Abstract:
A piece of scientific/technological equipment is presented for the generation of a convergent photon beam for radiotherapy or other applications. This equipment consists of adequately modifying the trajectory of an electron beam from a linear accelerator (LINAC) by applying magnetic and/or electric fields. These electrons perpendicularly impact the surface of a curved material that has a particular curvature ratio (anode), thus generating X-rays. The interaction of the electrons with the atoms of the anode&#39;s material generate X-rays with a non-isotropic angular-spatial distribution, with a greater concentration in the focal direction, which is defined by the geometry of the anode. A curved collimator with an adequate curvature ratio is attached to the back of the anode. The collimator is made up of an array of a great number of small holes that point toward the focal point. This device transmits X-rays solely in the focal direction. The Summary Figure presents a typical configuration of the invention that has been presented.

Description:
[0001]    From the discovery of the X-ray in 1895 until now, the emission of a radiation ray, at any energy range, is essentially divergent and the intensity is a function of the distance between it and the emission source (inverse square law). This is due to the X-ray production mechanism; in other words, electronsthat impact a target. There are currently several ways to generate X-ray beams, each with a determined source size and a specific, always-positive divergence. The X-ray beams employed in radiotherapy are divergent. 
         [0002]    The expected objective of radiotherapy is, by using X-rays, to achieve a high X-ray flow zone within a specific volume. These X-rays would then deposit their energy. The energy deposited per unit mass is known as dose in radiotherapy. Since the beam that is used is noticeably divergent, several beams (fields) aimed at the volume of interest must be employed. As is widely known, the depth dose for an X-ray beam is dependent on an exponential downward curve according to the depth, with a maximum value near the surface. A multi-field application allows for a maximum dose in the interest volume (tumor site), despite the fact that the dose values in the surrounding areas are lower than those at the tumor site. These dose values are significant as they have higher values than what is tolerable in some cases, which can prevent the use of an effective dose in the tumor. 
         [0003]    More refined techniques such as Intensity Modulated Radio Therapy (IMRT) or arc therapy, improve and conform the maximum flow volume of X-rays, thus lowering dose levels in neighboring tissues and organs, though this decrease is not significant. A dose value decrease of up to 80% in tissues and organs near the interest zone has currently been achieved in relation to the dose in the interest zone. Treatment planning, however, continues to be complex. A decrease of collateral effects caused by radiation is always attempted, though their complete eliminationis impossible. 
         [0004]    A radiotherapy technique that has lower collateral effects and greater radiobiological effectiveness at the tumor site is that of hadrontherapy. This technique uses hadrons (protons or heavier nuclei) to deposit high doses at the tumor site that are very conformed, that is to say, limited to that area. The cost of this technique, however, is much higher than conventional photon or electron methods, precluding its use for many patients. It is also rarely available at hospitals and health and treatment centers.  FIG. 1  shows a graph comparing the relative depth dose of the most widely used radiotherapy techniques. 
         [0005]    This invention proposes the use of a device able to generate a convergent photon beam with advantages that are significantly greater than the conventional external radiotherapy technique and the hadrontherapy techniques, the latter catalogued as being those that provide better results. 
         [0006]    From a comparative point of view, conventional conformal radiotherapy techniques or IMRT (the latter being better): administer a greater superficial dose; are a greater risk to healthy organs; require fractioning and a more complex planning system; require more energy and, therefore, more costly bunkers; not all tumors are accessible; thus rendering the techniques less effective. The advantages of these techniques are that a greater volume is treated and the positioning system is simpler.  FIG. 2  shows the fundamental difference between the conventional method, (a), and the convergent method, (b). 
         [0007]    The convergent method, however, presents: lower surface dose, low dose in healthy organs; high dose in the tumor which does not require fractioning; simpler planning system; shorter treatment (one or two sessions); greater effectiveness and accessibility to most tumors; simpler refrigeration system; high energy is not required thus bunker shielding requirements are lower. The disadvantage is that, as the treated volume is smaller, a tumor scan and a more precise positioning system are required. 
         [0008]    The only external photon method that is comparable, quality-wise, to the convergent technique of the invention being proposed is the arc therapy technique, also known as Tomotherapy, using photons with alinear accelerator (LINAC). Arc therapy emulates convergence by using an angular scan around the isocenter (tumor site). Despite longer sessions and equally complex planning, however, each beam is still essentially divergent and the doses in healthy organs are not insignificant. Like the other conventional LINAC techniques, several sessions are required. Similar results can be obtained using a robotic device called a “cyberknife”. 
         [0009]    The hadrontherapy technique presents the following: a low surface dose and is highly effective as it deposits a high dose depth in a very small site (Bragg peak, see  FIG. 1 ). Hadrons and ions have high radiobiological effectiveness (protons are 5 times more effective than photons) and complex positioning systems. However, a very complex installation is required, which includes a synchrotron able to accelerate particles to energies ranging from several hundred MeV to several GeV, high vacuum, and electrical and magnetic guide systems. Furthermore, the cost of a hadrontherapy system exceeds $100M USD. There are 28 hadrontherapy installations in the world&#39;s most developed nations and the technique continues to grow despite its high cost. Hadrontherapy is out of the question for Chile at present though Spain is evaluating the possibility of acquiring one of these installations in the next few years. Hadrontherapy has shown excellent results in patients with complex cancers as it is able to treat tumors that cannot be treated with photons. The cost of this therapy, however, means it is available to only a select few. 
         [0010]    The convergent method employed by the invention presented here delivers low surface dose and is highly effective, as it deposits a high depth dose in a very small area (“peak focus”). Photons have less radiobiological effectiveness, but the dose deposited at the focus peak site can be up to  100  times greater than the dose on the surface, despite the attenuation effect. This compensates for the photons&#39; lower radiobiological effectiveness and generates an even lower relative dose on the surface and in the healthy organs than that which is obtained in hadrontherapy. The positioning system, however, must be more precise than that of conventional techniques. All of the above will allow for the treatment of complex cancer cases as with hadrontherapy but with a less complex installation. 
         [0011]    Furthermore, the cost of a LINAC plus a bunker and control building is in the $2 to 3 MUSD ranges, while a LINAC-adaptable convergence system may cost $0.5 M USD or less, a noteworthy advantage in relation to the cost of a hadrontherapy installation which is almost two orders of magnitude greater. In this regard, a convergent system would function similarly to a hadrontherapy system but at a significantly lower cost. 
         [0012]    The first step taken prior to the development of this invention was the study of the effects of a photon beam&#39;s convergence on a specific material that was carried out by Monte Carlo Simulations (MCS) and theoretical calculations.  FIG. 3  shows the curves of a depth dose corresponding to MCS and the theoretical results. 
         [0013]    Devices currently exist that achieve beam convergence with a divergent X-ray beam based on the total reflection principle. The divergent X-rays enter a cone-shaped capillary, and the beams travel the length of it by total reflection inside the capillary until they reach the end. The exit section is smaller than the entry section, thus allowing a greater intensity to be achieved. In order to attain a significant increase in intensity, a set of these cone-shaped capillaries set in parallels is used. This makes up what is known as a poli-capillary and allows the entry area to be increased. However, as these devices employ the total reflection principle, its use is only advantageous with X-rays with energies below 50 keV, which limits its application in radiotherapy equipment, where the X-ray energy is much greater than the aforementioned amount. There is currently a great variety of X-ray focusing devices that use not only the total reflection principle but diffraction and/or refraction as well, though all of them can be used for low energy X-rays (&lt;50 keV). For example, in astronomy, an X-ray telescope (Chandra and equivalents) obtains X-ray images of the Universe, allowing us to see emission sources, including black holes. This is a large-scale device (several meters) that is based on the same total reflection principle and uses reflector plates and other materials. 
         [0014]    After considering existing devices, which are limited to low energy, and the results obtained from studies that were performed, this innovative idea of an electron- and convergent X-ray-generating piece of equipment was developed, appropriate for low, medium and high energies (&lt;0.1 MeV, 0.1-1.0 MeV and 1&gt;MeV respectively). This would also be the only way to achieve X-ray beam convergence at energies within the application&#39;s range in radiotherapy techniques. 
         [0015]    When this beam is pointed virtually towards a water phantom or water equivalent, a depth dose profile can be obtained like the one shown in  FIG. 4  for two different energies. These profiles were achieved using a MCS code. Other results attained by MCS are shown from  FIGS. 5 to 8 . All the MCS that were carried out show that the RTC convergent radiotherapy technique, as proposed with this invention, is noticeably better than the conventional techniques used to date. 
         [0016]    A very brief description of the positioning system for the various cases is given in this presentation of the invention. Directional arrows are also shown without providing further details, as that would not be part of the essence of this invention. Also, positioning systems are already available on the market. However, the various ways in which the invention must be adapted in each case shall be presented. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0017]      FIG. 1  shows a relative depth dose for the different techniques used in radiotherapy. 
           [0018]      FIG. 2   a  shows a diagram of the traditional X-ray radiotherapy system. 
           [0019]      FIG. 2   b  shows a diagram of a convergent X-ray radiotherapy system. 
           [0020]      FIG. 3  shows a depth dose for a convergent photon beam at 0.4 MeV in a water phantom, compared to the theoretical results and MCS. 
           [0021]      FIG. 4  shows a comparison of two dose profiles for convergent photons from two MCS for focal points at 2 and 10 cm from the surface of the phantom. 
           [0022]      FIG. 5  shows a sectional view of a depth dose achieved by MCS for convergent photons, for a non-refined case. 
           [0023]      FIG. 6  shows a sectional view of a depth dose achieved by MCS for convergent photons, generated by the electrons that incite on an anodic cap and then pass through a perforated cap-style collimator similar to those proposed in this invention. 
           [0024]      FIG. 7  shows a profile of the energy deposited at low energy (per voxel unit) (Z=0, Y=0) with angular collimator acceptance: polar: 2 degrees and azimuthal: 2 degrees. E=4 MeV. 
           [0025]      FIG. 8  shows a profile of the energy deposited at high energy (per voxel unit) (Z=0, Y=0) with angular collimator acceptance: polar: 2 degrees and azimuthal: 2 degrees. E=4 MeV. 
           [0026]      FIG. 9  shows a graph of the convergent electron beam generator element, which can be made up of more than one magnetic lens. 
           [0027]      FIG. 10  shows a graph of an alternate configuration of the convergent electron beam generator element, which can be made up of an electrostatic element similar to cylinder lenses. 
           [0028]      FIG. 11  shows a graph describing how the convergent photon beam is generated. 
           [0029]      FIG. 12  shows a graph of the present invention&#39;s essential parts. 
           [0030]      FIG. 13  shows a graph of the whole invention, including each of its parts. 
           [0031]      FIGS. 14   a  and  14   b  show a sectional view and front view, respectively, of a front-end unit. 
           [0032]      FIGS. 15   a  and  15   b  show a sectional view and front view, respectively, of an alternative configuration of a front-end unit. 
           [0033]      FIG. 16  shows a configuration of the present invention adapted to a typical LINAC. 
           [0034]      FIG. 17  shows a configuration of the present invention adapted to a cyberknife. 
           [0035]      FIG. 18  shows a configuration of the present invention adapted to a Tomotherapy system. 
           [0036]      FIG. 19  shows an alternate configuration of the present invention being used for low energy applications. 
           [0037]      FIG. 20  shows an alternate configuration wherein a flat collimator with a parallel beam exit is used. 
           [0038]      FIG. 21  shows an exchange of a photon exit cone for an electron exit cone. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0039]    The invention presented here consists of a device that generates a convergent electron and X-ray beam. First, an electron beam from an electron cannon is needed. The electrons are accelerated in a radiotherapy LINAC by a series of stages until a flow of electrons with energy between 6 and 18 MeV is achieved. It can also be used for intermediate energies, known as orthovoltage energy (hundreds of keV), generated solely by an electron cannon. 
         [0040]    As seen in  FIG. 12 , the relatively collimated electron beam coming from a LINAC is first expanded by an electron disperser. The electrons are then focalized by the action of an appropriate set magnetic or electrostaticlens ( 2 ). The electrons that emerge from the lens intercept the surface of ananode shaped as a spherical (or aspheric, parabolic) cap ( 3 ), which shall be referred to as an “anode cap”. The anode cap&#39;s curvature radius defines the focal distance (spherical) of the convergent system. 
         [0041]    As shown in  FIG. 9 , the magnetic lens has an entrance lens body (c), a field concentrator housing (d) and electric conductors with a solenoid winding (e). 
         [0042]    The convergent electron beam generator element, in an alternative configuration of the invention, can also be made up of an electrostatic element that is similar to cylinder lenses, which is in turn made up of three cylinders. The first is grounded (f), the second cylinder is negatively polarized (g), and the third is also grounded (h). (See  FIG. 10 ). 
         [0043]    The electronic lenses must be adjusted so that the electron beam impacts perpendicularly on the entire surface of the anode. As a result of the interaction of the electrons with the atoms that make up the anode&#39;s material, breaking radiation (known as bremsstrahlung), or X-rays in the material, is generated. As the incidence of the electrons occurs on the entire surface of the anode cap (i) (see  FIG. 11 ), the bremsstrahlung X-ray emission phenomenon will occur isotropically on the entire cap ( 3 ). Bremsstrahlung is generated at each point on the cap. According to  FIG. 11 , the X-rays that exit the cap have an angular non-isotropic distribution, with a greater intensity in the electrons&#39; incidence direction and an angular divergence inversely proportional to the incident electron&#39;s energy (k). The X-rays are then collimated by a spherical poli-collimator ( 5 ) (similar to the anode cap) with tens, hundreds or thousands of small holes (millimeter- or sub-millimeter-sized) pointing in the direction of the focal point (l). The X-rays that are able to pass through these holes will exit with a much lower angular dispersion than they had at the anode cap exit ( 3 ). The rest are absorbed into the material, thus generating a convergent photon beam, with its greatest intensity concentrated at the focal point. The definition of the focal point of this convergent photon beam may be improved by inserting a second poli-collimator cap ( 7 ). This effect globally generates a radiation volume that mainly points towards the system&#39;s focal point with a significantly greater intensity of X-rays at the focal point(peak-focus), the magnitude of which will depend upon the energy of the electrons, the curvature radius of the anode cap ( 3 ), the anode cap&#39;s surface and the opening of the field&#39;s diaphragm that will be shown further on. 
         [0044]    The invention&#39;s essential parts are shown in  FIG. 12 . Electrons coming from a source, whether a LINAC or an electron cannon, are dispersed by a small sheet (scattering foil) ( 1 ) in order to generate a flow of divergent electrons. The electrons are diverted towards the axis by a magnetic (or electrostatic) lens ( 2 ), thus generating a flow of convergent electrons (i) that is perpendicularly intercepted a) by a thin, cap-shaped (anode-cap), spherical, aspherical or parabolic anode ( 3 ), and a lateral beam breaker ( 4 ). The X-rays that are able to exit the thickness of the anode (k) are collimated by a collimator cap ( 5 ) that has small holes perforated on its entire surface ( 6 ) that point in the direction of the focal point. The convergent X-ray beam (l) can be collimated once again (m) by a second smaller poli-collimator ( 7 ) that is similar to the first. This collimator is surrounded by a concentric ring with a cone-shaped interior ( 8 ), which allows it to absorb the out of focus X-rays and decrease the beam&#39;s lateral penumbra. 
         [0045]      FIG. 13  shows the invention as an apparatus in detail. It has an electron source coupler ( 9 ), which allows the device to be attached to a specific LINAC or a particular electron cannon. Whichever the case, it is a piece that must adapt to the different devices available on the market or one that can be built solely for the convergent device. Above, in the middle section, there is a hole or window that allows the entry of electrons ( 10 ). Electrons coming from a LINAC can impact upon the previously described disperser ( 1 ), though the scattering foil is not necessary as the electrons emitted by the cannon have an angular aperture. The electron beam enters a vacuum space contained by a cone-shaped shield ( 11 ), with a vacuum connection ( 12 ) and at the base of the cone there is a ring-shaped support ( 13 ) that attaches to the external cylindrical housing ( 14 ). Further down is a phase coupler ( 15 ) that separates the electron part from the photon part. The device&#39;s photon part is made up of an external housing shaped like a truncated cone ( 16 ) that has internal shielding ( 17 ) with supports for pieces ( 4 ) and ( 8 ) as well as a vacuum connection ( 18 ) if required. Finally, there is a frontal unit ( 19 ) at the exit of the convergent beam, at the inferior end of the truncated cone. This frontal unit has position sensors, location laser lights and a mechanism that regulates field size, which in turn regulates the intensity at the focus peak. The unit&#39;s details and versions are described below. 
         [0046]      FIGS. 14   a  and  14   b  show two views of the frontal unit, which is made up of several diaphragms ( 20 ), placed one on top of the other, that regulate the size of the exit radiation field. In order to mark the entry field on the surface of the patient, there is a frontcover ( 21 ) made out of a low Z (atomic number) material, such as acrylic, with holes in which small laser guides or laser diodes ( 22 ) are placed that point in the focal point&#39;s direction. These are located along a circumference on the border of the field diaphragm, enabling visibility of the entry field upon the patient&#39;s skin undergoing treatment with this device. Given that the machine-patient positioning in this convergent radiotherapy technique can become a critical factor, the device has sub-millimetric precision sensors and/or reflectorson the front ( 23 ). Finally, in order to locate the axis of the isocenter focus cone, the apparatus has a small removable central laser guide ( 24 ). 
         [0047]      FIGS. 15   a  and  15   b  show two views of an alternate frontal unit in which two diaphragms are replaced by a solid interchangeable conical ring ( 25 ) that has a predefined field size. The surrounding laser guides can be incorporated into the front of the ring and the position sensors and central laser guide may be located on the acrylic or equivalent (low Z) cover, similar to that found in the previous figure. 
         [0048]      FIGS. 16 and 18  illustrate how this invention could be adapted to apparatuses currently in use for external photon radiotherapy.  FIG. 16  exhibits the invention adapted to a LINAC, showing an accelerator ( 26 ), the deflector magnet ( 27 ) and the invention being proposed here ( 28 ). The figure also demonstrates how the gantry would be replaced with the convergence device. Positioning system, table scan and head rotation with high precision position sensors on the contour of the field aperture diaphragm of the device and on the patient&#39;s skin. 
         [0049]      FIG. 17  shows a configuration of the invention adapted to a cyberknife: robotic system ( 29 ), small linear accelerator ( 30 ) and the invention ( 28 ). It already has a positioning system, movement and high precision sensors. 
         [0050]      FIG. 18  displays a configuration of the invention adapted to a Tomotherapy device. Rotation system ( 31 ), small linear accelerator ( 30 ) and the invention ( 28 ). Positioning system and gurney scan (x) and head rotation with radial movement of the apparatus (original part of the apparatus). Position sensors are added to the contour of the field aperture diaphragm of the device and others are adhered to the patient&#39;s skin. This generates feedback signals so that the positioning and scan system is more precise. 
         [0051]    The above means that the device is built a certain size so that it is adjustable to the size of the device to which it is adapted, provided that its entry diameter is the same size as the exit diameter of the device to which it will be adapted (gantry or beam exit cannon). 
         [0052]      FIG. 19  shows a prototype for intermediate energies in the ortho-voltage range. This prototype is made up of an electron cannon ( 32 ) for energy levels of several hundred keV and the convergent X-ray device being proposed ( 28 ). The electron cannon is comprised of a filament ( 33 ), a concentrator cathode ( 34 ) and an accelerator anode and disperser ( 35 ). It is also equipped with sensor systems for feedback positioning using the devices described above as well as sensors adhered to the patient&#39;s skin (similar to a bandage) ( 36 ). Additional advantages that a unit such as this one has to offer are its noteworthy low cost, small size and fewer shield requirements, thus making external photon radiotherapy an effective, low-cost technique available to a greater number of people. 
         [0053]    Another application is proposed in  FIG. 20  as an alternative to the invention presented here. It would be applied in the specific case that the anode and collimators&#39; curvature radius were to mathematically tend to infinity while maintaining the normal incidence condition of the electrons on the anode. In other words, by placing a flat collimator ( 37 ) like the one shown, the X-ray beam will be parallel and homogeneous upon exit. However, this is destined for other applications wherein the convergence of the beam is not required, as in images. 
         [0054]    Lastly, the description in  FIG. 21  explains how the proposed convergent photon beam unit can be converted to a unit with a convergent electron beam exit by exchanging the photon exit cone for an electron exit cone ( 38 ), as shown.