It is to be understood that this summary is not an extensive overview of the disclosure. This summary is exemplary and not restrictive, and it is intended to neither identify key or critical elements of the disclosure nor delineate the scope thereof. The sole purpose of this summary is to explain and exemplify certain concepts of the disclosure as an introduction to the following complete and extensive detailed description.
Certain embodiments of the disclosure relate to a therapeutic technique for modulation of the intensity of X-rays or gamma-rays emanating from a radiation source utilized to treat cancerous tumors. Such technique is referred to as compensator-based intensity modulated brachytherapy or compensator-based brachytherapy (CBT), and can enable treatment that is a non-invasive alternative to supplementary interstitial brachytherapy (BT) for 3D-imaging-guided brachytherapy of bulky cancerous tumors (e.g., cervical cancer tumors). The 3D imaging can be, for example, ultrasound imaging (USI), magnetic resonance imaging (MRI), computed-tomography (CT), positron emission tomography (PET), combinations thereof, or the like. In one aspect, the CBT can enable increased dosage conformity for non-symmetric tumors by utilizing a device that can shield radiation emanated from an electronic brachytherapy (BT) source or non-electronic BT source. The device can comprise, in one aspect, a radiation compensator having a treated surface that comprises a position-dependent thickness based at least on a radiation therapy plan specific to a patient and geometry of a patient region to be treated. In an additional or alternative aspect, the device can comprise a source of radiation movably inserted into an enclosure coupled to the radiation compensator. As part of CBT, in one implementation, the radiation source can reside at a plurality of locations within the radiator compensator during a respective plurality of dwell times based on the radiation therapy plan.
In one aspect, a method is provided. The method can comprise receiving data indicative of a radiation treatment and topology of a region to be treated (e.g., a volume or a surface to be treated); generating a position-dependent thickness profile of a radiation compensator surface based on the data indicative of the radiation treatment and the topology of the region to be treated; and generating a plurality of dwell times for a radiation source based on the thickness profile, wherein the radiation source is movably coupled to a radiation compensator and is adapted to reside at a plurality of locations within the radiation compensator during a respective plurality of periods, each period of the plurality of periods being equal to a respective dwell time of the plurality of dwell times. In certain embodiments, the method can further comprise supplying a treatment plan comprising the position-dependent thickness profile and the plurality of dwell times, wherein generating a position-dependent thickness profile of a radiation compensator surface based on the data indicative of the radiation treatment and the topology of the region to be treated can comprise discretizing the radiation compensator surface into a plurality of voxels and assigning a respective initial plurality of thicknesses to the plurality of voxels; and determining an extremum of an objective function by iteratively updating each thickness of the respective initial plurality of thicknesses and each dwell time of an initial plurality of dwell times, wherein the objective function is indicative of a difference among a prescribed dose at a position in the region to be treated and an actual dose provided at the position, the updating step yielding a current plurality of thicknesses and a current plurality of dwell times. In one aspect, the method, in response to identifying the extremum, can comprise performing the steps of configuring the current plurality of thicknesses as the position-dependent thickness profile; and configuring the current plurality of dwell times as the plurality of dwell times.
In another aspect, a computer-readable storage medium encoded with computer-executable instructions is provided. The computer-executable instructions can comprise first computer-executable instructions that, in response to execution, cause a processor to receive data indicative of a radiation treatment and topology of an area to be treated; second computer-executable instructions that, in response to execution, cause the processor to generate a position-dependent thickness profile of a radiation compensator surface based on the data indicative of the radiation treatment and the topology of the region to be treated; and third computer-executable instructions that, in response to execution, cause the processor to generate a plurality of dwell times for a radiation source based on the thickness profile, wherein the radiation source is movably coupled to a radiation compensator and is adapted to reside at a plurality of locations within the radiation compensator during a respective plurality of periods, each period of the plurality of periods being equal to a respective dwell time of the plurality of dwell times.
In yet another aspect, a device is provided. The device can comprise a radiation compensator having a treated surface having a position-dependent thickness according to a thickness profile based on a radiation therapy plan and geometry of a region to be treated; and a source of radiation movably inserted into a first enclosure coupled to the radiation compensator, wherein the radiation source is adapted to reside at a plurality of locations within the radiation compensator during a respective plurality of periods, each period of the plurality of periods being equal to a respective dwell time of the plurality of dwell times, and wherein each dwell time is based on the radiation therapy plan. In certain embodiments, the radiation compensator resides within a second enclosure that encompasses the first enclosure, the first enclosure adapted to move relative to the second enclosure, and wherein the second enclosure is coupled to alignment means for positioning the first enclosure relative to the second enclosure. In other embodiments, the alignment means for positioning the first enclosure relative to the second enclosure comprises means for indicating orientation of the second enclosure relative to the region to be treated; and means for locking at least part of the first enclosure outside the second enclosure in response to misalignment between orientation of the first enclosure and the orientation of the second enclosure. In certain embodiments, the means for indicating orientation of the second enclosure relative to the region to be treated are adapted to be visible on an three-dimensional imaging system.
Additional aspects, features, or advantages of the subject disclosure will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the subject disclosure. The advantages of the subject disclosure will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims. It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the subject disclosure.
The accompanying drawings are incorporated and illustrate exemplary embodiment(s) of the disclosure and together with the description and claims appended hereto serve to explain various principles, features, or aspects of the subject disclosure.
The subject disclosure may be understood more readily by reference to the following detailed description of exemplary embodiments of the subject disclosure and to the Figures and their previous and following description.
Before the present compounds, compositions, articles, devices, and/or methods are disclosed and described, it is to be understood that the subject disclosure is not limited to specific systems and methods for compensator-based brachytherapy and related devices. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting.
As used in the specification and the appended claims, the singular forms “a,” “an” and “the” include plural referents unless the context clearly dictates otherwise
Ranges may be expressed herein as from “about” one particular value, and/or to “about” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. It will be further understood that the endpoints of each of the ranges are significant both in relation to the other endpoint, and independently of the other endpoint.
In the subject specification and in the claims which follow, reference may be made to a number of terms which shall be defined to have the following meanings: “Optional” or “optionally” means that the subsequently described event or circumstance may or may not occur, and that the description includes instances where said event or circumstance occurs and instances where it does not.
As employed in this specification and annexed drawings, the terms “unit,” “component,” “interface,” “system,” “platform,” “stage,” and the like are intended to include a computer-related entity or an entity related to an operational apparatus with one or more specific functionalities, wherein the computer-related entity or the entity related to the operational apparatus can be either hardware, a combination of hardware and software, software, or software in execution. One or more of such entities are also referred to as “functional elements.” As an example, a unit may be, but is not limited to being, a process running on a processor, a processor, an object, an executable computer program, a thread of execution, a program, a memory (e.g., a hard disc drive), and/or a computer. As another example, a unit can be an apparatus with specific functionality provided by mechanical parts operated by electric or electronic circuitry which is operated by a software or a firmware application executed by a processor, wherein the processor can be internal or external to the apparatus and executes at least a part of the software or firmware application. In addition or in the alternative, a unit can provide specific functionality based on physical structure or specific arrangement of hardware elements. As yet another example, a unit can be an apparatus that provides specific functionality through electronic functional elements without mechanical parts, the electronic functional elements can include a processor therein to execute software or firmware that provides at least in part the functionality of the electronic functional elements. An illustration of such apparatus can be control circuitry, such as a programmable logic controller. The foregoing example and related illustrations are but a few examples and are not intended to be limiting. Moreover, while such illustrations are presented for a unit, the foregoing examples also apply to a component, a system, a platform, and the like. It is noted that in certain embodiments, or in connection with certain aspects or features thereof, the terms “unit,” “component,” “system,” “interface,” “platform” can be utilized interchangeably.
Throughout the description and claims of this specification, the words “comprise,” “include,” and “have” and variations of the word, such as “comprising,” “comprises,” “including,” “includes,” “has,” and “having” mean “including but not limited to,” and is not intended to exclude, for example, other additives, components, integers or steps. “Exemplary” means “an example of” and is not intended to convey an indication of a preferred or ideal embodiment. “Such as” is not used in a restrictive sense, but for explanatory purposes.
Reference will now be made in detail to the various embodiment(s), aspects, and features of the subject disclosure, example(s) of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers are used throughout the drawings to refer to the same or like parts.
As described in greater detail below, the disclosure relates, in one aspect, to a therapeutic technique for modulation the intensity of X-rays or gamma-rays emanating from a radiation source utilized to treat cancerous tumors. Such technique can be referred to as CBT and enables treatment that is a non-invasive alternative to supplementary interstitial brachytherapy (BT) for 3D-imaging-guided brachytherapy of bulky cancerous tumors, such as cervical tumors. The 3D imaging can be, for example, USI, MRI, PET, and/or CT. In one aspect, CBT dosage distributions can be generated by isotopes such as 192Ir, 131Cs, 125I, 103Pd, 198Au, 187W, 169Yb, 145Sm, 137Cs, 109Cd, 65Zn, 153Gd, 57Co, 56Co, and 58Co, or an electronic BT (eBT) source wrapped or otherwise contained in a novel compensator that is coated with varying thicknesses of high-Z material (e.g., atomic number Z greater than or equal to 22). Such isotopes can be referred to as, for example, non-electronic BT sources. In another aspect, CBT can permit treatment of lateral tumor extensions to dosages that are unlikely—and even unfeasible—to be delivered with conventional intracavitary BT due to dose limitations that can be imposed by presence of nearby healthy tissue (such as the bladder, rectum, and sigmoid in case of cervical cancer treatment). In another aspect, CBT can enable increased dosage conformity for non-symmetric tumors by utilizing a device that can shield radiation emanated from an electronic brachytherapy (BT) source or non-electronic BT source. The device can comprise, in one aspect, a radiation compensator having a treated surface that comprises a position-dependent thickness based at least on a radiation therapy plan specific to a patient and geometry of a patient region to be treated. In an additional or alternative aspect, the device can comprise a source of radiation movably inserted into an enclosure coupled to the radiation compensator. As part of CBT, in one implementation, the radiation source can reside at a plurality of locations within the radiator compensator during a respective plurality of dwell times based on the radiation therapy plan.
Various aspects or features of the disclosure can be applied to the field of radiation oncology. Conventional brachytherapy entails the insertion of radioactive sources into tumors through interstitial needles or intracavitary applicators, and delivers very high radiation doses to tumors but often with poor tumor dose conformity. Without wishing to be bound by theory and/or simulation, such poor tumor dose conformity is due to the fact that conventional BT dose distributions typically are radially symmetric and tumors usually are not. It should be appreciated that poor dose conformity is of clinical concern since tumor underdosage leads to recurrence and tumor overdosage excessively damages nearby healthy tissue. One or more embodiments of the disclosure can rectify such deficiency by wrapping the BT source with a patient-specific treatment-specific compensator that can be covered with spatially-varying (or position dependent) thicknesses of an attenuating material, e.g., a metal with high atomic number, such as lead, iron, gold, et cetera. In certain embodiments, the radiation compensator thickness distribution, or radiation compensator thickness profile, can be optimized or nearly optimized through computations based on the BT source positions in the tumor, tumor shape, and/or the desired radiation dose distribution associated with specific radiation treatment. In other embodiments, the radiation compensator thickness distribution can be designed to satisfy certain criteria not necessarily comprising optimization, but rather achieving a desired performance of a medical device for radiation treatment that employs the radiation compensator. Poor dose conformity can be prevented by shielding regions that would be conventionally overdosed more than regions that would be conventionally underdosed. In certain embodiments, radiation compensators can be fabricated by printing attenuating material on bendable plastic substrates, laminating, and/or wrapping the compensator around the source of treatment. In other embodiments, a radiation compensator can be produced by milling a surface of a radiopaque material according to a predetermined thickness profile. In yet other embodiments, radiation compensators can be generated by the milling cavities, or pockets, of a surface of a slab of solid material, filling at least a portion of the cavities with a radiopaque material, and laminating the resulting milled surface to yield an flexible compensator. In one aspect, CBT can be of commercial value because it is a feasible treatment that can provide improvement over conventional BT and can result in improved patient care. Examples of cancers that can be treated more effectively with CBT comprise vaginal, cervical, endometrial, breast, lung, liver/bile duct, and/or prostate tumors.
One or more of the principles of the disclosure can be utilized in various therapeutic radiation treatments. In one aspect, an exemplary application of CBT is in the field of radiation oncology. More specifically, yet not exclusively, CBT can be utilized for the treatment of tumors that are not radially symmetric about certain axis. In one example, CBT can overcome one or more limiting factors of treating breast lumpectomy cavities. In one embodiment, an electronic brachytherapy source, such as the Xoft (Sunnyvale, Calif.) Axxent™ can be inserted through a catheter and into a saline-filled balloon having a radius from about 1 cm to about 2 cm and being located inside the breast in order to treat the tissue within 5 mm of the balloon surface. In CBT as described herein, BT sources are not limited to electronic brachytherapy sources. The dose received by the target tissue can be sufficiently sensitive to the balloon shape that the procedure may be aborted due to slight defects (e.g., distortion of about 2 mm) in the radial symmetry of the balloon, if balloon-to-skin distance is less than 7 mm, and/or if non-conforming air or seroma is present in the cavity. Cancellation of treatment generally requires that the patient return on a different day for re-setup and re-imaging, which can be time-consuming and expensive. In one aspect, CBT can enable the delivery of dose distributions that overcome such limitations, removing the need to cancel treatment. Another example of a problem that CBT can overcome is the treatment of cervical cancer tumors, which rarely are radially symmetric. In one embodiment, CBT can deliver doses to cervical cancer tumors that are impractical to deliver with conventional BT.
Brachytherapy, or “short-distance therapy,” treats target tissues, such as cancerous tumors, with radiation sources that can be placed inside or directly adjacent to the target tissue using some applicator. Example target tissues include cervical, vaginal, endometrial, breast, and skin cancers. Example applicators include interstitial needles and intracavitary applicators. The advantage of brachytherapy over EBRT is that EBRT beams usually must pass through healthy tissue in order to reach their targets, while the radiation used in brachytherapy may not. As a result brachytherapy can be used to treat targets with very high radiation doses relative to those achievable with EBRT, with less concern for overdosing nearby healthy tissue. The application of 3-D imaging systems such as USI, CT, and MRI for brachytherapy guidance has revealed that the dose conformity to tumors is often poor. Without wishing to be bound by theory and/or simulation, it is believed that poor conformity of conventional brachytherapy (BT) typically is delivered with isotopes or electronic sources that emit radiation in a radially symmetric manner, yet tumors often are not radially symmetric. For example,
The feasibility of IMBT has been investigated and it has been demonstrated that IMBT could be delivered using radioisotopes and the Xoft (Sunnyvale, Calif.) Axxent electronic brachytherapy source, respectively, by collimating the source with high-density shields that create fan beams. The fan beam source is rotated inside the patient in a manner such that the amount of time the source spends irradiating a given direction is optimized to ensure better tumor coverage and better critical structure avoidance than conventional brachytherapy. Although both approaches support the potential benefits of IMBT, there are two major challenges associated with the rotating shield approach to IMBT delivery. First, rotating and verifying the location of a moving shield inside a curved applicator is non-trivial. Second, the delivery times associated with IMBT are increased relative to conventional BT. This is due to the loss of emitted radiation in the rotating shield, which must remove a large fraction, possibly around 90%, of the radiation in order to achieve an advantage over conventional BT. If the rotating fan beam accounts for only 10% of the radiation emitted by the BT source and the rest is lost in the shield, then delivering the same dose distribution as conventional BT will require at least ten times as long with rotating-shield IMBT. This is because the fan will have to be pointed in 10 directions and stay pointed in each direction for the same amount of time necessary to deliver an entire conventional BT plan, which loses 0% of the radiation due to shielding.
In another aspect, of the nearly 11,000 annual cases of newly-diagnosed cervical cancer in the U.S., about 45% (5,000) are of stage IB2 or higher. Cervical cancer of stage IB2 or higher has 5-year survival rates of up to about 70%, and 5-year survival and local control ranges from 0-20% and 18-48%, respectively, for stage IVA tumors. Such cancers typically are treated with a combination of chemotherapy, external beam radiation therapy (EBRT), and an intracavitary BT boost to the tumor. The advent of MRI-guided BT has revealed that the close proximity of the bladder, rectum, and sigmoid to the tumor restrict the radiation dose that can be delivered to the non-symmetric extensions of bulky (e.g., greater than about 40 cc) tumors with conventional BT, likely reducing the chances of local control. Tumor dose conformity for such bulky tumors can be significantly improved through the use of supplementary BT through interstitial needles, which is more invasive than intracavitary BT, may cause complications, and can add 35-70 minutes to the BT procedure.
The radially symmetric dose distributions of conventional BT poorly conform to non-symmetric cervical cancer tumors, an example of which is illustrated in
Compensator-based IMBT is a process for delivering IMBT with no moving parts in addition to those already present for conventional BT. In one aspect, with CBT, a source-containing catheter that is inserted into an applicator or the source itself wrapped in a patient-specific compensator that is covered with space-dependent thicknesses of an attenuating material, such as titanium, tungsten, or lead. The distribution of thicknesses of the attenuating material forming, in part, the radiation compensator surface can be determined by computerized optimization incorporating data indicative of tumor shape and applicator shape. At least a portion of such data can be obtained via an imaging technique, such as MRI, CT, or the like. As an example,
Certain principles of CIBT in accordance with the disclosure are illustrated in
A cross sectional view of a CBT insertion device 300 is illustrated in
It should be appreciated that the radiation compensator is coupled to the first enclosure formed by the catheter tube 320. In another aspect, the space 330 is bound by the applicator 340 (see, e.g.,
In one aspect, as described herein, the radiation compensator 315 has a treated surface (e.g., milled, sputtered, etched, printed, sintered, laminated, or any combination thereof) having a position-dependent thickness according to a thickness profile, such as the thickness profile of
During CBT, in one aspect, as described herein, the radiation source can be adapted (e.g., sized and mounted to displacement means) to reside at a plurality of locations within the radiation compensator 315 during a respective plurality of periods, each period of the plurality of periods being equal to a respective dwell time of the plurality of dwell times, and wherein each dwell time is based on the radiation therapy plan.
As illustrated in
In one aspect, implementation of CBT can comprise determination of optimal radiation compensator thicknesses for a specific target shape (e.g., tumor shape or shape of a region to be treated) and radiation dosage prescription. It may not be readily apparent that wrapping or otherwise covering the radiation source or catheter tube with a compensator can result in a significant advantage over conventional BT, especially yet not exclusively for the case of a treatment delivered using multiple dwell positions. Provided that IMBT delivery using a shield that rotates about the radiation source at each dwell position is part of conventional technology, a compensator that remains stationary throughout the delivery or radiation, or treatment, may appear to provide a limited amount of freedom to modulate the radiation source emissions in an advantageous manner. Yet, through computational modeling as described herein, in one aspect, it can be demonstrated that it is possible to customize (optimally, non-optimally, or according to a predetermined criterion) the radiation compensator thickness distribution (or radiation compensator thickness profile) in a manner that provides an advantage over conventional BT without the complication of additional moving parts associated with rotating-shield IMBT.
The total radiation dose delivered to voxel i from the radiation source with CBT can be approximated, in one aspect, as:
wherein {dot over (D)}ij is the dose rate at tumor voxel i due to source emissions at dwell position j and tj is the dwell time at source position j; TΔx is the source-dependent reference radiation transmission factor for a ray passing through the specific compensator material, such as a radiopaque material of high atomic number Z, (e.g., 78, 79), or an alloy of two or more such radiopaque materials, having a reference thickness Δx, which can be configured to a specific value (e.g., about 100 μm). The reference radiation transmission factor can be calculated, in one aspect, as follows:
where ƒ(E) is a real function describing the emission per unit energy of the radiation source for energy E. For example, ƒ(E) can be the fluence spectrum Φ′(E), which is measured in units of photons cm−2 MeV−1, or the energy fluence spectrum, Ψ′(E)=EΦ′(E) which is measured in units of cm−2 of the radiation source. Here, μ(E) is an energy-dependent absorption coefficient which can be determined as the product between a mass energy absorption coefficient μ(E)/ρ (in units of cm2/g, for example) and the density p (in units of g/cm3, for example) of a medium in which radiation is propagated: Raising TΔx to the power of ηk
In one aspect, the central computational problem of CBT comprises finding a satisfactory (optimal, nearly-optimal, etc.) vector of dwell times {right arrow over (t)}′ and an optimal vector of compensator thicknesses (or thickness profile) {right arrow over (η)}′ that produce a dose vector {right arrow over (d)}({right arrow over (t)}′, {right arrow over (η)}′) that minimizes the magnitude of the difference vector {right arrow over (δ)}={right arrow over (d)}({right arrow over (t)}′, {right arrow over (η)}′)−{right arrow over (d)}(p) or yields a magnitude of value {right arrow over (δ)} within a predetermined tolerance δ0 (a real value), wherein {right arrow over (d)}(p) is a prescribed radiation dose vector. As described herein, in addition to the magnitude of {right arrow over (δ)}, other objective functions that quantify agreement between {right arrow over (d)}(p) and {right arrow over (d)}({right arrow over (t)}′, {right arrow over (η)}′) can be utilized. For an available thickness profile {right arrow over (η)}′, a radiation compensator with a customized thickness according to such thickness profile can be manufactured through various processes in accordance with aspects described herein. A manufactured radiation compensator having the thickness profile {right arrow over (η)}′ can be inserted into an applicator, or CBT insertion device and the radiation treatment can be delivered using the satisfactory (e.g., optimized) dwell times. In one aspect, the manufactured radiation compensator can be inserted into the applicator by wrapping or otherwise mounting the compensator around the radiation source. In another aspect, in scenarios in which a catheter is available, the manufactured radiation compensator can be wrapped around the catheter in order to insert the compensator into the applicator.
In certain embodiments, vectors and {right arrow over (t)}′ and {right arrow over (η)}′ can be determined by computer-based stochastic optimization or deterministic optimization, which typically can involve, as described herein, determining an extremum of an objective function that quantifies the agreement between {right arrow over (d)}(p) and {right arrow over (d)}({right arrow over (t)}′, {right arrow over (η)}′). In one aspect, a maximum of the objective function can be determined. In another aspect, a minimum of the objective function can be determined. It should be appreciated that many of the optimization algorithms that can be employed to determine an extremum of the objective function can benefit from an analytical expression for the gradient of the objective function with respect to one or more optimization parameters. As an example, in embodiments in which the objective function is F[{right arrow over (d)}({right arrow over (t)}′, {right arrow over (η)}′)], the elements of the gradient of F can be obtained, in general, according to the following equations:
Based on Eq. (1), the following is obtained:
for all indices i, and
In the foregoing, Ik is the set of one or more voxel indices i that are affected by radiation compensator element k and a dwell position j, as illustrated in
In certain embodiments, the objective function can be a quadratic objective function, such as
and components of the gradient of such an objective function are
Determination of extrema of the quadratic objective function in Eq. (5) permits to demonstrate one example principle related to CBT: Dosage distribution delivered to a non-radially symmetric target (e.g., tumor) can be significantly improved with CBT. In one embodiment, a model of a brachytherapy source can be utilized and a lead radiation compensator with a thickness of less than 100 μm at most any location on the radiation compensator surface can be designed. In addition, in such embodiment, an example IMBT target can be an ellipsoidal tumor with an inferior-superior (I-S) length of about 10 cm, a right-left (R-L) width of about 6 cm, and a posterior-anterior (P-A) height of about 4 cm. In one aspect, the exemplary IMBT is designed to be of similar dimensions to the surface encompassed by a target region for brachytherapy of cervical cancer. A treatment plan for conventional BT can be generated and contrasted with a treatment plan for CBT generated in accordance with aspects described herein. In one aspect of an example implementation, such treatment plans can be generated by minimizing the quadratic objective function of Eq. (5) with definitions conveyed in accordance with Eq. (1), and under certain constraints, such as that the radiation compensator thickness does not exceed about 100 μm at most any location of the radiation concentrator surface and each dwell time of a plurality of dwell times for the radiation source (e.g., the model of the brachytherapy source) be greater than or equal to zero. In another aspect of the example implementation, the prescription dose can be configured to 100% for all voxels (or, more generally, finite regions) on the tumor surface. It is noted that in most computations (e.g., optimizations), voxels in the bulk of the tumor were excluded. The latter feature of implementation is typical in brachytherapy optimization or simulations in general, since position of the radiation source inside the tumor ensures that the dose inside the tumor is greater than the dose delivered at the surface.
The dose-surface histograms in
In other exemplary implementation, thicknesses at various locations of a radiation compensator surface can be determined for certain constraints related to dosage and organ anatomy.
A thickness profile of a plurality of thicknesses for a respective plurality of locations in the surface of a radiation compensator also can be determined according to aspects described herein.
Various advantages emerge from the features or aspects of the disclosure convey that CBT of cervical cancer is feasible and can be beneficial in increasing delivery time of treatment and conformity of irradiation onto areas to be treated thus preserving surrounding healthy tissue. For example, the majority of patients having IB1-IV cervical cancerous tumors can be advantageously treated with the various embodiments of CBT described herein.
It should be appreciated that compensator-based intensity modulated brachytherapy can significantly improve cervical cancer dosage distributions without the need for supplementary interstitial BT. In one practice aspect, a physician can have freedom to optimize the tradeoff between increased delivery time and tumor dosage conformity with CBT. Since the high-Z (e.g., Z greater than or equal to 22) layers of compensators can be less than about 100 μm thick (see, e.g.,
Various materials can be employed to produce a customized thickness profile of a radiation compensator described herein. The material can be a radiopaque material, which can comprise one or more of titanium, lead, gold, barium, barium sulphate, tungsten, bismuth, bismuth subcarbonate, tantalum, tin, iron, silver, molybdenum, platinum, and titanium. In other embodiments, the radiopaque material comprises one or more of a bismuth alloy, a tantalum alloy, a tin alloy, a silver allow, a molybdenum alloy, or a platinum alloy. In yet other embodiments, the radiopaque material comprises lead. In another embodiment, the radiopaque material further comprises one or more of lead powder or at least one etched lead sheets. In one embodiment, the radiopaque material comprises gold. In one aspect, the radiopaque material comprising gold can comprise gold nanoparticles. In another embodiment, the radiopaque material can comprise barium. In yet another embodiment, the radiopaque material comprises tungsten. In one aspect, tungsten can be present in the radiopaque material as tungsten powder. In certain embodiments, the radiopaque material comprises one or more of bismuth, tantalum, tin, silver, molybdenum, platinum, or titanium. In alternative or additional embodiments, the radiopaque material can comprise iron. In one aspect, iron can be present as iron powder or iron nanoparticles.
In addition, various equipment and systems can be exploited to fabricate a radiation compensator as described herein. As described herein, the attenuating material (e.g., radiopaque material, or semi-radiopaque material) can be printed or otherwise coated onto a surface of a radiation compensators that can be inserted into a delivery applicator of a device for radiation therapy. In certain embodiments, the attenuating material can be printing utilizing techniques similar, yet not identical to those employed for making printed circuit boards for computer components. In addition, since the thickness profile is customized to patient anatomy and to a region to be treated with radiation, such as a tumor, a thickness profile of a radiation compensator can break cylindrical or, more generally, radial symmetry of the radiation compensator and thus a mechanism or means for aligning the radiation compensator with a custom thickness profile as described herein can be needed prior to radiation delivery. In one aspect, such means for aligning the radiation compensator can include a small wire mounted on the inside of the applicator that, when aligned properly with the compensator, can send a signal to a user device or a control system (e.g., computer). In another aspect, the means for aligning can include a robust optimization algorithm that can produce compensators that mitigate or avoid sensitivity to misalignment.
In one aspect, exemplary apparatus 1200 can comprise a radiation source and a radiation detector system that can be included as part of a quality assurance stage being part of a manufacture of the radiation compensator. The quality assurance stage can comprise monitoring thickness of the etched region at one or more locations at such region. In one aspect, a radiation source can be inserted into the radiation compensator during the manufacturing process. The radiation source can be the same radiation source employed to implement a radiation treatment. Radiation emission from the radiation source and the radiation compensator can be detected outside of the radiation compensator and compared with expected measured values for radiation dose (see, e.g.,
Likewise,
In certain embodiments, an apparatus for providing a radiation compensator can comprise means for collecting data indicative of a position-dependent thickness profile; and means for providing a radiation compensator having a treated surface having a thickness according to the position-dependent thickness profile. Such profile can be determined in accordance with aspects of the disclosure. In one aspect, the means for providing the radiation compensator comprises means for etching a non-treated surface of the radiation compensator, wherein the non-treated surface is a substrate of a radiopaque material, the radiopaque material comprising at least one of a first high atomic-number material, a mixture of a plastic and a second high atomic-number material, and a mixture of a rubber and a third high atomic-number material. In another aspect, the means for etching comprises means for removing the radiopaque material in an amount effective to yield the thickness profile. In another aspect, the means for providing the radiation compensator comprises means for treating a non-treated surface of the radiation compensator with a radiopaque material, wherein the means for treating can yield the treated surface.
In another aspect, the non-treated surface of the radiation compensator 1310 or other non-treated surface can comprise a substrate of a radiotransparent material, and the means for treating comprises means for printing ink (e.g., laser or printer 1305) onto the substrate in an amount effective to produce the thickness profile, the ink containing the radiopaque material. In yet another aspect, the non-treated surface of the radiation compensator can comprise a substrate of a radiotransparent material, and wherein the means for treating comprises means for etching the substrate according to the thickness profile, wherein the means for etching yields an etched substrate.
In one aspect, the means for treating further comprises means for coating the etched substrate with a radiopaque material, and the means for treating further comprises means for sintering at least a portion of the radiopaque material.
In another aspect, the means for treating can comprise means for sputtering the non-treated surface of the radiation compensator with the radiopaque material, wherein the radiopaque material is a metal having a high atomic number (e.g., Z greater than or equal to 22). In certain embodiments, the radiopaque material comprises one or more of titanium, lead, gold, barium, barium sulphate, tungsten, bismuth, bismuth subcarbonate, tantalum, tin, iron, silver, molybdenum, platinum.
In other embodiments, the radiopaque material comprises lead. In another embodiment, the radiopaque material further comprises one or more of lead powder or at least one etched lead sheets. In one embodiment, the radiopaque material comprises gold. In one aspect, the radiopaque material comprising gold can comprise gold nanoparticles.
In another embodiment, the radiopaque material can comprise barium. In yet another embodiment, the radiopaque material comprises tungsten. In one aspect, tungsten can be present in the radiopaque material as tungsten powder.
In certain embodiments, the radiopaque material comprises one or more of bismuth, tantalum, tin, silver, molybdenum, or platinum. In alternative or additional embodiments, the radiopaque material can comprise iron. In one aspect, iron can be present as iron powder or iron nanoparticles.
In scenarios in which the circuit board plotter can mill pockets into the slab of solid material (e.g., plastic sheets) with a depth accuracy of approximately 10% or better of a maximum thickness (see, e.g.,
It should be appreciated that the milling process described herein is one example of various processes (e.g., sputtering) that can treat a non-treated surface, which can be an initial surface of a radiation compensator, to produce a specific thickness profile of a radiopaque material. In certain embodiments, instead of milling a slab of a solid material (e.g., a plastic or an intrinsic semiconductor), such slab can be etched to remove material from the slab and form an etched slab having a predetermined depth profile. Such depth profile can be complementary representation of an intended thickness profile. Accordingly, the etched slab can be coated (e.g., via sputtering or other deposition process) with a radiopaque material to form a predetermined thickness profile that can shield radiation and permit CBT according to one or more aspects described herein.
A portion of a compensator that can be produced through the assembly depicted in
In additional or alternative embodiments, a milling process can be utilized to treat the surface of a radiopaque material and, in response to treatment, yield a radiation compensator having a thickness distribution based at least on a specific area to be irradiated and specific radiation therapy.
In the illustrated embodiment, the milling apparatus 1700 comprises a milling member 1710 that performs the milling and can move along a first direction (e.g., z axis) normal to the surface of a radiopaque material to be milled to form the radiation compensator. It should be appreciated that the milling member 1710 can rotate about the direction normal to the surface of such material. In addition, the milling apparatus 1700 comprises a stock member 1730 that can hold the radiopaque material. In one aspect, the stock member 1730 can rotate an angle θ about a second direction (e.g., x axis) and translate along one or more of the first direction, the second direction, or a third direction (e.g., y axis). Such translational and rotation degrees of freedom can permit the milling member 1710 to remove material from the radiopaque material 1720 on substantially any position on the surface of the radiopaque material 1720. In should be appreciated that the milling apparatus 1730 has four degrees of freedom and thus it is referred to as “4D milling” apparatus. In one aspect of the illustrated embodiment, the milling apparatus 1700 can remove material with a depth accuracy of approximately 2.5 μm, which can provide a resolution suitable for generation of a thickness distribution as described herein (see, e.g.,
Operation of the milling apparatus 1700 can be automated in order to fabricate the radiation compensator according to a predetermined specification—e.g., a compensator suitable for treatment of a specific area with a specific radiation treatment). In certain implementations, automation can comprise generation of a design of a thickness profile to be milled onto the surface of the radiopaque material 1720. For example, the design can be produced with a suitable industrial design generation software application. As part of the automation, the design can converted to a suitable set of one or more computer-executable instructions (e.g., programming code instructions) that can be executed by a computing device (e.g., a controller) that is functionally coupled to the milling apparatus 1700 and, in response to execution, the computing device can control the milling apparatus 1700 to fabricate a radiation compensator according to the design. In one aspect, prior to automated milling, the stock member 1730 coupled to the radiopaque material 1720 can be suitable positioned (e.g., centered and the coordinates of the apparatus calibrated).
In certain implementations, the radiopaque material can be a titanium rod and the designed radiation compensator can have two end caps. In one aspect, the end caps can permit the radiopaque material to be mounted or otherwise fitted to the stock member 1730 via an adapter sleeve in such member in order to mill a predetermined thickness profile. In one aspect, the titanium rod can have a 0.5 in. diameter.
Diagram 1800 in
In 4D milling, milling time can be a factor affecting performance of fabrication of a radiation compensator. In an idealized scenario, a divergently large number of cuts performed with the milling member 1710 can be necessary to remove material from the radiopaque material 1720 and obtain a predetermined thickness profile of a radiation compensator (e.g., compensator main section 1810). Such large number of cuts, however, can incur a substantial milling time interval (e.g., hours). Thus, in one implementation scenario, number of cuts performed with the milling member 1710 can be reduced with the ensuing reduction of incurred milling time. For example, for milling each “pie section” of the example radiation compensator illustrated in diagram 1850, an 1/16 in. diameter mill member embodying the mill member 1710 can mill out a portion of radiopaque material to an intended depth in a first section of the radiopaque material 1720 (e.g., a middle section 1910), then the stock member 1730 can rotate clockwise (indicated with an arrow in
As described herein, the thickness profile of a compensator for CBT can be determined based on data indicative of a specific radiation treatment in order to attain a predetermined radiation dosage at a tumor or tissue to be treated. Accurate dose calculation software (e.g., compensator design software 1706) or firmware can be exploited to predict dose distributions within a specific accuracy (e.g., 5% deviation) in order to provide radiation treatment safely. In one aspect, to monitor radiation dosage for a specific compensator, dose distribution produced by the compensator can be measured in a phantom, referred to as a quality assurance (QA) phantom. In one embodiment, an acrylic QA phantom can be utilized in such measurements. In one aspect, the acrylic phantom can comprise two 4 cm thick acrylic cylindrical inserts having a cross section as illustrated in
Other assemblies can be utilized to produce compensators for CBT. For example, an apparatus for laser sintering can be utilized to treat a surface of a radiopaque material. Laser sintering can be implemented as an additive metal fabrication technology. In one aspect, laser sintering can produce a plurality of layers by laser-sintering very fine layers of metal powders on a layer-by-layer basis, permitting a gradual build-up of a solid structure (e.g., a metallic structure) according to a predetermined thickness profile as described herein. In one implementation of a laser sintering cycle, an initial layer of fine metal powder can be deposited onto a platform inside the apparatus for laser sintering. The initial layer can be sintered using a laser, such as a diode pump fibre optic laser, that can be controlled in a plane parallel to the platform in order to achieve a predetermined part shape and associated feature tolerances. An additional layer of metal powder can be deposited on top of the sintered initial layer, can be sintered by the laser to form a bond with the initial layer. The process can continue with deposition of a further layer of metal powder onto a previously sintered layer and sintering of the newly deposited layer. Other layers can be deposited sintered to a group of previously sintered layers.
To fabricate a compensator via laser sintering, in one aspect, a design of a desired radiation compensator can be supplied to a computing device (e.g., a controller) functionally coupled to or included in an apparatus for laser sintering. Based on the design, the computing device can generate a set of computer-executable instructions that, in response to execution (e.g., by the controller), can cause the apparatus for laser sintering to generate and sinter a plurality of layers having thicknesses according to the design. In one embodiment, the desired radiation compensator can be fabricated by laser sintering layers formed from cobalt-chrome powder. In another embodiment, the desired compensator can be fabricated by laser sintering layers formed from titanium powder. In the Ti-based embodiment, thickness resolution ranges from about 0.002 in. to about 0.005 in.
The various aspects of the subject disclosure provide a device for CBT. In certain embodiments, such device comprises a radiation compensator having a treated surface having a position-dependent thickness according to a thickness profile based on a radiation therapy plan and geometry of a region to be treated; and a source of radiation movably inserted into a first enclosure coupled to the radiation compensator, wherein the radiation source is adapted to reside at a plurality of locations within the radiation compensator during a respective plurality of periods, each period of the plurality of periods being equal to a respective dwell time of the plurality of dwell times, and wherein each dwell time is based on the radiation therapy plan.
In certain embodiments, the radiation compensator resides within a second enclosure that encompasses the first enclosure, the first enclosure adapted to move relative to the second enclosure, and wherein the second enclosure is coupled to alignment means (e.g., key or indexing unit 2110 and guide 2120) for positioning the first enclosure relative to the second enclosure. It should be appreciated that the thickness profile of a surface of the radiation compensator can break cylindrical symmetry thereof as a result of the thickness profile being tailor to a patient's anatomy and, more specifically, to an area of tissue affected by a tumor. Accordingly, orientation or alignment of the radiation compensator is important for adequate radiation therapy.
The alignment means can be manufactured of any material that can imaged with one or more 3D imaging techniques, such as one or more of USI, MRI, CT, PET, or the like. In one aspect, as illustrated in
As described supra, the radiation compensator attenuates radiation emanating from a radiation source. To at least such end, the radiation compensator in the device of the subject disclosure can be coated with a radiopaque material. In one aspect, the radiopaque material is a metal having a high atomic number (e.g., atomic number greater than or equal to 22). In another aspect, the radiopaque material is one of lead, gold, barium, barium sulphate, tungsten, bismuth, bismuth subcarbonate, tantalum, tin, iron, silver, molybdenum, platinum. In certain embodiments, the radiopaque material is a combination of such materials. Radiopaque materials utilized in the radiation compensator can be polycrystalline or monocrystalline. In addition, such materials can include nanoparticles or particulate matter of various sizes (e.g., particles with sizes of the order of a few to several microns).
When delivering CBT for treating a disease such as cervical cancer, a brachytherapy applicator, through which the radiation source travels, in one embodiment, is inserted into the patient prior to an image acquisition step, which is critical for treatment planning. The imaging system could be computed tomography, magnetic resonance imaging, or ultrasound, for example. In one embodiment, it is important that the applicator is in place during the imaging process, since the applicator is what geometrically constrains the radiation-emitting brachytherapy source during the treatment process. Without detailed imaging information on the applicator location relative to the cancer under treatment, and sensitive normal tissues such as rectum, bladder, and sigmoid colon, it is not possible, in one embodiment, to determine either how the compensator should be shaped or how long the source should stop at each planned position inside the applicator.
Once a patient-specific and treatment-specific compensator has been fabricated, a challenge associated with CBT delivery is inserting a patient-specific compensator into the applicator, which is often curved to match the patient's anatomy. A system for CBT delivery that enables compensator placement inside of a curved applicator is described below.
The curved CBT applicator system may comprise, in one embodiment, (1) a CBT applicator 2501 that includes a removable cap 2502 at the end (
In another embodiment, more than two notches 2503 are present along the inner surface of the applicator 2501, enabling an angularly-alternating pattern of notches 2503 on the outer compensator 2600 on the plane perpendicular to applicator 2501 axis. Such an approach distributes the protrusions 2603 in a manner that reduces the impact of the attenuation due to the protrusions 2603 on the radiation dose distribution in the patient. As the dosimetric effect of the protrusions 2603 can be accounted for in the CBT treatment planning process, the compensator 2600 thicknesses in the non-protrusion regions can be designed to offset the dosimetric impact of the protrusions 2603.
The CBT delivery process may, in one embodiment, entail inserting the individual compensator 2600 segments into the applicator 2501 and using a flexible plastic tube to push them to the distal end of the applicator 2501. After the treatment is finished, the applicator 2501 may be removed from the patient, the end cap 2502 may be unscrewed from the applicator 2501, and the compensator 2600 segments are pushed out of the applicator 2501 using a flexible plastic rod.
In view of the aspects described hereinbefore, an exemplary method that can be implemented in accordance with the disclosed subject matter can be better appreciated with reference to the flowchart in
At step 2230, generating a plurality of dwell times for a radiation source based on the thickness profile, wherein the radiation source is movably coupled to a radiation compensator and is adapted to reside at a plurality of locations within the radiation compensator during a respective plurality of periods, each period of the plurality of periods being equal to a respective dwell time of the plurality of dwell times. At step 2240, supplying a treatment plan comprising the position-dependent thickness profile and the plurality of dwell times.
In certain embodiments, exemplary method 2200 can further comprise providing a radiation compensator having a treated surface having a thickness according to the position-dependent thickness profile, wherein providing the radiation compensator comprises etching a non-treated surface of the radiation compensator, wherein the non-treated surface is a substrate of a radiopaque material, the radiopaque material comprising at least one of a first high atomic-number material, a mixture of a plastic and a second high atomic-number material, and a mixture of a rubber and a third high atomic-number material.
In one aspect, the etching step comprises removing the radiopaque material in an amount effective to yield the thickness profile, wherein providing the radiation compensator comprises treating a non-treated surface of the radiation compensator with a radiopaque material, wherein the treating step yields the treated surface.
In certain embodiments, in addition to providing the radiation compensator, exemplary method 2200 can further comprise aligning the radiation compensator inside an applicator configured to implement at least part of the radiation treatment. In other embodiments, exemplary method 2200 can further comprise monitoring thickness of the treated surface in response to the treating step and at one or more locations in the treated surface. The monitoring step can be implemented by an automation control system (e.g., a Programmable Logic Controller with suitable logic or, more generally a computing device such as computer 2401 programmed with suitable logic retained in system memory 2412) that controls an X-ray diffraction system or other equipment suitable for measuring thickness of the treated surface. In one aspect, the non-treated surface of the radiation compensator comprises a substrate of a radiotransparent material, and wherein the treating step comprises printing ink onto the substrate in an amount effective to produce the thickness profile, the ink containing the radiopaque material. In another aspect, the treating step can comprise painting a high-density material onto the substrate in an amount effective to produce the thickness profile, wherein the high-density material can contain the radiopaque material or can be an opaque or semi-opaque to radiation. In another aspect, wherein the non-treated surface of the radiation compensator comprises a substrate of a radiotransparent material, and wherein the treating step comprises etching the substrate according to the thickness profile, wherein the etching step yields an etched substrate. In the various embodiments of exemplary method 2200, the radiopaque material can be one of the various materials described herein or any combination thereof.
In certain embodiments, the treating step further comprises coating the etched substrate with a radiopaque material, wherein the treating step further comprises sintering at least a portion of the radiopaque material. In the alternative or in addition, the treating step can comprise sputtering the non-treated surface of the radiation compensator with the radiopaque material.
The various embodiments of the subject disclosure can be operational with numerous other general purpose or special purpose computing system environments or configurations. Examples of well known computing systems, environments, and/or configurations that can be suitable for use with the systems and methods comprise, but are not limited to, personal computers, server computers, laptop devices or handheld devices, and multiprocessor systems. Additional examples comprise wearable devices, mobile devices, set top boxes, programmable consumer electronics, network PCs, minicomputers, mainframe computers, distributed computing environments that comprise any of the above systems or devices, and the like.
The processing effected in the disclosed systems and methods can be performed by software components. The disclosed systems and methods can be described in the general context of computer-executable instructions, such as program modules, being executed by one or more computers or other computing devices. Generally, program modules comprise computer code, routines, programs, objects, components, data structures, etc. that perform particular tasks or implement particular abstract data types. The disclosed methods also can be practiced in grid-based and distributed computing environments where tasks are performed by remote processing devices that are linked through a communications network. In a distributed computing environment, program modules can be located in both local and remote computer storage media including memory storage devices.
Further, one skilled in the art will appreciate that the systems and methods disclosed herein can be implemented via a general-purpose computing device in the form of a computer 2401. The components of the computer 2401 can comprise, but are not limited to, one or more processors 2403, or processing units 2403, a system memory 2412, and a system bus 2413 that couples various system components including the processor 2403 to the system memory 2412. In the case of multiple processing units 2403, the system can utilize parallel computing.
In general, a processor 2403 or a processing unit 2403 refers to any computing processing unit or processing device comprising, but not limited to, single-core processors; single-processors with software multithread execution capability; multi-core processors; multi-core processors with software multithread execution capability; multi-core processors with hardware multithread technology; parallel platforms; and parallel platforms with distributed shared memory. Additionally or alternatively, a processor 2403 or processing unit 2403 can refer to an integrated circuit, an application specific integrated circuit (ASIC), a digital signal processor (DSP), a field programmable gate array (FPGA), a programmable logic controller (PLC), a complex programmable logic device (CPLD), a discrete gate or transistor logic, discrete hardware components, or any combination thereof designed to perform the functions described herein. Processors or processing units referred to herein can exploit nano-scale architectures such as, molecular and quantum-dot based transistors, switches and gates, in order to optimize space usage or enhance performance of the computing devices that can implement the various aspects of the subject disclosure. Processor 2403 or processing unit 2403 also can be implemented as a combination of computing processing units.
The system bus 2413 represents one or more of several possible types of bus structures, including a memory bus or memory controller, a peripheral bus, an accelerated graphics port, and a processor or local bus using any of a variety of bus architectures. By way of example, such architectures can comprise an Industry Standard Architecture (ISA) bus, a Micro Channel Architecture (MCA) bus, an Enhanced ISA (EISA) bus, a Video Electronics Standards Association (VESA) local bus, an Accelerated Graphics Port (AGP) bus, and a Peripheral Component Interconnects (PCI), a PCI-Express bus, a Personal Computer Memory Card Industry Association (PCMCIA), Universal Serial Bus (USB) and the like. The bus 2413, and all buses specified in this description also can be implemented over a wired or wireless network connection and each of the subsystems, including the processor 2403, a mass storage device 2404, an operating system 2405, compensator design software 2406, compensator design data 2407, a network adapter 2408, system memory 2412, an Input/Output Interface 2410, a display adapter 2409, a display device 2411, and a human machine interface 2402, can be contained within one or more remote computing devices 2414a,b,c at physically separate locations, connected through buses of this form, in effect implementing a fully distributed system.
In one aspect, compensator design software 2406 can comprise computer-executable instructions for implementing the various methods described herein, such as exemplary method 2200. In another aspect, compensator design software 2406 can include software to control various aspects of manufacturing of the radiation compensator and, as part of manufacturing, treating a surface in accordance with aspects described herein in order to attain a desired thickness profile for the surface of the radiation compensator. In certain embodiments, compensator design software 2406 also can include computer-executable instruction for selecting radiopaque materials for manufacturing the radiation compensator. Compensator design software 2406 and compensator design data 2407 configure processor 2403 to perform the one or more steps of the methods described herein. In addition or in the alternative, compensator design software 2406 and compensator design data 2407 can configure processor 2403 to operate in accordance with various aspects of the subject disclosure.
The computer 2401 typically comprises a variety of computer readable media. Exemplary readable media can be any available media that is accessible by the computer 2401 and comprises, for example and not meant to be limiting, both volatile and non-volatile media, removable and non-removable media. The system memory 2412 comprises computer readable media in the form of volatile memory, such as random access memory (RAM), and/or non-volatile memory, such as read only memory (ROM). The system memory 2412 typically contains data and/or program modules such as operating system 2405 and compensator design software 2406 that are immediately accessible to and/or are presently operated on by the processing unit 2403. Operating system 2405 can comprise OSs such as Windows operating system, Unix, Linux, Symbian, Android, iOS, Chromium, and substantially any operating system for wireless computing devices or tethered computing devices.
In another aspect, the computer 2401 also can comprise other removable/non-removable, volatile/non-volatile computer storage media. By way of example,
Optionally, any number of program modules can be stored on the mass storage device 2404, including by way of example, an operating system 2405, and compensator design software 2406. Each of the operating system 2405 and compensator design software 2406 (or some combination thereof) can comprise elements of the programming and the compensator design software 2406. Data and code (e.g., computer-executable instruction(s)) can be retained as part of compensator design software 2406 and can be stored on the mass storage device 2404. Compensator design software 2406, and related data and code, can be stored in any of one or more databases known in the art. Examples of such databases comprise, DB2®, Microsoft® Access, Microsoft® SQL Server, Oracle®, mySQL, PostgreSQL, and the like. Further examples include membase databases and flat file databases. The databases can be centralized or distributed across multiple systems.
In another aspect, the user can enter commands and information into the computer 2401 via an input device (not shown). Examples of such input devices comprise, but are not limited to, a camera; a keyboard; a pointing device (e.g., a “mouse”); a microphone; a joystick; a scanner (e.g., barcode scanner); a reader device such as a radiofrequency identification (RFID) readers or magnetic stripe readers; gesture-based input devices such as tactile input devices (e.g., touch screens, gloves and other body coverings or wearable devices), speech recognition devices, or natural interfaces; and the like. These and other input devices can be connected to the processing unit 2403 via a human machine interface 2402 that is coupled to the system bus 2413, but can be connected by other interface and bus structures, such as a parallel port, game port, an IEEE 1394 Port (also known as a Firewire port), a serial port, or a universal serial bus (USB).
In yet another aspect, a display device 2411 also can be connected to the system bus 2413 via an interface, such as a display adapter 2409. It is contemplated that the computer 2401 can have more than one display adapter 2409 and the computer 2401 can have more than one display device 2411. For example, a display device can be a monitor, an LCD (Liquid Crystal Display), or a projector. In addition to the display device 2411, other output peripheral devices can comprise components such as speakers (not shown) and a printer (not shown) which can be connected to the computer 2401 via Input/Output Interface 2410. Any step and/or result of the methods can be output in any form to an output device. Such output can be any form of visual representation, including, but not limited to, textual, graphical, animation, audio, tactile, and the like.
The computer 2401 can operate in a networked environment using logical connections to one or more remote computing devices 2414a,b,c. By way of example, a remote computing device can be a personal computer, portable computer, a mobile telephone, a server, a router, a network computer, a peer device or other common network node, and so on. Logical connections between the computer 2401 and a remote computing device 2414a,b,c can be made via a local area network (LAN) and a general wide area network (WAN). Such network connections can be through a network adapter 2408. A network adapter 2408 can be implemented in both wired and wireless environments. Such networking environments are conventional and commonplace in offices, enterprise-wide computer networks, intranets, and the Internet. Networking environments are referred to as network(s) 2415 and generally can be embodied in wireline networks or wireless networks (e.g., cellular networks, such as Third Generation (3G) and Fourth Generation (4G) cellular networks, facility-based networks (femtocell, picocell, Wi-Fi networks, etc.).
As an illustration, application programs and other executable program components such as the operating system 2405 are illustrated herein as discrete blocks, although it is recognized that such programs and components reside at various times in different storage components of the computing device 2401, and are executed by the data processor(s) of the computer. An implementation of compensator design software 2406 can be stored on or transmitted across some form of computer readable media. Any of the disclosed methods can be performed by computer readable instructions embodied on computer readable media. Computer readable media can be any available media that can be accessed by a computer. By way of example and not meant to be limiting, computer-readable media can comprise “computer storage media,” or “computer-readable storage media,” and “communications media.” “Computer storage media” comprise volatile and non-volatile, removable and non-removable media implemented in any methods or technology for storage of information such as computer readable instructions, data structures, program modules, or other data. Exemplary computer storage media comprises, but is not limited to, RAM, ROM, EEPROM, flash memory or other memory technology, CD-ROM, digital versatile disks (DVD) or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to store the desired information and which can be accessed by a computer.
In various embodiments, the disclosed systems and methods for CBT can employ artificial intelligence (AI) techniques such as machine learning and iterative learning for identifying patient-specific, treatment-specific compensators. Examples of such techniques include, but are not limited to, expert systems, case based reasoning, Bayesian networks, behavior based AI, neural networks, fuzzy systems, evolutionary computation (e.g., genetic algorithms), swarm intelligence (e.g., ant algorithms), and hybrid intelligent systems (e.g., Expert inference rules generated through a neural network or production rules from statistical learning).
While the systems, devices, apparatuses, protocols, processes, and methods have been described in connection with exemplary embodiments and specific illustrations, it is not intended that the scope be limited to the particular embodiments set forth, as the embodiments herein are intended in all respects to be illustrative rather than restrictive.
Unless otherwise expressly stated, it is in no way intended that any protocol, procedure, process, or method set forth herein be construed as requiring that its acts or steps be performed in a specific order. Accordingly, in the subject specification, where description of a process or method does not actually recite an order to be followed by its acts or steps or it is not otherwise specifically recited in the claims or descriptions of the subject disclosure that the steps are to be limited to a specific order, it is no way intended that an order be inferred, in any respect. This holds for any possible non-express basis for interpretation, including: matters of logic with respect to arrangement of steps or operational flow; plain meaning derived from grammatical organization or punctuation; the number or type of embodiments described in the specification or annexed drawings, or the like.
It will be apparent to those skilled in the art that various modifications and variations can be made in the subject disclosure without departing from the scope or spirit of the subject disclosure. Other embodiments of the subject disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the subject disclosure as disclosed herein. It is intended that the specification and examples be considered as non-limiting illustrations only, with a true scope and spirit of the subject disclosure being indicated by the following claims.
This application is a continuation-in-part of PCT Patent Application No. PCT/US2012/036979, filed on May 8, 2012, entitled “Compensator-Based Brachytherapy” which claims benefit of U.S. Provisional Patent Application No. 61/483,702 filed on May 8, 2011, entitled “Compensator-Based Intensity Modulated Brachytherapy”, the entirety of which is incorporated by references herein.
Number | Date | Country | |
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61483702 | May 2011 | US |
Number | Date | Country | |
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Parent | PCT/US2012/036979 | May 2011 | US |
Child | 14072270 | US |