Patient Support System for Full Access Prone Position Breast Radiotherapy
A patient support system to be used in conjunction with a standard linear accelerator, and other sources, is described that allows access of the treatment beam to the breast from up to 360 degrees. This support system places the patient in a prone position with the breast going through an aperture. The prone position increases the separation of the breast from the chest wall and other critical organs and reduces motion of the target tissue due to breathing. This invention offers up to 36-degree radiation beam access to the breast. This helps in skin sparing, better dose conformity, and allows one to use modern treatment techniques such as IMRT and IGRT. It also includes a provision for an imaging system. This invention can also be used with CT and MR imaging modalities.
This application is a continuation of U.S. Application No. 60/970,288, filed on Sep. 5, 2008, which claims the benefit of U.S. Provisional Application Ser. No. 60/970,288, filed Sep. 6, 2007, all of which are incorporated herein by reference.
BackgroundIn order to treat cancer with radiation, it is highly desirable to maximize the dose delivered to the target volume containing the tumor which is visible with various imaging modalities and some predetermined margin while sparing normal tissue.
Many mechanical configurations of radiation therapy machines and the associated radiation sources have been developed since Roentgen discovered X-Rays. Modern radiation therapy systems use relatively high-energy beams of radiation from radioactive isotopes, particle beam accelerators, or electron beam X-Ray generators. The X-Ray generators can employ either high voltage direct current or RF driven linear accelerators (LINACs). The conventional radiation therapy system uses a LINAC to generate an electron beam with between 4 and 22 MeV of energy at low current. The electron beam strikes a high-Z target, typically tungsten, and generates penetrating x-rays. The beam is shaped and delivered to the target volume from one or more directions. The overlapping dose at the target volume is usually higher than the dose at the surface from any one-delivery angle. The skin is sensitive to radiation, so it is desirable to limit the skin dose to minimize complications. If more delivery angles are used, the surface dose can be spread out and minimized with respect to the dose delivered to the target volume. A significant fraction of all radiation therapy treatments are employed to treat breast cancer with very good success. A typical general purpose radiation therapy system is designed to treat virtually all anatomical sites with some trade-offs being made in the design in order to make a universally applicable machine. A linear accelerator rotates about a horizontal axis, around a virtual point called the isocenter that intersects with the beam axis. A typical source to axis distance, or source to isocenter distance, SAD is 100 centimeters. The treatment couch rotates about a vertical axis intersecting with the same isocenter and including three additional Cartesian motions for patient alignment. The external dimensions and geometry of different linear accelerators vary, resulting in different available treatment angles, which can be limiting to couch position and gantry rotation.
Currently most of the breast cancer patient population is treated in the supine (laying on the back) position, which does not allow access from more than a few angles. The supine position is also inferior due to gravitational forces compressing the breast against the chest. In addition, breast motion resulting from breathing creates inaccuracies in locating the beam with respect to the target volume.
Alternatively, a prone position radiation therapy is used for access to the breast. This method is implemented with a tabletop attachment that works with a standard linear accelerator. This embodiment helps to reduce target motion associated with breathing and create a better separation of the target tissue with respect to the chest wall and other critical structures. However, this embodiment still only allows access to a few angles, typically two.
SUMMARYThis invention relates to a patient support system to be used with conventional radiation sources to position the patient in a more favorable geometry by allowing up to 360 degree access to the breast with the patient in the prone position.
This invention solves one of the remaining issues in breast cancer treatment, which is access to the breast from multiple angles, up to 360 degrees. The patient support system of the present invention can be made out of suitable materials making it CT and MR compatible for use with imaging modalities.
The present invention is directed to a prone position patient support system to be used in conjunction with a radiation source. The patient support system includes an anatomically contoured patient interface surface and an aperture to permit passage of the anatomy to be treated through the patient interface surface. The patient supports system further includes a support system for the patient interface surface that provides space below the patient interface surface to allow beam access from a radiation source for at least 180 degrees of rotation in a substantially horizontal plane.
In one embodiment, the radiation source is a LINAC. In another embodiment, the radiation source is a supervoltage x-ray generator. In another embodiment, the radiation source is a particle beam accelerator.
In one embodiment, the support system is CT compatible. In another embodiment, the patient support system is MR compatible.
In one embodiment, the support system further includes a rotational mechanism that allows rotation about the longitudinal axis of the patient support system.
In one embodiment, the support system includes one or more imaging components and associated software algorithms for patient registration.
In one embodiment, the support system for the patient interface surface further comprises a longitudinal translation stage and rotary stage.
In one embodiment, the support system for the patient interface surface further comprises cross shaped radiolucent spacers for separating the patient interface surface and bottom structure.
In accordance with another aspect of the invention, the invention is directed to a prone position patient support system to be used in conjunction with a radiation source. The patient support system includes an anatomically contoured patient interface surface and an aperture to permit passage of the anatomy to be treated through the patient interface surface. The patient support system further includes a support system for the patient interface surface that provides space below the patient interface surface to allow beam access from a radiation source for at least 270 degrees of rotation in a substantially horizontal plane.
In one embodiment, the radiation source is a LINAC. In another embodiment, the radiation source is a supervoltage x-ray generator. In another embodiment, the radiation source is a particle beam accelerator.
In one embodiment, the support system is CT compatible. In another embodiment, the support system is MR compatible.
In one embodiment, the support system includes one or more imaging components and associated software algorithms for patient registration.
In one embodiment, the support system for the patient interface surface is designed from radiolucent material.
In one embodiment, the support system for the patient interface surface is geometrically designed such that the radiation beam is unobstructed.
In one embodiment, the support system includes a rotational mechanism that allows rotation about the longitudinal axis of the patient support system.
In one embodiment, the support system for the patient interface surface is geometrically designed to have limited interference with the radiation beam.
In one embodiment, the support system for the patient interface surface further comprises a longitudinal translation stage and a rotary stage.
In one embodiment, the support system for the patient interface surface further comprises cross shaped radiolucent spacers for separating the patient interface surface and a bottom structure.
In accordance with another aspect of the invention, the invention is directed to a prone position patient support system to be used in a conjunction with a radiation source. The patient support system includes an anatomically contoured patient interface surface and an aperture to permit passage of the anatomy to be treated through the patient interface surface. The patient support system further includes a support system for the patient interface surface that provides space below the patient interface surface to allow beam access from a radiation source for 360 degrees of rotation in a substantially horizontal plane.
In one embodiment, the radiation source is a LINAC. In another embodiment, the radiation source is a supervoltage x-ray generator. In another embodiment, the radiation source is a particle beam accelerator.
In one embodiment, the support system is CT compatible. In another embodiment, the support system is MR compatible.
In one embodiment, the support system includes one or more imaging components and associated software algorithms for patient registration.
In one embodiment, the support system for the patient interface surface is designed from radiolucent material.
In one embodiment, the support system for the patient interface surface is geometrically designed such that the radiation beam is unobstructed.
In one embodiment, the support system includes a rotational mechanism that allows rotation about the longitudinal axis of the patient support system.
In one embodiment, the support system for the patient interface surface further comprises a longitudinal translation stage and a rotary stage.
In one embodiment, the support system for the patient interface surface further comprises cross shaped radiolucent spacers for separating the patient interface surface and a bottom structure.
In accordance with another aspect of the invention, the invention is directed to a prone position patient support system to be used in conjunction with a radiation source. The patient support system includes a contoured patient support surface including an aperture to permit passage of the anatomy to be treated through the patient support surface and a lower support structure. The patient support system further includes a support member between the patient support surface and the lower support structure, which provides space between the patient support surface and the lower support structure. The patient support system further includes a treatment couch on which the lower structure is coupled and the treatment couch has a rotary base. A rotational mechanism is coupled to the lower structure and treatment couch, which allows beam access from a radiation source for 360 degrees in a substantially horizontal plane.
In one embodiment, the radiation source is a LINAC. In another embodiment, the radiation source is a supervoltage x-ray generator. In another embodiment, the radiation source is a particle beam accelerator.
In one embodiment, the patient support system is CT compatible. In another embodiment, the patient support system is MR compatible.
In one embodiment, the rotational mechanism allows rotation about the longitudinal axis of the patient support system.
In one embodiment, the support system includes one or more imaging components and associated software algorithms for patient registration.
In one embodiment, the rotational mechanism comprises a longitudinal translation stage and rotary stage.
In one embodiment, the support member comprises cross-shaped radiolucent spacers for separating the patient interface surface and a bottom structure.
The foregoing and other features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.
This invention combines a unique support system with novel geometric motions to allow access to treat the breast in the prone position from up to 36-degrees. Presently this range of access and motion is not possible with conventional LINAC couches or existing attachments. An anatomically designed patient support surface 10 with contour 12 provides a surface for the patient to lie on during positioning and treatment. The contour 12 of the support surface 10 combined with the shape and size of the aperture 11 allows the patient to lie comfortably in position during set-up and treatment while allowing the anatomical volume of interest to protrude through the aperture 11. A series of inserts of different size, shape and symmetry (not shown) can be provided to allow small breasts to be treated comfortably in one extreme, while a large, asymmetrically shaped aperture can allow the chest wall and other related anatomy such as the axilla to be accessed for treatment. The support system can be made in mirror-image versions with left and right versions of the apertures for treating the left and right breast to maximize patient comfort and anatomy accessibility. Cushions can be provided for the support surface 10 and contour 12 to increase comfort during the procedure, which is typically 15 minutes with a beam-on time of 1 minute. The support surface 10 can be gently heated to increase patient comfort as well. A set of cushions that tilt the patient around the longitudinal axis can be provided to maximize access and comfort. The patient support system is shown in two basic configurations in
A second level of performance and complexity is shown in
The support system can be made as an integral part of a custom couch instead of as an attachment. Increased flexibility is obtained by integrating the structures instead of making an add-on attachment. Better access to oblique angles departing from the substantially horizontal position is possible by eliminating duplicate structures and providing cut-outs in strategically located areas. A patient support system as described may additionally be mounted on a “frog-leg” jointed support or robotic arm 25 which increased performance and flexibility, as shown in
The embodiments of the present invention can be used in conjunction with an already existing table, e.g., a treatment couch, or incorporated into the design of an entirely new treatment couch.
The patient support system of the present invention can be made out of materials making it CT and MR compatible for use with imaging modalities. The patient support system further includes one or more imaging components and associated software algorithms for patient registration.
While the present invention has been particularly shown and described with reference to exemplary embodiments thereof, it will be understood by those of ordinary skill in the art that various changes in form and details may be made therein without departing from the spirit and scope of the present invention as defined by the following claims.
Claims
1. A prone position patient support system to be used in conjunction with a radiation source, comprising:
- a substantially-horizontal patient support surface upon which a patient's body can be placed, said patient support surface having a first end proximal to said patient's breast and a second end proximal to said patient's feet;
- an aperture in said patient support surface to permit passage of an anatomy of said patient's body through the patient support surface with respect to said radiation source so as to permit application of a beam of radiation from said radiation source to said anatomy; and
- a cantilever support proximal to said second end of said patient support surface supporting said patient support.
2. The patient support system of claim 1 wherein the radiation source is a LINAC.
3. The patient support system of claim 1 wherein the radiation source is a supervoltage x-ray generator.
4. The patient support system of claim 1 wherein the radiation source is a particle beam accelerator.
5. The patient support system of claim 1 wherein the support system is CT compatible.
6. The patient support system of claim 1 wherein the support system is MR compatible.
7. The patient support system of claim 1 wherein the support system further comprises a rotational mechanism that allows rotation about the longitudinal axis of the patient support system.
8. The patient support system of claim 1 further comprising one or more imaging components and associated software algorithms for patient registration.
9. The patient support system of claim 1 wherein the support system for the patient interface surface further comprises a longitudinal translation stage and a rotary stage.
10. The patient support system of claim 1 wherein the support system for the patient interface surface further comprises cross shaped radiolucent spacers for separating the patient interface surface and a bottom structure.
11. A prone position patient support system to be used in conjunction with a radiation source, comprising:
- an anatomically contoured patient interface surface adapted to support a patient thereon in a cantilevered position;
- an aperture in said patient support surface, proximal to a breast of said patient, to permit passage of a breast of said patient to be treated through the patient interface surface; and
- a support system for the patient interface surface that provides space below the patient interface surface to allow beam access from a radiation source for at least 270 degrees of rotation in a substantially horizontal plane; said patient interface surface being rotatable and cantilevered at an end thereof proximal to said patient's feet.
12. The patient support system of claim 11 wherein the radiation source is a LINAC.
13. The patient support system of claim 11 wherein the radiation source is a supervoltage x-ray generator.
14. The patient support system of claim 11 wherein the radiation source is a particle beam accelerator.
15. The patient support system of claim 11 wherein the support system is CT compatible.
16. The patient support system of claim 11 wherein the support system is MR compatible.
17. The patient support system of claim 11 that includes one or more imaging components and associated software algorithms for patient registration.
18. The patient support system of claim 11 wherein the support system for the patient interface surface is designed from radio-lucent material.
19. The patient support system of claim 11 wherein the support system for the patient interface surface is geometrically designed such that the radiation beam is unobstructed.
20. The patient support system of claim 11 wherein the support system includes a rotational mechanism that allows rotation about the longitudinal axis of the patient support system.
21. The patient support system of claim 11 wherein the support system for the patient interface surface is geometrically designed to have limited interference with the radiation beam.
22. The patient support system of claim 11 wherein the support system for the patient interface surface further comprises a longitudinal translation stage and a rotary stage.
23. The patient support system of claim 11 wherein the support system for the patient interface surface further comprises cross shaped radiolucent spacers for separating the patient interface surface and a bottom structure.
24-35. (canceled)
36. A prone position patient support system to be used in conjunction with a radiation source, comprising:
- a contoured patient support surface including an aperture to permit passage of the anatomy to be treated through the patient support surface;
- a lower support structure;
- a support member between the patient support surface and the lower support structure which provides space between the patient support surface and the lower support structure;
- a treatment couch on which the lower structure is coupled, the treatment couch having a rotary base; and
- a rotational mechanism coupled to the lower structure and the treatment couch which allows beam access from a radiation source for 360 degrees in a substantially horizontal plane.
37. The patient support system of claim 36 wherein the radiation source is a LINAC.
38. The patient support system of claim 36 wherein the radiation source is a supervoltage x-ray generator.
39. The patient support system of claim 36 wherein the radiation source is a particle beam accelerator.
40. The patient support system of claim 36 wherein the support system is CT compatible.
41. The patient support system of claim 36 wherein the patient support system is MR compatible.
42. The patient support system of claim 36 wherein rotational mechanism allows rotation about the longitudinal axis of the patient support system.
43. The patient support system of claim 36 further comprising one or more imaging components and associated software algorithms for patient registration.
44. The patient support system of claim 36 wherein the rotational mechanism comprises a longitudinal translation stage and a rotary stage.
45. The patient support system of claim 36 wherein the support member comprises cross shaped radiolucent spacers for separating the patient interface surface and a bottom structure.
Type: Application
Filed: Aug 24, 2012
Publication Date: Aug 29, 2013
Inventors: Alan P. Sliski (Lincoln, MA), Jason Koshnitsky (Framingham, MA)
Application Number: 13/594,491
International Classification: A61B 6/04 (20060101);