CN1537657A - Radiotherapeutic apparatus in operation - Google Patents
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- CN1537657A CN1537657A CNA2003101080912A CN200310108091A CN1537657A CN 1537657 A CN1537657 A CN 1537657A CN A2003101080912 A CNA2003101080912 A CN A2003101080912A CN 200310108091 A CN200310108091 A CN 200310108091A CN 1537657 A CN1537657 A CN 1537657A
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Abstract
A radiotherapeutic apparatus using high-energy electron beams to radiate the bed of removed tumor and the residual tumor tissue in excision operation features that the CT or MRI 3D imaging software is used to determine the position of tumor focal, an analog technique is used to determine the incident direction, angle and position of electron beam, a radiotherapeutic plan system is used to calculate the radiation dosage, and a laser locator on the radiating head with straight-line electron accelerator is used to align the electron beam to the tumor focal.
Description
Technical field:
The present invention relates to radiotherapy unit in a kind of novel operation, belong to a kind of novel Medical Instruments, a kind of tumour radiotherapy device of more specifically saying so, the tumor bed and the tumors remaining tissue that utilize high-power electron beam to excise at intraoperative irradiation are with thorough radical cure local tumor and prevent that tumor from sending out to the distant place.
Background technology:
Intraoperative radiation therapy (Intraoperative radiotherapy) is a kind of new technique of tumour radiotherapy, it is in operation, after the surgeon excises local tumor, the application of radiation line shines tumor resection tumor bed or remaining tumor tissues partly by surgical field of view, is widely used in the therapeutic alliance of tumor of head and neck, chest, abdominal part, tumor of pelvic cavity.
Intraoperative radiation therapy originates in the eighties in this century, uses clinac in operation, utilizes the wild direct irradiation tissue surface of open operative, to kill local remaining tumor cell.Because when fashion does not have radiotherapy apparatus in the special-purpose art, therefore adopt the large-scale clinac of radiotherapy section to implement treatment, after ocal resection, patient still is under the narcotism, after wound covers with disinfecting towel, patient is directly delivered to linear accelerator therapeutic room together with operation table, implement radiotherapy in the art, this Therapeutic Method program complexity, operating difficulties, all bring inconvenience for clinician and patient, therefore greatly limited the universal and popularization of radiotherapy in the art.
The later stage nineties, first releases radiotheraphy device in the movable type mechanical arm art that trade name is NOVAC7 Italy Hitesys S.P.A., normal electron linear accelerator volume obviously dwindles, weight saving, can directly move to and carry out radiotherapy in the art in the operating room, United States Patent (USP) (the patent No.: 5,635,721) disclosed technology (an apparatus for the acceleration of electrons that " is used in particular for the electron accelerator of radiotherapy in the art ", particularly for intraoperative radiation therapy), describe radiotheraphy device in the art of this movable-type in detail, it adopts the arm-type device of machinery to support and mobile electron linear accelerator radiation head, move freely at six direction of principal axis, and, significantly alleviating the electron linear accelerator weight and volume by special design, the motion by automatization's control mechanical arm drives the electron linear accelerator radiation head and moves to surgical field of view, introoperative radiotherapy is implemented in aiming tumor bed position.
Follow thereafter, American I ntraop Medical Inc. releases principle, structure is similar to said apparatus, trade name is applied to the removable electron linear accelerator of operating room for " MOBETRON ", United States Patent (USP) (the patent No.: 5,321,271) disclosed technology " electron beam therapy system and device in the art " (Intraoperative electron beam therapy system andfacility), describe this specialized designs in detail and be used for the movable-type electron linear accelerator that operating room is carried out art radiotherapy, the method that it drives the electron linear accelerator radiation head is to adopt C shape arm assembly to support, fixing radiation head, and moving radiation head to surgical field of view by automatic control mode, the aiming tumor bed is carried out the electron beam irradiation.
Radiotheraphy device is disclosed in the world at present in above-mentioned two kinds of arts, radiotheraphy device in only two kinds of arts, its characteristics all are to dwindle the electron linear accelerator volume by particular design, and adopt the method for mechanical arm to come mobile electron linear accelerator radiation head, above-mentioned two kinds of equipment have all been used robotics, the multi-direction mechanical arm automatic control technology of multidimensional, and the electron linear accelerator technology of making low weight, small size have been represented current most advanced technical merit.However, still there is defective in above-mentioned technology, because in order to satisfy the purpose that significantly reduces weight and volume, and the special electronics accelerating tube design of carrying out, obviously lowered the radiant that can reach, only can reach 4～8Mev, this is far from being enough for the tumor cell of killing a lot of deep tissues, because said apparatus is to adopt mechanical arm to support mobile electron linear accelerator radiation head, limit to some extent and mechanical arm can drive the weight of radiation head, thus this defective be said apparatus and be difficult to overcome, and in the clinical expansion process, this is again extremely important key, and this defective will inevitably influence the universal and popularization of radiotherapy technology in the art.
Secondly, owing to adopted custom-designed electron linear accelerator, increased the difficulty of making and increased cost, and the production of this device can not arrive the batch process scale, quantity seldom, therefore, make holding at high price of said apparatus, influenced clinical expansion.
Although said apparatus has obviously alleviated the volume and weight of electron linear accelerator, the weight of said apparatus still weighs 2500 pounds, for moving 2500 pound weight flexibly, the manufacturing cost of multidimensional, multi-direction movable machinery arm is also inevitable very expensive, therefore, the high price of radiotheraphy device has obviously influenced the popularization of this technology in clinical hospital in the art.
Another obvious defects of said apparatus is, although they have adopted the multi-direction movable machinery arm of the multidimensional of superprecision technology, but, in clinical practice, lack 3 D stereo directional technology and device, only be to rely on doctor of Clinical Surgery and the doctor of radiotherapy section perusal to determine the position, CT or the MRI image of both not used hi-Fix are auxiliary, do not allow the doctor have perfect instrument to determine lesions position yet, angle, direction and with the relation of normal surrounding tissue, and to the influence of vitals on every side, thereby determine the incident optimal path of radiotherapy electron beam in the art, direction, angle, and the electron beam transmitting power of determining in view of the above, launch time etc.
Summary of the invention:
Task of the present invention is, a kind of novel intraoperative radiation therapy device is proposed, this device is specifically designed to intraoperative radiation therapy, can be easily installed in operating room, pass through autocontrol method, can drive the radiation head of electron linear accelerator easily, move to operating field, and this device is furnished with the parts of CT or the reconstruction of MRI image three-dimensional solid figure, reconstruction of three-dimensional image before the radiotherapy in art, allow the clear and definite focus of the doctor of radiotherapy section the position and with the relation of surrounding tissue, determine optimized electronic bundle incident angle, direction is worked out the intraoperative radiation therapy plan that is fit to patient's state of an illness, in addition, this device has laser locating apparatus on the electron linear accelerator radiation head, can accurately aim at the specified lesions position of doctor, and laser beam can clearly be indicated the position and the scope of electron beam irradiation, simultaneously, this device can load the radiation head through the conventional electrical linear accelerator of repacking, and motion rack construction is simple, low price obviously reduces manufacturing cost.
The technical scheme that the present invention solves its technical problem employing is, adopt CT and MRI image three-dimensional to rebuild software platform, rebuild the three-dimensional image of patient's lesions position, determine that lesions position reaches and the surrounding tissue relation, adopt the analogue technique of simulated emission line incident focus, in conjunction with stereoscopic three-dimensional image, thereby finally determine the direction of electron beam incident focus, angle, the position, the application of radiation treatment planning systems, in conjunction with CT and MRI volume scan numerical value, accurate Calculation is incident on the radiological dose on focus surface, work out in the clear and definite art reliably and carry out radiotherapy behind the radiotherapy planning, simultaneously, radiation headring week at electron linear accelerator is installed laser locator additional, four laser positioning pipe emitted laser bundle direct irradiations around electron linear accelerator focusing arrangement ring week are on the focus surface, just can observe incident position of electron beam and scope by naked eyes, allow the doctor can reaffirm the position of line of incidence, direction, angle, the radiation head of electron linear accelerator are fixed on the ceiling of operating room by the motion frame.Regulate the position of radiation head 301 by the moving movement frame to indication, move horizontally slide rail 306 by moving as X-direction along horizontal fixed slide rail and slide block 305, the arm 304 that vertically rotatablely moves moves as Y direction by moving horizontally slide block 307, vertical stretching motion arm 303 moves up and down along longitudinal axis Z-direction, thereby make radiation head 301 can reach spatial any point in the range of movement, rotation by the arm that vertically rotatablely moves and radiation head 301 are around the swing of horizontal axis, can adjust radiating electron Shu Fangxiang, electron beam is accurately shone on the focus.
Rotatablely move arm 310 in the Z-direction rotation by mobile therapeutic bed, and mobile therapeutic bed stretching motion arm 311 moves up and down in Y direction and drives therapeutic bed adapter 312, drives moving of therapeutic bed 313.Above-mentioned multi-dimensional direction, multi-angle move, and can guarantee that the lonizing radiation of radioactive source are injected focus from the specified any angle of doctor.
Move each other by motion frame and therapeutic bed, can make the multi-dimensional movement axle surpass the multi-direction mechanical arm of multidimensional.The present invention adopts the suspension type frame can improve utilization of space, minimizing is to the required precision of moving component, Z-direction moves both vertically and adopts ball-screw to drive, because the effect of helical angle, only need the just may command Z-direction motion of less moment of torsion, the axis of the center of gravity of radiation head 301 and vertical turning arm 303 and the friendship of radiation head 301 horizontal axis are closed when overlapping, inertia weight on its direction of motion and gravity additional load are invariable, therefore the motion frame drives radiation head 301 easily, even radiation head weight increases the weight of, as long as reinforcing the loading capacity of ceiling just can realize, thereby can directly use the radiation head that passes through the ordinary electronic linear accelerator of reequiping, can obviously reduce manufacturing cost.And, because therapeutic bed can move mutually with the motion frame, having reduced requirement to radiation head multi-dimensional movement direction and angle, therapeutic bed is in light weight, and control realizes easily.Thereby can come the multi-direction mechanical arm of multidimensional of replace complex, precision height, costliness with the motion frame and the movable therapeutic bed of easy realization, not only can obviously reduce manufacturing cost, also make operation easier, it is easier to safeguard, full-automatic control of easier realization and management.
The invention has the beneficial effects as follows, adopt radiotherapy unit in the novel operation, can locate focus more accurately, and work out radiotherapy scheme in the more scientific and reasonable art in view of the above, the laser positioning laser beam can obviously be indicated the position and the scope of incident beam, help monitoring in the medical treatment process, the motion frame and the therapeutic bed that drive radiation head move mutually, can make radiation head easier, more accurate incident target focus, it is complicated to adopt more simple telecontrol equipment to replace, expensive multidimensional mechanical arm, be significantly reduced to this, can select the multiple selectivity of multiple electron linear accelerator for use, reduced the difficulty and the cost of device fabrication, reduced in the art price of radiotheraphy device and can make that this technology is easier to be popularized in clinical hospital, and be more service for patients.
Description of drawings:
The invention will be further described below in conjunction with drawings and Examples.
Fig. 1 is a radiotherapy unit sketch map in the novel operation
Fig. 2 is a motion frame sketch map
Fig. 3 is the therapeutic bed sketch map
Fig. 4 is laser locator and radiation head position view
Fig. 5 is the laser locator vertical view
Fig. 6 is the radiation head connection diagram
Among the figure, 301-electron linear accelerator radiation head, 302-radiation head connecting rod, the vertical stretching motion arm of 303-, the 304-arm that vertically rotatablely moves, 305-horizontal fixed slide rail and slide block, 306-moves horizontally slide rail, 307-moves horizontally slide block, 308-radiation head link motion joint, 309-motion frame, the 310-therapeutic bed arm that rotatablely moves, 311-therapeutic bed stretching motion arm, 312-therapeutic bed adapter, the 313-therapeutic bed, 314-treats bed surface, 402-electron beam focusing arrangement, the 403-laser locator, 404-laser positioning pipe, 405-plastics light collecting barrel, 406-laser tube fixed disk, 407-laser holder medium pore
The specific embodiment:
The embodiment that Fig. 1, Fig. 2 show is radiotheraphy device motion frame and the radiation head that is connected thereof in the art.Intraoperative radiation therapy device of the present invention comprises radiation head 301 and motion frame 309 thereof, motion frame 309 comprise interconnective radiation head link motion joint 308, vertical stretching motion arm 303, vertically rotatablely move arm 304, horizontal fixed slide rail and slide block 305, move horizontally slide rail 306, move horizontally slide block 307.Each parts are linked in sequence, move freely each other, moving horizontally slide rail 306 moves as X-direction along horizontal fixed slide rail and slide block 305 by slide block, vertically rotatablely moving, to make y-axis shift moving by moving horizontally slide block 307 for arm 304, vertical stretching motion arm 303 moves up and down along longitudinal axis Z-direction, thereby make radiation head 301 can reach spatial any point in the range of movement, rotation by the arm that vertically rotatablely moves and radiation head 301 are around the swing of horizontal axis, can adjust the electron beam directions of rays, ray is accurately shone on the focus.It can be artificial move mode that above-mentioned parts move mutually, also can adopt any power drive mode, comprises motor, hydraulically operated equipment, pneumatic means, magnetoelectricity device, and control mode can be electronic control, digitized programme-control or wireless remote control mode.
The embodiment that Fig. 1, Fig. 3 show is motion frame and radiation head and therapeutic bed mutual alignment and therapeutic bed structure.Therapeutic bed 313 is made up of rotatablely move arm 310, therapeutic bed stretching motion arm 311, therapeutic bed adapter 312, treatment bed surface 314 of therapeutic bed.Above-mentioned parts are linked in sequence, and move freely each other.Rotate in Z-direction by the mobile therapeutic bed arm 310 that rotatablely moves, mobile therapeutic bed stretching motion arm 311 moves up and down in Y direction and can drive therapeutic bed adapter 312, thereby drive moving of therapeutic bed 313, above-mentioned multi-dimensional direction, multi-angle move the electron beam that can guarantee radiation head and inject focus from the specified any angle of doctor, and the mutual motion mode of above-mentioned parts, type of drive and control mode are identical with motion frame 309.
Fig. 4, among the embodiment that Fig. 5 shows, laser locator 403 is made up of laser tube fixed disk 406 and laser positioning pipe 404,4 laser positioning pipes 404 are installed in laser tube fixed disk 3 points respectively, 6 points, 9 points, 12 positions, the mode that the laser positioning pipe is fixed on the laser fixed disk can be any known mode, comprise that screw nut fixes, fixing band is fixed, paste fixing, buckle is fixed, the clasp fixed form, laser holder 403 is installed in electron beam focusing arrangement 402 surfaces, laser holder medium pore 407 just in time is in the focusing arrangement outlet, and 4 laser positioning pipes just in time are in the edge of electron beam outlet, the laser beam position of 4 laser positioning pipe radiation, direction, the zone of angle and formation thereof, scope, just in time represent the position of electron linear accelerator radiation head electrons emitted bundle, direction, angle and zone, incident scope of electron beam and zone are represented in the indicating area that laser beam forms in the target area.
What show among the embodiment that Fig. 6 shows is electron linear accelerator radiation head 301 and motion frame 309 being connected each other, 308 upper ends, radiation head link motion joint connect the arm that vertically rotatablely moves, the lower end connects radiation head connecting rod 302, radiation head link motion joint 308, can move along Z-direction, move freely in Z-direction thereby drive radiation head 301,120 °～180 ° of range of movement can be driven by manual driven mode or any power mode.
Be another most preferred embodiment of the present invention below
Patient lies on the back on the CT scan bed, does CT and enhanced ct scans, understands the spatial relationship of pathological changes target position, focus and adjacent organs and blood vessel.According to lesion locations, be with the adhesive plaster of 10mm diameter circular lead to post on the epidermis above the lesion region with one.Begin to carry out CT scan, adopt Single Slice Mode or helical scanning mode, the scanning number of plies is 6～10 layers, and the collection number of plies is many more, can provide more information for 3D image reconstruction.After the been scanned, the CT scan data is transferred to computer work by computer serial line interface 232, simultaneously with the CT scan information of importing, the input 3 D stereoscopic image is rebuild software, and (this software platform can be widely used the imaging technique of employing, surface projection's display mode or MIP method oneself exploitation, perhaps directly buy commercial three-dimensional reconstruction image software, for example the U.S. " 3D Doctor " 3-D stereoscopic image is rebuild software).Rebuilding 3 D stereoscopic image shows on the 3 D stereoscopic image display.The doctor observes 3 D stereoscopic image, determine lesions position, the degree of depth, angle, direction and with vitals on every side, blood vessel, neural relation, determine best incident path, angle, direction, the degree of depth, and according to CT and MRI sweep volume, and radiotherapy treatment planning system, calculate the incident electron beam dose, work out rational intraoperative radiation therapy plan.
Patient undergos surgery according to predetermined operation plan, will finish preceding 1 hour, technical staff's preheating electron linear accelerator in operation, parameters and index in the determinator perform introoperative radiotherapy and prepare, after ocal resection, through surgeon's approval, implement intraoperative radiation therapy.
Motion frame 309 and the electron linear accelerator radiation head that is connected thereof are moved to the therapeutic bed top, regulate the position of indicating in the radiotherapy planning that radiation head 301 works out to the doctor by the moving movement frame, moving horizontally slide rail 306 moves as X-direction along horizontal fixed slide rail and slide block 305 by slide block, the arm 304 that vertically rotatablely moves moves as Y direction by moving horizontally slide block 307, vertical stretching motion arm 303 moves up and down along Z-direction, rotation by the arm that vertically rotatablely moves and radiation head 301 are around the swing of horizontal axis, can adjust radioactive source lonizing radiation direction, ray is accurately shone on the focus.
Rotate in Z-direction by the mobile therapeutic bed arm 310 that rotatablely moves, mobile therapeutic bed stretching motion arm 311 moves up and down in Y direction, drive therapeutic bed adapter 312, drive moving of therapeutic bed 313, above-mentioned multi-dimensional direction, multi-angle move the lonizing radiation that can guarantee radioactive source and inject focus from the specified any angle of doctor.
After determining that mobile radiation head arrives assigned address, open laser localized light comparing 404, observe the indicating area of 4 laser beams in lesions position formation, the contrast 3-dimensional image, after definite position, direction were errorless, the medical worker left operating room, with the power treatment patient of 6～12Mev, about 2～4 minutes finish, thereby have finished intraoperative radiation therapy.
Radiotherapy unit in the novel operation can be widely used in thoracic cavity, abdominal cavity, the tumor of pelvic cavity resection operation,
Claims (7)
1. the present invention relates to radiotherapy unit in a kind of novel operation, the tumor bed and the tumors remaining tissue that utilize high-power electron beam to excise at intraoperative irradiation, it is characterized in that: adopt CT and MRI image three-dimensional to rebuild software platform, rebuild the three-dimensional image of tumor locus, determine that lesions position reaches and the surrounding tissue relation, adopt the analogue technique of simulated emission line incident focus, determine the direction of electron beam incident focus, angle, the position, the application of radiation treatment planning systems, accurate Calculation is incident on the radiological dose on focus surface, radiation headring week at electron linear accelerator is installed laser locator additional, four laser positioning pipe emitted laser bundle direct irradiations around electron linear accelerator focusing arrangement ring week are on the focus surface, indication incident position of electron beam and scope, the radiation head of electron linear accelerator is fixed on the ceiling of operating room by the motion frame, by the mutual motion between moving movement frame and the operation table, radiation head is seated in the predetermined treatment position of treatment plan, carries out radiotherapy in the art.
2. radiotherapy unit in the novel operation according to claim 1, it is characterized in that: use the image data that CT or MRI check tumor focus, by adopting 3D image reconstruction software, rebuild the three-dimensional graph of tumor by local lesions position, the position of clear and definite tumor focus and with surrounding tissue and vitals mutual relation, adopt image virtual cursor ruling, simulation electronic bundle incident tumor focus incident path, in conjunction with 3 D stereoscopic image, determine the position of electron beam incident tumor focus, direction, angle, the degree of depth, the application of radiation treatment planning systems, in conjunction with CT and MRI volume and scanning numerical value, accurate Calculation is incident on the radiological dose on focus surface, sets up clear and definite according to this, reliably, carry out radiotherapy in the art after the detailed introoperative radiotherapy plan.
3. radiotherapy unit in the novel operation according to claim 1, it is characterized in that: regulate the position of radiation head 301 to indication by the moving movement frame, moving horizontally slide rail 306 moves as X-direction along horizontal fixed slide rail and slide block 305 by slide block, the arm 304 that vertically rotatablely moves moves as Y direction by moving horizontally slide block 307, vertical stretching motion arm 303 moves up and down along Z-direction, thereby make radiation head 301 can reach spatial any point in the range of movement, rotation by the arm that vertically rotatablely moves and radiation head 301 are around the swing of horizontal axis, can adjust radiating electron Shu Fangxiang, make electron beam accurately shine on the focus, rotate in Z-direction by the mobile therapeutic bed arm 310 that rotatablely moves, mobile therapeutic bed stretching motion arm 311 moves up and down in Y direction and can drive therapeutic bed adapter 312, thereby drive moving of therapeutic bed 313, above-mentioned multi-dimensional direction, multi-angle moves, and can guarantee that the lonizing radiation of radioactive source are injected focus from the specified any angle of doctor.
4. radiotherapy unit in the novel operation according to claim 1, it is characterized in that: move each other by motion frame and therapeutic bed, can make the multi-dimensional movement axle surpass the multi-direction mechanical arm of multidimensional, the suspension type frame can improve utilization of space, minimizing is to the required precision of moving component, Z-direction moves both vertically and adopts ball-screw to drive, because the effect of helical angle only needs the just may command Z-direction motion of less moment of torsion.
5. radiotherapy unit in the novel operation according to claim 1, it is characterized in that: therapeutic bed 313 is made up of rotatablely move arm 310, therapeutic bed stretching motion arm 311, therapeutic bed adapter 312, treatment bed surface 314 of therapeutic bed, above-mentioned parts are linked in sequence, move freely each other, rotate in Z-direction by the mobile therapeutic bed arm 310 that rotatablely moves, mobile therapeutic bed stretching motion arm 311 moves on Y direction and drives therapeutic bed adapter 312, drives moving of therapeutic bed 313.
6. radiotherapy unit in the novel operation according to claim 1, it is characterized in that: laser locator 403 is made up of laser tube fixed disk 406 and laser positioning pipe 404,4 laser positioning pipes 404 are installed in laser tube fixed disk 3 points respectively, 6 points, 9 points, 12 positions, the mode that the laser positioning pipe is fixed on the laser fixed disk can be any known mode, comprise that screw nut fixes, fixing band is fixed, paste fixing, buckle is fixed, the clasp fixed form, laser holder 403 is installed in electron beam focusing arrangement 402 surfaces, laser holder medium pore 407 just in time is in the focusing arrangement outlet, and 4 laser positioning pipes just in time are in the edge of electron beam outlet, the laser beam position of 4 laser positioning pipe radiation, direction, the zone of angle and formation thereof, scope, just in time represent the position of electron linear accelerator radiation head electrons emitted bundle, direction, angle and zone, laser beam is represented incident scope of electron beam and zone in the indicating area of target area shape.
7. radiotherapy unit in the novel operation according to claim 1, it is characterized in that: 308 upper ends, radiation head link motion joint connect the arm lower end that vertically rotatablely moves and connect radiation head connecting rod 302, radiation head link motion joint 308, can move along Z-direction, thereby driving radiation head 301 moves freely in Z-direction, 120 °～180 ° of range of movement can be driven by manual driven mode or any power mode.
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