[go: up one dir, main page]

WO2010078048A2 - Appareil et procédé pour immobiliser le sein sous traction et compression simultanées pour l'imagerie et les interventions - Google Patents

Appareil et procédé pour immobiliser le sein sous traction et compression simultanées pour l'imagerie et les interventions Download PDF

Info

Publication number
WO2010078048A2
WO2010078048A2 PCT/US2009/068508 US2009068508W WO2010078048A2 WO 2010078048 A2 WO2010078048 A2 WO 2010078048A2 US 2009068508 W US2009068508 W US 2009068508W WO 2010078048 A2 WO2010078048 A2 WO 2010078048A2
Authority
WO
WIPO (PCT)
Prior art keywords
breast
chamber
patient
particle beam
chest
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2009/068508
Other languages
English (en)
Other versions
WO2010078048A3 (fr
Inventor
Jerry M. Jesseph
Frederick B. Jesseph
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
THERAPY POSITIONING TECHNOLOGIES LLC
Original Assignee
THERAPY POSITIONING TECHNOLOGIES LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by THERAPY POSITIONING TECHNOLOGIES LLC filed Critical THERAPY POSITIONING TECHNOLOGIES LLC
Publication of WO2010078048A2 publication Critical patent/WO2010078048A2/fr
Publication of WO2010078048A3 publication Critical patent/WO2010078048A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/04—Positioning of patients; Tiltable beds or the like
    • A61B6/0407—Supports, e.g. tables or beds, for the body or parts of the body
    • A61B6/0421—Supports, e.g. tables or beds, for the body or parts of the body with immobilising means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
    • A61B90/17—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins for soft tissue, e.g. breast-holding devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/30—Surgical pincettes, i.e. surgical tweezers without pivotal connections
    • A61B2017/306—Surgical pincettes, i.e. surgical tweezers without pivotal connections holding by means of suction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B2090/101—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis for stereotaxic radiosurgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/44—Constructional features of apparatus for radiation diagnosis
    • A61B6/4423—Constructional features of apparatus for radiation diagnosis related to hygiene or sterilisation

Definitions

  • One embodiment of the present invention is a method of treating a tumor mass location in a breast of a patient, including directing an isocenter of a particle beam at a center of a spherical portion of an outer chamber that overlaps the tumor mass location after passing the particle beam through a first fluid at least partially filling the outer chamber. Next it passes the beam through a second fluid at least partially filling an inner chamber having a reduced pressure environment that encompasses at least a portion of the breast. While beaming the patient's breast compressive force is maintained. The compressive force is against at least a portion of the patient's chest and is created using a plate that is fixed to the inner chamber with an airtight seal.
  • the particle beam is a proton particle beam
  • the first fluid and the second fluid are the same and have an electron density substantially similar to the breast.
  • Another refinement of the embodiment includes rotating the particle beam and the breast relative to one another while continuing to direct the isocenter of the particle beam at the center of the spherical portion of the outer chamber. Another refinement of the embodiment includes creating the relative rotation by moving a robotic arm connected to a treatment platform upon which the patient lays. [0007] Another refinement of the embodiment includes deactivating the particle beam at various times while rotating the particle beam and the breast relative to one another. In another refinement of the embodiment the particle beaming occurs after a surgical intervention on the breast, and further comprising deactivating the particle beam when the particle beam would otherwise pass through an existing incision site on the breast.
  • Another refinement of the embodiment includes deactivating the particle beam when the beam would otherwise pass through a planned future incision site on the breast.
  • Another refinement of the embodiment includes directing the particle beam so that it only passes through an underside of the breast of the patient.
  • Another refinement of the embodiment includes first imaging the breast and obtaining data regarding the tumor mass location within the breast and providing the data to a computer directing the particle beams at the breast.
  • Another embodiment of the present invention is a method of treating a tumor mass location of a breast, including directing an isocenter of a particle beam toward a center of a spherical portion of a chamber enclosing the breast and through a fluid having an electron density substantially similar to the breast.
  • the center of the spherical portion of the chamber overlaps the tumor mass location, and the particle beam is substantially normal to the spherical portion of the chamber.
  • the method further includes applying a compressive force while beaming against at least a portion of a chest wall around the breast.
  • the compressive force is created using a plate that is fixed to the chamber with an airtight seal.
  • One refinement of the embodiment includes rotating the breast and spherical portion of the chamber relative to the particle beam to scan through a plurality of particle beam entry angles into the breast while continuing to direct the particle beam substantially normal to the spherical portion of the chamber.
  • Another refinement of the embodiment includes directing the particle beam only through an underside of the breast.
  • Another refinement of the embodiment includes deactivating the particle beam except when scanning an underside of the breast.
  • Another refinement of the embodiment includes rotating the breast and spherical portion of the chamber relative to the particle beam by moving a robotic arm connected to a treatment platform upon which the patient lays.
  • Another refinement of the embodiment includes deactivating the particle beam at various times while rotating the particle beam and the breast relative to one another.
  • Another refinement of the embodiment includes first imaging the breast and obtaining data regarding the tumor mass location within the breast and providing the data to a computer directing the particle beam at the breast.
  • the imaging is done using a combination of 3-D ultrasound and CT.
  • Another embodiment of the present invention is a method of treating a tumor mass location of a breast of a patient.
  • the method includes applying a compressive force against at least a portion of a chest wall around the breast using a plate that is fixed to an inner chamber with an airtight seal.
  • the method further includes reducing pressure within the inner chamber that encloses at least a portion of the breast after creating a fluid tight seal between the inner chamber and the patient.
  • the inner chamber is at least partially filled with a fluid having an electron density substantially similar to the breast, and positions an outer chamber at least partially filled with the fluid so that a center of a spherically shaped portion of the outer chamber overlaps the tumor mass location.
  • a particle beam is scanned across an arc of a portion of the outer chamber while directing an isocenter of a particle beam at the center of the portion.
  • One refinement of the embodiment includes scanning the particle beam only across an underside of the breast.
  • Another embodiment of the present invention is a method of treating a breast cancer tumor mass location.
  • the method includes stabilizing the breast by simultaneously applying a compressive force to a portion of a chest wall using a plate and providing a reduced pressure environment via a chamber in a fixed spatial relationship with respect to the plate.
  • the method further includes applying an isocenter of a particle beam to a center of spherical portion of an at least partially fluid filled chamber that encloses at least a portion of the breast.
  • the fluid has an electron density substantially similar to the breast, and the center overlaps the tumor mass location.
  • the breast is stabilized by providing a reduced pressure environment around the breast.
  • Another refinement of the embodiment includes providing the reduced pressure environment using a fluid tight seal between a wall defining an inner chamber and a patient's body, and positioning the hemispherical portion of the chamber around at least a portion of the breast.
  • Another refinement of the embodiment includes first imaging the breast to determine data regarding the tumor mass location within the breast, and providing the data to a computer controlling the application of the particle beam.
  • Another embodiment of the present invention is a method of treating a tumor mass location in a breast of a patient, including stabilizing the breast within a reduced pressure environment enclosed by a chamber having a wall at least a portion of which is spherically shaped; imaging the breast to determine the location of the tumor; beaming the tumor with particles through the spherically shaped portion of the chamber; and rotating the beam relative to the tumor mass location around a center of the spherically shaped portion of the chamber, wherein the center overlaps the tumor mass location.
  • the patient is prone on a treatment platform, and the patient is rotated with respect to at least one stationary particle beam.
  • Another refinement of the embodiment includes directing the particle beam only through an underside of the breast.
  • Another refinement of the embodiment includes deactivating the particle beam except when scanning an underside of the breast. [00029] Another refinement of the embodiment includes using fiducial markers positioned within or on the breast to identify the tumor mass location.
  • the chamber is filled with a fluid having an electron density substantially similar to the breast.
  • the beaming is controlled to overlap a biopsy track along which prior surgical intervention of the breast has occurred.
  • Another embodiment of the present invention is an apparatus for treating a tumor location in a breast, including a first wall having an interior surface defining a first chamber sized to encompass at least a portion of the breast.
  • the apparatus includes tensive and compressive means for stabilizing the breast within the first chamber.
  • This apparatus also includes a second wall having an internal surface defining a second chamber, the second wall including a spherical (or cylindrical) portion around a center.
  • the first chamber is smaller than and positioned substantially within the second chamber, and the second chamber is movable with respect to the first chamber to position the center of the spherical portion to overlap the tumor location.
  • an edge of the first wall includes an adhesive for attaching the first wall to the breast in a substantially fluid tight fashion.
  • the adhesive is a replaceable tape.
  • the spherical portion of the second wall is substantially hemispherically shaped.
  • at least a portion of the first wall is substantially hemispherically shaped.
  • the spherical portion of the second wall is substantially hemispherically shaped.
  • At least a portion of the first wall is visually transparent.
  • Another refinement of the embodiment includes a fat equivalent fluid at least partially filling the first chamber and the second chamber.
  • the means for stabilizing the breast within the first chamber is a reduced pressure environment generated by a pump fiuidly connected to the first chamber by a conduit connected to a first port in the first wall, and wherein the conduit passes through a second port in the second wall.
  • the first wall defines a first port and further includes a valve within the first port.
  • first and/or second wall is manufactured from a material that may be sterilized for reuse.
  • first and/or second wall is a plastic.
  • first and/or second wall is a composite.
  • Another embodiment of the present invention is an apparatus for treating a tumor location in a breast including a first shell having an interior surface defining a first chamber sized to encompass at least a portion of the breast. At least a portion of the shell defines a spherical portion having a center. At least a portion of the first chamber is filled with a fluid having an electron density substantially similar to breast tissue.
  • the apparatus further includes tensive and compressive means for stabilizing the breast within the first shell.
  • the portion of the first shell is substantially hemispherically shaped.
  • an edge of the shell includes an adhesive for attaching the shell to the breast in a substantially fluid tight fashion.
  • the adhesive is a replaceable tape
  • an edge of the shell includes molding shaped to overlay an area around the breast.
  • Another refinement of the embodiment includes a second shell having an internal surface defining a second chamber.
  • the second shell includes a spherical portion around a second center, and the first chamber is smaller than and positioned substantially within the second chamber.
  • the second chamber is movable with respect to the first chamber to position the second center to overlap the tumor location.
  • Another refinement of the embodiment includes the fluid at least partially filling the second chamber.
  • the means for stabilizing the breast within the first chamber is a reduced pressure environment generated by a pump fluidly connected to the first chamber by a conduit connected to a first port in the first shell.
  • the conduit passes through a second port in the second shell.
  • the shell defines a port.
  • Another refinement of the embodiment includes a valve in the port of the shell.
  • first and/or second wall is manufactured from a material that may be sterilized for reuse.
  • the apparatus includes a chest plate and an adjustable arm having a first portion attached to the chest plate, and a second portion attached to a patient platform.
  • the arm is movable from a first position to a second position in which the chest plate exerts pressure on a patient.
  • the chest plate is shaped to contour to at least a portion of the human female anterolateral chest.
  • the chest plate defines an opening through which the breast may protrude.
  • the embodiment further includes a chamber for providing a reduced pressure environment.
  • An air tight seal is present between a first side of the chest plate and the chamber.
  • the arm is attached to the patient platform by at least one hinge.
  • the embodiment further includes at least one inflatable bladder attached to a second side of the chest plate.
  • the embodiment further includes a plurality of inflatable bladders attached to a second side of the chest plate.
  • the embodiment further includes instrumentation for measuring the pressure in at least one of the inflatable bladders.
  • the embodiment further includes instrumentation for monitoring the compressive force exerted by the chest plate against the patient.
  • the instrumentation may be in communication with any of the patient, the chest plate, one or more inflatable bladders, the arm, and/or the coupling between the arm and the patient support or robotic couch.
  • the chest plate includes a plurality of attached segments.
  • at least some of the segments are adjustable with respect to adjacent segments.
  • a first side of each segment is attached to a chamber for providing a reduced pressure environment.
  • An air tight seal is present between the first side of the chest plate and the chamber.
  • a second side of each segment includes a damper attached thereto.
  • the damper is an inflatable bladder.
  • the embodiment further includes padding.
  • the padding is located between the patient and the chest plate.
  • the padding is between the patient and the patient support or robotic couch.
  • the padding and/or bladders may be custom fitted to a patient.
  • the padding and/or bladders may be designed or configured for a specific patient configuration or combination of an arm, a chest plate and a robotic couch.
  • Another embodiment of the present invention is an apparatus for fixation of a patient's breast.
  • the apparatus includes a chest plate shaped to at least partially conform to the anterolateral chest of a human mammal, a chamber affixed with an airtight seal to the chest plate, and a rigid member connecting the chest plate to a platform upon which a patient may lay.
  • the member may translate from a first relaxed position to a second compressive position.
  • the member translates from a first or no contact patient position into a second or patient contacting position.
  • the arm and chest plate are positioned to provide compressive forces to at least a portion of the chest of the patient receiving treatment using a device secured to the patient using the arm and chest plate.
  • Another embodiment of the present invention is a method for stabilizing the breast for an imaging or interventional procedure. The method includes positioning a chest plate with an opening so that the breast protrudes through the opening into a chamber attached to the chest plate by an airtight seal. The method further includes reducing the pressure in the chamber while pressing the chest plate against the patient.
  • the tension/compression breast stabilization apparatus or treatment support includes a chest plate contoured to conform at least partially to the shape of a female human chest; an opening in the chest plate sized to allow passage of a female human breast; a chamber coupled to the chest plate so that the interior of the chamber is over the opening in the chest plate; a treatment platform; and an arm connected to the chest plate and moveably coupled to the patient support.
  • the chamber interior is has a generally hemispherical shape.
  • the chamber interior is sized to envelop a breast within the opening.
  • the arm at least partially encircles the chest plate or at least partially encircles the chamber.
  • the damper is a bladder, or a bladder is filled with a fluid.
  • a pump connected to the interior of the bladder configured to adjust the amount of fluid inside the bladder.
  • a gauge connected to measure the pressure within the bladder.
  • moveably coupled includes rotation about a hinge that joins the arm to the patient support.
  • moveably coupled includes sliding the arm relative to the patient support to adjust the spacing between the chamber and the patient support.
  • the arm is coupled to the treatment table or robotic couch using a sliding or lift arrangement.
  • a pneumatic cylinder, a pulley, a rack and pinion or other suitable mechanical or electromechanical linkage or system may be provided to adjust the position and orientation of the arm relative to the treatment table or robotic couch.
  • the patient support is a robotic couch having a robotic coupling configured to mate securely to a computer controller robotic patient positioning system.
  • the tension/compression breast stabilization apparatus would be coupled to a patient table using any suitable means, including a dual coupler system.
  • the patient table is part of a computer controlled patient positioning system that uses a robot to maneuver the patient table to allow a patient on the patient table to be measured, diagnosed or treated with therapy.
  • FIG. 1 illustrates a side cross-sectional view of one embodiment of a breast fixation apparatus encompassing at least a portion of a breast having a tumor.
  • FIG. 2 illustrates a side cross-sectional view of the embodiment of a breast fixation apparatus of FIG. 1 in which the spherical portion of the fixation apparatus is centered on a tumor mass location in a different location within the breast.
  • FIG. 3 illustrates a top view of a fixation apparatus of the present invention enclosing a breast with a tumor.
  • FIG. 4 illustrates a side view of a treatment apparatus of the present invention.
  • FIG. 5 illustrates a side cross-sectional view of an inner chamber of a multi- chamber fixation and treatment apparatus of the present invention.
  • FIG. 6 illustrates a side cross-sectional view of the inner chamber and outer chamber of a multi- chamber fixation and treatment apparatus of the present invention.
  • FIG. 7 illustrates a top view of a compressive/tensive fixation apparatus of the present invention enclosing a breast.
  • FIG. 8 is an end view of a compressive/tensive fixation apparatus of the present invention enclosing a breast.
  • FIG. 9 is a top perspective view of a patient laying on a beam treatment platform with the breast stabilized by an embodiment of the present invention.
  • FIG. 10 is an end view of a compressive/tensive fixation apparatus of the present invention enclosing a breast.
  • the current standard of care for treatment of breast cancer includes anesthesia, surgery, lymphatic tracing and sampling, along with post operative radiation therapy of part, or all, of the breast.
  • a patient who develops breast cancer has no choice but to accept scarring and deformity of the breast - or to have the breast removed entirely.
  • the present invention is a novel method and apparatus to treat breast cancers (particularly early-stage breast cancers) using protons, or other heavy ion particle beams.
  • particle beam includes those particle beams that have undergone testing and/or clinical evaluation such as protons, carbon, pions or pi mesons, helium (alpha particles), neon, iron and even anti-matter in the form of anti-protons.
  • Particle beam radiotherapy has shown superior dose distribution in tissues, and provides new opportunities for the treatment of breast cancer.
  • Partial breast radiation has shown increasing promise in the treatment of early stage cancer, thus particle therapy appears to be a feasible approach.
  • Many variations in technique along with different fractionation schedules are possible.
  • the approach of the present invention could provide for shorter treatment times and better cosmetic results, and could prove to be more cost effective as well.
  • One challenge for radiation of the breast has been reproducibly immobilizing the breast for treatment planning and proper targeting.
  • high skin dosage represents another challenge.
  • Various embodiments of the present invention provide for improved treatment options.
  • the methods and apparatus of the present application are preferably used in conjunction with a proton or carbon particle beam. While other particle beams might at present hint at better clinical results (such as anti-protons), cost constraints in the production or use of other particle beams might preclude their widespread usage. Results from proton and carbon beam treatments for cancers, such as ophthalmic melanomas, head and neck tumors, chordomas, and, recently, prostate and lung cancers are very encouraging. Particle beam treatments have the ability to provide tumoricidal dosage within tissues with millimeter geometric accuracy along with precision dosage accuracy while sparing surrounding normal tissues. Given existing economic tradeoffs, proton beams are presently preferred. However, the usage of other particle beams is contemplated as within the scope of the invention unless specifically claimed otherwise herein.
  • Image acquisition and/or treatment planning preferably include stabilization of the breast.
  • such stabilization of the breast is accomplished using a means for stabilizing the breast, such as a breast fixation apparatus.
  • a breast fixation apparatus examples of such a breast fixation apparatus are described in U.S. Patent No. 6,254,614, entitled “DEVICE AND METHOD FOR IMPROVED DIAGNOSIS AND TREATMENT OF CANCER,” that issued on 3 July 2001, and U.S. Patent Application Ser. No. 12/644,970 entitled “Apparatus and Method for the treatment of breast cancer with particle beams” filed on December 16, 2009, the contents of each of these is incorporated herein by reference.
  • the preferred breast fixation apparatus stabilizes the breast in space by providing a reduced pressure environment around the breast. Stabilizing the breast in space allows reproducible positioning, and permits determination and recordation of various data sets concerning, for example, tumor mass location, using imaging techniques. In one embodiment, imaging is preferably done using a combination of CT and 3-D ultrasound. This allows for precise fusion of data with options for better clarification of tissue characteristics. [00079] The current standard of care involves surgical intervention (with associated anesthesia, incision site(s), etc.) with post-operative radiation therapy.
  • a tumor is at least partially, but preferably entirely, surgically excised from the breast followed by particle beam therapy. Additionally, the methods and apparatus of the present invention might find use as a pre-operative form of therapy.
  • tumor mass location is intended to be construed broadly. It should be understood that the term tumor mass location might refer to the location of an existing tumor mass within the body. However, it should further be understood that as used herein a tumor mass location is present even in those instances in which particle beam therapy is preceded by surgical intervention in which the tumor mass is partially and/or entirely excised. Even after, for example, a lumpectomy removal of cells, the location of the resultant cavity (that fills with fluid and shrinks and closes after the surgery) is considered the tumor mass location. Similarly, when referring to or claiming herein treatment of a breast cancer tumor, it is contemplated as within the scope of the invention that such refers to treatment of the location of an existing tumor or to the location at which a tumor was thought present prior to surgical intervention.
  • the exterior surface 110 of a breast 100 of a patient having a tumor mass location 105 requiring treatment is placed at least partially (and, as illustrated in FIG. 1, preferably entirely) within a fixation apparatus 120.
  • the breast fixation apparatus 120 preferably includes at least one port 125 connected to a pump 130 by a conduit 123.
  • the conduit 123 or the breast fixation apparatus 120 preferably includes a valve at port 125. The presence of such a valve in conjunction with use of a conduit 123 that is detachable from the port 125 permits the pump 125 to reduce the pressure within, and then the valve is closed and conduit 123 can be removed.
  • fixation apparatus 120 might be pressed against the body by a strap or band (not illustrated) that extends around the patient to be tied, or tightened similar to a belt.
  • the fixation apparatus might be constructed as part of a bra-like apparatus for retention on the patient's chest and breast(s).
  • the cup-like fixation apparatus 120 is preferably at least partially spherical (the portion of apparatus 120 in FIG. 1 that lies below the imaginary line 119 that passes through the center 135 of the spherical portion).
  • the fixation apparatus 120 preferably includes a substantially rigid plastic spherical portion with an outer surface 121 and an inner surface 122.
  • the plastic (or composite) is preferably substantially transparent to the particular imaging modality (or modalities) used.
  • An internal cavity 124 exists between the inner surface 122 of fixation device and the exterior surface 110 of the breast 100.
  • the cavity 124 is preferably filled with fluid 150. Aspects of fluid 150 are discussed further below.
  • the center 135 of the spherical portion of fixation apparatus 120 is preferably at the center, or substantially overlaps the center, of the tumor mass location 105.
  • a tumor mass location is not necessarily a symmetrical volume, and thus the concept of a center for the tumor mass location is broader than the typical geometrical concept of a center of a circular area or spherical volume.
  • the center of the tumor mass location will be selected to maximize the energy dose delivered by the incident particle beam to potentially cancerous cells while minimizing the dose received by healthy surrounding tissue.
  • the energy dose resulting from the particle beam is typically modeled as a spherical volume with smaller dosages received the further the distance from the isocenter of the particle beam.
  • an oddly shaped tumor mass location might be treated as having more than one center to subject to treatment by particle beam therapy.
  • multiple overlapping spheres of smaller radius resulting from the particle beam energy dose might be preferred to a single sphere of a larger radius.
  • a particle beam 140 is directed at the tumor mass location 105 along a single trajectory designated by the lines making up rectangle 155.
  • Particle beam 140 is aimed at the center 135 (see FIG. 1) of the spherical portion of fixation apparatus 120, and the particles are intended to have a penetration depth that extends to that center with a maximum energy dose release in a substantially spherical volume 157 within breast 100.
  • Particles that travel a trajectory normal to the surface of the spherical portion of the fixation apparatus 120 have an equal path of electron density to the center of the hemisphere.
  • the spherical volume traversed by the particle beam preferably includes either breast tissue or fluid 150.
  • the fluid 150 acts as a compensator to allow delivery of spread-out Bragg peak energies precisely to the tumor mass location 105 and to a precise margin (volume 157 of FIG. 2) of the surrounding tissues. In one refinement of this embodiment, this is accomplished by placing the tumor center (preferably tagged with a fiducial marker during surgery) at the center of the sphere created by the fixation device.
  • the fixation, apparatus retains within it the electron-isodense fluid medium and the breast tissue itself.
  • Fluid 150 is preferably a fat equivalent fluid (such as water) that has an electron density substantially similar to that of the breast.
  • fluid is intended to encompass both liquids and gels, it being understood that a gel is contemplated as within the scope of the invention for filling the interior volume of the chamber (or chambers as in below described embodiments) surrounding the breast.
  • the fluid 150 within volume 124 of fixation apparatus 120 is preferably held at a slightly reduced pressure to expand the breast 100 to its structural envelope. It should be understood that fluid 150 only needs to be present in the portion of volume 124 that is below the imaginary line 119 that partially delineates the spherical portion of fixation apparatus. However, fluid 150 might fill the entire cavity between the exterior surface 110 of breast 100 (and the chest wall) and internal surface 122 of fixation apparatus 120. Air is pumped out of the internal cavity 124 through port 125 by pump 130. The fluid 150 preferably replaces the air as it is pumped out, but might be pumped in before or after pumping out the air. For patient comfort, the fluid 150 is preferably first heated to approximately body temperature.
  • the rim of the fixation apparatus 120 requires a substantially fluid tight seal between the rim of the fixation apparatus 120 and the patient's body.
  • the rim might include patient specific molding 128 that is shaped to conform to the chest of the patient's body, and to provide a fluid tight seal. It should be understood, however, that it is contemplated as within the scope of the invention that the rim of the fixation apparatus may be attached entirely to the chest, entirely to the breast, or to some combination of the chest and breast.
  • fiducial markers are positioned to identify a location relative to, and preferably substantially at or near to the center of the tumor mass location.
  • Treatment planning with a particle beam also includes determination of the isocenter of treatment and the dose.
  • isocenter is the position at which there is a maximum of the energy dose delivered by the particle beam.
  • the isocenter of the treatment preferably is at the center of the tumor mass location 105.
  • the breast 100 is placed in a reduced pressure environment within fixation apparatus 120.
  • the reduced pressure environment is preferably filled with a fat equivalent fluid 150.
  • a first particle beam 185 is applied with an isocenter that overlaps the tumor mass location 105.
  • the patient is then rotated (as indicated by the arrows 186), with the beam off, and a second particle beam 195 is applied having an isocenter that overlaps the tumor mass location 105, preferably at the same position as the first particle beam.
  • Both the particle beam 185 and the particle beam 195 travel substantially identical path radii (labeled as distance X in FIG. 3) to the center of the spherical.
  • the particle beam could be on the entire time during patient rotation and scan across the surface of the breast while being aimed or directed (having an isocenter) at the tumor mass location 105.
  • the dose will preferably include a tumoricidal sphere 200 around the tumor 105, and a larger sphere 220 of lesser dosage.
  • treatment is provided to the breast using the breast fixation apparatus.
  • the patient is preferably in a prone position, so that the isocenter 305 overlaps the center of a spherical portion 300 projecting below the movable treatment platform 400.
  • the cavity 324 within the spherical portion will be filled with a fluid 350 whose electron density is similar or identical to that of the breast tissue.
  • the same reduced pressure environment preferably exists within cavity 324 as used for imaging and/or treatment planning.
  • This provides a compensator for the path of the particle beam, which, in fact, converts any size and shape of breast into a substantially spherical shape along a range of potential trajectories.
  • Such a compensator allows more straightforward beam energy calculations and equidistance to the tumor mass location from any point on the outer surface 321 of the breast fixation apparatus 320.
  • treatment preferably proceeds with a low-angle gantry trajectory aimed at the isocenter.
  • the patient will be rotated (as indicated by arrow 460) around the isocenter with the beam on. This will smear the skin dosage around the breast and allow for simple changes of gantry angle to allow multiple arcs of treatment.
  • the patient may be spun about the isocenter (that overlaps the tumor mass location) preferably with a beam of constant energy.
  • the gantry angle may be changed and the same patient motion from before may be used.
  • tumors of irregular shape might preferably be subject to beam energies of greater energy along select entry angles into the breast.
  • tumors of irregular shape might instead, or in addition, require beaming more than one center of a tumor mass location.
  • FIGs. 5-6 illustrate aspects of a dual chamber apparatus for fixation and treatment of a breast.
  • FIG. 5 illustrates an inner chamber 520 of an embodiment that could allow for improved placement of the tumor at the center of the outer chamber 620.
  • Inner chamber 520 may be hemispherical or other shape. As illustrated in FIG. 5, inner chamber 520 is a cylindrical chamber. Outer chamber 620 (see FIG. 6) is positioned so that the tumor 505 is at the center of the larger outer chamber 620 around the inner chamber 520, the latter being fixed to the patient.
  • the exterior surface 510 of a breast 500 of a patient having a tumor mass location 505 requiring treatment is placed at least partially (and, as illustrated in FIG. 5, preferably entirely) within a fixation apparatus 520.
  • the breast fixation apparatus 520 preferably includes at least one port 525 connected to a pump 530 by a conduit 523.
  • the conduit 523 or the breast fixation apparatus 520 preferably includes a valve at port 525. Only the inner chamber need include a reduced pressure environment (or other means for stabilizing the breast).
  • the fixation apparatus 520 as illustrated is cylindrical, but other shapes
  • the fixation apparatus 520 preferably includes a substantially rigid plastic portion with an outer surface 521 and an inner surface 522.
  • the plastic or composite
  • An internal cavity 524 exists between the inner surface 522 of fixation device and the exterior surface 510 of the breast 500.
  • the cavity 524 is preferably filled with fluid 550.
  • the properties of fluid 550 are identical to previously described fluid 150.
  • the centerline axis of the cylindrical fixation apparatus 520 includes a point 535 that is preferably, but not necessarily, at the center, or substantially overlaps the center, of the tumor mass location 505.
  • the positioning of the inner chamber 520 with respect to the tumor mass location is not of particular importance.
  • the inner chamber 520 should be positioned to provide a reduced pressure environment around the breast 500 (or to otherwise accommodate some other form of means for stabilizing the position of the breast).
  • particle beam 685 is directed at the tumor mass location 505 along a first trajectory.
  • Particle beam 685 is aimed at the center 505 of the spherical portion of outer chamber 620, and the particles are intended to have a penetration depth that extends to that center with a maximum energy dose release in a spherical volume within breast 500.
  • Particles that travel a trajectory normal to the surface of the spherical portion of the outer chamber 620 have an equal path of electron density to the center of the spherical portion. This is because the spherical volume traversed by the particle beam preferably includes either breast tissue or fluid 550.
  • the fluid 550 also at least partially fills the volume between the interior surface 622 of outer chamber 620 and exterior surface 521 of inner chamber 520.
  • the fluid 550 acts as a compensator to allow delivery of spread-out Bragg peak energies precisely to the tumor mass location 505 and to a precise margin of the surrounding tissues.
  • the dual chamber apparatus retains within it the electron-isodense fluid medium and the breast tissue itself. Again, by creating an “anatomy of advantage,” it is possible to deliver uniform dosage due to substantially identical path radii to the center of the spherical portion.
  • the fluid 550 within volume 524 of fixation apparatus 520 is preferably held at a slightly reduced pressure to expand the breast 500 to its structural envelope. Air is pumped out of the internal cavity 524 through port 525 fluidly connected by conduit 523 to pump 620. Conduit 523 also passes through a similar port 625 in the wall defining outer chamber 620. Creating the reduced pressure environment requires a substantially fluid tight seal between the rim of the fixation apparatus 520 and the patient's body. As illustrated in FIGs. 5-6, the rim might include patient specific molding 528 that is shaped to conform to the chest of the patient's body, and to provide a fluid tight seal. It should be understood, however, that it is contemplated as within the scope of the invention that the rim of the fixation apparatus may be attached entirely to the chest, entirely to the breast, or to some combination of the chest and breast.
  • FIG. 6 illustrates how the double chamber embodiment can be rotated around the center of the outer chamber 620 for application of particle beam(s).
  • the center of the at least partially spherical outer chamber 620 at least partially overlaps the center 505 of the tumor mass location.
  • the reduced pressure environment is provided by the inner chamber 520.
  • Adjustments to the outer chamber 620 can be made in a more straightforward manner by moving only the outer chamber 620, leaving the patient, and the inner chamber apparatus in contact with the patient, stationary.
  • the isocenter of the treatment preferably is at the center of the tumor mass location 505.
  • the breast 500 is placed in a reduced pressure environment within inner chamber 520.
  • the inner chamber 520 and outer chamber 620 are both at least partially filled with a fat equivalent fluid 550.
  • a first particle beam 685 is applied with an isocenter that overlaps the tumor mass location 505.
  • the patient is then rotated (with the beam off), and a second particle beam 695 is applied having an isocenter that overlaps the tumor mass location 505, preferably at the same position as the first particle beam 785. Both the particle beam 685 and the particle beam 695 travel substantially identical path radii (labeled as distance Y in FIG.
  • the particle beam could be on the entire time during patient rotation and scan across the surface of the breast while being aimed or directed (having an isocenter) at the tumor mass location 505.
  • the dose will preferably include a tumoricidal sphere around the tumor 505, and a larger sphere of lesser dosage.
  • a preferred implementation of the present invention is a skin-sparing treatment in which the dose to the skin of the breast is spread out. Minimizing of external scarring and skin damage to the breast is considered an important psychological facet to patient treatment. Leaving aside the physiological preference for spreading the dose around the breast to minimize the damage to any given portion of the skin (and underlying tissue between the skin and the tumor mass location), such psychological factors are often of critical importance to patients.
  • One potential treatment aspect of the present invention entails moving the patient (spinning around the center) during beam-on treatment so that the dose to skin (and other surrounding tissue) is spread out. This geometric dispersion allows for skin-sparing while concentrating the energy via a beam isocenter that overlaps the tumor mass location. Additionally, other treatment aspects of the present invention can be implemented to achieve similar ends. It should be understood that the angles selected for beaming do not require rotation around the full circumference of a circle on the exterior surface of the substantially spherical shape surrounding the breast. Such angles might be selected based on cosmetic effect (i.e. minimize the dosage on the more readily visible top half of the breast when the patent is standing).
  • the patient is not rotated around a circumference, but only around an arc.
  • the beam may be turned off during portions of that rotation. For example, the beam might be off when it would otherwise be scanning across the top side of the breast.
  • beaming of the breast occurs only along select trajectories, or the beam is only on at select time intervals during scanning of the same around one or more circumferences or arcs on the spherical (including, but not limited to, hemispherical) portion of the chamber enclosing the breast.
  • This is considered desirable as part of an integrated approach to treatment. Namely, some physicians might consider it preferable to avoid beaming that intersects existing wound sites in the form of incisions from past surgical intervention. Thus, in lieu of a more extended period of time in which the patient recovers from such surgical intervention, particle beam therapy might be implemented sooner after surgical intervention.
  • the apparatus for treating the breast includes an inner chamber encompassing at least a portion of the breast as illustrated in FIG. 5.
  • the breast is positioned at least partially, and preferably entirely, within an internal volume of the inner chamber.
  • the inner chamber is positioned within an internal volume of an outer chamber. Both the inner chamber and the outer chamber (as illustrated in FIG. 6) are preferably at least partially filled with a fluid having an electron density substantially similar to that of the breast.
  • Both the inner and outer chambers are preferably, but not necessarily, at least partially spherically shaped.
  • FIG. 1 illustrates a first chamber at least a portion of which has a hemispherical shape.
  • FIG. 6 illustrates an outer chamber at least a portion of which has a spherical shape.
  • portions of either or both of the inner and outer chambers might have other shapes.
  • either or both of the inner and/or outer chambers might be cylindrically shaped.
  • the shape of the inner chamber is of lesser importance, except as might pertain to shaping the same to insure that it is better secured to the patient. That is to say, insuring equivalent particle path lengths for the particle beam can be controlled by having a substantially spherical (or cylindrical) outer chamber in combination with an inner chamber whose shape need only be determined based on other considerations. Such other considerations include enclosing the breast, being at least partially filled with a fat equivalent fluid, being secured to the patient, and fitting within the outer chamber. In other words, the outer chamber should be positioned so that the tumor mass location is at the center of the spherical portion of the outer chamber.
  • the shape of the inner chamber in a multi-chamber embodiment is not as important to the issue of substantially identical path length of the particle beam (as the beam and breast are shifted relative to one another). Additionally, only portions of the outer chamber need be spherically shaped, those portions preferably comprising the appropriate trajectories for particle beaming. In other words, it is contemplated as within the scope of the invention that only some portion (whether it be an arc, or a circumference of a circle on the outer surface of a sphere) of the outer chamber need include a spherical shape (circular or other shape that has circumferential arcs in a cylindrical embodiment).
  • the outer chamber might include more than one spherical portion, and such spherical portions need not be contiguous, though each preferably will have the same center.
  • the non-contiguous spherical portions of the outer chamber might have different centers.
  • the inner chamber includes a reduced pressure environment (or other means for stabilizing the breast in space).
  • the only fluid tight seal that needs to be present is between the inner chamber and the patient's body (whether to the chest wall, the breast, or some combination of both). Since the patient is preferably lying prone no fluid tight seal is necessary for the outer chamber, the inner chamber with the breast positioned therein simply being dipped into the at least partially fluid filled outer chamber.
  • the inner chamber might be attached (via adhesive, for example) to the breast at a plurality of contact points that might be pulled substantially radially outward to draw the breast outward, that tension fixing the breast in space.
  • tension based stabilization of the breast is preferred to fixation through, for example, two or more plates that apply pressure to the breast.
  • a self-sucking kind of device could pull the breast into a cup mold of a hemisphere. Such might be accomplished by fixing the breast using a liquid or gel that solidified into the desired at least partially spherical shape.
  • Various other embodiments along these lines might omit the reduced pressure environment and/or breast fixation apparatus as disclosed in U.S. 6,254,614. Some examples of such embodiments might include plates or other grasping mechanisms for fixing the breast in space.
  • the presently preferred embodiment uses a medium surrounding the breast that is fluid and adjustable. As discussed in U.S. Patent No. 6,254,614 increased pressure might cause cancer cells to pass through the lymph system more rapidly, thus increasing the possibility that the cancer might spread to other portions of the body.
  • fixation apparatus that involve actual contact with the breast will interpose objects along at least some beam paths to the tumor mass location. The presence of such objects alters the particle path length for those trajectories that intersect such objects. This makes it more difficult to continuously scan along all possible arcs or circumferences of circles of the substantially spherical portion of the chamber that retains therein the fluid having a electron density substantially the same as the breast.
  • imaging is preferably done using a combination of CT and 3-D ultrasound.
  • imaging techniques include Magnetic Resonance Imaging (MRI), Computerized Axial Tomography (CT) [including, but not limited to, cone beam CT], 3-D radial and standard ultrasound, Positron Emission Tomography (PET) scanning, radial and other x-rays, RF targeting with fiducial markers, radio guided imaging (for example, in conjunction with a radioactive seed for localizing the tumor), and other techniques (or combinations thereof) known to those of ordinary skill in the art.
  • CT Magnetic Resonance Imaging
  • CT Computerized Axial Tomography
  • PET Positron Emission Tomography
  • RF targeting with fiducial markers for example, in conjunction with a radioactive seed for localizing the tumor
  • radio guided imaging for example, in conjunction with a radioactive seed for localizing the tumor
  • Imaging might also be accomplished in conjunction with more invasive procedures, such as via a catheter inserted into the breast with a target for an infra-red imaging system.
  • imaging modalities
  • At least some of the embodiments discussed herein preferably include breast fixation, positioning, verification, and targeting allowing for rotational accuracy in time,, speed and duration.
  • Beam energies can be applied in a number of configurations and trajectories, and, as previously mentioned, might be applied to more than one tumor mass location center within the breast as an isocenter. Complete adjustment capability during the entirety of beam transfer is preferred, with multiple safety stops to minimize or prevent patient harm.
  • the methods and apparatus of the present application are preferably used on patients in a prone position. However, use in a supine or other position is also contemplated as within the scope of the invention. The prone position, however, is more preferred.
  • the apparatus and method stabilizes the breast and provides equal radial beam distances to the tumor.
  • the anatomy of the breast is transformed to a near perfect sphere using an electron isodense fluid around the breast with the tumor centrally placed at the center of the spherical portion of the chamber. This arrangement makes treatment planning and execution much simpler.
  • this device and technique allows for "arc treatment" of the tumor caused by rotating the patient around the isocenter with the beam on - allowing for a spreading of the entrance dose to the skin over a larger area and allowing for higher dosages to be used in a shorter time.
  • the previously described apparatus for providing a reduced pressure environment assists in maintaining the breast in a maximally distended position and to resist deformation due to gravity.
  • the chest wall and torso can generate considerable motion of the breast as well.
  • Such embodiment preferably includes a firm, yet pliable chest plate.
  • the chest plate preferably functions to provide an airtight seal around the breast and chamber, and to spread the compressive forces smoothly across the chest wall and to allow protrusion of the breast outward into a reduced pressure environment chamber.
  • the chest plate is held adjacent to the body by an adjustable lever or attachment arm or arms connected to the imaging table or treatment couch.
  • the plate can be compressed against the chest wall and thereby restrict the outward expansion of the chest from breathing while allowing air exchange by way of movements of the diaphragm and abdominal wall. Additionally, this compression restricts any movement of the torso in general, but allows free movement of one or more other body parts.
  • the adjustable attachment arm is adjustable is several different aspects.
  • the arm is itself adjustable by, for example, the movements of several segments that together form the arm. Each of the segments may be adjusted relative to one another or in groups.
  • adjustable refers to the movement of arm position relative to the treatment table or robotic couch.
  • the arm is movable between positions that change the relationship between the arm and the treatment table.
  • the arm may swing relative to the treatment table such as when the arm is hinged alongside or to the treatment table or robotic couch (see FIG. 7 for example).
  • the arm may raise and lower relative to the treatment table. This type of adjustment may be provided when the arm is coupled to the treatment table or robotic couch using a sliding or lift arrangement.
  • a pneumatic cylinder, a pulley, a rack and pinion or other suitable mechanical or electromechanical linkage or system may be provided to adjust the position and orientation of the arm relative to the treatment table or robotic couch.
  • adjustable may refer to changes in the horizontal and/or vertical arrangement of the arm and robotic couch.
  • adjustable attachment arm may be used alone or in any combination in order to provide patient support and stability to address the aforementioned motion concerns.
  • adjustable refers to the horizontal separation of the arm second portion from the patient or the patient platform (i.e., less separation in order to provide stability and engage with the patient and more separation to disengage from the patient).
  • Additional variations in the implementation of a chest plate are contemplated as within the scope of the invention.
  • additional components might be included to permit further compression of the chest plate against the chest wall and to accurately calibrate and adjust the compressive force against the chest.
  • the pressure measured can be recorded and used in subsequent treatments or measurements to ensure that the prior treatment conditions including patient placement, bladder/padding configuration as well as compressive force and negative pressure are accurately replicated through a patient's course of treatment.
  • an air bladder or multiple interconnected bladders that are attached to a pressure gauge and to a simple hand pump, such as that used with a sphygmomanometer.
  • These bladders might also be used as part of the sealing mechanism, as cushions to evenly apply pressure and to adjust the measured pressure of the device against the chest wall.
  • the resulting compressive force can be measured and recorded as a treatment parameter for the patient.
  • the compressive force applied to the subcutaneous fat of the chest wall acts to push the breast tissue further outward toward the chamber by way of extrusion. This should limit or reduce the amount of negative pressure applied to the chamber to stabilize the breast itself.
  • motion is minimized via a combination of the use of tensive (negative pressure) and compressive (from the chest plate) (positive pressure) applied differentially.
  • the chest plate is preferably a rigid plate having the contour of the anterolateral chest.
  • the chest plate has a hole to allow protrusion of the breast outward and into the negative pressure chamber.
  • a lever arm connects the chest plate to the couch or treatment platform or an extension beneath the patient.
  • the plate is compressed against the chest wall by a vice-like compression.
  • Pneumatic bladders in and around the chest plate can be used to seal the chamber, adjust for variations in chest contour and allow for fine adjustment, (see FIGs. 8 and 10)
  • the chest compression will transmit no breathing motion to the breast and allow for diaphragmatic breathing primarily.
  • the chest compression will also allow for locally restricted motion of the thorax.
  • the "tooth paste” effect With increasing amounts of fat in the subcutaneous region of the chest wall, one would expect a great propulsive protrusion of the breast tissue out into the chamber (the "tooth paste” effect).
  • the tension/compression breast stabilization apparatus or treatment support will include a reduced pressure chamber attached to a chest plate.
  • the reduced pressure chamber is preferably affixed with an airtight seal to a chest plate.
  • the reduced pressure chamber may take the form of the illustrated embodiments, those shown or described above in FIGs. 1, 5 or 6, or any of the embodiments described in U.S. Patent No. 6,254,614, entitled “DEVICE AND METHOD FOR IMPROVED DIAGNOSIS AND TREATMENT OF CANCER,” that issued on 3 July 2001, and/or U.S. Patent Application Ser. No. 12/644,970 entitled “Apparatus and Method for the Treatment of Breast Cancer with Particle Beams” filed on December 16, 2009.
  • the chest plate conforms to the shape of the anterolateral chest.
  • the chest plate is preferably centered on the breast, with an opening allowing protrusion of the breast into the reduced pressure chamber.
  • the chest plate is preferably composed of a single layer or multiple layers of material.
  • the plate attaches to an adjustable positioning arm or arms.
  • the arm or arms attach the chest plate to the treatment platform (robotic couch, imaging or interventional table, etc.) or any other adjacent or self-contained portion of the imaging or treatment assembly that serves to stabilize the arm and thence the chest plate.
  • the tension/compression apparatus further includes a plurality of dampers are positioned between the chest plate and the patient.
  • the dampers are fluid filled bladders.
  • compression air bladders might be used to cushion and conform the chest plate to the chest wall.
  • the bladder may also provide an airtight seal against the skin of the chest.
  • the pressure within the bladders may be adjustable so that the inflatable bladders might be used to adjust the actual, measurable pressure of the chest plate 710 against the chest wall.
  • the size, configuration and pressure of the bladders may be documented for each patient in order to permit reproduction of the patient specific treatment environment used during imaging and/or treatment.
  • padding is provided for positioning and patient comfort at locations on the torso, arms, head and neck. Padding may also be form fitted to the patient and used to aid in patient immobilization during imaging or treatment.
  • FIG. 7 illustrates an embodiment of a single arm 715 that is connected at ends 714 to a hinge 716 that is in turn connected to treatment platform or robotic couch 730.
  • FIG. 8 illustrates an embodiment of the tension/compression breast stabilization apparatus that includes a plurality of dampers are positioned between the bottom end of the chest plate 710 and the anterolateral chest of the patient 722 adjacent to the breast 700. Such dampers might be, for example, one or more fluid filled inflatable bladders 720. At least one compression arm 715 is used to press the chest plate 710 against the patient.
  • Compression arm 715 has a first portion 712 attached to the chest plate 710 and a second portion 714 attached to the treatment platform 730.
  • the lever arm 715 pivots using hinge 716.
  • other mechanisms for attaching a second portion 714 (preferably an end) of the lever arm 715 are contemplated as within the scope of the invention, as are translation mechanisms other than pivoting.
  • a contoured padding 780 is incorporated into or placed on the treatment platform 730.
  • the padding 780 may provide patient comfort and/or provide immobilization or stability. It is contemplated as within the scope of the invention that similar padding positioned between the patient's arm and/or shoulder and, for example, the compression arm 715 might be present. Additionally or alternatively, the padding 780 may only be on one side or only adjacent a portion of the patient 722 as shown in FIG. 8.
  • FIG. 9 there is illustrated embodiment of the tension/compression breast stabilization apparatus.
  • the patient 722 rests upon treatment platform 930 coupled to a pole 902.
  • the patient 722 is illustrated as undergoing beam therapy from particle beam source (not shown) delivered through a nozzle 910.
  • the nozzle 910 is precisely aimed at the immobilized breast 700 of the patient 722.
  • the chest plate 710 is preferably attached to the treatment platform 930 by two lever arms 911,913 that are affixed via, for example, hinges 916, 918 to the platform 930.
  • the treatment platform 930 is a robotic couch having a coupling mechanism configured to mate securely to a computer controller robotic patient positioning system. Additional details of this embodiment are described in U.S. Patent Application Publication No. US 2009/0070936 entitled “Patient Positioner System” filed on September 11, 2008, the entirety of which is incorporated herein by reference.
  • the tension/compression breast stabilization apparatus would be coupled to the patient table 50 using any suitable means, including the dual coupler system 52.
  • the patient table 50 is part of the patient positioning system 20 that uses robot 22 to maneuver the patient table 50 as described in paragraphs [0040-0047] and shown in FIGs. 1, 2 and 3 of U.S. Patent Application Publication No. US 2009/0070936 which are specifically incorporated herein by reference.
  • a number of existing imaging technologies can be used with one or more of the embodiments discussed herein for stabilization for imaging, biopsies and interventions.
  • the images thus obtained can be used for further surgical interventions and treatment planning and targeting for treatments with ionizing radiation and particle beams. Examples include whole breast irradiation, partial breast irradiation, brachytherapy and other invasive and non-invasive ablative technologies.
  • Reliable and reproducible immobilization of the breast opens many other opportunities for targeted diagnostics and treatments.
  • the morbidities of inaccurate breast position and stabilization are well known, especially in dosages of radiation given to the heart and lungs in standard therapies.
  • further precision in limiting breast motion will allow for great advances in registration and analysis of data sets from the differing imaging modes of ultrasound, X-ray and MRI.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Medical Informatics (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Veterinary Medicine (AREA)
  • Pathology (AREA)
  • Public Health (AREA)
  • Biomedical Technology (AREA)
  • General Health & Medical Sciences (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Neurosurgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • High Energy & Nuclear Physics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Optics & Photonics (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Apparatus For Radiation Diagnosis (AREA)
  • Radiation-Therapy Devices (AREA)

Abstract

L’invention concerne un appareil et un procédé pour traiter une masse cancéreuse située dans le sein d’une patiente. Le sein est stabilisé dans l’espace, de préférence par la création d’un environnement sous pression réduite autour du sein en combinaison avec une force de compression appliquée sur la paroi de la poitrine autour du sein. Des faisceaux de particules sont dirigés vers la masse cancéreuse positionnée au centre d’une partie sensiblement sphérique (ou cylindrique) d’une chambre remplie avec un fluide ayant une densité électronique sensiblement similaire à celle du sein. La plate-forme de traitement de patient est soumise à une translation pour diriger le faisceau de particules sur la masse cancéreuse, le faisceau de particule traversant et se diffusant perpendiculairement à la partie de la chambre.
PCT/US2009/068508 2008-12-17 2009-12-17 Appareil et procédé pour immobiliser le sein sous traction et compression simultanées pour l'imagerie et les interventions Ceased WO2010078048A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US20193308P 2008-12-17 2008-12-17
US61/201,933 2008-12-17

Publications (2)

Publication Number Publication Date
WO2010078048A2 true WO2010078048A2 (fr) 2010-07-08
WO2010078048A3 WO2010078048A3 (fr) 2010-10-14

Family

ID=42310552

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2009/068508 Ceased WO2010078048A2 (fr) 2008-12-17 2009-12-17 Appareil et procédé pour immobiliser le sein sous traction et compression simultanées pour l'imagerie et les interventions

Country Status (1)

Country Link
WO (1) WO2010078048A2 (fr)

Cited By (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2011014966A1 (fr) * 2009-08-06 2011-02-10 Sentinelle Medical Inc. Appareil et procédé permettant d'immobiliser notablement un sein pour des protocoles d'imagerie médicale
US8571632B2 (en) 2003-09-30 2013-10-29 Hologic, Inc. Open architecture imaging apparatus and coil system for magnetic resonance imaging
WO2014010185A1 (fr) * 2012-07-13 2014-01-16 Canon Kabushiki Kaisha Appareil de diagnostic médical
US8744550B2 (en) 2007-11-23 2014-06-03 Hologic, Inc. Open architecture tabletop patient support and coil system
US8747331B2 (en) 2009-06-23 2014-06-10 Hologic, Inc. Variable angle guide holder for a biopsy guide plug
WO2015013806A1 (fr) * 2013-07-31 2015-02-05 Body Fit Form Dispositif d'immobilisation du sein pour la radiothérapie
US9332926B2 (en) 2010-11-25 2016-05-10 Invivo Corporation MRI imaging probe
CN105617538A (zh) * 2016-02-18 2016-06-01 谭炳煦 一种方便胸部肿瘤放疗用组合式定位架装置
WO2016104654A1 (fr) * 2014-12-27 2016-06-30 フジデノロ株式会社 Dispositif de retenue
US9646376B2 (en) 2013-03-15 2017-05-09 Hologic, Inc. System and method for reviewing and analyzing cytological specimens
WO2019213165A1 (fr) * 2018-04-30 2019-11-07 Memorial Sloan Kettering Cancer Center Palettes de compression pour biopsies mammaires
CN110856657A (zh) * 2018-08-22 2020-03-03 通用电气公司 用于乳房造影术乳房压缩的装置和方法
CN119279971A (zh) * 2024-08-15 2025-01-10 江苏省肿瘤医院 一种用于乳腺外科手术上的床架

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP5448831B2 (ja) 2006-11-21 2014-03-19 ローマ リンダ ユニヴァーシティ メディカル センター 乳房放射線療法のために患者を固定する装置及び方法

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6254614B1 (en) * 1999-10-18 2001-07-03 Jerry M. Jesseph Device and method for improved diagnosis and treatment of cancer
US6480565B1 (en) * 1999-11-18 2002-11-12 University Of Rochester Apparatus and method for cone beam volume computed tomography breast imaging
CA2326026A1 (fr) * 2000-11-16 2002-05-16 Is2 Research Inc. Camera a scintillations utilisee pour la scintimammographie
JP2007050159A (ja) * 2005-08-19 2007-03-01 Japan Fine Ceramics Center 乳房のｘ線ｃｔ検査装置及び乳房のｘ線ｃｔ検査用乳房整形用具

Cited By (17)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9241765B2 (en) 2003-09-30 2016-01-26 Invivo Corporation Open architecture imaging apparatus and coil system for magnetic resonance imaging
US8571632B2 (en) 2003-09-30 2013-10-29 Hologic, Inc. Open architecture imaging apparatus and coil system for magnetic resonance imaging
US8744550B2 (en) 2007-11-23 2014-06-03 Hologic, Inc. Open architecture tabletop patient support and coil system
US8747331B2 (en) 2009-06-23 2014-06-10 Hologic, Inc. Variable angle guide holder for a biopsy guide plug
US8452374B2 (en) 2009-08-06 2013-05-28 Hologic, Inc. Apparatus and method for substantially immobilizing a breast for medical imaging procedure
WO2011014966A1 (fr) * 2009-08-06 2011-02-10 Sentinelle Medical Inc. Appareil et procédé permettant d'immobiliser notablement un sein pour des protocoles d'imagerie médicale
US9332926B2 (en) 2010-11-25 2016-05-10 Invivo Corporation MRI imaging probe
WO2014010185A1 (fr) * 2012-07-13 2014-01-16 Canon Kabushiki Kaisha Appareil de diagnostic médical
US9646376B2 (en) 2013-03-15 2017-05-09 Hologic, Inc. System and method for reviewing and analyzing cytological specimens
WO2015013806A1 (fr) * 2013-07-31 2015-02-05 Body Fit Form Dispositif d'immobilisation du sein pour la radiothérapie
WO2016104654A1 (fr) * 2014-12-27 2016-06-30 フジデノロ株式会社 Dispositif de retenue
CN105617538A (zh) * 2016-02-18 2016-06-01 谭炳煦 一种方便胸部肿瘤放疗用组合式定位架装置
WO2019213165A1 (fr) * 2018-04-30 2019-11-07 Memorial Sloan Kettering Cancer Center Palettes de compression pour biopsies mammaires
US11986328B2 (en) 2018-04-30 2024-05-21 Memorial Sloan Kettering Cancer Center Compression paddles for breast biopsies
CN110856657A (zh) * 2018-08-22 2020-03-03 通用电气公司 用于乳房造影术乳房压缩的装置和方法
CN110856657B (zh) * 2018-08-22 2023-09-12 通用电气公司 用于乳房造影术乳房压缩的装置和方法
CN119279971A (zh) * 2024-08-15 2025-01-10 江苏省肿瘤医院 一种用于乳腺外科手术上的床架

Also Published As

Publication number Publication date
WO2010078048A3 (fr) 2010-10-14

Similar Documents

Publication Publication Date Title
WO2010078048A2 (fr) Appareil et procédé pour immobiliser le sein sous traction et compression simultanées pour l'imagerie et les interventions
US8788017B2 (en) Method and equipment for image-guided stereotactic radiosurgery of breast cancer
US20100140500A1 (en) Apparatus and method for the treatment of breast cancer with particle beams
EP2032211B1 (fr) Système de traitement par radiothérapie
US20030028097A1 (en) Immobilizer probe system and method
CN103285527B (zh) 用于固定乳腺放疗患者的装置和方法
CN101015723B (zh) 机器人放射治疗系统
US20080177179A1 (en) Target Tissue Locator for Image Guided Radiotherapy
US20060235260A1 (en) Adaptive intracavitary brachytherapy applicator
JP5197021B2 (ja) 突出した形状適応的な器官の周辺近接照射治療に関する適用
WO2007139607A2 (fr) Appareil de contention du sein
WO2009012240A1 (fr) Systèmes et procédés de positionnement de patients pendant le suivi de cibles en radiothérapie et autres applications médicales
US20100128839A1 (en) Structure and Procedure for X-Ray CT Guided Cancer Treatment
US20220008742A1 (en) Global irradiation thermotherapy system based on coordinated rotation of microwave and radio frequency, and global thermotherapy instrument
CN109675207A (zh) 一种用于宫颈癌后装放疗的手术导板
CN2910255Y (zh) 机器人放射治疗系统
US20060067467A1 (en) Apparatus and method for conformal radiation brachytherapy for breast and other tumors
Lu et al. Role of gastrointestinal ultrasound in image-guided radiation therapy: A review
Yoshida et al. Daily CT measurement of needle applicator displacement during multifractionated high-dose-rate interstitial brachytherapy for postoperative recurrent uterine cancer
Ryken et al. Ultrasonographic guidance for spinal extracranial radiosurgery: technique and application for metastatic spinal lesions
Kirisits et al. Medical University of Vienna, Vienna, Austria
White et al. Principles of treatment accuracy and reproducibility
Yoshida et al. Interstitial brachytherapy using virtual planning and doppler transrectal ultrasonography guidance for internal iliac lymph node metastasis
Narbone Computed Tomography Simulation in Radiation Therapy for Non-small Cell Lung Cancer
MAHADEVAN et al. IGRT in Prostate Cancer—the Calypso 4D Localization System

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 09836958

Country of ref document: EP

Kind code of ref document: A2

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 09836958

Country of ref document: EP

Kind code of ref document: A2