WO1996008999A1 - Use of implant with magnetic properties to determine the position of a patient - Google Patents

Use of implant with magnetic properties to determine the position of a patient Download PDF

Info

Publication number
WO1996008999A1
WO1996008999A1 PCT/SE1995/001082 SE9501082W WO9608999A1 WO 1996008999 A1 WO1996008999 A1 WO 1996008999A1 SE 9501082 W SE9501082 W SE 9501082W WO 9608999 A1 WO9608999 A1 WO 9608999A1
Authority
WO
WIPO (PCT)
Prior art keywords
patient
implant
relation
magnetic
magnetic field
Prior art date
Application number
PCT/SE1995/001082
Other languages
French (fr)
Inventor
Bo Lennernäs
Original Assignee
Lennernaes Bo
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 Lennernaes Bo filed Critical Lennernaes Bo
Priority to EP95933014A priority Critical patent/EP0955879A1/en
Priority to JP8510822A priority patent/JPH10505776A/en
Publication of WO1996008999A1 publication Critical patent/WO1996008999A1/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/06Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/06Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/061Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A61B5/062Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00Radiation therapy
    • A61N5/10X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048Monitoring, verifying, controlling systems and methods
    • A61N5/1049Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3954Markers, e.g. radio-opaque or breast lesions markers magnetic, e.g. NMR or MRI
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/45For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4504Bones
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00Radiation therapy
    • A61N5/10X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048Monitoring, verifying, controlling systems and methods
    • A61N5/1049Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A61N2005/1051Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using an active marker

Definitions

  • the present invention relates to the determination of the position of special points or areas on or in live creatures.
  • live creatures relates to both humans and animals and they will in the following specification and claims, for simplicity reasons, jointly be called "patients”.
  • treatment In medicine it is common to make diagnoses, perform other investigations and treat patients by means of external equipments such as x-ray apparatuses, radiation treatment apparatuses and other types of apparatuses. For simplicity reasons such external diagnosis, other investigation or treatment will in the following jointly be referred to as "treatment". In many cases it is necessary to be able to reproduce the position of the patient in relation to the external equipment as accurately as possible in all space dimensions from one treatment to another. This is in particular true when the treatment might cause damages on surrounding organs, tissue etc., like in, for example, the case with radiation treatment.
  • the presently most common method for determining the position of a patient in relation to the external treatment-equipment from one treatment to another is to make markings on the skin of the patient, for example in the form of "crosses" or the like.
  • This procedure is not very reliable since the skin moves in relation to the internal organs, tissues, etc. which are to be treated. There is, therefore, a great chance that the treatment, in particular if it is radiation treatment, damages healthy internal organs, tissues, etc. in the patient. There is therefore a great need of being able to accurately and in a reproducable manner be able to align a patient in relation to the external equipment from one treat ⁇ ment to another.
  • US-A-5, 125,888 discloses a method for transporting, by means of an electromagnetic field, a drug with attached magnetic object to a desired location in the body, especially the brain, for administration of the drug to that spot, and retraction of the magnetic object.
  • SU-A-1,338,154 discloses a method of matching the radiation parameters in proton therapy, wherin detectors interrupt the treatment if permitted radiation parameters are exceeded.
  • FI,B, 79458 discloses a method and a device for eliminating errors which are caused by the patient's movements in a treatment situation, wherein a mark is made on the skin in the very treatment area. The momentaneous position of this mark is followed by continuously determining the position coordinates of the mark, and treatment is started when the position coordinates of the mark correspond to pre-determined comparison coordinates.
  • WO, Al, 93/00039 discloses a device for detecting and localizing, by means of an electomagnetic field, a metallic object which has been penetrated or implanted into a human or animal body.
  • the reference numeral 1 shows a magnetic implant which e.g. may be an implanted permanent magnet. It is, however, within the scope of the invention possible to choose an arbitrary implant having the ability to produce, as such or in combination with any other material, produce detectable magnetic fields (including electromagnetic fields) and/or changes of magnetic fields, etc.
  • the implant 1 is attached to a suitable body part 2 which, in contrast to the skin, has a comparatively constant position in the body.
  • the body part is a bone in the body.
  • Reference numeral 3 represents the skin of the patient. It is preferred to position the implant as close as possible to the respective area of treatment, but outside the same.
  • the implant can also often be suitable to encapsulate the implant in a more tissue-friendly material.
  • the implant is also preferably provided with devices and/or materials which are known per se and makes an accurate securing of the implant in bones possible, for example screws, plates, orthopedical supports and the like.
  • the implant can be an "explant", i.e. be located in a corresponding position outside the body, preferably in the vicinity of, and positionally connected to, underneath parts, e.g. a bone.
  • the schematically shown device 4 which is located outside the patient, represents one or more sensors detecting magnetic fields and/or changes of magnetic fields, e.g. from the implant 1 and/or another device cooperating therewith.
  • the implant does not have to be magnetic as such, but is capable of acting by induction, it will be possible to use e.g. magnetically insensitive spools of copper which do not interfere with investigations using magnetic resonanse tomography. Since the position of the sensor 4 is known, the position of the im- plant/explant 1 can be calculated in a simple manner. Since the position of the implant in the patient is known, as is also its relation to the target of the treatment such as a radiation target, it is also possible to determine the positions for the patient and the target of the treatment. The design of the sensors 4 can be varied as needed in the individual case, from a simple spool to more advanced elements which are sensitive to magnetic fields, e.g.
  • FIG. 1 shows a sensor 4 built-up from 25 analogous Hall sensors which are arranged in 5 rows of 5 sensors each. By reading the signals from the sensors into a computer 6, using an analogue-to-digital converter 5, each sensor can be read rapidly.

Abstract

Use of an implant having magnetic properties for reproducible determination of the position of a patient in time in relation to external treatment equipment, and an apparatus for reproducibly determining the position of a patient in relation to external treatment equipment. The apparatus comprises at least one magnetic device (1) which is so designed that it can be attached to a body part, the position in relation to the intended treatment target is substantially constant, and at least one sensor means (4) which is capable of detecting magnetic fields and/or changes of magnetic fields for determining the position of the patient in the space based thereon.

Description

Use of implant with magnetic properties to determine the position of a patient.
Technical Field
The present invention relates to the determination of the position of special points or areas on or in live creatures. The term live creatures relates to both humans and animals and they will in the following specification and claims, for simplicity reasons, jointly be called "patients".
Bakground of the Invention
In medicine it is common to make diagnoses, perform other investigations and treat patients by means of external equipments such as x-ray apparatuses, radiation treatment apparatuses and other types of apparatuses. For simplicity reasons such external diagnosis, other investigation or treatment will in the following jointly be referred to as "treatment". In many cases it is necessary to be able to reproduce the position of the patient in relation to the external equipment as accurately as possible in all space dimensions from one treatment to another. This is in particular true when the treatment might cause damages on surrounding organs, tissue etc., like in, for example, the case with radiation treatment.
Disclosure of Prior Art
The presently most common method for determining the position of a patient in relation to the external treatment-equipment from one treatment to another, is to make markings on the skin of the patient, for example in the form of "crosses" or the like. This procedure is not very reliable since the skin moves in relation to the internal organs, tissues, etc. which are to be treated. There is, therefore, a great chance that the treatment, in particular if it is radiation treatment, damages healthy internal organs, tissues, etc. in the patient. There is therefore a great need of being able to accurately and in a reproducable manner be able to align a patient in relation to the external equipment from one treat¬ ment to another.
It is also previously known to use magnetic implants for various purposes. One example is US-A-4, 978,323 which discloses systems and methods in which magnets are used for preventing opturation of such body channels, especially the air ducts, in which gas or liquid has to be able to flow. A combination of implan¬ ted and external permanent magnets, or only implanted magnets, are used in order to keep the body channel in question open. As an alternative to implanted magnets, for the same purpose, there are disclosed magnets which are swallowed by the patient as a "pill". An electronic system such as a Hall element can be used for e.g. checking that the magnets fulfil their function to keep the body channel in question open. Also disclosed is the use of magnets for keeping prostheses or endotracheal tubes in place.
US-A-5, 125,888 discloses a method for transporting, by means of an electromagnetic field, a drug with attached magnetic object to a desired location in the body, especially the brain, for administration of the drug to that spot, and retraction of the magnetic object. SU-A-1,338,154 discloses a method of matching the radiation parameters in proton therapy, wherin detectors interrupt the treatment if permitted radiation parameters are exceeded.
FI,B, 79458 discloses a method and a device for eliminating errors which are caused by the patient's movements in a treatment situation, wherein a mark is made on the skin in the very treatment area. The momentaneous position of this mark is followed by continuously determining the position coordinates of the mark, and treatment is started when the position coordinates of the mark correspond to pre-determined comparison coordinates.
WO, Al, 93/00039 discloses a device for detecting and localizing, by means of an electomagnetic field, a metallic object which has been penetrated or implanted into a human or animal body.
There are also a number of publications which make use of similar methods and devices for detecting objects in a human and animal body, e.g. SE 0314231, SE 0193509, US-A-4,987,309, US-A-4,502,147, JP 63-286170, US-A-4,618,980, US- A-4,445,501 and FI 81012.
In summary it is true that the above indicated documents make use of magnets as implants in connection with medical treatment, but none of said documents neither indicate or intimate the use of magnetic implants for solving the above mentioned problems with reproducable determination of the position of a patient on different occasions.
Short Description of the Drawing
An example of the presently preferred embodiment of the invention is illustrated in the enclosed drawings, in which
Figure 1 is a diagrammatic sectional view showing a patient having a magnetic implant and an external sensor, and Figure 2 is a schematic elevational view showing an example of external equipment for recordal and presentation of the position of the implant in the body.
Description of the Invention and Preferred Embodiments In Figure 1 the reference numeral 1 shows a magnetic implant which e.g. may be an implanted permanent magnet. It is, however, within the scope of the invention possible to choose an arbitrary implant having the ability to produce, as such or in combination with any other material, produce detectable magnetic fields (including electromagnetic fields) and/or changes of magnetic fields, etc. In accordance with the invention the implant 1 is attached to a suitable body part 2 which, in contrast to the skin, has a comparatively constant position in the body. In the shown embodiment the body part is a bone in the body. Reference numeral 3 represents the skin of the patient. It is preferred to position the implant as close as possible to the respective area of treatment, but outside the same. It can also often be suitable to encapsulate the implant in a more tissue-friendly material. The implant is also preferably provided with devices and/or materials which are known per se and makes an accurate securing of the implant in bones possible, for example screws, plates, orthopedical supports and the like. In an alternative embodiment the implant can be an "explant", i.e. be located in a corresponding position outside the body, preferably in the vicinity of, and positionally connected to, underneath parts, e.g. a bone.
The schematically shown device 4, which is located outside the patient, represents one or more sensors detecting magnetic fields and/or changes of magnetic fields, e.g. from the implant 1 and/or another device cooperating therewith.
The number and the type of sensors, implants and detection method will be chosen with regard to i.a. the desired accuracy. Thus, the magnetic field can be generated in any manner which fulfil the indicated purpose, for example by means of permanent magnets, induction with in-operated spool and power source in or outside the body. It is also possible, by induction to build up a voltage in the implant which subsequently can provide a magnetic field through a spool. It is not necessary for the implant as such to generate a magnetic field, but it can be so designed that its magnetic properties will change the applied magnetic field (for example a steel plate), and this change will be detected by the sensor. Thus the implant as such does not have to provide a magnetic field but only provide a change of a magnetic field, applied from the outside. In this case the implant has magnetic properties which can be detected by the sensor. It is also possible to combine an outer magnetic field with a magnetic field which is generated by the implant in an optional manner.
Since the implant does not have to be magnetic as such, but is capable of acting by induction, it will be possible to use e.g. magnetically insensitive spools of copper which do not interfere with investigations using magnetic resonanse tomography. Since the position of the sensor 4 is known, the position of the im- plant/explant 1 can be calculated in a simple manner. Since the position of the implant in the patient is known, as is also its relation to the target of the treatment such as a radiation target, it is also possible to determine the positions for the patient and the target of the treatment. The design of the sensors 4 can be varied as needed in the individual case, from a simple spool to more advanced elements which are sensitive to magnetic fields, e.g. Hall instruments, magnetic resistive sensors or the like which together build up a sensor. Such a sensor may contain one or more elements of the same or different type which are sensitive to magnetic fields. The elements may be grouped into different configurations (circular, in rows, etc.). The sensors may be movable or stationary. The elements of the sensors can also be immobile or movable in order to increase the area in which the magnetic field is detected. This is technique which is well known as such and which a person skilled in the art can apply on the present invention without any further description. Figure 2 shows a sensor 4 built-up from 25 analogous Hall sensors which are arranged in 5 rows of 5 sensors each. By reading the signals from the sensors into a computer 6, using an analogue-to-digital converter 5, each sensor can be read rapidly. Each sensor provides a voltage which is proportional to the magnetic field in which it is located. The magnets which are located closer to the center of the magnetic field provide the maximum deflection. By using this device the center of the magnetic field can be determined accurately in two directions and the accuracy increases when using more devices.
The invention is not intended to be restricted to the embodiments which have been described and/or shown, but many modifications and variations are possible within the scope of the appended claims.

Claims

1. Use of an implant having magnetic properties for in time reproducable determination of the position of a patient in relation to external treatment equipment.
2. Use according to claim 1, characterized in that the implant comprises a permanent magnet.
3. Use according to claim 1, characterized in that the implant comprises at least one material which, in co- oporation with at least one external material, producing a magnetic field by means of which the position of the patient in the space can be determined.
4. Use according to any one of claims 1 to 3, characterized in that the implant is attached to a body part whose position in relation to an intended treatment target is substantially constant.
5. Use according to any one of claims 1 to 4, characterized in that the body part is a bone in the body.
6. Use according to any one of claims 1 to 5, characterized in that the implant is an explant.
7. A device for in time reproducible determination of the position of a patient in relation to external treatment equipment, characterized in that it comprises
a) at least one device (1) which has magnetic properties and is so designed that it can be attached to a body part, the position of which is substantially constant in relation to an intended treatment target,
b) at least one sensor device (4) being capable of detecting a magnetic field and/or changes of a magnetic field and, based thereon, determine the position of the patient in the space.
PCT/SE1995/001082 1994-09-22 1995-09-22 Use of implant with magnetic properties to determine the position of a patient WO1996008999A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
EP95933014A EP0955879A1 (en) 1994-09-22 1995-09-22 Use of implant with magnetic properties to determine the position of a patient
JP8510822A JPH10505776A (en) 1994-09-22 1995-09-22 Use of magnetic implants to locate patients

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
SE9403193-7 1994-09-22
SE9403193A SE9403193L (en) 1994-09-22 1994-09-22 Method and device for position determination

Publications (1)

Publication Number Publication Date
WO1996008999A1 true WO1996008999A1 (en) 1996-03-28

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JP (1) JPH10505776A (en)
SE (1) SE9403193L (en)
WO (1) WO1996008999A1 (en)

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WO1998052466A1 (en) * 1997-05-21 1998-11-26 Lucent Medical Systems, Inc. Non-invasive sensing of a physical parameter
WO2000051514A1 (en) * 1999-03-01 2000-09-08 Lucent Medical Systems, Inc. Magnetic anatomical marker and method of use
US6129668A (en) * 1997-05-08 2000-10-10 Lucent Medical Systems, Inc. System and method to determine the location and orientation of an indwelling medical device
US6263230B1 (en) 1997-05-08 2001-07-17 Lucent Medical Systems, Inc. System and method to determine the location and orientation of an indwelling medical device
WO2002100485A1 (en) * 2001-06-08 2002-12-19 Calypso Medical Technologies, Inc. Guided radiation therapy system
WO2003011394A1 (en) * 2001-07-27 2003-02-13 Bhc Engineering, Lp Method and device for monitoring real-time position of an area targeted by a radiosurgery system
US6675810B2 (en) 1998-05-14 2004-01-13 Calypso Medical Technologies, Inc. System and method for bracketing and removing tissue
WO2004030536A1 (en) * 2002-10-01 2004-04-15 Potencia Medical Ag Detection of implanted injection port
US6812842B2 (en) 2001-12-20 2004-11-02 Calypso Medical Technologies, Inc. System for excitation of a leadless miniature marker
US6822570B2 (en) 2001-12-20 2004-11-23 Calypso Medical Technologies, Inc. System for spatially adjustable excitation of leadless miniature marker
US6838990B2 (en) 2001-12-20 2005-01-04 Calypso Medical Technologies, Inc. System for excitation leadless miniature marker
US6889833B2 (en) 2002-12-30 2005-05-10 Calypso Medical Technologies, Inc. Packaged systems for implanting markers in a patient and methods for manufacturing and using such systems
WO2006077200A1 (en) * 2005-01-18 2006-07-27 Charité - Universitätsmedizin Berlin Endoscopic marking agent, instruments for applying and detecting the marking agent and for operatively fixing the marked tissue area
EP1803413A3 (en) * 2005-12-30 2008-08-13 DePuy Products, Inc. Magnetic sensor array for bone registration in computer-assisted orthopaedic surgery
AU2006252293B2 (en) * 2005-12-30 2011-10-13 Depuy Products, Inc. System and method for registering a bone of a patient with a computer assisted orthopaedic surgery system
US8068648B2 (en) 2006-12-21 2011-11-29 Depuy Products, Inc. Method and system for registering a bone of a patient with a computer assisted orthopaedic surgery system
US8862200B2 (en) 2005-12-30 2014-10-14 DePuy Synthes Products, LLC Method for determining a position of a magnetic source
US8857043B2 (en) 2002-12-30 2014-10-14 Varian Medical Systems, Inc. Method of manufacturing an implantable marker with a leadless signal transmitter
US9237860B2 (en) 2008-06-05 2016-01-19 Varian Medical Systems, Inc. Motion compensation for medical imaging and associated systems and methods
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WO2023020241A1 (en) * 2021-08-16 2023-02-23 The University Of Hong Kong Non-contact, non-radiation device that accurately locates multiple implants in patient's body

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WO1998052466A1 (en) * 1997-05-21 1998-11-26 Lucent Medical Systems, Inc. Non-invasive sensing of a physical parameter
US6675810B2 (en) 1998-05-14 2004-01-13 Calypso Medical Technologies, Inc. System and method for bracketing and removing tissue
US6698433B2 (en) 1998-05-14 2004-03-02 Calypso Medical Technologies, Inc. System and method for bracketing and removing tissue
WO2000051514A1 (en) * 1999-03-01 2000-09-08 Lucent Medical Systems, Inc. Magnetic anatomical marker and method of use
US6173715B1 (en) 1999-03-01 2001-01-16 Lucent Medical Systems, Inc. Magnetic anatomical marker and method of use
EP2314348A3 (en) * 2001-06-08 2011-08-03 Calypso Medical Technologies, INC. Guided radiation therapy system
WO2002100485A1 (en) * 2001-06-08 2002-12-19 Calypso Medical Technologies, Inc. Guided radiation therapy system
US7657302B2 (en) 2001-06-08 2010-02-02 Calypso Medical Technologies, Inc. Guided radiation therapy system
US7657303B2 (en) 2001-06-08 2010-02-02 Calypso Medical Technologies, Inc. Guided radiation therapy system
EP2289597A1 (en) * 2001-06-08 2011-03-02 Calypso Medical Technologies, INC. Guided radiation therapy system
US7657301B2 (en) 2001-06-08 2010-02-02 Calypso Medical Technologies, Inc. Guided radiation therapy system
US9072895B2 (en) 2001-06-08 2015-07-07 Varian Medical Systems, Inc. Guided radiation therapy system
WO2003011394A1 (en) * 2001-07-27 2003-02-13 Bhc Engineering, Lp Method and device for monitoring real-time position of an area targeted by a radiosurgery system
US7176798B2 (en) 2001-12-20 2007-02-13 Calypso Medical Technologies, Inc. System for spatially adjustable excitation of leadless miniature marker
US6838990B2 (en) 2001-12-20 2005-01-04 Calypso Medical Technologies, Inc. System for excitation leadless miniature marker
US6822570B2 (en) 2001-12-20 2004-11-23 Calypso Medical Technologies, Inc. System for spatially adjustable excitation of leadless miniature marker
US7696876B2 (en) 2001-12-20 2010-04-13 Calypso Medical Technologies, Inc. System for spatially adjustable excitation of leadless miniature marker
US6812842B2 (en) 2001-12-20 2004-11-02 Calypso Medical Technologies, Inc. System for excitation of a leadless miniature marker
US9616248B2 (en) 2002-06-05 2017-04-11 Varian Medical Systems, Inc. Integrated radiation therapy systems and methods for treating a target in a patient
US9682253B2 (en) 2002-06-05 2017-06-20 Varian Medical Systems, Inc. Integrated radiation therapy systems and methods for treating a target in a patient
AU2003265186B2 (en) * 2002-10-01 2008-06-26 Implantica Patent Ltd. Detection of implanted injection port
CN100342824C (en) * 2002-10-01 2007-10-17 波滕西亚医疗公司 Detection of implanted injection port
WO2004030536A1 (en) * 2002-10-01 2004-04-15 Potencia Medical Ag Detection of implanted injection port
US8297030B2 (en) 2002-12-30 2012-10-30 Varian Medical Systems, Inc. Methods for manufacturing packaged systems for implanting markers in a patient
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SE9403193L (en) 1996-03-23
SE9403193D0 (en) 1994-09-22
EP0955879A1 (en) 1999-11-17

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