Method for pre-irradiation preparation and irradiation and treatment-diagnostics table for use with the method

FIELD: methods and devices for treatment of oncology patients using sources of ionizing radiation, namely, technology of pre-irradiation preparation and irradiation during intracavitary and interstitial radiotherapy.

SUBSTANCE: method for pre-irradiation preparation and irradiation includes positioning the patient on treatment-diagnostics table, inserting into cavity to be irradiated of hollow applicators with imitators of ionizing radiation sources, controlling position thereof relatively to target being irradiated with usage of x-ray television device, building of dosimetric plane and irradiation, while applicators inserted into cavity being irradiated are connected to treatment-diagnostics table, x-ray radiography is performed with output of image onto monitor of viewing station of x-ray television device, image via the interface is transported into planning system, dosimetric plane of irradiation is computed, which is then exported into system for controlling device and irradiation procedure is performed. Treatment-diagnostics table has frame, two supporting posts with overhung table top mounted on them, consisting of a pelvic-dorsal and two extending leg sections, connected to pelvic-dorsal section by means of twin joints. For connection of applicator table is provided with mounting pillar.

EFFECT: possible irradiation directly near apparatus without moving the patient during x-ray control of position of applicators and, therefore, increased quality of radiotherapy and therapeutic efficiency, decreased duration of pre-irradiation preparation.

2 cl, 3 dwg

 

The present invention relates to methods of treating patients with malignant tumors and can be used at contact (intracavitary and interstitial) radiation therapy using ionizing radiation sources.

Contact radiation therapy is conducted in two stages - predlozena preparation and irradiation.

Predlozena training includes introduction to the exposed cavity (tissue) hollow applicators, introduction to the applicators simulators sources of radiation, monitoring the position of the applicator relative to the irradiated target, determining the coordinates of the spatial location of the sources (imitators), the calculation of the radiation irradiation plan and implementation plan using the apparatus for contact radiotherapy.

The known method preglacial training and exposure in contact radiation therapy [1], in which the irradiated enter the cavity applicators, put on a gurney and transported the patient to the x-ray Cabinet, shift the patient from the gurney to the table of the x-ray apparatus and perform radiographic introduced into the cavity applicators, the patient is again placed on a gurney and transported to the office of radiation therapy, during this time, the x-ray film showing, fixed and dried, and then mounted on the digitizer, the read position is Nata radiation sources and bring them into the planning system, calculate the dosimetric plan using the planning system and write it to a floppy disk. A floppy disk is inserted into the system unit control apparatus for contact radiotherapy computer and perform radiation treatment.

The disadvantages of this method are the possibility of uncontrolled bias applicators for lifting and transport of the patient, especially after controlling for their position and, consequently, the possibility of rejection of the implemented plan radiation from prescribed, which can lead to radiation complications in the neighboring tumor healthy tissue, nedoobsudili or incorrect irradiation of a tumor, reduce therapeutic efficacy. In addition, this technology creates discomfort for the patient when lifting and transport, increasing the duration of training in connection with the lifting and transportation, manifestation, fixing and drying of x-ray film, laborious and tedious process of reading the coordinates of the sources using the digitizer.

The closest analogue is the prototype of the present invention is a method [2], in which the irradiated enter the cavity applicators, put the patient on the stretcher, carry the patient into the office tomography, put the patient on the table of the MRI scanner, perform tomography vvedennyh cavity applicators, put on a gurney and transported the patient to the office of radiation therapy, removed the tomogram export in the planning system, calculate the dosimetric plan of irradiation, the irradiation plan can be exported to the system management apparatus and perform radiation treatment.

The disadvantages of the prototype are the same drawbacks as in the similar [1]associated with the lifting and transportation of the patient, and the use of unnecessarily expensive stationary equipment (scanner, simulator etc).

The proposed solution eliminates the disadvantages of the prototype and provides technical result - improving quality assurance of radiation therapy and therapeutic efficacy due to the stability of the provisions introduced into the exposed cavity applicators and compliance of the implemented plan radiation prescribed in the plan.

This goal is achieved due to the fact that the way preglacial training and exposure, which consists in laying the patient on a medical diagnostic table, the introduction of irradiated hollow cavity applicators with imitators of sources of ionizing radiation, control of their position relative to the irradiated target using x-ray installation, preparation of dosimetric plan and exposure introduced into the exposed cavity applicators is yxiuut to treatment table, perform x-rays to display images on the monitor viewing station x-ray installation, the image interface exported to the planning system, calculate the dosimetric plan radiation, which is then exported to the system management apparatus and perform radiation treatment.

An example of the method.

The proposed method can be carried out using the medical diagnostic table 1 (see figure 1) with tripod for fixing the applicator. The design of the table makes it possible to bring the x-ray image amplifier 2 x-ray installation 3 under the countertop with simultaneous placement of the x-ray emitter 4 over laid on the table 5 patients. To plan the exposure system used for dosimetric planning 6, to implement the apparatus for contact radiotherapy 7 remote control 8.

When preglacial preparation and irradiation of the proposed method in irradiated enter the cavity applicators and fix them to the medical diagnostic table 1, are x-rays on x-ray installation 3, export x-ray image in the system of dosimetric planning 6, calculate the dosimetric plan exposure, export plan in the remote control apparatus 8 for radiation therapy and conduct radiation.

The use of the proposed method eliminates the need for lifting and transportation of the patient after insertion of applicators (which ensures the stability of their position relative to the target), applications of x-ray film with the lengthy procedure of its manifestations, fixing, drying, eliminating the need for laborious and tedious procedure of reading the coordinates of radiation sources using the digitizer, the use of bulky and expensive control devices (scanner, simulator, stationary x-ray apparatus and the like) by providing the possibility of obtaining x-ray images directly on the spot of irradiation, export images in the system of dosimetric planning and subsequent export plan exposure control system of the apparatus for contact radiotherapy and the implementation of irradiation procedures.

Implementation of the proposed method using a known medical diagnostic tables is not possible to obtain the claimed technical result. Known table (couch) for radiation treatment of cancer patients [1]. The couch is from the top (stove) for placement of a patient, the frame with wheels and a lifting mechanism for adjusting the height of the couch.

The disadvantage of this table (couch) is nebo is the possibility of x-ray or x-ray control provisions introduced into the exposed cavity applicators in connection with employment podpalennogo space lifting mechanism and other elements of the design. In this regard, control of the position of the applicators is carried out on a stationary x-ray machine with subsequent delivery to the patient gurney in the study of radiation therapy and putting the patient on the couch, this can cause uncontrolled displacement of the applicator relative to the target, therefore, uncontrolled deviation of the implemented plan radiation from prescribed, which can lead to radiation complications in the neighboring healthy tissues, nedoobsudili or overexposure of the target.

The closest analogue prototype is the table [3] for patient positioning used in a combined device for diagnosis and radiotherapy and ensuring the orientation of the irradiated target in the body of the patient relative to the radiation beam due to the movement of the table top in any of the three orthogonal directions of up-down, forward-backward, left-right.

The disadvantages of this table is the inability to create conditions for introduction into the exposed cavity of the applicator and its rigid fixation and, therefore, a possible shift in the position of the applicator from the prescribed or reject the implemented plan radiation from prescribed

The proposed technical solution for implementing the inventive method diagnostic table eliminates the disadvantages of protot the PA and provides technical result - improving the quality assurance of radiation therapy and therapeutic efficacy due to the stability of the provisions introduced into the exposed cavity applicators relative to the target and thereby ensure compliance with the implemented plan exposure is prescribed.

This technical result is ensured by the fact that the medical diagnostic table for preglacial training and exposure that contains the frame, radiolucent table top, wheels with brakes, tabletop consists of pelvic-dorsal and two detachable relative to each other foot sections with connecting castle, United by a double hinge with pelvic-dorsal section and a cantilever mounted on two supporting pillars of the framework, the table is equipped with a tripod to commit introduced into the exposed cavity applicators consisting of a horizontal rod mounted on the crossbar of the frame, and provided with a hinge placed in it a vertical rod, providing vertical and horizontal movement, turns back and forward vertical rod placed on its upper end a ball joint with the jaws to clamp applicator.

The proposed device, medical diagnostic table, shown in figure 2 (General view). Figure 3 shows a table with divorced foot sections.

On Fig and 3: 1 - pelvic-dorsal section countertops, 2 - foot sections, 3 - dual hinge and foot sections, 4 - supporting frame uprights, 5 - horizontal rod tripod for fixing the applicator 6 is a transverse cross-bar frame, 7 - joint, 8 - clip hinge 9 is a vertical rod tripod, 10 - ball joint, 11 - sponge for fixing the applicator, 12 - arm clamp, 13 - applicator, 14 - step, 15 - podkolennik.

Work with a table as follows (for example gynecology).

By pressing the connecting lock the foot part 2 extended and rotated around the vertical axis, dual hinge, disposed in the direction of rotation around the horizontal axis down. The footrest 14 is moved into position. The patient is placed on the table top in position convenient for insertion into the exposed cavity of the applicator (using podkolennik 15). After introduction into the exposed cavity of the applicator 13 and orientation relative to the target using the arm 12 is fixed between the jaws 11, using the ability to move left-right, up-down, vertical rod 9 in the hinge 7 and it twists back and forth around the horizontal rod 5. Foot section is returned to its original position, legs sore from podkolennik down on the foot part, to the applicator connect the device to contact the radiation therapy, perform radiographic introduced into the cavity applicators, image export in a system of dosimetric planning, expect dosimeter irradiation plan, export it to the system control apparatus for contact radiotherapy and perform radiation treatment.

As follows from the above, the sliding performance of the foot sections provides easy access for inspections and the introduction of irradiated cavity applicators.

Console execution countertops frees up space under it to summing amplifier x-ray image x-ray installation, thus providing a possibility x-ray control provisions introduced into the exposed cavity applicators and conducting irradiation procedures in one place, eliminating the necessity of moving the patient and his transportation ensures a stable position of the irradiated cavity applicators, the compliance of the implemented plan prescribed irradiation, improving quality assurance and therapeutic efficacy of radiation therapy reduces the duration preglacial training, eliminates the discomfort for the patient and staff.

Method and device successfully tested in the treatment of cancer patients.

LITERATURE

1. The Low Dose Rate Remote Alterioading Selectron LDR Prospect company STEPHANIX, The Netherlands, p.6, 7.

2. VariSource. The prospectus of the company VARIAN, 7, 9, 10.

3. Claim US No. 2003/0048868 A1 2003

1. The way preglacial training and exposure, which consists in laying the patient on a medical diagnostic table, the introduction of irradiated hollow cavity applicators with imitators of sources of ionizing radiation, control of their position relative to the irradiated target using x-ray installation, preparation of dosimetric plan and irradiation, characterized in that it introduced into the exposed cavity applicators is fixed to the treatment table, perform x-rays to display images on the monitor viewing station x-ray installation, the image interface export in the planning system: calculate dose plan radiation, which is then exported to the system management apparatus and perform radiation treatment.

2. Diagnostic table for preglacial training and exposure that contains the frame, radiolucent table top, wheels with brakes, characterized in that the surface consists of pelvic-dorsal and two detachable relative to each other foot sections with connecting castle, United by a double hinge with pelvic-dorsal section and a cantilever mounted on two supporting pillars of the frame, and the frame f is Yong tripod to commit introduced into the exposed cavity applicators.



 

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