EP1951373A1 - Dispositif de brachytherapie aux rayons x, et procede pour positionner une sonde inseree a l'interieur d'un corps a des fins de brachytherapie aux rayons x - Google Patents

Dispositif de brachytherapie aux rayons x, et procede pour positionner une sonde inseree a l'interieur d'un corps a des fins de brachytherapie aux rayons x

Info

Publication number
EP1951373A1
EP1951373A1 EP06793885A EP06793885A EP1951373A1 EP 1951373 A1 EP1951373 A1 EP 1951373A1 EP 06793885 A EP06793885 A EP 06793885A EP 06793885 A EP06793885 A EP 06793885A EP 1951373 A1 EP1951373 A1 EP 1951373A1
Authority
EP
European Patent Office
Prior art keywords
probe
image
irradiation area
ultrasound
ray source
Prior art date
Legal status (The legal status 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 status listed.)
Withdrawn
Application number
EP06793885A
Other languages
German (de)
English (en)
Inventor
Jens Fehre
Bernd Granz
Markus Lanski
Ralf Nanke
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Siemens AG
Original Assignee
Siemens AG
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 Siemens AG filed Critical Siemens AG
Publication of EP1951373A1 publication Critical patent/EP1951373A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
    • A61N5/1002—Intraluminal radiation therapy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3925—Markers, e.g. radio-opaque or breast lesions markers ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3983—Reference marker arrangements for use with image guided surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4416—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to combined acquisition of different diagnostic modalities, e.g. combination of ultrasound and X-ray acquisitions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/52—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/5215—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
    • A61B8/5238—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
    • A61B8/5261—Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image combining images from different diagnostic modalities, e.g. ultrasound and X-ray
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A61N2005/1058—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using ultrasound imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N2005/1092—Details
    • A61N2005/1094—Shielding, protecting against radiation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam

Definitions

  • the invention relates to a device for X-ray brachytherapy and to a method for positioning a probe inserted into the interior of a body for X-ray brachytherapy.
  • X-ray brachytherapy is a thera ⁇ Guideic treatment with X-rays, where the X-ray source very close to the tissue to be treated example, a local tumor or a vessel wall after performing an endovascular dilatation is brought.
  • a miniaturized X-ray source is required, as is known, for example, from US Pat. No. 6,721,392 B1.
  • This is arranged at the distal end of a probe which is positioned intraoperatively, for example, in a tumor or after its removal in a tumor bed, as described, for example, in the PR information of Carl Zeiss AG, Medizintechnik Innovation of Carl Zeiss AG,
  • US 2003/0149327 A1 discloses a miniaturized x-ray source which is arranged in a catheter with which it can be introduced into the body cavities (lumens) in order to irradiate selected tissue zones from close proximity. It contains a shield rotatable about the axis of the catheter in order to radiate the X-rays in a substantially perpendicular to the axis into a selected solid angle. With an optical observation device arranged in the catheter, the environment of the catheter to be viewed as. For this purpose, a light source is used, which illuminates only the part of the surface of the cavity, which is also irradiated.
  • brachytherapy catheter with an OCT catheter based on optical coherence tomography is integrated into a unit.
  • OCT optical coherence tomography
  • the X-ray source in a radiation field outside the Ka theters emitted X-rays largely exclu ⁇ fore- most on tissue to be treated, such as the tumor, incident to minimize the burden of the healthy tissue located near ensured.
  • the invention is based on the object to provide a Einrich ⁇ tion for X-ray brachytherapy with an insertable into the interior of a body probe, with a ge ⁇ accurate positioning of the irradiation area is possible.
  • Au ⁇ ßerdem the invention is based on the object, a method for positioning an inserted into the interior of a body for x-ray brachytherapy probe indicated.
  • the device includes a probe insertable into the interior of a body having at its distal end an X-ray source, the X-radiation in an irradiation area outside the probe radiates, wherein a plurality of markers is provided, which in one of a image forming device are visible, and which are arranged in or on the probe in a known spatial relationship to the irradiation area. From the location of these markers in the image, it is then possible to deduce the position of the irradiation area in this image. In other words, the markers at least indirectly mark the irradiation area. This enables accurate positioning of the irradiation area, that is, accurate positioning of the X-ray source and the solid angle area in which the X-rays generated by the X-ray source are radiated.
  • probe is hereinafter generally to an instrument to be understood that can be introduced into the inside of a body into ⁇ . This can be both a catheter in the narrow sense, which is transferred into the cavities of the body (transluminally) was ⁇ , as well as being within a tissue zone (percutaneously or intertstitially) placeable needle-like instrument.
  • each usable in the medical diagnostic device can be generated with the two- or three-dimensional image representing a befind ⁇ inside a body-pending area.
  • the invention is not limited to the use of a single imaging device. Rather, also on different principles based imaging systems, particularly ultrasound ⁇ images and radiographs generating imaging facilities as well as working on the basis of magnetic resonance imaging systems tomographi- see used reach. In this case, it is advantageous if the markers are recognizable in all imaging devices used.
  • the probe and the position of the X-ray source itself can be seen in the image, both the navigation and the identification of the spatial location of the irradiation area is facilitated.
  • the probe is in the setting of the exposure area relative to the X-ray source, a movable shield ⁇ is arranged, the exposure area can be flexibly set even if static probe.
  • the markers are preferably spatially coupled to the shield.
  • the markers may also be arranged stationarily on or in the probe when the position of the shield, ie the position of a window or opening from which the X-rays exit, is detected relative to the markers with the aid of a sensor or already is known from the outset by a STEU ⁇ tion of the movement of the shield.
  • the device includes a positionable independently of the probe imaging means for generating an at least part of the exposure area reproducing Bil ⁇ of, and reproducing means for displaying the BiI- of and identified making of the exposure area in the image. This allows a particularly simple and illustrative Po ⁇ tioning of the exposure area.
  • the dose rate required at different locations of the irradiation area can be adjusted in a targeted manner.
  • an optical image of a is at least a part of the area containing Bestrah ⁇ lung environment of the probe by means of arranged in or on the probe optical observation device.
  • the imaging device an ultrasonic applicator, in particular an insertable into a cavity of the body Ultra ⁇ acoustic probe, which preferably has a Ultraschallwandleranord- voltage for generating ultrasound images in two mutually perpendicular cutting planes.
  • a device according to the invention is particularly suitable for insertion into a urethra or a ureter and for the therapeutic treatment of a prostate, bladder or kidney tumor.
  • an optical image of at least a part of the irradiation region generates one object containing the region in which the exposure area is identified by a phosphor is applied to the ⁇ particular, which is preferably in a tumor anneals.
  • the irradiation area can then be correctly positioned in a particularly simple and illustrative manner by making the irradiation area coincide with the area marked by the phosphor.
  • an ultrasonic marker is applied, in which it is egg NEN active ingredient, which is preferably in a tumor at ⁇ deposited and is accompanied by gas bubbles or generated them. These gas bubbles are shown particularly clearly in an ultrasound image.
  • a method according to the invention is particularly suitable for the support of the treatment of a prostate, bladder or kidney tumor, wherein the probe into a urethra or ureter ei ⁇ nen is introduced.
  • FIG. 1 shows a device according to the invention in a schematic schematic diagram
  • Fig. 4 shows an alternative embodiment of the invention with an ultrasonic applicator for extracorporeal application.
  • the X-ray source 8 is associated with a shield 10, the ent in the exemplary embodiment a cylindrical part 10a holding ⁇ which is provided in its circumference with an aperture or opening 12 through which X-rays 14 perpendicularly to the
  • the cylindrical part 10a of the shield 10 is rotatably disposed within the probe 6 about its longitudinal axis 16, so that the irradiation area 18 can also be pivoted about this longitudinal axis 16.
  • the outer wall of the probe 6 is preferably made of a polymeric material, so that it is at least partially transparent to ultrasound.
  • the shield 10 has at one of its end faces on a front plate 10b, which is provided with a not shown in the figure, closable aperture, with which it is possible to selectively emit X-rays 14 in the direction of the longitudinal axis 16.
  • a movable closure is provided, with which the opening 12 can be closed or an additional shield, which is arranged in the probe 6 such that the opening 12 can be positioned in Be ⁇ rich this shield.
  • the rectum as an imaging device is an ultrasonic image generating
  • Ultrasonic probe 24 is introduced, in which at its distal end an ultrasonic transducer assembly 30 is arranged, which generates an ultrasound image from a plane illustrated by boundary lines 32 flat object area 34, which overlays at least a portion of the irradiation area 18.
  • Ultrasound transducer array 30 is a linear transducer array or two linear transducer array, the Ult ⁇ generate raschallhow in mutually perpendicular, in the example parallel and perpendicular to the plane extending section planes. Probes of this type are known in ultrasound diagnostics as biplanar rectal probes.
  • the ultrasound probe 24 is also shown in a dashed line position in which it generates an ultrasound image in a plane perpendicular to the plane object ⁇ jektebene that intersects the plane of the drawing in a dashed line section line 38.
  • the probe 6 also includes a schematically indicated op ⁇ diagram observation device 40 with which a subject region can be observed, the at least one part of the irradiation area 18 reproduces.
  • a plurality of markers 36 are arranged, three of which are shown in the figure.
  • This Mar ⁇ ker 36 for example balls or gas-filled (air) hollow spaces with about lmm in diameter, are of the ultrasonic ⁇ transducer assembly 30 ultrasound image generated recognizable and allow a reconstruction of the sectional area of the exposure area 18 with the information detected by the ultrasonic transducer assembly 30 object plane.
  • the markers 36 are in the examples rigidly game to the rotatable cylindrical portion 10a of the shield 10 is coupled and are in a fixed relation to the exposure area 18, the markers have at ⁇ play at the same time an increasing angular position, and an increasing distance with respect to a displayable geo - Metric point, eg the proximal edge of the cylindrical part 10a.
  • markers 36 are located on an ultrasound-imageable or ultrasonically transparent location of the probe 6. In the example illustrated in the figure, markers 36 are shown lying in a plane which is the center axis of the beam of x-rays 14 ent ⁇ holds. If these three markers 36 are detected in the ultrasound image, this is an indication that the imaged object plane also contains this center axis. From the position of the three markers 36 in the ultrasound image it is now possible to deduce the position of the irradiation area 18.
  • the markers 36 are displayed in an X-ray image, so that the position and angular position of the probe 6 may also be profiled CONTROL ⁇ with an X-ray device.
  • the probe 6 and the ultrasound probe 24 are connected to a control and evaluation device 42 with which the X-ray source 8, the ultrasound transducer arrangement 30 and the observation device 40 are controlled and the signals transmitted by the ultrasound transducer arrangement 30 and by the observation device 40 are evaluated that they can be displayed as an ultrasonic image or as an optical image in a re ⁇ display device 44, such as a monitor.
  • the markers 36 are identified and the irradiation area 18 ⁇ position faithfully reconstructed and made recognizable image in the ultrasound ⁇ .
  • Fig. 1 is located in the region of the wall 50 of the cavity 2 to be treated a therapeutically Gewebezo ⁇ ne 52, in the example, a prostate tumor that is to be irradiated with the X-ray beams 14.
  • the tissue to be treated ⁇ zone 52 may also be another via a body opening more accessible tumor, such as a bladder tumor or a kidney tumor.
  • this tissue zone 52 and the wall 50 is shown schematically.
  • the sectional area of the exposure area 18 with the information detected by the ultrasonic transducer assembly object plane is now, for example, by displaying its lateral Be ⁇ grenzungslinien indicated nineteenth
  • the irradiation area 18 inserted into the ultrasound image in this manner enables a correct positioning of the probe or the x-ray source.
  • the three markers 36 can be seen, with which a reconstruction of the position of the irradiation area 18 is possible.
  • the center axis of the X-ray beam lies in the ultrasound image.
  • given object plane (section plane), and the cavity 2 and the probe 6 are shown in the idealized in Fig. 1 arrangement shown in the form of a longitudinal section.
  • Li ⁇ nien 54 are displayed in the ultrasound image also as Li ⁇ nien 54 the same dose rate, which indicate the therapist the current local dose rate.
  • These lines 54 are located, for example, at a distance which corresponds to the drop in the dose rate to 1 / e each. These are about 1.2 cm in X-rays with a mean energy of 20keV in the tissue. The therapist can then set the required dose rate by changing the operating parameters of the X-ray source (anode current, acceleration voltage). These lines 54 of the same dose rate then shift in the ultrasound image according to the dose rate changing as the operating parameters change.
  • an ultrasound marker it is also possible to use an ultrasound marker.
  • the patient is given an active substance which preferably attaches itself to the tumor and at the same time is accompanied, for example, by small gas bubbles, or generates small gas bubbles.
  • the ⁇ se gas bubbles are shown particularly clearly in the ultrasound image.
  • the center axis of the X-ray beam in the picture reproduced in the ultrasonic ⁇ object plane (sectional plane), so that the lines 54 have a circular arc shape.
  • an ultrasound image is shown, as may arise when the ultrasound probe 24 is located in a dashed line in FIG. 1 position and the object plane perpendicular to the plane of FIG. 1 and obliquely to the center axis of the probe. 6 runs, as indicated by the dashed line 38 between the object plane and the drawing plane in FIG. is shown.
  • the cavity 2 and the probe 6 can be seen in the ultrasonic image in the form of an oblique cross-section.
  • the boundary line 19 of the Rönt ⁇ genstrahles then as well as the lines 54 of the same dose rate, an approximately elliptical shape.
  • Sectioning plane oriented perpendicular to the center axis of the X-rays, the boundary lines 19 and the line 54 have a circular shape.
  • an optical image is also generated from the surroundings of the probe, in which, with appropriate illumination, the wall 50 of the cavity is visible.
  • a phosphor is applied, for example directly with the aid of the probe, which preferably attaches to the tissue zone 52, if this is a tumor, and is excited, for example, by the light source used for illumination and emits fluorescent light in the visible range,
  • the tumor 52 can also be visualized in the optical image, at least in its surface region with which it adjoins the cavity.
  • the exact positioning can also be carried out with the aid of the optical image in addition to the positioning with the ultrasound image, since In this case, an image information from another, for example, to the image plane of the ultrasound image vertical plane before ⁇ is.
  • an ultrasound head 60 is provided as an ultrasound applicator, which is coupled to the outer surface 62 of the body 4 and, starting from this surface 62, the cavity 2, the son - de 6 and the tissue zone 52 detected.
  • the invention is illustrated by means of a catheter inserted into the cavity of a body.
  • the invention is also suitable for probes which are introduced directly into the tissue, as is the case with the invasive after-treatment of a tumor bed of a previously removed tumor explained in the introduction.
  • the tissue to be treated ⁇ zone it can also be a vessel wall which is to be irradiated after performing a dilation noserate to reduce Reste-.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Pathology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)
  • Radiation-Therapy Devices (AREA)

Abstract

La présente invention concerne un dispositif pour réaliser une brachythérapie aux rayons X, et un procédé pour positionner une sonde (6) introduite à l'intérieur d'un corps (4) à des fins de brachythérapie aux rayons X, la sonde présentant à son extrémité distale une source de rayons X (8) qui émet depuis la sonde (6) des rayons X (14) dans une zone de rayonnement (18). L'invention fait intervenir une pluralité de marqueurs (36) qui apparaissent dans une image produite par un dispositif de restitution d'image, et qui sont disposés dans ou sur la sonde (6) selon une relation spatiale connue par rapport à la zone de rayonnement (18).
EP06793885A 2005-11-24 2006-09-28 Dispositif de brachytherapie aux rayons x, et procede pour positionner une sonde inseree a l'interieur d'un corps a des fins de brachytherapie aux rayons x Withdrawn EP1951373A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102005056080A DE102005056080B4 (de) 2005-11-24 2005-11-24 Einrichtung für die Röntgen-Brachytherapie mit einer in das Innere eines Körpers zur Röntgen-Brachytherapie einführbaren Sonde
PCT/EP2006/066849 WO2007060051A1 (fr) 2005-11-24 2006-09-28 Dispositif de brachytherapie aux rayons x, et procede pour positionner une sonde inseree a l'interieur d'un corps a des fins de brachytherapie aux rayons x

Publications (1)

Publication Number Publication Date
EP1951373A1 true EP1951373A1 (fr) 2008-08-06

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
EP06793885A Withdrawn EP1951373A1 (fr) 2005-11-24 2006-09-28 Dispositif de brachytherapie aux rayons x, et procede pour positionner une sonde inseree a l'interieur d'un corps a des fins de brachytherapie aux rayons x

Country Status (4)

Country Link
US (1) US9162080B2 (fr)
EP (1) EP1951373A1 (fr)
DE (1) DE102005056080B4 (fr)
WO (1) WO2007060051A1 (fr)

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Title
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WO2007060051A1 (fr) 2007-05-31
DE102005056080A1 (de) 2007-05-31
US20080275341A1 (en) 2008-11-06
DE102005056080B4 (de) 2010-04-08
US9162080B2 (en) 2015-10-20

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