WO2008125680A1 - Procédé et dispositif pour le traitement thérapeutique par rayons de tissu grâce à une installation de tomodensitométrie à rayons x ou une installation à rayons x orthovolt ou de diagnostic - Google Patents

Procédé et dispositif pour le traitement thérapeutique par rayons de tissu grâce à une installation de tomodensitométrie à rayons x ou une installation à rayons x orthovolt ou de diagnostic Download PDF

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Publication number
WO2008125680A1
WO2008125680A1 PCT/EP2008/054577 EP2008054577W WO2008125680A1 WO 2008125680 A1 WO2008125680 A1 WO 2008125680A1 EP 2008054577 W EP2008054577 W EP 2008054577W WO 2008125680 A1 WO2008125680 A1 WO 2008125680A1
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Prior art keywords
ray
concentrator
tumor
energy
radiation
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PCT/EP2008/054577
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German (de)
English (en)
Inventor
Vladimir Arkadiev
Daniel Fratzscher
Johannes Rabe
Reiner Wedell
Hanns-Joachim Weinmann
Rüdiger LAWACZECK
Hubertus Pietsch
Sven Golfier
Gregor Jost
Peter Wust
Lutz LÜDEMANN
Norbert Langhoff
Michael Haschke
Michael Krumrey
Martin Gerlach
Levent Cibik
Original Assignee
Institut Für Angewandte Photonik E.V.
Bayer Schering Pharma Ag
Charité - Universitätsmedizin Berlin
Ifg - Institute For Scientific Instruments Gmbh
Physikalisch-Technische Bundesanstalt
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Application filed by Institut Für Angewandte Photonik E.V., Bayer Schering Pharma Ag, Charité - Universitätsmedizin Berlin, Ifg - Institute For Scientific Instruments Gmbh, Physikalisch-Technische Bundesanstalt filed Critical Institut Für Angewandte Photonik E.V.
Publication of WO2008125680A1 publication Critical patent/WO2008125680A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/06—Diaphragms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • 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
    • A61N5/1077—Beam delivery systems
    • A61N5/1084—Beam delivery systems for delivering multiple intersecting beams at the same time, e.g. gamma knives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B82—NANOTECHNOLOGY
    • B82Y—SPECIFIC USES OR APPLICATIONS OF NANOSTRUCTURES; MEASUREMENT OR ANALYSIS OF NANOSTRUCTURES; MANUFACTURE OR TREATMENT OF NANOSTRUCTURES
    • B82Y10/00—Nanotechnology for information processing, storage or transmission, e.g. quantum computing or single electron logic
    • G—PHYSICS
    • G21—NUCLEAR PHYSICS; NUCLEAR ENGINEERING
    • G21K—TECHNIQUES FOR HANDLING PARTICLES OR IONISING RADIATION NOT OTHERWISE PROVIDED FOR; IRRADIATION DEVICES; GAMMA RAY OR X-RAY MICROSCOPES
    • G21K1/00—Arrangements for handling particles or ionising radiation, e.g. focusing or moderating
    • G21K1/02—Arrangements for handling particles or ionising radiation, e.g. focusing or moderating using diaphragms, collimators
    • G—PHYSICS
    • G21—NUCLEAR PHYSICS; NUCLEAR ENGINEERING
    • G21K—TECHNIQUES FOR HANDLING PARTICLES OR IONISING RADIATION NOT OTHERWISE PROVIDED FOR; IRRADIATION DEVICES; GAMMA RAY OR X-RAY MICROSCOPES
    • G21K1/00—Arrangements for handling particles or ionising radiation, e.g. focusing or moderating
    • G21K1/06—Arrangements for handling particles or ionising radiation, e.g. focusing or moderating using diffraction, refraction or reflection, e.g. monochromators
    • G21K1/062—Devices having a multilayer structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/02—Devices for diagnosis sequentially in different planes; Stereoscopic radiation diagnosis
    • A61B6/03—Computerised tomographs
    • A61B6/032—Transmission computed tomography [CT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/40—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for generating radiation specially adapted for radiation diagnosis
    • A61B6/4035—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for generating radiation specially adapted for radiation diagnosis the source being combined with a filter or grating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/48—Diagnostic techniques
    • A61B6/481—Diagnostic techniques involving the use of contrast agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
    • A61B6/50—Clinical applications
    • A61B6/501—Clinical applications involving diagnosis of head, e.g. neuroimaging, craniography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/1048—Monitoring, verifying, controlling systems and methods
    • A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
    • A61N2005/1061—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using an x-ray imaging system having a separate imaging source
    • 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
    • A61N2005/1085—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy characterised by the type of particles applied to the patient
    • A61N2005/1091—Kilovoltage or orthovoltage range photons
    • 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
    • A61N2005/1092—Details
    • A61N2005/1095—Elements inserted into the radiation path within the system, e.g. filters or wedges
    • 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
    • A61N2005/1092—Details
    • A61N2005/1098—Enhancing the effect of the particle by an injected agent or implanted device
    • G—PHYSICS
    • G21—NUCLEAR PHYSICS; NUCLEAR ENGINEERING
    • G21K—TECHNIQUES FOR HANDLING PARTICLES OR IONISING RADIATION NOT OTHERWISE PROVIDED FOR; IRRADIATION DEVICES; GAMMA RAY OR X-RAY MICROSCOPES
    • G21K2201/00—Arrangements for handling radiation or particles
    • G21K2201/06—Arrangements for handling radiation or particles using diffractive, refractive or reflecting elements
    • G21K2201/061—Arrangements for handling radiation or particles using diffractive, refractive or reflecting elements characterised by a multilayer structure
    • G—PHYSICS
    • G21—NUCLEAR PHYSICS; NUCLEAR ENGINEERING
    • G21K—TECHNIQUES FOR HANDLING PARTICLES OR IONISING RADIATION NOT OTHERWISE PROVIDED FOR; IRRADIATION DEVICES; GAMMA RAY OR X-RAY MICROSCOPES
    • G21K2201/00—Arrangements for handling radiation or particles
    • G21K2201/06—Arrangements for handling radiation or particles using diffractive, refractive or reflecting elements
    • G21K2201/064—Arrangements for handling radiation or particles using diffractive, refractive or reflecting elements having a curved surface
    • G—PHYSICS
    • G21—NUCLEAR PHYSICS; NUCLEAR ENGINEERING
    • G21K—TECHNIQUES FOR HANDLING PARTICLES OR IONISING RADIATION NOT OTHERWISE PROVIDED FOR; IRRADIATION DEVICES; GAMMA RAY OR X-RAY MICROSCOPES
    • G21K2201/00—Arrangements for handling radiation or particles
    • G21K2201/06—Arrangements for handling radiation or particles using diffractive, refractive or reflecting elements
    • G21K2201/067—Construction details

Definitions

  • the invention relates to a method and a device for the radiotherapeutic treatment of tissue, that is to say tumors, by means of an X-ray CT system or of tumors or other diseases by means of a diagnostic or orthovolt X-ray system, each having at least one X-ray source, an X-ray optical module, consisting of an energy-dispersive X-ray concentrator and a diaphragm system, an imaging unit and a measuring device for determining the radiation dose.
  • a medical focus for the use of the method is seen in the treatment of malignant brain tumors, because these types of tumors are relatively well accessible due to the skull dimensions with the aforementioned X-rays and have with conventional therapies an extremely poor prognosis.
  • Radioactive implants are permanently or temporarily placed in the target volume (brachytherapy) and thus achieve a particularly high dose in the tumor.
  • brachytherapy Radioactive implants
  • pelt radioisotopes of targeting substances can also link imaging and therapy.
  • the selectivity is far from sufficient so far, so that radiation exposure, and in particular the burden of the excretory organs liver and kidney, are limiting.
  • a) Ablation Method Such techniques are based on the introduction of probes into the tumor area to be ablated. The tumor is overheated, undercooled or irradiated with high doses. Depending on the physical method, a distinction is made e.g. radio ablation, radio frequency ablation, laser ablation or cryoablation. Ethanolinjections are also applied to the tumor for local therapy. In extensive processes, embolization techniques are used to occlude the vessels supplying the tumor. All of these methods disadvantageously require intratumoral administration and are thus invasive.
  • Neutron capture therapy in which high-capture substances (e.g., boron or gadolinium compound) for thermal neutrons are delivered to the tumor and then activated in the neutron beam.
  • high-capture substances e.g., boron or gadolinium compound
  • the fission and emission products lead to local cell killing.
  • the therapy is physically very expensive. A breakthrough has not been achieved even after several clinical trials.
  • CT X-ray energy
  • X-ray energies for imaging and radiation differ by an order of magnitude.
  • X-ray systems with acceleration voltages up to 140 kV, which are excellently suited for imaging have been replaced in conventional radiotherapy because of the low penetration depth, thus high surface doses, first by Telekobalt and then by the high-voltage linear accelerators.
  • tomotherapy units ie systems that can be used equally for imaging as for radiation therapy, are currently being considered.
  • WO 2005081842 and DE 698 39 480 T2 disclose proposals according to which an X-ray system used for irradiation therapy is combined with a magnetic resonance imaging system.
  • the systems must be arranged so that the coil systems of the magnetic resonance system can not be disturbed by the treatment beam of the X-ray system.
  • Such a plant would have enormous costs.
  • the open design of the MRI system results in a lower spatial resolution compared to the closed high-field variants and CT imaging.
  • the acquisition times are within 10 minutes or more, so that no real simultaneous diagnosis and therapy is possible.
  • the invention has for its object to provide a method and a device that get along with the same principle device technology as the diagnostics to allow a targeted and gentle radiotherapy.
  • the goal is the coupling of diagnosis and therapy in the fight against cancer.
  • the object is achieved by features that are mentioned in the main claims 1 and 9.
  • Advantageous embodiments are the subject of the dependent claims.
  • the invention is the instrumental extension of a conventional CT device (or a simplified version of a diagnostic or Orthovolt X-ray system, as will be shown later) such that the CT device for diagnostics hardware remains unmodified, for therapy, an X-ray optical concentrator the beam path is pushed and an additional emission detector is attached. Both additional elements can be easily replaced and ultimately be electromechanically swung out of the control console or into the beam, so that the radiation risk for the operating personnel is kept as low as possible.
  • a quasi-monochromatic X-radiation is selected from the divergent and polychromatic X-radiation emitted by the conventional high-performance tube and focused specifically on the target, the tumor.
  • This physical measure of X-ray optics alone achieves a considerable increase in intensity in the target.
  • a monochromatization and a further dose increase in the target area are effected by previously introduced absorber elements.
  • This dose increase should be registered on-line (ie without time delay) via the radiated X-ray fluorescence with a second detector.
  • the monochromatization of the X-ray beam allows optimal energy adaptation of X-ray excitation and absorber element.
  • the Streuanteil can be suppressed by means of an energy-dispersive detector or by a fine optics.
  • a CT apparatus is to be used for radiotherapeutic treatment, with a plurality of radiation sources being used. are used, whose divergent rays are focused with a concentrator. In addition, an aperture system is provided in each case. The measurement of the radiation dose should be made on the diaphragm system.
  • the computational tomograph generates the representation of patient anatomy and topography for the exact determination of the tumor extent and the determination of the target volume in three-dimensional imaging, usually with the help of contrast agents.
  • the spatial resolution of such devices is now in the submillimeter range and represents anatomical conditions in high detail accuracy.
  • the basic device is extended by two additional functions.
  • the imaging software needs to be a new one
  • Enhanced or rewrote diagnostic therapy software which should also contain the therapy planning mode.
  • the additional modules will be described in more detail below.
  • the two device components can be individually introduced manually or, controlled by the control panel, in the beam path or be removed again.
  • This conversion from diagnostics to therapy (and possibly back again) can be done while the patient is placed on the couch.
  • the two additional functions can be retracted. These conversions are done in a short time so that the target coordinates have not changed practically due to motion artifacts.
  • the measurement of the dose increase with the fluorescence detection module allows an exact control of the irradiation of the target area.
  • Modern high-performance tubes allow the application of therapeutically common radiation doses in the minute range, so that normally a target coordinate changes only minimally fails. A readjustment is possible at any time by switching to the diagnostic mode of the CT device. Ultimately, switching to the diagnostic mode at the press of a button can be done so quickly that motion artifacts and the pharmacokinetics of the contrast agents can be detected and adapted to the radiation.
  • the patient is displaced in the z direction on the couch during CT scans.
  • the Lungsmodus is thought to move the patient bed additionally in the x and y directions.
  • the gantry can be tilted and the beam intensity can be modulated during the circulation, so that even larger tumors can be scanned specifically with the focused and monochromatized X-ray beam and the X-radiation introduced from the outside into the area of the dose increase
  • the X-ray tubes used in medical practice emit a divergent beam in a broad energy spectrum.
  • the possibilities for modulating X-rays in the range of 20-140 keV in X-ray optical elements are limited.
  • the use of a glare system alone does not represent a solution to the problem at hand.
  • This method has no possibility of problem-matching and thus energetically modifying the beam quality.
  • convergent and quasi-monochromatic radiation that is, defined energies
  • the diaphragm system in the Z plane, which is already present on CT, is therefore used together with an X-ray concentrator for focusing and monochromatization.
  • graphite-based X-ray concentrators may be used to form convergent quasi-monochromatic beams.
  • the beam is precisely focused on the tumor and its intensity is increased substantially precisely in the spectral range in which the activatable sensitizers (PREs below) are most effective.
  • the goal of the concentrator is to form a convergent or quasiparallel and quasi-monochromatic beam from a fan-shaped and spectrally wide beam of a CT device.
  • the concentrator is a two-layered closed surface with a beam stop.
  • the inner layer is made of an energy-dispersive material, preferably graphite crystals.
  • the outer layer is made of a highly absorbent material so that the direct jet can not penetrate the wall of the concentrator.
  • the concentrator may also contain multiple closed or non-closed surfaces.
  • the concentrator is a hollow cylinder with a HOPG layer on its inner wall.
  • the layer thickness must be adapted to the photon energies, so that an effective reflection is realized.
  • the diameter and length of the concentrator can vary between 1 to 5 cm for the diameter and 1 to 15 cm for the length. Preferred values are about 2 cm for the diameter and about 8 cm for the length.
  • the concentrator is located at a distance of about 20 to 30 cm from the focal spot of the anode and is mounted on a plate with an adjusting device which is constructed similar to the usual CT CT collimator, so a replacement is easily and quickly possible.
  • an adjusting device which is constructed similar to the usual CT CT collimator, so a replacement is easily and quickly possible.
  • the hollow cylinder with constant diameter over the length of other shapes are preferred in which the diameter over the length of elliptical or in the form of a logarithmic spiral is varied, but also any other forms are advantageously possible.
  • the reflection on the HOPG crystal is due to the Bragg relationship, whereby the closed shape with its focusing geometry helps to optimally illuminate the target area and thus to increase the intensity in the target area.
  • a beam stop is attached. Position and shape of the beam stop adapt to the shape of the X-ray optics. Only the Beamstop guarantees that only Bragg-reflected X-rays with defined energy are focused on the target area.
  • the X-ray optics are designed so that the focus coincides with the isocenter of the gantry.
  • the wall of the concentrator is also decisive. The wall material and the wall thickness must be optimized in terms of energy, so that the direct beam and its scattering are totally shaded.
  • the building block X-ray concentrator can alternatively be provided with a device for measuring the radiation intensity.
  • the determination of the radiation dose is carried out by measuring the X-ray fluorescence of the contrast agent, as described in DE 102005 026940 Al.
  • a detection system arranged in the vicinity of the tumor is provided, which is preferably attached to the patient couch.
  • a sensitive energy dissolving detector eg a CdTe detector
  • a dosimeter in combination with an optical system. This optical system is similar in construction to the concentrator described above.
  • the X-ray fluorescence is focused on the measuring probe of the dosimeter, without the Streuanteil significant importance. Instead of the dosimeter, a photon counter can also be used. Photons activatable substances
  • PRE Photoelectric Radiation Enhancer
  • EPR enhanced permeation and retention
  • gadolinium (element 64) is suitable for this purpose. In both cases, due to the photoelectric effect, increased absorption and, as a consequence, a local radiation dose increase occur.
  • Suitable for radiation dose increase are substances containing one or more, even different atoms of atomic numbers 38-42, 44-53, 56-83 elements.
  • the heavy alkaline elements are difficult to formulate specifically for parenteral administration and are thus only available for oral or topical applications.
  • iodine-containing X-ray contrast agents are also compounds MR contrast agents in question, such as Gd-DTPA or Gd-DOTA.
  • the aim is to achieve a higher concentration in the tumor than in the surrounding tissue in order to further increase the selectivity of radiotherapy in addition to the radiation guidance. This can be further increased by using tumor-affine compounds or nanoparticles.
  • chemotherapeutic agents for example cis-platinum
  • other modern metal complexes which have already found their way into tumor therapy and act intracellularly.
  • the dose increase by radiation-absorbing substances is based on the photoelectric effect. The incoming X-ray photon, upon sufficient energy and collision with an atom, strikes an electron from an inner shell.
  • the Photoelectric Radiation Enhancer (PRE) is first applied.
  • the images then generated in the imaging mode are used for anatomical localization and thus for defining the areas to be irradiated.
  • After further PRE application and the achievement of the target or necessary for the photoelectric dose increase effect concentration in the tumor is switched from the imaging mode in the therapy mode and started with the irradiation.
  • the software can calculate the coordinates for an exact positioning of the irradiation from the measuring signals and take over the control of the CT device. Within the feedback loops, it is ensured that if the concentration falls below a threshold concentration in the tumor, a message is issued and a subsequent dosing of the PRE can be carried out. Is this for the sake of acute Tolerability is no longer possible, the radiation can be stopped and a new meeting can be scheduled.
  • the irradiation planning can be carried out daily in the shortest time before each radiotherapy in accordance with the contrast agent-based CT image. This considerably increases the accuracy of radiation therapy, as deviations in patient positioning and changes in the target volume (for example, tumor regression or organ mobility) are immediately taken into account during radiotherapy without interruption.
  • Diagnostics, treatment planning and therapy can be fused in one device. This is a significant financial and logistical advantage over currently established technologies. It is not insignificant that systems operating according to the method according to the invention can be installed at any hospital (even in emerging countries) without great safeguards (radiation protection), since ortho- Protect volt photons against megavolt photons by minor constructional measures or do not incur additional costs with existing CT devices.
  • CT high technology is not critical and one can also use the X-ray concentrator with conventional C-arms and other diagnostic X-ray units combine.
  • the complete 3D imaging is not possible or only to a limited extent, it is still possible to advantageously combine diagnostics and therapy.
  • the tumor can also be irradiated in this variant from all 3D directions. The same applies to interventional applications or Orthovolt irradiation devices.
  • the x-ray concentrator is pushed into the x-ray beam prior to the beam exit of the x-ray tube for the therapy mode.
  • X-ray energy and beam focus are adjusted to the target area.
  • the irradiation can be computer-controlled from all spatial directions focused on the tumor.
  • the energy profile can be adjusted so that the main dose is deposited in the near-surface target areas.
  • PREs photon activatable substances
  • the range of described photon activatable substances (PREs) can be extended to those which are known or can be formulated directly in the form of ointments, solutions, creams, emulsions from dermatological applications. Examples are povidone-iodine (poly (1-vinyl-2-pyrrolidone) -iodo-complex) containing solutions or ointments such as Betaisodona®.
  • the advantage of the method over the photodynamic therapy results from the fact that the location of the irradiation focus can be arbitrarily variable even in the centimeter range below the skin surface. Furthermore, in contrast to the X-ray diagnosis, which has a very high spatial and temporal resolution, the diagnostics in the optical range is limited by the strong absorption and the high scattered radiation background.
  • CT system is a schematic diagram of a working according to the invention
  • 3 is a schematic diagram of the function of the X-ray concentrator
  • FIG. 6 shows the intensity distribution in focus (identical to the gantry rotation center) of the energy range concentrator of the W-KCC line.
  • Fig. 7 shows the energy spectrum in focus
  • Fig. 1 The operation of the device system is outlined in Fig. 1.
  • An X-ray-optical module consisting of a diaphragm system 2 and an X-ray concentrator 3, which focuses or collimates the X-rays onto a tumor 4, is attached to the output of an X-ray tube 1.
  • a CT system is used (see FIG. 2).
  • X-ray tube 1 and X-ray optical module rotate about the tumor 11 and can specifically irradiate the localized tumor 11, wherein adjacent, healthy tissue is spared maximum.
  • the tumor 11 is sensitized by the application of PREs for the X-radiation. Radiation and PREs must be coordinated.
  • the effect of the therapy is followed in order to simulate the treatment planning in a feedback step.
  • the marker function is time-dependent.
  • the marker substances in the blood circulation are removed, ie the markers do not encase themselves in the cancer cells.
  • the core of the irradiation unit is a modern CT scanner with a movable patient table 5. It can be a standard product, as it is used by any radiotherapeutic device for radiation diagnosis. The range of application of such a CT device must be extended by therapy tasks. Such an image therapy CT (IT-CT) can then be operated in diagnostic and therapy mode. This results in hardly any additional spatial requirements, which increases the acceptance and significantly reduces the financial expenses for the users.
  • IT-CT image therapy CT
  • the positioning of the tumor 11 plays the decisive role. Since the localization of the tumor 11 can be controlled by the imaging, automation of the positioning of the tumor 11 in the rotation of the X-ray tube 1, tilting the gantry and advancing the patient table 5 is possible, so that the highest possible precision in the irradiation are ensured can.
  • An advantageous effect is the detection system 6 for determining the registered tumor dose (by photoelectric effect) on the basis of the measured X-ray fluorescence 7.
  • the induced by the photoelectric effect X-ray fluorescence 7 increases sigmoid with the atomic number, so that for this example, iodine and gadolinium are suitable elements .
  • the effective radiation dose deposited in the tumor 11 or the dose-increasing effect in the tumor 11 can be determined. This provides the radiation therapist criteria for further individualized, therapeutic approach. Since photons from linear accelerators interact with matter via the Compton effect, which has a comparably low dependence on the atomic number of the elements and does not lead to the release of photons from inner electron shells, the above-described high-energy fluorine detection of the linear accelerators is not possible.
  • a controlled diaphragm system 2 is preferably provided for the device according to the invention.
  • the shutter system 2 alone would significantly reduce the irradiation intensity and have no possibility of modifying the emission spectrum. This can be achieved with the aid of the aperture system 2 and X-ray concentrator 3 existing X-ray optics.
  • the concentrator 3 is a two-layered closed surface with a Beamstop 8 ( Figure 3).
  • the inner layer 14 is made of an energy dispersive material. For physical reasons, a graphite layer (HOPG - Highly Oriented Pyrolytic Graphite) is favored.
  • the outer layer 13 is made of a highly absorbent material, so that the direct beam can not penetrate the wall of the X-ray concentrator 3.
  • the X-ray concentrator 3 may also contain a plurality of closed or non-closed surfaces. In the simplest case, the X-ray concentrator 3 is a hollow cylinder with a HOPG layer on its inner wall.
  • the X-ray concentrator 3 should be adjusted to an energy of about 60 keV (this corresponds approximately to the W KCC line of the anode material): In this case, a quasi-monochromatic X-ray having a bandwidth of about ⁇ E ⁇ 15 keV ( ⁇ E / E ⁇ 20 %) expected.
  • a Beamstop 8 is provided to block the direct beam.
  • the X-ray concentrator 3 is positioned immediately in front of the exit window of the X-ray tube 1.
  • the radiation leaving the X-ray concentrator 3 consists of a reflected radiation component 9 and a direct beam 10 (FIG. 1).
  • the X-ray concentrator 3 is equipped with a beam stop 8 for blocking the direct jet 10. In this way, only the reflected radiation portion 9 is focused on the tumor 11, whereby a high intensity quasi-monochromatic radiation in the focal spot 4 is generated.
  • FIG. 4 shows a photograph of a practical embodiment of the X-ray concentrator 3 prior to installation on the collimator plate of the CT device.
  • the X-ray concentrator 3 can be seen in the installed state.
  • the plastic cover of the CT device must be removed.
  • FIG. 7 shows the energy spectrum measured with an energy-dispersive detector. The measurement was made on the basis of the scattered radiation on a Kapton foil and recalculation of the Compton shift. It can clearly be seen that the energy is concentrated in the range around 60 keV.
  • the spectrum of the X-ray beam without X-ray concentrator 3 is shown. It can be seen clearly that the X-ray concentrator 3 leads, in addition to the monochromatization of the radiation, to a marked increase in intensity in the center.
  • the local increase in dose due to radiation-absorbing substances is an advantageous element for the therapy.
  • the desired dose distribution or the dose drop from the target volume to the environment can be generated.
  • Iodine- or lanthanide-containing PRE examples should accumulate in the tumor area in relation to the surrounding tissue or show high tumor tissue concentration quotients. They are very compatible at the same time.
  • FIG. 8 reflects the dependence of the dose increase of iodine and gadolinium as a function of the X-ray photon energy and shows that the maximum of the dose increase of iodine and gadolinium in the energy range is about 60 keV. This energy range is currently well covered by the X-ray optics (see FIG. 7). Because the Gd K edge is at about 50 keV, photons with energies of about 50-70 keV are most suitable for the excitation of Gd K lines. These optimum conditions are provided with a tungsten tube as X-ray tube 1 which emits a strong W-KCC line at 59.3 keV.
  • the use of the X-ray concentrator 3 increases the intensity of the primary radiation in the energy range 50-70 keV essential. In addition, in this case, all high-energy photons (> 80 keV) are suppressed, whereby the scattered radiation background can be reduced.
  • the determination of the absorbed dose is based on the measurement of the X-ray fluorescence signal of the registered contrast agent (for example Gd) by a detection system 6.
  • the underlying finding is that the X-radiation used for the therapy stimulates characteristic lines of the contrast agent. These fluorescence lines can be registered by means of at least one detector. With known contrast medium concentration, the measured intensity of the secondary radiation is a measure of the absorbed dose.
  • the detection system 6 is located on the patient couch 5. Because the active area of these detectors of the detection system 6 is relatively small, multiple detectors can be assembled into arrays to increase the capture angle for registration of fluorescence radiation. If necessary, it would also be possible to use a secondary concentrator for effective trapping of the emitted characteristic line of the contrast agent and the suppression of stray radiation as far as possible.
  • Suitable detectors are CdTe detectors with good efficiency and acceptable energy resolution at high energies.
  • the present method has a number of features:
  • a CT detector 12 which is present in any case in the CT system, is used for imaging purposes.
  • the concentrator 3 is swiveled out of the beam path of the x-ray tube 1 and thus rendered ineffective. In this way, high-contrast, high-resolution images can be obtained.
  • the images can be used directly to design the further therapy. They also serve to control the current concentration of the contrast agent (PRE).
  • PRE contrast agent

Abstract

L'invention concerne un dispositif de diagnostic par rayons X que l'on modifie de sorte que le diagnostic est obtenu et que la radiothérapie de tumeurs est possible. Pour l'amélioration du diagnostic, un agent contrastant usuel pour rayons X est utilisé comme dans le diagnostic par rayons X. Pour le renforcement du dosage en mode thérapeutique par rayon, on utilise également des agents contrastants qui contiennent un ou plusieurs atomes d'éléments lourds. L'augmentation du dosage est basée sur l'effet photoélectrique. La tumeur n'est irradiée que jusqu'à ce qu'une concentration théorique de l'agent contrastant dans la tumeur est dépassée. Des dispositifs de diagnostic par rayons X préférés sont les tomodensitomètres qui sont équipés de tubes à rayons X haute performance et fonctionnent avec des tensions élevées dans la plage allant jusqu'à 140 kV ou au-dessus. Les modifications lors du passage du mode diagnostic au mode thérapeutique concernent les modules supplémentaires de concentrateur 3 de rayons X et d'unité 6 de détecteur de fluorescence. Avec le concentrateur de rayons 3 X, qui est déplacé dans le trajet de rayon de manière mécanique ou de manière électromécanique assortie d'un contrôle informatisé, le faisceau de rayons X est monochromatisé à des énergies optimales pour l'augmentation du dosage de l'agent contrastant et focalisé sur la zone cible. Avec le détecteur de fluorescence 6, la concentration de l'agent contrastant dans la tumeur 11 est mesurée en ligne pendant l'irradiation. En variante, la concentration doit être déterminée à partir de l'image de diagnostic grâce à une commutation rapide au mode diagnostic.
PCT/EP2008/054577 2007-04-16 2008-04-16 Procédé et dispositif pour le traitement thérapeutique par rayons de tissu grâce à une installation de tomodensitométrie à rayons x ou une installation à rayons x orthovolt ou de diagnostic WO2008125680A1 (fr)

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DE102007018102A DE102007018102B4 (de) 2007-04-16 2007-04-16 Einrichtung zur strahlentherapeutischen Behandlung von Gewebe mittels einer Röntgen-CT-Anlage oder einer diagnostischen oder Orthovolt-Röntgen-Anlage

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WO2010006722A1 (fr) * 2008-07-16 2010-01-21 Bayer Schering Pharma Aktiengesellschaft Radiothérapie à l'aide de tubes à haute puissance, renforcée par des produits de contraste
FR2996347A1 (fr) * 2012-10-03 2014-04-04 Norbert Beyrard Reflecteur a rayons x comprenant des particules de minerai d'uranium ou de plomb pour l'absorption des rayons partiellement reflechis
EP2814573A4 (fr) * 2012-02-13 2015-12-23 Convergent R N R Ltd Administration de rayons x guidée par imagerie
RU2697228C2 (ru) * 2017-03-24 2019-08-13 федеральное государственное бюджетное образовательное учреждение высшего образования "Северный государственный медицинский университет" Министерства здравоохранения Российской Федерации Способ фиксации коленного сустава для проведения ортовольтной рентгенотерапии
WO2021048764A1 (fr) * 2019-09-09 2021-03-18 Universidad De La Frontera Système intégré de sources d'orthovoltage qui induisent un rayonnement ionisant
CN113950354A (zh) * 2019-04-08 2022-01-18 会聚R.N.R有限公司 优化放射治疗的系统和方法
US11898971B2 (en) 2019-06-24 2024-02-13 Sms Group Gmbh Controlling process parameters by means of radiographic online determination of material properties when producing metallic strips and sheets

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EP4201328A1 (fr) * 2021-12-21 2023-06-28 Universität Hamburg Appareil de rayonnement de rayons x, comprenant une optique de mise en forme spectrale des rayons x et un dispositif d'ouverture de filtre spectral, pour imagerie par rayons x

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WO2010006722A1 (fr) * 2008-07-16 2010-01-21 Bayer Schering Pharma Aktiengesellschaft Radiothérapie à l'aide de tubes à haute puissance, renforcée par des produits de contraste
EP2814573A4 (fr) * 2012-02-13 2015-12-23 Convergent R N R Ltd Administration de rayons x guidée par imagerie
FR2996347A1 (fr) * 2012-10-03 2014-04-04 Norbert Beyrard Reflecteur a rayons x comprenant des particules de minerai d'uranium ou de plomb pour l'absorption des rayons partiellement reflechis
EP2717271A1 (fr) * 2012-10-03 2014-04-09 Norbert Beyrard Réflecteur à rayons X comprenant des particules de minerai d'uranium ou de minerai de plomb pour l'absoption des rayons X non totalement réfléchis
RU2697228C2 (ru) * 2017-03-24 2019-08-13 федеральное государственное бюджетное образовательное учреждение высшего образования "Северный государственный медицинский университет" Министерства здравоохранения Российской Федерации Способ фиксации коленного сустава для проведения ортовольтной рентгенотерапии
CN113950354A (zh) * 2019-04-08 2022-01-18 会聚R.N.R有限公司 优化放射治疗的系统和方法
US11898971B2 (en) 2019-06-24 2024-02-13 Sms Group Gmbh Controlling process parameters by means of radiographic online determination of material properties when producing metallic strips and sheets
WO2021048764A1 (fr) * 2019-09-09 2021-03-18 Universidad De La Frontera Système intégré de sources d'orthovoltage qui induisent un rayonnement ionisant

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TW200920437A (en) 2009-05-16
DE102007018102A1 (de) 2009-01-02
PE20090134A1 (es) 2009-05-08
UY31025A1 (es) 2008-11-28
DE102007018102B4 (de) 2009-09-03

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