WO2014207622A1 - Curiethérapie adaptative guidée par ultrasons - Google Patents

Curiethérapie adaptative guidée par ultrasons Download PDF

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Publication number
WO2014207622A1
WO2014207622A1 PCT/IB2014/062403 IB2014062403W WO2014207622A1 WO 2014207622 A1 WO2014207622 A1 WO 2014207622A1 IB 2014062403 W IB2014062403 W IB 2014062403W WO 2014207622 A1 WO2014207622 A1 WO 2014207622A1
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WO
WIPO (PCT)
Prior art keywords
placement
recited
devices
ultrasonically
ultrasonic
Prior art date
Application number
PCT/IB2014/062403
Other languages
English (en)
Inventor
Francois Guy Gerard Marie Vignon
Shriram Sethuraman
Jochen Kruecker
Ameet Kumar Jain
Original Assignee
Koninklijke Philips N.V.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by Koninklijke Philips N.V. filed Critical Koninklijke Philips N.V.
Publication of WO2014207622A1 publication Critical patent/WO2014207622A1/fr

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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
    • A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
    • A61N5/1027—Interstitial radiation therapy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0833—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures
    • A61B8/0841—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures for locating instruments
    • 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
    • A61N5/1007—Arrangements or means for the introduction of sources into the body
    • 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
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3925—Markers, e.g. radio-opaque or breast lesions markers ultrasonic
    • A61B2090/3929—Active markers
    • 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
    • A61N2005/1058—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using ultrasound imaging

Definitions

  • This disclosure relates to medical instruments and more particularly to tracking of medical instruments for brachytherapy using acoustic technology.
  • brachytherapy wherein radioactive "seeds" are distributed in a prostate gland to kill the tissue, is employed for treatment of early-stage, localized prostate cancer.
  • brachytherapy outcomes are generally good in terms of curing the cancer, there is room for improvement.
  • the procedure is associated with a high rate of side effects which have a significant impact on quality of life, such as impotence (10-30%) and difficulty with urination (30-60%).
  • the current clinical workflow for low-dose-rate (LDR) prostate brachytherapy includes pre-procedural three dimensional (3D) ultrasound of the prostate acquired by collecting several two-dimensional (2D) transverse planes.
  • the prostate and sensitive anatomy (urethra, rectal wall, nerve bundles) are segmented from the 3D ultrasound image, and a plan for spatial deposition of the seeds is computed. The physician then proceeds to seed deposition according to the plan, aided by a dosing template that is co-registered with the ultrasound probe.
  • Intra-procedural 2D biplane ultrasound imaging permits visualization of a brachytherapy needle with respect to the anatomy to make sure that the sensitive anatomy is spared.
  • a computed tomography (CT) scan is performed to check the seed deposition pattern and verify that there are no "cold spots".
  • CT computed tomography
  • EM electromagnetic guidance may be employed to enhance the workflow.
  • a tip of the brachytherapy needle is tracked by EM in 3D to provide guidance for needle deposition and adaptive dose planning.
  • a system for placement and tracking of a treatment element includes a placement device and an ultrasonically marked device configured to mark a position responsive to ultrasonic energy.
  • the ultrasonically marked device is mounted on or integrated into the placement device.
  • An ultrasonic probe is configured to transmit and receive ultrasonic energy.
  • a tracking program is configured to track progress of the placement device using the ultrasonically marked device such that a position of a treatment element placed by the placement device or to be placed by the placement device is determined in three-dimensional space and stored in memory.
  • Another system for placement and tracking of a treatment element includes a placement device including an ultrasonically marked device configured to mark a position responsive to ultrasonic energy.
  • the ultrasonically marked device is mounted on or integrated into the placement device when the placement device is deployed in an organ to be treated.
  • An ultrasonic probe is configured to transmit and receive ultrasonic energy for imaging a volume including the organ.
  • a tracking program is configured to track progress of the placement device using the ultrasonically marked device such that a position of a treatment element placed by the placement device or to be placed by the placement device is determined in three-dimensional space and stored in memory.
  • a planning program is configured to compute an effect of the treatment element at the position and determine whether a dosage amount has been achieved by the at least one treatment element for treatment of the organ.
  • a treatment method includes planning placements of one or more treatment devices using a pre-operative image space; placing one or more treatment devices in a subject organ using tracked placement devices which carry the one or more treatment devices, the tracked placement devices each including an ultrasonically marked device mounted on or integrated in the tracked placement devices; and highlighting the ultrasonically marked devices in an ultrasonic image to accurately determine placement of the tracked placement devices.
  • FIG. 1 is a block/flow diagram showing a system for brachytherapy with an ultrasonic guided delivery device in accordance with one embodiment
  • FIG. 2 is a diagram showing an instrument having an ultrasonically responsive device deployed thereon in accordance with one embodiment
  • FIG. 3 is a diagram showing an instrument having another ultrasonically responsive device deployed thereon in accordance with another embodiment
  • FIG. 4 is a diagram showing an instrument having yet another ultrasonically responsive device deployed thereon in accordance with another embodiment
  • FIG. 5 is a flow diagram showing a high-level method for ultrasonically tracking delivery instruments for performing brachytherapy in accordance with an illustrative embodiment
  • FIG. 6 shows a raw image and an image having a marker showing a placement of a catheter for performing brachytherapy in accordance with an illustrative embodiment
  • FIG. 7 is a flow diagram showing a method for performing brachytherapy using ultrasonically tracked delivery instruments in accordance with another illustrative embodiment.
  • present embodiments improve outcomes in terms of cancer recurrence rates and quality of life (impotence and difficulty of urination are common side effects of brachytherapy that result from irradiating the nerve bundles and urethra). In addition, reduced costs are achieved owing to easier and faster procedures, and repeat procedures to fill in cold spots are avoided.
  • Ultrasound-based technology is employed to provide enhanced effectiveness and more accurate needle tip localization with respect to the surrounding anatomy. Since tracking and imaging are performed with the same ultrasound beams, tracked positions are inherently automatically co-registered with the anatomy as visualized by ultrasound. The tracking accuracy is expected to be ⁇ 1 mm compared to ⁇ 3 - 4 mm in real clinical practice for EM tracking. In addition, enhanced safety is achieved as unequivocal localization of the needle tip is determined on the ultrasound image. Currently, even with EM tracking, the clinician has to rely on B-mode imaging of the needle to verify that it is not interfering with the sensitive anatomy. Standard ultrasound pulse-echo needle imaging is insensitive and artifact-prone, especially for the tip.
  • Ultrasound tracking is performed using the same probe that is employed for intra-procedural prostate imaging. There is no need for an external tracking system (as is the case for EM), simplifying the setup, the workflow, and reducing direct costs.
  • the present invention will be described in terms of medical instruments; however, the teachings of the present invention are much broader and are applicable to any ultrasonic guided or tracked instruments.
  • the present principles are employed in tracking or analyzing complex biological or mechanical systems.
  • the present principles are applicable to internal tracking procedures of biological systems, procedures in all areas of the body such as the lungs, prostate, gastrointestinal tract, excretory organs, blood vessels, etc.
  • the elements depicted in the FIGS may be implemented in various combinations of hardware and software and provide functions which may be combined in a single element or multiple elements.
  • processors can be provided through the use of dedicated hardware as well as hardware capable of executing software in association with appropriate software.
  • the functions can be provided by a single dedicated processor, by a single shared processor, or by a plurality of individual processors, some of which can be shared.
  • explicit use of the term "processor” or “controller” should not be construed to refer exclusively to hardware capable of executing software, and can implicitly include, without limitation, digital signal processor ("DSP”) hardware, read-only memory (“ROM”) for storing software, random access memory
  • DSP digital signal processor
  • ROM read-only memory
  • RAM random access memory
  • non-volatile storage etc.
  • embodiments of the present invention can take the form of a computer program product accessible from a computer-usable or computer-readable storage medium providing program code for use by or in connection with a computer or any instruction execution system.
  • a computer-usable or computer readable storage medium can be any apparatus that may include, store, communicate, propagate, or transport the program for use by or in connection with the instruction execution system, apparatus, or device.
  • the medium can be an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system (or apparatus or device) or a propagation medium.
  • Examples of a computer-readable medium include a semiconductor or solid state memory, magnetic tape, a removable computer diskette, a random access memory (RAM), a read-only memory (ROM), a rigid magnetic disk and an optical disk.
  • Current examples of optical disks include compact disk - read only memory (CD-ROM), compact disk - read/write (CD-R/W), Blu-RayTM and DVD.
  • FIG. 1 a block diagram showing a system 100 for tracking brachytherapy needles (or other devices) with ultrasound is illustratively depicted in accordance with one embodiment.
  • the system 100 may include a workstation or console 102 from which procedures (e.g., low dose radiation (LDR) brachytherapy) are supervised and managed.
  • Workstation 102 preferably includes one or more processors 106 and memory 104 for storing programs and applications. It should be understood that the functions and components of system 100 may be integrated into one or more workstations or systems.
  • Workstation 102 may include one or more displays 108 for viewing ultrasonic images.
  • the display 108 may also permit a user to interact with the workstation 102 and its components and functions. This is further facilitated by a user interface 1 10, which may include a keyboard, mouse, joystick, or any other peripheral or control to permit user interaction with the workstation 102.
  • Memory 104 may store one or more programs or modules configured to determine the placement and/or motion of (e.g., radioactive) sources within one or more delivery devices or instruments 1 16.
  • the devices 1 16 preferably include a needle or catheter, but may include one or more of a guidewire, a probe, an endoscope, an applicator, a robot, an electrode, a filter device, a balloon device, or other component, etc. Needle 1 16 may be placed within a subject 1 12 (e.g., patient) for treatment, such as low dose rate (LDR) brachytherapy.
  • LDR low dose rate
  • the present principles may also apply to other types of treatments and procedures.
  • System 100 improves the accuracy of treatment device placement (e.g., brachytherapy seeds) via intra-operative seed localization using ultrasound, dosimetry, and adaptive planning in a subject 1 12 (e.g., a patient).
  • Real-time localization of radioactive seeds 132 and seed delivery devices 1 16 is performed using an ultrasonic imaging and tracking system 120.
  • the tracking system 120 is preferably used in tandem with adaptive, intra-procedural treatment evaluation and planning.
  • a planning/treatment program or method 1 14 stored in memory 104 automatically adapts treatment planning to take intra-procedural findings into account. Treatment evaluation and planning can be done many times during a procedure, so that treatment evaluation and planning can be kept current with intra-procedural findings of actual seed locations, to take into account any detectable plan variations.
  • Program 1 14 works in conjunction with the processor 106.
  • Processor 106 controls system functions, executes program(s) 114, generates display images on display 108, manages an interface 110 (which may include input and output devices including the display 108), etc.
  • Tracking system 120 works in conjunction with the workstation 102 to track devices/needles 1 16 and seeds 132. Images of the needles 1 16 and seeds 132 may be generated at the same time as and with anatomical imaging. In one embodiment, the tracking system 120 may be part of the workstation 102.
  • Program 1 14 provides an improved workflow by allowing the user to define dosimetry targets, and computing seed locations automatically upon placement using the ultrasonic tracking and imaging system 120 to reduce the amount of user interaction needed.
  • the present embodiments are employed to reduce radiation dose to critical anatomical structures and prevent overdosing. Seed densities may be varied to achieve higher doses in regions with increased suspicion of cancer, instead of, for example, treating an entire prostate gland or other organ 103 in the same way.
  • Using the tracking system 120 with ultrasound enables improved accuracy over other tracking systems, resulting in less dosage and shorter dosing times.
  • the tracking device 120 includes an ultrasound system having an ultrasonic probe 107, e.g., a transrectal probe or endorectal probe, preferably 3D for 3D tracking of one or more needles 1 16, but a 2D or modified 2D probe may be employed with a transformation for 3D tracking.
  • An ultrasound sensor 109 is mounted or integrated in the brachytherapy devices or needles 1 16, preferably at the tip.
  • the sensor 109 may include a deposition of copolymer piezoelectric material on the outside of the needle (1 16) (see FIG. 2) alternatively, a small piece of piezoelectric material can be embedded in a needle stylet or integrated into the needle wall (see FIG. 3).
  • the sensor 109 is preferably a US receiver.
  • the senor 109 may include a transducer that generates ultrasound or a transponder that receives and reemits ultrasound.
  • the device or needle includes an ultrasonically opaque or reflective material and relies on the ultrasonic energy from the probe 107.
  • the ultrasonic probe 107 may be mounted on a probe holder 127 and may include a probe stepper 128 for moving the probe 107.
  • the delivery device 1 16 e.g., needle
  • the delivery device 1 16 is equipped with an ultrasound sensor 109 that is passive (i.e., just receives ultrasound coming from the transrectal imaging 2D or 3D probe 107). Analysis of these signals permits computation of the 3D position of the sensor 109 aboard the delivery device 1 16 in a coordinate system of the US image generated by the transrectal probe 107.
  • Program 1 14 may work in conjunction with a tracking algorithm 1 15 that permits continual highlighting of the needle tip on the intra-procedural ultrasound image.
  • the program 114 and algorithm 115 may be combined in a single module or program.
  • the tracking algorithm 1 15 interprets ultrasonic energy received from the sensors 109. This information can be interpreted directly by the signal processing and beamforming capabilities of the tracking system 120 and/or the tracking algorithm 1 15 and therefore can be rendered in the US image.
  • Program 1 14 records spatial positions of the deposited seeds 132 with respect to the anatomy (e.g., prostate as derived from pre-operative or intra-operative ultrasound).
  • Program 1 14 further includes an adaptive planning algorithm 1 17 that updates the prescribed seed deposition pattern based on the recorded positions of the deposited seeds.
  • the ultrasound probe stepper 128 may be employed to automatically advance/retract the probe 107.
  • a template grid 1 1 1 may be employed to assist in determining positions and marking instrument process.
  • Template grid 1 11 may be a physical grid or a virtual grid generated using the workstation 102. Any and all of ultrasound probe 107, the probe holder 127 (to secure the probe), stepper 128 and template grid 1 1 1 may be spatially tracked with US, EM or other localization system. This can provide a point(s) of reference which enables a determination of where the needles 1 16 and hence the seeds 132 are being placed within the body of a subject 1 12. Needles 1 16 or other seed delivery devices such as a Mick applicator are employed for delivering radioactive seeds 132.
  • the seeds 132 may be loose or stranded.
  • the program 1 14 permits the determination of where seeds 132 have been placed using the US sensors 109 on the needles 1 16 to determine the position and trajectory of the needles 1 16 to determine where the seeds 132 are deployed.
  • the adaptive planning method 1 17 employs the localization of seeds to update the plan for the remaining seeds to be placed. Recorded seed locations 148 are stored and are employed to compute the dosage fields around each seed 132 and determine a net effect of all seeds that have been implanted.
  • program support and applications may be provided where a physician can place a virtual seed 146 in the planning stage at any location to see its effect on the dosage field. The placement of virtual seeds may be employed as a planning tool to plan seed placement.
  • the seeds 132 may be accurately planted using the tracking system 120 and needles 1 16 (or other devices).
  • the program 1 14 can recompute metrics to determine if the desired result has been achieved and if not corrections may be made in real-time.
  • Dose determination for the program 1 14 may preferably determine 3D dose plans using methods based on, e.g., the American Association of Physicists in Medicine (AAPM). Other methods of determining a 3D dose plan are also contemplated.
  • the 3D dose distribution resulting from each source may be additively superimposed in the 3D dose plan to generate a cumulative 3D dose distribution.
  • device 116 includes copolymer piezoelectric rings 202 deposited near the tip of a brachytherapy seed deposition needle 205 to form the piezoelectric sensors 109.
  • a microcoaxial wire, thin-gage wire, printed trace or any other form of a thin electrical conductor 204 may be employed to carry electric signals.
  • US signals from the probe 107 (FIG. 1) reach the needle tip.
  • the piezoelectric rings 202 act as a receiver to passively collect ultrasound information and generate electrical signals, which are transferred over the conductor 204.
  • the US imaging probe 107 (FIG. 1) emits ultrasound beams that regularly sample the field of view (FOV) in an array of beams in azimuth and elevation directions.
  • FOV field of view
  • Temporal signals sensed by the receiver (rings 202) during the acquisition of one image are formatted in a 3D data matrix.
  • a maximum intensity projection (MIP) of the "data matrix" over the time dimension is performed to yield a 2D MIP matrix on which a 2D Gaussian fit can be applied.
  • the Gaussian center is used to estimate the angular coordinates of the receiver in the US coordinate system.
  • Depth information is obtained by finding the time at which the maximum signal arrives at that angle and multiplying by the speed of sound.
  • the sensor (rings 202) location is computed. It should be noted that other methods may be employed to analyze the signals from the rings 202 to determine the positions of the rings 202 and therefore the needle 205.
  • the US signals reflected off of the piezoelectric material may be measured in the US image.
  • the US signal is received and the rings 202 form a transducer controlled by electric signals from the workstation 102 where the signals are employed to generate ultrasound to determine the position of the device 1 16.
  • the sensor 109 generates its own US signal which can be viewed in the US image.
  • the rings 202 may include an ultrasonically opaque or reflective material and based upon the geometry of the rings 202, a signature is created that is visible in ultrasound images. Other device (e.g., needle, catheter, etc.) configurations are also contemplated.
  • device 116 includes a piezoelectric device 206 (e.g., Lead (Pb) Zirconium (Zr) Titanate (Ti) (PZT)) as a sensor 109, which is inserted in or mounted on a wall of a needle.
  • a piezoelectric device 206 e.g., Lead (Pb) Zirconium (Zr) Titanate (Ti) (PZT)
  • PZT Zirconium Titanate
  • a microcoaxial cable or other embodiment of a thin electrical conductor 208 is mounted in the lumen of the needle or in a groove in the wall of the needle to carry an electrical signal.
  • the cable 208 may be replaced by a low-profile printed conductor (including one or more dielectric films for isolation).
  • device 116 includes a piezoelectric shape 210 (e.g., PZT) as a sensor 109, which is embedded in a wall of a needle in accordance with another embodiments.
  • a low-profile printed conductor 213 including one or more dielectric films for isolation
  • circuitry 211 may be employed to connect the shape 210 to a cable 208.
  • a high level US-based tracking procedure 300 for brachytherapy of the prostate is shown in accordance with one illustrative embodiment.
  • Ultrasound-specific tracking enables better procedure guidance and adaptive dose re-calculation.
  • US tracking in accordance with the present embodiments is simpler and more accurate than EM tracking and other conventional procedures.
  • pre-procedural 3D ultrasound is acquired of the prostate or other organ and surrounding anatomy. This includes employing 3D imaging, e.g., US imaging and may involve the use of the US probe and a probe stepper.
  • initial planning is performed. The prostate and other organs are manually or automatically segmented from the pre-procedural image as part of initial planning.
  • the initial planning also includes a physician defining target dosimetry, for example, desired dose levels for the prostate and surrounding organs at risk. This may include an inverse dose computation using virtual seeds and computer software. A planning algorithm can automatically compute virtual seed locations needed to best reach the physician's dose targets.
  • intraoperative seed placement is carried out.
  • the dosimetrist arranges the seeds and spacers according to the plan.
  • a first seed delivery needle is inserted into the prostate (or other organ).
  • its location is identified on intraprocedural ultrasound images with US-sensor-based highlighting of the needle tip.
  • the seed locations, along with a target location aid the physician to best reach that target while avoiding sensitive anatomy.
  • a needle template may be employed as a guide and imaging overlays may be employed based on the segmented US image. The overlays are generated to provide the target location in accordance with the plan.
  • the US-based localization system records the actual seed locations in a coordinate system of the ultrasound imaging.
  • the target location can be highlighted in the US images by employing the US sensors/devices on the needle itself.
  • replanning may be performed based upon seed placement.
  • the actual seed locations are fed back into the planning algorithm so that it can adapt the remaining virtual seed locations to best match reach the physician's dose targets.
  • An inverse dose computation is performed to reevaluate the placement of future seeds in the segmented image (pre-op and/or intra-op images) of the organ being treated.
  • the locations that are fed back are preferably based upon the US located/tracked tips of the needles. Seed deposition steps are repeated until all seeds have been placed and the desired dose targets have been achieved.
  • a post-operative evaluation may be performed using a different imaging modality, such as a CT scan or the like.
  • a catheter (device 116) is inserted and imaged with an ultrasound probe through 12 cm of muscle tissue (in vivo calf).
  • the device 116 is not visible.
  • an image 404 the same muscle tissue is depicted, with ultrasound-based tracking and marking of the catheter tip with a marker 406 inserted into the image 404.
  • the catheter body and tip are almost invisible on the raw image 402 but can be marked confidently with ultrasound-based tracking as depicted in image 404.
  • a treatment method is illustratively shown, which employs ultrasonic tracking of placement devices for treating an organ.
  • placements of one or more treatment devices are planned using a pre-operative image space.
  • a template grid may be provided for assisting in guiding the one or more tracked placement devices.
  • preoperative images are collected, and an organ to be treated is segmented in the images.
  • one or more treatment devices are placed in the subject organ to be treated using ultrasonically tracked placement devices which carry the one or more treatment devices.
  • One or more treatment devices are deposited at or close to a planned target position.
  • the tracked placement devices each include an ultrasonically responsive device (US marked device) mounted on or integrated in the tracked placement devices.
  • the ultrasonically marked devices may include one or more of: an ultrasonic sensor, an ultrasonic receiver, an ultrasonic transducer, an ultrasonic transponder (a combination of a sensor and an emitter, either through a transmit/receive (T/R) switch or two physically separated ultrasonic transducers) and an ultrasonically reflective or opaque material.
  • the ultrasonically marked devices are highlighted in an ultrasonic image to accurately determine placement of the tracked placement devices.
  • positions of the one or more treatment devices are recorded using US tracking.
  • future placements are replanned based upon the recorded positions. Iterations are performed until the plan is executed.
  • the present embodiments are directed to prostate brachytherapy with low dose seeds, the low dose rate prostate brachytherapy is illustrative.
  • the present principles are applicable to other procedures, e.g., high-dose-rate prostate brachytherapy, brachytherapy of other organs, etc.

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  • Biomedical Technology (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
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Abstract

La présente invention concerne un système de positionnement et de suivi d'un élément de traitement qui comprend un dispositif de positionnement (116) et un dispositif repérable par ultrasons (109) configuré pour repérer une position répondant à une énergie ultrasonore. Le dispositif repérable par ultrasons est monté sur ou intégré dans le dispositif de positionnement. Une sonde ultrasonore (107) est configurée pour transmettre et recevoir l'énergie ultrasonore Un programme (115) est configuré pour suivre la progression du dispositif de positionnement en utilisant le dispositif repérable par ultrasons de telle sorte qu'une position d'un élément de traitement positionné par le dispositif de positionnement ou à positionner par le dispositif de positionnement est déterminée dans l'espace en trois dimensions et stockée en mémoire.
PCT/IB2014/062403 2013-06-28 2014-06-19 Curiethérapie adaptative guidée par ultrasons WO2014207622A1 (fr)

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WO2016196973A1 (fr) * 2015-06-03 2016-12-08 Memorial Sloan-Kettering Cancer Center Système, procédé, support accessible par ordinateur, et appareil permettant la localisation de grain radioactif rapide dans un faisceau conique préopératoire ct pour curiethérapie de la prostate à faible débit de dose
WO2020249703A1 (fr) * 2019-06-13 2020-12-17 Koninklijke Philips N.V. Différenciation de capteurs ultrasonores passifs pour des interventions médicales
EP3771433A1 (fr) * 2019-07-30 2021-02-03 Koninklijke Philips N.V. Différentiation de capteurs à ultrasons passifs pour des procédures médicales interventionnelles

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WO2020249703A1 (fr) * 2019-06-13 2020-12-17 Koninklijke Philips N.V. Différenciation de capteurs ultrasonores passifs pour des interventions médicales
EP3771433A1 (fr) * 2019-07-30 2021-02-03 Koninklijke Philips N.V. Différentiation de capteurs à ultrasons passifs pour des procédures médicales interventionnelles

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