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 , 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 , 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 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 . 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  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.
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.
FIELD: irradiating devices adapted to relative displacement of radiation source and part being irradiated.
SUBSTANCE: proposed device that has electron accelerator with slit-type outlet window and castor-mounted modules is provided in addition with paired modules whose castors are of different diameters and are installed on axles of modules in increasing or decreasing order of their diameters, order of castors installation on axles within each pair of modules being similar; modules of each pair are disposed either side of outlet window against one another and their axes are parallel and are crossing plane of outlet window disposition, and also they cross or are intersected with axes of modules of one or more pairs. Where module castors are of different diameter, these diameters vary in arithmetical progression whose difference equals double pitch of their disposition on module axle multiplied by tan α, where α is angle between module axle carrying castors and plane of outlet window disposition.
EFFECT: improved quality of irradiated parts, such as cables, due to their uniform irradiation.
2 cl, 6 dwg
FIELD: medicine, in particular, radiotherapy.
SUBSTANCE: during irradiation of oncology patients on cobalt distance apparatuses dose field is formed by injecting topographic-anatomic information of patient into dose planning system and generating with its consideration of main dose field on basis of results of calculations of main dose field, dose deficiency area is located within limits of target and iso-centers of additional dose fields are positioned therein, while width of radiation beams, generating additional dose fields, is less than width of beam of main dose fields 1,5-2,5 times, while value of dose of main field is 0,7-0,85 of resulting dose within limits of target.
EFFECT: possible generation of dose field with minimal possible dose change on target while simultaneously decreasing radiation loads on normal tissues and skin.
2 dwg, 1 ex
FIELD: medicine, in particular, oncology.
SUBSTANCE: in accordance to method, thermo-radio-therapy of malignant tumors is performed in form of split course in mode of enlarged dynamic fractioning of dose in 6 fractions of 4 Gy and 8 fractions of 2 Gy in first course, and 6 fractions of 4 Gy and 3 fractions of 2 Gy in second course in conjunction with hyper-thermal effect in the same day when radio-therapy is performed.
EFFECT: increased apparent counter-tumor local effect.
FIELD: medicine, namely, medicinal use of radiation, possible use for determining dose really received by pathologic focus having absorbed open radioactive nuclide.
SUBSTANCE: method for verification of dose during medicinal usage of open radioactive nuclides includes measuring intensiveness of radiation, with consideration of changes in radiation source activity in time, during that, by means of tissue-equivalent phantom, original intensiveness of radiation of open radionuclide is measured immediately prior to injecting it into organism of patient as well as average intensiveness of radiation from focuses having absorbed radionuclide, and after that individual relative dose of open radionuclide injected into pathologic focuses is computed using formula
where Dn/o - value of relative dose in %, Io - original intensiveness of radiation at the moment of injection of radionuclide, In - average intensiveness of radiation from focuses at day or hour of measurement of n, B0 and Bn - background values of radiation intensiveness at the moment of injection of radionuclide and at the day of measurement, respectively, k - coefficient of daily or hourly decomposition of radionuclide, n - number of days or hours having passed since the moment of injection of radionuclide.
EFFECT: invention allows verification of relative dose in most precise and individual manner.
FIELD: medical facilities.
SUBSTANCE: device can be used as a tool for malignant tumors surgery. Device for radionuclide surgery has gamma radiation detector, collimator and handle. Wire of detector is connected with measuring unit. Gamma radiation detector is fixed in metal tip with sharpened side edge, which passes in plane being perpendicular to optical axis of gamma radiation detector. Detector is made in form of semiconductor crystal; two collimators adjoin opposite surfaces of crystal. Collimators have cells which pass in parallel to optical axis of gamma detector. Measuring unit has electronic circuit with sonic signal source.
EFFECT: ability of reaching area of lesion for removing it.
4 cl, 2 dwg
SUBSTANCE: device belongs to wide spectrum of influence devices, which is able to make prophylactic and medicinal influence onto human body; in particular, it can be used for destroying benign and malignant tumors and other concentrated formations. Device for making physiotherapeutic effect has control unit and influence localization unit connected with influence localization area. It also has hard base and unit for movement along x, y and z coordinates. Physiotherapeutic device is made in form of frame mounted onto hard base for shift in linear coordinates x, y and z, and n physiotherapeutic influence sources. The sources are disposed along perimeter of frame, which frame is connected mechanically with corresponding outputs of shift unit along coordinates x, y and z. Inputs o shift unit are connected with corresponding outputs along coordinates x, y and z of control unit. Corresponding inputs of control unit are connected with additional outputs of shift unit along coordinates x, y and z. Control input of control unit is connected with output of influence localization unit.
EFFECT: improved efficiency of physiotherapeutic effect; reduced negative reactions of organs and tissues surrounding the area.
13 cl, 5 dwg
SUBSTANCE: method involves administering Wobenzyme combined with brachytherapy with radiomodification and transpupillary thermotherapy or combined with isolated transpupillary thermotherapy. When combined with brachytherapy with radiomodification, Wobenzyme is given 2 days before brachytherapy at a dose of 3 pills 3 times a day with the exception of 8 h before fixation and removal of β-applicator. Next to it, Wobenzyme is given at a dose of 4-6 pills 3 times a day during 3 months. Then, the dose is reduced by 2 pills every month at the fourth, fifth and sixth months. Adjuvant transpupillary thermotherapy is carried out 6 months later after brachytherapy. Wobenzyme is given at a dose of 2-3 pills 3 times a day 2 days before transpupillary thermotherapy. Then, the dose is 4-6 pills 3 times a day during 2 months with following dose reduction by 3 pills every month to prophylactic dose of 1 pill a day. When carrying out isolated transpupillary thermotherapy, Wobenzyme is given in the same mode that it was the case when carrying out adjuvant transpupillary thermotherapy after brachytherapy. To prevent metastasis occurrence, Wobenzyme administration is continued at a dose of 1 pill 7 days every month during the first year and at a dose of 1 pill 3 days every month during the second observation year.
EFFECT: accelerated resorption processes; reduced risk of radiation treatment complications.
FIELD: medicine, oncology.
SUBSTANCE: one should carry out radiation therapy with quick neutrons 6.3 Mev twice weekly in two stages: at the first stage it is necessary to prescribe 3-4 seances of neutron therapy at interval of 48-72 h directly onto area of tumoral relapse and onto surrounding normal tissues at the distance of about 3-5 cm against tumoral foci, single focal dosage being 1.6-2.0 Gy, relative biological efficiency corresponds to 2.91-2.79, onto the skin - 2.0-2.2 Gy, up to total focal dosage being 6.6±1.5 Gy, onto the skin - 8.3±1.3 Gy, at the second stage it is necessary to carry out gamma- or electronic therapy at single focal dosage being 2.0-3.0 Gy, 5 fractions weekly, moreover, total course dosage of neutron-photon irradiation per a focus corresponds to 60 Gy by isoeffect at duration of irradiation course of about 20-25 d.
EFFECT: higher efficiency of therapy.
2 dwg, 3 ex
SUBSTANCE: assembly can be used for revealing pathologic cells when determining elemental composition of matter from gamma-radiation, for example, from 59Fe isotope stored in mammal gland. Gamma-spectrometry assembly for inspection of mammal gland has patient's chair, collimators, radiation protection, drives for moving chair, spectrometer, ionizing radiation detectors and control board. Collimators are disposed in radiation protection aid and they are made of material which well absorbs ionizing radiation. Collimators are mounted for direction of radiation onto ionizing radiation detectors. Collimators and ionizing radiation detectors are mounted in unit with cavities in form of cups for placing objects to be tested.
EFFECT: improved radiation safety.
2 cl, 3 dwg
FIELD: medicine, ophthalmology.
SUBSTANCE: before the onset of protonotherapy one should surgically withdraw eyelids beyond bony orbital borders for the purpose of complete prevention of complications associated with blepharoirradiation at conducting protonotherapy and creating conditions for the next valuable prosthetics. Thus, after external canthotomy one should make two through vertical incisions of the upper eyelid up to bony orbital border at developing a P-shaped fragment of the upper eyelid, moreover, internal incision should be made about 2-3 mm laterally against the upper lacrimal point, and external one - against internal edge of canthotomic incision. Then one should apply per one P-shaped suture onto both external and internal angles of the fragment, moreover, it is necessary to puncture in needles from cutaneous side of the fragment by applying ligatures in palpebral thickness at capturing a cartilage and perform punctures out into intramarginal space. Similarly, one should apply a single similar P-shaped suture onto the lower eyelid in area of its middle part. The ends of P-shaped sutures should be fixed without tightening frontal and buccal skin, correspondingly. Before carrying out the seance of protonotherapy it is necessary to tighten sutures till eyelids come beyond bony orbital borders, and on finishing the seance of protonotherapy sutures should be weakened till the moment of palpebral juncture.
EFFECT: higher efficiency of prophylaxis.
1 cl, 1 dwg, 1 ex
FIELD: medicine, oncology.
SUBSTANCE: one should carry out morphological testing of therapy results, moreover, in the course of therapy it is necessary to conduct immunohistochemical study for the levels of Ki-67 antigen expression, markers to protein-negative regulator of apoptosis: p53 and Bcl-2 and the level of melanoma marker expression HMB-45 and at decreased levels against the values in untreated tumors it is possible to state upon therapy as efficient. The innovation enables to achieve high clinical efficiency of therapy due to applying neoadjuvant autohemochemotherapy in combination with radiation therapy.
EFFECT: higher accuracy of detection.
FIELD: medicine, oncology.
SUBSTANCE: the present innovation deals with treating patients with uterine cervix cancer with relapses in parametral fiber and in case of no possibility for radical operative interference and effect of previous radiation therapy. During the 1st d of therapy one should intravenously inject 30 mg platidiam incubated for 1 h at 37 C with 150 ml autoblood, during the next 3 d comes external irradiation per 2.6 G-r. During the 5th d of therapy one should introduce the following composition into presacral space: 60 ml 0.5%-novocaine solution, 1 ml hydrocortisone suspension, 2 ml 50%-analgin solution, 1 ml 0.01%-vitamin B12 solution, 1.6 g gentamycine, 800 mg cyclophosphan, 10 mg metothrexate. These curative impacts should be repeated at mentioned sequence four times. The method enables to decrease radiation loading and toxic manifestations of anti-tumor therapy at achieving increased percent of tumor regression.
EFFECT: higher efficiency of therapy.
FIELD: medicine, oncology.
SUBSTANCE: invention relates to a method for treatment of uterus body topically spread cancer involving applying chemotherapy and intrauterus irradiation. Method is carried out by the following manner: at the 1-st day of treatment cyclophosphan is administrated in the dose 1200-1600 mg by interstitial paratumoral route; at the 2-d day cream-like based fluorouracil in the dose 300-550 mg or adriablastin in the dose 20-30 mg is administrated into uterus cavity; on the next day sйance of intracavitary irradiation is carried out in the dose 10 Gr. All these procedures are repeated three times with interval for 6 days. Method provides high topical concentrations of chemopreparations in tumor zone in reducing their adverse toxic effect that results to the curative effect of patients of elderly age with accompanying therapeutic diseases.
EFFECT: improved method for treatment.
SUBSTANCE: method involves carrying out argon plasma of tracheal and/or bronchial lumen recanalization by applying power of 60-90 W with argond discharge rate being 2.0-2.4 l/min large. Brachitherapy is applied next to it moving the source with 5 mm large step. Trajectory length is 5 to 20 cm large. Reference isodose depth is 10 mm far from the source with applicator moving above and below the tumor from 1 to 3 cm. Dose from 14 to 28 Gr is to be administered once a week in 7 Gr large portions.
EFFECT: enhanced effectiveness of treatment; reduced risk of complications; prolonged remission period.
FIELD: medical equipment; radiation therapy.
SUBSTANCE: radioactive source has radioisotope disposed inside air-tight biocompatible container. At least some part of container is made profiled and have rough, non-smooth surface. Radioactive source is made by loading it inside air-tight container. Composition has assemblage of radioactive sources mounted in line onto biologically decomposed material. Invention helps to improve ultrasonic visibility of source and/or reduce the trend of source to migrate in patient's body after implantation.
EFFECT: improved quality of treatment.
22 cl, 8 dwg