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US20080317204A1 - Radiation treatment planning and delivery for moving targets in the heart - Google Patents

Radiation treatment planning and delivery for moving targets in the heart Download PDF

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Publication number
US20080317204A1
US20080317204A1 US12/077,016 US7701608A US2008317204A1 US 20080317204 A1 US20080317204 A1 US 20080317204A1 US 7701608 A US7701608 A US 7701608A US 2008317204 A1 US2008317204 A1 US 2008317204A1
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Prior art keywords
target
region
heart
radiation
target tissue
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US12/077,016
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Thilaka Sumanaweera
Patrick Maguire
Ed Gardner
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CyberHeart Inc
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CyberHeart Inc
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Priority to US12/077,016 priority Critical patent/US20080317204A1/en
Application filed by CyberHeart Inc filed Critical CyberHeart Inc
Assigned to VENTURE LENDING & LEASING IV, INC. AND VENTURE LANDING & LEASING V, INC. reassignment VENTURE LENDING & LEASING IV, INC. AND VENTURE LANDING & LEASING V, INC. SECURITY AGREEMENT Assignors: CYBERHEART, INC.
Publication of US20080317204A1 publication Critical patent/US20080317204A1/en
Priority to US12/900,717 priority patent/US8345821B2/en
Priority to US13/619,064 priority patent/US20130102896A1/en
Priority to US14/624,056 priority patent/US9968801B2/en
Assigned to CYBERHEART, INC. reassignment CYBERHEART, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: GARDNER, EDWARD, SUMANAWEERA, THILAKA, MAGUIRE, PATRICK
Priority to US16/194,964 priority patent/US10974075B2/en
Priority to US17/038,912 priority patent/US11241590B2/en
Priority to US17/645,887 priority patent/US11712581B2/en
Priority to US18/353,260 priority patent/US20240017094A1/en
Abandoned legal-status Critical Current

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    • 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
    • A61N5/1064—Monitoring, verifying, controlling systems and methods for adjusting radiation treatment in response to monitoring
    • A61N5/1065—Beam adjustment
    • A61N5/1067—Beam adjustment in real time, i.e. during treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/33—Heart-related electrical modalities, e.g. electrocardiography [ECG] specially adapted for cooperation with other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/02—Arrangements for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computed tomography [CT]
    • A61B6/032—Transmission computed tomography [CT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
    • A61B6/503—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5235—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5294—Devices using data or image processing specially adapted for radiation diagnosis involving using additional data, e.g. patient information, image labeling, acquisition parameters
    • 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
    • A61N5/103—Treatment planning systems
    • A61N5/1031—Treatment planning systems using a specific method of dose optimization
    • 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
    • A61N5/103—Treatment planning systems
    • A61N5/1039—Treatment planning systems using functional images, e.g. PET or MRI
    • 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
    • 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
    • A61N5/1064—Monitoring, verifying, controlling systems and methods for adjusting radiation treatment in response to monitoring
    • A61N5/1068—Gating the beam as a function of a physiological signal
    • 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
    • A61N5/1077—Beam delivery systems
    • 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
    • A61N2005/1061—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using an x-ray imaging system having a separate imaging source
    • 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
    • A61N5/103—Treatment planning systems
    • A61N5/1037—Treatment planning systems taking into account the movement of the target, e.g. 4D-image based planning

Definitions

  • the present invention generally provides improved methods, devices, and systems for treatment of tissue, in many cases by directing radiation from outside the body toward an internal target tissue.
  • Exemplary embodiments may deposit a specified radiation dose at a target in the heart muscle while limiting or minimizing the dose received by adjoining radiation sensitive structures.
  • targets such as tumors in the head, spine, abdomen and lungs have been successfully treated by using radiosurgery.
  • the target is bombarded with a series of beams of ionizing radiation (for example, a series of MeV X-ray beams) fired from various different positions and orientations by a radiation delivery system.
  • the beams can be directed through intermediate tissue toward the target tissue so as to affect the tumor biology.
  • the beam trajectories help limit the radiation exposure to the intermediate and other collateral tissues, using the cumulative radiation dose at the target to treat the tumor.
  • the CyberKnifeTM Radiosurgical System (Accuray Inc.) and the TrilogyTM radiosurgical system (Varian Medical Systems) are two such radiation delivery systems.
  • Atrial fibrillation During atrial fibrillation, the atria lose their organized pumping action. In normal sinus rhythm, the atria contract, the valves open, and blood fills the ventricles (the lower chambers). The ventricles then contract to complete the organized cycle of each heart beat. Atrial fibrillation has been characterized as a storm of electrical energy that travels across the atria, causing these upper chambers of the heart to quiver or fibrillate. During atrial fibrillation, the blood is not able to empty efficiently from the atria into the ventricles with each heart beat. By directing ionizing radiation toward the heart based on lesion patterns used in open surgical atrial fibrillation therapies (such as the Maze procedure), the resulting scar tissue may prevent recirculating electrical signals and thereby diminish or eliminate the atrial fibrillation.
  • the present invention generally provides improved medical devices, systems, and methods, particularly for radiation treatment planning and delivery for moving tissues in a heart.
  • the invention allows improved radiosurgical treatment of tissues of the heart, often enhancing the capabilities of existing robotic radiosurgical systems for targeting tissues of the heart to mitigate arrhythmias such as atrial fibrillation or the like.
  • a method for radiating a moving target inside a heart comprising acquiring sequential volumetric representations of an area of the heart and defining a target tissue region and/or a radiation sensitive structure region in 3-dimensions (3D) for a first of the representations.
  • the target tissue region and/or radiation sensitive structure region are identified for another of the representations by an analysis of the area of the heart from the first representation and the other representation.
  • Radiation beams to the target tissue region are fired in response to the identified target tissue region and/or radiation sensitive structure region from the other representation.
  • a method for radiating a moving target of a wall of a heart comprising acquiring at least one volume of the heart and defining the target tissue region and/or critical structure region in 3D so that the target tissue region extends through the wall of the heart.
  • a dose distribution is computed and radiation beams are fired to the target to obtain the simulated dose distribution transmurally through the wall of the heart.
  • a method for radiating a moving target inside a heart comprising acquiring a computed tomography (CT) volume and defining a transmural target tissue region.
  • CT computed tomography
  • a dose distribution is computed and visualized using volume or surface rendering in 3D so as to verify transmurality.
  • a system for radiating a moving target inside a heart comprising a volume acquisition system for acquiring at least one CT volume of an area of the heart and a processor coupled to the image acquisition system.
  • the processor is configured for defining the target tissue region and/or critical structure region in 3D and computing a dose distribution.
  • a robot is coupled to the processor and a radiation beam source is supported by the robot and is coupled to the processor.
  • the processor controls the firing of a series of the radiation beams from the radiation source so as to treat the target tissue region.
  • a system for radiating a moving target inside a heart comprising a volume acquisition system for acquiring a computed tomography (CT) volume and a processor coupled to the image acquisition system.
  • CT computed tomography
  • the processor is configured for defining a transmural target tissue region and computing a dose distribution.
  • a visualization system is used for visualizing the dose distribution using volume or surface rendering in 3-dimensions (3D) so as to verify transmurality.
  • volume rendering (2) maximum intensity projection, (3) minimum intensity projection, (4) X-ray projection, (5) haptic feedback, (6). virtual fly-through, (7) stereoscopic 3D rendering, (8) virtual reality and (9) multi-planar, oblique and curved reconstruction.
  • contours of the target tissue region and/or a radiation sensitive structure region are outlined in 3D.
  • an electrogram may be registered to the CT volumes.
  • the moving target is a wall of a heart and the methods and systems ensure transmurality of the target.
  • FIG. 1 is an exemplary CyberKnife stereotactic radiosurgery system for use in embodiments of the invention.
  • FIG. 2 schematically illustrates locations of the target, the radiation sensitive structures, the nodes and the beams in the CyberKnife system.
  • FIG. 3 graphically illustrates an EKG waveform showing the phases where CT volumes may be acquired.
  • FIG. 4 illustrates a screenshot of a display showing an output obtained using an exemplary software application for loading and proscribing a target in moving tissue.
  • FIGS. 5( a ), 5 ( b ) and 5 ( c ) illustrate one example of a target shape to be defined in the case of PV ostia to ensure transmurality.
  • FIG. 6 schematically illustrates a method for treating a target tissue using a radiosurgical system.
  • the present invention generally provides improved devices, systems, and methods for treatment of tissue, often using radiosurgical systems.
  • the invention is particularly well suited for tracking of moving tissues such as tissues of the heart and tissue structures adjacent the heart that move with the cardiac or heartbeat cycles. Alternatively, it is also suited for tracking of moving tissues in the heart and its adjacent structures due to respiration.
  • the invention may take advantage of structures and methods which have been developed for treating tumors, particularly those which are associated with treatments of tissue structures that move with the respiration cycle. A variety of differing embodiments may be employed, with the following description presenting exemplary embodiments that do not necessarily limit the scope of the invention.
  • Radiosurgery is a known method of treating targets in the body, such as tumors in the head, spine, abdomen and lungs.
  • the target is bombarded with a series of MeV X-ray beams fired from various different positions and orientations by using a radiation delivery system, to affect the tumor biology using the cumulative radiation dose at the target.
  • the radiation can be delivered invasively in conjunction with traditional scalpel surgery, or through a percutaneous catheter. Radiation can also be delivered non-invasively from outside the body, through overlying tissue.
  • CyberKnifeTM Acceluray Inc.
  • TrilogyTM Variarian Medical Systems
  • Advances in stereotactic surgery have provided increased accuracy in registering the position of tissue targeted for treatment and a radiation source.
  • Stereotactic radiosurgery systems may be commercially available from ACCURAY, INC. of Sunnyvale, Calif., and BRAINLAB.
  • the Accuray CyberknifeTM stereotactic radiosurgery system has reportedly been used to provide targeted, painless, and fast treatment of tumors.
  • Improvements in imaging and computer technology have led to advances in radiation treatment, often for targeting tumors of the spine and brain.
  • CT scanners enables surgeons and radiation oncologist to better define the location and shape of a tumor.
  • Further improvements in imaging technology include MRI, ultrasound, fluoroscopy and PET scanners.
  • radiation therapy has also been aided by enhancements in ancillary technologies such as simulators to help position patients and advanced computers to improve treatment planning to enable the radiation oncologist to deliver radiation from a number of different angles.
  • Computer technology has been introduced that enable radiation oncologists to link CT scanners to radiation therapy, making treatment more precise and treatment planning faster and more accurate, thereby making more complex plans available.
  • Such advancements allow integrated conformal therapy, in which the radiation beam conforms to an actual shape of a tumor to minimize collateral damage to the surrounding healthy tissue.
  • Suitable system components may comprise:
  • the above 5 items may correspond to:
  • Radiosurgery system 10 has a single source of radiation, which moves about relative to a patient.
  • Radiosurgery system 10 includes a lightweight linear accelerator 12 mounted to a highly maneuverable robotic arm 14 .
  • An image guidance system 16 uses image registration techniques to determine the treatment site coordinates with respect to linear accelerator 12 , and transmits the target coordinates to robot arm 14 which then directs a radiation beam to the treatment site.
  • system 10 detects the change and corrects the beam pointing in real-time or near real-time. Real-time or near real-time image guidance may avoid any need for skeletal fixation to rigidly immobilize the target.
  • System 10 makes use of robot arm 14 and linear accelerator 12 under computer control.
  • Image guidance system 16 includes diagnostic x-ray source 18 and image detectors 20 , this imaging hardware comprising two fixed diagnostics fluoroscopes. These fluoroscopes provide a stationary frame of reference for locating the patient's anatomy, which, in turn, has a known relationship to the reference frame of robot arm 14 and linear accelerator 12 .
  • Image guidance system 16 can monitor patient movement and automatically adjust system 10 to maintain the radiation beam directed at the selected target tissue. Rather than make use of radiosurgery system 10 and related externally applied radiosurgical techniques to tumors of the spine and brain tissues, the invention applies system 10 to numerous cardiac conditions, and in one exemplary method to the treatment of atrial fibrillation (AF).
  • AF atrial fibrillation
  • System 10 allows intensity modulated radiation therapy. Using computerized planning and delivery, intensity modulated radiation therapy conforms the radiation to the shape of (for example) a tumor. By using computers to analyze the treatment planning options, multiple beams of radiation match the shape of the tumor. To allow radiosurgery, system 10 can apply intense doses of high-energy radiation to destroy tissue in a single treatment. Radiosurgery with system 10 uses precise spatial localization and large numbers of cross-fired radiation beams. Because of the high dosage of radiation being administered, such radiosurgery is generally more precise than other radiation treatments, with targeting accuracies of 1 to 2 mm.
  • Linear accelerator 12 is robotically controlled and delivers pin-point radiation to target regions throughout the body of the patient. Radiation may be administered by using a portable linear accelerator such as that illustrated in FIG. 1 . Larger linear accelerators may also generate the radiation in some embodiments. Such linear accelerators may be mounted on a large rotating arm that travels around the patient, delivering radiation in constant arcs. This process delivers radiation to the target tissue and also irradiates a certain amount of surrounding tissue. As a result, such radiation therapy may be administered in a series of relatively small doses given daily over a period of several weeks, a process referred to as fractionation. Each radiation dose can create some collateral damage to the healthy surrounding tissue.
  • robot arm 14 of system 10 is part of a pure robotics system, providing six degree of freedom range of motion.
  • the surgeon basically pushes a button and the non-invasive procedure is performed automatically with the image guidance system continuously checking and re-checking the position of the target tissue and the precision with which linear accelerator 12 is firing radiation at the tumor.
  • Image guidance system provides ultrasound guidance that gives the surgeon the position of internal organs. Image guidance system continuously checks, during a procedure, that the radiation beam is directed to the target.
  • the image guidance system includes an X-ray imaging system as is the case with the traditional Accuray CyberKnifeTM radiosurgery system.
  • the exemplary image guidance system takes the surgeon's hand out of the loop. The surgeon may not even be in the operating room with the patient. Instead, the image guidance system guides the procedure automatically on a real-time basis.
  • the target shape may be a three-dimensional shape and may include (1) volume rendering, (2) maximum intensity projection, (3) minimum intensity projection, (4) X-ray projection, (5) haptic feedback, (6). virtual fly-through, (7) stereoscopic 3D rendering, (8) virtual reality, and (9) multi-planar, oblique and curved reconstruction.
  • the system 10 creates the target shape to encompass (including or surrounding) the anatomical site.
  • the anatomical site may include an ostium of a pulmonary vein (PV), a cavotricuspid isthmus (CTI), an Atrioventricular (AV) node or junction, Sinoatrial (SA) node, His-Purkinje fibers, or ablation of areas necessary to control and treat aberrant arrhythmias, an atrial or ventricular site, neural fibers near or adjacent to the heart (ganglionic) or neural fibers in the chest or neck.
  • PV pulmonary vein
  • CTI cavotricuspid isthmus
  • AV Atrioventricular
  • SA Sinoatrial
  • His-Purkinje fibers or ablation of areas necessary to control and treat aberrant arrhythmias
  • an atrial or ventricular site neural fibers near or adjacent to the heart (ganglionic) or neural fibers in the chest or neck.
  • the coordinates are relayed to robot arm 14 , which adjusts the pointing of linear accelerator 12 and radiation is delivered.
  • the speed of the imaging process allows the system to detect and adjust to changes in target position in less than one second.
  • the linear accelerator is then moved to a new position and the process is repeated.
  • Alternative systems may make use of laser triangulation, which refers to a method of using so-called laser tattoos to mark external points on the skin's surface so as to target the location of internal organs and critical structures.
  • An alternative system commercialized by BRAINLAB uses a slightly different approach that measures chest wall movements.
  • the system is capable of directing one or more doses of radiation from outside of the patient's body toward the target shape to ablate the target shape.
  • the dose is strongly dependent on the type of radiation and the time span, also called “dwell time”.
  • An application dose rate is the dose of radiation per time (delivered or received).
  • the dose rate delivered by a source depends on the activity of the source and the radionuclide that it contains.
  • Biological effects of the absorbed radiation are dependent on the type of radiation and the type of tissue which is irradiated. Both total radiation dose and dose rate are important, since damage caused by radiation can be repaired between fractionated doses or during low dose rate exposure.
  • the target dose rate may be between 15 to 80 Gy, preferably, between 25 to 40 Gy to achieve histological change at the target site without harm to other tissue.
  • the accuracy of is better than 2 mm, which is within the range of cardiac motion certain portions of the heart at or within 2 mm plus or minus.
  • System 10 combines robotics and advanced image-guidance to deliver true frameless radiosurgery.
  • Multiple beams of image guided radiation are delivered by robot arm 14 mounted linear accelerator 12 .
  • the radiation can converge upon a tumor, destroying it while minimizing exposure to surrounding healthy tissue.
  • Elimination of a stereotactic frame through the use of image guided robotics enables system 10 to treat targets located throughout the body, not just in the head. Radiosurgery is thus possible in areas such as the spine that have traditionally been difficult to treat in the past with radiosurgery, and for pediatric patients such as infants, whose skulls are too thin and fragile to undergo frame-based treatment.
  • System 10 allows ablation of tissue anywhere in the patient's body.
  • the present invention uses high energy x-ray irradiation from a linear accelerator mounted on a robot arm to produce ablation of target tissue.
  • system 10 is used to ablate tumors or other defects of the heart treatable with radiation.
  • system 10 include a treatment which can be provided on an outpatient basis, providing a painless option without the risk of complications associated with open surgery. Treatment may be applied in a single-fraction or hypo-fractionated radiosurgery (usually 2 to 5 fractions) for treatment near sensitive structures.
  • System 10 provides flexibility in approach through computer control of flexible robotic arm 14 for access to hard-to-reach locations. System 10 is capable of irradiating with millimeter accuracy. System 10 also has the ability to comprehensively treat multiple target shapes. System 10 allows isocentric (for spherical) or non-isocentric (for irregularly shaped) target shapes. The creation of the target shapes also takes into account critical surrounding structures, and through the use of robotic arm 14 , harm to the critical structures surrounding may be reduced.
  • Sophisticated software allows for complex radiation dose planning in which critical structures are identified and protected from harmful levels of radiation dose. After careful planning, the precise robotic arm can stretch to hard-to-reach areas. The precise radiation delivered from the arm then minimizes the chance of injury to critical surrounding structures, with near-real-time image-guidance system eliminating the need for rigid immobilization, allowing robot arm 12 to track the body throughout the treatment.
  • beam nodes 30 and weights may be selected by a computer programming module to:
  • a CT volume of the target vicinity is acquired.
  • Other imaging modalities such as MRI, PET and ultrasound may also be used.
  • the user defines the target and any radiation sensitive structures by outlining a series of contours in slices through the CT volume;
  • a computer program then generates the set of nodes 30 from which a set of beams 36 will be fired and the weights for each of the beams.
  • the user selects the nodes and the computer program generates the weights.
  • a series of CT volumes called a volumetric movie may be acquired to capture the motion of the target.
  • the definition of the target and the radiation sensitive structures can be time consuming since the user may outline contours in each of the volumes in the volumetric movie.
  • the volumetric movie may be acquired as a function of a physiologic waveform such as EKG, respiratory signal or both.
  • Radiosurgical ablation creates scar tissue and eliminates abnormally conducting tissue. Radiosurgical ablation thus has the ability to suppress arrhythmias by creating lesions at targets such as the cavotricuspid isthmus and pulmonary vein ostia.
  • targets such as the cavotricuspid isthmus and pulmonary vein ostia.
  • One of key objectives when defining the target on heart muscle is to ensure that the target is transmural, i.e., covers the entire thickness of the heart muscle.
  • the methods for defining targets in the body using CT involves the user drawing 2-dimensional contours in axial, sagittal, coronal or oblique slices generated from the CT volume. Since heart is a complex 3-dimensional shape, it is not easy to draw such contours on heart muscle in above mentioned slices to ensure that target transmurality is achieved. Embodiments of the invention eliminates this limitation by allowing target definition in 3-dimensions, and providing techniques to visualize the target on heart muscle to ensure that the target is in fact transmural.
  • the user defines the target and the radiation sensitive structures much more quickly.
  • the steps of this embodiment method may include the following:
  • Imaging 52 , planning 54 , and treatment 56 steps and/or structures used before and during radiosurgical treatment may include an associated processor module.
  • the processor modules will typically comprise computer processing hardware and/or software, with the software typically being in the form of tangible media embodying computer-readable instructions or code for implementing one, some, or all of the method steps described herein.
  • Suitable tangible media may comprise a random access memory (RAM), a read-only memory (ROM), a volatile memory, a non-volatile memory, a flash memory, a magnetic recording media (such as a hard disk, a floppy disk, or the like), an optical recording media (such as a compact disk (CD), a digital video disk (DVD), a read-only compact disk, a read/write compact disk, a memory stick, or the like).
  • RAM random access memory
  • ROM read-only memory
  • volatile memory volatile memory
  • non-volatile memory a flash memory
  • a magnetic recording media such as a hard disk, a floppy disk, or the like
  • an optical recording media such as a compact disk (CD), a digital video disk (DVD), a read-only compact disk, a read/write compact disk, a memory stick, or the like.
  • the various modules described herein may be implemented in a single processor board of a single general purpose computer, or may be run on several different processor boards of multiple proprietary computers, with the code, data, and signals being transmitted between the processor boards using a bus, a network (such as an Ethernet, intranet, or internet), via tangible recording media, using wireless telemetry, or the like.
  • the code may be written as a monolithic software program, but will typically comprise a variety of separate subroutines and/or programs handling differing functions in any of a wide variety of software architectures, data processing arrangements, and the like. Nonetheless, breaking the functionality of the program into separate modules is useful for understanding the capabilities of the various aspects of the invention.
  • a time-sequence of 3-D volumes may be acquired using computed tomography (CT), magnetic resonance imaging (MRI), ultrasound imaging, X-ray imaging, optical coherence tomography, a combination of these or other imaging modalities, and/or the like.
  • CT computed tomography
  • MRI magnetic resonance imaging
  • ultrasound imaging X-ray imaging
  • optical coherence tomography a combination of these or other imaging modalities, and/or the like.
  • corresponding EKG signals may also be received by the image processor module, and the processor may optionally use the EKG signals to time the acquisition of the 3-D volumes.
  • the respiratory signal may also be received by the image processor module, and the processor may optionally use the respiratory signal to time the acquisition of the 3D volumes.
  • a cardiac gated CT volume may be acquired at a particular phase of the EKG cycle.
  • Two variations of cardiac gated CT may include a held-breath version and a free-breathing version.
  • the held-breath cardiac gated CT the patient is holding their breath (typically either at full inspiration or full expiration), so that respiration motion is absent while the data is acquired.
  • the free breathing cardiac gated CT the patient is breathing freely.
  • the CT volume may be acquired at a desired point of the respiration cycle. By measuring the respiration wave form, the exact respiratory phase at which the CT volume is acquired can be known (similar to the known cardiac phase at which the CT volume is acquired). In either variation, both the cardiac phase and the respiration cycle phase can be identified for the cardiac gated CT.
  • CT volume Yet another type of volume which may be acquired is the respiratory-gated CT volume.
  • CT volumes may be acquired at a particular phase of the respiration cycle. Respiratory gating of CT may be performed prospectively or retrospectively. The cardiac motion may generally be ignored in this type of CT volume, so that the rapidly moving cardiac structures may be blurry in such CT volumes.
  • a series of respiratory-gated CT volumes are acquired at a series of respiratory phases.
  • Embodiments of the invention may employ the 3-D volumes acquired in the imaging step 52 during the planning 54 , with exemplary embodiments making use of the motion model represented by the time sequence of 3-D tissue volumes so as to more accurately identify exposure of radiation outside of the target, within sensitive tissue structures, inside the target, and the like.
  • Planned timing of some or all of a series of radiation beams may be established based on the cardiac cycle, the respiration cycle, and/or the like so as to generate the desired dosages within the target tissue, so as to minimize or inhibit radiation exposure to critical structures, and/or to provide desired gradients between the target tissue and collateral or sensitive structures.
  • the order of the planned radiation beams may be altered and/or the trajectories of the radiation beams may be calculated in response to the motion of the model volume.
  • an EKG sensor may be coupled to the patient to provide EKG signals to a targeting processor module.
  • the targeting module configures the robot so as to position and orient the linear accelerator (or other radiation source) toward the target tissue along the desired trajectory for a particular radiation beam from among the series.
  • the tracking module may fire the radiation beam by energizing the linear accelerator.
  • the tracking module benefits from the motion model developed during the imaging steps, and the model may optionally be revised using data obtained immediately before and/or during treatment.
  • Suitable types of radiation including particle beam radiation, may be employed.
  • the present invention encompasses the use of a GammaKnifeTM radiosurgery system to ablate the moving tissue.
  • gamma radiation could be administered during open heart or other invasive procedures, the currently preferred applications are substantially non-surgical.

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US12/077,016 US20080317204A1 (en) 2007-03-16 2008-03-14 Radiation treatment planning and delivery for moving targets in the heart
US12/900,717 US8345821B2 (en) 2007-03-16 2010-10-08 Radiation treatment planning and delivery for moving targets in the heart
US13/619,064 US20130102896A1 (en) 2007-03-16 2012-09-14 Radiation Treatment Planning and Delivery for Moving Targets in the Heart
US14/624,056 US9968801B2 (en) 2007-03-16 2015-02-17 Radiation treatment planning and delivery for moving targets in the heart
US16/194,964 US10974075B2 (en) 2007-03-16 2018-11-19 Radiation treatment planning and delivery for moving targets in the heart
US17/038,912 US11241590B2 (en) 2007-03-16 2020-09-30 Radiation treatment planning and delivery for moving targets in the heart
US17/645,887 US11712581B2 (en) 2007-03-16 2021-12-23 Radiation treatment planning and delivery for moving targets in the heart
US18/353,260 US20240017094A1 (en) 2007-03-16 2023-07-17 Radiation treatment planning and delivery for moving targets in the heart

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US20110137158A1 (en) 2011-06-09
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US20170189721A1 (en) 2017-07-06
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US20130102896A1 (en) 2013-04-25

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