GB2408904A

GB2408904A - Apparatus for treatment by ionising radiation

Info

Publication number: GB2408904A
Application number: GB0325698A
Authority: GB
Inventors: Kevin John Brown
Original assignee: Elekta AB
Current assignee: Elekta AB
Priority date: 2003-10-23
Filing date: 2003-11-04
Publication date: 2005-06-08
Anticipated expiration: 2023-11-04
Also published as: DE602004016202D1; CN1870940B; GB0324676D0; GB0325698D0; CN1870940A; ATE406137T1; GB2408904B

Abstract

A radiation therapy device suitable for the treatment of tumours in the brain. The device comprises a circular rotatable support 20, on which is provided mount 26 and 28 extending transversely from the support out of the plane of the circle, and a radiation source, such as a linear accelerator 32 attached to the mount via a pivot 30. The pivot has an axis which passes through the axis of rotation of the support and the radiation source is aligned and collimated so as to produce a beam which passes through the coincidence of the rotation axis and the pivot axis.

Description

Apparatus for treatment by ionising radiation

FIELD OF THE INVENTION

This invention relates to a device for treating a patient with ionising radiation. It is particularly suited to forms of radiosurgery and to certain forms of radiotherapy.

BACKGROUND ART

It is known that exposure of human or animal tissue to ionising radiation will kill the cells thus exposed. This finds application in the treatment of pathological cells. In order to treat tumours deep within the body of the patient, the radiation must however penetrate the healthy tissue in order l:o irradiate and destroy the pathological cells. In conventional radiation therapy, large volumes of healthy tissue can thus be exposed to harmful doses of radiation, resulting in prolonged recovery periods for the patient. It is, therefore, desirable to design a device for treating a patient with ionising radiation and treatment protocols so as to expose the pathological tissue to a dose of radiation which will result in the death of these cells, whilst keeping the exposure of healthy tissue Lo a minimum.

Several methods have previously been employed to achieve the desired pathological cell-destroying exposure whilst keeping the exposure of healthy cells to a minimum. Many methods work by directing radiation at a tumour from a number of directions, either simultaneously from multiple sources or multiple exposures from a single source. The intensity of radiation emanating from each source is therefore less than would be required to destroy cells, but where the radiation beams from the multiple sources converge, the intensity of radiation is sufficient to deliver a therapeutic dose.

The point of intersection of the multiple radiation beams is herein referred to as the"target point". The radiation field surrounding a target point is herein referred to as the "target volume", the size of which can be varied by varying the size of the intersecting beams.

A radiation device of this type is sold by the applicant as the Leksell Gamma Knifed (LGK). The LGK device is described in US-A-4,780,898 and USA-5,528,651. In the LGK, a plurality of radiation sources are distributed around the head of the patient, in a hemispherical arrangement. By means of collimators, the radiation beams from each source are focussed to a small volume in the brain.

The LGK uses Magnetic Resonance Imaging (MRI), Computer Tomography (CT), PET and/or angiography to determine the exact location of the tumour, with the patient being held in a fixed position by the use of a reference frame, to construct a three-dimensional image of the target. The treatment parameters for each radiation beam are then determined such that the pathological tissue is treated to the necessary dose of radiation, whilst surrounding healthy tissue receives a minimal dose of radiation.

The treatment may be spread over a number of days or weeks, thus requiring that the patient is placed in exactly the same position in relation to the point of intersection of the converging beams at each treatment, to avoid the risk that pathological tissue is missed or that surrounding healthy tissue is irradiated unintentionally. This is extremely important in the case where diseases in the brain are treated, which requires the radiation beam to be focussed with pinpoint accuracy to avoid damage to sensitive areas such as e.g. the optic nerve, which if irradiated will result in the patient losing their sight.

This method therefore calls for the presence of a highly skilled, specialist team of technical experts to provide radiation treatment using these appliances.

SUMMARY OF THE INVENTION

Cells (and the living tissue that they make up) respond to ionizing radiation in a very complex manner. The radiation sensitivity of cells depends on a number of factors including histology and (for instance) on their oxygenation. Anoxic cells, common in central parts of tumors, are relatively radiation resistant as compared to otherwwise similar welloxygenated cells. A second important biological factor is the repair of radiation damage induced in the DNA strands of cells. A radiation dose delivered over a relatively longer period of time causes less damage to DNA as when the same dose is given over a relatively short time. The cell has more time to repair during a longer exposure, and is thus given a better chance to survive. If cells of normal tissue survive as a result of longer exposures, healthy tissue may be spared. On the other hand, if the surviving cells are malignant they may continue to divide and the patient may not be cured.

Thus, an ideal irradiation apparatus will provide the largest possible freedom in the delivery of the radiation dose. The radiation must be delivered accurately and very selectively to small regions of delicate neurological and other tissue. This advanced irradiation procedure must be reproducible during the entire lifetime of the treatment unit.

It is an object of the invention to provide a radiation therapy and/or surgery device thus optimised to meet the needs of the Neurosurgeon, i.e. for the treatment of pathological tissue in the brain or vicinity. It combines the qualities of a good penu Libra and accuracy, simple prescription and operation, together with high reliability and minimal technical support.

Preferred embodiments of the invention deliver radiation with high geometrical accuracy from a wide range of directions. The dose rate can be changed in a wide range with the irradiation direction. The cross section of the radiation beam can be changed in shape and size with irradiation direction The present invention therefore provides an apparatus, comprising a rotateable support, on which is provided a mount extending therefrom, and a radiation source attached to the mount via a pivot, the pivot having an axis which passes through the axis of rotation of the support, the radiation source being collimated so as to produce a beam which passes through the co-incidence of the rotation axis and the pivot.

It will generally be easier to engineer the apparatus if the rotateable support is planar.

Patients generally prefer to lie down whilst being treated, and are more likely to remain still if doing so. It is therefore preferred that the rotateable support is disposed in an upright position.

The rotation of the rotateable support will be eased if this part of the apparatus is circular.

A preferred orientation is one in which the radiation source is spaced from the rotateable support, to allow it to pivot without fouling the latter. It is thus preferred that the mount extends transverse to the support. In this way, the pivot axis is spaced from the rotateable support providing free space in which the radiation source can pivot. Another way of expressing this preference is to state that the pivot axis is located out of the plane of the rotateable support.

To simplify the geometry of the device and the associated arithmetic, it is preferred both that the pivot axis is substantially perpendicular to the rotation axis, and that the beam direction is perpendicular to the pivot axis.

It is preferred that the radiation source is a linear accelerator.

The output of the radiation source is preferably collimated, for example to conform to the shape of the area to be treated. The degree of collimation of the radiation source is preferably selectable or adjustable. It is preferred that a control means is provided, for programmably controlling the collimation of the radiation source in a manner correlated with the movement thereof.

The apparatus will generally include a patient support. It is preferred that the position of the patient support is adjustable, particularly under the control of the control means, with the control means being adapted to adjust that position in a manner correlated with the movement of the radiation source and/or the collimation thereof. This will allow increased flexibility in treatment.

It is also preferred that the intensity of the radiation source is selectable as a function of its position. Again, it is preferable for this to be under the control of the control means, adapted to adjust that intensity in a manner correlated with at least one of the movement of the radiation source, the collimation thereof, and the position of a patient table.

An integral imaging device can be used to determine the position of the patient, for example by way of feedback to the control means.

BRIEF DESCRIPTION OF THE DRAWINGS

An embodiment of the present invention will now be described by way of example, with reference to the accompanying figures in which; Figure 1 shows an external view of the apparatus prior to insertion of a patient; Figure 2 shows the apparatus with the patient in a treatment position; Figure 3 shows a perspective view of the internal structure of the apparatus from a foot end; Figure 4 shows a perspective view of the internal structure of the apparatus from a head end in a first position; Figure 5 shows the same apparatus in a second position; Figure 6 shows a second embodiment of the device in a perspective view from the head end; Figure 7 shows the beam orientation in the sectional view; Figure 8 shows the beam orientation of Figure 7 in plan view; Figure 9 shows a perspective view from the head end of the internal structure of a second embodiment in a second position; Figure 10 shows the beam structure in this position, in a perspective view; Figure 11 shows the beam structure of Figure 10 in plan view; Figure 12 shows a vertical cross section through the device in a first position; Figure 13 shows a vertical cross section of the device in a second position; Figure 14 shows a perspective view of a third embodiment with the radiation source in one position; and Figure 15 shows a corresponding view of the embodiment of figure 14 with the radiation source in a different position.

DETAILED DESCRIPTION OF THE EMBODIMENTS

Figure 1 shows the general external appearance of a device according to the present invention. The device 10 comprises an enclosure in which is formed a concave recess 12. Between the enclosure and the recess i2 is provided the apparatus for producing a therapeutic beam of radiation, to be described later.

The material defining the concave enclosure 12 will be of a material which is radio-transparent so as to allow transmission of the therapeutic bee n into the enclosure.

A patient table 14 is located outside the concave enclosure 12, on which is formed a moveable patient support 16. The patient 18 lies on the moveable support 16, which is then moved as shown in Figure 2 to bring the patient inside the concave enclosure 12. In this position, the therapeutic beam of radiation can be directed at the relevant part of the patient 18.

Figure 3 shows the interior workings of the apparatus, ie. with the patient table and all exterior covers removed. A base 20 for the apparatus consists of a vertically aligned mounting ring of a substantial and solid material such as steel.

This is mounted on suitable feet 22 so as to maintain it on a secure and fixed location. This ring, in use, lies around the patient and defines the extent of the concave recess 12.

A second, rotateable, ring 24 is supported on the mounting ring 20 so as to be mutually rotateable. Thus, the second ring 24 can rotate around the patient 18. On the rotateable ring 24 are a pair of first and second mounting brackets 26, 28 located diametrically opposite each other. Each extends in a direction out of the plane of the rotateable ring 24 and provides a pivotal mounting point 30 spaced from that plane.

The line passing between the mounting points 30 of the first and second mounting brackets 26, 28 passes directly through the axis of rotation of the rotateable ring 24. This point of intersection is at the same height as a patient lying on the patient table 16.

A linear accelerator (linac) 32 is mounted on the pivotal mounting points on a suitable housing 34. A motor 36 is provided to allow the linac housing 34 and thus the linac 32 to be rotated about the pivotal mounting points 30.

The height of the linear accelerator 32 and its direction are set so that its beam axis passes through the point of Intersection defined above.

Thus, by use of the above relations, the linear accelerator can be manipulated in two directions, being the angle at which it approaches the patient 18 and the rotational direction from which it makes this approach. These can be adjusted independently, while the geometric properties of the mounting structure mean that its beam will always pass through its point of intersection.

In this way, the point of intersection can be defined and the patient located relative thereto, and the linac can be moved freely so as to direct a dose at that point of intersection.

In practice, this means that the linac can be moved continuously or stepwise so as to provide a minimal dose to areas outside the target volume and a maximum dose at the target. In this way, this apparatus can replicate the treatment profile of an LGK with the use of a single linear accelerator source. As the moving parts of the device are covered, they can be rotated at speeds up to approximately 15rpm, which will allow the radiation source to cover the positions of all the sources of the LGK in approximately 20 seconds.

Existing linear accelerator-based devices can provide similar functionality but do so via generic robotic arms. In such devices, the precision required of the device must be imposed by accurate software and by precision measurement. In the above-described embodiment, precision is engineered into the structure and therefore arises automatically.

In addition, the general background dosage is less that that which would be encountered through the LGK, since there is only a single source. Thus, a shielding can be provided more easily and more inexpensively since only the main source needs to be shielded as opposed to the shielding of a large number of sources. This shielding is achieved by the enclosure 34, the beam stop 42 and the collimator 43 which will be formed of a material which is generally radiopaque so as to limit unnecessary exposure of staff and patients outside the device. The weight of such a reduced amount of shielding will also be significantly less.

Moreover, in comparison to the existing LGK, the use of a linear accelerator allows dynamic changes to the intensity of the beam or its temporary interruption. These changes to the beam may be programmed to occur when the beam is passing through sensitive areas. This will permit the protection of sensitive areas such as the optic nerve without having to provide selective plugs to specific sources. Moreover, it is well known that to conform to irregular distributions of pathological tissue that combinations of beams collimated to different sizes are often required. As this device only has a single source a programmable collimator such as a multileaf collimator or selection of different sized collimators can be provided. The size of the collimator can be programmed to change at certain times in the treatment. The device can also be used for imaging by suitable variation of the output energy as (for example) shown in our previous patent application WO 01/11928 or otherwise. In this way, specific areas of the patient (such as the auditory canal) or known objects such as the head frame or calibration items placed on the head frame can be located through an imaging function. This can provide a check of the positioning of the patient, or a dynamic adjustment of the patient positioning via the patient table.

Further, in the apparatus as described, the rotation speeds of the source can be varied. This allows the device to deal with biological factors such as the inhomogeneity of certain tumours in the resistance to radiation over their surface. In addition, the ability to vary the dose rate, collimation, and rotation speeds dynamically during treatment offers the ability to tailor the therapy or surgery in novel ways to achieve the maximum therapeutic benefit with the minimum side effects.

At the same time, the patient position can be adjusted via the patient positioning system 14, 16. This can be carried out dynamically during treatment, or stepwise between treatments and can be in addition or alternative to adjustment of the beam collimation. A system which combines dynamic beam collimation with dynamic patient positioning will in practice provide a powerful and flexible treatment potential.

Figures 4 onwards show further detail of this and other embodiments. In Figure 4 an arrangement is shown in which the mounting brackets 26, 28 are continued backwards and joined via a U-shaped link arm 38. This provides additional rigidity to the structure and enables a rotateable electrical connection to be provided to bring power on to the rotateable structure. In Figure 4, the device is shown with the pivot axis 30 vertical and the linear accelerator 32 at a low deflection of 5 relative to the patient axis. In Figure 5, the same apparatus is shown at an increased accelerator angle of 35 .

Figure 6 shows the device of Figure 3 at a low angle relative to the patient, of approximately 5 .

Figure 7 shows the general geometry of the device relative to the patient 18. In the arrangement shown in Figure 7 (at 5 relative to the patient), it can be seen that there is ample space for an irradiation of the patient head 18a and that shielding 42 can be provided which will remain opposite the linear accelerator 44 and thus move with it. As a result, the shielding provided can be minimised thereby reducing the overall weight and cost of the device.

Figure 8 shows the same device as Figure 7, in plan.

Figure 9 shows the general arrangement as shown in Figure 6 but with the linear accelerator at an increased angle of 35 . Figure 10 shows the arrangement of the parts within the device at this increased angle, from which it can be seen that the angle of up to 35 can be obtained without fouling other items such as the mounting ring 20 and without irradiating unintended areas such as the patient shoulder 18b. Figure 11 shows this arrangement in plan form.

As shown in Figures 12 and 13, by rotating the second (rotateable) ring 24 relative 24 to the mounting ring 20 through 90 , the linear accelerator 34 can be lifted (or lowered, not shown) into a vertical position relative to the patient and can then irradiate the relevant area of the patient from above, or indeed from any desired angle. Figure 12 shows the linear accelerator at an angle relative to the vertical of 5 and Figure 13 shows the same linear accelerator at an increased angle of 35 .

Figures 14 and 15 show a third embodiment. In this alternative design, the base 100 carries a rotateable bearing 102, which supports a spindle 104 that is therefore rotateable. The spindle 104 carries a C-arm 106 at the ends of which are a pair of aligned pivots 108, 110. The pivots 108, 110 are aligned such that their shared axis is co-incident with the axis of rotation of the spindle.

In this embodiment, the preferred arrangement of orthogonal co-incidence is illustrated.

A radiation source support 112 is mounted on the pivots and consists of a concave enclosure on which is provided a radiation source 114 opposite a beam stop 116. The source is adapted to produce a collimated beam 118 which passes within the concave area, through the co-incidence point of the two axes, and ends at the beam stop 116.

The entire structure is enclosed within a suitable enclosure, shown partly at 120. An aperture or recess 122 is provided in the enclosure to allow entry of a patient 124 into the concave enclosure of the radiation source support 112. In practice, the patient 124 will be supported on a moveable patient table 126 which can extend and retract the patient into and out of the concave enclosure.

This embodiment will provide the same accuracy and alignment advantages as the embodiments described above, and can be operated in substantially the same manner.

It will thus be appreciated that the present invention provides a versatile radio surgery device that is capable of precision work. It can retain both the accuracy and functionality of multiple source devices such as the LGK whilst achieving the increased flexibility and reduced weight of accelerator-based designs.

Thus, the device described provides a powerful tool in radiosurgery and radiotherapy. It is applicable both (as described) to treatment of the cranial and nearby regions, and also to other parts of the body where these are susceptible to placement within the device. It will of course be understood that many variations may be made to the above-described embodiment without departing from the scope of the present invention.

Claims

1. Device for treating a patient with ionising radiation comprising: a rotateable support, on which is provided a mount extending therefrom, and a radiation source attached to the mount via a pivot; the pivot having an axis which passes through the axis of rotation of the support, the radiation source being collimated so as to produce a beam which passes through the co-incidence of the rotation axis and the pivot.

2. Device for treating a patient with ionising radiation according to claim 1 in which the rotateable support is planar.

3. Device for treating a patient with ionising radiation according to claim 1 or claim 2 in which the rotateable support is disposed in an upright position.

4. Device for treating a patient with ionising radiation according to any one of the preceding claims in which the rotateable support is circular.

5. Device for treating a patient with ionising radiation according to any one of the preceding claims in which the mount extends transverse to the support.

6. Device for treating a patient with ionising radiation according to any one of claims 2 to 5 in which the pivot axis is located out of the plane of the rotateable support.

7. Device for treating a patient with ionising radiation according to claim 6 in which the pivot axis is substantially perpendicular to the rotation axis.

8. Device for treating a patient with ionising radiation according to any one of the preceding claims in which the beam direction is perpendicular to the pivot axis.

9. Device for treating a patient with ionising radiation according to any one of the preceding claims in which the radiation source is a linear accelerator.

10. Device for treating a patient with ionising radiation according to any one of the preceding claims, in which the output of the radiation source is collimated.

11. Device for treating a patient with ionising radiation according to claim 10 in which the collimation is adjustable.

12. Device for treating a patient with ionising radiation according to claim 11 including a control means for programmable controlling the collimation of the radiation source in a manner correlated with the movement thereof.

13. Device for treating a patient with ionising radiation according to any one of the preceding claims including a patient support.

14. Device for treating a patient with ionising radiation according to claim 13 in which the position of the patient support is adjustable.

15. Device for treating a patient with ionising radiation according to claim 12 including a patient table whose position is adjustable under the control of the control means, the control means being adapted to adjust that position in a manner correlated with the movement of the radiation source and/or the collimation thereof.

16. Device for treating a patient with ionising radiation according to any one of the preceding claims, in which the intensity of the radiation source is selectable as a function of its position.

17. Device for treating a patient with ionising radiation according to any one of claims 12 to 15 in which the intensity of the radiation source is selectable by the control means, the control means being adapted to adjust that intensity in a manner correlated with at least one of the movement of the radiation source, the collimation thereof, and the position of a patient table.

18. Device for treating a patient with ionising radiation according to any one of claims 12 to 17 in which at least one rotation speed of the radiation source is controllable by the control means, the control means being adapted to adjust that speed in a manner correlated with at least one of the movement of the radiation source, the collimation thereof, and the position of a patient table.

19. Device for treating a patient with ionising radiation according to any one of the preceding claims, in which an integral imaging device is used to determine the position of the patient.

20. Device for treating a patient with ionising radiation substantially as herein described with reference to and/or as illustrated in the accompanying drawings.