embodiment 20 of the medical monitor system of the invention.
The system includes a support structure having a base portion 22, a vertical post 24, and a support arm structure 26 to the end of which a video monitor 28 is secured. As it is shown in Fig. 1A, the screen 29 of the monitor 28 faces downwardly.
A mirror support structure 30 is suspended below the monitor and supports a plurality of mirrors 74, 76, 78 and 80 just above the operating area 81 on a patient 84 lying on an operating table 86. Each of the mirrors is supported at an acute angle to horizontal so as to present an image of the monitor screen which is near and above the patient. This makes the image easy to see by medical personnel such as the doctor 40 shown in Figure 1, as well as other doctors, nurses and other medical personnel (not shown) standing at the operating table. Four to six or more such personnel often are present.
An endoscope 32 has been inserted into the patient's body. As it is well known, the endoscope is a fiber-optic or other device..which illuminates and conveys images of internal body parts upwardly from the lower internal end to the upper external end. A miniature video camera 34 is mounted at the upper end of the endoscope to convert the images from the endoscope into video signals. The video signals are sent through a cable 36 to the monitor 28 where they are displayed.
One or more instruments, exemplified by the instrument 38, also are inserted into the patient's body through devices called trocars. The instruments used include laparoscopes, forceps, lasers, hemostats, cauterizers, and other well known medical instruments. The instruments are inserted through relatively small holes, rather than into a large incision, thus "invading" the patient's body only minimally.
The lines of sight from the eyes 41 of the doctor 40 to the mirror 74, the instrument 38, and the opposite side of the table are shown in Fig. 1A, as well as in Fig. 1. The line of sight to the mirror is 94; the line to the instrument is 92, and the line of sight to the opposite side of the table is shown as the horizontal line 88.
It can be seen from Fig. 1A that the sight line 94 to the mirror 74 can be below horizontal, and very close to the sight line 92 to the instrument. Thus, the angle θ (Fig. 1A) between the two sight lines can be relatively small to facilitate rapid shifting of the line of sight by the medical "personnel. At the same time, the line of sight 88 to the opposite side of the operating table is unobstructed. Thus, the doctor can readily "keep eye contact with other personnel on the opposite side of the table.
Further, the distance from the eye 41 to the instrument 38 or the operating area on the patient is close to the effective distance of the monitor images seen by the eye 41. This minimizes the amount of re-focusing required in shifting the line of sight between the two objects.
The monitor 28 has two control panels 91 with indicator lights and control switches to control the contrast, brightness, etc. of the video picture on the monitor. The sight line 90 to the panel 91 also is unobstructed, and is similar in length to the paths to the other objects the medical personnel must watch. Moreover, each panel 91 is close enough to the personnel to enable them to operate the controls easily, without walking away from the operating table. The control panels may be of the "touch" type with a disposable sterile cover 93 made of flexible transparent material.
In accordance with another aspect of the present invention, the images appearing on the screen of the video monitor 28 are reversed so as to give the mirror images seen by the medical personnel the right orientation. This is done quite /0 simply by reversing the connections to the vertical deflection coil of the T.V. monitor.
SUPPORT STRUCTURE
The base portion 22 includes two L-shaped legs 42 and 44, one end of which adjustably fits inside of one end of a
T-shaped hollow member consisting of a horizontal bottom portion
46 and a vertical portion 48 extending upwardly from the bottom portion. Each of the L-shaped legs 42 and 44 of the base has a pair of casters 45 and 47. Each of the casters 47 can be locked to prevent undesired movement.
A weight 50 is located in the bottom of the vertical portion 48 in order to counter-balance the weight of the monitor 28 acting upon its mounting arm. This tends to stabilize the unit and prevent it from tipping over.
Also mounted inside the vertical portion 48 of the post is a compression spring 52 pushing upwardly on the bottom edge of a square tube 54 which slides vertically within the tube 48. The tube 54 has a series of holes 51 and a pin 49 which can be inserted into one of the holes to adjust the height of the structure. The coil spring pushes upwardly on the tube 54 to assist in increasing the monitor height. If preferred, a lead- screw motorized drive can be provided for power-assisted lowering and raising of the monitor. //
The support arm 26 consists of a first square tube 60 with a smaller square tube 62 slidably mounted within the tube 60. The tubs 60 is rotatably mounted on the vertical post 24 by means of a mounting structure 46 whose details are not shown in Fig. 1, but will be shown and described below.
The arm 62 slides inwardly and outwardly in the tube 60 to shorten or lengthen the arm 26 to best position the monitor 28 and the mirror support structure 30.
The monitor 28 is pivotably mounted on a vertical post (not shown in Fig. 1) which fits into a receptacle 64 secured to one side of the monitor housing. Thus, the monitor 28 also can be rotated about a vertical axis to adjust its angular position within a horizontal plane.
The cable 36 from the video camera 34 is connected to a unit 58 of known construction which contains a power supply, a video processor for sizing, adding text and image enhancement for the video monitor 28, and contains circuitry for color balancing, color correction, etc. The cable then leaves the box 58 and passes through a hole in the metal tubing and passes through the hollow interior of the arms 60 and 62. The cable exits the tube 62 and is connected to the input terminals 65 on the monitor 28.
Electric power is supplied to the components in the box '58 from an ordinary 60 Hz, 120 volt outlet through a cord 37. /I
MIRROR SUPPORT Fig. 2 is a partially cross-sectional view of the mirror support structure 30. The mirrors are supported on a metal housing 72 which is shaped to be a light reflector and which is secured to a mounting member 98 (see Fig. 1 as well as Fig. 2) which is connected through a hollow vertical shaft and a tube 68 to a height adjustment unit 66, to be described in detail below. The unit 66 operates in conjunction with a handle 82 to raise and lower the mirror mounting assembly 30 to provide for optimum spacing of the assembly 30 from the tops of the medical instruments being manipulated so as to provide adequate space for manipulating the instruments. In addition, movement of the mirror support structure 30 can be used to optimize its position for ease of viewing images, and to ensure open lines of sight between personnel on opposite sides of the operating table.
Referring again to Fig. 2, only one mirror 74 of the four mirrors is shown in Fig. 2, for the sake of simplicity. Preferably, the mirror is a first-surfaced mirror made out of acrylic material. Such a mirror does not shatter like glass mirrors, and can be made at prices sufficiently low to enable the mirrors to be discarded after use in order to maintain operating room sterility with a minimum of labor. Of course, conventional "glass mirrors also can be used, if preferred. A3
Each of the mirrors 74, 76, 78 and 80 is attached to the housing--72 by means of a ring 100 made out of stainless steel and secured to the housing by means of a bolt 102 and a bushing 104.
Each of the mirrors is clipped onto the ring 100 by means of a plastic clip 108 which is attached by adhesive to the rear surface of the mirror. The clip 108 can be any of a number of readily- available commercial plastic clips such as those used for anchoring electric cable. One suitable type of clip is sold .under the brand name "Kwik-Klip". By this means, the angle of the mirror can be adjusted by rotating it in the direction shown by the arrow 75 in Fig. 2. The friction between the clip and the ring 100 will hold the mirror at any position to which it is moved. Each mirror can be moved along the length of the ring to change its position in that direction too.
The size and shape of the mirrors should be such that the entire monitor screen can be seen at. a glance from a single viewing point near the operating table 86 so that medical personnel need not move their heads to see the images. A round mirror of a size a little smaller than the monitor screen has been found to be satisfactory. LAMP
In accordance with another advantageous feature of the invention, the housing 72 also serves as a reflector and protector for.a lamp module 109 having four high-intensity halogen lamp bulbs 112, only one of which is shown in Fig. 2. The bottom of the housing 72 is covered by a transparent window 110 made out of polycarbonate plastic material. The window 110 is held in place by means of a centrally-located bolt 118 with a stop member 114 and a nut 116 on the lower end.
-The power for-the lamp comes through a cord 111 which passes-through the.hollow interior of the member 98, the shaft 7Q, the box,66, and- is connected to receive power through the cable 36.
The lamp built into the unit 30 is highly advantageous in that it is relatively close to the patient and the instruments immediately below it, and thus is highly efficient. Furthermore, it eliminates any shadow which might be created by the monitor 28 or the unit 30. It also allows the overhead lighting to be less intense, and this minimizes the "wash-out" effect of such light on the images on the monitor screen or other display. Advantageously, the monitor 28 faces downwardly and is shaded from overhead lights by its housing. These features make the images easier to see. S
Figures 2C, 2D and 2E show the lamp module 109 and the details of its construction.
Th module 109 includes a central hub 113 preferably made of a high-temperature-resistant plastic material such as a high-temperature cross-linked polyvinylchloride ("PVC") material.
Extending radially outwardly from the hub 113 are four aluminum arms 115 spaced at 90° from one another. At the end of each arm is a bulb-holding bracket 119 which grips the bulb 112 in the seal region 127 (Fig. 2D) of the bulb. This arm construction serves as a heat sink to keep the seal area 127 at temperatures below 350°c, -while not cooling the bulb wall 125 (Fig. 2D) to temperatures below 250°c. These temperatures are required by some tungsten halogen bulbs for proper operation.
Each arm 115 is formed by one end of an aluminum bar which is bent at two points 117 to form a central recessed portion which fits into the hollow interior of the hub 113. The bolt 118 passes through a hole in each bar, and the bars are secured to the hub by means of a nut 133 threaded onto the bolt 118.
The module 109 is mounted in the housing 72 (Figure 2) by means of a pair of nuts 135 and 137 threaded onto the bolt 118. The bulbs 112 are spaced from the housing 72 by a pre¬ determined distance. The hub 113 has a recess 123 in one edge with electrical contacts adapted to mate with similar contacts on a contact block 121 (Figure 2E) secured to the housing 72. The block 121 is shaped to fit into the recess 123 when the module 109 has the correct angular orientation. The pressure of forcing the hub 113 against the housing 72 forces the contacts on block 121 and in recess 123 together to make good electrical contact.
Twelve or twenty-four volt A.C. is supplied through lines 111 and the contacts described above to the light bulbs 112 through thin aluminium tubes 131 extending from the hub 113 to the bulbs. Each bulb 112 -has a pair of conductive pins 129 (Fig. 2D) each of which is inserted into one of the tubes 131, and the end of the tube crimped and/or onto soldered the pin.
The module 109 has several advantages. First, the bulbs 112 can be replaced when they burn out simply by replacing the module 109. The bulbs 112 are made of quartz and should not be touched with the bare hand, either when hot or when they are cold.
Providing multiple bulbs, each of a relatively low (e.g. 50 watts) wattage, has the advantage over providing a single bulb of high wattage in that the light distribution can be spread more evenly over a wide area. Also, when one of the four bulbs burns out, the other three can be used until the module can be replaced, thus allowing an operation to continue to completion.
Since the failure of one bulb usually means that the others are nearly ready to burn out, all of the bulbs should be replaced simultaneously, even if some are not burned out. The module 109 fosters this practice.
Moreover, the bulbs 112 are positioned accurately in the housing 72, both as to angular position as well as spacing from the wall of the housing 72. The use of the aluminium tubes 131 as conductors eliminates the need for more expensive hollow conduits for wires, and eliminates the potential problem of deterioration of insulation on the wires, due to the high temperatures in the housing 72.
UTILITY RING
Suspended below the lamp housing by means of a mounting bracket 106 is a utility ring 96. This ring is used as a convenient attachment member to hold instruments or other objects used by the medical personnel. This frees the hands of the medical personnel who otherwise might have to hold the instruments.
As an example, a ball-joint holding structure 120 is shown in Fig. 2 as it is used to attach the upper end of the endoscope 32,to the utility ring 96. the structure 120 includes a pair of links 122 and 124, each having a ball 128 at each end. /8
Also provided are three ball clips 126, each of which grips one of the balls 128 in a socket while allowing the ball to turn in the socket. The clip can be clipped around the ring 96 or any similar object such as the upper end of the endoscope 32, by loosening a knurled thumbscrew 130, inserting the ring between the open jaws, and then tightening the thumbscrew. Thus, the structure 120 provides a flexible support for holding up the upper end of the endoscope 32.
TELESCOPING ARM
Figs. 3, 3A, 3B, and 3C show details of the construction of the telescoping arm 26.
Secured at the right end of the square tube 62 is a vertical spindle 136 which extends upwardly from the tube. At the base of the spindle 136 is a high-density polyethylene thrust washer which provides a certain amount of resistance to rotation of the monitor 28 on the spindle, thus holding the monitor in any position to which it is rotated.
Attached to the inside walls of the tube 60 are three longitudinal bars 132 and 134. (also see Fig. 3C) . The bar 132 extends upwardly, and the two bars 134 extend horizontally. The bars are held in place by means of screws 140 which pass through the wall of the outer tube 60 and into threaded holes in the bars '134 and 132. _. Referring now to both Figs. 3 and 3C, the tube 62 rolls inwardly and outwardly smoothly in the larger tube 60 on a set of ball-bearing"rollers mounted on axles 148, 150, 153 and 157 in the inner tube 62 (see Fig. 3C) . The rollers consist of two lower side rollers 154, and two upper side rollers 156 which are located considerably to the right of the rollers 154, as it is shown in Fig. 3. The rollers 156 bear downwardly against the upper surfaces of the bars 134, and the rollers 154 are urged upwardly by the weight of the arm 62.
Also provided are two additional sets of rollers 158 and 160 which bear against opposite sides of the upper bar 132 (see Fig. 3) to guide its movement smoothly inwardly and outwardly in the larger tube 60 (the rollers 160 do not appear in Fig. 3C) .
Also provided, as shown in Figs. 3A and 3B, is a pair of drag brakes 162, consisting of a housing with a high-density polyethylene friction plunger 164 urged outwardly from the housing by an internal spring 166. The spring forces the friction plungers against the bar 132 to give a controlled amount of friction to cause the arm to stay in one place until someone applies enough force to overcome the friction of the plungers. This serves as a friction lock to hold the section 62 in a desired position. Fig. 3A shows the construction of a wiper 142 which is used to seal the end of the tube 60 into which the tube 62 extends. The wiper 142 consists of a metal support plate 144, and a high-density polyethylene wiper sheet 146 which is attached by adhesive to the plate 144. The plate 144 is secured inside the right end of the larger tube 60 by means of a pair of screws 152.
Each of the plate 144 and the wiper sheet 146 has a central hole which is square to fit around of the metal tube 62. The hole in the sheet 146 is dimensioned so that the sheet rubs with some force against the surfaces it meets so as to form a seal for the end of the tube 160. This prevents any debris which might accumulate in the tube due to flaking of metal from the rollers 154 etc. from falling downwardly into the operating table area below it. Caps (not shown) are placed on the right end of the tube 62, and on the left end of the tube 60 for the same purpose.
Fig. 4 shows the rotatable mounting of the arm 60 on the vertical post structure. A round shaft 168 is mounted in bearings (not shown) inside the square tube 54 and is attached to a mounting plate 174 which is secured to the under side of the metal tube 60. The arm structure can be rotated to move the "monitor at the end of the arm forwardly and backwardly towards or away from operating personnel at the sides of the operating table.
A--stop member 170 is secured to the shaft 168. A pair of stop screws 172 and 173 mate with threaded holes in opposite sides of the tube 54. The ends of the screws 172 and 173 can be adjusted inwardly or outwardly to provide variable stop positions for the member 170 to limit the degree of rotation of the arm structure to prevent it from being moved so far that it unbalances the unit 20.
As it can be seen in Fig. 4, the cable 36 is coiled inside of the tube 60 to allow for the lengthening and shortening of its path through the arm 26 as the tube 62 is moved inwardly and outwardly inside of the tube 60.
MIRROR HEIGHT ADJUSTMENT
Fig. 5 is a partially broken-way perspective view of the structure used to adjust the height of the mirrors.
The handle 82 is secured to a rotatable horizontal shaft (not shown) which has a bevel gear 178 at one end meshing with another bevel gear 179 which is attached at the end of a vertical shaft 180 which extends upwardly through the tube 70. The tube 70 moves up and down in a linear bearing 69 which is mounted in a large tube 68 which is secured to the housing of the unit 66. 21
The upper end 182 of the shaft 180 is threaded at 182 and mates with a threaded block 184 mounted on the inside of the housing 66.~~By rotation of the handle 82, the rod 180 is rotated in the threaded block 184, thus raising and lowering the mirror mounting unit.
Two vertical guides 188 and 186 are mounted in the housing 66. A horizontal cross bar 190 is attached to the tube 70 and slides on a linear bearing 196 around the shaft 188. The arms formed by the slot 192 at the other end of the member 190 ride on shaft 186. This structure serves to stabilize and hold the tube 70 against unwanted movement.
A "Negator" brand constant force spring 194 is attached between the member 190 and the housing to provide a constant lifting force to assist in moving the structure upwardly.
The wire 111 passes through a hole in the center of the shaft 70 and into the"lighting fixture as shown in Fig. 2.
Further, it is desirable that the doctor 40 be able to adjust handle 82 without contaminating his sterile gloves. Therefore a disposable sterile transparent plastic cover 81 shaped to fit on the handle preferably is fitted over the handle 82 during use.
FLAT DISPLAY PANEL EMBODIMENT
Fig. 6 shows an embodiment of the invention which is essentially the same as that shown in Fig. 1, except that two vertical flat display panels 220 and 222 are provided instead of a video monitor and mirrors. Also, for the sake of illustration, the support" structure is different. It should be understood, however, that either support structure, or any other disclosed herein, is usable with the devices shown in Figs 1 and 6. Parts of the embodiment shown in Fig. 6 which are the same as in Fig. 1 are given the same reference numerals as in Fig. 1.
The support base consists of two arms 226 and 228 attached perpendicularly to one another at the base of the square tube 48. Three locking casters 232, 230 and 234 are provided.
The support arm 200 for the monitor system also is different. The support arm consists of three hollow cylindrical tubular sections 202, 210 and 212 hinged together by two hinges 204 and 206 with bellows 208 and 214 providing flexible closures for the tubes at the hinges.
A control unit 216 for the display panels 220 and 222 is provided. The unit 216 has two control panels 218 on opposite sides, similar to the panels 91 shown in Fig. 1. Typically, the control unit contains computer hardware and software to control the operation of the display panels. A disposable tranparent cover 219, shaped to fit over the end of the unit 216, is provided to cover the control panels 218, for the same purpose as the covers 9? in Fig. 1. _ .
The mechanism used to raise and lower the panels 220 and 222 is substantially the same as that shown in Fig. 5.
The display panels are any of a number of high- resolution color LCD flat display panels which are now available for the display of video pictures, graphics or computer information. Flat panel displays using active-matrix TFT (thin- film transistor) color technology, which can produce pictures of photographic quality, are being used in laptop computers. One example of such computors is the "Colorstar" by Sharp. Another suitable flat display is a TFT LCD color display with touch¬ screen operation, sold by Computer Dynamics of Greer, South Carolina. The touch screen can be used, with a sterile protective cover, to control various parameters such as color balance, contrast, etc. By the addition of adapters, such displays can be used to display video pictures produced by the video camera 34.
Referring now to Figure 7, as well as Figure 6, the first section 202 of the arm 200 is pivotably mounted on the tube 54 in the same manner as the arm 60 is mounted in the tube 54 as shown in Fig. 4.
The arm shown in Fig. 6 has the advantage that it can be flexed readily to move the position of the monitor equipment in the horizontal plane. 2S
As in the embodiment in Fig. 1, the cable delivering •power- and video signal to the units 216, 220, 222 and the lamps pass through the hollow interior of the arms.
Referring now to Fig. 7, it can be seen that the section 212 of the flexible arm is connected to the unit 216 by means of an angular mounting block 236.
Also shown in Fig. 7 is the pivot member 203 about which the arm pivots with respect to the metal tube 54.
ALTERNATIVE SUPPORT STRUCTURES
Figs. 8 through 17 show ten different alternative •support structure for use in the invention. Each of the figures is schematic and omits details unnecessary to the basic understanding of the embodiment.
Fig. 8 shows the use of a pair of vertical cylindrical columns 242 and 244 for use in supporting a single arm 238. The arm is pivotably connected to the member 242 at 240.
The monitor 28 hangs downwardly from an attachment 246 which slides in a slot on the underside of the arm 238, Rollers inside the arm 238 allow the monitor to be moved in the direction of the arrow 248 along the arm. The arm also can be swung in a arc indicated by the arrow 251, and the monitor 28 can be rotated as indicated by the arrow 250 because the attachment at 246 is 'pivotable. 2i>
Fig. 9 shows an embodiment like the one shown in Fig. 8, except that, instead of the monitor 28 sliding in a slot in the arm 238, it is attached at one point to the end of the arm 253, which slides in a square tube guide 254 pivotably mounted' on the post 242.
The embodiment shown in Fig. 10 is similar to the telescoping arm embodiment shown in Fig. 1, except that it has three telescoping parts 256, 258 and 260.
Fig. 11 shows a wall-mounted device like that shown in Fig. l. The wall is shown at 262. The end of the tube 60 is pivotably mounted to a wall mounting plate 264. Otherwise, the operation of the device shown in Fig. 11 is the same as that shown in Fig. l.
Fig. 12 shows a device like that of Fig. 1, except that it is mounted to hang down from the ceiling 166 of a room in which it is located instead of standing on a floor stand. The square tube 48 is secured to a mounting plate 264 which is fastened to the ceiling of the room.
Fig. 13 is a device like that shown in Fig. 6, except that it is mounted to the ceiling. Again, a mounting plate 264 is used.
The ceiling and wall mounted units shown in Figs. 11 'through 13 have advantages in certain installations. There is no mechanism to get in the way of operating personnel, and there is no possibility of tipping the equipment over.
Fig. 14 shows another embodiment, similar to that of Fig. 6, except that two sections 268 are hinged together at 272. The section 268 is pivotably mounted on the post 242, and the monitor 28 is pivotably mounted at the end of section 270.
Fig. 15 shows an embodiment in which a single arm 274 is fixedly secured at 276 to the post 242. A bearing member 278 can slide along the arm 274 in the direction 286. The monitor 28 is attached to a shaft 282 which can slide on the bearing member 278 in the direction 284. A counter-weight is provided at 280 to balance or partially counterbalance the structure. The embodiment in Fig. 15 thus provides movement of the monitor in mutually perpendicular directions.
Fig. 16 shows a support structure with two post formations 294 and 296, each consisting of sections 242 and 244. A guide rail 288 is connected between the posts 242, and the bearing member 278 moves along the guide rail 288 in the direction shown by the arrows 292. Again, the monitor 28 can move on the guide member in the direction indicated by the arrow 290, as in the embodiment shown in Fig. 15.
The embodiment shown in Fig. 16 has the advantage of great stability in its structure. It will not easily tip over and gives solid support for the equipment it holds. 99
The embodiment shown in Fig. 17 also has two mounting support structures, consisting of horizontal members 298, which are attached to vertical members 48, with lockable casters 300. A horizontal bar 302 connects the bars 298 together rigidly.
The structures -which are attached to the monitor 28 are the same as those shown in Fig. 1. The monitor can be pulled forwardly or backwardly and the arms 62 will move inwardly and outwardly in the arms 60 to accommodate the forward and backward movement. Similarly, the monitor can be moved to the left and the right as shown in Fig. 17.
The base structure consisting of the members 298 and 302 is generally C-shaped so as to fit around an operating table.
Again, as in Fig. 16 structure, the Fig. 17 structure is very solid and stable and provides greater supporting strength for the monitor and the other equipment which support it.
MATERIALS
The preferred material for the support structure of the invention is stainless steel.
A satisfactory material is steel coated electrostatically with an epoxy power and heated to give a smooth, tough surface at a cost lower than for stainless steel. Other materials have been mentioned for specific elements of the 'structure. 21
VARIANTS
Majiy variations of the invention can be devised without deviating from the spirit and scope of the invention. For example, the display system can be of the three-dimensional variety in which the medical personnel wear special glasses for three-dimensional viewing.
Another such variant is one in which a flat panel display replaces the monitor 28 in Figure 1A. The use of a single flat panel and several mirrors may improve image sharpness, while reducing costs.
Text matter can be displayed with the body images, and, because the images are so close to the viewers, the text can be read easily. The text matter can contain vital statistics for the patient, and other such information.

Claims

1. A medical display device, said device comprising, in combination, support means for supporting an electronic display means at a location near and above the position of said patient near the sight lines of medical personnel when watching medical instruments being utilized in performing medical procedures on said medical patient, and conducting means for conducting to said display means electronic picture signals representing pictures of portions of said patient's body.
2. A device as in Claim 1 in which said portions of said patient's body are internal portions on which said medical procedures are to be performed.
3. A device as in Claim 1 including means for transmitting images from within a patient's body, and image conversion means for converting said images into electronic picture signals.
4. A device as in Claim 1 in which said display means is selected from the group consisting of at least one video monitor, and at least one flat display panel.
5. A device as in Claim 1 in which said display means comprises a video monitor mounted with its screen at an angle to the viewing direction of medical personnel performing said medical procedures, and at least one reflecting means for reflecting the image from said screen in the direction of said medical personnel.
6. A device as in Claim 5 in which said screen faces downwardly, and including mirror support means, and a plurality of mirrors mounted on said mirror support means relative to said screen to permit said screen to be viewed by a plurality of personnel distributed around said monitor.
7. A device as in Claim 5 in which monitor is adapted to reverse the images on said screen from their normal orientation so that the image reflected by said reflecting means is the normal orientation.
8. A device as in Claim 1 in which said electronic display means including at least two separate electronic displays, each displaying images for viewing from a different direction.
9. A device as in Claim 8 in which said displays comprise back-to-back flat display panels.
10. A device as in Claim 1 in which said support means includes a vertical post, a support arm extending laterally from said post to a position above said medical patient position, a base structure secured to said post, said display means being connected to said arm.
11. A device as in Claim 10 in which said arm is rotatably mounted on said post, and said arm and said display means being adapted so that the position of said display means can be changed to be nearer to or farther from said post.
12. A device as in Claim 6 in which the mounting of said mirrors leaves an open space between said screen and said • mirrors, and including means for adjusting the distance between said mirrors and said screen.
13. A device as in Claim 10 in which the construction of said arm is selected from the group consisting of: a plurality of hollow telescoping sections nested together; articulated hollow sections; a beam slidable longitudinally in a guide mounted adjacent said post; an arm of fixed length with movable mounting means for mounting said display means to move lengthwise on said arm; each of arms being rotatably mounted on said post; and an arm of fixed length affixed to said post, a connecting member slidably mounted on said arm, and a cross-arm slidably mounted on said connecting member, with said display means being mounted on said cross-arm.
14. A device as in Claim 13 in which said base structure is selected from the group consisting of: a movable floor base structure; a wall mounting structure; a ceiling mounting structure; and a pair of support structures for supporting said display means between them.
15. A device as in Claim 1 including a lamp and means for support-i-fig said lamp below said display means and above said position of said patient.
16. A device as in Claim 6 in which said mirror support means comprises a lamp housing positioned for shining light downwardly towards the patient position.
17. A device as in Claim 16 in which said housing has sloping sides with a mirror attachment bar extending around said housing, each of said mirrors being attached to said bar with a releasable clip allowing rotation of each mirror on said bar and sliding of the mirror along said bar to adjust the position of the mirror.
18. A device as in Claim 6 in which each of said mirrors is made of a first-surface acrylic material.
19. A device as in Claim 1 including an attachment member mounted on said support means and means for flexibly securing medical instruments to said attachment member.
20. A medical display device, said device comprising, in combination, an endoscope for transmitting images from within a patient, a miniature video camera for converting said images into electrical signals, a video monitor connected to receive said signals and to display corresponding images on a display screen, a support for holding said monitor above but near a patient position, with the images on said display screen appearing just above the patient so that medical personnel can shift their--view back and forth between said patient and said screen to facilitate the performance of medical procedures within said patient.
21. A system as in Claim 20 in which said support is selected from the group consisting of; a floor stand with a movable arm extending laterally from said stand and said monitor attached to said arm; and a ceiling or wall-mounted structure for movably supporting said monitor.
22. A system as in Claim 20 in which said support is adapted to hold said monitor with its screen facing downwardly, and including a mirror mounting structure depending from said support, a plurality of mirrors mounted on said mounting structure so as to present the images from said screen at a plurality of locations around said monitor.
23. A system as in Claim 22 including adjustable means for adjusting the positions of said mirrors relative to said monitor, including hand rotor means for rotating said mirror mounting structure and holding it in a position to which it has been rotated.
24. A system as in Claim 22 in which said support includes means for permitting said monitor to be moved
*• vertically, and horizontally, in two directions, and a lamp shining down from said support. 3S
25. A system as in Claim 24 in which said support includes a vertical post, a telescoping arm rotatably mounted on said post, said monitor being secured to said arm.
26. A method of performing medical procedures on a - patient while using a device for developing images of internal organs of the patient and displaying them on a display screen, said method including the improvement of locating said display screen near the lines of sight of medical personnel when viewing the site of the procedures on the patient's body so as to minimize the angle through which the medical personnel must shift their gaze when changing from viewing said site to viewing said display.
27. A method as in Claim 26 including the step of suspending said display near and above said site by means of a supporting structure displaced from the areas in which said personnel operate.
28. A method as in Claim 27 including the step of displaying said images in at least two different directions to enable personnel to view the images from two different locations on opposite sides of said patient.
29. A method as in Claim 28 in which said displaying step is selected from the group consisting of using mirrors to reflect the images from the screen of a video monitor; and utilizing flat panel display devices. *3l
30. In or for a medical monitor system utilizing one or more mirrors for reflecting images from a monitor screen, a mirror with a releasable mounting device secured thereto for releasably mounting said mirror on a mirror support structure in said system, the size and shape of said mirror being sufficient to enable the viewing of all of the images on said screen from a single location.
31. A mirror as in Claim 30 in which said mounting comprises a clip made of resilient material, and said mirror 'is sterile.
32. A mirror as in Claim 30 in which said mounting device comprises means for gripping a round bar to rotate thereon and slide longitudinally thereof for adjusting the position of said mirror.
33. A mirror as in Claim 32 in which said mounting device comprises a generally C-shaped resilient clip secured to the rear surface of said mirror.
34. A mirror as in Claim 30 in which said mirror is a first-surfaced mirror made out of a plastic material so as to be disposable.
35. In or for a medical monitor system having one or more controls for controlling the monitor system, said control having a tactile control surface, a disposable, flexible transparent sterile plastic cover shaped to fit over said tactile control surface to operate said controls without touching said control surfaces..
36. A cover as in Claim 35 selected from the group consisting of: a cover for a monitor control panel; and a display surface position control member.
37. In or for a medical operating room lamp, a high- intensity lamp bulb module comprising a lamp support structure, a plurality of high-intensity lamp bulbs mounted on said support at spatially separated points, and means for mounting said module in a housing with said lamp bulbs in a pre-determined location relative to said housing.
38. A module as in Claim 37 including heat-sink holding means for holding said bulbs, and contact means on said support structure for making contact with electrical power supply means in a lamp housing to which said module is to be secured.
39. A module as in Claim 37 in which said support structure includes a hub, a plurality of arms extending from said hub, with each of said bulbs being secured near the end of one of said arms.
PCT/US1993/001713 1992-02-25 1993-02-24 Medical monitor system and method WO1993017527A1 (en)

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US84087692A 1992-02-25 1992-02-25
US07/840,876 1992-02-25

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Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4953539A (en) * 1986-12-26 1990-09-04 Olympus Optical Co., Ltd. Endoscope apparatus
US4998972A (en) * 1988-04-28 1991-03-12 Thomas J. Fogarty Real time angioscopy imaging system

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4953539A (en) * 1986-12-26 1990-09-04 Olympus Optical Co., Ltd. Endoscope apparatus
US4998972A (en) * 1988-04-28 1991-03-12 Thomas J. Fogarty Real time angioscopy imaging system

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