RU2722547C2 - Systems and methods for determining protocols for injecting a pharmaceutical liquid based on voltage on an x-ray tube - Google Patents

Abstract

FIELD: medical equipment.SUBSTANCE: group of inventions relates to means of delivering a pharmaceutical liquid to a patient, and especially for delivering a contrast preparation to a patient during a medical injection procedure. Patient visualization system comprises a visualization system and a system parameter generator for visualizing a patient to determine parameters of at least a first phase of the injection procedure, wherein the visualization system comprises a tomograph, comprising at least one X-ray tube, and wherein the parameter generator is programmed to determine at least one of the parameters based on the voltage to be transmitted to at least one X-ray tube during the visualization procedure, wherein the parameter generator is programmed to determine at least one of the volume of the pharmaceutical liquid to be injected during at least the first phase, and the pharmaceutical liquid consumption to be injected during at least the first phase, based on the voltage to be transmitted to at least one X-ray tube during the visualization procedure, wherein the parameter generator is programmed to determine the volume of the pharmaceutical liquid to be injected during at least the first phase, by the volume parameter correction in the basic injection protocol by applying a voltage variation coefficient on the tube to the volume parameter in the basic injection protocol, and wherein the patient visualization system additionally comprises an injector system in functional connection with the parameter generator, and at least one source of pharmaceutical liquid, wherein the injector system is configured to administer the injection of the pharmaceutical liquid during at least a first phase in accordance with the determination of the volume of the pharmaceutical liquid to be injected during at least the first phase. Method of operating a system for controlling an injector system for delivering a pharmaceutical liquid to a patient, as part of a visualization procedure, wherein the injector system is functionally connected to the visualization system, comprises determining the injection parameters in at least the first phase of the injection procedure using the system parameters generator, controlling the injector system by the system, at least partially based on certain injection parameters, wherein the parameter generator determines at least one of the volume of the pharmaceutical liquid, which must be injected during at least a first phase, and a pharmaceutical liquid consumption to be injected during at least a first phase based on a voltage to be transmitted to at least one X-ray tube during the visualization procedure, and wherein the parameter generator determines the volume of the pharmaceutical liquid to be injected in the at least a first phase by adjusting the volume parameter in the basic injection protocol by applying a voltage variation coefficient on the tube to the volume parameter in the basic protocol of injection, and injecting a pharmaceutical liquid by an injector system during at least a first phase in accordance with determining the volume of the pharmaceutical liquid to be injected during at least a first phase. Method of creating an injection protocol for use with an injector system in a functional connection to a visualization system comprising a tomograph, includes steps of determining injection parameters in at least a first phase of the procedure and injecting a pharmaceutical liquid by an injector system during at least a first phase in accordance with determining the volume of the pharmaceutical liquid, which must be injected during at least a first phase. Injector system for delivering pharmaceutical liquid to a patient by an injection procedure conducted in conjunction with a visualization procedure, wherein the visualization procedure, carried out with the visualization system, includes a parameter generator programmed to determine the volume of the pharmaceutical liquid, which must be injected during at least a first phase, by adjusting the volume parameter in the basic protocol of injection by applying a voltage variation coefficient on the tube to the volume parameter in the basic protocol of injection, such that the injection system is configured to administer the injection of the pharmaceutical liquid to the patient during at least the first phase of the injection procedure in accordance with the determination of the volume of the pharmaceutical liquid.EFFECT: use of inventions makes it possible to increase convenience and flexibility of operation of injector systems.27 cl, 10 tbl, 22 dwg

Description

[1] This application contains an object of the invention, which may be associated with objects disclosed and / or claimed in US patent No. 7925330, filed March 27, 2007, in the publication of patent application US No. 2007/0213662, filed March 27, 2008; No. 2007/0255135, filed March 27, 2007; No. 2008/0097197, filed March 22, 2007; No. 2010-0030073, filed June 12, 2009; No. 2010-0113887, filed June 15, 2009; No. 2010-0204572, filed January 15, 2010; and in international patent applications No. WO / 2006/058280 (international patent PCT application No. PCT / US 05/042891), filed November 23, 2005, and WO / 2006/055813 (international patent PCT application No. PCT / US 2005/041913) filed November 16, 2005, the disclosures of which are incorporated herein by reference and form part of it.

BACKGROUND OF THE INVENTION

FIELD OF THE INVENTION

[2] The present invention relates to devices, systems and methods for delivering a fluid, and in particular, to devices, systems and methods for delivering a pharmaceutical fluid to a patient, and especially for delivering a contrast agent to a patient during a medical injection procedure from diagnostic and / or therapeutic considerations.

Description of the prior art

[3] The following information is provided in order to help the reader understand the invention disclosed below and the environment in which it is usually to be applied. The terms used in this document are intended to be not limited to any particular narrow meaning, unless otherwise expressly indicated herein. References to sources cited herein may facilitate understanding of the present invention or the background of the present invention. Disclosures of all references cited herein are incorporated by reference.

[4] The administration of a contrast agent, for example, using an automatic injector for radiological examinations, usually begins with a clinician filling an empty disposable syringe with a specific volume of the pharmaceutical agent of the contrast agent. In other procedures, a syringe pre-filled with a contrast medium can be used. The clinician then determines the volumetric flow rate and the amount of contrast medium that the patient needs to enter in order to provide diagnostic imaging. Injection of saline in volume and at a flow rate determined by the operator often follows the introduction of a contrast agent into the veins or arteries. The range of injectors currently available allows the operator to program several individual phases with volumetric flow rates and delivery volumes. For example, SPECTRIS SOLARIS® and STELLANT injectors, available from MEDRAD, INC., From Bayer HealthCare, provide up to six separate pairs or phases of volumetric flow rate and volume, inclusive, for patient delivery (e.g., for contrast medium and / or saline). Such injectors and injector control protocols for use with them are disclosed, for example, in US Pat. No. 6,643,537 and published in US patent application No. 2004/0064041, the copyright holder of which is the applicant of the present invention, the disclosures of which are incorporated herein by reference. Values or parameters in the fields for such phases are usually entered manually by the operator for each type of procedure and for each patient undergoing an injection / imaging procedure. Alternatively, manually entered values for volume and flow rate can be stored and later recalled from the computer's memory. Nevertheless, the methods in which such parameters should be determined and brought into line with specific procedures for a particular patient are not well developed.

[5] In this regard, differences were found in the dosing requirements of the contrast medium for different patients during imaging and other procedures. For example, in US patent No. 5840026, the copyright holder of which is the applicant of the present invention, the disclosure of which is incorporated herein by reference, devices and methods are disclosed in order to adapt the injection to the patient's requirements using the patient specific patient data obtained before or during injection time. Although differences in dosage requirements for medical imaging procedures were established based on differences between patients, conventional medical imaging procedures continued to use pre-set doses or standard delivery protocols for injecting contrast agents during medical imaging procedures. Given the increased scanning speed of recently available computed tomographs (CT), including MDCT (or MSCT) tomographs, single-phase injections prevail over biphasic or other multiphase injections in those parts of the world where such fast tomographs are used. Although using standard, fixed, or predefined protocols (either single-phase, two-phase, or multiphase) for delivery simplifies the procedure, providing the same amount of contrast agents for different patients using the same protocol can give very different results in contrast and image quality. Moreover, with the introduction of the latest MDCT tomographs, the unresolved issue in clinical practice and in the CT literature is whether standard contrast protocols used with single-slice spiral tomographs will be well transferred to procedures using MDCT devices. See, for example, Cademartiri, F. and Luccichenti, G., et al., "Sixteen-row multi-slice computed tomography: basic concepts, protocols, and enhanced clinical applications." Semin Ultrasound CT MR 25 (1): 2-16 (2004).

[6] Several studies have attempted to quantify the injection process during computed tomographic angiography (CTA) in order to improve and sharpen the enhancement of arterial contrast. For example, Bae and coworkers developed pharmacokinetic (PK) models of the nature of contrast changes and solved a system of coupled differential equations in order to identify a defining function that causes the most uniform increase in arterial contrast. K.T. Bae, J.P. Heiken, and J.A. Brink, "Aortic and hepatic contrast medium enhancement at CT. Part I. Prediction with a computer model," Radiology, vol. 207, pp. 647-55 (1998); K.T. Bae, "Peak contrast enhancement in CT and MR angiography: when does it occur and why? Pharmacokinetic study in a porcine model," Radiology, vol. 227, pp. 809-16 (2003); K.T. Bae et al., "Multiphasic Injection. Method for Uniform Prolonged Vascular Enhancement at CT Angiography: Pharmacokinetic Analysis and Experimental Porcine Method," Radiology, vol. 216, pp. 872-880 (2000); US patents No. 5583902, 5687208, 6055985, 6470889 and 6635030, the disclosures of which are incorporated herein by reference. The inverse solution for the set of differential equations in the simplified compartment model set forth by Bae et al. Indicates that an exponentially decreasing flow rate of the contrast medium can result in optimal / constant contrast enhancement during the imaging procedure during CT. However, injection profiles calculated using the inverse solution in the RK model are profiles that are difficult to implement with most automatic CT injectors without significant modification.

[7] With another approach, Fleischmann and co-workers considered the physiology of the cardiovascular system and the kinetics of contrast as “an object of study with unknown properties,” and determined its impulse response by stimulating the system with short bolus injections of a contrast medium (approximately taken as single impulses). In that method, the specialist implements the Fourier transform on the impulse response and manipulates this estimate of the transfer function to determine an estimate of a more optimal injection curve than has been used previously. D. Fleischmann and C. Hittmair, "Mathematical analysis of arterial enhancement and optimization of bolus geometry for CT angiography using the discrete Fourier transform," J. Comput. Assist Tomogr., Vol. 23, pp. 474-84 (1999), the disclosure of which is incorporated herein by reference.

[8] Single-phase administration of a contrast medium (typically 100-150 ml of a contrast medium with a single flow rate) results in an uneven gain curve. See, for example, D. Fleischmann and K. Hittmair, above; and K.T. Wae, "Peak contrast enhancement in CT and MR angiography: when does it occur and why? Pharmacokinetic study in a porcine model," Radiology, vol. 227, pp. 809-16 (2003), the disclosures of which are incorporated herein by reference. Fleischmann and Hitmair thus presented a scheme in which they attempted to adapt the administration of a contrast agent by means of a two-phase injection selected for an individual patient in order to optimize visualization of the aorta. A fundamental difficulty in controlling the presentation of contrast agent for CT is that the hyperosmolar drug diffuses rapidly from the central blood vessels. In addition, the contrast agent is mixed with and diluted with blood, which does not contain a contrast agent.

[9] Fleischmann indicated that a small bolus injection, a test bolus injection of a contrast medium (16 ml of a contrast medium with a flow rate of 4 ml / s) was administered before the diagnostic scan. Dynamic amplification scanning was performed on a vessel of interest. The obtained processed scan data (the image obtained as a result of the test scan) was interpreted as the impulse response of the patient / contrast medium system. Fleischmann performed the Fourier transform on the transfer functions of the patient by dividing the results of the Fourier transform for the image obtained as a result of the test scan by the Fourier transform for a test injection. Assuming that the system was a linear time-stationary (LTI) system and that the desired signal from the region at the time of output was known (diagnostic scanning of a flat area with a predetermined gain level), Fleischmann received the signal at the time of input by dividing the frequency of domain representations with the desired output a signal to that for the patient transfer function. Since the method according to Fleischmann et al. calculates the input signals that are not feasible in reality as a result of the limitations of the injection system (for example, restrictions on the flow rate), the specialist must cut and approximate the calculated continuous signal.

[10] In addition, in order to control the automatic injector to obtain the desired curve for increasing contrast over time, the operation of the automatic injector must be carefully monitored to ensure patient safety. For example, it is desirable not to exceed a certain fluid pressure during the injection procedure. In addition to possible dangers for the patient (for example, vascular damage) and possible deterioration of the diagnostic and / or therapeutic suitability of the injected fluid, excessive pressure can lead to equipment failure. Disposable syringes and other components of the fluid supply system (sometimes collectively referred to as the “disposable kit”) are typically made from plastics with different tensile strengths under the influence of internal pressure. If the injector creates a pressure in the system that provides the fluid flow in excess of the tensile strength of the disposable element of the system that provides fluid flow, then the element of the system that provides fluid flow fails.

[11] In addition to control problems in modern injection systems, many of these systems lack the convenience and flexibility of the method by which injection systems should work. In this regard, the complexity of medical injection procedures and the feverish pace in all areas of the healthcare industry attach great importance to operator time and skills.

[12] Although advances have been made in managing fluid delivery systems, for example, to provide the desired curve for enhancing contrast over time and to ensure patient safety, it remains desirable to develop improved devices, systems and methods for delivering fluids to the patient.

BRIEF DESCRIPTION OF THE PRESENT INVENTION

[13] In one aspect of the present invention, there is provided a patient imaging system comprising an imaging system and a parameter generator for determining parameters of at least a first phase of an injection procedure, the imaging system comprising a tomograph comprising at least one x-ray tube, and wherein a generator parameters is programmed to determine at least one of the parameters based on the voltage that must be applied to at least one x-ray tube during the imaging procedure. The tomograph can be a computer tomograph, which can be programmed to operate at various voltages on the x-ray tube.

[14] In certain embodiments, a parameter generator in a system may be in communication with a visualization system. In certain embodiments, a parameter generator may be integrated into a visualization system.

[15] In some non-limiting embodiments, the implementation of the system may further comprise an injection system, and the injection system may include at least one injection mechanism, at least one fluid reservoir functionally associated with at least one injection mechanism, wherein of liquid containers, is intended to contain a contrast enhancing agent, and one of the liquid containers is intended to contain a diluent, and a controller operably connected to at least one delivery mechanism.

[16] In certain embodiments, the parameter generator may be in communication with at least one of the imaging system and controller of the injector system, and in certain embodiments, the parameter generator may be integrated into the injector system.

[17] In some non-limiting embodiments, a parameter generator may be programmed to determine at least one of the volume of pharmaceutical fluid that needs to be injected during at least the first phase and the flow rate of the pharmaceutical fluid that needs to be injected during at least as a first phase, based on the voltage that must be applied to at least one x-ray tube during the imaging procedure. The pharmaceutical liquid may include a contrast enhancer.

[18] In certain non-limiting embodiments, a parameter generator may be programmed to determine the volume of pharmaceutical fluid to be injected during at least the first phase, according to the formula: V ₁ = Bec * X * Y, in which V ₁ represents is the volume of the pharmaceutical fluid, X depends on the weight of the patient and the voltage on the x-ray tube, and Y depends on the concentration of the contrast enhancer in the pharmaceutical fluid. A parameter generator can be programmed to determine X for a specific patient weight from a lookup table in which X is presented as a function of patient weight and voltage that must be applied to at least one x-ray tube during the imaging procedure.

[19] In some non-limiting embodiments, a parameter generator may be programmed to determine at least a first pharmaceutical fluid flow rate by dividing V ₁ by the duration of the injection in the first phase. The parameter generator can be programmed to determine the duration of the injection based on one or more criteria entered by the operator, and these criteria may include at least the identification of the area of the body that must be visualized during the visualization procedure.

[20] In certain non-limiting embodiments, a parameter generator may be further programmed to determine the volume V _{2 of the} pharmaceutical fluid to be delivered in at least the second phase of the injection procedure into which both the pharmaceutical fluid and diluent must be delivered.

[21] In some non-limiting embodiments, a parameter generator may be programmed to determine the volume of pharmaceutical liquid to be injected during at least the first phase by adjusting the volume parameter in the basic injection protocol. Data representing the basic injection protocol may be present in the system memory or may be available to the system. A parameter generator can also be programmed to determine the basic injection protocol based on one or more criteria entered by the operator. In certain embodiments, a parameter generator may be programmed to determine the volume of pharmaceutical fluid to be injected during at least the first phase by applying the coefficient of change in voltage on the tube to the volume parameter in the basic injection protocol.

[22] In some non-limiting embodiments, a parameter generator may be programmed to determine the flow rate of the pharmaceutical fluid to be injected during at least the first phase by adjusting the flow rate parameter in the basic injection protocol. Data representing the basic injection protocol may be present in the system memory or may be available to the system. A parameter generator can also be programmed to determine the basic injection protocol based on one or more criteria entered by the operator. In certain embodiments, a parameter generator may be programmed to determine the flow rate of the pharmaceutical fluid to be injected during at least the first phase by applying the coefficient of variation in the tube voltage to the flow rate parameter in the basic injection protocol.

[23] In another aspect, a parameter generator is provided for use in an imaging system comprising a tomograph comprising at least one X-ray tube, the parameter generator being programmed to determine parameters of at least a first phase of an injection procedure, including at least one parameter based on the voltage to be applied to at least one x-ray tube during the imaging procedure.

[24] In another non-limiting embodiment, a method is provided for administering an injection system for delivering pharmaceutical fluid to a patient as part of an imaging procedure, the injection system being operatively connected to an imaging system comprising a tomograph containing at least one x-ray tube. The steps of the method include: determining, using a generator of parameters, the injection parameters in at least the first phase of the injection procedure, wherein at least one of the injection parameters is determined based on the voltage to be applied to at least one x-ray tube during the imaging procedure ; and control of the injection system, at least in part based on certain parameters of the injection.

[25] In some non-limiting embodiments of the method, the injection parameters that are determined include at least one of the volume of pharmaceutical liquid that must be injected during at least the first phase of the injection procedure, and the flow rate of the pharmaceutical liquid that needs to be injected into during at least the first phase of the injection procedure. The volume of pharmaceutical liquid that must be injected during at least the first phase can be determined in accordance with the formula: V ₁ = Bec * X * Y, in which V ₁ represents the volume of pharmaceutical liquid, X depends on the patient’s weight and voltage x-ray tube, and Y depends on the concentration of the contrast enhancer in the pharmaceutical fluid. In certain embodiments, X is determined for a particular patient weight from a lookup table in which X is presented as a function of patient weight and voltage to be applied to at least one x-ray tube during the imaging procedure.

[26] In certain non-limiting embodiments of the method, at least a first pharmaceutical fluid flow rate is determined by dividing V ₁ by the duration of the injection in the first phase. The duration of the injection in the first phase can be entered by the operator using the graphical user interface. The duration of the injection can also be determined by the parameter generator, based on one or more criteria entered by the operator.

[27] In some non-limiting embodiments of the method, the volume of pharmaceutical liquid to be injected during at least the first phase is determined by adjusting the volume parameter in the basic injection protocol. Data representing the basic injection protocol can be recalled from memory associated with or accessible to at least one of the injection system, the imaging system, and the parameter generator. The basic injection protocol can also be determined based on one or more criteria entered by the operator. The volume of pharmaceutical fluid that must be administered by injection during at least the first phase of the injection procedure can be determined by applying the coefficient of change in voltage on the tube to the volume parameter in the basic injection protocol.

[28] In certain non-limiting embodiments of the method, the flow rate of the pharmaceutical fluid to be injected during at least the first phase is determined by adjusting the flow rate parameter in the basic injection protocol. Data representing the basic injection protocol can be recalled from memory associated with or accessible to at least one of the injection system, the imaging system, and the parameter generator. The basic injection protocol can be determined based on one or more criteria entered by the operator. The flow rate of the pharmaceutical fluid to be injected during at least the first phase can be determined by applying the coefficient of variation of the voltage across the tube to the flow rate parameter in the basic injection protocol.

[29] In some non-limiting embodiments of the method, the method may further include the step of populating certain injection parameters on a graphical user interface associated with at least one of the injection system and the imaging system.

[30] In another aspect, a method is provided for creating an injection protocol for use with an injection system in operative connection with an imaging system comprising a tomograph comprising at least one x-ray tube, the method comprising the step of determining, using a generator of parameters, the injection parameters of at least in the first phase of the injection procedure, at least one of the injection parameters is determined based on the voltage that must be applied to at least one x-ray tube during the imaging procedure.

[31] The present invention, together with its characteristic features and related advantages, will be best appreciated and understood in light of the following detailed description in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF GRAPHIC MATERIALS

[32] Figure 1 illustrates an embodiment of a multiphase graphical user interface (GUI) for use in setting parameters for several phases in a two-syringe injector, also illustrated in figure 1.

[33] Figure 2 illustrates an embodiment of a graphical interface from which the operator can select a region of interest with vessels for visualization.

[34] Figure 3 illustrates an embodiment of a graphical interface from which an operator can enter variables related to a particular visualization procedure.

[35] Figure 4 illustrates an embodiment of a graphical interface that presents to the operator a calculated injection protocol.

[36] Figure 5 illustrates a simulated histogram in the right heart region.

[37] Figure 6 illustrates the total amount of contrast material delivered to model patients for different weight and tube voltage values corresponding to contrast agent delivery protocols obtained using an embodiment of a parameter generating system.

[38] Figure 7 illustrates the average flow rate of contrast material delivered to model patients for different weight and tube voltage values corresponding to contrast agent delivery protocols obtained using an embodiment of a parameter generating system.

[39] Figure 8 illustrates the average value of contrast enhancement of the right side of the heart (RH) achieved in model patients for different weight and tube voltage values corresponding to contrast agent delivery protocols obtained using an embodiment of a parameter generating system.

[40] Figure 9 illustrates the distribution of patients by weight in a sample of patients.

[41] Figure 10 illustrates the distribution of patients by height in a sample of patients from figure 9.

[42] Figure 11 illustrates the age distribution of patients in a sample of patients from Figure 9.

[43] Figure 12 illustrates the average flow rate at different patient weights for a sample of patients from Figure 9, corresponding to contrast agent delivery protocols obtained at various tube voltages using an embodiment of a parameter generating system.

[44] Figure 13 illustrates the average total volume of contrast medium delivered at different patient weights for the patient sample of Figure 9, corresponding to contrast agent delivery protocols obtained at various tube voltages using an embodiment of a parameter generating system.

[45] Figure 14 illustrates the average contrast enhancement value in the sample of patients from Figure 9 for different scan times, corresponding to contrast agent delivery protocols obtained at various tube voltage values using an embodiment of a parameter generating system.

[46] Figure 15 illustrates the average flow rate of the volume of delivered contrast medium at various scan times for a sample of patients from Figure 9 corresponding to contrast delivery protocols obtained with different values of tube voltage using an embodiment of a parameter generating system.

[47] Figure 16 illustrates the average contrast enhancement value in the sample of patients from Figure 9 at various injection durations corresponding to contrast agent delivery protocols obtained at various tube voltage values using an embodiment of a parameter generating system.

[48] Figure 17 illustrates an embodiment of a graphical interface from which an operator can select a vessel region of interest and a basic protocol for visualization.

[49] Figure 18 illustrates another embodiment of a graphical interface from which the operator can select a vessel region of interest and a basic protocol for visualization.

[50] Figure 19 illustrates an embodiment of a graphical interface from which an operator can select a voltage value on a tube.

[51] Figure 20 illustrates an embodiment of a graphical interface from which the operator can select the voltage value on the tube along with other variables in the injection procedure.

[52] Figure 21 illustrates another part of a graphical interface for use with an embodiment of a parameter generating system.

[53] Figure 22 illustrates another part of a graphical interface for use with an embodiment of a parameter generating system.

[54] Figure 23 illustrates an embodiment of a graphical interface that presents to the operator a calculated injection protocol.

[55] Figure 24 illustrates another embodiment of a graphical interface that presents to the operator a calculated injection protocol.

[56] Figures 25-27 illustrate examples of the methodology presented as an example in various embodiments of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[57] As used herein for the injection procedure, the term “protocol” refers to a group of parameters, such as flow rate, volume to be injected, duration of injection, etc., determining the amount of liquid (s) to be delivered to the patient during the injection procedure. Such parameters can be changed during the injection procedure. Used in this document, the term "phase", in General, refers to a group of parameters that determine the amount of fluid (s) that must be delivered to the patient over a period of time (or phase duration), which may be less than the total duration of the injection procedure. Therefore, the phase parameters provide a description of the injection over a time period corresponding to the time duration of the phase. The injection protocol for a particular injection procedure, for example, can be described as single-phase (single phase), two-phase (two phases) or multiphase (two or more phases, but usually more than two phases). Multiphase injections also include injections in which the parameters can change continuously during at least part of the injection procedure.

[58] In some embodiments, an injection system (such as a two-syringe injection system 100, which is illustrated in Figure 1 and which, for example, is disclosed in US Patent No. 6643537 and US Patent Application Publication No. 2004/0064041) can be used to implement the idea, described in detail in this document, and it usually contains two sources of fluid delivery (sometimes referred to as source "A" and source "B" in this document, such as syringes), which are configured to introduce the first fluid and / or second fluid (e.g., contrast medium, saline / diluent, etc.) to the patient independently (e.g., simultaneously, simultaneously with a different ratio of volumetric flow rates of one to the other or sequentially, or one after the other (i.e., then B or B then AND)).

[59] In the embodiment of FIG. 1, source A is operatively connected to a delivery mechanism, such as actuator 110A, and source B is operatively connected to an injection mechanism, such as actuator 110B. Each of source A and source B can be, for example, a liquid container. The injection system 100 comprises a controller 200 in operative connection with the injection system 100 and the drive elements 110A and 110B, which is configured to control the operation of the drive elements 110A and 110B to control the injection of liquid A (e.g., a contrast medium) from source A and injection of liquid B ( e.g. saline / diluent) from source B, respectively. The controller 200 may, for example, include a user interface comprising a display 210. The controller 200 may also comprise a processor 220 (eg, a digital microprocessor known in the art) in operative connection with a memory 230. The system may further comprise a visualization system 300. A visualization system 300 may, for example, be a computed tomography (CT) system or other tomographic imaging system. The injector system 100 may be in communication with the imaging system 300, and one, several, or all components of the injector system 100 and the imaging system 300 may be integrated into a single device.

[60] One example of an imaging system 300 is a CT system. The CT system typically contains a tomograph that uses x-rays to create an image using the principle of attenuation. Attenuation is a measure of the sequential loss of flux intensity, such as x-rays, as it passes through a medium, such as tissue, bone, and other body materials. CT systems generally comprise an x-ray source, typically an x-ray tube or tubes, and one or more x-ray sensors located opposite the x-ray source to capture the attenuated x-rays after they pass through the body, including body structures that can be filled with a contrast agent.

[61] With respect to X-ray imaging techniques using contrast media, attenuation and absorption of X-ray photons passing through body structures filled with iodinated contrast material increase as voltage supplied to the X-ray source (eg, X-ray tubes) decreases. It is believed that the increase in attenuation is due to the predominance of photoelectric absorption at lower x-ray excitation energies, especially when they reach the absorption peak for the iodine K shell. The following table (table 1) reflects the prior art relationship between the voltage on the x-ray tube and the ratio of attenuation to the concentration of the contrast medium (also known as the k-factor). (See, Takanami, et al., 2008).

[62] Since the ratio of attenuation to the concentration of the contrast medium varies depending on the voltage applied to the x-ray tube, all other things being equal, two scans using the same concentration of contrast medium at different voltages on the x-ray tube will produce different images. In particular, in the resulting image generated by the CT system, increased attenuation creates a brighter dimming and better contrast in the image between the structures filled with the contrast medium and the surrounding tissue. Since dimming can increase as the voltage on the tube decreases, the amount of contrast medium needed to achieve sufficient dimming to contrast in the area of interest can be reduced by using lower voltage on the tube. Similarly, since the dimming can decrease as the voltage on the tube increases, a larger volume of contrast medium may be necessary to achieve sufficient dimming for contrasting and appropriate visualization when higher voltage on the tube is used during the scanning procedure.

[63] The present disclosure provides methods, systems and algorithms for obtaining phase parameters, which, as previously determined, are effective for the type of imaging procedure that are based, at least in part, on the voltage on the tube that will be supplied during the procedure renderings. It was found that the selection of phase parameters taking into account the voltage on the tube not only leads to savings in contrast medium, but also helps to avoid not quite ideal results of contrast enhancement for higher voltage on the tube in the case when the ratio HU / (mg I. ml ^-1 ) is smaller. Such phase parameters can be set using a number of methods, including by collecting patient data over an extended period (for example, using artificial intelligence methods, statistical tools, adaptive learning techniques, etc.), through mathematical modeling, by modifying the basic or known protocols, taking into account changes in the voltage values on the tube or otherwise.

[64] In certain non-limiting embodiments, the injection phase parameters described above are populated into a programming mechanism for a phase or parameter generator, which may be a computer with software installed on it to implement the methods described herein based on one or several parameters of interest, including, but not limited to, the contrast medium concentration (e.g. iodine concentration in the case of the CT procedure), the patient parameter (e.g. body weight, height, gender, age, cardiac output, etc. .), the type of scan being performed, the type of catheter inserted into the patient for intravascular access, and the voltage applied during imaging scanning (for example, the voltage applied to one or more x-ray tubes during a CT scan). The parameter generator is typically in communication with at least one of the imaging system 300 and the injector system 100. The parameter generator may also include a processor (eg, a digital microprocessor known in the art) in functional communication with the memory. In some non-limiting embodiments, a parameter generator may be integrated into the imaging system 300 and / or the injection system 100.

[65] The programming mechanism for the phase can, for example, give the operator the ability to control the injection system by entering the “Create Protocol or Generation Mode Wizard”, “Advisory Support Mode”, or “Operator Prompt Mode”. After the operator selects a mode input with prompts for the operator, a graphic user interface may be presented to the operator that provides a mechanism or mode for entering information used to fill in the phase parameters. In the mode with prompts for the operator, the protocol parameters are filled in automatically, usually in response to the information entered by the operator through the graphical user interface and received by the parameter generator. The graphical user interface can present the operator with a series of selection procedures, such as questions about the procedure, about the patient, or both, answers to which can help the software associated with the programming mechanism for the phase to determine the appropriate injection protocol and parameters phase.

[66] For example, one embodiment of a graphical user interface from which the operator receives prompts for selecting an area of interest for acquiring an image and which follows the process described in this document is shown in Figure 2. The operator may, for example, select an area of interest by highlighting on the screen, for example, using a touch screen or using the mouse cursor, the area of interest in the illustration of the body outlined on the user interface, or can select the area of interest from a menu such as a drop-down menu. Hierarchical groupings of areas of interest can be provided.

[67] After selecting the area to be visualized, the operator can be prompted to select from among the various available preset protocols, each of which can have predefined parameters associated with it, such as the concentration of the contrast medium, whether test injection or transit bolus are used injection, maximum flow rate, pressure limits, injection duration, scan duration, etc., as shown in figure 2 and is called there "details" of the selected protocol. The “details” shown in FIG. 2 are illustrative only and are not intended to be limiting. Preset protocol parameters can be stored in the system’s memory, such as in memory associated with one or more of the above system components, or in a database accessible via the network, and recalled when a particular protocol is selected. These predefined values could be entered into the system’s memory by the operator or by someone associated with it in order to reflect the operator’s preferences for a particular protocol. These values can also be preloaded into the system during programming, and they can reflect values that are commonly used in the industry. Preset parameters, such as "max, flow rate" and "pressure limitation", can be parameters that are set for patient safety reasons. Other parameters can be set depending on the capabilities of the hardware in the system with a specific injector or tomograph. In some embodiments, the predefined values may be redefined, such as by directly entering new values by an operator or by creating a protocol requiring parameters incompatible with the predefined values. In the event that the preset values are incompatible with the created protocol, the operator can get a hint that such a case has occurred, and he is given the opportunity to adjust and / or approve the created protocol.

[68] After the protocol is selected, the operator can then be prompted to enter values for other variables (for example, physiological variables for the patient, such as weight, height, gender of the patient, etc., or variables for the procedure, such as concentration contrast medium, voltage on the tube, scan duration, etc., although it should be understood that the general order in which the operator is prompted for information or in which the operator enters information is not intended as a limitation. in which the variables "patient weight", "concentration" and "voltage on the tube" are selected or entered. An example of an embodiment or implementation of this is to provide a button console on a graphical user interface with which the operator enters the patient's weight in pounds or kilograms. In another embodiment, the operator selects a weight range from among low, medium and high whom ranges. Similarly, the voltage on the handset can be entered using the keypad or selected from among several preset values. Such variables can also be measured using one or more measuring devices associated with the system and / or read electronically or digitally from the patient’s medical record, which can be stored in a hospital database accessible via the network. For example, the system can be configured to automatically fill in the patient’s weight based on the patient’s medical records, or to automatically fill the voltage on the tube based on the capabilities or current settings of the tomograph in a connected imaging system. One or more of these variables can also be automatically populated based on one or more criteria selected in the previous step, such as the predefined protocol selected in Figure 2. An automatically populated value can then serve as the default value if it is not changes are made until they are made. The operator can also make a request if the operator wishes to perform a test injection or an injection for timekeeping.

[69] The location of the graphical user interface in the system is not intended as a limitation. In addition to the interface on the injector system, selection procedures can also or alternatively be performed on a graphical user interface on an imaging system or tomograph and / or from a database on an imaging system or tomograph. In the case when the selection procedures are performed through an interface or a database located in the tomograph, the data can then be transferred to the injector. Moreover, the interface can only be present on the tomograph / imaging system. In this case, the final protocol can be transferred to the injection system. Similarly, an interface or database may be present on a device or system separately from the injector and tomograph. Data, such as protocols, can be transferred from such a system to the injector. A communication interface that can be used in the invention according to this document is disclosed in US patent No. 6970735, the contents of which are incorporated herein by reference. One or more visualization systems can also be connected via a network to a central control unit in which one or more computer interfaces can be present to display and / or enable control of networked visualization systems. For example, several imaging systems can be connected to a conventional computer or a group of computers located in a control center in which the operator can monitor and adjust the protocols that are used on one or more of the imaging systems. A radiologist who wants to determine the specific injection protocol to use in a particular case can take advantage of such a network to correct the protocol from such an interface.

[70] Based on the selection, software implementing the present invention calculates an injection protocol including parameters such as flow rates and volumes for the phase, including test injection, if necessary, for consideration by the operator. One such example of a graphical user interface showing an injection protocol for consideration by an operator is shown in FIG. 4.

[71] In certain non-limiting embodiments, the calculation of the parameters of the injection protocol is performed using a variable weight coefficient (mg iodine / kg body weight), which is used to determine the dose or total volume of iodine for a patient at a specific voltage on the tube or a range of its values. In general, there is a linear relationship between the concentration of iodine in the blood plasma and the amplification (or CT number) in units of the Hounsfield scale in the blood vessel. Weight is easy to obtain before scanning the patient, and it serves as practical tools for calculating the pre-loaded volume of the contrast medium. The requirement for calculating the pre-loaded volume can be eliminated by using a flow system using containers, for example, with a contrast medium and a washing liquid or diluent (e.g., saline solution), as described, for example, in US Pat. Nos. 6,901,283, 6731971, 6442418, 6306117 , 6149627, 5885216, 5843037 and 5806519, US Patent Application Publication No. 2006/0211989 (US Patent Application Serial No. 11/072999) and International Patent Application Publication No. WO / 2006/096388 (PCT International Patent Application PCT / US2006 / 007030), the contents of which are incorporated herein by reference.

[72] In several embodiments, the software used in the method samples the weight ranges of subjects, for example, into 7 ranges (eg, <40 kg, 40-59 kg, 60-74 kg, 75-94 kg, 95-109 kg, 110 -125 kg,> 125 kg), and the tube voltage, for example, by 4 values (80 kV _peak , 100 kV _peak , 120 kV _peak and 140 kV _peak ) for each weight range. Weights are associated with each combination of weight range / tube voltage. Illustrative weights that depend on the patient’s weight and tube voltage and vary depending on them are shown in Table 2 below.

[73] The weights shown in Table 2 were obtained using the multi-criteria optimization operation (Gembicki, FW, "Vector Optimization for Control with Performance and Parameter Sensitivity Indices," Case Western Reserve University (1974)) for model patients representing each of the weight ranges This process is described in US Patent Application Publication No. 2010/0113887, the rights of which belong to the copyright holder of this application, the entire contents of which are incorporated by reference.

[74] A similar multicriteria optimization was performed to determine the weight coefficient values for the same set of discretized weight ranges for tube voltages of 80, 100, and 140 kV _peak. For each, a goal was set to achieve a contrast enhancement value of at least 325 HU on the right side of the heart while keeping the volumes of contrast medium and flow rates as low as possible. The values of the weight coefficient were calculated in order to ensure the highest probability of achieving this goal. Other parameters were also taken into account when determining the weights. For example, the optimal value of the weight coefficient usually increases as the scan duration increases. This is primarily due to the fact that a larger amount of contrast medium is required to ensure that the goal of enhancing contrast is achieved in the full scan window. Moreover, longer scan times typically involve lower flow rates, which may reduce contrast enhancement and therefore require additional contrast media to compensate. However, the calculated weights may correspond to all scan times.

[75] For each weight group, weight, height, age, and gender were randomly generated for 50 model patients. The parameters of the dosing protocol of the contrast medium were changed during the simulation as follows:

contrast agent concentration: 320 and 370 mg I / ml

scan duration: 4, 10, 16 and 20 seconds

minimum injection duration: 12 seconds

maximum flow rate: 7 ml / s

syringe capacity: 194 ml

dual stream: ON and OFF

[76] The enhancement of contrast on the right side of the heart was calculated as the average enhancement of contrast during the scan window. A test bolus injection of 20 ml of contrast medium, 40 ml of saline was used to determine the appropriate time period for the scan window. The minimum duration of the injection did not change, since it is usually set for 12 seconds when the injection is performed to visualize the heart. Usually, there is no need to change the value of the minimum injection duration, unless the scan duration values are selected so as to simulate all possible states of volume and flow rate correction during the creation of the protocol.

[77] For each of the model patients, all possible combinations of the above parameters were modeled in accordance with the PK model described by Bae. K.T. Wae, J.P. Heiken, and J.A. Brink, "Aortic and hepatic contrast medium enhancement at CT. Part I. Prediction with a computer model," Radiology, vol. 207, pp. 647-55 (1998); K. T. Bae, "Peak contrast enhancement in CT and MR angiography: when does it occur and why? Pharmacokinetic study in a porcine model," Radiology, vol. 227, pp. 809-16 (2003); K.T. Bae et al., "Multiphasic Injection. Method for Uniform Prolonged Vascular Enhancement at CT Angiography: Pharmacokinetic Analysis and Experimental Porcine Method," Radiology, vol. 216, pp. 872-880 (2000); U.S. Patent Nos. 5,583,902, 5,687,208, 6,055,985, 6,470,889 and 6635030.

[78] When choosing the best possible values of the weight coefficient, a set of contrast enhancement criteria was determined for each application. For angiography of pulmonary vessels, for example, the goal was to achieve a contrast enhancement of at least 325 HU using the least amount of contrast medium and the lowest flow rate. The cost function was built in accordance with the following equation:

;

;

R: flow rate (ml / s)

V _cD : diagnostic volume of contrast medium (ml);

E _RH : average contrast enhancement on the right side of the heart during the “window” scan (HU).

[79] In addition, it was considered desirable to limit the number of cases in which the contrast enhancement on the right side of the heart fell in the range of less than 275 HU. Therefore, for each group by weight, the statistical distribution of the weight coefficient values for all cases corresponding to the result of the cost function 47.5, which was an arbitrarily selected cost function, based on which the value was taken as an acceptable value, was compared with the distribution of the weight coefficient values, for which contrast enhancement in the right side of the heart was more than 275 HU, and another distribution for cases that do not correspond to the result of the cost function, in which the flow rate exceeded 6 ml / s.

[80] The histograms of each distribution were calculated, and the point at which the maximum positive difference between the high and low contrast gain distributions was observed was considered the best possible weight coefficient, since it represents the value at which the contrast enhancement criterion will be satisfied most of the time, and at in which the contrast enhancement in the right heart region will fall below 300 HU in a very limited number of cases. Figure 5 shows an example of a histogram distribution for a tube voltage of 100 kV _peak. , and in the group by weight 40-59 kg.

[81] From the histogram shown in figure 5, a weight coefficient of 0.39 g I / kg was considered optimal for the studied combination of the weight range / voltage on the tube. Less than 1% of cases with low contrast enhancement occurred at this value according to modeling data. The integral distribution function will show that cases with low contrast enhancement or high flow rates did not occur with weight ratios greater than or equal to 0.4 g I / kg. Therefore, selecting the point with the greatest positive difference also guarantees very little overlap between the two distribution curves.

[82] The simulation data described above was used to determine whether the patient or injection protocol parameters are likely to affect the results of contrast enhancement, or, in other words, to determine whether a particular contrast enhancement result is more likely to be achieved for either a given type of patient, or for a specific injection protocol. To analyze the effect of patient age, for example, the average age of model patients who achieved 325 HU, was compared with the average age of the full group of model patients. This was done for each value of the voltage on the tube and in all groups by weight. The results are shown in table 3 below.

[83] The results in Table 3 show that the average age of patients in cases where the result is achieved differs from the average age of the entire group of patients with statistical significance of the differences, showing a slight bias towards older patients. A possible explanation for this fact is that, by and large, older patients tend to have lower cardiac output values, which leads to higher contrast enhancement peaks.

[84] The growth of model patients was also evaluated in a similar manner, and the results of this evaluation are shown in table 4 below.

[85] From the results shown in table 4, it is obvious that the differences in growth between the groups in which the result is achieved by increasing contrast and the general group of patients are not significant. The difference reaches statistical significance, but from a physical point of view it has no practical value.

[86] The influence of the scan duration was also measured, which was observed by calculating, for each tube voltage, the percentage of scans that successfully achieved the result obtained for each of the four scan durations. The results of this assessment are shown in table 5.

[87] In Table 5, the percentage of successful cases occurring with scan durations of 4 and 10 seconds tends to increase as the voltage on the tube increases, although it decreases with scan durations of 16 and 20 seconds. This is probably, at least in part, due to the long scan times, the average contrast enhancement is lower due to both a larger scan window and a lower injection rate of the contrast medium. As the voltage on the tube increases, the amount of contrast medium required to achieve the result of enhancing the contrast increases to the same extent. This can lead to cases in which the amount of contrast medium calculated using the protocol exceeds the capacity of the syringe, which leads to a lower than expected plateau of contrast enhancement in the scan window. If this is the case, with a shorter duration of the “windows” of scanning, it is more likely to achieve a result of enhancing the contrast, since scanning will occur only during the period with the highest contrast enhancement.

[88] The effects of contrast agent and gender concentration were also evaluated, and the results of this evaluation are shown in Tables 6 and 7 below.

[89] From the data in Table 6, it is not obvious that the concentration of the contrast medium has a particular effect on the success rate, since both tested concentrations of the contrast medium produce similar percentages of success. Similarly, it is not obvious from table 7 that gender has any particular effect on the successful achievement of contrast enhancement results.

[90] The above simulations were used to obtain weights in table 8 below.

[91] In addition, weights in Table 8 were checked to ensure that they did not give unrealistic injection protocols. To this end, a statistical analysis of the flow rate and the use of the volume of the contrast medium was carried out to confirm that the injection protocols created in accordance with the procedure described in US Patent Application Publication No. 2010/0113887 using these weights were practically feasible. The results of this analysis are shown in figures 6-8 and are described below.

[92] Figure 6 shows that the volumes of the contrast medium calculated with the weights from Table 8 will not produce unrealistic protocols in terms of the total volume of the delivered contrast medium. As shown, the average volume increased with increasing stress on the tube and with increasing weight in the group by weight, as expected. The smallest volume of contrast medium, calculated at 80 kV _peak. , amounted to 29.2 ml, while the largest volume of contrast medium calculated at 140 kV _peak. , was 161 ml. This constitutes a range of volumes calculated using the algorithms from the protocols in US Patent Application Publication No. 2010/0113887 using the weights of Table 8.

[93] In figure 7, the flow rate calculated using the algorithm using the weights of table 8 also increase with increasing voltage on the tube and with increasing weight in the group by weight. All calculated values are realistic and can all be used in clinical injection protocols. The smallest flowrate used in the sample at 80 kV _peak. , was 2 ml / s, and the highest flow rate used at 140 kV _peak. was 7 ml / s due to flow rate restrictions.

[94] The average contrast enhancement on the right side of the heart during the scan window was also calculated using weights in Table 8, and the results are shown in Figure 8. For most weight groups, a contrast enhancement result of 325 HU was easily achieved when the voltage the tube was set either at 80 kV _peak. , or at 100 kV _peak. For conditions of 120 kV _peak. and 140 kV _peak. the result of enhancing contrast was not achieved so often, partly because for these values the capacity of the syringe may be a limiting factor and cause a reduction in the injection protocol. Moreover, at 120 kV _peak. weights were set to the same or lower than the initial values of the weights, in an attempt to limit flow rates and volumes for applications in pulmonary angiography.

[95] Clinical studies of weighting factors from Table 8 were also performed using patient data from clinical trials at UPMC and Münster. The study involved 105 patients whose summary statistics are presented in table 9 below.

[96] The sample included 63 male patients and 42 female patients. Figures 9, 10 and 11 represent the distribution of weight, height and age in the sample, respectively.

[97] The above simulation was performed on this patient data using the weights of Table 8. For each patient weight, the injection protocol was calculated in accordance with the protocol calculation method set forth in US Patent Application Publication No. 2010/0113887 for each tube voltage, and the average flow rate in each of the injection protocols was plotted against the weight of the patients for each tube voltage value. The results are shown in Figure 12. In these results, flow rates increased as the voltage on the tube increased, but the average value of flow rates remained below 6 ml / s even for the conditions of the highest voltage on the tube. The flow rates obtained for the calculated injection protocols were thus within the expected range.

[98] Similarly, the total volume of the contrast medium used in the injection protocol, including the diagnostic phase and the dual-flow phase, was also calculated for each patient and plotted against weight, these results are shown in Figure 13. 13, the average volume remained below 100 ml for all injection protocols. Nevertheless, there were cases in which the volume exceeded 100 ml, especially for patients with a large weight.

[99] Figure 14 shows the effect of scan duration on the contrast enhancement value on the right side of the heart in a patient sample. Figure 14 shows that the contrast enhancement value for scan durations of 16 and 20 seconds is lower than for scan durations of 4 and 10 seconds. This is believed to be at least partially due to the fact that the contrast enhancement value was calculated as the average contrast enhancement value in the scan “window”, thereby causing a lower average contrast enhancement value for longer scan “windows”. Moreover, as shown in FIG. 15, shorter scan times tend to result in higher flow rates, further contributing to the increase in contrast enhancement. However, if the scan duration is shorter than the minimum test injection duration of 4 seconds, the contrast medium for the diagnostic phase is reduced, which explains why the contrast enhancement is usually lower for scan durations of 4 seconds than for scan durations of 10 seconds. Contrast enhancement also tends to drop below 300 HU for scan durations longer than 16 seconds in Figure 14.

[100] Figure 16 shows the effect of the minimum injection duration on the average value of contrast enhancement. In particular, for the patient sample shown in the graph in Figure 16, the average contrast enhancement on the right side of the heart drops below 300 HU for a voltage value of 120 kV _peak on the tube _. and 140 kV _peak. but remains above this threshold for lower tube voltages, regardless of the programmed scan duration.

[101] Using weights, injection protocols for a patient can be determined using a system according to a weight-based algorithm. One such embodiment of a weight-based algorithm for determining the volume of a pharmaceutical fluid, such as a contrast agent, to be administered by injection during the injection phase, is represented by the following equation:

V ₁ : volume of pharmaceutical fluid to be delivered per phase;

X: weighting factor

Y: concentration of contrast medium in the pharmaceutical fluid.

[102] Once the total volume to be delivered during a particular phase is known, the system can determine the appropriate flow rate for a particular phase in accordance with the formula:

[103] The duration of an injection can be determined using a number of methods. For example, the duration of an injection can be determined by the system based on one or more criteria related to the imaging procedure (for example, the area of the body to be imaged) and / or the patient (for example, the patient’s weight), it can be a value that is entered directly by the operator, or it may be a predefined parameter, as described above.

[104] The parameters of the additional phases can be determined in a similar manner. For example, the system can determine the parameters for the first phase in which only the pharmaceutical liquid is to be delivered, and for the second phase with dilution, in which both the pharmaceutical liquid and the diluent, such as saline, are to be delivered.

[105] The implementation software may be programmed to generate injection protocol parameters based on the above algorithms and weights, which are partly based on the voltage on the x-ray tube. After generating the parameters, you can fill in the graphical user interface for review by the operator. As previously described, FIG. 4 represents an embodiment of a graphical user interface capable of presenting an injection protocol to an operator for review. In various embodiments, weights can be determined by the system using an algorithmic approach in which weights are calculated using information about a patient’s weight, tube voltage, etc., as described above, for example. The weights can, alternatively or in addition to this, be stored in advance in memory, for example, in the form of a data file in the look-up table, uploaded to the system or accessible to the system via the network, providing the possibility of recalling the weights if necessary. Table 8, for example, illustrates exemplary weighting related information that can be made available in a lookup table.

[106] In other non-limiting embodiments, the determination of the appropriate parameters of the injection protocol can be performed by modifying or correcting the protocol parameters in the basic injection protocol using the coefficient of change in voltage on the tube taking into account the differences between the voltage applied to the x-ray tube during a particular scan (or phase), and the voltage on the tube, which was used or assumed when determining the parameters in the basic protocol.

[107] In the context of this disclosure, basic injection protocols include protocols that have been established in the clinical literature, established by collecting patient data over an extended period, for example, using artificial intelligence methods, statistical tools, adaptive learning techniques, etc., or established by mathematical modeling. These protocols may depend, for example, on the concentration of the contrast medium, for example, the iodine concentration in the case of the CT procedure, the patient parameter, for example, body weight, height, gender, age, cardiac output, etc., on the type of scan performed, type a catheter inserted into the patient for intravascular access, and / or other specific patient data. In some non-limiting examples, basic protocols have been or can be created using a weighting coefficient, like creating protocols using the weighting factors discussed above. Such protocols, as well as methods and systems for creating such protocols, are described in International PCT Patent Application No. PCT / US05 / 41913, entitled “Pharmaceutical Distribution Modeling,” filed November 16, 2005 stating the benefit of a provisional US patent application serial number 60 / 628201, the rights under which belong to the copyright holder of this application, and in PCT International Patent Application No. PCT / US07 / 26194, entitled “Parameter Generation Systems for Medical Injection Procedures Based on Patient Data”, filed December 21, 2007, claiming the advantage of provisional applications for US patents with serial numbers No. 60/877779 and No. 60/976002, the copyright holder of which is the applicant of the present invention, the disclosures of which are incorporated herein by reference.

[108] The basic injection protocols for use herein may be stored in a system memory, may be accessible to the system via a network, or may be determined by the system in response to one or more of the entered values. For example, a number of basic injection protocols, each of which, as you know, provides optimal dosage parameters for certain combinations of the scanned area, body weight, contrast medium concentration, etc. at a specific voltage on the tube, can be stored in memory. The system can then recall information about the corresponding basic protocol for use in creating the injection protocol after sufficient information about the injection protocol to be created is known. For example, if the operator selects a combination of the scanned area / body weight / concentration of the contrast medium for the new injection procedure, the system can re-invoke the basic protocol created for the same or similar combination of the scanned area / body weight / concentration of the contrast medium. Alternatively, the system may include software that can calculate basic injection protocols based on one or more patient-specific or procedure-specific criteria entered by the operator, including the values discussed above (e.g., patient-specific or patient-specific procedure parameters).

[109] The basic injection protocols generally reflect optimal dosing parameters of the contrast medium at a particular tube voltage, which is referred to herein as the base tube voltage. The most common base voltage on the tube is 120 kV _peak. The baseline voltage on the tube associated with the baseline injection protocol can be stored along with other information on the baseline injection protocol, although in some non-limiting embodiments, the operator may be prompted to enter the baseline voltage on the tube for a particular baseline injection protocol, or it can be assumed that the baseline the voltage on the tube is 120 kV _peak. Due to the relationship between tube voltage and attenuation, the basic injection protocol may not provide optimal dosing parameters for the contrast medium if, using this protocol, a tube voltage different from the base voltage on the tube is used. Accordingly, the basic parameters of the protocol can be modified or adjusted in order to achieve a more optimal dosage of contrast medium with a new voltage value on the tube. Since the modified parameters are not completely known to the injector operator, the system generating the parameters described in this document facilitates the task of the operator by providing tube voltage coefficients that should be used in conjunction with the basic injection protocol to determine more optimal injection parameters for the voltage of interest on the phone.

[110] In several non-limiting embodiments, the application of the coefficient of variation of the voltage on the tube to one or more of the parameters in the basic injection protocol can be used to obtain a new injection protocol adjusted to the specific voltage on the tube to be used when scanning, for example, using correction or modification of parameters in the basic protocol.

[111] In one non-limiting embodiment, the coefficients of change in the voltage on the tube are determined from an analysis of the relationship between the attenuation to concentration ratio of the contrast agent (k-factor) and the voltage on the tube. The relationship between the k-factor and the voltage on the tube can be established through a review of the clinical literature, and the prior art relationship is shown in Table 1 above. Alternatively or in addition to this, the relationship between the k-factor and the voltage on the tube can be determined by performing a calibration operation on the tomograph.

[112] One such calibration operation involves the preparation of several vesicles, each of which contains a mixture with a known concentration of iodine, usually in mg I / ml. The bubbles are then scanned at various voltages on the tube, for example, at 80, 100, 120 and 140 kV _peak. , and record the attenuation value for each bubble at each voltage on the tube. Test tube voltages should at least include the base voltage on the tube used in determining the baseline protocol, which is typically 120 kV _peak. , as well as any other voltage on the tube that can be used with the tomograph, for reasons that will become apparent below. For each of the studied voltages on the tube, the concentration in the bubbles was plotted on the graph depending on the recorded attenuation values, and a curve of maximum correspondence for each voltage on the tube was obtained. For each voltage on the tube, the slope of the maximum correspondence curve represents the corresponding k-factor for that particular tube voltage in units of HU / mg I / ml. Typical k-factor values determined in accordance with this calibration operation should generally correspond to those known in the art from the values given in Table 1.

[113] Coefficients of tube voltage variation for various tube voltages can be determined based on k-factors and information on the base voltage of the tube by calculating the relative increase or decrease in the k-factor between the specific tube voltage and the base voltage of the tube. For example, if the base voltage on the tube had a k-factor of 25 HU / mg I / ml, the coefficient of change in voltage on the tube corresponding to the voltage on the tube with a k-factor of 41 HU / mg I / ml would be calculated as (25-41) / 41 or -39%.

[114] Table 10 below illustrates tube voltage variation factors for various tube voltages, assuming that the base tube voltage is 120 kV _peak. using the k-factors from table 1.

[115] Further correction of the calculated tube voltage variation factors may be appropriate with the care of the operator, since other aspects of the image, in particular noise, change along with changes in the tube voltage. Thus, the operator may prefer that instead of a 39% drop at 80 kV _peak. for example, only a 30% reduction was used. Although the calculated default values are offered by the software based on the results of a calibration experiment, the operator is given the opportunity to change the proposed values according to his or her preference.

[116] As soon as the coefficients of voltage variation on the tube are known, the operator can decide which parameters in the basic injection protocol should be adjusted based on the coefficients of change. For example, the operator may decide that the parameters of both the total volume and the flow rate need to be adjusted based on the coefficient of change in the voltage on the tube in order to maintain a constant injection duration, or only the total volume can be reduced in order to maintain a constant flow rate and reduce the injection duration . Typically, if the flow rate of the contrast medium is changed, the flow rates of any phases with saline are adjusted by the same amount to maintain consistency between the diagnostic phases with the contrast medium, patency checks of the patient’s vessels using saline and flushing with saline. Alternatively, the software can be configured to automatically select one or more parameters in the basic injection protocol for correction in accordance with the coefficient of variation of the voltage on the tube, usually the volume and flow rate.

[117] The parameter generator must also recognize or be capable of identifying the voltage on the tube to be supplied as part of a new injection procedure to determine the appropriate coefficient of change in the voltage on the tube for use. For example, the value of the voltage on the tube can be entered directly by the operator directly into the parameter generator, or the parameter generator can receive information about the voltage on the tube from a tomograph or other component of the system, while the voltage on the tube is known to the component due to the specific settings or capabilities of the component or because the operator entered the voltage value on the tube into the component. Once this is known, an injection protocol can be created by applying the coefficient of variation of the voltage across the tube to the basic parameters of the protocol. For example, in the case of a change in the volume and flow rate in the basic protocol, obtaining new parameters for the volume and flow rate includes increasing or decreasing the volume and flow rate parameters in the basic protocol, taking into account the coefficient of change of voltage on the tube. Create injection protocols using the system software by recalling from the memory and / or creating a basic protocol, determining the coefficient of variation of the voltage on the tube based on the details of the selected basic protocol, including the base voltage on the tube and the estimated voltage on the tube to be applied , and correction of the parameters of the basic protocol, taking into account the coefficient of change of voltage on the tube.

[118] Correction of the protocol parameters using the coefficient of variation of the voltage on the tube provides the ability to change the basic protocol in order to maintain similar characteristics of contrast enhancement, despite the change in voltage on the tube. For example, if the indicated volume and flow rate provide a contrast enhancement of 300 HU in the indicated region of interest, scanned at 120 kV _peak. , the iodine concentration in this area can be calculated from the k-factor in table 1 as 12 mg I / ml (300 HU ÷ 25 HU / mg I / ml). Using the same volume and flow rate (and therefore assuming the same iodine concentration in a given area) to scan the same area of interest at 100 kV _peak. an increase of 372 HU contrast is expected to be achieved using the k-factor in table 1 (31 HU / mg I / ml * 12 mg I / ml). To maintain 300 HU at 100 kV _peak. the volume and / or flow rate can be reduced by a coefficient of change of voltage on the tube of 19% to obtain an iodine concentration of 9.7 mg 1 / ml.

[119] Like the embodiments described above, a graphical user interface may be presented to an operator that provides a mechanism or a mode for inputting information necessary to fill in phase parameters based on the coefficient of change of voltage on the tube.

[120] For example, one embodiment of a graphical user interface from which the operator selects a body region of interest and which follows the process described with reference to FIGS. 17, 19, 21 and 23 is described in FIG. 17. The operator may, for example , select the area of interest by highlighting on the screen, for example, using the touch screen or using the mouse cursor, the area of interest in the illustration of the body outlined on the user interface, or can select the area of interest from the menu, such as a drop-down menu. Hierarchical groupings of areas of interest can be provided. Figure 18 shows another embodiment of a graphical user interface from which the operator can select an area of interest, and an alternative sequence of operations is described herein with reference to figures 18, 20, 22 and 24.

[121] After selecting the area of the body to be visualized, the operator can get a hint for choosing from among the various available base protocols, each of which can have predefined parameters associated with it. For example, Figure 17 illustrates a user interface representing one option in the protocol, designated as “Head Protocol 1,” which, when selected, can show the default flow rates and volume for each phase along with the total diagnostic volume of the contrast medium and the total diagnostic volume of saline , which are also shown in FIG. 17. FIG. 18 illustrates a user interface representing several basic protocols, from which a basic protocol can be selected. The selected base protocol may have additional parameters associated with them, such as injection pressure or flow rate restrictions, iodine concentration, scan duration, whether a test bolus injection is performed, etc., which may or may not be displayed and which it is possible or impossible to correct. Figure 18 shows an example in which additional details about a particular selected base protocol are displayed to the operator. The indicator can also be associated with a predefined protocol, indicating that a particular protocol can be adjusted based on the rule for changing the voltage on the tube, for example, by applying the coefficient of change in voltage on the tube, as discussed above. The illustrative interfaces in FIG. 17 and FIG. 18 represent it in the form of a “kV _peak. ” Icon associated with the “Head Protocol 1” and “Cardiac w / Bolus Tracking” protocols. Other available protocols may not have the option of changing the voltage on the handset associated with them, such as the Dr A's Cardiac protocol in Figure 18.

[122] After selecting the area to be visualized and the basic protocol, the operator can be prompted to enter values for the “tube voltage” to be used. Figure 19 shows an example of a graphical interface in which you can select or enter "voltage on the tube." In this example, the voltage on the handset can be selected from several preset values, although the voltage on the handset can also be entered using a keypad or the like. The voltage value on the tube can also be automatically filled based on the capabilities or settings of the associated tomograph. 20 illustrates another example of an interface in which “tube voltage” can be selected from among various options. In the embodiment of FIG. 20, “patient weight” and “concentration” are additional parameters available to the operator to select. The specific parameters shown in figures 19 and 20 are not intended to be limiting, and other parameters are intended to be selected by the operator in accordance with the above discussion.

[123] After selecting the voltage on the tube, the base protocol and / or other input parameters, such as patient weight and iodine concentration, the software for implementing the parameter generator can determine the corresponding change in the base protocol, for example, by determining the coefficient of change of voltage on the tube. The operator can then be presented with an interface informing the operator about the selected parameters and the associated correction performed as a result of the selected voltage value on the tube. An example of one such interface is shown in Figure 21, which confirms to the operator that a voltage value of 100 kV _peak on the tube has been selected _. , and under the “note” that the selected value of the voltage on the tube is associated with a 19% decrease in the volume of the contrast medium from the base volume of the contrast medium. Figure 22 similarly shows an example of an interface that informs the operator about the selected patient weight, iodine concentration and the voltage value on the tube and that a 19% decrease in the volume of the contrast medium is associated with a specific voltage on the tube selected from the base value.

[124] Based on the selection of the voltage on the tube, the software for implementation calculates the injection protocol using the coefficient of variation of the voltage on the tube. Protocol parameters, such as flow rates and volumes for phases (including test injection, if one is used), can then be presented to the operator for consideration by him or her. One such example of an interface displaying a calculated injection protocol is shown in Figure 23. Another such example is shown in Figure 24.

[125] After the consideration of the calculated protocols by the operator is completed, the operator can begin the injection process, which will be carried out in accordance with the detailed data in the created protocol.

[126] FIG. 25 illustrates one example of a technique associated with embodiments involving varying the voltage across a tube. The left side of the diagram illustrates an example of this technique applied to the standard protocol. Stage I represents the operator’s choice of the standard protocol in accordance with Figure 17. Stage 2 represents the selection of the tube voltage from the list of tube voltages illustrated in Figure 19. Stage 3 describes the application of the change factor to the parameters in accordance with the particular tube voltage selected in step 2. This step corresponds to that illustrated using the graphical user interface from Figure 21. Step 4 represents the display of the modified protocol as shown in Figure 23. Similarly, steps 1-4 on the right side of the circuit depict the application of the change in voltage on the handset to a predefined type protocol, which can be obtained using one or more of the products based on P3T® technology available from MEDRAD, INC., a Bayer HealthCare company. These steps follow the illustrations from figures 18, 20, 22 and 24, respectively.

[127] Figure 26 shows an example of a technique underlying the embodiments in which the tube voltage parameter is integrated directly into the algorithm (s) according to the present invention. Stage 2 illustrates the input of parameters, such as the corresponding voltage value on the tube, in algorithms implemented, for example, in the products P3T ^® Cardiac or P3T ^® PA, for visualization of the vascular network of the heart and lungs, respectively. When implementing the adjusted dosing coefficients obtained in this method, the resulting protocol is created in step 3 and then displayed in step 4.

[128] Figure 27 illustrates an example of the technique underlying the embodiments in which the protocol was calculated with at least some input parameters obtained from the tomograph. Stage 1 shows that the source protocol can be selected from the tomograph, and the tomograph updates at step 2 the entered values of the input parameters taking into account the voltage on the tube. After the values of the input parameters are read in step 3, the protocol calculator then determines the resulting protocol, either when using changes based on the rule represented by steps 4a and 4b on the left side of the circuit, or dosing coefficients represented by step 4 on the right side of the circuit . Steps 5 and 6 represent the steps for transferring the resulting protocol to a tomograph (for example, a display), as well as transferring it back to the injector, respectively.

[129] The corresponding embodiments described above are discussed primarily in the context of CT imaging. However, the devices, systems and methods described herein are characterized by their widespread use in the injection of pharmaceuticals. For example, the systems, devices, and methods discussed above may be useful for injection of contrast agents for tomographic imaging procedures other than CT.

[130] In general, embodiments of the system generating the parameters described above determine the parameters of the source protocol using information available to the operator, including information about the voltage on the tube that needs to be applied during the imaging procedure. The source protocol provides information regarding the volume of one or more fluids to be delivered, for example, to enable preloading of one or more syringes. The parameters of the created protocol can be adjusted based on the characteristics of the cardiovascular system. The parameter generating systems of the present disclosure have been described with respect to an injection comprising an initial phase with injection of only a contrast agent and a subsequent phase of adding an impurity. One skilled in the art will understand that this parameter generating system is applicable for injecting various pharmaceuticals with or without diluent injected into the wash liquids through injection protocols that may include one, two or more phases.

[131] Although the present invention has been described in detail with respect to the above embodiments and / or examples, it should be understood that such details are illustrative and not restrictive, and that one skilled in the art can create variations that deviate from the present invention. The scope of the present invention is defined by the following claims, and not by the above description. All changes and variations that fall within the meaning and range of equivalents of the claims should be covered by their scope.

Claims (39)

1. A system for imaging a patient, comprising an imaging system and a parameter generator of a system for imaging a patient for determining parameters of at least a first phase of an injection procedure, the imaging system comprising a tomograph comprising at least one x-ray tube, and wherein the parameter generator is programmed to determining at least one of the parameters based on the voltage that must be applied to at least one x-ray tube during the imaging procedure, and a parameter generator is programmed to determine at least one of the volume of the pharmaceutical fluid to be injected during the at least first phase and the flow rate of the pharmaceutical fluid to be injected during the at least first phase based on the voltage to be applied at least one x-ray tube during the imaging procedure, moreover, the parameter generator is programmed to determine the volume of pharmaceutical liquid that must be injected during at least the first phase, by adjusting the volume parameter in the basic injection protocol by applying the coefficient of change in voltage on the tube to the volume parameter in the basic injection protocol, and moreover, the system for imaging the patient further comprises an injection system in functional connection with a parameter generator, and at least one source of pharmaceutical fluid, the injection system configured to inject pharmaceutical fluid during at least the first phase in accordance with the determination of the volume of pharmaceutical fluid, which must be administered by injection during at least the first phase. 2. The system according to claim 1, characterized in that the data representing the basic injection protocol is in the system memory or accessible to the system. 3. The system according to claim 1, characterized in that the parameter generator is programmed to determine the basic injection protocol based on one or more criteria entered by the operator. 4. The system according to claim 1, characterized in that the parameter generator is programmed to determine the flow rate of the pharmaceutical fluid that must be injected during at least the first phase, using the correction of the flow parameter in the basic injection protocol. 5. The system according to claim 4, characterized in that the data representing the basic injection protocol is stored in the system memory or accessible to the system. 6. The system according to claim 4, characterized in that the parameter generator is programmed to determine the basic injection protocol based on one or more criteria entered by the operator. 7. The system according to claim 4, characterized in that the parameter generator is programmed to determine the flow rate of the pharmaceutical fluid that must be injected during at least the first phase, by dividing the volume of pharmaceutical fluid that must be injected during the at least first phase for the duration of the injection in the first phase. 8. A method of operating a system for administering an injector system for delivering pharmaceutical fluid to a patient as part of an imaging procedure, the injector system being operatively connected to an imaging system comprising a tomograph comprising at least one x-ray tube, the method steps including (a) determining injection parameters in at least the first phase of the injection procedure using a system parameter generator, wherein at least one of the injection parameters is determined based on the voltage that must be applied to at least one x-ray tube during the imaging procedure; (b) controlling the injection system through the system, at least in part based on certain injection parameters, the parameter generator determining at least one of the volume of pharmaceutical fluid that must be injected during at least the first phase and the flow rate of the pharmaceutical fluid that you need to enter by injection during at least the first phase, based on the voltage that you need to apply to at least one x-ray tube during the imaging procedure, and the parameter generator determines the volume of pharmaceutical fluid that must be injected during at least the first phase by correcting the volume parameter in the basic injection protocol by applying the coefficient of variation of the voltage on the tube to the volume parameter in the basic injection protocol; and (c) administering an injection of the pharmaceutical fluid through the injection system during the at least first phase in accordance with the determination of the volume of the pharmaceutical fluid to be administered by injection during the at least first phase. 9. The method according to p. 8, characterized in that the data representing the basic injection protocol is recalled from memory associated with or accessible to at least one of the injection system, the imaging system and the parameter generator. 10. The method according to p. 8, characterized in that the basic injection protocol is determined based on one or more criteria entered by the operator. 11. The method according to p. 8, characterized in that the volume of pharmaceutical fluid that must be injected during at least the first phase of the injection procedure is determined by applying the coefficient of change in voltage on the tube to the volume parameter in the basic injection protocol. 12. The method according to p. 8, characterized in that the flow rate of the pharmaceutical fluid to be injected during at least the first phase is determined by correcting the flow parameter in the basic injection protocol. 13. The method according to p. 12, characterized in that the data representing the basic injection protocol is recalled from memory associated with or accessible to at least one of the injection system, the imaging system and the parameter generator. 14. The method according to p. 12, characterized in that the basic injection protocol is determined based on one or more criteria entered by the operator. 15. The method according to p. 12, characterized in that the flow rate of the pharmaceutical fluid that must be injected during at least the first phase is determined by dividing the volume of pharmaceutical fluid that must be injected during the at least first phase by the duration of the injection in the first phase. 16. The method according to claim 8, the method further comprising the step of filling in certain parameters of the injection on a graphical user interface associated with at least one of the injection system and the imaging system. 17. A method of creating an injection protocol for use with an injection system in functional connection with an imaging system comprising a tomograph comprising at least one x-ray tube, the method comprising the steps of: (a) determining injection parameters in at least the first phase of the injection procedure using a parameter generator, wherein at least one of the injection parameters is determined based on the voltage that must be applied to at least one x-ray tube during the imaging procedure, moreover, the parameter generator determines at least one of the volume of the pharmaceutical fluid that must be injected during at least the first phase, and the flow rate of the pharmaceutical fluid that must be injected during the at least first phase, based on the voltage that must be applied to at least one x-ray tube during the imaging procedure, and the parameter generator determines the volume of pharmaceutical fluid that must be injected during at least the first phase by adjusting the volume parameter in the basic injection protocol by applying the coefficient of change in voltage on the tube to the parameter volume in the basic injection protocol; and (b) administering an injection of the pharmaceutical fluid through the injection system during the at least first phase in accordance with the determination of the volume of the pharmaceutical fluid to be administered by injection during the at least first phase. 18. The method according to p. 17, and the method further includes the steps of the generator generating information parameters establishing the area of the body to be scanned, at least one of the injection parameters is determined based on the area of the body to be scanned. 19. The method according to p. 17, further comprising the step of obtaining the generator information about the patient’s weight, at least one of the injection parameters is determined based on the patient’s weight. 20. An injection system for delivering pharmaceutical fluid to a patient through an injection procedure carried out in conjunction with a visualization procedure, wherein the visualization procedure carried out with the imaging system includes a tomograph comprising at least one x-ray tube, wherein the imaging system includes: a parameter generator programmed to determine the parameters of at least the first phase of the injection procedure, wherein at least one of the parameters is determined based on the voltage that must be applied to at least one x-ray tube of the imaging system during the visualization procedure, and the parameter generator is programmed to determining at least one of the volume of the pharmaceutical fluid to be injected during at least the first phase, and the flow rate of the pharmaceutical fluid to be injected during the at least first phase, based on the voltage that must be applied to at least one x-ray tube during the imaging procedure, moreover, the parameter generator is programmed to determine the volume of pharmaceutical liquid that must be injected during at least the first phase, by adjusting the volume parameter in the basic injection protocol by applying the coefficient of change in voltage on the tube to the volume parameter in the basic injection protocol, such that the injection system is adapted to administer the injection of the pharmaceutical fluid to the patient during at least the first phase of the injection procedure in accordance with the determination of the volume of the pharmaceutical fluid to be administered by injection during the at least first phase. 21. The injection system according to claim 20, characterized in that the data representing the basic injection protocol is located in the memory of the injection system or is accessible to the injection system. 22. The injection system according to claim 20, characterized in that the parameter generator is programmed to determine the basic injection protocol based on one or more criteria entered by the operator. 23. The injection system according to claim 20, characterized in that the parameter generator is programmed to determine the volume of pharmaceutical fluid that must be injected during at least the first phase by applying the coefficient of change in voltage on the tube to the volume parameter in the basic injection protocol. 24. The injection system according to claim 20, characterized in that the parameter generator is programmed to determine the flow rate of the pharmaceutical fluid that must be injected during at least the first phase by correcting the flow parameter in the basic injection protocol. 25. The injection system according to claim 24, wherein the data representing the basic injection protocol is stored in the memory of the injection system or is accessible to the injection system. 26. The injection system according to claim 24, characterized in that the parameter generator is programmed to determine the basic injection protocol based on one or more criteria entered by the operator. 27. The injection system according to claim 24, characterized in that the parameter generator is programmed to determine the flow rate of the pharmaceutical fluid that must be injected during at least the first phase, by dividing the volume of pharmaceutical fluid that must be injected during the first phase by the duration injections in the first phase.

Images