The present invention relates to implantable sensor devices and related systems and methods.
Radiation therapy is used to treat localized cancers or other conditions. Examples of radiation therapy treatments include conventional external beam radiation therapy, as well as three-dimensional conformal external beam radiation, intensity modulated radiation therapy (IMRT), a “gamma knife” that employs a highly focused gamma ray radiation obtained from crossing or collimating several radiation beams, stereotactic radiosurgery and brachytherapy.
The efficacy of the radiation treatment can depend on the total dose of radiation delivered to the target region. However, the amount of radiation effectively delivered to the target region (as well as the amount delivered to healthy tissue) can vary from a desired or planned amount. The variation can be particularly problematic when radiation therapy is used on deep tumors, when the therapy is delivered to tumors located close to healthy sensitive regions or organs, and/or when complex beam shapes are employed.
Typically, the radiation therapy is directed not only to the known tumor location, but also to healthy tissue proximate the tumor based on a treatment margin. Unfortunately, to compensate for the potential for imprecise radiation delivery, the planned treatment margin may be increased. As radiation can be detrimental to healthy tissue, a therapy goal should be to use smaller treatment margins while delivering radiation doses in the planned amounts and to the planned location. However, delivering external beam radiation doses in the desired dose amount to the actual tumor treatment site can be complicated as the tumor and/or markers used to locate and guide the radiation therapy may shift over time, either during or between radiation sessions.
For example, tumor motion can occur during the active delivery of the radiation due to normal biophysical actions. That is, in certain locations in the body, such as in the prostate, movement of target tissue may occur during radiation treatment, primarily attributable to the patient's breathing or filling and/or voiding of the bladder. Thus, dynamic changes in the position of the tumor during active radiation delivery can increase the potential of collateral damage to healthy or non-targeted tissue.
In the past, systems using positional markers have been proposed to determine spatial positioning information for targets from within a patient's body. Such localization may be used to direct or guide the radiation therapies. For example, ACCULOC® is an image-guided localization system that includes both hardware and software to provide localization based on implanted gold markers for an internal reference system. ACCULOC® employs gold spheres as bone markers in cranial and spinal applications, and cylindrical gold markers for soft tissue applications that can be inserted using a needle. These markers may be visible on standard port films as well as electronic portal imaging devices (EPID). Other procedures may also benefit from acquiring spatial knowledge during administration of a therapy to focus external energies to a desired targeted internal location, such as ultrasonic radiation treatments, microwave or RF ablation therapies, and localized ultrasonic or light activation of drugs.
Accordingly, there remains a need for improved or alternate techniques for providing localization data for target regions.
According to some embodiments of the present invention, an implantable biocompatible sensor unit includes a sensor body comprising a biocompatible material and having at least one sensor element configured for in vivo placement proximate a tumor treatment site. The sensor element is configured to provide data corresponding to treatment of the tumor treatment site. The sensor unit further includes a transmitter coil and associated electronic components within the sensor body configured for wireless transmittal of the data to a spatially remote receiver. In addition, the sensor unit includes a high-atomic weight member within the sensor body that is configured to be detectable by an imaging modality. The sensor unit is configured to be inductively powered to wirelessly transmit the data to the remote receiver while remaining implanted proximate the tumor treatment site.
According to other embodiments of the present invention, a medical system for patients undergoing treatment for cancer includes at least one wireless implanted sensor unit configured for in vivo placement proximate a tumor treatment site, and an external reader configured to inductively power the at least one sensor unit. The sensor unit includes a high-atomic weight member held in a biocompatible housing. The high-atomic weight member is configured to be visualized as a fiducial marker by an imaging modality. The sensor unit is configured to provide data including at least one sensed internal parameter, and is configured to be inductively powered to wirelessly transmit the data. The external reader is configured to receive the data from the at least one sensor unit, and the system is configured to dynamically monitor selected in vivo parameters associated with one or more of dose and/or processing of a therapy administered to the tumor treatment site based on the data from the at least one sensor unit.
According to further embodiments of the present invention, a method for treating a patient for cancer includes positioning at least one wireless sensor unit including at least one sensor element and a high-atomic weight member in the body of the patient proximate a tumor treatment site. A position of the sensor unit proximate to the tumor treatment site is determined using an imaging modality based on the high-atomic weight member. A radiation therapy is administered to the patient based on the determined position, and a signal is detected in vivo from the at least one sensor unit corresponding to the dose of the administered therapy proximate the tumor treatment site. Administration of the radiation therapy is also dynamically adjusted responsive to changes in the determined position.
Advantageously, the systems, methods, and devices of the present invention can act as positional markers and may monitor, in real time and/or dynamically, radiation dose, fluorescence, temperature, and/or specific indices associated with tumor physiology or other desired internal parameters to affirm therapeutic treatments. Embodiments of the present invention may be particularly suitable for oncology applications.
The present invention now will be described more fully hereinafter with reference to the accompanying drawings, in which embodiments of the invention are shown. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. Like numbers refer to like elements throughout. In the drawings, like numbers refer to like elements throughout, and thickness, size and dimensions of some components, lines, or features may be exaggerated for clarity. The order of operations and/or steps illustrated in the figures or recited in the claims are not intended to be limited to the order presented unless stated otherwise.
Certain embodiments of the present invention are directed to operations that determine the in situ location of implanted sensor units that are adapted to detect, at sufficient intervals, one or more parameters, such as radiation received internally to a target tumor treatment site and/or to non-targeted healthy tissue or sensitive sites. The radiation doses may be delivered by an external beam therapy system. The target site may be any internal region undergoing analysis or therapy, and may be a site associated with tumors such as cancerous tissue. That is, the target site may be a localized cancerous tumor or a site where the tumor has been excised. As such, the excision site and/or tissue proximate thereto may be the target site. In certain embodiments, non-target sites may also be monitored for selected internal parameters or conditions. In particular embodiments, sensitive or non-target sites may be monitored to detect radiation dose received thereat, as desired. The radiation dose may be detected using additional implanted sensor units and/or disposable externally mounted radiation sensor patches. For additional discussion of suitable disposable (typically single-use) external radiation sensor patches, see co-pending U.S. patent application Ser. No. 10/303,591, filed Nov. 25, 2002, the contents of which are hereby incorporated by reference as if recited in full herein.
Fiducial markers may be used to help align the patient and compensate for patient motion during external beam radiation therapy. Since many linear accelerators (LINACs) may not have the capability to image using diagnostic x-ray, it may be difficult to locate an implanted sensor unit, due to a lack of significant contrast with the surrounding soft tissue. Accordingly, in some embodiments of the present invention, a high-atomic weight material, such as gold, is added to the sensor unit (for example, in the form of a gold wire coil or clip). Some advantages of the use of a high-atomic weight member in an implantable sensor unit may include improved visualization on MV (mega voltage) images obtained during radiation therapy. For example, a sensor unit may be visible with relatively high contrast on diagnostic x-ray and/or CT images (at energies between about 80-120 kVp). However, during radiation therapy, port films may be acquired using the treatment beam, which may usually be between about 6 MV and about 18 MV, and the sensor unit may not be as visible at these energies. Accordingly, when a high atomic weight material, such as gold, is added to the sensor unit, the sensor unit may be imaged with improved contrast during radiation therapy in relation to the surrounding tissue, and can be used to align the patient and/or compensate for patient motion through continuous tracking.
As such, the sensor units and methods of the present invention can be useful in many applications, such as, for example, pulmonary, gastrointestinal, neuroscience and pre-clinical research. Nonetheless, the present invention is believed to have particular importance and suitability for in vivo treatment of cancer.
In certain embodiments, the sensor units can be implanted relatively deep in the body of the subject and may remain in the body for a 1-8 week period or even longer in order to provide in vivo evaluation and monitoring of tumors prior to, during, and subsequent to an active treatment, and preferably over an entire treatment regime or period. As such, the internal in situ sensors of the present invention are preferably configured to be biocompatible and provide a service life suitable for episodic treatment evaluation of at least about 1-8 weeks, whether exposed to radiation, chemotherapy, heat or ionic electric fields (such as the treatment provided by a Thermotron® system) directed to the tumor. Additional description of suitable sensor units is found in U.S. Pat. Nos. 6,402,689, 7,010,304, and 7,011,814, and in pending U.S. patent application Ser. Nos. 10/551,366 and 10/779,907, the disclosures of which are incorporated by reference herein in their entireties. The sensor units are configured with internally mounted electronics that wirelessly communicate with an external reader. The sensor units can be configured as a miniaturized elongate (medical grade glass encapsulated or suitable aluminosilicate material) sensor body having a length of about 25 mm or less and a width of about 3 mm or less implantable via a trocar. More particularly, in some embodiments, the sensor body may have a length of about 20 mm and a width of about 2.1 mm. The sensor body itself may be radio-opaque and/or may use radio-opaque coatings for visibility on CT or X-ray scans.
The sensor units can be configured as radiation sensors that can be used to detect, confirm, or verify irradiation doses delivered during photon irradiation treatment (cumulatively, typically in the range of between about 3000-6000 cGy, with each treatment optionally being increments of the total, such as 150-500 cGy). Thus, use of a radiation sensor during real time delivery can help control a more precise delivery dose of radiation to the tumor treatment site. Data regarding the distribution of dose within the tumor following irradiation and/or verification of a calculated or planned dose, may be particularly of interest as complex beam shaping, high dose conformal therapy, or beams at oblique angles may not consistently deliver the planned dose. In certain embodiments, the sensor units may be β radiation monitors used to monitor radioactively labeled compounds, drug uptake and/or utilization, blood flow in the tumor, sensitivity to specific drugs, drug distribution, labeled-glucose (or bio-constituent or metabolite thereof) or another analyte of interest in various locations or organs (as well as cell proliferation as discussed above).
Patients according to the present invention can be any animal subject, and are preferably mammalian subjects (e.g., humans, canines, felines, bovines, caprines, ovines, equines, rodents, porcines, and/or lagomorphs), and more preferably are human subjects.
The present invention is described herein with reference to flowchart illustrations and/or block diagrams of operations, methods and computer program products according to embodiments of the invention. It will be understood that each block of the flowchart illustrations and/or block diagrams, and combinations of blocks in the flowchart illustrations and/or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, embedded processor or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions specified in the flowchart and/or block diagram block or blocks.
These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the flowchart and/or block diagram block or blocks.
The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart and/or block diagram block or blocks.
As will be appreciated by one of skill in the art, the present invention may be embodied as a system, method, data or signal processing system, or computer program product. Accordingly, the present invention may take the form of an embodiment combining software and hardware aspects. Furthermore, the present invention may, in part, take the form of a computer program product on a computer-usable storage medium having computer-usable program code means embodied in the medium. Any suitable computer readable medium may be utilized including hard disks, CD-ROMs, optical storage devices, or magnetic storage devices.
The computer-usable or computer-readable medium may be, for example but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, device, or propagation medium. More specific examples (a non-exhaustive list) of the computer-readable medium would include the following: an electrical connection having one or more wires, a portable computer diskette, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), an optical fiber, and a portable compact disc read-only memory (CD-ROM). Note that the computer-usable or computer-readable medium could even be paper or another suitable medium, upon which the program is printed, as the program can be electronically captured, via, for instance, optical scanning of the paper or other medium, then compiled, interpreted or otherwise processed in a suitable manner if necessary, and then stored in a computer memory.
Computer program code for carrying out operations of the present invention may be written in an object oriented programming language such as Java7, Smalltalk or C++. However, the computer program code for carrying out operations of the present invention may also be written in conventional procedural programming languages, such as the “C” programming language or even assembly language. The program code may execute entirely on the user's computer, partly on the user's computer, as a stand-alone software package, partly on the user's computer and partly on a remote computer or entirely on the remote computer. In the latter scenario, the remote computer may be connected to the user's computer through a local area network (LAN) or a wide area network (WAN), or the connection may be made to an external computer (for example, through the Internet using an Internet Service Provider).
The flowcharts and block diagrams used herein illustrate systems and/or operations that can be used to obtain and/or analyze localization data for telemetric (wirelessly operated) implantable sensor units. The analysis of the localization and a data can be carried out to provide real-time data on spatial location (i.e., movement) of a tumor during active delivery of a therapy such as, but not limited to, external beam radiation therapy. This spatial data can be interfaced with a delivery system to control the delivery of the therapy based on the spatial location of the tumor. For example, the spatial data can be used with a radiation (external beam) therapy system to thereby control, direct, guide, and/or gate (gate meaning direct the “on” or “off” of a radiation beam transmitted into the body) during an external beam radiation therapy session.
The flowcharts and block diagrams used herein also illustrate systems and/or operations that telemetrically obtain and/or analyze data associated with radiation measurements from the telemetric implantable sensor units. In this regard, each block in the flow charts or block diagrams represents a module, segment, or portion of code, which comprises one or more executable instructions for implementing the specified logical function(s). It should also be noted that in some alternative implementations, the functions noted in the blocks may occur out of the order noted in the figures. For example, two blocks shown in succession may be executed substantially concurrently or the blocks may sometimes be executed in the reverse order, depending upon the functionality involved.
Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and/or the present specification and will not be interpreted in an idealized or overly formal sense unless expressly so defined herein.
Turning now to the figures,
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As mentioned above, the sensor unit 10 includes a high-atomic weight member 110 within the sensor body 10b that can be detected by an imaging modality. As used herein, a “high-atomic weight” member or element may refer to an element (and/or alloys/mixtures thereof) having an atomic weight of greater than about 180 atomic mass units (amu) and having a sufficient radio opacity to provide visual contrast when imaged using an imaging modality such as MV imaging. Examples of such high-atomic weight elements may include gold (Au) and platinum (Pt). As shown in
The sensor unit 10 can be held in a hermetically sealed encapsulated housing 10c, such as a glass capsule or other medically suitable material that is substantially impermeable. The sensor unit 10 electronics 10e can, for example, include a microprocessor controller that controls data acquisition and reader/sensor unit communications that can be mounted on a ceramic substrate. The electronics 10e can include custom chip designs with routings to semiconductor chips provided for data acquisition. For example, the electronics 10e may include an ASIC that includes data acquisition and communications electronics on a single chip. The sensor unit 10 can include a bidirectional antenna. The sensor unit 10 can be configured with digital communication components (such as a digital signal processor) using a 12-16 bit data acquisition that can provide about a 1 mV or less resolution (or better) of the Vth measurement and may operate with a 16-bit CRC error checking capacity. For example, in some embodiments, the sensor unit 10 may include a 14-bit ADC with about 0.26 mV resolution. The electronics 10e can be potted in Class VI USP epoxy and hermetically sealed inside the capsule 10c. The external surface or body of the capsule can be coated with a Parylene C material or other biocompatible coating. The sensor unit can be EO sterilized and adapted to be suitable for chronic in vivo implantation as described. The sensor body itself (or portions of the sensor body) may be radio-opaque for visual contrast in CT scans and port films and the like. Additional description of exemplary sensor unit housing configurations can be found in co-pending U.S. patent application Ser. No. 10/353,857, the disclosure of which is incorporated by reference herein in its entirety.
For systems where multiple sensors 10 are used, the external reader 30 can be configured to serially poll each sensor at the same frequency, with each sensor having a unique RF identification data bit or bits allowing identification and individual interrogation. The multiple sensors may be placed adjacent or in tumors or proximate normal or non-targeted tissue or organs. Such placement can be selected to allow for external monitoring of doses received proximate sensitive and/or non-targeted sites, such as the thyroid, heart, or proximate the tumor or targeted treatment region.
The sensor unit 10 further includes at least one high-atomic weight member 110 that is configured to be detected by an imaging modality (not shown), such as MV, CT, X-ray, and/or other means that provide images of spatial location. For example, the high-atomic weight member may be gold (Au) and/or platinum (Pt). As shown in
A spatial data processor 20 may be configured to determine the position and/or orientation of the sensor based on detection of the high-atomic weight member 110 via the imaging modality. In some embodiments, the external reader 30 and the spatial data processor 20 may be housed in the same primary housing unit and/or may share the same or portions of the same data or computer processing system. In other embodiments, the external reader 30 and the spatial data processor 20 may be separate units held in different housings. For example, the external reader 30 may be included in a radiation dose reader, a separate reader, and/or a combined reader, while the spatial data processor 20 may be included in the imaging modality.
For additional description of the sensor unit 10 and reader 30, see U.S. Pat. No. 6,402,689 and co-pending U.S. patent application Ser. No. 10/127,207; the contents of these documents are hereby incorporated by reference as if recited in full herein. Suitable sensor units and telemetric readers may be provided by the DVS® system available from Sicel Technologies, Inc., located in Morrisville, N C. For example, in some embodiments, the sensor unit 10 may be a miniature DVS® sensor manufactured by Sicel Technologies, Inc. The sensor unit 10 may have dimensions of about 20 mm×2.1 mm, and may be configured to pinpoint the tumor treatment site 15 during a patient's treatment cycle and also to measure the amount of radiation received at or proximate to the tumor treatment site 15. Accordingly, sensor units according to some embodiments of the present invention may facilitate the visualization of tumor localization and provide actual dose information at the tumor location, which may be beneficial to accuracy in providing radiation therapy treatment.
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In certain embodiments, the system 100 can be configured to individually selectively (serially) poll, address, and/or interrogate a selected implanted sensor unit 10. The sensor units 10 can be configured to operate or wirelessly communicate with the reader 30 at the same frequency. The read range between the external reader 30 and the implanted sensor units 10 may be between about 5 cm-15 cm, and is typically less than about 12 cm, depending on the particular configuration of the sensor units 10. For example, the read range for a sensor unit 10 including a gold coil may be about 11 cm or less, as compared to a read range of about 12-14 cm or less for a sensor unit including a conventional copper coil. Also, the sensor units 10 may be implanted at least 3 cm deep. To control and/or identify which of the sensor units 10 are in active communication mode, a single or multi-bit identifier can be communicated to the reader 30 by the sensor units 10 in the data stream. For example, in some embodiments, each sensor unit 10 includes a unique 32-bit identifier, and the reader 30 addresses each sensor unit 10 using this identifier.
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In certain embodiments, the selected internal parameter is radiation dose detected by the at least one implanted sensor unit. For example, where the sensor unit includes two axially spaced apart high-atomic weight members 110a and 110b (for instance, as illustrated in
As will be appreciated by those of skill in the art, the operating system 352 may be any operating system suitable for use with a data processing system, such as OS/2, AIX or OS/390 from International Business Machines Corporation, Armonk, N.Y., WindowsCE, WindowsNT, Windows95, Windows98, Windows2000, WindowsXP or Windows XT from Microsoft Corporation, Redmond, Wash., PalmOS from Palm, Inc., MacOS from Apple Computer, UNIX, FreeBSD, or Linux, proprietary operating systems or dedicated operating systems, for example, for embedded data processing systems.
The I/O device drivers 358 typically include software routines accessed through the operating system 352 by the application programs 354 to communicate with devices such as I/O data port(s), data storage 356 and certain memory 314 components and/or the image acquisition system 320. The application programs 354 are illustrative of the programs that implement the various features of the data processing system 305 and preferably include at least one application that supports operations according to embodiments of the present invention. Finally, the data 356 represents the static and dynamic data used by the application programs 354, the operating system 352, the I/O device drivers 358, and other software programs that may reside in the memory 314.
The I/O data port(s) can be used to transfer information between the data processing system and another computer system or a network (e.g., the Internet) or to other devices controlled by the processor. These components may be conventional components such as those used in many conventional data processing systems, which may be configured in accordance with the present invention to operate as described herein.
While the present invention is illustrated, for example, with reference to the computation module 350 being an application program in
A signal corresponding to the dose and/or processing of the administered therapy proximate to the tumor treatment site is detected in vivo from the at least one sensor unit (block 1130). For example, as discussed above, the sensor unit may include first and second to sensor elements in opposing ends thereof and may be configured to transmit a signal indicating the dose of radiation delivered to each sensor element. The signal(s) from the sensor unit(s) are relayed to a location external of the patient's body (block 1140). For example, the signals may be relayed to an external reader, such as the reader 30 of
The foregoing is illustrative of the present invention and is not to be construed as limiting thereof. Although a few exemplary embodiments of this invention have been described, those skilled in the art will readily appreciate that many modifications are possible in the exemplary embodiments without materially departing from the novel teachings and advantages of this invention. Accordingly, all such modifications are intended to be included within the scope of this invention as defined in the claims. In the claims, means-plus-function clauses are intended to cover the structures described herein as performing the recited function and not only structural equivalents but also equivalent structures. Therefore, it is to be understood that the foregoing is illustrative of the present invention and is not to be construed as limited to the specific embodiments disclosed, and that modifications to the disclosed embodiments, as well as other embodiments, are intended to be included within the scope of the appended claims. The invention is defined by the following claims, with equivalents of the claims to be included therein.
This application claims priority to U.S. Provisional Application Ser. No. 60/949,321, filed Jul. 12, 2007, the disclosure of which is incorporated by reference herein in its entirety.
Number | Date | Country | |
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60949321 | Jul 2007 | US |