Method for operating a medical radiation therapy arrangement, and medical radiation therapy arrangement

Abstract

A method for operating a medical radiation therapy arrangement is disclosed, wherein a wound cavity in the patient from which a tumor has been surgically removed is measured three-dimensionally in a reference coordinate system via a surgical microscope of the medical radiation therapy arrangement and/or via a probe-based registration device of the medical radiation therapy arrangement, wherein an x-ray applicator of an intraoperative radiation therapy device of the medical radiation therapy arrangement is selected and/or arranged in the wound cavity on the basis of three-dimensional measurement data generated during the measurement, with the x-ray applicator being navigable in the reference coordinate system. Furthermore, the disclosure relates to a medical radiation therapy arrangement.

Claims

1. A method for operating a medical radiation therapy arrangement, the method comprising: three-dimensionally measuring, in a reference coordinate system, a wound cavity in a patient from which a tumor has been surgically removed, wherein said three-dimensional measuring is performed via at least one of a surgical microscope of the medical radiation therapy arrangement and a probe-based registration device of the medical therapy arrangement; and, at least one of selecting and arranging an x-ray applicator of an intraoperative radiation therapy device of the medical radiation therapy arrangement in the wound cavity on a basis of three-dimensional measurement data generated during said three-dimensional measuring with the x-ray applicator being navigable in the reference coordinate system.

2. The method of claim 1 further comprising transmitting the three-dimensional measurement data via interconnected interfaces, which are configured for said transmitting, of at least one of the surgical microscope, the probe-based registration device, a confocal endomicroscope of the medical radiation therapy arrangement, and a further apparatus for tissue differentiation and the intraoperative radiation therapy device.

3. The method of claim 1, wherein, for said arranging, a feed trajectory for the x-ray applicator to and/or into the wound cavity is at least one of determined, output, and implemented by moving the x-ray applicator, on the basis of the generated three-dimensional measurement data.

4. The method of claim 1, wherein said arranging of the x-ray applicator is performed via a robotic stand on which the x-ray applicator is arranged.

5. The method of claim 1, wherein, as part of selecting the x-ray applicator, at least one external part of the x-ray applicator is made taking into account the three-dimensional measurement data.

6. The method of claim 1, wherein the wound cavity is measured additionally via at least one of a confocal endomicroscope of the medical radiation therapy arrangement, and a further apparatus for tissue differentiation, wherein a density of tumor cells left behind in the wound cavity after the surgical removal of at least one of the tumor and an other tissue characteristic that is relevant for the therapy is determined in the reference coordinate system in a spatially resolved manner; and, said selecting of the x-ray applicator takes place taking into account a density of a corresponding one of the tumor cells determined in the spatially resolved manner and the other tissue characteristic that is relevant for the therapy.

7. The method of claim 1, wherein the wound cavity is measured additionally via at least one of a confocal endomicroscope of the medical radiation therapy arrangement, and a further apparatus for tissue differentiation, wherein a density of tumor cells left behind in the wound cavity after the surgical removal of at least one of the tumor and an other tissue characteristic that is relevant for the therapy is determined in the reference coordinate system in a spatially resolved manner; and, at least an outer part of the x-ray applicator is made taking into account the density of a corresponding one of the tumor cells determined in a spatially resolved manner and the other tissue characteristic that is relevant for the therapy.

8. The method of claim 1, wherein the wound cavity is measured additionally via at least one of a confocal endomicroscope of the medical radiation therapy arrangement, and a further apparatus for tissue differentiation, wherein at least one of a density of tumor cells left behind in the wound cavity after the surgical removal of the tumor and an other tissue characteristic relevant for the therapy is determined in the reference coordinate system in a spatially resolved manner; said selecting of the x-ray applicator takes place taking into account the density of a corresponding one of the tumor cells determined in the spatially resolved manner and the other tissue characteristic relevant for the therapy; and, at least an outer part of the x-ray applicator is made taking into account the density of a corresponding one of the tumor cells determined in a spatially resolved manner and the other tissue characteristic that is relevant for the therapy.

9. The method of claim 5, wherein the outer part of the x-ray applicator is made via a 3D printing method.

10. The method of claim 6, wherein the outer part of the x-ray applicator is made via a 3D printing method.

11. The method of claim 1, wherein marked regions adjoin at least one of the tumor and the wound cavity; wherein at least one of: the marked regions are captured, the marked regions are identified, measurement data describing the marked regions are received, and simulation data describing the marked regions are received; and, wherein the data are taken into account during the selection and/or during a making of the x-ray applicator.

12. The method of claim 1, wherein three-dimensional external measurement data describing the tumor that is to be removed are received; at least one of a start position and a start orientation for at least one of the surgical microscope and the intraoperative radiation therapy device are determined in the reference coordinate system on a basis of the received three-dimensional external measurement data; and, at least one of the surgical microscope and the intraoperative radiation therapy device is brought into at least one of a corresponding one of the determined start position and the determined start orientation in the reference coordinate system.

13. A medical radiation therapy arrangement comprising: at least one of a surgical microscope and a probe-based registration device; said at least one of said surgical microscope and said probe-based registration device being configured to three-dimensionally measure in a reference coordinate system a wound cavity in a patient from which a tumor was surgically removed; an intraoperative radiation therapy device having an x-ray applicator; said x-ray applicator being navigable in the reference coordinate system; and, said intraoperative radiation therapy device being configured to at least one of select the x-ray applicator and arrange the x-ray applicator in the wound cavity on a basis of three-dimensional measurement data generated during the measurement.

14. The medical radiation therapy arrangement of claim 13, wherein at least one of said surgical microscope, said probe-based registration device, a confocal endomicroscope of the medical radiation therapy arrangement, and a further apparatus for tissue differentiation and said intraoperative radiation therapy device have interconnected interfaces configured to transmit the three-dimensional measurement data.

15. The medical radiation therapy arrangement of claim 13 further comprising: at least one of a confocal endomicroscope and a further apparatus for tissue differentiation; said at least one of said confocal endomicroscope and said further apparatus for tissue differentiation being configured to additionally measure the wound cavity, wherein at least one of a density of at least one of tumor cells left behind in the wound cavity after surgical removal of the tumor and another tissue characteristic that is relevant for the therapy is determined in the reference coordinate system in a spatially resolved manner; and, wherein the selection of said x-ray applicator takes into account at least one of the density of the tumor cells determined in a spatially resolved manner and the other tissue characteristic that is determined.

16. The medical radiation therapy arrangement of claim 15, wherein at least an outer part of the x-ray applicator is produced taking into account at least one of the density of the tumor cells determined in a spatially resolved manner and the other tissue characteristic that is determined.

17. The medical radiation therapy arrangement of claim 13 further comprising: at least one of a confocal endomicroscope and a further apparatus for tissue differentiation; said at least one of said confocal endomicroscope and said further apparatus for tissue differentiation being configured to additionally measure the wound cavity, wherein at least one of a density of at least one of tumor cells left behind in the wound cavity after surgical removal of the tumor and another tissue characteristic that is relevant for the therapy is determined in the reference coordinate system in a spatially resolved manner; and, wherein at least an outer part of the x-ray applicator is made taking into account at least one of the density of the tumor cells determined in a spatially resolved manner and the other tissue characteristic that is determined.

Description

BRIEF DESCRIPTION OF DRAWINGS

[0036] The invention will now be described with reference to the drawings wherein:

[0037] FIG. 1 shows a schematic illustration of an embodiment of the medical radiation therapy arrangement; and,

[0038] FIG. 2 shows a schematic flowchart of an embodiment of the method for operating a medical radiation therapy arrangement.

DETAILED DESCRIPTION

[0039] FIG. 1 shows a schematic illustration of an embodiment of the medical radiation therapy arrangement 1. The medical radiation therapy arrangement 1 includes a surgical microscope 2 and an intraoperative radiation therapy device 3. The medical radiation therapy arrangement 1 is configured to carry out the method described in this disclosure. The surgical microscope 2 and the intraoperative radiation therapy device 3 each have a control device 4, 5, which perform data processing that is necessary to carry out measures of the method.

[0040] Alternatively, the measures of the method can also be carried out via a common control device, for example a central data processing device.

[0041] The individual devices of the radiation therapy arrangement 1, in particular the surgical microscope 2, any central data processing device that may be present, and the intraoperative radiation therapy device 3, are interconnected in particular via suitable hardware and/or software interfaces 40.

[0042] The surgical microscope 2 is configured to three-dimensionally measure in a reference coordinate system 30 a wound cavity 21 in a patient 20 from which a tumor was surgically removed. For this purpose, in particular stereoscopic image representations are captured and evaluated via a stereoscopic camera of the surgical microscope 2. A pose of the surgical microscope 2 within the reference coordinate system 30 can be changed for this purpose via a robotic stand 6. In this way, the wound cavity 21 can be captured and measured from different directions. In particular, outer walls of the wound cavity 21 are topographically measured in the process. In particular methods in which three-dimensional positions of the outer wall of the wound cavity 21 are determined via triangulation from the stereoscopic image representations can be used here. The surgical microscope 2 provides three-dimensional measurement data 7 describing the wound cavity 21. The three-dimensional measurement data 7 are supplied to the intraoperative radiation therapy device 3, in particular via the hardware and/or software interfaces 40 that are configured for this purpose.

[0043] In particular, provision is made for an entrance and/or a canal to the wound cavity 21 to be three-dimensionally measured in the reference coordinate system 20 in addition to the wound cavity 21.

[0044] A pose of the surgical microscope 2 in the reference coordinate system 30 is known, and the positions of the outer wall of the wound cavity 21 can thus be determined from the captured stereoscopic image representations. The pose of the surgical microscope 2 can be determined for example by capturing optical marks via the surgical microscope 2 and/or another sensor system. Alternatively or additionally, a pose of the surgical microscope 2 can also be captured and/or determined via a surgical navigation system (not shown).

[0045] Alternatively or additionally, provision may be made for the three-dimensional measurement to be performed via a registration device 18. The registration device 18 is used for example to probe and consequently measure (in particular manually) points within the wound cavity 21. A pose of the registration device 18 in the reference coordinate system 30 is known here, for example by way of capturing optical marks arranged on the registration device 18 via a surgical navigation system. The registration device 18 can alternatively also generate light markings within the wound cavity 18, which are then stereoscopically captured via cameras of the surgical microscope 2 (or of another suitable device), wherein a position of the generated light marking is determined from the stereoscopic image representations captured. In this way, the wound cavity 21 can be captured and measured (in particular manually) step-by-step.

[0046] The intraoperative radiation therapy device 3 has an x-ray applicator 8 that is navigable in the reference coordinate system 30. The applicator is arranged in particular at a distal end of a robotic stand 9. In particular, a pose of the x-ray applicator 8 can be changed via the robotic stand 9. The intraoperative radiation therapy device 3 is configured to select the x-ray applicator 8 and/or arrange it in the wound cavity 21 on the basis of the three-dimensional measurement data 7 generated during the measurement. For this purpose, the three-dimensional measurement data 7 are received by the interface 40 of the intraoperative radiation therapy device 3 and processed by the control device 5.

[0047] The selection can be carried out for example via a magazine of the radiation therapy device 3 that is held available for this purpose. X-ray applicators 8 of different sizes and/or shapes are stored in sterile fashion in the magazine. Provision is made here in particular for the radiation therapy device 3 to select an x-ray applicator 8 that is suitable for the wound cavity 21 and/or for the entrance and/or the canal to the wound cavity 21. For this purpose, the radiation therapy device 3, in particular the control device 5, determines, for example, a volume of the wound cavity 21 on the basis of the three-dimensional measurement data 7 and selects a suitable x-ray applicator 8 from the applicators 8 that are held available in the magazine, on the basis of the volume determined. The x-ray applicator 8 selected is then in automated fashion taken from the magazine by the radiation therapy device 3 and coupled to the robotic stand 9. Alternatively, the x-ray applicator 8 can also be manually taken from the magazine and connected to the stand 9.

[0048] Subsequently, the selected x-ray applicator 8 is arranged in the wound cavity 21. A pose, that is, a position and an orientation, of the x-ray applicator 8, in particular a pose of a part of the x-ray applicator 8 that is active during the irradiation, is determined on the basis of the three-dimensional measurement data 7. In particular, this process is implemented via the control device 5. The arrangement is then performed in particular in automated fashion via the robotic stand 6. In principle, however, a manually guided arrangement is also possible, in which a surgeon or an assistant manually inserts the x-ray applicator 8, supported by the three-dimensional measurement data 7 and the pose determined therefrom, (through the entrance and/or the canal) into the wound cavity 21. For this purpose, for example (three-dimensional) visualization 10 of the three-dimensional measurement data 7 and a pose of the x-ray applicator 8, for example on a display device 11 of the radiation therapy arrangement 1, can take place.

[0049] Provision can be made, for arrangement purposes, for a feed trajectory 12 for the x-ray applicator 8 to and/or into the wound cavity 21 to be determined and/or output and/or implemented by moving the x-ray applicator 8, on the basis of the generated three-dimensional measurement data 7. The feed trajectory 12 includes an ordered set of poses that each include a position and an orientation of the x-ray applicator 8 in the reference coordinate system 30. The feed trajectory 12 begins at a current pose of the x-ray applicator 8 and terminates in an end pose in the wound cavity 21. The determination of the feed trajectory 12 is effected in particular via the control device 5. Provision may be made for the determined feed trajectory 12 to be displayed on the display device 11 in order to aid a surgeon or an assistant with the orientation and navigation.

[0050] Provision may be made for at least an outer part of the x-ray applicator 8 to be produced taking into account the three-dimensional measurement data 7. For this purpose, the three-dimensional measurement data 7 are supplied for example to a 3D printer 13, which produces an outer part of the x-ray applicator 8 on the basis of the three-dimensional measurement data 7 of the wound cavity 21, of the entrance and/or of the canal. For example, the outer part of the x-ray applicator 8 can be produced as a negative image or negative shape of the wound cavity 21, with the result that the x-ray applicator 8 can be arranged with an exact fit in the wound cavity 21. In principle, it is possible here for a radiologist or an assistant to specify parameters for the production process, for example at a user interface (not shown) that is provided for this purpose. For example, it is also possible to select a region of the wound cavity 21 that is to be produced as a negative shape. The production can take place in a sterile environment. Alternatively or additionally, the produced x-ray applicator 8 can be sterilized after production, for example via methods using UV radiation, ethylene oxide (EtO) and/or a plasma. The produced x-ray applicator 8 is subsequently arranged on the robotic stand 9 and arranged in the wound cavity 21, as already described.

[0051] Provision may be made for the medical radiation therapy arrangement 1 to additionally have a confocal endomicroscope 14 and/or another apparatus (not shown) for tissue differentiation. The endoscope or other apparatus are connected to the other devices of the radiation therapy arrangement 1 in particular via a suitable hardware and/or software interface 40. Provision is then made for the wound cavity 21 to be measured additionally via the confocal endomicroscope 14 and/or the other apparatus, wherein a density 15 of tumor cells that are left behind in the wound cavity 21 after the tumor has been surgically removed and/or another tissue characteristic that is relevant for the therapy is determined in a spatially resolved manner in the reference coordinate system 30. The x-ray applicator 8 is then selected taking into account the density 15 of the tumor cells determined in a spatially resolved manner and/or the other tissue characteristic that is relevant for the therapy. Alternatively or additionally, at least the outer part of the x-ray applicator 8 can be produced taking into account the density 15 of the tumor cells determined in a spatially resolved manner and/or the other tissue characteristic that is relevant for the therapy. In particular, the x-ray applicator 8 can here be selected or produced such that regions having a greater density 15 are irradiated with a greater irradiance (intensity or dose) than regions having a lower density 15. Such an x-ray applicator 8 can be produced in particular via the 3D printer 13 by selecting a wall thickness and/or structure (for example a solid configuration or one with cavities, with a honeycomb structure et cetera) of the outer part of the x-ray applicator 8 such that a weakening corresponding thereto results in a desired irradiance (intensity or dose). Alternatively or additionally, a (spatially resolved) material selection (for example by admixing a metal component et cetera) during 3D printing can bring about a desired weakening. Another apparatus for tissue differentiation can be, for example, an optical coherence tomography (OCT) apparatus or a Raman spectroscopy apparatus. Furthermore, provision may be made for the other apparatus to be provided by the surgical microscope in the form of fluorescence imaging.

[0052] Provision may be made for marked regions adjoining the tumor and/or the wound cavity 21 to be captured and/or identified, and/or for measurement and/or simulation data 16 describing these marked regions to be received, wherein these data are taken into account during the selection and/or during the production of the x-ray applicator 8. The marked regions can be, for example, functionally active areas and/or bundles of fibers in the brain of the patient 20, which are captured and/or identified using suitable methods.

[0053] Provision may be made for three-dimensional external measurement data 17 describing the tumor that is to be removed to be received, wherein a start position and/or a start orientation at least for the surgical microscope 2 and/or the intraoperative radiation therapy device 3 are determined in the reference coordinate system 30 on the basis of the received three-dimensional external measurement data 17, and wherein the surgical microscope 2 and/or the intraoperative radiation therapy device 3 are brought into the respectively determined start position and/or the respectively determined start orientation in the reference coordinate system 30. For this purpose, the control devices 4, 5 determine, on the basis of the three-dimensional external measurement data 17, the respective start positions and/or start orientations in the reference coordinate system 30 and control (in open-loop and/or closed-loop fashion) the robotic stands 6, 9 accordingly.

[0054] FIG. 2 shows a schematic flowchart of an embodiment of the method for operating a medical radiation therapy arrangement. The method is carried out in particular via a medical radiation therapy arrangement according to any of the previously described embodiments.

[0055] In a measure 100, a wound cavity in the patient from which a tumor was surgically removed is three-dimensionally measured in a reference coordinate system. This can be done via a surgical microscope (measure 100a) of the medical radiation therapy arrangement and/or via a probe-based registration device of the medical radiation therapy arrangement (measure 100b). Additionally, in particular a surgical navigation system can be used in this case, with which poses of the surgical microscope and/or of the registration device in the reference coordinate system are determined.

[0056] In a measure 102, an x-ray applicator of an intraoperative radiation therapy device of the medical radiation therapy arrangement is selected on the basis of three-dimensional measurement data generated during the measurement (measure 102a), with the x-ray applicator being navigable in the reference coordinate system. Alternatively, provision may also be made, as part of the measure 102, for at least an outer part of the x-ray applicator to be produced taking into account the three-dimensional measurement data (measure 102b). This can be effected in particular via a 3D printing method.

[0057] Provision may be made in measure 103 for a feed trajectory for the x-ray applicator to and/or into the wound cavity to be determined and/or output on the basis of the generated three-dimensional measurement data.

[0058] In measure 104, the x-ray applicator is arranged in the wound cavity. For this purpose, in particular the feed trajectory determined in measure 103 can be implemented. In a simple case, the arrangement can be effected manually by a surgeon or an assistant. Provision may in particular furthermore be made for the arrangement of the x-ray applicator to be performed via a robotic stand on which the x-ray applicator is arranged. The arrangement via the robotic stand can be effected both under manual control or in automated fashion. Combinations are also possible; for example, provision may be made for the robotic stand to implement the feed trajectory up to a specified position in automated fashion, but for a remaining portion of the feed trajectory to be implemented under manual control by the surgeon or the assistant. For this purpose, provision may be made in particular for the feed trajectory to be displayed on a display device together with a presentation of the three-dimensional measurement data of the wound cavity, of the entrance and/or of the canal to the wound cavity and the current pose of the x-ray applicator.

[0059] When the x-ray applicator has been successfully arranged in the wound cavity, the tissue adjoining the wound cavity is irradiated in a measure 105 via the x-ray applicator.

[0060] After the irradiation, the x-ray applicator is removed from the wound cavity in a measure 106. This takes place in particular by implementing the feed trajectory in the opposite direction.

[0061] Provision may be made in an additional measure 101 for the wound cavity to be measured additionally via a confocal endomicroscope of the medical radiation therapy arrangement and/or via another apparatus for tissue differentiation, wherein a density of tumor cells that are left behind in the wound cavity after the tumor has been surgically removed and/or another tissue characteristic that is relevant for the therapy is determined in the process in a spatially resolved manner in the reference coordinate system. The x-ray applicator is then selected in measure 102a taking into account the density of the tumor cells determined in a spatially resolved manner and/or the other tissue characteristic that is relevant for the therapy. Alternatively, at least an outer part of the x-ray applicator is produced in measure 102b taking into account the density of the tumor cells determined in a spatially resolved manner and/or the other tissue characteristic that is relevant for the therapy.

[0062] Provision may furthermore be made in an additional measure 99 for marked regions adjoining the tumor and/or the wound cavity to be captured and/or identified, and/or for measurement and/or simulation data describing these marked regions to be received, wherein these data are taken into account during the selection in measure 102a and/or during the production of the x-ray applicator in measure 102b. Capturing can be effected for example via a magnetic resonance imaging (MRI) method or another suitable imaging method.

[0063] Provision may furthermore be made for three-dimensional external measurement data describing the tumor that is to be removed to be received, wherein a start position and/or a start orientation at least for the surgical microscope and/or the intraoperative radiation therapy device are determined in the reference coordinate system on the basis of the received three-dimensional external measurement data, and wherein the surgical microscope and/or the intraoperative radiation therapy device are brought into the respectively determined start position and/or the respectively determined start orientation in the reference coordinate system.

[0064] It is understood that the foregoing description is that of the preferred embodiments of the invention and that various changes and modifications may be made thereto without departing from the spirit and scope of the invention as defined in the appended claims.

LIST OF REFERENCE SIGNS

[0065] 1 Medical radiation therapy arrangement [0066] 2 Surgical microscope [0067] 3 Intraoperative radiation therapy device [0068] 4 Control device [0069] 5 Control device [0070] 6 Robotic stand [0071] 7 Three-dimensional measurement data [0072] 8 X-ray applicator [0073] 9 Robotic stand [0074] 10 Visualization [0075] 11 Display device [0076] 12 Feed trajectory [0077] 13 3D printer [0078] 14 Confocal endomicroscope [0079] 15 Density (of tumor cells left behind) [0080] 16 Measurement and/or simulation data [0081] 17 External measurement data [0082] 18 Registration device [0083] 20 Patient [0084] 21 Wound cavity [0085] 30 Reference coordinate system [0086] 40 Interface [0087] 99-106 Measures of the method