WO2004030761A1 - Improvements in or relating to radiation treatment planning - Google Patents

Improvements in or relating to radiation treatment planning Download PDF

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Publication number
WO2004030761A1
WO2004030761A1 PCT/GB2003/003935 GB0303935W WO2004030761A1 WO 2004030761 A1 WO2004030761 A1 WO 2004030761A1 GB 0303935 W GB0303935 W GB 0303935W WO 2004030761 A1 WO2004030761 A1 WO 2004030761A1
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Prior art keywords
image
images
tumour
figures
treatment
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PCT/GB2003/003935
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French (fr)
Inventor
Christian Peter Behrenbruch
Jerome Declerck
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Mirada Solutions Limited
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Priority to AU2003264752A priority Critical patent/AU2003264752A1/en
Publication of WO2004030761A1 publication Critical patent/WO2004030761A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/103—Treatment planning systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5235—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5247—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/103—Treatment planning systems
    • A61N5/1039—Treatment planning systems using functional images, e.g. PET or MRI
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/055—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves  involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging

Definitions

  • the present invention relates to radiation treatment planning and in particular to improvements in the definition of the treatment volume.
  • One of the techniques for the treatment of cancer is to irradiate the tumour - with beams of high-energy x-ray radiation to kill the tumour cells.
  • the treatment is effected by means of several beams of x-rays intersecting at the tumour from different directions as shown in Figure 6 of the accompanying drawings. Only where the beams A, B, C intersect is the cumulative intensity enough to kill cells of the tumour 110. The cross-sectional profile of each intersecting beam is carefully matched to the corresponding shape of the tumour 110 as seen from that direction. Other parts of the patient 100 receive a lower dose or no radiation.
  • the definition of the volume to be treated is achieved by taking a CT scan of the area. As shown in Figure 1 this consists of a number of x-ray slice images (a), (b) (c) through the patient, which can be stacked next to each other to give a three-dimensional representation. Figures 7A to C show three slice images of a real CT scan.
  • the CT image is displayed to a clinician who can observe the tumour 5 in the image and "draw" a contour 20 around the tumour, usually in each slice image, as shown in Figure 2 (for clarity bone structure 3 has been omitted from Figure 2).
  • a contour 22 defining what is known as a planning treatment volume is defined outside it (e.g. 1 cm outside it) corresponding to the region around the tumour which can receive the lower dose.
  • Figures 8 A to C show examples of the two contours drawn on the CT slice images of Figures 7 A to C.
  • the contours 32, together with the CT image 30 are supplied in a common format known as a DICOM (Digital Image and Communication in Medicine) file 34 to radiation treatment planning (RTP) software 36, such as that produced by Accuray, Varian, Elelcta or Siemens.
  • RTP radiation treatment planning
  • This software allows for clinician input 38, such as to edit the beam directions and dosage, and on the basis of this input 38, the CT data 30 and the contours 32 defining the treatment volume produces an output file 40 which comprises the data necessary to control the treatment apparatus to irradiate the patient.
  • the RTP software itself may provide for the display of the CT data 30 and the definition of the contours 32.
  • CT images show structure clearly, such as bones 3 within the body 1, the accurate definition of the clinical treatment volume is difficult because the tumours 5 are often ill-defined and very difficult to see in CT images.
  • the difficulty is evident if Figures 7 A to C are compared with Figures 8A to C. Further, they may cause anatomical and morphological abnormalities in surrounding tissue, which can obscure or be confused with the tumour. There is a danger therefore that parts of the patient will be irradiated which should not be, or that areas of the tumour are missed.
  • the present invention provides for the clinician to define the treatment volume with reference also to a second image in which the tumour is more clearly visible.
  • the second image is coregistered with a first, structural, image, ie the spatial relationship between the two images is obtained so that corresponding locations in the two images can be mapped to each other.
  • This involves finding a mathematical transformation which may include a spatial translation, rotation and scaling so that the relationship between the coordinates in the first and second images can be mapped to each other.
  • the two images are displayed separately, as a contour is drawn in one image, it can be displayed in the other. Or the two images can be displayed superposed on each other as a fused image, and a contour drawn on the fused image.
  • the first and second images may be the same or different modalities.
  • the structural image may be a CT image, which clearly shows the body structure
  • the second image may be based on an imaging modality which shows up abnormalities in metabolic function (as are found in tumours), such as positron emission tomography (PET), or a modality which, while giving a structural image, shows up the tumour better than the first CT image, eg magnetic resonance imaging (MRI).
  • PET positron emission tomography
  • MRI magnetic resonance imaging
  • Two MR images may be used, e.g. Tl weighted or T2 weighted, which shows up different features.
  • the invention may be implemented by means of computer software processing digital images.
  • the invention therefore also provides a computer program comprising program code means for implementing the method, and a system for implementing the method.
  • Figures 1 (a), (b), (c) show schematically three slices in a CT image
  • Figures 2 (a), (b), (c) show schematically contours defined in the three slices of Figure 1;
  • Figure 3 illustrates schematically the process flow in prior art RTP
  • Figure 4(a), (b), (c) show schematically three slices in a PET image
  • FIG. 5 illustrates schematically the process flow of an embodiment of the present invention
  • Figure 6 illustrates schematically the irradiation of a patient's tumour using intersecting beams of high energy x-rays
  • Figures 7 A to C are CT scans of a patient
  • Figures 8 A to C show contours defining clinical and planning treatment volumes on the CT scans of Figures 7 A to C;
  • Figures 9 A to C show PET scans of the patient of Figures 7 and 8;
  • Figures 10A to C show fused images in which the PET scans of Figures 9 A to C have been superimposed on the CT scans of 7A to C;
  • Figures 11 A to C show contours defining the clinical and planning treatment volumes drawn on the fused images of Figures 10A to C.
  • Figure 5 illustrates schematically how the present invention is applied in a radiation treatment planning process of the type discussed above, though it should be appreciated that the improvement in defining the volume occupied by a tumour within the body is applicable to other applications and techniques (eg in guiding surgery or other forms of treatment).
  • a PET image 50 is taken.
  • PET images show the tumour clearly, but do not contain much useful structural information (such as the bones) making it difficult to determine accurately the position of the tumour in the body.
  • Figures 9 A to C show PET images corresponding to Figures 7 A to C and 8 A to C.
  • the tumour 5 is much more clearly visible, shown up by its high metabolic activity.
  • the two images are coregistered using a registration technique 52 which may be one of the many known techniques described in US 5,672,877 or US 5,871,013 incorporated herein by reference, or as proposed by the present applicant in copending British application number 0216854.0 incorporated herein by reference. These techniques are based on identifying corresponding structures (eg edges or intensity patterns) in the images and finding the spatial transformation which maps them to each other.
  • the two images may be displayed alongside each other 54, or overlaid on each other in a fused image (eg with the CT image in grey and the PET image as a transparent colour overlay).
  • Figures 10A to C show fused images in which the PET images of Figures 9 A to C have been superimposed on the CT images of Figures 7 A to C.
  • the tumour 5 is clearly visible as a result of the PET image.
  • the clinician defines the treatment volume by drawing a contour on the registered or fused image using mainly the PET information which clearly shows the tumour. By virtue of the images being registered, this contour may be simultaneously displayed on the CT image, allowing its position in relation to other structures to be checked.
  • Figures 11 A to C show the contours 20 and 22 drawn on the fused image of Figures lOA to C.
  • the resulting contour 58, and the CT image 30 are assembled into a DICOM file as before, and delivered to the RTP software 36, which, with clinician input 38, produces the output file 40 to control the treatment 42.
  • PET and CT data instead of the PET and CT data, other combinations of data such as MRI data (T1,T2, proton density etc) may be used.
  • MRI data T1,T2, proton density etc

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Radiology & Medical Imaging (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Pathology (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
  • Physics & Mathematics (AREA)
  • High Energy & Nuclear Physics (AREA)
  • Computer Vision & Pattern Recognition (AREA)
  • Optics & Photonics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Apparatus For Radiation Diagnosis (AREA)

Abstract

A method of defining a treatment volume for use in radiation treatment planning in which the treatment volume is defined by use of at least two coregistered or fused images, one of which shows structural information and one of which shows up the tumour well. The images may be a CT image and a PET image, or one or both may be MR images.

Description

IMPROVEMENTS IN OR RELATING TO RADIATION TREATMENT
PLANNING
The present invention relates to radiation treatment planning and in particular to improvements in the definition of the treatment volume.
One of the techniques for the treatment of cancer is to irradiate the tumour - with beams of high-energy x-ray radiation to kill the tumour cells. In order that only the tumour, and not the surrounding tissue, receives an effective dose of the radiation, the treatment is effected by means of several beams of x-rays intersecting at the tumour from different directions as shown in Figure 6 of the accompanying drawings. Only where the beams A, B, C intersect is the cumulative intensity enough to kill cells of the tumour 110. The cross-sectional profile of each intersecting beam is carefully matched to the corresponding shape of the tumour 110 as seen from that direction. Other parts of the patient 100 receive a lower dose or no radiation.
Clearly it is important for the volume where the beams are to intersect to be carefully defined. It needs to be as close as possible to the boundaries of the tumour. Further while there may be a region around the tumour which can receive a lower dose, there may be sensitive areas near the tumour (eg the spinal cord or a vital organ) which must receive no radiation. Typically the definition of the volume to be treated is achieved by taking a CT scan of the area. As shown in Figure 1 this consists of a number of x-ray slice images (a), (b) (c) through the patient, which can be stacked next to each other to give a three-dimensional representation. Figures 7A to C show three slice images of a real CT scan. The CT image is displayed to a clinician who can observe the tumour 5 in the image and "draw" a contour 20 around the tumour, usually in each slice image, as shown in Figure 2 (for clarity bone structure 3 has been omitted from Figure 2). Sometimes in addition to the contour 20 defining the clinical treatment volume (corresponding as closely as possible to the rumour) a contour 22 defining what is known as a planning treatment volume is defined outside it (e.g. 1 cm outside it) corresponding to the region around the tumour which can receive the lower dose. Figures 8 A to C show examples of the two contours drawn on the CT slice images of Figures 7 A to C.
As shown in the process flow of Figure 3 the contours 32, together with the CT image 30 are supplied in a common format known as a DICOM (Digital Image and Communication in Medicine) file 34 to radiation treatment planning (RTP) software 36, such as that produced by Accuray, Varian, Elelcta or Siemens. This software allows for clinician input 38, such as to edit the beam directions and dosage, and on the basis of this input 38, the CT data 30 and the contours 32 defining the treatment volume produces an output file 40 which comprises the data necessary to control the treatment apparatus to irradiate the patient. Sometimes the RTP software itself may provide for the display of the CT data 30 and the definition of the contours 32.
However, although as schematically illustrated in Figure 1 CT images show structure clearly, such as bones 3 within the body 1, the accurate definition of the clinical treatment volume is difficult because the tumours 5 are often ill-defined and very difficult to see in CT images. The difficulty is evident if Figures 7 A to C are compared with Figures 8A to C. Further, they may cause anatomical and morphological abnormalities in surrounding tissue, which can obscure or be confused with the tumour. There is a danger therefore that parts of the patient will be irradiated which should not be, or that areas of the tumour are missed.
Accordingly the present invention provides for the clinician to define the treatment volume with reference also to a second image in which the tumour is more clearly visible. The second image is coregistered with a first, structural, image, ie the spatial relationship between the two images is obtained so that corresponding locations in the two images can be mapped to each other. This involves finding a mathematical transformation which may include a spatial translation, rotation and scaling so that the relationship between the coordinates in the first and second images can be mapped to each other.
This means that if the two images are displayed separately, as a contour is drawn in one image, it can be displayed in the other. Or the two images can be displayed superposed on each other as a fused image, and a contour drawn on the fused image.
The first and second images may be the same or different modalities. For example, the structural image may be a CT image, which clearly shows the body structure, and the second image may be based on an imaging modality which shows up abnormalities in metabolic function (as are found in tumours), such as positron emission tomography (PET), or a modality which, while giving a structural image, shows up the tumour better than the first CT image, eg magnetic resonance imaging (MRI). Two MR images may be used, e.g. Tl weighted or T2 weighted, which shows up different features.
By allowing the treatment volume to be defined by reference to an image which better shows up the tumour, the clinical treatment volume may be much more accurately defined. Further, the definition of the planning treatment volume may also be improved and the radiation dose may be reduced. The invention may be implemented by means of computer software processing digital images. The invention therefore also provides a computer program comprising program code means for implementing the method, and a system for implementing the method.
The invention will be further described by way of example with reference to the accompanying drawings, in which:-
Figures 1 (a), (b), (c) show schematically three slices in a CT image;
Figures 2 (a), (b), (c) show schematically contours defined in the three slices of Figure 1;
Figure 3 illustrates schematically the process flow in prior art RTP; Figure 4(a), (b), (c) show schematically three slices in a PET image;
Figure 5 illustrates schematically the process flow of an embodiment of the present invention;
Figure 6 illustrates schematically the irradiation of a patient's tumour using intersecting beams of high energy x-rays; Figures 7 A to C are CT scans of a patient; Figures 8 A to C show contours defining clinical and planning treatment volumes on the CT scans of Figures 7 A to C;
Figures 9 A to C show PET scans of the patient of Figures 7 and 8;
Figures 10A to C show fused images in which the PET scans of Figures 9 A to C have been superimposed on the CT scans of 7A to C; and
Figures 11 A to C show contours defining the clinical and planning treatment volumes drawn on the fused images of Figures 10A to C.
Figure 5 illustrates schematically how the present invention is applied in a radiation treatment planning process of the type discussed above, though it should be appreciated that the improvement in defining the volume occupied by a tumour within the body is applicable to other applications and techniques (eg in guiding surgery or other forms of treatment).
As illustrated in Figure 5, in addition to the CT image 30 another image, in this case a PET image 50, is taken. As illustrated schematically in Figure 4, PET images show the tumour clearly, but do not contain much useful structural information (such as the bones) making it difficult to determine accurately the position of the tumour in the body. Figures 9 A to C show PET images corresponding to Figures 7 A to C and 8 A to C. The tumour 5 is much more clearly visible, shown up by its high metabolic activity. The two images are coregistered using a registration technique 52 which may be one of the many known techniques described in US 5,672,877 or US 5,871,013 incorporated herein by reference, or as proposed by the present applicant in copending British application number 0216854.0 incorporated herein by reference. These techniques are based on identifying corresponding structures (eg edges or intensity patterns) in the images and finding the spatial transformation which maps them to each other.
The two images may be displayed alongside each other 54, or overlaid on each other in a fused image (eg with the CT image in grey and the PET image as a transparent colour overlay). Figures 10A to C show fused images in which the PET images of Figures 9 A to C have been superimposed on the CT images of Figures 7 A to C. The tumour 5 is clearly visible as a result of the PET image. Then at 56 the clinician defines the treatment volume by drawing a contour on the registered or fused image using mainly the PET information which clearly shows the tumour. By virtue of the images being registered, this contour may be simultaneously displayed on the CT image, allowing its position in relation to other structures to be checked. Figures 11 A to C show the contours 20 and 22 drawn on the fused image of Figures lOA to C.
The resulting contour 58, and the CT image 30 are assembled into a DICOM file as before, and delivered to the RTP software 36, which, with clinician input 38, produces the output file 40 to control the treatment 42.
Instead of the PET and CT data, other combinations of data such as MRI data (T1,T2, proton density etc) may be used.

Claims

1. A method of defining a treatment volume for use in radiation treatment planning, comprising the steps of:- receiving a structural image, receiving at least one further image containing metabolic functional, or different structural, information, coregistering the images, defining the treatment volume using the coregistered images.
2. A method according to claim 1 wherein the structural image is a CT image.
3. A method according to claim 1 or 2 wherein the at least one further image is a PET or MR image.
4. A method according to claim 1, 2 or 3 further comprising the step of displaying the structural image and at least one further image overlaid as a fused image.
5. A method according to any one of the preceding claims wherein the step of defining the treatment volume comprises providing for display of a user- definable contour on at least one of the images.
6. A method according to any one of the preceding claims wherein the structural image and further image comprises, sets of slice images through a patient's body.
PCT/GB2003/003935 2002-10-04 2003-09-11 Improvements in or relating to radiation treatment planning WO2004030761A1 (en)

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Cited By (6)

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WO2005112768A1 (en) * 2004-05-21 2005-12-01 Tissuomics Limited Method and apparatus for imaging body tissue
WO2007018646A1 (en) * 2005-04-29 2007-02-15 Varian Medical Systems Technologies, Inc. Radiation treatment systems and components thereof
WO2010089416A1 (en) * 2009-02-09 2010-08-12 Spectracure Ab System and method for pre-treatment planning of photodynamic light therapy
US8582841B2 (en) 2006-08-15 2013-11-12 Spectracure Ab System and method for pre-treatment planning of photodynamic light therapy
US8986358B2 (en) 2006-08-15 2015-03-24 Spectracure Ab System and method for controlling and adjusting interstitial photodynamic light therapy parameters
CN110831664A (en) * 2017-05-11 2020-02-21 医科达有限公司 System and method for accounting for shape changes during radiation therapy

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Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005112768A1 (en) * 2004-05-21 2005-12-01 Tissuomics Limited Method and apparatus for imaging body tissue
US9498167B2 (en) 2005-04-29 2016-11-22 Varian Medical Systems, Inc. System and methods for treating patients using radiation
WO2007018646A1 (en) * 2005-04-29 2007-02-15 Varian Medical Systems Technologies, Inc. Radiation treatment systems and components thereof
US7640607B2 (en) 2005-04-29 2010-01-05 Varian Medical Systems, Inc. Patient support systems
US10441226B2 (en) 2005-04-29 2019-10-15 Varian Medical Systems, Inc. Medical systems with patient supports
US7983380B2 (en) 2005-04-29 2011-07-19 Varian Medical Systems, Inc. Radiation systems
US10188356B2 (en) 2005-04-29 2019-01-29 Varian Medical Systems, Inc. Radiation systems
US9974494B2 (en) 2005-04-29 2018-05-22 Varian Medical Systems, Inc. System and methods for treating patients using radiation
US8582841B2 (en) 2006-08-15 2013-11-12 Spectracure Ab System and method for pre-treatment planning of photodynamic light therapy
US8986358B2 (en) 2006-08-15 2015-03-24 Spectracure Ab System and method for controlling and adjusting interstitial photodynamic light therapy parameters
JP2012517252A (en) * 2009-02-09 2012-08-02 スペクトラキュアー アーベー System and method for pretreatment planning for photodynamic phototherapy
WO2010089416A1 (en) * 2009-02-09 2010-08-12 Spectracure Ab System and method for pre-treatment planning of photodynamic light therapy
CN110831664A (en) * 2017-05-11 2020-02-21 医科达有限公司 System and method for accounting for shape changes during radiation therapy
CN110831664B (en) * 2017-05-11 2021-04-27 医科达有限公司 System and method for accounting for shape changes during radiation therapy

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