Radiosurgical Ablation of the Myocardium

• US 20090080610A1
• Filed: 09/26/2008
• Published: 03/26/2009
• Est. Priority Date: 09/26/2007
• Status: Active Grant

• Current Assignee: Varian Medical Systems Incorporated (Siemens AG)
• Original Assignee: Cyberheart, Inc. (Siemens AG)
• Inventors: Young, Roderick A., Maguire, Patrick, Sumanaweera, Thilaka
• Granted Patent: US 8,315,691 B2
• Time in Patent Office: Days
• US Class Current: 378/65
• CPC Class Codes: A61N 2005/1059 using cameras imaging the patient
• 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 5/1039 using functional images, e.g. PET or MRI
• 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

Abstract

The invention provides a non-invasive system and method for treatment of the heart. In a first aspect, a method for treatment of an anatomical site related to arrhythmogenesis of a heart of a patient comprises creating a target shape encompassing the anatomical site, directing particle beam radiation or x-ray radiation from outside the patient toward the target shape wherein one or more doses of radiation ablates the target shape and disregarding at least one orientation of cardiac motion while creating the target shape or directing the particle beam or both.

Claims

1. A method for treatment of an anatomical site related to arrhythmogenesis of a heart of a patient, the method comprising:

creating a target shape encompassing the anatomical site;

directing particle beam radiation or x-ray radiation from outside the patient toward the target shape wherein one or more doses of radiation ablates the target shape; and

disregarding at least one orientation of cardiac motion while creating the target shape or directing the particle beam or both.

2. The method of claim 1, wherein disregarding cardiac motion includes not compensating for cardiac motion of less than 2 mm.

3. The method of claim 1, wherein disregarding cardiac motion includes disregarding cardiac motion in the direction along which the motion is the least.

4. The method of claim 1, wherein disregarding cardiac motion includes disregarding cardiac motion in two orientations.

5. The method of claim 1, wherein disregarding cardiac motion includes disregarding motion in three dimensional space.

6. The method of claim 1, wherein directing particle beam radiation or x-ray radiation from outside the patient toward a target shape is done with an accuracy of better than 2 mm.

7. The method of claim 6, wherein an accuracy of better than 2 mm is within the range of cardiac motion at or within 2 mm plus or minus, certain portions of the heart.

8. The method of claim 1, further comprising compensating for respiratory motion.

9. The method of claim 8, wherein the anatomical site includes an ostium of a pulmonary vein (PV).

10. The method of claim 8, wherein the anatomical site includes a cavotricuspid isthmus (CTI).

11. The method of claim 8, wherein the patient is having ventricular tachycardia and/or ventricular fibrillation and the anatomical site includes a valve annulus, a ventricular site, ventricular outflow tract, or within or outside of a ventricular aneurysm.

12. The method of claim 8, wherein compensating for respiratory motion includes motion greater than 2 mm.

13. The method of claim 12, wherein the anatomical site includes a pulmonary vein (PV).

14. The method of claim 12, wherein the anatomical site includes a cavotricuspid isthmus (CTI).

15. The method of claim 12, wherein the anatomical site includes an Atrioventricular (AV) node or junction, Sinoatrial (SA) node, His-Purkinje fibers, or ablation of these areas are necessary to control and treat aberrant arrhythmias.

16. The method of claim 12, wherein the anatomical site includes an atrial or ventricular site.

17. The method of claim 1, wherein the anatomical site includes neural fibers near or adjacent to the heart (ganglionic) or neural fibers in the chest or neck.

18. The method of claim 1, wherein creating a target shape includes registration by combining two or more images selected from the group consisting of a Computer Tomography (CT) scan, a Magnetic Resonance Image (MRI) scan, a sonogram, an X-ray, an angiogram, electrophysiologic map or PET scan.

19. The method of claim 1, wherein creating a target shape includes using one or more fiducials.

20. The method of claim 1, wherein the one or more doses is between 15-80 Gy.

21. The method of claim 1, wherein creating a target shape includes determining anatomical structures proximate to the target shape when determining a dose strength of the one or more doses.

22. A system for treatment an anatomical site related to arrhythmogenesis of a heart of a patient, the system comprising:

an apparatus configured to create a target shape encompassing the anatomical site, wherein the apparatus disregards at least one orientation of cardiac motion, including not compensating for cardiac motion of less than 2 mm; and

a particle beam radiation or x-ray radiation device configured to direct one or more doses of radiation from outside the patient toward the target shape to ablate the target shape.

23. The system of claim 22, wherein disregards at least one orientation of cardiac motion further includes disregarding cardiac motion in the direction along which the motion is the least.

24. The system of claim 22, wherein disregards at least one orientation of cardiac motion further includes disregarding cardiac motion in two orientations.

25. The system of claim 22, wherein disregards at least one orientation of cardiac motion further includes disregarding motion in three dimensional space.

26. The system of claim 22, wherein the apparatus compensates for respiratory motion.

27. The system of claim 22, wherein create a target shape includes registration by combining two or more images selected from the group consisting of a Computer Tomography (CT) scan, a Magnetic Resonance Image (MRI) scan, a sonogram, an X-ray, an angiogram, electrophysiologic map or PET scan.

28. The system of claim 22, wherein create a target shape includes using one or more fiducials.