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Apparatus and method for interstitial laser therapy of small breast cancers and adjunctive therapy

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US20060241727A1
US20060241727A1 US11381950 US38195006A US20060241727A1 US 20060241727 A1 US20060241727 A1 US 20060241727A1 US 11381950 US11381950 US 11381950 US 38195006 A US38195006 A US 38195006A US 20060241727 A1 US20060241727 A1 US 20060241727A1
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Prior art keywords
treatment
laser
unit
patient
mammography
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Abandoned
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US11381950
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Kambiz Dowlatshahi
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NOVIAN HEALTH Inc
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Kelsey Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/04Positioning of patients; Tiltable beds or the like
    • A61B6/0407Tables or beds
    • A61B6/0414Tables or beds with compression means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/50Clinical applications
    • A61B6/502Clinical applications involving diagnosis of breast, i.e. mammography
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02Instruments for taking cell samples or for biopsy
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B2018/2005Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser with beam delivery through an interstitially insertable device, e.g. needle
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37Surgical systems with images on a monitor during operation
    • A61B2090/376Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B50/00Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
    • A61B50/20Holders specially adapted for surgical or diagnostic appliances or instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00Radiation therapy
    • A61N5/06Radiation therapy using light
    • A61N5/0601Apparatus for use inside the body

Abstract

Apparatus and method for performing interstitial laser therapy and adjunctive therapy on a patient are revealed. The apparatus employs a combination of a mammography unit, an interstitial laser treatment device attached to the mammography unit and a treatment platform positioned relative to the mammography unit to enable the interstitial laser therapy to be performed. The use of the treatment platform with the mammography unit enables the interstitial laser therapy to be performed and, if necessary, adjunctive therapy to be performed in the same treatment room without transferring the patient to a new platform.

Description

    PRIORITY CLAIM
  • [0001]
    This application is a continuation of, claims priority to and the benefit of U.S. patent application Ser. No. 10/319,765, filed Dec. 12, 2002, the entire contents of which are incorporated herein.
  • BACKGROUND
  • [0002]
    1. Field of the Invention
  • [0003]
    The present application relates to an apparatus and method for conducting interstitial laser therapy on tumors, such as breast tumors, and adjunctive therapy on the same treatment table and in the same treatment room. The apparatus employs a combination of a mammography unit, an interstitial laser treatment device which operates with the mammography unit, and a mammography/biopsy chair positioned relative to the mammography unit to enable the interstitial laser therapy and axillary lymph node surgery (sentinel node biopsy) to be performed.
  • [0004]
    2. Description of the Related Art
  • [0005]
    Percutaneous in situ or on-site treatment of malignant breast tumors is being developed in part due to the fact that breast cancer is being detected at earlier stages because of the increasing number of women receiving mammograms annually. If breast cancer and other cancers or tumors are detected in an early stage of development, they can be effectively treated by minimal surgery or by using an ablative agent such as laser energy, applied to the tumor for its destruction within the breast.
  • [0006]
    Mammography is the roentgenography or X-ray of the mammary gland. A mammography unit allows a physician to screen a breast for a tumor. A rotatable/positionable mammography unit with stereotactic capability allows a physician to do even more, i.e., screen a breast for a tumor, locate the tumor and obtain a biopsy of the tumor. Addition of digital technology to mammography assists the physician to process the image better and faster. In other words, a digital mammography unit functions as a screening unit, a diagnostic work-up system and a stereotactic biopsy unit.
  • [0007]
    The widespread practice of screening mammography and the increasing awareness of women as to its benefits has resulted in a growing number of tumors smaller than one cm being detected. Diagnosis of these non-palpable breast tumors is made by stereotactic or ultrasound-guided core biopsy, a less invasive procedure than wire localization and excisional biopsy. Currently, the favored local treatment of such tumors is by lumpectomy plus either axillary node dissection or sentinel node biopsy followed by chemo-radiation therapy.
  • [0008]
    Image-guided laser treatments of malignant tumors such as, breast, liver, head and neck tumors, have been in development for more than a decade. For example, U.S. Pat. No. 5,169,396 (Dowlatshahi et al.) is directed to the interstitial application of laser radiation therapy to tumor masses. In general, the apparatus includes a laser probe having a thin metallic cannula for insertion into a tumor mass, a laser for generating light having a chosen wavelength and intensity and an optical fiber for receiving and transmitting the laser light to the tumor mass. In operation, the optical fiber is inserted into the cannula such that a chosen physiologically acceptable fluid can flow coaxially between the cannula and the optical fiber. In addition, a heat sensing member or temperature probe is inserted adjacent into the tumor mass for monitoring the tumor temperature. The devitalized tumor is gradually cleared by the body immune system and within six months is replaced with a scar.
  • [0009]
    The current known technique for performing interstitial laser therapy for breast tumor includes having the patient lie face down on a platform of a stereotactic table. The patient's breast having the tumor extends through an aperture defined by the platform. The table supports a mechanism positioned below the platform for performing the interstitial laser therapy with the laser probe and in one embodiment a temperature probe.
  • [0010]
    One problem with such stereotactic tables is that some patients' breast are too small to extend fully to the necessary position adjacent to the mechanism for performing the interstitial laser therapy with the laser probe and temperature probe.
  • [0011]
    Other problems with stereotactic tables used for performing interstitial laser therapy for breast tumor are (1) the operator (surgeon) must work below or under the table in a cramped space and (2) axillary lymph node surgery cannot be done in that position. In other words, the patient has to be moved from the stereotactic table and transferred to a more appropriate treatment table, usually located in another treatment room, for any adjuvant operation.
  • [0012]
    In operations and many other procedures, including adjunctive therapies, where blood loss is possible, a patient must be placed on a suitable operating table or the like which has an inverted head position. One such adjunctive therapy procedure related to interstitial laser therapy for treating breast tumors includes the removal of one or more of the patient's lymph nodes. In the event that the patient's blood pressure drops during the procedure, a doctor can place the patient in an inverted head position to direct more blood to the patient's head to avoid any period of time where an insufficient amount of blood is being provided to the patient's brain. An insufficient amount of blood to a patient's brain can, of course, result in brain damage or death.
  • [0013]
    Additionally, stereotactic tables are relatively expensive. Accordingly, there is a need for a relatively inexpensive apparatus and method for conducting interstitial laser therapy and adjunctive therapies in the same treatment room without requiring the patient to move to a different platform or a different treatment room.
  • SUMMARY
  • [0014]
    The present invention overcomes the above-recited problems by providing an apparatus and method for conducting interstitial laser therapy and adjunctive therapy on the same table (platform) and in the same treatment room.
  • [0015]
    The method for performing interstitial laser therapy and adjunctive therapy on a patient comprises the steps of a) placing the patient on an apparatus, the apparatus comprising a mammography unit, an interstitial laser treatment device attached to the mammography unit, where the device comprises a laser probe and a treatment platform positioned relative to the mammography unit to enable the interstitial laser therapy to be performed, where the apparatus is located in a single treatment room, where the treatment platform comprises a first platform surface, and where adjunctive therapy may be performed in the treatment room without transferring the patient to a second platform surface; b) performing a mammographic examination on the patient; c) analyzing results from the mammographic examination to determine whether interstitial laser therapy alone or interstitial laser therapy with adjunctive therapy should be performed on the patient; and d) performing interstitial laser therapy alone or interstitial laser therapy with adjunctive therapy on the patient.
  • [0016]
    In preferred embodiments of the method, the mammography unit is a rotatable/positionable digital mammography unit; the interstitial laser treatment mechanism further comprises a temperature probe; the treatment platform has at least two positions including a patient lying position and an inverted head position; and/or the adjunctive therapy comprises axillary node dissection or sentinel node biopsy.
  • [0017]
    In another preferred embodiment of the method, the treatment platform has at least three positions including a patient sitting position, a patient lying position and an inverted head position.
  • [0018]
    In yet other preferred embodiments of the method, the treatment platform is supported on wheels; the wheels comprise a stationary mechanism; and/or the stationary mechanism is selected from the group consisting of a locking mechanism, a positioning mechanism and combinations thereof.
  • [0019]
    In a more preferred embodiment of the method, the mammography unit is a rotatable/positionable digital mammography unit; the interstitial laser treatment device further comprises a temperature probe; the treatment platform has at least three positions including a patient sitting position, a patient lying position and an inverted head position; and the adjunctive therapy comprises axillary node dissection or sentinel node biopsy.
  • [0020]
    The apparatus for performing interstitial laser therapy and adjunctive therapy on a patient comprises
  • [0021]
    a) a mammography unit;
  • [0022]
    b) an interstitial laser treatment device attached to the mammography unit, where the mechanism comprises a laser probe; and
  • [0023]
    c) a treatment platform positioned relative to the mammography unit to enable the interstitial laser therapy to be performed,
  • [0024]
    where the apparatus is located in a single treatment room, where the treatment platform comprises a first platform surface, and where adjunctive therapy may be performed in the treatment room without transferring the patient to a second platform surface.
  • [0025]
    In preferred embodiments of the apparatus, the mammography unit is a rotatable/positionable digital mammography unit; the interstitial laser treatment device further comprises a temperature probe; the treatment platform has at least three positions including a patient sitting position, a patient lying position and an inverted head position; and/or the adjunctive therapy comprises axillary node dissection or sentinel node biopsy.
  • [0026]
    In another preferred embodiment of the apparatus, the treatment platform has at least three positions including a patient sitting position, a patient lying position and an inverted head position.
  • [0027]
    In yet other preferred embodiments of the apparatus, the treatment platform is supported on wheels; the wheels comprise a stationary mechanism; and/or the stationary mechanism is selected from the group consisting of a locking mechanism, a positioning mechanism and combinations thereof.
  • [0028]
    In a more preferred embodiment of the apparatus, the mammography unit is a rotatable/positionable digital mammography unit; the interstitial laser treatment device further comprises a temperature probe; the treatment platform has at least three positions including a patient sitting position, a patient lying position and an inverted head position; and the adjunctive therapy comprises axillary node dissection or sentinel node biopsy.
  • [0029]
    Additional features and advantages are described herein, and will be apparent from, the following Detailed Description and the figures.
  • BRIEF DESCRIPTION OF THE FIGURES
  • [0030]
    FIG. 1 is a schematic representation of a rotatable/positionable digital mammography unit with a biopsy device.
  • [0031]
    FIG. 2A is a schematic representation of a treatment platform in a patient sitting or seated position.
  • [0032]
    FIG. 2B is a schematic representation of the treatment platform in a patient lying or bed position.
  • [0033]
    FIG. 2C is a schematic representation of the treatment platform in an inverted head or slanted bed position.
  • [0034]
    FIG. 3A is a schematic representation of a patient on the treatment platform in a sitting or seated position relative to a cut away view of the rotatable/positionable digital mammography unit.
  • [0035]
    FIG. 3B is a schematic representation of a frontal view of a patient on the treatment platform in a patient lying or bed position relative to a cut away view of the rotatable/positionable digital mammography unit with a biopsy device.
  • [0036]
    FIG. 3C is a schematic representation of a rear view of a patient on the treatment platform in a patient lying or bed position relative to a cut away view of the rotatable/positionable digital mammography unit.
  • [0037]
    FIG. 4 is a schematic representation of a close up of the biopsy device mounted on a cut away view of the mammography unit in the present invention.
  • [0038]
    FIG. 5 is a schematic representation of a close up of the interstitial laser treatment device mounted on a cut away view of the mammography unit in the present invention.
  • DETAILED DESCRIPTION
  • [0039]
    The present invention employs a combination of a mammography unit, an interstitial laser treatment mechanism attached to the mammography unit and a treatment platform positioned relative to the mammography unit to enable the interstitial laser therapy to be performed. FIG. 1 is a schematic representation of a rotatable/positionable digital mammography unit 10 with a mounted biopsy device. FIG. 4 is a schematic representation of a close up of the biopsy device 40 mounted on the mammography unit in the present invention. FIG. 5 is a schematic representation of a close up of the interstitial laser treatment device 50 mounted on the mammography unit in the present invention. The biopsy device 40 and the interstitial laser treatment device 50 can be mounted separately on the mammography unit 10 in the present invention.
  • [0040]
    The treatment platform 20 has at least two positions including a patient lying position, FIG. 2B, and an inverted head position, FIG. 2C. In a preferred embodiment, the treatment platform 20 has a third position, i.e., a patient sitting position, FIG. 2A.
  • [0041]
    In addition, the treatment platform 20 is supported on wheels 24. One or more of the wheels 24 contains a stationary mechanism which when engaged prevents the treatment platform 20 from moving. The stationary mechanism can comprise a locking mechanism on the wheels or a positioning mechanism to lift the wheels from the floor. In FIG. 2A-2C, the treatment platform is shown as a mammography/biopsy chair. FIG. 2B shows an example of one type of locking mechanism 25 and FIG. 2C shows an example of one type of positioning mechanism 27.
  • [0042]
    The use of the treatment platform with the mammography unit enables the interstitial laser therapy to be performed and, if necessary, adjunctive therapy to be performed in the same treatment room without transferring the patient to a new platform.
  • [0043]
    FIG. 2A is a schematic representation of the treatment platform 20 in a patient sitting or seated position. FIG. 2B is a schematic representation of the treatment platform 20 in a patient lying or bed position and indicating the platform 22 surface.
  • [0044]
    In operations and many other procedures, including adjunctive therapies, where blood loss is possible, a patient must be placed on a suitable operating table or the like which has an inverted head position. One such adjunctive therapy procedure related to interstitial laser therapy for treating breast tumors includes the removal of one or more of the patient's lymph nodes. In the event that the patient's blood pressure drops during the procedure, a doctor can place the patient in an inverted head position to direct more blood to the patient's head to avoid any period of time where an insufficient amount of blood is being provided to the patient's brain. An insufficient amount of blood to a patient's brain can, of course, result in brain damage or death.
  • [0045]
    FIG. 4 is a schematic representation of a close up of the biopsy device 40 mounted on the mammography unit in the present invention. FIG. 5 is a schematic representation of a close up of the interstitial laser treatment device 50 mounted on the mammography unit in the present invention. Thus, both the biopsy device 40 and the interstitial laser treatment device 50 are mounted on the mammography unit 10 in the present invention.
  • [0046]
    FIG. 4 is a schematic representation of a close up of the biopsy device 40 mounted on the mammography unit in the present invention. FIG. 5 is a schematic representation of a close up of the interstitial laser treatment device 50 mounted on the mammography unit in the present invention. FIG. 5 shows a laser device 52, a stereotactic device 54, a needle holder 56, a laser needle or probe 58, a thermal needle or probe 60, a compression plate 62, a digital image receptor 64 and the X-ray tube 66 from the mammography unit 10.
  • [0047]
    Both the biopsy device 40 and the interstitial laser treatment device 50 are mounted on the mammography unit 10 in the present invention. At the time of treatment, the biopsy device 40 can be detached from the mammography unit 10 and replaced with the interstitial laser treatment device 50.
  • [0048]
    With the present invention, the treatment platform is easily and quickly converted from either a patient sitting position or a patient lying position to an inverted head or slanted bed position. FIG. 2C is a schematic representation of the treatment platform 20 in an inverted head or slanted bed position. The head end 26 and the foot end 28 of the treatment platform 20 in the inverted head or slanted bed position are indicated in FIG. 2C.
  • [0049]
    FIG. 3A is a schematic representation of a patient 30 on a treatment platform 20 in a sitting or seated position relative to a cut away view of the rotatable/positionable digital mammography unit 10.
  • [0050]
    As mentioned above, with the present invention, a patient does not have to be removed from the platform of the treatment table and transferred to a more appropriate treatment table for any related or adjunctive therapies or procedures. In addition, all therapies and procedures are performed in a single treatment room.
  • [0051]
    FIG. 3B is a schematic representation of a frontal view of a patient 30 on a treatment platform 20 in a patient lying or bed position relative to a cut away view of the rotatable/positionable digital mammography unit 10 with an attached biopsy device 40. FIG. 3C is a schematic representation of a rear view of a patient 30 on a treatment platform 20 in a patient lying or bed position relative to a cut away view of the rotatable/positionable digital mammography unit 10.
  • [0052]
    While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiments, it is to be understood that the invention is not limited to the disclosed embodiments, but on the contrary is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims.
  • [0053]
    Thus, it is to be understood that variations in the present invention can be made without departing from the novel aspects of this invention as defined in the claims. All patents and articles cited herein are hereby incorporated by reference in their entirety and relied upon.
  • [0054]
    It should be understood that various changes and modifications to the presently preferred embodiments described herein will be apparent to those skilled in the art. Such changes and modifications can be made without departing from the spirit and scope of the present subject matter and without diminishing its intended advantages. It is therefore intended that such changes and modifications be covered by the appended claims.

Claims (10)

1. An interstitial laser treatment device comprising:
a laser probe;
a separate thermal probe; and
a probe holder configured to:
(a) removably receive and position the laser probe,
(b) removably receive and position the thermal probe relative to the laser probe, and
(c) be adjacently attached to a mammography unit to form a single treatment unit in a single treatment room such that said single treatment unit is configured to perform a mammographic examination and interstitial laser therapy in sequence to a patient on a treatment platform positioned relative to the single treatment unit.
2. The interstitial laser treatment device of claim 1, which includes a laser device connectable to the laser probe.
3. The interstitial laser treatment device of claim 1, which includes a stereotactic device, said probe holder being configured to be adjacently attached to said stereotactic device for stereotactic placement of the laser probe.
4. The interstitial laser treatment device of claim 1, wherein the probe holder is configured to be mounted adjacent to a compression plate of the mammography unit such that the laser probe and thermal probe are extendable pass a portion of the compression plate when held by the laser probe.
5. The interstitial laser treatment device of claim 1, wherein the probe holder is configured to be mounted adjacent to a compression plate of the mammography unit such that the laser probe and thermal probe are extendable through a portion of the compression plate when held by the laser probe.
6. The interstitial laser treatment device of claim 1, wherein the probe holder is configured to perform interstitial laser treatment on a person lying on the treatment platform.
7. An interstitial laser treatment device comprising:
a laser probe;
a laser device connectable to the laser probe;
a separate thermal probe;
a stereotactic device for stereotactic placement of the laser probe;
a probe holder configured to:
(a) removably receive and position the laser probe,
(b) removably receive and position the thermal probe relative to the laser probe, and
(c) be adjacently attached to said stereotactic device which is adjacently attached to a mammography unit to form a single treatment unit in a single treatment room such that said single treatment unit is configured to perform a mammographic examination and interstitial laser therapy in sequence to a patient on a treatment platform positioned relative to the single treatment unit.
8. The interstitial laser treatment device of claim 7, wherein the probe holder is configured to be mounted adjacent to a compression plate of the mammography unit such that the laser probe and thermal probe are extendable pass a portion of the compression plate when held by the laser probe.
9. The interstitial laser treatment device of claim 7, wherein the probe holder is configured to be mounted adjacent to a compression plate of the mammography unit such that the laser probe and thermal probe are extendable through a portion of the compression plate when held by the laser probe.
10. The interstitial laser treatment device of claim 7, wherein the probe holder is configured to perform interstitial laser treatment on a person lying on the treatment platform.
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