Focused ultrasound devices use ultrasound (“US”) transducers to deliver a generally thermal or cavitational dose to a small, well-defined spot at some fixed distance, focal distance or relative distance from a transducer surface. One or more ultrasound crystals may be combined to form a transducer that can be geometrically or electronically focused at a point distant from the surface of the transducer, thereby concentrating the US energy at the focal spot. Such concentration of sound energy results in cavitational and thermal damage to the region of focus and can be used, among other things, to destroy cancerous tissue.
One way to deliver thermal dose to a larger region is to move the transducer so that the small spot of thermal dose is applied over the region that is to receive thermal or cavitational dose(s). Alternatively, the patient may be moved relative to the transducer. The latter approach is often used in extracorporeal devices where the transducer is located outside the patient; for example, InSightec, Ltd's EXABLATE™ system. The former approach, in comparison, is often used in devices where the transducer is located inside the patient. Such is the case with devices such as the SonCare Medical's SONATHERM™ and SONABLATE™ devices.
In devices where the transducer is introduced into the patient and is moved potentially relative to the patient, it is typically deployed in a probe housing. The probe will typically include a way to couple the transducer to the tissue to be treated. Coupling involves providing a continuous water path between the transducer and the tissue being treated. In addition, the coupling mechanism is used to control the depth of the focal point of the transducer in the region of interest; increasing the depth of the water contained by the means for coupling allows the focal point of the transducer to be moved deeper or shallower in the tissue to which it is coupled. The probe may contain an US transparent window through which the thermal US energy passes. This window typically is larger than the transducer. The transducer can be moved around inside the window in order to deliver dose to a region greater in width and or length than the size of the transducer itself.
Rigid shaft-based drive systems can be employed to move the transducer inside the probe so that that the spot of thermal dose can be scanned over the region that is to receive thermal or cavitational dose without the need to move the probe itself around inside the patient. This reduces the amount of trauma to which the patient would be subjected, and the loss of tissue coupling that would occur, if the probe itself were moved around. However, these types of systems increase the size of the probe due to the need for the window to be as large as the largest volume of tissue to be treated.
Typically, such drive systems, including motors that are connected to the transducer by a shaft, are housed within the probe body that houses the transducer. Motors are provided to move the transducer across multiple axes. Approaches using a rigid straight shaft require a line of sight or a direct path for the probe to the targeted tissue. With such geometry, it may not be possible to position the transducer so that it can reach targets that may lie on the underside or backside of an organ, since the shaft cannot be bent such that it can “see” around a corner or other obstruction. In addition, it may be difficult to deliver a high intensity focused ultrasound (“HIFU”) treatment to regions located directly in front of or behind the axis of the probe if the US window effectively is on the side of the shaft.
The transducers could be mounted at the end of the probe in a forward facing direction. However, because of the length of transducer assemblies used to deliver HIFU and the need to scan these transducers over a region greater than their length, mounting the transducers at the end of a shaft orthogonal to the shaft would necessitate a very large surgical opening in order to introduce the probe into a patient.
Flexible delivery devices for HIFU have been developed. For instance, U.S. Pat. No. 5,492,126 (Hennige) is an example of such a device, which allows the position of the transducer to be adjusted relative to the orientation of its long axis. However the device of Hennige, which consists of a focused ultrasound (“FUS”) transducer incorporated into a flexible endoscope, requires manual positioning of the transducer and is not capable of being scanned over a large region. Another approach can be found in U.S. Pat. No. 7,591,794 (Lacoste), which teaches ways of angulating the end of the probe containing the transducer. However, Lacoste does not teach the use of focused ultrasound. Therefore, Lascoste teaches a relatively inefficient means of delivering ablative energy. Further, Lascoste does not teach the use of integrated US imaging.
It would be desirable to provide a means of moving a transducer inside a patient without requiring line of sight, without the need to enlarge the size of the probe to accommodate movement of the transducer within the probe, without the need to utilize a large surgical opening in order to introduce the probe, with the ability to use focused ultrasound for the treatment, and/or with the integration of optical and US imaging. The device, system and method of the present disclosure accomplish the above and other objectives.
According to an embodiment of the present disclosure, an ultrasound probe includes ultrasound transducers capable of generating thermal or cavitational lesions with US and optionally of imaging such lesions with US, attached to one or more pairs of jaws mounted on the end of a flexible drive shaft. The probe may include a tissue coupling mechanism including a fixed or variable fillable fluid membrane with ingress and egress ports secured in a manner that covers the transducers. The flexible shaft can be connected to a set of motors that may be activated manually or under computer control to adjust the position of the transducer assembly. The motors may control all or some combination of: bending of the shaft, opening and closing of the jaws, rotation of the shaft and jaws together, and/or rotation of the jaws themselves. Computer or manually controlled movement of the various degrees of freedom of the system may be provided to allow the probe with the jaws closed to be inserted through a small opening in the patient in order to cause the jaws, and thereby the transducers, to be deployed in an open treatment position once inside the patient, the probe to be positioned correctly relative to the region to be treated, and the focal spot of the transducer scanned over the region to be treated by a combination of controlled movements including bending and rotating.
In a further embodiment of the present disclosure, various portions of the probe and transducers can be equipped with localization technology so that the position and orientation of various portions of the probe and transducer relative to the target and/or a fixed point in space, or relative to a known reference, can be determined.
In another embodiment of the present disclosure, the probe may include an optical imaging system at its distal end, thereby allowing the region that is to be treated to be visualized optically.
In an additional embodiment of the present disclosure, the probe may be deployed in a fluid filled chamber where the probe itself does not require a tissue coupling mechanism and where ingress and egress of fluid into the chamber is controlled through separate means. The volume of the chamber may be used to determine the position of the focal spot in the chamber wall.
In an alternative embodiment of the present disclosure, an ultrasound probe includes ultrasound transducers capable of generating thermal or cavitational lesions with US and optionally of imaging such lesions with US, attached to the end of a flexible drive shaft oriented such that the direction of the therapy and imaging US beams is at least generally, if not exactly, orthogonal to the long axis of the shaft and the position of the transducers relative to the shaft may be adjusted. The probe may include a tissue coupling mechanism including a fixed or variable fillable fluid membrane with ingress and egress ports secured so that covers the transducers. The flexible shaft can be connected to a set of motors that can be activated manually or under computer control to adjust the position of the transducer assembly. The motors can control all or some combination of: bending of the shaft, rotation of the entire shaft, and/or rotation of the end of the shaft only. Computer or manually controlled movement of the various degrees of freedom of the system may be provided to allow the probe to be inserted through a small opening in the patient, then angled to the desired treatment position once inside the patient, the probe to be positioned correctly relative to the region to be treated to be treated by a combination of controlled movements including bending of the shaft and rotation the entire shaft, which will direct the body of the transducer in the correct direction, and rotation of the end of the shaft, which will direct the active portion of the transducer in the desired direction.
In another embodiment of the present disclosure, a method of delivering a FUS treatment is provided. The method may include advancing into a patient through a surgically created or naturally occurring opening a probe that contains at least a single pair of closed jaws each fitted with a FUS transducer, that may contain an imaging transducer mounted at the center of the jaws, and includes a means for coupling the transducer to the tissue to be treated through which is installed an acoustic window; under computer or manual control advancing the probe while using a flexible drive shaft system that can change the shape of the probe so as to adjust the position of the end of the probe and bring it in proximity to the region to be treated; opening the jaws under computer or manual control so that the FUS transducers are deployed in the treatment position; creating a tissue coupling interface if required; adjusting the volume of the coupling so as to position the focal point of the transducer correctly in the region to be treated; imaging the region of interest by scanning the imaging crystal over the region to be treated; delivering to a first location a dose of FUS that is distributed over a wide entrance angle by rotating the jaws while delivering FUS; moving the transducer to an at least second position by adjusting the shape of the flexible shaft under computer or manual control; delivering an additional dose of HIFU at the new position of the transducer; thereby scanning the focal spot of the transducer over the region to be treated and delivering a dose of thermal or cavitational energy to a region of tissue that is larger than the size of the focal spot of the transducer.
In embodiment of the present disclosure, an additional method of delivering a FUS treatment is provided. The method may include advancing into a patient through a surgically created or naturally occurring opening a probe that contains at least a single pair of closed jaws each fitted with a FUS transducer, that may contain an imaging transducer mounted at the center of the jaws, that includes a means for localizing at least the end of the probe relative to the target or to an external landmark, and includes a means for coupling the transducer to the tissue to be treated through which is installed an acoustic window; under computer or manual control advancing the probe while using a flexible drive shaft system that can change the shape of the probe so as to adjust the position of the end of the probe and bring it to the correct region to be treated as indicated by the localization device; opening the jaws under computer or manual control so that the FUS transducers are deployed in the treatment position; creating a tissue coupling interface if required; adjusting the volume of the coupling so as to position the focal point of the transducer correctly in the region to be treated; imaging the region of interest by scanning the imaging crystal over the region to be treated; delivering to a first location a dose of FUS that is distributed over a wide entrance angle by rotating the jaws while delivering FUS; moving the transducer under computer or manual control to an at least second position as defined by the localization system by adjusting the shape of the flexible shaft; delivering an additional dose of HIFU at the new position of the transducer; thereby scanning the focal spot of the transducer over the region to be treated and delivering a dose of thermal or cavitational energy to a region of tissue that is larger than the size of the focal spot of the transducer.
Another method of delivering a FUS treatment is provided according to a further embodiment of the present disclosure. The method may include advancing into a patient through a surgically created or naturally occurring opening a probe that contains at least a single pair of closed jaws each fitted with a FUS transducer, that may contain an imaging transducer mounted at the center of the jaws, that includes optical means for visualizing the region to be treated, and includes a means for coupling the transducer to the tissue to be treated through which is installed an acoustic window; under computer or manual control advancing the probe while using a flexible drive shaft system that can change the shape of the probe so as to adjust the position of the end of the probe and bring it in proximity to the region to be treated; confirming the correct location of the probe by optical visualization; opening the jaws under computer or manual control so that the FUS transducers are deployed in the treatment position; creating a tissue coupling interface if required; adjusting the volume of the coupling so as to position the focal point of the transducer correctly in the region to be treated; delivering to a first location a dose of FUS that is distributed over a wide entrance angle by rotating the jaws while delivering FUS; moving the transducer to an at least second position confirmed by the optical visualization system by adjusting the shape of the flexible shaft under computer or manual control; delivering an additional dose of HIFU at the new position of the transducer; thereby scanning the focal spot of the transducer over the region to be treated and delivering a dose of thermal or cavitational energy to a region of tissue that is larger than the size of the focal spot of the transducer.
A further method of delivering a FUS treatment is provided according to an embodiment of the present disclosure. The method may include advancing into a patient through a surgically created or naturally occurring opening a probe that contains at least a single pair of closed jaws each fitted with a FUS transducer, that may contain an imaging transducer mounted at the center of the jaws, that includes a means for localizing at least the end of the probe relative to the target or to an external landmark, that includes optical means for visualizing the region to be treated, and includes a means for coupling the transducer to the tissue to be treated through which is installed an acoustic window; under computer or manual control advancing the probe while using a flexible drive shaft system that can change the shape of the probe so as to adjust the position of the end of the probe and bring it to the correct region to be treated as indicated by the localization device; confirming the correct location of the probe by optical visualization; opening the jaws under computer or manual control so that the FUS transducers are deployed in the treatment position; creating a tissue coupling interface if required; adjusting the volume of the coupling so as to position the focal point of the transducer correctly in the region to be treated; imaging the region of interest by scanning the imaging crystal over the region to be treated; delivering to a first location a dose of FUS that is distributed over a wide entrance angle by rotating the jaws while delivering FUS; moving the transducer under computer or manual control to an at least second position as defined by the localization system and confirmed by the optical visualization system by adjusting the shape of the flexible shaft; delivering an additional dose of HIFU at the new position of the transducer; thereby scanning the focal spot of the transducer over the region to be treated and delivering a dose of thermal or cavitational energy to a region of tissue that is larger than the size of the focal spot of the transducer.
A further method of delivering a FUS treatment is provided according to an embodiment of the present disclosure. The method may include advancing into a patient through a surgically created or naturally occurring opening a probe, a probe that contains at least a single FUS transducer at its end aligned with the long axis of the probe; under computer or manual control advancing the probe while using a flexible drive shaft system that can change the shape and direction of the probe so as to direct the end of the probe to the correct region to be treated as indicated by a localization device or US or optical imaging system incorporated into the probe; rotating the end of the probe so as to direct the transducer to the region to be treated; creating a tissue coupling interface if required; adjusting the volume of the coupling so as to position the focal point of the transducer correctly in the region to be treated; delivering to a first location a dose of FUS; moving the transducer under computer or manual control to an at least second position by adjusting the shape of the flexible shaft and/or adjusting the position of the transducer relative to the shaft; delivering an additional dose of HIFU at the new position of the transducer; thereby scanning the focal spot of the transducer over the region to be treated and delivering a dose of thermal or cavitational energy to a region of tissue that is larger than the size of the focal spot of the transducer.
The foregoing summary, as well as the following detailed description of the invention, will be better understood when read in conjunction with the appended drawings. For the purpose of illustrating the invention, there are shown in the drawings various illustrative embodiments. It should be understood, however, that the invention is not limited to the precise arrangements and instrumentalities shown. In the drawings:
a is a schematic diagram of the probe assembly shown in
b is a schematic diagram of a system or probe assembly according to an exemplary embodiment of the present disclosure, wherein a configuration of transducers may be controlled by one or more bend motors;
c is a schematic diagram of the probe shown in
a is an enlarged schematic diagram of a transducer arrangement of the probe shown in
b is a schematic diagram of a transducer arrangement according to an exemplary embodiment of the present disclosure;
a is a schematic diagram of a system or probe assembly according to an exemplary embodiment of the present disclosure, wherein a pair of transducers are shown in a closed or compact configuration;
b is a schematic diagram of the probe assembly shown in
c is a schematic diagram of a system probe assembly according to an exemplary embodiment of the present disclosure, wherein at least one imaging transducer may emit one or more beams;
d is a schematic diagram of the probe assembly shown in
e is another schematic diagram of the probe assembly shown in
f is a schematic of a system or probe assembly according the an exemplary embodiment of the present disclosure;
g is a schematic of a system or probe assembly according the an exemplary embodiment of the present disclosure;
a is a schematic diagram of a system or probe assembly according to an exemplary embodiment of the present disclosure;
b is a schematic diagram of the probe assembly shown in
c is a schematic diagram of the probe assembly shown in
Various embodiments of the present disclosure are described hereinafter with reference to the figures. It should be noted that the figures are not drawn to scale and elements of similar structures or functions are represented by like reference numerals throughout the figures. It should also be noted that the figures are not intended to facilitate the description of specific embodiments of the invention. The figures are not intended as an exhaustive description of the invention or as a limitation on the scope of the invention. In addition, an aspect described in conjunction with a particular embodiment of the present disclosure is not necessarily limited to that embodiment and can be practiced in any other embodiments of the present disclosure. It will be appreciated that while various embodiments of the present disclosure are described in connection with radiation treatment of tumors, the claimed disclosure has application in other industries and to targets other than cancers.
Any headings used herein are for organizational purposes only and are not meant to limit the scope of the description or the claims. Certain terminology is used in the following description for convenience only and is not limiting. As used herein, the word “may” is used in a permissive sense (e.g., meaning having the potential to) rather than the mandatory sense (e.g., meaning must). Similarly, the words “a,” “an” and “the” mean “at least one,” and the words “include,” “includes” and “including” mean “including, but not limited to.”
In one or more embodiments of the present disclosure, such as those depicted in
Referring to
A point at which one or more lines passing perpendicularly to, and/or through a center of, a surface of each transducer 12 may determine the focal point of the transducers 12. Space allowing, additional pairs of jaws may be installed at or attached to the distal end 14a of the drive shaft 14 to create a rosette of transducers 12 (see
As shown in
Referring to
The motor(s) 30, 32, 34, 36 that can be used to control the various states or configurations of the probe 10 can be housed at a proximal end thereof or can be mounted remotely at some distance from the probe 10 using long drive lines. The motor(s) 30, 32, 34, 36 can be activated manually and/or under computer control to alter the shape of the probe 10, the deployment of the transducers 12, and the rotation of the shafts and transducers 12. The motor(s) 30, 32, 34, 36 can be of types that can alter shape and position and orientation and deployment in discrete steps or continuously. The motor(s) 30, 32, 34, 36 also can be replaced by manual means for adjusting shape and position and orientation and deployment.
Referring to
In operation, the probe 10 may be inserted at least partially through a naturally occurring opening in a patient, such as the rectum, the urethra, the mouth or the nasal passage, for example, or through a surgically created opening. Referring to
Once the probe 10 is in the correct or appropriate location, the membrane may be partially or completely filled with fluid, the distal end of the membrane may be enlarged by an amount proportional to the amount of fluid instilled in the membrane, thereby positioning the distal end of the probe 10 a defined distance from the tissue to be treated. As shown in
As shown in
Alternatively, referring to
When employing an imaging transducer 12b that incorporates some form of array, the region to be imaged can be scanned by the transducer 12 directly. Where a single fixed crystal is employed, the crystal may be scanned mechanically over the region to be imaged. This can be done, while the imaging is activated, by adjusting in a continuous or stepwise fashion the shape and orientation of the flexible drive shaft 14 so that the imaging beam 46b is swept over the region of interest. Line data generated from each effective position of the imaging crystal can be compiled to generate 2-D or volumetric representations of the region. Positional information can be gathered for each position of the imaging crystal by the use of a magnetic localization device affixed to the end of the drive shaft 14 or by encoders affixed to the motors controlling the shape and orientation of the drive shaft 14.
In the example where the transducers 12 are mounted to a rotational means secured to the distal end 14a of the drive shaft 14 rather than as jaws (see, for example,
It will be appreciated by those skilled in the art that changes could be made to the embodiments described above without departing from the broad inventive concept thereof. It is understood, therefore, that this disclosure is not limited to the particular embodiments disclosed, but it is intended to cover modifications within the spirit and scope of the present disclosure as defined by the appended claims.
This application claims priority to U.S. Provisional Patent Application No. 61/818,987, filed May 3, 2013 and entitled “Flexible Endoscope Probe,” which is hereby incorporated by reference in its entirety.
Number | Date | Country | |
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61818987 | May 2013 | US |