DESCRIPTION OF THE DRAWINGS
FIG. 1
a is a perspective view of the tip of a solid applicator with an open tip, and having a source catheter positioned within emitting axially directed radiation at the tip.
FIG. 1
b is a perspective view of the embodiment of FIG. 1a, but with the source catheter advanced and emitting radiation isotropically.
FIG. 1
c is a perspective view of the tip of the embodiment of FIG. 1a, but with a closed tip which can be opened by advancement of the source catheter of FIG. 1a.
FIG. 1
d is a perspective view of the tip of the embodiment of FIG. 1c, but with the source catheter advanced and emitting radiation.
FIG. 2
a is a perspective view of the tip of a solid applicator having “paddle” shaped shielding elements deployed circumferentially at the tip of the applicator sheath, and showing proximal extensions of the shielding members for axial manipulation of the elements from outside the patient, and with an axially shielded source catheter positioned within the shielding members.
FIG. 2
b is a perspective view of the applicator tip of the embodiment of FIG. 2a with two of six shielding elements retracted and partially exposing the top side of the source catheter in order to emit radiation radially over a portion of the applicator circumference.
FIG. 2
c is a section taken through the shaft of the applicator of the embodiment of FIG. 2a.
FIG. 3
a is a perspective view of the tip of a two-part, coaxial attenuation embodiment to be positioned over the source catheter but within the sheath lumen, having castellated ends that in this view are so rotated as to act in concert to shield radial radiation completely.
FIG. 3
b is a perspective view of the embodiment of FIG. 3a, but with the two parts so rotated as to permit two opposed beams of radiation radially.
FIG. 4
a is a perspective view in partial section of the tip of a two-part attenuation embodiment, with open tip, to be positioned over the source catheter, each part having a window and the windows shown so rotated as to block all radial radiation emission.
FIG. 4
b is a perspective view of the embodiment of FIG. 4a, but with one window rotated and translated such that the window is partially open.
FIG. 4
c is a perspective view of the embodiment of FIG. 4a, but with the tip of the inner part capped to prevent radiation emissions distally.
FIG. 5 is a perspective view of a one-part attenuation embodiment to operate within the applicator sheath and over the source catheter, having an angularly truncated distal tip, and with a source catheter shown within, such that directional radiation is provided.
FIG. 6 is a perspective view of another one-part embodiment as in FIG. 5, but having a window through which radiation can emanate so as to provide directional radiation.
FIG. 7 is a cross sectional view of the tip of a one-part attenuating sheath having a tapered distal tip to provide varied attenuation.
FIG. 8 is a cross sectional view of the tip of a one-part attenuating sheath having a stepped distal tip to provide varied attenuation.
FIG. 9 is a perspective view of an applicator similar to that of FIG. 1b but including a balloon.
FIG. 10 is a perspective view of an applicator similar to that of FIG. 2b but including a balloon with the applicator affixed to the balloon at two points.
FIG. 11 is a side elevation view with partial sectioning showing a balloon applicator having a shielding apparatus similar to that of FIG. 4b and with the applicator sheath affixed to the balloon at two points.
FIG. 12 is a side elevation view of a balloon applicator having a one-part shield similar to that of FIG. 5.
FIG. 13 is a side elevation view of a balloon applicator having a one part shield similar to that of FIG. 6 with the applicator sheath affixed to the balloon at two points.
FIG. 14 is a side elevation view showing two axially shielding embodiments to attenuate proximally directed radiation, the one at right being a shielding section molded as part of the balloon or affixed on the balloon during or after balloon manufacture, and the embodiment at left being a solid attenuating flange with hub mounted slidably on the shaft of the applicator.
FIG. 15 is a side elevation view of a balloon applicator having an inflatable, attenuating balloon collar as an integral part of and proximal to the main applicator balloon.
FIG. 16 is a side elevation view of a balloon applicator and source having an independently inflatable collar mounted on the shaft of the applicator.
FIG. 17 is a schematic view of a balloon applicator positioned within breast tissue in the vicinity of a bone (rib) wherein the balloon has a shielding segment positioned adjacent to the bone so as to protect the bone from radiation.
FIG. 18 is a schematic view of an applicator and source positioned within breast tissue and having a solid flange shield as in FIG. 14 positioned on the applicator shaft at the entry into breast tissue.
DESCRIPTION OF PREFERRED EMBODIMENTS
The figures generally illustrate the shielding embodiments of the present invention wherein the shielding serves to selectively protect certain tissue structures while not interfering with prescribed radiation therapy. In the drawings, the straight sheath or shaft of the applicators illustrated are shown shorter than they would in fact be. Furthermore, balloons are depicted as being transparent in order to more clearly illustrate apparatus within the balloons.
FIG. 1
a shows a simple, solid, tubular attenuating applicator 10 having an open end 11, into the lumen of which is inserted a source catheter 12. Depending on the source and catheter characteristics, radiation can be emitted from the distal end. The degree of collimation will depend on the depth of the source within the applicator lumen. Such an applicator can be fashioned from a polymer like polyurethane, polypropylene, or a metal like stainless steel. In general, at least with electronic radiation sources, most metallic shielding totally absorbs any incident radiation in the range of interest for brachytherapy. If polymeric, attenuation can be controlled by filler additions into the material from which the applicator is made. Typical fillers might include barium sulfate or tungsten or stainless steel powder. Generally, the greater the filler component, the greater the degree of attenuation in the resulting filled material. In design, this applicator need be nothing more than a tube, perhaps extruded if polymeric, and drawn or machined if metallic.
FIG. 1
b illustrates how such an applicator 10 as shown in FIG. 1a might function when the source 13 is advanced to a position distal of the end of the applicator shaft. In this case, the radiation is shown as if the source is essentially isotropic, emitting radiation throughout generally a spherical envelope.
FIG. 1
c shows a variation of the applicator 10 of FIG. 1a, but with a closed tip which is separated into segments 14 which can hinge out of the way of the source catheter 12 as it is advanced. In this way, the embodiment shown is self-closing and can completely close off radiation when the catheter is withdrawn within the applicator rather than emitting radiation distally out of an open tip as in FIG. 1a. When the source and catheter are advanced, however, the tip opens by the segments hinging as shown in FIG. 1d, permitting radiation emission as in FIG. 1b. This can be accomplished with a polymeric material that tends to retain and to return to a preferred shape as in FIG. 1c.
FIGS. 2
a-2e show an applicator 20 having a central lumen 21 for positioning the source catheter 12 centrally within the applicator 20. The applicator 20 also has satellite lumina 24 for positioning and manipulating paddle-like attenuation members or fingers 22 positioned in slots 23 within the wall of the shaft or sheath of the applicator tip, into which the paddles can be partially or completely retracted. Paddles 22 have rod-like proximal extensions 25 operating in lumina 24 which can be used to manipulate the paddles or fingers from outside the patient's body, as indicated by the axial arrows. Alternatively, the paddles 22 and source 13 can function completely within the envelope of the applicator, never emerging axially from the tip of the applicator. In this embodiment, the applicator sheath 20 is fashioned from a polymer as described above, but with minimal attenuating filler, and more preferably without filler. The paddles are made of filler loaded, attenuating polymer such as that described above. They could also be metallic. In operation, retraction of selective paddles as shown in FIG. 2b will allow radiation emission in selective sectors around the circumference of the applicator. When positioned to act in concert, all radial emissions can be blocked or absorbed. Radiation can be swept rotationally by active use of the shielding members.
FIG. 2
c shows a cross section through the shaft or sheath of the applicator 12. The lumina 24 for operating the paddles 22 are arranged as satellites around the central lumen 21 through which the source and its catheter are passed. It must be appreciated that other than paddle shapes can be employed without departing from the scope this invention.
FIG. 3
a depicts a pair castellated tubes 31 and 32 designed to operate within the central lumen of the applicator (not shown), but generally surrounding the source catheter (not shown). When the tubes are positioned as shown in FIG. 3a, all radial emission is blocked. When positioned as shown in FIG. 3b, circumferential segments 33 of the applicator emit radiation. At intermediate relative rotations, those segments are narrower than when fully open, as shown. In the embodiment shown, the castellation notches are rectilinear. They could equally be other shapes to suit a given situation without departing from the invention. The materials for the two tubes is preferably metallic, or alternatively attenuating polymers containing fillers as described previously.
The embodiment shown in FIGS. 4a and 4b generally corresponds to that of FIGS. 3a and 3b, but rather than notches in the ends of the tubes, each tube 41, 42 has a window 43, 44 which can be positioned to cooperatively restrict the beam of radiation allowed to exit the applicator. The beam can be restricted axially by axial adjustment of one tube relative to the other, and it can be limited circumferentially by relative rotation (see arrows). Depending on the attenuation properties chosen, the beam can be partially blocked (one tube thickness of attenuation) or not attenuated (open window). By blocking the end of one or both tubes, by a disc 45 integral with tube 42 for example, axial (distal) radiation can be blocked as well.
FIGS. 5 and 6 show one-part shield embodiments 50, 60 that comprise tubes which can be manipulated (see arrows) to operate within the applicator lumen (not shown) and outside of the source catheter 12, or alternatively outside the applicator shaft or sheath, or still further, can comprise the applicator sheath itself. The end can be shaped arbitrarily to suit the situation at hand. FIG. 5 shows a truncated, obliquely angled tip 51 whereas FIG. 6 shows a window 61 which can optionally have a sealed tip 62 (as shown). With such a shielding apparatus, the materials of construction are preferably attenuating.
FIGS. 7 and 8 show applicator tips 71, 81 which have graduated levels of shielding attenuation along their length by virtue of their geometry—the more distal, the less attenuating. In the embodiments shown, one tip 72 is tapered (FIG. 7), and the other tip 82 stepped (FIG. 8). If the source is positioned near the distal tip of the applicator, the radial radiation is more intense. if more proximal, the radiation is less intense. The tip may be open (as shown) or optionally sealed to prevent axial emission.
FIG. 9 depicts a balloon applicator apparatus corresponding in part to the applicator described in FIGS. 1a, b, but having a balloon 100 affixed to the shaft or sheath of the applicator 103 at point 102. A conventional hub 101 is affixed to the proximal end of the applicator shaft or sheath in order to provide for both source catheter 12 introduction through the in-line port which is fitted with seals (not shown) to prevent balloon leakage past the catheter shaft, and for inflation of balloon 100 through the auxiliary port, a connecting lumen within the wall of the applicator shaft, and through a port in the shaft into the balloon. The elements of the inflation circuit are not detailed since they are standard within the industry.
FIG. 10 depicts a balloon applicator apparatus corresponding in part to the applicator described in FIGS. 1a, b, but having a balloon 100 affixed to the shaft or sheath of the applicator 103 at point 102. A conventional hub 101 is affixed to the proximal end of the applicator shaft or sheath in order to provide for both source catheter 12 introduction through the in-line port which is fitted with seals (not shown) to prevent balloon leakage past the catheter shaft, and for inflation of balloon 100 through the auxiliary port, a connecting lumen within the wall of the applicator shaft, and through a port in the shaft into the balloon. The elements of the inflation circuit are not detailed since they are standard within the industry.
FIG. 11 depicts a balloon applicator apparatus incorporating shielding elements similar to those of FIGS. 4a, b, but having a balloon 120 affixed to the applicator shaft at point 121 on applicator shaft 122. Within applicator shaft lumen, but outside the source catheter 12, are the two tubular shielding tubes 41 and 42 each having windows 43 and 44, and extending distally to be received by cup 124, providing rotating fixation of the balloon 120 relative to the applicator axis at two points. At the proximal end of the applicator shaft is a conventional hub 123. The source catheter and shielding tubes all pass concentrically through the straight port, with conventional seals (not shown) between adjacent parts to prevent balloon leakage. The auxiliary port is for inflation of the balloon 120 through a connecting lumen within the wall of the applicator shaft, and a port in the shaft into the balloon. The elements of the inflation circuit are not detailed since they are standard within the industry.
FIG. 12 depicts applicator apparatus having a truncated, oblique shield sleeve 131 similar to that described in FIG. 5, but with a balloon 130 affixed to applicator sheath 133 at a point 132. A conventional hub 134 is affixed to the proximal end of applicator sheath 133 to provide for introduction of the source catheter 12 and the shield sleeve 131, each of which must be properly sealed. The auxiliary port is for inflation of balloon 130 through this port, a connecting lumen within the wall of the applicator shaft, and through a port in the shaft into the balloon. The elements of the inflation circuit are not detailed since they are standard within the industry.
FIG. 13 depicts applicator apparatus having a shield sleeve 141 with window, similar to that described in FIG. 6, but with its distal tip extended, and a balloon bonded or otherwise affixed to the applicator shaft 143 at a point 142. The distal extension of shield sleeve 141 cooperates with a balloon mounted cup 145 to provide a rotational fixation between sleeve 141 and balloon 140, thus providing two point balloon fixation as previously described. A conventional hub 144 is affixed to the proximal end of applicator shaft 143 to provide for introduction of the source catheter 12 and the shield sleeve 141, each of which must be properly sealed. The auxiliary port is for inflation of balloon 140 through this port, a connecting lumen within the wall of the applicator shaft, and through a port in the shaft into the balloon. The elements of the inflation circuit are not detailed since they are standard within the industry.
FIG. 14 depicts a balloon applicator 148 having two alternate shielding apparatus for preventing, or at least attenuating, radiation directed along the applicator shaft 159, proximal of a balloon 150. To the right is an attenuating portion 151 of the balloon itself. This portion can be an integral portion of the balloon, with a hub as shown, or alternately without a hub, either molded in place or bonded to the balloon after or as part of fabrication, or as a segmental part of the balloon itself and included in the fabrication process. Preferably it is of polymer and filled with attenuating filler as previously described and sufficiently flexible so as to expand with the balloon upon inflation. To the left in FIG. 15 is a stand-alone flange 152 with collar 153 to affix the flange to the applicator shaft, as an alternate embodiment. The flange is solid and is optionally movable along the applicator shaft 159 (see arrow) by a sliding fit tight enough to retain its set position, or alternately having a conventional clamp or bonded fastening. The flange material is preferably a filled polymer, but could be metallic.
FIG. 15 depicts a balloon applicator 158 having a balloon 160 which in turn has an integral inflatable torus 161 located on an applicator shaft 169 proximal of the main balloon 160. The torus 161 is preferably a filled polymer, acting as a radiation shield that is deployed as the balloon 160 is inflated.
The embodiment 168 of FIG. 16 is similar to that of FIG. 15, but in this instance, the torus 171 mounts on an applicator shaft 169 proximal of main balloon 170. With appropriate accommodation for inflation, as for example by a separate tube outside the applicator shaft, the torus 171 can be movable on shaft 169. It could also be fixed axially, and have an internal inflation as has been described for the main balloons. This torus is also preferably of a filled polymer.
FIG. 17 shows an applicator 178 similar to the apparatus described in FIGS. 1a, 1b and FIG. 10, except that a segment 181 of the balloon 180 is made attenuating by adding attenuating material to one portion of the balloon. The applicator is shown within breast tissue 178, and adjacent to a bone, in this example, a rib 182, with the attenuating material situated between the source 179 and the rib.
FIG. 18 shows an applicator 188 with balloon 190 and source 192 within breast tissue 19 and having a solid flange 189 as described in FIG. 14 (to the left) mounted on the applicator shaft 191. The flange 189 in this embodiment is shown slightly cupped to conform to the breast surface. In other applications, the flange may optionally be shaped to accommodate different anatomy.
An important feature of most of the above embodiments is that a radiation shield is included on an applicator, the shield having radiation attenuating properties that vary with position. Such variation with position includes positions beyond the shield, where no attenuation occurs, and includes positions where a hole may occur in a shield, for zero attenuation at that hole or window. Thus, variation with position is intended to include a simple shield wherein the x-ray source is positioned so as to have its radiation attenuated by the shield or positioned so as not to have its radiation attenuated.
The above described preferred embodiments are intended to illustrate the principles of the invention, but not to limit its scope. Other embodiments and variations to these preferred embodiments will be apparent to those skilled in the art and may be made without departing from the spirit and scope of the invention as defined in the following claims.
Patent Application
20080009658
