Mobile radiation therapy

A mobile radiation therapy apparatus includes a vehicle cabin including driving controls for the vehicle cabin. A patient treatment compartment is rigidly attached to the vehicle cabin. A high dose rate radiation source configured to emit radiation is disposed within the patient treatment compartment. A patient treatment table is disposed within the patient treatment compartment and in proximity to the radiation source. A radiation shield is disposed around the patient treatment table, the radiation shield including a plurality of radiation shield sections rigidly attached to the patient treatment compartment and configured to substantially impede the radiation emitted from the radiation source.

BACKGROUND OF THE INVENTION

Radiation Therapy is one of the three primary methods to cure cancer, the others being surgery and chemotherapy. Radiation treatment typically requires multiple sessions (often over 20), and therefore may require a great deal of travel time wherein the patients must come into a cancer center for treatment. Additionally, patients are often required to endure prolonged time periods in waiting rooms at the cancer center for their treatments, even though these actual treatments are generally quick. This extensive queuing is most difficult for patients who are sick and infirm, which comprise a significant proportion of cancer patients.

This invention provides patients with a quality of radiation therapy which is substantially similar to current fixed location cancer centers, but without the need to travel to the center. The mobile aspects of the invention provide a quality treatment experience because fewer appointments are missed and a higher percentage of completed therapy protocols are accomplished. Additionally, a commonly seen phenomena of patient procrastination (i.e. wherein patients do not come to their initial consults, or even make their appointments) can be reduced. The invention assists in the treatment of patients who are currently unable (or are able only with major difficulties) to obtain radiation therapy.

Previous attempts to provide mobile radiation therapy are founded in the notion of merely creating satellite stationary treatment centers. For example, a radiation therapy center such as described in U.S. Pat. No. 4,449,746 can be set up in one location for an entire day, and then relocated to another location for the next day. Although this approach does create increased access to care, it fails to address the special needs of very sick and feeble patients because these patients must find the means to travel to the satellite center. The consequences of missing radiation therapy sessions or consultation visits can be life threatening.

OBJECTS AND SUMMARY OF THE INVENTION

It is therefore an object of the invention to provide an improved system and method for mobile radiation therapy. In one embodiment, a mobile radiation therapy apparatus includes a vehicle cabin including driving controls for the vehicle cabin. A patient treatment compartment is rigidly attached to the vehicle cabin. A high dose rate radiation source configured to emit radiation is disposed within the patient treatment compartment. A patient treatment table is disposed within the patient treatment compartment and in proximity to the radiation source.

A radiation shield is disposed around the patient treatment table, the radiation shield including a plurality of radiation shield sections rigidly attached to the patient treatment compartment and configured to substantially impede the radiation emitted from the radiation source.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Embodiments of the invention provide techniques for diagnosing and evaluating medical conditions and providing appropriate treatment at a patient's home residence. A physician conducts an initial house call with a patient to gather personal and medical data. A mobile diagnostic x-ray team may be subsequently dispatched to the patient's home residence. A technical team reviews patient data to determine the proper therapy plan. Additional house visits and/or telephone interviews may be conducted. A mobile radiation therapy apparatus is dispatched to the patient's home as required by the therapy plan. The mobile radiation therapy apparatus includes a radiation source and shielding, and is capable of superficial radiation therapy and/or High Dose Rate (HDR) implant therapy. For HDR therapy, low dose particle therapy, protons, neutrons, ytterbium 169, low frequency vacuum tube (such as xoft, inc), cyber knife or any type of XRT therapy, the mobile radiation therapy apparatus itself is a specialized radiation vault which the patient will enter. Therapy data is stored in the mobile radiation therapy apparatus and transferred to the technical team for additional analysis. The technical team adjusts the therapy plan based on the additional analysis, and the mobile radiation therapy apparatus is dispatched in accordance with adjusted therapy plan.

Referring toFIG. 1, a mobile radiation therapy apparatus (MRTA)10comprises a vehicle cabin12, at least one patient access door14, an interface panel16, radiation shielding sections18a-e, a patient treatment compartment20, and at least one wireless communication antenna22. The MRTA10, including the vehicle cabin12and the patient treatment compartment20, is sufficiently compact in size to travel within an urban population center to a patient's parking lot or driveway (e.g. the patient treatment compartment is approximately 28′ in length by 8′ in width). The vehicle cabin12includes the driving controls for the MRTA10and is detachable from the patient treatment compartment20. For example, the MRTA10is designed as a pod which is capable of being carried on a flatbed vehicle. In one embodiment, the MRTA10is designed as a trailer which is capable of being coupled and uncoupled from a vehicle. Further, the MRTA10is capable of being air-lifted into an area and operates independent of the vehicle (e.g., provide radiation therapy when roads have become inaccessible).

In one embodiment, such as for use in urban areas where street and parking space is generally less, the MRTA10includes a combination vehicle cabin12and patient treatment compartment20that are rigidly connected (e.g., similar to a standard delivery truck). This rigid connection decreases the overall footprint of the MRTA10.

The patient treatment compartment20includes at least one patient access door14to permit access to and egress from the interior of the patient treatment compartment20. The patient access door14may include ramps or other lifting devices to improve access for non-ambulatory patients. The patient treatment compartment20includes a plurality of radiation shielding sections18a-e(e.g. lead, aluminum, alloys of lead, polymers (such as acrylic), concrete and fiberglass). The position and number of radiation shield sections18a-eis exemplary only and not a limitation as additional sections of radiation shielding will be included to meet existing shielding requirements (e.g., federal and state regulations, ALARA recommendations). Also, the thickness and location of the radiation shielding sections18a-eis dependent on the material used and the configuration of the interior of the patient treatment compartment20(e.g. the location of the radiation source, the treatment table and interior radiation shields).

The radiation shielding may be in the form of walls that are tapered in thickness according to position from the centerline of a high dose rate radiation source, the position being calculated based upon perpendicular rays transverse to the radiation shielding, whereby a savings in weight is accomplished. The walls may be tapered in height as they approach the high dose rate radiation source.

The whole of the MRTA10is considered as a radiation vault with shielding affixed and disposed on the practicable outer boundary of the MRTA10(e.g., on the body of the MRTA vehicle, and on a divider behind the driver compartment). For example, as shown inFIG. 1, a MRTA10with dimensions of approximately 29 feet in length, by 8 feet in width, with an inner height of 6 feet. With a radiation source located in the center of the MRTA10, the thickness of the radiation shielding sections at the front and rear of the MRTA10(i.e., sections18b,c) is approximately 1.37 inches of lead. The thickness of the radiation shielding on the sides of the MRTA10(i.e., sections18a,d) is approximately 0.88 inches of lead. The thickness of the radiation shielding on the ceiling of the MRTA10(i.e., section18e) is approximately 1.18 inches of lead. These values are exemplary only as the number, geometry and thickness of the sections will be modified based on the radiation source configuration as well as patient table shielding, and optional interior shielding, if any.

The MRTA10is capable of generating and receiving power and communication signals. The interface panel16includes connection ports for power and communication systems. For example, the patient treatment compartment20is capable of receiving power (e.g. 120 v, 60 Hz) and communication inputs (e.g. cable television signals, Internet access) from external sources. The interface panel16is also capable of providing power from generators and batteries installed within the MRTA10, and communication signals from onboard computer systems, in support of detached operations. The wireless antenna22is a component of an onboard computer system and provides access to the Internet via commercial broadband signals (e.g. Verizon BroadbandAccess™). The wireless antenna22also supports a wireless local area network (e.g. Wi-Fi, Bluetooth, WIMAX, HomeRF) to support detached operations.

RegardingFIG. 2, the patient treatment compartment20includes a treatment table26, a radiation source28, optional patient area radiation bulkheads30,32with access doors27,41, and operator radiation shielding34, an operator control station40, a control power system42, and a patient entertainment device44. In general, the patient treatment compartment20is configured to include an interior that is conducive to patient relaxation (e.g., soft lighting, frosted glass partitions etched with scenes of local beauty, and a sound system for appropriate music). In one embodiment, the treatment table26is enclosed within optional patient area radiation bulkheads30,32(e.g. lead, or titanium for standard radiation protection). The treatment table26is also comprised of radiation shielding material. The optional patient area radiation bulkheads30,32, and the material within the treatment table26, are of sufficient density to provide a partial barrier during High Dose Rate (HDR) implant therapy. For example, the optional patient area radiation bulkheads30,32is comprised of 0.46 inches of lead.

The access doors27,41are composed of radiation shielding material (e.g. lead or titanium) and are configured to allow patients and medical personnel to enter the treatment table26. The doors27,41include, or are capable of integrating with, patient transfer systems to assist in moving a patient from a stretcher, wheelchair, or seat, to the treatment table26. INSERT BRANDS/TYPES OF TRANSFER SYSTEMS (IF KNOWN). Further, the treatment table26is configured to rotate the patient to an appropriate position for therapy.

The radiation source28is configured to provide a dosage appropriate for a prescribed therapy plan. In general, the radiation source28includes a 192Ir source. For example, if the therapy plan requires a variable low dose rate, then the MRTA10will be configured with a Nucletron microSelect PDR™ as the radiation source28. In another example, if the therapy plan requires a high dose rate, then the MRTA10will be configured with a Nucletron microSelect HDR™ as the radiation source28. The invention is not limited to the selection of a single Nucletron source, nor is it limited to a single supplier of radiation sources. In another example, the Xoft Axxent™ HDR X-ray Source 2.2 and associated Axxent™ controller will be used. Further, in addition to the radiation source26, the MRTA10is configured with an optional portable X-ray imaging device.

The disposition of the radiation source28inFIG. 2is exemplary only and not a limitation as alternative mounting configurations are also envisioned. For example, the radiation source28is mounted on the ceiling of the MRTA10and disposed to deliver radiation to a patient below. Further, multiple sources are installed in a single MRTA10such as from both a side and an overhead mount. Portable radiation sources are also included in the MRTA10as bulkhead spares, to be configured prior to a radiation therapy session. Combinations of sources rigidly fixed within the MRTA10, and portable sources which are stored within the MRTA10are envisioned. Further, portable sources will be configured to connect to the interface panel16during detached operations.

The operator control station40is disposed behind radiation shielding34and is operable connected to the MRTA10. For example, the radiation shielding34is approximately 1 inch thick lead, and is disposed to shield an operator working at the control station40. In one embodiment, the radiation shielding34is divided into 2 sections such that the upper section is comprised of 1 inch thick lead, and the lower section is comprised of 0.53 inch thick lead. The reduction in lead for the lower half of the shielding34is based on the influence of the optional patient area bulkhead30and the patient table26.

The operator control station40comprises networked computer processors, the computer processors including input and output devices, and configured to control the MRTA10sub-systems (e.g. doors and interlocks, patient table height and orientation, climate control, power generation, Internet connectivity) as well as control the radiation source and store patient therapy data. The power control system42includes power generation and control equipment capable of providing electrical power to the MRTA10, including the radiation source22and operator control station40. In one embodiment, the power control system42receives electrical power through the interface panel16thus reducing the need to generate power within the MRTA10.

The patient entertainment device44is disposed within sight of the patient table26and is configured to provide multimedia content to the patient during therapy.

RegardingFIG. 3, with further reference toFIG. 2, the patient treatment compartment20in the MRTA10includes the treatment table26, the radiation source28, optional patient area radiation bulkheads30,32with access doors27,41, a patient entertainment device44, and an octagon patient table shield60. The octagon patient table shield60is configured around the patient table26and disposed to reduce the amount radiation energy entering the patient treatment compartment20. The height and configuration of the octagon patient table shield60is exemplary only, as the location of type of radiation source will impact the necessary geometry of the radiation shielding. As known in the art, post installation adjustments of the radiation shielding (e.g.,18a-e,30,32,34, and60) will be required to reduce hot spots within and beyond the MRTA10.

Referring toFIG. 4, with further reference toFIGS. 1-3, the patient treatment compartment20includes a treatment table26, the radiation source28, the patient entertainment device44, and an oval patient table shield62. The patient treatment compartment20is enclosed by radiation shield sections18a-e(n.b., radiation shield sections18a,care not shown inFIG. 4because of the perspective of the illustration). The height and angle of the oval patient table shield62are exemplary, and not a limitation as the configuration will change based on the relative location of the radiation source28. In one embodiment, portions of the patient table shield62are on hinges and configured to fold down to provide direct access to the treatment table26. The hinged portion of the patient table62is further configured to lock in the upright position after a patient is placed on the treatment table26.

Referring toFIG. 5, with further reference toFIG. 1, a system diagram of detached radiation therapy100is shown. Detached operation includes the MRTA10, the communication antenna22, the radiation source26, a control tether110, a local computer120, a wireless network interface122, a wireless data connection124, and portable shielding130. The MRTA10is configured to connect to the control tether110through the interface port16. The control tether100includes power and data communication portions, and is configured to connect to the radiation source26. The local computer120connects to the radiation source26and is configured with corresponding control software for monitoring and controlling the radiation source26. The local computer120is also configured to communicate with the MRTA10through the control tether100, or via wireless network interface122, and the wireless data connection124. The portable shielding130is configured to be removed from the MRTA10and moved into a residential space (e.g., through standard doors and stairwells). The portable shielding130is exemplary and not limiting as other configurations of transportable shielding are envisioned.

In operation, the elements within the MRTA10such as the radiation source16, computer control system40, and bulkheads30,32can be detached from the MRTA10and set-up in the patient's home. In detached operation100, the elements of the MRTA are tethered to the MRTA10via a control tether110, including cables for power and data communications. The data communication between the local computer120and the MRTA10is established via wireless link122,124,22. The computer control system40is capable of bridging the wireless link122,124,22to the internet. In one embodiment, power to the radiation source26is provided locally from the patient's residential service. Also, the portable radiation shielding130is configured to collapse to 2.5×2.5 feet and expand up to 5×7 feet.

In operation, referring toFIG. 6, with further reference toFIGS. 2-5, a process200for providing mobile radiation therapy using the MRTA10includes the stages shown. The process200, however, is exemplary only and not limiting. The process200may be altered, e.g., by having stages added, removed, or rearranged.

At stage210, a physician makes a house call in order to assess a patient. The house call includes general patient consulting, actual physical tumor measurements, assessments of normal adjacent dose limiting structures, treatment planning, and obtaining digital photos, as well as portable x-rays where necessary. Also, all consent forms are obtained at the initial consult, including HIPPA forms and any other forms and insurance information. This initial house call can be more than just information gathering. For example, it creates a personal bond between the patient and physician and helps increase patient commitment to the program and thereby increase chances for successful treatment.

At stage220, the physician takes the information back to a centralized headquarters area for technical review. A technical review involves a technical department (e.g. therapists, dosimetrists, nurses, and physicists), or similar staff to complete a technical analysis. The technical department processes the information as needed to plan a therapy. For example, additional x-rays may be required, in which case a MRTA10will be dispatched to obtain them at stage230. The technical department also accesses existing x-rays available via hard films (CT scans, PET scans, MRI scans, Bone scans, etc.), or via digital mediums such as memory discs or the internet.

At stage240, and based on the technical review at stage220, additional telephone phone contact with the patient, as well as additional visits may be required. This individual treatment helps to ensure that the patient feels a sense of individual commitment as well as confidence in the treatment program. This sense of commitment in turn helps improve compliance with the prescribed therapy. The individual treatment also helps reduce the frustrations associated with stationary cancer centers, such as the long queue time patients must endure while simultaneously being surrounded by sick patients who are often likely complain and promote a pessimistic outlook.

At stage250, a radiation therapy plan is created or reviewed by the physician. Additional x-rays will be obtained by dispatching a MRTA10to the patient's home residence at stage260.

At stage270, the MRTA10is dispatched to the patient's home residence or other appropriate location. A simulation is performed on site (i.e., the patient's home residence) by the physician in the mobile radiation therapy unit. The dispatched MRTA10is equipped with the appropriate radiation source28to complete the therapy plan indicate at stage250(e.g., low dose rate and high dose rate sources). The MRTA10vehicle is sufficiently compact in size to travel to the patient's residence to begin therapy in the patient's parking lot or residential driveway (e.g. the MRTA10compartment is approximately 28′ long by 8′ wide).

At stage280, the patient under goes radiation treatment in accordance with the prescribed therapy plan as indicated at stage250.

Embodiments of the MRTA10include pop-out walls located on the side of the vehicle. The pop-out walls are configured to decreased radiation leakage. Also a sliding lead lined panel with treatment viewing window may cover the pop out to create a place for the technician and physicist to stand during treatment Also, a possible shielded drape over or on top of the applicator may allow decreased shielding requirements in the walls. The MRTA10is also configured with interlocks to secure the radiation source28when a potentially unsafe condition exists (e.g., open doors, vehicle movement, high radiation sensors).

Another embodiment includes an MRTA10configured to provide chemotherapy including exam tables, seats, and intravenous apparatus along with standard monitoring equipment and personnel required during chemotherapy. Other embodiments of the MRTA10is configured to allow mobile surgery simultaneously with intra-operative radiation therapy, or post-operative radiation therapy and chemotherapy in a mobile setting.

Other embodiments are within the scope and spirit of the invention. For example, due to the nature of software, functions described above can be implemented using software, hardware, firmware, hardwiring, or combinations of any of these. Features implementing functions may also be physically located at various positions, including being distributed such that portions of functions are implemented at different physical locations.