JP6907177B2 - 軟組織を同時に画像化しながら等角放射線治療を送達するためのシステム - Google Patents
軟組織を同時に画像化しながら等角放射線治療を送達するためのシステム Download PDFInfo
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- JP6907177B2 JP6907177B2 JP2018224559A JP2018224559A JP6907177B2 JP 6907177 B2 JP6907177 B2 JP 6907177B2 JP 2018224559 A JP2018224559 A JP 2018224559A JP 2018224559 A JP2018224559 A JP 2018224559A JP 6907177 B2 JP6907177 B2 JP 6907177B2
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Description
本願は、2004年2月20日に出願された、米国仮特許出願番号60/546,670に対する優先権を主張する。
適用なし。
本発明は、放射線治療のシステムおよび方法に関し、さらに詳しくは、数日または数週間の経過にわたるいくつかの部分において、患者へと投与される実際の電離放射線量を割り出すことができ、器官の運動または患者の形状の変化によって生じる処置の投与の誤差を補償すべく治療を調節できるよう、放射線治療の際に患者へと線量が投与される瞬間において、患者の体構造を迅速かつ繰り返し画像化するための放射線治療システムおよび方法に関する。さらに、本発明において使用される磁気共鳴画像化法は、既存のX線コンピュータ断層撮影(CT)画像化に比べて軟組織のコントラストを改善し、代謝および生理に関するさらなる情報を提供して、対象の描写を改善し、治療に対する患者または疾病の応答の監視を可能にすることができる。
がんおよび冠動脈再狭窄など、増殖性の組織異常によって引き起こされる疾病の放射線による治療においては、患者において疾病を含んでいることが分かっている部分、あるいは疾病を含んでいると考えられる部位が、照射される。この目的のため、放射線治療計画システムが使用され、まずは疾病部位および周囲の領域について計画用の画像が取得される。
によって与えられるローレンツ力に直面することは、周知である。MRIユニットによって生じるローレンツ力によって、電子が直線経路で移動することができなくなり、事実上リニアックをオフにするため、リニアックによる電子の加速が不可能になる。さらに、リニアックの高い無線周波数(RF)の放射が、MRIユニットのRF送受信システムに問題を引き起こし、画像の再現に必要とされる信号を劣化させ、おそらくは繊細な回路を破壊してしまう。リニアックとMRIユニットとの一体化は、途方もない技術的努力であり、未だ可能にされていない。
本発明は、電離放射線治療用ビームを生成するための少なくとも1つ、おそらくはより多くの放射性同位体源、前記治療用ビームによってIMRTを実行するための少なくとも1つ、おそらくはより多くのMLCまたは減衰器システム、目標領域および周囲の健康な組織または重要構造を前記電離放射線の投与の最中に同時に画像化する磁気共鳴画像化(MRI)システム、および/またはすべての構成要素に伝達可能に接続されたコントローラを含んでいる放射線治療システムを提供する。MRIからもたらされた画像データが、実際に投与された電離放射線の線量の定量的評価を可能にするとともに、IMRTによって投与される電離放射線を目標領域へとより正確に案内するため、処置の投与の再最適化または再計画を可能にする。以下では、本発明の有益な実施形態を説明する。この有益な実施形態においては、オープンMRIの主磁石ヘルムホルツ・コイル対が、分割ソレノイドとして設計され、磁石の中央の円筒形の穴を通って患者カウチが走行し、IMRTユニットが、2つのソレノイド部分の間のすき間を通って患者に照準する(図1〜図4)。この実施形態においては、分割ソレノイドMRI(015)が静止したままである一方で、マルチリーフ・コリメータIMRTユニット(020)を備え、遮蔽され、位置合わせされている同位体放射源が、ガントリー(025)上でカウチを中心にして軸回転する(有益には、2つより多くの(020)を使用することができる)。患者(035)は、同時の画像化および処置のために患者カウチ(030)上に配置される。マルチリーフ・コリメータを備え、位置合わせされている同位体放射源(020)は、固定の主コリメータ(120)、二次二重ダイバージェント・マルチリーフ・コリメータ(125)、および二次マルチリーフ・コリメータ(125)からのリーフ間の漏れを遮断するための三次マルチリーフ・コリメータ(130)で視準される放射性同位体源(115)を含んでいる(図5〜図7)。
例えば、本発明は以下の項目を提供する。
(項目1)
・1つ以上の放射性同位体源から電離放射線を投与するための装置、
・磁気共鳴画像化システム、および
・前記電離放射線の投与と実質的に同時に画像を取得できるよう、前記電離放射線を投与するための装置および前記磁気共鳴画像化システムに接続されたコントローラを有している放射線治療システム。
(項目2)
前記磁気共鳴画像化システムが、磁気共鳴画像化データが前記電離放射線の投与と実質的に同時にトレーサの摂取の領域を特定するように構成および配置されている項目1に記載の放射線治療システム。
(項目3)
前記磁気共鳴画像化システムが、磁気共鳴画像化データが前記電離放射線の投与と実質的に同時にコントラスト強調の領域を特定するように構成および配置されている項目1に記載の放射線治療システム。
(項目4)
前記磁気共鳴画像化システムが、前記電離放射線の投与と実質的に同時に分光学的情報を取得するように構成および配置されている項目1に記載の放射線治療システム。
(項目5)
前記磁気共鳴画像化システムが、前記電離放射線の投与と実質的に同時に代謝の情報または生理学的情報を取得するように構成および配置されている項目1に記載の放射線治療システム。
(項目6)
前記磁気共鳴画像化システムが、前記電離放射線の投与と実質的に同時に磁気共鳴血管造影データ、リンパ管造影データ、または両者が取得されるように構成および配置されている項目1に記載の放射線治療システム。
(項目7)
前記磁気共鳴画像化システムが、取得した磁気共鳴画像化データを被験体の治療への応答を前記電離放射線の投与と実質的に同時に監視するために使用するように構成および配置されている項目1に記載の放射線治療システム。
(項目8)
前記磁気共鳴画像化システムが、照射の最中の体構造および放射線治療ターゲットの動きを追跡するため、前記電離放射線の投与と実質的に同時に取得した磁気共鳴画像化データについて、変形可能画像の位置合わせ法の使用を可能にするように構成および配置されている項目1に記載の放射線治療システム。
(項目9)
前記磁気共鳴画像化システムが、照射の最中に動きの存在下での被験体への線量を割り出すため、前記電離放射線の投与と実質的に同時に取得した磁気共鳴画像化データについて、線量計算の方法の使用を可能にするように構成および配置されている項目1に記載の放射線治療システム。
(項目10)
前記磁気共鳴画像化システムが、照射の最中に動きの存在下での被験体への線量を割り出すため、前記電離放射線の投与と実質的に同時に取得した磁気共鳴画像化データについて、変形可能画像の位置合わせ法および線量計算の方法の使用を可能にするように構成および配置されている項目1に記載の放射線治療システム。
(項目11)
前記磁気共鳴画像化システムが、被験体のIMRT処置を再最適化するため、前記電離放射線の投与と実質的に同時に取得した磁気共鳴画像化データについて、変形可能画像の位置合わせ法、線量計算の方法、およびIMRT最適化の方法の使用を可能にするように構成および配置されている項目1に記載の放射線治療システム。
(項目12)
前記磁気共鳴画像化システムが、生体内温度測定法を実行するために、前記電離放射線の投与と実質的に同時に取得した磁気共鳴画像化データを使用するように構成および配置されている項目1に記載の放射線治療システム。
(項目13)
実質的に同時の画像の案内のもとで除去的治療(ablative therapy)を実行するように構成および配置されている項目1に記載の放射線治療システム。
(項目14)
実質的に同時の画像の案内のもとで増殖性組織を抑制するように構成および配置されている項目1に記載の放射線治療システム。
(項目15)
実質的に同時の画像の案内のもとで血管の増殖性組織を抑制するように構成および配置されている項目14に記載の放射線治療システム。
(項目16)
前記放射線の1つ以上の放射性同位体源が、1つ以上のマルチリーフ・コリメータ強度変調放射線投与システムに組み合わせられている項目1に記載の放射線治療システム。
(項目17)
前記1つ以上のマルチリーフ・コリメータ強度変調放射線投与システムが、リーフ間の漏れを遮断し、閉じられたときに放射源の放射を完全に遮断することができるように構成および配置された個々のリーフを使用する二重ダイバージェント・マルチリーフ・コリメータ・システムを有している項目16に記載の放射線治療システム。
(項目18)
磁気共鳴画像化データから割り出された投与線量を、被験体の強度変調放射線治療を再最適化するために使用するように構成および配置されている項目1に記載の放射線治療システム。
(項目19)
前記磁気共鳴画像化システムが、磁気共鳴画像化データが前記電離放射線の投与と実質的に同時にトレーサの摂取の領域を特定するように構成および配置されている項目1に記載の放射線治療システム。
(項目20)
前記磁気共鳴画像化システムが、
・高い診断用品質の磁気共鳴画像化が、治療の開始前、治療の開始後、または両者において実行され、かつ
・低い品質の磁気共鳴画像化システムが、体構造およびターゲットの追跡のために、前記電離放射線を投与するための装置からの実質的に同時の電離放射線の投与の最中に実行される
ように構成および配置されている項目1に記載の放射線治療システム。
(項目21)
前記磁気共鳴画像化システムが、
・高い分解能の磁気共鳴画像化が、治療の開始前、治療の開始後、または両者において、データ空間サンプリング・パターンを取得するために使用され、かつ
・低い分解能の磁気共鳴画像化が、実質的に同時の電離放射線の投与の最中の器官の運動を捉えるべくデータ空間サンプリング・パターンbを取得するために使用される
ように構成および配置されている項目1に記載の放射線治療システム。
(項目22)
・強磁界の送出システムが、治療の開始前に実行される診断用の磁気共鳴画像化の品質を改善すべく構成および配置され、かつ
・低磁界の送出システムが、体構造およびターゲットの追跡の目的のために実質的に同時の電離放射線の投与の最中に画像が取得されるときに、磁気共鳴画像化の空間的完全性を向上させるとともに、投与される線量の分布の乱れを少なくするように構成および配置されている
項目1に記載の放射線治療システム。
(項目23)
前記1つ以上の放射性同位体源から電離放射線を投与するための装置が、陽子ビーム、重イオンビーム、中性子源ビーム、またはこれらの組み合わせから選択される治療用ビームによって増強されている項目1に記載の方法。
(項目24)
・陽子ビーム、重イオンビーム、中性子源ビーム、またはこれらの組み合わせから選択される1つ以上の治療用ビームから電離放射線を投与するための装置、
・磁気共鳴画像化システム、および
・前記電離放射線の投与と実質的に同時に画像を取得できるよう、前記電離放射線を投与するための装置および前記磁気共鳴画像化システムに接続されたコントローラ
を有している放射線治療システム。
本発明を、多数の変更および変種が当業者にとって明らかであるがためにあくまで例示を意図するものである以下の実施例において、さらに詳しく説明する。本明細書および特許請求の範囲において使用されるとき、単数形「a」、「an」、および「the」は、そのようでないことが文脈から明らかでない限り、複数への言及を含んでもよい。同様に、本明細書および特許請求の範囲において使用されるとき、用語「・・・からなる(comprising)」は、「・・・で構成される」実施形態、および「・・・で基本的に構成される」実施形態を含み得る。
によって与えられるローレンツ力に直面する。この力は、役に立つイオン化光子および電子の物体との相互作用の物理学を大きく変化させるほどには充分に大きくないが、イオン化電子の全体的な輸送、したがって得られる線量分布に影響を及ぼし得る。二次電子の輸送に対する磁界の影響は、50年よりも前から始まって、物理学の文献においてよく研究されている。最近の研究は、患者における局所的な線量の体積を増加させるために一次または二次電子の合焦または捕捉を助けるため局所化された磁界を使用する試みにおいて、モンテカルロ・シミュレーションおよび分析的分析を使用している。これらの研究はすべて、ローレンツ力で電子の輸送を横方向に閉じ込めるため、磁力線をビーム軸の方向に整列させつつ調査されている(「長手方向の」磁界と称され、ここで長手という用語は、患者ではなくビームを指している)。約1.5〜3.0Tの間の磁界の強磁界のMRIにおいて、旋回の初期の半径が二次電子の大角度散乱相互作用(制動放射、弾性散乱、および強衝突(hard collisions))のMFPに比べて小さく、この状況が電子の所望の捕捉または合焦をもたらすことが知られている。電子がエネルギーを失うと、
に比例して半径が小さくなり、大角度散乱相互作用(CSDA)が存在しないとき、電子は停止するまで半径の減少する螺旋に従う。この螺旋は、電子のフルエンスを変化させ得るが、何ら有意なシンクロトロン放射を生まないことが知られている。本発明においては、平行なMRIでリアルタイムの画像化が可能であるために、磁界が照射ビームに対して直交していなければならない。最近の研究が、6MVリニアック・ビームのビーム軸に直交する1.5Tの磁界が、6MVリニアック・ビームレットについて、水への線量分布を大きくかき乱し得ることを示している。このような線量分布のひずみの回避、および画像化データの空間的完全性を損ない得るMRIアーチファクトの防止の両者のため、本発明の有益な実施形態は、磁界を患者の上下方向に沿って導くことができる低磁界オープンMRIの設計を使用する(図1を参照)。コバルトγ線からの二次電子についての旋回の半径の簡単な評価が、旋回の半径が電子の大角度散乱相互作用のMFPよりもはるかに大きいことを示している。これは、ローレンツ力が磁界の大きさ
に比例し、旋回の半径が磁界(104)に反比例するため、容易に理解できる。本発明者らは、スラブ・ファントム形状のコバルトγ線源からのビームレットのモデル化を、よく検証されたIntegrated Tiger Series(ITS)Monte Carlo packageおよびそのACCEPTMサブルーチンを磁界中での輸送について使用して実行した。シミュレーションのため、0.1MeVの電子および0.01MeVの光子の輸送エネルギーのカットオフ、標準的な凝縮されたヒストリー・エネルギー格子(ETRANアプローチ)、ランドー分布からサンプルしたエネルギー・ストラグリング、ベーテ理論にもとづく質量衝突停止パワー、デフォルトの電子輸送サブステップ・サイズ、および束縛効果を含んでいる非コヒーレントな散乱を使用した。3組のシミュレーションを実行し、各組は、ビーム方向に平行な0.3Tの一様な磁界の存在下および非存在下での実行を含んでいた。2cmの円形コバルトγ線ビームレットを、以下の形状についてモデル化した。すなわち、30×30×30cm3の水ファントム、10cmの肺密度(0.2g/cc)水スラブを5cmの深さに有する30×30×30cm3の水ファントム、および10cmの空気密度(0.002g/cc)水スラブを5cmの深さに有する30×30×30cm3の水ファントムである。シミュレーションは、推定される線量において1パーセント未満の標準偏差を得るため、8〜30時間にわたってP4 1.7GHz PCで3000万〜1億のヒストリーにて実行された。結果は図10〜12に示されている。図10は、本発明の有益な実施形態において存在するような0.3Tの直交一様磁界が、軟組織または骨における線量分布を測定可能なほどにはかき乱さないことを明確に証明している。本発明にとってきわめて有用な処置部位は、体内で最も顕著な組織異質性を含んでいる肺および胸部である。図11に示されているように、ファントムに12cmの肺密度(0.2g/cc)の水スラブを加えることで、高および低密度の領域の境界において、線量にきわめて小さいが検出可能である乱れが引き起こされている。これらの乱れは、補正なしで認容可能な臨床適用を可能にするために充分小さい。図12において、最後に我々は、低密度の領域および境界領域に大きく存在する顕著な乱れを観測した。これは、空洞が、正確な線量測定に関して最大の課題を有することを示している。しかしながら、低密度の媒体との境界を除くと、軟組織および(MFPが軟組織よりもさらに短くなる)骨において大きな乱れは存在しないはずである。このデータは、低磁界(0.2〜0.5テスラ)のMRIでの本発明の有益な実施形態において、線量の乱れは、組織が存在していないため正確な線量測定が必要とされない空洞の内側を除き、小さいことを示している。コバルト遠隔治療ユニットなどの公知の放射線源を使用することによって、MRI磁界の強さが既知であれば、偏向の量を容易に割り出すことができる。しかしながら、磁界の強さが既知であっても、線形加速器が使用される場合には、未知である放射のエネルギー・スペクトルが計算をはるかに困難にする。
Claims (21)
- 命令を記憶する非一時的な機械可読媒体を備えるコンピュータプログラムであって、前記命令は、少なくとも1つのプログラム可能プロセッサにより実行されるときに、前記少なくとも1つのプログラム可能プロセッサに、
患者に最適化されたIMRT治療計画で放射線治療を開始することと、
前記放射線治療を開始した後に治療フラクション中の患者の放射線治療中に磁気共鳴画像化システムによって取得された磁気共鳴画像化データを受信することであって、前記磁気共鳴画像化データは、フラクション内の器官の運動を捕捉するのに十分なレートで取得される、ことと、
前記患者に送達される電離放射線を示すデータを受信することと、
前記放射線治療を開始した後に、前記磁気共鳴画像化データ及び前記患者に送達された前記電離放射線データを示すデータを利用して前記最適化されたIMRT治療計画を再計算し再最適化することにより、再最適化されたIMRT治療計画を生成することと、
を含む動作を実行させる、コンピュータプログラム。 - 前記再最適化されたIMRT治療計画を生成することは、前記磁気共鳴画像化データが前記放射線治療中のフラクション内の器官の運動の存在を示すときに生じる、請求項1に記載のコンピュータプログラム。
- 前記IMRT治療計画は、前記患者の放射線治療中に再最適化される、請求項1に記載のコンピュータプログラム。
- 前記IMRT治療計画は、前記治療フラクションの後に再最適化される、請求項1に記載のコンピュータプログラム。
- 前記治療フラクションの少なくとも一部にわたり前記患者に送達された線量を合計することによる前記送達された電離放射線データおよび前記磁気共鳴画像化データから前記患者における実際の線量の堆積を決定することをさらに含む、請求項1に記載のコンピュータプログラム。
- 前記IMRT治療計画の前記再最適化は、前記決定された実際の線量の堆積も利用する、請求項5に記載のコンピュータプログラム。
- 前記磁気共鳴画像化データは、三次元データを含む、請求項1に記載のコンピュータプログラム。
- 前記電離放射線は、陽子ビームまたは重イオンビームを含む1つ以上の治療ビームから送達される、請求項1に記載のコンピュータプログラム。
- システムであって、前記システムは、
治療フラクション中に患者へと電離放射線を送達するビームの減衰のために構成されたマルチリーフ・コリメータであって、前記患者は、前記治療フラクション中に運動している組織を有している、マルチリーフ・コリメータと、
患者に最適化されたIMRT治療計画で放射線治療を開始した後に、前記治療フラクション中にフラクション内の器官の運動を捕捉するのに十分に速く患者体構造の磁気共鳴画像化データを取得するように構成された磁気共鳴画像化システムと、
前記放射線治療を開始した後に、前記磁気共鳴画像化データを利用して前記最適化されたIMRT治療計画を再計算し再最適化することにより、再最適化されたIMRT治療計画を生成するように構成されたコントローラと
を備える、システム。 - 前記コントローラは、前記磁気共鳴画像化データが前記治療フラクション中のフラクション内の器官の運動の存在を示すときに前記IMRT治療計画を再最適化するように構成されている、請求項9に記載のシステム。
- 前記コントローラは、前記治療フラクション中に前記IMRT治療計画を再最適化する、請求項9に記載のシステム。
- 前記コントローラは、前記治療フラクションの後に前記IMRT治療計画を再最適化する、請求項9に記載のシステム。
- 前記コントローラは、前記治療フラクションの少なくとも一部にわたり前記患者に送達された線量を合計することによる送達された電離放射線および前記磁気共鳴画像化データから前記患者における実際の線量の堆積を決定するようにさらに構成されている、請求項9に記載のシステム。
- 前記コントローラは、前記決定された実際の線量の堆積も利用して前記IMRT治療計画を再最適化するように構成されている、請求項13に記載のシステム。
- 前記コントローラは、前記実際の線量の堆積が線量の誤差を証明する場合に、電離放射線の送達を停止するように構成されている、請求項13に記載のシステム。
- 前記コントローラおよびマルチリーフ・コリメータは、フラクション内の器官の運動を補償するために迅速に調節するように構成されている、請求項9に記載のシステム。
- 前記コントローラおよび磁気共鳴画像化システムは、前記治療フラクション中に治療に対する前記患者の応答を監視するようにさらに構成されている、請求項9に記載のシステム。
- 前記磁気共鳴画像化システムは、0.2Tと0.5Tとの間の場の強さで動作するように構成されている、請求項9に記載のシステム。
- 前記磁気共鳴画像化データは、三次元データを含む、請求項9に記載のシステム。
- 前記システムは、除去的治療を実行するように構築および配置されている、請求項9に記載のシステム。
- 前記ビームを送達するための装置をさらに備え、前記ビームは、陽子ビームまたは重イ
オンビームを含む、請求項9に記載のシステム。
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