Therapy apparatus with a radiation source

A therapy apparatus has a radiation source and a base part standing on the floor of the treatment room, the radiation source being connected to the base part and the base part containing devices required for the operation of the radiation source. The base part has an upper part fashioned at least as part of a patient bearing assembly. At least one further part of the patient bearing assembly is attached to the base part, at least during operation of the therapy apparatus.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
The present invention is directed to a therapy apparatus of the type having 
a radiation source and with a base part standing on the floor of the 
treatment room, the radiation source being connected to the base part and 
said base part containing the devices required for the operation of the 
therapy apparatus. 
Such a therapy apparatus can have, for example, a source of acoustic waves 
or a source of electromagnetic waves as the radiation source. 
2. Description of the Prior Art 
Normally, the base part of therapy apparatus of the above type is movable, 
so that the apparatus can be positioned relative to a patient seated on a 
bed, a chair or the like such that the radiation source is aligned to the 
region to be treated. The patient, however, must often assume an 
uncomfortable posture. Alleviation of this problem could be created by 
providing the therapy apparatus with a suitable patient bearing means; 
this, however, would lead to a structure of the therapy apparatus 
requiring a large amount. 
Patient bearing means that have a base part standing on the floor with an 
upper part fashioned the patient supporting structure are disclosed by the 
German periodical acta medicotechnica, No.1/1980, German Utility Model 81 
00 048, German OS 29 42 193 and European Application 02 41 701. The 
massive structure of these patient bearing means and the large space 
requirements associated therewith, however, make these unusable for use as 
a mobile diagnostic or system for therapy use. 
The publication "Philips-Medizinsysteme MFL5000--der urologische 
Arbeitsplatz fur die Diagnose und Therapie" also discloses a therapy means 
(lithotriptor) has a stationary base part, a separate patient bearing 
table attached thereto, a pivotable X-ray system and a pivotable shockwave 
applicator. The shockwave applicator, however, can only be pivoted in an 
extremely limited range in order to assure access to the kidney region. 
Other body regions cannot possibly be reached for therapy purposes without 
patient displacement except on the basis of swivel motions of the 
shockwave applicator. 
The therapy apparatus disclosed by German OS 41 35 177 is in fact portable 
but is implemented without patient bearing means. Further, the therapy 
head of the therapy apparatus is only pivotable by 180.degree., and as a 
result the freedom of motion of the therapy head is limited and, like that 
of the therapy apparatus from the Philips publication, is likewise limited 
to simple swivel motions. An unrestricted alignment of the radiation 
source onto a body region of a patient is likewise not possible with this 
therapy apparatus without the patient having to accept discomfort. 
SUMMARY OF THE INVENTION 
An object of the present invention is to provide an apparatus of the type 
initially described wherein discomfort for the patient is alleviated and a 
compact structure of the therapy apparatus is nonetheless assured. 
This object is inventively achieved by a therapy apparatus with a radiation 
source and a base part standing on the floor of the treatment room, the 
radiation source being connected to the base part and the base part 
containing devices required for the operation of the therapy apparatus, 
and that has an upper part fashioned at least as part of a patient bearing 
means. Without an additional space requirement, the inventive therapy 
apparatus is at least provided with the part of a patient bearing means in 
this way. The patient is thus placed on the upper part in a position 
relative to the radiation source that is defined at least within certain 
limits. With little outlay, it is therefore possible to attach the 
radiation source to the base part such that it can be aligned to the 
region of the patient to be treated required, without forcing the patient 
to assume an uncomfortable position. 
Since the patient can normally assume only a sitting position on the upper 
part, in a version of the invention at least a further part of the patient 
bearing means is attached to the base part at least during operation of 
the therapy apparatus. More versatile bearing possibilities for the 
patient are obtained in this way, these being even more versatile when the 
further part of the patient bearing means is removably attached to the 
base part and can be attached to the base part at different locations. The 
further part of the patient bearing means can be directly attached to the 
base part, or can be indirectly attached to the base part via attachment 
to the upper part. 
A further improvement of the bearing possibilities is achieved when the 
further part of the patient bearing means is adjustable relative to the 
upper part. 
For achieving a targeted treatment, in another version of the invention 
that the source is adjustably attached to the base part. It can be 
attached to the base part with a column, an articulated arm or an 
articulated arm connected to a column. 
According to a preferred embodiment of the invention, the radiation source 
is adjustable at least in such a range that arbitrary locations of the 
upper part torso of the apparatus can be reached. Dependent on the 
position assumed by the patient, it is thus assured that at least the body 
regions of the patient located on the upper part are accessible to the 
radiation source. 
For achieving universal applicability of the therapy apparatus, the source 
thereof in one embodiment is adjustable in a range of adjustment such that 
a patient who is seated on a bearing means different from the bearing 
means of the therapy apparatus and located close to the therapy apparatus 
can also be reached. There is thus the also possibility of treating, for 
example, a patient lying in a bed. 
In order to employ the therapy apparatus in portable fashion, the base part 
thereof is provided with wheels in one version of the invention. In order 
to be independent from the power mains, the base part contains an energy 
storage element, particularly an electrical accumulator whose capacity is 
adequate in order to store the energy for at least one therapy procedure. 
In order to be able to utilize the therapy apparatus for the treatment of 
pain in the way disclosed in German OS DE 43 15 282, in a preferred 
embodiment of the invention a source of focussed acoustic waves, 
particularly a shockwave source, is provided as the radiation source. 
Since it is expedient for an exact alignment of the radiation source to the 
region to be treated to be able to precisely locate this region, in an 
embodiment of the invention an ultrasound locating means is provided whose 
diagnostic ultrasound transducer is preferably recessed in the radiation 
source, so that a defined allocation of the ultrasound diagnostic 
transducer and the radiation source is assured in a simple way. 
In order to be able to undertake examinations with the ultrasound locating 
means independently of the radiation source, or of the therapy apparatus, 
in a version of the invention the diagnostic ultrasound transducer of the 
ultrasound locating means can be removed from the radiation source. 
In order to facilitate observation of the monitor of the ultrasound 
locating means for the attending personnel, in one embodiment a holder for 
the monitor is provided at the base part. 
The upper part, moreover, closes the base part in the manner of a cover. If 
the upper part is made removable from the base part, good accessibility to 
the devices located in the inside of the base part and required for the 
operation of the therapy apparatus is established. Maintenance work can 
therefore be carried out with little outlay.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
The invention is explained below with reference to the example of a therapy 
apparatus shown in the drawings that is provided for pain therapy and that 
has a acoustic shockwave source as the radiation source. 
According to FIG. 1, the inventive therapy apparatus has a base part 1 that 
stands on the floor of the treatment room with wheels 2 in order to assure 
the portability of therapy apparatus. 
A shockwave source 3 shown in greater detail in FIG. 9, is provided as the 
radiation source, which generates focussed acoustic shockwaves and which 
is adjustably connected to the base part 1 via an articulated arm 4 and a 
column 5. 
The adjustability of the shockwave source 3 is first assured by means of 
the articulated arm 4 being rotatably connected to the column 5, so as to 
be pivotable around a horizontal axis A.sub.1 in the direction of the 
double arrow .alpha. and around a vertical axis A.sub.2 in the direction 
of the double arrow .beta.. Adjustability of the shockwave source 3 is 
also facilitated by the articulated arm 4 being composed of two arm parts 
4a and 4b and a fork 4c, the two arm parts 4a and 4b being connected to 
one another so as to be pivotable around a horizontal axis A.sub.3 in the 
direction of the double arrow y. The fork 4c is rotatable in the direction 
of the double arrow .delta. at the arm part 4b around an axis A4 
proceeding parallel to the longitudinal axis of the arm part 4b. A further 
adjustment possibility is provided by the shockwave source 3 being 
accepted in the fork 4c so as to be pivotable around an axis A.sub.5 in 
the direction of the double arrow .epsilon.. 
The devices required for the operation of the therapy apparatus are located 
in the base part 1, which is closed by a removable upper part 6 in the 
manner of a cover. For example, the base part 1 can contain a high-voltage 
pulse generator 7 required for the operation of the shockwave source 3, an 
accumulator 8 permitting mains independent operation of the therapy 
apparatus for the duration of at least an average treatment procedure, a 
water supply 9 required for the operation of the shockwave source 3, and 
ultrasound apparatus processing circuitry 10 serving, together with an 
ultrasound application 29 (FIG. 9) and a monitor 31 (FIGS. 1 and 9), for 
locating the region to be treated. The lines leading to the shockwave 
source 3 are conducted through the column 5 and the articulated arm 4. 
As FIG. 8 shows, the devices 7 through 10 required for the operation of the 
therapy apparatus are modular and are arranged for easily accessibly, so 
that the inventive therapy apparatus is maintenance-friendly. 
The upper part 6 functions not only as a cover for the base part 1 but also 
constitutes a part of the patient bearing assembly of the inventive 
therapy apparatus. The patient hearing assembly in addition to the upper 
part 6, also includes the bearing plane sections 12 and 13. In a manner 
not shown in greater detail, these sections 12 and 13 are pivotably 
attached to the ends of the upper part 6 lying opposite one another so 
that they can assume different angles of inclination relative to the upper 
part 6, which is arranged in a horizontal plane, as can be seen from FIGS. 
1 through 7. There is also the possibility of directly attaching the 
bearing plate sections 12 and 13 to the base part 1. 
In this way, it is possible to individually adapt the patient bearing 
assembly of the inventive therapy apparatus to a large variety of 
treatment cases. 
The adaptability of the patient bearing assembly is further enhanced by the 
bearing plate section 13 being removable from the upper part 6 so that it 
can be attached to that longitudinal edge of the upper part 6 lying 
opposite the column 5, as indicated with broken lines in FIG. 1. For 
example, there is then the possibility of seating a patient on his or her 
side with flexed legs. 
The upper part 6 and the bearing plate sections 12 and 13 have channels 14 
through 17 along their edges, these channels 14 through 17 being provided 
for the acceptance of accessory parts, for example leg supports, infusion 
stands and the like. The possibility of being able to introduce accessory 
parts into the channels 14 through 17 is illustrated in FIG. 2, which 
shows an arm support 18 introduced into the channel 16 of the upper part 
6. 
As a result of the described adjustment possibilities of the articulated 
arm 4, the shockwave source 3 exhibits an adjustability that is adequate 
for reaching arbitrary points of at least the surface of the upper part 6 
with the coupling membrane 19 provided for the application of the 
shockwave source 3 to a patient. In the described exemplary embodiment, 
however, the range of adjustment of the shockwave source 3 is so great 
that arbitrary locations of the patient bearing assembly formed by the 
upper part 6 and the bearing plate sections 12 and 13 can be reached with 
the coupling membrane 19. 
Moreover, there is the possibility of also employing the therapy apparatus 
for treatment of a patient lying, for example, on an ordinary hospital bed 
or on a patient bearing unit other than the patient bearing assembly 6, 12 
and 13 of the inventive therapy apparatus. To that end, the articulated 
arm 4 is pivoted in the direction of the double arrow .beta. into the 
position indicated with broken lines in FIG. 1. The inventive therapy 
apparatus is also preferably brought into its space-saving standby 
position shown in FIG. 3, wherein the bearing plate sections 12 and 13 are 
pivoted down so as to press against the end faces of the base part 1. 
In order to be able to push and maneuver the inventive therapy apparatus, 
moreover, gripping element or handle 20 is attached to the end face of the 
bearing plate section 13. 
A swivel arm 21 having a platform 22 that is provided for the acceptance of 
the monitor 31 of the ultrasound apparatus 10 is provided at the column 5. 
As shown in FIG. 9, the shockwave source 3 has a generally pot-shaped 
housing 23, a shockwave generator generally referenced 24 being provided 
in the region of one end thereof. At its open end, the housing 23 of the 
shockwave source 3 is closed with the flexible coupling membrane 19, with 
which the shockwave source 3 is pressed against the body of the patient P 
in a known way for acoustic coupling. The housing 23 is filled with water 
that is provided as acoustic propagation medium for the shockwaves 
emanating from the shockwave generator 24. The shockwave source 3 is in 
communication with the water supply 9 (see FIG. 8) via conduits that are 
not shown in FIG. 9. The shockwave source 3 is dynamically balanced 
relative to its central axis M. 
The shockwave generator 24 is an electromagnetic shockwave generator. The 
shockwave generator 24 is preceded by an acoustic positive lens 25 that 
focusses the planar shockwaves emanating from the shockwave generator, 
which then converge in the focus zone F lying on the middle axis M as 
indicated with broken lines in FIG. 9. The shockwave generator 24 and the 
positive lens 25 are provided with respective central openings 26 and 27 
aligned with one another, and through which a tube 28 extends in which the 
ultrasound applicator 29 of the ultrasound device 10 is arranged. This 
allows ultrasound B-images of a slice of the patient containing the middle 
axis M and the focus zone F to be produced. 
The ultrasound locating system formed by the ultrasound applicator 29 and 
the ultrasound device 10 makes it possible to align the shockwave source 3 
relative to the body of the patient in a known way such that a region to 
be charged with shockwaves, for example a painful shoulder or knee joint, 
is located in the focus zone F of the shockwaves. This occurs in a known 
way with the assistance of a mark F' identifying the focus zone F that is 
mixed into the ultrasound B-image displayed on a monitor 31 in a known 
way. 
The ultrasound applicator 29, moreover, is longitudinally displaceable in 
the tube 28 in the direction of the middle axis M and is also arranged so 
as to be pivotable around the middle axis M in order to be able to 
generate an optimally undisturbed, informative ultrasound B-image 
dependent on the special circumstances of the treatment case, and in order 
to be able to bring the dome-shaped sound exit window of the ultrasound 
applicator 29 into engagement with that side of the coupling membrane 19 
adjoining the acoustic propagation medium in the manner required for good 
image quality, while the other side thereof presses against the body 
surface of the patient. The position of the mark F' is thereby adapted in 
a known way to the respective position of the ultrasound applicator 29. 
The adjustment units required for the described adjustment of the 
ultrasound applicator 29 and the positional correction of the mark F' can 
be realized without difficulty by a person skilled in the art and are 
therefore not shown. As required, the ultrasound applicator 29 can be 
retracted during the generation of shockwaves to such an extent that it 
does not impede their propagation. 
The shockwave generator 24 has a planar membrane containing electrically 
conductive material, for example copper or aluminum, having one side is 
adjacent to the water situated in the housing 23. On the other side of the 
membrane 32 a helically wound flat coil 34 is disposed that, for example, 
is attached to a coil carrier 35 by gluing. An insulating foil 33 is 
interposed between the flat coil 34 and the membrane 32. The flat coil 34 
is in communication via terminals 36 and 37 with the high-voltage pulse 
generator 7, with which the flat coil 34 can be charged with high-voltage 
pulses having high amperage (kV and kA range). The high-voltage pulse 
generator 7 is fashioned in a known way so that the intensity of the 
shockwaves and the repetition rate of the shockwaves are adjustable. To 
this end, an operating panel 38 (FIG. 1) is provided at the platform 32 
and is connected to the high-voltage pulse generator 7 to allow activation 
of the shockwave generator 24 as well as setting the aforementioned 
parameters. 
When the flat coil 34 is charged with a high-voltage pulse, eddy currents 
that are directed oppositely to the current flowing through the flat coil 
34 are induced in the membrane 32. This results in that the magnetic field 
associated with the eddy currents and the magnetic field associated with 
the current flowing through the flat coil 34 being oppositely directed. 
The membrane 32 thus moves suddenly away from the flat coil 34. A 
shockwave that is focussed with the acoustic positive lens 25 is therefore 
formed in the water located in the housing 23. The pulse duration of the 
generated shockwave lies in the .mu.s range. The energy of the generated 
shockwave can lie on the order of magnitude of up to 120 millijoules, 
whereby the energy density in the focus can amount to up to approximately 
0.6 millijoules/mm.sup.2. The peak pressure in the focus can amount to up 
to 700 bar. Energy density and peak pressure can be arbitrarily reduced. 
In order to facilitate preliminary examinations of patients, or in order to 
be able to employ the inventive therapy apparatus as an ultrasound 
diagnostic apparatus, there is the possibility of removing the ultrasound 
applicator 29 of the ultrasound device 10 from the shockwave source 3 and 
employing it independently thereof. When the ultrasound applicator 29 is 
removed, moreover, an appropriate plug (not shown) is introduced into the 
shockwave source in order to prevent the escape of water. 
Although it is especially advantageous to employ an electromagnetic 
shockwave source of the type described since this type of source can be 
well-controlled, other shockwave sources can be employed within the scope 
of the invention, for example piezoelectric (U.S. Pat. No. 4,526,168), 
magnetostrictive, electrohydraulic (German OS 23 51 247) and other 
shockwave sources. Further, the pressure pulse source employed in the 
invention need not necessarily be a shockwave source. 
Further, the radiation source need not necessarily be a pressure pulse 
source. Other acoustic radiation sources, for example ultrasound sources, 
can be employed. 
Additionally, sources other than an acoustic radiation source can be 
employed, for example a source of electromagnetic radiation. 
Although modifications and changes may be suggested by those skilled in the 
art, it is the intention of the inventor to embody within the patent 
warranted hereon all changes and modifications as reasonably and properly 
come within the scope of his contribution to the art.