SYSTEM FOR SUPPORTING A BRACHYTHERAPY TREATMENT, METHOD FOR PROVIDING A SUPERVISION INFORMATION AND COMPUTER PROGRAM PRODUCT

Abstract

A system for supporting a brachytherapy treatment includes a medical imaging system and a processing unit. The medical imaging system includes a SPECT unit and/or a CT unit. The processing unit is configured to receive a planning dataset, and determine a brachytherapy treatment plan based on the planning dataset. The treatment plan includes a planned dose distribution for a radiation source. The medical imaging system is configured to acquire a supervision dataset that includes an intra-procedural representation of the radiation source that, in an operating state of the system, has been positioned at a treatment site within a treatment region via a medical guide instrument. The processing unit is configured to register the supervision dataset and the planning dataset, determine an actual dose distribution based on the supervision dataset, and provide supervision information based on a comparison between the planned and actual dose distribution.

Claims

1. A system for supporting a brachytherapy treatment, the system comprising: a medical imaging system; and a processing unit; wherein the medical imaging system comprises a single photon emission computed tomography (SPECT) unit, a computed tomography (CT) unit, or the SPECT unit and the CT unit, wherein the processing unit (22) is configured to: receive a planning dataset comprising a pre-procedural representation of a treatment region of a subject; determine a brachytherapy treatment plan based on the planning dataset, wherein the brachytherapy treatment plan comprises a planned dose distribution for at least one radiation source to be positioned within the treatment region, wherein the medical imaging system is configured to acquire a supervision dataset, the supervision dataset comprising an intra-procedural representation of the at least one radiation source that, in an operating state of the system, has been positioned at a treatment site within the treatment region via at least one medical guide instrument; register the supervision dataset and the planning dataset; determine an actual dose distribution based on the supervision dataset; and provide a supervision information based on a comparison between the planned dose distribution and the actual dose distribution.

2. The system of claim 1, wherein the brachytherapy treatment plan comprises at least one planned dwell position and at least one planned dwell time for the at least one radiation source to be positioned, wherein the supervision dataset comprises a time-resolved intra-procedural representation of the at least one radiation source, wherein the processing unit is further configured to determine at least one actual dwell position and at least one actual dwell time of the at least one radiation source based on the supervision dataset, wherein the comparison between the planned dose distribution and the actual dose distribution comprises a comparison between the at least one planned dwell position and the at least one actual dwell position and between the at least one planned dwell time and the at least one actual dwell time.

3. The system of claim 1, wherein the SPECT unit comprises a first detection unit, wherein the first detection unit comprises a first gamma camera and a first collimator, wherein the first collimator is spatially arranged within a field of view of the first gamma camera, wherein the first collimator is configured to collimate incident gamma photons towards the first gamma camera, wherein the first gamma camera is configured to detect gamma photons emitted by the at least one radiation source, and wherein the SPECT unit is configured to acquire the supervision dataset by mapping the detected gamma photons.

4. The system of claim 3, wherein the first collimator is a high-energy collimator, a pin-hole collimator, or a high-energy and pin-hole collimator.

5. The system of claim 3, wherein the SPECT unit further comprises a second detection unit, wherein the second detection unit comprises a second gamma camera and a second collimator, wherein the second collimator is spatially arranged within a field of view of the second gamma camera, wherein the second collimator is configured to collimate incident gamma photons towards the second gamma camera, wherein the second gamma camera is configured to detect gamma photons emitted from the at least one radiation source, wherein a main mapping direction of the first detection unit is substantially not collinear with a main mapping direction of the second detection unit, wherein the SPECT unit is configured to acquire the supervision dataset by mapping the gamma photons detected by the first gamma camera and the second gamma camera in three dimensions (3D).

6. The system of claim 5, wherein the second collimator is a high-energy collimator, a pin-hole collimator, or a high-energy and pin-hole collimator.

7. The system of claim 3, wherein the SPECT unit and the CT unit are arranged in a SPECT/CT-configuration, wherein the CT unit is configured to acquire the planning dataset, and wherein the supervision dataset is co-registered with the planning dataset.

8. The system of claim 2, wherein the SPECT unit and the CT unit are arranged in a SPECT/CT-configuration, wherein the brachytherapy treatment plan further comprises at least one planned positioning for the at least one medical guide instrument, wherein the CT unit is configured to acquire a first intra-procedural image dataset of the treatment region, wherein the first intra-procedural image dataset comprises a representation of the at least one medical guide instrument, wherein the supervision dataset is co-registered with the first intra-procedural image dataset, wherein the processing unit is further configured to: identify at least one actual positioning of the at least one medical guide instrument in the first intra-procedural image dataset; and provide the supervision information also based on a comparison between the at least one planned positioning and the at least one actual positioning of the at least one medical guide instrument.

9. The system of claim 2, wherein the CT unit is configured to acquire the supervision dataset, the supervision dataset comprising a second intra-procedural image dataset of the treatment region, wherein the second intra-procedural image dataset comprises the time-resolved intra-procedural representation of the at least one radiation source, and wherein the processing unit is further configured to determine the at least one actual dwell position and the at least one actual dwell time based on the second intra-procedural image dataset.

10. The system of claim 1, wherein the processing unit is further configured to: determine a deviation between the planned dose distribution and the actual dose distribution; compare the deviation with a pre-defined threshold; adapt, redefine, or adapt and redefine the brachytherapy treatment plan based on the supervision information, the supervision dataset, or the supervision information and the supervision dataset in case the deviation reaches, exceeds, or reaches and exceeds the pre-defined threshold.

11. The system of claim 10, further comprising an afterloader unit that is communicatively coupled to the processing unit, wherein the processing unit is further configured to provide the adapted, redefined, or adapted and redefined brachytherapy treatment plan to the afterloader unit, wherein the at least one medical guide instrument is connected to the afterloader unit, and wherein the afterloader unit is configured to reposition the at least one radiation source along the at least one medical guide instrument in accordance with the adapted, redefined, or adapted and redefined brachytherapy treatment plan.

12. A method for providing supervision information, the method comprising: receiving a planning dataset comprising a pre-procedural representation of a treatment region of a subject; determining a brachytherapy treatment plan based on the planning dataset, wherein the brachytherapy treatment plan comprises a planned dose distribution for at least one radiation source to be positioned within the treatment region; acquiring, by a medical imaging system, a supervision dataset, wherein the medical imaging system comprises a single photon emission computed tomography (SPECT) unit a computed tomography (CT) unit, or the SPECT unit and the CT unit, and wherein the supervision dataset comprises an intra-procedural representation of the at least one radiation source that has been positioned at a treatment site within the treatment region via at least one medical guide instrument before the beginning of the method; registering the supervision dataset and the planning dataset; determining an actual dose distribution based on the supervision dataset; and providing the supervision information based on a comparison between the planned dose distribution and the actual dose distribution.

13. The method of claim 12, wherein the brachytherapy treatment plan comprises at least one planned dwell position and at least one planned dwell time for the at least one radiation source to be positioned, and wherein the supervision dataset comprises a time-resolved intra-procedural representation of the at least one radiation source, wherein the method further comprises determining at least one actual dwell position and at least one actual dwell time of the at least one radiation source based on the supervision dataset, and wherein the comparison between the planned dose distribution and the actual dose distribution comprises a comparison between the at least one planned dwell position and the at least one actual dwell position, and between the at least one planned dwell time and the at least one actual dwell time.

14. The method of claim 12, wherein the SPECT unit and the CT unit are arranged in a SPECT/CT-configuration, wherein the supervision dataset is acquired by the SPECT unit through a mapping of gamma photons emitted by the at least one radiation source, wherein the method further comprises acquiring the planning dataset using the CT unit, and wherein the supervision dataset is co-registered with the planning dataset.

15. The method of claim 12, wherein the SPECT unit and the CT unit are arranged in a SPECT/CT-configuration, wherein the brachytherapy treatment plan further comprises at least one planned positioning for the at least one medical guide instrument, wherein the supervision dataset is acquired by the SPECT unit through a mapping of gamma photons emitted by the at least one radiation source, wherein the method further comprises: acquiring a first intra-procedural image dataset of the treatment region using the CT unit, wherein the first intra-procedural image dataset comprises a representation of the at least one medical guide instrument; and identifying at least one actual positioning of the at least one medical guide instrument in the first intra-procedural image dataset, and wherein providing the supervision information comprises providing the supervision information also based on a comparison between the at least one planned and the at least one actual positioning of the at least one medical guide instrument.

16. The method of claim 13, further comprising acquiring the supervision dataset comprising a second intra-procedural image dataset using the CT unit, wherein the second intra-procedural image dataset comprises the time-resolved intra-procedural representation of the at least one radiation source, and wherein the at least one actual dwell position and the at least one actual dwell time are determined based on the second intra-procedural image dataset.

17. The method of claim 12, wherein the comparison between the planned dose distribution and the actual dose distribution comprises: determining a deviation between the planned dose distribution and the actual dose distribution; comparing the deviation with a pre-defined threshold; and adapting, redefining, or adapting and redefining the brachytherapy treatment plan based on the supervision information, the supervision dataset, or the supervision information and the supervision dataset when the deviation reaches, exceeds, or reaches and exceeds the pre-defined threshold.

18. In a non-transitory computer-readable storage medium that stores instructions executable by one or more processors to provide supervision information, the instructions comprising: receiving a planning dataset comprising a pre-procedural representation of a treatment region of a subject; determining a brachytherapy treatment plan based on the planning dataset, wherein the brachytherapy treatment plan comprises a planned dose distribution for at least one radiation source to be positioned within the treatment region; acquiring, by a medical imaging system, a supervision dataset, wherein the medical imaging system comprises a single photon emission computed tomography (SPECT) unit a computed tomography (CT) unit, or the SPECT unit and the CT unit, and wherein the supervision dataset comprises an intra-procedural representation of the at least one radiation source that has been positioned at a treatment site within the treatment region via at least one medical guide instrument before the beginning of the method; registering the supervision dataset and the planning dataset; determining an actual dose distribution based on the supervision dataset; and providing the supervision information based on a comparison between the planned dose distribution and the actual dose distribution

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0080] FIG. 1 shows a schematic representation of an embodiments of a system for supporting a brachytherapy;

[0081] FIGS. 2 and 3 show schematic representations of a treatment region;

[0082] FIGS. 4 and 5 show schematic representations of further embodiments of a system for supporting a brachytherapy; and

[0083] FIGS. 6 to 8 show schematic representations of embodiments of a method for providing a supervision information.

DETAILED DESCRIPTION

[0084] FIG. 1 shows a schematic representation of an embodiment of a system for supporting a brachytherapy treatment. The system may include a medical imaging system and a processing unit 22. For example, the medical imaging system may include a SPECT unit. The processing unit 22 may be configured to receive a planning dataset comprising a pre-procedural representation of a treatment region of a subject 31. Further, the processing unit 22 may be configured to determine a brachytherapy treatment plan based on the planning dataset, where the brachytherapy treatment plan includes a planned dose distribution for at least one radiation source to be positioned within the treatment region.

[0085] The SPECT unit may include a first detection unit G.1 and a second detection unit G.2. The first detection unit G.1 may include a first gamma camera C.1 and a first collimator PH.1. In addition, the second detection unit G.2 may include a second gamma camera C.2 and a second collimator PH.2. In one embodiment, the first collimator PH.1 and the second collimator PH.2 may each be a high-energy and/or pin-hole collimator, featuring a pin-hole aperture AP.1, AP.2. The first collimator PH.1 may be spatially arranged within a field of view of the first gamma camera C.1. Likewise, the second collimator PH.2 may be spatially arranged within a field of view of the second gamma camera C.2. The first PH.1 and second collimator PH.1 may each be configured to collimate incident gamma photons towards the first gamma camera C.1 and the second gamma camera C.2, respectively. Further, the first gamma camera C.1 and the second gamma camera C.2 may each be configured to detect gamma photons emitted by the at least one radiation source. In one embodiment, a main mapping direction of the first detection unit G.1 may be substantially non-collinear with a main mapping direction of the second detection unit G.2. Further, the first detection unit G.1 and the second detection unit G.2 may each provide a signal 76.1 and 76.2 that is dependent on the detected gamma photons to the processing unit 22. Thereby, the SPECT unit may be configured to acquire and to provide a supervision dataset comprising an intra-procedural representation of the at least one radiation source that has been positioned at a treatment site within the treatment region via at least one medical guide instrument MG. The processing unit 22 may be configured to receive the supervision dataset via the signals 76.1 and 76.2. The processing unit 22 may further be configured to register the supervision dataset and the planning dataset. In addition, the processing unit 22 may be configured to determine an actual dose distribution based on the supervision dataset. Moreover, the processing unit 22 may be configured to provide a supervision information based on a comparison between the planned and actual dose distribution.

[0086] For example, the processing unit 22 may be configured to determine a deviation between the planned and actual dose distribution. In addition, the processing unit 22 may be configured to compare the deviation with a pre-defined threshold and to adapt and/or redefine the brachytherapy treatment plan based on the supervision information and/or the supervision dataset in case the deviation reaches and/or exceeds the pre-defined threshold.

[0087] Further, the system may include an afterloader unit AL. The afterloader unit AL may be communicatively coupled to the processing unit 22 (e.g., via a signal 35). Further, the processing unit 22 may be configured to provide the adapted and/or redefined brachytherapy treatment plan to the afterloader unit AL (e.g., via the signal 35). Further, the at least one medical guide instrument MG may be connected to the afterloader unit AL (e.g., via a channel CH). The afterloader unit AL may be configured to reposition the at least one radiation source along the at least one medical guide instrument MG in accordance with the adapted and/or redefined brachytherapy treatment plan.

[0088] The system may further include a display unit 41 (e.g., a display and/or monitor) and/or an input unit 42 (e.g., a keyboard). The input unit 42 may be integrated into the display unit 41 (e.g., as a capacitive and/or resistive touch display). The input unit 42 may be configured to capture a user input (e.g., from medical staff). Further, the processing unit 22 may be configured to receive the user input from the input unit 42 via a signal 26. In addition, the display unit 41 may be configured to display information and/or graphical representations of information (e.g., information and/or parameters of the system and/or components of the system). For this purpose, the processing unit 22 may further be configured to send a signal 25 to the display unit 41. For example, the display unit 41 may be configured to display a graphical representation of the planning dataset, an intra-procedural image dataset, the supervision dataset, and/or the supervision information. Further, the display unit 41 may be configured to display multiple of the aforementioned graphical representations simultaneously (e.g., side-by-side and/or picture-in-picture and/or at least partially overlaid).

[0089] FIG. 2 shows a schematic representation of the treatment region TR in a first operating state of the proposed system (e.g., before the at least one radiation source has been positioned within the treatment region TR). The treatment region TR may include an anatomical region AR (e.g., a prostate). Further, a distal portion of the at least one medical guide instrument MG (e.g., three medical guide instruments MG) may be positioned at least partially within and/or adjacent to the treatment region TR (e.g., the anatomical region AR). By way of example, the medical guide instruments MG may be configured as interstitial needles.

[0090] FIG. 3 shows a schematic representation of the treatment region TR in a second operating state of the proposed system (e.g., after the at least one radiation source RS has been positioned within the treatment region TR). In one embodiment, the afterloader unit AL may be configured to introduce and/or translate a carrier instrument CI inside the at least one medical guide instrument MG. The carrier instrument CI may be configured to encapsule and/or carry the at least one radiation source RS (e.g., as a wire). In addition, the carrier instrument CI may be configured to be inserted into and translated along the elongated hollow lumen of the at least one medical guide instrument MG. The afterloader unit AL may include, for example, an electromagnetic and/or mechanical and/or pneumatic stepping motor that is configured to introduce and/or translate the carrier instrument CI (e.g., the at least one radiation source RS) inside the at least one medical guide instrument MG. In addition, the afterloader unit AL (e.g., the stepping motor) may be configured to extract the at carrier instrument CI (e.g., the at least one radiation source RS) from the at least one medical guide instrument MG. In addition, the afterloader unit AL may be configured to introduce and/or translate the at least one radiation source RS inside the at least one medical guide instruments MG through the channels CH (e.g., simultaneously or subsequently).

[0091] Further, the afterloader unit AL (e.g., the stepping motor) may be configured to position the carrier instrument CI (e.g., the at least one radiation source RS) along the at least one medical guide instrument MG in accordance with the brachytherapy treatment plan.

[0092] In one embodiment, the brachytherapy treatment plan may include at least one planned dwell position DP and at least one planned dwell time for the at least one radiation source RS to be positioned. Further, the intra-procedural representation of the at least one radiation source RS may be time-resolved. Further, the processing unit 22 may be configured to determine at least one actual dwell position and at least one actual dwell time of the at least one radiation source RS based on the supervision dataset. Further, the comparison between the planned and actual dose distribution may include a comparison between the at least one planned DP and the at least one actual dwell position and between the at least one planned and the at least one actual dwell time.

[0093] Alternatively or in addition, the brachytherapy treatment plan may include at least one planned positioning for the medical guide instrument MG.

[0094] FIG. 4 shows a schematic representation of a further embodiment of a system. CT unit CTU may include an X-ray source 33, an X-ray detector 34, a cover A, a rotating gantry frame DR, and a rotational bearing (not shown here). The rotating gantry frame DR and the rotational bearing may be covered by the cover A. The X-ray source 33 and the X-ray detector 34 may be mounted on the rotating gantry frame DR opposite each other in relation to an axis of rotation RX. The rotating gantry frame DR may further be mounted rotatably around the axis of rotation RX with respect to the annular frame 0 using the rotational bearing. The subject 31 may be positioned at least partially inside the patient receiving area 59. An acquisition area 54 of the CT unit CTU may be coincident within the patient receiving area 59. The subject 31 (e.g., the treatment area) may be positioned at least partially within the acquisition area 54, such that an X-ray bundle 67 (e.g., a fan-beam) emitted by the X-ray source 33 may be received by the X-ray detector 34 after an interaction between the X-ray bundle and the subject.

[0095] The system may further include a patient positioning unit 32, where the patient positioning unit 32 may further include a bearing socket 51 and a bearing plate 52 configured to receive the subject 31. In addition, the bearing plate 52 may be maneuverable with respect to the bearing socket 51 (e.g., such that the bearing plate 52 may be maneuvered along a longitudinal direction of the bearing plate 52 into the acquisition area 54).

[0096] The CT unit CTU may be configured to acquire the supervision dataset including a second intra-procedural image dataset of the treatment region TR. Further, the second intra-procedural image dataset may include the time-resolved intra-procedural representation of the at least one radiation source RS. In one embodiment, the processing unit 22 may be configured to determine the at least one actual dwell position and the at least one actual dwell time based on the second intra-procedural image dataset of the at least one radiation source RS.

[0097] FIG. 5 shows a schematic representation of a further embodiment of a system. The medical imaging system may include a SPECT unit and a CT unit CTU, which are arranged in a SPECT/CT-configuration.

[0098] The SPECT unit and the CT unit CTU may each be mounted rotatably around a common axis of rotation RX. For example, the first detection unit G.1 and the second detection unit G.2 may be mounted on the rotating gantry frame DR rotatably around the common axis of rotation RX. In one embodiment, the SPECT unit (e.g., the first detection unit G.1 and the second detection unit G.2) and the CT unit CTU (e.g., the X-ray source 33 and the X-ray detector 34) may be configured to rotate independently around the common axis of rotation RX. In one embodiment, the subject 31 may be positioned in a common receiving area 59 of the SPECT unit and the CT unit CTU (e.g., substantially along the common axis of rotation RX).

[0099] The SPECT unit may be configured to acquire the supervision dataset by mapping the gamma photons detected by the first gamma camera C.1 and the second gamma camera C.2 in 3D. Further, the CT unit CTU may be configured to acquire the planning dataset and/or a first intra-procedural image dataset of the treatment region. In one embodiment, the CT unit CTU may be configured to provide the planning dataset and/or the first intra-procedural image dataset via the signal 77 to the processing unit 22. In one embodiment, the supervision dataset may be co-registered with the planning dataset and/or with the first intra-procedural image dataset. For example, the SPECT unit and the CT unit CTU may be configured to simultaneously acquire the supervision dataset and the first intra-procedural image dataset of the treatment region. The first intra-procedural image dataset may include a representation of the at least one medical guide instrument MG. The processing unit 22 may further be configured to identify at least one actual positioning of the at least one medical guide instrument MG in the first intra-procedural image dataset. Further, the processing unit 22 may be configured to provide the supervision information also based on a comparison between the at least one planned positioning and the at least one actual positioning of the at least one medical guide instrument MG, where the brachytherapy treatment plan may include the at least one planned positioning of the at least one medical guide instrument MG.

[0100] Further, the SPECT unit and the CT unit CTU may respectively be configured to acquire the supervision dataset and the first intra-procedural image dataset substantially coplanar with respect to the common axis of rotation RX.

[0101] FIG. 6 shows a schematic representation of an embodiment of a method for providing PROV-SI a supervision information SI. In a first act, the planning dataset DS.p including a pre-procedural representation of the treatment region TR of the subject 31 may be received REC-DS.p. Further, the brachytherapy treatment plan TP may be determined DET-TP based on the planning dataset DS.p. The brachytherapy treatment plan TP may include the planned dose distribution DD.p for the at least one radiation source RS to be positioned within the treatment region TR. In a further act, the supervision dataset DS.s may be acquired by the medical imaging system. Further, the supervision dataset DS.s may include the intra-procedural representation of the at least one radiation source RS that has been positioned at the treatment site within the treatment region TR via the at least one medical guide instrument MG before the beginning of this method. Further, the supervision dataset DS.s and the planning dataset DS.p may be registered REG-DS. In addition, the actual dose distribution DD.m may be determined based on the supervision dataset DS.s. Further, the supervision information SI may be provided PROV-SI based on a comparison COMP-DD between the planned DD.p and the actual dose distribution DD.m.

[0102] FIG. 7 shows a schematic representation of a further embodiment of a proposed method, where the brachytherapy treatment plan TP may include the at least one planned dwell position DP.p and the at least one planned dwell time DT.p for the at least one radiation source RS to be positioned. Further, the intra-procedural representation of the at least one radiation source RS, which is comprised by the supervision dataset DS.s, may be time-resolved. In addition, the at least one actual dwell position DP.m and the at least one actual dwell time DT.m of the at least one radiation source RS may be determined based on the supervision dataset DS.s. Further, the comparison COMP-DD between the planned dose distribution DD.p and the actual dose distribution DD.m may include a comparison COMP-DP-DT between the at least one planned dwell position DP.p and the at least one actual dwell position DP.m and between the at least one planned dwell time DT.p and the at least one actual dwell time DT.m.

[0103] In one embodiment, the supervision dataset DS.s may be acquired ACQ-DS.s by the CT unit CTU including a second intra-procedural image dataset ID.i2, where the second intra-procedural image dataset ID.i2 may include the time-resolved intra-procedural representation of the at least one radiation source RS. Further, the at least one actual dwell position DP.m and the at least one actual dwell time DT.m may be determined based on the second intra-procedural image dataset ID.i2.

[0104] FIG. 8 shows a schematic representation of a further embodiment of a method. The brachytherapy treatment plan TP may further include the at least one planned positioning POS.p for the at least one medical guide instrument MG. In addition, the supervision dataset DS.s may be acquired by the SPECT unit through a mapping of the gamma photons emitted by the at least one radiation source RS. Further, a first intra-procedural image dataset ID.i1 including a representation of the at least one medical guide instrument MG may be acquired ACQ-ID.i1 by the CT unit CTU. In addition, the at least one actual positioning POS.m of the at least one medical guide instrument MG may be identified ID-POS in the first intra-procedural image dataset ID.i1. In one embodiment, the supervision information SI may be provided also based on the comparison COMP-POS between the at least one planned positioning POS.p and the at least one actual positioning POS.m of the at least one medical guide instrument MG.

[0105] Although the present invention has been described in detail with reference to exemplary embodiments, the present invention is not limited by the disclosed examples from which the skilled person is able to derive other variations without departing from the scope of the invention. In addition, the utilization of indefinite articles such as “a” and/or “an” does not exclude multiples of the respective features. Further, terms such as “unit” and “element” do not exclude that the respective components may include multiple interacting sub-components, where the sub-components may further be spatially distributed.

[0106] The elements and features recited in the appended claims may be combined in different ways to produce new claims that likewise fall within the scope of the present invention. Thus, whereas the dependent claims appended below depend from only a single independent or dependent claim, it is to be understood that these dependent claims may, alternatively, be made to depend in the alternative from any preceding or following claim, whether independent or dependent. Such new combinations are to be understood as forming a part of the present specification.

[0107] While the present invention has been described above by reference to various embodiments, it should be understood that many changes and modifications can be made to the described embodiments. It is therefore intended that the foregoing description be regarded as illustrative rather than limiting, and that it be understood that all equivalents and/or combinations of embodiments are intended to be included in this description.