The present invention is directed to the field of software for planning radiation therapy.
Radiation therapy can be used to treat localized cancer. In a typical application, a radiation delivery system has an ionizing radiation device mounted to a movable gantry. The radiation delivery system controls the motion of the radiation device to direct an ionizing radiation beam to a specific point in space commonly referred to as the “machine isocenter.” During radiation therapy, a patient is positioned so that the patient's tumor is located at the machine isocenter throughout treatment.
Radiation is typically delivered to a patient during a radiation therapy session in accordance with a session plan. A session plan typically specifies, for each of one or more “treatment fields,” such information as the gantry position, which determines the path that radiation energy will take to the tumor during the treatment field; collimator settings that determine the shape and cross-sectional area of the radiation energy beam; the intensity level of the radiation beam; and a duration that determines for how much time radiation energy will be delivered during the field. Various session plans may include different or additional information, however.
A plan is typically prepared using determinants such as the following: the tumor's mass, volume, shape, orientation, location in the body, and proximity to different organs and other anatomical structures; and information about radiation energy intended to be delivered to the tumor in foregoing radiation therapy sessions, as well as other approaches previously used to treat the tumor. Various plan preparation techniques may use fewer, more, or different determinants, however.
Conventionally, a batch of several session plans are prepared for a number of future sessions in advance of the sessions. In this batch approach to session plan preparation, the individual plans of the batch are often homogeneous, and assume either (1) no relevant changes in the patient's condition during the course of the batch, or (2) projected changes in the patient's condition determined in advance. This approach further typically assumes (1) that radiation has been and will be delivered in accordance with each plan with complete accuracy, or (2) that radiation has been and will be delivered in accordance with each plan at a projected level of accuracy determined in advance.
The batch approach to session plan preparation has the disadvantage that each plan of a batch after the first plan is based upon important assumptions that may in many cases be unwarranted. As a result, individual plans prepared using the batch approach may have various deficiencies, which have the effect of degrading the effectiveness of radiation therapy in treating the tumor.
In view the foregoing, and approach to session plan preparation having a reduced reliance on such important assumptions would have significant utility.
A software facility for facilitating and/or performing dynamic and/or adaptive treatment planning for radiation therapy (“the facility”) is described. The facility provides or uses the output of a patient tracking system for one or more past radiation therapy sessions for a patient to plan one or more future sessions for the patient. In particular, embodiments of the facility provide or use information about the position and/or orientation of a patient isocenter relative to the machine isocenter throughout some or all of the time that radiation energy was delivered during the past sessions, in a manner that can be correlated or otherwise associated with information about the planned and/or actual delivery of radiation during the past sessions. As one example, embodiments of the facility provide or use information about patient position and/or orientation in time-series form, enabling this information to be correlated with planned and/or actual delivery of radiation also in time-series form.
In some embodiments, the facility provides patient position and/or orientation information to—or in a form usable by—an external treatment planning mechanism. In some embodiments, the facility directly performs treatment planning using patient position and/or orientation information. In some embodiments, the facility delivers radiation energy in a later treatment session based upon patient position and/or orientation during one or more past treatment sessions.
In addition to the position and/or orientation of the patient isocenter relative to the machine isocenter, information from past treatment sessions provided for use in future treatment planning can include the relative position and/or relative orientation of implanted fiducials or other markers, such as the passive magnetic transponders described in U.S. Pat. No. 7,912,529, entitled PANEL-TYPE SENSOR/SOURCE ARRAY ASSEMBLY, filed Dec. 30, 2002; U.S. patent application Ser. No. 09/877,498, entitled GUIDED RADIATION THERAPY SYSTEM, filed Jun. 8, 2001; U.S. Pat. No. 7,747,307, entitled METHOD AND SYSTEM FOR MARKER LOCALIZATION, filed Oct. 6, 2003; U.S. Pat. No. 8,196,589, entitled IMPLANTABLE MARKER WITH WIRELESS SIGNAL TRANSMITTAL, filed Dec. 24, 2003; and U.S. patent application Ser. No. 10/749,478, entitled RECEIVER USED IN MARKER LOCALIZATION SENSING SYSTEM, filed Dec. 31, 2003, each of which is hereby incorporated by reference in its entirety.
By providing or using patient tracking information from one or more past radiation therapy sessions to plan one or more future radiation therapy sessions in some or all of the ways described above, the facility can reduce the reliance on assumptions required for session planning, potentially improving the effectiveness of treatment in accordance with the resulting treatment plans.
In some embodiments, the facility uses the patient tracking computer system to obtain patient positioning data during a period of time when the patient is not undergoing radiation therapy. As one example, the patient tracking computer system may collect patient positioning data during a patient observation phase preceding radiation therapy treatment, during which the present position of the target location within the patient's body and/or its pattern of movement within the patient's body is determined in preparation for radiation therapy. In various embodiments, this phase can be performed inside or outside the treatment vault. As another example, the patient tracking computer system may collect patient positioning data during a treatment rehearsal phase inside the treatment vault. Such a rehearsal phase may be performed, for example, to ensure that all of the physical activity anticipated during the actual treatment session, such as movement of the linear accelerator and/or other equipment resident in the vault, can be successfully performed in the presence of the patient. In these embodiments, it is typical for the facility to transmit the collected patient positioning data to the planning computer system without accompanying actual treatment parameters, and for the planning computer system to create or adapt a treatment plan based on this unaccompanied patient positioning data.
In some cases, computer systems 101-103 are connected by one or more data networks 120. In some embodiments, some or all of data 112-114 are transferred between computer systems in a way other than using a network, such as by storing this data on removable media physically transferred between the computer systems.
In some embodiments, the facility uses a different set of computer systems, including sets including additional computer systems, sets including fewer computer systems, or sets in which the functionality of different computer systems is divided or consolidated. As examples, the patient tracking computer system can be consolidated with the treatment computer system, the planning computer system may be consolidated with the patient tracking computer system, the planning computer system may be consolidated with the treatment computer system, all three computer systems may be consolidated together, etc.
In some embodiments, the facility uses or operates in conjunction with hardware and/or software as described U.S. patent application No. 60/590,697, entitled USER INTERFACE FOR GUIDED RADIATION THERAPY, filed Jul. 23, 2004, and U.S. Pat. No. 7,899,513, entitled MODULAR SOFTWARE SYSTEM FOR GUIDED RADIATION THERAPY, filed Jul. 25, 2005, each of which is hereby incorporated by reference in its entirety.
The facility may adapt treatment plans for a patient based upon deviations in the positioning information contained in the positioning data structure. For example, rows 313-315 reflect a fairly significant deviation in patient isocenter displacement in the x and y dimensions. The facility may, for example, increase an integrated dose associated with a future treatment plan based upon the likelihood that this deviation caused the actual integrated dose in the Jul. 15, 2004 session to fall short of the planned integrated dose for that session. The facility may similarly respond to deviations in other patient positioning information, such as target tissue orientation, transponder displacement, transponder orientation, etc.
Those skilled in the art will appreciate that the facility may use positioning data structures having various contents and formats. For example, the facility may use positioning data structures that contain more, less, or different patient and session identifying information, and/or positioning data structures that contain more, less, or different substantive positioning information, or substantive positioning information in different units, coordinate schemes, etc. The positioning data structure may be expressed in a variety of formats, such as the format shown one of a number of existing or new tag-based markup languages, such as XML or a variant; or a compliant or non-compliant version of a standard format for transferring digital medical images or other digital medical data, such as present or future versions of the Digital Imaging and Communications in Medicine, or “DICOM,” format adopted by the National Electrical Manufacturers Association, described at xray.hmc.psu.edu/physresources/dicom/index.html. The positioning data structure may be organized in a variety of ways, and may be compressed and/or encrypted in a variety of ways. One sample alternative data structure organization is shown in U.S. Patent Application No. 60/590,693, entitled DATA PROCESSING FOR REAL-TIME TRACKING OF A TARGET IN RADIATION THERAPY, filed Jul. 23, 2004, and U.S. Pat. No. 8,095,203, entitled DATA PROCESSING FOR REAL-TIME TRACKING OF A TARGET IN RADIATION THERAPY, filed concurrently herewith, each of which is hereby incorporated by reference in its entirety.
In step 402, the facility associates the patient positioning data collected in step 401 with other treatment parameters. Such association may reflect a time-based correlation, or associations of other types. The patient positioning data can be associated with a wide variety of treatment parameters, including beam activation, beam intensity, collimator settings, gantry positions, etc. Patient positioning data may be associated with planned treatment parameters, actual treatment parameters, or a combination thereof. In step 403, the facility provides the patient positioning data associated in step 402 to a treatment planning facility. After step 403, these steps conclude.
The tracking unit is responsible for generating patient tracking records each indicating the current location and/or orientation of a patient isocenter relative to a reference point, such as relative to a machine isocenter during radiation treatment.
In some embodiments, the tracking unit computes patient tracking records with no more than a maximum latency after the time of the underlying measurements, such as a maximum latency of 50 milliseconds, or a maximum latency of 200 milliseconds. In some embodiments, the tracking unit generates patient tracking records at least a minimum frequency, such as a minimum frequency of 20 hertz. Additional detail about the generation of patient tracking records is discussed in U.S. patent application Ser. No. 11/166,801, entitled SYSTEMS AND METHODS FOR REAL TIME TRACKING OF TARGETS IN RADIATION THERAPY AND OTHER MEDICAL APPLICATIONS, filed Jun. 24, 2005 and incorporated by reference in its entirety.
The radiation delivery source of the illustrated embodiment is an ionizing radiation device 18 (i.e., a linear accelerator). Suitable linear accelerators are manufactured by Varian Medical Systems, Inc. of Palo Alto, Calif.; Siemens Medical Systems, Inc. of Iselin, N.J.; Elekta Instruments, Inc. of Iselin, N.J.; or Mitsubishi Denki Kabushik Kaisha of Japan. Such linear accelerators can deliver conventional single or multi-field radiation therapy, 3D conformal radiation therapy (3D CRT), intensity modulated radiation therapy (IMRT), stereotactic radiotherapy, and tomo therapy. The radiation delivery source 20 can deliver a gated, contoured or shaped beam 19 of ionizing radiation from a movable gantry 20 to an area or volume at a known location in an external, absolute reference frame relative to the radiation delivery source 18. The point or volume to which the ionizing radiation beam 19 is directed is referred to as the machine isocenter.
The tracking system includes the localization system 10 and one or more markers 30. The localization system 10 determines the actual location of the markers 30 in a three-dimensional reference frame, and the markers 30 are typically implanted within the patient 16. In the embodiment illustrated in
The localization system 10 provides several features, either individually or in combination with each other, that enhance the ability to accurately deliver high doses of radiation to targets within tight margins. For example, many embodiments of the localization system use leadless markers that are implanted in the patient so that they are substantially fixed with respect to the target. The markers accordingly move either directly with the target or in a relationship proportional to the movement of the target. As a result, internal movement of the target caused by respiration, organ filling, cardiac functions, or other factors can be identified and accurately tracked before, during and after medical procedures. Moreover, many aspects of the localization system 10 use a non-ionizing energy to track the leadless markers in an external, absolute reference frame in a manner that provides objective output. In general, the objective output is determined in a computer system without having a human interpret data (e.g., images) while the localization system 10 tracks the target and provides the objective output. This significantly reduces the latency between the time when the position of the marker is sensed and the objective output is provided to a device or a user. For example, this enables an objective output responsive to the location of the target to be provided at least substantially contemporaneously with collecting the position data of the marker. The system also effectively eliminates inter-user variability associated with subjective interpretation of data (e.g., images).
The illustrated system 10 includes a plurality of markers 30 positioned in or adjacent to the target 12 to mark the target's actual location in the body 14. Accordingly, the markers 30 are markers in, on or near the body. In one example, the markers 30 may be attached to patient-immobilization devices at known locations relative to the treatment isocenter. The markers 30 are energized or excited by an excitation source 32 positioned exterior of the patient's body 14. When the markers 30 are excited, they each resonate at a selected unique frequency and generate a low energy radio-frequency magnetic signal measurable from outside of the body 14. The signals from the markers 30 are detected and measured by an array 34 of sensors 36 located exterior of the patient's body 14. The sensors 36 are positioned in a fixed, selected geometry relative to each other, so the array 34 defines a fixed reference coordinate system from which location and movement are calculated. The sensors 36 are operatively coupled to a computer controller 38 that receives the measurement information from each sensor and determines the actual location of the markers 30 within the patient's body 14 relative to the sensors.
In one embodiment, the computer controller 38 includes algorithms used to define and determine the location of the target isocenter 40 within the target 12, based upon the signal measurements by the sensors 36 from the resonating markers. In another embodiment, the location of the target isocenter 40 within the target 12 is selected, and the computer controller 38 utilizes position information about the position and/or orientation of each marker 30 relative to the selected target isocenter. The target isocenter 40 is the point or position within the target to which the shaped dose of radiation is configured around or referenced to as determined by a treatment planning process. In one embodiment, the sensors 36 are polled twelve or more times per minute to track the actual position of the target isocenter 40 within the patient's body 14 relative to the sensor array 34. Accordingly, the actual position of the target 12 and the target isocenter 40 can be monitored in real time when the patient is positioned adjacent to the sensor array 34.
The actual position of the target isocenter 40 is compared to the position of the machine isocenter 22 relative to the sensor array 34. The illustrated system 10 has a reference device 42 positioned on the gantry 20 of the linear actuator or another selected position on a radiation therapy delivery device used in alternate embodiments. In these alternate embodiments, the other radiation therapy delivery device can include cobalt machines, a Gamma Knife, a Cyberknife, specialized stereostatic radiotherapy devices, or a TomoCT assembly (which utilizes a linear actuator in a CT scanner). The reference device 42 is positioned at a known spatial or geometric relationship relative to the machine isocenter 22. The reference device 42 in one embodiment is a resonating, three axis, single frequency marker that provides a measurable signal detectable by the sensors 36 in the array 34. The reference device 42 in alternate embodiments can be positioned in a remote location away from the gantry 20. In either embodiment, the location of the machine isocenter 22 relative to the sensor array 34 can be calculated upon determining the position of the reference device 42 relative to the sensor array. The sensors 36 provide the measurement data about the reference device 42 to the computer controller 38, and the computer controller calculates the location of the machine isocenter 22 relative to the sensor array 34.
The location of the target isocenter 40 relative to the sensor array 34 is compared to the position of the machine isocenter 22 relative to the sensor array. If the target isocenter 40 and machine isocenter 22 are spatially misaligned such that the two isocenters are not three-dimensionally coincident with each other, the patient 16, and/or target 12 can be moved relative to the machine isocenter 22. The target 12 position is moved until the target isocenter 40 is coincident with the machine isocenter 22. Once the target and machine isocenters 40 and 22 are acceptably aligned, the radiation delivery source 18 can be activated to provide the ionizing radiation beam 19 referenced to the target isocenter, thereby irradiating the target according to a radiation treatment plan, while minimizing or eliminating collateral damage to healthy tissue surrounding the target 12. The actual location of the target isocenter 40 can also be monitored in real time during the radiation therapy to ensure that the target isocenter does not move an unacceptable amount relative to the machine isocenter 22 and allow for treatment when the treatment isocenter and the machine isocenter are within acceptable displacement limits.
In the illustrated embodiment, the system 10 also includes a monitoring assembly 44 coupled to the computer controller 38 that provides feedback data to a user interface for the doctor or technician operating the system and/or the radiation delivery device 18. As an example, the monitoring assembly 44 can provide the feedback data as a visual representation of the target isocenter's position in three-dimensional space relative to the machine isocenter's position in real time as the patient is being set up and positioned for the radiation therapy. The monitoring assembly 44 can also provide other feedback data to the user interface including, for example, confirmation of setup completion, graphical information, patient information, radiation treatment plan information, or other information that can be utilized during the guided radiation therapy process.
As best seen in
In one embodiment, as illustrated in
As best seen in
In one embodiment, the wireless, excitable markers 30 are configured to resonate and provide a measurable signal within the frequency range of approximately 10kHz to 200kHz, inclusive. In other embodiments, the markers 30 can be self-contained, powered markers that include a power source, such as a battery, that provides sufficient power to produce the measurable identifiable marker signal. In other embodiments, the markers 30 can be “wired” markers connectable via wires to a selected power or excitation source to allow the markers to generate the unique marker signal. The marker signal can be unique as a function of frequency (i.e., frequency multiplexing) as a function of time or time multiplexing.
In selected applications, a single marker 31, preferably a single-axis marker, is implanted in the target 12, and the intensity of the signals from the single resonating marker is used to determine the target location information relative to the sensor array 34. In alternate embodiments, two, three, or more markers 30 are implanted at known locations in or adjacent to the target. Each marker 30 produces its unique signal relative to the other markers, so the sensor array 34 differentiates between the markers by frequency multiplexing. The sensor array 34 measures the intensity of the unique signals from the markers 30. The signal intensity measurements are converted for use in geometric calculations (discussed in greater detail below) to accurately determine the actual three-dimensional location (X, Y, Z) and possibly the angular orientation (pitch, yaw, roll) of the marker relative to the sensor array 34.
Referring again to
The illustrated embodiments of
It is known that the strength of a magnetic field decreases at a ratio proportional to the cube of the distance from the source. Accordingly, the distance of the marker from the sensor can be determined based upon the marker's signal strength. The geometric relationship from the marker to a series of sensors that are spaced at known locations relative to each other is used to solve a series of equations with one unique result. Accordingly, the distance between the marker 30 and the sensor 36 calculated by the computer controller 38 based on the marker's signal strength measured by the respective sensors and iterated for a best fit solution to the geometric equations.
The precise location of a marker 30 in space relative to the sensor array 34 can be calculated based upon the distances between that marker and at least four separate three-axis sensors spaced apart from each other in the array. The absolute magnitude of the distance from the three-axis sensor is determined by squaring the each of the three axis magnitudes (x, y, and z orientations), adding the results and finally taking the square root for the distance resultant. As an example, the distance between one sensor 36 and one of the markers 30 corresponds geometrically to the radius of a sphere.
As best seen in
Once the target 12 is positioned so the target isocenter 40 is coincident with the machine isocenter 22, ionizing radiation can be selectively and very accurately delivered directly to the target area or volume. Application of the radiation therapy to the target 12, can be provided at the selected dosage and intensity with precise accuracy, while potentially minimizing the margin needed around the target. In one embodiment, the actual position of the target isocenter 40 is substantially continuously monitored and tracked relative to the machine isocenter 22 during delivery of the radiation therapy. If the target isocenter 40 moves away from the machine isocenter 22 beyond an acceptable range of displacement distances, the computer controller 38 provides a signal to the radiation delivery device to interrupt the radiation therapy to the target. The target's position can then be adjusted manually or automatically until the target isocenter 40 is again coincident with the machine isocenter 22, and radiation therapy can resume. In one embodiment, the computer controller 38 is programmed so that if the target isocenter 40 moves from the machine isocenter 22, but the distance of movement does not exceed the acceptable range, the computer controller 38 will not interrupt the radiation therapy. This range of movement is dependent upon many factors, such as the target type (e.g., prostate, lung, liver), target size, target location, beam shape/size, and the radiation treatment plan.
Tracking of the target isocenter's position is facilitated by the monitoring assembly 44, which is coupled to the computer controller 38.
The monitoring assembly 44 also receives and displays information from the computer controller 38 to show the actual locations of the markers 30 and target isocenter 40 relative to the machine isocenter 22, and relative to the simulated target and markers. Accordingly, the feedback portion 80 allows the operator to determine the actual position of the markers relative to the simulated markers, and the target isocenter 40 relative to the machine isocenter 22 substantially in real time while the patient 16 is on the support table 76 (
In addition to accurately tracking and monitoring the position of the target 12 relative to the machine isocenter 22, the system 10 is also usable to monitor the status of the target, such as a tumor or the like, in a patient's body 14 over time.
As an example,
In the embodiments discussed above, the markers 30 are described and shown as being subcutaneously implanted in or next to a target 12. This implantation of the markers 30 is performed when needed to ensure that, if the target 12 moves, the markers will move with the target as a unit. In an alternate embodiment illustrated in
The surface-mounted markers 105 in one embodiment are wireless markers, so that the markers can remain adhered on the patient's body 14 after a radiation treatment session so that the patient 16 can come and go from the treatment area without disrupting the position of the markers 105 relative to the target 12. In alternate embodiments, the markers 105 remain adhered to the patient 16 and are connectable to lead wires of a “wired” marker system in the treatment area. The lead wires can be disconnected from the markers 105 to allow the patient 16, to leave the treatment area while the markers remain fixed in place on the patient's body.
The surface-mounted markers 105 are also usable to monitor a patient's base-line girth (anterior-posterior and lateral dimensions) during a radiation treatment program. The base-line girth measurements, referred to as patient separations, are initially obtained by CT, MRI, or physical measurements. Patient separations are used when preparing a radiation treatment plan for the patient. The surface-mounted markers 105 can be utilized alone or in combination with implanted markers to provide data about changes in the patient separations that may occur during chemo or radiotherapy. Each surface-mounted marker 105 has an identifiable initial position in space relative to, as an example, the target isocenter or relative to each other. The sensor array 34 and computer controller 38 are configured to determine the distances between each surface-mounted marker and/or the target isocenter. The computer controller 38 calculates and monitors the distances, corresponding to the patient separations. During the course of radiation treatment, if the patient separations change significantly, such as due to substantial weight loss from chemo or radiotherapy, the treatment plan may become invalid because less patient tissue is available to alternate the radiation beam, thereby resulting in higher than planned doses of radiation.
In one embodiment, the surface-mounted markers 105 are usable to facilitate and speed up patient set-up procedures before and/or during the radiation therapy procedure. The surface mounted markers 105 are positioned at selected locations on the patient's body 14 at known positions. The markers 105 are excited and the locations relative to the sensor array are determined. The marker's location information can then be used to calculate the Target Skin Distance or Source Skin Distance, which is the distance between the exterior skin of the patient and the linear actuator or the tabletop. The markers 105 can also be used to determine the tabletop-to-isocenter, which is the distance between the tabletop to the marker or other alignment means, such as laser cross-hairs projected on to the patient's skin. Accordingly, the surface mounted markers 105 can be used to automatically calculate the relevant distances during the set up procedure to quickly determine if the patient is properly positioned in accordance with the radiation therapy treatment plan.
In another embodiment, the surface-mounted markers 105 can be used in conjunction with one or more markers 30 implanted in or near the target 12. The relative location of each marker 105 or 30 can be calculated and used for any combination of patient set-up, target locating, target positioning, target motion tracking, and/or target evaluation, as discussed above.
It will be appreciated by those skilled in the art that the above-described facility may be straightforwardly adapted or extended in various ways. For example, the facility may operate in a wide variety of radiation treatment and treatment planning environments. The facility can exchange positioning data containing various elements, in various formats, via various storage or communications media. The facility can use a wide variety of treatment planning processes to incorporate the positioning data in future treatment plans. In preparing treatment plans, the facility can use positioning data from any number of prior sessions to prepare plans for any number of future sessions. In some cases, the facility adapts the treatment plan for a session during the course of the session, and delivers radiation therapy in accordance with the adapted plan. While the foregoing description makes reference to preferred embodiments, the scope of the invention is defined solely by the claims that follow and the elements recited therein.
This application is a continuation of U.S. patent application Ser. No. 11/189,431 filed Jul. 25, 2005, which claims the benefit of U.S. Patent Application No. 60/590,503 filed Jul. 23, 2004, which is hereby incorporated by reference in its entirety.
Number | Name | Date | Kind |
---|---|---|---|
3967161 | Lichtblau | Jun 1976 | A |
4023167 | Wahlstrom | May 1977 | A |
4114601 | Abels | Sep 1978 | A |
4123749 | Hartmann et al. | Oct 1978 | A |
4127110 | Bullara | Nov 1978 | A |
4160971 | Jones et al. | Jul 1979 | A |
4222374 | Sampson et al. | Sep 1980 | A |
4260990 | Lichtblau | Apr 1981 | A |
4393872 | Reznik et al. | Jul 1983 | A |
4618822 | Hansen | Oct 1986 | A |
4633250 | Anderson, III et al. | Dec 1986 | A |
4643196 | Tanaka et al. | Feb 1987 | A |
4696287 | Hortmann et al. | Sep 1987 | A |
4795995 | Eccleston et al. | Jan 1989 | A |
4799495 | Hawkins et al. | Jan 1989 | A |
4909789 | Taguchi et al. | Mar 1990 | A |
4936823 | Colvin et al. | Jun 1990 | A |
4945914 | Allen | Aug 1990 | A |
4994079 | Genese et al. | Feb 1991 | A |
5031634 | Simon | Jul 1991 | A |
5062847 | Barnes | Nov 1991 | A |
5095224 | Renger | Mar 1992 | A |
5099845 | Besz et al. | Mar 1992 | A |
5107862 | Fabian et al. | Apr 1992 | A |
5142292 | Chang | Aug 1992 | A |
5170055 | Carroll et al. | Dec 1992 | A |
5325873 | Hirschi et al. | Jul 1994 | A |
5353804 | Kornberg et al. | Oct 1994 | A |
5409004 | Sloan | Apr 1995 | A |
5423334 | Jordan | Jun 1995 | A |
5425367 | Shapiro et al. | Jun 1995 | A |
5425382 | Golden et al. | Jun 1995 | A |
5446548 | Gerig et al. | Aug 1995 | A |
5509900 | Kirkman | Apr 1996 | A |
5528651 | Leksell et al. | Jun 1996 | A |
5626630 | Markowitz et al. | May 1997 | A |
5638819 | Manwaring et al. | Jun 1997 | A |
5651043 | Tsuyuki et al. | Jul 1997 | A |
5680106 | Schrott et al. | Oct 1997 | A |
5697384 | Miyawaki et al. | Dec 1997 | A |
5707362 | Yoon | Jan 1998 | A |
5707390 | Bonutti | Jan 1998 | A |
5711299 | Manwaring et al. | Jan 1998 | A |
5727552 | Ryan | Mar 1998 | A |
5735795 | Young et al. | Apr 1998 | A |
5748767 | Raab | May 1998 | A |
5754623 | Seki | May 1998 | A |
5757881 | Hughes | May 1998 | A |
5764052 | Renger | Jun 1998 | A |
5769861 | Vilsmeier | Jun 1998 | A |
5810851 | Yoon | Sep 1998 | A |
5840148 | Campbell et al. | Nov 1998 | A |
5868673 | Vesely | Feb 1999 | A |
5879297 | Haynor et al. | Mar 1999 | A |
5910144 | Hayashi | Jun 1999 | A |
5928137 | Green | Jul 1999 | A |
5951481 | Evans | Sep 1999 | A |
5957934 | Rapoport | Sep 1999 | A |
5989265 | Bouquet de la Joliniere et al. | Nov 1999 | A |
6026818 | Blair et al. | Feb 2000 | A |
6059734 | Yoon | May 2000 | A |
6061644 | Leis | May 2000 | A |
6067465 | Foo et al. | May 2000 | A |
6076008 | Bucholz | Jun 2000 | A |
6081238 | Alicot | Jun 2000 | A |
6082366 | Andra et al. | Jul 2000 | A |
6144875 | Schweikard et al. | Nov 2000 | A |
6161009 | Skurdal et al. | Dec 2000 | A |
6198963 | Haim et al. | Mar 2001 | B1 |
6222544 | Tarr et al. | Apr 2001 | B1 |
6246900 | Cosman et al. | Jun 2001 | B1 |
6307473 | Zampini et al. | Oct 2001 | B1 |
6325758 | Carol et al. | Dec 2001 | B1 |
6353758 | Gliner et al. | Mar 2002 | B1 |
6359959 | Butler et al. | Mar 2002 | B1 |
6360116 | Jackson, Jr. et al. | Mar 2002 | B1 |
6363940 | Krag | Apr 2002 | B1 |
6371379 | Dames et al. | Apr 2002 | B1 |
6377162 | Delestienne et al. | Apr 2002 | B1 |
6381485 | Hunter et al. | Apr 2002 | B1 |
6385286 | Fitchard et al. | May 2002 | B1 |
6385288 | Kanematsu | May 2002 | B1 |
6393096 | Carol et al. | May 2002 | B1 |
6405072 | Cosman | Jun 2002 | B1 |
6416520 | Kynast et al. | Jul 2002 | B1 |
6501981 | Schweikard et al. | Dec 2002 | B1 |
6510199 | Hughes et al. | Jan 2003 | B1 |
6526415 | Smith et al. | Feb 2003 | B2 |
6535756 | Simon et al. | Mar 2003 | B1 |
6650930 | Ding | Nov 2003 | B2 |
6662036 | Cosman | Dec 2003 | B2 |
6675810 | Krag | Jan 2004 | B2 |
6698433 | Krag | Mar 2004 | B2 |
6711431 | Sarin et al. | Mar 2004 | B2 |
6812842 | Dimmer | Nov 2004 | B2 |
6822570 | Dimmer et al. | Nov 2004 | B2 |
6838990 | Dimmer | Jan 2005 | B2 |
6882947 | Levin | Apr 2005 | B2 |
6889833 | Seiler et al. | May 2005 | B2 |
6918919 | Krag | Jul 2005 | B2 |
6934356 | Satheesan et al. | Aug 2005 | B1 |
6937696 | Mostafavi | Aug 2005 | B1 |
6977504 | Wright et al. | Dec 2005 | B2 |
6993112 | Hesse | Jan 2006 | B2 |
6999555 | Morf | Feb 2006 | B2 |
7026927 | Wright et al. | Apr 2006 | B2 |
7027707 | Imaki | Apr 2006 | B2 |
7072707 | Galloway, Jr. et al. | Jul 2006 | B2 |
7135978 | Gisselberg et al. | Nov 2006 | B2 |
7142905 | Slayton et al. | Nov 2006 | B2 |
7154991 | Earnst et al. | Dec 2006 | B2 |
7174201 | Govari et al. | Feb 2007 | B2 |
7176798 | Dimmer et al. | Feb 2007 | B2 |
7206626 | Quaid, III | Apr 2007 | B2 |
7206627 | Abovitz et al. | Apr 2007 | B2 |
7213009 | Pestotnik et al. | May 2007 | B2 |
7221733 | Takai et al. | May 2007 | B1 |
7280863 | Shachar | Oct 2007 | B2 |
7289599 | Seppi et al. | Oct 2007 | B2 |
7289839 | Dimmer et al. | Oct 2007 | B2 |
7318805 | Schweikard et al. | Jan 2008 | B2 |
7447643 | Olson et al. | Nov 2008 | B1 |
7557353 | Black et al. | Jul 2009 | B2 |
7587234 | Owens et al. | Sep 2009 | B2 |
7606405 | Sawyer et al. | Oct 2009 | B2 |
7657301 | Mate et al. | Feb 2010 | B2 |
7657302 | Mate et al. | Feb 2010 | B2 |
7657303 | Mate et al. | Feb 2010 | B2 |
7684849 | Wright et al. | Mar 2010 | B2 |
7912529 | Herron et al. | Mar 2011 | B2 |
8239002 | Neustadter et al. | Aug 2012 | B2 |
8239005 | Wright et al. | Aug 2012 | B2 |
20010029509 | Smith et al. | Oct 2001 | A1 |
20020049362 | Ding | Apr 2002 | A1 |
20020065461 | Cosman | May 2002 | A1 |
20020083951 | Stegmaier et al. | Jul 2002 | A1 |
20020165443 | Mori | Nov 2002 | A1 |
20020188194 | Cosman | Dec 2002 | A1 |
20020193685 | Mate et al. | Dec 2002 | A1 |
20020193686 | Gilboa | Dec 2002 | A1 |
20030002621 | Hughes et al. | Jan 2003 | A1 |
20030023161 | Govari et al. | Jan 2003 | A1 |
20030052785 | Gisselberg et al. | Mar 2003 | A1 |
20030088178 | Owens et al. | May 2003 | A1 |
20030125616 | Black et al. | Jul 2003 | A1 |
20030153829 | Sarin et al. | Aug 2003 | A1 |
20030192557 | Krag et al. | Oct 2003 | A1 |
20030206610 | Collins | Nov 2003 | A1 |
20030206614 | Kendrick et al. | Nov 2003 | A1 |
20040019274 | Galloway et al. | Jan 2004 | A1 |
20040068182 | Misra | Apr 2004 | A1 |
20040096033 | Seppi et al. | May 2004 | A1 |
20040116804 | Mostafavi | Jun 2004 | A1 |
20040122308 | Ding | Jun 2004 | A1 |
20040122311 | Cosman | Jun 2004 | A1 |
20040122608 | Levin | Jun 2004 | A1 |
20040124105 | Seiler et al. | Jul 2004 | A1 |
20040125916 | Herron et al. | Jul 2004 | A1 |
20040127787 | Dimmer et al. | Jul 2004 | A1 |
20040133101 | Mate et al. | Jul 2004 | A1 |
20040138555 | Krag et al. | Jul 2004 | A1 |
20040158146 | Mate et al. | Aug 2004 | A1 |
20040176931 | Wright et al. | Sep 2004 | A1 |
20050059884 | Krag | Mar 2005 | A1 |
20050059887 | Mostafavi et al. | Mar 2005 | A1 |
20050077459 | Engler et al. | Apr 2005 | A1 |
20050085710 | Earnst et al. | Apr 2005 | A1 |
20050113855 | Kennedy et al. | May 2005 | A1 |
20050151649 | Wright et al. | Jul 2005 | A1 |
20050152495 | Hesse | Jul 2005 | A1 |
20050154280 | Wright et al. | Jul 2005 | A1 |
20050154283 | Wright et al. | Jul 2005 | A1 |
20050154284 | Wright et al. | Jul 2005 | A1 |
20050154293 | Gisselberg et al. | Jul 2005 | A1 |
20050195084 | Dimmer et al. | Sep 2005 | A1 |
20050203431 | Brodnick et al. | Sep 2005 | A1 |
20050234332 | Murphy | Oct 2005 | A1 |
20050261570 | Mate et al. | Nov 2005 | A1 |
20060052694 | Phillips et al. | Mar 2006 | A1 |
20060058648 | Meier et al. | Mar 2006 | A1 |
20060063999 | Herron et al. | Mar 2006 | A1 |
20060074301 | Meier et al. | Apr 2006 | A1 |
20060074302 | Meier et al. | Apr 2006 | A1 |
20060078086 | Riley et al. | Apr 2006 | A1 |
20060079764 | Wright et al. | Apr 2006 | A1 |
20060093089 | Vertatschitsch et al. | May 2006 | A1 |
20060100509 | Wright et al. | May 2006 | A1 |
20070161884 | Black et al. | Jul 2007 | A1 |
20080226149 | Wischmann et al. | Sep 2008 | A1 |
Number | Date | Country |
---|---|---|
07-313515 | Dec 1995 | JP |
8166446 | Jun 1996 | JP |
2001-008947 | Jan 2001 | JP |
WO9525475 | Sep 1995 | WO |
WO9608208 | Mar 1996 | WO |
WO9712553 | Apr 1997 | WO |
WO9830166 | Jul 1998 | WO |
WO9838908 | Sep 1998 | WO |
WO9840026 | Sep 1998 | WO |
WO9927839 | Jun 1999 | WO |
WO9930182 | Jun 1999 | WO |
WO9933406 | Jul 1999 | WO |
WO9940869 | Aug 1999 | WO |
WO9958044 | Nov 1999 | WO |
WO9958065 | Nov 1999 | WO |
WO0038579 | Jul 2000 | WO |
WO0051514 | Sep 2000 | WO |
WO0053115 | Sep 2000 | WO |
WO0065989 | Nov 2000 | WO |
WO0239917 | May 2002 | WO |
WO0239918 | May 2002 | WO |
WO03053270 | Jul 2003 | WO |
Entry |
---|
P.G. Seiler, et al., A novel tracking technique for the continuous precise measurement of tumour positions in confomral therapy, Jun. 7, 2000, IOP Publishing Ltd., Phys. Med. Biol., vol. 45, pp. N103-N110. |
Seppenwoolde et al, Precise and real-time measurement of 3D tumor motion in lung due to breathing and heartbeat, measured during radiotherapy, Int. J. Radiat. Oncol. Biol. Phys. Jul. 15, 2002, 53, pp. 822-834. |
Sharp et al., Prediction of Respiratory Tumour Motion for Real-Time Image-Guided Radiotherapy, IPO Publishing Oltd.; Jan. 16, 2004, pp. 425-440. |
Beyer, Thomas et al. “Dual-modality PET/CT Imaging: the effect of respiratory motion on combined image quality in clinical oncology.” European journal of nuclear medicine and molecular imaging 30.4 (2003): 588-596. |
Low, Daniel A., et al. “A method for the reconstruction of four-dimensional synchronized CT scans acquired during free breathing.” Medical physics 30.6 (2003) 1254-1263. |
Wolthaus, J. W. H., et al. “Fusion of respiration-correlated PET and CT scans: correlated lung tumour motion in anatomical and functional scans.” Physics in medicine and biology 50.7 (2005): 1569. |
Number | Date | Country | |
---|---|---|---|
20140093049 A1 | Apr 2014 | US |
Number | Date | Country | |
---|---|---|---|
60590503 | Jul 2004 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 11189431 | Jul 2005 | US |
Child | 13888288 | US |