Radiation treatment planning and delivery for moving targets in the heart

Abstract

Method and systems are disclosed for radiating a moving target inside a heart. The method includes acquiring sequential volumetric representations of an area of the heart and defining a target tissue region and/or a radiation sensitive structure region in 3D for a first of the representations. The target tissue region and/or radiation sensitive structure region are identified for another of the representations by an analysis of the area of the heart from the first representation and the other representation. Radiation beams to the target tissue region are fired in response to the identified target tissue region and/or radiation sensitive structure region from the other representation.

1 . A method of radiating a moving target inside a heart, the method comprising:
 A acquiring sequential volumetric representations of an area of the heart;   B defining a target tissue region and/or a radiation sensitive structure region in 3-dimensions (3D) for a first of the representations;   C identifying the target tissue region and/or radiation sensitive structure region for another of the representations by an analysis of the area of the heart from the first representation and the other representation; and   D firing radiation beams to the target tissue region in response to the identified target tissue region and/or radiation sensitive structure region from the other representation.   
   
   
       2 . The method of  claim 1 , wherein steps B and/or C include using a method selected from the group of: (1) volume rendering, (2) maximum intensity projection, (3) minimum intensity projection, (4) X-ray projection, (5) haptic feedback, (6) virtual fly-through, (7) stereoscopic 3D rendering and, (8) virtual reality. 
   
   
       3 . The method of  claim 1 , wherein steps B and/or C include outlining contours of the target tissue region and/or a radiation sensitive structure region in 3D. 
   
   
       4 . The method of  claim 1 , wherein step C includes expanding the target tissue region and/or a radiation sensitive structure region with a margin based on the motion of the target tissue region and/or the radiation sensitive structure region. 
   
   
       5 . The method of  claim 4 , wherein the margin used includes the full motion of the tissue target region and/or the radiation sensitive structure region. 
   
   
       6 . The method of  claim 4 , wherein the margin used has been drawn to contain the full tissue target region and/or the radiation sensitive structure region some fraction of the time. 
   
   
       7 . The method of  claim 6 , wherein margins are drawn for more than one fraction. 
   
   
       8 . The method of  claim 1 , wherein the target comprises heart muscle extending through a wall of the heart from a first surface to a second surface, and wherein steps B and/or C include visualizing through the heart muscle in 3D so as to ensure transmurality of the target. 
   
   
       9 . The method of  claim 1 , further comprising registering an electrogram to the CT volumes 
   
   
       10 . The method of  claim 1 , wherein the sequential volumetric representations are acquired over one cardiac cycle. 
   
   
       11 . The method of  claim 1 , wherein the sequential volumetric representations are acquired over one respiratory cycle. 
   
   
       12 . The method of  claim 1 , wherein firing radiation beams to the target tissue region includes firing a series of radiation beams along different trajectories from outside the patient and through intervening tissue toward the target tissue region. 
   
   
       13 . The method of  claim 1 , wherein one or more of steps A, B, C, D include a processor configured with machine-readable code embodying instructions for performing the step. 
   
   
       14 . A method of radiating a moving target of a wall of a heart, the method including the steps of:
 A acquiring at least one volume of the heart;   B defining the target tissue region and/or critical structure region in 3D so that the target tissue region extends through the wall of the heart;   C computing a dose distribution; and   D firing radiation beams to the target to obtain the simulated dose distribution transmurally through the wall of the heart.   
   
   
       15 . The method of  claim 14 , wherein step B includes using a method selected from the group of: (1) volume rendering, (2) maximum intensity projection, (3) minimum intensity projection, (4) X-ray projection, (5) haptic feedback, (6) virtual fly-through, (7) stereoscopic 3D rendering, (8) virtual reality and (9) multi-planar, oblique and curved reconstructions. 
   
   
       16 . The method of  claim 14 , wherein step B includes outlining contours of the target tissue region and/or a radiation sensitive structure region. 
   
   
       17 . The method if  claim 14 , wherein at least two sequential computed tomography (CT) volumes of the heart are acquired during a cardiac cycle or respiratory cycle or both, where the target comprises heart muscle, and further comprising ensuring transmurality of the target using the two or more sequential volumes. 
   
   
       18 . The method of  claim 17 , wherein step C includes computing separate dose distribution for each CT volume and combining them. 
   
   
       19 . The method of  claim 17 , wherein step C includes determining nodes using CT data from a series of volumes defining a volumetric movie. 
   
   
       20 . The method of  claim 17 , further comprising registering an electrogram to the CT volumes 
   
   
       21 . A method of radiating a moving target inside the heart, the method comprising:
 A acquiring a computed tomography (CT) volume;   B defining a transmural target tissue region;   C computing a dose distribution;   D visualizing the dose distribution using volume or surface rendering in 3-dimensions (3D) so as to verify transmurality; and   E. delivering the dose using radiation beams to the transmural target tissue region.   
   
   
       22 . The method of  claim 21  wherein step D includes a method selected from the group of: (1) volume rendering, (2) maximum intensity projection, (3) minimum intensity projection, (4) X-ray projection, (5) haptic feedback, (6) virtual fly-through, (7) stereoscopic 3D rendering, (8) virtual reality and (9) multi-planar, oblique and curved reconstructions. 
   
   
       23 . The method of  claim 21 , wherein step C includes computing radiation beam trajectories from outside the patient toward the target tissue region. 
   
   
       24 . The method of  claim 21 , wherein one or more of steps A, B, C, D include a processor configured with machine-readable code embodying instructions for performing the step. 
   
   
       25 . The method if  claim 21 , wherein at least two sequential CT volumes of the heart are acquired during a cardiac cycle or respiratory cycle or both, where the target comprises heart muscle, and further comprising ensuring transmurality of the target using the two or more sequential volumes. 
   
   
       26 . A system for radiating a moving target inside a heart, the system comprising:
 a volume acquisition system for acquiring at least one computed tomography (CT) volume of an area of the heart;   a processor coupled to the volume acquisition system, the processor configured for:
 defining the target tissue region and/or critical structure region in 3-dimensions (3D); 
 computing a dose distribution; 
   a robot coupled to the processor; and   a radiation beam source supported by the robot and coupled to the processor;   the processor being configured with machine-readable code embodying instructions for firing a series of the radiation beams from the radiation source so as to treat the target tissue region.   
   
   
       27 . The system of  claim 26 , wherein defining the target tissue region and/or critical structure region in 3D is selected from the group of: (1) volume rendering, (2) maximum intensity projection, (3) minimum intensity projection, (4) X-ray projection, (5) haptic feedback, (6) virtual fly-through, (7) stereoscopic 3D rendering, (8) virtual reality and (9) multi-planar, oblique and curved reconstructions. 
   
   
       28 . The system of  claim 26 , wherein the volume acquisition system is capable of acquiring a plurality of volumes of the tissue over a cycle. 
   
   
       29 . The system of  claim 26 , wherein firing a series of the radiation beams includes different trajectories from outside the patient and through intervening tissue toward the target tissue region, and wherein the target region extends transmurally through a wall of the heart. 
   
   
       30 . A system for radiating a moving target of a wall of a heart, the system comprising:
 a volume acquisition system for acquiring a computed tomography (CT) volume;   a processor coupled to the volume acquisition system, the processor configured for:
 defining a transmural target tissue region; 
 computing a dose distribution; and 
   a visualization system for visualizing the dose distribution using volume or surface rendering in 3-dimensions (3D) so as to verify transmurality.   
   
   
       31 . The system of  claim 30 , further comprising:
 a robot coupled to the processor; and   a radiation beam source supported by the robot and coupled to the processor;   the processor being configured with machine-readable code embodying instructions for firing a series of the radiation beams from the radiation source so as to treat the target tissue region.   
   
   
       32 . The system of  claim 30 , wherein firing a series of the radiation beams includes different trajectories from outside the patient and through intervening tissue toward the target tissue region. 
   
   
       33 . A method of radiating a moving target inside a heart, the method comprising:
 A acquiring sequential volumetric representations of an area of the heart;   B defining a target tissue region and/or a radiation sensitive structure region in 3-dimensions (3D);   C expanding the target tissue region and/or a radiation sensitive structure region with a margin based on a motion of the target tissue region and/or the radiation sensitive structure region; and   D firing radiation beams to the target tissue region in response based on the margin.   
   
   
       34 . The method of  claim 33 , wherein the margin includes the full motion of the tissue target region and/or the radiation sensitive structure region. 
   
   
       35 . The method of  claim 33 , wherein the margin used has been drawn to contain the full tissue target region and/or the radiation sensitive structure region some fraction of the time. 
   
   
       36 . The method of  claim 35 , wherein margins are drawn for more than one fraction. 
   
   
       37 . The method of  claim 33 , wherein the motion is based on a cardiac cycle and/or a respiratory cycle. 
   
   
       38 . The method of  claim 33 , wherein the motion is based on an estimate of a cardiac cycle and/or a respiratory cycle. 
   
   
       39 . The method of  claim 33 , further comprising computing a dose distribution based on the margin. 
   
   
       40 . The method of  claim 33 , wherein steps B and/or C include using a method selected from the group of: (1) volume rendering, (2) maximum intensity projection, (3) minimum intensity projection, (4) X-ray projection, (5) haptic feedback, (6) virtual fly-through, (7) stereoscopic 3D rendering, (8) virtual reality, and (9) multi-planar, oblique and curved reconstructions. 
   
   
       41 . The method of  claim 33 , wherein steps B and/or C include outlining contours of the target tissue region and/or a radiation sensitive structure region in 3D. 
   
   
       42 . The method of  claim 33 , wherein the sequential volumetric representations are acquired over one cardiac cycle. 
   
   
       43 . The method of  claim 33 , wherein the sequential volumetric representations are acquired over one respiratory cycle. 
   
   
       44 . The method of  claim 33 , wherein firing radiation beams to the target tissue region includes firing a series of radiation beams along different trajectories. 
   
   
       45 . A system for radiating a moving target inside a heart, the system comprising:
 a volume acquisition system for acquiring sequential volumetric representations of an area of the heart;   a processor coupled to the image acquisition system, the processor configured for:
 defining the target tissue region and/or critical structure region in 3-dimensions (3D); 
 expanding the target tissue region and/or a radiation sensitive structure region with a margin based on a motion of the target tissue region and/or the radiation sensitive structure region; 
 computing a dose distribution; 
   a robot coupled to the processor; and   a radiation beam source supported by the robot and coupled to the processor;   the processor being configured with machine-readable code embodying instructions for firing a series of the radiation beams from the radiation source so as to treat the target tissue region based on the margin.   
   
   
       46 . The system of  claim 45 , wherein the margin includes the full motion of the tissue target region and/or the radiation sensitive structure region. 
   
   
       47 . The system of  claim 45 , wherein the margin used has been drawn to contain the full tissue target region and/or the radiation sensitive structure region some fraction of the time. 
   
   
       48 . The system of  claim 47 , wherein margins are drawn for more than one fraction. 
   
   
       49 . The system of  claim 45 , wherein defining the target tissue region and/or critical structure region in 3D is selected from the group of: (1) volume rendering, (2) maximum intensity projection, (3) minimum intensity projection, (4) X-ray projection, (5) haptic feedback, (6) virtual fly-through, (7) stereoscopic 3D rendering, (8) virtual reality and (9) multi-planar, oblique and curved reconstructions. 
   
   
       50 . The system of  claim 45 , wherein the volume acquisition system is capable of acquiring a plurality of volumes of the tissue over a cardiac cycle and/or respiratory cycle. 
   
   
       51 . The system of  claim 45 , wherein firing a series of the radiation beams includes different trajectories from outside the patient and through intervening tissue toward the target tissue region.