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WO2018058293A1 - Procédé de positionnement d'applicateur basé sur une imagerie par résonance magnétique, et tube applicateur externe - Google Patents

Procédé de positionnement d'applicateur basé sur une imagerie par résonance magnétique, et tube applicateur externe Download PDF

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Publication number
WO2018058293A1
WO2018058293A1 PCT/CN2016/100310 CN2016100310W WO2018058293A1 WO 2018058293 A1 WO2018058293 A1 WO 2018058293A1 CN 2016100310 W CN2016100310 W CN 2016100310W WO 2018058293 A1 WO2018058293 A1 WO 2018058293A1
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WO
WIPO (PCT)
Prior art keywords
applicator
outer tube
chamber
magnetic resonance
tube
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/CN2016/100310
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English (en)
Chinese (zh)
Inventor
朱艳春
李雅芬
刘勇
张志诚
付楠
谢耀钦
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Shenzhen Institute of Advanced Technology of CAS
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Shenzhen Institute of Advanced Technology of CAS
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Publication date
Application filed by Shenzhen Institute of Advanced Technology of CAS filed Critical Shenzhen Institute of Advanced Technology of CAS
Priority to PCT/CN2016/100310 priority Critical patent/WO2018058293A1/fr
Publication of WO2018058293A1 publication Critical patent/WO2018058293A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves
    • A61B5/055—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy

Definitions

  • the present application relates to the field of applicator positioning technologies, and in particular, to a magnetic field imaging-based application position localization method and an applicator outer tube.
  • the positioning of the applicator is usually obtained by a positive lateral radiograph or a three-dimensional computed tomography (CT) scan.
  • CT computed tomography
  • MRI Magnetic Resonance Imaging
  • Post-loading radiation therapy refers to placing a treatment container (applicator) without a radioactive source on the treatment site, and the computer remote-controlled stepper motor (post-installation machine) sends the radioactive source to the applicator for radiation therapy, so as to avoid prevention. Medical staff were injured by radiation during the treatment.
  • the function of the post-installation machine is to place the radioactive source accurately, safely and regularly into the human lesion through the application tube.
  • Post-loading therapy is an auxiliary treatment for external irradiation.
  • the dose at the near-source is much larger than the distance from the far source.
  • tumor tissue can achieve an effective killing dose, while adjacent normal tissues can be protected. It can be seen that one of the quality assurances of the post-loading treatment is the accuracy of the radioactive source, which directly affects the therapeutic effect.
  • the workflow of the post-loading treatment is to insert the disinfected application tube into the patient's treatment site according to the doctor's diagnosis result, and fix it; then, use the simulator to take a positive lateral radiograph or a three-dimensional CT image, and position the application.
  • the location of the source tube, the best treatment time at each point, design The treatment plan; the application tube is connected to the post-loading treatment machine, and then the radiotherapy plan is executed by the post-installation control system; after a certain amount of irradiation is completed, the radioactive source is automatically returned to the storage source under the control of the post-installation computer. , complete a close-up post-loading treatment.
  • magnetic resonance imaging has the advantages of no radiation, high resolution, high soft tissue contrast, etc., which makes magnetic resonance imaging more and more attention.
  • the positive side X-ray film is taken by the simulator, and the treatment plan is made according to the coordinate reconstruction result.
  • the treatment plan is simple, the dose accuracy is very low, and the lesion range and the normal tissue cannot be correctly evaluated. The situation in turn gives a personalized and precise radiotherapy dosage regimen.
  • Chinese patent CN101152090A has published a "single-tube post-loading device for cervical cancer that can be used for CT scanning", which can scan and image the cervical cancer posterior device, which includes a hollow source pipe.
  • One end of the pipeline is connected with the rear application tube, and the other end is a lesion treatment end.
  • the treatment end is composed of an elliptical inner tube made of a shielding functional material, and a circular hole is arranged in the center of the inner tube, and the circular hole is
  • the application pipeline is connected, and the movable sleeve is also provided with a cylindrical outer tube made of CT-compatible polymer material.
  • the invention can obtain a three-dimensional image of the lesion by CT scanning, thereby accurately estimating the lesion.
  • the scope and surrounding normal tissue conditions provide an image data basis for individualized and accurate radiotherapy.
  • CT three-dimensional imaging can realize the positioning of the applicator and develop a precise radiotherapy plan, but the CT image soft tissue contrast is poor, and usually the internal irradiation therapy is for the soft tissue cavity, and the CT image is not well presented.
  • the three-dimensional magnetic resonance image can clearly show the structure of the lesion and surrounding organs, but the current application of the polymer tube for magnetic resonance imaging is often not because of magnetic resonance imaging.
  • the signal is reflected in black on the three-dimensional image, which results in the magnetic resonance three-dimensional image not being able to exert its original advantages to accurately locate the position of the application tube, and also affects the observability of the surrounding tissue lesions.
  • an object of the present application is to provide a magnetic field imaging-based application position localization method and a donor device, which can accurately position the outer tube of the applicator in a magnetic resonance image. And clearly show the shape and pathological changes of the tissues and organs around the outer tube of the applicator, and effectively improve the treatment accuracy.
  • the magnetic resonance imaging-based application position localization method proposed by the embodiment of the present application includes: inserting an outer tube of a donor device having a chamber in a tube wall into a predicted application site, and performing three-dimensional magnetic resonance imaging; The imaging agent in the chamber determines a specific source of application.
  • the outer tube of the applicator of the magnetic resonance imaging-based applicator has a chamber in the tube wall of the applicator outer tube, and the chamber is filled with magnetic Resonance imaging of imaging agents.
  • the three-dimensional magnetic resonance scanning can be performed in the three-dimensional magnetic resonance imaging by inserting the outer tube of the tube having the container filled with the imaging agent into the predicted application site for three-dimensional magnetic resonance scanning.
  • Brightly display the outer tube of the applicator which can accurately locate the position of the outer tube of the applicator, clearly show the morphological structure and pathological changes of the diseased tissue and surrounding tissues and organs, provide better soft tissue contrast, and better display the tissue characteristics of the lesion. Therefore, it can accurately locate the position of the outer tube of the applicator, and provide a basis for accurately designing the radiotherapy plan, accurately controlling the location and time of the radioactive source, and improving the treatment accuracy and safety.
  • FIG. 1 is a schematic flow chart of a method for locating a position based on magnetic resonance imaging according to an embodiment of the present application
  • FIG. 2 is a schematic cross-sectional structural view of an outer tube of an applicator of a magnetic resonance imaging-based applicator according to an embodiment of the present application;
  • FIG. 3 is a schematic structural view of a magnetic resonance imaging based applicator according to an embodiment of the present application.
  • FIG. 4 is a schematic diagram of an inner tube of an applicator of a magnetic resonance imaging-based applicator according to an embodiment of the present application
  • FIG. 5 is a schematic flow chart of a method for positioning a position based on magnetic resonance imaging according to another embodiment of the present application.
  • FIG. 6 is a schematic diagram of a model for calculating a depth position of a source position based on magnetic resonance imaging according to another embodiment of the present application.
  • Figure 7 is a cross-sectional view of the inner tube of the applicator of another embodiment of the present application.
  • Embodiments of the present application provide a method and device for applying a position based on magnetic resonance imaging.
  • FIG. 1 is a schematic flow chart of a method for locating a position based on magnetic resonance imaging according to an embodiment of the present application. As shown in FIG. 1, the method includes:
  • step 101 the outer tube of the applicator having the chamber in the tube wall is inserted into the predicted application site, and three-dimensional magnetic resonance imaging is performed.
  • the chamber may be, for example, a plurality of apertured spaces uniformly disposed in the wall of the outer tube of the applicator, or an interlayer between the inner and outer walls of the outer tube of the applicator, and other possible forms.
  • the imaging agent filled in the chamber has a high signal-to-noise ratio in magnetic resonance imaging and can be highlighted in 3D magnetic resonance imaging.
  • the imaging agent may be oil, water or other contrast enhancing agent (or imaging agent, contrast agent, etc.) suitable for magnetic resonance imaging, pre-closed in the positioning tube to ensure high in the three-dimensional magnetic resonance image Lights up the position of the outer tube of the applicator.
  • the contrast enhancer is, for example, a complex of DTPA ( ⁇ -diethylenediaminepentaacetic acid) or the like.
  • Step 102 determining a specific application location based on the imaging agent in the chamber.
  • the applicator outer tube of the present invention is made of an MRI compatible polymer material.
  • the three-dimensional magnetic resonance localization treatment has a lower radiation and provides better soft tissue contrast than existing CT-guided internal illumination treatments. Since the internal irradiation treatment is mainly for treating the cavity lesions in the human body, the better presentation of the diseased tissue and the peripheral organs is the basic condition for formulating a precise radiotherapy plan.
  • the outer tube of the applicator is inserted into the patient in advance, and the imaging agent is pre-filled with magnetic resonance imaging to ensure accurate display of the position of the outer tube of the applicator in the three-dimensional magnetic resonance image.
  • the three-dimensional magnetic resonance scan is completed, and a treatment plan for radiation therapy is prepared according to the condition of the diseased tissue and the normal tissue or organ in the three-dimensional magnetic resonance image and the position of the outer tube of the applicator.
  • a suitable inner tube of the applicator is inserted, and the insertion angle of the inner tube is adjusted according to the positioning image, and the radioactive source channel is inserted into the inner tube.
  • different configurations of the inner tube of the applicator can be designed to accommodate different requirements for the number and location of the source channels.
  • the external tube of the applicator having the chamber filled with the imaging agent in the tube wall is inserted into the predicted application site for three-dimensional magnetic resonance scanning, and the external tube of the applicator can be highlighted in the three-dimensional magnetic resonance imaging.
  • Accurately locate the position of the outer tube of the applicator clearly show the morphological structure and pathological changes of the diseased tissue and surrounding tissues and organs, provide better soft tissue contrast, better display the tissue characteristics of the lesion, so that it can be accurately positioned outside the applicator
  • the location of the tube, and the precise location Provide a basis for radiotherapy planning, accurate control of the location and time of the radioactive source, and improve treatment accuracy and safety.
  • the embodiment of the present application further provides an external tube of the applicator of the magnetic resonance imaging based applicator, which can be used to implement the method described in the above embodiments, as described in the following embodiments. Since the principle of solving the problem of the application tube outer tube of the magnetic resonance imaging-based applicator is similar to the magnetic field imaging-based application position localization method, the implementation of the magnetic resonance imaging-based applicator can be referred to the magnetic resonance imaging-based method. The implementation of the source location method will not be repeated here.
  • the devices described in the following embodiments are preferably implemented in hardware, software, or a combination of software and hardware, is also possible and contemplated.
  • FIG. 2 is a schematic cross-sectional structural view of an outer tube of an applicator of a magnetic resonance imaging-based applicator according to an embodiment of the present application.
  • the external tube 10 of the magnetic resonance imaging-based applicator has a chamber 11 in the tube wall of the applicator outer tube 10, and the chamber 11 is filled with magnetic material.
  • the chamber may be, for example, a plurality of hole-shaped spaces uniformly disposed in the wall of the outer tube of the applicator, or an interlayer between the inner and outer walls of the outer tube of the applicator.
  • the imaging agent filled in the chamber has a high signal-to-noise ratio in magnetic resonance imaging and can be highlighted in 3D magnetic resonance imaging.
  • the imaging agent may be oil, water or other contrast enhancing agent (or imaging agent, contrast agent, etc.) suitable for magnetic resonance imaging, pre-closed in the positioning tube to ensure high in the three-dimensional magnetic resonance image Lights up the position of the outer tube of the applicator.
  • the contrast enhancer is, for example, a complex of DTPA ( ⁇ -diethylenediaminepentaacetic acid) or the like.
  • the cross section of the chamber is in one-to-one correspondence with the distance from the cross section to the nozzle of the outer tube of the applicator.
  • the area or width of each cross section may vary with the depth of the cross section in the outer tube of the applicator.
  • the thickness of the interlayer may become smaller or larger as the depth in the outer tube of the applicator increases.
  • the relative depth of the cross-section from the orifice of the outer tube of the applicator can be determined from the cross-sectional thickness of the interlayer in the magnetic resonance image.
  • each or one of the hole-shaped spaces may be tapered such that the cross-section of the hole-shaped space varies with the distance from the cross-section to the nozzle.
  • the depth positioning device can have various designs, such as a reverse conical shape, and the principle is the same, and details are not described herein again.
  • the chamber when the chamber is a plurality of hole-shaped spaces uniformly disposed in the wall of the outer tube of the applicator shown in FIG. 2, the plurality of holes are in the cross-sectional direction.
  • the relative angle between the specific application site and the outer tube of the applicator can be determined according to the position of each hole-shaped space.
  • FIG. 3 is a schematic structural view of the applicator of the outer tube of the applicator of the present embodiment.
  • the outer tube of the applicator of the embodiment can be matched with the post-installer 20 (not shown)
  • the source channel 30 and the source tube 40 are used.
  • the applicator outer tube 10 of the present invention is made of an MRI-compatible polymer material, and the surface is provided with a preset precision scale, and the scale may include one or more dimensions of the longitudinal depth and the angle scale.
  • the operator can accurately determine the depth and/or angle of the inner tube of the applicator according to the scale on the outer tube of the applicator, and in the three-dimensional magnetic resonance image, can also assist in positioning the outer tube of the applicator. Position and deviation.
  • the applicator may include at least one set of the applicator outer tubes.
  • the number of outer tubes of the applicator is not limited according to the needs of the treatment, and each of the outer tubes of the applicator is equipped with an exact match (for example, matching of length, diameter, and interface connection).
  • the structure of the inner tube of the source and the inner tube of the source is shown in Fig. 4.
  • the inner tube of the applicator is fixedly engaged with the outer tube of the applicator through a predetermined structure, and the radioactive source channel is inserted through the hole-shaped passage on the inner tube.
  • the specific card fastening method is designed according to actual needs, which is not limited in this application.
  • One end of the source channel is connected to the after-loading machine through a preset interface, and the other end is placed in the inner tube of the applicator to be the treatment end of the lesion.
  • the radioactive source is introduced into a preset position in the source channel according to the radiotherapy plan under the computer control of the post-installation machine.
  • the external tube of the applicator having the chamber filled with the imaging agent in the tube wall is inserted into the predicted application site for three-dimensional magnetic resonance scanning, and the external tube of the applicator can be highlighted in the three-dimensional magnetic resonance imaging.
  • Accurately locate the position of the outer tube of the applicator clearly show the morphological structure and pathological changes of the diseased tissue and surrounding tissues and organs, provide better soft tissue contrast, better display the tissue characteristics of the lesion, so that it can be accurately positioned outside the applicator
  • the location of the tube and the basis for accurate design of the radiotherapy plan, accurate control of the location and time of the radioactive source, improve treatment accuracy and safety.
  • FIG. 5 is a schematic flowchart of a magnetic resonance imaging-based application position localization method according to another embodiment of the present application. As shown in FIG. 5, the method includes:
  • step 201 the outer tube of the applicator having the chamber in the tube wall is inserted into the predicted application site, and three-dimensional magnetic resonance imaging is performed.
  • the sterile external tube of the applicator is inserted into the patient's body prior to treatment for magnetic resonance three-dimensional imaging.
  • the operator can predict the position of the application site based on experience or known information, and insert the outer tube of the applicator with the positioning tube inserted into the estimated application site.
  • the imaging agent may be oil, water or other contrast enhancing agent (or imaging agent, contrast agent, etc.) suitable for magnetic resonance imaging, pre-closed in the positioning tube to ensure high in the three-dimensional magnetic resonance image Lights up the position of the application tube.
  • the contrast enhancer is, for example, a complex of DTPA ( ⁇ -diethylenediaminepentaacetic acid) or the like.
  • Step 202 determining a specific application location based on the imaging agent in the chamber.
  • Three-dimensional magnetic resonance imaging is used to determine the position of the outer tube of the applicator in the body, as well as the surrounding tissues and organs, to accurately assess the extent of the lesion and its relationship with the surrounding vital organs, and to develop an individualized radiotherapy plan based on this, and then Determine the deviation between the position of the outer tube of the current applicator and the actual application position, and adjust the position of the outer tube of the applicator.
  • the feature such as the area or width of the cross section of the chamber may vary with the distance from the cross section to the nozzle of the outer tube of the applicator, and the cross section corresponds to the distance one-to-one, according to The cross section of the chamber determines the relative depth of the application site to the mouthpiece of the applicator outer tube.
  • the depth position calculation method of one embodiment of the present application is as shown in FIG. 6.
  • the width d, D and H in the figure are the diameter of the conical bottom surface and the cone height, respectively.
  • the chamber When the chamber is a plurality of hole-shaped spaces (longitudinal strips, etc.) uniformly disposed in the tube wall of the outer tube of the applicator, it may also be based on the developer in the plurality of holes. A relative angle of the application site to the outer tube of the applicator is determined. The wall outside the chamber is black in the magnetic resonance image. Since the imaging space is filled with the imaging agent, it is easy to accurately find the hole-shaped space capable of positioning the angle in the image. In practice, in order to facilitate direct By observing the angle, more hole-shaped space structures can be designed to make the angle scale finer.
  • Step 203 adjusting a position of the outer tube of the applicator according to the application position.
  • the application tube is fixed at a determined source position.
  • step 204 the radiation dose distribution and the number and distribution structure of the desired source channels are determined.
  • the radiation treatment plan can be precisely designed, such as the irradiation position of the radiation source, the irradiation angle, the irradiation dose, etc., and the number and distribution structure of the radiation source channels are determined according to the actual radiation source placement requirements.
  • Step 205 selecting an inner tube of the applicator corresponding to the source channel of the quantity and distribution structure.
  • the structure of the inner tube of the applicator is various, such as: the number of radioactive source channels on the inner tube of the applicator is different, and the distribution positions of the channels are different.
  • Figure 7 shows a cross section of an applicator inner tube comprising a plurality of source channels, in one embodiment.
  • Step 206 Fix the applicator inner tube in the applicator outer tube according to the application position.
  • Step 207 inserting the source channel connected to the installed device into the corresponding inner tube of the applicator, and irradiating the source position with the source.
  • Embodiments of the present application can highlight the outer tube of the applicator in three-dimensional magnetic resonance imaging by inserting the outer tube of the tube having the chamber filled with the imaging agent into the predicted application site for three-dimensional magnetic resonance scanning. It can accurately locate the position of the outer tube of the applicator, clearly show the morphological structure and pathological changes of the diseased tissue and surrounding tissues and organs, provide better soft tissue contrast, better display the tissue characteristics of the lesion, and thus can accurately locate the application.
  • the position of the external tube is provided, and the basis for accurately designing the radiotherapy plan, accurately controlling the location and time of the radioactive source, and improving the treatment accuracy and safety.
  • portions of the application can be implemented in hardware, software, firmware, or a combination thereof.
  • multiple steps or means may be implemented in software or firmware stored in a memory and executed by a suitable instruction execution system.
  • a suitable instruction execution system For example, if implemented in hardware, as in another embodiment, it can be implemented by any one or combination of the following techniques well known in the art: having logic gates for implementing logic functions on data signals. Discrete logic Circuit, ASIC with suitable combination logic gate, Programmable Gate Array (PGA), Field Programmable Gate Array (FPGA), etc.

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Abstract

La présente invention concerne un procédé de positionnement d'applicateur basé sur une imagerie par résonance magnétique (IRM), et un tube applicateur externe (10). Le procédé consiste à : insérer un tube applicateur externe (10), ayant une cavité de réception (11) dans une paroi de celui-ci, à l'intérieur d'une partie d'application estimée, et réaliser une imagerie par résonance magnétique tridimensionnelle (201) ; et déterminer, en fonction d'un agent d'imagerie dans la cavité de réception (11), une position d'application spécifique (202). Le procédé de la présente invention permet de localiser avec précision la position d'un tube applicateur externe (10) dans une image obtenue par IRM, et de présenter clairement la morphologie et les changements pathologiques des tissus et organes au niveau d'une périphérie du tube applicateur externe (10), améliorant ainsi la précision d'un traitement.
PCT/CN2016/100310 2016-09-27 2016-09-27 Procédé de positionnement d'applicateur basé sur une imagerie par résonance magnétique, et tube applicateur externe Ceased WO2018058293A1 (fr)

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109675207A (zh) * 2019-01-22 2019-04-26 天津大学 一种用于宫颈癌后装放疗的手术导板
CN112043977A (zh) * 2020-09-30 2020-12-08 河南科技大学第一附属医院 一种用于肛管癌及肛周癌放射治疗的施源装置
CN112569484A (zh) * 2020-12-09 2021-03-30 北京大学第三医院（北京大学第三临床医学院） 一种直肠腔内可调整多分隔气囊多通道后装施源器

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US20130053682A1 (en) * 2011-08-31 2013-02-28 Jacqueline Esthappan Gynecological brachytherapy applicator for use in mr-guided intracavitary brachytherapy
CN104994908A (zh) * 2012-12-12 2015-10-21 核通运营有限公司 近距离放射治疗仪器、成像系统以及图像采集的方法
CN106345048A (zh) * 2016-09-27 2017-01-25 深圳先进技术研究院 基于磁共振成像的施源位置定位方法和施源器外管

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Publication number Priority date Publication date Assignee Title
CN2912675Y (zh) * 2006-06-15 2007-06-20 卢金利 双腔水囊型食道施源器
US20080119784A1 (en) * 2006-11-17 2008-05-22 Suranjan Roychowdhury Systems, Apparatus and Associated Methods for Needleless Delivery of Therapeutic Fluids
CN101152090A (zh) * 2007-09-22 2008-04-02 泸州医学院附属医院 可用于ct扫描的宫颈癌单管式后装施源器
CN201871125U (zh) * 2010-10-31 2011-06-22 陈萍 食管癌后装施源器
CN201848022U (zh) * 2010-11-17 2011-06-01 山东省肿瘤防治研究院 一种用于食管癌近距离放疗的施源器
US20130053682A1 (en) * 2011-08-31 2013-02-28 Jacqueline Esthappan Gynecological brachytherapy applicator for use in mr-guided intracavitary brachytherapy
CN104994908A (zh) * 2012-12-12 2015-10-21 核通运营有限公司 近距离放射治疗仪器、成像系统以及图像采集的方法
CN106345048A (zh) * 2016-09-27 2017-01-25 深圳先进技术研究院 基于磁共振成像的施源位置定位方法和施源器外管

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN109675207A (zh) * 2019-01-22 2019-04-26 天津大学 一种用于宫颈癌后装放疗的手术导板
CN112043977A (zh) * 2020-09-30 2020-12-08 河南科技大学第一附属医院 一种用于肛管癌及肛周癌放射治疗的施源装置
CN112569484A (zh) * 2020-12-09 2021-03-30 北京大学第三医院（北京大学第三临床医学院） 一种直肠腔内可调整多分隔气囊多通道后装施源器

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