Classifications

• • 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
  • A61N5/1031—Treatment planning systems using a specific method of dose optimization
• • 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
  • A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
• • 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
  • A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
  • A61N5/1014—Intracavitary radiation therapy
  • A61N5/1015—Treatment of resected cavities created by surgery, e.g. lumpectomy
• • 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
  • A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
  • A61N5/1028—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy using radiation sources applied onto the body

Definitions

• the present invention relates to a method of generating and/or providing data for tissue treatment, in particular for tumor treatment, by means of a radiation device.
• a first image of the tissue, which is to be irradiated is generated in an image-providing medical technical method.
• a first parameter setting of the irradiation appliance is carried out.
• the tissue is irradiated with this parameter setting.
• at least one further image of the tissue, which is to be irradiated is generated.
• an automatic comparison of the images is carried out and a signal is generated in case of deviations.
• an image for example, a CT- or x-ray image
• This image is displayed on a display screen.
• the tumor and/or the tissue, which is to be irradiated is marked.
• An irradiation plan is established, via a method, for example by means of appropriate software.
• the generated pictures are overlaid, for example by plotting isodose curves / surfaces / volumes, with values, which were calculated from the irradiation plan.
• a disadvantage of this known solution is, that it is not applicable to low-energy irradiation appliances or irradiation methods, respectively.
• Low-energy irradiation appliances are frequently being used in intraoperative methods.
• low-energy systems do not represent systems with monochromatic radiation quality.
• Low-energy systems rather show a very complex radiation spectrum from 0 to the current maximal radiation energy of for example 50 keV. That means, that with an increase in penetration of the radiation of the low- energy irradiation system into the tissue, the weakening even changes with homogenous tissue, as the radiation spectrum changes with increasing absorption in the tissue.
• the present invention is therefore based on the problem of providing a method of generating and/or providing data for tissue treatment via an irradiation method, wherein a direct, in particular visual, irradiation planning in connection with a low- energy irradiation appliance and/or a low-energy irradiation method can be performed.
• This problem is solved by the method with the features according to independent patent claim 1 as well as by the computer program product with the features according to independent patent claim 10. Further features and details of the invention can be derived from the dependent claims as well as from the description. Features and details, which are described in connection with the method according to the invention, of course also apply in connection with the computer program product and vice versa.
• the method according to the invention in particular provides a solution for a low- energy irradiation system or irradiation method, respectively, which allows for a direct, in particular visual, treatment planning.
• a system or method, respectively may be used in an intraoperative method.
• such a system or method, respectively may be used for treatment of surfaces, for example outside of the body. But the invention is not limited to the mentioned possible applications.
• the system or method, respectively, according to the invention may be used in connection with tumor treatment.
• usage which is independent of a tumor surgery, may also be performed.
• the low-energy irradiation system or low-energy irradiation method in particular represents a system or method, respectively, for radiotherapy of a tissue bed, for example a tumor bed.
• the tissue bed for example the tumor bed, is irradiated with soft rays, in particular X-rays.
• an emitting device of an irradiation source which is preferably provided with an appropriate applicator of the correct size, is placed in the tissue bed, for example the tumor bed.
• the desired cell tissue can be irradiated directly, without having to irradiate through healthy tissue first.
• a method of, in particular automatic, generating and/or providing of data for tissue treatment, in particular a tumor treatment, via a low- energy irradiation appliance wherein the low-energy irradiation appliance has an irradiation source for generating soft radiation, preferably radiation with a spectrum of 0 to a maximal radiation energy of 100keV, in particular a radiation with a spectrum of 0 to a maximal radiation energy of 50keV, and an emitting device for emitting the radiation to a tissue which is to be irradiated.
• the invention is not limited to a radiation source up to 100kV, in particular 50kV.
• the present invention is rather generally applicable for the soft radiation range, in particular the soft X-ray range.
• the low-energy irradiation appliance thus firstly has a radiation source, which in operation generates radiation, for example X-radiation.
• the generated radiation is directed to the tissue, which is to be irradiated, via an appropriate emitting device.
• the emitting device may be arranged and/or formed directly at the radiation source or may be connected to the radiation source via a probe device.
• applicator equipment is used in the radiation appliance of the invention.
• Applicator equipment for example, consists of an applicator element, which is designed for receiving the emitting device. That means, that the emitting device, possibly with the probe device, is inserted, for example pushed, into the applicator element. If applicator equipment is being used, the applicator equipment may, for example, be the emitting device.
• the emitting device may be defined such, that it is a device, via which or from which, as the case may be, the radiation is emitted from the irradiation appliance to the tissue which is to be irradiated.
• - quality data of the tissue for example the tumor tissue and/or the tissue in the vicinity of the tumor, is determined;
• - physical property data of the determined tissue in connection with the radiation of the radiation source is determined;
• - data for the tissue treatment for example the tumor treatment
• the determined data is generated from the determined data and/or the determined data is provided for generating data for the tissue treatment, in particular the tumor treatment.
• the method according to the invention is not limited to a specific course scheme, in particular of the first three method steps. It is merely important, that the respective data is determined and is subsequently further processed.
• the method according to the invention is carried out with support of computer(s).
• at least one processing device and/or at least one data processing device is preferably provided, on which the method is carried out.
• physical data of the radiation source is determined directly from leaving the emitting device.
• those physical data is determined at a location or in the area or vicinity of a location, where the radiation of said radiation source leaves the emitting device.
• physical data are such data which physically describe and/or characterise the radiation source and/or the radiation being delivered or emitted from said radiation source.
• the spectrum of the radiation source is determined directly from leaving the emitting device as physical data of the radiation source.
• the spectrum of the radiation source directly from leaving the tip of the probe element or the applicator equipment, respectively may be determined.
• the values of the spectrum or of the spectra may preferably be generated by appropriate measurements, the results of which are advantageously stored in a file or data base.
• Monte-Carlo-calculations can be envisioned, which ab initio calculate and/or simulate the emitting characteristics of the x-ray source.
• the file and/or data base is preferably stored in a storage device, which the method or the processing unit, whereon the method is carried out, as the case may be, accesses or may access.
• quality data of the tissue for example of the tumor tissue and/or of the tissue in the vicinity of the tumor, is determined.
• quality data are such data which provide information relating to the quality and/or nature and/or constitution and/or appearance and/or character and/or composition and/or consistence and/or configuration and/or texture and the like of the tissue.
• the quality data of the tissue for example of the tumor tissue and/or of the tissue in the vicinity of the tumor, is determined by means of an image-providing method.
• appropriate images may be generated, such as CT-images, roentgenogram, x-ray images and the like.
• the tissue type for example of the tumor tissue or of the tissue in the vicinity of the tumor, for example the images, for example CT-pictures or x-ray pictures, which were taken beforehand, may be used.
• the so called Voxel in the vicinity of the tissue, for example in the vicinity of the tumor, the respective absorption at that location and thus the tissue type may be deducted from the respective gray value, preferably in Hounsfield-units.
• Voxel in particular denominates a data element in a three dimensional graphic.
• physical property data of the tissue is determined in connection with the radiation of the radiation source.
• the mass-energy-absorption-coefficient will be determined as physical property data of the determined tissue is determined in connection with the radiation of the radiation source.
• the file and/or data base is preferably stored in a storage device, which the method or the processing unit, whereon the method is carried out, as the case may be, accesses or may access.
• the values may thus be stored in the file or data base for future, in particular automatic, usage and/or calculation.
• data for the tissue treatment for example for the tumor treatment
• the determined data is generated from the determined data and/or the determined data is provided for generating data for the tissue treatment, for example the tumor treatment.
• Preferred but non-exclusive examples for this will be described in greater detail in the course of the description.
• the method according to the invention it, in particular, becomes possible to indicate or display, respectively, the required data for planning a tissue treatment, for example a tumor treatment, with a low-energy irradiation system directly, in particular visually, in connection with quality data of the tissue, for example with CT-images or x-ray images.
• the method according to the invention thus, in particular, allows for the planning of a tissue treatment, for example a tumor treatment, by means of a low- energy radiation system with calculation and display of the physical and/or biological and/or medical effectiveness of the system.
• the dose rate for the tissue may be calculated, in particular automatically, from the determined data. If at a specific location within the tissue, the value of the dose rate, which reaches that location during the treatment, is required or desired, this can now easily be calculated with the method according to the invention, in particular, if the spectrum at the surface of the emitting device or the applicator device, is known. For example, the calculation of the absorbed dose rate at a specific point can be carried out from the radiation spectrum and from tissue type at this point.
• the course of the calculation may be such that the connecting vector between the isocentre of the radiation emitting device and the point of the tissue, which is to be irradiated, is determined for calculating the dose rate; that the point of exit of the connecting vector at the surface of the radiation emitting device is calculated; that the path section between the point of exit and the point of the tissue, which is to be irradiated, is calculated; that the associated spatial volumes in the quality data of the tissue, for example the tumor tissue and/or the tissue in the vicinity of the tumor, are determined along the calculated path section; that the tissue types and their position and/or extension along the calculated path section are determined; that the radiation spectrum, which after transmission along the calculated path section exists at the point of the tissue, which is to be irradiated, is calculated; and that the dose rate at the point of the tissue, which is to be irradiated, is calculated from the radiation spectrum and the tissue type at the point of the tissue, which is to be irradiated.
• the course of calculation with the method according to the invention may take place as follows, wherein in this example, the spectrum at the surface of the emitting device has to be known:
• the connecting vector between the isocentre I of a roentgen system XRS and the point G is determined.
• the point of exit A of the connecting vector at the surface of the emitting device is calculated.
• the path section from A to G and the associated Voxels are calculated along this path section in the images, for example CT-images, which have been generated beforehand.
• the calculation or determination, respectively, of the tissue types and their respective position and/or extension along the path section from A to G or in the determined Voxels, respectively, is carried out.
• the radiation spectrum, for example roentgen spectrum, S is calculated, which is present at the endpoint G after transmission along the path section from A to G.
• the calculation of the absorbed dose rate D at point G is carried out from the radiation spectrum S and the tissue type at this point. Thereby, the physical effectiveness becomes known.
• further physical and/or biological and/or medical data may be generated and/or determined and/or provided, wherein the further physical and/or biological and/or medical data is being used for generating data for the tissue treatment, for example the tumor treatment, and/or is being provided for generating data for the tissue treatment, for example the tumor treatment.
• the RBE relative biological effectiveness
• the RBE relative biological effectiveness
• the RBE may, if desired, be calculated and preferably be displayed, for example be shown, at each arbitrary location in the tissue as biological values and the probability of recurrence of the tumor (probability of recurrence) as medical values.
• the determined and/or calculated data and/or data for the tissue treatment may visually be displayed on a display screen.
• the physical data of the radiation source and/or the physical property data of the determined tissue in connection with the radiation of the radiation source and/or the further physical and/or biological and/or medical data are visually displayed together with, in particular shown in, quality data of the tissue, for example the tumor tissue and/or the tissue in the vicinity of the tumor.
• the method according to the invention becomes possible to directly, visually illustrate the required data for planning the tissue treatment, in particular the tumor treatment, with the low-energy irradiation system on a display screen together with or shown in CT-images, x-ray images or roentgenograms of the tissue, for example the tumor tissue, with the tissue vicinity.
• the data which is shown in the images, may provide the different users with important information regarding the physical/biological/medical effectiveness of the system and/or the treatment, which would otherwise cumbersomely have to be calculated by the user himself.
• the dose rate in the tissue can not only be calculated. This data may rather also be shown in an image of the tissue. In addition, also further biological/medical data/information can be calculated and also shown in the image.
• the method according to the invention is based on the knowledge of the physical properties of the radiation of the low-energy irradiation system, for example the spectrum, and the physical property of different tissue types in connection with the radiation of the low-energy irradiation system and/or with soft x-rays, that means the energy dependent absorption behaviour and the like of tissue with x-radiation up to 100keV, in particular up to 50keV.
• the method is also based, in particular, on the knowledge of the image, for example the CT-picture or the roentgen picture, of the affected tissue vicinity, for example the tumor vicinity, with association of the gray levels of the picture pixels in the image to respective tissue types, for example on the basis of the Hounsfield scale.
• a calculation in 3D is not necessarily mandatory. In general, a sectional view in 2D is also sufficient.
• the method does not necessarily have to posses the ability of calculating
• a computer program which, if it is executed on a data processing device or unit or is loaded into such a device or unit, interacts such that the method according to the invention as described above, is executed on the data processing unit.
• the computer program preferably is one for a low-energy irradiation system with calculation and display of the physical and/or biological and/or medical effectiveness of the system.
• Figure 1 shows, in schematic depiction, a low-energy irradiation appliance with which a method according to the invention for generating and/or providing data for an intraoperative tumor treatment can be carried out
• Figure 2 shows, in schematic depiction, a low-energy irradiation appliance with which a method according to the invention for generating and/or providing data for a tissue treatment at the surface can be carried out;
• Figure 3 shows, in schematic depiction, how the dose rate for a tissue, which is to be irradiated, can be calculated at a specific point G.
• a low-energy irradiation appliance 10 is shown, which can be used for intraoperative irradiation of tissue after a breast tumor excision.
• the low-energy irradiation appliance 10 has an arrangement 1 1 for generating an electron beam and an adjacent beam deflector 12. Furthermore a guiding device 13 for guiding the generated electron beam to a radiation source 14 is provided.
• the radiation source 14, which may have a gold target, generates a low-energy soft radiation, for example with a spectrum of from 0 to maximal radiation energy of 100keV, in particular 50keV.
• the radiation, which is generated by the radiation source 14, can be directed onto a tissue, which is to be irradiated, via an emitting device. Therein, the radiation can be released in a targeted fashion into the predefined tissue.
• applicator equipment 16 is provided, which is a balloon applicator in the depicted example.
• the irradiation appliance 10 is supposed to serve for irradiating tissue 17 in the tumor vicinity during a breast irradiation. Firstly, the tumor is excised by surgery.
• the applicator equipment 16 is introduced at the irradiation place. Subsequently, the radiation source 14 is inserted into the applicator equipment 16, wherein the radiation source 14 can be positioned precisely by means of the applicator equipment 16.
• a method of generating and/or providing data for a tumor treatment by means of the low-energy irradiation appliance 10 is provided.
• a processing unit 20 is provided for carrying out the method.
• Physical data of the radiation source 14 is determined directly from leaving the emitting device 15.
• the spectrum of the radiation source 14 is determined directly from leaving the emitting device 15 as physical data of the radiation source 14, which is clarified by the connecting line 21 .
• the values of the spectrum or the spectra, respectively, may preferably be generated by means of appropriate measurements, the results of which are preferably stored in a file or data base.
• the file and/or data base is stored in a storage device 22, which the method or the processing unit 20, whereon the method is carried out, as the case may be, accesses or may access.
• quality data of the tissue 17 in the tumor vicinity is determined. It may for example be provided, that the quality data of the tissue 17 in the vicinity of the tumor is generated by means of a device 23 for carrying out an image-providing method, which is clarified by the connecting line 24.
• appropriate images such as CT-images, x-ray images and the like, may be generated by means of device 23.
• the images for example CT-pictures or x-ray pictures, which have been taken beforehand, may for example be used.
• an image of the tissue 17 in the vicinity of the tumor may be generated by means of an image-providing method.
• the thus generated image is then transmitted to an analysis device 25 within the processing unit 20, which is clarified by the connecting line 26, and is analysed in the analysis device 25 by means of an analysis method, for example with regards to the respective gray values.
• the tissue type is then determined from the determined gray values and is provided in form of or as quality data.
• physical property data of the determined tissue in connection with the radiation of the radiation source 14 is determined.
• the mass-energy- absorption-coefficient is determined for this purpose.
• the mass-energy- absorption-coefficient dependent of the energy [ ⁇ / ⁇ ( ⁇ )] ⁇ tissue type ⁇ in the soft radiation range for example X-ray range
• the mass-energy-adsorption-coefficients for different tissue types are or have been stored in a file or data base.
• the file and/or data base is preferably stored in a storage device 27, which the method or the processing unit 20, whereon the method is carried out, as the case may be, accesses or may access.
• the data 28 for the tumor treatment is generated from the determined data and/or the determined data is provided for generating data for the tumor treatment.
• the dose rate for the tissue, which is to be irradiated may, in particular automatically, be calculated from the determined data.
• the determined and/or calculated data and/or the data for the tumor treatment are visually illustrated on a display screen 29.
• the physical data of the radiation source 14 and/or the physical property data of the determined tissue in connection with the radiation of the radiation source 14 and/or further physical and/or biological and/or medical data is visually illustrated together with, in particular shown in, the quality data of the tissue in the vicinity of the tumor.
• FIG 2 a low-energy irradiation appliance 10 is depicted, which is used for irradiation of tissue at the body surface.
• the low-energy irradiation appliance 10 has an arrangement 1 1 for generating an electron beam and an adjacent beam deflector 12. Furthermore, a guiding device 13 for guiding the generated electron beam to a radiation source 14 is provided.
• the radiation source 14, which may for example have a gold target, generates a low- energy soft radiation, for example with a spectrum of from 0 to maximal radiation energy of 100keV, in particular 50keV.
• the radiation Via an emitting device 15, the radiation, which is generated by the radiation source 14, can be directed onto a tissue, which is to be irradiated. Therein, the radiation can be released in a targeted fashion into the predefined tissue.
• applicator equipment 16 is provided, which is a surface applicator, so that an irradiation of tissue 17 may be carried out also outside of the body, also independent of a tumor surgery.
• the radiation is not introduced intraoperatively, as was indicated in connection with figure
• the radiation is rather applied to the surface, which is to be irradiated.
• the applicator equipment 16 of the embodiment which is depicted in figure
• the element 18 for influencing the ray is preferably provided as a lens for changing the ray characteristics.
• the element 18 is preferably exchangeably, that means detachably, arranged on the applicator equipment 16.
• the radiation is applied to the tissue surface 17, which is to be irradiated, from the radiation source 14 via the ray influencing element 18.
• the embodiment which is shown in figure 2 and which has been described above, is, for example, also suitable for irradiation of surface lesions or tumors, in particular on the skin or on the surface of organs.
• a method of generating and/or providing data for a tumor treatment by means of the low-energy irradiation appliance 10 is provided.
• a processing unit 20 is provided for carrying out the method.
• Physical data of the radiation source 14 is determined directly from leaving the emitting device 15.
• the spectrum of the radiation source 14 is determined directly from leaving the emitting device 15 as physical data of the radiation source 14, which is clarified by the connecting line 21 .
• the values of the spectrum or the spectra, respectively, may preferably be generated by means of appropriate measurements, the results of which preferably are stored in a file or data base.
• the file and/or data base is stored in a storage device 22, which the method or the processing unit 20, whereon the method is carried out, as the case may be, accesses or may access.
• quality data of the tissue 17 in the tumor vicinity is determined.
• the quality data of the tissue 17 in the vicinity of the tumor is generated by means of a device 23 for carrying out an image-providing method, which is clarified by the connecting line 24.
• appropriate images such as CT-images, x-ray images and the like, may be generated by means of the device 23.
• the images for example CT-pictures or x-ray pictures, which have been taken beforehand, may for example be used.
• first an image of the tissue 17 in the vicinity of the tumor may be generated by means of an image-providing method.
• the thus generated image is then transmitted to an analysis device 25 within the processing unit 20, which is clarified by the connecting line 26, and is analysed in the analysis device 25 by means of an analysis method, for example with regards to the respective gray values.
• the tissue type is then determined from the determined gray values and is provided in form of or as quality data.
• the mass-energy- absorption-coefficient is determined for this purpose.
• the mass-energy-absorption-coefficient dependent of the energy [ ⁇ / ⁇ ( ⁇ )] ⁇ tissue type ⁇ in the soft radiation range for example X-ray range.
• the mass-energy- adsorption-coefficients for different tissue types are or have been stored, respectively, in a file or data base.
• the file and/or data base is preferably stored in a storage device 27, which the method or the processing unit 20, whereon the method is carried out, as the case may be, accesses or may access.
• the data 28 for the tumor treatment is generated from the determined data and/or the determined data is provided for generating data for the tumor treatment.
• the dose rate for the tissue, which is to be irradiated may, in particular automatically, be calculated from the determined data.
• the determined and/or calculated data and/or the data for the tumor treatment are visually illustrated on a display screen 29.
• the physical data of the radiation source 14 and/or the physical property data of the determined tissue in connection with the radiation of the radiation source 14 and/or further physical and/or biological and/or medical data is visually illustrated together with, in particular shown in, the quality data of the tissue in the vicinity of the tumor.
• FIG 3 it is schematically shown, how the dose rate for tissue, which is to be irradiated, can be calculated at a specific point G. If at a specific point G in the tissue the value of the dose rate, which reaches that point during treatment is required or desired, it can now easily be calculated by means of the method according to the present invention.
• the course of calculation with the method according to the present invention may be carried out as follows, wherein in this example, the spectrum at the surface of the emitting device has to be known. Firstly, the connecting vector V between the isocentre I in the area of the tip of the radiation source 14 - here an x-ray source -, which is located within an applicator equipment 16, and the point G is determined. Then the point of exit A of the connecting vector V at the surface of the emitting device, which in the present example is applicator equipment, is calculated.
• the path section from A to G through different tissue types 1 , 2, 3 and 4 and the associated Voxels are calculated along this path section in the images, for example CT-images, which have been generated beforehand. Furthermore, the calculation or determination, respectively, of the tissue types 1 , 2, 3 and 4 and their respective position and/or extension along the path section from A to G and/or in the determined Voxels is carried out. Furthermore, the radiation spectrum, for example roentgen spectrum, is calculated, which is present at the endpoint G after transmission along the path section from A to G. The calculation of the absorbed dose rate D at point G is carried out from the radiation spectrum S and the tissue type at this point. Thereby, the physical effectiveness becomes known.
• the radiation spectrum for example roentgen spectrum

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• 2010
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