Apparatus and method for compensating for respiratory and patient motion during treatment

• US 20030125622A1
• Filed: 10/18/2002
• Published: 07/03/2003
• Est. Priority Date: 03/16/1999
• Status: Active Grant

• Current Assignee: Achim Schweikard, John R. Adler
• Original Assignee: Achim Schweikard, John R. Adler
• Inventors: Adler, John R., Schweikard, Achim
• Granted Patent: US 7,318,805 B2
• Time in Patent Office: Days
• US Class Current: 600/437
• CPC Class Codes: A61B 10/0233 Pointed or sharp biopsy instruments
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2017/00694 with means correcting for movement of or for synchronisation with the body
• CPC Class Codes: A61B 2017/00699 correcting for movement caused by respiration, e.g. by triggering
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/25 User interfaces for surgical systems
• CPC Class Codes: A61B 6/08 Auxiliary means for directing the radiation beam to a particular spot, e.g. using light beams
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/527 using data from a motion artifact sensor
• CPC Class Codes: A61B 90/10 for stereotaxic surgery, e.g. frame-based stereotaxis
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61N 2005/1058 using ultrasound imaging
• CPC Class Codes: A61N 2005/1061 using an x-ray imaging system having a separate imaging source
• CPC Class Codes: A61N 5/1037 taking into account the movement of the target, e.g. 4D-image based planning
• CPC Class Codes: A61N 5/1049 for verifying the position of the patient with respect to the radiation beam
• CPC Class Codes: A61N 5/1067 in real time, i.e. during treatment
• CPC Class Codes: A61N 5/107 : in real time, i.e. during treatment
• CPC Class Codes: A61N 7/02 : Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

An apparatus and method for performing treatment on an internal target region while compensating for breathing and other motion of the patient is provided in which the apparatus comprises a first imaging device for periodically generating positional data about the internal target region and a second imaging device for continuously generating positional data about one or more external markers attached to the patient'"'"'s body or any external sensor such as a device for measuring air flow. The apparatus further comprises a processor that receives the positional data about the internal target region and the external markers in order to generate a correspondence between the position of the internal target region and the external markers and a treatment device that directs the treatment towards the position of the target region of the patient based on the positional data of the external markers.

Claims

1. A method for compensating for breathing and other motions of the patient during treatment, the method comprising:

generating images of the target region prior to the treatment;

periodically generating positional data about the internal target region;

continuously generating positional data about external motion of the patient'"'"'s body using one or more external sensors; and

generating a correspondence between the position of the internal target region and the external sensors so that the treatment is directed towards the position of the target region of the patient based on the positional data of the external sensors and the target region'"'"'s position is subsequently matched to the position of the target region in the preoperative images.

2. The method of claim 1, wherein periodically generating positional data comprises generating positional data about one or more fiducial markers located near the target region and wherein generating a correspondance further comprises computing the deformation state of the target region based on the relative position of the fiducial markers.

3. The method of claim 2 further comprising preoperative planning the treatment of the patient, the preoperative planning further comprising adding the computed deformation of the target region into preoperative planning based on the acquisition of more than one tomographic data set.

4. The method of claim 1, wherein generating a correspondance further comprises generating a deformation model for representing the correlation between the external and the internal patient motion further comprising generating a single snapshot so that the patient is instructed to return to the position within the respiration cycle corresponding to this single point.

5. The method of claim 1, wherein generating a correspondance further comprises generating a deformation model for representing the correlation between the external and the internal patient motion further comprising generating a series of snapshots to obtain a model for the correlation between the internal and the external motion, generating a new intraoperative snapshot, continuously updating the model during treatment by recomputing the entire model when the intraoperative snapshot is generated.

6. The method of claim 1, wherein generating images prior to treatment further comprising gathering a series of treatment data from more than one patient, generating a general model from the series of treatment data for the motion correlation between the external and the internal motion wherein the general model is used to one or more of infer the internal position data at fewer time points and without using internal fiducial markers.

7. The method of claim 1 further comprising moving a treatment beam in response to the correspondance of the internal and external motion.

8. The method of claim 1 further comprising moving the individual leaves of a multileaf collimator dynamically in response to the correspondence of the external and internal motions.

9. The method of claim 1 further comprising gating the treatment in response to the correspondance between the internal and external motions so that the treatment is switched on and off periodically.

10. The method of claim 7, wherein the treatment beam moving further comprises compensating for the time lag between a command to move the treatment beam and the movement of the treatment beam by determining the placement of the target region at a future time from the deformation model.

11. The method of claim 10, wherein the compensation further comprises determining the periodicity of the pulsation motion and the respiration motion.

12. The method of claim 1 further comprising distinguishing between voluntary patient motion and respiratory motion by comparing an actual internal placement of the target region to a placement of the target region inferred from a deformation model and recomputing the deformation model whenr the deviation between actual internal placement of the target region and the inferred placement of the target region exceeds a threshold value.

13. The method of claim 1 further comprising delineating the target region shown in an image generated prior to the treatment and matching the delineation to the three dimensional shape of the target region shown in the images generated prior to the treatment in order to determine the position of the target region.

14. The method of claim 13, wherein the delineating further comprises projecting the three dimensional shape of the target region generated by the images generated prior to treatment onto the periodically generated positional data.

15. An apparatus for compensating for breathing and other motions of the patient during treatment, the apparatus comprising:

a first detection device for periodically generating positional data about the internal target region;

a second detection device for continuously generating positional data about pulsation motions within the patient; and

a processor that receives the positional data about the internal target region and the pulsation in order to generate a correspondence between the position of the internal target region and the pulsation so that the treatment is directed towards the position of the target region of the patient based on the positional data obtained from the pulsation sensors.

16. The apparatus of claim 15 further comprising a third sensor for continuously generating positional data about respiratory motion and wherein the processor receives the positional data for the internal target region, the respiratory sensor and the pulsation sensor to compensate for the respiration and pulsations motions of the patient.

17. The apparatus of claim 15 further comprising a treament beam having a multileaf collimator wherein the individual leaves of the multileaf collimator are moved dynamically in response to the correspondance of the external and internal motions.

18. The apparatus of claim 15 further comprising a treatment beam having a gating element so that, in response to the correspondance between the internal and external motions, the treatment beam is switched on and off periodically.

19. A method for compensating for breathing and other motions of the patient during treatment, the method comprising:

generating images of the target region prior to the treatment;

periodically generating ultrasound images indicating positional data about the internal target region;

determining the current position of the internal target region based on the ultrasound images so that the treatment is directed towards the position of the target region of the patient based on the ultrasound image.

20. The method of claim 19 further comprising repositioning an ultrasound camera in order to make the target region visible in the ultrasound images.

21. The method of claim 19, wherein the repositioning further comprises remotely operating a robotic arm connected to the ultrasound camera in order to reposition the camera.

22. The method of claim 21, wherein generating ultrasound images further comprises preventing the ultrasound device or robotic arm from applying undesirable force to the patient using a force sensor.

23. The method of claim 21, wherein generating the ultrasound images further comprises positioning a liquid filled cushion between the ultrasound device and the patient to improve the ultrasound pictures.