US007880154B2
`
`12 United States Patent
`
`10 Patent No.:
`
`9
`9
`US 7 880 154 B2
`
`Otto
`
`(45) Date of Patent:
`
`*Feb. 1, 2011
`
`(54) METHODS AND APPARATUS FOR THE
`PLANNING AND DELIVERY OF RADIATION
`TREATMENTS
`
`5,027,818 A
`5,332,908 A
`
`7/1991 Bova et al.
`7/1994 Weidlich
`
`(75)
`
`Inventor: Karl Otto, 717 West 7th Avenue,
`Vancouver, BC (CA) V5Z 1B9
`
`( * ) Notice:
`
`Subject to any disclaimer, the term of this
`patent is extended or adjusted under 35
`U.S.C. 154(b) by 207 days.
`
`This patent is subject to a terminal dis-
`claimer.
`
`(Continued)
`
`FOREIGN PATENT DOCUMENTS
`
`W0
`
`9948558
`
`9/1999
`
`(21) A 1 N
`pp .
`
`o.:
`
`12/132 597
`,
`
`(22)
`
`Filed:
`
`Jun. 3, 2008
`
`(65)
`
`Prior Publication Data
`Us 2008/0298550 A1
`Dec. 4, 2008
`
`(Continued)
`OTHER PUBLICATIONS
`
`Earl et al., “Inverse Plarming for Intensity-Modulated Arc Therapy
`Using Direct Aperture Optimization”, Physics in Medicine and Biol-
`ogy 48 (2003), Institute ofPhysics Publishing, pp. 1075-1089.
`
`Related U S Application Data
`(63) Continuation-in-part of application No. 11/996,932,
`filed as application No. PCT/CA2006/001225 on Jul.
`25,
`
`(Continued)
`ff Vnh
`Ch
`1:}:ma3)Examinef1(Nikita Well?
`1(\/I )0 ”";”gI
`fem!
`0’ W‘ em =
`1
`C ung
`enze
`
`auen
`
`(60) Provisional application No. 60/701,974, filed on Jul.
`25, 2005.
`
`(57)
`
`ABSTRACT
`
`(51)
`
`(2006 01)
`1I4n6t}]$le%/10
`'
`Am <2oosm>
`G21K1/02
`(200601)
`(52) U.S. Cl.
`................. 250/505.1; 250/492.3; 315/505;
`315/500; 378/65; 378/147; 378/152
`(58) Field of Classification Search .............. 250/505.1,
`250/492.3; 378/65, 147, 152; 315/505, 500
`.
`.
`.
`See apphcanon file for Complete Search hlstory
`References Cited
`U. S. PATENT DOCUMENTS
`3,987,281 A
`10/1976 Hodes
`4,868,843 A
`9/1989 Nunan
`4,858,844 A
`9/1989 Nunan
`
`(56)
`
`Methods and apparatus are provided for plarming and deliv-
`'
`d'
`'
`b
`d 1'
`'
`hi h '
`1
`-
`:::m:::d::::::2?:;:.-23;“
`wfiile deliverin radiation $0 theJ subleyct
`In some embddi-
`meme the radiaion Source is moved goneinuouely along the
`tra'ecto while in some embodiments the radiation source is
`melved termmemlye some embodiments involve the eee_
`.
`.
`.
`.
`.
`.
`.
`mization of the radiation delivery plan to meet various opti-
`mization goals while meeting a number of constraints For
`each of a number of control points along a trajectory, a radia-
`tion delivery plan may comprise: a set ofmotion axes param-
`eters, a set of beam shape parameters and a beam intensity.
`
`38 Claims, 16 Drawing Sheets
`
`25A
`
`TREATMENT
`PLANNING
`SYSTEM
`
`
`CONTROLLER
`
`
`
`25B
`
`Page 1 of 37
`
`Elekta Exhibit 1001
`
`Page 1 of 37
`
`Elekta Exhibit 1001
`
`

`
`US 7,880,154 B2
`Page 2
`
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`5/2005 Geng
`................... .. 378/65
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`9/2008 Otto .......................... .. 378/65
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`2010/0020931 A1
`1/2010 Otto et al.
`
`.............. .. 378/65
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`
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`A. Gladwish et al., “Segmentation and leaf sequencing for intensity
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`E. Wong, J. Z. Chen, and J. Greenland, “Intensity-modulated arc
`therapy simplified,” Int. J. Radiat. Oncol. Biol. Phys. 53, 222-235
`2002.
`K. Bratengeier, “2-Step IMAT and 2-Step IMRT in three dimen-
`sions,” Med. Phys. 32, 3849-3861 2005.
`C. Cameron, “Sweeping-window arc therapy: An implementation of
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`S. M. Crooks et al., “Aperture modulated arc therapy,” Phys. Med.
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`images for adaptive radiation therapy of the prostate”, Med. Image
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`

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`androgen deprivation”, Clin. Oncol. (R Coll. Radiol) 17(6), 465-468
`(2005).
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`beam therapy: Patterns and predictors”, Int. J. Radiat. Oncol., Biol.,
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`* cited by examiner
`
`Page 3 of 37
`
`Page 3 of 37
`
`

`
`U.S. Patent
`
`Feb. 1, 2011
`
`Sheet 1 of 16
`
`US 7,880,154 B2
`
` CONTROL
`
`22
`
`FIGURE 1
`
`23
`
`SYSTEM
`
`
`
`TREATMENT
`PLANNING
`SYSTEM
`
`
`
`25
`
`FIGURE 1A
`
`28
`
`Z
`
`YTL, S
`
`X
`
`Page 4 of 37
`
`Page 4 of 37
`
`

`
`U.S. Patent
`
`Feb. 1, 2011
`
`Sheet 2 of 16
`
`US 7,880,154 B2
`
`32
`
`«it?
`
`———>---
`
`Radiation
`Source
`
`Source
`trajectory
`
`Radiation
`Beam
`
`FIGURE 2
`
`Page 5 of 37
`
`Page 5 of 37
`
`

`
`U.S. Patent
`
`Feb. 1, 2011
`
`Sheet 3 of 16
`
`US 7,880,154 B2
`
`
`
`FIGURE 3A
`
`/- 33,35
`
`/\
`
`38
`
`“A
`
`37
`
`
`
`
`
`
`
`
`
`36
`
`
`
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`
`
`
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`
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`
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`/////7//////////A
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`
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`
`41
`
`
`
`FIGURE 3B
`
`FIGURE 3C
`
`Page 6 of 37
`
`Page 6 of 37
`
`

`
`U.S. Patent
`
`Feb. 1, 2011
`
`Sheet 4 of 16
`
`US 7,880,154 B2
`
`
`
` DESIRED
`TRAJECTORY
`
`
`...........__..._.._......I\
`.........-..._.
`ESTABLISH
`OPTIMIZATION
`FUNCTION
`
`INIT. SHAPE
`AND INTENSITY
`
`DESIRED DOSE
`DISTRIBUTION
`
`OTHER
`
`OPTé\(/I3Iif-SFION
`
`55 AND/OR
`
`SIMULATE INIT.
`DOSE
`
`DETERMINE
`INIT.
`OPTIMIZATION
`RESULT
`
`..
`
`VARY SHAPE
`
`INTENSITY
`
`66
`
`SIMULATE
`
`VARIED DOSE
`
`68
`
`72
`
`DETERMINE
`CURRENT
`OPTIMIZATION
`RESULT
`
`
`
`70
`
` KEEP
`VARIATION
`?
`
`YES
`
`
`
`73
`
`UPDATE
`VARIABLES
`
`
`
`FIGURE 4A
`
`NO
`
`74
`
`9 YES
`
`75
`
`
`
`SAVE
`VARIABLES
`
`_
`
`I
`
`I"
`
`I I I I I I I I I I I I I I I ‘
`
`I
`
`I I I I I I I I I I I I I I I I I I I I I I I
`
`Page 7 of 37
`
`Page 7 of 37
`
`

`
`U.S. Patent
`
`Feb. 1, 2011
`
`Sheet 5 of 16
`
`US 7,880,154 B2
`
`10
`
`50
`
`1 OD
`
`# control points
`150
`
`200
`
`300
`
`Optimization
`Goal 51-->
`
`Worse
`
`Batter
`T
`Dose
`Distribution
`
`Quality
`¢
`
`I
`1x1oA4
`
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`I
`3x1oA4
`
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`
`5x1'oA4
`
`5x1'oA4
`
`# OF ITERATIONS
`
`HGURE9
`
`310 J‘ 300
`
`QBTAEN
`
`PROVIDE
`
`DELIVER AND
`
`TRAJECTORY
`
`OPTIMIZATION
`GOALS
`
`I
`
`RADIATION
`DELIVERY
`PARAMETERS
`
`:
`
`TREATMENT
`PLAN To
`RADIATION
`DELIVERY
`DEVICE
`
`RADIATION TO
`SUBJECT
`
`HGURE4B
`
`Page 8 of 37
`
`Page 8 of 37
`
`

`
`U.S. Patent
`
`Feb. 1, 2011
`
`Sheet 6 of 16
`
`US 7,880,154 B2
`
`==:.=.:§ 1
`
`IIII IIUI
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`
`32A
`
`Page 9 of 37
`
`Page 9 of 37
`
`

`
`U.S. Patent
`
`Feb. 1, 2011
`
`Sheet 7 of 16
`
`US 7,880,154 B2
`
`DOSE
`SIMULATION
`ERROR
`
`DESIRED
`ACCURACY
`
`10
`
`50
`
`100
`
`150
`
`200
`
`250
`
`# OF CONTROL POINTS
`
`HGURE6
`
`Optimization
`
`Goal 61-—>
`
`I
`1X1 0"3
`
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`
`# OF ETERATIONS
`
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`
`Page 10 of 37
`
`Page 10 of 37
`
`

`
`U.S. Patent
`
`Feb. 1, 2011
`
`Sheet 8 of 16
`
`US 7,880,154 B2
`
`152
`
`
`DESIRED
`TRAJECTORY
`
`&
`
`\
`
`\
`
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`
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`
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`I
`OPTIMIZATION
`I
`FUNCTION
`156'
`|
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`L
`
`GET DATA
`
`INIT. SHAPE,
`INTENSITY &
`LEVEL COUNT
`
`158
`
`164
`
`165
`
`SIIVIULATE INIT.
`
`DOSE
`
`DETERMINE
`
`INIT.
`OPTIMIZATION
`RESULT
`
`VARY SHAPE
`AND/OR
`
`INTENSITY 166
`
`. _ _ _ _ _ .. _
`
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`
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`
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`
`63
`
`150
`
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`
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`
`154
`
`FIGURE 8
`
`I I I I I I I I I I I I
`
`I
`
`I I I I I I I I I I I I I
`
`I
`
`SIMULATE
`
`VARIED DOSE
`
`168
`
`172
`
`173
`
`DETERMINE
`CURRENT
`OPTIMIZATION
`
` KEEP
`VARIATION
`?
`
`YES
`
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`' VARIABLES
`
`170
`RESULT
`
`
`
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`
`174
`
`182
`
`180
`
`was
`
`175
`
`INCREII/IENT
`LEVEL COUNTE
`
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`
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`POINTS
`
`NO
`
`178
`
`SAVE
`YES VARIABLES
`
`Page 11 of 37
`
`Page 11 of 37
`
`

`
`U.S. Patent
`
`Feb. 1, 2011
`
`Sheet 9 of 16
`
`US 7,880,154 B2
`
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`12
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`FIGURE 11B
`
`Page 12 0f37
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`Page 12 of 37
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`U.S. Patent
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`Feb. 1, 2011
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`Sheet 10 of 16
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`US 7,880,154 B2
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`1
`
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`
`
`0
`
`Dose (Gy)
`
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`
`Page 13 of 37
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`U.S. Patent
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`Feb. 1, 2011
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`Sheet 11 of 16
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`US 7,880,154 B2
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`Optimization
`Goal
`——>
`
`Dose
`
`Distribution
`
`Quaiity \ Number of
`
`control points
`
`0
`
`3x103
`
`6x103
`
`9x103
`
`12x1O3
`
`FIGURE 13
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`Page 14 of 37
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`Page 14 of 37
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`Feb. 1, 2011
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`Sheet 12 of 16
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`US 7,880,154 B2
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`
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`
`200
`150
`Control Point
`
`300
`
`100
`
`150
`
`200
`
`Control Point
`
`F|GURE 14B
`
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`
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`100
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`150
`
`200
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`
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`Control Point
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`FIGURE 14C
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`
`300
`
`350
`
`FIGURE 14D
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`Page 15 of 37
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`Page 15 of 37
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`U.S. Patent
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`Feb. 1, 2011
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`Sheet 13 of 16
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`US 7,880,154 B2
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`ISODOSE LINEs (Gy)
`FOR FINAL RADIATION
`
`DELIVERY PLAN (AXIAL
`CROSS-SECTION
`
`THROUGH CENTER)
`
`FIGURE 15
`
`Page 16 of 37
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`Page 16 of 37
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`U.S. Patent
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`Feb. 1, 2011
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`Sheet 14 of 16
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`US 7,880,154 B2
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`
`
`3:
`
`I,w_...I
`
`353:;
`
`‘in.
`
`
`35
`
`I
`
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`
`36
`
`FIGURE 16B L‘ 43
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`Page 17 of 37
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`U.S. Patent
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`Feb. 1, 2011
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`Sheet 15 of 16
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`US 7,880,154 B2
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`3053
`
`Z
`
`305A-2
`
`307
`
`—-—-—-—>
`
`——-——->
`Gantry = 180 degrees
`
`307
`
`Gantry = 0 degrees
`
`
`
`309
`
`309
`
`FIGURE 17
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`Page 18 of 37
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`Page 18 of 37
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`U.S. Patent
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`Feb. 1, 2011
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`Sheet 16 of 16
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`US 7,880,154 B2
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`x\\
`
`"Vv
`\
`
`7
`
`Gantry = eeeeeees
`F|GURE 18A
`
`Gantry = 180 degrees
`FIGURE 183
`
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`
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`
`
`
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`
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`
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`
`anry=
`
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`
`FIGURE 18C
`
`FIGURE 18D
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`Page 19 of 37
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`

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`US 7,880,154 B2
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`1
`METHODS AND APPARATUS FOR THE
`PLANNING AND DELIVERY OF RADIATION
`TREATMENTS
`
`CROSS-REFERENCE TO RELATED
`APPLICATIONS
`
`This application is a continuation in part of U.S. applica-
`tion Ser. No. 11/996,932 filed in the US on 25 Jan. 2008,
`which is itself a national phase entry under 35 U.S.C. §371 of
`Patent Cooperation Treaty application No. PCT/CA2006/
`001225 with an international filing date of 25 Jul. 2006. Both
`U.S. application Ser. No. 11/996,932 and PCT application
`No. PCT/CA2006/001225 are hereby incorporated herein by
`reference.
`
`This application claims priority from, and the benefit under
`35 U.S.C. §119 of, U.S. patent application No. 60/701,974
`filed on 25 Jul. 2005, which is hereby incorporated herein by
`reference.
`
`TECHNICAL FIELD
`
`2
`
`Treatment plarming involves identifying an optimal (or at
`least acceptable) set of parameters for delivering radiation to
`a particular treatment volume. Treatment planning is not a
`trivial problem. The problem that treatment planning seeks to
`solve involves a wide range of variables including:
`the three-dimensional configuration of the treatment vol-
`ume;
`the desired dose distribution within the treatment volume;
`the locations and radiation tolerance oftissues surrounding
`the treatment volume; and
`constraints imposed by the design of the radiation delivery
`apparatus.
`
`The possible solutions also involve a large number of vari-
`ables including:
`the number of beam directions to use;
`the direction of each beam;
`the shape of each beam; and
`the amount of radiation delivered in each beam.
`
`Various conventional methods of treatment planning are
`described in:
`
`10
`
`15
`
`20
`
`This invention relates to radiation treatment. The invention
`
`relates particularly to methods and apparatus for plarming and
`delivering radiation to a subject to provide a desired three-
`dimensional distribution of radiation dose.
`
`25
`
`BACKGROUND
`
`The delivery of carefully-plarmed doses of radiation may
`be used to treat various medical conditions. For example,
`radiation treatments are used, often in conjunction with other
`treatments, in the treatment and control of certain cancers.
`While it can be beneficial to deliver appropriate amounts of
`radiation to certain structures or tissues, in general, radiation
`can harm living tissue. It is desirable to target radiation on a
`target volume containing the structures or tissues to be irra-
`diated while minimizing the dose of radiation delivered to
`surrounding tissues. Intensity modulated radiation therapy
`(IMRT) is one method that has been used to deliver radiation
`to target volumes in living subjects.
`IMRT typically involves delivering shaped radiation
`beams from a few different directions. The radiation beams
`
`are typically delivered in sequence. The radiation beams each
`contribute to the desired dose in the target volume.
`Atypical radiation delivery apparatus has a source ofradia-
`tion, such as a linear accelerator, and a rotatable gantry. The
`gantry can be rotated to cause a radiation beam to be incident
`on a subject from various different angles. The shape of the
`incident radiation beam can be modified by a multi-leaf col-
`limator (MLC). A MLC has a number of leaves which are
`mostly opaque to radiation. The MLC leaves define an aper-
`ture through which radiation can propagate. The positions of
`the leaves can be adjusted to change the shape of the aperture
`and to thereby shape the radiation beam that propagates
`through the MLC. The MLC may also be rotatable to different
`angles.
`Objectives associated with radiation treatment for a subject
`typically specify a three-dimensional distribution ofradiation
`dose that it is desired to deliver to a target region within the
`subject. The desired dose distribution typically specifies dose
`values for voxels located within the target. Ideally, no radia-
`tion would be delivered to tissues outside of the target region.
`In practice, however, objectives associated with radiation
`treatment may involve specifying a maximum acceptable
`dose that may be delivered to tissues outside of the target.
`
`30
`
`35
`
`40
`
`45
`
`50
`
`55
`
`60
`
`65
`
`Page 20 of 37
`
`S. V. Spirou and C.-S. Chui. A gradient inverse planning
`algorithm with dose-volume constraints, Med. Phys. 25,
`321-333 (1998);
`Q. Wu and R. Mohand. Algorithm andfunctionality ofan
`intensity modulated radiotherapy optimization system,
`Med. Phys. 27, 701-711 (2000);
`S. V. Spirou and C. -S. Chui. Generation ofarbitrary inten-
`sity profiles by dynamic jaws or multileafcollimators,
`Med. Phys.21, 1031-1041 (1994);
`P. Xia and L. J. Verhey. Multileafcollimator leafsequenc—
`ing algorithm for intensity modulated beams with mul-
`tiple static segments, Med. Phys. 25, 1424-1434 (1998);
`and
`
`K. Otto and B. G. Clark. Enhancement ofIMRT delivery
`through MLC rotation,” Phys. Med. Biol. 47, 3997-4017
`(2002).
`Acquiring sophisticated modern radiation treatment appa-
`ratus, such as a linear accelerator, can involve significant
`capital cost. Therefore it is desirable to make efiicient use of
`such apparatus. All other factors being equal, a radiation
`treatment plan that permits a desired distribution of radiation
`dose to be delivered in a shorter time is preferable to a radia-
`tion treatment plan that requires a longer time to deliver. A
`treatment plan that can be delivered in a shorter time permits
`more efiicient use of the radiation treatment apparatus. A
`shorter treatment plan also reduces the risk that a subject will
`move during delivery of the radiation in a manner that may
`significantly impact the accuracy of the delivered dose.
`Despite the advances that have been made in the field of
`radiation therapy, there remains a need for radiation treatment
`methods and apparatus and radiation treatment planning
`methods and apparatus that provide improved control over
`the delivery of radiation, especially to complicated target
`volumes. There also remains a need for such methods and
`
`apparatus that can deliver desired dose distributions relatively
`quickly.
`
`SUMMARY
`
`One aspect ofthe invention provides a method for planning
`delivery ofradiation dose to a target area within a subject. The
`method comprises: defining a set of one or more optimization
`goals, the set of one or more optimization goals comprising a
`desired dose distribution in the subject; specifying an initial
`plurality of control points along an initial trajectory, the initial
`trajectory involving relative movement between a radiation
`
`Page 20 of 37
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`

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`US 7,880,154 B2
`
`3
`source and the subject in a source trajectory direction; and
`iteratively optimizing a simulated dose distribution relative to
`the set of one or more optimization goals to determine one or
`more radiation delivery parameters associated with each of
`the initial plurality of control points. For each of the initial
`plurality of control points, the one or more radiation delivery
`parameters may comprise positions of a plurality of leaves of
`a multi-leaf collimator (MLC). The MLC leaves may be
`moveable in a leaf-translation direction. During relative
`movement between the radiation source and the subject along
`the initial traj ectory, the leaf-translation direction is oriented
`at a MLC orientation angle <1) with respect to the source
`trajectory direction and wherein an absolute value of the
`MLC orientation angle <1) satisfies 0°<|<1)|<90°.
`Another aspect of the invention provides a method for
`delivering radiation dose to a target area within a subject. The
`method comprises: defining a trajectory for relative move-
`ment between a treatment radiation source and the subject in
`a source trajectory direction; determining a radiation delivery
`plan; and while effecting relative movement between the
`treatment radiation source and the subject along the trajec-
`tory, delivering a treatment radiation beam from the treatment
`radiation source to the subject according to the radiation
`delivery plan to impart a dose distribution on the subject.
`Delivering the treatment radiation beam from the treatment
`radiation source to the subject comprises varying at least one
`of: an intensity ofthe treatment radiation beam; and a shape of
`the treatment radiation beam over at least a portion of the
`trajectory.
`Varying at least one of the intensity of the treatment radia-
`tion beam and the shape of the treatment radiation beam over
`at least the portion of the trajectory, may comprise varying
`positions of a plurality of leaves of a multi-leaf collimator
`(MLC) in a leaf-translation direction. During relative move-
`ment between the treatment radiation source and the subject
`along the trajectory, the leaf-translation direction may be
`oriented at a MLC orientation angle <1) with respect to the
`source trajectory direction wherein an absolute value of the
`MLC orientation angle <1) satisfies 0°<|<1)|<90°.
`Varying at least one of the intensity of the treatment radia-
`tion beam and the shape of the treatment radiation beam over
`at least the portion of the trajectory may comprise varying a
`rate of radiation output ofthe radiation source while effecting
`continuous relative movement between the treatment radia-
`
`tion source and the subject along the trajectory.
`Other aspects of the invention provide program products
`comprising computer readable instructions which, when
`executed by a processor, cause the processor to execute, at
`least in part, any of the methods described herein. Other
`aspects of the invention provide systems comprising, inter
`alia, controllers configured to execute, at least in part, any of
`the methods described herein.
`
`Further aspects of the invention and features of embodi-
`ments of the invention are set out below and illustrated in the
`
`accompanying drawings.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`5
`
`10
`
`15
`
`20
`
`25
`
`30
`
`35
`
`40
`
`45
`
`50
`
`55
`
`The appended drawings illustrate non-limiting example
`embodiments of the invention.
`
`60
`
`FIG. 1 is a schematic view of an exemplary radiation deliv-
`ery apparatus in conjunction with which the invention may be
`practised.
`FIG. 1A is a schematic view of another exemplary radia-
`tion delivery apparatus in conjunction with which the inven-
`tion may be practised.
`FIG. 2 is a schematic illustration of a trajectory.
`
`Page 21 of 37
`
`4
`FIG. 3A is a schematic cross-sectional view of a beam-
`
`shaping mechanism.
`FIG. 3B is a schematic bearn’s eye plan view ofa multi-leaf
`collimator-type beam-shaping mechanism.
`FIG. 3C schematically depicts a system for defining the
`angle of leaf-translation directions about the beam axis.
`FIG. 4A is a flow chart illustrating a method of optimizing
`dose delivery according to a particular embodiment of the
`invention.
`
`FIG. 4B is a schematic flow chart depicting a method for
`planning and delivering radiation to a subject according to a
`particular embodiment of the invention.
`FIGS. 5A, 5B and 5C illustrate dividing an aperture into
`beamlets according to a particular embodiment of the inven-
`tion.
`
`FIG. 6 graphically depicts the error associated with a dose
`simulation calculation versus the number of control points
`used to perform the dose simulation calculation.
`FIG. 7 graphically depicts dose quality versus the number
`of optimization iterations for several different numbers of
`control points.
`FIG. 8 represents a flow chart which schematically illus-
`trates a method of optimizing dose delivery according to
`another embodiment of the invention where the number of
`
`control points is varied over the optimization process.
`FIG. 9 graphically depicts the dose distribution quality
`versus the number of iterations for the FIG. 8 optimization
`method where the number of control points is varied over the
`optimization process.
`FIG. 10 is a depiction of sample target tissue and healthy
`tissue used in an illustrative example of an implementation of
`a particular embodiment of the invention.
`FIGS. 11A and 11B respectively depict the initial control
`point positions of the motion axes corresponding to a trajec-
`tory used in the FIG. 10 example.
`FIGS. 12A-12F depict a dose volume histogram (DVH)
`which is representative of the dose distribution quality at
`various stages of the optimization process of the FIG. 10
`example.
`FIG. 13 another graphical depiction of the optimization
`process of the FIG. 10 example.
`FIGS. 14A-14D show the results (the motion axes param-
`eters, the intensity and the beam shaping parameters) of the
`optimization process of the FIG. 10 example.
`FIG. 15 plots contour lines of constant dose (isodose lines)
`in a two-dimensional cross-sectional slice ofthe target region
`in the FIG. 10 example.
`FIGS. 16A and 16B show examples ofhow the selection of
`a particular constant MLC orientation angle may impact
`treatment plan quality and ultimately the radiation dose that is
`delivered to a subject.
`FIG. 17 schematically depicts how target and healthy tis-
`sue will look for opposing beam directions.
`FIGS. 18A and 18B show an MLC and the respective
`projections of a target and healthy tissue for opposing beam
`directions corresponding to opposing gantry angles.
`FIGS. 18C and 18D show an MLC and the respective
`projections of a desired beam shape for opposing beam direc-
`tions corresponding to opposing gantry angles.
`
`DESCRIPTION
`
`65
`
`Throughout the following description specific details are
`set forth in order to provide a more thorough understanding to
`persons skilled in the art. However, well known elements may
`not have been shown or described in detail to avoid unneces-
`
`Page 21 of 37
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`
`US 7,880,154 B2
`
`5
`sarily obscuring the disclosure. Accordingly, the description
`and drawings are to be regarded in an illustrative, rather than
`a restrictive, sense.
`This invention relates to the planning and delivery ofradia-
`tion treatments by modalities which involve moving a radia-
`tion source along a trajectory relative to a subject wh