DE202019107134U1 - Device for monitoring the breath of a patient - Google Patents

Abstract

A device for monitoring the breathing of a patient (P), comprising at least one sensor (3), by means of which the patient's breathing can be monitored and displayed optically and / or acoustically on the basis of the position of the chest, characterized in that the sensor (3) is on an arcuate , the patient is arranged at least partially spanning bracket and can be brought into contact with the patient's chest in such a way that the expansion of the chest can be detected by means of the sensor (3) during the breathing process and a switching process can be triggered.

Description

The invention relates to a device for monitoring the breathing of a patient according to the preamble of the first protection claim.

In modern radiation therapy, breath triggering is an indispensable way of significantly reducing the rate of side effects. The DIBH (Deep Inspiration Breath Hold) irradiation technique in particular when irradiating the left chest or chest wall leads to significant protection of the heart and the coronary arteries near the chest wall. A later risk of ischemic heart disease is thus considerably reduced. However, this requires constant “deep inhalation” and lung filling (DIBH). This inhalation point must be sampled consistently both during planning and for each radiation fraction.

Breathing monitoring is often implemented using movement sensors that are attached to elastic straps that are guided over the chest. However, such bands can prove to be a hindrance during irradiation.

The pamphlet DE 42 29 073 A1 discloses a measuring arrangement for detecting and monitoring the respiratory activity through the respiratory movement in humans and animals, the change in body volume being detected by one or more sensors that detect changes in body circumference resulting from the change in volume, for example of the chest and abdomen, and from elastic electrical conductors exist, the resistance of which changes proportionally to a change in length. The elastic conductors can negatively affect the comfort of the patient.

The pamphlet DE 10 2007 035 549 A1 discloses a method for monitoring a patient in which a) a breathing movement of the patient is detected by means of a thorax strain sensor placed in the region of the chest and by means of an abdomen strain sensor placed in the region of the abdomen, b) a phase difference between one of the thorax Thorax measurement signal delivered to the strain sensor and an abdomen measurement signal delivered by the abdomen strain sensor is determined, c) the determined phase difference is checked for exceeding at least one phase threshold value or for an increase over time, and d) based on a phase difference lying above the phase threshold value or based on a As the phase difference increases, the presence of a disorder in the respiratory tract of the patient being monitored is detected. Two strain sensors are used here, which are attached to the patient using elastic straps and can significantly reduce the patient's comfort.

The pamphlet WO 98 02093 A1 describes a method for monitoring the respiratory processes of persons equipped with respiratory devices, in particular of sport and professional divers, characterized by the following steps: recording of vital functional parameters of the person, in particular of the sport and professional diver, determination of at least one breathing pattern as actual breathing pattern based on the recorded Parameters, comparison of the actual breathing pattern with at least one predetermined target breathing pattern, determination of whether the actual breathing pattern is within or outside the predetermined target breathing pattern, information or instruction of the person, in particular the sport and professional diver, that the The actual breathing pattern is adapted to the predetermined target breathing pattern.

Breath monitoring by means of imaging methods is also conceivable but complex to implement.

In the pamphlet EP 1 208 796 A1 a method is described for supporting irradiation in the event of displacements of an irradiation target caused by breathing, in which the assignment of the lung filling values to the distance between the moving structure, which can be seen during fluoroscopy, in particular on an X-ray, and an anatomical structure that is fixed on breathing is determined, the current Irradiation target position is detected on the basis of the lung filling value, and in which the irradiation is carried out with the assistance of the known current irradiation target position. The movement of the chest during breathing is determined by means of imaging processes using markers affixed to the thorax. The additional application of imaging methods is complex to implement and costly.

In the pamphlet US 2004/254492 A1 describes a system for breathing monitoring in which a non-invasive breathing monitor combines signals from a spirometer and a laser chest displacement sensor to reduce signal errors. The breathing signal can be used for position correction in radiation therapy and imaging and can be displayed to a user in breathing control technology. The spirometer significantly reduces the comfort of the patient and the combination of several sensor signals requires a complex additional evaluation.

In the pamphlet DE 10 2009 037 097 A1 a device for automatic breathing and ventilation monitoring of patients with a sensor, a PC connected to it and intelligent software is disclosed. The breathing activity is recorded via an acoustic signal Sensor system using a microphone, stethoscope and ultrasound. The additional application of acoustic sensor systems is complex to implement.

The pamphlet WO 2018/130253 A1 describes a method for reporting back to the patient with regard to his breathing in radiation therapy, in particular in breathing gating, whereby information about his current breathing state and / or instructions for action with regard to his breathing are transmitted to the patient by room signals. The current breathing state is determined optically, in particular by camera systems, and / or mechanically, in particular by strain gauges. The optical monitoring of the respiratory status is imprecise and prone to errors and the strain gauges reduce the patient's comfort.

The object of the invention is to provide a device for breathing monitoring which influences the irradiation as little as possible and gives the patient a high level of comfort.

This problem is solved with the characterizing features of the first claim for protection. Advantageous refinements result from the subclaims.

According to the invention, a device for monitoring the breathing of a patient ( P ), comprising at least one sensor, by means of which the patient's breathing can be monitored and visually and / or acoustically indicated based on the position of the chest, the sensor being arranged on an arched holder spanning the patient at least in some areas. The sensor can be brought into contact with the patient's chest in such a way that the expansion of the chest can be detected by means of the sensor during the breathing process and a switching process can be triggered.

The holder has at least one fastening area and at least one arcuate area. The sensor preferably has a microswitch, by means of which the switching process can be triggered.

The at least one fastening area is advantageously used to fasten the device according to the invention to a base on which the patient is supported. This can be a bed, a couch, a mattress or some other device used to support the patient.

In particular, the at least one fastening area is provided with at least two bores through which screws, alternatively also rivets, are preferably used for fastening to the base on which the patient is supported. The at least one fastening area is preferably wider than the arcuate area of the holder, but can also have the same width or be made narrower. The at least one fastening area can have two or a plurality of bores, by means of which fastening by screws and / or rivets can be realized.

Alternatively, the at least one fastening area is designed as a clamping device. In this case, two axially displaceable, radially protruding webs which are axially displaceable along a longitudinal axis of the device according to the invention are arranged on the device according to the invention so as to be displaceable relative to one another. The clamping device can furthermore have one or more bores and / or one or more screws for fixing the axial position of one of the two or both webs.

Alternatively, the clamping device can be designed as a clamp or in some other way from an elastically at least partially deformable material.

The at least one fastening area designed as a clamping device can alternatively or additionally have a plurality of bores by means of which fastening by screws can be realized.

In a preferred embodiment, the arcuate holder has a first fastening area formed on a first end and a second fastening region on a second end of the arcuate holder.

Advantageously, the arched holder with the two fastening areas can be fastened to a respective longitudinal side of a base on which the patient is supported in such a way that its longitudinal extent extends over the patient lying on the base, in particular over his chest.

In this embodiment, the sensor is arranged between the first and the second fastening area, so that the sensor can thereby be positioned over the chest of a patient lying on a surface.

In a further preferred embodiment, the arcuate holder has a longitudinal extension with only one fastening area, in such an embodiment the sensor being arranged at an end of the arcuate holder opposite the at least one fastening region along the longitudinal extension.

Advantageously, the arched holder with the fastening areas can be fastened to a longitudinal side of a base on which the patient is supported in such a way that its longitudinal extension extends over the patient lying on the base, in particular over his chest, and the microswitch thereby extends over the chest of a patient lying on a mat can be positioned.

The at least one arcuate region of the holder preferably extends between the at least one fastening region and the sensor with the microswitch arranged thereon or between the first and the second fastening region.

The at least one arcuate area of the holder is connected to the at least one fastening area, preferably in a height-adjustable manner.

The at least one arcuate region preferably has an essentially semicircular or part-circular course.

In a device according to the invention, which can be fastened to a base by means of first and second fastening regions, the elastic region advantageously has a semicircular profile.

In a device according to the invention, which can be fastened to a base via precisely one fastening region, the elastic region advantageously has a part-circular course.

In particular, the at least one arcuate area is formed from a fiber-reinforced plastic. Furthermore, the at least one fastening area is made from a fiber-reinforced plastic.

The fiber-reinforced plastic of the arched area and the fastening area is preferably a carbon fiber-reinforced plastic. Four-layer carbon fibers are preferably used. Alternatively, reinforcement with glass fibers, natural fibers such as wood fibers, hemp fibers or other suitable fibers is possible. These can be continuous fibers or short fibers. Reinforcement with rovings or other flat structures is also conceivable.

The sensor is preferably attached to the at least one arcuate area via a support arm.

The support arm is preferably designed to be adjustable, so that an exact positioning of the sensor and in particular the associated microswitch is possible both horizontally and vertically.

The arcuate holder preferably has at least one first adjusting mechanism for changing the vertical position of the sensor and at least one second adjusting mechanism for changing the horizontal position of the sensor. The adjustment mechanism is preferably designed in the form of a first and second linear guide.

The first and / or the second adjustment mechanism are preferably arranged in the support arm. In particular, the support arm has a holder which is fixed in position with respect to the arcuate region of the holder and on which a vertically adjustable first strut is arranged. A horizontally adjustable second strut, on which the sensor or the microswitch is arranged, is preferably arranged on the vertically adjustable first strut.

The first and / or the second strut are preferably provided with scales.

Alternatively, the first and / or the second adjusting mechanism can also be arranged in one or both of the at least one fastening area of the arched holder.

The sensor is preferably connected to at least one optical and / or to at least one acoustic signal transmitter.

In particular, one, particularly preferably two, LEDs is designed as the optical signal transmitter. The at least one optical signal transmitter is preferably formed on the support arm of the device, in particular on the fixed bracket of the support arm. At least one optical signal transmitter is preferably arranged pointing in the direction of the patient's gaze and at least one further optical signal transmitter pointing in another direction, so that at least one further optical signal transmitter can be clearly recognized by a person monitoring the patient.

The at least one acoustic signal generator can also be formed on the support arm of the device, in particular on the fixed bracket of the support arm.

Furthermore, the sensor is preferably connected to at least one external control system. An external control system can be an irradiation system or a control for the room light.

The sensor can also trigger a signal to be sent to an external display unit such as a mobile terminal device or a surveillance monitor.

The device according to the invention is preferably operated with a rechargeable battery, particularly preferably with a 5V rechargeable battery.

The device according to the invention also preferably has a charge monitor.

In particular, the construction is designed in such a way that the microswitch does not protrude into the irradiation field with conventional irradiation technology.

1. a. Positionieren des Mikroschalters über dem Brustkorb eines liegenden Patienten,
2. b. Aufsetzen des Mikroschalters auf das caudale Sternum des Patienten bei maximalem Brustvolumen und erfassen einer Aktivierungsposition des Mikroschalters,
3. c. Höhenverstellung des Mikroschalters derart, dass der Mikroschalter in der Aktivierungsposition wenigstens einen optischen und/oder wenigstens einen akustischen Signalgeber aktiviert.

The device can be used to implement a method for monitoring a patient's breath, comprising the steps:

1. a. Positioning the microswitch over the chest of a patient lying down,
2. b. Place the microswitch on the caudal sternum of the patient with maximum breast volume and detect an activation position of the microswitch,
3. c. Height adjustment of the microswitch in such a way that the microswitch activates at least one optical and / or at least one acoustic signal transmitter in the activation position.

The microswitch is first positioned over the chest of a patient lying on a mat. The base can be a bed, a couch, a mattress or some other device used to support the patient. The device according to the invention is fastened to the base in the form of a patient support plate by means of one or two fastening areas in such a way that the microswitch is located above the patient's chest.

The patient is asked to breathe in inspiration and to hold the point of inspiration, which results in a maximum chest volume for the patient.

The microswitch is then placed centrally on the patient's caudal sternum with the patient's chest volume at maximum. For this purpose, the microswitch is precisely positioned via at least one first adjusting mechanism for changing the vertical position of the microswitch and at least one second adjusting mechanism for changing the horizontal position of the microswitch.

The fine positioning is preferably carried out by adjusting the height and length of the preferably adjustable support arm to which the microswitch is attached.

The microswitch is first brought into a position in which an optical and / or acoustic signal transmitter is not yet activated.

When the microswitch is placed on the caudal sternum of the patient at maximum breast volume, the microswitch is adjusted in height such that the microswitch activates at least one optical and / or at least one acoustic signal generator in the activation position.

The height adjustment can take place via the at least one second adjustment mechanism for changing the horizontal position of the microswitch, the preferably adjustable support arm preferably being adjusted in height.

In the activation position, the microswitch finally reaches a switching point at which the at least one optical and / or the at least one acoustic signal generator is / are activated.

The height and length coordinates for this point are preferably noted on scales on the support arm. The patient can thus, both optically and acoustically monitored, hold this inhalation point / gating point independently and reproducibly.

Furthermore, in the activation position, the microswitch can preferably send signals to at least one external control system and / or to at least one external display unit such as a mobile terminal device or a surveillance monitor. An external control system can be an irradiation system or a control for the room light.

The device according to the invention and the method that can be implemented by means of the device advantageously ensure improved breathing monitoring during radiation therapy, which offers the patient a high level of comfort, the radiation field is not influenced and can be operated intuitively.

The invention is explained in more detail below with reference to exemplary embodiments and associated drawings, without being restricted to these.

• 1: schematisch eine Ansicht einer Ausführungsform der erfindungsgemäßen Vorrichtung mit zwei Befestigungsbereichen, welche über dem Brustkorb eines Patienten positioniert ist;
• 2: schematisch eine Detailansicht eines Tragarms einer erfindungsgemäßen Vorrichtung mit daran angebrachtem Mikroschalter;
• 3: schematisch eine Detailansicht eines Befestigungsbereiches einer erfindungsgemäßen Vorrichtung;
• 4: schematisch eine Ansicht einer weiteren Ausführungsform der erfindungsgemäßen Vorrichtung mit einem Befestigungsbereich, welche über dem Brustkorb eines Patienten positioniert ist;

Show:

• 1 : a schematic view of an embodiment of the device according to the invention with two fastening areas, which is positioned over the chest of a patient;
• 2 : a schematic detailed view of a support arm of a device according to the invention with a microswitch attached thereto;
• 3 : schematically a detailed view of a fastening area of a device according to the invention;
• 4th : a schematic view of a further embodiment of the device according to the invention with a fastening area, which is positioned over the chest of a patient;

In 1 is a schematic view of an embodiment of the device according to the invention with an elastic region 1 and two attachment areas 2 shown which is above a patient's chest P is positioned.

The device has an arcuate holder with two attachment areas 2 and an elastic area 1 and a sensor with a microswitch attached to the arched bracket 3 on.

The arched bracket is over the attachment areas 2 on a pad U attached to which a patient P lies. The patient P is shown here as seen from the head end. The arched area 1 is about screws 2.1 at the fastening areas 2 arranged adjustable in height such that it is arcuate between the two fastening areas 2 extends.

Between the two attachment areas 2 is roughly in the middle of the arched area 1 a support arm 4th at the arcuate area 1 arranged. The support arm 4th is via a fixed bracket 4.1 at the arched area 1 the bracket arranged. On the fixed bracket 4.1 is one about a first set screw 4.3 vertically adjustable strut 4.2 arranged. On the vertically adjustable strut 4.2 is one via a second adjusting screw 4.5 horizontally adjustable strut 4.4 attached to which in turn the microswitch 3 is attached.

On the fixed bracket 4.1 is still an LED 4.6 with one in the fixed holder 4.1 integrated electronics arranged. The LED is in the form of an LED that switches from green to red 4.6 educated. This switching point is simultaneously made audible via a beep.

The one on the pad U lying patient P has a maximum chest volume in the state of maximum inhalation and the chest rises to a first level h1 . The position of the microswitch 3 is set so that the microswitch 3 touches the patient's caudal sternum and the LED at the same time 4.6 activated. In addition, the microswitch can activate at least one further LED and / or at least one acoustic signal generator and / or at least one external control system and / or at least one external display unit.

When the patient exhales, his chest lowers to a second height h2 at which the microswitch is no longer in contact with the caudal sternum. The LED is no longer contacted and goes out. An acoustic signal also sounds.
2 shows schematically a detailed view of a support arm of a device according to the invention with a microswitch attached thereto 3 .

The support arm 4th is via a fixed bracket 4.1 at the arched area 1 the bracket arranged. On the fixed bracket 4.1 is one about a first set screw 4.3 vertically adjustable strut 4.2 arranged. On the vertically adjustable strut 4.2 is one via a second adjusting screw 4.5 horizontally adjustable strut 4.4 attached to which in turn the microswitch 3 is attached.

On the fixed bracket 4.1 are two LEDs in the embodiment shown 4.6 arranged. It is conceivable that an LED 4.6 When contact is made by the microswitch, it lights up red and goes out when the microswitch does not make contact, while the second LED lights up green when the microswitch does not make contact and goes out when the microswitch makes contact.

In radiation therapy, the arched area attached above the patient is used 1 a microswitch 3 with an adjustable support arm 4th assembled. The device is switched on and signals via a, on the bracket 4.1 arranged, green LED 4.6 Operational readiness. Furthermore is on the bracket 4.1 a second LED 4.6.1 arranged in the form of a red LED. The support arm 4th and arcuate area 1 can be adjusted lengthways and in height. The patient breathes in inspiration according to his possibilities and holds this inspiration point. The button with microswitch 3 is then over the support arm 4th placed on the caudal sternum and adjusted in height so that it lights up the green LED 4.6 turns on. This switching point is simultaneously made audible via a beep. The height and length coordinates for this point are on scales on the support arm 4th written down. The patient can thus, both visually also monitored acoustically, keeping this inhalation point / gating point independent and reproducible.

Are preferred on the bracket 4.1 four LEDs 4.6 arranged, with two pointing in the direction of the patient and two being arranged on the opposite side in the direction of the monitoring person. One LED is preferably red and one LED is green in each direction.

Through the video surveillance, the radiographer can then drive the planning CT from outside or trigger the radiation later. The LED 4.6 is on both sides of the bow 1 attached so that the switching status can be clearly seen via the video surveillance.
The irradiation system itself (Rad on) or the room light could also be controlled via a potential-free switch contact.

Technically, the device according to the invention is operated with a 5V battery. The device according to the invention has a charge monitor. A measuring void with a defined height setting can be used for quality assurance and quality requirements.

The construction is carried out in such a way that the microswitch does not protrude into the irradiation field with the usual irradiation technology.

In 3 is shown schematically a detailed view of a fastening area of a device according to the invention.

The attachment area 2 has a screw 2.1 on which the arcuate area 1 is attached and which in a guide groove 2.3 of the fastening area 2 is mounted in such a way that the arcuate area 1 is height adjustable.

In the embodiment shown, the fastening area 2 a screw 2.1 and a guide groove 2.3 on. It is also conceivable that there are two or more screws and two or more guide grooves.

The fastening area also has bores 2.2 by means of which it can be attached to a base using screws or rivets.

4th shows schematically a view of a further embodiment of the device according to the invention with only one fastening area 2 which is placed over a patient's chest P is positioned.

The device has a holder with exactly one fastening area 2 and an arcuate area 1 and a microswitch attached to the arched bracket 3 on.

The arched bracket is over the mounting area 2 on a pad U attached to which a patient P lies. The patient P is shown here as seen from the head end. The arched area 1 is about a screw 2.1 at the attachment area 2 height-adjustable arranged such that it is arcuate from the fastening area 2 up to the patient's chest P extends.

On the one to the fastening area 2 having the end of the arcuate area 1 opposite end of the arcuate area 1 is a support arm 4th arranged. The support arm 4th is via a fixed bracket 4.1 at the arched area 1 the bracket arranged. On the fixed bracket 4.1 is one about a first set screw 4.3 vertically adjustable strut 4.2 arranged. On the vertically adjustable strut 4.2 is one via a second adjusting screw 4.5 horizontally adjustable strut 4.4 attached to which in turn the microswitch 3 is attached.

On the fixed bracket 4.1 is still an LED 4.6 arranged.

The one on the pad U lying patient P has a maximum chest volume in the state of maximum inhalation and the chest rises to a first level h1 . The position of the microswitch 3 is set so that the microswitch 3 touches the patient's caudal sternum and the LED at the same time 4.6 activated. In addition, the microswitch can activate at least one further LED and / or at least one acoustic signal generator and / or at least one external control system and / or at least one external display unit.

When the patient exhales, his chest lowers to a second height h2 at which the microswitch is no longer in contact with the caudal sternum. The LED is no longer contacted and goes out.

List of reference symbols

1

Arched area

2

Attachment area

2.1

screw

2.2

drilling

2.3

Guide groove

3

Sensor / microswitch

4th

Beam

4.1

fixed bracket

4.2

vertically adjustable strut

4.3

first adjusting screw of the support arm

4.4

horizontally adjustable strut

4.5

second adjusting screw of the support arm

4.6

LED

4.6.1

second LED

P

patient

U

document

h1

Chest height at maximum inhalation

h2

Height of the chest in the relaxed state after exhaling

QUOTES INCLUDED IN THE DESCRIPTION

This list of the documents listed by the applicant was generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Patent literature cited

• DE 4229073 A1 [0004]
• DE 102007035549 A1 [0005]
• WO 9802093 A1 [0006]
• EP 1208796 A1 [0008]
• US 2004254492 A1 [0009]
• DE 102009037097 A1 [0010]
• WO 2018/130253 A1 [0011]

Claims (14)

A device for monitoring the breathing of a patient (P), comprising at least one sensor (3), by means of which the patient's breathing can be monitored and displayed optically and / or acoustically on the basis of the position of the chest, characterized in that the sensor (3) is on an arcuate , the patient is arranged at least partially spanning bracket and can be brought into contact with the patient's chest in such a way that the expansion of the chest can be detected by means of the sensor (3) during the breathing process and a switching process can be triggered. Device according to Claim 1 , characterized in that the holder has at least one fastening area (2) and at least one arcuate area (1). Device according to Claim 1 or 2 , characterized in that the sensor has a microswitch (3) for triggering the switching process. Device according to one of the Claims 1 to 3 , characterized in that the arcuate bracket has a first fastening area (2) at a first end of the arcuate bracket and a second fastening area (2) at a second end of the arcuate bracket. Device according to Claim 4 , characterized in that the sensor (3) is arranged between the first and the second fastening area (2). Device according to Claim 1 , characterized in that the arcuate holder has a longitudinal extension and that the sensor (3) is arranged at an end of the arcuate holder opposite the at least one fastening area (2) along the longitudinal extension. Device according to one of the Claims 1 to 6th , characterized in that the at least one arcuate area (1) has an essentially semicircular or part-circular course. Device according to one of the Claims 1 to 7th , characterized in that the at least one arcuate area (1) is formed from a fiber-reinforced plastic, in particular carbon fiber material. Device according to one of the Claims 1 to 8th , characterized in that the at least one fastening area (2) is formed from a fiber-reinforced plastic, in particular carbon fiber material. Device according to one of the Claims 1 to 9 , characterized in that the sensor (3) is attached to the at least one arcuate area (1) via a support arm (4). Device according to one of the Claims 1 to 10 , characterized in that the arcuate holder has at least one first adjusting mechanism (4.2, 4.3) for changing the vertical position of the sensor (3) and at least one second adjusting mechanism (4.4, 4.5) for changing the horizontal position of the sensor (3). Device according to Claim 11 , characterized in that the first (4.2, 4.3) and second adjustment mechanism (4.4, 4.5) are arranged in the form of a first and second linear guide on the support arm (4). Device according to one of the Claims 1 to 12th , characterized in that the sensor (3) is connected to at least one optical (4.6) and / or to at least one acoustic signal transmitter. Device according to one of the Claims 1 to 13th , characterized in that the sensor (3) is connected to at least one external control system.

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