Abstract:
A radiation therapy system for irradiating a target volume with a particle beam is provided. The radiation therapy system includes a radiation source that is operable to output an adjustable irradiation field that includes a particle beam that is scanned point by point over the target volume. A 3D imaging device may obtain a 3D radiation treatment data set in a radiation treatment phase. An adaptation unit adapts the irradiation field to a change in position and/or shape of the target volume in the radiation treatment phase. The adaptation unit compares the 3D radiation treatment data set with a 3D planning image data set furnished and obtains a transformation that describes the change in position and/or shape of the target volume. The adaptation unit transforms an irradiation field based on the transformation.

Description:
[0001]    The present patent document claims the benefit of the filing date of German Patent Application No. DE 10 2006 044 139.7 and U.S. Provisional Patent Application Ser. No. 60/845,030, both filed Sep. 15, 2006, which are hereby incorporated by reference. 
     
     BACKGROUND 
       [0002]    The present embodiments relate to a radiation therapy system for irradiating a target volume that may change position and/or shape over time. 
         [0003]    Radiation therapy may use high-energy photons or particles. U.S. Pat. No. 6,687,330 B2 discloses radiation therapy that uses high-energy photons. A particle therapy system typically has an accelerator unit and a high-energy beam guidance system. A synchrotron or cyclotron may be used to accelerate the particles, such as protons or carbon or oxygen ions. 
         [0004]    The high-energy beam transporting system transports the particles from the accelerator unit to one or more treatment rooms. A distinction is made between “fixed beam” treatment rooms and gantry-based treatment rooms. Particles arrive at the treatment site from a fixed direction in “fixed beam” treatment rooms. In a gantry-based treatment room, the particle beam may be aimed at the patient from various directions using a gantry. 
         [0005]    A distinction may also be made between scanning and scattering. Scattering employs a large-area beam adapted to the dimensions of the volume to be irradiated Scanning scans a “pencil beam” with a diameter of a few millimeters to centimeters over the volume to be irradiated. When a scanning system is embodied as a grid scanning system, the particle beam is steered “point by point” to a volume element of a grid until such time as a previously defined number of particles has been applied. The volume elements in the scanning area are irradiated in succession; preferably, the expanse of the “pencil beams” that are side by side overlap. The particles for one volume element contribute to the dose within this volume element and along the entire path struck by the particles. 
         [0006]    A monitoring and safety system of the particle therapy system may be used to direct a particle beam, characterized by the parameters wanted, into the appropriate treatment room. The parameters of a radiation treatment procedure, for example, in a treatment plan, are summarized as an irradiation field. The irradiation field includes an association of the particle with the volume element. The irradiation filed is defined by how many particles from which direction and with what energy, are supposed to strike the patient or the volume elements. The energy of the particles determines the penetration depth into the patient. For example, the energy of the particles may determine the site at which the maximum interaction with the tissue takes place in the particle therapy. The energy of the particles defines the site where the maximum dose is deposited. During the treatment, the maximum deposited dose is located inside the tumor (or in the case of other medical applications of the particle beam, in the particle target area). 
         [0007]    The monitoring and safety system controls a positioning device, with which the patient is positioned relative to the particle beam. For carrying out the treatment plan, the patient should assume a position for the irradiation that matches the planning. Matching the position to the plan is done, for example, by 2D position verification. 2D position verification includes, for example, before the irradiation is performed, calibrating 2D images with images from the irradiation planning. 
         [0008]    European Patent Disclosure EP 0 986 070 and “The 200-MeV Proton Therapy Project at the Paul Scherrer Institute: Conceptual Design and Practical Realization”, E. Pedroni et al, Med. Phys. 22, 37-53 (1995) disclose particle therapy systems with a scanning system. 
         [0009]    When planning a treatment, typically a plurality of irradiation fields, with different angles of incidence, are planned for individually. Each irradiation field is adapted to the scanning system. For example, each field is planned individually and its expanse is limited by a scanning range of the scanning system. The maximum deflection of the particle beam determines the scanning range. A distinction is made between 2D scanning (the particle beam deflection is in two directions) and 1D scanning. In 1D scanning, the patient is moved in increments, so that even a volume that is extensive in the second dimension can be irradiated. 
         [0010]    Irradiation of a target volume in the radiation treatment phase may have a different position and/or size than was determined in the planning phase for setting up the irradiation field. This may be problematic because as a result of the change in location and/or size of the target volume, the target volume may not be located at the planned site in the patient despite position verification of the patient. 
         [0011]    A similar situation arises in irradiation of targets that, for example, move because of respiration. These problems are discussed, for example, in E. Rietzel et al, “Four-Dimensional Image Based Treatment Planning: target volume segmentation and dose calculation in the presence of respiratory motion”, Int. J. Radiation Oncology Biol. Phys. Vol. 61, No. 5, pp. 1535-1550, 2005. This article also discloses methods for segmentation that may be used for demarcating a tumor tissue. In radiooncology, segmentation and registering of image data are known. 
       SUMMARY 
       [0012]    The present embodiments may obviate one or more of the drawbacks or limitations of the related art. For example, in one embodiment, the performance of an irradiation of a volume whose position and/or size varies is simplified. The embodiments will be discussed below predominantly in conjunction with a particle therapy system, but the same problems and solutions arise in photon therapy as well. 
         [0013]    In one embodiment, an irradiation field is adapted for a target volume, which can change its position and/or shape in the patient over time. A 3D planning image data set, which may already be generated in a planning phase of the radiation therapy, is furnished together with an irradiation field planned on the basis of the 3D planning image data set. The irradiation field corresponds to an association of doses to be applied to individual volume elements of the target volume. In the radiation treatment phase, the patient is then prepared for the irradiation and positioned accordingly. Because of the later time of the irradiation session in comparison to the irradiation planning, the target volume may have changed its position and/or shape in the patient. 
         [0014]    In one embodiment, the irradiation is adjusted to compensate for changes of the position and/or shape of the target volume in the patient. A 3D radiation treatment set is obtained in the radiation treatment phase. This 3D radiation treatment data set is registered with the 3D planning image data set. An associated transformation is obtained which in a matching coordinate system describes, for example, the displacement, scaling, shearing, and/or also deformation of the target volume. To take the change in the target volume into account, the irradiation field from the planning phase is adapted with this transformation to the radiation treatment phase. The 3D radiation treatment data set then three-dimensionally reproduces the target volume to be irradiated at the time of a radiation session, or, for example, during the radiation treatment phase. 
         [0015]    The planned irradiation field, verified for the irradiation and checked, does not require reverification despite the change in the target volume. Slight changes in position and/or shape in the target volume may be taken into account quickly and easily in the radiation treatment phase. The doses of the irradiation field may be verified or adapted on the basis of the density distribution in the 3D radiation treatment data set in the respective inlet conduit, for example, for greater changes in position and/or shape in the target volume. The requisite precision in particle therapy in terms of the penetration depths of the particles may be assured. 
         [0016]    In one embodiment, the irradiation field may be regularized. The irradiation field may be regularized for irradiation with a scanner. In another example, the irradiation field may be regularized whenever individual volume elements in the target volume change their spacing because of compression and no longer can be projected onto the grid of the scanner, for example. The doses may be interpolated via the radiation treatment grid. Even in the event of major changes in position and/or shape in the target volume, the irradiation plan may be used. 
         [0017]    The registering may be done manually, in partly automated fashion, or in automated fashion. An operator, for example, marks matching points in the various 3D image data sets and on the basis of these input parameters has the transformation of the marked points calculated. A register may be made in automated fashion with the aid of Hounsfield values, which are significant for the target volume. 
         [0018]    In one embodiment, motions of tissue that surrounds the target volume may be registered. These motions may be used for adaptation of the direction of incidence. These motions may, for example, have an influence on the direction of incidence, if this tissue must not be irradiated. Tissue regions located in the vicinity of the target volume, for example, which are to be spared, are kept out of the inlet conduit. 
         [0019]    In one embodiment, a warning signal may be generated (for instance acoustically or visually) when the registering that the change in position and/or shape of the target volume exceeds a limit value. An operator may discontinue the radiation treatment phase, for example, if the operator assesses the changes as problematic. Alternatively, the operator may disable the warning signal and continue the irradiation with the adapted irradiation field. 
         [0020]    In one embodiment, a radiation therapy system may include a radiation source for generating an irradiation field which is adjustable. The radiation therapy system may also include a 3D imaging device for obtaining a 3D radiation treatment data set in a radiation treatment phase of the radiation therapy. The radiation therapy system may include an adaptation unit, which may adapt the irradiation field to a change in position and/or shape present in the radiation treatment phase. The adaptation unit is embodied to register the 3D irradiation data with a furnished 3D planning image data set and to obtain an associated transformation which describes the change in position and/or shape of the target volume. The adaptation unit is embodied for transforming a furnished planning field with the obtained transformation and adapting it to the change in position and/or shape of the target volume in the radiation treatment phase. The planning field is planned in a planning phase by association of doses to be applied with volume elements of the target volume based on the 3D planning image data set. 
         [0021]    The radiation therapy system is able, without reverification of an irradiation field, to use this irradiation field with altered target volumes. This speeds up the radiation therapy, since recalculations of irradiation fields that would otherwise be needed are dispensed with. 
         [0022]    In one embodiment, the radiation source may output a high-energy particle beam or photon beam. This beam is adjustable in terms of its energy, beam direction, shape, grid scale, energy distribution, and/or intensity. The changes in the applied radiation may be made on the basis of the transformation. Changes may be necessary, for example, whenever the adaptation unit is embodied for verifying or adapting doses of the irradiation field on the basis of the density distribution in the 3D radiation treatment data set in the particular inlet conduit. Adjustment changes may be needed whenever the adaptation unit is embodied for regularizing the irradiation field on the basis of the change in position and/or shape, and interpolating it to a predetermined radiation treatment grid. Changes in the applied radiation may also be required whenever the adaptation unit is embodied for adapting the direction of incidence, for example, to a change in position and/or shape of a volume surrounding the target volume. Overdoses in tissue, which are to be spared, may, for example, be prevented. 
     
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0023]      FIG. 1  illustrates one embodiment of a particle therapy system; 
           [0024]      FIG. 2  illustrates one embodiment of an adaptation of an irradiation field; 
           [0025]      FIG. 3  illustrates the registering of the target volume and a tissue to be spared in the vicinity of the inlet conduit; and 
           [0026]      FIG. 4  illustrates changing an irradiation field in the event of translation and deformation of the target volume. 
       
    
    
     DETAILED DESCRIPTION 
       [0027]    In one embodiment, as shown in  FIG. 1 , a radiation therapy system I includes a radiation source  2  and an irradiation site  3 . The radiation therapy system I may include a scanning system  5  and a patient  7  aligned with it. In the case of a particle therapy system, the radiation source  2 , for example, has an accelerator system (e.g., synchrotron and cyclotron) and a high-energy beam supply. There, particles and ions, such as protons or carbon ions, are accelerated to energies of up to several  100  MeV. With the scanning system  5 , the beam may be adjusted in its beam position, such as parallel within a scanning region. 
         [0028]    In  FIG. 1 , as an example, a prostate of the patient  7  is to be irradiated. The location of the prostate varies daily, depending on how full the bladder and intestines are. The prostate is one example of a target volume  9  that as a function of time changes in terms of its position and/or size over time. The reasons for such changes may also be shrinkage or growth of the tumors and changes in the weight and shape based on how full nearby organs are. On a shorter-term time scale, motions, which cause a change in position and/or size, may be caused by peristalsis, the heartbeat, or respiration. With suitably high-speed computing power, even such brief changes in position may be taken into account in the irradiation. 
         [0029]    In one embodiment, as shown in  FIG. 1 , the radiation therapy system  1  includes a positioning device  11  (for instance robot-based). The positioning device  11  may flexibly adjust the alignment of the patient support  13 . Variations in the irradiation position or angle of incidence may be done in terms of the patient by using the patient positioning device  11  and/or in terms of the beam delivery using the scanner  5  and/or by rotating a gantry. 
         [0030]    In one embodiment, as shown in  FIG. 1 , the radiation therapy system  1  includes a schematic 3D imaging device  15 . The schematic 3D imaging device  15  performs 3D imaging of the target volume and its surroundings in the radiation treatment phase, for example, shortly before the application of the radiation is tripped. 
         [0031]    In one embodiment, as shown in  FIG. 1 , the radiation therapy system  1  includes an adaptation device  17 . The adaptation device  17  may be, for example, a monitoring system. The adaptation device  17  may cause adjustments to be made in the patient positioning device  11  and the scanner  5 , a gantry angle, and radiation parameters of the radiation source  2  (such as energy, energy distribution, intensity, and so forth). The adaptation device  17  may be in direct contact with a workstation  19  for treatment planning that, for example, has a planning CT unit and suitable planning programs for calculating a dosage distribution of an irradiation field. The adaptation device  17  may, for example, directly, obtain a 3D planning image data set with an associated irradiation field or irradiation fields from the planning workstation  19 . The adaptation device  17 , for example, may have an input and output device, with which a registering of the 3D planning image data set and the 3D radiation image data set may be tripped and monitored. Optionally, the adaptation device  17  may perform this registering in automated fashion. The transformation associated with the registering of the target volume is available to the adaptation device  17  for adapting the irradiation field to a change in position and/or shape of the target volume. The adaptation device  17  uses the transformation to adapt the irradiation field to the changes. 
         [0032]    One embodiment of the adaptation procedure is illustrated in  FIG. 2 . The 3D planning image data set  21  may be in the form of a rectangle, for example, represented by a schematic upper body of the patient  7  with the target volume  22 . A 3D radiation treatment image data set  23  may include a target volume  22  that is displaced in the direction of the patient support  25 . This displacement is determined by the adaptation device  17  by the transformation T upon the registering of the two 3D image data sets. 
         [0033]    The three-dimensional irradiation field  27  is also shown, with volume elements  29  and with the isocenter  31  located centrally in it. The geometry of the irradiation field  27  upon irradiation is in geometric relationship with the isocenter  31 , which may be located in the target volume  22 . The adaptation device  17  may cause the transformation T to act on the irradiation field  27 , resulting in an adapted irradiation field  27 ′ in which the isocenter  31  is displaced in the X direction and is located in the upper region of the irradiation field. 
         [0034]      FIG. 3  illustrates the possible changes in the event of an exemplary displacement of a target volume  33  (in dashed lines) to a displaced target volume  33 ′ (in solid lines) in accordance with a transformation T. The target volume  33  may have an irradiation field  35 , which in its dimensions has only a small safety ring  37 . The change in position may be taken into account based on the adaptation made in the irradiation field via the transformation T. 
         [0035]    In one embodiment, the irradiation field  35  may cover the position of the displaced target volume  33 ′. For example, if no adaptation of the irradiation field has been made, then the irradiation field  35  must also cover the position of the displaced target volume  33 ′, which in part is located outside the safety ring  37 . In the irradiation, the irradiation field  35  may be irradiated with a particle beam in the Z direction in its entirety, or if the grid scanning technique is used, it may be treated by the irradiation of individual volume elements  41 . The dose to be applied to a volume element  41  is calculated in the 3D planning data set with the aid of the attenuation coefficients in the inlet conduit  43 . As shown in  FIG. 3 , an inlet conduit  43  may begin at the body surface  44 , for a volume element  45 . 
         [0036]    In one embodiment, an additional displacement of a tissue region  47  that has increased absorption may be ignored. For example, the additional displacement should be initially ignored. After the displacement T of the target volume  33 , the inlet conduit  43  for the volume element  45 ′ of the displaced target volume  33 ′ has been shortened by two volume elements. The same direction of incidence in the particle beam must be reduced in its energy. The required energy may be calculated based on the absorption of the shortened inlet conduit  40 . The absorption may be calculated in turn from the 3D radiation treatment image data set. 
         [0037]    The displacement T between the isocenters  32  and  32 ′ may be obtained by registering the two image data sets. If the tissue volume  47  that is highly absorbent need not be spared, then the direction of incidence in the Z direction may remain unchanged. 
         [0038]    Alternatively, if the tissue volume  47  is to be spared and should not be located in the inlet conduit  43 , then by additional registering of the tissue volume  47  and calculation of the associated transformation T′, a rotated direction of incidence  49  for the irradiation field may be determined. Based on the rotation, with the doses maintained unchanged in the individual volume elements of the displaced target volume  33 ′, a new grid scale or reshaping of the particle beam is necessary. In  FIG. 3 , this is shown at the tilted volume elements. 
         [0039]    In one embodiment, as shown in  FIG. 4 , the irradiation field may be adapted to a shape change. In the planning image data set, a curved target volume  51  with an irradiation field  53  comprising three volume elements is planned for irradiation in a direction Z. In the 3D radiation treatment image data set, the target volume expanded and contracted. The altered target volume  51 ′ may be treated with two volume elements of an irradiation field  53 ′. The dose previously distributed over three volume elements is now distributed over only two volume elements. The transformation T may rotate the direction of incidence Z′. 
         [0040]    While the invention has been described above by reference to various embodiments, it should be understood that many changes and modifications can be made without departing from the scope of the invention. For example, although the embodiments were discussed in conjunction with a particle therapy system, the same problems and solutions arise in photon therapy as well. It is therefore intended that the foregoing detailed description be regarded as illustrative rather than limiting, and that it be understood that it is the following claims, including all equivalents, that are intended to define the spirit and scope of this invention.