Abstract:
A medical system for treatment with focussed acoustic waves having a locating device, a therapy device, a patient positioning device, power supply devices for these devices. The complete system is installed in an integrated manner and adjusted on a common equipment carrier. The carrier frame corresponds in width and length to the projected floor area of a standard hospital bed so that the complete system can be easily transported in its mounted and adjusted state.

Description:
BACKGROUND OF THE INVENTION  
         [0001]    The invention relates to a medical system according to the preamble of the patent application of the claim  1 .  
           [0002]    A medical system of this type is known from DE 197 46 956 C2. This known system serves the purpose of treating a patient with focussed acoustic waves. The patient is placed on a positioning device in the form of a table. That part of the patient&#39;s body to be treated, e.g. a concrement or a section of tissue is determined by means of a locating device. A therapy device generates acoustic waves which are focussed onto the determined part of the body by means of the locating device in order to there cause the desired therapeutical effect, e.g. to destroy a concrement or a tumour.  
           [0003]    In this known system the locating device and the therapy device are each separate equipment which are each provided with their own power supply device. The locating device is designed as an X-ray unit with a C-or U-arm. In order that the system can be used, the locating device and the therapy device are mechanically coupled and mutually adjusted so that the focus of the acoustic waves generated by the therapy device falls into the isocentre of the X-ray locating device.  
           [0004]    The locating device and the therapy device are relatively large and heavy equipment. The coupling and especially the mutual adjustment and electrical connection of the locating device and of the therapy device are troublesome, time-consuming and have to be carried out by specialist personnel. Transport of the system, whereby the individual components have to be separated from each other, is thus only carried out in exceptional cases.  
         BRIEF SUMMARY OF THE INVENTION  
         [0005]    The underlying idea of the invention is to create a medical system of the type mentioned above which is flexible with respect to its spatial application possibilities.  
           [0006]    The essential thought of the invention is that that the locating device, the therapy device and the positioning device with their respective power supply devices are arranged and mounted in a common equipment carrier. The length and width of the system mounted in the equipment carrier are at the greatest as large as the projected floor area of a standard hospital bed, i.e. or only very slightly exceed these floor area dimensions.  
           [0007]    The locating device, the therapy device and the positioning device are permanently installed in the equipment carrier and adjusted relative to each other. The resulting small floor area makes it possible to transport the system in its fully assembled state especially also in the treatment rooms of a clinic or a physician&#39;s practice. This results in the essential advantage that the system can be delivered and installed factory mounted and adjusted without the necessity of carrying out comprehensive mounting and adjustment tasks at the installation location. Furthermore, the system can be transported in the mounted state from one treatment location to another treatment location without the necessity of decoupling the individual devices which on the other hand would necessitate coupling and adjusting at the new installation location.  
           [0008]    Therefore, the system can be taken in a comfortable manner from one room to another room in a building and it is also especially suitable for mobile application in which case the system can be rented out or made available to various users at various locations for a limited period of time.  
           [0009]    The positioning device of the medical system according to the invention is expediently adjustable so that the patient lying on the positioning device with his or her body area to be treated can be positioned in the focus of the therapy device.  
           [0010]    If the positioning device has been designed with a reclining chair on which the patient to be treated can sit then this reclining chair can be essentially included within the outside dimensions of the equipment carrier so that the simple transport possibility of the system is not influenced by the positioning device.  
           [0011]    In an advantageous design the positioning device has a reclining table on which the patient can lie stretched out during the treatment. In order not to impair the transport possibilities of the system the design of the reclining table is such that it can be reduced in size preferably without the aid of tools. For this purpose, the reclining surface of the reclining table is expediently subdivided whereby the individual surface parts can be pushed together, folded together or folded up so that they no longer protrude beyond the outside perimeter of the equipment carrier.  
           [0012]    Preferably, the reclining table of the positioning device is arranged on one of the narrow sides of the equipment carrier and transverse to its longitudinal extent. In this way, the reclining table is freely accessible from at least three sides so that a frail or handicapped patient can easily onto the reclining table or laid onto the reclining table with the aid of the nursing personnel. Moreover, the patient lying on the reclining table is easily accessible for the treating physician or for the treating personnel. The arrangement of the positioning device on an end narrow side of the equipment carrier also makes it possible that the reclining table can be provided with a large vertical lifting distance whereby especially lowering of the reclining surface of the reclining table is possible in order to make it easier to climb onto the reclining table. In this respect, the reclining table can be lowered so far, for example, such that the reclining surface has a climb-on height of less than 75 cm above the floor.  
           [0013]    In order to obtain an as compact as possible arrangement of the system in the equipment carrier, the power supply devices for the therapy device, the locating device and the positioning device are arranged in the end area of the equipment carrier and the locating device and the therapy device are arranged on the narrow front end of the power supply device which is facing the positioning device. As a rule, the locating device is arranged such that it can be swivelled in order to spatially localise the body area to be treated and to position the locating device in the isocentre.  
           [0014]    If the locating device is arranged at the narrow front end of the power supply device then the swivelling axis of the locating device runs preferably horizontal in the longitudinal direction of the equipment carrier. If the locating device is especially designed as an X-ray device with an X-ray source and an X-ray receiver on a swivable C-or U-arm, then this C-or U-arm is preferably arranged laterally bent at right angels. In this manner, the swivelling axis of the C-or U-arm and the shock wave source of the therapy device can lie above each other in vertical plane and the C-or U-arm is led laterally around the shock wave source.  
           [0015]    The electrical power supply and control of the locating device, the therapy device and the positioning device are integrated into a compact unit in the equipment carrier. This has the advantage that the electrical components required can be considerably reduced so that a common cabling can be installed and electrical coordination of the locating device, therapy device and positioning device and their power supply devices is not necessary. Furthermore, the overall control of the locating device, the therapy device and the positioning device can be facilitated via a control and data bus system. The control and data bus system can be connected via one single interface with an operator and control desk, by means of which the locating device, the therapy device and the positioning device can be controlled and operated. The operator and control desk can be designed as a separate unit which can be connected cable-dependant or non-cable-dependant to the control and data bus system. The operator and control desk can also be integrated into the system and arranged on the equipment carrier.  
           [0016]    The integration of the entire electrical and electronic components and especially their installation in a control and data bus system also facilitates remote diagnosis and/or maintenance of the entire system, e.g. via a GSM modem or a telephone modem. In this way, time saving and cost saving maintenance and servicing of the system is possible.  
           [0017]    The locating device is expediently equipped with an imaging device, which is preferably provided with a monitor integrated into the operator and control desk so that the part of patient&#39;s body to be treated and the patient&#39;s positioning can be observed and assessed by the physician. Depending on the part of the body to be treated the patient can be placed in various ways on the positioning device.  
           [0018]    Especially an alternative position of lying on the back or face down is possible and transposition of head and foot position of the patient is also possible e.g. for locating and treating the right or left kidney. In an advantageous design the image processing device is so designed that by entering the position of the patient mirror-imaging of the screen information can be made in such a way that the image on the monitor of the operator and control desk is always given in the same patient position, e.g. in such a way that the body of the patient is seen from the front and the head of the patient is at the top of the picture. The compensating mirror-imaging of the various positions of the patient on the positioning device can also be transferred to the control of the positioning device by means of the operator and control desk. In this way, the physician can carry out positioning on the operator and control desk if required in accordance with the mirrored images on the monitor screen whereby the positioning device is moved in a controlled manner corresponding to the actual position of the patient.  
           [0019]    The complete medical system can be simply transported by means of the equipment carrier and installed stationary. If a change in the installation location is intended then it is preferable to design the equipment carrier to be transportable. In an advantageous design the equipment carrier has in this respect swivelling rollers or wheels at one end. The other end of the equipment carrier rests on the floor so that the system stands stable in its location. For transporting, a lifting truck is used which engages at the opposite end of the equipment carrier to the swivelling rollers or wheels in order to make the equipment carrier with the complete integrated system mobile. In this respect, the lifting truck engages preferably positively on the equipment carrier in order to lift it from the floor. The lifting truck is steerable in order to facilitate easy manoeuvring during moving. Expediently, the lifting truck can also be driven by a motor, e.g. by means of a battery-powered electric motor.  
       
    
    
     BRIEF DESCRIPTION OF THE DRAWING  
       [0020]    These and other features, aspects and advantages of the present invention will become better understood with reference to the following description, appended claims, and accompanying drawing, where:  
         [0021]    [0021]FIG. 1 depicts a side view of the medical system of the first embodiment of the invention.  
         [0022]    [0022]FIG. 2 depicts a different view of the system of FIG. 1.  
         [0023]    [0023]FIG. 3 depicts a top view of the system of a second embodiment.  
         [0024]    [0024]FIG. 4 depicts a side view of the system of a second embodiment during transportation.  
         [0025]    [0025]FIG. 5 depicts a different view of FIG. 4.  
         [0026]    [0026]FIG. 6 depicts a side view of the operating unit.  
         [0027]    [0027]FIG. 7 depicts a different view of the operating unit.  
         [0028]    [0028]FIG. 8 depicts a side view of the system of a third embodiment with integrated operating unit. 
     
    
     LIST OF REFERENCE NUMBERS  
       [0029]    [0029] 10  equipment carrier  
         [0030]    [0030] 12  swivelling weels  
         [0031]    [0031] 14  feet  
         [0032]    [0032] 16  housing  
         [0033]    [0033] 18  X-ray source  
         [0034]    [0034] 20  X-ray receiver  
         [0035]    [0035] 22  C-or U-arm  
         [0036]    [0036] 24  swivelling axis  
         [0037]    [0037] 26  therapy head  
         [0038]    [0038] 28  coupling membrane  
         [0039]    [0039] 30  axis of the X-ray beam  
         [0040]    [0040] 32  positioning device  
         [0041]    [0041] 34  vertical lifting columns  
         [0042]    [0042] 36  horizontal guides  
         [0043]    [0043] 38  vertical guides  
         [0044]    [0044] 40  pneumatic unit  
         [0045]    [0045] 42  recess  
         [0046]    [0046] 44  surface parts  
         [0047]    [0047] 46  pneumatic units  
         [0048]    [0048] 48  lifting truck  
         [0049]    [0049] 50  swivelling wheels  
         [0050]    [0050] 52  handle  
         [0051]    [0051] 54  operator and control desk  
         [0052]    [0052] 56  operator&#39;s panel  
         [0053]    [0053] 58  imaging device  
         [0054]    Equivalent parts are indicated by the same reference numbers.  
       DETAILED DESCRIPTION OF THE INVENTION  
       [0055]    The invention summarized above and defined by the enumerated claims may be better understood by referring to the following detailed description, which should be read in conjunction with the accompanying drawing. This detailed description of a particular preferred embodiment, set out below to enable one to practice the invention, is not intended to limit the enumerated claims, but to serve as a particular example thereof.  
         [0056]    [0056]FIG. 1 shows the medical system in a first embodiment.  
         [0057]    An equipment carrier  10  carries the complete system. The equipment carrier  10  has essentially the shape of a horizontal rectangle and is formed by a simple, one-piece light steel structure. The equipment carrier  10  has swivelling wheels  12  at its narrow end. At the other narrow end the equipment carrier  10  stands on the floor with feet  14 .  
         [0058]    On the equipment carrier  10  is located a housing  16 , which takes up about half of the longitudinal extent of the equipment carriers. At the front narrow end of the housing  16  there is a device for locating and/or diagnosis (brief locating device) of the body part of a patient to be treated, a device for generating and focusing acoustic waves (brief therapy device) onto the body area to be treated and a device for accommodating the patient to be treated (brief positioning device).  
         [0059]    The locating device represented in the design example is an X-ray locating device consisting of an X-ray source  18  and an X-ray receiver  20 . The X-ray source  18  and the X-ray receiver  20  are fitted to the two free ends of a C-or U-arm  22 . The C-or U-arm  22  is bearing-mounted in its central area onto the housing  16  and is swivable around a swivelling axis  24 . The swivelling axis  24  runs horizontal and in the direction of the longitudinal axis of the equipment carrier  10 . The mode of operation of such an X-ray locating unit is known state of the art technology.  
         [0060]    Instead of an X-ray locating device as shown in the drawing another known locating device can also be used e.g. an ultrasound locating device.  
         [0061]    The therapy device has a therapy head  26 . In the therapy head  26  acoustic pressure waves for example are generated by means of an electric spark discharge in a liquid which are focused e.g. by means of a parabolic reflector as shock waves. The therapy head  26  is closed off by means of a coupling membrane  28  which is placed on the body of the patient in order to transmit the acoustic shock waves generated in the therapy head  26  into the body of the patient.  
         [0062]    The axis  30  of the X-ray beam sent from the X-ray source  18  to the X-ray receiver  20  intersects the swivelling axis  24  of the C-or U-arm in an isocentre. This isocentre thus remains spatially fixed when the C-or U-arm  22  is swivelled around the swivelling axis  24 . The therapy head  26  is arranged rigid on the housing  16  and aligned in such a way that its centre axis intersects the isocentre and the focus of the acoustic shock waves falls into this isocentre.  
         [0063]    The positioning of the C-or U-arm  22  with the swivelling axis  24  lies in a vertical plane which runs through the longitudinal axis of the equipment carriers  10  above the therapy head  26 . That is why the C-or U-arm  22  is laterally bent at right angles between the swivelling axis  24  and the X-ray source  18  and led in a bend around the therapy head  26 .  
         [0064]    The housing  16  accommodates the electrical supply and the electronic control circuit of the locating device and the therapy device. Likewise, if needed the housing  16  can also contain a preparing device for the liquid medium of the therapy head  26 . The electronic circuits and controls of the power supply devices are combined via a common control and data bus system.  
         [0065]    The positioning device has a horizontal reclining table  32  upon which the patient to be treated is positioned. The height of the reclining table  32  is adjustable by means of telescopic retractable vertical lifting columns  34 . Moreover, the reclining table  32  can be moved towards and from the therapy device by means of horizontal guides  36 . Further to the horizontal guides  36  there are vertical guides  38  which serve the purpose of moving the reclining table  32  transverse to the longitudinal direction of the frame of the equipment carrier  10 . The height adjustment by means of the lifting columns  34  and the horizontal adjustment in the guides  36  and  38  is carried out preferably by means of a pneumatic or hydraulic or electric drive.  
         [0066]    A pneumatic unit  40  for the horizontal transverse movement in the guides  38  can be seen in FIG. 2.  
         [0067]    In middle area on the edge facing the housing  16  the reclining table  32  has a recess  42  as shown in FIG. 3. The patient is positioned on the reclining table  32  in such a manner that the part of the body to be treated e.g. a body concrement to be destroyed, a tumour, a bone area to be treated or similar lies on this recess  42 . By means of the lifting columns  34  and the guides  36  and  38  the reclining table  32  with patient can be moved under control in the three spatial coordinates in order to position the part of the body to be treated as localised by the locating device in the isocentre and thus in the focus of the therapy head  26 . In this respect, the signals of the locating device, e.g. the signals of the X-ray receiver  20  are fed to an image processor and represented in an imaging system e.g. on a monitor. By swivelling the C-or U-arm  22 , observation under various spatial directions is possible in order to determine the spatial position of the body part to be treated.  
         [0068]    In FIG. 2 is shown by means of a dotted line how the X-ray locating device can be swivelled from the vertical position by 30° in order to locate and localise the part of the body to be treated from two spatial directions.  
         [0069]    In FIGS. 2 and 3 is shown the reclining surface of the reclining table  32  divided into three surface parts. The middle surface part with the recess  42  is carried movable for positioning the patient in the guides  36  and  38 . The two end parts  44  of the reclining surface protruding out to both sides beyond the equipment carrier  10  can be swivelled upwards around a horizontal axis running in the longitudinal direction of the equipment carrier  10  until they stand vertically upwards and are thus located within the floor area of the equipment carrier  10 . Pneumatic units  46  are also used to swivel the end parts  44  upwards. As the end parts  44  in the FIGS. 1, 2 and  3  are shown folded down so that the reclining table  32  has a continuous horizontal reclining surface, the FIGS. 4 and 5 show the end parts  44  in the swivelled up position.  
         [0070]    The length and width of the equipment system correspond to the floor area of a standard hospital bed or are possibly also smaller than this floor area. Correspondingly, the overall length of the integrated system arranged on the equipment carrier  10  is given with 1920 mm in FIGS. 1 and 3 and in FIG. 5 the width of the system with end parts  44  swivelled up is given with 980 mm.  
         [0071]    In the design shown in the drawing in which the equipment carrier  10  is provided with swivelling wheels  12 , the system is transportable. As represented in FIGS. 4 and 5 a lifting truck  48  can be used for this purpose and which is applied at the narrow end of the equipment carrier  10  at the opposite end to the swivelling wheels and which runs under the equipment carrier  10  in order to lift the equipment carrier  10  so that the feet  14  lift free from the floor. Preferably, the lifting truck  48  engages positively on the underside of the equipment carriers  10 . The lifting truck  48  is provided with swivelling wheels  50  and preferably motor driven e.g. by means of a battery-powered electric motor. A handle  52  serves to guide and manoeuvre the transportable system on the swivelling wheels  12  of the equipment carrier  10  and the running wheels  15  of the lifting truck  48 . Due to the above-mentioned dimensions of the equipment carriers  10  and of the integrated system arranged on the equipment carrier moving and manoeuvring of the system is also possible inside buildings and through door openings.  
         [0072]    In the designs shown in FIGS.  1  to  5  the system is operated with a separate operator and control desk  54  which is shown in FIGS. 6 and 7. The operator and control desk  54  is designed as an independent transportable unit. The operator and control desk  54  has an operator&#39;s panel  56  which can be implemented for example as a touch screen. The operator&#39;s panel  56  contains switching elements for the operation and control of the locating device and of the therapy device as well as switching elements for moving the reclining table  32  in the three spatial axes. Furthermore, the operator and control desk  54  has display devices, e.g. monitors  58 , in order to display the images received from the locating device. The operator and control desk  54  is connected to the system via cable or via a non-cable-dependent signal exchange.  
         [0073]    [0073]FIG. 8 shows a further variation of the system in which the operator and control desk  54  is arranged on the equipment carrier  10  and is integrated into the system. For this purpose, the operator and control desk  54  is mounted on the housing  16  which results in a further space saving and ease of transport.