HUE034302T2 - Optikai szál mûködésének modellezése fotodinamikus terápiás kezelés során és az említett kezelés tervezésének támogatása - Google Patents

Description

MODELLING OF TH Ci ACTION OF AN OPTICAL FIBRE IN PHOTO!) V N.A M IC THÍÍAFT fREATMENT, AND ASSISTANCE IN THE PLANNING OF SAÏII TREATMENT TÄf pfesetst mvetnleo relates id a method ter modelling; the Sictka) öl «si opucgt fibre Mfeaufed to b« mâkrnmmnmMap®m by photodynamk therapy, sauf tua tnsthod Ibr m&tphmM0imëhw treatment.

Photodynamic Émmy är FPf 1$ a Mg? mmiw$ m » photosenslsitiv« substance ar phosísemiöser, which Is |»e!creötMÍy taken up % tissues, íor example: tumeur cells, sud -hen hr todf«»8g tissues by means of a light smsree of suitable wavelength, able to activate the photosenshiser, winch thus releases in sMu nmnstötnic Oxygen m -te radicals that arc exttvmsly reactive and: oxidise immsáiaíöly neighbouring tissues, causing the cancerous cells to die by apoptosis (rnogrammed ceii death) or by isehaetnta if the blood vessels irrigating the tumour ceils are targeted (Vascular·! argeted Photodynamic Therapy or VTP). The OSygcn-comainiag radical species thus produced generally have a short diffusion, length and a very short lifetime so the.) their toxic effect is very localised. The id>T technique allows pathotogies such as certain caneers or AMD Cage-related maeular depnetadon) to he treated.

Recently a «umher of rtudtcs have shown that FID" la an effective alternative; .fer the treatment of prostate cancer, when tire photuseusitissr is associated with spécii« lasers and dedicated; optical fibres.

The Applicant Company has thus studied various pnniosensitisers, In partieniac WST-*, or Tookad®, and more· recently WSTH 1 (which tire described 1« patent applications WÖ 20iMb4S4F2 and EF 1137411:) which,have turned out to be particularly suitable lot the treatment of prostate ameer. in the case of proaiate cancer, the phutoseasirtser is first administered luimvenously to; the patient its order to he takers up by the: cancer cells, AI this stapy the medication remains inactive as long as it is nor exposed to light of De right; wavelength.

Light is then applied via a laser supplying a plurality of optical ihres that we positioned; ander échographie guidattce. To do this, a plural hy of optical libres spie to be supplied by a laser are introduced (le. inserted) into the predate. Att extertta! grid of the typo used in; hraohytherapy allows the surgeon to precisely position the various optical fibres in the prostate and with respect to one another. More precisely, such a grid include* a plurality of orifices that are arranged lu the same plane In a matrix array of a plurality of tows and a plurality Of columns of known spacing. By way of example, the braehytheragy grid 1 shown In Figure f includes:« matrix array of ÍJ rows and 13 celmnus that are spaced apart by 0.5· mm, with a througmoriliee placed at each intersectlott of a row and a column, like the orifice 2 located at the Intersectloo of the eohmm SF’ and the row "ST Each optica! fibre (not shown In Figure I) Is inserted perpendicularly to fee external grid through an orifice until it penetrates into the mm to be treated of the prostate, Echographie guidance by means of a probe connected to &; viewing monitor allows; the surgeon to see; the prostate on the scree« of the moni tor and to make each fibre penetrate over a given pneteaflen length;

For an effective treatment, the «anther of libres used, their position in a particular orifice of the hrachytherapy grid, and the insertion length of «ash libre; ist the rone id be treated must he eery precisely determined lor each patient, in particular In lia case of treatment of the postaié, ÚKlivIdnái tremns^tt planning É essential mrnrnm various pamaeima that are she number of optical Hb!««, their position 5îs;d their rcsertiim 1¾¾¾ Will hleseiy vary $αα» one patient iœlrsî depending online nature β£.&τρε®*»ιβ {voÈutttêv fhhpfe ë®,}x í>8 the location nf the caneemus iumotsrs, and:on tegiapsetie ebnieos {feosi:trnste^sg hesn-sbiei s% etc.).

Tfee document “Computer moäbl fór pteiodyoatmc therapy ofiho prtwiai«B, deray Jenkim-éisL œlmm :iötbg pim;nini öf :e ireaisststtCiti'iha prnstsíe byphbindysamie îherapy. A software product tor implemeniitsg a method for assisting in the planning of a treatment of the prostatg by photodynamic therapy, with the aim of guaranteeing that a patient will receive a suifciant dose of iihiidnmm in the targeted zone, or gone to bo fmteâ, while the ithomnaiioa dose received ixv sutTbuhdmg nonMdrgetad «mes is mimmlsed,: is already in psfiictdar Éröom Mm the ilocaxnent “Treaimerfe mà pltS:ad!ng: anidte SihtdpIS: for iaforätitfel photodsuamic therapy of probte cancer". Sean R H Davison rt aL I’hyv Med, Bloh SfopÔifo) ZW4êlk in this document, the planning is based on the prediction of the distribution of lighti ih tbepfofsië and' the 'Sidfdtänding rones, and more precisely on solution. using a finite etemen· solution methods of iaii étidatien lesershthg the scatterum of light. The action of the optical Obres assocmïeO with the ghotoSdntitlaer tins modelled, tifo planning then consists tn Unding the configuration fin particular the number of libres and the position of the libres with respect to a brachytherapy grid) In which the modelled light distfiihttidst tgfhd most sttitahle fer the treatment ofthe guffem

The main drawback of tins piarsring method resides in the comptes mathematical calculations involved itt the modelling. Thus, the total length of rime repaired to obtain the results of the plantdng, depending on the parameters of the configumÄ, xnay exceed several hours. Any achnstmeuts made by practhiotiers t raxhologbts or surgeonm must be made lieratiyoly and mmruállyv rnhll a light disnnbudot! compatible with the sought-aher distribution is obtained.

Application of tins method is subject to »narked difficulties! the inser tion of a probe, then Pptictrl fibres; xoto the prostate sigmricantiy modifies· die shape and volume of the prostate, and has an Impact on the consistence of the pian, the tnodei giving ptiotiry to the relative position of the optical fibres with respcci to the target ty.ooe to he treated),,

Beoattse of the repaired processing tinte an .adjustment cd'fite parameters actually measured at the moment of the treatment (by échographie probe* proves to be unreahsahlc

Thus, there is at the present time no known method for modelling the action of the optical; ibfp Offer assistittg in the planning of a P|>T peatment that Is simple enough to deliver, almost automatically, an optimised, with respect to each patient, configuration of the parameters to be. applied during a POT npstmptfe and that requires only few imerventions by the practitioner.

The aim of the present invention i? in particular to mitigate ihe drawbacks of the known methods by providing, on the one hand, a computer-based modelling tool baaed on simple calculations, and on the other hátid, a planning tool, which is also computer-based, that is simple for practitioners to use, and that allows, very rapidly, typically in a fow minutes, a plan adapted to each patient and providing; the practitioner with an optimisatirm of the number of fibres to use, and their lengths and their positions f with respect to an eereroai grid such as the type: of grid

One sulject of tho pres®at fewenfipn is a method tor assisting:Jit the planning patient by photodynamic therapy according to Clairs; J:...

According to epe preferred implementation of the assistance method according to the invention, the hy «MgMMtfPI» si optai»#**· sdprhto« Mmmtymjpt gy^pte

Powelfs algorithm. A computer program product which, when implemented on a computet, may catty ouï the mudcdlkíg according to fee immliétiM provided. ftnstly, another suifeet pite invention^ a «(^ásr progmm product whlefe wiipo äajpfemssisä op a computer, catties out the plamtutg assistance method accenting to the ίκνοηΙΙοη. 1 ho 1¾¾ soraposot program products may he independent, or combined in the same eoiopoter program product. 1¾ various aspects of the iovetfemrwillibe Mter uadatst«>o£t: ia light cfe ths Miowtng; deseripiinm which is gives with reference to the appended figures, is which: - FlmrrU :1, which has already hson dOsefihed above, shows external grid of the typo used ht brachytherapy, serving to position a plurality of optical libras tora PDT treatment; -· figure 2 Illustrates, in the ferm of a simplified ftowchaft. the varions steps implemented in a modelling method accuMingto the invention; - Figure 3 ;0 «strates the emission profiles of a particular optical fibre, ta varions angles of observation, at h wa velength of 1iS nm;

Fignre 4 Schetpatically shows an example of a: transverse cross section through a prostate before treatment, aod of the positions of the optical fibres that were actually Used lot a P.O? treatment in a chnieal trial; * Figure 5 vhova an example magnetic resonance image showing a transverse cross section through the pre-state, obtained severt days after the POT treatment of a clinical trial; » Fsgnre 6 schematically illustrates the principle of the modelling of the action of a set of optical fibres as a function of then relative positions ina hrachyiherapy grid; - Figure 7 «lustrâtes the results of various rorrda:ions carried out to validate the model;

Figure h schematically illustrates two optical fibres positioned so as to aehfeyo à aone of overlap; * Figure 9 shows, in the form of a simplified flowchart, various· ships ..implemented In a planning· assistance method according to the invention;

Figure SO is a vompuier screenshot showings graphic user inferfttce after a first step of the planning asslstate method according to the invention;:

Flpres I if 12a and l;2l am of images displayed; in a viewing zone;of the gftgthlh user interlhoe In vi-ions sips: of the panning aasistanee method accntdisg to dite Invention;

To start wltlu the various step·:; o-f the method for modelling, according to the invention, the action of an optical fibre Intended to he ttsed In an turn-cancer treatment of a patient by photodynamic therapy wifi he detaded with reference to Figure 2. It will also be recalled Ihat this method is intended to be implemented via a software product able to be installed on a computer. The software product thus:cmbprSses a plurality of software routines, some minting to estfewtion of computation steps Involved:: ip: fee modeHiog, others being mote: specifically related to the management, by the user, of a graphic intertaeepbie to be displayed on the semen of the computer, sad to the processing pf infermahoo liable to be Inpul by the user via this graphic interbred

In its worfeiho Applicantltas : validated «s modelling method for use of a specific optical libre at the wavelength of'?63 ηχη, in association with tho phoiBSexiÄser WST1 I, Ihr the treatment of the prosit. ft wih easily he mêw!$màâmê® prixrefples of tbs toodsitegi aädst^sösöfdfee ihatstm this modelling, may be reted £**itar associations; of optical; m>m atà phmmmMmm, mä applied io m tre;«íí(öxdor other orgaM,

The mOtMlmg method; sceordlog to the mvesüoa Is sssemiaih based on she tact diát she theoretical elémentsfv action volume of the optical fahre in cpresnott, to association wuh the pnotosenstfiaer, ma> he modelled by that of a cylinder of radius R corresponding to the action raoms os the fibre·, asm of tength I. corresponding to the length over which the tiare aoûts sight, i bis modes ts Pared on the examination o; the emission profiles of the fibre at various angles of observation, as shown tn figure .·> Specificat-s, η wdi be noted. on comparing the various curves corresponding to various angles ot observation, that the maximuRi intensity -s obtained for an angle of observation of 90' with respect to the iongitndtnai axis of the libre. Therefore, the Applicant has sought a means that would allow is to determine a value of the action radius R of a fibre from the results of prior clinical triais.

The studies of the Applicant have shown that it is possible to esu&iisbM.afthi^aÄitlpfWlIih a Correlation coefficient higher than 0.8t between: a® dte: one: hpi. dm voiMpes of genre n#tajly necrosed during eintest trials earned out: m wious patietds ush$g.:& .giv:bgi|^!ÍtöS#§ftkit!f least odd: optical fibre, each clinical trial being; associated with :8. :sei: of pMmmm- :.cö^rep»#5g io thé seteíd; Conditions bf :the cllmeal trial and Oöífipdsíog at least the mmtber of optica! fibres used, JhtÉ p&ibn with respectM A brachÿiheragy grid, and the insertion length of eseh pf the fibres in the «one to he : treated; and on the, other hsán!, the theoretical .actios volontés computed on the basis of the satne set: of parameters: attd of the; theoretical elementary seta volume of a fibre,

Sltme Iheorefinaf action vohms.es are depatnrènt on the theoretical elemesttary setlbn volume of a fibre, which is itself dependent its particular o:a the action radios, isis therefore possible to determine thlsaetton radius very simply.

With reference to Figure 3, fire modelling tnethod UIO thus includes a prior step l ib of budding a database ttom the results of clinical trials carded ont beforehand on a plurality of patients using the same photosensitiser to the same dose, for example 4 mg/kg of WST1 Í, in association with a least one optical fibre that it k sought: to módéi. This building consists m sioring in the database one record per patient ispiudiog at least the following elements: a first digital file corresponding to a series of magnetic, resonance images of the zone to be treated before the clirdcai trial and preferably a series oflransvems in-ages; a second digital die corresponding fe a series of magnetic resonance images of the zone alter the clinical trial and preferably a few days after the treatment of the zone by PDT; the set of parameters corresponding to the actual conditions under which She clime«!; hM was :perftmrrebi namely af least the nymbei' ofopdeaf flbres tlun svere tjsed^ fbetr position wid- respect to the brechytherapy grid, and the insertion length of each Of the fibres in the gone tobe »esteti,

By way of example. Figure 4 schematically shows a transverse cross section through a prostate of butimé (or contour) 3 before treatment, the optical libres 4 that were actually used for the PDF treatment of the plhica! trial In question, namely 12 ideulMÍ öpta1;8k«%íaná'tl^lr'psitas, The eehtral poiht::S schematleaSiy stows tto position ai the 'upthra. Beside etoh dot representative of m opiktí 8ta, a nanther iiÄatos. the insertion length öí e&amp;eh fibre In îhe prostate. ligure S fór is pert shows the ssme »mw« cross seetinn of the pr<ts»Ps obtained to a omgnetle tmw®m tosp taken seven days sfe the FÍ3T treatment.

Once the database hss been created, a step 120 of the rnethod is impiemstHed so: as to determine,, by measurement, for each patient of the database^ namely &amp;r esteit retord of the database, the volume of the aone actually necrosed during the; eilnica! trief from said first ttod second digits;! flies.

According to one preferred embodiment of die invention, this: stop 120 adVtoisgeousiy comprises a Inst step 12 i it· which the series of images of the second eootpoier fde is leaded diet· displayed, image by image, on a graphic user Interlace (not shown) displayed on a computer screen. The oser, to ihe present ease the radiologist or surgeon, -nay then proceed, in a sicp f 22.. to eontonr (i,e, ootiioc) the zone that has actually been necrosed bv direct inpot on each image of fite scries displayed on the tompoter semen, preferably hy way of a mouse connected to the computer. The ontlsne Input by the paeilliouer Is displayed directly overlaid oo each of the images, allowing him to malte any outline rtwdfikattons that prove to be necessary betöre passing to the tdllowing step. The volume of the gone actually necrosed may then be computed in a step 123. by volume reconstruction via conventional digital processing of the entered outlines.

Steps 121 in 123 are miterated ihr each rtootd of the: damhasm At the end of step IP. all the volumes of rnttes actually necrosed tint known for ail tlte clinical trials stored in the database. t he fellowing step 53Ü of toe osethod of the invention^ which may moreover to carried put either tope. 8|«r or at the same time as step 12Ô. then consists id: computing, fur each patient of the database, the Mal dteorefical action volume depending on the total: ntupber of fibres, to the psltldtt of each ibr«, on the insertion length of elteh fibre had on the theoretical: eltotentary action volume of a giveh; optlcai fibre, via the folktwíög relationship-

Once again, this volume is computed using: conventional volume teconstmohoa teehmgaes, hut here, in each tmusvsrse pto«*. taiotaFpyerall nutlùse of the set of optical libres is taken into aeeomst. each optical item being modelled as a cylinder. Figure b shows, by way of example, fór the Sato of comparison, a transverse magnetic resonance: image of a prostate, which image teas generated ftonthe second dtgiml fitom which image the position of the optietil fibres 4 actually used in the corresponding clinical trial: have: been shown, overlaid:, with respect to the braebythempy grid · (led- hasídmarf oifidgure d) and the totst #vetäll.-ötttliö4. te t&amp;fc sarué plane, when the action volume of each fibre, tepreschted by a, white rectangle, ts Modelled by a eydnder Crighbhtmd pasi of Figure fi).

Dace steps 128: and OÙ bave been cseried «nti: ai! thai there remains:to do, in a step mfórenped 146 in Figure 2, Is to continue to determine the action ratlins 8: of an optical fibre by eotrelattoa, for each; pattant to me database, ©f the computed total theoretical ,addon volume with the measured volume ot me zone actoany necrosed, tie nmdsiimg method: IDO describee above has been: validated with a database containing the results of 28 clinical trials mM-. m With a dosingof 4 mg: per kilo of the patients In question,: a number of fibres being used each time over Insertion lengths varying fitem 15 to -ID mm in steps os 5 mm.

Ti® fgrssgh show» il» the sightdsand pad of Figure ? dttnstratea the tflwy goso eorröísüo« leamdafton h*#* ) obtained between the theoretical volumes Üté die volâmes os: the xöoos aetoai!y ocemsed ÄwfnRifte etolcal trials. C5n cstetdating Öse vtÄ of R te which Ille iÉsôôdïeââ vosume was dosest to the volume of the zone actually nécroSéd in thé 28 dinied oitds, ao average radius dt 7.49 mm, with a precæon ot 7.(18 mm, was obiahseds

The orach In the left-hand part of Fsgwe 7 for its part show;; the: results of a correlation or the volume actually arrowed whit the sans of the elesnem ary volumes of We fibres. Therefore, it will be noted that a much better correlation is obtained by taking into consideration the actual volume formed by all the. Obres depending 0!', their sxsslî.toï! ras.het than the sans of she ehonematy volumes ot the ftbtes. because rhis makes It possible to sake sxtto account the fees the·, when two hhres A 3od 8 été positioned. so &amp;s to .achieve ,t gotsC ο, -jvetutp (-·, es Illustrated by way ofexatnpie is) figure 8, the actual volume does not correspond to the sum of the dement ary yoltsmeä of (he » separat®: libres* but rather m the hum of shush etasntafy volumes mmu» the commöS volume. hs other words, the action of a bbre must not be taken into cortil^bdíS-títe modelling m a vohmi$ portion already covered by the action of another fibre, because She ceils prusetti ih the zone oi overlap cas·» be peemsed ©sky once. ' ><. .esiit·' '"'he ax1!. I sv dew lx )*k<' u 5 rv« ht ehe hs \ t av t< ’"las r%* future· «ed«n**te bv PDT, bv implementing the planning assistance method 2ÍK? according to the invention 'that Will rhdVi be described, in particular with tefcrence to figure 9. Once again, lb® assistance method· its intended .'to be Implemented by a software product able to be lusta lied on a computer, ;md certain steps of the method a user, typically the practitioner, to intervene via a graphic interface able to be d|?pH§y^d:-p.p-ft^-«piiphiff scregtp sod controlled by the soÉwsre product. The objective of this planning is to be able to rapidly deliver to the practitioner a set of parameters that are optimised stt terms of numbers of libres to be used, their positiots with respect to a brachyihcrapy grid, and insertios) length in the rone to be treated, with respect to any patient having to undergo a treatment fey photodynamic therapy.

Up b§i#lf toÄpIfment the variotss steps 21 d to 240 that will now Ite described In detail, a calibration öftb«ispftwpcsp^det:-mpt^yp%ö«-e^M':^bOfdrehíbtd::!^:::ás to set She valuta of the action radius :R of m optical: fibre. Thismay bé done by storing the R value delemslned elsewhere, or by allowing Ih® eset to choose a wrists: of R Írom: is set of possible value», for example the set of values flf mm, 5.0 mnt: 6.5«: ?.S nun; 8.5 öitp}2-f|őwcv#rppr8íbt^y,#Pd«tste4-.ta Fights &amp; yÄ#g|p).ö' software ptodhet by implsmesxthig the Steps of the »noddling method lilft described above. Thus, if is possible to recaifetéi m any moment, the value of the action radius so as to take Into account any stew clinical triads). A first step 21Ö of Its Msista^ in allowing, a digital file cotxexpondieg to a series of dighttymage«,:ditb^magn*dris^n^«e-:er ulhmatnd Images, preferably transverse plane tmaggs* of th»: Xoa® to be treated: to be ksadeti Into and displayed on a graphic user interface displayed on «. screen of thé compta®?,: The digital: lie is Ifar exasppie in the I.MOiM: fbotsat. figure 10 sllusPipes,: by way pf exapsple, a computer screenshot showistg aiigrepble iuser interface b containing a mm ibkt-.wftkbâ4ra»sversedi^âg#.f'Pf::d:: prostate of a patient has been loaded lor display. As may lse seen its this screenshot, ihe graphic interface i> also includes an information zone 8 with a piumlity of fields that the user tssay fill by direct inpd by means of a .keyboard: comseefed; to. the computer, and: various control· bottons allowing the user to trigger a pluralily of stetipps, In,padlósda?, actes/end of stçpdlO, the user tossy navigate betweenifât«: varions: cross serrions of the digital ük of images by virtue of the navigation buttons of a sorte 9 of the interlace, moot is? and out dons each displayed Image ? by way of two buttons of a sone Ki of the interlace. Other buttons allowing the displayed Imagé w. be movad dt oootmsl to be meipââl Varions pieces of iofomtsfooo on tbp palidnt may be Input dtreetlv into the xm i of foe tuterfoee, for evstopis the evannusiion ctes, the identifier and ite natne of the pab&amp;bb bis: dam of birth, the delivered dose and delivered energy, and any suhabfe observations. All: Ibis infosmatibn is saved at the end öfdtP:pIatntingytöy«sísntpie: in adlib an Pt)b fómurt.

At the etkf of step 2Ί0* the prMtifcer may prooeed, directly ttcthwgraplhe intetlike 6, to: a step 226 of 0tíií»tog:;:ibe mm to be treated. This outlining d achieved via direct input on cads heap ? of the series dispiayed on tbe graphie Inierlbee b, preibrsbly via ite monse connected to the computer. Th«? outline input by the practitioner Is displayed direetiy overlaid on each of the images, showing the practitioner io make any Älftigs^ÄlbatiöM.'ÖsaitP^^be'S^nSs^* before passing to the following step. Fig sire 11 Mms, by way of example, a computer screenshot shewing the mm of tbe graphic user interface in which an outline 11 has been drawn by the oser and may he seen overlaid on the kansverse plane image ?.

It should he noted at this stage that, during: a trpbmenl by fibl’ of piostal« mnmgmrkmrm^Mfih» gland mgy he treated. In conformity tv«h these vacKWk elimcai itrnsedtrrekfhe comptflerfoased: assistance: ipetbpd: advaniageottsly allows tbs user to define ifee one that Is auitafei® tor :die patient. It tbns offers: four possibilities: treatment; of the entire gland; * treatment ot the right lobe ought hemiabktKp*.}; treatment cd the left lobe tied bemiabtatiou^. focal treatment.

Prior to the mdiining step 2¾ the user: may Mv&amp;mageousiy choose the typo of treatment envisaged, fór evampie via a drop-down menu in a Äetiun Äun« 1:2 of tbe ptpbie user mierinee foeef'ignre 10).

Depending; on fits type of treatment selected, she user will pcisslbiy have to input, in addition to the outbne of the prostate, other outlines defining more precisely the anus to be treated.

At the erei of the outlining step 220, a series of transverse MRis and a series of outlines of the eons to he of the graphie user interlace. The same navigation buttons 9, magnlficaffoa buttons id and buttons fór modifying contrast or moving tbe displayed irusge as described above may fee used Ctl:feMdg&amp; :Âd· dütfinest^tây; advantageously be saved in order to he reloaded and displayed subsequently at any time.

The febowittg step 238 Uf the planning assistance: method according to the Invention then consists in tneaauring thé voluthe of the rone to be treated by vohnne reconstruction via eunvuntionai digital processing of the outlines input in step 220. This step is pmierahiy triggered following tbc action of the user on a sped be eontroi huttOs, soeb bs ihn pohirof button 13 shown in Figure .10, in-the .tarn-to be treated comesposds The volume thus measured is advantageously displayed: m m? m the graphie ibieriaee; Wien ; foe fosasnmd volume is that of the prostate,; povlsfoh may also be made to compute and display the maximum dimensions in nniibnotres of fne prostate in the three planes of space (the transverse, sagittal-and coronal planes).

The following step 240 of the planning assistance method according to the invention consists in allowing after representation of the brachytoetapy grid to be displayed mut positioned overlaid on each. SMP #îlt# series mé ttofeespmKbng Input; edfenes, To do Éis>: the stset most; seïeei: stt iss»p): fn>t»; ïb ssrfes d'trnmfM bouges ioiätfeSi Itefotehâmfe pfiÉlpfeiy Shir sms#: tmtessgoodfeg gfe She <*à Ä seefem ét. \M séries, Ilus plecfö^ lípép is displayed in she cotmpotKbng display

IhéreOn, She one Sfe Ütőre (nniioes bipsif beSbtehfesd W step: 230. At fele Stage, the user Spay sdvätnsigeoosäy (légiié a first margin of safety corresponding to the required minimum distance between: täte eligible; fee positions and the capsule of the prostate. This distance is by default initialised a; a pradaiennioed fixed vatu·-:. g?r example etjuai to 6 «hü, bp dp osodlfled via fet gfophic Infeftecte; in m input ape 14 feeu Fsgme 10), Step 240 is preferably triggered by she oser, for exansple by actnatioii of a specific action burton of the graphic aspr interface. located in the lupus rone 34.

Figures lit): end 13b |pi, by pay of «Mispie, m&amp; sos-eenshots obtained1 dnring fee; hopfemenmtteo of sipp 340. Mote pipcisely, Figur«: 12η: 0®w the koop of fee griffese user interface bt which appear sfeofemseotsaly thp seieeted bnnsvsrse glane phagn ?, feg: oniiine I i asspelated beFFebifed msd rnpsd by fee; oser {step 228), and a square l|i fee aide of which corafepgnds to dip irrst snarghf of safety and the esőire nf whseit corresponds to a spedilo posMoa on fee brächyfescapy grldt iypseafly the position: B) eprrerponding Sir the intersection between Sh« central; eoteotn .0 of grid Illustrated ;ht 3%nr» i< and the holtont: row 1 of this: grid;. Iliig square may udvaulsgsoosly he mo ved by the oser via fee; graphfe ioserfeee by sltekissg m its cuntm! point:.

Tigtsse lib: for its part: shows the mm of the graphic interface: $ in which tippears a graphic plane mpmmi&amp;im·. Id of the hraehyfeerapy grid, overlaid on at selected transverse: platte image 7 and a corresponding outline ! I ingot: beihreitand (step 220). The plane: representation Id appeps as a »iumlitv of signs, here circles, arranged in srmotrte: array aucordfeg to the brachythempy grid of Figure L CoInfeT may advantageously be used at this stage: to give a visual indication to rite: user of fee fibre positions: ihat; are possibly eligible for the 'imMML·. For psatnpie, &amp; eitel« of white colour will sipify that fee posidon ie not eligible because 33 is located outside of the outline of the prostate, and a circle nf red; colour will correspond; to a position Jo the interior of the outline of the proslfem but not eligible either, ifeeease it: is oof; In the sons to he: treated; or because it is too dose fo a a« at risk, for «topic fhaeapsule or dm urethra, depending on fee: margin of safety defined beforehand) A circle of green colour will possibly then slgnl% that:» particular positihn; Is eligible, this; feus giving an Indication: offen mntdmmn number of optical libres that It: will be possible to: choose.

The Ibilewing step 2 SO (Flpre: f) is the head: of fee pfemsiug: assistance: inetltod according to the invention, if relates to fee automatic detormfefekm fcy coorpufailon of optimal; parameters, is: toms of number of optical fibres to be used, their position wife respect to fee teuebytheragy ;grid and their insertion length, that: will allow the best eorcespondence to its obtained1 between a computed total theoretical: action volume and tbs volume measured in step 2.10 of! he gone to be treated.

The computation of the thsoretlcal action voluuic is based on fee sams modeilisg principles as those described svhh rcfereuoe to she tuodeiliog method Í 00 of Figure 2. Thus, this fotel theoretical acdon volume is computed depndmg or the position of each libre, and on the theoretical elementary action volmne of a libre, She latter elementas-y vohtme eorrsspofsdmg to fee volume of a cylissdof of predetermined actios radius 'K atsd of height eorrcsposuhng to the ioseruoo length ofthe $bre.

To allow she opthmsasion, the step: 2dd pmferabiy uses sm optlmisutloit: algorltbtn of; fee gradient descent type, such as Fp^plFs; :%hrithtek "'Ä tógdri#fo féailses sihkihsfemioss&amp;l mlnlmisasánss in etmjsgate #æsîfom§. îw. vectors (or direction# of ^ are öatsjugate with respect to armait» Ä that iS: defined to be positive abb symmetric If

· . 1'his algorithm thus requires un objective function f to bs mihupfsed,: to be defined. Hare, tbs tmnuion t has been defined so that the algorithm position? the fibres :f dpw:l$? M optimal oydrlsp df the tinget «eus, but updt?s· the eo?tstb&amp;mt that there bemo evira-prostafic: region necrosed (i s. no tseerosla outside of tbs target ) Tirs tîttottotitosed tMÿ fee ltd io w itt g t elat los »ship:

írt which fei ip g toid number of fibres* 1 Is an mdex representative ofospsitie fibre, ? Is a voxel T the target regionsodiff ffest remaining outside of the target, attd ws and w> are feed positive weigÄ "M other words, fioweirx algorithm is bere used: to fin# the best vaiacaff (hutabe'C % position: of easts fibre: n insertion length) that will onnnnire iha ,di%reofebfi|ep^&amp; volonte computed for variosts parameter vsiues sod the measured voissroe of tbs «one to be b®atod, In practice, tbs algorithm will xtafi fey estmusfitsg a mst posslhie vtdoe of N, estitnated fey dividing tbn target volume measured itt step 2 ?0 tty the theoretical: eiomentarv setion volume of a fibre, the latter being stjosi: to sft^L, where E laine predefined netten: rutfe of the: fibre.

The «igöfttecÄas ,poce«$s to iteratively seek, for aii the possible fibre positions and insertion lettgfhs, those: that will: aiistv.the: algoritltnt to: eobverge toward' tfea nfinlrnttin vabre ot the funsrtion f. OnapCípii of the modal: ebosetr:and on the sitnpiipity of the computation eotptoyed: by the algorithm. a result ibgy fee obhtltted: vary rapidly, slier only a :iew: mlntdes, The sqmptdatlonx are all : the more rapid given that: the algorithm considers only positions thsi are aeismlly eligible (eireies of green colour in the plane representation Of the gyíd,displayed in stepifefO},

The opimlsatlon step SSifis preièrafeiy triggered by iheper, tor sxsttnple fey actuation of a specific act too hums« =7 ebibe graphic user interface 6. which button is located in an input «one id (see figure HH. it shoold fee noted that greater ilex ibliity may also fee achieved m practice fey asking the user, betoeethe optimisation 250 is launched, to choose certamparanmssrs, s«ctrm for example the number of fibres to fee used, provided that litis number is not: incorttpafefele with the maxlmmtt number of fibres that are eligible bn the pone to fee treated. In: this: ease,, tfee: ntustfeer of fibres Is tbos input: dlrcetly by the user,. -jsreferafeiy da tfe inptbypnu í S ef die grisphle user may himself de fine,, :ln addition to the slbretneniidnud first margin oi sstotyj two addEtounl margins ofsaffety,. aims·: margin that corresponds to: the: minhnutn histsoee between: the end of the fibres sud the capsule of the prostate at the base {set fey default: fir fi mm), and tr second nmsgnrof safety that corresponds to the minimum distance between: the end of the: fibres and tbc capsule fit the prostate at the apex tset by defines to ,> mm). These various : margins efsafety may advantageously fee mortifiedby she usei, fey direct input, in specifically dedicated: fields In the input «one, lb of the graphic Interlace, fstsffy, as: sun already been mentioned above, the user may seieot the: valtse: ff of the snfion radlus ttom Uto: set:ot vattses tum; » 6 nm g Ö.5 mm; 7.t mm; B 5 turn).

In any ease, ar the end of theoptimisation step 2Ä 8 result is obtained giving ót least the niupfeef

Claims (5)

1. sdkoeti !'> the mer -·>ί .mmmTk· xhv optinmedt, she posstkm and length öt each fibre., the vakss «f alt thsoe tMSvimeteis haxùxg being optimised fo* the pisrhsml&amp;r cava oS'sîse pimeixt. fais sestbs h advoBtsgeotssly dk.phsycb or the graphie aver interface. tor evsmxpie ina spéciik estspiny ?.tme |d (Figure H).i siestr-o the input j>one iS. i > bit K n o tK ^ fuiv «eh o ' ' < sp ' ooîï ... <u o t «ai « > tic o eu1' 3 ο :k .. Pc-.se a v\ ' v'\ ' cp«;. < Hr <* «η an imiev nom. spondunt to dxe o« the se'igthv of shs-> fibre' so e" sm s.ogm volume ;%·· the Stars ·· ν', gioptu ' i\í'fx's.e!'ívS'v <''ϊ of the 'ή'η lateo au mo mvh uc in fite MRl ismox,' m tíxethtve mudcnces tvS\i xi - X oïoeai vt«d sagittal » vív v! 'Lelő ti \ \v \t " 00, \<! C \ X !ö k ''“kíll'Xv. 3 S V ! 'N ' p'XlX'sU, ü.0 thvit ir„ ιΜ v X" consult ;st any moment, b> display on computer or printing on paper, a planning report |e psrtimhT sessB'mtuhstksg: beforehand into slkPgssstphtepsxtertiseOv < six·,' various sneaaured xtfumev » the type of trevVsxnettt chorea. he tnargins of .uifety take« xsstix cooxsderixtKm ns the optimisation, rise nted action radius of She {three, s the cKöven m optimised -'Kmxber <xf bores the pov.hm; mxd n"spth't the sR-u \ -s the disSsmecvhgtuiessi: esch (shse; the ehsain&amp;d. .index,. the obtated sum of the lengths of the fibres end the obtained degree of overtap; the vanOtsS: MKI ertxss pöfibtk nsed ihr the p fPikihs|; Fhe obtained plan; rtsay-advantageously be relined, for example by manually modifying the number of fibres. On each addition or subtraction of a fibre, the degree of overlap, the index und the sum of the lengths of the fibres are recalculated and displayed on she Interthce.
2. A new plats for a given patient may furthermore easily be initiated by modifying one or snore fiatameiers chosen frotn: ~ n\ vxs s' v * v \ ΗχνΚΦ< r'p' 'io w the number of fibres * the mar gins of calks h sh, adton c alms * , 1' , OniHA!S/\! Ml'KOlH'vFXtkMOt*mF/FSI> ΗίΤΟΟΓΗΜΙΚΛ $ rHUPKS ivL/l I IT SORÁN FS Ad fhvll.inrn KEZELÉS ÏERVRZÈhLNFK l'AMCK.iAI ÀSA SZA&amp;ADALAI! Ifff.NYPONTOK 4:. Son' f'lvt v i<xSut\ ' x^atoo μ a^ththiTv, voxvxbcn txa, κ ns fdfosifpasoikíts terápiával tätfhhd tevésének éprân során egysofef .megfcátátózótit AyêwM^y ányapt keli kesifei a jövetei páöleRsnek, s^ítóftH!egJc®!l it «Isighäoi egy «Ilse meghmÉtezótt htdlámhosszdíbs'ty~ nyel aáöi aiif azbixts optikai ssálpi Ipgii, melyek egy adott bevezetés! hosszon behelyezhetek 8 kezelendő zónába egy kmokyte^ffe íácsiíöa ÿB viszonyított pozlc kának megfeleKten, ahol mindegyik optikai szál olyan tiposú, hogy maximális intenzitással sugároz a szál kössptangeiyére merőleges irány-kan, ttmely epres tartalmaz: aoysgpr: vonatkozóan egy optikai szál «tîôjèietî «terni hafás-rérRígat&amp;o&amp;k ntotótelséro egy olyan hessgsr niodellezéserévén,: a»lyoek Risatbsogara, és· L hossza w,. atnely hossz smngÄi a* «litt behelyezést hosszsBk. ék ahol M R baídsngar az alábbi lépésekkel kerül «ieghstáz&amp;zásta: - Méphüok (ki 0} egy számítógépi apibiklsriküteah0sS::hePg&amp;ke8: végseik kiBlkal tesz-lekből származó .adamítiól»: -ahol a kezeléseket iegaláhb agy optikai szálhoz iariméi fényérzékeny anyag feinaszts&amp;iásával végezzük, terel mindegyik kboihal teszthez társítva van egy psr$$élerkés/.let, amely megleld a, kliaïka! lesKt: akföálly feítétdemek és tártál·· snazza leplâlsb a felhajtsál! optika! szálak száméi, az pptlkáíászáfeskeák a Ixaehyterápiás ifésköz vísKoftjfliütt relatív pozícióját, az egyes optikai szálaknak a kezelendő zóaóp ípa-•ifiS!'behelyezés hosszát, «mely adatbázis felépítése során at hsáén egyes pácienshez az adatbázisban etórólatsk égy első digitalis àiioaasaÿÎ, aataly &amp; klinikai tesztetaaspidzdea a kezelendő zóna digitális képesből alkotott képsoswotot tasMmaz, egy második digitális ál» lománvt, amely megfelel a klMkai teszteket kővetően sz említett zése áigttsíss álló képsorozatnak, valamint as «iaiitedpSîPÂerkészletet, «mely megfe tei a klinikái teszt aktuális feltételeinek - - az adatfeáxssban szereplő tsihxien egyes pác>enshéá"!iíépíéfjpfé;:{lt0>á:klhifcÉ teszt -w* nie ténylegesen elhalt zóna térfogatát az első és; a második digitális állományok-felhasznáSásávsk - az adatbázisban szereplő minden egyes pácienshez jílszátpítjpk Π301 a teljes elméleti hn-tótérfogatot az említett paraméterit észlel és egy adathassál éknéteti elemi hatótéríogatáből; - az. adatbázisban szereplő minden egyes pácienshez mélfeátárdzzuk 040? az esőikéit R ha-édstïgaràt ;á MszáídsóSt elmélet! teljes :haídtei;í|íga|pák a tehyiégesen elhalt zéssa mért térfogatával veti korrelációja revén; * őgy Skiai a jövőbeni páciens kezelésének megtervezésé%:imély ák-iillbt lépéseket: farlálmaz' kát V betölti tik és !negéteni|sk pld): s pzelendd zóna d%tÂ.%épsorôÂR«É;.m^«lÂdi-gkális állományt egy számítógépi monitoron megjelenített gmftkos telhasználóí interfészen (6): - a számítógépi monitoron kiielzetf képsorozat mindegyik Mpb közvetled: bevitellel meg* húzzak i22ü) a kezdendő sorts körvonalát; · a bevití kononakk (111 dmstális ®llié|50M^yàiÂ0RSlm8lt térfogát: revén megmérjhk :(lí30j á kezelendő zdtta lerlogatáb -sa- képsorozat egyss képes (3): és a«körvöítshtk filj féléit megjetes a|||iÉ;és «ik ábsAzolásái (16¾ - számítással meghatározzuk (250) az alkalmazandó optikai s?4lak. &amp;&amp;K$£i. ;M hraéhyléráplás és azok bsbélvfö^skl^ssgls:, mélyek §gyite* tMM bptinatiizápk a: kiázámiteit:teles flipé loti h&amp;ti$&amp;&amp;gó* és svfestes# Mm méri téttogaia közötti a Ufas pjkp#fi báíástéríbgst; as egyes szálak po#» oiöjá és a nrodsllezési fázis aóifiö modellezett fényérzékeny anyaghoz tartozó optikai szál elemi eírmieii AmSMv' fogata dop an s « ^vanfona 2. $£;:'-t>: jpénypmtf a«e*ÍW írogató «Ij&amp;fe (ZQ&amp;% azzal Jatlemezvf, bogy a kezelendő zona digitális képeinek (?) sorozata megfelel s kezelendő zöm keresztmetszeti képeinek.
3. 3. M előző tglnyposfok bÉdPÂke szerinti támogató eljárás (200), azzal ftftjnezVís hogy s digitális kápk mágneses rezonancia képek vagy ultrahang képek.
4. 4. Azelőző IPnypontókbáfoml^ azzal jellemezve, hogy s sÂiié- gépes meghatározás iépésében (250) grsdiens-csökkönésen alapuló optimalizáló algoritmust sikaiamsmk.;
5. 5. A 4 Jgéaysxah szerinó íámogspó ebasns (200}, 'P»l jellemezve, hogy a; SKáadiáss#tópM tnegha-kirázás lépésében (2:S0}alhn¥e:ix5lgoíáhíU!St:alk&amp;ióiaasuk. fo Azelázó igéttyponiok Mrtnefyike szerinti: támogató epráspöö}, azzal jefietnezve, hogy a modelte- zéái: fázis során az első : és ; második digitális: ál lomány digitáli s képeinek sorozata megfelel a kezelés éibííh illetve kezelés utánkkeresztmeiszeti: képeknek - ?, Az elézh: igénypontok hármeiyik«: szerinti: iótnogttté eljárás (200), s»*al jellemezve,, hogy « modelle zési tizishsn a ténylegesen elhalt zóna térfogatának mérési lépésében (120) az alábbi ipisapt iptjtik végre;: *· betömjük: és egy számítógépi; monitoron megjelenített grahkos -ielhasználöi mforiessen kupiez-zök (12 i) ;a második szánbíőgépes állomány képeinek sorozatéi;:: - a szándtógépas morttoon metielenheti képsorozat tnindt^yik képén közvetlen bevitellel megy bázznk (122) a ténylegesen elhalt zóna körvonalát; -a bevitt körvonaluk digitális fekioigostásával rekonstruált térfogat révén tnegtnériök (123) a tény-legesen elhalt zóna térfogatát, I; Számítógépi progmmtermék, amely egy számítógépen Ittalva vépeiatiia az: 1-2, igénypontok Mmro-lylke szermtl támogató eljárást.