ES1165083U - Device for the positioning of patients in radiotherapy treatments (Machine-translation by Google Translate, not legally binding) - Google Patents

Abstract

Device for positioning patients in radiotherapy treatments, said device (1) characterized in that it comprises a positioning arm (2) capable of varying its distance (D) with respect to a support base (3) configured to receive a patient (P), wherein said positioning arm (2) has at least one contact sensor (4) that allows generating one or more control signals (S1, S2, S3) upon contact with a patient (P) disposed between the support base (3) and the positioning arm (2), and keep said said or said control signals (S1, S2, S3) activated while in contact with the patient (P). (Machine-translation by Google Translate, not legally binding)

Description

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DEVICE FOR THE POSITIONING OF PATIENTS IN TREATMENTS

OF RADIOTHERAPY

DESCRIPTION

Field of the Invention The present invention relates to a device for positioning patients in radiotherapy treatments in general, and especially in those in which the patient must be irradiated in a deeply inspired position maintained and maintain said position during the process of irradiation, such as treatment of left breast cancer or treatment of supra-diaphragmatic Hodgkin lymphoma, among others.

Background of the invention Cardiotoxicity induced by radiotherapy treatments, and especially for the treatment of left breast cancer, is well documented. The risk begins a few years after radiotherapy treatment and continues for decades. The most recent data [Sara C. Darby et al: Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer. N Engl J Med 2013; 368: 987-98] suggest that the incidence of severe coronary toxicity increases linearly 7.4% per Gray of average cardiac dose, with no apparent dose threshold below which no toxicity is detected.

The implementation of radiotherapy techniques that reduce the doses the heart receives is very important. Although the doses received by the lung and the contralateral breast should not be ignored because the follow-up of the patients demonstrates a risk of induction of pulmonary fibrosis and of lung and contralateral breast cancer.

In radiotherapy treatments, in which the patient must be irradiated in the position of Deep Inspired Maintenance (DIBHI), the thoracic cavity expands and the anterior wall of the thorax moves in the antero-lateral direction. In addition, the diaphragm contracts and consequently, the heart moves posteriorly and towards the diaphragm. These changes in the position of the organs increase the distance between the heart and the irradiated planning volume, a fact that reduces the dose that the heart receives.

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All radiotherapy techniques that use breathing control to reduce toxicity in the heart are based on these arguments, since they do not affect the treatment at all, provided that it can be reproducible. In this way they help reduce toxicity to the heart.

To control breathing, patients are trained to perform deep inspirations, as well as maintaining them for about 30 seconds. The process is usually repeated between 3 and 6 times per visit. Currently, to ensure that the patient has the right degree of inspiration at the time of irradiation, there are, among others, infrared emission and detection devices. These devices are positioned on the patient and synchronized with the electron accelerator to emit radiation only when the patient is in the correct position, previously defined by software provided by the equipment manufacturer. For the correct operation of these devices, it is necessary to make a customized adjustment of the position of the infrared reflector for each patient, so that it is correctly synchronized with the electron accelerator.

The problem with this type of device, as well as with others based on spirometers or surface tracking systems, is its high price, in addition to the need to have to perform daily calibrations and periodic quality controls. So these solutions are often not available to most centers.

The present invention consists of a simple and economical device that allows to reproduce daily and reliably the positioning of the patient and the deep inspiration maintained. Being its purpose that the irradiation is directed exclusively to the target volume, preventing other risk organs from being damaged by said radiation, and therefore minimizing the cardiotoxicity induced in radiotherapy treatments.

Furthermore, the device of the present invention speeds up the radiotherapy treatment. image4 as for the patients, resulting easier to adjust on the patient, offering a contact and visual reference of the amplitude of the forced inspiration maintained, allowing to quickly detect those situations in which the patient does not present a position and a forced inspiration maintained adequate , as well as stop irradiation at the moment that happens.

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Description of the invention The device for positioning patients in radiotherapy treatments of the present invention comprises a positioning arm capable of varying its distance from a support base configured to receive a patient. In turn, said positioning arm has at least one contact sensor that allows one or more control signals to be generated when coming into contact with a patient disposed between the support base and the positioning arm, and keeping said or said signals activated. control while in contact with the patient.

The control signals are mainly light, acoustic and / or electric, controlled by an electrical circuit associated with the contact sensor. They preferably serve to notify and / or inform both staff and the patient about whether the deep inspiration maintained is being carried out correctly or not. Specifically, a correct inspiration occurs when the patient's chest is in contact with the sensor during the time set by the specialist, having previously adjusted the positioning arm with the patient arranged on the support base (stretcher, treatment table , etc.). According to the preferred mode of operation, once the patient reaches the correct position, the device begins to emit a light signal and an acoustic signal, which serve as a reference to the patient and the radiation therapy technical staff to know that it is in the position correct. These signals remain activated while the sensor detects contact with the patient. Each time such contact is lost, the device stops emitting the signals so that the patient corrects his position, and / or for the expert to act as he sees fit. However, there are many other options to carry out this mode of operation, for example, in the opposite way to the case described, combining the signals differently, using different colors and / or

sound tones as a reference for each of the positions, etc.

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Also, the signals can also be used, independently or in combination, to activate / deactivate other complementary safety devices.

Among the different contact sensors that can be used in the device of the present invention, preferably an elongated and thin configuration force sensor is used, as a strip, capable of adhering to the lower face of the positioning arm by means of adhesive means. However, it is also possible to use end-of-stroke contact sensors conveniently arranged in said positioning arm.

Also, in order not to interfere with the radiotherapy treatment, most of the components of the device, and especially all those that can interfere with the radiation field, are made with radiolucent materials, such as; carbon fiber, fiberglass, quartz, or other radiolucent equivalents.

According to a preferred embodiment, the positioning arm comprises:

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a fixed bar attachable to the support base; Y

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a mobile bar on which the contact sensor is arranged, attached to the fixed bar and configured to move along it maintaining a parallel position with respect to the support base.

Preferably, the positioning arm has a "L" shaped configuration, where the fixed bar is arranged in a vertical position, while the mobile bar is arranged in a horizontal position at an angle of 90 ° with respect to the fixed bar and parallel to The support base.

To facilitate the movement of the mobile bar, it comprises a sliding carriage configured to move along a longitudinal rail arranged in the fixed bar. Said car allows at the same time to maintain the attachment of the mobile bar to the fixed bar, preventing them from separating from each other.

In turn, the positioning arm comprises a retention element that

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It allows to fix the vertical position of the mobile bar with respect to the fixed bar once the desired distance is reached. To facilitate the manipulation of the device, preferably, said retention element has a threaded pin with a knob at its end that facilitates its manipulation by hand, so that its threaded / unscrewed allows the mobile bar to be attached / released with respect to the fixed bar .

In order that the user of the device can know exactly the value of the distance of the positioning arm from the support base, the fixed bar comprises a graduated length scale arranged according to the direction of travel of the moving bar, and that allows you to choose the fixing point with a margin of less than 1 mm.

The device for positioning patients in radiotherapy treatments of the present invention allows operation based exclusively on the supervision of the expert, guided in turn by the light and / or acoustic control signals. However, as mentioned above, said device can work in conjunction with other complementary security systems or devices.

For this, the mobile bar comprises an auxiliary mechanism configured to couple an infrared reflector device synchronized with an electron accelerator. Preferably, said auxiliary mechanism comprises:

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a holding base configured to be attached to the mobile bar above the contact sensor, so as not to interpose between the patient's chest and said contact sensor;

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a positioning guide having an upper end attached to the infrared reflector device and a lower end; configured to move vertically with respect to the clamping base, so as to allow the lower end to be taken from a lower position below the contact sensor, to an upper position at the height of the contact sensor; Y

•

a guide groove configured to receive a guide pivot attached to the positioning guide, which allows to delimit the vertical movement of the positioning guide and prevent its rotation.

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On the other hand, it should be noted that the positioning arm can be directly coupled to a support base formed by a stretcher, treatment table, etc., or indirectly, through a support base integrated in the device itself and configured to engage on said treatment table or table. In any case, the support base must be made of materials that provide sufficient strength, preferably radiolucent, such as carbon fiber.

In any case, the positioning arm has the peculiarity that it is removable with respect to the support base. That is, it can be easily mounted on the support base and subsequently disassembled. In turn, the device is easily attachable to any type of treatment table or table. This is especially practical to significantly reduce the preparation time prior to the start of treatment. Specifically, once the device has been adjusted for a certain patient during the location session (simulation session), these settings can be reproduced in subsequent treatment sessions, without having to repeat the initial adjustment process. For this, during this location session, images are usually taken by computerized axial tomography (CT) to obtain the patient's anatomical record, and a tattoo is also performed to mark the horizontal position of the positioning arm. This tattoo is performed with the mobile bar in contact with the patient, on the cranial side and without inspiration. Subsequently, the value of the vertical distance of said arm with respect to the support base is recorded, with the patient in a position of deep inspiration maintained. In subsequent treatment sessions, technical personnel only have to follow these instructions to reproduce the exact position between the patient and the device.

Thus, it is necessary to establish a fixed relative position between the support base and the positioning arm. For this, the fixed bar comprises a coupling element that allows said fixed bar to be coupled over a fixed position of the support base, as well as allowing its subsequent decoupling. In turn, the support base comprises a receiving element that allows the coupling element to fit and its subsequent removal.

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To fix the support base on any type of treatment table or table, and subsequently be able to disassemble it, preferably the support base comprises an anchoring mechanism that can be easily manipulated without the use of tools. For this, the anchoring mechanism comprises:

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a first side stop located at a first end of the support base; Y

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a second lateral stop located at a second end of the support base, where said second lateral stop forms a cam configured to rotate with respect to a rotation axis by turning a handle integral thereto.

The rotation of the cam makes it possible to reduce or increase the horizontal distance between the first lateral stop and the second lateral stop, depending on the direction of rotation of the lever. So, turning the handle in one direction the stops approach to fix the support base to the treatment table or table, while in the opposite direction they move away to release it. This makes the use of the device compatible with treatment tables or tables of different widths.

BRIEF DESCRIPTION OF THE DRAWINGS A series of drawings that help to better understand the invention and that expressly relate to an embodiment of said invention which is presented as a non-limiting example thereof is described very briefly below.

Figure 1 represents a perspective view of the device of the present invention.

Figure 2 represents a first elevation view of Figure 1, with the positioning arm arranged in an upper position.

Figure 3 represents a second elevation view of Figure 1, with the positioning arm arranged in a lower position.

Figure 4 represents a partial bottom view of the mobile bar.

Figure 5 represents a sectional view along the line A-A of Figure 6.

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Figure 6 represents a plan view of Figure 5.

Figure 7 represents a rear view of Figure 2.

Figure 8 represents a sectional view along the line B-B of Figure 7.

Figures 9a and 9b show an example of application of the device of the present invention.

DETAILED DESCRIPTION OF THE INVENTION As can be seen in Figure 1, the device (1) of the present invention comprises a positioning arm (2) capable of varying its distance (D) from a support base (3) configured for receiving a patient (P), where said positioning arm (2) has at least one contact sensor (4), illustrated in Figures 2-4, which allows one or more control signals to be generated (S1, S2, S3) upon contact with a patient (P) disposed between the support base (3) and the positioning arm (2), and keeping said control signals (S1, S2, S3) activated while in contact with the patient (P).

According to the present example, the contact sensor (4) allows generating a light control signal (S1) through a light indicator (5) arranged in the device itself (1). Said indicator light (5) turns on or off depending on whether the patient's position (P) is correct or not. In turn, the contact sensor (4) also allows to generate an acoustic control signal (S2) through an acoustic indicator (6), which produces a sound when the patient's position (P) is correct. The acoustic indication (6) is also located in the device (1), to make it more compact, autonomous and functional. However, in other possible embodiments, said indicators (5, 6) may be separated from the device (1), forming part of a fixed installation of the treatment room, conveniently located to allow its correct visualization and / or perception, and receiving the signals (S1, S2, S3) wirelessly or by wiring from the device

(one).

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Also, the contact sensor (4) is configured to generate an electrical control signal (S3) through an electrical contact, located in this case in the control and / or power supply box (7) of the device (1) , and that can be integrated into an electrical control and / or power circuit. This electrical contact can be used in various ways, including; to enable / disable other devices and / or indicators,

or as an electrical safety interlock, etc.

According to the present example, the constructive configuration of the device (1) that allows the variation of the distance (D), is based on a positioning arm (2) made of carbon fiber, comprising:

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a fixed bar (21) attachable to the support base (3); Y

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a movable bar (22) in which the contact sensor (4) is arranged, attached to the fixed bar (21) and configured to move along it maintaining a parallel position with respect to the support base (3 ).

As can be seen, the positioning arm (2) has an inverted "L" shaped configuration, where the fixed bar (21) is arranged in an upright position, while the mobile bar (22) is arranged in a horizontal position forming An angle of 90º with respect to the fixed bar (21) and parallel to the support base (3).

The positioning arm (2) is removable with respect to the support base (3). That is, it can be easily mounted on the support base (3) and subsequently disassembled. For this, the fixed bar (21) comprises a coupling element

(28) which allows said fixed bar (21) to be coupled on a preset position (XYREF) of the support base (3), as well as allowing its subsequent decoupling. In turn, the support base (3) comprises a receiving element (31) that allows the coupling element (28) to fit and its subsequent removal. For the convenience of technical personnel, the coupling element (28) and the receiving element (31) are joined by screws or pins (29) that can be handled without tools.

According to the present example, the device (1) is adapted to work together with a complementary safety device. To do this, the bar image17 mobile (22) comprises an auxiliary mechanism (27) configured to

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Infrared reflector device (100) synchronized with the electron accelerator of the radiotherapy equipment to emit radiation only when the patient (P) is in the correct position.

Figures 2 and 3 show two elevational views with the positioning arm (2) arranged in different vertical positions, in order to show how its distance (D) varies with respect to the support base (3). In figure 2, the positioning arm (2) is located at a first distance (D1) further away from the support base (3), while in figure 3 it is located at a second distance (D2) closer to the same.

Figure 4 shows in more detail the arrangement of the contact sensor (4). According to the present example, an elongated and thin configuration force sensor is used, as a strip, capable of adhering to the lower face of the positioning arm (2) by adhesive means.

As can be seen in Figure 5, to facilitate the movement of the mobile bar (22), it comprises a sliding carriage (24) configured to move along a longitudinal rail (23) arranged in the fixed bar (21) . Said carriage (24) allows at the same time to maintain the fastening of the mobile bar (22) to the fixed bar (21), preventing them from separating from each other.

In turn, the positioning arm (2) comprises a retaining element (25) that allows to fix the position of the mobile bar (22) with respect to the fixed bar (21) once the desired distance (D) is reached. Said retaining element (25) has a threaded pin (251) with a knob (252) at its end, so that its threading / unscrewing joins / releases the movable bar (22) with respect to the fixed bar (21).

• a first side stop (33) located at a first end (3a) of the support base

As can be seen in figures 6 and 7, to fix the support base (3) on any type of treatment table or table (M), and subsequently disassemble it, the support base (3) comprises an anchoring mechanism (32) that can be easily manipulated without the use of tools. To do this, the anchoring mechanism (32) image19 understands:

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(3); Y

• a second lateral stop (34) located at a second end (3b) of the support base (3), where said second lateral stop (34) forms a cam (35) configured to rotate with respect to a rotation axis (Z34 ) by turning a handle (36) integral thereto.

The rotation of the cam (35) allows to reduce or increase the horizontal distance between the first lateral stop (33) and the second lateral stop (34), depending on the direction of rotation of the handle (36). So, turning the handle (36) in one direction the stops (33, 34) approach to fix the support base (3) to the treatment table or table (M), while in the opposite direction they move away to release it.

In order not to interfere with a possible electron accelerator or scanner (TAC), the handle

(36) comprises a push-button (37) that allows the lever (36) to be disengaged from the cam (35). In this way, once the support base (3) is fixed, the button (37) can be pressed so that the handle (36) turns freely with respect to the cam (35) leaving it collected within the area defined by the table or table of treatment (M), as shown in Figure 9b.

In order that the user of the device (1) can know exactly the value of the distance (D) of the positioning arm (2) with respect to the support base (3), the fixed bar (21) comprises a scale of graduated length (26) arranged according to the direction of travel of the mobile bar (22), which interacts with a pointer

(261) solidarity with it.

Figure 8 shows in greater detail the auxiliary mechanism (27) that allows the integration of the infrared reflector device (100). Said auxiliary mechanism

(27) includes:

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a support base (271) configured to be attached to the mobile bar (22) above the contact sensor (4), so as not to interpose between the patient's chest (P) and the contact sensor (4);

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a positioning guide (272) having an upper end (2721) attached to the infrared reflector device (100) and a lower end (2722); configured to move vertically with respect to the clamping base (271),

so as to allow the lower end (2722) to be brought from a lower position (YI) located below the contact sensor (4), to a higher position (YS) located at the height of the contact sensor (4); Y

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a guide groove (273) configured to receive a guide pivot (2723) attached to the positioning guide (272), which allows to delineate the vertical displacement of the positioning guide (272) and prevent its rotation.

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The auxiliary mechanism (27) is completed with a separator (274) that allows to limit the downward movement of the positioning guide (272), preventing the guide pivot (2723) from leaving the guide groove (273). Likewise, it is also possible to orient the reflectors (101), arranging them in the opposite direction to the position shown in Figure 7, after 180 ° rotation of the infrared reflector device

(100) in the cranio-caudal direction, and subsequent fixation thereof in the desired orientation.

The auxiliary mechanism (27) can be mounted symmetrically to the one shown in Figure 8. To do this, you just have to loosen the screw (275), completely remove the auxiliary mechanism (27), turn it 180º and mount it again on the bar mobile (22).

Figures 9a and 9b show the mode of operation of the device (1) of the present invention, which comprises the following steps: a) Place the support (3) on the treatment table (M), approximately halfway

patient back (P). b) Place the patient (P) lying on the treatment table (M). c) Fix the positioning arm (2) in inverted “L” arrangement and move

horizontally the entire device (1) until reaching the patient's mark / tattoo. d) Fix the device (1) to the table (M) using the anchoring mechanism (32). e) Position the mobile bar (22) at the height indicated for the patient in question (the height

noted after completion of the adjustment process in the previous session), using the graduated length scale (26) provided on the fixed bar (21). f) Fix the movable bar (22) to the fixed bar (21) at the indicated height, rotating the retention element (25). g) Electrically connect the device (1).

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h) Activate the indicator light (5) and the acoustic indicator (6) by means of a switch located in the control and / or power supply box (7).

i) Place the infrared reflector device (100) to the mobile bar (22), using the auxiliary mechanism (27).

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Claims (15)

image 1 1. Device for positioning patients in radiotherapy treatments, said device (1) characterized in that it comprises a positioning arm (2) capable of varying its distance (D) from a support base (3) configured to receive a patient (P), where said positioning arm (2) has at least one contact sensor (4) that allows generating one or more control signals (S1, S2, S3) when coming into contact with a patient (P) disposed between the support base (3) and the positioning arm (2), and keeping said or said control signals activated (S1, S2, S3) while in contact with the patient (P). 2. Device according to claim 1, characterized in that the contact sensor (4) allows generating a light control signal (S1) through a light indicator (5).

3.

Device according to any of claims 1 to 2, characterized in that the contact sensor (4) allows to generate an acoustic control signal (S2) through an acoustic indicator (6).

Four.

Device according to any of claims 1 to 3, characterized in that the contact sensor (4) is configured to generate an electrical control signal (S3) through an electrical contact.

5.

Device according to any of claims 1 to 4, characterized in that the contact sensor (4) is a force sensor.

6.

Device according to any one of claims 1 to 5, characterized in that the positioning arm (2) is made of radiolucent material.

7.

Device according to any one of claims 1 to 6, characterized in that the positioning arm (2) comprises:

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a fixed bar (21) attachable to the support base (3); Y

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a mobile bar (22) on which the contact sensor (4) is arranged, attached to the fixed bar (21) and configured to move along it

image2 image3 maintaining a parallel position with respect to the support base (3).

8.

Device according to claim 7, characterized in that the fixed bar (21) comprises a longitudinal rail (23); and because the mobile bar (22) comprises a slide carriage (24) configured to move along the longitudinal rail (23).

9.

Device according to any of claims 7 to 8, characterized in that the positioning arm (2) comprises a retaining element (25) which allows to fix the position of the mobile bar (22) with respect to the fixed bar (21) once the desired distance (D) is reached.

10.

Device according to any of claims 7 to 9, characterized in that the fixed bar (21) comprises a graduated length scale (26) that allows to know the value of the distance (D).

eleven.

Device according to any of claims 7 to 10, characterized in that the mobile bar (22) comprises an auxiliary mechanism (27) configured to couple an infrared reflector device (100) synchronized with an electron accelerator.

12.

Device according to claim 11, characterized in that the auxiliary mechanism (27) comprises:

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a clamping base (271) configured to attach to the movable bar (22) above the contact sensor (4);

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a positioning guide (272) having an upper end (2721) attached to the infrared reflector device (100) and a lower end (2722); configured to move vertically with respect to the clamping base (271), so as to allow the lower end (2722) to be brought from a lower position (YI) located below the contact sensor (4), to a higher position (YS) located at the height of the contact sensor (4); Y

•

a guiding groove (273) configured to receive a guiding pivot (2723)

attached to the positioning guide (272), which allows to delimit the displacement image4 Vertical positioning guide (272) and prevent its rotation. image5 Device according to any one of claims 7 to 12, characterized in that the fixed bar (21) comprises a coupling element (28) which allows said fixed bar (21) to be coupled over a preset position (XYREF) of the base of 5 support (3), as well as allow subsequent decoupling. 14. Device according to claim 13, characterized in that the support base (3) comprises a receiving element (31) that allows the fitting of the coupling (28) and its subsequent extraction. 10 15. Device according to any of claims 1 to 14, characterized in that the support base (3) comprises an anchoring mechanism (32) configured to fix said support base (3) to a treatment table or stretcher (M) . Device according to claim 15, characterized in that the anchoring mechanism (32) comprises:

•

a first side stop (33) located at a first end (3a) of the support base (3); Y

•

a second lateral stop (34) located at a second end (3b) of the base of

20 support (3), wherein said second lateral stop (34) forms a cam (35) configured to rotate with respect to a rotation axis (Z34) by turning a handle (36) integral thereto. image6