EP2822651A1 - Procédé et installation d'irradiation d'un volume cible - Google Patents

Procédé et installation d'irradiation d'un volume cible

Info

Publication number
EP2822651A1
EP2822651A1 EP13709358.9A EP13709358A EP2822651A1 EP 2822651 A1 EP2822651 A1 EP 2822651A1 EP 13709358 A EP13709358 A EP 13709358A EP 2822651 A1 EP2822651 A1 EP 2822651A1
Authority
EP
European Patent Office
Prior art keywords
target volume
ion beam
phases
radiographic
deposition
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP13709358.9A
Other languages
German (de)
English (en)
Inventor
Christoph Bert
Alexander Gemmel
Robert LÜCHTENBORG
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
GSI Helmholtzzentrum fuer Schwerionenforschung GmbH
Original Assignee
GSI Helmholtzzentrum fuer Schwerionenforschung GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by GSI Helmholtzzentrum fuer Schwerionenforschung GmbH filed Critical GSI Helmholtzzentrum fuer Schwerionenforschung GmbH
Priority to EP18155862.8A priority Critical patent/EP3342463B1/fr
Publication of EP2822651A1 publication Critical patent/EP2822651A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—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
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1042—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy with spatial modulation of the radiation beam within the treatment head
    • A61N5/1043—Scanning the radiation beam, e.g. spot scanning or raster scanning
    • 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
    • A61N5/1069—Target adjustment, e.g. moving the patient support
    • A61N5/107—Target adjustment, e.g. moving the patient support in real time, i.e. during treatment
    • 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
    • A61N2005/1054—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using a portal imaging system
    • 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
    • A61N2005/1062—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 using virtual X-ray images, e.g. digitally reconstructed radiographs [DRR]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N2005/1085—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy characterised by the type of particles applied to the patient
    • A61N2005/1087—Ions; Protons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N2005/1092—Details
    • A61N2005/1095—Elements inserted into the radiation path within the system, e.g. filters or wedges

Definitions

  • the invention relates to a method and a
  • Irradiation system for irradiating a target volume with an ion beam, in particular for tumor therapy.
  • Gating and beam tracking are basically known to the person skilled in the art; see. for gating eg "Respiratory Gated Irradiation System for Heavy-Ion Radiotherapy "by Shinichi Minohara et al., Int. J. Oncology Biol. Phys., Vol. 47, No. 4, pp. 1097-1103, 2000 or” Gated Irradiation with Scanned Particle Beams by Christoph Bert et al Int., J. Oncology Biol. Phys., Vol. 73, No. 4, pp. 1270-1275, 2009, and Beam
  • Some motion detection systems measure
  • Tumor movement is often associated with surgical intervention in the patient or with a significantly increased dose loading of the patient, e.g. in conventional X-ray fluoroscopy, especially when using high image acquisition rates.
  • Motion detection systems are inherently limited to performing a very indirect measurement, why, among other things, the precision of detecting the tumor movement is in need of improvement. Furthermore, the tumor movement, for example in a lung tumor be highly complex and each translational, rotational and
  • Ion therapy only in conjunction e.g. is used with 4DCT records because the range of the beam is from
  • Ion sources used to produce different types of ions, which are brought together in a mixing chamber. However, this procedure can only be used for certain
  • the invention is therefore based on the object to provide a method and an irradiation system for irradiating a target volume with an ion beam, which allow a high precision of the irradiation despite a moving target volume.
  • Another aspect of the object of the invention is a
  • Method and an irradiation system for irradiating a moving target volume with an ion beam to provide that the adverse effect of the movement of the target volume on the energy loss and the range of the ion beam in the target volume can be determined as precisely as possible.
  • Yet another aspect of the object of the invention is a
  • the ion beam is first generated by an accelerator device and accelerated and guided to the target volume.
  • the accelerator device comprises in particular a circular accelerator such as a
  • Cyclotron or synchrotron a linear accelerator or a combination thereof.
  • ion beam is used in particular
  • Proton beam or a beam of heavier ions e.g. Understood oxygen or carbon.
  • ions e.g. Understood oxygen or carbon.
  • the irradiation of the target volume is subdivided in time into at least one radiographic phase and at least one deposition phase in order to reduce the energy of the target volume
  • Ion beam, i. one and the same ion beam, between the at least one radiographic phase and the at least one deposition phase is to vary in time and in such a way that
  • the Range of the ion beam distal to the target volume in the beam direction behind the target volume, so that in the at least one radiographic phase, the ion beam penetrates or transilluminates the target volume to use the ion beam an ionic radiogram of the target volume
  • Ion beam is detected with a distal of the target volume arranged Ionenradiographiedetektor and
  • the range of the ion beam is within the target volume, so that the ion beam in the target volume
  • Target volume can be detected, but the radiography and the deposition are carried out with one and the same ion beam, but with different energy and time consecutive.
  • the radiography phase the
  • the beam range is adjusted so that the Bragg maximum distal to the patient, more precisely in the
  • Ionenradiographiedetektor lies to the position of the Bragg maximum by means of energy and spatially resolving
  • the energy of the ion beam is in the Ionenradiographiedetektor.
  • Radiography phase to a higher radiographic energy and during the deposition phase to a lower
  • Radiography phase and the deposition phase therefore consists in switching the energy of the ion beam.
  • a carbon ion beam is generated, which at an energy E 'in the range of 600 MeV / u, the target volume substantially completely penetrates and with this energy E' for radiography and with a
  • both the dose deposition and the one with the same ion beam are reduced to an energy E in the range of 250 MeV / u for dose reduction according to the treatment plan.
  • Beam range is changed only by a few millimeters and which, if necessary, additionally performed.
  • ion radiography are set independently, in particular the lateral coverage of the
  • Target volume in a scanning process
  • Ion energy whose influence can be calculated very accurately. Furthermore, a lower dose is to be expected compared to conventional fluoroscopy. In an advantageous manner, the method can nevertheless be carried out without major modifications of the accelerator device. Particularly simple is e.g. the
  • Accelerator device is set to the higher radiographic energy and then by means of a passive
  • Deposition phases of the higher radiographic energy to the lower deposition energy is reduced by the ion beam is decelerated in the energy modulator.
  • the energy of the ion beam can easily be varied fast enough to alternately irradiate the tumor (deposition) and perform the radiography, and in real time in response to the Controlling the target volume to be able to intervene in the irradiation.
  • a digital, eg a rotating pie-shaped energy modulator is irradiated proximal to the target volume (in the beam direction in front of the target volume) in which a piece of cake is missing in order to reduce the energy and thus the range of the beam between a target
  • Pie slice remains the energy of the ion beam
  • Wedge systems for actively tracking the beam range to the movement of the target volume during beam tracking which may be additionally present.
  • the energy may be varied by binary modulator plates, such as e.g. in "The PSI Gantry 2: A Second Generation Proton Scanning Gantry” by Eros Pedroni et al., Z. Med. Phys. 14 (2004), 25-34, or by a variation of the settings on the Fiat top at Synchrotron -based acceleration, such as in "Update of an Accelerator Control System for the New Treatment.”
  • Accelerator device passive modulator
  • Cyc-LINAC the end of the acceleration
  • the ionic radiography detector is accordingly an energy-resolving detector, which measures the (residual) energy of the ion beam after passing through the target volume.
  • the energy loss caused by the penetration of the target volume can be calculated and, in turn, the effect of the movement of the target volume on the deposition can be determined.
  • one and the same ion beam is used for the deposition and the ionic radiography in the sense that the ion type and the charge are identical and only the energy is different.
  • one and the same ion beam is used, whose
  • Energy is consecutively varied in time, but not simultaneously two different ion beams.
  • the ionic radiography and the deposition are temporally successive and in the context of this
  • the irradiation of the target volume in time into a plurality of radiographic phases and a plurality of
  • the range of the ion beam is distal to the target volume, so that in the radiographic phases, the ion beam penetrates or transilluminates the target volume and by means of the ion beam ion radiographs of the target volume are recorded by the ion beam with a distal of the target volume
  • the range of the ion beam in the target volume is such that the ion beam in the target volume is stopped to deposit a predetermined dose in the target volume, respectively.
  • Radiography phases are adapted to the movement phases of the target volume. Alternatively or additionally, the time sequence of the radiographic phases to the
  • Irradiation of isoenergy layers to be adjusted when the target volume is divided into isoenergy layers which are successively irradiated.
  • Isoenergy slaughter the target volume can be approached with the ion beam to deposit a predetermined dose in each of the isoenergy layers, e.g. at least before radiation for dose deposition everyone
  • the intensity of the ion beam in the at least one or the plurality of deposition phases is set considerably higher than in the at least one or the plurality of radiographic phases, which can also be controlled in real time. This can be in
  • the dose burden of the patient are kept low.
  • the target volume is a target volume cycling during the irradiation, e.g. a lung tumor during respiration, is the cyclic movement of the
  • Target volume divided into several phases of movement it is advantageous to choose the duration of the at least one radiography phase or the plurality of radiographic phases no longer than the duration of the movement phases. Then, if desired, in - preferably at the beginning - everyone
  • Movement phase carried out an ion-radiography measurement.
  • steps i) and ii) performed in the same movement phase or the radiographic phase and
  • Deposition phase are at least partially in the same phase of movement.
  • the active tracking of the ion beam i. the beam tracking is controlled in response to the ion radiographic measurement performed by the ionic radiography detector.
  • This control of the active tracking of the ion beam (beam tracking) in response to the radiographic measurement can also be performed in real time.
  • Deposition phase are controlled independently.
  • the ion beam in the radiographic phase independently of the deposition, can be controlled via the lateral extent of the target volume.
  • the Ionenradiographiedetektor is designed as a spatially resolving detector, so that in the at least one or
  • a plurality of radiographic phases a laterally two-dimensionally spatially resolved ionic radiogram, preferably at least of Internal target volume (ITV, according to ICRU 62) is captured by passing through a plurality of halftone dots of the target volume and the range of the ion beam after passing through the target volume for each of the halftone dots in the target volume
  • ITV Internal target volume
  • Ion radiograph is determined to be at least one
  • This map of the range of the ion beam may e.g. as monitoring or
  • Deposition phase can be used.
  • Target volume in the ionic radiogram advantageously allows a particularly precise and reliable tracking of the movement of the target volume.
  • the irradiation procedure uses a scanning method, e.g. is a raster scanning method
  • the ion beam is referred to as a so-called pencil beam (pencil beam) in the at least one deposition phase or the plurality of
  • Radiographic phase or the plurality of radiographic phases at least over a part of the lateral surface of the
  • the target volume is the target volume.
  • a lateral two-dimensional ionic radiogram can hereby be recorded despite the use of a fine pencil beam. Furthermore, it is advantageous that the wobble for radiography measurement can be performed independently of the scanning during the deposition. This is particularly advantageous since
  • Range losses - if desired - can be precalculated finer than on grid point basis of the deposition. This has e.g. for the sweep, where the beam is driven quickly over a larger range, the advantage that more or even all positions can be compared directly, without to nominal grid positions
  • the ion beam is scanned over the clinical target volume (so-called Clinical Target Volume, CTV according to ICRU 50). Is preferred in the
  • the ion beam at least over a part of the lateral area of the internal target volume (ITV, according to ICRU 62) that goes beyond the clinical target volume.
  • This sweep of the entire internal target volume can be done in a time interval between 1 ms and 1000 ms, for example in the range of 10 ms,
  • Target volume can be included.
  • Target volume especially if at least the internal target volume (ITV) is covered, that is the clinical
  • Target volume maps in all states of motion, the entire amplitude of movement of the target volume can be covered in an advantageous manner.
  • Range of the ion beam to calculate.
  • Range Map of the range of the ion beam to create during the irradiation in the
  • Radiographic phase then becomes the actual range of the ion beam after penetrating the target volume
  • a multidimensional ionic radii created with the respective actual ranges of the ion beam and the ionic radii is compared with the simulated setpoint map.
  • Simulating calculation can be made in an advantageous manner, a balance between the movement of the target volume and the movement of the ion beam, in which potentially not only parameters with respect to the movement and range change can be acquired, but also on the interference between the two, in particular the Interplay or Template.
  • Invention is provided with a corresponding internal or external motion measuring system (sometimes referred to as
  • Motion sensor measures the movement of the target volume or a movement surrogate. According to the invention, the measurement results with the means of
  • Ionic radiography detector automatically recorded, e.g. linked by an appropriately programmed microcomputer and the irradiation is in
  • the target volume in the at least one or the plurality of radiographic phases can be irradiated from more than one direction and at least one spatially more than two-dimensional ionic radiogram ("second SD detection") is recorded This is advantageous for irradiation sites which more than Here, it is possible to record radiograms from more than one direction, thus enabling 2.5D detection, and a gantry also has a "RapicArc" analogue
  • the collected data should be evaluated in terms of expectation in real time, using the methods known from fluoroscopy, i. E. among other things, a comparison between measurement and digital
  • DRRM Reconstructed Range Map
  • Exceeding predetermined limits e.g. when comparing between range simulation and energy loss measurement, generates an interlock signal, by means of which the
  • the invention is not limited to pure motion monitoring, but also a verification of the DRRMs obtained is possible, so that e.g. in the event of excessive deviations, the irradiation may be interrupted and possibly even rescheduled.
  • the irradiation may be interrupted and possibly even rescheduled.
  • Ionradiographiedetektor which measures ion energy and thus directly with the particle range a dose-relevant factor is detected directly (in contrast to the methods that capture only substitute quantities).
  • markers gold balls, carbon spheres, etc.
  • the invention is also in inter-fractionally moving or static head-neck
  • an irradiation system for irradiating a moving target volume with an ion beam, with which the method described above can be carried out.
  • irradiation facility includes the irradiation facility:
  • an accelerator and beam guiding device for generating and accelerating an ion beam and for guiding and directing the ion beam onto the
  • control device for controlling the irradiation system
  • Radiographic phase and at least one deposition phase in particular in addition to the range change for the dose deposition in different Isoenergiesayer, by means of which means
  • Radiography energy is set at which the
  • the energy of the ion beam to a lower
  • Deposition energy is set at which the
  • Range is within the target volume and the
  • Ionradiography detector for picking up
  • the device switches to temporal
  • the energy of the ion beam in particular during the irradiation or in a radiation break - and in addition to the range change for starting the isoenergy layers in the deposition phase - in a cyclic sequence of a plurality of radiographic phases and a plurality of deposition phases, the energy of
  • Ion beam alternately between the radiographic energy and the deposition energy back and forth.
  • the ionic radiography detector has a temporal resolution sufficient to be present in each
  • Radiography phase to generate a new radiogram to possibly control the irradiation in real time.
  • the control device preferably controls the irradiation system such that in the deposition phases
  • Ion radiography detector is performed.
  • a passive energy modulator is used, wherein the ion beam is first generated by the accelerator device with the radiographic energy and in the deposition phase by deceleration in the material of
  • the passive energy modulator is, for example, a round disc with a pie-shaped section and rotates in the ion beam, so that the ion beam cyclically alternately penetrates the material of the disc and is thereby slowed down to the deposition energy
  • control means controls the
  • Irradiation plant such that the intensity of the ion beam at the deposition in the target volume is higher than in the radiography measurement to keep the additional radiation exposure due to the radiography measurement for the patient low.
  • Rotation speed is preferably adapted to the duration of the movement phases so that the duration of the
  • Radiographic phases is shorter than the duration of the
  • the control device is preferably hereby operatively connected to the beam
  • the ionic radiography detector is preferably an energy and location-resolving detector which receives an energy and laterally two-dimensionally spatially resolved ionic radiogram of at least parts of the internal target volume (ITV). A computing device then determines the ITV.
  • Target volume for each of the grid points and creates a two-dimensional map of the range of the ion beam after penetrating the target volume.
  • the preferably included scanning device for scanning the ion pencil beam (diameter typically a few millimeters) is controlled by the controller so that the ion beam for dose deposition two- or
  • the controller controls the scanning device (with or without separate wobbling magnets) e.g. such that the ion beam is scanned at the dose position over the target clinical volume (CTV, ICRU 50) and at
  • Target volume (ITV, ICRU 62).
  • the range simulation calculation described above is typically performed by a suitably programmed microcomputer, which also performs the comparison with the ranges actually determined and subsequently generates, preferably in real time, control signals to which e.g. the irradiation is adapted or interrupted.
  • control signals e.g. the irradiation is adapted or interrupted.
  • the control device records the measurement results of the motion measurement system and the ionic radiograms of the ionic radiography detector, automatically combines the measurement results and the ionic radiograms, and controls
  • the controller controls the change between the radiographic phases and the deposition phases in response to the measurement results of the
  • the irradiation system has a plurality of jet pipes and / or a rotatable gantry, with which the target volume can be irradiated from more than one direction to a locally more than two-dimensional
  • the method and the irradiation system according to the invention are in particular designed for tumor therapy. But they can also be used to irradiate a target volume that is not human or
  • animal body belongs.
  • Fig. 1 is a schematic representation of the irradiation
  • Fig. 2 is a schematic representation of the irradiation
  • Fig. 3 is a schematic representation of a
  • Fig. 4 is a schematic representation of a
  • Fig. 5 is a schematic representation of a
  • Fig. 6 is a schematic representation of a
  • Irradiation unit with scanned ion beam and an energy modulator according to another
  • Fig. 7 is a schematic representation of a
  • Fig. 8 is a schematic representation of the irradiation of a target volume combined with a
  • FIG. 10 shows a schematic representation of an irradiation of a target volume with rotating gantry
  • Fig. 13 is a representation of the radiographic phases
  • Fig. 15 is a flowchart of a real time evaluation with
  • DRRM according to an embodiment of the invention 16 is a flowchart of a combination of
  • FIG. 1 shows a tumor as a clinical target volume 12 (CTV) according to ICRU 50 in a reference movement phase 12a.
  • the tumor 12 moves within an envelope within which the motion states 12a, 12b, 12c and 12d are mapped by way of example.
  • the envelope forms the internal target volume 14 (ITV) according to ICRU 62.
  • ionic radiography detector 20 information about
  • Fig. 2 shows the irradiation of the target clinical volume 12 with a scanned ion beam 18.
  • Radiographic measurement with the ionic radiography detector 20 To obtain information about the range distribution in the entire internal target volume 14, the ion beam is hereby swept over the entire internal target volume 14, which is schematically represented by the dotted arrows 18
  • the wobble is the fine
  • Pencil beam is moved rapidly over the lateral extent of the entire internal target volume 14, which is shown in FIG. 2 only one dimension is shown because the second lateral dimension is perpendicular to the plane of the drawing.
  • the measured range distribution is e.g. compared with a Digitally Reconstructed Range Map (DRRM).
  • DRRM Digitally Reconstructed Range Map
  • Radiographic beam which is irradiated from its specific direction at a certain position with a certain energy through a CT (or a phase of a 4D CT) stored for a plurality of beams.
  • a CT or a phase of a 4D CT
  • the measured values of the radiography measurement are compared with the DRRM. This is used e.g. the
  • Verified or independent determination of the movement phase is made in response to the Radiographietician.
  • FIG. 3 shows a known irradiation system 1 with an accelerator device 22 comprising a cyclotron 24 and a beam guiding device 26.
  • the ion beam 16 is scattered with a scattering system 28. Then the range is with a
  • Range modulator 30 (rank modulator) and a
  • Range slider 32 (ranked shifter) widened. Subsequently, the scattered ion beam 16 is collimated with a collimator 34 to the extent of the internal target volume. The dose field is adjusted by means of a compensator 36 to the distal contour of the target volume. The originally fine ion beam 16, as he from the
  • Accelerator 22 is emitted is by the scattering system and various subsequent passive
  • Beam shaping devices adapted to the target volume. It is a completely passive one
  • Fig. 4 shows a known irradiation apparatus 1 with an intensity-controlled magnetic scanning system, as e.g. is used at the GSI in Darmstadt.
  • the intensity-controlled magnetic scanning system as e.g. is used at the GSI in Darmstadt.
  • Accelerator device 22 in this example comprises a synchrotron 24 'and a beam guiding device 26, which guides the ion beam into the irradiation chamber (not shown) in order to supply the target volume 12 there
  • the fine ion beam 18 also referred to as Pencil Beam
  • the fine ion beam 18 is scanned over the lateral extent of the target volume by a scanning device 38, which comprises fast scanning magnets 38a, 38b for scanning the ion beam 18 in the X and Y directions.
  • the Bragg peak is scanned over a plurality of isoenergy layers 13a to 13i.
  • the ion beam 18 is, for example, an 80 to 430 MeV / u 12 C ion beam.
  • the corresponding beam parameters of the ion beam 18 are controlled by the synchrotron control system 40 and pulsed from the synchrotron 24 '. Typically, these isoenergy layers
  • Target volume 12 is first prepared in a preparatory phase, the so-called radiation planning, in which an irradiation plan is calculated and determined, which is stored in the therapy control system 42.
  • the therapy control system 42 is alternate
  • Scanning device 38 to control the respective grid point for dose deposition. Furthermore, the beam position is monitored with a beam position monitor 46 and transmitted to the therapy control system 42.
  • an irradiation system with scanning system 38 according to FIG. 4 is shown, wherein, according to the invention, a pie-shaped energy modulator 48 proximal to the target volume or proximal of the target volume, respectively
  • Beam position monitor 46 is arranged. In this case
  • Example is the energy modulator 48 distal to the
  • Scanning device 38 is arranged.
  • the actual irradiation of the target volume 12, i. the dose deposition is with a therapy energy or deposition energy E
  • Energy modulator 48 rotates to define the timing of deposition phases and radiographic phases. In the times when the energy modulator is irradiated, namely in the massive region 48a in which the modulation material is located, the energy modulator 48 modulates the ion beam energy of the
  • the radiographic energy E ' E + dE arrives.
  • the radiographic energy E 'or the energy loss dE is selected to be sufficiently large so that the target volume and, in the case of therapeutic irradiation, the entire patient is completely penetrated by the ion beam, which is represented by the dashed line 52.
  • Target volume 12 is arranged and has a size which should cover at least the entire internal target volume, spatially resolved, the energy loss in the target volume 12 and measured in the patient. Consequently, in this radiographic phase with the radiographic energy E 'becomes a
  • Ion radiography measurement performed with the ionic radiography detector 20 For example, the
  • the location and energy resolving ionic radiography detector 20 in this example comprises a stack of up to 61 parallel ionization chambers between each
  • Absorber plates made of PMMA are used.
  • the thickness of the absorber plates is chosen between 0.5 mm and 5 mm depending on the requirements.
  • the ionic radiography detector 20 may further comprise a fixed or variable pre-absorber which increases the water equivalent reach by 90 mm reduces to 90 mm.
  • Ion radiography detector 20 is, for example
  • 300 x 300 mm 2 in order to provide at least one measuring field of 200 x 200 mm 2 for the ion beam 18.
  • the energy modulator 48 is in operative connection with the control device 39 of the irradiation system 1
  • Control energy modulator 48 and / or the energy modulator 48 provides feedback on its respective
  • Energymodulators 48 defined radiographic phases and deposition phases time to synchronize or synchronize.
  • the irradiation system 1 additionally comprises a known motion measuring system 54, which has a
  • Information about the movement of the target volume 12 to the controller 39 is transmitted.
  • This can be a direct motion information with an internal motion measurement system or a surrogate information with an external motion
  • the energy modulator is designed as a binary energy modulator plate 48 ', which defines the reduction of the beam energy from the radiographic energy to the deposition energy by moving the energy modulator plate 48' in and out of the beam path of the ion beam 18.
  • the Radiography spot can By driving in the energy modulator plate 48 ', the radiographic energy E' delivered by the accelerator device is reduced by dE to the deposition energy E to irradiate the target volume 12 so as to deposit the dose set in the irradiation plan which is represented by the solid line 50 in FIG. 6, the fourth isoenergy layer 13d seen from the distal side being irradiated here by way of example. Since, in this example, the energy modulator 48 'is located proximal to the scanner 38, the
  • Energy modulator 48 arranged magnets of the beam guide to be readjusted. This can be done in real time with correspondingly fast magnet systems, controlled by the
  • Control device 39 can be realized.
  • the positioning of the energy modulator in front of the scanner 38 has the advantage of a lower patient burden
  • Scanning device or before the patient, as shown in Fig. 5, has the advantage that to a corresponding readjustment of the scanning device 38 and others
  • Beam guide elements can be dispensed with.
  • FIG. 7 shows another embodiment in which the energy variation between the radiographic energy and the deposition energy is performed by the accelerator device 22.
  • the accelerator device 22 e.g. a cyclotron 24 with a downstream linear accelerator 58.
  • the structure is substantially the same as that in FIGS. 5 and 6.
  • the passive energy modulators 48, 48 'used in FIGS. 5 and 6 the
  • downstream linear accelerator 58 can be accomplished.
  • one or more the accelerator cavities 58a to 58g turned off to reduce the energy of the ion beam from the radiographic energy to the deposition energy.
  • the Cyc-LINAC can be used, which is described in the review article cited above by Ugo Amaldi et al.
  • FIG. 8 shows the combination of the movement measuring system 54 with the radiographic measurement by means of the
  • Radiography detector 20 according to the present invention.
  • the known motion measuring system 54 transmits the data on the movement of the target volume to the
  • Control device 39 In the radiographic phase, the ionic radiography detector 20 records ionic ionograms of the target volume (and of the surrounding tissue) by means of the ion beam 18 which radiates the target volume 12 or the patient 15. The controller 39 compares the ionic radiography measurements 60 with the measurements of the
  • Motion measuring system 54 which e.g. may be a surrogate in the form of a stereo camera image of the patient's breast. With the movement measuring system 54 can first in itself
  • the movement phase of the patient to be determined.
  • the controller 39 determines that the determined by means of the Abstractsmesssystems 54
  • the ion beam 18 is irradiated from at least two different directions, ionic radiograms stand out
  • the beam application 62 can be selectively controlled with the respective ionic radiogram.
  • FIG. 10 shows an exemplary embodiment with a rotating gantry, wherein the rotation of the beam application 62 is symbolized by the arrow 64.
  • the Ionenradiographiedetektor 20 is opposite to the beam application also with the gantry (not shown) co-rotated, which is symbolized by the arrow 66.
  • the gantry not shown
  • Beam exit and the Ionenradiographiedetektor 20 are rotated during the radiographic irradiation to the patient, so that 3D-Ionenradiogramme can be created similar to an X-ray CT, but here in addition to that inherent to the ionic radiogram
  • FIG 11 shows an exemplary embodiment of a time sequence of the radiographic phases and deposition phases.
  • the uppermost graph 72 shows the energy of the ion beam radiating between radiographic phases 74
  • Radiography energy and deposition phases 76 with
  • the intensity 78 of the ion beam is controlled, i. that in the radiographic phases 74 a lower intensity of the ion beam is applied than in the deposition phases 76. Therefore, the
  • Radiation exposure in the inventive method advantageously relatively low.
  • the factor by which the ion beam intensity in the radiographic phase can be reduced compared to the deposition phase depends e.g. from the speed of the wobble magnets and the
  • Ionradiography detector 20 operate, the greater the intensity reduction can be usually selected.
  • Deposition phases tuned to the scanning of the target volume 12 with the scanning device 38 for deposition For example, the change takes place from the deposition phase 76 in FIG the radiographic phase 74 after a predetermined number of irradiated halftone dots, eg after 100 halftone dots.
  • the duration of the deposition phase 76 corresponds to the period of irradiation of 100 halftone dots.
  • the duration of the radiographic phases 74 is chosen to be significantly shorter than the duration of the deposition phases 76.
  • the example shown relates to a
  • Irradiation plant 1 with a synchrotron 24 ' As is known to those skilled in the art, the ion beam is discontinuously extracted from a synchrotron in so-called spills, the spills being labeled 80 and the spill pauses 82.
  • the movement of the target volume 12 is in eleven
  • dashed line 84 at which a new
  • a movement cycle typically takes in the region of 5 seconds.
  • Fig. 12 indicates an alternative cycle
  • Radiographic phases 74 and deposition phases 76 wherein the radiographic deposition cycle is adapted to the movement phases 12a to 12k, or with the movement phases
  • the change from a deposition phase 76 into a radiographic phase 74 takes place at the same time as the change from one movement phase to the next.
  • the cycle of radiographic phases and deposition phases is triggered by the measurement of the motion measuring system 54, to the extent that the change from the deposition phase 76 to the radiographic phase 74 occurs when the
  • Motion measuring system 54 the change to the next
  • Motion phase detected This has the advantage that a separate radiographic measurement is carried out for each movement phase. In this example, therefore
  • Cycle of radiographic phases and deposition phases synchronized with the cycle of motion phases. Referring to FIGS. 5 to 7, the synchronization is performed by the controller 39.
  • the cycle may be off
  • Fig. 14 shows a flow chart for irradiation in the context of the present invention with radiographic phases
  • radiotherapy is prepared, which includes diagnosis, imaging, and 4D radiation planning, etc.
  • the radiographic parameters are determined, comprising the radiographic energy E ', the beam intensity 78 in the radiographic phases 74 and / or the field size for the radiographic measurement and / or frequency as well as the time or cycle of the radiographic measurements.
  • a DRRM is calculated, eg by
  • Step 204a defines a deposition phase 76 with the lower deposition energy E and higher
  • a deposition phase 76 may comprise the irradiation of a plurality of halftone dots.
  • the parameters of the irradiation facility 1 are adapted for the subsequent radiographic measurement. This includes in particular the variation of the beam energy 72 from the deposition energy E to the radiographic energy E ', e.g. with the energy modulator 48, 48 'and possibly the
  • step 204c the radiographic measurement is performed, eg, by sweeping the entire internal target volume 14 (ITV) by wobbling with the ion beam 18.
  • the scanner magnets 38a, 38b are controlled accordingly by the control device 39.
  • the irradiation is interrupted if necessary in step 205. It may even be followed by a new treatment planning. If the radiography measurement within predetermined
  • step 204d if necessary - the irradiation can be adapted.
  • step 204b the irradiation system is switched back to the deposition energy E, e.g. by
  • the radiography measurement is used as a control parameter within the control loop 204a to 204d.
  • the irradiation is also ended in step 205.
  • FIG. 15 shows a flow chart for combining the
  • step 301 the radiography measurement is performed with the
  • Ion radiography detector 20 performed.
  • step 302 simultaneously and independently thereof, the movement of the target volume by means of the
  • Motion detection system 54 e.g. in form of a
  • step 303 the controller 39 compares the ion-radiographic measurement with the expectation of FIG
  • step 304 the irradiation of the target volume then takes place in a deposition phase 76 when continuing. Otherwise, the method sequence corresponds to that in FIG. 14.
  • 16 shows a flow chart of a real time evaluation with DRRM.
  • step 401 for each 4DCT phase, a DRRM
  • step 403 a radiography measurement in a
  • Radiography phase 74 performed.
  • step 404 for example by means of the control device 39, the result of the radiographic measurement from step 403 is compared with the expectation from the precalculated DRRM 402. Depending on the result of this comparison 404, if necessary, the irradiation is adapted in step 405 or

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

Abstract

La présente invention concerne un procédé et une installation d'irradiation pour irradier un volume cible en mouvement à l'aide d'un faisceau ionique, en particulier dans la thérapie tumorale. Des mesures du volume cible sont réalisées par radiographie à ionisation, et l'irradiation en vue de la formation d'un dépôt et celle en vue de la radiographie sont effectuées avec le même faisceau ionique, mais de manière consécutive dans le temps, en faisant varier l'énergie du faisceau ionique entre une énergie supérieure pour la radiographie et une énergie inférieure pour la formation d'un dépôt, par exemple au moyen d'un modulateur d'énergie passif situé à proximité du patient.
EP13709358.9A 2012-03-05 2013-03-05 Procédé et installation d'irradiation d'un volume cible Withdrawn EP2822651A1 (fr)

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DE102012004170A DE102012004170B4 (de) 2012-03-05 2012-03-05 Verfahren und Bestrahlungsanlage zur Bestrahlung eines Zielvolumens
PCT/EP2013/054361 WO2013131890A1 (fr) 2012-03-05 2013-03-05 Procédé et installation d'irradiation d'un volume cible

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CN104540547A (zh) 2015-04-22
CN104540547B (zh) 2017-08-11
EP3342463A1 (fr) 2018-07-04
JP2018079341A (ja) 2018-05-24
DE102012004170A1 (de) 2013-09-05
US9486649B2 (en) 2016-11-08
US20150217139A1 (en) 2015-08-06
DE102012004170B4 (de) 2013-11-07
JP6392125B2 (ja) 2018-09-19
WO2013131890A1 (fr) 2013-09-12
JP2015510781A (ja) 2015-04-13
EP3342463B1 (fr) 2019-09-25

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