JPH10505776A - Use of magnetic implants to locate patients - Google Patents

Use of magnetic implants to locate patients

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Publication number
JPH10505776A
JPH10505776A JP8510822A JP51082296A JPH10505776A JP H10505776 A JPH10505776 A JP H10505776A JP 8510822 A JP8510822 A JP 8510822A JP 51082296 A JP51082296 A JP 51082296A JP H10505776 A JPH10505776 A JP H10505776A
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implant
patient
magnetic field
magnetic
body part
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ボォ レンナーネス
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ボォ レンナーネス
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A61B5/062—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3954—Markers, e.g. radio-opaque or breast lesions markers magnetic, e.g. NMR or MRI
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/45—For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4504—Bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A61N2005/1051—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using an active marker

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Pathology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Biophysics (AREA)
  • Physics & Mathematics (AREA)
  • Human Computer Interaction (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Measurement Of Length, Angles, Or The Like Using Electric Or Magnetic Means (AREA)
  • Magnetic Treatment Devices (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

(57)【要約】 外部治療装置に対して、早急に患者の位置を再生可能に特定するための磁性を有するインプラントの使用、及び外部治療装置に対して、患者の位置を再生可能に特定する装置。装置は、体部に取り付けられるように設計された少なくとも一つのデバイス（１）を備え、その意図する治療目標に関係する位置は実質的に一定であり、そして磁場及び／または磁場の変化を検出出来、それに基づいて空間内の患者の位置を特定する少なくとも一つのセンサ手段を具備する。 (57) [Summary] Use of a magnetic implant to quickly and reproducibly locate a patient for an external treatment device, and reproducibly locate a patient to an external treatment device apparatus. The apparatus comprises at least one device (1) designed to be mounted on the body, its position relative to the intended treatment target is substantially constant, and detects magnetic fields and / or changes in magnetic fields And at least one sensor means for determining the position of the patient in the space based thereon.

Description

【発明の詳細な説明】 患者の位置を特定する為の磁性を備えたインプラントの使用技術分野 本発明は、生物上の又は内の特定点又は領域の位置の特定に関する。用語「生 物」はヒトと動物の両者に関し、以下の明細書及び請求項では、簡単化の理由で 、共に「患者」と呼ぶことにする。発明の背景 医学においては、Ｘ−線装置、放射線治療装置及び他の形式の装置により診断 をし、他の検査を実行し、そして患者を治療するのが普通である。簡単化の理由 で、かかる外部診断、他の検査又は治療を以下では、共に「治療」として言及す る。多くの場合、外部装置に対して患者の位置を一つの治療から他の治療に亘り 全空間寸法で出来るだけ正確に再現出来ることが必要である。これは、例えば、 放射線治療の場合のように、治療が周囲の器官、紺織等に損傷を生ずるかも知れ ない時、特に正しい。従来技術の記載 患者の位置を一つの治療から他の治療に亘り外部治療装置に関して特定する現 在のところ最も普通の方法は、例えば「十字」等の形式で患者の皮膚にマーク付 けをすることである。この処置は、皮膚が治療されるべき内部器官、組織等に関 し動くので、必ずしも信頼出来ない。従って、治療は、特にそれが放射線治療で ある場合、患者内の健全な内部器官、組織等を損傷する可能性が大きい。従って 、一つの治療から他の治療に亘って外部装置に対し患者を正確に且つ再現出来る ように位置決めすると云う大きな必要性が有る。 また、種々の目的の為に磁性インプラントを用いることが既に知られている。 一例は米国特許第４，９７８，３２３号で、かかる体内チャンネル、特に気体又 は液体が流れることが出来るエアーダクトの閉鎖を阻止するのに磁石が用いられ るシステム及び方法を開示している。埋め込まれた永久磁石と外部の永久磁石の 組み合わせ、又は埋め込まれた磁石のみで、問題の体内チャンネルを開かれた状 態に維持することが行われる。同じ目的で、埋め込み磁石の代替物として、「ピ ル」として患者が飲み込む磁石が開示されている。ホール効果素子等の電子シス テムは、例えば、磁石が問題の体内チャンネルを開かれた状態に維持するその機 能を満たしていることを検査する為に用いられる。更に開示されているのは、人 工器官又は気管をその位置に維持する為の磁石の使用である。 米国特許第５，１２５，８８８号は、電磁場により、薬物を取り付けられた磁 性体を体内、特に脳内の所望位置に搬送してその薬物をそのスポットに投与し、 そして磁性体を取り出す方法を開示している。 ソ連特許第１，３３８，１５４号は、許容放射線パラメータが超えられると検 出器が治療を中断するプロトン療法で放射線パラメータを整合する方法を開示し ている。 フィンランド特許第７９７５８号は、治療領域内にある皮膚にマークをする治 療位置での患者の動きにより生ずる誤差を除去する方法及び装置を開示している 。このマークの瞬間的位置は、マークの位置座標によって連続的に追跡され、マ ークの座標位置が所定比較座標に対応する時、治療が開始される。 ＷＯ，Ａ１，９３／０００３９は、電磁場により、人体又は動物身体に侵入又 は埋め込まれた金属物体を検出且つつきとめる装置を開示している。 また、人体及び動物身体内の物体を検出する同様の方法及び装置を用いる多数 の刊行物、例えば、ＳＥ０３１４２３１，ＳＷ０１９６５０９，ＵＳ−Ａ−４， ９８７，３０９，ＵＳ−Ａ−４，５０２，１４７、ＪＰ６３−２８６１７０、Ｕ Ｓ−Ａ−４，６１８，９８０、ＵＳ−Ａ−４，４４５，５０１及びＦＩ８１０２ がある。 まとめると、上記文献は医療に関連してインプラントとして磁石を用いている ことは事実であるが、これ等の文献の何れも、異なるケースにおいて、患者の位 置の再現可能な決定で上記問題を解決する為に磁気インプラントの使用を記述又 は示唆していない。図面の簡単な説明 本発明の現在のところより好ましい実施例の一例は添付図面に例示されている 、図中、 図１は、磁性インプラントと外部センサを有する患者を示す概略的断面図であ り、そして 図２は、体内のインプラントの位置の記録と表示の為の外部装置の一例を示す 概略的立面図である。発明と好ましい実施例の記載 図１において、参照番号１は、例えば、埋め込まれた永久磁石である磁性イン プラントを示す。しかしながら、そのように又は他の何れかの材料との組み合わ せで、検出可能な磁場（電磁場を含む）及び／又は磁場の変化等を発生する能力 を有する任意のインプラントを選ぶことは、本発明で可能な範囲内である。 本発明に従って、インプラント１は、皮膚とは対照的に、体内に比較的一定な 位置を有する適切な身体部分２に取り付けられる。図示の実施例においては、身 体部分は体内の骨である。参照番号３は患者の皮膚を表す。このインプラントは それぞれの治療領域に出来るだけ近接し且つその外部に位置付けることが望まし い。このインプラントを、組織に優しい材料で覆っておくことが望ましい。また 、インプラントは好ましくは、それ自体知られており且つ骨内にインプラントの 正確な固定をする装置及び／又は材料、例えば、ネジ、板、整形支持体等が設け られる。 代替的実施例においては、インプラントは「エキスプラント」であっても、即 ち、体外、好ましくは下部部分、例えば、骨に近接して且つこれと位置的に接続 される対応位置に在っても良い。 患者の外側に位置する概略的に示された装置４は、例えばインプラント１から の磁場又は磁場の変化を検出する一つ又はそれ以上のセンサ及び／又はこれと協 同する他の装置を表す。 センサ、インプラントの数及び型そして検出方法は例えば、所望の精度に応じ て選ばれる。従って、磁場は、例えば、永久磁石や、操作による誘導及び体内又 は体外の電源等、上記目的を充足するどんな方法でも発生することが出来る。ま た、誘導により、スプールを通して磁場を引き続いて提供出来るインプラント内 電圧を立ち上げることも出来る。インプラントが磁場を発生する必要は無く、イ ンプラントはその磁気特性が印加磁場（例えば鋼板）を変化し且つこの変化がセ ンサにより検出されるように設計出来る。かくして，そのようにインプラントは 磁場を提供しなければならないことはなく，外部から印加された磁場の変化を提 供するのみで良い。この場合、インプラントは、センサにより検出され得る磁気 特性を有する。また、外部磁場を住意にインプラントにより発生される磁場とく みあわせることも出来る。 インプラントはそのように磁気的でなければならないことはなく、誘導により 作動出来るので、例えば、磁気共鳴断層撮影法を用いる検討と干渉することの無 い銅の磁気的不感知スプールを用いることが出来る。 センサ４の位置は知られているので、インプラント／エキスプラント１の位置 は単純に計算出来る。患者内のインプラントの位置は、放射線標的等の治療の対 象とのその関係と同様に、知られているので、患者と治療対象に対する位置を特 定することも出来る。 センサ４の設計は、単純なスプールから磁場に感知性のより進んだ素子、例え ば、共にセンサを構成するホール素子、磁気抵抗センサ等等、個々の場合に適す るように変えることが出来る。かかるセンサは、磁場に感知する同じ又は異なる 型の一つ又はそれ以上の素子を含んでも良い。これ等のセンサは異なる形状（円 形、列等）に配列出来る。センサは可動又は静止性の何れでも良い。センサの素 子はまた、磁場が検出される領域を増大する為、不動又は可動でも良い。これは 、そのように良く知られ且つ当業者が更なる記述無しに本発明に適用出来る技術 である。 図２は、５×５に配置された２５のアナログホールセンサから組み立てられた センサを示している。センサからの信号をコンピュータ６に読み込ませることに よって、アナログ／ディジタル変換器５を用いて各センサは迅速に読まれる。各 センサは、それが位置する磁場に比例する電圧を提供する。磁場中心により近く 位置する磁石は最大の屈折を提供する。この装置を用いることによって、磁場中 心は二方向に正確に特定出来、精度は、より多くの装置を用いる時、増大する。 この発明は、記述及び／又は図示された実施例に制限されるものではなく、多 くの修正及び変更が添付する請求項の範囲内で可能である。BACKGROUND OF THE INVENTION Use TECHNICAL FIELD The present invention of an implant having a magnetic for specifying the position of the patient is directed to a specific position of the specific point or area on the inner or on the organism. The term "organism" relates to both humans and animals, and will be referred to in the following specification and claims, for simplicity, together as "patient". BACKGROUND OF THE INVENTION In medicine, it is common to make diagnoses, perform other tests, and treat patients with x-ray equipment, radiation therapy equipment and other types of equipment. For reasons of simplicity, such external diagnosis, other tests or treatments will be referred to below together as "treatment". In many cases, it is necessary for the external device to be able to reproduce the position of the patient as accurately as possible in all spatial dimensions from one treatment to another. This is particularly true when the treatment may cause damage to surrounding organs, dark blue weaves, etc., as in the case of radiotherapy, for example. Description of the Prior Art At present, the most common method of locating a patient with respect to an external therapy device from one treatment to another is by marking the patient's skin in the form of, for example, a "cross". is there. This procedure is not always reliable as the skin moves with respect to the internal organs, tissues, etc. to be treated. Thus, the treatment is likely to damage healthy internal organs, tissues, etc. in the patient, especially if it is radiation treatment. Accordingly, there is a great need to accurately and reproducibly position a patient with respect to an external device from one treatment to another. It is already known to use magnetic implants for various purposes. One example is U.S. Pat. No. 4,978,323, which discloses a system and method in which magnets are used to prevent the closure of such body channels, particularly air ducts through which gases or liquids can flow. A combination of an implanted permanent magnet and an external permanent magnet, or an implanted magnet alone, is used to keep the body channel in question open. For the same purpose, a magnet swallowed by the patient as a "pill" has been disclosed as an alternative to an implanted magnet. Electronic systems, such as Hall effect devices, are used, for example, to test that a magnet fulfills its function of keeping the body channel in question open. Also disclosed is the use of a magnet to maintain the prosthesis or trachea in place. U.S. Pat. No. 5,125,888 discloses a method for delivering a magnetic substance with a drug attached thereto to a desired position in the body, particularly in the brain by an electromagnetic field, administering the drug to the spot, and removing the magnetic substance. Has been disclosed. US Pat. No. 1,338,154 discloses a method of matching radiation parameters with proton therapy in which a detector interrupts treatment if an acceptable radiation parameter is exceeded. Finnish Patent 79758 discloses a method and apparatus for eliminating errors caused by movement of a patient at a treatment location that marks the skin within the treatment area. The instantaneous position of the mark is continuously tracked by the position coordinates of the mark, and the treatment is started when the coordinate position of the mark corresponds to the predetermined comparison coordinates. WO, A1, 93/00039 discloses a device for detecting and locating metal objects that have entered or embedded in a human or animal body by means of an electromagnetic field. Also, a number of publications using similar methods and devices for detecting objects within the human and animal body, such as SE0314231, SW0196509, US-A-4, 987,309, US-A-4,502,147, JP 63-286170, US-A-4,618,980, US-A-4,445,501 and FI8102. In summary, it is true that the above references use magnets as implants in the context of medical care, but none of these references solves the above problem with reproducible determination of patient position in different cases. It does not describe or suggest the use of magnetic implants to do so. BRIEF DESCRIPTION OF THE DRAWINGS An example of a presently preferred embodiment of the present invention is illustrated in the accompanying drawings, in which: FIG. 1 is a schematic cross-sectional view showing a patient having a magnetic implant and an external sensor; FIG. 2 is a schematic elevation view showing an example of an external device for recording and displaying the position of an implant in a body. Description of the Invention and Preferred Embodiment In FIG. 1, reference numeral 1 indicates a magnetic implant, for example, an embedded permanent magnet. However, choosing any implant that has the ability to generate a detectable magnetic field (including an electromagnetic field) and / or a change in a magnetic field, etc., either in combination with any other material, is contemplated by the present invention. Within the possible range. According to the invention, the implant 1 is attached to a suitable body part 2 which has a relatively constant position in the body as opposed to the skin. In the illustrated embodiment, the body part is a bone in the body. Reference number 3 represents the patient's skin. It is desirable that the implant be located as close as possible to and external to the respective treatment area. Desirably, the implant is covered with a tissue-friendly material. Also, the implant is preferably provided with devices and / or materials known per se and for accurate fixation of the implant in the bone, for example screws, plates, orthopedic supports and the like. In an alternative embodiment, the implant may be an "explant", i.e., at a corresponding location extracorporeally, preferably in the lower part, e.g., close to and physically connected to the bone. good. The schematically shown device 4 located outside the patient represents, for example, one or more sensors for detecting a magnetic field or a change in the magnetic field from the implant 1 and / or other devices cooperating therewith. The number and type of sensors, implants and method of detection are selected, for example, according to the desired accuracy. Thus, the magnetic field can be generated in any manner that satisfies the above objectives, such as, for example, permanent magnets, manipulation guidance and internal or external power supplies. Induction can also raise the voltage within the implant, which can subsequently provide a magnetic field through the spool. The implant need not generate a magnetic field, and the implant can be designed such that its magnetic properties change the applied magnetic field (eg, steel plate) and this change is detected by a sensor. Thus, such an implant does not have to provide a magnetic field, only a change in the externally applied magnetic field. In this case, the implant has magnetic properties that can be detected by a sensor. Also, an external magnetic field can be combined with the magnetic field generated by the implant at home. The implant need not be so magnetic and can be actuated by induction, so that, for example, a magnetically insensitive spool of copper can be used without interfering with studies using magnetic resonance tomography. Since the position of the sensor 4 is known, the position of the implant / explant 1 can be simply calculated. The location of the implant within the patient is known, as is its relationship to the subject to be treated, such as a radiation target, so that the location relative to the patient and the subject to be treated can be determined. The design of the sensor 4 can be varied to suit the individual case, from a simple spool to an element that is more sensitive to the magnetic field, for example a Hall element, a magnetoresistive sensor, etc., which together make up the sensor. Such sensors may include one or more elements of the same or different types that sense the magnetic field. These sensors can be arranged in different shapes (circles, rows, etc.). The sensor may be movable or stationary. The elements of the sensor may also be immobile or movable to increase the area over which the magnetic field is detected. This is a technique so well known and can be applied to the present invention by those skilled in the art without further description. FIG. 2 shows a sensor assembled from 25 analog Hall sensors arranged in a 5 × 5 arrangement. By reading the signals from the sensors into the computer 6, each sensor is quickly read using the analog / digital converter 5. Each sensor provides a voltage that is proportional to the magnetic field in which it is located. Magnets located closer to the center of the magnetic field provide maximum refraction. By using this device, the center of the magnetic field can be accurately determined in two directions, and the accuracy increases when more devices are used. The invention is not limited to the embodiments described and / or illustrated, but many modifications and variations are possible within the scope of the appended claims.

Claims (1)

【特許請求の範囲】 １．外部治療装置に対して、患者の位置を早急に再現可能に特定するための磁気 特性を有するインプラントの使用。 ２．インプラントが永久磁石から成ることを特徴とする請求項１による使用。 ３．インプラントは、少なくとも一つの外部材料と協同して、空間内の患者の位 置が特定出来る磁場を発生する少なくとも一つの材料であることを特徴とする請 求項１による使用。 ４．インプラントは、その位置が意図する治療標的に関して実質的に一定である 身体部分に取り付けられることを特徴とする請求項１から３までの何れか一つに よる使用。 ５．身体部分が体内の骨であることを特徴とする請求項１から４までの何れか一 つによる使用。 ６．インプラントがエキスプラントである請求項１から５までの何れか一つによ る使用。 ７．外部治療装置に対して、患者の位置を早急に再現可能に特定するための装置 であって、 ａ）磁気特性を有し且つ身体部分に取り付けられ、その位置が意図する治療標的 に関し実質的に一定であるように設計された少なくとも一つの装置（１）、及び ｂ）磁場及び／又は磁場の変化を検出出来、且つ、それに基づいて、空間内の患 者の位置を特定する少なくとも一つのセンサ装置（２） から成る装置。[Claims] 1. Magnetic field for the external therapy device to quickly and reproducibly locate the patient Use of implants with properties. 2. 2. Use according to claim 1, wherein the implant comprises a permanent magnet. 3. The implant cooperates with at least one external material to position the patient in the space. At least one material that generates a identifiable magnetic field. Use according to claim 1. 4. The implant is substantially constant in its position with respect to the intended therapeutic target 4. The device according to claim 1, wherein the device is attached to a body part. Use. 5. 5. The body part according to claim 1, wherein the body part is a bone in the body. Use by one. 6. 6. The implant according to claim 1, wherein the implant is an explant. Use. 7. A device to quickly and reproducibly locate the patient relative to the external therapy device And a) Therapeutic target which has magnetic properties and is attached to the body part, the position of which is intended At least one device (1) designed to be substantially constant with respect to b) a magnetic field and / or a change in the magnetic field can be detected and based on it, At least one sensor device for determining the position of the person (2) Device consisting of
JP8510822A 1994-09-22 1995-09-22 Use of magnetic implants to locate patients Pending JPH10505776A (en)

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SE9403193A SE9403193L (en) 1994-09-22 1994-09-22 Method and device for position determination
SE9403193-7 1994-09-22
PCT/SE1995/001082 WO1996008999A1 (en) 1994-09-22 1995-09-22 Use of implant with magnetic properties to determine the position of a patient

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SE9403193L (en) 1996-03-23
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WO1996008999A1 (en) 1996-03-28

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