CN102641561A - 用于提供适形放射治疗同时对软组织进行成像的系统 - Google Patents
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Abstract
一种设备和处理,其用于在强度调制放射治疗(IMRT)期间对患者的解剖学构造进行高时间和空间分辨率MR成像,从而直接测量和控制递送给患者的高适形电离辐射剂量,用于治疗由于增生性组织紊乱导致的疾病。本发明将开放MRI、多叶式准直仪或基于补偿过滤器的IMRT递送、和钴放射疗法等技术组合在单一共配准的且台架式安装的系统内。
Description
本申请是2005年2月17日递交的PCT国际申请PCT/US2005/004953于2006年10月11日进入中国国家阶段的中国专利申请号200580010944.6、发明名称为“用于提供适形放射治疗同时对软组织进行成像的系统”的发明专利申请的分案申请。
相关专利申请参考
本申请要求获得于2004年2月20日提出申请的美国临时专利申请No.60/546,670的优先权。
关于政府资助研究或开发的声明
不适用。
技术领域
本发明涉及放疗系统和方法,更特别地,涉及用于在放射治疗期间向患者递送放射剂量时对患者的解剖学构造进行快速和反复成像的放射治疗系统和方法,从而可以确定在多天或多周内递送给患者的实际电离辐射剂量,并且可以对治疗进行调节,以解决由于器官运动或者患者几何形状改变造成的任何治疗递送误差。本发明采用的磁共振成像方法与现有的x-射线计算断层摄影(CT)成像相比,可改善软组织的对比度,并可以提供额外的代谢和生理信息,以改善靶标描述,并允许监视患者或疾病对治疗的响应。
背景技术
在治疗由于增生组织紊乱导致的疾病时,例如癌症和冠状动脉再狭窄,对患者已知含有或怀疑含有病灶的部分进行放射。出于这个目的,使用放射治疗计划系统首先获取患病部分和周围区域的计划图像。
放射治疗计划系统一般包括CT或磁共振成像(MRI)模拟器。在开始治疗之前的某一天进行CT或MRI放射治疗,以获得多个共配准(coregistered)剖面2-D图像。这些剖面图像用已知的算法加以组合可以产生3-D图像。对这些3-D模拟图像进行显示然后加以分析,以鉴别待处理的可疑患病区的位置,例如射线照相显见的肿瘤或微小疾病扩散的可疑区。这些待处理的区域称作放射治疗靶标。为了努力解决器官运动问题,提出了边际和计划靶标体积(PTV)的概念,试图在大多数照射期间,对很可能含有靶标的体积进行放射。PTV包括几何边际,用于解决患者几何或运动差异。相似地,显示并分析3-D图像以鉴别可能被放射损伤的重要正常解剖结构和组织,例如脊髓和肺,从而评估放射对这些组织功能的潜在冲击。这些需要被隔离或者保护免于过多放射的区域称作危险临界结构或器官,并可以包括一个边际以解决患者几何或运动的差异。然后根据由单系列CT和/或MRI图像得出的放射治疗靶标和临界结构的单静止模型传统地规划放射治疗的递送。因为已知技术不允许同时进行成像和治疗,因此患者和其全部内部器官都需要精确地复位,以便进行精确的剂量递送。然而,在技术上已知,即使对于单次剂量递送而言,精确地将患者复位也是不可能的,这是由于如下的几个因素:不能重现患者姿态,也就是患者躯体的几何形状和对直;患者的生理变化,例如体重降低或者肿瘤生长或萎缩;和患者的器官运动,包括但不仅限于呼吸运动、心脏运动、直肠膨胀、蠕动、膀胱充盈和自主肌肉运动。注意,器官运动可能以很快的时间发生,例如可能在单次剂量递送期间发生(例如,呼吸运动),称作“次内(intra-fraction)”器官运动,或者它们可能以较慢的时间发生,例如在不同剂量递送之间发生改变,称作“次间(inter-graction)”器官运动。对患有颅外癌症的患者进行的大部分治疗处理要求所递送的辐射治疗是分次的,也就是说,剂量分许多次加以递送。典型地,每天递送的剂量为单次1.8-2.2Gy或者双次1.2-1.5Gy,并且在工作日期间递送(周一到周五);分别以2.0或1.8Gy用7-8周递送例如70-72Gy的累积剂量。本发明的目的是克服在放射治疗的多周内由于患者姿态误差、生理变化以及次内和次间器官运动对放射治疗的限制。另一个目的是允许医生通过执行MRI提供代谢和生理信息或估计整个疾病的生长或萎缩,从而周期性监视患者疾病对于治疗的响应。
然后确定放射场形状,使之与显示在计划图像中的患病靶标区或可疑区的图像轮廓一致。从包括患病部分的宽阔区域的剖面图像或者从由3-D模拟图像产生的从一个特定方向观看的透射图像确定放射角。显示从放射角观看到的透射图像。然后操作者根据所显示的图像确定放射场的形状,给放射场设定一个等角点(参考点)。
任选地,患者可以相对于传统的模拟器定位(能够为放射治疗设备产生门静脉图像的垂直电压X-射线成像系统)。设置该模拟器的放射角,使之等于如上确定的放射角,并且通过放射线照相技术在胶片上产生放射图像,用作参考放射图像。利用CT或MRI模拟软件可以产生相似的数字重建放射图像。
然后使患者相对于放射治疗装置定位并加以固定,该放射治疗装置一般包括放射源,典型地有线性加速器。将放射角设定为如上确定的放射角,并从放射治疗装置发射射线进行胶片放射照相。该放射胶片图像与上述用作参考放射图像的胶片图像相关联,从而在进行放射治疗之前,确认患者是否已经根据计划尽可能地定位。通常需要一些复位,以便将患者定位成使参考放射图像中的结构与治疗放射图像中的结构之间的匹配度在0.2-0.5cm的公差之内。在确认获得了可以接受的患者定位之后,开始放射治疗。
患者姿态误差、生理变化和器官运动导致在进行放射治疗处理时治疗波束相对于放射治疗靶标和患者临界结构的失准增加。多年以来,从业者一直要求用放射治疗波束获取患者的硬拷贝胶片,技术上称作“端口胶片(port film)”,试图保证波束位置偏离原始计划不太显著。然而,所获得的端口胶片一般只是在放射治疗处理期间以一些预定的间隔(典型地为1周)获得的单2-D投影图像。端口胶片不能解决器官运动问题。此外,端口胶片不能以显著的对比度成像软组织解剖结构,只能提供关于患者多骨解剖结构的可靠信息。因此,失准信息只能在进行端口成像的即刻提供,并且因为多骨解剖结构与软组织解剖结构的对准不需要相互关联和随时间改变,所以可能会让人误解。通过在端口图像内提供合适的标记,可以确定波束失准,然后修正到有限的程度。
更近些时候,有人公开了电子地获取端口图像,称作电子端口成像。该成像技术采用固态半导体、闪烁器或液体电离室阵列技术利用线性加速器或有关千伏X-射线单元捕获患者的X-射线透射放射图像。与硬拷贝技术相同,失准数据只能在进行端口成像的瞬时提供。电子端口成像的另一个最新进展包括使用灌注组织间隙放射性不透明标记,试图对软组织的位置进行成像。这些过程是侵入性的,并且标记会移动。即使在快速获取许多图像时,也只能发现通过软组织内部的放射性不透明标记识别的离散点的运动,不能解决器官运动的真实复杂性以及由其导致的剂量测定误差。另一个最新进展,从许多2D电子端口图像产生3D体积测定图像集合,是在每天治疗递送之前或之后获得体积测定锥形波束X-射线CT或螺旋断层治疗兆伏级X-射线CT图像集合。尽管这一技术可以解决患者姿态误差问题,也就是患者躯体的几何形状和对准,患者的生理变化,例如体重降低或肿瘤生长和萎缩,以及患者的次间器官运动,例如直肠充盈和排空;但是它不能解决患者的次内器官运动。次内器官运动是非常重要的,包括但不仅限于,呼吸运动、心脏运动、直肠气体膨胀、蠕动、膀胱充盈和自主肌肉运动。
在过去,放射治疗被递送到躯体的较大区域,包括靶标体积。尽管为了解决可能的微小疾病扩散需要一些体积边际,但是大部分的体积边际是为了解决治疗计划和放射递送的不确定性。减小放射组织的总体积是有利的,因为这可以减小放射正常组织的量,因此减少放射治疗对患者的总体毒性。而且,减小总处理量可以扩大对靶标的剂量,因此增加肿瘤控制的可能性。
在20世纪50年代早期,临床钴(Co60放射性同位素源)治疗单元和MV线性加速器(或直线性加速器)被几乎同时引入。最初的两个临床钴治疗单元几乎同时于1951年10月安装在安大略省的萨斯卡通和伦敦。第一个用于临床应用的MV线性加速器是于1952年6月单独安装在英国伦敦的Hammersmith医院。该机器于1953年8月治疗第一个病人。这些设备很快被普遍应用于癌症治疗。深度穿透离子化光子束迅速成为放射治疗的中流砥柱,允许对深位肿瘤进行广泛的非侵入式治疗。X-射线治疗的角色随着这些设备的引入缓慢的从一种主要的缓和治疗变为最终的根治。尽管相似,但是钴单元和直线性加速器在外部波束放疗中一直被看作竞争的技术。这种竞争导致在美国和西欧直线性加速器最终占主导地位。钴单元过分单纯,并且在很长时间内在技术上没有显著进展。当然,钴单元的过分简单是对其要求的一个原因;钴单元非常可靠、精确并且需要的维护和运行专门技术很少。在早期,这使得钴治疗成为外部射线治疗最广泛的形式。直线性加速器是技术上更强的设备。将高电子流加速到4-25MeV的能量,从而产生轫致辐射光子流或散射电子流,直线性加速器是一种通用得多的机器,可产生具有更清晰半阴影和更高剂量速度、穿透能力更强的波束。随着直线性加速器变得更加可靠,具有更强穿透能力光子波束以及附加电子波束的优点被看成取代现有钴单元的足够强的推动力。如果没有反对声,那么钴治疗不会消失,这个商、讨论的基本点可以在Laughlin,Mohan和Kutcher于1986年撰写的著名论文中找到,其解释了钴单元与直线性加速器的正面和负面。与此同时,来自Suit的评论呼吁继续钴单元并在技术上进行进一步开发。前面已经列举了钴单元和直线性加速器的正面。钴单元的负面是,穿透深度剂量较小、由于源的尺寸导致较、大半阴影、由于低能污染电子导致对于大场的大表面剂量、和忽视了强制性调节。直线性加速器的负面随着其能量的增加(由此与低能钴波束不同)而增大,并且包括衰减增加、由于电子传输导致半阴影增加、对骨的剂量增加(这是因为由于电子偶的产生导致剂量增大),和最重要的,在超过10MV的加速电势下产生光中子。
在强度调制放射治疗(IMRT)之前的时代,直线性加速器与钴治疗相比具有有限的优势。利用4MV直线性加速器加速电势可产生与钴非常相似的波束的事实以及直线性加速器可产生电子波束或者穿透性更高的光子波束的能力使得直线性加速器更加优选。当钴治疗的价值压倒直线性加速器治疗的价值时,放射场只能人工地开发,不能获得IMRT的益处。随着IMRT的发展,更高MV直线性加速器加速电势的波束和电子波束的使用很大程度上被社会所遗弃。这部分地是因为对由于IMRT需要更长的放射时间从而导致中子产生(并且增加患者全身剂量)和使电子束最优化的复杂性的关注的增加,但是更重要的是因为低MV光子束IMRT能够为癌症治疗的所有部位产生质量优良的治疗计划。
IMRT代表数十年改善3D剂量计算和优化的最高点,我们能够为静止目标获得高度的准确性和精确性。然而,在我们目前可以接受的用于剂量建模的范例中存在一个重要的缺陷。问题在于如下的事实,即患者基本上是动态可变形的目标,我们不能或者不能完美地复位以便进行分次放射治疗。即使对于单剂量递送,次内器官运动也会产生显著的误差。尽管存在这一事实,但是放射治疗的递送传统上仍然根据放射治疗靶标和临界结构的静止模型进行计划。实际的问题在于如下的事实,即颅外放射治疗(也就是,除了使用趋实体性放射治疗处理CNS疾病之外)需要分次治疗,也就是,必须每天递送单次1.8-2.2Gy或者双次1.2-1.5Gy,并且通常在工作日内递送(周一到周五);用7-8周分别以2.0或1.8Gy递送70-72Gy的累积剂量。这种日间分次要求患者及其所有内部器官精确地复位,以便进行精确的剂量递送。这给放射治疗产生了一个极其重要的问题:“如果靶标和临界结构在实际治疗期间到处移动,那么我们已经开发出来的所有优秀的剂量计算和优化有什么用处?”关于器官运动研究的最新评述总结了到2001为止的现有文献,显示有两种最重要类型的器官运动:患者姿态误差和器官运动。尽管在临床上经常观察到患者确实发生了显著的生理变化,例如头颈癌症的显著肿瘤萎缩,但是我们尚没有良好地加以研究。器官运动研究进一步分为次内和次间器官运动,并且已知这两者不能明确地分离,也就是,次内运动明显地可以同时观察到次间运动。关于妇产科肿瘤、前列腺、膀胱和直肠次内运动的数据已经公开,还有肝脏、膈、肾、胰腺、肺肿瘤和前列腺的次内运动数据。许多对等评论的出版物,跨度为该出版物之前的20年,证实了如下的事实,即次间和次内器官运动对放射治疗剂量测定均有显著影响。这可以从如下的事实中看出,即在少于50名患者的研究中普遍会发现0.5-4.0cm的位移。大量器官运动观察结果的平均位移可能会小,但是即使罕见但较大的位移也会显著改变患者所接收的生物学有效剂量,因为大家都认可,必须保证每次的正确剂量以便进行有效的剂量控制。在更受关注的最近由Goitein公布的关于次内器官运动的评论中(2004放射肿瘤学研讨会(Seminar in Radiation Oncology 2004),日本,14(1):2-9),精确地陈述了处理器官运动相关剂量测定误差的重要性:“......不可否认,在一些患者中会发生不可接受的,至少不期望的大运动......”Goitein进一步解释,器官运动问题一直受到放射治疗的关注:“从放射一开始在癌症治疗中使用时,我们就知道患者运动和呼吸以及他们的心脏跳动和肠蠕动。在并不久远的年代里,我们的解决办法是简单地在模拟器的荧光屏上观察所有那些运动,然后将场边际线设定得足够宽,使得靶标(并不介意我们不能看到它)位于该场内。”
在解决由于在放射治疗的整个周期内患者姿态误差、生理变化和器官运动对放射治疗施加的限制的尝试中,先前技术增强了能够在每次放射递送之前或之后获得测体积CT“快照(snap shot)”的成像系统。这个放射治疗单元与放射成像设备的新组合被称作图像引导的放射治疗(IGRT),或者优选地图像引导的IMRT(IGIMRT)。先前技术具有除去在放射治疗的全程期间患者姿态误差、缓慢生理变化和次间器官运动的潜力。然而,先前技术不能解决次内器官运动,其是器官运动的一个非常显著的形式。先前技术设备仅用于移动总患者位置。先前技术不能捕获次内器官运动,并且受螺旋或锥形波束CT成像的可执行速度的限制。其次但可能同样重要的,CT成像会增加递送给患者的离子化放射剂量。众所周知,在低-中剂量区域内存在二次致癌作用发生率,并且进行多次CT成像研究会增加整体剂量。
CT成像和MRI单元都是在20世纪70年代提出的。在早期,CT成像被用作放射治疗成像的“金标准”,因为它具有内在的空间完整性,这来自于X-射线衰减的物理过程。尽管MRI中可能出现空间变形,但是它作为用于放射治疗的成像形式仍然非常有吸引力,因为它与CT成像相比具有好得多的软组织对比度,并且具有成像生理和代谢信息的能力,例如化学肿瘤信号或充氧水平。影响数据空间完整性的MRI矫作物(artifact)与磁场均匀性的不理想波动有关,并且可以分成两类:1)由于扫描器造成的矫作物,例如磁设计的场不均匀性本质并且由于梯度转换导致感应涡流;和2)由于成像对象造成的矫作物,也就患者内在的磁化率。现代MRI单元是仔细设计的,并且采用重建算法,可以有效地消除由于扫描器造成的矫作物。在高磁场强度下,1.0-3.0T的范围内,患者的磁化率可能会产生显著的变形(其与场强度成正比),并且其通常可以通过首先获取磁化率成像数据加以消除。最近,许多学术中心开始采用MRI用于放射治疗处理计划。许多放射治疗中心并不处理高磁场下患者相关的矫作物,而是采用具有0.2-0.3T的低磁场MRI单元用于放射治疗处理计划,因为这些单元可以将患者磁化率空间变形消除到不显著的水平。为了处理次内器官运动,MRI是高度受欢迎的,因为它足够快,能够实时跟踪患者运动,具有容易调节的、可定向的视场,并且不会向患者递送任何额外的离子化放射,这些额外的离子化放射可以增加二次致癌作用发生率。最近许多研究组开始采用呼吸控制和肺活量计门控的快速多片层CT,用于对次内呼吸运动进行估计或建模。快速、单片层MRI也已经用于估计次内运动,并且动态平行MRI能够执行体积测定次内运动成像。对于快速重复成像,MRI相对于CT的优势有限,因为需要CT成像向患者递送更高剂量。对于IMRT的全身剂量导致二次致癌作用增加的关注早已存在,并且随着额外的重复CT成像,变得更显著地差。
在先前技术中,两个研究组似乎同时试图开发一种集成有直线性加速器的MRI单元。在2001年,Green提出了专利申请,其讲授了一种集成MRI和直线性加速器设备。2003年,来自荷兰乌得勒支大学的一个研究组提出了他们关于集成MRI和直线性加速器设备的设计,并且后来报导了剂量测定计算以检验他们的设备的可行性。集成MRI单元与直线性加速器对抗CT成像单元的显著困难在于,MRI单元的磁场使得直线性加速器不可操作。众所周知,速度为的电荷在磁场中受到的洛仑兹力为由于MRI导致的洛仑兹力不允许电子被直线性加速器加速,因为它们不能以直线路径运动,从而有力地关闭直线性加速器。直线性加速器的高射频(RF)发射能力还对MRI单元的RF收发器系统造成问题,恶化图像重建所需的信号,并可能毁坏精密电路。将直线性加速器与MRI单元集成是一个巨大的工程学努力,尚没有成功。
强度调制放射治疗(IMRT)是一种外部波束处理,其能够对肿瘤的尺寸、形状和位置进行适形放射。IMRT是相对于传统放射治疗的一个重大改进。IMRT放射治疗递送方法在放射治疗领域是熟知的,在Steve Webb的著作中有说明,书名为“强度调制放射治疗”(Intensity-Modulated Radiation Therapy)(IOP出版社,2001,ISBN0750306998)。本申请书引用Webb的著作内容作为参考,并且在后文称作“Webb 2001”。传统放射治疗的有效性受到肿瘤定靶不完美和放射剂量不充分的限制。由于这些限制,传统的放射会使过多的健康组织暴露于放射,因此导致副作用或并发症。利用IMRT,向肿瘤递送根据本领域已知的标准限定的最佳3D剂量分布,并且递送给周围健康组织的剂量被最小化。
在典型的IMRT处理过程中,患者要经历处理计划X-射线CT成像模拟,以及可能的附加MRI模拟或位置发射X线断层摄影(PET)研究,以获得用于定靶疾病的代谢信息。当开始扫描时,患者以一种和处理相一致的方式加以固定,从而以高度精确性完成成像。放射肿瘤学家或者其它有关保健专家通常对这些图像进行分析,并确定需要处理的3D区域,以及需要隔离的3D区域,例如临界结构如脊髓和周围器官。根据该分析,利用大尺度优化开发IMRT处理计划。
IMRT依赖于两种先进技术。第一种是反演处理计划。使用高速计算机通过精密复杂的算法,利用优化处理确定可以接受的处理计划,用于向肿瘤递送预定的均匀剂量,同时使周围健康组织的过多暴露最小化。在反演计划期间,大量(例如数千)包括放射波束的笔形波束或小波束(beamlet)以高精度独立地向肿瘤或其它靶标结构定靶。通过最优化算法,确定单个小波束的不均匀强度分布,从而获得某些特殊的临床目的。
第二种构成IMRT的技术一般利用多叶式准直仪(MLC)。该技术递送由反演处理计划系统得出的处理计划。使用一种称作叶定序的分离的最优化将小波束能流(fluence)系列转换成叶运动指令等价系列或具有相关能流的静止孔径的。MLC典型地包括计算机控制的钨叶片,其根据处理计划的强度分布移动形成特定图形,阻挡放射波束。作为MLC递送的替代,还可以设计衰减过滤器与小波束的能流相匹配。本发明考虑了如下的事实,即MLC递送能够快速地调节递送,从而解决次内器官运动问题,而衰减过滤器不能主动地进行调节。
在产生计划并且完成质量控制检查之后,患者被固定和定位在处理台上,试图重现最初用于X-射线CT或磁共振成像的定位。然后通过MLC指令或衰减过滤器向患者递送辐射。然后重复这一过程达多个工作周,直到认为递送了预定的累积剂量为止。
磁共振成像(MRI)是一种先进的诊断成像程序,其不需要像X-射线或兆伏级X-射线CT成像那样使用离子化辐射即可产生体内结构的细节图像。MRI诊断成像方法在放射和放射治疗技术领域是为人所知的,并且在E.M.Haacke,R.W.Brown,M.R.Thompson,R.Venkatesan的著作中有说明,书名为《磁共振成像:物理原理和序列设计》(John Wiley&Sons出版社,1999,ISBN 0-471-35128-8),在Z.-P.Liang和P.C.Lauterur的著作《磁共振成像原理:一种信号处理透法》中也有说明。本申请引用Haacke等以及Liang和Lauterur的工作作为参考,后文分别称为“Haacke等,1999”和“Liang和Lauterur,2001”。MRI通过使用强大的主磁体、磁场梯度系统、射频(RF)收发器系统和图像重建计算机系统能够产生细节图像。开放式磁共振成像(开放式MRI)是MRI诊断成像的先进形式,其使用在成像期间不完全包围患者的主磁体几何体系。MRI是用于放射治疗的一种备受关注的成像模式,因为它比CT成像具有高得多的软组织对比度,并且能够对生理和代谢信息进行成像,例如光谱化学肿瘤信号或者充氧水平。许多用于MRI的示踪剂目前已经存在或者正在研发,以改善软组织对比度(例如用于改善肾或肠的钆喷酸双葡胺或用于一般对比度的Gadoterate葡甲胺)。目前正在研制新型造影剂,其允许对肿瘤进行代谢检测,与采用含有碳13、氮15或类似稳定同位素试剂的超极化液的或者采用顺磁性非离子表面活性剂泡囊的PET相似。所有这些诊断MRI技术可增强疾病的精确定靶,并有助于估计在放射治疗中对处理的响应。
用于IMRT处理计划的CT扫描用薄切片(2-3mm)加以执行,有时是在静脉内注射了含碘的造影介质并且在软组织和骨窗进行拍片和水平设定之后进行。其优点在于,更容易获得,比磁共振成像(MRI)廉价,并且可以被校准从而为处理计划产生电子密度信息。不能用MRI检查的患者(由于幽闭恐怖症、心脏起搏器、动脉瘤钳等)可以用CT进行扫描。
目前,放射治疗期间的患者姿态误差、生理变化和器官运动是放射肿瘤学领域一个最受关注并且最显著的话题。众所周知,在单次剂量递送期间(次内变化,例如器官运动如由于气体导致直肠膨胀、膀胱充尿、或胸部呼吸运动)和每天剂量递送之间(次间变化,例如生理变换如体重增加和肿瘤生长或萎缩、以及患者几何形状变化),适形放射治疗的精度都会受到患者质量、位置、方向、关节几何构型以及次间和次内器官运动(例如在呼吸期间)的显著限制。除了本发明之外,尚不知有其它单一的有效方法能够同时解决每次实际剂量递送期间的所有这些偏差。成像技术的当前状态允许在放射治疗之前或之后对患者进行2D和3D兆伏级和垂直电压X-射线CT“快照”,或者可以在放射递送期间进行没有软组织对比度的时间解析2D放射图。
尽管在适形放射治疗领域已经取得了巨大的进展,但是如果没有本发明所提供的完全实时成像的引导和控制,尚不能实现其真实的效力。术语“实时成像”,我们是指来自放射波束的剂量被递送的同时,可以获得足够快的重复成像,从而捕获和分辩会出现的并且可导致患者几何形状发生显著变化的次内器官运动。通过实时成像获得的数据可以确定患者的实际剂量沉积。这个目的的实现可以通过采用已知的技术进行可变形配准和插值从而计算递送给运动组织和靶标的剂量总和。该数据接收放射治疗的整个多周时间,同时放射波束轰击患者并递送剂量,从而允许定量地确定3D体内的剂量测定。因此,本发明是估计和控制或消除与器官运动有关的剂量递送误差的唯一有效方法。
发明内容
本发明的一个方面,提供一种放射治疗系统,其包括用于从一个或多个放射性同位素源递送离子化辐射的设备、磁共振成像系统和控制器,控制器与用于递送离子化辐射的设备和磁共振成像系统相连,使得可以与离子化辐射的递送基本上同时地捕获图像。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,磁共振成像数据识别示踪剂摄取的区域。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,磁共振成像数据识别对比度增强的区域。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,获取光谱信息。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,获取代谢或生理信息。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,获取磁共振血管造影数据、淋巴管造影数据或者两者同时获取。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,采用所得的磁共振成像数据监视对象对治疗的响应。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,能够利用所得磁共振成像数据采用可变形图像配准方法来跟踪解剖结构和放射治疗靶标在照射期间的运动。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,利用所得磁共振成像数据采用剂量计算方法来确定在照射期间存在运动时给予对象的剂量。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,利用所得磁共振成像数据采用可变形图像配准和剂量计算方法来确定在照射期间存在运动时给予对象的剂量。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,利用所得磁共振成像数据采用可变形图像配准、剂量计算和IMRT优化方法来递送离子化辐射以重新优化对象的IMRT治疗。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,利用所得磁共振成像数据来执行在体温度测定。
在一些实施方案中,放射治疗系统被构建和配置成使得在基本上同时的图像引导下执行消融治疗。
在一些实施方案中,放射治疗系统被构建和配置成使得在基本上同时的图像引导下控制增生组织。优选地,放射治疗系统被构建和配置成使得在基本上同时的图像引导下控制血管增生组织。
在一些实施方案中,辐射的放射性同位素源与一个或多个多叶式准直仪强度调制放射递送系统耦连。优选地,一个或多个多叶式准直仪强度调制放射递送系统包括双分散多叶式准直仪系统,其采用被构建并配置成阻挡叶间泄漏并且在闭合时能够完全阻挡源辐射的独立叶片。
在一些实施方案中,放射治疗系统被构建和配置成使用由磁共振成像数据确定的递送剂量为患者重新优化强度调制的放射治疗。
在一些实施方案中,磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,磁共振成像数据识别示踪剂摄取的区域。
在一些实施方案中,磁共振成像系统被构建和配置成使得在治疗开始之前、在开始治疗之后或者在两个时间进行高诊断质量磁共振成像;和基本上在递送离子化辐射的设备递送离子化辐射的同时,执行低质量磁共振成像系统用于解剖结构和靶标的跟踪。
在一些实施方案中,磁共振成像系统被构建和配置成使得在治疗开始之前、在开始治疗之后或者在两个时间采用高分辨率磁共振成像获取数据空间采样图形b;和基本上在递送离子化辐射的同时,采用低分辨率磁共振成像获取数据空间采样图形。
在一些实施方案中,高磁场递送系统被构建和配置成提高在开始治疗之前执行的诊断磁共振成像的质量;和低磁场递送系统被构建和配置成基本上在递送离子化辐射的同时,为解剖结构和靶标的跟踪目的当获得成像时提高磁共振成像的空间完整性,和减轻递送剂量分布的干扰。
在一些实施方案中,从一个或多个放射性同位素源递送离子化辐射的设备被增加选自如下的治疗波束:质子束、重离子束、中子源束、或其组合。
本发明的另一方面,提供一种放射治疗系统,包括:从一种或多种治疗波束递送离子化辐射的设备、磁共振成像系统和控制器,该治疗波束包括质子束、重离子束、中子源束、或其组合,该控制器与递送离子化辐射的设备以及磁共振成像系统相连,使得可以基本上在递送离子化辐射的同时捕获图像。
本发明提供了一种放射治疗系统,其包括:至少一个或者多个放射性同位素源,以产生离子化放射治疗波束;至少一个或多个MLC或衰减器系统,从而用治疗波束进行IMRT;磁共振成像(MRI)系统,其在递送离子化辐射期间同时对靶标区域和周围健康组织或临界结构进行成像;和/或控制器,其与所有的部件通讯连接。从MRI得到的图像数据允许定量地估计实际递送的离子化放射剂量,并能够重优化或重计划治疗递送,从而更加精确地向靶标区域引导由IMRT递送的离子化辐射。现在我们说明本发明的一个优选实施例。在该优选实施例中,开放式MRI的主磁体赫尔姆霍茨线圈对被设计成分裂螺线管,从而患者台能够运动通过磁体中心的圆柱形孔,并且IMRT单元定向下降到位于患者的两个螺线管部分之间的缝隙处(图1-图4)。在本实施例中,在具有多叶式准直仪IMRT单元的屏蔽的共配准同位素放射源(020)围绕托台(025)轴向旋转的同时(注意可以有利地采用多于一个(020)),分裂螺线管MRI(015)保持静止。患者(035)定位在患者台(030)上,用于同时进行成像和治疗。该具有多叶式准直仪的共配准同位素放射源(020)包括放射性同位素源(115),其与固定的主准直仪(120)对直,第二双发散(divergent)多叶式准直仪(125)和第三多叶式准直仪(130),其用于阻挡第二多叶式准直仪(125)的叶间泄漏(图5-图7)。
本实施例是有利的,因为它不需要旋转开放式MRI即可提供轴向处理估计,并且它沿着患者的头尾方向提供了磁场,允许用平行多相阵列RF收发器线圈进行快速图像获取从而提高MRI速度。
现在我们说明具有不同复杂性和计算需要的本发明处理的其它优选实施例。所有这些处理实施例能够采用任何设备实施例。所有这些处理实施例可以包括在每天递送放射之前获取高分辨诊断质量体积测定MRI数据,然后在放射递送期间获取实时MRI数据,其中实时数据可以收集在不同的空间网格上,或者消除信噪比,从而提高获取速度。一个有益的处理实施例可以获取该MRI数据,并采用本领域已知的方法用于可变形图像配准和对已递送的IMRT钴单元能流进行剂量计算,从而确定在每次递送期间递送给靶标和临界结构的剂量。然后对患者治疗进行修正,增加或减少递送次数以分别提高肿瘤控制或减少副作用。在剂量测定估计的同时,还可以每天估计患者疾病的尺寸和进展。
第二有益处理实施例获取MRI数据并且在每次单次放射递送之前对IMRT处理计划进行重优化,以便提高治疗递送的精度。该处理可以和先前的处理联用,以便估计每次递送期间递送给靶标和临界结构的剂量。
第三有益处理实施例获取MRI数据并且在单次放射递送中在递送每个放射束之前逐射束地优化IMRT处理计划,以便提高治疗递送的精度。这个处理一般包括在每个射束递送之前快速执行的第一处理。
第四有益处理实施例获取MRI数据并且在单次放射递送中在递送每个放射束的每个部分期间逐时地优化IMRT处理计划,以便提高治疗递送的精度。这个处理一般包括与放射递送基本上同时地实时执行第一处理。本发明考虑采用许多优选地通过一个低延迟网络或安全连接连接在广域网络上的计算机进行平行计算,从而大大提高本领域中已知的用于图像重建、可变形图像配准、剂量计算和IMRT优化的算法的速度。
在另一个方面,本发明还提供了一种施加放射治疗的方法,其包括如下步骤:确定施加放射治疗的治疗计划;用磁共振成像(MRI)系统获取对象体积内靶标区域的图像;用治疗波束辐射靶标和临界结构区域,其中治疗波束处理靶标区域;和在辐射靶标区域期间连续获得靶标和临界结构的图像;其中在治疗期间可以根据在治疗期间获得的靶标和临界结构的图像改变治疗计划。
附图说明
这里显示的附图、实施例是当前的设想,应当理解,本发明并不仅限于所示的精确布置和手段。
图1是放射治疗系统的示意图,包括开放式分裂螺线管磁共振成像设备(015)、具有多叶式准直仪的屏蔽的共配准同位素放射源(020)(注意,在优选实施例中可以采用多于一个020)、用于改变(020)角度的台架(025)、患者台(030)、和定位成同时成像和治疗的患者。
图2是台架旋转的示范,其中具有多叶式准直仪的屏蔽的共配准同位素放射源(020)从右侧波束位置旋转到了前后波束位置。
图3是图1中系统的顶视图。
图4是图1中系统的侧视图。
图5是图1中具有多叶式准直仪的屏蔽的共配准同位素放射源(020)的细节示意图。放射性同位素源(115)显示具有固定的主准直仪(120)、第二双发散多叶式准直仪(125)和用于阻挡第二多叶式准直仪(125)的叶间泄漏的第三多叶式准直仪(130)。
图6是第二双发散多叶式准直仪(125)和用于阻挡第二多叶式准直仪(125)的叶间泄漏的第三多叶式准直仪(130)的透视图。
图7是放射性同位素源(115)、第二双发散多叶式准直仪(125)和用于阻挡第二多叶式准直仪(125)的叶间泄漏的第三多叶式准直仪(130)沿波束观看视图。
图8显示了用商业钴小波束计划的单头颈IMRT实例的轴向剂量分布。
图9显示了从用商业钴小波束计划的单头颈IMRT获得的DVH数据。
图10是在0.3特斯拉磁场下和没有该磁场时水中钴小波束剂量分布。
图11是在0.3特斯拉磁场下和没有该磁场时水和肺中钴小波束剂量分布。
图12是在0.3特斯拉磁场下和没有该磁场时水和空气中钴小波束剂量分布。
具体实施方式
在下面的实例中将对本发明进行更详细地说明,这些实例只是举例说明,并且本领域技术人员可以显见多种修改和变化。在说明书和权利要求中使用的单数形式“一个”和“该”可以包括多个指示物,除非文中明确指明。另外,在说明书和权利要求中,术语“包括”可以包括“由......构成”和“主要由......构成”。
本发明是一种在强度调制放射治疗(IMRT)期间对患者的解剖结构和疾病进行高时间和空间分辨率磁共振成像(MRI)的设备和处理,以便对递送给患者的高适形离子化放射剂量直接进行测量和控制。在优选实施例中,本发明将允许向患者轴向采用IMRT放射束的开放式MRI、基于多叶式准直仪或补偿过滤器的IMRT递送系统和钴60远距放射疗放射源等技术组合在单一共配准且台架安装的系统内。
如前所述,先前技术不能在递送放射治疗期间在波束轰击患者的同时,实时地对人的软组织解剖结构进行成像。相反,图像在放射递送之前和/或之后产生,这些图像不能反映患者在放射递送期间可能发生的移动和/或自然改变。因此,如果在获取了最初的图像之后、治疗之前,待处理的身体部分或者自然地发生了尺寸变化或者由于患者的移动改变了位置,也就是发生了患者姿态误差或者患者解剖结构的几何和对准误差;患者生理变化,例如体重降低或肿瘤生长和萎缩;以及患者体内的器官运动,包括但不仅限于呼吸运动、心脏运动、直肠膨胀、蠕动、膀胱充盈和自主肌肉运动,那么如果没有本发明,则不可能成功地进行靶向放射。
本发明通过与放射递送基本上同时地执行患者实时MRI,然后如果待处理的区域经历了任何类型的剂量测定误差,其可能由于患者姿态误差、生理变化和次间和次内器官运动造成的,则对靶向放射进行重调节,从而有助于消除所有这些问题。可以采取许多操作,包括但不仅限于:移动患者位置以解决靶标和解剖构造的尺寸和/或位置变化;停止治疗同时允许在重新开始治疗之前确定附加的计算或者允许停止暂时运动;增加额外的递送次数以便增加肿瘤控制的可能性,或限制递送次数以便降低副作用的可能性;任何前述的有益处理实施例;和以各种时间刻度重新优化IMRT治疗计划,例如为每次递送、每个波束或者执行IMRT计划的每个部分执行重新优化。
本发明的优选实施例包括计算机控制的锥形波束钴治疗单元,例如钴60治疗单元,其具有安装在旋转台架上的多叶式准直仪或自动补偿过滤系统以及直角安装的“开放式”MRI单元。由图1可见,IMRT钴单元(020)向轴向开放MRI单元(015)的中心投射锥形波束几何学辐射,并且IMRT钴单元围绕台架(025)上的患者轴向旋转(围绕患者的纵(头尾)轴)。在台架旋转以改变波束角度的同时,可以使用可调节处理台(030)将患者支持在静止位置。
本发明使用钴远距放射疗法作为放射治疗。尽管一些IMRT使用线性电子加速器用于递送穿透力更强的放射治疗,但是加速器本身会产生与辐射水平相比高度可变的处理波束。因此,难以精确地确定用于患者的放射量,并且难以调节用于IMRT递送的MLC的运动。伽马射线是通过放射性同位素裂变发射的电磁辐射,具有足够的能量用于产生离子化,典型地从大约100keV到略高于1MeV。用于放射线目的的最有用的伽马发射放射性同位素是钴(Co60)、铱(Ir192)、铯(Cs137)、镱(Yb169)和铥(Tm170)。因此,放射性同位素的裂变是众所周知的现象,因此由钴远距放射疗法发射的辐射更加恒定,由此更容易计算,为患者制定治疗方案(regimen)。
本发明的钴IMRT的能力已经通过计算分析加以证实。对利用商业上可获得的钴治疗单元和MLC执行的IMRT递送进行了模拟。使用了一种具有钴小波束模型的基于3D图像的放射治疗处理计划系统,并利用从Theratronics 1000C钴治疗单元测得的辐射变色(radiochromic)胶片数据进行了验证。产生了各向同性的4x4x4mm3剂量体素网格(对γ-射线IMRT源半阴影的高效Shannon-Nyquist限制)。该小波束模型适合于已公布的数据,并对1x1cm2小波束进行辐射变色胶片测量加以确认,其中1x1cm2小波束是通过Cerrobend块(block)形成的,并用先前报导的方法学加以测量。然后对结构进行标准三维射线跟踪为相同的体素确定计算深度。利用密度-深度比例计算,以便更好地解决剂量模型中的组织异质性。使用CPLEX,ILOGConcert技术工业优化解算器利用用于IMRT优化的密集柱处理(dense column handling)执行阻挡层内点方法(barrier interior-pointmethod),从而实现最佳IMRT计划。对于叶定序(leaf sequencing),小波束能流对于每个波束离散5%的水平。通过加和用可递送离散强度加权的剂量值计算最终的计划剂量分布和直方图。对于强度不是零的小叶,叶发射泄漏强度保守地估计为1.7%。最后,采用标准探索性叶定序优化方法为治疗计划生成递送指令。我们采用维吉尼亚医学院的同时集成增强(simultaneous integrated boost)(SIB)靶标剂量水平方案,因为在文献中它声称是最大的最大-最小临床处方剂量比例,使它成为可以满足的最困难的剂量处方方案。头颈IMRT为检验IMRT优化提供了优良的基础,这是由于如下的原因:1)具有节制的(sparing)唾液腺和其它结构的良好限定的治疗目的,同时保持均匀的靶标覆盖;2)对实现这些目标测试IMRT优化的尝试达到技术上的极限;和3)大的阶段I/II多公共机构试验,放射治疗肿瘤学研究组(RTOG)用于口咽癌的适形和强度调制放射H-0022I/II期研究定义了一个通用的计划标准系列。病例检查用7个平均分布的国际电子技术委员会(IEC)台架角分别为0°、51°、103°、154°、206°、257°和309°的波束执行。处理计划系统产生了1289个小波束,从7个波束角度充分地覆盖靶标,并且4mm各向同性体素网格产生了417,560个体素。结果如图8和9所示。注意,我们的系统将计划标准化,以保证95%的高剂量靶标覆盖率。图8显示了得自于用商业钴小波束计划的单头颈IMRT实例轴向剂量分布。可以观察到优良的靶标覆盖率和组织隔离。图9显示了得自于使用4mm体素和1Gy剂量箱(dose bin)的叶定序和泄漏修正计划(也就是,可递送计划)的DVH数据。基于IMRT的钴源为头颈患者生成优异的IMRT处理计划。γ-射线IMRT能够清晰地隔离右腮腺(RPG),将左腮腺(LPG)和右下颌下腺(RSMG)保持在少于50%体积处于30Gy,同时在处方剂量或者更高剂量下,覆盖超过95%的靶标体积(CTV和GTV)。所有其它的结构都在公差之下。未指明的组织(皮肤)保持在60Gy之下,超过50Gy的体积小于3%。所用的优化模型与Romeijn等所公开的相同,并没有为钴波束进行修改。对于深度较大的位点,例如前列腺和肺,在技术上已知,增加额外的波束或等角点允许用可以获得与基于直线性加速器的IMRT相同的临床质量标准的钴IMRT生成治疗计划。这种能够实现的示范显示,钴治疗单元能够提供高质量IMRT。
在磁场存在下本发明能够为钴IMRT实现剂量计算的能力已经通过计算分析加以证实。此外,通过使用钴远距放射疗法,本发明能够更好地根据MRI的磁场进行计算。在执行放射治疗时,尽管患者被固定在MRI内,但是磁场仍然会略微偏离靶向放射。因此,需要用于确定治疗方案的计算将这种偏差考虑在内。在磁场存在下,以速度在真空中移动的电荷所受的洛仑兹力为这个力并不足够显著,以至于显著改变有关离子化光子和电子的物理相互作用;然而,它可能影响离子化电子的整体传输,因此导致剂量分布。50年前,物理文献就已完善地研究了磁场对二次电子传输的影响。最近的研究采用蒙特卡洛模拟和解析分析,试图使用局部化磁场帮助聚焦或俘获一次或二次电子,从而增加患者体内的局部剂量沉积。所有这些研究都检验的是对准沿着波束轴方向的磁场线方向,从而用洛仑兹力横向限制电子传输(称作“纵向”磁场,其中术语纵向是指波束而不是患者)。对于高场MRI,已知在大约1.5-3.0T的磁场下,回旋的初始半径相对于二次电子大角度散射(轫致辐射、弹性散射和硬碰撞)相互作用的MFP较小,并且这个条件可产生理想的电子俘获或聚焦。随着电子损失能量,半径减小,因为其与成比例,当不存在大角度散射相互作用(CSDA)时,电子会沿着一个螺旋减小半径,直至停止。尽管这种螺旋运动会改变电子的能流,但是已知,它不会产生任何显著的同步加速半径。在本发明中,磁场必须与放射波束垂直,以便实现用于实时成像的平行MRI。最近的工作显示,与6MV直线性加速器波束的波束轴垂直的1.5T的磁场可以显著干扰6MV直线性加速器小波束在水中的剂量分布。为了避免这种剂量分布畸变和防止MRI矫作物,其会损害成像数据的空间完整性,本发明的优选实施例使用一种低场开放式MRI设计,其允许沿着患者的上下方向导向磁场(见图1)。由γ-射线简单地估计二次电子回旋半径表明,回旋半径比电子大角度散射相互作用的MFP大得多。这是容易理解的,因为洛仑兹力与磁场的大小成正例,回旋半径与磁场(104)成反比。我们试图使用良好证实的集成Tiger系列(ITS)蒙特卡洛程序包及其ACCEPTM子程序对来自呈厚片幻像几何结构的钴γ-源的小波束在磁场内的传输进行建模。为了该模拟,我们采用0.1MeV电子和0.01MeV光子传输能量截止(cutoff),标准密集历史能量网格(ETRAN方法),从Landau分布零散采样的能量,基于Bethe理论的质量碰撞停止功率,缺省电子传输子步尺寸,和包括绑定效应(binding effect)的不连贯散射。运行了三对模拟,其中每一对包括含有或者不含有与波束方向平行的0.3T均匀磁场。根据如下的几何体系对2cm圆形钴γ-射线小波束进行了建模:30x30x30cm3水幻像;30x30x30cm3水幻像,并且在5cm深度具有10cm肺密度(0.2g/cc)水厚片;和30x30x30cm3水幻像,并且在5cm深度具有10cm空气密度(0.002g/cc)水厚片。在一台P4 1.7GHz PC上用8-30小时对3千万-1亿个历史纪录进行了模拟,从而使估计剂量的标准偏差小于百分之一。结果如图10-12所示。图10明显地证实,在本发明优选实施例中可能存在的0.3T垂直均匀磁场不会对软组织或骨内的剂量分布造成可测量的干扰。本发明的一个非常有用的处理位点是体内具有最显著组织异质性的肺和胸腔。如图11所示,向幻像中添加12cm肺密度(0.2g/cc)水厚层在高和低密度区会对剂量产生非常小但是可以检测到的干扰。这些干扰足够小,从而无需修正即可进行可以接受的临床应用。在图12中,我们最终观察到了显著的干扰,其主要存在于低密度和界面区。这证实,空气腔会对精确剂量测定产生最大的挑战。然而,除了具有较低密度介质的界面之外,软组织和骨中没有显著的干扰(其中MFP缩短的程度超过软组织)。这个数据证实,在具有低(0.2-0.5特斯拉)磁场MRI的本发明优选实施例中,除了空气腔内部之外,剂量干扰很小,但是在空气腔内部不需要精确的剂量测定,因为没有组织。通过已知的放射源,例如钴远距放射单元,如果已知MRI场的强度,则可以容易地确定偏差量。然而,即使已知磁场强度,如果使用线性加速器,则未知的放射能谱也会使计算变得困难得多。
本发明还包括不会显著干扰MRI单元工作的可选择放射源,例如由MRI单元外部的加速器或反应器产生的并通过射束传输到患者身上的质子、重离子和中子。
此外,MRI场的强度将作为计算的因素,结果,使用开放式MRI比封闭式MRI更有优势。在开放式MRI中,所产生磁场的强度一般小于封闭式MRI的磁场。这样,由开放式MRI获得的图像具有更多的噪音,并且不如来自更高场封闭式MRI的图像那样清晰和/或确定。然而,封闭式MRI的强磁场造成的放射处理偏差比开放式MRI的弱磁场所造成的更大。因此,根据最有利于给定处理方案的特征,本发明设想可以使用封闭式MRI。然而,由于容易计算和/或如下的事实,即在治疗期间略微不清晰的图像足以调节大多数治疗方案,因此本发明设想使用具有如图1所示几何结构的开放式MRI和钴治疗,从而消除显著的剂量干扰,防止空间图像畸变,并允许快速的平行相位阵列MRI。
通过使用开放式MRI和钴远距放射疗法,本发明在放射治疗期间可以对患者进行三维(3D)成像。这样,通过使用靶标区的3D图像和靶标区的计划图像,可以确定根据在放射治疗期间接收的连续3D图像加以更新的位移。利用所得信息,随后在放射过程中,例如如果测得的位移处于预定极限之外的话,患者可以相对于治疗波束平移,从而减少位移。然后在平移之后继续放射。选择地,治疗波束可以移动。在治疗期间可以进行平移,或者治疗可以停止,然后进行平移。
通过在治疗期间使用3D图像并且在治疗期间利用这些图像对患者进行快速定位和/或调整,可以显著提高治疗精度。如果在施加放射的同时患者失准,那么该失准可以通过位置调节加以减轻。除了可能的剂量自动调节之外,提高定位精度还允许治疗目前认为使用传统系统进行放射不可能治疗的肿瘤。例如,原发性脊髓瘤和脊髓转移是典型的不能用传统的反射系统加以治疗的,因为在如此重要的功能解剖学区域需要高精度的处理损害。通过在治疗期间进行3D成像提高精度使得有可能治疗这种类型的肿瘤。对于位于肺、上胸腔以及其它已知的次内器官运动可导致放射治疗剂量测定问题的区域内的靶标,也可能得到改善。
在可选择实施例中,本发明可以包括用于跟踪患者位置的分离的引导系统,用于将实际患者位置与在计划和放射治疗期间获得的图像信息相关联。本发明的这个部分通过在整个患者布置和治疗递送期间,甚至当患者移动到与放射治疗设备的坐标体系不垂直的位置时,通过提供可更新的图像关联和定位信息,可以显著改善患者定位的容易性。这种监视处于非共面治疗位置的患者位置的能力可以显著改善传统的放射治疗系统。在一个优选实施例中,引导系统可以包括可调节床或托台,用于将患者定位在上面。在可选择的优选实施例中,引导系统可以包括台架,其允许基本上同时地移动MRI和钴治疗单元。一些优选实施例同时包括台架和可调节床或托台。
本发明根据计算机程序的使用确定最初放射治疗和/或治疗方案的任何改变,其中该计算机程序考虑了各种因素,包括但不仅限于,患者待治疗的面积、放射强度、MRI场强度、患者相对于放射单元的位置、患者在治疗期间的任何改变,和/或患者和/或放射单元在治疗期间需要的任何位置改变。然后对最终的IMRT进行编程并开始治疗。
本发明使用的用于为强度调制放射治疗(IMRT)确定治疗计划的一个实施例包括如下步骤:将患者的三维体积分割成剂量体素网格,其中每个剂量体素从多个小波束接收预定剂量的放射,每个小波束具有小波束强度;和提供具有凸目标函数的凸编程模型,以便优化放射递送。求解该模型,从而获得总体最佳能流图,该能流图包括多个小波束每一个的小波束强度。该方法在专利申请U.F.公开No.11296中有更详细的说明。
一般地,优选实施例中用于确定治疗计划的方法是内部点方法(interior point method)及其变型。该方法是有利的,因为它效率高从而一般计算时间短。内部点方法在Steven J.Wright的书中有说明,标题为《原始对偶内部点方法》(Primal-Dual Interior-Point Methods)(SIAM出版社,1997,ISBN 089871382X)。原始对偶算法是内部点分类中最有利和最有用的算法。Wright公开了用于线性编程的主原始对偶算法,包括路径跟随算法(path-following algorithms)(短步和长步,预测器-校正器),势能降低算法(potential-reduction algorithms)和不可行内部点算法(infeasible-interior-point algorithms)。
一旦确定治疗计划,本发明便可以使临床医生确保遵循治疗计划。待治疗患者定位在MRI内。获取待治疗区域的图像,MRI持续发送该区域的3D图像。将治疗计划输入到钴放射远距放射治疗单元,并开始治疗。在治疗期间,观察正在处理的区域的连续图像。如果待处理的区域位置发生改变,例如如果患者移动或者待处理区域的尺寸发生变化,本发明或者重新计算治疗计划和/或调整患者或放射单元,而不中断治疗;或者本发明停止治疗,在重新开始治疗之前,重新计算治疗计划,调整患者和/或调整放射单元。
本发明构想了多个处理实施例,它们可以用于提高患者治疗的精度。一个处理实施例获取MRI数据并对所递送的IMRT钴单元能流应用本领域已知的用于可变形图像配准和计算计算的方法,从而确定在每次递送期间向靶标和临界结构递送的剂量。然后对患者治疗进行校正,增加或减少递送次数,分别用于改善肿瘤控制或减少副作用。除了剂量测定估计之外,还可以每天估计患者疾病的尺寸和进展。
第二处理实施例获取MRI数据并且在每次单次放射递送之前重新优化IMRT治疗计划,以便提高治疗递送的精度。该处理可以和先前的处理联用,用于估计在每次递送期间向靶标和临界结构递送的剂量。
第三处理实施例获取MRI数据并且在单次放射递送中递送每个放射波束之前重新优化IMRT治疗计划,以便提高治疗递送的精度。该处理包括在每次波束递送之前快速执行第一处理。
第四处理实施例获取MRI数据并且在单次放射递送中在递送每个放射波束的每个部分期间逐时地重新优化IMRT治疗计划,以便提高治疗递送的精度。该处理还包括与放射递送同时地实时执行第一处理。本发明构想了利用多个计算机进行平行计算,这些计算机优选地通过低延迟网络或者一个安全连接连接在广域网络上,从而可以大大提高本领域中用于MRI图像重建、可变形图像配准、剂量计算和IMRT优化的已知算法的速度。
现在参考附图的特殊细节,其中在所有的简图中,相似的指代数字表示相似的或等价的元件,并且从图1开始。
在图1中,本发明在一个实施例中显示了本发明的系统,其具有开放式MRI015和IMRT钴治疗单元020。该系统还包括在020中执行IMRT的装置,例如MLC或补偿过滤器单元,和台架025,其可以用于旋转钴单元020同时使MRI015保持静止。患者035定位在系统的可调节固定台030上。
图2显示了使用中的系统,其中台架025顺时针旋转了大约90度。这样,钴治疗单元020位于对处于多个可选位置中的其中一个位置上的患者进行处理的位置。图3是图1中系统的顶视图。图4是图1中系统的侧视图。
尽管本说明书参考附图和实例对本发明的例证性实施例进行了说明,但是应当理解,本公开并不仅限于那些精确的实施例,在不背离本发明精神范围的前提下,本领域的技术人员可以进行各种改变和修饰。所有这些改变和修饰都包含在由附加权利要求书限定的公开范围之内。
Claims (20)
1.一种放射治疗系统,其包括
外部设备,其通过一个或多个离子化放射波束,从一个或多个放射性同位素源递送离子化辐射;
磁共振成像系统,其具有与所述一个或多个离子化放射波束基本上垂直的磁场;以及
控制器,其与用于递送离子化辐射的该外部设备和该磁共振成像系统相连,使得可以与离子化辐射的递送基本上同时地捕获图像。
2.根据权利要求1的放射治疗系统,其中磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,能够利用所得磁共振成像数据采用可变形图像配准方法来跟踪解剖结构和放射治疗靶标在照射期间的运动。
3.根据权利要求1的放射治疗系统,其中磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,利用所得磁共振成像数据采用剂量计算方法来确定在照射期间存在运动时给予对象的剂量。
4.根据权利要求1的放射治疗系统,其中磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,利用所得磁共振成像数据采用可变形图像配准、剂量计算和IMRT优化方法来重新优化对象的IMRT治疗。
5.根据权利要求1的放射治疗系统,其中磁共振成像系统被构建和配置成使得基本上在递送离子化辐射的同时,利用所得磁共振成像数据来执行在体温度测定。
6.根据权利要求1的放射治疗系统,其中该系统被构建和配置成使得在基本上同时的图像引导下执行消融治疗。
7.根据权利要求1的放射治疗系统,其中辐射的放射性同位素源与一个或多个多叶式准直仪强度调制放射递送系统耦连。
8.根据权利要求1的放射治疗系统,其中该系统被构建和配置成使用由磁共振成像数据确定的递送剂量为对象重新优化强度调制的放射治疗。
9.一种使用磁共振成像系统将离子化辐射的递送引导至患者的方法,该方法包括:
从一个或多个外部放射性同位素源递送离子化辐射;以及
从该磁共振成像系统获取磁共振成像数据,其中该递送和获取的步骤基本上被同时执行。
10.根据权利要求9的方法,其还包括:
在该递送步骤之前为该离子化辐射的递送确定治疗计划;以及
至少部分地基于在该获取步骤期间获取的磁共振成像数据改变该治疗计划。
11.一种用于图像引导的放射治疗的放射治疗装置,其包括:
构造来从一个或多个外部放射性同位素源向对象递送离子化辐射的照射装置;
可操作地与该照射装置结合的磁共振成像装置,该磁共振成像系统被构造成从该对象获取磁共振成像数据;以及
控制器,其与该照射装置和该磁共振成像装置通信,该控制器被构造成控制该照射装置以向该对象递送离子化辐射,并且基本上同时控制该磁共振成像系统,以足以解决次内的器官运动的频率,从该对象获取磁共振成像数据。
12.根据权利要求11的放射治疗装置,其中该磁共振成像磁场基本上垂直于该放射波束。
13.一种放射治疗系统,其包括:
构造成从一个或多个外部放射性同位素源向对象递送离子化辐射的照射设备;
可操作地与该照射设备结合的磁共振成像系统,该磁共振成像系统被构造成足够快地获取该对象一系列的3D图像以捕捉次内器官运动;
控制器,其与该照射设备和该磁共振成像系统通信,使得该控制器可以基本上同时
a)控制该照射设备向该对象递送离子化辐射和记录递送的放射性同位素波束能流;并且
b)控制该磁共振成像系统以获取该对象的该3D图像;以及
处理器,其被构造成从该3D图像和该递送的放射性同位素波束能流确定在该对象中的实际剂量沉积。
14.根据权利要求13的放射治疗系统,其中该控制器被构造成基于该确定的实际剂量沉积重新优化放射递送。
15.根据权利要求13的放射治疗系统,其中该控制器被构造成如果该实际剂量沉积表明剂量测定误差,停止该离子化辐射的递送。
16.根据权利要求13的放射治疗系统,其还包括构造成快速地调节放射递送以解决次内器官运动的多叶式准直仪。
17.一种放射治疗方法,该方法包括:
从照射设备的一个或多个外部放射性同位素源向对象递送离子化辐射;
通过可操作地与该照射设备结合的磁共振成像系统足够快地获取该对象的一系列3D图像以捕捉次内器官运动;基本上同时
a)控制该照射设备以向该对象递送离子化辐射和记录递送的放射性同位素波束能流;并且
b)控制该磁共振成像系统以获取该对象的该3D图像;以及
通过处理器从该3D图像和该递送的放射性同位素波束能流确定在该对象中的实际剂量沉积。
18.根据权利要求17的放射治疗方法,其还包括基于该确定的实际剂量沉积重新优化放射递送。
19.根据权利要求17的放射治疗方法,其还包括如果该实际剂量沉积表明剂量测定误差,停止该离子化辐射的递送。
20.根据权利要求17的放射治疗方法,其还包括通过多叶式准直仪快速地调节放射递送以解决次内器官运动。
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