CN107432993B - Cancer Treatment - Proton Tomography and Methods of Using the Same - Google Patents

Abstract

The present invention includes a proton therapy tumor treatment system integrated with a proton tomography imaging system that uses coated sheets designed to emit photons upon interaction with a charged particle beam. Typically, one or more detectors that image photons emitted from the coated sheet, also referred to as an imaged sheet, are used to determine one or more point locations of the charged particle beam at a given time. Combining the plurality of point locations produces a local segment directed to the location of the charged particle beam, e.g. into and/or out of the patient. The positively charged particle state determination system produced using one or more coatings is used in conjunction with a scintillation detector or a tomographic imaging system when mapping a tumor and surrounding tissue sample and/or when treating a tumor, where a common synchrotron, beam delivery, and/or nozzle element is used for both proton imaging and cancer treatment.

Description

Cancer Treatment - Proton Tomography and Methods of Using the Same

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of US Patent Application No. 15/467,840, filed March 23, 2017, which is a continuation-in-part of US Patent Application No. 15/402,739, filed January 10, 2017, which is a continuation-in-part of US patent application Ser. No. 15/348,625, filed Nov. 10, 2016, which is a continuation-in-part of US patent application Ser. No. 15/167,617, filed May 27, 2016.

technical field

The present invention generally relates to imaging and treatment of tumors.

Background technique

cancer treatment

Proton therapy works by targeting high-energy ionizing particles, such as protons accelerated with a particle accelerator, at a targeted tumor. These particles damage the DNA of cells, eventually leading to their death. Cancer cells are particularly vulnerable to their DNA due to their high rate of division and reduced ability to repair damaged DNA.

The patents related to the present invention are summarized as follows.

Proton beam therapy system

U.S. Patent No. 4,870,287, "Multi-Station Proton Beam Therapy System," by F. Cole et al., Loma Linda University Medical Center (September 26, 1989) , which describes a proton beam therapy system for selectively generating and delivering a proton beam from a single proton source and accelerator to selected ones of multiple patient treatment rooms.

question

There is a need in the field of charged particle cancer therapy for accurate, precise and rapid imaging of patients and/or the use of charged particles to treat tumors.

SUMMARY OF THE INVENTION

The present invention includes cancer imaging/therapy apparatuses and methods of use thereof.

Description of drawings

A more complete understanding of the present invention is obtained by reference to the detailed description and claims described in connection with the accompanying drawings, wherein like reference numerals refer to like parts.

FIG. 1A shows the connection of components of a charged particle beam therapy system, and FIG. 1B shows a charged particle beam therapy system;

Figure 2 shows a tomography system;

Figure 3 shows a particle beam path identification system;

Figure 4A shows a particle beam path identification system coupled to a particle beam delivery system and a tomographic scintillation detector, and Figure 4B shows the scintillation detector rotating with the patient and gantry nozzle;

Figure 5 shows a therapy delivery control system;

Figure 6A shows a 2D-2D imaging system relative to a cancer treatment beam, Figure 6B shows a multiple gantry supported imaging system, and Figure 6C shows a rotatable cone beam;

Figure 7A shows the process of determining the position of a treatment room object, and Figure 7B shows an iterative position tracking, imaging and treatment system;

Figure 8 shows a fiducial marker enhanced tomography imaging system;

Figure 9 shows a fiducial marker enhancement therapy system;

10A-10C illustrate an isocenterless cancer treatment system;

Figure 11 shows a switchable shaft system for tumor treatment;

Figure 12 shows a semi-automated cancer therapy imaging/therapy system;

Figure 13 shows a system for automatically generating radiation therapy regimens;

Figure 14 shows a system for automatically updating a cancer radiation therapy regimen during treatment; and

Figure 15 shows an automated radiation therapy protocol development and implementation system.

Elements and steps in the figures are illustrated for simplicity and clarity and have not necessarily been performed in any particular order. For example, the figures show steps performed simultaneously or in different orders to help improve understanding of embodiments of the present invention.

Detailed ways

The present invention includes proton therapy cancer treatment systems integrated with proton tomography imaging systems using one or more coatings designed to emit photons upon interaction with a charged particle beam. Typically, one or more detectors (also referred to as imaging patches or layers) that image photons emitted from the coating are used to determine the location of one or more spots of the charged particle beam at a given time. Combining the multiple point locations produces local vectors that highlight the charged particle beam locations (eg, entering and/or exiting the patient). Charged particle state determination systems using one or more coatings are used in conjunction with scintillation detectors or tomographic imaging systems, where common synchrotron, beam Delivery, and/or nozzle elements are used in proton imaging and cancer therapy.

The above-described embodiments are optionally used in combination with a set of fiducial marker detectors configured to detect photons emitted and/or reflected from a set of fiducial markers located on one or more objects in the treatment room , and the resulting determined distances and/or calculated angles are used to determine the relative positions of multiple objects or elements in the treatment room. Typically, in an iterative process, at a first time, objects such as treatment beamline output nozzles, patient-specific beverages relative to the tumor, scintillation detection materials, X-ray system elements, and/or detection elements are mapped and determined relative position and/or angle between them. At the second time, the location of the mapped object is used for: (1) imaging, such as X-ray, positron emission tomography and/or proton beam imaging, and/or (2) beam targeting and therapy, eg, positively charged particles are Basic cancer treatment. Since the fiducial marker system is used to dynamically determine the relative position of objects in the treatment room, engineering and/or mathematical constraints on the isocenter of the treatment beamline are removed.

The combination describes a method and apparatus for determining the location of a tumor in a patient for the use of positively charged particles in a treatment room to treat the tumor. More specifically, the method and apparatus use a set of fiducial markers and fiducial detectors to mark/determine the relative position of static and/or movable objects in the treatment room with photons from the markers to the detectors. In addition, the position and orientation of at least one object is calibrated to a reference line, such as a zero-offset beam treatment line through an outlet nozzle, which generates the relative position of each marked object in the treatment room. The reference line and/or points on it are then used to determine treatment calculations. The inventors note that treatment calculations are optionally and preferably performed without the use of isocenters, such as those around which the treatment room gantry rotates, thus eliminating the need for isocenters, i.e. the practical mid-center volume. mechanical error.

In combination, a method and apparatus for imaging a tumor in a patient using positively charged particles and X-rays includes the steps of: (1) delivering the positively charged particles from an accelerator to a patient site using a beam delivery line, wherein the beam delivery line includes the positively charged particles Particle beam path and X-ray beam path; (2) use a scintillation detector system to detect scintillation caused by positively charged particles; (3) use an X-ray detector system to detect X-rays; (4) by linear extension/retraction Back-positioning the mounting rails to: position the scintillation detector system at a first extended position of the mounting rails at a first time from the patient opposite the outlet nozzle, and then at a second time at a second position of the mounting rails an extended position, positioning the X-ray detector system at a position opposite the outlet nozzle of the patient; (5) using the scintillation detector system and the output of the X-ray detector system to generate an image of the tumor; and (6) by using the tape The positively charged particles alternate between the steps of detecting scintillation and treating the tumor by irradiating the tumor.

In combination, the tomography system is optionally used in combination with a charged particle cancer therapy system. Tomography systems use tomography or tomographic imaging, which involves imaging through sections or slicing through the use of penetrating waves, such as positively charged particles from injectors and/or accelerators. Optionally and preferably, a shared injector, accelerator and beam delivery system is used for charged particle based tomographic imaging and charged particle cancer therapy. In one case, the output nozzle of the beam delivery system is positioned with a gantry system, and the gantry system and/or patient support maintains the scintillator plate of the tomography system on the opposite side of the patient from the output nozzle.

In another example, a charged particle state determination system of a cancer treatment system or tomographic imaging system associates one or more coatings with a scintillation material, a scintillation detector, and a /or in conjunction with a tomographic imaging system, eg to determine the input vector of the charged particle beam into the patient and/or the output vector of the charged particle beam output from the patient.

In another example, a charged particle tomograph is used in combination with a charged particle cancer treatment system. For example, tomographic imaging of cancerous tumors is performed using charged particles generated by an injector, accelerated by an accelerator, and guided by a delivery system. Cancer treatment systems use the same injectors, accelerators and guided delivery systems to deliver charged particles to cancerous tumors. For example, tomographs and cancer treatment systems use common grating beam methods and instruments to treat solid cancers. More specifically, the present invention includes multi-axis and/or multi-field grating beam charged particle accelerators for: (1) tomography and (2) cancer therapy. Optionally, the system independently controls patient translational position, patient rotational position, two-dimensional beam trajectory, delivered radiation beam energy, delivered radiation beam intensity, beam velocity, timing of charged particle delivery, and/or distribution of radiation impacting healthy tissue . The system operates with negative ion beam sources, synchrotrons, patient positioning, imaging and/or targeting methods and instruments to deliver effective and uniform doses of radiation to tumors while distributing radiation impinging on healthy tissue.

For clarity of presentation and without loss of generality, herein, treatment systems and imaging systems are described with respect to a patient's tumor. More generally, however, any sample is imaged with any imaging system described herein, and/or any element of the sample is treated with a positively charged particle beam described herein.

charged particle beam therapy

In this document, charged particle beam therapy systems, such as proton beams, hydrogen ion beams, or carbon ion beams, are described. This article uses proton beams to describe charged particle beam therapy systems. However, the approaches taught and described in proton beams are not intended to be limited to proton beam approaches, but are exemplary charged particle beam systems, positively charged beam systems, and/or multilayer charged particle beam systems, such as C4 ⁺ or C ⁶⁺ . Any techniques described herein are equally applicable to any charged particle beam system.

Referring now to FIG. 1A , a charged particle beam system 100 is shown. The charged particle beam preferably includes a number of subsystems including any of the following: main controller 110; injection system 120; synchrotron 130, typically including: (1) accelerator system 131 and (2) an internal or connected extraction system 134 ; beam delivery system 135 ; scanning/targeting/delivery system 140 ; nozzle system 146 ; patient interface module 150 ; display system 160 ;

Exemplary methods of using charged particle beam system 100 are provided. The main controller 110 controls one or more subsystems for accurate and precise delivery of protons to the patient's tumor. For example, the main controller 110 obtains images, such as a portion of the body and/or tumor, from the imaging system 170 . The main controller 110 also obtains location and/or timing information from the patient interface module 150 . The main controller 110 optionally controls the injection system 120 to inject protons into the synchrotron 130 . A synchrotron typically includes at least an accelerator system 131 and an extraction system 134 . The main controller 110 preferably controls the proton beam within the accelerator system, eg, by controlling the speed, trajectory and timing of the proton beam. The main controller then controls the extraction of the proton beam from the accelerator through the extraction system 134 . For example, the controller controls the timing, energy and/or intensity of the extracted beam. The controller 110 also preferably controls the targeting of the proton beam to the patient interface module 150 or the patient with the patient positioning system via the scanning/targeting/delivery system 140 . One or more components of the patient interface module 150 , such as the translational and rotational position of the patient, are preferably controlled by the main controller 110 . Furthermore, the display elements of the display system 160 are preferably controlled by the main controller 110 . Displays, such as display screens, are typically provided for one or more operators and/or one or more patients. In one embodiment, the master controller 110 times the delivery of the proton beam from all systems so that the protons are delivered to the patient's tumor in an optimal therapeutic manner.

Herein, master controller 110 refers to a single system that controls charged particle beam system 100 , a single controller that controls multiple subsystems that control charged particle beam system 100 , or one or more subsystems that control charged particle beam system 100 of multiple individual controllers.

Example I

Charged Particle Cancer Therapy System Control

Referring now to FIG. 1B , an illustrative example embodiment of one version of charged particle beam system 100 is provided. The number, location, and type of description of the components are illustrative in nature and not restrictive. In the illustrated embodiment, the implantation system 120 or ion source or charged particle beam source produces protons. Implantation system 120 optionally includes one or more of the following: a negative ion beam source, a positive ion beam source, an ion beam focusing lens, and a tandem accelerator. Protons are delivered into vacuum tubes that extend into, through and out of the synchrotron. The resulting protons are delivered along the initial path 262. Optionally, a focusing magnet 127 (eg, a quadrupole magnet or an injection quadrupole magnet) is used to focus the proton beam path. A quadrupole magnet is a focusing magnet. The injector bending magnet 128 bends the proton beam towards the plane of the synchrotron 130 . Concentrated protons with initial energy are introduced into injector magnet 129, which is preferably an injector Lambertson magnet. Typically, the initial beam path 262 is along an axis exiting the plane of circulation of the synchrotron 130, such as above. Injector bending magnet 128 and injector magnet 129 combine to move protons into synchrotron 130 . The main bending, dipole, rotating or circulating magnet 132 is used to rotate the protons along the circulating beam path 264 . Dipole magnets are curved magnets. The primary bending magnet 132 bends the initial beam path 262 into a recurring beam path 264 . In this example, the main bending magnets 132 or circulating magnets are represented as four sets of four magnets to maintain the circulating beam path 264 as a stable circulating beam path. However, any number or set of magnets may optionally be used to move protons around a single orbit during cycling. The protons pass through the accelerator 133 . The accelerator accelerates the protons in the circulating beam path 264 . As the protons are accelerated, the field applied by the magnet increases. In particular, the velocity of the protons obtained by the accelerator 133 is synchronized with the magnetic field of the main bending magnet 132 or the circulating magnet to maintain stable circulation of the protons around the center point or region 136 of the synchrotron. At various points in time, the accelerator 133/main bending magnet 132 combination is used to accelerate and/or decelerate the circulating protons while keeping the protons in the circulating path or orbit. The extraction elements of the recurve/deflector system are used in combination with Lambertson extraction magnets 137 to remove protons from the circulating beam path 264 within the synchrotron 130 . An example of a deflector component is a Lambertson magnet. Typically, a deflector moves protons from the circulation plane to an axis away from the circulation plane (eg, above the circulation plane). Using extraction bending magnet 142 and optional extraction focusing magnet 141 (eg, a quadrupole magnet) and optional bending magnet, the extracted protons are preferably along a positively charged particle beam transport path 268 in beam transport system 135, such as The beam path, or proton beam path, is directed and/or focused into the scanning/targeting/delivery system 140 . The two components of the scanning system 140 or sighting system typically include a first axis control 143 such as a vertical control and a second axis control 144 such as a horizontal control. In one embodiment, the first axis controller 143 allows approximately 100 mm of vertical or y-axis scanning of the proton beam 268, while the second axis controller 144 allows approximately 700 mm of horizontal or x-axis scanning of the proton beam 268. The nozzle system 146 is used to direct the proton beam, to image the proton beam, to define the shape of the proton beam, and/or to act as a vacuum barrier between the low pressure beam path of the synchrotron and the atmosphere. Protons are delivered in a controlled manner to the patient interface module 150 and the patient's tumor. All of the above-listed elements are optional and can be used in various permutations and combinations.

Extract ions from the ion source

For clarity of presentation without loss of generality, the examples focus on protons from the ion source. More generally, however, cations of any charge are optionally extracted from a corresponding ion source using the techniques described herein. For example, C4 ⁺ or C6 ⁺ is optionally extracted using the ion extraction methods and apparatus described herein. Furthermore, by reversing the polarity of the system, anions are optionally extracted from an anion source, where the anion is any charge.

Herein, for clarity of presentation and without loss of generality, ion extraction is combined with tumor treatment and/or tumor imaging. However, in any method or apparatus that uses a stream of ions or a discrete time beam of ions, ion extraction is optional.

delivery of bundles

A beam delivery system 135 is used to move charged particles from the accelerator to the patient, eg, through nozzles in the gantry described below.

nozzle

After being extracted from synchrotron 130 and transported along proton beam path 268 in beam delivery system 135 , the charged particle beam exits through nozzle system 146 . In one example, the nozzle system includes a nozzle foil covering the end of the nozzle system 146 or a cross-sectional area within the nozzle system, thereby forming a vacuum seal. The nozzle system includes nozzles that expand with an x/y cross-sectional area along the z-axis of the proton beam path 268 to allow scanning of the proton beam 268 along the x- and y-axes by the vertical and horizontal control elements, respectively. The nozzle foil is preferably mechanically supported by the outer edge of the outlet port of the nozzle or nozzle system 146 . An example of a nozzle foil is an approximately 0.1 inch thick sheet of aluminum foil. Typically, the nozzle foil separates the atmospheric pressure on the patient side of the nozzle foil from the low pressure region (eg, about 10" ⁵ to 10" ⁷ Torr region) on the synchrotron 130 side of the nozzle foil. The low pressure region is maintained to reduce scattering of the circulating charged particle beam in the synchrotron. Herein, the exit foil of the nozzle is optionally the first sheet 760 of the charged particle beam state determination system 750 described below.

Tomography/Beam Status

In one embodiment, charged particle tomography is used to image a patient's tumor. As current beam position determination/validation is used in tomography and cancer treatment, for clarity of presentation and without limitation, beam state determination is also addressed in this section. However, beam state determination can be used separately and without tomography.

In another example, a charged particle tomograph is used in combination with a charged particle cancer treatment system using common components. For example, tomographic imaging of cancerous tumors is performed using charged particles generated by an injector, accelerated by an accelerator, and directed by a delivery system that are part of a cancer treatment system as described below.

In various examples, the tomographic imaging system optionally operates concurrently with a charged particle cancer treatment system using common elements, allowing tomographic imaging while the patient is rotated, the patient is operable in upright, semi-upright, and/or horizontal positions, Can operate concurrently with X-ray imaging, and/or allow the use of adaptive charged particle cancer therapy. Furthermore, elements of the common tomography and cancer therapy apparatus are optionally operated in multi-axis and/or multi-field grating beam modes.

In conventional medical X-ray tomography, cross-sectional images through the body are made by moving one or both of the X-ray source and the X-ray film relative to the patient during exposure. By modifying the direction and degree of motion, the operator can select different focal planes containing structures of interest. A more modern variation of tomography involves collecting projection data from multiple directions by moving the X-ray source and feeding the data into a tomographic projection reconstruction software algorithm that is processed by a computer. Here, in sharp contrast to known methods, the radiation source is a charged particle, such as a proton ion beam or a carbon ion beam. The tomography system described herein uses a proton beam, but the description applies to heavier ion beams, such as carbon ion beams. Furthermore, in sharp contrast to known techniques, the radiation source is optionally stationary while the patient rotates.

Referring now to FIG. 2, an example of a tomograph is described, and an example of beam state determination is described. In this example, tomography system 700 uses the same elements as charged particle beam system 100 , including one or more of the following: injection system 120 , accelerator 130 , positively charged particles within beam delivery housing 320 in beam delivery system 135 Particle beam delivery path 268, targeting/delivery system 140, patient interface module 150, display system 160, and/or imaging system 170 (eg, X-ray imaging system). The scintillation material is optionally one or more scintillation plates, such as scintillation plastic, for measuring the energy, intensity and/or position of the charged particle beam. For example, a scintillation material 710 or scintillation plate is located behind the patient 730 relative to the elements of the targeting/delivery system 140, and the scintillation material 710 is optionally used to measure the intensity and/or position of the charged particle beam after passing through the patient. Optionally, a second scintillation plate or charged particle inducing photon emitting sheet, described below, is located in front of the patient 730 relative to the elements of the targeting/delivery system 140, which is optionally used to measure the charged particle beam prior to passing through the patient. Incident intensity and/or location. The charged particle beam system 100 as described above has been demonstrated to operate at up to and including 330 MeV, which is sufficient to send protons through the body and into contact with the scintillation material. In particular, 250 MeV to 330 MeV is used to pass the beam through a standard sized patient, eg, through the chest, at a standard sized path length. The intensity or number of protons hitting the plate as a function of position was used to create the image. The speed or energy of the protons hitting the scintillation plate is also used to create an image of the tumor 720 and/or an image of the patient 730 . The patient 730 is rotated about the y-axis and new images are collected. Preferably, a new image is collected every time the patient is rotated about one degree, resulting in about 360 images being combined into a tomogram using tomographic reconstruction software. The tomographic reconstruction software uses the overlapping rotation-varying images in the reconstruction. Optionally, a new image is collected every time the patient is rotated about 2, 3, 4, 5, 10, 15, 30 or 45 degrees.

Herein, the scintillation material 710 or scintillator is any material that emits photons when struck by positively charged particles, or when the energy that the positively charged particles will transfer to the scintillation material is sufficient to cause light emission. Optionally, the scintillation material 710 emits photons after a delay, such as fluorescence or phosphorescence. Preferably, however, the scintillator has a fast fifty percent extinction time, eg, less than 0.0001, 0.001, 0.01, 0.1, 1, 10, 100 or 1000 milliseconds, such that the luminescence rapidly dims, decays or ends. Preferred scintillation materials include sodium iodide, potassium iodide, cesium iodide, iodide salts, and/or doped iodide salts. Other examples of scintillation materials include, but are not limited to: organic crystals, plastics, glass, organic liquids, luminophores and/or inorganic materials or crystals such as barium fluoride, BaF2; calcium fluoride, _CaF2 , _doped fluoride Calcium, sodium iodide, NaI; doped sodium iodide, thallium doped sodium iodide, Nal(TI); cadmium tungstate, CdWO ₄ ; bismuth germanate; cadmium tungstate, CdWO ₄ ; calcium tungstate, CaWO ₄ ; cesium iodide, CsI; doped cesium iodide; thallium doped cesium iodide, CsI(TI); cesium iodide doped with CsI(Na); potassium iodide, KI; doped potassium iodide, oxysulfide Gadolinium, Gd ₂ O ₂ S; cerium-doped lanthanum bromide, LaBr ₃ (Ce); lanthanum chloride, LaCl ₃ ; cesium-doped lanthanum chloride, LaCl ₃ (Ce); lead tungstate, PbWO ₄ ; LSO or Lutetyl Orthosilicate (Lu ₂ SiO ₅ ); LYSO, Lu _1.8 Y _0.2 SiO ₅ (Ce); Yttrium Aluminum Garnet, YAG(Ce); Zinc Sulfide, ZnS(Ag); and Zinc Tungstate , ZnWO ₄ .

In one embodiment, a tomogram or individual tomographic cross-sectional images are collected concurrently with cancer treatment using the charged particle beam system 100 . For example, a tomographic image is collected and a cancer treatment is subsequently performed: the patient is not moved from the positioning system, eg in a semi-vertical local fixation system, a seated local fixation system, or a lying position. In a second example, the tumor 720 is irradiated, eg, within about 1, 2, 5, 10, 15, or 30 seconds, using the first cycle of the accelerator 130 and using the next cycle of the accelerator 130 to collect a single tomographic slice. In the third case, within about 5, 10, 15, 30, or 60 seconds of the subsequent tumor radiation treatment, about 2, 3, 3, 4 or 5 tomographic slices.

In another embodiment, independent control of the tomographic imaging process and the X-ray acquisition process allows simultaneous single-field and/or multi-field acquisition of the X-ray and tomographic images, alleviating interpretation of multiple images. In effect, the X-ray and tomographic images are optionally overlaid and/or integrated while the patient 730 is optionally in the same position in each image, thereby forming a hybrid X-ray/proton beam tomographic image.

In another embodiment, a tomogram of the patient 730 is collected at approximately the same location where the patient's tumor was treated with subsequent radiation therapy. For some tumors, the patient is in the same upright or semi-upright position, allowing better separation of the tumor 720 from surrounding organs or tissues of the patient 730 than in the recumbent position. Positioning of the scintillation material 710 behind the patient 730 allows tomographic imaging to occur while the patient is in the same upright or semi-upright position.

The use of common elements in tomographic imaging and charged particle cancer therapy enables cancer therapy (described above) to have many benefits, optionally with tomographic imaging, such as proton beam x-axis control, proton beam y-axis control, proton beam y-axis control Control of beam energy, control of proton beam intensity, control of timing of beam delivery to the patient, control of patient rotation, and control of patient translation, all in a grating beam mode of proton energy delivery. Using a single proton or cation beamline for imaging and therapy eases patient setup, reduces alignment uncertainty, reduces beam state uncertainty, and simplifies quality assurance.

In yet another embodiment, three-dimensional tomographic and/or proton-based reference images, such as hundreds of individually rotated images of tumor 720 and patient 730, are initially collected. Subsequently, prior to proton therapy for cancer, collect only a few 2D control tomographic images of the patient, such as the patient at rest or only in a few rotational positions, such as images directly to the patient, with the patient rotated about 45° in all aspects and/or Either the X-ray source and/or the patient are rotated about 90° in all directions about the y-axis. Compare a single control image with a 3D reference image. Adaptive proton therapy is then optionally performed, wherein: (1) based on the difference between the three-dimensional reference image and one or more two-dimensional control images, proton cancer therapy is not used to specify the location, and/or (2) based on the three-dimensional Differences between a reference image and one or more two-dimensional control images, modify proton cancer therapy in real time.

Charged Particle State Determination/Verification/Photon Monitoring

Still referring to Figure 2, tomography system 700 is optionally used with charged particle beam state determination system 750, optionally as a charged particle verification system. Charged particle state determination system 750 optionally measures, determines and/or verifies one of: (1) the position of the charged particle beam, eg, treatment beam 269, (2) the direction of treatment beam 269, (3) the intensity of treatment beam 269 , (4) the energy of the treatment beam 269, (5) the position, direction, intensity and/or energy of the charged particle beam, such as the residual charged particle beam 267 after passing through the sample or patient 730, and/or (6) the charged particle beam history.

For clarity of presentation and without loss of generality, charged particle beam state determination system 750 is described and illustrated in FIGS. 3 and 4A, respectively; however, as described herein, elements of charged particle beam state determination system 750 are optional Preferably and preferably integrated into the nozzle system 146 and/or the tomography system 700 of the charged particle therapy system 100 . More specifically, any element of the charged particle beam state determination system 750 is integrated into the nozzle system 146, the dynamic gantry nozzle, and/or the tomography system 700, such as the surface of the scintillation material 710 or of the scintillation detector, plate, or system. surface. Nozzle system 146 or dynamic gantry nozzles provide an exit for the charged particle beam from a vacuum tube initially at injection system 120 through synchrotron 130 and beam delivery system 135 . Any plate, sheet, fluorophore or detector of the charged particle beam state determination system is optionally integrated into the nozzle system 146 . For example, the exit foil of the nozzle is optionally the first sheet 760 of the charged particle beam state determination system 750, and a first coating 762 is optionally applied to the exit foil, as shown in FIG. Similarly, the surface of the scintillation material 710 is optionally a support surface for the fourth coating 792, as shown in FIG. 2 . Charged particle beam state determination system 750 is described further below.

Referring now to FIGS. 2, 3, and 4A, four sheets, a first sheet 760, a second sheet 770, a third sheet 780, and a fourth sheet 790, are used to illustrate detection and/or photon emission with respect to the transmission of a charged particle beam Sheet. Each sheet is optionally coated with a photon emitter such as a fluorophore, eg, a first sheet 760 may optionally be coated with a first coating 762. Without loss of generality and for clarity of presentation, all four sheets are shown in units with no emissive layer shown. Thus, for example, the second sheet 770 may alternatively refer to a support sheet, a light-emitting sheet, and/or a support sheet coated by a light-emitting element. These four sheets represent n sheets, where n is a positive integer.

Referring now to Figures 2 and 3, charged particle beam status verification system 750 is a system that allows real-time monitoring of the actual charged particle beam position without disrupting the charged particle beam. Charged particle beam state verification system 750 preferably includes a first positional element or first beam verification layer, also referred to herein as a coating, luminescent layer, fluorescent layer, phosphorescent layer, radiative layer, or viewing layer. The first position element optionally and preferably comprises a coating or thin layer substantially in contact with the sheet material (eg the inner surface of the nozzle foil), wherein the inner surface is on the synchrotron side of the nozzle foil. Less preferably, the verification layer or coating is substantially in contact with the outer surface of the nozzle foil, wherein the outer surface is on the patient treatment side of the nozzle foil. Preferably, the nozzle foil provides a coating-coated substrate surface. Optionally, an adhesive layer is located between the coating and the nozzle foil, substrate or support sheet. Optionally, the positional element is placed anywhere in the charged particle beam path. Optionally, one or more positional elements, respectively on more than one sheet, are used for the charged particle beam path and for determining state characteristics of the charged particle beam, as described below.

Still referring to Figures 2 and 3, coatings called fluorophores, due to the transmission of the proton beam, produce a measurable spectral response that is spatially visible by a detector or camera. The paint is preferably a phosphor, but is alternatively any material that is visible or imaged by the detector as a result of a beam of charged particles impinging on or passing through the paint or coating resulting in a change in the material. A detector or camera observes the secondary photons emitted from the coating and determines the position of the treatment beam 269 from the spectral differences produced by the proton and/or charged particle beam passing through the coating, also referred to as the current position of the charged particle beam or The final treatment vector for the charged particle beam. For example, during treatment of tumor 720, when the proton beam or positively charged cation beam is being scanned by, for example, first axis controller 143, vertical control, and second axis controller 144, horizontal control, beam position control elements , the camera observes the surface of the coating surface. The camera observes the current position of the charged particle beam or treatment beam 269 as measured by the spectral response. The coating is preferably a phosphor or luminescent material that emits light and/or emits photons for a short time due to excitation by a charged particle beam, eg 50% intensity in 5 seconds. The detector observes temperature changes and/or observes photons emitted from the charged particle beam through the spot. Optionally, multiple cameras or detectors are used, with each detector viewing all or a portion of the coating. For example, two detectors are used, where the first detector observes the first half of the coating and the second detector observes the second half of the coating. Preferably, at least a portion of the detector is mounted into the nozzle system to observe the proton beam position after passing through the first axis controller 143 and the second axis controller 144 . Preferably, the coating is located in the proton beam path 268 before the protons impinge on the patient 730 .

Referring now to FIGS. 1A , 1B and 2 , the main controller 110 connected to the camera or detector output optionally and preferably compares the final proton beam position or the position of the treatment beam 269 with the proton beam position and/or calibration reference of the protocol (eg, a calibrated beamline) to determine if the actual proton beam position or the position of the treatment beam 269 is within tolerance. The charged particle beam state determination system 750 is preferably used in one or more stages, such as a calibration stage, a mapping stage, a beam position verification stage, a treatment stage, and a treatment plan modification stage. The calibration phase is used to correlate the x,y positions of the first axis controller 143 and the second axis controller 144 as a function of the actual x,y position of the proton beam at the patient interface. During the treatment phase, the charged particle beam position is monitored and compared to calibration and/or treatment regimens to verify accurate proton delivery to tumor 720 and/or as a charged particle beam cutoff safety indicator. Referring now to FIG. 5 , the location verification system 179 and/or the treatment delivery control system 112 optionally generate and/or provide a recommended treatment change 1070 in determining tumor metastasis, unpredictable tumor deformation and/or treatment abnormalities at the time of treatment. While the patient 730 is still in the treatment position, treatment changes 1070 are optionally sent, eg, to a nearby physician or to a remote physician via the Internet for physician approval 1072, which upon receipt allows the now modified and approved treatment regimen to continue.

Example I

Referring now to FIG. 2, a first example of a charged particle beam state determination system 750 is shown using two cation-induced signal generating surfaces (referred to herein as first sheet 760 and third sheet 780). Each sheet is described below.

Still referring to FIG. 2, in a first example, an optional first sheet 760 located in front of the patient 730 along the charged particle beam path is coated with a first fluorophore coating 762 in which cations ( For example, a charged particle beam) excites the localized fluorophores of the first fluorophore coating 762, resulting in the emission of one or more photons. In this example, the first detector 812 images the first fluorophore coating 762, and the main controller 110 uses the fluorophore coating 762 and the image of the detected photons to determine the current position of the charged particle beam. The intensity of the detected photons emitted from the first fluorophore coating 762 is optionally used to determine the intensity of the charged particle beam used in treating the tumor 720, or in producing a tomogram and/or slice of the tumor 720 in the patient 730 It is detected by the tomography system 700 when taking the image. Thus, the position and/or intensity of the emitted photons, respectively, is used to determine the first position and/or the first intensity of the charged particle beam.

Still referring to Figure 2, in the first example, an optional third sheet 780 located behind the patient 730 is optionally a cation-induced photon emitting sheet as described in the preceding paragraph. However, as shown, the third sheet 780 is a solid state beam detection surface, such as a detector array, for example. For example, the detector array is optionally a charge coupled device, charge sensing device, CMOS or camera detector, wherein the elements of the detector array are read directly as in a commercial camera, without secondary emission of photons. Similar to the detection described for the first sheet, the third sheet 780 is used to determine the position of the charged particle beam and/or the intensity of the charged particle beam using the signal position and/or signal intensity, respectively, from the detector array.

Still referring to FIG. 2 , in a first example, the signals from the first sheet 760 and the third sheet 780 generate positions in front of and behind the patient 730 , allowing a more accurate determination of the charged particle beam passing between the patients 730 . Optionally, the charged particle beam path in targeting/delivery system 140 is known, eg, via a first magnetic field strength through first axis controller 143 or a second magnetic field strength through second axis controller 144 , combined with the signal obtained from the first sheet 760 to generate a first vector of pre-charged particles prior to entering the patient 730 and/or the point of entry of the charged particle beam into the patient 730, which also contributes to: (1) Control, monitor and/or document tumor treatment, and/or (2) development/interpretation of tomography. optionally, using the signal obtained from the third sheet 780 located behind the patient 730 in combination with the signal obtained from the tomography system 700 (eg, the scintillation material 710 ) to generate a second vector of charged particles behind the patient 730, and The point at which the charged particle beam exits the patient 730, which also assists in: (1) controlling, monitoring, deciphering, and/or (2) interpreting tomograms or tomographic images.

For clarity of presentation and without loss of generality, the charged particle beam state determination system 750 is further described using detection of photons emitted from a sheet. However, any of the cation-induced photon emitting sheets described herein are optionally detector arrays. Furthermore, any number of cation-induced photon emitting sheets are used before and/or after patient 730, eg, 1, 2, 3, 4, 6, 8, 10, or more. Additionally, any cation-induced photon emitting sheets are placed anywhere in the charged particle beam, such as in the synchrotron 130, in the beam delivery system 135, in the targeting/delivery system 140, the nozzle system 146, in the treatment room and/or in the tomography system 700 . Any cation-induced photon emitting sheet is used to generate a beam state signal as a function of time, which is optionally recorded, eg, to treat an accurate history of the tumor 720 of the patient 730 and/or to aid in the generation of tomographic images .

Example II

Referring now to FIG. 3, a second example of a charged particle beam state determination system 750 is illustrated using three cation-induced signal generating surfaces (referred to herein as second sheet 770, third sheet 780, and fourth sheet 790). Any of the second sheet 770, the third sheet 780, and the fourth sheet 790 include any of the features of the sheets described above.

Still referring to FIG. 3, in a second example, a second sheet 770 positioned in front of the patient 730 is optionally integrated into the nozzle and/or nozzle system 146, but is shown as a separate sheet. The signal obtained from the second sheet 770 (eg, at point A) is optionally combined with the signal from the first sheet 760 and/or the state of the targeting/delivery system 140 to provide at the first time t ₁ at the sample or A first line or vector _v1a from point A to point B of the charged particle beam is generated before the patient 730, and a second line or vector v from point F to point G of the charged particle beam is generated before the sample at a second time _{t2 2a} .

Still referring to Figure 3, in a second example, a third sheet 780 and a fourth sheet 790 located behind the patient 730 are optionally integrated into the tomography system 700, but are shown as separate sheets. The signal obtained from the third sheet 780 (eg, at point D) is optionally combined with the signal from the fourth sheet 790 and/or the signal from the tomography system 700 to follow the patient 730 at the first time t ₁ generating a first line segment or vector v _1b from point C ₂ of the charged particle beam to point D and/or point D to point E, and at a second time t ₂ after the sample, for example from point H of the charged particle beam to The second line segment or vector v _2b of point I. The signals obtained from the third sheet 780 and/or the fourth sheet 790 and the corresponding first vector at the _second time t ₂ are used to determine the output point C ₂ , which can and is usually different from the first vector An extension of v _1a , the non-scattered beam path from point A to point B through the patient to point C ₁ . _The difference between point _C1 and point C2 and/or the angle α between the first vector _v1a at the first time and the first vector _v1b at the second time is used to determine/map/identify the patient 730, the sample and/ or the internal structure of the tumor 720, e.g. by tomographic analysis, especially when scanning the charged particle beam combination in the x/y plane as a function of time, e.g. by the second vector _v2a at the first time and the second Vector v _2b shows that angle β is formed and/or patient 730 is rotated (eg, about the y-axis) as a function of time.

Still referring to FIG. 3, a plurality of detectors/detector arrays are shown for detecting signals from a plurality of sheets, respectively. However, as described further below, a single detector/detector array is optionally used to detect signals from multiple sheets. As shown, a set of detectors 810 is shown including a second detector 814 that images a second sheet 770 , a third detector 816 that images a third sheet 780 , and a first detector 816 that images a fourth sheet 790 Four detectors 818 . Any detectors described herein are optionally detector arrays, optionally coupled with any filters, and/or optionally use one or more intermediate optics to image the four sheets 760, 770, 780 , any of 790. Additionally, two or more detectors optionally image a single sheet, eg, a region of the sheet, to assist in optical coupling, eg, F-number optical coupling.

Still referring to Figure 3, a vector or line segment of the charged particle beam is determined. In particular, in the example shown, the third detector 816 determines the charged particle beam propagating through point D by detection of secondary emitted photons, and the fourth detector 818 determines the charged particle beam propagating through point E, wherein Points D and E are used to determine the first vector or line segment v _1b at the second time, as described above. To improve the accuracy and precision of the determined charged particle beam vectors, the first determined beam position and the second determined beam position are optionally and preferably separated by a distance d ₁ , eg greater than 0.1, 0.5, 1, 2, 3 , 5, 10 or more cm. Support element 752 is shown, which optionally connects any two or more elements of charged particle beam state determination system 750 to each other and/or to any element of charged particle beam system 100, such as for positioning and/or The rotating platform 756 of the patient 730 and any elements of the tomography system 700 are jointly rotated.

Example III

Still referring to FIG. 4A , a third example of a charged particle beam state determination system 750 is shown in an integrated tomographic cancer treatment system 900 .

Referring to FIG. 4A , a plurality of sheets and a plurality of detectors are shown to determine the state of the charged particle beam prior to the patient 730 . As shown, a first camera 812 spatially images photons emitted from the first sheet 760 (the result of the transfer of energy from a passing charged particle beam) at point A to generate a first signal, and a second camera 814 at point A B spatially images the photons emitted from the second sheet 770 (the result of energy transfer from the passing charged particle beam), resulting in a second signal. The first and second signals allow a first vector or line segment v _1a to be calculated and subsequently to determine the entry point 732 of the charged particle beam into the patient 730 . The determination of the first vector _v1a is optionally supplemented by information obtained from the first axis controller 143, the vertical control, and the second axis controller 144, the horizontal axis control, the surrounding magnetic field state, as described above.

Still referring to FIG. 4A , the charged particle beam state determination system is shown with light having multiple distinguishable wavelengths of light as a result of the transmission of the charged particle beam through more than one molecular type, luminescent center, and/or fluorophore type. emission. For clarity of presentation and without loss of generality, the first fluorophore in the third sheet 780 is shown as emitting blue light b and the second fluorophore in the fourth sheet 790 is shown as emitting red light r, both of which detected by the third detector 816 . The third detector is optionally coupled to any wavelength separation device such as a filter, grating or Fourier transform device. For clarity of presentation, the system is depicted as red light passing through a red transmissive filter blocking blue light and blue light passing through a blue transmissive filter blocking red light. Using any manner of wavelength separation allows one detector to detect the position of the charged particle beam resulting from a first secondary emission at a first wavelength, eg at point C, and a second secondary emission at a second wavelength, eg at point D. By extension, multiple sheets and/or sheets before and after the sample are imaged using appropriate optics, optionally a camera. The spatial determination of the origin of the red and blue light allows the calculation of the first vector v _1b at the second time and from the patient 730 compared to the non-scattering exit point 734 from the patient 730 determined from the first vector v _1a at the first time Actual exit point 736 to leave.

Still referring to FIG. 4A and now to FIG. 4B , an integrated tomographic cancer treatment system 900 is shown with an optional configuration in which the elements of the charged particle beam state determination system 750 are co-rotatable with the nozzle system 146 of the cancer treatment system 100 . More specifically, in one instance, a sheet of charged particle beam state determination system 750 positioned in front of, behind, or on both sides of patient 730 co-rotates with scintillation material 710 about any axis, as shown about the y-axis. Additionally, any elements of charged particle beam state determination system 750 , such as a detector, a two-dimensional detector, multiple two-dimensional detectors, and/or optical coupling optics, move with movement of the gantry, eg, along nozzle system 146 . common arc of motion and/or a fixed distance from the common arc. For example, a monitoring camera located on the opposite side of the tumor 720 or patient 730 from the nozzle system 146 remains in position on the opposite side of the tumor 720 or patient 730 as the gantry moves. In each case, co-rotation is achieved by co-rotating the gantry of the charged particle beam system and the patient's support, such as the rotatable platform 756, also referred to herein as movable or dynamic Positioned patient platform, patient chair or patient sofa. Mechanical elements, such as support element 752 , secure the various elements of charged particle beam state determination system 750 relative to each other, relative to nozzle system 146 and/or relative to patient 730 . For example, the support element 752 maintains a second distance d ₂ between the location of the tumor 720 and the third sheet 780 , and/or maintains a third distance d ₃ between the location of the third sheet 780 and the scintillation material 710 . More generally, the support elements 752, optionally controlled by a computer, for example, dynamically position any elements around the patient 730 relative to each other or in x, y, z space in the patient's diagnosis/treatment room.

Referring now to FIG. 4B , positioning the nozzle system 146 of the gantry 960 on the opposite side of the patient 730 from the detection surface (eg, the scintillation material 710 ) in the gantry movement system 950 is described. Typically, in the gantry movement system 950, one or more magnets of the nozzle/nozzle system 146 and/or beam delivery system 135 are repositioned as the gantry 960 is first rotated about the axis. As shown, the nozzle system 146 is positioned by the gantry 960 in a first position at a first time t ₁ and in a second position at a second time t ₂ , where n positions are selectable. An electromechanical system, such as a patient table, patient bed, patient sofa, patient rotation device, and/or scintillation plate holder, holds the patient 730 between the nozzle system 146 and the scintillation material 710 of the tomography system 700 . Similarly, not shown for clarity, as the gantry 960 rotates or moves the nozzle system 146, the electromechanical system maintains the position of the third sheet 780 and/or the fourth sheet 790 to the back of the patient 730 or Opposite side from nozzle system 146 . Similarly, as the gantry 960 rotates or moves the nozzle system 146, the electromechanical system maintains the position of the first sheet 760 or the first screen and/or the position of the second sheet 770 or second screen in the patient 730 and the nozzle The same or front side of the system 146 . As shown, the electromechanical system optionally positions the first sheet 760 in the positively charged particle path at a first time t ₁ and rotates, pivots and/or rotates the first sheet 760 at a second time t ₂ Or slide away from the positively charged particle path. The electromechanical system is optionally and preferably connected to the main controller 110 and/or the therapy delivery control system 112 . The electromechanical system optionally maintains a fixed distance between (1) the patient and the nozzle system 146 or nozzle tip 612, (2) the patient 730 or tumor 720 and the scintillation material 710, and/or (3) the nozzle system 146 and the scintillation For the material 710, the gantry 960 is in the first position during the first treatment time, and the gantry 960 is in the second position during the second treatment time. Using a common charged particle beam path for imaging and cancer treatment and/or maintaining a known or fixed distance between the beam delivery/guiding element and the treatment and/or detection surface enhances the accuracy and accuracy of the images generated and/or tumor treatment /or Accuracy, as described above. Optionally, the gantry includes counterweights on opposite sides of the rotation axis of the gantry. Ideally, the counterweight does not affect the net moment of the gantry counterweight system about the gantry axis of rotation. In practice, the counterweight mass and distance force (all elements herein are on one side of the axis of rotation of the gantry) are 10% of the mass and distance force on the cross-section of the gantry on the opposite side of the axis of rotation of the gantry, Within 5%, 2%, 1%, 0.1% or 0.01%.

system integration

Any systems and/or elements described herein are optionally integrated together and/or optionally with known systems.

Therapy Delivery Control System

Referring now to FIG. 5, a centralized charged particle therapy system 1000 is shown. Typically, once a charged particle therapy regimen is designed, a central control system or therapy delivery control system 112 is used to control the subsystems, while reducing and/or eliminating direct communication between major subsystems. Typically, the therapy delivery control system 112 is used to directly control multiple subsystems of a cancer therapy system without direct communication between selected subsystems, which enhances safety, simplifies quality assurance and quality control, and facilitates programming. For example, the therapy delivery control system 112 directly controls one or more of the following: imaging systems, positioning systems, infusion systems, radio frequency quadrupole systems, linear accelerators, toroidal accelerators or synchrotrons, extraction systems, beamlines, irradiation nozzles, stages racks, display systems, sighting systems and verification systems. Typically, the control system integrates the subsystems, and/or integrates the output of one or more of the aforementioned cancer treatment system elements with the input of one or more of the aforementioned cancer treatment system elements.

Still referring to FIG. 5, an example of a centralized charged particle therapy system 1000 is provided. Initially, doctors such as oncologists prescribed 1010 or recommended the use of charged particles for tumor treatment. Subsequently, the treatment planning 1020 is initiated and the output of the treatment planning step 1020 is sent to the oncology information system 1030 and/or directly to the treatment delivery system 112 , which is an example of the master controller 110 .

Still referring to Figure 5, the treatment planning step 1020 is further described. Generally speaking, radiation (radiation) therapy planning is the process by which a team of oncologists, radiation therapists, medical physicists and/or medical dosimeters administers appropriate charged particle therapy to a patient's cancer. Typically, tumors and/or patients are imaged using one or more imaging systems 170, as described below. Planning optionally: (1) forward planning and/or (2) backward planning. Cancer treatment regimens are optionally evaluated with the aid of dose-volume histograms, which allow clinicians to assess the uniformity of dose to tumor and surrounding healthy structures. Typically, patient tomographic datasets are computed using multimodal image matching, image co-registration, or fusion, and treatment planning is almost entirely computer-based.

plan ahead

In forward planning, the treating oncologist places the beams in the radiation therapy planning system, including how many radiation beams to use and from which angle to deliver each beam. This planning is used for relatively simple cases where the tumor has a simple shape and is not close to any vital organs.

backward planning

In inverse planning, the radiation oncologist defines the patient's vital organs and tumors, and gives target doses and importance factors for each. Then, the optimizer is run to find the treatment that best matches all the input conditions.

Oncology Information System

Still referring to Figure 5, the oncology information system 1030 is further described. Generally, the oncology information system 1030 is one or more of the following: (1) an oncology-specific electronic medical record that manages the clinical, financial and administrative processes of the medical, radiological and surgical oncology departments; (2) a comprehensive An information and image management system; and (3) a complete patient information management system that centralizes patient data; Typically, the oncology information system 1030 interfaces with commercial charged particle therapy systems.

Safety Systems/Therapy Delivery Control Systems

Still referring to Figure 5, the therapy delivery control system 112 is further described. Typically, the therapy delivery control system 112 receives therapy inputs, such as charged particle cancer therapy regimens, from the therapy planning step 1020 and/or from the oncology information system 1030, and uses the therapy inputs and/or therapy regimens to control one of the charged particle beam systems 110 or multiple subsystems. The therapy delivery control system 112 is an example of the master controller 110, where the therapy delivery control system receives subsystem inputs from a first subsystem of the charged particle beam system 100 and provides to a second subsystem of the charged particle beam system 100:( 1) directly, the received subsystem input, (2) a processed version of the received subsystem input, and/or (3) such as a command or oncology information system 1030 for satisfying the requisites of the treatment planning step 1020 instructions. Typically, most or all of the communication between the subsystems of the charged particle beam system 100 is to and from the therapy delivery control system 112 rather than communicating directly with another subsystem of the charged particle beam system 100 . Using a logically centralized therapy delivery control system has a number of benefits, including: (1) a single centralized code to maintain, debug, secure, update, and check, for example, quality assurance and quality control; (2) access to information between subsystems (3) the ability to replace subsystems with only one interface code modification; (4) room security; (5) software access control; (6) a single centralized control of security monitoring; and (7) centralized code leads to Integrated safety system 1040 that includes most or all subsystems of charged particle beam system 100 . Examples of subsystems of the charged particle cancer treatment system 100 include: any controllable or Monitorable elements, targeting/delivery system 140, nozzle system 146, gantry 1060 or elements of gantry 1060, patient interface module 150, patient positioner 152, display system 160, imaging system 170, patient position verification system 179, any of the foregoing element and/or any subsystem element. On-treatment therapy changes 1070 are optionally computer-generated with or without the assistance of a technician or physician, and are approved while the patient is still in the therapy room, chair, and/or therapy position.

Integrated cancer therapy-imaging system

One or more imaging systems 170 are optionally used in a fixed position in the cancer treatment room, and/or moved with a gantry system, such as a gantry system supporting: part of beam delivery system 135, targeting/delivery control system 140, and /or move or rotate around a patient positioning system, such as at a patient interface module. Without loss of generality and for ease of describing the present invention, an example of an integrated cancer therapy-imaging system follows. In each system, the beam delivery system 135 and/or the nozzle system 146 direct a positively charged beam path, such as from a synchrotron, as described above for tumor treatment and/or tomography.

Example I

Referring now to FIG. 6A, a first example of an integrated cancer therapy-imaging system 1300 is shown. In this example, charged particle beam system 100 is shown with a treatment beam 269 directed at tumor 720 of patient 730 along the z-axis. Also shown are a set of imaging sources 1310, imaging system elements and/or their paths, and a set of detectors 1320 corresponding to the corresponding elements of the set of imaging sources 1310. Herein, the set of imaging sources 1310 is referred to as the source, but is alternatively any point of the beam train preceding the tumor or the center point of the element or gantry rotation. Thus, a given imaging source is optionally a dispersive element for forming a cone beam. As shown, the first imaging source 1312 produces a first beam path 1332 and the second imaging source 1314 produces a second beam path 1334, wherein each path enters at least the tumor 720, and optionally and preferably separately to the set of detections First detector array 1322 and second detector array 1324 of detector 1320 . Herein, first beam path 1332 and second beam path 1334 are shown forming a 90° angle, which produces complementary images of tumor 720 and/or patient 730 . However, the angle formed is optionally any angle from 10 to 350°. Herein, for clarity of presentation, first beam path 1332 and second beam path 1334 are shown as single lines, which are optionally expanded, uniform diameter, or concentrated beams. Herein, the first beam path 1332 and the second beam path 1334 are shown in transmission mode, with their respective sources and detectors located on opposite sides of the patient 730, respectively. However, the beam path from the source to the detector is optionally a scattering path and/or a diffuse reflection path. Optionally, one or more detectors in the set of detectors 1320 are a single detector element, a row of detector elements or preferably a two-dimensional detector array. The use of two two-dimensional detector arrays is referred to herein as a two-dimensional-two-dimensional imaging system or a 2D-2D imaging system.

Still referring to FIG. 6A, the first imaging source 1312 and the second imaging source 1314 are shown in a first position and a second position, respectively. Each of first imaging source 1312 and second imaging source 1322 optionally: (1) maintain a fixed position; (2) provide first beam path 1332 and second beam path 1334, respectively, such as to imaging system detector 1340 or through gantry 960, such as through a set of one or more holes or slits; (3) first beam path 1332 and second beam path 1334, respectively, are provided off-axis to the plane of motion of nozzle system 146; (4) ) move with the gantry 960 when the gantry 960 rotates about at least the first axis; (5) move with the auxiliary imaging system, as described above, independent of the motion of the gantry; and/or (6) Represents a narrow cross-section of the path of the expanding cone beam.

Still referring to FIG. 6A , the detectors 1320 of the set are shown coupled with corresponding elements of the sources 1310 of the set. Each member of the set of detectors 1320 optionally and preferably co-moves and/or co-rotates with the corresponding member and the corresponding member of the set of sources 1310 . Thus, if the first imaging source 1312 is statically positioned, the first detector 1322 is optionally and preferably statically positioned. Similarly, to facilitate imaging, if the first imaging source 1312 moves along a first arc as the gantry 960 moves, the first detector 1322 optionally and preferably moves along the first arc as the gantry 960 moves. An arc or second arc movement where the relative position of the first imaging source 1312 on the first circular arc, the point around which the stage 960 moves, and the relative position of the first detector 1322 along the second arc are constant. To facilitate this process, the detectors are optionally mechanically connected, eg, to mechanically support the stage 960, so that when the stage 960 moves, the stage moves the source and corresponding detector simultaneously. Optionally, the source moves, such as a series of detectors along the second arc to capture a set of images. As shown in Figure 6A, first imaging source 1312, first detector array 1322, second imaging source 1314, and second detector array 1324 are coupled to a rotatable imaging system support 1812, which is optionally independent of Stage 960 rotates, as described further below. As shown in FIG. 6B, first imaging source 1312, first detector array 1322, second imaging source 1314, and second detector array 1324 are coupled to stage 960, which in this case is a rotatable stage shelf.

Still referring to Figure 6A, optionally and preferably, a combination of elements of the set of sources 1310 and elements of the set of detectors 1320 is used to collect a series of responses, eg, one source and one detector to produce detected intensities , and the rotatable imaging system support 1812 preferably a set of detected intensities to form an image. For example, a first imaging source 1312 (eg, a first X-ray source or a first cone beam X-ray source) and a first detector 1322 (eg, an X-ray film, a digital X-ray detector, or a two-dimensional detector) are in a first A first X-ray image of the patient is produced at a time, and a second X-ray image of the patient is produced at a second time, for example, to confirm the holding position of the tumor, or the movement of the gantry and/or nozzle system 146, or the rotation of the patient 730 subsequent holding position. A set of collected using the first imaging source 1312 and the first detector 1322 as a function of the motion of the gantry and/or the nozzle system 146 supported by the gantry, and/or as a function of the motion and/or rotation of the patient 730 n images, optionally and preferably combined to produce a three-dimensional image of patient 730, eg, a three-dimensional X-ray image of patient 730, where n is a positive integer, eg greater than 1, 2, 3, 4, 5, 10, 15, 25 , 50 or 100. Optionally, the set of n images is as described using a second imaging source 1314 (eg, a second X-ray source or a second cone beam X-ray source) and a second detector 1324 (eg, a second X-ray detection imager) collected in combination, wherein using two or more source/detector combinations are combined to produce an image in which the patient 730 does not move between images, since the two or more images are optionally and preferably in Collected at the same time, eg time difference less than 0.01, 0.1, 1 or 5 seconds. A longer time difference can be used. Preferably, the n two-dimensional images are collected as a function of the rotation of the gantry 960 about the tumor and/or the patient, and/or as a function of the rotation of the patient 730, and the two-dimensional images of the X-ray cone beam are mathematically combined to form the tumor 720 and/or a three-dimensional image of the patient 730 . Optionally, the first X-ray source and/or the second X-ray source are X-ray sources that diverge divergently form a cone through the tumor. A set of images collected using a two-dimensional detector that detects the divergent X-rays transmitted through the tumor as a function of the divergent X-ray cone rotating around the tumor, is used to form the three-dimensional X-rays of the tumor and a portion of the patient, For example in X-ray computed tomography.

Still referring to Figure 6A, using two imaging sources and two detectors positioned at 90° to each other allows the gantry 960 or patient 730 to be rotated through half the angle required to use only one imaging source and detector combination. The third imaging source/detector combination allows the three imaging source/detector combinations to be arranged at 60° intervals, allowing the imaging time to be sliced into the gantry 960 or patient required to use a single imaging source-detector combination 730 spins a third of the time. Typically, the combination of n source detectors reduces the time and/or rotation requirements to 1/n. Further shortening is possible if the patient 730 and the gantry 960 are rotated in opposite directions. In general, the use of multiple source-detector combinations for a given technology allows for significant engineering benefits that do not require the gantry to be rotated through large angles.

Still referring to Figure 6A, the set of sources 1310 and the set of detectors 1320 optionally use more than one imaging technique. For example, the first imaging technique uses X-rays, the second imaging technique uses fluoroscopy, the third imaging technique detects fluorescence, the fourth imaging technique uses cone beam computed tomography or cone beam CT, and the fifth imaging technique uses other electromagnetic waves . Optionally, the set of sources 1310 and the set of detectors 1320 use two or more sources and/or two or more detectors of a given imaging technique, such as the two X-ray sources described above to n X-ray sources.

Still referring to Figure 6A, one or more of the set of sources 1310 and one or more of the set of detectors 1320 are used, optionally coupled with the use of a positive charged particle tomography system as described above. As shown in Figure 6A, the positively charged particle tomography system uses a second mechanical support 1343 to co-rotate the scintillation material 710 with the stage 960, as well as with optional sheets, such as the first sheet 760 and /or fourth sheet 790.

Example II

Referring now to FIG. 6B, a second example of an integrated cancer therapy-imaging system 1300 using greater than three imagers is shown.

Still referring to Figure 6B, two pairs of imaging systems are shown. In particular, the first imaging source 1312 and the second imaging source 1314 coupled to the first detector 1322 and the second detector 1324 are as described above. For clarity of presentation and without loss of generality, the first imaging system and the second imaging system are referred to as a first X-ray imaging system and a second X-ray imaging system. In a similar manner to the first and second imaging systems described in the previous examples, the second pair of imaging systems uses a third imaging source 1316 coupled to a third detector 1326 and a third imaging source 1316 coupled to a fourth detector 1328. Four imaging sources 1318. Herein, the second pair of imaging systems optionally and preferably uses a second imaging technique, such as fluoroscopy. Optionally, the second pair of imaging systems is a single unit, such as the third imaging source 1316 coupled to the third detector 1326, rather than a pair of units. Optionally, one or more of the set of imaging sources 1310 are statically positioned while one or more of the set of imaging sources 1310 co-rotate with the gantry 960 . Pairs of imaging sources/detectors optionally have common and different distances, such as a first distance d ₁ , eg for a first source-detector pair, and a second distance d ₂ , eg for a second source- detector or second source-detector pair. As shown, the tomographic detector or scintillation material 710 is at a third distance _d3 . The apparent difference allows the source-detector elements to rotate on a separate rotation system at a different rate than that of the gantry 960, which allows for the collection of full three-dimensional images during tumor treatment with positively charged particles.

Example III

For clarity of presentation, referring now to FIG. 6C, any beam or beam path described herein is optionally a cone beam 1390 as shown. Patient support 152 is a mechanical and/or electromechanical device for positioning, rotating and/or constraining tumor 720 and/or any portion of patient 730 relative to any axis.

Tomography Detector System

The tomography system optically couples the scintillation material to the detector. As mentioned above, the tomography system optionally and preferably uses one or more detection sheets, beam tracking elements and/or tracking detectors to determine/monitor the presence of samples, imaging elements, patients or tumors in the beam path before and The position, shape and/or orientation of the subsequent charged particle beam. Herein, without loss of generality, the detectors are described as a detector array or a two-dimensional detector array located next to the scintillation material; however, the detector array optionally uses one or more optics with the scintillation material Optical coupling. Optionally and preferably, the detector array is part of an imaging system that images the scintillation material 710, wherein the imaging system addresses the original volume on the viewing plane of secondary photons emitted as a result of the passage of the remaining charged particle beam 267 or Origin position. As described below, more than one detector array is optionally used to image the scintillation material 710 from more than one direction, which contributes to the three-dimensionality of the original photon spot, positively charged particle beam path, and/or tomographic image reconstruction.

imaging

Typically, medical imaging is performed using imagers to produce visual and/or symbolic representations of internal components of the body for diagnosis, treatment, and/or as a recording of the state of the body. Typically, tumors and/or patients are imaged using one or more imaging systems. For example, the X-ray imaging system and/or the positively charged particle imaging system as described above are optionally used alone, together and/or with any additional imaging systems, such as using X-ray radiography, magnetic resonance imaging, Medical ultrasound imaging, thermal imagers, medical photography, positron emission tomography (PET) systems, single photon emission computed tomography (SPECT) and/or another nuclear/charged particle imaging technique.

datum mark

The fiducial markers and fiducial detectors are optionally used to locate, locate, track, avoid and/or adjust objects moving relative to the nozzle or nozzle system 146 of the charged particle beam system 100 and/or relative to each other in the treatment room. Here, for clarity of presentation and without loss of generality, fiducial markers and fiducial detectors are described in terms of a movable or statically positioned therapy nozzle and a movable or static patient position. Typically, however, fiducial markers and fiducial detectors are used to mark and identify the location or relative location of any objects in a treatment room (eg, cancer therapy treatment room 1222). Here, the fiducial indicator refers to a fiducial marker or a fiducial detector. Here, photons travel from a fiducial marker to a fiducial detector.

Here, datum refers to a fixed basis for comparison, such as points or lines. A fiducial marker or fiducial is an object placed in the field of view of an imaging system that optionally appears in a generated image or digital representation of a scene, area, or volume generated for use as a reference point or as a metric. Herein, a fiducial marker is an object that is placed on a treatment room object or patient but does not enter the treatment room object or patient. In particular, in this context, the fiducial markers are not implanted devices in the patient's body. In physics, a datum is a reference point: a fixed point or line in the scene to which other objects can be measured in relation or relative to it. Observe the fiducial marks using sighting equipment used to determine direction or measure angles, such as a sighting instrument or a modern digital inspection system. Two examples of modern position determination systems are the Passive Polaris Spectra system and the Polaris Vicra system (NDI, Ontario, Canada).

Referring now to FIG. 7A, the use of the fiducial notation system 3200 is described. Typically, a fiducial marker is placed 3210 on the subject, light from the fiducial marker is detected 3230, a relative object position is determined 3240, and subsequent tasks, such as treating a tumor 3270, are performed. For clarity of presentation and without loss of generality, non-limiting examples of fiducial markers and X-ray and/or positively charged particle tomography imaging and/or therapy using positively charged particles are provided below.

Example I

Referring now to FIG. 8, a fiducial marker assisted tomography system 3300 is shown and described. Typically, a set of fiducial marker detectors 3320 detect photons emitted and/or reflected from a set of fiducial markers 3310 and the resulting determined distances and calculated angles are used to determine a plurality of objects or elements such as in the treatment room 1222 relative position.

Still referring to FIG. 8, initially, a set of fiducial markers 3310 are placed on one or more components. As shown, the first fiducial mark 3311 , the second fiducial mark 3312 and the third fiducial mark 3313 are located on the preferably rigid first support element 3352 . As shown, the first support element 3352 supports the scintillation material 710. Since each of the first fiducial marker 3311 , the second fiducial marker 3132 , the third fiducial marker 3333 , and the scintillation material 710 are fixedly or statically positioned on the first support element 3352 , based on the degree of freedom of movement of the first support element , if the positions of the first fiducial marker 3311, the second fiducial marker 3312, and/or the third fiducial marker 3313 are known, the relative position of the scintillation material 710 is also known. In this case, one or more distances between the first support element 3352 and the third support element 3356 are determined, as described further below.

Still referring to FIG. 8 , a set of fiducial detectors 3320 is used to detect light emitted and/or reflected from one or more fiducial markers of the set of fiducial markers 3310 . As shown, ambient photons 3221 and/or photons from an illumination source are reflected by first fiducial markers 3311, travel along a first fiducial path 3331, and are detected by a first fiducial detector 3321 of the set of fiducial detectors 3320 . In this case, the first signal from the first fiducial detector 3321 is used to determine the first distance to the first fiducial marker 3311. If the first support element 3352 supporting the scintillation material 710 is only translated along the z-axis relative to the nozzle system 146 , the information of the first distance is sufficient to determine the position of the scintillation material 710 relative to the nozzle system 146 . Similarly, photons emitted, for example, from light emitting diodes embedded in the second fiducial marker 3312 travel along the second fiducial path 3332 and generate a second signal when detected by the second fiducial detector 3322 of the set of fiducial detectors 3320 . The second signal is optionally used to confirm the position of the first support element 3352, reduce errors in the determined position of the first support element 3352, and/or to determine the degree of movement of the second axis of the first support element 3352, For example the inclination of the first support element 3352. Similarly, photons passing from the third fiducial marker 3313 travel along a third fiducial path 3333 and generate a third signal when detected by the third fiducial detector 3323 of the set of fiducial detectors 3320. The third signal is optionally used to confirm the position of the first support element 3352, reduce errors in the determined position of the first support element 3352, and/or to determine the range of second or third axis motion of the first support element 3352 , such as the rotation of the first support element 3352.

If all moveable elements within the treatment room 1222 move together, then depending on the degrees of freedom of the moveable elements, determining the position of one, two, or three fiducial marks is sufficient to determine the position of all moveable elements that move together. Optionally, however, two or more objects in treatment room 1222 move independently or semi-independently of each other. For example, the first movable object is optionally translated, tilted and/or rotated relative to the second movable object. One or more additional fiducial markers in the set of fiducial markers 3310 placed on each movable object allow the relative position of each movable object to be determined.

Still referring to FIG. 8 , the position of the patient 730 is determined relative to the position of the scintillation material 710 . As shown, the second support element 3354 that positions the patient 730 is optionally translated, tilted, and/or rotated relative to the first support element 3352 that positions the scintillation material 710 . In this case, the fourth fiducial marker 3314 attached to the second support element 3354 allows the current position of the patient 730 to be determined. As shown, the position of a single fiducial element, the fourth fiducial mark 3314, is determined by a first fiducial detector 3321 and a second fiducial detector 3322, the first fiducial detector 3321 determining the first distance to the fourth fiducial mark 3314, The second fiducial detector 3322 determines a second distance to the fourth fiducial marker 3314 with a first arc of the first distance from the first fiducial detector 3321 and a second arc of the second distance from the second fiducial detector 3322 , at a point where the fourth fiducial mark 3334 marks the position of the second support element 3352 and the support position of the patient 730 . In conjunction with the system for determining the location of the scintillation material 710 described above, the location of the scintillation material 710 relative to the patient 730 and thus relative to the tumor 720 is determined.

Still referring to Figure 8, a fiducial marker and/or a fiducial detector are optionally and preferably used to determine more than one distance or angle from one or more objects. In the first case, as shown, the light from the fourth fiducial marker 3314 is detected by both the first fiducial detector 3321 and the second fiducial detector 3322. In the second case, the light detected by the first reference detector 3321 passes through the first reference mark 3311 and the fourth reference mark 3314 as shown. Thus, (1) one fiducial marker and two fiducial detectors are used to determine the position of the object, (2) two fiducial markers and one fiducial detector on both elements are used to determine the distance of the two elements relative to a single detector , and/or as shown and described below with respect to FIG. 10A , and/or (3) use a single fiducial detector to detect the position of two or more fiducial markers on a single object, wherein the single object is determined from the resulting signal distance and orientation. Typically, multiple fiducial markers and multiple fiducial detectors are used to determine or factors to determine the position of multiple objects, especially when the objects are rigid (eg, support elements) or semi-rigid (eg, human, head, torso) or limb).

Still referring to FIG. 8, the fiducial marker assisted tomography system 3300 is further described. As shown, the set of fiducial detectors 3320 are mounted on a third support member 3356 whose position and orientation relative to the nozzle system 146 is known. Thus, using the set of fiducial markers 3310, the position and orientation of the nozzle system 146 relative to the tumor 720, the patient 730, and the scintillation material 710 are known, as described above. Optionally, the main controller 110 uses input from the set of fiducial detectors 3320 to: (1) indicate movement of the patient 730 or operator; (2) utilize the installed fiducial markers and/or fiducial detectors to control, adjust and/or dynamically adjust the position of any element, and/or (3) control the operation of the charged particle beam, eg, for imaging and/or therapy or to perform a safety stop of the positively charged particle beam. Additionally, based on past movement, such as operator movement through the treatment room 1222 or relative movement of the two objects, the master controller is optionally and preferably used to predict or predict the treatment beam 269 and the moving object (in this case next operator) and take appropriate action or prevent a collision of the two objects.

Example II

Referring now to FIG. 9, a fiducial marker assisted therapy system 3400 is depicted. To illustrate the invention without loss of generality, this example uses positively charged particles to treat tumors. However, the methods and apparatus described herein are suitable for imaging of samples as described above.

Still referring to Figure 9, Figure 9 shows four further cases of the fiducial marker-fiducial detector combination. In the first case, the first fiducial detector 3321 is used to detect photons from the first fiducial marker 3311 as described in the previous example. However, since the sixth fiducial path 3336 is blocked, in this case by the patient 730 , the photons from the fifth fiducial marker 3315 are blocked and prevented from reaching the first fiducial detector 3321 . The inventors noticed that there were no expected signals, previously observed signals disappeared over time, and/or the appearance of new signals (each adding information about the presence), and/or the movement of objects. In the second case, the photons from the fifth fiducial marker 3315 passing along the seventh fiducial path 3337 are detected by the second fiducial detector 3322, which shows that the generation can be used to find flexible elements or elements with many degrees of freedom A fiducial marker for blocked and unblocked signals at edges (eg, a patient's hand, arm, or leg). In the third case, photons traveling from the fifth fiducial marker 3315 and the sixth fiducial marker 3316 along the seventh fiducial path 3337 and the eighth fiducial path 3338, respectively, are detected by the second fiducial detector 3322, which shows A fiducial detector optionally detects signals from multiple fiducial markers. In this case, the photons from the multiple reference sources are optionally of different wavelengths, occur at different times, occur in different overlapping time periods and/or are phase modulated. In the fourth case, the seventh fiducial marker 3317 is fixed on the same element as the fiducial detector, in this case the front surface plane of the third support element 3356. Additionally, in the fourth case, a fourth reference detector 3324 that observes photons traveling along the ninth reference path 3339 is mounted on a fourth support element 3358 , which locates the patient 730 and its tumor 720 , and/or attached to one or more reference source elements.

Still referring to FIG. 9 , a fiducial marker-assisted therapy system 3400 is further described. As described above, the set of fiducial markers 3310 and the set of fiducial detectors 3320 are used to determine the relative position of an object in the treatment room 1222, as shown, the object has a third support element 3356, a fourth support element 3358, Patient 730 and Tumor 720. Furthermore, as shown, the physical location and orientation of the third support element 3356 relative to the nozzle system 146 is known. Thus, using position signals from the set of fiducial detectors 3320 representing the fiducial markers 3310 and chamber elements, the main controller 110 controls the targeting of the treatment beam 269 as a function of time, movement of the nozzle system 146 and/or movement of the patient 730 (Targeting) Tumor 720.

Example III

Referring now to FIG. 10A, a fiducial marker assisted treatment room system 3500 is depicted. Without loss of generality and for clarity of presentation, the zero vector 3501 is from the nozzle when the first axis controller 143 of the scanning system 140, such as the vertical controller, and the second axis controller 144, such as the horizontal controller, are turned off A vector or line from the system 146 . Without loss of generality and future clarity, the zero point 3502 is the point on the zero vector 3501 at the plane of the exit face of the nozzle system 146 . Typically, defined points and/or defined lines are used as reference positions and/or reference directions, and fiducial markers are defined relative to the points and/or lines in space.

Six additional cases of the fiducial marker-fiducial detector combination are shown to further describe the fiducial marker assisted treatment room system 3500. In the first case, the location of the patient 730 is determined. Herein, the first fiducial markers 3311 mark the location of the patient positioning device 3520 and the second fiducial markers 3312 mark the location of a portion of the skin (eg, limb, joint) of the patient 730 , and/or a specific location relative to the tumor 720 . In the second case, the plurality of fiducial markers of the set of fiducial markers 3310 and the plurality of fiducial detectors of the set of fiducial detectors 3320 are used to determine the position/relative position of a single object, wherein this process is optional and preferred This is repeated for each object in the processing chamber 1222. As shown, the patient 730 is marked with the second fiducial marker 3312 and the third fiducial marker 3313, and the second fiducial marker 3312 and the third fiducial marker 3313 are monitored using the first and second fiducial markers 3321 and 3322. In the third case, the fourth fiducial marker 3314 marks the scintillation material 710 and the sixth fiducial path 3336 shows another example of a blocked fiducial path. In the fourth case, the fifth fiducial marker 3315 marks an object that is not always present in the treatment room, such as a wheelchair 3540, a walker or a cart. In the sixth case, a sixth fiducial marker 3316 is used to mark the operator 3550 , which is movable and must be protected from unwanted illumination by the nozzle system 146 .

Still referring to FIG. 10A, FIG. 10A depicts a clear field therapy vector and a blocked field therapy vector. The unobstructed field treatment vector includes the path of the treatment beam 269 that does not intersect non-standard objects, where the standard object includes all elements in the path of the treatment beam 269 used to measure the properties of the treatment beam 269, such as the first sheet 760, the first sheet Two sheets 770 , a third sheet 780 and a fourth sheet 790 . Examples of non-standard or interfering objects include the armrests of a patient couch, the back of a patient couch and/or support bars, such as robotic arms. Using a fiducial indicator, such as a fiducial marker, on any potentially interfering objects allows the main controller 110 to treat only the tumor 720 of the patient 730 with a clear field treatment vector. For example, the fiducial markers are optionally placed along the edges or corners of the patient couch or patient positioning system, or virtually anywhere on the patient couch. Combining known knowledge of the geometry of non-standard objects, the master controller can derive/calculate the presence of non-standard objects in current or future unobstructed field therapy vectors, form obstructed field therapy vectors, and perform either: add therapy beams 269 of energy to compensate, move interfering non-standard objects, and/or move the patient 730 and/or nozzle system 146 to a new location to produce a patency field therapy vector. Similarly, for a given determined patency field treatment vector, the total treatable area for a given nozzle-patient couch position is optionally and preferably determined using scanning of the proton beam. Furthermore, the patency field vector is optionally and preferably predetermined and used in the development of the radiation therapy regimen.

Referring again to FIGS. 7A, 8, 9, and 10A, typically, one or more fiducial markers and/or one or more fiducial detectors are attached to any movable and/or statically positioned Objects/elements that allow the relative position and orientation between any group of objects in the treatment room 1222 to be determined.

Optionally, acoustic emitters and detectors, radar systems, and/or any range and/or direction finding systems are used in place of the source-photon-detector systems described herein.

2D-2D X-ray imaging

Still referring to FIG. 10A, for clarity of presentation and without loss of generality, FIG. 10A shows a two-dimensional-two-dimensional (2D-2D) X-ray imaging system 3560, which is representative of any source-sample-detector transmission based imaging system . As shown, 2D-2D imaging system 3560 includes a 2D-2D source end 3562 on a first side of patient 730 and a 2D-2D detector end 3564 on a second (opposite) side of patient 730. 2D - 2D source end 3562 holds/positions and/or aligns source imaging elements such as: (1) one or more imaging sources; (2) first imaging source 1312 and second imaging source 1322; and/or (3) First cone beam X-ray source 1392 and second cone beam X-ray source 1394; meanwhile, 2D-2D detector ends 3564 hold, position and/or align, respectively: (1) one or more imaging detectors 3566 ; (2) a first imaging detector and a second imaging detector; and/or (3) a first cone beam X-ray detector and a second cone beam X-ray detector.

In practice, optionally and preferably, the 2D-2D imaging system 3560 as a unit rotates around the patient about a first axis (eg, the axis of the treatment beam 269), as shown at a second time _t2 . For example, at a second time _t2 , the 2D-2D source end 3562 moves up out of the plane shown, while the 2D-2D detector end 3564 moves down out of the plane shown. Thus, the 2D-2D imaging system can be operated at one or more positions by rotating about the first axis while the path of the treatment beam 269 is not interfered with during operation of the treatment beam 269 .

Optionally and preferably, the 2D-2D imaging system 3560 does not physically obstruct the treatment beam 269 or the associated residual energy imaging beam from the nozzle system 146 . Through the relative movement of the nozzle system 146 and the 2D-2D imaging system 3560, the average path of the treatment beam 269 and the average path of the X-rays from the X-ray source of the 2D-2D imaging system 3560 form an angle from 0° to 90°, and more Preferably the angle is greater than 10°, 20°, 30° or 40° and less than 80°, 70° or 60°. Still referring to FIG. 10A, as shown at the second time _t2 , the angle between the average treatment beam and the average X-ray beam is 45°.

The 2D-2D imaging system 3560 is optionally rotated about a second axis, eg, an axis perpendicular to FIG. 10A and passing through the patient and/or passing through the first axis. Thus, as shown, when the outlet port of the output nozzle system 146 moves in an arc and the treatment beam 269 enters the patient 730 from another angle, the 2D-2D imaging system 3560 rotates about a second axis perpendicular to FIG. 10A, 2D - The first axis of the 2D imaging system 3560 continues to rotate about the first axis, which is the axis of the treatment beam 269 or the remaining charged particle beam 267 in the case of imaging with protons.

Optionally and preferably, one or more elements of the 2D-2D X-ray imaging system 3560 are marked with one or more fiducial elements, as described above. As shown, the 2D-2D detector end 3564 is configured with a seventh fiducial marker 3317 and an eighth fiducial marker 3318, while the 2D-2D source end 3562 is configured with a ninth fiducial marker 3319, wherein any number of fiducial markers are used.

In many cases, because the two fiducial indicators are physically connected, movement of one fiducial indicator requires movement of the second fiducial indicator. Therefore, a second fiducial indicator is not strictly necessary given the complex code for calculating the relative positions of multiple fiducial markers, which are typically rotated around the patient 730, translated through the patient 730, and/or relative to one or more additional fiducial markers. The fiducial mark moves. The code is further complicated by non-mechanically connected and/or independently movable obstacles, such as a first obstacle object moving along a first concentric path and a second obstacle object moving along a second concentric path. The inventors note that the complex location determination code is greatly simplified if the path of the treatment beam 269 to the patient 730 is determined to be unobstructed by using fiducial indicators prior to treating at least one and preferably each voxel of the tumor 720 . Thus, multiple fiducial markers placed on potentially obstructing objects simplifies the code and reduces treatment-related errors. Typically, a treatment area or treatment cone is determined from the current position of all possible obstruction objects (eg, support elements of a patient couch), wherein the treatment cone from the output nozzle system 146 to the patient 730 does not pass through any obstructions. While moving in an arc about the patient 730, the path of the treatment beam 269 and/or the path of the remaining charged particle beam 267 optionally moves from the treatment cone to the treatment cone as the treatment cones overlap, while Continuous use of imaging/therapy beams is not required. Thus, the transformation of the standard tomography algorithm thus allows physical obstacles to the imaging/treatment beam to be avoided.

non-isocentric system

The inventors note that the fiducial assisted imaging system, fiducial assisted tomography system 3300, and/or fiducial assisted therapy system 3400 may be applicable to treatment rooms 1222 without treatment beam isocenters, treatment rooms without tumor isocenters 1222, and/or a treatment room 1222 that does not rely on the use of and/or relies on calculations of isocenters. In addition, the inventors note that all positively charged particle beam therapy centers in public view are based on a mathematical system that uses isocenters to calculate beam position and/or treatment position, and the fiducial markers assisted imaging and treatment described herein The system does not require isocenters and is not necessarily based on a mathematical system using isocenters, as described further below. In sharp contrast, defined points and/or defined lines are used as reference positions and/or reference directions, and fiducial markers are defined relative to the points and/or lines in space.

Traditionally, the isocenter 263 of a gantry-based charged particle cancer treatment system is the point in space around which the rotation of the output nozzle surrounds. In theory, isocenter 263 is an infinitesimal point in space. However, conventional gantry and nozzle systems are large and very heavy equipment with mechanical errors associated with each element. In real life, the gantry and nozzle rotate around the central volume rather than a point, and at any given location of the gantry-nozzle system, the average or unchanged path of the treatment beam 269 traverses a portion of the central volume, but does not Must be a single point at isocenter 263. Therefore, in order to distinguish between theory and reality, this paper refers to the central volume as a mechanically defined isocentric volume, where under best engineering practice an isocenter has a geometric center, isocenter 263 . Furthermore, theoretically, as the gantry-nozzle system rotates around the patient, the average or unchanged line of the treatment beam 269 intersects at a point at the first time and the second time, preferably at all times, which is equal to Center point 263, whose location is unknown. In practice, however, the line passes through the mechanically identified isocentric volume 3512. The inventors note that in all gantry supported movable nozzle systems, the mathematically assumed isocenter 263 point is used to calculate the state of the beam used, eg the energy, intensity and direction of the charged particle beam. The inventors further note that, as in practice, the treatment beam 269 passes through the mechanically defined isocenter volume, but misses the isocenter 263, between the actual treatment volume and the calculated treatment volume of the patient's 730 tumor 720 at each time point. There is an error. The inventors have also noted that errors result in the treatment beam 269: (1) not impacting a given volume of tumor 720 with the prescribed energy, and/or (2) impacting tissue outside the tumor. Mechanically, this error cannot be eliminated, only reduced. However, as described above, the use of fiducial markers and fiducial detectors removes the limitation of using isocenters 263 at unknown locations, as the output of the fiducial markers and fiducial detectors are used without isocenters 263, without assumption of isocenters 263, and/or There is no spatial treatment calculation based on isocenter 263 to determine the actual location of the patient positioning system, tumor 720 and/or patient 730, to determine where the treatment beam 269 is impacting to achieve the treatment prescription provided by the physician. Instead, physically defined points and/or lines (eg, zero point 3502 and/or zero vector 3501 ) are used in conjunction with datums to: (1) determine the position and/or orientation of an object relative to the point and/or line, and/or or (2) perform calculations such as radiation therapy regimens.

Referring again to Figure 7A and again to Figure 10A, optionally and preferably, the task of determining relative object position 3240 uses a fiducial element (eg, an optical tracker) mounted in the treatment room 1222 (eg, in a gantry or nozzle system), and is calibrated to the "zero" vector 3501 of beam 269, which is defined as the electromagnetic and/or electrostatic steering of one or more final magnets in beam delivery system 135, and/or the output nozzle attached to its end point The path of the processing bundle when the system 146 is shut down. The zero vector 3501 is the path of the treatment beam 269 when the first axis controller 143 (eg, vertical control) and second axis controller 144 (eg, horizontal control) of the scanning system 140 are turned off. Zero point 3502 is any point, such as a point on zero vector 3501. Herein, without loss of generality and for clarity of presentation, the zero point 3502 is the point on the zero vector 3501 passing through the plane defined by the end points of the nozzles of the nozzle system 146 . Ultimately, using zero vector 3501 and/or zero point 3502 is a way to directly and optionally actively relate the coordinates of objects in treatment room 1222 (eg, moving objects and/or patient 730 and its tumor 720) to each other; not passively Associated with imaginary points in geo-relevant space (such as isocenters of a theory) that are not mechanically implemented in practice as spatial points, but always as isocenter volumes, e.g. including well-designed system isocenters The isocenter volume of the point. The example further differentiates between isocenter based and fiducial marker based targeting systems.

Example I

Referring now to FIG. 10B, a non-isocentric system 3505 of the fiducial marker-assisted treatment room system 3500 of FIG. 10A is depicted. As shown, the nozzle/nozzle system 146 is positioned relative to a reference element such as the third support element 3356. The reference element is optionally a reference fiducial marker and/or a reference fiducial detector affixed to any part of the nozzle system 146 and/or a rigid, known-position mechanical element affixed to the nozzle system 146 . As described above, the location of the tumor 720 of the patient 730 is also determined using the fiducial markers and fiducial detectors. As shown, at a first time t ₁ , the first average path of the treatment beam 269 passes through the isocenter 263 . At the second time t ₂ , the second mean path therapy beam 269 does not pass through the isocenter 263 due to inherent mechanical errors associated with the movement of the nozzle system 146 . In conventional systems, this would result in a treatment volume error. However, using a fiducial marker based system, the actual positions of the nozzle system 146 and the patient 730 are known at the second time _t2 , which allows the main controller to use the first axis controller 143 of the scanning system 140 (eg, vertical control) and The second axis controller 144 (eg, horizontal control) directs the treatment beam 269 to the target and the prescribed tumor volume. Again, since the actual position at the time of treatment is known using the fiducial marker system, mechanical errors due to movement of the nozzle system 146 are removed, and the actual known positions of the nozzle system 146 and tumor 720 are used for the x/y of the treatment beam 269 Axis adjustment, in contrast to the x/y axis adjustment made in conventional systems that assume the treatment beam 269 passes through the isocenter 263. Essentially: (1) the x/y axis adjustment of conventional targeting systems is wrong because the uncorrected treatment beam 269 does not pass through the assumed isocenter, (2) the x/y axis adjustment of the fiducial marker based system knows the treatment The actual position of the beam 269 relative to the patient 730 and its tumor 720, which allows for different x/y axis adjustments, adjusts the treatment beam 269 to treat a prescribed tumor volume at a prescribed dose.

Example II

Referring now to FIG. 10C, an example is provided showing the error in the isocenter 263 with a fixed beamline position and a moving patient positioning system. As shown, at the first time t ₁ , the average/unaltered treatment beam path 269 passes through the tumor 720 but misses the isocenter 263 . As mentioned above, conventional treatment systems assume an average/unaltered treatment beam path 269 through the isocenter 263 and adjust the treatment beam to a prescribed volume of the tumor 720 for treatment, with an assumed path through the center and adjustments based on the isocenter The paths are all wrong. In stark contrast, the fiducial marker system: (1) determines that the path of the actual mean/unaltered treatment beam 269 does not pass through the isocenter 263, (2) determines the actual path of the mean/unchanged treatment beam 269 relative to the tumor 720 , and (3) use a reference system such as zero line 3501 and/or zero point 3502 to adjust the actual average/unchanged therapy beam 269 to use the first axis controller 143 (eg, vertical controller) of the scanning system 140 and a second axis controller 144 (eg, a horizontal controller) to impinge a prescribed volume of tissue. As shown, at a second time _t2 , the average/unaltered treatment beam path 269 again misses the isocenter 263, resulting in a treatment error for conventional isocenter-based targeting systems, but as discussed above, at the second time _t2 Repeat the following steps until the nth treatment time, where n is a positive integer of at least 5, 10, 50, 100, or 500: (1) Determine the relative positions of: (a) Average/unchanged treatment beam 269 and (b) the patient 730 and its tumor 720, and (2) using the first axis controller 143, the second axis controller 144 to adjust the average/unaltered treatment beam 269 to actually position it relative to the tumor 720 to hit the prescribed tissue volume.

Referring again to Figures 8 and 9, typically at a first time, objects such as patient 730, scintillation material 710, X-ray system and nozzle system 146 are mapped and relative positions are determined. At a second time, the location of the mapped object is used for imaging (eg, X-ray and/or proton beam imaging) and/or therapy (eg, cancer therapy). Furthermore, isocenters are optionally used or not. Furthermore, since there is no need to know beam isocenter constraints, as long as a fiducial marker system is used, the treatment room 1222 can optionally be designed with a static or movable nozzle system 146 in combination with any patient positioning system along any set of axes.

Referring now to FIG. 7B, an alternative use of the fiducial marker system 3200 is described. After the initial step of placing fiducial markers 3210, the fiducial markers are optionally illuminated 3220, eg, with ambient or ambient light, as described above. The light from the fiducial marks is detected 3230 and used to determine the relative position of the object 3240, as described above. Thereafter, the object position is optionally adjusted 3250, eg, under the control of the master controller 110. The step 3220 of illuminating the fiducial marker and/or the step 3230 of detecting light from the fiducial marker and the step 3240 of determining the relative object position are iteratively repeated until the object is correctly positioned. Simultaneously or separately, the fiducial detector position 3280 is adjusted until the object is properly placed, eg, for treating a particular tumor voxel. By using any of the above steps: (1) optionally aligning one or more images 3260, such as X-ray images and proton tomography images collected using the determined location; (2) treating 3270 of tumor 720; and/ Or (3) track changes 3290 in tumor 720 to obtain dynamic treatment changes, and/or record treatment sessions for subsequent analysis.

Reference Charged Particle Paths

Referring now to FIG. 11, FIG. 11 depicts a charged particle reference beam path system 4000 in stark contrast to the isocentric reference point of the gantry system described above. The charged particle reference beam path system 4000 defines voxels in the treatment room 1222 , the patient 730 and/or the tumor 720 with respect to the reference path of the positively charged particles and/or a transformation thereof. The reference path of the positively charged particle includes one or more of the following: a zero vector, an unredirected beamline, an unsteered beamline, the nominal path of the beamline, and/or, for example, in a rotatable In case of gantry, and/or movable nozzle, translatable and/or rotatable position of zero vector, first non-redirecting beamline 2841, second non-redirecting beamline 2842 and/or third non-redirecting beamline Wire harness 2843. For clarity of presentation and without loss of generality, the term reference beam path as used herein refers to a system of axes defined by a charged particle beam under a known set of controls, eg entering a known location of the treatment room 1222, entering a treatment A known vector in chamber 1222 , a first known field applied in first axis controller 143 and/or a second known field applied in second axis controller 144 . Furthermore, as described above, the reference zero or null 3502 is a point on the path of the reference beam. More generally, reference beam path and reference zero alternatively refer to a calibrated reference beam path and a mathematical transformation of a calibrated reference zero of the beam path, such as an axis system defined by a charged particle beam path. The calibrated reference zero point is any point; however, preferably the reference zero point is on the calibrated reference beam path, and as used herein, for clarity and without loss of generality, is defined by the end point of the nozzles passing through the nozzle system 146 The plane's calibration reference point on the beam path. Optionally and preferably, in a previous calibration step, the applied field is based on one or more of the first and second known fields, and optionally the charged particle beam (eg along the treatment beam 269 ). Path) energy and/or flux/intensity, calibrate the reference beam path against one or more system position markers. The reference beam path is optionally and preferably implemented with a fiducial marker system. This will be further described below.

Example I

Still referring to FIG. 11 , in a first example, the charged particle reference beam path system 4000 is further described using a radiation therapy protocol developed using a conventional isocentric system 4022 . A physician-approved radiation therapy plan 4010, such as a radiation therapy plan developed using a conventional isocentric system 4022, is converted to a radiation therapy plan using a reference beam path-reference zero therapy plan. When coupled to the calibrated reference beam path, the conversion step uses the ideal isocenter; thus, subsequent treatment using the calibrated reference beam and fiducial indicator 4040 eliminates errors in the isocenter volume. For example, prior to tumor treatment 4070, the fiducial indicator 4040 is used to determine the location of the patient 730 and/or to determine an unobstructed treatment path to the patient 730. For example, the reference beam path and/or treatment beam path 269 thus obtained are projected in software to determine if the treatment beam path 269 is not obstructed by equipment in the treatment room, using the known geometry and indication of the treatment room objects The position and/or orientation of one or more and preferably all movable treatment room objects is determined by reference indicator 4040 . The software is optionally implemented in a virtual therapy system. Preferably, within less than 5, 4, 3, 2, 1, and/or 0.1 seconds before each use of therapy beam path 269, and/or within less than 5 seconds after movement of the patient positioning system, patient 730, and/or operator , 4, 3, 2, 1, and/or 0.1 seconds, the software system verifies an unobstructed treatment path relative to the actual physical obstacle marked with the fiducial indicator 4040.

Example II

In a second example, referring again to Figure 11, a charged particle reference beam path system 4000 is further described.

Typically, a radiation therapy regimen 4020 is developed. In the first case, an isocentric system 4022 is used to develop a radiation therapy plan 4020. In the second case, a system 4024 using a reference beam path of charged particles is used to develop a radiation therapy regimen. In the third case, before the physician approves the radiation therapy plan 4010, the radiation therapy plan 4020 developed using the reference beam path is converted to the isocentric system 4022 to conform to the traditional format presented to the physician, where the conversion uses the actual isocentric system 4022 The center point, rather than the mechanically defined isocenter volume and the error associated with the size of the volume, as described above. In any event, using the benchmark indicator 4040, the radiation therapy regimen is tested in software and/or a dry run without tumor therapy. Dry run allows for real-life error checking to ensure that no mechanical elements pass through the treatment beam in the proposed or developed radiation treatment plan 4020. Optionally, a physical dummy placed at the patient's treatment site is used in the dry run.

After the physician approves the radiation treatment plan 4010, tumor treatment 4070 begins, optionally and preferably with an intermediate step of verifying a clear treatment path 4052 using the fiducial indicator 4040. If the main controller 110 uses the reference beam path and the fiducial indicator 4040 to determine that the treatment beam 269 will intersect the subject or operator in the treatment room 1222, multiple options exist. In the first case, upon determining that the treatment path of the treatment beam 269 is blocked and/or obstructed, the main controller 110 temporarily or permanently halts the radiation therapy protocol. In the second case, a revised treatment plan 4054 is developed, optionally following interruption of the radiation therapy protocol, followed by the physician's approval of the revised radiation treatment plan 4010. In a third case, optionally after interrupting the radiation therapy regimen, a physical transformation 4030 of the delivery shaft system is performed, eg, by moving the nozzle system 146, rotating and/or translating the nozzle position 4034, and/or switching to another beam Line 4036. Subsequently, the tumor treatment 4070 is resumed and/or the revised treatment plan is submitted to the physician for approval of the radiation treatment plan.

Automated Cancer Therapy Imaging/Treatment Systems

Cancer treatment using positively charged particles includes multi-dimensional imaging, multi-axis tumor irradiation treatment protocols, particle beam control of multi-axis beams, multi-axis patient movement during treatment, and intermittent intervention between patient and/or treatment nozzle systems object. Automation of a subset of the overall cancer treatment system using robust code simplifies work with mixed variables, which facilitates oversight by medical professionals. Here, the automated system is optionally semi-automated, eg supervised by a medical professional.

Example I

In a first example, still referring to FIG. 11 and now referring to FIG. 12, a first example of a semi-automatic cancer therapy treatment system 4200 is described, and a charged particle reference beam path system 4000 is further described. Charged particle reference beam path system 4000 is optionally and preferably used to automatically or semi-automatically: (1) identify an upcoming treatment beam path; (2) determine the presence of a subject in the upcoming treatment beam path; and/or (3) Redirecting the path of the charged particle beam to produce an alternate on-coming treatment beam path. In addition, the main controller 110 optionally and preferably contains a prescribed tumor irradiation regimen, such as provided by the prescribing physician. In this example, the main controller 110 is used to determine an alternative treatment regimen to achieve the same purpose as the prescribed treatment regimen. For example, the master controller 110 instructs and/or controls: movement of the interventional object; movement of the patient positioning system; position to achieve the same or substantially the same treatment for the tumor 720 with radiation doses in each voxel and/or in the direction of tumor atrophy, where substantially the same is 90%, 95%, 97%, 98%, 99% of the prescription, or within 99.5% of dose and/or direction. Herein, the approaching treatment path is the next treatment path of the charged particle beam of the tumor for the current version of the radiation therapy protocol, and/or the treatment beam that is scheduled to be used in the next 1, 5, 10, 30 or 60 seconds path/vector. In the first case, a modified tumor treatment protocol is sent to a physician, eg in a nearby control room and/or in a remote laboratory or outside building, for physician approval. In the second case, the current or remote physician supervises (eg, generated using the master controller) the automatic or semi-automatic modification of the tumor treatment protocol. Optionally, the physician stops the treatment, suspends the treatment pending analysis of the modified tumor treatment protocol, slows the treatment program, or allows the master controller to continue following the computer-suggested modified tumor treatment protocol. Optionally and preferably, imaging data and/or imaging information such as those described above are input to the main controller 110 and/or provided to a supervising physician or physician authorized to modify the tumor treatment irradiation regimen.

Example II

Referring now to FIG. 12, a second example of a semi-automatic cancer therapy treatment system 4200 is depicted. Initially, a physician, such as an oncologist, provides an approved radiation therapy regimen 4210 to be implemented in a treatment step 4228 delivering charged particles to the tumor 720 of the patient 730. In parallel with the performance of the treatment steps, additional data is collected (eg, by updated/new images from the imaging system and/or via the fiducial indicator 4040). Subsequently, in an automatic process or a semi-automatic process, the main controller 110 optionally adjusts the provided physician-approved radiation therapy plan 4210 to form the current radiation therapy plan. In the first case, cancer treatment is stopped until the doctor approves the recommended/adjusted treatment plan, and the current radiation treatment plan approved by the doctor is continued. In the second case, the computer-generated radiation treatment plan automatically continues with the current treatment plan. In a third scenario, a computer-generated treatment plan is sent for approval, but the cancer treatment occurs at a reduced rate, giving doctors time to monitor the changed plan. The reduced rate is optionally less than 100%, 90%, 80%, 70%, 60% or 50% of the original treatment rate, and/or greater than 0, 10%, 20%, 30%, 40% of the original treatment rate or 50%. At any time, the supervising physician, medical professional, or staff member may increase or decrease the rate of treatment.

Example III

Still referring to FIG. 12, a third example of a semi-automatic cancer therapy treatment system 4200 is depicted. In this example, the process of semi-automatic cancer treatment 4220 is implemented. In stark contrast to the previous example where the physician provided the original cancer treatment plan 4210, in this example, the cancer treatment system 110 automatically generates the radiation treatment plan 4226. Subsequently, the automatically generated treatment plan (ie, the current radiation treatment plan) is implemented, for example, by a process step 4228 of delivering charged particles to the tumor 720 of the patient 730 . Optionally and preferably, the automatically generated radiation therapy plan 4226 is reviewed in an intermediate and/or parallel physician oversight step 4230, wherein the automatically generated radiation therapy plan 4226 is approved as the current treatment plan 4232 or approved as an alternative Treatment regimen 4234; once approved, called current treatment regimen.

Typically, the original physician-approved treatment plan 4210, the automatically generated radiation treatment plan 4226, or the altered treatment plan 4234, when administered, is referred to as the current radiation treatment plan.

Example IV

Still referring to FIG. 12, a fourth example of a semi-autonomous cancer therapy treatment system 4200 is depicted. In this example, the current radiation therapy regimen is analyzed according to the patency path analysis as described above, prior to being administered to a particular set of voxels of the tumor 720 of the patient 730 . More specifically, the fiducial indicator 4040 is used to determine an unobstructed treatment path prior to treatment along an approximated beam treatment path for one or more voxels of the patient's tumor 720 . When implemented, the approximated therapy vector is the therapy vector in the Deliver Charged Particles step 4228.

Example V

Still referring to FIG. 12, a fifth example of a semi-automatic cancer therapy treatment system 4200 is depicted. In this example, the cancer treatment plan is semi-automatically or automatically generated using the master controller 110 and the processes of the semi-automatic cancer treatment system. More specifically, the process of semi-automatic cancer treatment 4220 uses input from: (1) semi-automatic patient positioning step 4222; (2) semi-automatic tumor imaging step 4224; and/or for fiducial indicator 4040; A software-encoded set of radiotherapy instructions for selected weighting parameters. For example, the treatment order includes a set of criteria to: (1) treat the tumor 720; (2) simultaneously reduce energy transfer of the charged particle beam outside the tumor 720; minimize or greatly reduce the penetration of the charged particle beam into things such as the eye, nerve center or organ. For critical sites, the process of semi-automatic cancer treatment 4220 optionally automatically generates the original radiation treatment plan 4226. The automatically generated raw radiation treatment plan 4226 is optionally implemented automatically, eg, by delivering charged particles step 4226, and/or optionally reviewed by a physician, eg, during physician supervision 4230 described above. Optionally and preferably, semi-automated imaging step 4224 generates and/or uses data from: (1) one or more proton scans from an imaging system that image tumor 720 using protons; (2) use one or more proton scans; One or more X-ray images of a plurality of X-ray imaging systems; (3) a positron emission system; (4) a computed tomography system; and/or (5) any imaging technique or system described herein.

The inventors note that, traditionally, days have elapsed between imaging the tumor and treating the tumor while the team of oncologists is developing the radiation regimen. In stark contrast, using the automated imaging and treatment steps described herein (eg, implemented by the main controller 110 ), the patient is optionally available from the time of imaging, to the time of radiation planning, and to at least the first tumor treatment session. , remain in the treatment room and/or the treatment position in the patient positioning system.

Example VI

Still referring to FIG. 12, a sixth example of a semi-automatic cancer therapy treatment system 4200 is depicted. In this example, with the current radiation therapy regimen, parallel and/or scatter images from the semi-automatic imaging system 4224 (as explained) are used, eg, via the course of the semi-automatic cancer treatment 4220 and from the fiducial indicator 4040 and/or the semi-automatic patient position Input to the system 4222, automatically or semi-automatically adjusts the step 4228 of delivering charged particles.

Referring now to FIG. 13, a system for formulating a radiation therapy regimen 4310 using positively charged particles is depicted. More specifically, a semi-automatic radiation therapy planning system 4300 is described, wherein the semi-automatic system is optionally fully automated or contains sub-processes that are fully automated.

In the automated radiation therapy planning system 4300, scores, sub-scores, and/or outputs are generated, eg, using a computer-implemented algorithm implemented by the main controller 110, to score a set of automatically generated potential radiation therapy plans, wherein the scores are used for Determine optimal radiation therapy regimens, recommended radiation therapy regimens, and/or automated radiation therapy regimens.

Still referring to Figure 13, the semi-automatic or automatic radiation therapy planning system 4300 optionally and preferably provides a set of inputs, guidelines and/or weights for radiation therapy development code that processes the inputs to produce optimal radiation therapy A regimen and/or a preferred radiation therapy regimen based on inputs, guidelines and/or weights. Inputs are target specifications, but not absolute fixed requirements. The input targets are optionally and preferably weighted and/or associated with hard limits. Typically, radiation therapy development code uses algorithms, optimization protocols, intelligent systems, computer learning, supervised and/or unsupervised algorithmic protocols to generate suggested and/or immediate radiation therapy protocols, which are compared through the aforementioned scores. Inputs to the semi-automatic radiation therapy planning system 4300 include images of the tumor 720 of the patient 730, treatment goals, treatment constraints, associated weights for each input, and/or associated constraints for each input. To facilitate the description and understanding of the invention, and without loss of generality, optional inputs are shown in Figure 13 and will be further described herein through a set of examples.

Example I

Still referring to FIG. 13 , the first input to the semi-automatic radiation therapy planning system 4300 (for generating the radiation therapy plan 4310 ) is the requirement for dose allocation 4320 . Herein, dose allocation includes one or more parameters, such as the prescribed dose to be delivered 4321; uniform or uniform distribution of radiation dose allocation 4322; the goal of reducing the overall dose 4323 delivered to the patient 730; The specification of the dose delivered 4324 for key voxels, eg, a portion of the patient's eye, brain, nervous system, and/or heart; and/or the extent of dose distribution 4325 outside the perimeter of the tumor. The automated radiation therapy planning system 4300 uses input, such as via a computer-implemented algorithm, to calculate and/or iterate an optimal radiation therapy plan.

Each parameter provided to the automated radiation therapy planning system 4300 optionally and preferably contains a weight or importance. For the sake of clarity and without loss of generality, two cases will be used to illustrate.

In the first case, the requirement/target of dose reduction or even complete elimination of radiation dose to the optic nerve of the eye set in the Minimize dose to critical voxels 4324 input is given more than minimizing dose to outer regions of the eye ( The requirements/targets for doses to the rectus muscle (eg rectus muscle) or the internal volume of the eye (eg the vitreous humor of the eye) are weighted higher. This first case is an example where one input provides more than one sub-input, where each sub-input optionally includes a different weighting function.

In the second case, the first weight and/or the first sub-weight of the first input is compared with the second weight and/or the second sub-weight of the second input. For example, the distribution function, probability, or precision of the Uniform Radiation Dose Allocation 4322 input may optionally include lower relative weights than those provided for the total dose reduction 4323 input to prevent the computer algorithm from attempting to increase the radiation dose, resulting in a fully uniform dose distribute.

Each parameter and/or sub-parameter provided to the automated radiation therapy planning system 4300 optionally and preferably contains bounds, such as hard bounds, upper bounds, lower bounds, probability bounds, and/or assignment bounds. The boundary requirements are optionally used by the computer algorithm that generates the radiation therapy plan 4310, with or without weighting parameters as described above.

Example II

Still referring to FIG. 13 , the second input to the semi-automatic radiation therapy planning system 4300 is the patient motion 4330 input. Patient motion 4330 inputs include: patient input in one direction 4332, patient uniform motion 4333 input, total patient rotation 4334 input, patient rotation rate 4335 input, and/or patient tilt 4336 input. For clarity of presentation and without loss of generality, patient motion input is further described in the above contexts.

Still referring to Figure 13, in the first case, the automated radiation therapy planning system 4300 provides guidance input, such as input to move the patient 4332 in one direction, but further associated instructions are if other goals require or if radiation is achieved A better overall score for the treatment plan 4310, then optionally automatically relaxes the guide input. Similarly, the input of moving patient 4333 at a constant velocity is also provided with guidance input, such as the low associated weights of the radiation therapy regimen 4310 can be further relaxed to produce high scores, but the relaxation or implementation is limited to the number of relevant fixed or hard bounds only.

Still referring to FIG. 13, in the second case, in the automated radiation therapy planning system 4300, a computer-implemented algorithm optionally generates subscores. For example, the patient comfort score optionally includes a combined score of two or more of the following related measures: input for moving patient 4332 in one direction, input for moving patient 4333 at a constant speed, input for total patient rotation 4334, patient rotation Input of rate 4335, and/or reduction of patient tilt 4336. The sub-scores (optionally with preset bounds) allow the flexibility of the computer-implemented algorithm to regenerate patient motion parameters as a whole for patient comfort.

Still referring to Figure 13, in a third scenario, the automated radiation therapy planning system 4300 optionally includes inputs for more than one sub-function. For example, the input to reduce treatment time 4331 is optionally used as a patient comfort parameter and is also linked to the input of dose distribution 4320.

Example III

Still referring to FIG. 13, the third input of the automated radiation therapy planning system 4300 includes the output of an imaging system, such as any imaging system described herein.

Example IV

Still referring to FIG. 13 , a fourth optional input to the automated radiation therapy planning system 4300 is the structure and/or physical elements present in the treatment room 1222 . Again, for clarity of presentation and without loss of generality, treatment room object information as input to the automatic formulation of radiation therapy plan 4310 is illustrated in two cases.

Still referring to Figure 13, in the first case, the automated radiation therapy planning system 4300 is optionally provided with a pre-scan of a potential interventional support structure 4422 input, such as a patient support device, a patient couch, and/or a patient support element , where prescan is the image/density/redirection effect of the support structure on the positively charged particle therapy beam. Preferably, the pre-scan is an actual image or tomogram of the support structure, utilizing the actual facility synchrotron, remotely generated actual images and/or the calculated influence of the intervening structure on the positively charged particle beam. The determination of the effect of the support structure on the charged particle beam is described further below.

Still referring to FIG. 13 , in a second scenario, the automated radiation therapy planning system 4300 optionally provides reduced therapy through input from the support structure 4344 . As noted above, the associated weights, guides, and/or bounds optionally provide reduced therapy through the input of the support structure 4344, and as also described above, the support structure input may be relative to more critical parameters, such as delivery specifications Dose 4321 infusion or minimal dose of key voxel 4324 infusion to patient 730 is compromised.

Example V

Still referring to Figure 13, a fifth optional input to the automated radiation therapy planning system 4300 is a physician input 4236, eg, provided only before the radiation therapy plan is automatically generated. Separately, the automated radiation therapy planning system 4300 is optionally provided with physician oversight 4230 while the protocol is being developed, such as intervening to limit a certain action, intervening to force a certain action, and/or intervening to change a particular Some input to the automated radiation therapy planning system 4300 for the individual's radiation regimen.

Example VI

Still referring to FIG. 13 , a sixth input to the automated radiation therapy planning system 4300 includes information about the shrinkage and/or metastasis of the patient's 730 tumor 720 during treatment. For example, the radiation therapy plan 4310 is automatically updated using the automated radiation therapy planning system 4300 during treatment using the input of an image of the patient's 730 tumor 720 that was collected during therapy using positively charged particles. For example, as the size of the tumor 720 decreases with treatment, the tumor 720 shrinks and/or metastasizes inward. The automatically updated radiation therapy plan is optionally implemented automatically, eg, the patient does not have to move from the treatment location. Optionally, automated radiation therapy planning system 4300 tracks the dose of untreated voxels of tumor 720, and/or tracks partially irradiated voxels relative to prescribed dose 4321, and dynamically and/or automatically adjusts radiation therapy planning 4310 , which in turn provides the full prescribed dose for each voxel regardless of tumor 720 movement. Similarly, the automated radiation therapy planning system 4300 tracks the dose of the tumor 720 treated voxels and adjusts the automatically updated tumor therapy plan to reduce and/or minimize further radiation delivery to fully treated and metastatic tumor voxels, Concurrently, treatment of a portion of the treated voxels and/or untreated metastatic voxels of tumor 720 continues.

Automatic adaptive therapy

Referring now to FIG. 14, a system for automatically updating a radiation therapy plan 4500 and preferably automatically updating and administering a radiation therapy plan is shown. In a first task 4510, an initial radiation therapy plan, such as the automatically generated radiation therapy plan 4226 described above, is provided. The first task is the initiation of a task iteration loop and/or group of task loops, described herein as including tasks two through four. In a second task 4520, the tumor 720 is treated using positively charged particles delivered from the synchrotron 130. In a third task 4530, changes in tumor shape and/or changes in tumor location relative to surrounding components of the patient 730 are observed, eg, by any imaging system described herein. Imaging optionally occurs concurrently, concurrently, periodically, and/or intermittently with the second task, while the patient remains positioned in the patient positioning system. The main controller 110 uses the images from the imaging system and the provided and/or current radiation treatment plan to determine whether to continue or modify the treatment plan. The fourth task 4540 of updating the treatment plan may optionally and preferably be performed automatically when relative movement of the tumor 720 relative to other components of the patient 730 and/or a change in shape of the tumor 730 is detected, and/or as described above The radiation therapy planning system 4300 is used as described above. The tasks of tasks two to four are optionally preferably repeated n times, where n is a positive integer greater than 1, 2, 5, 10, 20, 50, or 100, and/or until the treatment phase of the tumor 720 ends and the patient 730 leaves treatment until room 1222.

automatic treatment

Referring now to FIG. 15, an automated cancer therapy treatment system 4600 is shown. In the automated cancer therapy treatment system 4600, most tasks are performed according to computer-based algorithms and/or intelligent systems. Optionally and preferably, a medical professional supervises the automated cancer therapy treatment system 4600 and stops or alters treatment when an error is detected, but essentially observes the system using electromechanical elements (such as any hardware and/or software described herein) A computer algorithm-guided implementation process. Optionally and preferably, each subsystem and/or subtask is automated. Optionally, one or more subsystems and/or subtasks are performed by a medical professional. For example, the patient 730 is optionally first positioned in the patient positioning system by a medical professional, and/or the medical professional loads the tray insert 510 into the tray assembly 400 . Optionally and preferably, the automatic (eg computer algorithm implemented) subtasks include one or more and preferably all of the following:

receiving treatment plan input 4300, such as prescriptions, guidelines, patient movement guidelines 4330, dose allocation guidelines 4320, information on intervention objects 4310, and/or images of tumor 720;

· Automatically generate radiation treatment plans 4226 using treatment plan input 4300;

Automatically locate 4222 patients 730;

Automatic imaging 4224 Tumor 720;

Implementing Directive 4238 Supervision of Medical Professionals;

automatic administration of radiation therapy regimen 4520/delivery of positively charged particles to tumor 720;

automatic repositioning of patient 4521 for subsequent radiation delivery;

automatic rotation 4522 of the nozzle position of the nozzle system 146 relative to the patient 730;

automatic translation 4523 of the nozzle position of the nozzle system 146 relative to the patient 730;

Automatic verification of an unobstructed treatment path using an imaging system, such as via X-ray images to observe the presence of metallic objects or unforeseen dense objects;

Automatic verification of an unobstructed treatment path 4524 using a fiducial indicator;

automatic control of the state 4525 of the positively charged particle beam, such as energy, intensity, position (x, y, z), duration and/or direction;

automatic control of particle beam path 4526, such as to a selected beamline and/or to a selected nozzle;

automatic implementation of positioning tray insert 510 and/or tray assembly 400;

Automatic update of tumor image 4610;

automatic observation of tumor motion 4530; and/or

· Generate auto-corrected radiotherapy regimen 4540/new regimen.

Yet another embodiment includes any combination and/or permutation of any of the elements described herein.

The host controller, local communication device, and/or system for communication of information optionally includes one or more subsystems stored on the client. A client is a computing platform configured as a client device or other computing device, such as a computer, personal computer, digital media device, and/or personal digital assistant. The client includes a processor optionally coupled to one or more internal or external input devices (such as a mouse, keyboard, display device, speech recognition system, motion recognition system, etc.). The processor may also be communicatively coupled to an output device, such as a display screen or data link, to display or transmit data and/or processed information, respectively. In one embodiment, the communication device is a processor. In another embodiment, the communication means is a set of instructions stored in a memory for execution by a processor.

(Microsoft，华盛顿州雷德蒙)、(MathWorks，马萨诸塞州内蒂克)，

(Oracle公司，加州雷德伍德城)和Java

(Oracle公司，加州雷德伍德城)。The client includes a computer-readable storage medium such as a memory. Memory includes, but is not limited to, electronic, optical, magnetic, or other storage or transmission data storage media capable of being coupled to a processor (eg, a processor in communication with a touch-sensitive input device linked with computer-readable instructions). Examples of other suitable media include, for example, flash drives, CD-ROMs, read only memory (ROM), random access memory (RAM), application specific integrated circuits (ASICs), DVDs, magnetic disks, optical disks, and/or memory chips. The processor executes a set of computer-executable program code instructions stored in the memory. The instructions may include code from any computer programming language, including, for example, C (originally developed by Bell Labs), C++, C#, Visual

(Microsoft, Redmond, WA), (MathWorks, Natick, MA),

(Oracle Corporation, Redwood City, CA) and Java

(Oracle Corporation, Redwood City, CA).

Herein, any number such as 1, 2, 3, 4, 5 is optionally greater than, less than, or within 1%, 2%, 5%, 10%, 20%, or 50% of the number.

Herein, elements and/or objects are optionally moved manually and/or mechanically, for example with motors and/or under the control of a master controller, along the guiding elements.

The specific embodiments shown and described are illustrative of the invention and its best mode, and are not intended to otherwise limit the scope of the invention. In fact, for the sake of brevity, general fabrication, connection, preparation, and other functional aspects of the system may not be described in detail. Furthermore, the connecting lines shown in the various figures are intended to represent exemplary functional relationships and/or physical couplings between the various elements. Many alternative or additional functional relationships or physical connections may exist in an actual system.

In the foregoing description, the present invention has been described with reference to specific exemplary embodiments; however, it should be understood that various modifications and changes may be made without departing from the scope of the invention as set forth herein. The specification and drawings are to be regarded in an illustrative fashion, not a restrictive one, and all such modifications are intended to be included within the scope of the present invention. Accordingly, the scope of the invention should be determined by the general embodiments described herein and their legal equivalents, and not by the specific embodiments described above alone. For example, the steps described in any method or process embodiment may be performed in any order, and are not limited to the explicit order presented in the particular embodiment. Additionally, the components and/or elements described in any device embodiment may be assembled in various permutations or otherwise operatively configured to produce substantially the same results as the present invention and are therefore not limited to those described in the specific embodiments configuration.

Benefits, other advantages, and solutions to problems have been described above with respect to specific embodiments; however, any benefit, advantage, or solution to problems, or any element that may cause any particular benefit, advantage, or solution to occur or become more apparent, does not Should be construed as a critical, required or essential feature or component.

As used herein, the terms "comprising", "comprising" or any variation thereof are intended to refer to a non-exclusive inclusion such that a process, method, article, composition or device including a list of elements includes not only those elements described, but also Main processes, methods, articles, compositions or devices not expressly listed or inherent may also be included. Other combinations and/or modifications of the above-described structures, arrangements, applications, proportions, elements, materials or components used in the practice of the present invention may be varied or otherwise specifically adapted to a particular environment, manufacturing specifications, design parameters or other operational requirements without departing from its general principles.

While the invention has been described herein with reference to certain preferred embodiments, those skilled in the art will readily appreciate that other applications may be substituted for those set forth herein without departing from the spirit and scope of the invention. Accordingly, the present invention is to be limited only by the following claims.

Claims (13)

1. An apparatus for determining the location of a tumor in a patient in a treatment room using positively charged particles, comprising: a synchrotron, a first beam delivery system and an outlet nozzle, in use, the positively charged particles are delivered from the synchrotron sequentially through the first beam delivery system, the outlet nozzle to at least a patient location; Imaging systems based on positively charged particles, including: a first sheet comprising a first light-emitting element; a first detector configured to image a first photon generated by a first particle of the positively charged particle transmitted through the first light emitting element to form a first signal; A second detector configured to image a second photon to form a second signal from which the second light-emitting element is emitted as the first particle passes through the second light-emitting element on the second sheet Two photons, the first sheet does not cross the second sheet; a third sheet comprising third light emitting elements, wherein a third signal is generated by third photons emitted from the third sheet by the first particles passing through the third sheet; and a scintillation plate of a tomography system detector of a tomography system, configured to generate a fourth signal when the first particles penetrate the scintillation plate during use; and a controller configured to determine a first segment of the beam path of the first particle using the first signal and the second signal, and to use the first signal, the second signal, the third signal and the fourth signal to determine the segments of the beam path of the first particle. 2. The apparatus of claim 1, further comprising: a first location intersecting the beam path between the outlet nozzle and a patient location, occupied by the first sheet; a second location intersecting the beam path between the outlet nozzle and the patient location, occupied by the second sheet, the controller configured to, during use, use the first signal and the The second signal determines the point of entry of the positively charged particles into the patient. 3. The apparatus of claim 2, further comprising: a third location intersecting the beam path between the patient location and the scintillation plate, occupied by the third sheet, the controller configured to, during use, use the third signal and The fourth signal determines the exit point at which the positively charged particles exit the patient. 4. The apparatus of claim 2, wherein the controller is configured to use the first signal, the second signal, the third signal, and the fourth signal to determine the first particle the beam path and confirm the location of the tumor in the patient. 5. The apparatus of claim 4, further comprising: A nozzle repositioning system including at least a motor and a guide track configured to move the outlet nozzle from a first position at a first time to a second position at a second time, the first position being associated with all The second position does not intersect, the scintillation plate is movable together with the outlet nozzle to maintain a position on the patient position side opposite the outlet nozzle at the first time and the second time, so The scintillation plate is used to image a patient using: (1) a first set of the positively charged particles passing through the outlet nozzle at the first position, and (2) passing through all the positively charged particles at the second position. a second set of said positively charged particles of said outlet nozzle; and A set of common elements for imaging a patient and treating a patient's tumor, including: the synchrotron, the first beam delivery system, the exit nozzle, and a patient positioning system. 6. The apparatus of claim 5, wherein the beam delivery system is configured to co-rotate with the scintillation plate and the outlet nozzle about a patient location. 7. The device of claim 5, further comprising: A set of benchmark indicators, including: a set of fiducial markers, a first fiducial marker of the set of markers mechanically affixed to a first subject of a set of subjects in the treatment room, a second fiducial marker of the set of fiducial markers affixed a second object in the set of objects; and A set of fiducial detectors configured to detect marker photons from the set of fiducial markers, wherein at least one reference element in the set of the set of fiducial markers and the set of fiducial detectors includes a reference element to the set of objects The mechanical connection of the components used to establish the reference line in the ; and The controller is configured to use all of the reference elements, the set of fiducial markers, and the set of fiducial detectors to determine the relative position of each subject in the treatment room with respect to the reference line, where The controller is configured to target the tumor of the patient with the positively charged particles using the determined relative position of each object in the treatment chamber. 8. The apparatus of claim 7, the controller further comprising computer-executable code to, after positioning of the patient relative to the outlet nozzle and based on the output of the set of reference detectors: (1) to irradiate the The treatment plan for the tumor of the patient is automatically changed to pass the positively charged particles through a solid object for positioning at least one of a treatment room imaging system element and a patient positioning system, and (2) in the Treatment of the tumor of the patient is automatically continued until the patient leaves the treatment room. 9. The apparatus of claim 7, wherein the reference line is defined relative to a zero vector path of positively charged particles through the outlet nozzle in which there is no electromagnetic steering. 10. The apparatus of claim 5, further comprising: An x-ray imaging system including an x-ray source and an x-ray detector located on opposite sides of the patient location and configured to generate x-ray images, wherein the detector of the tomography system is used to detect the positively charged During the first particle of particles, the X-ray detector maintains the position of the X-ray detector between the patient position and the scintillation plate. 11. The apparatus of claim 10, wherein the X-ray source further comprises: a first cone beam X-ray source; and A second cone beam X-ray source, the first cone beam X-ray source and the second cone beam X-ray source are integrated with the outlet nozzle. 12. The apparatus of claim 11, wherein the set of fiducial markers further comprises: A fiducial element placed on at least two of: the outlet nozzle, the X-ray imaging system, the tomography system, the patient, and a patient positioning system. 13. The apparatus of claim 10, wherein the controller further comprises computer executable code to, after positioning the patient relative to the outlet nozzle and based on the X-ray imaging system and the tape positive an output of at least one of the imaging systems of electrical particles to automatically: (1) alter the treatment regimen irradiating the tumor of the patient, and (2) continue to treat the patient until the patient leaves the treatment room of tumor.

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