Method and apparatus for selective internal radiation therapy planning and implementation

• US 8,738,115 B2
• Filed: 05/11/2010
• Issued: 05/27/2014
• Est. Priority Date: 05/11/2010
• Status: Active Grant

• Current Assignee: Siemens Healthineers AG (Siemens AG)
• Original Assignee: Siemens AG
• Inventors: Amberg, Jessica, Deuerling-Zheng, Yu, Ferschel, Sigrid, Lautenschlaeger, Stefan, Meissner, Oliver
• Primary Examiner(s): Jung, Unsu
• Assistant Examiner(s): FISHER, MICHAEL NAPOLEON
• Application Number:
  US12/777,575
• Publication Number:
  US 20110282193A1
• Time in Patent Office: 1,477 Days
• Field of Search: 600/312, 600/317, 600/321, 600/325, 600/329, 600/407, 600/419, 600/420, 600/433, 600/436, 600/437, 600/454, 600/456, 424/1.11, 424/9.3
• US Class Current: 600/427
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/4441 the rigid structure being a C-arm or U-arm
• CPC Class Codes: A61B 6/4458 the source unit or the detector unit being attached to robotic arms
• CPC Class Codes: A61B 6/481 involving the use of contrast agents
• CPC Class Codes: A61B 6/487 involving fluoroscopy
• CPC Class Codes: A61B 6/504 for diagnosis of blood vessels, e.g. by angiography
• CPC Class Codes: A61B 6/5217 extracting a diagnostic or physiological parameter from medical diagnostic data
• CPC Class Codes: G16H 20/17 delivered via infusion or injection
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 30/40 for processing medical images, e.g. editing

Abstract

In a method and system for planning and implementing a selective internal radiation therapy (SIRT), the liver volume and the tumor volume are automatically calculated in a processor by analysis of items segmented from images obtained from the patient using one or more imaging modalities, with the administration of a contrast agent. The volume of therapeutic agent that is necessary to treat the tumor is automatically calculated from the liver volume, the tumor volume, and the body surface area of the patient and the lung shunt percentage for the patient. The therapeutic agent can be administered via respective feeder vessels in respectively different amounts that correspond to the percentage of blood supply to the tumor from the respective feeder vessels, this distribution also being automatically calculated by analysis of one or more parenchymal blood volume (PBV) images.

Claims

1. A method for planning and implementing a selective internal radiation therapy (SIRT), comprising the steps of:

providing a processor with a large volume dataset of a patient who is to undergo SIRT, said large volume dataset encompassing the entire liver of the patient, said liver having a tumor therein fed with blood by feeder vessels emanating from a main branch;

in the processor, automatically segmenting the liver from surrounding tissue in said large volume dataset by executing a computerize segmentation algorithm, and automatically calculating the volume of the liver from the segmented liver;

injecting contrast agent into said main branch for said feeder vessels and acquiring a contrast-enhanced tomographic volume dataset from the patient comprising a contrast-enhanced tumor and contrast-enhanced feeder vessels that supply blood to said contrast-enhanced tumor;

in said processor, automatically segmenting said contrast-enhanced tumor and said contrast-enhanced feeder vessels from surrounding tissue in said contrast-enhanced volume dataset by executing a computerize segmentation algorithm;

in said processor, automatically calculating the volume of the tumor from the segmented contrast-enhanced tumor;

determining a lung shunt percentage for said patient;

determining the body surface area (BSA) of the patient;

in said processor, automatically calculating an amount of therapeutic agent for use in said SIRT for treating said tumor, from the BSA, the lung shunt percentage, the liver volume, and the tumor volume;

obtaining a live fluoroscopic image of the liver of the patient during SIRT and overlaying the segmented contrast-enhanced liver and the segmented contrast-enhanced feeder vessels on said live fluoroscopic image, to obtain an overlay image;

using said overlay image, positioning a catheter with respect to at least one of said feeder vessels; and

via said catheter, administering the calculated amount of said therapeutic agent during SIRT.

2. A method as claimed in claim 1 comprising calculating a volume of radioactive microspheres as said therapeutic agent, and administering the calculated volume of radioactive microspheres during SIRT.

3. A method as claimed in claim 1 comprising acquiring each of said large volume dataset and said contrast-enhanced volume dataset using a robotic computed tomography system.

4. A method as claimed in claim 1 comprising, during SIRT, acquiring a further tomographic volume dataset encompassing the liver of the patient and using said further tomographic volume dataset to overlay said segmented contrast-enhanced tumor and said segmented contrast-enhanced feeder vessels on said live fluoroscopic image with an anatomically correct, for said patient, registration with respect to the liver in said overlay image.

5. A method as claimed in claim 1 comprising:

for each tumor and for each feeder vessel feeding each tumor, acquiring a parenchymal blood volume (PBV) scan of the liver of the patient using an imaging modality with contrast-agent injected successively into each of said feeder vessels;

in said processor, automatically analyzing each of said PBV scans to identify a percentage of blood supply to each tumor produced by each of said feeder vessels; and

controlling administration of said therapeutic agent to administer respective amounts of said therapeutic agent to said tumor via the respective feeder vessels thereto corresponding to the percentage of blood supplied to the tumor by each of said feeder vessels.

6. A system for planning and implementing a selective internal radiation therapy (SIRT), comprising:

a tomographic imaging modality;

a control unit configured to operate said tomographic imaging modality to generate a large volume dataset of a patient who is to undergo SIRT, said large volume dataset encompassing the entire liver of the patient, said liver having a tumor therein fed with blood by feeder vessels emanating from a main branch;

a processor supplied with said large volume dataset and configured to automatically segment the liver from surrounding tissue in said large volume dataset by executing a computerize segmentation algorithm, and automatically calculate the volume of the liver from the segmented liver;

a contrast agent injector;

said control unit being configured to operate said tomographic imaging modality and said contrast agent injector to inject contrast agent into said main branch for said feeder vessels and to acquire a contrast-enhanced tomographic volume dataset from the patient comprising a contrast-enhanced tumor and contrast-enhanced feeder vessels that supply blood to said contrast-enhanced tumor;

said processor being configured to automatically segment said contrast-enhanced tumor and said contrast-enhanced feeder vessels from surrounding tissue in said contrast-enhanced volume dataset by executing a computerize segmentation algorithm;

said processor being configured to automatically calculate the volume of the tumor from the segmented contrast-enhanced tumor;

said processor also being supplied with an input representing a lung shunt percentage for said patient and an input representing the body surface area (BSA) of the patient, and said processor being configured to automatically calculate an amount of therapeutic agent for use in said SIRT for treating said tumor, from the BSA, the lung shunt percentage, the liver volume, and the tumor volume;

a fluoroscopic imaging modality configured to obtain a live fluoroscopic image of the liver of the patient during SIRT and to overlay the segmented contrast-enhanced liver and the segmented contrast-enhanced feeder vessels on said live fluoroscopic image, to obtain an overlay image;

a catheter that is positioned dependent on said overlay image, with respect to at least one of said feeder vessels; and

said catheter being connected to a source of said therapeutic agent and being operated to administer the calculated amount of said therapeutic agent during SIRT.

7. A system as claimed in claim 6 wherein said processor is configured to calculate a volume of radioactive microspheres as said therapeutic agent, and wherein said source of therapeutic agent is a source of said radioactive microspheres.

8. A system as claimed in claim 6 wherein said tomographic imaging modality is a robotic computed tomography system.

9. A system as claimed in claim 6 wherein said control unit is configured to operate said tomographic imaging modality during SIRT to acquire a further tomographic volume dataset encompassing the liver of the patient and wherein said fluoroscopic imaging modality is configured to use said further tomographic volume dataset to overlay said segmented contrast-enhanced tumor and said segmented contrast-enhanced feeder vessels on said live fluoroscopic image with an anatomically correct, for said patient, registration with respect to the liver in said overlay image.

10. A system as claimed in claim 6 wherein:

said control unit is configured to operate said tomographic imaging modality and said contrast agent injector to acquire for each tumor and for each feeder vessel feeding each tumor, a parenchymal blood volume (PBV) scan of the liver of the patient with contrast-agent injected successively into each of said feeder vessels;

said processor is configured to automatically analyze each of said PBV scans to identify a percentage of blood supply to each tumor produced by each of said feeder vessels; and

said catheter is successively positionable with respect to each of said feeder vessels to administer respective amounts of said therapeutic agent to said tumor via the respective feeder vessels thereto corresponding to the percentage of blood supplied to the tumor by each of said feeder vessels.