CN118141398A - 放射治疗***和方法 - Google Patents
放射治疗***和方法 Download PDFInfo
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Abstract
包括用于对患者成像的诊断质量的CT扫描仪和邻近诊断质量的CT扫描仪定位的放射治疗装置的***,该诊断质量的CT扫描仪具有成像等中心,该放射治疗装置包括承载放射治疗束源的机架并且具有与诊断质量的CT扫描仪的成像等中心分开的放射治疗等中心。该***包括床,该床被配置成通过在诊断质量的CT扫描仪和放射治疗装置之间平移患者来定位患者以进行成像和放射治疗。
Description
本申请是申请日为2017年12月13日、申请号为201780086321.X且题为“放射治疗***和方法”的PCT国际发明专利申请的分案申请。
相关申请的交叉引用
本申请要求2016年12月13日提交的题为“放射治疗***和方法(RadiationTherapy Systems And Methods)”的美国临时申请No.62/433,745的权益,该临时申请通过引用结合于此。
技术领域
本公开涉及用于执行放射治疗(包括准直或成形放射束)的***、方法和计算机软件。
背景技术
例如,可以使用准直器来成形放射束,以提供精确的医疗放射治疗。放射治疗***、方法和软件也可以结合成像,例如,可以在递送放射治疗之前执行CT成像,或者可以在放射治疗的递送期间执行MRI成像。
发明内容
公开了与执行放射治疗有关的***、方法和软件。一些实施方式可以包括用于对患者成像的诊断质量的CT扫描仪,其中诊断质量的CT扫描仪具有成像等中心。这样的实施方式还可以包括邻近诊断质量的CT扫描仪定位的放射治疗装置。放射治疗装置可包括承载放射治疗束源的机架,并且具有与诊断质量的CT扫描仪的成像等中心分开的放射治疗等中心。而且,床可以被配置为通过在诊断质量的CT扫描仪和放射治疗装置之间平移患者来定位患者以进行成像和放射治疗。一些实施方式可以包括将***配置为仅递送共面放射治疗。
在一些变型中,放射治疗装置可以不是悬臂式的。机架可以是环形机架,并且可以被配置成仅将源移动到平面内的不同位置。而且,床可以被配置为不旋转。
在一些变型中,放射治疗束源可以是直线加速器,并且直线加速器可以被分成围绕机架间隔开的部件,并且利用直线加速器部件之间的至少一个RF波导。
在一些变型中,诊断质量的CT扫描仪可以被设计用于RT模拟,或者可以是PET/CT扫描仪。
在一些实施方式中,该***可以包括控制***,该控制***被配置为利用诊断质量的CT图像来重新优化治疗计划。当患者在床上时,可以在治疗之前执行重新优化。
在某些实施方式中,机架可以被配置为与床移动正交地平移。而且,机架可以被配置为在至少8cm的范围内平移,以便于在治疗之前将放射治疗等中心定位在患者中。
在再其他实施方式中,该***还可以包括用于准直放射束的准直***。准直***可以具有具有多个叶片的第一多叶准直器和具有多个叶片的第二多叶准直器,并且被配置成使得放射束在穿过第二多叶准直器之前将穿过第一多叶准直器,并且在轰击目标之前穿过第二多叶准直器。
在一些实施方式中,第一多叶准直器的叶片和第二多叶准直器的叶片可以被配置为彼此独立地移动。第一多叶准直器和第二多叶准直器中的至少一个可以是双重聚焦的。
在某些实施方式中,第一多叶准直器可以具有焦点,并且第二多叶准直器可以具有焦点,并且第一多叶准直器的焦点可以与第二多叶准直器的焦点不同。第一多叶准直器和第二多叶准直器的不同焦点可以改善第一多叶准直器和第二多叶准直器之间的半影的匹配。第一多叶准直器的焦点也可以位于有效源点处,并且第二多叶准直器的焦点可以移出有效源点。
第一多叶准直器和第二多叶准直器可以进一步配置成准直比第一和第二多叶准直器的叶片的宽度细的束。第一多叶准直器的叶片也可以被配置成彼此紧邻,并且第二多叶准直器的叶片也可以彼此紧邻。
在再其他实施方式中,该***还可以包括放射治疗装置和诊断质量的CT扫描仪之间的放射屏蔽件。放射屏蔽件可以包括高原子序数材料,其覆盖或替换面向放射治疗装置的诊断质量的CT扫描仪的外罩的一部分。
在一些实施方式中,放射治疗装置可以是直线加速器,并且***还可以包括用于直线加速器的至少一个部件的RF屏蔽件。
在其他实施方式中,该***可包括至少一个通用基板,其被配置成安装至少一个***,该一个***选自包括放射治疗装置、CT扫描仪、MRI、CT床、PET/CT床和MRI床的组。至少一个通用基板可允许***在CT引导和MRI引导之间转换而无需移除放射治疗装置。
附图说明
包含在本说明书中并构成本说明书的一部分的附图示出了本文公开的主题的某些方面,并且与说明书一起帮助解释与所公开的实施方式相关联的一些原理。在图中,
图1是示出根据本公开的某些方面的利用示例性机架和具有放射源的准直装置的示例性放射治疗装置的简化图。
图2是根据本公开的某些方面的示例性多叶准直器及其可以形成孔的方式的简化图示。
图3是根据本公开的某些方面的示例性双堆叠准直装置的简化图示。
图4A和4B是根据本公开的某些方面的双堆叠准直装置可准直放射束的方式的简化图示。
图5是根据本公开的某些方面的示例性双堆叠准直装置的简化等距视图。
图6是根据本公开的某些方面的示例性双堆叠准直装置的简化图示。
图7是根据本公开的某些方面的利用阶梯式叶片设计的示例性双堆叠准直装置的简化图示。
图8是根据本发明的某些方面的具有附加驱动硬件的示例性双堆叠准直装置的简化图示。
图9是根据本公开的某些方面的具有附加引导硬件的示例性双堆叠准直装置的简化图示。
图10是根据本公开的某些方面的示例性叶片组件的简化图示。
图11是根据本公开的某些方面的示例性放射治疗装置的简化图示,其中直线加速器被分成围绕机架间隔开的部件。
图12是根据本公开的某些方面的被设计用于放射治疗模拟的示例性“成品”诊断质量的CT扫描仪的简化图示。
图13是根据本公开的某些方面的邻近CT扫描仪放置的示例性放射治疗装置的简化图示。
图14是根据本公开的某些方面的组合CT/RT***的示例性布置的简化图示。
图15是根据本公开的某些方面的被配置为横向移动的示例性放射治疗装置的简化图示。
图16是根据本公开的某些方面的与示例性分离MRI设计和通用基板组合的RT***简化图示。
具体实施方式
图1中描绘了示例性放射治疗装置101,其包括承载能够发射放射束106的放射源104的机架112。
准直装置102可以放置在放射束106的路径中并且被配置成在放射束106朝向目标108行进时选择性地衰减放射束106。放射源104可以是例如放射性同位素、重离子加速器、用于产生电子或光子束的直线加速器等。虽然本公开的技术可以用于利用放射束的任何领域,但是本文描述的实施例将医疗患者P描绘为目标108。
图2描绘了称为多叶准直器(或MLC)的特定类型的准直装置。示出的示例性MLC200包括与第二组可移动叶片204相对的一组可移动叶片202。在这样的装置中,每个叶片206可独立调节,以便能够形成孔212,孔212将束准直成用于治疗的期望形状。
MLC 200中的每个叶片可被描述为具有宽度208和高度110(高度在图1中示出)。高度110也可以描述为叶片的“厚度”,并且在确定MLC 200对束106的衰减量时是重要的。衰减量还受到制成MLC的叶片的材料的影响,并且因此,使用高衰减材料,例如钨、钨合金、钽、钽合金、铅、铅合金等。
本公开所考虑的示例性准直***在图3中示出并且包括多个“堆叠”MLC。例如,所描绘的实施例包括第一MLC 302和第二MLC 304。MLC被堆叠成使得它们的衰减值相对于放射束106是相加的。第一MLC 302定位得比第二MLC 304更靠近放射源104,使得放射束106在穿过第二MLC 304之前穿过第一MLC 302。这里描绘的实施例示出了两个堆叠MLC,但是可以预期可以沿循本公开的一般教导添加附加的MLC(例如,三个的堆叠)。
虽然准直装置通常靠近放射源104放置,但是本公开考虑了使准直装置更靠近目标或患者的实施例。例如,本公开的优选实施方式在不限制目标/患者占据的期望孔或体积的情况下使准直装置尽可能靠近目标移动。在一个优选实施方式中,最接近目标108的准直装置的边缘(即,距离放射源104最远的第二MLC 304的边缘)距离等中心小于60cm,并且优选距离等中心大约50cm。可以设想,这样的设计有利于在组装期间定位准直装置并减少束半影(penumbra)。
图4A和图4B是如何利用示例性双堆叠MLC***准直束的简化图示。如两幅图所示,第一MLC 302和第二MLC 304中的叶片偏移叶片宽度的一半,或者偏移叶片宽度的大约一半。第一MLC 302和第二MLC 304中的叶片可以彼此独立地移动。在图4A中,第一MLC 302中的一个叶片和第二MLC 304中的一个叶片可以缩回以产生束106可以穿过的最小孔(在对应于叶片宽度的维度中)。因此,MLC的叶片以允许准直比第一和第二多叶准直器中的每一个的叶片的宽度细的束的方式偏移。
在一个特定实施方式中,当第一MLC 302和第二MLC 304中的叶片的宽度均为约8.3mm时,这样的束的宽度可为4.15mm。图4B示出当其中一个MLC的两个叶片缩回并且另一个MLC中的重叠叶片缩回时,产生放射束106(例如,宽度为8.3mm的束)可以穿过的第二最小孔。
在一个实施方式中,MLC被堆叠,每个MLC中的叶片具有大致相同的宽度,并且第一MLC 302中的叶片与第二MLC 304中的叶片偏移其宽度的大约一半(如图4所示)。在这样的实施方式中的MLC叶片可以被设计为大约是一般MLC的宽度的两倍,同时仍然实现大致相同的分辨率。例如,为了在等中心处获得5mm的分辨率,一般单个MLC将需要大约2.5mm宽的叶片,而在具有偏移的双堆叠设计中,叶片可以是大约5mm宽并且实现相同的分辨率。这样的设计对于易于加工和为连接叶片或与叶片连接的设备提供更多材料可能是理想的。
图5是图3的示例性准直***的等距视图,示出了双堆叠MLC 302和304。由于示例性准直***包括多个MLC,其被布置成具有相加的束衰减效果,所以各个MLC中的每一个中的叶片与标准单MLC准直***中的叶片相比,可具有降低的高度或厚度。作为示例,在使用两个MLC的情况下,每个MLC中的叶片可以是由相同材料制成的一般单个MLC中的叶片高度的大约一半。这样可以减少各个叶片的重量,使它们更容易控制并允许更快速移动,这可以减少整体治疗时间。此外,如果准直器被设计成聚焦或双重聚焦(优选地,并且在下面进一步描述),则暴露于束的MLC的边缘将具有更大的衰减,并且每个MLC的叶片的高度可以进一步减小。
鉴于图4中所示的束准直特征以及本文所述的束衰减的重要性,本公开的优选实施方式利用相同或近似相同的第一MLC 302和第二MLC 304的叶片高度。因为第一MLC 302和第二MLC 304都负责成形放射束106,所以第一MLC 302和第二MLC 304均优选地设计成具有足以完全衰减放射束106的叶片高度,作为示例,用于医疗放射治疗。在一个特定实施方式中,第一MLC 302和第二MLC 304的叶片均由17.5gm/cc或更高密度的钨合金(例如,5:5:90Cu:Ni:W)制成,并且各自约5.5cm厚。优选的示例性准直***可以包括第一MLC 302的每个组(bank)中的34个叶片,并且包括第二MLC 304的每个组中的35个叶片,但是可以预期每个组中的叶片的分辨率和数量不同。
优选地,与本公开的技术一起使用的MLC是双重聚焦的,如附图中所示(与使用非聚焦准直器(例如具有直线叶片移动和圆形叶片端部的非聚焦准直器)不同)。当叶片的所有束限定表面投射回到放射源时,MLC是双重聚焦的。例如,参考图1,放射束106从放射源104散开(fan out)。因为示例性准直***利用沿圆弧缩回的弯曲叶片(例如,如图1,3所示),所以叶片的边缘在它们缩回时始终表示投射回放射源104的线。利用这种设计,当束106穿过准直装置时,叶片的整个厚度将衰减束106,提供具有低半影的更锐利的束边缘,而不管叶片缩回什么程度。
当准直束106的所有四个叶片表面投射回放射源时,准直***是“双重”聚焦的。图5示出了MLC可以在其他维度上将束106聚焦的方式-借助于叶片的宽度随着距放射源104的距离而增加。在图5中,例如,在MLC 302的顶部处的叶片的宽度是最细的。在MLC 302的叶片的底部处宽度更大,在第二MLC 304中的叶片的顶部处更大,并且在MLC 304中的叶片的底部处最大。这种设计也在图6中示出。
在一个实施方式中,叶片设计的聚焦有目的地略微散焦。例如,叶片表面可以设计成投射到实际放射源上方或下方一到两厘米的点。这种轻微的散焦可以显著减少通过叶片之间的空间(即,叶间间隙)的放射泄漏,同时对束半影只有很小的影响。
在另一实施方式中,第一MLC 302和第二MLC 304具有不同的焦点。因此,MLC行进的圆弧将在某些点处相交,但是在它们的边界内,它们可以被设计成彼此具有足够的间隙。可以选择不同的焦点以改善第一多叶准直器和第二多叶准直器之间的半影匹配,即使它们在距离源不同的距离处。例如,第一MLC的焦点可以放置在有效源点处,并且第二MLC的焦点可以移出有效源点。这样的示例性设计将增加下MLC的半影以更好地匹配上MLC的半影并且提供由第一MLC和第二MLC成形的束边缘的更好的剂量测定匹配。
对于常规的非聚焦MLC,准直器钳口是防止束孔外的放射泄漏所必需的。由于常规MLC的圆形叶片端部即使在完全关闭时阻挡放射也很差,因此关闭的叶片端部通常移动到它们被常规的准直器钳口阻挡的位置。双重聚焦叶片的使用将叶片端部泄漏和半影限制到这样的程度:合理厚度的邻近的堆叠的MLC(具有偏移的叶片会合位置)将足以阻挡传输,从而不需要常规的准直器钳口。因此,本公开考虑了不包括准直器钳口的准直***。
虽然本公开的优选实施方式利用双重聚焦MLC,但是可以预期也可以使用单聚焦或非聚焦MLC,或者可以在多个堆叠MLC上使用聚焦类型的混合。
当在聚焦实施方式中比较第一MLC 302和第二MLC 304的叶片的宽度时,上面指出叶片宽度随着距放射源104的距离而连续增加。虽然这样,本公开的优选实施方式包括在第一MLC 302中具有与在第二MLC 304中大致相同的宽度的叶片设计。当以这种方式描述时,“大致相同的宽度”意味着第一MLC 302中的叶片的底部宽度与第二MLC 304中的叶片的顶部宽度相比大致相同(即,仅稍微小一些)。换句话说,第一和第二MLC中的聚焦叶片可以被认为具有大致相同的宽度-包括当叶片从放射源104进一步延伸时沿着叶片添加的小的附加宽度,这是提供聚焦设计所必需的(例如,如图5和6所示)。
虽然优选实施方式利用其中第一MLC 302和第二MLC 304中的叶片宽度大致相同的叶片设计,但本公开考虑了其中叶片宽度在堆叠MLC之间可以不同的设计。
在本公开的优选实施方式中,第一MLC 302的叶片彼此紧邻或接触,并且第二MLC304的叶片彼此紧邻或接触。在该实施方式中,第一MLC 302和第二MLC 304中的邻近叶片之间的间隙以使叶片之间的放射泄漏最小化但仍允许相对移动的方式被最小化。这种类型的实施方式在例如图4、5和6中示出。
因为MLC的叶片能够独立地移动,所以它们之间必然存在小间隙,一些放射可以穿过该小间隙。本公开的准直***设想第一MLC 302的叶片和第二MLC 304的叶片优选地布置成使得叶片之间的间隙不对齐,使得放射束106可能不通过第一MLC 302中的叶片间隙并且然后直接通过第二MLC 304中的叶片间隙传输。而是,第一MLC 302的叶片优选地偏移第二MLC 304的叶片,使得没有直线路径使束通过两个MLC的叶间间隙行进。参见,例如,图4、5和6。
在示例性实施例中,第一MLC 302和第二MLC 304的叶片偏移其宽度的大约50%,以便提供第一MLC 302和第二MLC 304的叶间间隙之间的最大分离。本公开考虑了小于叶片宽度的50%的偏移,但优选使用偏移,并且偏移优选大于叶片宽度的10%。
在仅具有一个MLC的一般准直***中,必须通过在叶片彼此配合或邻接的位置中对叶片的复杂加工来防止叶间泄漏。例如,可以采用舌槽或阶梯式设计来中断可能允许显著的束泄漏的要不是这样的话的直线叶间间隙。本公开的准直***考虑了消除这样的附加加工的能力,因为即使使用直边叶片,通过准直***的泄漏路径也将由于先前描述的第一MLC 302和第二MLC 304之间叶片的重叠或偏移而中断。优选的实施方式包括简单的直边叶片,没有附加的加工或特征来阻挡叶间泄漏。这样的设计还可以导致更均匀的叶片边缘和减少的束半影。
在当前描述的准直***的替代实施例中,尽管具有多个MLC和叶片偏移,但是叶片的配合表面可以被加工以进一步减小泄漏路径并且能够降低MLC的高度。非线性表面的任何配置都可证明是有益的,例如舌槽设计等。在图7中描绘的示例性实施例中,将阶梯加工到叶片的配合表面中。图7示出了对应于第一MLC 302的第一部分叶片组702和对应于第二MLC 304的第二部分叶片组706。在所示实施例中,叶片具有宽度709和高度704和708。在示例性实施例中,部分叶片组702的叶片高度704和部分叶片组706的叶片高度708是相同的并且约为5.5cm。但是,每个叶片组的高度不必相同。
图7中描绘的示例性叶片配合表面加工是阶梯特征,包括在第一MLC 302和第二MLC 304的叶片中。出于简化讨论的目的,我们将假设高度704和高度708是相同,并且都等于变量“H”。在图7的示例中,将存在例如路径710的传输路径,其中入射放射束106必须行进通过叶片组702的全高度704,以及叶片组706的全高度708,表现出通过2×H的厚度的最大束衰减。但是,也存在将遇到叶间间隙的传输路径,例如路径712和714,由于仅穿过H+1/2H=3/2H的总叶片厚度,其将表现出减小的衰减。然而,这个3/2H的衰减厚度大于将在没有“阶梯”特征的双堆叠准直***中遇到的仅1H的厚度。因此,阶梯特征允许MLC 302和MLC304中的叶片的总高度减少33%,以实现在没有阶梯特征的情况下由MLC观察到的相同衰减。因此,这样的特征可用于减少所需材料的量和叶片的重量,从而提高MLC速度和性能。作为示例,每个MLC 302 304的叶片高度可以是大约3.7cm。
在双堆叠设计中,借助偏移,叶片偏移将导致束106在孔212的边缘的位置处仅被衰减一般材料量的大约一半。或者,如果使用阶梯特征,则放射束106将被甚至更少的材料衰减(参见,例如,图7中的路径716)。
本文讨论的示例性MLC组件还可包括用于支撑和驱动叶片的机械结构,用于操纵叶片位置的伺服电动机,以及用于实现期望的束形状和衰减的控制***。图8是示例性准直***的进一步描绘,其包括驱动连杆802和叶片驱动电动机组件804。未示出许多其他相关***,例如控制***、编码器、电力电缆等,但是也可以被包括在内。
图9描绘了用于支撑和驱动示例性准直***的叶片的附加结构,包括顶部叶片支撑引导件902、中间叶片支撑引导件904和底部叶片支撑引导件906。在一个实施例中,叶片在它们的顶部和底部表面处包括突片(tab),其可以骑靠在叶片支撑引导件中的凹槽内骑行(参见例如图6)。此外,还可以包括引导压力调节板908以确保叶片的平滑但不松散的移动。一个特定的实施方式还可以包括杆910,以进一步引导叶片的移动并避免过度摇摆。
现在参照图10,叶片组件1002的设计的一种实施方式利用框架1004,框架1004与衰减材料1006分开。在这样的设计中,叶片组件1002的将与叶片支撑引导件接合的框架1004部分将由与衰减材料1006不同的材料制成。虽然衰减材料1006通常是钨合金或用于放射衰减的其他高密度材料,但是框架1004可以由另一种材料制成,例如不锈钢。衰减材料1006可以被设计成进入框架1004的***件,并且可以使用例如粘合、烧结或焊接的多种方法将两种材料固定在一起。优选地,框架1004不一直延伸到叶片组件1002的衰减边缘1008,以避免叶片组件1002的整体衰减特性的变化。
如上面关于图1所描述的,示例性放射治疗装置101可以利用承载能够发射放射束106的放射源104的机架112。图11描绘了放射治疗装置101的实施方式,其中放射源104是直线加速器,并且直线加速器被分成围绕机架112间隔开的部件1102。这样的配置可以利用直线加速器(linac)部件1102之间的RF波导1104并且可以导致放射治疗装置101的最大直径的整体减小。在替代实施方式中,可以在机架112周围包括多个放射源。
示例性机架112尽可能紧凑,同时具有大孔,例如,孔可设计成大于80cm。在一种实施方式中,孔为110cm。
本文考虑的机架的一种实施方式是环形机架,其可以承载至少一个放射治疗束源并且用于在治疗期间以允许递送共面束的方式重新定向束源。当在本文中使用术语环形机架时,可以预期机架不一定需要完全为环形的形状。预期偏离圆形形状或甚至在其结构中包含(一个或多个)断裂的机架。
本文讨论的放射治疗装置可以利用上述任何有益的准直装置实施例和构思。这样的装置将具有非常小的传输,低半影束,并且能够提供高质量的治疗计划。因此,本公开涵盖了被配置为仅递送共面放射治疗的放射治疗***的实施例。例如,虽然本文公开的放射治疗装置可以被配置成以允许非共面治疗的方式定位(一个或多个)束源,或者在束开启时平移患者床(例如,断层治疗(TomoTherapy)的螺旋递送),但是某些实施方式将替代地被配置成仅将(一个或多个)束源移动到单个平面内的不同位置并且仅递送共面放射治疗。在这样的实施方式中可以使用如图1和11所示的环形机架。另外,虽然预期本公开的放射治疗装置可以是悬臂式的,并且与放射治疗装置相关联的床可以是可旋转的(以允许非共面治疗),但是在某些实施方式中,患者床不被配置成旋转并且放射治疗装置不是悬臂式的,但***仍然可以递送高质量的治疗计划。如本文所用,术语“悬臂式”是指包括臂或其他结构以将放射束从装置发射出的位置延伸远离主旋转结构。这样的悬臂式装置通常与床一起使用,该床旋转以使得能够从仅在给定平面内移动的射束源对患者进行非共面治疗。对于与本公开相关时装置是“悬臂式”的,发射放射束的位置必须基本上延伸,例如,为了允许床旋转并能够递送非共面束的目的。束发射位置仅延伸不足以实现非共面治疗的较小距离的放射治疗装置不被认为是悬臂式的。
本文公开的放射治疗装置的实施例可用于执行圆弧治疗(也称为VMAT),其中放射治疗束源在源移动时(例如,在机架旋转期间)发射放射束。然而,可以设计利用上面讨论的准直装置构思的某些有益实施例,使得放射治疗装置不被配置成递送圆弧治疗,但是仍然可以在短时间段内递送高质量的治疗计划。
本公开考虑结合所公开的放射治疗***使用诊断质量的CT扫描仪。诊断质量的CT扫描仪通常连续旋转CT***,基于具有单切片或多切片检测器功能的“滑环(slip-ring)技术”,并且能够进行轴向或螺旋数据获取和图像重建。它们可以具有多个源和检测器阵列,其被配置为获取数十至数百个图像切片。它们通常用于医院或诊所的诊断X射线部门,并且通常利用围绕患者旋转的扇束几何形状的千伏能量X射线。诊断质量的CT扫描仪通常用于获取高质量CT成像,用于放射治疗患者的治疗计划。高质量的CT图像允许将豪斯菲尔德数(Hounsfield number)校准到组织密度以改善剂量计算。
诊断质量的CT扫描仪不同于锥形束CT***,其可采用可缩回X射线管和平板成像器来产生锥形束X射线CT。由锥形束CT(也称为CBCT)产生的CT成像数据具有比标准CT单元差的图像质量、较低的软组织对比度、器官移动伪影和不准确反映被成像组织的电子密度的豪斯菲尔德数。诊断质量的CT扫描仪也不同于兆伏***,其可以使用兆伏放射治疗束作为成像源,借助平板成像器,以产生也导致具有低软组织对比度的较差质量的噪声图像的兆伏CT图像。
本文使用的诊断质量的CT扫描仪的某些实施方式将具有大孔(例如,70-90cm)。在一个实施方式中,诊断质量的CT扫描仪可以是被设计用于放射治疗模拟的“成品”单元,包括与放射治疗和治疗固定设备兼容的床。图12中描绘了这样的扫描仪1201的一个示例。替代地,诊断质量的CT扫描仪可以是具有与正电子发射断层扫描(PET)扫描仪相邻的CT扫描仪的PET/CT扫描仪。
诊断质量的CT扫描仪可以邻近本文讨论的任何放射治疗装置放置,用于下面讨论的有益用途。在一个实施方式中(如图13所示),CT扫描仪1201可以邻近利用环形机架的放射治疗装置101放置,如前所述。“邻近”仅仅意味着非常接近,并且涵盖装置接触、稍微分离或集成在一起。然而,在优选实施方式中,CT和放射治疗装置旨在具有单独的机架。
在组合的CT/RT***中,诊断质量的CT扫描仪具有成像等中心,并且放射治疗装置具有与成像等中心分开的放射治疗等中心。分开被理解为意味着等中心分离很远,例如,以使得床必须在成像和治疗之间移动患者。在一种实施方式中,等中心彼此远离约80cm。在优选实施方式中,CT扫描仪和放射治疗装置相对于彼此固定就位,并且还相对于治疗室固定,这意味着它们以不能移动的方式安装(就像例如它们在轨道或转台上)。
虽然图13中的CT和RT***被示出为布置成使得床首先进入CT,然后进入RT装置,但是可以预期该布置可以反转。
在组合的CT/RT***的一般实施例中,CT***和RT***通常彼此对齐,使得床可以在一个方向上平移患者以从一个***移动到另一个***。例如,当RT***包括具有孔的机架(例如环形机架)时,CT和RT***的孔通常是对齐的。在RT***的总高度大于CT***的高度的情况下,这可以通过在平台上升高CT***或通过使用治疗室的地板中的凹坑降低RT***来实现(参见图15中从一端观察的RT***101的图示,示出了***的孔和地板中的凹坑1504;凹坑也可以在图14中看到)。
组合的CT/RT***可以利用床,该床被配置成通过在诊断质量的CT扫描仪和放射治疗装置之间平移患者来定位患者以用于成像和放射治疗。
可以为组合的CT/RT***专门设计床。在一种实施方式中,床将被设计成上下移动,并且通过***的(一个或多个)孔平移,但是可以被配置成不旋转,如上所述。替代地,可以使用成品CT模拟器床,并将其定位得尽可能靠近CT/RT***,以便它可以延伸通过两个等中心。在另一种实施方式中,可以使用成品的PET/CT扫描仪床,因为其被设计用于多等中心***。当在本文中使用术语“成品”***时,它指的是可以在准备好被使用或仅以微小修改被使用的配置中购买的***。
以上关于预期的放射治疗递送***讨论的原理也适用于本公开的组合的CT/RT***。例如,组合的***可以被配置成仅递送共面放射治疗。在示例性实施例中,放射束源可以仅在平面内(例如,在环形机架上)行进,RT装置可以不是悬臂式的,并且RT/CT床可以不被配置为旋转。
组合的CT/RT***具有在放射治疗之前获取在治疗床上的患者的诊断质量的CT图像的能力,这可以提供许多益处。例如,对于治疗前成像和对于治疗本身患者将以完全相同的方式定位,从而减少当患者的身体在成像和治疗之间以不同方式定位或支撑时可能发生的治疗误差。
通过使用组合的CT/RT***的控制***和相关软件实现组合的CT/RT***的其他益处。例如,该***可以被配置为基于其诊断质量的CT成像重新优化治疗计划并执行台上适应性治疗。
在该功能的一个实施方式中,治疗床可以使患者移动就位以进行CT成像。由于接收的成像是诊断质量的,因此***可以有效地应用可变形图像配准以将原始治疗计划变形到当前CT上。然后,***可以允许将在原始计划中分割的组织和目标自动勾画到当前CT扫描上。可以将当前扫描上的CT数转换成电子密度,以在治疗患者之前计算准确的剂量递送预测。然后可以评估当前计划的剂量分布的质量,并且如果计划不是最理想的(例如,对肿瘤/目标的剂量太低或对关键结构的剂量太高),则可以重新优化治疗计划以改善该点位上的剂量分布。然后,床可以将患者移向RT等中心进行治疗。以这种方式,该***能够适应自从原始治疗计划创建时间以来可能已经改变的与患者或患者设置相关的状况,并且能够递送改进的计划。这种适应性治疗/重新优化可以显著改善剂量分布和患者结果。在一个实施方式中,***可以被配置为利用诊断质量的CT图像来重新优化治疗计划,并且可以被配置为当患者在床上时在治疗之前这样做。
因此,控制***和软件的功能可以包括但不限于CT图像获取、可变形图像配准、自动组织分割/勾画、剂量计算、治疗计划优化和放射治疗递送。
图14包括用于组合CT/RT***的示例性布置的附加视图。RF屏蔽件可以包括在本文公开的CT/RT***的某些实施例中。作为示例,当放射治疗束源是直线加速器时,来自各种直线加速器部件的RF放射可能干扰房间中或患者中的装置(例如起搏器、ICD等)。用于减少干扰的一种方式是在用于直线加速器部件1102的容器中使用RF屏蔽件。这样的容器的例子可以在图14中看到,并在当前受让人的美国专利8,836,332和9,446,263中详细讨论,这些专利在此引入作为参考。
组合的CT/RT***的实施例还可以包括用于CT扫描仪的部件的放射屏蔽件,以防止由来自放射治疗束源的兆伏放射的散射引起的对扫描仪部件的损坏。一种实施方式可以利用诊断质量的CT扫描仪和放射治疗装置之间的屏蔽件。另一种实施方式可以适形(formfit)并且用高原子序数材料覆盖或替换面向放射治疗单元的CT扫描仪的外罩,以吸收放射或远离X射线CT扫描仪的未受保护部件散射放射。例如,屏蔽件材料可以是几厘米的铅或一厘米的钨。
在某些实施例中,所选择的治疗床可具有有限的自由度。例如,床可以仅能够上下平移,以及进和出孔(如一般的成品CT***的情况)。如果目标位于患者的纵向轴线的横向或远离正中矢状平面,则这种横向移动的缺乏可能导致将患者定位以进行放射治疗的问题。预期许多设计可以克服该限制。例如,成品的CT床可以安装在能够横向移动的平台上。替代地,可以改变或重新设计床以包括附加的自由度。在图15中描绘的实施例中,放射治疗装置101(这里描绘在可选凹坑1504内部)可以被配置成自身被移位以相对于位于其孔内的床和患者横向移动。在一个实施例中,机架可以被配置成在至少8cm的范围内与床移动正交地平移,以便于在治疗之前将放射治疗等中心定位在患者中。
本文所述的放射治疗装置还可以被配置成与MRI一起使用,如在转让给本公开的受让人的许多其他专利和申请中所描述的(例如,美国专利No.9,446,263)。图16示出了这种配置的示例,其利用具有磁体半部1602和1604的分离MRI设计,所述磁体半部1602和1604围绕放射治疗装置101并且通过支撑件1606而连接。
该***可以被设计成安装有MRI引导或X射线CT引导,并且还可以被设计成通过一个通用基板或多个通用基板促进不同类型的引导之间的转换(参见,例如,图16)。(一个或多个)基板覆盖***下方区域的至少一部分,其足以刚性地安装和对准它。作为一个示例,(一个或多个)基板可以设计有多个钻孔图案以接受例如1)RT装置、2)CT扫描仪或MRI以及3)CT床、PET/CT床或MRI床。在这个问题上,***可以从CT引导转换为MRI引导而无需移除或干扰放射治疗装置本身。
本文描述的主题的一个或多个方面或特征,例如,用于多叶准直器的控制***,可以在数字电子电路、集成电路、专门设计的专用集成电路(ASIC)、现场可编程阵列(FPGA)计算机硬件、固件、软件和/或其组合中实现。这些各个方面或特征可以包括在可编程***上可执行和/或可解释的一个或多个计算机程序中的实施方式,该可编程***包括至少一个可编程处理器,其可以是专用的或通用的,耦合成从存储***接收数据和指令以及将数据和指令发送到存储***,至少一个输入装置和至少一个输出装置。可编程***或计算***可包括客户端和服务器。客户端和服务器通常彼此远离,并且通常通过通信网络进行交互。客户端和服务器的关系借助于在各个计算机上运行并且彼此具有客户端-服务器关系的计算机程序而产生。
这些计算机程序也可以称为程序、软件、软件应用、应用、组件或代码,包括用于可编程处理器的机器指令,并且可以以高级过程语言、面向对象编程语言、函数编程语言、逻辑编程语言和/或汇编/机器语言来实现。。如本文所使用的,术语“机器可读介质”(或“计算机可读介质”)是指任何计算机程序产品、装置和/或设备,例如磁盘、光盘、存储器和可编程逻辑器件(PLD),其用于向可编程处理器提供机器指令和/或数据,包括将机器指令作为机器可读信号接收的机器可读介质。术语“机器可读信号”(或“计算机可读信号”)是指用于向可编程处理器提供机器指令和/或数据的任何信号。机器可读介质可以非暂时性地存储这样的机器指令,例如非瞬态固态存储器或磁性硬盘驱动器或任何等同的存储介质。机器可读介质可以替代地或附加地以瞬态方式存储这样的机器指令,例如处理器高速缓存或与一个或多个物理处理器核相关联的其他随机存取存储器。
为了提供与用户的交互,可以在计算机上实现本文描述的主题的一个或多个方面或特征,计算机具有显示设备(例如阴极射线管(CRT)或液晶显示(LCD)或发光二极管(LED)监视器,用于向用户显示信息)和用户可以通过其向计算机提供输入的键盘和指示设备,例如鼠标或轨迹球。其他类型的设备也可用于提供与用户的交互。例如,提供给用户的反馈可以是任何形式的感觉反馈,例如视觉反馈、听觉反馈或触觉反馈;并且可以以任何形式接收来自用户的输入,包括但不限于声学、语音或触觉输入。其他可能的输入装置包括但不限于触摸屏或其他触敏装置,例如单点或多点电阻或电容式触控板、语音识别硬件和软件、光学扫描仪、光学指示器,数字图像捕获装置和相关联的解释软件等。
在以上的描述和权利要求中,可以出现例如“……中的至少一个”或“……中的一个或多个”之类的短语,之后是元素或特征的联合列表。术语“和/或”也可以出现在两个或更多个元素或特征的列表中。除非另外隐含地或明确地与其使用的上下文相矛盾,否则这样的短语旨在单独表示列出的任何元件或特征,或者与任何其他记载的元件或特征组合的任何记载的元件或特征。例如,短语“A和B中的至少一个”;“A和B中的一个或多个”;“A和/或B”各自旨在表示“A单独、B单独或A和B一起”。类似的解释也适用于包括三个或更多项目的列表。例如,短语“A、B和C中的至少一个”;“A、B和C中的一个或多个”;“A、B和/或C”各自旨在表示“A单独、B单独、C单独、A和B一起、A和C一起、B和C一起、或A和B和C一起”。在上面和权利要求中使用术语“基于”,旨在表示“至少部分地基于”,使得未提及的特征或元素也是允许的。
本文描述的主题的各方面可以根据期望的配置体现在***、装置、方法、计算机程序和/或物品中。在附图中描绘和/或在此描述的任何方法或逻辑流程不一定需要所示的特定顺序或顺序次序来实现期望的结果。在前面的描述中阐述的实施方式不代表与本文描述的主题一致的所有实施方式。相反,它们仅仅是与所描述的主题相关的方面一致的一些示例。尽管上面已经详细描述了一些变化,但是其他修改或添加也是可能的。特别地,除了本文所述的那些之外,还可以提供其他特征和/或变化。上述实施方式可以针对所公开的特征的各种组合和子组合和/或上述其他特征的组合和子组合。此外,上述优点并非旨在将任何公布的权利要求的应用限制于实现任何或所有优点的过程和结构。
另外,章节标题不应限制或表征可能从本公开公布的任何权利要求中阐述的本发明。具体而言,并且作为示例,尽管标题指的是“技术领域”,但是这些权利要求不应受到在该标题下选择的用于描述所谓技术领域的语言的限制。此外,“背景技术”中的技术的描述不应被解释为承认技术是本公开中的任何发明的现有技术。“发明内容”也不被认为是在公布的权利要求中阐述的发明的特征。此外,通常对本公开的任何提及或以单数形式使用词语“发明”并不意味着暗示对下面阐述的权利要求的范围的任何限制。可以根据从本公开公布的多个权利要求的限制来阐述多个发明,并且这样的权利要求因此限定了由其保护的发明及其等同物。
Claims (16)
1.一种存储指令的非瞬态机器可读介质,所述指令在由至少一个可编程处理器执行时使所述至少一个可编程处理器执行操作,所述操作包括:
接收用于放射治疗的递送的治疗计划;
从诊断质量的CT扫描仪接收诊断质量的CT图像;
通过将可变形图像配准应用于所述治疗计划,将所述治疗计划变形到所述诊断质量的CT图像上;
评估用于所述治疗计划的剂量分布的质量;和
当所述剂量分布的质量被确定为不是最理想时,重新优化所述治疗计划。
2.根据权利要求1所述的非瞬态机器可读介质,所述操作还包括:
控制患者床,以将患者置于进行诊断质量的CT成像的位置;和
在接收所述诊断质量的CT图像之后,控制所述患者床以将患者置于放射治疗等中心。
3.根据权利要求1所述的非瞬态机器可读介质,所述操作还包括:
将在所述治疗计划中分割的组织和/或目标自动勾画到所述诊断质量的CT图像上。
4.根据权利要求1所述的非瞬态机器可读介质,所述操作还包括:
通过将所述诊断质量的CT图像中的诊断质量的CT数转换为电子密度来确定剂量递送预测。
5.根据权利要求1所述的非瞬态机器可读介质,所述操作还包括:
控制患者床,以将患者置于进行诊断质量的CT成像的位置;和
在放射治疗的递送之前执行所述重新优化。
6.一种***,包括:
用于对患者成像的诊断质量的CT扫描仪,所述诊断质量的CT扫描仪具有成像等中心;
放射治疗装置,所述放射治疗装置邻近所述诊断质量的CT扫描仪定位,所述放射治疗装置包括承载放射治疗束源的机架,并且具有与所述诊断质量的CT扫描仪的成像等中心分开的放射治疗等中心;
患者床,所述患者床被配置为通过在所述诊断质量的CT扫描仪和所述放射治疗装置之间平移患者来定位患者以进行成像和放射治疗;和
存储指令的非瞬态机器可读介质,所述指令在由至少一个可编程处理器执行时使所述至少一个可编程处理器执行操作,所述操作包括:
接收用于放射治疗的递送的治疗计划;
从所述诊断质量的CT扫描仪接收诊断质量的CT图像;
通过将可变形图像配准应用于所述治疗计划,将所述治疗计划变形到所述诊断质量的CT图像上;
评估用于所述治疗计划的剂量分布的质量;和
当所述剂量分布的质量被确定为不是最理想时,重新优化所述治疗计划。
7.根据权利要求6所述的***,所述操作还包括:
控制患者床,以将患者置于进行诊断质量的CT成像的位置;和
在接收所述诊断质量的CT图像之后,控制所述患者床以将患者置于所述放射治疗等中心。
8.根据权利要求6所述的***,所述操作还包括:
将在所述治疗计划中分割的组织和/或目标自动勾画到所述诊断质量的CT图像上。
9.根据权利要求6所述的***,所述操作还包括:
通过将所述诊断质量的CT图像中的诊断质量的CT数转换为电子密度来确定剂量递送预测。
10.根据权利要求6所述的***,所述操作还包括:
控制患者床,以将患者置于进行诊断质量的CT成像的位置;和
在放射治疗的递送之前执行所述重新优化。
11.一种***,包括:
基板,所述基板被配置为安装和对准具有钻孔图案的放射治疗***的部件,所述钻孔图案将基板配置为固定放射治疗(RT)装置、计算机断层扫描(CT)装置和磁共振成像(MRI)装置。
12.根据权利要求11所述的***,还包括用于固定和对准CT床的钻孔图案。
13.根据权利要求12所述的***,其中,所述CT床被配置为不旋转。
14.根据权利要求11所述的***,还包括被配置用于横向移动并被配置用于安装CT床的平台。
15.根据权利要求11所述的***,还包括用于固定和对准PET/CT床的钻孔图案。
16.根据权利要求11所述的***,其中,所述基板位于所述RT装置下方。
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KR20190092530A (ko) | 2019-08-07 |
EP3554635B1 (en) | 2021-01-20 |
JP2023164855A (ja) | 2023-11-14 |
US11931602B2 (en) | 2024-03-19 |
CN110382049A (zh) | 2019-10-25 |
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