WO2022219093A1 - Attelle dentaire pour radiothérapie et radiochirurgie stéréotaxiques, système médical pour localiser une région cible dans la zone de tête d'une personne, et procédé pour localiser une région cible dans la zone de tête d'une personne - Google Patents

Attelle dentaire pour radiothérapie et radiochirurgie stéréotaxiques, système médical pour localiser une région cible dans la zone de tête d'une personne, et procédé pour localiser une région cible dans la zone de tête d'une personne Download PDF

Info

Publication number
WO2022219093A1
WO2022219093A1 PCT/EP2022/059964 EP2022059964W WO2022219093A1 WO 2022219093 A1 WO2022219093 A1 WO 2022219093A1 EP 2022059964 W EP2022059964 W EP 2022059964W WO 2022219093 A1 WO2022219093 A1 WO 2022219093A1
Authority
WO
WIPO (PCT)
Prior art keywords
target region
head
image data
person
dental splint
Prior art date
Application number
PCT/EP2022/059964
Other languages
German (de)
English (en)
Inventor
Bodo Lippitz
Original Assignee
Bodo Lippitz
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.)
Filing date
Publication date
Application filed by Bodo Lippitz filed Critical Bodo Lippitz
Publication of WO2022219093A1 publication Critical patent/WO2022219093A1/fr

Links

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
    • 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
    • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
    • 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
    • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
    • A61B90/16—Bite blocks
    • 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
    • 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
    • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B2090/101—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 for stereotaxic surgery, e.g. frame-based stereotaxis for stereotaxic radiosurgery
    • 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
    • A61N2005/1059—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using cameras imaging the patient
    • 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
    • A61N2005/1092—Details
    • A61N2005/1097—Means for immobilizing the patient

Definitions

  • the invention relates to a dental splint for stereotactic radiotherapy and radiosurgery.
  • the invention relates to a medical system for localizing a target region in the head area of a person and a method for localizing a target region in the head area of a person.
  • Targeted precision treatments are playing an increasingly important role in medicine, since more targeted treatments can achieve greater effectiveness with fewer side effects.
  • Stereotaxy is the term used to describe treatment methods in which precise localization control is carried out using image-guided X-ray systems, computer tomography (CT), magnetic resonance imaging (MRT) and computer-assisted target guidance systems.
  • CT computer tomography
  • MRT magnetic resonance imaging
  • computer-assisted target guidance systems with the help of this localization control, very precise radiation can be carried out in stereotactic radiotherapy or stereotactic radiosurgery.
  • Localization control is often carried out by fixing the patient using an individually adapted head mask or by fixing the patient in a so-called stereotactic frame screwed directly to the head.
  • the head is fixed in a semi-stable manner using a head shell or head mask.
  • a localization check is carried out using a surface scanner or by means of a localization check using frequent X-ray checks.
  • a representation of a target region in a person's head is first acquired, for example by MRI, CT or angiography.
  • the head is mechanically fixed in a frame system. This takes place directly on the cranial bone after penetrating the skin, which means that the fixation is very precise and a change in the person's position is not possible.
  • a reference system is attached to the frame system, by means of which the coordinates of the target region can be determined. Due to the mechanical fixation of the person, the coordinates can be transferred directly to an irradiation device.
  • frame fixation is painful and results in small wounds at the penetration site, preventing daily repetition.
  • image data of the target region are acquired using MRI and transferred to an image acquired using CT by image fusion.
  • the patient is held in place in an individually adapted face mask by means of a head shell.
  • the position of the head is checked before the radiation treatment by means of a CT examination on the radiation device, so that any deviations in the position can be corrected individually.
  • the position of the head in the face mask is imprecise, which often has to be compensated for by increasing the radiation volume.
  • the face mask is uncomfortable for the person.
  • the object of the invention is therefore to achieve a localization of a target region in the head area of a person that is precise and at the same time largely painless for the person.
  • a dental splint for stereotactic radiotherapy and radiosurgery with at least one position marking, the at least one position marking being designed as an infrared reflector, so that a position of the position marking can be detected using an infrared imaging method.
  • the at least one position marking is therefore part of a dental splint that is used on a person and fixed in particular by means of an adhesive compound.
  • the insertion of the dental splint is painless for the person and not as uncomfortable as wearing a face mask.
  • Another advantage is the continuous localization control of the patient, which immediately detects a change in the patient's position during the irradiation process and thus ensures the precision of the irradiation.
  • the dental splint thus enables non-invasive control of the position of target coordinates to be irradiated during stereotactic irradiation.
  • a change in position of the position marking and thus of the person can be detected continuously and very precisely by means of the infrared imaging method, for example by using an infrared camera and an infrared source.
  • This change in position can be transferred directly to the coordinates of the target region, so that the current position of the target region is precisely determined at all times.
  • the device for stereotactic precision irradiation of the head can be precisely controlled and any changes in the patient's position can be corrected immediately.
  • a correction of the person's position during a treatment can be automated and a complete fixation of the person's head is no longer necessary.
  • the toothed splint has at least three, in particular at least four, position markings. This allows an extremely precise three-dimensional determination of the position changes of the person.
  • the dental splint is made in particular from a hard plastic.
  • the dental splint can be used for several patients or is manufactured individually for each patient.
  • the at least one position marker is arranged on a labially protruding holder of the dental splint, with the holder in particular protruding from the person's mouth when the dental splint is in place.
  • the position of the at least one position marking can advantageously be determined even when the person's mouth is closed.
  • the at least one position marking is arranged at a point on the holder which projects out of the person's mouth when the dental splint is in place.
  • the holder is fixed to the dental splint with a detachable adapter. In this way, the holder with the position markings can be reused, even if the dental splint is changed for each patient.
  • the at least one position marking is arranged on an occlusal surface of the dental splint.
  • the dental splint is formed as an upper jaw splint.
  • the dental splint preferably comprises an adhesive compound which is designed to fix the dental splint in the oral cavity of the person without play.
  • the adhesive mass is advantageously achieved that the dental splint and so that the at least one position marking can be fixed in the oral cavity without play. This prevents the change in position of the at least one position marker from deviating from a change in position of the target region due to the dental splint slipping.
  • the adhesive mass is particularly silicone-based.
  • a medical system for localizing a target region in the head area of a person, in particular for stereotactic radiation comprising a primary image acquisition device, an infrared camera and a dental splint, in particular according to one of the aforementioned embodiments, the system is set up to: capture image data of the target region by means of the primary image capturing device,
  • the medical system embodies the same advantages, features and properties as the dental splint previously described.
  • the medical system changes in the person's position during a treatment can be recorded extremely precisely and without pain for the person.
  • the position marking does not necessarily have to be arranged in the oral cavity as well.
  • the position marker is arranged on a holder of the dental splint, which protrudes from the oral cavity or the mouth.
  • the head area is an area which, in addition to the person's head, can also include surrounding areas, for example a fixation device attached to the head.
  • the system comprises a control device, for example a computer.
  • the control device is set up to determine the starting position of the position marking, to determine the spatial arrangement of the position marking in relation to the target region and/or to determine the current position of the target region.
  • the system includes in particular an infrared source by means of which the The head area, in particular the infrared reflector fixed to the dental splint, can be illuminated with light in the infrared wavelength range.
  • the infrared source is integrated into the infrared camera. The infrared source ensures that the infrared camera can clearly detect the position of the position markings designed as infrared reflectors.
  • the system includes a bed that is designed to record the person while the image data of the head area and/or the target region are being captured, with the bed being movable horizontally and/or vertically and/or pivoting.
  • the system preferably comprises a head fixation device which is designed to limit the freedom of movement of a person's head, the head fixation device comprising in particular a occipital shell and a front fixation device.
  • the head fixation device prevents major movements of the head. However, a complete fixation of the head, which prevents any movement, is not necessary.
  • the design of the head fixation device with a occipital shell and a frontal fixation device restricts the person only to a small extent and is painless.
  • a mobility of the head in the millimeter range is compensated for by the detection of the change in position of the target region by the system.
  • the head fixation device is semi-stable.
  • the back of the head shell is molded or can be molded onto the back of the head.
  • the end-side fixing device includes, in particular, a grid network that is designed to Being placed and/or pulled over the head.
  • the forehead fixation device comprises a fixed loop that is pulled over the forehead and allows a semi-rigid fixation of the head.
  • the loop is attached in particular by means of a Velcro fastener.
  • the head-fixing device does not include any flattening-piercing flaps that lie directly against the cranial bone.
  • the system is preferably set up to determine the starting position of the at least one position marking and the current position of the target region relative to at least one fixed point, in particular where the at least one fixed point is on the head fixing device or on a play-free connection with the head fixing device ver connected device is arranged.
  • the fixed point spans stereotactic coordinates.
  • the fixed point is stationary in relation to at least one component of the medical system and/or stationary in relation to a treatment device.
  • a stationary reference system is provided by the arrangement of the fixed point on the head-fixing device or the device connected to the head-fixing device without play.
  • the position and orientation of a medical treatment device for example an irradiation device, can be precisely determined in relation to the target region.
  • the toothed splint which is fixed with a stable flat mass without play and has at least one integrated infrared reflector, replaces in particular an otherwise conventional stereotactic frame.
  • the head-fixing device forms a reference system for the medical system, which can be used to determine the position and alignment of other devices in the system.
  • Stereotactic markings are preferably attached to the head fixation device without play, with the stereotactic markings in particular comprising the at least one fixed point or being designed as the at least one fixed point. In this case, whoever uses the device-specific commercially available stereotactic markings, which are adapted to the imaging.
  • the stereotactic markers are imaged simultaneously with the target region and infrared reflectors using MRI, CT, or angiography.
  • the stereotactic markings span the stereotactic coordinates and allow a precise three-dimensional calculation of the position of the target region in the head.
  • the stereotactic coordinates of the target region obtained through this imaging using the primary imaging device are related to the stereotactic coordinates of the infrared reflectors of the dental splint, so that later the coordinates of the target region can be determined simply by calculating the position of the infrared reflectors of the dental splint is possible.
  • the stereotactic markings are attached to the occiput.
  • the system is set up to determine the stereotactic coordinates by imaging using a secondary image capturing device, with the image data of the target region first being captured using the primary image capturing device, and then the image data of the head area are captured by the secondary image capturing device and finally the image data of the target region are electronically fused with the image data of the head area.
  • the secondary image capturing device or a point arranged stationary relative to the secondary image capturing device in particular spans the stereotactic coordinate system. In this way, all image data captured with the secondary image capturing device automatically includes a stereotactic coordinate system, so that stereotactic coordinates are assigned to the image data of the head area, including the position marking.
  • the image fusion also assigns stereotactic coordinates to the image data of the target region, as a result of which the position of the target region relative to the position marker is present in stereotactic coordinates.
  • the secondary image acquisition device is integrated into a treatment device.
  • the secondary imaging device is a volumetric tomography (cone beam CT) device.
  • the system is preferably set up to continuously detect the change in position of the at least one position marking and to continuously determine the current position of the target region.
  • the current position of the target region is not only determined once, but also time-dependent changes in position are recorded and new current positions of the target region are determined therefrom.
  • the current position of the target region is transmitted, for example, to an automated irradiation device that irradiates the target region in a targeted manner.
  • the continuous determination of the current position of the target region ensures that even if the head changes position, only the target region is actually irradiated.
  • the current position is determined at definable time intervals.
  • the continuous detection of the position of the position marking by the infrared camera enables the patient's position to be continuously monitored and thus the position of the target area in relation to the radiation device to be continuously monitored.
  • the system preferably includes an adhesive mass, by means of which the dental splint can be fixed without play in the oral cavity, in particular on the upper jaw of the person.
  • the adhesive mass ensures that the splint and thus the position marking remain in a constant spatial arrangement in relation to the target region.
  • the primary image acquisition device is preferably a magnetic resonance tomograph and/or a computer tomograph and/or an angiography device.
  • both the image data of the head area and the image data of the target region are captured by means of the primary image capturing device.
  • image data is captured by MRT, CT or angiography examinations using the primary image capturing device, on which the head area of the person and the position marking designed as an infrared reflector and in particular the stereotactic markings can be clearly seen. In this way, the initial position of the target area to be irradiated can be directly determined without any problems.
  • the image data of the primary imaging device allow a direct calculation of the position of the target area to be irradiated in relation to the infrared reflectors of the dental splint and in particular also in relation to the stereotactic markings, whereby the current position of the target area to be irradiated can be calculated three-dimensionally by the position of the infrared reflectors.
  • the image data of the head area are captured by means of a secondary image capturing device, with the secondary image capturing device capturing the image data in particular by means of computed tomography.
  • an image acquisition is carried out with the primary image acquisition device, for example an MRT examination, and then an image acquisition with the secondary image acquisition device, for example a CT examination.
  • the toothed rail with the infrared reflectors is not used during image acquisition with the primary image acquisition device.
  • the secondary image capturing device can be used to capture image data on which the person's head area including the position marking, and in particular the stereotactic markings, can be clearly seen, so that the starting position of the target region to be irradiated can be determined without any problems.
  • the image data of the secondary image capturing device are then electronically fused with the image data of the primary image capturing device, whereby the current position of the position marking, which represents a reference system, can be calculated three-dimensionally with precise location in relation to the target region in the head through the image fusion.
  • the position of the target region can be determined by detecting the infrared reflectors alone.
  • the image data of the target region are recorded in particular before the stereotactic radiation and have a high level of anatomical detail. The high level of anatomical detail ensures that the position, shape and dimensions of the target region are precisely determined.
  • this high level of detail is integrated into the image data of the head region where the position of the position marker is visible.
  • the spatial arrangement of the position marker relative to the target region can therefore be determined with high precision in the resulting combined image data.
  • the system preferably comprises a bed, the system being set up to transmit position data comprising the current position of the target region to the bed, the bed being set up to use the position data to match the position of the target region with a desired position of the target region to bring by moving a position of a head of the person by means of the couch.
  • the couch is intended and arranged to serve as a support for the person.
  • the person lies in particular on the bed while the change in position is recorded by means of the infrared camera.
  • the desired position is an original position of the target region before the head moves. In this way, a movement of the head of the person and thus of the target region is advantageously corrected in a simple manner.
  • the couch in particular a headrest of the couch, is moved so that the radiation from a treatment device is again directed exactly to the location of the target region.
  • the couch or the headrest is moved in particular by known methods, for example by motor.
  • the transmission of the position data comprising the current position of the target region to the bed is understood in particular that the position data to a device for Motion control of the couch are transmitted.
  • the device for controlling the movement of the couch comprises in particular a control system and means for moving the person placed on the couch.
  • the device for controlling the movement of the lounger is set up in particular to move and/or tilt the person's head in any spatial direction.
  • the bed includes the device for controlling the movement of the bed.
  • the position data including the current position of the target region, is transmitted to a treatment device, with the treatment device being set up to align radiation emitted by the treatment device with the current position of the target device.
  • the radiation emitted by the treatment device follows a movement of the person's head and thus of the target region. This is advantageous, for example, when the couch does not have means for changing the position of the head.
  • the object is achieved by a method for localizing a target region in a head area of a person, in particular for stereotactic radiotherapy or stereotactic radiosurgery, comprising the following method steps:
  • the method for locating a target region embodies the same advantages, features and properties as the dental splint and medical system described above.
  • the image data of the head area and the image data of the target region are acquired either simultaneously or in two steps with subsequent electronic image fusion.
  • the image data of the header area are captured in particular by means of a secondary image capturing device.
  • the image data of the target region are preferably captured before freedom of movement of the head is restricted by means of a head-fixing device.
  • Position data comprising the current position of the target region are preferably transmitted to a couch, the position data being used to match the position of the target region with a desired position of the target region by moving a position of a person's head using the couch.
  • Embodiments according to the invention can fulfill individual features or a combination of several features.
  • FIG. 1 shows a schematic representation of a medical system for localizing a target region in the head area one person
  • Fig. 2 shows a schematic cross-sectional representation of a head area of a person in whose upper jaw a dental splint for stereotaxy is fixed
  • FIG. 3 shows a flow chart of a method for locating a target region in a head area of a person
  • FIG. 4 shows a schematically simplified representation of a dental splint with infrared reflectors
  • FIG. 5 shows a schematically simplified representation of a head fixing device with a flint head shell and a front fixing device
  • Fig. 6 is a schematically simplified representation of a stereoscopic marking
  • FIG. 7 shows a schematically simplified representation of a treatment device and a patient bed
  • Fig. 8 is a schematically simplified representation of a wide ren embodiment of a dental splint with infrared reflectors.
  • Fig. 1 is a simplified schematic medical system 2 for Localization of a target region in the head area 12 of a person 10 shows ge.
  • the target region is, for example, an irradiation target for stereotactic radiotherapy or stereotactic radiosurgery, which is to be carried out using a treatment device 90, for example a precision irradiation device.
  • the medical system carries out a localization check to ensure that the treatment is carried out exactly in the target region.
  • the system 2 comprises a primary image capturing device 30, an infrared camera 40, a secondary image capturing device 50 and a dental splint 60 which has at least one position marking 62.
  • FIG. 1 is a simplified schematic medical system 2 for Localization of a target region in the head area 12 of a person 10 shows ge.
  • the target region is, for example, an irradiation target for stereotactic radiotherapy or stereotactic radiosurgery, which is to be carried out using a treatment device 90, for example a precision
  • the secondary image acquisition device 50 is combined with the treatment device 90 and the infrared camera 40 in one structural unit. According to other embodiments, it is provided that the secondary image capturing device 50, the treatment device 90 and/or the infrared camera 40 form separate units. It can also be provided that no secondary image capturing device 50 is included and/or the primary image capturing device 30 is combined in a structural unit with other components.
  • the dental splint 60 is fixed in an upper jaw of the person 10 without play. The dental splint is designed in such a way that the position marking 62 is clearly visible to the infrared camera 40 during the treatment.
  • the position marker is an infrared reflector whose position can be precisely determined by the infrared camera 40 .
  • the secondary image acquisition device 50 is, for example, a computer tomograph, eg a cone beam CT.
  • the secondary image capture device 50 is configured to capture image data of the head portion 12 along with the dental splint 60 and the position marker 62 .
  • the position of the position marker 62 is determined in the image data of the head region 14 .
  • the image data of the head region 14 are combined with image data of the target region by means of image fusion.
  • the image data of the target region were previously captured, for example, using the primary image capturing device 30, which is, for example, a magnetic resonance tomograph, a computer tomograph or a device for performing an angiography, and has a high level of anatomical detail in the area of the target region .
  • a spatial arrangement between the position marking 62 and the target region is determined in the image data. This spatial arrangement in relation to the target region remains constant throughout the treatment, since the dental splint 60 and the position marking 62 are fixed without play on the upper jaw and thus on the skull.
  • both the image data of the target region and the image data of the head region 14 are captured by the primary image capturing device 30 .
  • the infrared camera 40 includes, for example, an infrared source whose infrared radiation is reflected at the position marking, so that the camera can capture the reflected infrared radiation.
  • the knowledge of the change in position is used to determine the current position of the target region in a stereotactic coordinate system using the known spatial arrangement between the position marker 62 and the target region.
  • the current position of the target region in the stereotakti's coordinate system can then, for example, to the Treatment device 90 are transmitted, so that it adapts the treatment according to the change in position.
  • To control the image capturing device 30 and the infrared camera 40, to determine the starting position of the position marker 62 in the image data of the head area, to merge the image data, to determine the spatial arrangement of the position marker 62 to the target region and to determine the current position of the target region includes System 2 a control device 95, example, a computer.
  • Fig. 2 shows a schematically simplified cross section through the head area 12 of the person 10 with the target region 20 and the dental splint 60 used is held, which restricts the mobility of the head 14 a.
  • the head restraint 80 includes an occipital cup 82 and a frontal restraint 84 that hold the head 14 semi-rigidly.
  • semi-stable means that although the mobility of the head 14 is restricted, changes in the position of the head 14 of the order of a few millimeters can still occur.
  • the end-side fixing device 84 is a fixed loop that is fixed in the head 14 by means of a Velcro fastener.
  • Such a head fixation device 80 is significantly more comfortable for the person 10 than a frame fixation directly on the cranial bone of the person 10 or a tight-fitting face mask.
  • the head fixing device 80 is connected to one or more stereotactic markings 70 without play, for example during the acquisition of the image data by means of MRI, CT or angiography. which act as fixed points 72, are imaged simultaneously with the target area and allow precise three-dimensional calculation of the location of the target area in the head (see Figure 6).
  • device-specific commercially available stereotactic markings 70 are used, which are adapted to the imaging.
  • the coordinates obtained by this detection in the imaging are related to the coordinates of the toothed splint 60 so that later it is possible to determine the target coordinates simply by calculating the position of the position markings 62 of the toothed splint 60 .
  • stereotactic markings 70 can be dispensed with.
  • the image data of the head area 12 are automatically recorded in a stereotactic coordinate system.
  • the image fusion also transfers the target region 20 into this stereotactic coordinate system.
  • the dental splint 60 is fixed without play in an oral cavity 16 on an upper jaw 18 of the person 10 by means of an adhesive compound 66 .
  • the position marking 62 is attached to a holder 64 of the dental splint 60 that protrudes labially from the mouth 17, so that the position marking 62 remains visible even when the mouth 17 is closed.
  • method step 100 the image data of the target region 20 are captured by means of the primary image capturing device 30. Then the person 10 is used in method step 110, the dental splint 60 and by means of the adhesive 66 fixed without play. The freedom of movement of the head 14 is restricted at process step 120 by means of the head fixation device 80 .
  • method step 130 the image data of the head area 12 are captured by means of the secondary image capturing device 50 and then in method step 140 the starting position of the position marking 62 in the image data of the head area 12 is determined.
  • method step 150 the image data of the head area 12 are combined with the image data of the target region 20 by means of image fusion, and in method step 160 the spatial arrangement of the position marking 62 in relation to the target region 20 is determined. Subsequently, while the treatment is being carried out, each change in the position of the position marking 62 is continuously recorded by means of the infrared camera 40 in method step 170 and in method step 180 based on the change in position of the position marking 62 and the spatial arrangement between the position marking 62 and the target region 20 a current position of the target region 20 relative to the fixed points 72 is determined.
  • the dental splint 60 is first inserted and fixed, the freedom of movement of the head 14 is restricted by means of the head fixing device 80 and then both the image data of the head area 12 and the image data of the target region 20 are recorded with the primary image acquisition device 30, in particular at the same time. detected.
  • the starting position of the position marking 62 is determined by means of stereotactic markings 70 or other fixed points 72 which are mapped in the image data of the head region 12 .
  • the remaining method steps 160, 170 and 180 correspond to the method presented above.
  • Fig. 4 shows a schematically simplified perspective view of an exemplary embodiment of a toothed splint 60.
  • Fig. 4 shows a schematically simplified perspective view of an exemplary embodiment of a toothed splint 60.
  • the toothed splint 60 has an adhesive compound 64 is introduced, with which the dental splint 60 is fixed without play in the patient's mouth.
  • the holder 64 protrudes in the labial direction, so that the position markings 62, which are formed as infrared reflectors, can also be detected by the infrared camera 40 when the patient's mouth is closed.
  • FIG. 5 shows a schematically simplified exemplary embodiment of a head fixation device 80 with an occipital shell 82 and a front fixation device 84.
  • the front fixation device 84 is designed as a grid mask that is placed or pulled over the patient's face and attached to the occipital shell 82 and/or a patient bed. In this way, the patient's head 14 is kept semi-stable so that the fixation does not require an uncomfortable fixation on the cranial bone.
  • FIG. 6 shows a simplified, schematic representation of a stereotactic marking 70 embodied as a fixed point 72 .
  • the stereotactic marker 70 shown can be fixed to the occiput shell 82 .
  • FIG. 7 shows a schematically simplified example of a treatment device 90 with a control device 95 and a bed 97.
  • the bed 97 can be moved horizontally and/or vertically. This allows the position of the target region (20) to be corrected if it has been determined by means of the infrared measurement that the head (14) and thus the target region (20) has moved.
  • the treatment device 90 irradiates the person from several angles, for example the treatment device 90 rotates the head of the patient lying on the bed 97 during the treatment.
  • Fig. 8 shows schematically simplified an embodiment of a Dental splint 60 with position markings 62 designed as infrared reflectors on a protruding bracket 64.
  • the skull is held on a bed (not shown) by means of a loop 86 which acts as a fixing device 84 on the front side.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • General Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Pathology (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Radiology & Medical Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Neurosurgery (AREA)
  • Apparatus For Radiation Diagnosis (AREA)

Abstract

La présente invention concerne une attelle dentaire (60) pour la radiothérapie et la radiochirurgie stéréotaxiques. L'attelle dentaire (60) comprend au moins un marqueur de position (62). Ledit marqueur de position se présente sous la forme d'un réflecteur infrarouge, de sorte qu'une position du marqueur de position (62) peut être détectée par un procédé d'imagerie infrarouge.
PCT/EP2022/059964 2021-04-15 2022-04-13 Attelle dentaire pour radiothérapie et radiochirurgie stéréotaxiques, système médical pour localiser une région cible dans la zone de tête d'une personne, et procédé pour localiser une région cible dans la zone de tête d'une personne WO2022219093A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102021109530.1A DE102021109530A1 (de) 2021-04-15 2021-04-15 Zahnschiene für Stereotaktische Radiotherapie und Radiochirurgie, Medizinisches System zur Lokalisierung einer Zielregion im Kopfbereich einer Person und Verfahren zum Lokalisieren einer Zielregion im Kopfbereich einer Person
DE102021109530.1 2021-04-15

Publications (1)

Publication Number Publication Date
WO2022219093A1 true WO2022219093A1 (fr) 2022-10-20

Family

ID=81597762

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2022/059964 WO2022219093A1 (fr) 2021-04-15 2022-04-13 Attelle dentaire pour radiothérapie et radiochirurgie stéréotaxiques, système médical pour localiser une région cible dans la zone de tête d'une personne, et procédé pour localiser une région cible dans la zone de tête d'une personne

Country Status (2)

Country Link
DE (1) DE102021109530A1 (fr)
WO (1) WO2022219093A1 (fr)

Citations (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020032453A1 (en) * 1995-01-31 2002-03-14 Cosman Eric R. Repositioner for head, neck, and body
DE69530423T2 (de) * 1995-02-14 2004-02-05 University of Florida Research Foundation, Inc., Gainesville Mehrfach-fixierung bei einem rahmenlosen stereotaxieverfahren
US20050182316A1 (en) * 2002-08-29 2005-08-18 Burdette Everette C. Method and system for localizing a medical tool
DE69833881T2 (de) * 1997-12-01 2006-12-07 Sherwood Services Ag Chirurigisches positioniersystem
US20090129556A1 (en) * 2007-11-19 2009-05-21 Pyronia Medical Technologies, Incorporated Patient positioning system and methods for diagnostic radiology and radiotherapy
US20090209852A1 (en) * 2005-03-02 2009-08-20 Calypso Medical Technologies, Inc. Systems and Methods for Treating a Patient Using Guided Radiation Therapy or Surgery
US20100275926A1 (en) * 2009-04-30 2010-11-04 Elekta Ab (Publ) Fixation device
US20140275698A1 (en) * 2013-03-15 2014-09-18 Elekta Ab (Publ) Intra-fraction motion management system and method
US20150126796A1 (en) * 2012-04-12 2015-05-07 University Of Florida Research Foundation, Inc. Prevention of setup errors in radiotherapy
EP2948056A1 (fr) * 2013-01-24 2015-12-02 Kineticor, Inc. Systèmes, dispositifs et procédés pour suivre et compenser un mouvement du patient pendant un balayage d'imagerie médicale
US20190105514A1 (en) * 2017-10-09 2019-04-11 Varian Medical Systems, Inc. Optical system for radiation treatment
EP3588119A1 (fr) * 2018-06-26 2020-01-01 Medical Intelligence Medizintechnik GmbH Agencement de bobine de tête pour appareil de résonance magnétique présentant une meilleure immobilisation
US20210015581A1 (en) * 2018-01-19 2021-01-21 Jonathan Tyler Calibration Frame for Gamma Knife

Family Cites Families (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
AU2003251545A1 (en) 2002-06-19 2004-01-06 University Of Florida Interactive patient positioning system
FR3063427B1 (fr) 2017-03-03 2022-01-14 Modjaw Dispositif de fixation mandibulaire d'un marqueur de localisation

Patent Citations (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020032453A1 (en) * 1995-01-31 2002-03-14 Cosman Eric R. Repositioner for head, neck, and body
DE69530423T2 (de) * 1995-02-14 2004-02-05 University of Florida Research Foundation, Inc., Gainesville Mehrfach-fixierung bei einem rahmenlosen stereotaxieverfahren
DE69833881T2 (de) * 1997-12-01 2006-12-07 Sherwood Services Ag Chirurigisches positioniersystem
US20050182316A1 (en) * 2002-08-29 2005-08-18 Burdette Everette C. Method and system for localizing a medical tool
US20090209852A1 (en) * 2005-03-02 2009-08-20 Calypso Medical Technologies, Inc. Systems and Methods for Treating a Patient Using Guided Radiation Therapy or Surgery
US20090129556A1 (en) * 2007-11-19 2009-05-21 Pyronia Medical Technologies, Incorporated Patient positioning system and methods for diagnostic radiology and radiotherapy
US20100275926A1 (en) * 2009-04-30 2010-11-04 Elekta Ab (Publ) Fixation device
US20150126796A1 (en) * 2012-04-12 2015-05-07 University Of Florida Research Foundation, Inc. Prevention of setup errors in radiotherapy
EP2948056A1 (fr) * 2013-01-24 2015-12-02 Kineticor, Inc. Systèmes, dispositifs et procédés pour suivre et compenser un mouvement du patient pendant un balayage d'imagerie médicale
US20140275698A1 (en) * 2013-03-15 2014-09-18 Elekta Ab (Publ) Intra-fraction motion management system and method
US20190105514A1 (en) * 2017-10-09 2019-04-11 Varian Medical Systems, Inc. Optical system for radiation treatment
US20210015581A1 (en) * 2018-01-19 2021-01-21 Jonathan Tyler Calibration Frame for Gamma Knife
EP3588119A1 (fr) * 2018-06-26 2020-01-01 Medical Intelligence Medizintechnik GmbH Agencement de bobine de tête pour appareil de résonance magnétique présentant une meilleure immobilisation

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
THOMAS ROCKWELL MACKIE ET AL: "Image guidance for precise conformal radiotherapy", INTERNATIONAL JOURNAL OF RADIATION ONCOLOGYBIOLOGYPHYSICS, vol. 56, no. 1, 1 May 2003 (2003-05-01), pages 89 - 105, XP055168696, ISSN: 0360-3016, DOI: 10.1016/S0360-3016(03)00090-7 *

Also Published As

Publication number Publication date
DE102021109530A1 (de) 2022-10-20

Similar Documents

Publication Publication Date Title
EP1219260B1 (fr) Procédé et dispositif de traitement dentaire assisté par un système de navigation
DE69922980T2 (de) Verfahren und vorrichtung zur positionierung eines geräts in einem körper
DE10206716B4 (de) Verfahren zur Festlegung eines Zielbereichs einer CT-Röntgenbildaufnahmevorrichtung
DE19809460C1 (de) Medizinisches Zielgerät zur atemadaptierten Punktion
DE69925010T2 (de) System zum positionieren eines patienten
EP1142536B1 (fr) Référencement d'un patient dans un système de navigation médical utilisant des points lumineux projetés
EP1127549B1 (fr) Appareil de radiographie et poste opérateur pour la diagnose et pour interventions chirurgicales sur la tête et sur la mâchoire d'un patient
DE10215808B4 (de) Verfahren zur Registrierung für navigationsgeführte Eingriffe
DE10108547B4 (de) Operationssystem zur Steuerung chirurgischer Instrumente auf Basis von intra-operativen Röngtenbildern
EP1296609B1 (fr) Dispositif medical pour la stereotaxie et le positionnement d'un patient
EP1785093B1 (fr) Dispositif d'imagerie et système de thérapie équipé d'un tel dispositif
DE69530423T2 (de) Mehrfach-fixierung bei einem rahmenlosen stereotaxieverfahren
EP2292300B1 (fr) Dispositif et procédé de représentation d'une figure géométrique sur la surface d'un corps de patient
EP2563224B1 (fr) Système à rayons x et procédé de génération de données d'image 3d
DE102012215922B4 (de) Medizintechnische Anlage und Verfahren zur Erzeugung von Bildern
DE3838011A1 (de) Verfahren und vorrichtung zur erzeugung von bildern der anatomie
EP2098169A2 (fr) Dispositif et procédé de représentation d'un champ sur la surface du corps d'un patient
WO2011144412A1 (fr) Détermination et vérification de la transformation des coordonnées entre un système radiographique et un système de navigation chirurgicale
EP1887960B1 (fr) Système de positionnement d'aiguille
DE102014210458B4 (de) Ermittlung einer Position einer zu bestrahlenden Zielregion eines Patienten in einer Bestrahlungseinrichtung
DE102015222821A1 (de) Verfahren und Vorrichtung zum Betreiben eines dentaldiagnostischen Bilderzeugungssystems
EP1114621B1 (fr) Dispositif pour representer d'images
DE102015201067B4 (de) Bestimmung eines Winkels zwischen zwei Teilen eines Knochens
DE19619761C2 (de) Vorrichtung und Verfahren zur Fixierung des menschlichen Kopfes
DE102007034343A1 (de) Bissgabel

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 22722532

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 22722532

Country of ref document: EP

Kind code of ref document: A1