A METHOD AND APPARATUS FOR DETERMINING THE POSITION OF A TARGET RELATIVE TO KNOWN CO-ORDINATES

Abstract: The invention relates to a method and to apparatus for determining the exact position of a target (c) relative to a reference (O) of known co-ordinates. The apparatus comprises a source of radiation (30) for forming an image of a target (c), which image is received by a receiver device (24) situated beyond the target. A mask-forming device (40) is interposed between the receiver device and the source of radiation, the mask-forming device including at least one localization means (R1, R2) of known position relative to a reference point and suitable for forming an image in said image-forming radiation, means are also provided for displacing the radiaton source in three dimensions, at least between two different angular positions (S1, S2), thereby displacing the co-ordinates of two different images of the target obtained from the two different angular positions of the source. The invention makes it possible to determine the exact position of a target with a very high degree of precision using a method which is simple and which limits the radiation dose. The target may be a cell or a stone or a bone to be treated.

Description: A METHOD AND APPARATUS FOR DETERMINING THE POSITION OF A TARGET RALATIVE TO KNOWN CO-ORDINATES The present invention relates essentially to a method and to apparatus for determining the position of a target relative to a reference of known co-ordinates and without a priori knowledge of the position of a source of radiation. BACKGROUND OF THE INVENTION Various methods and apparatuses are already known for determining the exact position of a target by using a source of radiation emitting radiation which can be received by a receiver device, the said source and said receiver device being disposed on opposite sides of said target (see EP-A-0 240 565 or EP-A-0 260 550). In prior apparatuses, the source of radiation is exclusively a source of X-rays, thereby tending to subject a patient to considerable doses of X-ray irradiation, which is not desirable. Further, prior methods and apparatuses require the X-ray source and the radiation receiver device to be fully integrated with equipment for treating the target, which means that radiation sources that may already exist in treatment centers are unsuitable, thereby considerably increasing the cost of such apparatuses. Another major drawback of prior methods and apparatuses lies in the fact that they require the initial position of the source to be known, which is why they need to be fully integrated in the target treatment equipment. Thus a main object of the present invention is to solve the novel technical problem consisting in determining the exact position of a target independently of a priori knowledge of the position in three dimensions of the source of radiation. Another main ob ect of the present invention is to solve the novel technical problem consisting in providing a method and an apparatus for determining the exact position of a target without a priori knowledge of the distance and/or angular position in three dimensions of the source of radiation relative to said target, the apparatus being simple in design and cheap. Another object of the present invention is to solve the novel tec-hnical problem consisting in providing a method and apparatus for determining the exact position of a target independently of a priori knowledge of the position in three dimensions of the source of radiation, making use of a source of radiation which is independent of the target treatment equipment, which is particularly advantageous for therapeutic treatment of targets that may be constituted, for example, by cells, lithiases or concretions, or bones to be treated. The invention also makes it possible to use sources of radiation that are available in treatment centers for other purposes. Another ob ect of the present invention is to solve the novel technical problems specified above with a minimum of manipulation, in particular using a minimum number of steps or taking a minimum number of pictures with the localization apparatus, thus limiting the dose of exposure to the radiation emitted by the localization apparatus, which is particularly impoirfcant when the localization apparatus emits X-rays. Another object of the present invention is to solve the novel technical problem consisting in determining the exact position of a target without having to displace the patient. For the first time, the present invention makes it possible to solve the technical problems specified above simultaneously, particularly simply, cheaply, and in a manner that is usable on an industrial scale. SUMMARY OF THE INVENTION Thus, in a first aspect, the present invention provides a method of determining the exact position of a target relative to a reference point as determined, for example, by equipment for treating the target, the method comprising using an emission device comprising a radiation source emitting image- forming radiation for forming an image at least of the target and capable of being received by a receiver device for receiving said radiation, said source and said receiver device being disposed on opposite sides of said target, wherein: a mask-forming device is disposed between said receiver device and said radiation source, the mask-forming device comprising at least one localization means of known position relative to said reference point, said localization means being suitable for forming an image using said image-forming radiation; the emission device is brought into a position facing a localization means; the radiation source is adjusted approximately into a first angular position in three dimensions relative to the localization means, and it is verified that said radiation simultaneously encompasses the receiver device, the target, and the localization means; said source is caused to emit said image-forming radiation in order to form a first image of the target and a . first image of said localization means on the receiver device, and the respective first position co-ordinates thereof are noted; the radiation emission device is displaced to an angular position which is different from the preceding angular position, and being capable, in said different angular position, of simultaneously encompassing the receiver device, the target, and the localization means; the radiation source is adjusted approximately into a second angular position in three dimensions relative to the localization means, and it is verified that said radiation simultaneously encompasses the receiver device, the target, and the localization means; said source is caused to emit second radiation to obtain a second image of the target, and a second image of said localization means on the receiver device, and the respective second position co-ordinates thereof are noted; and the co-ordinates of the target are calculated from the known co-ordinates of the localization means and on the basis of at least some of the co-ordinates of the first and second images of the target, and of at least some of the co-ordinates of the first and second images of said localization means. In a preferred implementation of the invention, the invention provides a method of determining the exact position of a target relative to a reference point as determined, for example, by equipment for treating the target, the method comprising using an emission device comprising a radiation source emitting image-forming radiation for forming an image at least of the target and capable of being received by a receiver device for receiving said radiation, said source and said receiver device being disposed on either side of the target and wherein: a mask-forming device is interposed between said receiver device and said source of radiation whose position is unknown, the mask-forming device comprising at least two groups of localization means having known positions relative to the reference point, i.e. a first group of localization means and a second group of localization means, said first and second groups of localization means being disposed at two different known angular orientations relative to the reference point, said first group and said second group of localization means . being suitable for forming images by means of said image- forming radiation; the emission device is brought to a first position facing the first group of localization means; the radiation source is adjusted approximately into a first angular position in three dimensions relative to the first localization means and it is verified that the said radiation simultaneously encompasses the receiver device, the target, and the first group of localization means; the source is caused to emit image-forming radiation in order to obtain a first image of the target and a first image of the first group of localization means on the receiver device, and the respective first position co-ordinates thereof are noted; the radiation emission device is displaced to face the second group of localization means; the radiation source is approximately adjusted into a second angular position in three dimensions relative to the second group of localization means, and it is verified that said radiation simultaneously encompasses the receiver device, the target, and the second group of localization means; the source is caused to emit image-forming radiation to form a second image of the target and a second image of the second group of localization means on the receiver device, and the respective second position co-ordinates thereof are noted; and the co-ordinates of the target are calculated on the basis of the known co-ordinates of the first and second groups of localization means, on the basis of at least some of the co¬ ordinates of the first image of the target, on the basis of at least some of the co-ordinates of the second image of the target, and on the basis of at least some of the co-ordinates of the images of the first and second groups of localization means. In a variant implementation, a first group of at least three localization means is provided disposed in a given plane and having known co-ordina~es, together with a second group of at least three localization means of known co-ordinates disposed in a common oblique plane sloping at a known angle relative to the first group of localization means. In a variant implementation, one of the localization means is disposed on the axis of symmetry of the target treatment equipment with the reference point likewise lying on said axis. In another variant implementation, the plane of the first group of localization means is disposed substantially perpendicular to the axis of symmetry of the treatment equipment. In another particular variant implementation of the method of the invention, at least ' one shadow means is used disposed between the target and the receiver device to form a shadow, e.g. a cross, on the receiver device while the radiation for forming an image of the target is being emitted, the co¬ ordinates of said shadow means being known relative to the reference point. In another variant implementation, a group is provided comprising a plurality of shadow means (preferably three), with at least some of the shadow means being disposed on the opposite side of the axis of symmetry of the treatment equipment relative at least to the first group of localization means. In yet another particular variant implementation of the invention, a first group of at least three reference means is provided having co-ordinates that are known relative to the reference point, a first reference means being disposed on an axis of symmetry of the target treatment equipment passing through the reference point, a second reference means being disposed on an X-axis defined by the longitudinal displacement axis of the treatment equipment, and a third reference means disposed on an Y-axis defined by the transverse displacement axis of the target treatment equipment. In yet another particular variant implementation of the method of the invention, a group of at least three shadow means is provided, disposed between the target and the receiver device, said shadow means being preferably disposed in the vicinity of the receiver device and forming a shadow, e.g. a cross, on the receiver device while the radiation for forming an image of the target is being emitted, the co-ordinates of the shadow means being known relative to the reference point, the group comprising a first shadow means disposed on an axis of symmetry of the target treatment equipment so that its shadow on the receiver device preferably defines the above- mentioned reference point, a second shadow means disposed in a plane defined by the axis of symmetry of the target treatment equipment and the substantially longitudinal displacement direction of the target treatment equipment, which direction is referred to as the positive X-axis, and a third shadow means disposed in the plane defined by the Z-axis of symmetry of the target treatment equipment and by the direction substantially transverse to the displacement direction of the target treatment equipment, said direction being referred to as the positive Y-axis. In a particular variant implementation of the invention, the image-forming radiation source is an X-ray source and the receiver device includes an X-ray sensitive film, the method preferably including a system for measuring cartesian co¬ ordinates, e.g. in the form of a digitizing tablet. In another variant implementation of the invention, the image-forming radiation source is an X-ray source and the receiver device, comprises a fluoroscopic receiver device, preferably fitted with a monitor screen provided with a system for measuring cartesian co-ordinates, the system for measuring cartesian co-ordinates being integrated or independent, e.g. in the form of a system for digitizing a video signal. In a variant implementation, the radiation-emitting device also includes means for emitting collimation radiation which is preferably visible, thereby facilitating alignment of the emission device on the reference means. In a particular variant implementation of the invention, the above-mentioned emission means emit collimation radiation identical to the radiation from the source for forming an image of the target, in which case only one radiation source is present. In another particular variant implementation of the invention, the emission means emit collimation radiation which is different from the radiation from the source for forming an image of the target, with the collimation radiation emitted by the emission means preferably being visible radiation while the image-forming radiation emitted by the source is X-radiation. In another particular implementation of the invention, the collimation radiation is parallel or colinear with the radiation emitted by the source for forming an image of the target, with the collimation radiation emission means including localization means intended to be brought substantially into alignment with at least one of the above-mentioned localization means in each position of the radiation source. In a particularly advantageous implementation of the invention, the method is applied to the treatment or destruction of the target by shock waves, with the reference point being constituted by a point which is situated on the axis or which coincides with the shock wave focus point that is to be brought into coincidence with the target. In a particular implementation, the shock wave focus point is constituted by the focusing center of a shock wave generated by any type of generator and focusing equipment, in particular of the magneto-strictive, hydraulic, or electrohydraulic type, in particular constituted by a second focus of a truncated ellipsoid or by a piezoelectric generator and focusing device. According to another advantageous characteristic of the method of the invention, the radiation receiver device is in a known position relative to the reference point. Advantageously, the center of the receiver device defines the reference point or is situated on an axis of symmetry of the target treatment equipment passing through the reference point. According to another characteristic of the invention, the above-mentioned localization means and shadow means are disposed on either side of the axis of symmetry of the target treatment equipment passing the reference point. According to another advantageous characteristic of the invention, a first group of localization means is used, said means being disposed in a horizontal plane of the mask-forming device which is itself perpendicular to the axis of symmetry of the target treatment equipment passing through the reference point, and a second group of localization means is used, said means being disposed in an oblique plane defined by the mask- forming device and forming an angle of known value relative to the horizontal plane containing the first group of localization means of the mask-forming device. In a second aspect, the present invention also provides an apparatus for determining the exact position of a target relative to a reference point as determined, for example, by equipment for treating the target, the apparatus comprising a radiation emission device comprising a radiation source emitting radiation for forming an image of the target and capable of being received by a radiation receiver device, said source and said receiver device being disposed on opposite sides of said target, wherein the apparatus comprises: a mask-forming device interposed between the receiver device and the radiation source and comprising at least one localization means of known position relative to the reference point; means for displacing the radiation emission device in three dimensions, and thus displacing the radiation source between at least two different angular positions; means being provided for adjusting the orientation in three dimensions of the radiation source relative to the localization means; means for noting the co-ordinates of two different images of the target resulting from two different angular positions of the source; and means for calculating the co-ordinates of the target on the basis of the noted co-ordinates of the localization means of at least some of the co-ordinates of two different images of the target, and of at least some of the co-ordinates of the first and second images of the localization means as obtained with two different orientations of the source. A variant embodiment of the apparatus includes means for displacing the mask-forming device out of the beam of radiation for forming an image of the target. According to another characteristic of the apparatus of the invention, it includes at least one shadow means disposed between the target and the surface of the receiver device to form a shadow, e.g. in the form of a cross, when radiation is emitted for forming an image of the target, said shadow means having co-ordinates which are known relative to the reference point. Another variant embodiment of the invention includes a first group of localization means and a second group of localization means, said first and second groups of localization means being disposed in two different known angular orientations relative to the reference point. In another particular embodiment, the first and second groups of localization means are disposed on a frame connected to the reference point, said frame including two substantially plane surfaces, one of which is.disposed substantially parallel to the surface of the receiver device and the other of which is disposed sloping at a predetermined known angle relative to the first surface which is parallel to the surface of the receiver device, each surface containing one of said first and second groups of localization means in its plane, and the sloping surface preferably slopes towards the receiver device. Another particular variant embodiment of the invention includes target treatment equipment determining the reference point with the mask-forming device being connected to the target treatment equipment, and the target may be constituted, in particular, by a cell, by a stone or concretion, or by a bone to be treated. It will readily be understood that the invention provides all of the above-mentioned technical advantages of significance, together with others that will appear to the person skilled in the art from the following description which is made with reference to the presently preferred implementation of the invention which is given purely by way of example. The scope of the invention is naturally not limited in any way to the specific example. BRIEF DESCRIPTION OF THE DRAWINGS An embodiment of the invention is described by way of example with reference to the accompanying drawings, in which: Figure 1 is a diagrammatic elevation view in a plane per¬ pendicular to a patient P represented by dot-dashed lines, said patient P including a target C to be treated, e.g. a renal con¬ cretion or kidney stone, with the view showing the presently preferred embodiment of apparatus of the invention associated with target treatment equipment 20 represented by dashed lines near the bottom of the figure and comprising, for example, a device 22 for generating and focusing shock waves and consti¬ tuted in conventional manner, for example, by a truncated ellipsoid having an internal focus F x and an external focus F2 Figure 2 is a view on a larger scale showing a mask- forming device 40 of the invention which is also visible in Figure 1; Figure 2A is a plan view in partial section through the mask-forming device; Figure 3 is a plan view on a larger scale than Figure 1 showing a particular embodiment of a receiver device 24 for receiving radiation emitted by a radiation source Si, S2 (visible in Figure 1), this figure having dashed lines showing the position of the target treatment equipment shown in Figure 1; and Figure 4 is a diagrammatic perspective view showing a beam of radiation emitted by the radiation source S^ with the radiation source in a first determined position, e.g. a position which is substantially perpendicular to the surface of the radiation receiver device. DETAILED DESCRIPTION With reference to Figures 1 to 3, apparatus of the invention is given an overall reference 11. This apparatus serves to determine the exact position of a target C relative to a reference point 0 as determined, for example, by equipment for treating the target C and designated by overall reference 20. In Figure 1, it can be seen that the reference point 0 is defined by the intersection of the axis of symmetry of the treatment equipment 20 (constituted in this case by a device 22 for generating and focusing shock waves, e.g. a truncated ellipsoid reflector defining an internal focus F and an external focus F2 which is to be subsequently brought into coincidence with the target C), and the substantially horizontal plane defined by the surface of a radiation receiver device 24 constituted, for example, by a film F sensitive to the radiation emitted by a source of radiation Si, S2 constituting a part of an emission device given an overall reference 30. The apparatus of the invention is characterized in that it includes a mask-forming device 40 including at least one group of localization means given overall references R , R2 of known position relative to the reference point 0. In the example shown, the mask-forming device 40 includes a first group of localization means R and a second group of localization means R2, with the first and second groups of localization means Ri and R2 being disposed at two different known angular orientations relative to the reference point 0, the angular difference being 20°, for example, as shown. According to a preferred characteristic of the invention, when using two groups of localization means as shown, one (Rl) of the first and second groups of localization means Ri and R2 is disposed on the axis of symmetry of the target treatment equipment passing through the reference point 0. The apparatus also includes means for measuring the angular orientation of the radiation source S , S2 such as a protractor 44 which can be seen in the view of Figure 1 by way of example and serving to assist the practitioner in positioning the source. Such protractor devices are common practice in conventional radiation-emitting devices 30 and in particular in portable devices as are preferably used in the present case, which devices are independent from the treatment equipment 20. The emission device 30 including the radiation source Si, S2 is thus mounted on a support arm 46 enabling the height of the radiation source Si, S2 to be adjusted and also enabling its angular position in the planes X, Y, and Z to be adjusted, with the support arm itself being mounted on a moving stand (not shown) as is well known in the art. In addition to its radiation source S , S2 which is usually an X-ray source, the radiation emission device 30 also includes a source of collimation radiation, which is usually a light source and which is disposed in such a manner as to emit radiation which is parallel to or preferably colinear with the X-ray source Si, S2. In an advantageous embodiment, apparatus of the invention includes calculation means 50 for calculating the co-ordinates of the target C relative to known co-ordinates of the localization means, constituted in this case by the first and second groups of localization means R^ and R2. The calculation is performed on the basis of at least some of the co-ordinates of a first image Iχ of the target C using the source S and at least some co-ordinates of a second image 12 of the target C using the source S2, together with at least some of the co-ordinates of a first image and a second image of the localization means. In the presently preferred embodiment of the invention, as shown, the mask-forming device 40 has a section substantially in the form of an upsidedown L-shape, thereby defining a portion 40a which is substantially perpendicular to the plane F and a portion 40b substantially parallel to the surface F. The substantially parallel portion 40b advantageously includes a group of localization means, in this case the group of localiz¬ ation means Rτ_. In the present case, as shown, there are two groups of localization means, with the other localization means R2 being disposed in a plane 40c which is inclined at a pre¬ determined angle relative to the plane of the group of localiz¬ ation means R , e.g. 20°, and sloping towards the receiver device 24. In a particular variant embodiment, the mask-forming device 40 may be removably assembled relative to the treatment equipment 20. This may be done, for example, by assembling the mask-forming device 40 on an adapter given overall reference 60 and in a predetermined position relative to the reference point 0. In another particular variant embodiment, the first group of localization means R^ comprises three localization means forming a cross, said means being opaque to X-rays, e.g. by being made of metal, and being given respective references 5, 6, and 7. These reference numbers may also be made of metal and disposed adjacent to the corresponding crosses so as to facilitate visual identification when radiation is projected onto the receiver device. By way of example, the first localization means given reference 5 may be disposed in the center of a window 70 which serves to limit the zone which is exposed to radiation from the radiation source Si or S2 (generally X-radiation) while the target C is being irradiated by the source Si, S2. Advantageously, the localization means referenced 5 is situated substantially on the axis of symmetry of the treatment equipment 20 as represented by dot-dashed lines in Figure 2 and as clearly visible in Figure 1. A second localization means, referenced 6, is at a distance substantially equal to A from the first localization means referenced 5 in a direction extending substantially transversely to the treatment equipment 20 and in the negative Y-axis direction therefrom as can clearly be seen in Figure 2A. Similarly, the third localization means, referenced 7, is at a distance substantially equal to A from the localization means referenced 5 in a substantially longitudinal direction of the treatment equipment 20 and in the negative X-axis direction, as can also be clearly seen. The second group of localization means R2 disposed in the oblique plane 40c which slopes at a predetermined angle relative to the plane of the group Ri of localization means is likewise constituted in a preferred embodiment by three X- ray opaque localization means likewise disposed in a window 72 for limiting the zone exposed to radiation. The localization means referenced 8 is disposed in the center of the window 72. The position of the second screen 40c is derived from the position of the first screen substantially by rotation about an axis situated on the surface of the radiation-sensitive film F (sensitive in particular to X-rays) disposed inside the receiver device 24 as described in greater detail below. This axis passes through the axis of symmetry of the treatment equipment 20 and extends along a substantially longitudinal direction. As a result-, the localization means referenced 8, 9, and 10 correspond to the localization means 5, 6, and 7 after such rotation. Similarly, each localization means is accompanied by a reference number made in the form of radiation-opaque metal. It will thus be understood that the localization means referenced 9 is likewise situated in the negative direction along the Y-axis, and the localization means 10 is disposed in the negative direction along the X-axis. It will thus be understood that the position of each of the localization means 5, 6, 7, 8, 9, and 10 is known relative to the treatment equipment 20. In an advantageous embodiment of the invention, the radiation receiver device 24 is positioned in a predetermined position relative to the adapter 60. In the example shown, the adapter 60 is removably fixed to the treatment equipment 20, e.g. on the top surface of a truncated ellipsoid reflector 22, and in a predetermined angular position, by means of a position centering point 61 and a countersink engaging one another on the top of the ellipsoid- reflector 22. When the radiation receiver device is constituted by a cassette 62 containing X-ray sensitive film F, it is also advantageous for the cassette 62 to be disposed in a cassette support 64 which is fixed to, or takes up an accurate position relative to, the adapter 60. As shown in Figure 3, it is preferable, in accordance with the invention, for the cassette 62 to be provided with a group of shadow means 66 comprising at least one shadow element referenced 1, and preferably three shadow elements as shown (referenced 1, 2, and 3) disposed inside the cassette 62 at a relatively small predetermined distance above the surface of the film F, for the purpose of forming a shadow (e.g. cross shaped) when the source Si and S2 emits radiation for forming an image of the target C. These cross-shaped shadow means are referenced by metal numbers 1, 2, and 3 for facilitating recognition thereof. The three shadow means 1, 2, and 3 are situated in a plane which is substantially perpendicular to the axis of symmetry of the treatment equipment 20 and they are situated at a known distance from the surface of the film F. Advantageously, the first shadow means referenced 1 is substantially on the axis of symmetry or the main axis, of the treatment equipment 20. The second shadow means referenced 2 lies at a distance substantially equal to 2A (where A is equal to 1 inch for example, i.e. 2.54 cm) from the shadow means 1 and substantially in the longitudinal direction of the treatment equipment 20 in the positive X-axis direction, which direction preferably corresponds substantially to the positive X-axis displacement direction of the treatment equipment 20. The third shadow means referenced 3 lies at a distance substantially equal to 2A from the first shadow means 1 in a direction substantially transverse to the displacement • direction of the treatment equipment 20 and in the positive Y- axis direction which corresponds substantially to the positive Y-axis displacement direction of the treatment equipment 20. It can thus be observed that the second and third shadow means referenced 2 and 3 are disposed respectively on the X- axis and on the Y-axis but in the opposite directions to the localization means respectively referenced 7, 10 or 6, 9. In a variant embodiment, the receiver device 24 for receiving radiation from the source Si or S2 is in a known fixed position, thereby avoiding the need to use shadow means 66. Figure 4 is a diagram showing the members which are essential for determining the position of the target C which may be a kidney stone or a gall bladder stone. These items comprise the source S (shown in its position S^) above the horizontal plane 40b of the mask-forming device 40, and the receiver device 24 which itself comprises a cassette 62 carrying the shadow means 1, 2, and 3, and a sensitive film F onto which the image C'ι or C*2 of the target C is to be projected together with the images of the localization means 5, 6, 7, 8, 9, and 10 and the images of the shadow means 1, 2, and 3. All of the co-ordinates of the localization means and of the shadow means are known, while the co-ordinates of the target C are not known. The operation of apparatus of the invention will readily be understood from the above description. The apparatus of the invention makes it possible to put into operation the method of the invention as defined above. Operation of the apparatus may essentially be defined as follows: the patient P is initially disposed over the treatment equipment 20 which is itself fitted with the adapter 60 and provided with the radiation receiver device 24, and the radiation source Si or S2 is put into position above the patient P; and the mask-forming device 40 is interposed between the receiver device 24 (or in this case the patient P) and the radiation source Si or S2, as shown in Figures 1 and 2, with the exact position of the radiation source being unknown or inaccurate in particular because the source is independent from the treatment equipment 20. It may be observed that this positioning device 40 can be pivotally mounted about an axis 41 which is shown in Figure 1 and in Figure 3, thereby facilitating putting it into place by bringing it into abutment against a positioning stop 82 which is fixed to the adapter 60. The device 40 is thus in the form of a frame. Then, e.g. starting from the position S facing the group Ri of localization means 5, 6, and 7 as shown in Figure 4, it is preferable to emit a light beam from a light source (not shown) integrated in the radiation emission device 30, which beam generally includes a cross-shaped mark, thereby making it possible to bring the mark into alignment with a first localization means such as the means 5 in the group R^, which localization means is likewise in the form of a cross as can clearly be seen in Figure 2A. Once alignment has been achieved, it is verified that the light beam encompasses the zone where the target C is assumed to lie, the reference point 0, and the film F, and in practice this can be facilitated by preadjusting the corresponding angle on the protractor 44 to a value close to the vertical relative to the substantially horizontal plane of the film F. The operator causes the treatment equipment 20 to rise until the waterproof cassette 62 is as close as possible to the skin of the patient. This is to minimize attenuation of the X- rays emitted by the radiation source S as they pass through water, with water being used as means for transmitting the treatment waves, e.g. shock waves emitted by the treatment equipment 20 which is constituted, for example, by a shock wave generator and a truncated ellipsoid reflector 22, as is well known to the person skilled in the art. A first exposure to the radiation is thus made by causing the source of radiation S to emit radiation while in its position S . Advantageously, the position of the treatment equipment 20 while the film F is being exposed may be recorded in a computer. In a variant implementation, the treatment equipment 20 may be lowered to its starting position. The cassette 62 is removed for the purpose of developing the film F, thereby revealing images of the localization means 1, 2, 3, 5, 6, and 7 together with an image C'ι of the stone C. A new waterproof cassette 62 containing X-ray sensitive film is reinserted in the adapter 60. The moving X-ray apparatus including the source S is then placed over the sloping second plane 40c. The direction in which the radiation source is pointing (now in its position S2 represented in Figure 1 by dot-dashed lines) is now adjusted so that the main beam is directed substantially along an angle at 20° relative to the vertical so that it is substantially perpendicular to the sloping screen 40c and is directed downwards. The collimation is readjusted, e.g. on the central localization means 8 in the window 72, and a second X- ray exposure is made, with this exposure including the localization means 8, 9, and 10, the target C, and the shadow means 1, 2, and 3. The position of the treatment equipment 20 in which the film is exposed is also recorded in the computer. When the second film is developed, the images of the points 1, 2, 3, 8, 9, and 10 as well as the image C'2 of the stone C appear on the second film. Each of the first and second films can then be placed on a digitizing tablet. The position of the film may be arbitrary, and it can be in any orientation thereon. The only require- ments are that the images of the localization points and of the stone should lie over the sensitive zone of the digitizing tablet and that the film should be the right way up. This is easily verified by ensuring that the reference numbers that appear on the film adjacent to the crosses can be read. In an advantageous implementation, the reference crosses can be pointed to using a stylus or a mouse of appropriate accuracy. A mouse provides greater accuracy. The points successively pointed to with the first film are the points 1, 2, and 3, the stone, and the points 5, 6, and 7, and with the second film they are the points 1, 2, and 3, the stone, and the points 8, 9, and 10. Each time a point is pointed to, the computer receives X- axis and Y-axis co-ordinate information relative to the point in question. The. computer initially calculates the exact positions in three dimensions of the X-ray source Si or S2 in each of the two exposures, on the basis both of the data concerning the co-ordinates en the two films of the points pointed to by an operator, and of the positions of the treatment equipnent in which the films have been exposed. Thereafter, the position of the stone C is deduced. The mathematical equations describing lines in three dimensions which interconnect the localization pointr or the stone with the images thereof on the films are well known to the person skilled in the art. These lines necessarily converge on the X-ray source which is assumed to be a point source, thereby giving its position S or S2- It will be understood from the above, that the Z-axis is constituted by the axis of symmetry of the treatment equipment 20, in this case the main axis of the truncated ellipsoid reflector 22, and that the X and Y axes are situated in the plane of the films F. The X-axis extends in the positive X- axis displacement direction of the treatment equipment 20 and substantially in the longitudinal direction of the machine, and the Y-axis extends in the positive Y-axis displacement direction of the machine in a substantially transverse direction. Further, the positions of the localization points 1- to 3, and 5 to 10 are fixed by design. Their co-ordinates in the working frame of reference are written x n , y n , z n where n is the number of the point under consideration. On the basis of the co-ordinates Xj_ n and Y n of the points pointed to on the digitizing tablet as expressed in the frame of reference of the tablet, the first procedure is to determine the co-ordinates xin Yin' an< z in of he points in the working frame of reference (where n is the number of the point pointed to, with n = 4 corresponding to the stone C, and where i means "image point"). The points pointed to are situated on the surface of the film. Thus, zι n = 0, for all values of n. x in an< Yin are determined by changing axes and by changing scale. A scale change consists merely in multiplying the co-ordinates by a scale factor. In order to change axes, a rotation and a translation are required. The angle of rotation is the angle between the lines interconnecting image points 1-2, 5-7 or 8-10 with the X-axis of the digitizing tablet. It is also the angle between the lines interconnecting image points 1-3, 5-6 or 8-9 with the Y- axis of the digitizing tablet. This angle is written α (i.e. the Greek letter "alpha"). x l and yn are the co-ordinates of the image of point 1 on the film in the working frame of reference. x ± anci γ± are both unknown a priori. However they are both very close to 0 for the first film and very close to x = 0 and y = Hl*sin 20° for the second film, where HI is the height of the shadow means 1 above the film. Initially they are assumed to be equal to said values. The axis changing equations are as follows: x in = x il + (( χ in " Xϋ)*cosα + (Yι n - Y- )*sinα)*scale yin = Yil + ((Xin - Xil)*cosα + (Y in - Yii)*sinα)*scale Position of the X-ray source The co-ordinates of the X-ray source in the vertical position are written x sv , y S v anci z sv (__ for source and v for vertical). The co-ordinates of the source in the oblique position are written x so , y so , and z so (o for oblique). The X-ray source during vertical exposure with the first screen lies on the intersection of the straight lines interconnecting the point 5 and its image on the first film, the point 6 and its image on the first film, and the point 7 and its image on the first film. During the oblique exposure through the second screen, the X-ray source lies on the intersection between the lines joining the point 8 and its image of the second film, the point 9 and its image on the second film, and the point 10 and its image on the second film. Intermediate calculation variables are written L, LI, and L2. The mathematical equations giving the co-ordinates of the position of the X-ray source in the vertical position are as follows: LI = (x 7 - x 5 )/(x i5 - x i7 - x 5 + χ 7 ) L2 = (y 7 - y5)/(yi5 - yι 7 - y + y 7 ) L = %(L1 + L2) Ysv = Y5 + L*(y±l + Yi5 ~ Y5) z sv = z 5*( 1 ~ L ) The mathematical equations giving the co-ordinates of the position of the X-ray source in the oblique exposure are as follows: LI = (x 10 - x 8 )/(xi8 - x il0 " x 8 + x lθ) L2 = ( yig - yis)/(Y8 - Yil - Yi8 " (Y9 ~ Y±l ~Yi9 ) * z 8 z 9) L = %(1 - LI + L2) x sv = x 8 + (1 " L )*( χ il + x i8 " x δ) Ysv = Yil + Yi8 " L*(y±l + Yi8 " Y8) z sv = Z 5* L The results obtained are verified for various consist¬ encies: the source must be situated above the masks (z > h2) and the source must be pointing within +_5 " about the vertical for the vertical exposure and. about 20° for the oblique exposure. The calculations may be reiterated in order to refine the values for x±± and y± . Position of the stone The stone lies on the intersection of the line joining the source in its vertical position and the image of the stone on the first film and the straight line joining the source in its oblique position and the image of the stone on the second film. Again there are intermediate calculation variables Ll and L2. The co-ordinates of the image of the stone on the first film are x v , yι v , an< 3 -iv; and the co-ordinates of the image of the stone on the second film are written i Q , Yl θ ' and z Q . Both zχ v and zι 0 are equal to 0. The mathematical equations for determining the co- ordinates of the stone (X, Y, Z) are as follows: L1 = (Ylo - Yso)/( z lo " z so) L2 = (y v - y sv )/( z lv " z sv) Z = (Ll*z so - L2*z sv - y so + y sv )/(Ll - L2) Y - Ll*(z - z so ) + y so X = %[( io - x so )* (z ~ z so)/ (z lo ~ z so) + x so + (x iv - x sv )*(z - z sv )/(z lv - Zgv) + x sv3 This thus provides a method for obtaining the position of the stone in three dimensions relative to a known rectangular frame of reference. The equations given above are given by way of example and in particular they take advantage of the special situation of the localization points. These equations are reduced from a system of general equations for determining the position of a stone while using localization points that are disposed arbitrarily. It will thus be understood that the present invention makes it possible to calculate the position in three dimensions of the target C very accurately, thereby making it possible to obtain extremely reliable and reproducible treatment of the target C and this is particularly important when applying therapy, e.g. when treating kidney stones or lithiasis present i the kidney 80 of a patient. P or in the treatment of bone tumors, by using shock waves emitted by a shock wave generator device 20, in a manner well known to the person skilled in the art. When using an X-ray emitting source Si or S2, in combination with a receiver device 24 including an X-ray sensitive film F, the present invention makes it possible to avoid the need for a priori knowledge about the position of the source, thereby making it possible to use any radiation device 30 that may be available in a treatment center, and in particular making it possible to use moving devices. Further, the invention makes it possible to subject patients to minimum doses of radiation without any need to modify the patient treatment equipment significantly, since all that is required is an additional mask-forming device 40 used in association with a cassette system containing the film F, which system is itself conventional, or else in association with a fluoroscopic device, as is also conventional. It is also necessary to use a system for measuring cartesian co¬ ordinates, e.g. in the form of a digitizing tablet or in the form of a system for digitizing a video signal, both of which are conventional. Further, the invention makes it possible to perform the above method without displacing the patient, and while exposing the patient only twice to X-rays, whereas prior apparatuses have required a much larger number of exposures prior to determining the exact position of the target.

Claims: CLAIMS 1/ A method of determining the exact position of a target relative to a reference point as determined, for example, by equipment for treating the target, the method comprising using an emission device comprising a radiation source emitting image-forming radiation for forming an image at least of the target and capable of being received hy a receiver device for receiving said radiation, said source and said receiver device being disposed on opposite sides of said target, wherein: a mask-forming device is disposed between said receiver device and said radiation source, the mask-forming device comprising at least one localization means of known position relative to said reference point, said localization means being suitable for forming an image using said image forming radiation; the emission device is brought into a position facing a localization means; the radiation source is adjusted approximately into a first angular position in three dimensions relative to the localization means, and it is verified that said radiation simultaneously encompasses the receiver device, the target, and the localization means; said source is caused to emit said image-forming radiation in order to form a first image of the target and a first image of said localization means on the receiver device, and the respective first position co-ordinates thereof are noted; the radiation emission device is displaced to an angular position which is different from the preceding angular position, and being capable, in said different angular position, of simultaneously encompassing the receiver device, the target, and the localization means; the radiation source is adjusted approximately into a second angular position in three dimensions relative to the localization means, and it is verified that said radiation simultaneously encompasses the receiver device, the target, and the localization means; said source is caused to emit second radiation to obtain a second image of the target, and a second image of said localization means on the receiver device, and the respective second position co-ordinates thereof are noted; and the co-ordinates of the target are calculated from the known co-ordinates of the localization means and on the basis of at least some of the co-ordinates of the first and second images of the target, and of at least some of the co-ordinates of the first and second images of said localization means. 2/ A method according to claim 1, wherein the mask-forming device comprising at least two groups of localization means having known positions relative to the reference point, i.e. a first group of localization means and a second group of localization means, said first and second groups of localization means being disposed at two different known angular orientations relative to the reference point, said first group and said second group of localization means being suitable for forming images by means of said image-forming radiation; the emission device is brought to a first position facing the first group of localization means; the radiation source is adjusted approximately into a first angular position in three dimensions relative to the first localization means and it is verified that the said radiation simultaneously encompasses the receiver device, the target, and the first group of localization means; the source is caused to emit image-forming radiation in order to obtain a first image of the target and a first image of the first group of localization means on the receiver device, and first position co-ordinates are noted; the radiation emission device is displaced to face the second group of localization means; the radiation source is approximately adjusted into a second angular position in three dimensions relative to the second group of localization means, and it is verified that said radiation simultaneously encompasses the receiver device, the target, and the second group of localization means; the source is caused to emit image-forming radiation to form a second image of the target and a second image of the second group of localization means on the receiver device, and second position co-ordinates are noted; and the co-ordinates of the target are calculated on the basis of the known co-ordinates of the first and second group of localization means, on the basis of at least some of the co¬ ordinates of the first image of the target, on the basis of at least some of the co-ordinates of the second image of the target, and on the basis of at least some of the co-ordinates of the images of the first and second groups of localization means. 3/ A method according to claim 1, wherein a first group of at least three localization means is provided disposed in a given plane and having known co-ordinates, together with a second group of at least three localization means of known co¬ ordinates disposed in a common oblique plane sloping at a known angle relative to the first group of localization means. 4/ A method according to claim 1, wherein one of the localiz¬ ation means is disposed on the axis of symmetry of the target treatment equipment, with the reference point likewise lying on said axis. 5/ A method according to claim 4, wherein the plane of the first group of localization means is disposed substantially perpendicular to the axis of symmetry of the treatment equipment. 6/ A method according to claim 1, wherein at least one shadow means is used disposed between the target and the receiver device to form a shadow, e.g. a cross, on the receiver device while the radiation for forming an image of the target is being emitted, the co-ordinates of said shadow means being known relative to the reference point. 7/ A method according to claim 6, wherein a group is provided comprising a plurality of shadow means, with at least some of the shadow means being disposed on the opposite side of the axis of symmetry of the treatment equipment relative at least to the first group of localization means. 8/ A method according to claim 1, wherein the image-forming radiation source is an X-ray source and the receiver device includes an X-ray sensitive film, the method preferably including a system for measuring cartesian co-ordinates, e.g. in the form of a digitizing tablet. 9/ A method according to claim 1, wherein the image-forming radiation source is an X-ray source and the receiver' device comprises a fluoroscopic receiver device, preferably fitted with a monitor screen provided with a system for measuring cartesian co-ordinates, the system for measuring cartesian co¬ ordinates being integrated or independent, e.g. in the form of a system for digitizing a video signal. 10/ A method according to claim 1, wherein the above-mentioned emission means emit collimation radiation identical to the radiation from the source for forming an image of the target, in which case only one radiation source is present. 11/ A method according to claim- 1, wherein the emission means emit collimation radiation which is different from the radiation from the source for forming an image of the target, with the collimation radiation emitted by the emission means preferably being visible radiation while the image-forming radiation emitted by the source is X-radiation. 12/ A method according to claim 1, wherein the collimation radiation is parallel or colinear with the radiation emitted by the source for forming an image of the target, with the collimation radiation emission means including localization means intended to be brought substantially into alignment with at least one of the above-mentioned localization means in each position of the radiation source. 13/ A method according to claim 1, wherein the method is applied to the treatment or destruction of the target by shock waves, with the reference point being constituted by a point which is situated on the axis or which coincides with the shock wave focus point that is to be brought into coincidence with the target. 14/ A method according to claim 13, wherein the shock wave focus point is constituted by the focusing center of a shock wave generated by any type of generator and focusing equipment, in particular of the magneto-strictive, hydraulic, or electro- hydraulic type, in particular constituted by a second focus of a truncated ellipsoid or by a piezoelectric generator and focusing device. 15/ Apparatus for determining the exact position of a target relative to a reference point as determined, for example, by equipment for treating the target, the apparatus comprising a radiation emission device comprising a radiation source emitting radiation for forming an image of the target and capable of being received by a radiation receiver device, said source and said receiver device being disposed on opposite sides of said target, wherein the apparatus comprises: a mask-forming device interposed between the receiver device and the radiation source and comprising at least one localization means of known position relative to the reference point; means for displacing the radiation emission device in three dimensions, and thus displacing the radiation source, between at least two different angular positions; means being provided for adjusting the orientation in three dimensions of the radiation source relative to the localization means; means for noting the co-ordinates of two different images of the target resulting from two different angular positions of the source; and means for calculating the co-ordinates of the target on the basis of the noted co-ordinates of the localization means, of at least some of the co-ordinates of two different images of the target, and of at least some of the co-ordinates of the first and second images of the localization means as obtained with two different orientations of the source. 16/ Apparatus according to claim 15, including means for displacing the mask-forming device out of the beam of radiation for forming an image of the target. 17/ Apparatus according to claim 15, including at least one shadow means disposed between the target and the surface of the receiver device to form a shadow, e.g. in the form of a cross, when radiation is emitted for forming an image of the target, said shadow means having co-ordinates which are known relative to the reference point. 18/ Apparatus according to claim 15, including a first group of localization means and a second group of localization means, said first and second group of localization means being disposed in two different known angular orientations relative to the reference point. 19/ Apparatus according to claim 18, wherein the first and second groups of localization means are disposed on a frame connected to the reference point, said frame including two substantially plane surfaces, one of which is disposed substantially parallel to the surface of the receiver device, and the other of which is disposed sloping at a predetermined known angle relative to the first surface which is parallel to the surface of the receiver device, each surface containing one of said first and second groups of localization means in its plane, and the sloping surface preferably slopes towards the receiver device. 20/ Apparatus according to claim 15, including target treatment equipment determining the reference point with the mask- orming device being connected to the target treatment equipment, and the target may be constituted, in particular, by a cell, by a stone or concretion, or by a bone to be treated. 21/ Apparatus according to claim 20, wherein the treatment equipment is equipment for generating and focusing shock waves at a focal point, in particular of the magneto-strictive, hydraulic, or electrohydraulic type, and in particular comprising a truncated ellipsoid generator focusing shock waves emitted from a focus to the external focus which is intended to be put into coincidence with the target, or else a piezoelectric generator and focusing device. 22/ Apparatus according to claim 15, wherein one of the localization means is disposed on the axis of sy metry of the target treatment equipment on which the reference point also lies.

Inventors: DANCER PAUL, LACOSTE FRANCOIS, DANCER, PAUL, LACOSTE, FRANCOIS
Applicants: TECHNOMED INT SA, TECHNOMED INTERNATIONAL
Application year: 1990
Main classification: A61B6
IPC codes: A61B6