WO1993014712A1 - Apparatus for treating a target such as a lesion with a tracer element - Google Patents

Apparatus for treating a target such as a lesion with a tracer element Download PDF

Info

Publication number
WO1993014712A1
WO1993014712A1 PCT/FR1993/000081 FR9300081W WO9314712A1 WO 1993014712 A1 WO1993014712 A1 WO 1993014712A1 FR 9300081 W FR9300081 W FR 9300081W WO 9314712 A1 WO9314712 A1 WO 9314712A1
Authority
WO
WIPO (PCT)
Prior art keywords
lesion
therapy
marker
locating
treated
Prior art date
Application number
PCT/FR1993/000081
Other languages
French (fr)
Inventor
Jean-Yves Chapelon
Frédéric PRAT
Emmanuel Blanc
Original Assignee
Technomed International
Institut National De La Sante Et De La Recherche Medicale
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Technomed International, Institut National De La Sante Et De La Recherche Medicale filed Critical Technomed International
Publication of WO1993014712A1 publication Critical patent/WO1993014712A1/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/42Details of probe positioning or probe attachment to the patient
    • A61B8/4209Details of probe positioning or probe attachment to the patient by using holders, e.g. positioning frames
    • A61B8/4218Details of probe positioning or probe attachment to the patient by using holders, e.g. positioning frames characterised by articulated arms
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/225Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves
    • A61B17/2256Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for for extracorporeal shock wave lithotripsy [ESWL], e.g. by using ultrasonic waves with means for locating or checking the concrement, e.g. X-ray apparatus, imaging means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0833Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37Surgical systems with images on a monitor during operation
    • A61B2090/374NMR or MRI

Definitions

  • the present invention essentially relates to a device for treating a target, such as a lesion inside the body of a mammal, in particular a human being, using a marker element implanted in or in the vicinity of the target for
  • CT Co puterized Tomography
  • Imaging devices by .. ⁇ sor.a ⁇ ee.-I ⁇ gr'éf que (-.nar £ ⁇ jé • RM)
  • nuclear imaging devices called scintigraphy
  • conventional radiology devices and finally ultrasound imaging devices (ultrasound).
  • CT and MRI offer very high image quality, but use very complex and expensive technology which limits their distribution to hospital departments specializing in diagnostics such as radiology departments.
  • the imaging means such as ultrasound or conventional radiology offer the image quality necessary and sufficient for the therapeutic procedure, their flexibility of use easily allows them to be integrated into therapy devices.
  • Extracorporeal lithotripsy for destruction of stones for example, combines an acoustic shock wave generator with means of locating stones such as ultrasound or X-rays.
  • the integration of these imaging devices on the Therapy devices also allow real-time monitoring of the therapeutic act to ensure its quality (see applicants FR-A-2598073; EP-A-0 169 311 or FR-A- 2587 893).
  • a geometric location has been proposed using a stereotaxic frame fixed on the patient's skull.
  • the document W0 90/05494 describes the use of a stereotaxic frame comprising marking elements integral with the frame, arranged externally to the patient, allowing well before the operation, to locate a lesion at destroy inside the patient's skull, and to reference it with respect to the stereotaxic framework which subsequently serves as a benchmark in which the surgical instruments are placed.
  • this solution can only be used in the context of lesions the position of which does not vary with respect to the external stereotaxis device used when determining the position of the lesion to be treated, which is principally applicable ⁇ also to the brain, the position of which is essentially fixed in the skull.
  • this approach is no longer envi ⁇ able to precisely guide the therapeutic gesture.
  • the main object of the present invention is therefore to solve the new technical problem consisting in providing a solution making it possible to accurately reference a lesion to be treated inside a surrounding medium, preferably an organ located at the inside a mammal, such as an animal or man, and to use this reference to guide the therapeutic act, whatever the difficulty of observing the lesion during the per phase -operative, or the displacements of said lesion occurring between the time when the reference of said lesion was carried out and the time when the therapeutic act was carried out.
  • the main object of the present invention is also to solve the new technical problem consisting in providing a solution enabling the surgeon to find the best approach very quickly, which makes it possible to avoid damaging a sensitive organ when the 'surgery.
  • the main object of the present invention is also to solve the new technical problem consisting in providing a solution making it possible to optimize the acoustic field of the therapy device comprising piezoelectric transducer elements to avoid destroying identified biological structures. to be preserved which are crossed by the acous- tick.
  • the invention preferably allows automatic monitoring of the target constituted by a lesion to be destroyed.
  • the present invention also aims to solve these new technical problems in a particularly simple, inexpensive manner, usable on an industrial scale, so that during the intraoperative phase the use of inexpensive locating means, easy to use, available in hospitals, such as a conventional radiology device or ultrasound imaging device (ultrasound).
  • the present invention makes it possible to solve these new technical problems in a simple, safe and reliable, reproducible, inexpensive manner.
  • the invention allows the treatment of target area consisting of soft tissues such as organs, and in particular benign or malignant tumors located in these organs, these organs can thus be mobile organs and not precisely referable with respect to a bone structure like the liver for example.
  • the invention also makes it possible to orient the therapy device, in particular an ultrasound therapy device according to the best approach.
  • the present invention provides an apparatus for therapy of a lesion to be treated, located in a surrounding medium such as an organ, in particular inside the body of a mammal, such as an animal or a human being, of the type comprising means for therapy of said lesion, means for locating said lesion, said means for locating being linked, for example mec * -_ ⁇ _qu_- ⁇ * e ⁇ t ou é_ £ c u ⁇ iqu - ⁇ e ⁇ t, to means therapy; a central control unit rena ⁇ t means for calculating the position of the lesion relative to the therapy means using the locating means; and means for activating therapy means for carrying out said therapy after acquisition of the position coordinates of said lesion, characterized in that said locating means carry out locating of at least one marker element, made of a material repê ⁇ - maple by said locating means, previously implanted inside said lesion, or in its vicinity or inside of the organ in which said lesion is located, said organ possibly being capable of displacement; said calculating means calculate the
  • said marker element is implanted beforehand substantially at the center of the lesion to be treated.
  • marker elements are previously implanted in the lesion to be treated so as to mark substantially all or most of the volume of the lesion to be treated.
  • At least four marker elements are implanted beforehand in the lesion to be treated, so as to form a Cartesian reference mark inside the lesion to be treated or of the organ containing said lesion .
  • one of said four marker elements is implanted substantially in the center of the lesion to be treated, the other three marker elements being implanted in such a way that all of the four marker elements are not located in the same plane.
  • the above-mentioned marker element is made of a bio-compatible material.
  • the aforementioned marker element is made of a material which does not disturb the therapeutic process or the diagnostic process, in particular does not disturb the advantageously focused acoustic waves used for said therapy.
  • the material of the marker element does not disturb focused ultrasonic acoustic waves or focused acoustic shock waves emitted by the therapy means.
  • the dimension of the marker element does not exceed a quarter of the ultrasonic wavelength used.
  • the dimension of the marker element is less than about 2 mm, better still less than 1 mm and ideally less than about 500 micrometers.
  • the marker element is in the form of a ball or a ring. The realization in the form of a ring is preferred because it limits or prevents any movement of migra ⁇ tion.
  • the marker element is made of a material chosen from the group consisting of a biocompatible metal, preferably a noble metal such as gold, titanium or platinum; a contrast agent at least visible by said locating means linked to the therapy means, in particular by X-rays and / or ultrasound; a radioactive product for example of the technetium type and visible by any device detecting ionizing radiation, for example a & - camera; a magnetic material; a material emitting acoustic or electromagnetic waves.
  • the marking of the target area is carried out by injection of visible microbubbles of air by means of location such as ultrasound. This embodiment has the advantage of not using foreign bodies in the organ to be treated.
  • the marker elements according to the invention are easily implantable in an extremely precise manner inside the lesion to be treated in a phase prior to therapy, for example in a radiology department physically distant from the operating room or even outside the hospital environment, with the use of tracking devices providing a very high image quality such as scanners or so-called MRI imaging devices.
  • a particularly interesting process for implanting the marker elements consists in using a biopsy needle inserted inside the lesion to be treated in the organ containing it inside. which needle is introduced the marker element to be brought inside said lesion, this operation being repeated as many times as necessary to introduce the desired number of markers, this operation being guided under permanent ultrasound observation or with the repé ⁇ rage device previously indicated.
  • the locating means of the therapy apparatus linked to the therapy means, are used to locate the element or markers in said lesion to guide the very precise positioning.
  • therapy means relative to the lesion in order to improve the treatment efficiency of the lesion and this in the entire volume of the lesion which it is desired to treat.
  • the approach route is completely determined from a target point of coordinates x, y, z which according to the invention is preferably the marker element, and an observation direction or orientation, of angular coordinates Ox, Oy, Oz.
  • these data must be defined in a geometric coordinate system which can be found at the time of processing, which is achieved thanks to the invention by the use of marker elements implanted in the organ and which are visible both on the image planes produced at the time of, or just after, the implantation as well as at the time of treatment.
  • the invention provides a therapy device comprising a central control unit for the therapy means, in which data defining the best route to the therapy means can be taken into account, said therapy central control unit controlling the movement of the therapy means in order to position them with the correct orientation according to the best approach thus defined.
  • This data can be entered in the control unit for example using an interface or peripheral device such as a keyboard.
  • the invention therefore makes it possible to eliminate the drawbacks of the prior art which did not contain any solution for operating on mobile and non-referable organs with precision with respect to a bone structure, as is generally the case with tumors.
  • tumors often have ill-defined contours and, moreover, are not easily identifiable. Their detection must therefore generally be carried out by experts such as radiologists. Under these conditions, the work of finding a pathway is made even more difficult because the manipulator must simultaneously target the tumor, which in itself is not easy, and still orient his detection device, in particular an ultrasound probe. , around this tumor to identify the best route first without losing the target point.
  • the invention makes it possible to eliminate these drawbacks by the use of a marker element in the target area.
  • the invention makes it possible to physically represent the ideal approach route, by marking the patient's surface with windows for the passage of ultrasonic waves.
  • the invention proposes to use, in an advantageous alternative embodiment, a standard echo ⁇ graphic locating probe, giving a "mode B" image plane, centered on the longitudinal axis of the probe.
  • a marking device making it possible to mark the patient's skin, is made solid with the imaging probe.
  • This marking device can, for example, include a pen. The user then moves the ultrasound probe over the patient's skin to visualize the area to be treated and the biological obstacles to avoid. It can thus define the optimal acoustic window.
  • the marking device marks the patient's skin and the marking represents in a way the projection, on the patient's skin, of the ideal surface of the ultrasonic field which will make it possible to avoid biological obstacles.
  • a multi-element transducer therapy device comprising at least one multi-element piezoelectric transducer element so that the interactions between the acoustic field of the device of therapy and the biological structures which hinder it are practically nonexistent.
  • a multi-element transducer therapy device is provided, for example in rows of arrays which may be annular, or in a mosaic structure, well known to those skilled in the art.
  • each of the transducer elements of the therapy device is operated in ultrasound mode, that is to say in a manner identical to the operation of ultrasound imaging waves to detect by an electronic circuit the reflected acoustic echoes. by biological structures.
  • This electronic circuit is identical in all respects to those used in ultrasound imaging. From these signals, it is possible to reconstruct images of the biological structures traversed by the acoustic field of the therapy device which should be preserved.
  • the control unit In the event of detection of biological structures to be preserved in the path of certain transducing elements, provision is made for the control unit not to control the supply of these corresponding transducing elements in order to avoid destroying the identified biological structures.
  • the invention thus optimizes the ultrasonic acoustic field of the therapy device vis-à-vis biological obstacles perfectly, this is automatic and perfectly reliable since the obstacle detection agent (acoustic wave) is the same as that used to perform therapy with the therapy device.
  • the invention also makes it possible to carry out an automatic follow-up of the target thanks to the presence of the marker element placed at the center of the lesion to be destroyed which is used for automatic detection of the target formed by the lesion as well as '' automatic monitoring thereof, in particular during a movement, for example under the effect of breathing, with respect to the therapy device assumed to be in a fixed position.
  • the devices for implementing such automatic monitoring are well known to those skilled in the art.
  • the present invention also covers a method of therapeutic treatment of a lesion in a surrounding medium, such as an organ located inside the body of a mammal, such as an animal or a being. human, including the provision of a therapy device comprising means for locating the lesion, means for therapy of the lesion, the locating means being linked to the therapy means; a control unit comprising means for calculating the coordinates of position of the lesion relative to the therapy means, and control means for the therapy means in particular by means of the control unit for performing positioning of these in any position of the space along the axes X, Y, Z as a function of the position coordinates of said lesion, characterized in that the implantation of at least one marker element locatable by said locating means linked to said means therapy, in said lesion or in the vicinity of this lesion inside said organ;
  • the implantation of several marker elements is carried out in said lesion or in said organ prior to therapy.
  • at least four marker elements are used which are implanted beforehand in said lesion and / or in said organ in a non-aligned manner in a plane, to allow identification of the whole or of most of the volume of the lesion to be treated.
  • the method at the time of the implantation of at least the aforementioned marker element or just after said implantation, several planes of image sections are produced according to different angular orientations, containing said element marker, in order to determine the best approach first, and the coordinates of this approach first are noted, comprising the coordinates of a target point x, y, z preferably constituted by the marker element itself, as well as a direction of orientation of coordinates ⁇ x, ⁇ y, ⁇ z determined by the orientation of the locating means giving the image cutting plane of the best path first, and finally we note or record all of this data as the best pathway data first.
  • these recorded or recorded data are used at the time of therapy to position the therapy means relative to the marker element linked to the lesion according to the best route of abrr ⁇ .
  • ⁇ Therapy means are com ⁇ therapy means taking at least a focused ultrasonic transducer device, such as a spherical cup; or a device for generating focused acoustic shock waves, for example by electro-hydraulic means as is known in the context of Lithotripsy.
  • aforementioned locating means it will preferably be an ultrasound device and / or an X-ray radiology device. It is also possible to use an electromagnetic wave or acoustic wave detector or a ionizing radiation detector such as ⁇ -camera.
  • the term "peroperative phase” means the phase of searching for the markers prior to the actual therapy. This research can be done naturally at the very start of therapy but can be repeated as many times as the practitioner wishes during therapy or else be continued continuously during therapy by then real-time monitoring. of therapy thanks to the markers.
  • the invention thus makes it possible to carry out an automatic detection of the Lesion thanks to the marker element, then an automatic monitoring of The Lesion in the event of movement thereof for example under the effect of Respiration, and to a automated therapy controlled by a central control unit comprising the abovementioned calculation means.
  • FIG. 1 shows schematically and in a side view a therapy device according to the present invention for the treatment of a lesion, for example a tumor, located inside an organ, for example the liver, a mammal, here a human being;
  • FIG. 1 schematically shows the pre-implantation procedure for at least one marker element uti l ized in the context of the present invention and showing an alternative embodiment for calculating the lesion position coordinates to be treated in the identifies markers; and
  • Figure 3 schematically shows the general method of therapy.
  • ? - Figure 4 shows schematically a ⁇ say positive therapy 12 'with its focal point F coincides with the marker element in the MO element 0, and its acoustic field with its path partially through a biological structure
  • FIG. 5 represents the acoustic signal emitted by the piezoelectric transducer element T2, encountering no obstacles in its path with the echo signal of the marker element symbolized SMO exceeding the echo signal threshold fixed by reference, represented symbolically in dotted lines, the operation of the transducer element being in mode A, that is to say with linear signal; and
  • FIG. 6 represents an echo signal curve emitted by the piezoelectric transducer element T1 and showing an echo signal returned by the biological structure, referenced SBS an instant t less than the instant T of the echo signal of L 'MO marker element allowing to identify that the transducer element T1 has its acoustic field crossing a biological structure.
  • a therapy device bearing the general reference number 10.
  • This device comprises therapy means represented by the general reference number 12.
  • These therapy means can, for example, to understand a therapy device proper 14 here with emitting surface 16 focusing naturally by presenting a shape of a spherical cup for focusing acoustic waves into a focus f.
  • These acoustic waves can be shock acoustic waves, or maintained ultrasonic acoustic waves.
  • the therapy means 12 can also include, in an integrated manner, imaging means 18 preferably arranged here along the axis of symmetry of the device 14 generating acoustic waves for permanently observing the focal point F.
  • These imaging means 18 can, for example, be constituted by an ultrasound probe, for example capable of carrying out a sectoral type B scan.
  • the therapy means 12 are preferably supported by a support device (not shown) capable of being controlled to move in space and to rotate about these axes, by means of appropriate displacement control means 20, themselves controlled by a control center 22 advantageously comprising calculation means such as a computer, computer or microcomputer.
  • this device 10 also comprises locating means represented by the general reference number 30, or 40.
  • the locating means 30 are locating means by ultrasonic means comprising at least one ultrasound probe 32, for example mounted at the end
  • These position coordinates as well as the images supplied by the locating means 30 are transmitted to the central control unit 22 by appropriate means 38.
  • the other locating means 40 can , for example, include at least one X-ray tracking source 42, preferably that described in the previous Techno ed patent F -A-2,665,545 and which is movable between two distinct positions as symbolized by -5 by the arrow R and whose data are collected are transmitted to the control unit 22 by means of transmission appro ⁇ invited 48 well known to the man of art.
  • a patient P is lying whose organ 0, for example here the liver, has a lesion L, such as a benign or malignant tumor which we can understand that it occupies a certain volume inside
  • At least one marker element M has been implanted in organ 0, and more particularly in lesion L or in the vicinity of said lesion four marker elements marked respectfully MO, M1, M2 and M3.
  • One of said marker elements here the element MO, is preferably incorporated substantially at the center of the lesion L, while the three marker elements M1, M2 and M3 have been implanted in the vicinity of said lesion, for example l the marker element M1 is incorporated at the border of the lesion L and the marker elements M2 and M3 are incorporated in the vicinity of the lesion L in organ 0.
  • all of the marker elements MO, Ml, M2 and M3 are not contained in the same plane.
  • the set of these marker elements makes it possible to define a geometric coordinate system because ⁇ tésien x, y and z as well as angular directions ⁇ x, ⁇ y, ⁇ z. Furthermore, to the right of Figure 1, The arrows OX,
  • OY and OZ define the Cartesian geometric reference frame for determining the coordinates of position x, y, z and of angular direction ⁇ x, ⁇ y, ⁇ z, in the space of the therapy means 12, these axes OX, OY and OZ being the axes of movement in space of the therapy means 12 by the displacement means ⁇ ment 20.
  • the actuation means of the therapy means 12 are identified by the reference number 60, these means d actuation being themselves controlled by the control unit 22.
  • control unit 22 can also receive by appropriate means 70 coordinates of position x , y, x, and of direction of angular orientation ⁇ x, ⁇ y, ⁇ z, of the Lesion L to be treated in the reference frame of the marker elements MO, M1, M2 and M3 calculated separately, after implantation of the marker elements in The Lesion L.
  • FIG 2 there is shown schematically the step of implantation of the marker elements MO, M1, M2 and M3 in the lesion L inside the organ 0 itself inside the body d 'A patient P, for example using a biopsy needle 80.
  • These marking elements are, for example, constituted by a ball which is dragged inside the biopsy needle 80 until to reach the positions indicated.
  • This implantation takes place under the control of imaging means providing a very precise image of La Lésion L, preferably a scanner or magnetic resonance imaging means, MRI, available in a specialized radiology center and allowing the very precise, safe and reproducible positioning of the marker elements at the desired positions in the L lesion and / or in the organ 0 containing the L lesion.
  • imaging means providing a very precise image of La Lésion L, preferably a scanner or magnetic resonance imaging means, MRI, available in a specialized radiology center and allowing the very precise, safe and reproducible positioning of the marker elements at the desired positions in the L lesion and / or in the organ 0
  • the same implantation can also be carried out under ultrasound or X-ray control.
  • a scanner device 90 moving successively from position 1 to position n to obtain n image planes in serial section making it possible to obtain a complete image of the organ 0, of the lesion L and marker elements MO to M3 by means of conventional combined imaging means referenced 92, the data of which are transmitted to a computer center 94 comprising at least one computer, computer or microcomputer.
  • this computing center 94 is integrated into the control unit 22.
  • the scanner 90 comprises means for storing all the data collected, for example on a floppy disk which can then be used with the control unit 22 so that the stored data are analyzed and processed by the calculation means of the control unit 22, the input of this data being symbolized by box 70.
  • the calculation means either independent 94 or integrated into the control unit 22 calculate the coordinates of position x, y, z and advantageously of direction of angular orientation ⁇ x, ⁇ y, ⁇ z, of the lesion L to be treated in the reference frame of the marker elements MO, Ml, M2 and M3, when this additional step, not currently necessary, is desired.
  • the invention ppr and thus determine the best path first.
  • this therapy method takes two steps A and B, a first step A of implantation of the marker elements in the lesion L or in the vicinity thereof, of the organ to be treated 0 as clearly understandable from the consideration of Figure 2; and a second processing step B proper comprising first of all the identification of the markers MO, M1, M2 and M3 with the identification means 30 or 40, then a step of calculating the position coordinates of the lesion L in the geometric coordinate system 0X, 0Y, 0Z of the therapy means 12; then positioning in space by displacement along the axes OX, OY and OZ of the therapy means 12 so that the point or the focal zone F is positioned with regard to the lesion to be treated in order to carry out the treatment of a point of Lesion, then by successive displacement point by point, the treatment of the complete volume of Lesion L is carried out.
  • the effectiveness of the treatment of each point is controlled in real time thanks to the presence of the auxiliary display means 18, 32 or 42 , permanently giving an image of the focal point by imaging means 96, 38 or 48, the data of which can also be transmitted to the control unit 22 and which can be used at the end of treatment to give post-operative control imaging .
  • FIG. 2 which represents a step C intermediate between step A and step B, it is possible to calculate the position coordinates of the lesion to be treated in the reference frame of the marker elements MO , M1, M2 and M3, using imaging means, for example those 90 which were used to carry out the precise implantation of the marker elements in the L lesion.
  • One technique consists in identifying on each of the images the contours of The Lesion organ to be treated as well as the markers to obtain a three-dimensional representation.
  • a calculation then makes it possible to determine the coordinates of each point of La Lesion to be treated in the geometric frame of the marker elements MO, M1, M2 and M3. These coordinates are then used to carry out the calculation of the position coordinates of La Lesion in the coordinate system OX, OY and OZ of displacement of the therapy means 12.
  • the invention also makes it possible, from successive image cutting planes in particular according to different angular orientations, from location means in particular with high definition image as used for the implantation of the marker element such as scanner or MRI, to determine the best approach first and thus the angular orientation coordinates ⁇ x, ⁇ y and
  • REPLACEMENT SHEET ⁇ z of the best route first which are then used at the time of treatment to define the angular orientation position of the best route first of the therapy means 12, in particular in the reference OX, OY and OZ. This can be done simply by entering these angular position coordinates ⁇ z, ⁇ y and ⁇ z with the position coordinates X, Y, Z in the control unit 22 of the therapy means 12, for example using an interface or a peripheral organ such as a keyboard.
  • the lesion L has a simple geometric shape, for example substantially spherical, as is the case with certain tumors, it is only necessary to use a marker element MO advantageously substantially placed at the center of the lesion L and in this case the above-mentioned step C is superfluous.
  • the L lesions have complex geometric shapes, then it is essential for a complete, precise therapeutic treatment of the Lesion, to implant several marker elements, and preferably at least four, as shown, to obtain a geometric location. in which the volume of the lesion can be defined geometrically. In that case.
  • step C which makes it possible to calculate separately and beforehand the position coordinates of the lesion to be treated in the reference frame of the marker elements MO, M1, M2 and M3, which allows the calculation of the coordinates of the L lesion in the OX, OY and OZ coordinate system after identification of the marker elements by the identification means 30 or 40.
  • the invention makes it possible, in a decisive manner, to carry out a fully automated processing which is made possible thanks to the presence of at least one marker element making it possible to offer significant contrast to allow automatic detection of this marker element by the means of marking 30 or 40, therefore of the position of La Lésion then making it possible to automatically position the therapy means opposite La Lésion and to treat it, without special intervention by the attending physician.
  • the appended drawings of FIGS. 1 to 3 form an integral part of the invention and therefore of the present description.
  • the invention also covers all the means which appear to be new vis-à-vis a prior art.
  • the invention makes it possible to carry out the treatment of any lesion which can be treated by acoustic waves, as is the case with all benign or malignant tumors such as cancers.
  • Particularly preferred applications are currently primary and secondary cancers of the liver, pancreas. Prostate cancer, breast cancer, cancer of the bladder, kidney and in general of all organs.
  • the invention also offers the determining advantage that even in the case of organs which move for example under the effect of respiration, the presence of 0 marker elements makes it possible to automatically follow the movement of the organ, thus ensuring effectively automatic treatment of the lesion in said mobile organ.
  • the invention also makes it possible to carry out a monitoring of the target even in the case of the movement of the therapy device relative to the target, which can occur in the case of a treatment or the therapy device would simply be hand-held.
  • the invention thus makes it possible to advantageously envisage manual treatments. Detection devices and automatic target tracking are known to humans from
  • the invention also makes it possible to carry out a treatment of all lesions located in a mobile and non-dreamable organ that can be renounced with precision with respect to a bone structure, and preferably according to the best approach, which was very difficult to achieve and even less reproducible
  • Multi-element transducers are well known to those skilled in the art. They can be in networks of rows which can be annular, or in mosaic structure as shown in Figure 4 by being composed of a plurality of elements T., T, to T.
  • the therapy device 12 ' focuses the acoustic field at the focal point F which is placed in coincidence with the marker element MO located in the center of the lesion L, for example a tume ' ur benign or malignant, itself located in the organ 0 which can be, for example, the liver, this organ being movable relative to the bony structures of patient P (FIG. 1).
  • Biological structures BS can be partially in the path of the individual transducer elements such as in particular T ..
  • the transducer element T. has no obstacles formed by a biological structure in its path acoustic.
  • This biological structure can, for example, be bones, or a sensitive organ such as for example a lung, as shown in FIG. 4.
  • each of the transducer elements such as T .., T-, at T is operated initially in ultrasound mode, that is to say in a manner identical to the operation of the imaging probes. ultrasound.
  • Each element such as T., T-, sends an acoustic pulse and detects by an electronic circuit the acoustic echoes reflected by the biological structures. This electronic circuit
  • REPLACEMENT SHEET being identical in all respects to those used in ultrasound imaging. From these signals, it is possible to reconstruct images of the biological structures BS crossed by the acoustic field of the therapy device 12 ′ and in particular to determine which transducer elements are tsl ⁇ "" u ⁇ T whose siqnal crosses the structure organic BS.
  • SBS biological structure signal in abbreviation SBS appearing at the instant t much lower than the instant T of the normal echo signal of the marker element at the point focal.
  • the control unit 22 integrate the data relating to the transducer elements such as T. not to be activated during therapy to avoid destroying the identified biological structures in order to perfectly optimize the ultrasonic acoustic field vis-à-vis -vis biological obstacles. It is understood that the invention makes it possible to do it automatically and perfectly reliable since the agent for detecting (acoustic wave) obstacles BS is the same as that used to carry out the therapy.

Abstract

A therapeutical apparatus includes a device (12) for treating a lesion (L), a device (30 or 40) for locating the lesion (L), the locating device (30, 40) being connected, e.g. mechanically (34) or electronically, to the treatment device, a device for computing the position of the lesion (L) relative to the treatment device by means of the locating device, and a device (22, 60) for actuating the treatment device (12). At least one tracer element (M0, M1, M2, M3) implanted within the lesion is located by the locating device (30 or 40), and the computing device (22) computes the position co-ordinates of the tracer element (M0, M1, M2, M3) relative to the treatment device (12) said co-ordinates being used for moving the spatially movable treatment device (12) into a given position determined according to axes X, Y and Z. The apparatus provides accurate treatment of the lesion.

Description

APPAREIL DE TRAITEMENT D ' UNE CIBLE, TELLE QU ' UNE LESION UTI LISANT UN ELEMENTAPPARATUS FOR TREATING A TARGET, SUCH AS A LESION USING A MEMBER
MARQUEUR.MARKER PEN.
0505
La présente invention concerne essentiellement un appa¬ reil de traitement d'une cible, telle qu'une lésion à l'intérieur du corps d'un mammifère, en particulier d'un être humain, utilisant un élément marqueur implanté dans ou au voisinage de la cible pourThe present invention essentially relates to a device for treating a target, such as a lesion inside the body of a mammal, in particular a human being, using a marker element implanted in or in the vicinity of the target for
10 piloter la thérapie de ladite cible.10 pilot the therapy of said target.
On sait que les instruments de diagnostic actuels per¬ mettent de détecter la plupart des atteintes tissulaires bénignes ou malignes dès les premiers stades de la maladie. Parmi ces dispo¬ sitifs, les plus répandus sont les scanners (en anglais :We know that current diagnostic instruments make it possible to detect most benign or malignant tissue damage from the early stages of the disease. Among these devices, the most widespread are scanners (in English:
15 Co puterized Tomography, en abréviation CT) , les dispositifs d'Ima¬ gerie par ..ώsor.aπee .-iεgr'éf que (-.n a r£τjé RM) , les dispositifs d'imagerie nucléaire (dénommé scintigraphie) , les dispositifs de radiologie conventionnelle et enfin les dispositifs d'imagerie ultrasonore (échographie) .15 Co puterized Tomography, abbreviated as CT), Imaging devices by ..ώsor.aπee.-Iεgr'éf que (-.nar £ τjé RM), nuclear imaging devices (called scintigraphy), conventional radiology devices and finally ultrasound imaging devices (ultrasound).
20 Les deux premiers dispositifs, CT et IRM, offrent une très grande qualité d'image, mais mettent en oeuvre une technologie très complexe et coûteuse qui limite leur diffusion aux services hospitaliers spécialisés dans le diagnostic tels que les services de radiologie.The first two devices, CT and MRI, offer very high image quality, but use very complex and expensive technology which limits their distribution to hospital departments specializing in diagnostics such as radiology departments.
25 A l'opposé, les dispositifs de radiologie conventionnelle et d'échographie, moins coûteux et d'une plus grande souplesse d'utilisation, sont d'une diffusion beaucoup plus large, mais n'offrent pas cependant une qualité d'image équivalente à celle du scanner ou de l'IRM.25 In contrast, conventional radiology and ultrasound devices, which are less expensive and more flexible, are much more widely available, but do not, however, offer equivalent image quality. to that of the scanner or MRI.
30 La complémentarité entre ces différents dispositifs d'imagerie est satisfaisante lors de la phase de diagnostic d'une maladie chez un patient. Les examens de routine sont réalisés à partir des dispositifs les plus répandus (radiologie convention¬ nelle et échographie) et si nécessaire des examens plus approfondisThe complementarity between these different imaging devices is satisfactory during the diagnostic phase of a disease in a patient. Routine examinations are carried out using the most common devices (conventional radiology and ultrasound) and, if necessary, more in-depth examinations
35 sont réalisés, par la suite, avec les scanners et IRM. Le problème est différent pour l'application d'une thérapeutique extracorporelle. En effet, il est nécessaire de parfaitement repérer et référencer une lésion chez un patient afin de guider le geste thérapeutique pour réaliser un traitement effi- cace de la lésion. Cette phase de localisation doit donc nécessai¬ rement intervenir au moment de la phase de thérapie.35 are subsequently carried out with scanners and MRI. The problem is different for the application of extracorporeal therapy. In fact, it is necessary to perfectly identify and reference a lesion in a patient in order to guide the therapeutic gesture to carry out an effective treatment of the lesion. This localization phase must therefore necessarily occur during the therapy phase.
Lorsque les moyens d'imagerie tels que l'échographie ou la radiologie conventionnelle offrent la qualité d'image nécessaire et suffisante à l'acte thérapeutique, leur souplesse d'utilisation permet sans difficulté de les intégrer aux dispositifs de thérapie. La lithotritie extracorporelle pour la destruction des calculs, par exemple, associe un générateur d'ondes de choc acoustiques à des moyens de localisation des calculs tels que *1'échographie ou les rayons X. L'intégration de ces dispositifs d'imagerie sur les dis- positifs de thérapie permet en outre de réaliser un suivi en temps réel de l'acte thérapeutique afin de s'assurer de sa qualité (voir FR-A-2598073 des déposants ; EP-A-0 169 311 ou FR-A-2587 893) .When the imaging means such as ultrasound or conventional radiology offer the image quality necessary and sufficient for the therapeutic procedure, their flexibility of use easily allows them to be integrated into therapy devices. Extracorporeal lithotripsy for destruction of stones, for example, combines an acoustic shock wave generator with means of locating stones such as ultrasound or X-rays. The integration of these imaging devices on the Therapy devices also allow real-time monitoring of the therapeutic act to ensure its quality (see applicants FR-A-2598073; EP-A-0 169 311 or FR-A- 2587 893).
Mais, lorsque ces mêmes moyens d'imagerie ne sont plus suffisants pour identifier au cours de l'acte thérapeutique les lésions à traiter comme dans le cas de tumeurs du foie et plus particulièrement de la prostate, en raison d'une faiblesse de con¬ traste ou d'une faiblesse d'êchogénêicitê, il est nécessaire d'avoir recours à d'autres solutions de repérage.However, when these same imaging means are no longer sufficient to identify, during the therapeutic procedure, the lesions to be treated as in the case of tumors of the liver and more particularly of the prostate, due to weakness of con¬ traste or weakness of echogenicity, it is necessary to have recourse to other solutions of location.
En outre, il est souvent nécessaire d'appliquer le dis- positif de repérage contre le corps du patient, pour obtenir une image de qualité suffisante, ce qui provoque un déplacement de l'organe, de sorte que le repérage de la lésion es faussé en vue de l'acte thérapeutique.In addition, it is often necessary to apply the locating device against the patient's body, in order to obtain an image of sufficient quality, which causes displacement of the organ, so that the locating of the lesion is distorted. in view of the therapeutic act.
De ce fait, on a déjà tenté de réaliser une imagerie pré-opératoire. Dans ce cadre, plus spécialement pour la neuro¬ chirurgie, on a proposé un repérage géométrique à l'aide de cadre stéréotaxique fixé sur le crâne du patient. Par exemple, le docu¬ ment W0 90/05494 décrit l'emploi d'un cadre stéréotaxique compor¬ tant des éléments marqueurs solidaires du cadre, disposés extêrieu- rement au patient, permettant bien antérieurement à l'opération, de repérer une lésion à détruire à l'intérieur du crâne du patient, et de la référencer par rapport au cadre stéréotaxique qui sert par la suite de repère dans lequel sont placés les instruments chirur¬ gicaux.As a result, we have already attempted to carry out preoperative imaging. In this context, more specifically for neurosurgery, a geometric location has been proposed using a stereotaxic frame fixed on the patient's skull. For example, the document W0 90/05494 describes the use of a stereotaxic frame comprising marking elements integral with the frame, arranged externally to the patient, allowing well before the operation, to locate a lesion at destroy inside the patient's skull, and to reference it with respect to the stereotaxic framework which subsequently serves as a benchmark in which the surgical instruments are placed.
Cette solution n'est en pratique utilisable que dans le cadre de lésions dont la position ne varie pas par rapport au dis¬ positif externe de stéréotaxie utilisé lors de la détermination de la position de la lésion à traiter, ce qui n'est applicable princi¬ palement qu'au cerveau dont la position est essentiellement fixe dans la boîte crânienne. Mais, dans le cas d'intervention sur des organes mobiles et non référençables avec précision par rapport à une structure osseuse, comme le foie par exemple, cette approche n'est plus envi¬ sageable pour guider précisément le geste thérapeutique.In practice, this solution can only be used in the context of lesions the position of which does not vary with respect to the external stereotaxis device used when determining the position of the lesion to be treated, which is principally applicable ¬ also to the brain, the position of which is essentially fixed in the skull. However, in the case of intervention on mobile organs which cannot be referenced with precision with respect to a bone structure, such as the liver for example, this approach is no longer envi¬ able to precisely guide the therapeutic gesture.
La présente invention a donc pour but principal de résoudre le nouveau problème technique consistant en la fourniture d'une solution permettant de référencer avec exactitude une lésion à traiter à l'intérieur d'un milieu environnant, de préférence un organe se trouvant à l'intérieur d'un mammifère, tel qu'un animal ou l'homme, et d'utiliser cette référence pour guider l'acte théra- peutique, et ce, quelle que soit la difficulté d'observation de la lésion lors de la phase per-opératoire, ou les déplacements de ladite lésion intervenus entre le moment où on a réalisé la réfé¬ rence de ladite lésion et le moment où on réalise l'acte thérapeu¬ tique. La présente invention a encore pour but principal de résoudre le nouveau problème technique consistant en la fourniture d'une solution permettant au chirurgien de trouver très rapidement la meilleure voie d'abord qui permet d'éviter d'endommager un organe sensible au moment de l'opération. La présente invention a encore pour but principal de résoudre le nouveau problème technique consistant en la fourniture d'une solution permettant d'optimiser le champ acoustique du dispo¬ sitif de thérapie comprenant des éléments transducteurs piézo¬ électriques pour éviter de détruire des structures biologiques identifiées à préserver qui sont traversées par le champ acous- tique. L'invention permet de préférence un suivi automatique de la cible constituée par une lésion à détruire.The main object of the present invention is therefore to solve the new technical problem consisting in providing a solution making it possible to accurately reference a lesion to be treated inside a surrounding medium, preferably an organ located at the inside a mammal, such as an animal or man, and to use this reference to guide the therapeutic act, whatever the difficulty of observing the lesion during the per phase -operative, or the displacements of said lesion occurring between the time when the reference of said lesion was carried out and the time when the therapeutic act was carried out. The main object of the present invention is also to solve the new technical problem consisting in providing a solution enabling the surgeon to find the best approach very quickly, which makes it possible to avoid damaging a sensitive organ when the 'surgery. The main object of the present invention is also to solve the new technical problem consisting in providing a solution making it possible to optimize the acoustic field of the therapy device comprising piezoelectric transducer elements to avoid destroying identified biological structures. to be preserved which are crossed by the acous- tick. The invention preferably allows automatic monitoring of the target constituted by a lesion to be destroyed.
La présente invention a encore pour but de résoudre ces nouveaux problèmes techniques d'une manière particulièrement simple, peu coûteuse, utilisable à l'échelle industrielle, permet¬ tant lors de la phase per-opératoire l'utilisation de moyens de repérage peu coûteux, simples d'utilisation, disponibles en milieu hospitalier, tels que dispositif de radiologie conventionnelle ou dispositif d'imagerie ultrasonore (échographie). La présente invention permet de résoudre ces nouveaux problèmes techniques d'une manière simple, sûre et fiable, repro¬ ductible, d'une manière peu coûteuse. L'invention permet le traite¬ ment de zone cible constituée de tissus mous tels que des organes, et en particulier des tumeurs bénignes ou malignes situées dans ces organes, ces organes peuvent ainsi être des organes mobiles et non référeπçables avec précision par rapport à une structure osseuse comme le foie par exemple.The present invention also aims to solve these new technical problems in a particularly simple, inexpensive manner, usable on an industrial scale, so that during the intraoperative phase the use of inexpensive locating means, easy to use, available in hospitals, such as a conventional radiology device or ultrasound imaging device (ultrasound). The present invention makes it possible to solve these new technical problems in a simple, safe and reliable, reproducible, inexpensive manner. The invention allows the treatment of target area consisting of soft tissues such as organs, and in particular benign or malignant tumors located in these organs, these organs can thus be mobile organs and not precisely referable with respect to a bone structure like the liver for example.
Avantageusement, l'invention permet également d'orienter le dispositif de thérapie, en particulier un dispositif ultrasonore de thérapie selon la meilleure voie d'abord.Advantageously, the invention also makes it possible to orient the therapy device, in particular an ultrasound therapy device according to the best approach.
Ainsi, la présente invention fournit un appareil de thérapie d'une lésion à traiter, située dans un milieu environnant tel qu'un organe, en particulier à l'intérieur du corps d'un mammi¬ fère, tel qu'un animal ou un être humain, du type comprenant des moyens de thérapie de ladite lésion, des moyens de repérage de ladite lésion, lesdits moyens de repérage étant liés, par exemple méc*-_τ_qu_-ι*eπt ou é_£c uιiqu--τιeπt, aux moyens de thérapie ; une centrale de ccππiande cα renaπt des moyens de calcul de la position de la lésion relativement aux moyens de thérapie à l'aide des moyens de repérage ; et des moyens d'activation des moyens de thérapie pour réaliser ladite thérapie après acquisition des coordonnées de position de ladite lésion, caractérisé en ce que lesdits moyens de repérage réalisent le repé¬ rage d'au moins un élément marqueur, réalisé en un matériau repê- rable par lesdits moyens de repérage, préalablement implanté à l'intérieur de ladite lésion, ou à son voisinage ou à l'intérieur de l'organe dans lequel se trouve ladite lésion, ledit organe étant éventuellement susceptible de déplacement ; lesdits moyens de calcul calculent les coordonnées de position dudit élément marqueur par rapport aux moyens de thérapie qui sont utilisées pour posi- tionner les moyens de thérapie prévus deplaçables dans l'espace dans une position quelconque selon les axes X, Y, Z pour que, lors de l'activation des moyens d'activation des moyens de thérapie, une thérapie précise de ladite lésion soit réalisée.Thus, the present invention provides an apparatus for therapy of a lesion to be treated, located in a surrounding medium such as an organ, in particular inside the body of a mammal, such as an animal or a human being, of the type comprising means for therapy of said lesion, means for locating said lesion, said means for locating being linked, for example mec * -_τ_qu_-ι * eπt ou é_ £ c uιiqu - τιeπt, to means therapy; a central control unit renaπt means for calculating the position of the lesion relative to the therapy means using the locating means; and means for activating therapy means for carrying out said therapy after acquisition of the position coordinates of said lesion, characterized in that said locating means carry out locating of at least one marker element, made of a material repê¬ - maple by said locating means, previously implanted inside said lesion, or in its vicinity or inside of the organ in which said lesion is located, said organ possibly being capable of displacement; said calculating means calculate the position coordinates of said marker element with respect to the therapy means which are used to position the therapy means provided which can be displaced in space in any position along the axes X, Y, Z so that, during activation of the means for activating the therapy means, precise therapy of said lesion is carried out.
Selon une variante de réalisation avantageuse, ledit élément marqueur est implanté préalablement sensiblement au centre de la lésion à traiter.According to an advantageous alternative embodiment, said marker element is implanted beforehand substantially at the center of the lesion to be treated.
Selon une autre variante de réalisation avantageuse, plusieurs éléments marqueurs sont préalablement implantés dans la lésion â traiter de manière à marquer sensiblement la totalité ou la majeure partie du volume de la lésion à traiter.According to another advantageous alternative embodiment, several marker elements are previously implanted in the lesion to be treated so as to mark substantially all or most of the volume of the lesion to be treated.
Selon une variante de réalisation particulièrement avan¬ tageuse, au moins quatre éléments marqueurs sont préalablement implantés dans la lésion à traiter, de manière à former un repère cartésien à l'intérieur de la lésion à traiter ou de l'organe con- tenant ladite lésion. De préférence, l'un desdits quatre éléments marqueurs est implanté sensiblement au centre de la lésion à traiter, les trois autres éléments marqueurs étant implantés de telle façon que l'ensemble des quatre éléments marqueurs ne soit pas situé dans le même plan. Selon une autre variante de réalisation avantageuse, l'élément marqueur précité est réalisé en un matériau bio¬ compatible.According to a particularly advantageous variant embodiment, at least four marker elements are implanted beforehand in the lesion to be treated, so as to form a Cartesian reference mark inside the lesion to be treated or of the organ containing said lesion . Preferably, one of said four marker elements is implanted substantially in the center of the lesion to be treated, the other three marker elements being implanted in such a way that all of the four marker elements are not located in the same plane. According to another advantageous alternative embodiment, the above-mentioned marker element is made of a bio-compatible material.
Selon une autre variante de réalisation particulière, l'élément marqueur précité est réalisé en un matériau ne pertur- bant pas le processus thérapeutique ni le processus de diagnos¬ tique, en particulier ne perturbant pas des ondes acoustiques avan¬ tageusement focalisées utilisées pour ladite thérapie. Ainsi, de préférence, le matériau de l'élément marqueur ne perturbe pas des ondes acoustiques ultrasonores focalisées ou des ondes de choc acoustiques focalisées émises par les moyens de thérapie. Dans le cas d'une thérapie par ondes acoustiques ultrasonores focalisées, il est préféré que la dimension de l'élément marqueur ne dépasse pas le quart de la longueur d'onde ultrasonore utilisée.According to another particular variant embodiment, the aforementioned marker element is made of a material which does not disturb the therapeutic process or the diagnostic process, in particular does not disturb the advantageously focused acoustic waves used for said therapy. . Thus, preferably, the material of the marker element does not disturb focused ultrasonic acoustic waves or focused acoustic shock waves emitted by the therapy means. In the case of focused ultrasonic acoustic wave therapy, it is preferred that the dimension of the marker element does not exceed a quarter of the ultrasonic wavelength used.
Selon une autre variante de réalisation avantageuse, la dimension de l'élément marqueur est inférieure à environ 2 mm, encore mieux inférieure à 1 mm et idéalement inférieure à environ 500 micromètres. En particulier, l'élément marqueur est sous forme d'une bille ou d'un anneau. La réalisation sous forme d'un anneau est préférée car elle limite ou empêche tout mouvement de migra¬ tion. Selon un mode de réalisation particulièrement avantageux, l'élément marqueur est réalisé en un matériau choisi parmi le groupe consistant d'un métal biocompatible, de préférence un métal noble tel qu'or, titane ou platine ; d'un agent de contraste au moins visible par lesdits moyens de repérage liés aux moyens de thérapie, en particulier par rayons X et/ou ultrasons ; un produit radioactif par exemple du type technétium et visible par tout dis¬ positif détecteur de rayonnement ionisant, par exemple une &- caméra ; un matériau magnétique ; un matériau émetteur d'ondes acoustiques ou électromagnétiques. Selon un mode de réalisation avantageux, le marquage de la zone cible est réalisé par injection de microbulles d'air visibles par des moyens de repérage tels que les ultrasons. Cette réalisation présente l'avantage de ne pas utiliser de corps étrangers dans l'organe à traiter. On peut observer que les éléments marqueurs selon l'invention sont aisément implaπtables de manière extrêmement pré¬ cise à l'intérieur de la lésion à traiter dans une phase antérieure à la thérapie, par exemple dans un service de radiologie physique¬ ment éloigné de la salle opératoire ou même extérieur au milieu hospitalier, avec l'emploi de dispositifs de repérage fournissant une très grande qualité d'image comme les scanners ou les dispositifs d'imagerie dits IRM. Un procédé particulièrement inté¬ ressant d'implantation des éléments marqueurs consiste à procéder par l'emploi d'une aiguille de biopsie introduite à l'intérieur de la lésion à traiter dans l'organe la contenant à l'intérieur de laquelle aiguille est introduit l'élément marqueur pour être amené à l'intérieur de ladite lésion, cette opération étant renou¬ velée autant de fois qu'il est nécessaire pour introduire le nombre de marqueurs désiré, cette opération étant guidée sous observation permanente échographique ou avec le dispositif de repé¬ rage précédemment indiqué.According to another advantageous alternative embodiment, the dimension of the marker element is less than about 2 mm, better still less than 1 mm and ideally less than about 500 micrometers. In particular, the marker element is in the form of a ball or a ring. The realization in the form of a ring is preferred because it limits or prevents any movement of migra¬ tion. According to a particularly advantageous embodiment, the marker element is made of a material chosen from the group consisting of a biocompatible metal, preferably a noble metal such as gold, titanium or platinum; a contrast agent at least visible by said locating means linked to the therapy means, in particular by X-rays and / or ultrasound; a radioactive product for example of the technetium type and visible by any device detecting ionizing radiation, for example a & - camera; a magnetic material; a material emitting acoustic or electromagnetic waves. According to an advantageous embodiment, the marking of the target area is carried out by injection of visible microbubbles of air by means of location such as ultrasound. This embodiment has the advantage of not using foreign bodies in the organ to be treated. It can be observed that the marker elements according to the invention are easily implantable in an extremely precise manner inside the lesion to be treated in a phase prior to therapy, for example in a radiology department physically distant from the operating room or even outside the hospital environment, with the use of tracking devices providing a very high image quality such as scanners or so-called MRI imaging devices. A particularly interesting process for implanting the marker elements consists in using a biopsy needle inserted inside the lesion to be treated in the organ containing it inside. which needle is introduced the marker element to be brought inside said lesion, this operation being repeated as many times as necessary to introduce the desired number of markers, this operation being guided under permanent ultrasound observation or with the repé¬ rage device previously indicated.
Ainsi, au moment de procéder à la thérapie de ladite lésion, on utilise les moyens de repérage de l'appareil de thérapie, liés aux moyens de thérapie, pour repérer le ou les êlé- ents marqueurs dans ladite lésion pour guider le positionnement très précis des moyens de thérapie relativement à la lésion afin d'améliorer l'efficacité de traitement de la lésion et ce dans la totalité du volume de la lésion que l'on désire traiter.Thus, at the time of therapy of said lesion, the locating means of the therapy apparatus, linked to the therapy means, are used to locate the element or markers in said lesion to guide the very precise positioning. therapy means relative to the lesion in order to improve the treatment efficiency of the lesion and this in the entire volume of the lesion which it is desired to treat.
Grâce à la présence d'au moins un élément marqueur implanté dans l'organe et dans une phase préalable au traitement, en particulier juste après l'implantation, on peut réaliser des plans de coupes images de la lésion ou de l'organe la contenant, à partir du dispositif de repérage fournissant une très grande qualité d'image comme les scanners ou les dispositifs d'imagerie dits IRM, et selon des angles d'orientation différents. Le médecin peut mentalement imaginer quel sera le trajet du champ acoustique à l'intérieur du patient et quelles seront les structures biologiques à éviter et déterminer en conséquence la meilleure voie d'abord. Cette détermination de la meilleure voie d'abord peut lui être rendue plus aisée et conviviale en utilisant des outils informa¬ tiques qui sont pour la plupart disponibles commercialement et associés au dispositif d'imagerie, afin de construire une représen¬ tation en trois dimensions des coupes du patient.Thanks to the presence of at least one marker element implanted in the organ and in a phase prior to treatment, in particular just after implantation, it is possible to produce cross-sectional images of the lesion or of the organ containing it. , from the tracking device providing a very high image quality such as scanners or so-called MRI imaging devices, and according to different orientation angles. The doctor can mentally imagine what the path of the acoustic field will be inside the patient and which biological structures will be avoided and consequently determine the best approach. This determination of the best approach can be made easier and more user-friendly by using computer tools which are for the most part commercially available and associated with the imaging device, in order to construct a three-dimensional representation of the patient cuts.
On notera que la voie d'abord est totalement déterminée à partir d'un point cible de coordonnées x, y, z qui selon l'inven¬ tion est de préférence l'élément marqueur, et une direction ou orientation d'observation, de coordonnées angulaires Ox, Oy, Oz. Ces données, pour être exploitables au moment du traitement, doivent être définies dans un repère géométrique qui puisse être retrouvé au moment du traitement ce qui est réalisé grâce à l'invention par l'utilisation d'éléments marqueurs implantés dans l'organe et qui sont visibles à la fois sur les plans image réa¬ lisés au moment de, ou juste après, l'implantation ainsi qu'au moment du traitement. Ainsi, selon un mode de réalisation particulièrement avantageux, l'invention fournit un appareil de thérapie comprenant une centrale de commande des moyens de thérapie, dans laquelle peuvent être pris en compte des données définissant la meilleure voie d'abord des moyens de thérapie, ladite centrale de commande commandant le déplacement des moyens de thérapie pour les posi¬ tionner avec l'orientation correcte selon la meilleure voie d'abord ainsi définie. Ces données peuvent être entrées dans la centrale de commande par exemple à l'aide d'une interface ou organe périphé¬ rique tel qu'un clavier. Ainsi, au moment du traitement, la présence d'au moins l'élément marqueur indiquant la position de la lésion, telle qu'une tumeur, par exemple dans un organe environnant, va grandement faci¬ liter le travail du médecin. En effet, en plaçant au moins un élé¬ ment marqueur dans la zone cible, on offre au médecin un point de repère parfaitement identifiable qui en quelque sorte lui permet de viser immédiatement la zone cible et finalement de pouvoir se con¬ sacrer entièrement à la recherche de la meilleure voie d'abord.It will be noted that the approach route is completely determined from a target point of coordinates x, y, z which according to the invention is preferably the marker element, and an observation direction or orientation, of angular coordinates Ox, Oy, Oz. To be usable at the time of processing, these data must be defined in a geometric coordinate system which can be found at the time of processing, which is achieved thanks to the invention by the use of marker elements implanted in the organ and which are visible both on the image planes produced at the time of, or just after, the implantation as well as at the time of treatment. Thus, according to a particularly advantageous embodiment, the invention provides a therapy device comprising a central control unit for the therapy means, in which data defining the best route to the therapy means can be taken into account, said therapy central control unit controlling the movement of the therapy means in order to position them with the correct orientation according to the best approach thus defined. This data can be entered in the control unit for example using an interface or peripheral device such as a keyboard. Thus, at the time of treatment, the presence of at least the marker element indicating the position of the lesion, such as a tumor, for example in a surrounding organ, will greatly facilitate the work of the doctor. Indeed, by placing at least one marker element in the target area, the doctor is offered a perfectly identifiable benchmark which in a way allows him to immediately target the target area and finally to be able to devote himself entirely to the finding the best path first.
L'invention permet donc d'éliminer les inconvénients de la technique antérieure qui ne contenait aucune solution pour intervenir sur des organes mobiles et non rêférençables avec préci¬ sion par rapport à une structure osseuse, comme c'est généralement le cas de tumeurs. Or, les tumeurs ont souvent des contours mal définis et sont, en outre, peu aisément identifiables. Leur détec¬ tion doit donc être conduite généralement par des experts tels que des radiologues. Dans ces conditions, le travail de recherche d'une voie d'abord est rendue encore plus difficile car le manipulateur doit simultanément viser la tumeur, ce qui est en soi peu aisé, et encore orienter son dispositif de détection, en particulier une sonde échographique, autour de cette tumeur pour identifier la meilleure voie d'abord sans perdre le point visé. L'invention, comme il ressort de ce qui précède et de la description suivante, permet d'éliminer ces inconvénients par l'emploi d'un élément marqueur dans la zone cible.The invention therefore makes it possible to eliminate the drawbacks of the prior art which did not contain any solution for operating on mobile and non-referable organs with precision with respect to a bone structure, as is generally the case with tumors. However, tumors often have ill-defined contours and, moreover, are not easily identifiable. Their detection must therefore generally be carried out by experts such as radiologists. Under these conditions, the work of finding a pathway is made even more difficult because the manipulator must simultaneously target the tumor, which in itself is not easy, and still orient his detection device, in particular an ultrasound probe. , around this tumor to identify the best route first without losing the target point. The invention, as appears from the above and from the following description, makes it possible to eliminate these drawbacks by the use of a marker element in the target area.
L'invention permet selon encore une autre variante, de représenter physiquement la voie d'abord idéale, en marquant la surface du patient de fenêtres de passage des ondes ultrasonores.According to yet another variant, the invention makes it possible to physically represent the ideal approach route, by marking the patient's surface with windows for the passage of ultrasonic waves.
Pour cela, l'invention propose d'utiliser dans une variante de réalisation avantageuse, une sonde de repérage écho¬ graphique standard, donnant un plan image "mode B", centré sur l'axe longitudinal de la sonde. En outre, un dispositif de mar¬ quage, permettant de marquer la peau du patient, est rendu soli¬ daire de la sonde d'imagerie. Ce dispositif de marquage peut, par exemple, comprendre un stylo. L'utilisateur déplace alors la sonde échographique sur la peau du patient pour visualiser la zone à traiter ainsi que les obstacles biologiques à éviter. Il peut définir ainsi la fenêtre acoustique optimale. Lors de ce déplace¬ ment, le dispositif de marquage marque la peau du patient et le marquage représente en quelque sorte la projection, sur la peau du patient, de la surface idéale du champ ultrasonore qui permettra d'éviter les obstacles biologiques.For this, the invention proposes to use, in an advantageous alternative embodiment, a standard echo¬ graphic locating probe, giving a "mode B" image plane, centered on the longitudinal axis of the probe. In addition, a marking device, making it possible to mark the patient's skin, is made solid with the imaging probe. This marking device can, for example, include a pen. The user then moves the ultrasound probe over the patient's skin to visualize the area to be treated and the biological obstacles to avoid. It can thus define the optimal acoustic window. During this displacement, the marking device marks the patient's skin and the marking represents in a way the projection, on the patient's skin, of the ideal surface of the ultrasonic field which will make it possible to avoid biological obstacles.
Selon encore un autre mode de réalisation avantageux de l'invention, il est possible d'optimiser le champ acoustique du dispositif de thérapie comprenant au moins un élément transducteur piézo-électrique multi-éléments de telle sorte que les interactions entre le champ acoustique du dispositif de thérapie et les struc¬ tures biologiques qui lui font obstacle soient pratiquement inexis¬ tantes. Dans ce cas, on prévoit un dispositif de thérapie à trans¬ ducteur multi-éléments, par exemple en réseaux de rangées qui peuvent être annulaires, ou en structure en mosaïque, bien connu à l'homme de l'art. Dans une première phase, on fait fonctionner chacun des éléments transducteurs du dispositif de thérapie en mode échographie, c'est-à-dire d'une manière identique au fonctionnement des ondes d'imagerie échographique pour détecter par un circuit électronique les échos acoustiques réfléchis par les structures biologiques. Ce circuit électronique est en tout point identique à ceux utilisés en imagerie échographique. A partir de ces signaux, il est possible de reconstruire des images des structures biolo¬ giques traversées par le champ acoustique du dispositif de thérapie qu'il y a lieu de préserver. En cas d'une détection de structures biologiques à préserver dans le trajet de certains éléments trans¬ ducteurs, on prévoit que la centrale de commande ne commande pas l'alimentation de ces éléments transducteurs correspondants pour éviter de détruire les structures biologiques identifiées. L'inven¬ tion permet ainsi d'optimiser parfaitement le champ acoustique ultrasonore du dispositif de thérapie vis-à-vis des obstacles bio¬ logiques, ceci de manière automatique et parfaitement fiable puisque l'agent de détection (onde acoustique) des obstacles est le même que celui utilisé pour réaliser la thérapie avec le dispositif de thérapie. L'invention permet encore de réaliser un suivi automa¬ tique de la cible grâce à la présence de l'élément marqueur placé au centre de la lésion à détruire qui est utilisé pour une détec¬ tion automatique de la cible formée par la lésion ainsi qu'à un suivi automatique de celle-ci, notamment lors d'un mouvement par exemple sous l'effet de la respiration, par rapport au dispositif de thérapie supposé en position fixe. Les dispositifs de mise en oeuvre d'un tel suivi automatique sont bien connus à l'homme de l'art.According to yet another advantageous embodiment of the invention, it is possible to optimize the acoustic field of the therapy device comprising at least one multi-element piezoelectric transducer element so that the interactions between the acoustic field of the device of therapy and the biological structures which hinder it are practically nonexistent. In this case, a multi-element transducer therapy device is provided, for example in rows of arrays which may be annular, or in a mosaic structure, well known to those skilled in the art. In a first phase, each of the transducer elements of the therapy device is operated in ultrasound mode, that is to say in a manner identical to the operation of ultrasound imaging waves to detect by an electronic circuit the reflected acoustic echoes. by biological structures. This electronic circuit is identical in all respects to those used in ultrasound imaging. From these signals, it is possible to reconstruct images of the biological structures traversed by the acoustic field of the therapy device which should be preserved. In the event of detection of biological structures to be preserved in the path of certain transducing elements, provision is made for the control unit not to control the supply of these corresponding transducing elements in order to avoid destroying the identified biological structures. The invention thus optimizes the ultrasonic acoustic field of the therapy device vis-à-vis biological obstacles perfectly, this is automatic and perfectly reliable since the obstacle detection agent (acoustic wave) is the same as that used to perform therapy with the therapy device. The invention also makes it possible to carry out an automatic follow-up of the target thanks to the presence of the marker element placed at the center of the lesion to be destroyed which is used for automatic detection of the target formed by the lesion as well as '' automatic monitoring thereof, in particular during a movement, for example under the effect of breathing, with respect to the therapy device assumed to be in a fixed position. The devices for implementing such automatic monitoring are well known to those skilled in the art.
Selon un deuxième aspect, la présente invention couvre également un procédé de traitement thérapeutique d'une lésion dans un milieu environnant, tel qu'un organe se trouvant à l'intérieur du corps d'un mammifère, tel qu'un animal ou un être humain, com¬ prenant la prévision d'un appareil de thérapie comprenant des moyens de repérage de la lésion, des moyens de thérapie de la lésion, les moyens de repérage étant liés aux moyens de thérapie ; une centrale de commande comprenant des moyens de calcul des coor¬ données de position de la lésion par rapport aux moyens de thérapie, et des moyens de commande des moyens de thérapie notamment par l'intermédiaire de la centrale de commande pour réa- liser un positionnement de ceux-ci dans une position quelconque de l'espace selon les axes X, Y, Z en fonction des coordonnées de position de ladite lésion, caractérisé en ce qu'on réalise au préalable l'implantation d'au moins un élément marqueur repérable par lesdits moyens de repérage liés auxdits moyens de thérapie, dans ladite lésion ou au voisinage de cette lésion àl'intérieur dudit organe ;According to a second aspect, the present invention also covers a method of therapeutic treatment of a lesion in a surrounding medium, such as an organ located inside the body of a mammal, such as an animal or a being. human, including the provision of a therapy device comprising means for locating the lesion, means for therapy of the lesion, the locating means being linked to the therapy means; a control unit comprising means for calculating the coordinates of position of the lesion relative to the therapy means, and control means for the therapy means in particular by means of the control unit for performing positioning of these in any position of the space along the axes X, Y, Z as a function of the position coordinates of said lesion, characterized in that the implantation of at least one marker element locatable by said locating means linked to said means therapy, in said lesion or in the vicinity of this lesion inside said organ;
- on effectue un repérage dudit élément marqueur par lesdits moyens de repérage liés au moyen de thérapie dans la phase per-opératoire ; - on calcule à l'aide des moyens de calcul précités les coordonnées de position de l'élément marqueur dans un système de coordonnées lié aux moyens de thérapie ;- performing a marking of said marker element by said marking means linked to the therapy means in the intraoperative phase; - Using the above calculation means, the position coordinates of the marker element are calculated in a coordinate system linked to the therapy means;
- on procède au positionnement précis des moyens de thérapie relativement audit élément marqueur ; et - on procède à la thérapie de ladite lésion avec les moyens de thérapie ainsi positionnés.- Precise positioning of the therapy means is performed relative to said marker element; and - therapy of said lesion is carried out with the therapy means thus positioned.
Selon une variante de réalisation préférée, on procède à l'implantation de plusieurs éléments marqueurs dans ladite lésion ou dans ledit organe préalablement à la thérapie. Selon un mode de réalisation particulièrement préféré, on utilise au moins quatre éléments marqueurs que l'on implante préa¬ lablement dans ladite lésion et/ou dans ledit organe de manière non-alignée dans un plan, pour permettre un repérage de la totalité ou de la majeure partie du volume de la lésion à traiter. Selon un autre mode de réalisation particulièrement avan¬ tageux du procédé, au moment de l'implantation d'au moins l'élément marqueur précité ou juste après ladite implantation, on réalise plusieurs plans de coupes images selon des orientations angulaires différentes, contenant ledit élément marqueur, afin de déterminer la meilleure voie d'abord, et on note les coordonnées de cette voie d'abord comprenant les coordonnnées d'un point cible x, y, z cons¬ tituées de préférence par l'élément marqueur lui-même, ainsi qu'une direction d'orientation de coordonnées θx, θy, θz déterminée par l'orientation des moyens de repérage donnant le plan de coupe image de la meilleure voie d'abord, et enfin on relève ou enregistre l'ensemble de ces données comme étant les données de la meilleure voie d'abord. Avantageusement, ces données relevées ou enregistrées sont utilisées au moment de la thérapie pour positionner les moyens de thérapie relativement à 1 'élément marq- eur lié à la lésion selon la meilleure voie d'abrrα.According to a preferred embodiment, the implantation of several marker elements is carried out in said lesion or in said organ prior to therapy. According to a particularly preferred embodiment, at least four marker elements are used which are implanted beforehand in said lesion and / or in said organ in a non-aligned manner in a plane, to allow identification of the whole or of most of the volume of the lesion to be treated. According to another particularly advantageous embodiment of the method, at the time of the implantation of at least the aforementioned marker element or just after said implantation, several planes of image sections are produced according to different angular orientations, containing said element marker, in order to determine the best approach first, and the coordinates of this approach first are noted, comprising the coordinates of a target point x, y, z preferably constituted by the marker element itself, as well as a direction of orientation of coordinates θx, θy, θz determined by the orientation of the locating means giving the image cutting plane of the best path first, and finally we note or record all of this data as the best pathway data first. Advantageously, these recorded or recorded data are used at the time of therapy to position the therapy means relative to the marker element linked to the lesion according to the best route of abrrα.
D'autres variantes de réalisation du procédé sont immé¬ diatement apparentes à L'homme de L'art à partir de La description précédente de l'appareil et également à partir de la description explicative suivante faite en référence à un mode de réalisation actuellement préféré d'un appareil de thérapie selon L'invention.Other process embodiments are imme diately ¬ apparent to those skilled in the art from the foregoing description of the apparatus and also from the following explanatory description made with reference to a presently preferred embodiment of a therapy device according to the invention.
Pour L'un ou L'autre des aspects précédents, il est pré¬ féré que Les moyens de thérapie soient des moyens de thérapie com¬ prenant au moins un dispositif transducteur ultrasonique focalisé, par exemple sous forme de coupelle sphérique ; ou un dispositif générateur d'ondes de choc acoustiques focalisées, par exemple par voie électrohydraulique comme cela est connu dans Le cadre de La Lithotritie.For one or other of the foregoing aspects, it is pre ferred that ¬ Therapy means are com ¬ therapy means taking at least a focused ultrasonic transducer device, such as a spherical cup; or a device for generating focused acoustic shock waves, for example by electro-hydraulic means as is known in the context of Lithotripsy.
D'autre part, comme moyen de repérage précité, on utili¬ sera de préférence un dispositif d'échographie et/ou un dispositif de radiologie par rayons X. On peut aussi utiliser un détecteur d'ondes électromagnétiques ou d'ondes acoustiques ou un détecteur de rayonnement ionisant tel que γ-caméra.On the other hand, as aforementioned locating means, it will preferably be an ultrasound device and / or an X-ray radiology device. It is also possible to use an electromagnetic wave or acoustic wave detector or a ionizing radiation detector such as γ-camera.
Dans La présente description et Les revendications, on entend par "phase per-opératoire", La phase de recherche des élé- ments marqueurs préalablement à la thérapie proprement dite. Cette recherche peut être faite naturellement tout au début de La thérapie mais peut être renouvelée autant de fois que le souhaite le praticien au cours de la thérapie ou bien être continuée en per¬ manence au cours de La thérapie en réalisant alors un suivi en temps réel de la thérapie grâce aux éléments marqueurs. L'invention permet ainsi de réaLiser une détection automatique de La Lésion grâce à L'élément marqueur, puis un suivi automatique de La Lésion en cas de mouvement de celle-ci par exemple sous l'effet de La res¬ piration, et à une thérapie automatisée pilotée par une centrale de commande comprenant Les moyens de calcul précités. D'autres buts, caractéristiques et avantages de l'inven¬ tion apparaîtront clairement à la lumière de la description expli¬ cative qui va suivre faite en référence aux dessins annexés repré¬ sentant un mode de réalisation actuellement préféré de l'invention donné simplement à titre d'illustration et qui ne saurait donc en aucune façon limiter la portée de l'invention. Dans les dessins :In the present description and the claims, the term "peroperative phase" means the phase of searching for the markers prior to the actual therapy. This research can be done naturally at the very start of therapy but can be repeated as many times as the practitioner wishes during therapy or else be continued continuously during therapy by then real-time monitoring. of therapy thanks to the markers. The invention thus makes it possible to carry out an automatic detection of the Lesion thanks to the marker element, then an automatic monitoring of The Lesion in the event of movement thereof for example under the effect of Respiration, and to a automated therapy controlled by a central control unit comprising the abovementioned calculation means. Other objects, characteristics and advantages of the invention will become clear in the light of the explanatory description which follows, given with reference to the appended drawings representing a currently preferred embodiment of the invention given simply by title of illustration and which could therefore in no way limit the scope of the invention. In the drawings:
- la figure 1 représente schématiquement et selon une vue latérale un appareil de thérapie selon la présente invention pour le traitement d'une lésion, par exemple une tumeur, se trouvant à l intérieur d'un organe, par exemple le foie, d'un mammifère, ici un être humain ;- Figure 1 shows schematically and in a side view a therapy device according to the present invention for the treatment of a lesion, for example a tumor, located inside an organ, for example the liver, a mammal, here a human being;
- la figure 2 représente schématiquement la procédure d'implantation préalable d'au moins un élément marqueur utilisé dans le cadre de la présente invention, et représentant une variante de réalisation permettant de calculer les coordonnées de position de la lésion à traiter dans le repère des éléments marqueurs ; et la figure 3 représente schématiquement le procédé général de thérapie. ? - la figure 4 représente de manière schématique un dis¬ positif de thérapie 12' avec son point focal F en coïncidence avec l'élément marqueur MO dans l'organe 0, et avec son champ acoustique ayant son trajet traversant partiellement une structure biologique- Figure 2 schematically shows the pre-implantation procedure for at least one marker element uti l ized in the context of the present invention and showing an alternative embodiment for calculating the lesion position coordinates to be treated in the identifies markers; and Figure 3 schematically shows the general method of therapy. ? - Figure 4 shows schematically a ¬ say positive therapy 12 'with its focal point F coincides with the marker element in the MO element 0, and its acoustic field with its path partially through a biological structure
BS ; 5 - la figure 5 représente le signal acoustique émis par l'élément transducteur piézoélectrique T2, ne rencontrant pas d'obstacles sur son passage avec le signal d'écho de l'élément marqueur symbolisé SMO dépassant le seuil de signal écho fixé par référence, représenté symboliquement en pointillé, le fonctionne- 0 ment de l'élément transducteur étant en mode A, c'est-à-dire à signal linéaire ; et La figure 6 représente une courbe de signal d'écho émise par L'élément transducteur piézoélectrique T1 et montrant un signal d'écho renvoyé par La structure biologique, référencé SBS un instant t inférieur à L'instant T du signal d'écho de L'élément marqueur MO permettant d'identifier que L'élément transducteur T1 a son champ acoustique traversant une structure biologique.BS; 5 - FIG. 5 represents the acoustic signal emitted by the piezoelectric transducer element T2, encountering no obstacles in its path with the echo signal of the marker element symbolized SMO exceeding the echo signal threshold fixed by reference, represented symbolically in dotted lines, the operation of the transducer element being in mode A, that is to say with linear signal; and FIG. 6 represents an echo signal curve emitted by the piezoelectric transducer element T1 and showing an echo signal returned by the biological structure, referenced SBS an instant t less than the instant T of the echo signal of L 'MO marker element allowing to identify that the transducer element T1 has its acoustic field crossing a biological structure.
En référence à La figure 1, on a représenté un appareil de thérapie selon La présente invention portant Le numéro de réfé¬ rence général 10. Cet appareil comprend des moyens de thérapie représentés par Le numéro de référence général 12. Ces moyens de thérapie peuvent, par exemple, comprendre un dispositif de thérapie proprement dit 14 ici à surface émettrice 16 focalisante naturelle¬ ment en présentant une forme de coupelle sphérique pour focaliser des ondes acoustiques en un foyer f. Ces ondes acoustiques peuvent être des ondes acoustiques de choc, ou des ondes acoustiques ultra¬ sonores entretenues. Les moyens de thérapie 12 peuvent également comporter de manière intégrée des moyens d'imagerie 18 disposés de préférence ici selon l'axe de symétrie du dispositif 14 générateur d'ondes acoustiques pour observer en permanence Le point focal F. Ces moyens d'imagerie 18 peuvent, par exemple, être constitués par une sonde échographique, par exemple capable de réaliser un balayage sectoriel de type B.Referring to FIG. 1, a therapy device according to the present invention is shown bearing the general reference number 10. This device comprises therapy means represented by the general reference number 12. These therapy means can, for example, to understand a therapy device proper 14 here with emitting surface 16 focusing naturally by presenting a shape of a spherical cup for focusing acoustic waves into a focus f. These acoustic waves can be shock acoustic waves, or maintained ultrasonic acoustic waves. The therapy means 12 can also include, in an integrated manner, imaging means 18 preferably arranged here along the axis of symmetry of the device 14 generating acoustic waves for permanently observing the focal point F. These imaging means 18 can, for example, be constituted by an ultrasound probe, for example capable of carrying out a sectoral type B scan.
Il est à noter que les moyens de thérapie 12 sont de préférence supportés par un dispositif support non représenté capable d'être commandé en déplacement dans L'espace et en rotation autour de ces axes, grâce à des moyens de commande en déplacement appropriés 20, eux-mêmes commandés par une centrale de commande 22 avantageusement comprenant des moyens de calcul tels qu'un calcul- Lateur, ordinateur ou micro-ordinateur. Selon un mode de réalisation avantageux, cet appareil 10 comprend aussi des moyens de repérage représentés par Le numéro de référence général 30, ou 40. Par exemple, Les moyens de repérage 30 sont des moyens de repérage par voie uLtrasonique comprenant au moins une sonde échographique 32, par exemple montée à L'extrémitéIt should be noted that the therapy means 12 are preferably supported by a support device (not shown) capable of being controlled to move in space and to rotate about these axes, by means of appropriate displacement control means 20, themselves controlled by a control center 22 advantageously comprising calculation means such as a computer, computer or microcomputer. According to an advantageous embodiment, this device 10 also comprises locating means represented by the general reference number 30, or 40. For example, the locating means 30 are locating means by ultrasonic means comprising at least one ultrasound probe 32, for example mounted at the end
FEUILLE DE REMPLACEMENT d'un bras de robot 34 pourvu d'éléments codeurs de position dans un repère cartésien x, y, z ainsi que la direction angulaire selon des angles θx, θy, θz, lui-même monté sur le châssis de l'appareil 10, en permettant ainsi de déterminer les coordonnées de position 5 dans le repère cartésien x, y, z ainsi que d'orientation angu¬ laire selon les angles θx, θy, θz des moyens de repérage 30 par rapport au châssis 36 de l'appareil 10 et donc par rapport aux moyens de thérapie 12. Ces coordonnées de position ainsi que les images fournies par Les moyens de repérage 30 sont transmises à la 0 centrale de commande 22 par des moyens appropriés 38. De même, les autres moyens de repérage 40 peuvent, par exemple, comprendre au moins une source de repérage 42 à rayons X, de préférence celle qui est décrite dans le brevet précédent de Techno ed F -A-2 665 545 et qui est déplaçable entre deux positions distinctes comme symbolisé -5 par la flèche R et dont les données recueillies sont transmises à la centrale de commande 22 par des moyens de transmission appro¬ priés 48, bien connus à l'homme de L'art.REPLACEMENT SHEET a robot arm 34 provided with coding elements for position in a Cartesian coordinate system x, y, z as well as the angular direction at angles θx, θy, θz, itself mounted on the chassis of the device 10, thus making it possible to determine the coordinates of position 5 in the Cartesian coordinate system x, y, z as well as of angular orientation according to the angles θx, θy, θz of the locating means 30 relative to the chassis 36 of the apparatus 10 and therefore with respect to the therapy means 12. These position coordinates as well as the images supplied by the locating means 30 are transmitted to the central control unit 22 by appropriate means 38. Similarly, the other locating means 40 can , for example, include at least one X-ray tracking source 42, preferably that described in the previous Techno ed patent F -A-2,665,545 and which is movable between two distinct positions as symbolized by -5 by the arrow R and whose data are collected are transmitted to the control unit 22 by means of transmission appro¬ invited 48 well known to the man of art.
Sur le châssis 36 de l'appareil, en particulier sur une table habituellement horizontale 50, il a été prévu une ouvertureOn the chassis 36 of the apparatus, in particular on a usually horizontal table 50, an opening has been provided.
__ 52 permettant le passage des ondes acoustiques de thérapie symbo¬ lisées par le cône C de focalisation. Sur cette table, est allongé un patient P dont un organe 0, par exemple ici le foie, comporte une lésion L, telle qu'une tumeur bénigne ou maligne dont on peut bien comprendre qu'elle occupe un certain volume à l'intérieur de__ 52 allowing the passage of acoustic therapy waves symbolized by the focusing cone C. On this table, a patient P is lying whose organ 0, for example here the liver, has a lesion L, such as a benign or malignant tumor which we can understand that it occupies a certain volume inside
<-.-. l'organe 0.<-.-. organ 0.
Selon la présente invention, et par une étape préalable représentée à la figure 2, il a été implanté dans l'organe 0, et plus particulièrement dans la lésion L ou au voisinage de ladite lésion, au moins un élément marqueur M, de préférence ici quatre éléments marqueurs repérés respect vement MO, M1, M2 et M3. L'un desdits éléments marqueurs, ici l'élément MO, est de préférence incorporé sensiblement au centre de la lésion L, tandis que les trois éléments marqueurs M1, M2 et M3 ont été implantés au voisi¬ nage de ladite lésion, par exemple l'élément marqueur M1 est incor- 35 pore à la frontière de La lésion L et les éléments marqueurs M2 et M3 sont incorporés au voisinage de la Lésion L dans L'organe 0. IL est à noter de préférence que l'ensemble des éléments marqueurs MO, Ml, M2 et M3 ne sont pas contenus dans un même plan. L'ensemble de ces éléments marqueurs permet de définir un repère géométrique car¬ tésien x, y et z ainsi que des directions angulaires θx, θy, θz. Par ailleurs, à la droite de La figure 1, Les flèches OX,According to the present invention, and by a prior step shown in FIG. 2, at least one marker element M, preferably here, has been implanted in organ 0, and more particularly in lesion L or in the vicinity of said lesion four marker elements marked respectfully MO, M1, M2 and M3. One of said marker elements, here the element MO, is preferably incorporated substantially at the center of the lesion L, while the three marker elements M1, M2 and M3 have been implanted in the vicinity of said lesion, for example l the marker element M1 is incorporated at the border of the lesion L and the marker elements M2 and M3 are incorporated in the vicinity of the lesion L in organ 0. IL it should preferably be noted that all of the marker elements MO, Ml, M2 and M3 are not contained in the same plane. The set of these marker elements makes it possible to define a geometric coordinate system because ¬ tésien x, y and z as well as angular directions θx, θy, θz. Furthermore, to the right of Figure 1, The arrows OX,
OY et OZ définissent Le repère géométrique cartésien de détermina¬ tion des coordonnées de position x, y, z et de direction angu¬ laire θx, θy, θz, dans l'espace des moyens de thérapie 12, ces axes OX, OY et OZ étant les axes de déplacement dans l'espace des moyens de thérapie 12 par les moyens de déplace¬ ment 20. D'autre part, les moyens d'actionnement des moyens de thérapie 12 sont repérés par le numéro de référence 60, ces moyens d'actionnement étant eux-mêmes commandés par La centrale de com¬ mande 22. Enfin, La centrale de commande 22 peut également recevoir par des moyens appropriés 70 des coordonnées de oositioπ x, y, x, et de direction d'orientation angulaire θx, θy, θz, de la Lésion L à traiter dans Le repère des éléments marqueurs MO, M1, M2 et M3 calculées séparément, après implantation des éléments marqueurs dans La Lésion L.OY and OZ define the Cartesian geometric reference frame for determining the coordinates of position x, y, z and of angular direction θx, θy, θz, in the space of the therapy means 12, these axes OX, OY and OZ being the axes of movement in space of the therapy means 12 by the displacement means ¬ ment 20. On the other hand, the actuation means of the therapy means 12 are identified by the reference number 60, these means d actuation being themselves controlled by the control unit 22. Finally, the control unit 22 can also receive by appropriate means 70 coordinates of position x , y, x, and of direction of angular orientation θx, θy, θz, of the Lesion L to be treated in the reference frame of the marker elements MO, M1, M2 and M3 calculated separately, after implantation of the marker elements in The Lesion L.
Ainsi, à la figure 2, on a représenté schématiquement l'étape d'implantation des éléments marqueurs MO, M1, M2 et M3 dans la Lésion L à l'intérieur de l'organe 0 lui-même à L'intérieur du corps d'un patient P, par exemple à L'aide d'une aiguille de biopsie 80. Ces éléments marqueurs sont, par exemple, constitués par une bille que L'on fait glisser à l'intérieur de l'aiguille à biopsie 80 jusqu'à aboutir aux positions indiquées. Cette implanta¬ tion a Lieu sous contrôle de moyens d'imagerie fournissant une image très précise de La Lésion L, de préférence un scanner ou des moyens d'imagerie par résonance magnétique, IRM, disponible(s) dans un centre de radiologie spécialisé et permettant Le positionnement très précis, sûr et reproductible des éléments marqueurs aux posi¬ tions souhaitées dans la Lésion L et/ou dans l'organe 0 contenant La Lésion L. On peut également réaliser La même implantation sous contrôle échographique ou rayons X. On a représenté schématiquement à la figure 2 un dispo¬ sitif scanner 90 se déplaçant successivement de La position 1 à la position n pour obtenir n plans images en coupe sériée permettant d'obtenir une image complète de l'organe 0, de la lésion L et des éléments marqueurs MO à M3 grâce à des moyens d'imagerie classiques combinés référencés 92, dont les données sont transmises à un centre de calcul 94 comprenant au moins un calculateur, ordinateur ou micro-ordinateur. Selon une caractéristique préférée de l'inven¬ tion, cette centrale de calcul 94 est intégrée à la centrale de commande 22. Dans ce cas, le scanner 90, comme cela est d'ailleurs classique, comprend des moyens de stockage de toutes Les données recueillies, par exemple sur une disquette qui peut être ensuite utilisée avec la centrale de commande 22 pour que les données stockées soient analysées et traitées par les moyens de calcul de la centrale de commande 22, L'entrée de ces données étant symbo¬ lisée par la case 70. Ainsi, les moyens de calcul soit indépendants 94, soit intégrés à la centrale de commande 22 calculent les coordonnées de position x, y, z et avantageusement de direction d'orientation angulaire θx, θy, θz, de la lésion L à traiter dans le repère des éléments marqueurs MO, Ml, M2 et M3, lorsque cette étape complémentaire, non actuellement nécessaire est souhaitée. L'invention ppr et ainsi de déterminer la meilleure voie d'abord.Thus, in Figure 2, there is shown schematically the step of implantation of the marker elements MO, M1, M2 and M3 in the lesion L inside the organ 0 itself inside the body d 'A patient P, for example using a biopsy needle 80. These marking elements are, for example, constituted by a ball which is dragged inside the biopsy needle 80 until to reach the positions indicated. This implantation takes place under the control of imaging means providing a very precise image of La Lésion L, preferably a scanner or magnetic resonance imaging means, MRI, available in a specialized radiology center and allowing the very precise, safe and reproducible positioning of the marker elements at the desired positions in the L lesion and / or in the organ 0 containing the L lesion. The same implantation can also be carried out under ultrasound or X-ray control. There is shown diagrammatically in FIG. 2 a scanner device 90 moving successively from position 1 to position n to obtain n image planes in serial section making it possible to obtain a complete image of the organ 0, of the lesion L and marker elements MO to M3 by means of conventional combined imaging means referenced 92, the data of which are transmitted to a computer center 94 comprising at least one computer, computer or microcomputer. According to a preferred characteristic of the invention, this computing center 94 is integrated into the control unit 22. In this case, the scanner 90, as is moreover conventional, comprises means for storing all the data collected, for example on a floppy disk which can then be used with the control unit 22 so that the stored data are analyzed and processed by the calculation means of the control unit 22, the input of this data being symbolized by box 70. Thus, the calculation means either independent 94 or integrated into the control unit 22 calculate the coordinates of position x, y, z and advantageously of direction of angular orientation θx, θy, θz, of the lesion L to be treated in the reference frame of the marker elements MO, Ml, M2 and M3, when this additional step, not currently necessary, is desired. The invention ppr and thus determine the best path first.
En référence à la figure 3, on a représenté le procédé général de thérapie qui comprend deux variantes. Selon la variante de base, ce procédé de thérapie com¬ prend deux étapes A et B, une première étape A d'implantation des éléments marqueurs dans la lésion L ou au voisinage de celle-ci, de l'organe à traiter 0 comme clairement compréhensible à partir de la considération de La figure 2 ; et une deuxième étape B de traite- ment proprement dit comprenant tout d'abord Le repérage des marqueurs MO, M1, M2 et M3 avec les moyens de repérage 30 ou 40, puis une étape de calcul des coordonnées de position de la lésion L dans le repère géométrique 0X, 0Y, 0Z des moyens de thérapie 12 ; ensuite Le positionnement dans L'espace par déplacement selon les axes OX, OY et OZ des moyens de thérapie 12 de manière que le point ou La zone focale F se positionne au regard de la Lésion à traiter pour réaliser Le traitement d'un point de La Lésion, puis par déplacement successif point par point, on réalise Le traitement du volume complet de La Lésion L. L'efficacité du traitement de chaque point est contrôlée en temps réel grâce à la présence des moyens de visualisation auxiliaires 18, 32 ou 42, donnant en permanence une image du point focal par des moyens d'imagerie 96, 38 ou 48, dont les données peuvent également être transmises à La centrale de commande 22 et pouvant servir en fin de traitement à donner une imagerie de contrôle post-opératoire.Referring to Figure 3, there is shown the general method of therapy which includes two variants. According to the basic variant, this therapy method takes two steps A and B, a first step A of implantation of the marker elements in the lesion L or in the vicinity thereof, of the organ to be treated 0 as clearly understandable from the consideration of Figure 2; and a second processing step B proper comprising first of all the identification of the markers MO, M1, M2 and M3 with the identification means 30 or 40, then a step of calculating the position coordinates of the lesion L in the geometric coordinate system 0X, 0Y, 0Z of the therapy means 12; then positioning in space by displacement along the axes OX, OY and OZ of the therapy means 12 so that the point or the focal zone F is positioned with regard to the lesion to be treated in order to carry out the treatment of a point of Lesion, then by successive displacement point by point, the treatment of the complete volume of Lesion L is carried out. The effectiveness of the treatment of each point is controlled in real time thanks to the presence of the auxiliary display means 18, 32 or 42 , permanently giving an image of the focal point by imaging means 96, 38 or 48, the data of which can also be transmitted to the control unit 22 and which can be used at the end of treatment to give post-operative control imaging .
Selon une variante de réalisation représentée à la figure 2, et qui représente une étape C intermédiaire entre L'étape A et L'étape B, on peut procéder au calcul des coordonnées de position de La lésion à traiter dans le repère des éléments marqueurs MO, M1, M2 et M3, en utilisant des moyens d'imagerie, par exemple ceux 90 qui ont servi à réaliser L'implantation précise des éléments marqueurs dans la Lésion L. Une technique consiste à iden- tifier sur chacune des images Les contours de L'organe de La Lésion à traiter ainsi que Les marqueurs pour en obtenir une repré¬ sentation en trois dimensions. Un calcul permet alors de déterminer Les coordonnées de chaque point de La Lésion à traiter dans Le repère géométrique des éléments marqueurs MO, M1 , M2 et M3. Ces coordonnées étant ensuite utilisées pour réaliser Le calcul des coordonnées de position de La Lésion dans Le repère OX, OY et OZ de déplacement des moyens de thérapie 12.According to an alternative embodiment represented in FIG. 2, and which represents a step C intermediate between step A and step B, it is possible to calculate the position coordinates of the lesion to be treated in the reference frame of the marker elements MO , M1, M2 and M3, using imaging means, for example those 90 which were used to carry out the precise implantation of the marker elements in the L lesion. One technique consists in identifying on each of the images the contours of The Lesion organ to be treated as well as the markers to obtain a three-dimensional representation. A calculation then makes it possible to determine the coordinates of each point of La Lesion to be treated in the geometric frame of the marker elements MO, M1, M2 and M3. These coordinates are then used to carry out the calculation of the position coordinates of La Lesion in the coordinate system OX, OY and OZ of displacement of the therapy means 12.
L'invention permet également à partir de plans de coupes images successifs en particulier selon des orientations angulaires différentes, à partir des moyens de repérage en particulier à image haute définition telle qu'utilisée pour L'implantation de l'élément marqueur tel que scanner ou IRM, de déterminer la meilleure voie d'abord et ainsi les coordonnées d'orientation angulaire θx, θy etThe invention also makes it possible, from successive image cutting planes in particular according to different angular orientations, from location means in particular with high definition image as used for the implantation of the marker element such as scanner or MRI, to determine the best approach first and thus the angular orientation coordinates θx, θy and
FEUILLE DE REMPLACEMENT θz de la meilleure voie d'abord qui sont ensuite utilisées au moment du traitement pour définir la position d'orientation angu¬ laire de la meilleure voie d'abord des moyens de thérapie 12, en particulier dans le repère OX, OY et OZ. Ceci peut être réalisé simplement en entrant ces coordonnées de position angulaire θz, βy et θz avec les coordonnées de position X, Y, Z dans la centrale de commande 22 des moyens de thérapie 12, par exemple à l'aide d'une interface ou d'un organe périphérique tel qu'un clavier.REPLACEMENT SHEET θz of the best route first which are then used at the time of treatment to define the angular orientation position of the best route first of the therapy means 12, in particular in the reference OX, OY and OZ. This can be done simply by entering these angular position coordinates θz, βy and θz with the position coordinates X, Y, Z in the control unit 22 of the therapy means 12, for example using an interface or a peripheral organ such as a keyboard.
On comprend que lorsque la lésion L présente une forme géométrique simple, par exemple sensiblement sphérique, comme cela est le cas de certaines tumeurs, il est seulement nécessaire d'uti¬ liser un élément marqueur MO avantageusement sensiblement placé au centre de la lésion L et dans ce cas l'étape C précitée est super¬ flue. Cependant, lorsque les lésions L présentent des formes géométriques complexes, alors il s'avère indispensable pour un traitement thérapeutique complet précis de la Lésion, d'implanter plusieurs éléments marqueurs, et de préférence au moins quatre, comme représenté, pour obtenir un repérage géométrique dans lequel on peut définir géométriquement le volume de La lésion. Dans ce cas. Les calculs étant complexes, il est préférable de réaliser l'étape C qui permet de calculer séparément et préalablement les coordonnées de position de la lésion à traiter dans Le repère des éléments marqueurs MO, M1, M2 et M3, ce qui permet le calcul des coordonnées de la Lésion L dans le repère OX, OY et OZ après repé¬ rage des éléments marqueurs par les moyens de repérage 30 ou 40.It is understood that when the lesion L has a simple geometric shape, for example substantially spherical, as is the case with certain tumors, it is only necessary to use a marker element MO advantageously substantially placed at the center of the lesion L and in this case the above-mentioned step C is superfluous. However, when the L lesions have complex geometric shapes, then it is essential for a complete, precise therapeutic treatment of the Lesion, to implant several marker elements, and preferably at least four, as shown, to obtain a geometric location. in which the volume of the lesion can be defined geometrically. In that case. Since the calculations are complex, it is preferable to carry out step C which makes it possible to calculate separately and beforehand the position coordinates of the lesion to be treated in the reference frame of the marker elements MO, M1, M2 and M3, which allows the calculation of the coordinates of the L lesion in the OX, OY and OZ coordinate system after identification of the marker elements by the identification means 30 or 40.
On comprend ainsi que l'invention permet de réaliser un traitement précis, efficace, sûr et reproductible, par des prati¬ ciens non spécialistes des techniques d'imagerie, ce qui est le cas du médecin traitant qui n'est évidemment pas un radiologue.It is thus understood that the invention makes it possible to carry out a precise, effective, safe and reproducible treatment, by practitioners who are not specialists in imaging techniques, which is the case for the attending physician who is obviously not a radiologist.
D'autre part, l'invention permet de manière déterminante, de réaliser un traitement entièrement automatisé qui est rendu possible grâce à la présence d'au moins un élément marqueur permettant d'offrir un contraste significatif pour permettre une détection automatique de cet élément marqueur par les moyens de repérage 30 ou 40, donc de la position de La Lésion permettant alors de positionner automatiquement les moyens de thérapie en regard de La Lésion et de traiter celle-ci, sans intervention par¬ ticulière du médecin traitant. IL est à noter que Les dessins annexés des figures 1 à 3 font partie intégrante de l'invention et donc de La présente description. L'invention couvre également tous les moyens qui appa¬ raissent être nouveaux vis-à-vis d'un état de la technique quel¬ conque. D'autre part, l'invention permet de réaliser Le traite¬ ment de toute Lésion qui peut être traitée par ondes acoustiques, comme c'est Le cas de toutes Les tumeurs bénignes ou malignes comme les cancers. Les applications particulièrement préférées sont actuellement les cancers primitifs et secondaires du foie, du pan- 5 créas. Le cancer de la prostate, le cancer du sein, le cancer de la vessie, du rein et en général de tous Les organes.On the other hand, the invention makes it possible, in a decisive manner, to carry out a fully automated processing which is made possible thanks to the presence of at least one marker element making it possible to offer significant contrast to allow automatic detection of this marker element by the means of marking 30 or 40, therefore of the position of La Lésion then making it possible to automatically position the therapy means opposite La Lésion and to treat it, without special intervention by the attending physician. It should be noted that the appended drawings of FIGS. 1 to 3 form an integral part of the invention and therefore of the present description. The invention also covers all the means which appear to be new vis-à-vis a prior art. On the other hand, the invention makes it possible to carry out the treatment of any lesion which can be treated by acoustic waves, as is the case with all benign or malignant tumors such as cancers. Particularly preferred applications are currently primary and secondary cancers of the liver, pancreas. Prostate cancer, breast cancer, cancer of the bladder, kidney and in general of all organs.
D'autre part. L'invention offre également l'avantage déterminant que même dans Le cas des organes qui se déplacent par exemple sous L'effet de la respiration, la présence d'éléments 0 marqueurs permet de suivre automatiquement le mouvement de L'organe, en assurant ainsi effectivement un traitement automatique de la lésion dans ledit organe mobile. L'invention permet aussi de réaliser un suivi de la cible même dans le cas du mouvement du dis¬ positif de thérapie par rapport à la cible, ce qui peut se produire 5 dans le cas d'un traitement ou le dispositif de thérapie serait simplement tenu à la main. L'invention permet ainsi d'envisager avantageusement des traitements manuels. Les dispositifs de détec¬ tion et αe suivi automatique de la cible sont connus à l'homme deOn the other hand. The invention also offers the determining advantage that even in the case of organs which move for example under the effect of respiration, the presence of 0 marker elements makes it possible to automatically follow the movement of the organ, thus ensuring effectively automatic treatment of the lesion in said mobile organ. The invention also makes it possible to carry out a monitoring of the target even in the case of the movement of the therapy device relative to the target, which can occur in the case of a treatment or the therapy device would simply be hand-held. The invention thus makes it possible to advantageously envisage manual treatments. Detection devices and automatic target tracking are known to humans from
1'art. 0 Enfin, l'invention permet également de réaliser un trai¬ tement de toutes lésions situées dans un organe mobile et non rêfé- rençable avec précision par rapport à une structure osseuse, et de préférence selon la meilleure voie d'abord, ce qui était très difficilement réalisable et encore moins de manière reproductibleArt. 0 Finally, the invention also makes it possible to carry out a treatment of all lesions located in a mobile and non-dreamable organ that can be renounced with precision with respect to a bone structure, and preferably according to the best approach, which was very difficult to achieve and even less reproducible
-*•--. dans le cadre des solutions antérieures. Les figures 1 à 6 annexées font partie intégrante de L'invention et donc de la description.- * • - -. in the context of previous solutions. Figures 1 to 6 attached form an integral part of the invention and therefore of the description.
En référence à la figure 4, on a représenté une variante de réalisation du dispositif de thérapie 12' sous forme d'un trans- ducteur piézoélectrique multi-éléments. Les transducteurs multi- éléments sont bien connus à l'homme de l'art. Ils peuvent être en réseaux de rangées qui peuvent être annulaires, ou en structure mosaïque comme cela est représenté à la figure 4 en étant composés d'une pluralité d'éléments T., T, à T . Le dispositif de thérapie 12' focalise le champ acoustique au point focal F qui est mis en coïncidence avec l'élément marqueur MO situé au centre de la Lésion L, par exemple une tume'ur bénigne ou maligne, située elle-même dans l'organe 0 qui peut être par exemple le foie, cet organe étant mobile par rapport à des structures osseuses du patient P (figure 1). Des structures biologiques BS peuvent être partielle¬ ment dans Le trajet des éléments transducteurs individuels tels que notamment T.. Par contre, par exemple, L'élément transducteur T., n'a pas d'obstacles formés par une structure biologique dans son trajet acoustique. Cette structure biologique peut, par exemple, être des os, ou un organe sensible tel que par exemple un poumon, comme représenté à la figure 4.Referring to Figure 4, there is shown an alternative embodiment of the therapy device 12 'in the form of a multi-element piezoelectric transducer. Multi-element transducers are well known to those skilled in the art. They can be in networks of rows which can be annular, or in mosaic structure as shown in Figure 4 by being composed of a plurality of elements T., T, to T. The therapy device 12 'focuses the acoustic field at the focal point F which is placed in coincidence with the marker element MO located in the center of the lesion L, for example a tume ' ur benign or malignant, itself located in the organ 0 which can be, for example, the liver, this organ being movable relative to the bony structures of patient P (FIG. 1). Biological structures BS can be partially in the path of the individual transducer elements such as in particular T .. On the other hand, for example, the transducer element T., has no obstacles formed by a biological structure in its path acoustic. This biological structure can, for example, be bones, or a sensitive organ such as for example a lung, as shown in FIG. 4.
Dans ce cas, L'invention permet d'optimiser le champ acoustique du dispositif de thérapie 12' de telle sorte que les interactions entre le champ acoustique du dispositif de thérapie et les structures biologiques qui lui font obstacle soient pratique¬ ment inexistantes. Selon l'invention, on fait fonctionner dans un premier temps chacun des éléments transducteurs tels que T.. , T-, à T en mode échographie, c'est-à-dire d'une manière identique au fonctionnement des sondes d'imagerie échographique. Chaque élément tel que T., T-, envoie une impulsion acous¬ tique et détecte par un circuit électronique les échos acoustiques réfléchis par les structures biologiques. Ce circuit électroniqueIn this case, the invention makes it possible to optimize the acoustic field of the therapy device 12 ′ so that the interactions between the acoustic field of the therapy device and the biological structures which obstruct it are practically nonexistent. According to the invention, each of the transducer elements such as T .., T-, at T is operated initially in ultrasound mode, that is to say in a manner identical to the operation of the imaging probes. ultrasound. Each element such as T., T-, sends an acoustic pulse and detects by an electronic circuit the acoustic echoes reflected by the biological structures. This electronic circuit
FEUILLE DE REMPLACEMENT étant en tout point identique à ceux utilisés en imagerie écho¬ graphique. A partir de ces signaux, il est possible de reconstruire des images des structures biologiques BS traversées par le champ acoustique du dispositif de thérapie 12' et en particulier déter- miner αuels sont les éléments transducteurs tslε ""uε T dont le siqnal traverse la structure biologique BS.REPLACEMENT SHEET being identical in all respects to those used in ultrasound imaging. From these signals, it is possible to reconstruct images of the biological structures BS crossed by the acoustic field of the therapy device 12 ′ and in particular to determine which transducer elements are tslε "" uε T whose siqnal crosses the structure organic BS.
Comme il est représenté aux figures 5 et 6, il est possible d'utiliser directement le signal électrique de l'écho de retour linéaire, ou en mode A avant son utilisation pour la forma¬ tion d'images. De ce fait, on peut, par exemple, donner la consigne que tout signal d'écho ou d'amplitude supérieure à un seuil déter¬ miné représenté aux figures 5 et 6 par la ligne en pointillé, et apparaissant avant le délai T correspondant à un signal d'écho en provenance du point focal et résultant de la présence de l'élément marqueur MO (signal référencé SMO) , est détecté comme un écho émis par une structure biologique très réfléchissante et donc pouvant faire obstacle au champ ultrasonore comme par exemple une interface tissu/air ou tissu/os est représenté à la figure 6 par le signal de structure biologique en abrégé SBS apparaissant à l'instant t bien inférieur à l'instant T du signal d'écho normal de l'élément marqueur au point focal.As shown in FIGS. 5 and 6, it is possible to use the electrical signal of the linear return echo directly, or in mode A before it is used for image formation. Therefore, it is possible, for example, to give the instruction that any echo signal or amplitude greater than a determined threshold represented in FIGS. 5 and 6 by the dotted line, and appearing before the delay T corresponding to an echo signal coming from the focal point and resulting from the presence of the marker element MO (signal referenced SMO), is detected as an echo emitted by a highly reflective biological structure and therefore capable of obstructing the ultrasonic field, for example a tissue / air or tissue / bone interface is represented in FIG. 6 by the biological structure signal in abbreviation SBS appearing at the instant t much lower than the instant T of the normal echo signal of the marker element at the point focal.
Ainsi, on peut déterminer quels sont les éléments trans¬ ducteurs individuels tels que T. qui ont sur leur trajet acoustique un obstacle à préserver. Il est ainsi possible de faire intégrer par la centrale de commande 22 les données relatives aux éléments transducteurs tels que T. à ne pas activer pendant la thérapie pour éviter de détruire les structures biologiques identifiées afin d'optimiser parfaitement le champ acoustique ultrasonore vis-à-vis des obstacles biologiques. On comprend que l'invention permet de le faire de manière automatique et parfaitement fiable puisque l'agent de détection (onde acoustique) des obstacles BS est le même que celui utilisé pour réaliser la thérapie.Thus, it is possible to determine which are the individual transducing elements such as T. which have on their acoustic path an obstacle to be preserved. It is thus possible to have the control unit 22 integrate the data relating to the transducer elements such as T. not to be activated during therapy to avoid destroying the identified biological structures in order to perfectly optimize the ultrasonic acoustic field vis-à-vis -vis biological obstacles. It is understood that the invention makes it possible to do it automatically and perfectly reliable since the agent for detecting (acoustic wave) obstacles BS is the same as that used to carry out the therapy.
Par ailleurs, l'invention couvre toute caractéristique résultant de La description, incorporant Les dessins, qui apparaît être nouvelle vis-à-vis d'un état de La technique quelconque. Furthermore, the invention covers any characteristic resulting from the description, incorporating the drawings, which appears to be new vis-à-vis any prior art.

Claims

REVENDICATIONS
1. Appareil de thérapie (10) d'une lésion (L) à traiter, située dans un milieu environnant tel qu'un organe (0), en particu- lier à l'intérieur du corps d'un mammifère, tel qu'un animal ou un être humain, du type comprenant des moyens (12) de thérapie de ladite lésion (L), des moyens de repérage (30 ou 40) de Ladite lésion (L), lesdits moyens de repérage (30 ou 40) étant liés, par exemple mécaniquement (34, 36) ou lectroniquement, aux moyens de thérapie (12) ; une centrale de commande (22) c-_πp?enaπt des moyens de calcul de la position de la lésion relativement aux moyens de thérapie à l'aide des moyens de repérage (30 ou 40) ; et des moyens d'activation (22,60), des moyens de thérapie (12) pour réaliser ladite thérapie après acqui¬ sition des coordonnées de position de ladite lésion (L) , caracté- risé en ce que lesdits moyens de repérage (30 ou 40) réalisent le repérage d'au moins un élément marqueur (MO, M1, M2, M3), réalisé en un matériau repérable par lesdits moyens de repérage (30 ou 40), préalablement implanté à l'intérieur de ladite lésion (L), ou à son voisinage ou à l'intérieur de l'organe (0) dans lequel se trouve ladite lésion, ledit organe (0) étant éventuellement susceptible de déplacement ; lesdits moyens de calcul (22, 70) calculent les coor¬ données de position dudit élément marqueur (MO, M1, M2, M3) par rapport aux moyens de thérapie (12) qui sont utilisées pour posi¬ tionner les moyens de thérapie (12) prévus deplaçables dans l'espace dans une position quelconque selon Les axes X, Y, Z (par les moyens 20) pour que, lors de l'activation des moyens d'activa¬ tion (22, 60) des moyens de thérapie (12), une thérapie précise de Ladite lésion (L) soit réalisée.1. Therapy device (10) for a lesion (L) to be treated, situated in a surrounding medium such as an organ (0), in particular inside the body of a mammal, such as an animal or a human being, of the type comprising means (12) for therapy of said lesion (L), means for locating (30 or 40) said lesion (L), said means for locating (30 or 40) being linked, for example mechanically (34, 36) or electronically, to the therapy means (12); a control unit (22) c-_πp? enaπt means for calculating the position of the lesion relative to the therapy means using the locating means (30 or 40); and activation means (22,60), therapy means (12) for carrying out said therapy after acquisition of the position coordinates of said lesion (L), characterized in that said locating means (30 or 40) mark at least one marker element (MO, M1, M2, M3), made of a material which can be identified by said marking means (30 or 40), previously implanted inside said lesion (L ), or in the vicinity of or inside the organ (0) in which said lesion is located, said organ (0) possibly being capable of displacement; said calculation means (22, 70) calculate the position coordinates of said marker element (MO, M1, M2, M3) relative to the therapy means (12) which are used to position the therapy means (12 ) provided movable in space in any position along the axes X, Y, Z (by means 20 ) so that, upon activation of the activation means (22, 60) of the therapy means ( 12), precise therapy of said lesion (L) is carried out.
2. Appareil selon la revendication 1, caractérisé en ce que l'élément marqueur précité (MO) est implanté préalablement sen¬ siblement au centre de La lésion à traiter (L) .2. Apparatus according to claim 1, characterized in that the aforementioned marker element (MO) is implanted beforehand sensibly in the center of the lesion to be treated (L).
3. Appareil selon la revendication 1 ou 2, caractérisé en ce que plusieurs éléments marqueurs (MO, M1, M2, M3) sont préala¬ blement implantés dans la Lésion (L) à traiter de manière à marquer sensiblement la totalité ou La majeure partie du volume de la lésion à traiter. 3. Apparatus according to claim 1 or 2, characterized in that several marking elements (MO, M1, M2, M3) are previously implanted in the lesion (L) to be treated so as to mark substantially all or most the volume of the lesion to be treated.
4. Appareil selon l'une des revendications 1 à 3, carac¬ térisé en ce qu'il comprend au moins quatre éléments marqueurs (MO, M1, M2, M3) qui sont préalablement implantés dans la lésion (L) à traiter, de manière à former un repère cartésien à l'intérieur de La lésion (L) à traiter ou de L'organe (0) contenant Ladite4. Apparatus according to one of claims 1 to 3, charac¬ terized in that it comprises at least four marker elements (MO, M1, M2, M3) which are previously implanted in the lesion (L) to be treated, so as to form a Cartesian coordinate system inside the lesion (L) to be treated or the Organ (0) containing the said
Lésion ; de préférence, l'un (MO) desdits quatre éléments marqueurs est implanté sensiblement au centre de la Lésion à traiter, les trois autres éléments marqueurs (M1, M2, M3) étant implantés de telle façon que l'ensemble des quatre éléments marqueurs ne soit pas situé dans le même plan.Lesion; preferably, one ( MO ) of said four marker elements is implanted substantially at the center of the lesion to be treated, the other three marker elements ( M1, M2, M3) being implanted in such a way that all of the four marker elements do not is not located in the same plane.
5. Appareil selon l'une des revendications 1 à 4, carac¬ térisé en ce que L'élément marqueur précité (MO, M1, M2, M3) est réalisé en un matériau biocompatible, de préférence en un matériau ne perturbant pas le processus thérapeutique ni Le processus diagnostique, en particulier ne perturbant pas des ondes acous¬ tiques avantageusement focalisées utilisées pour La thérapie.5. Apparatus according to one of claims 1 to 4, charac¬ terized in that the aforementioned marker element (MO, M1, M2, M3) is made of a biocompatible material, preferably a material which does not disturb the process therapeutic The diagnostic process, in particular not disturbing advantageously focused acoustic waves used for therapy.
6. Appareil selon l'une des revendications 1 à 5, carac¬ térisé en ce que Le matériau de L'élément marqueur (MO, M1, M2, M3) ne perturbe pas des ondes acoustiques ultrasonores focalisées ou des ondes de choc acoustiques focalisées émises par Les moyens de thérapie (12).6. Apparatus according to one of claims 1 to 5, charac¬ terized in that the material of the marker element (MO, M1, M2, M3) does not disturb focused ultrasonic acoustic waves or focused acoustic shock waves emitted by Therapy means (12).
7. Appareil selon La revendication 6, caractérisé en ce que dans Le cas d'une thérapie par ondes acoustiques ultrasonores focalisées émises par Les moyens de thérapie (12), La dimension de L'élément marqueur (MO, M1, M2, M3) ne dépasse pas Le quart de La7. Apparatus according to claim 6, characterized in that in the case of therapy by focused ultrasonic acoustic waves emitted by the therapy means (12), the dimension of the marker element (MO, M1, M2, M3) does not exceed a quarter of a
Longueur d'onde ultrasonore utilisée.Ultrasonic wavelength used.
8. Appareil selon L'une des revendications 1 à 7, carac¬ térisé en ce que La dimension de L'élément marqueur (MO, M1, M2, M3) est inférieure à environ 2 mm, encore mieux inférieure à 1 mm et idéalement inférieure à environ 500 μm, en particulier l'élément marqueur est sous forme d'une bille ou d'un anneau.8. Apparatus according to one of claims 1 to 7, charac¬ terized in that the dimension of the marker element (MO, M1, M2, M3) is less than about 2 mm, even better less than 1 mm and ideally less than about 500 μm, in particular the marker element is in the form of a ball or a ring.
9. Appareil selon L'une des revendications 1 à 7, carac¬ térisé en ce que L'élément marqueur (MO, M1, M2, M3) précité est réalisé en un matériau choisi parmi Le groupe consistant d'un métal biocompatible, de préférence un métal noble tel qu'or, titane ou platine ; d'un agent de contraste au moins visible par lesdits moyens de repérage (30 ou 40) Liés aux moyens de thérapie (12), et en particulier par rayons X et/ou ultrasons, des microbulles d'air ; un produit radioactif par exemple du type technétium ; un matériau magnétique ; un maté.iau émetteur d'ondes acoustiques ou électromagnétiques.9. Apparatus according to one of claims 1 to 7, charac¬ terized in that the marker element (MO, M1, M2, M3) above is made of a material chosen from the group consisting of a biocompatible metal, preferably a noble metal such as gold, titanium or platinum; of a contrast agent at least visible by said locating means (30 or 40 ) Linked to the therapy means (12), and in particular by X-rays and / or ultrasound, air microbubbles; a radioactive product, for example of the technetium type; a magnetic material; a material emitting acoustic or electromagnetic waves.
10. Appareil selon l'une des revendications précédentes, caractérisé en ce que les moyens de thérapie (12) sont des moyens de thérapie comprenant au moins un dispositif transducteur ultra- sonique focalisé (14), par exemple sous forme de coupelle sphé- rique ; ou un dispositif générateur d'ondes de choc acoustiques focalisées, par exemple par voie électrohydraulique.10. Apparatus according to one of the preceding claims, characterized in that the therapy means (12) are therapy means comprising at least one focused ultrasonic transducer device (14), for example in the form of a spherical cup. ; or a device for generating focused acoustic shock waves, for example by electro-hydraulic means.
11. Appareil selon l'une des revendications précédentes, caractérisé en ce que les moyens de repérage comprennent un dispo- sitif d'échographie (32) et/ou un dispositif de radiologie par rayons X (42) ou un détecteur de rayonnement ionisant tel que γ- caméra, un détecteur d'ondes électromagnétiques ou d'ondes acous¬ tiques.11. Apparatus according to one of the preceding claims, characterized in that the locating means comprise an ultrasound device (32) and / or an X-ray radiology device (42) or an ionizing radiation detector such as γ- camera, a detector of electromagnetic waves or acoustic waves.
12. Appareil selon l'une des revendications précédentes, caractérisé en ce qu'il s'agit d'un appareil de thérapie de toutes les lésions pouvant être traitées par ondes acoustiques, comme les tumeurs bénignes ou malignes comme les cancers, en particulier les cancers primitifs et secondaires du foie, du pancréas, le cancer de la prostate, le cancer du sein, le cancer de la vessie, du rein et en général de tous les organes, ces organes pouvant éventuellement être deplaçables, par exemple sous l'effet de la respiration.12. Apparatus according to one of the preceding claims, characterized in that it is an apparatus for therapy of all lesions which can be treated by acoustic waves, such as benign or malignant tumors such as cancers, in particular primary and secondary cancers of the liver, pancreas, prostate cancer, breast cancer, cancer of the bladder, kidney and in general of all the organs, these organs possibly being able to be moved, for example under the effect of breathing.
13. Appareil selon l'une quelconque des revendications précédentes, caractérisé en ce que les moyens d'activation pré¬ cités (22, 60) comprennent une centrale de commande (22) permettant par les moyens de repérage (30, 40 et 18) de détecter auto¬ matiquement les éléments marqueurs (MO, Ml, M2, M3) et ainsi la lésion à traiter. 13. Apparatus according to any one of the preceding claims, characterized in that the aforementioned activation means (22, 60) include a control unit (22) allowing by the locating means (30, 40 and 18) to automatically detect the marker elements (MO, Ml, M2, M3) and thus the lesion to be treated.
14. Appareil selon l'une quelconque des revendications précédentes, caractérisé en ce que les moyens d'activatioπ précités (22, 60) comprennent une centrale de commande (22) permettant par les moyens de repérage .'30, 40 et 18) repérant les élé¬ ments marqueurs (MO, Ml, M2, M3) , de suivre automatiquement les mouvements de L'organe contenant La Lésion (L), en assurant ainsi effectivement un traitement automatique de La Lésion dans Ledit organe même s'il est mobile. 14. Apparatus according to any one of the preceding claims, characterized in that the aforementioned activatioπ means (22, 60) comprise a control unit (22) allowing by the locating means .'30, 40 and 18) locating the ele ments ¬ markers (MO, Ml, M2, M3), to automatically track the movements of the body containing the lesion (L), thereby effectively providing automatic treatment of the lesion in said same member if mobile .
15. Appareil selon l'une quelconque des revendications précédentes, caractérisé en ce qu'il comprend des moyens d'imagerie fine, en particulier par imagerie scanner, par résonance magnétique dite IRM, permettant de procéder avant l'opération à une Localisa¬ tion spatiale de la zone cible par rapport au marqueur, Les moyens de calculs précités permettant de déterminer les coordonnées de position de la lésion par rapport au système de coordonnées défini par les éléments marqueurs (MO, M1, M2, M3).15. Apparatus according to any one of the preceding claims, characterized in that it comprises means of fine imaging, in particular by scanner imaging, by magnetic resonance called MRI, making it possible to carry out a localization before the operation. spatial of the target area with respect to the marker, The abovementioned calculation means making it possible to determine the position coordinates of the lesion with respect to the coordinate system defined by the marker elements (MO, M1, M2, M3).
16. Appareil selon l'une quelconque des revendications précédentes, caractérisé en ce que les moyens de repérage (30 ou 40) permettent de réaliser plusieurs plans de coupe successifs selon des orientations angulaires différentes, contenant au moins un élément marqueur précité, pour déterminer un ensemble de données comprenant les coordonnées de position de la lésion x, y, z et une direction d'orientation angulaire &x, θy, θz selon la meilleure voie d'abord.16. Apparatus according to any one of the preceding claims, characterized in that the locating means (30 or 40) make it possible to produce several successive cutting planes according to different angular orientations, containing at least one aforementioned marker element, to determine a data set including the position coordinates of the lesion x, y, z and an angular orientation direction & x, θy, θz according to the best approach.
17. Appareil selon l'une quelconque des revendications précédentes, caractérisé en ce que le dispositif de thérapie com¬ prend une pluralité d'éléments transducteurs T. , T„ à T par exemple disposés en mosaïque, et la centrale de commande (22) pré¬ citée n'active pas les éléments transducteurs tels que T. dont le trajet ultrasonore traverse des structures biologiques BS (figure 4) . 17. Apparatus according to any one of the preceding claims, characterized in that the therapy device includes a plurality of transducer elements T., T „to T for example arranged in mosaic, and the control unit (22) cited above does not activate the transducer elements such as T. whose ultrasonic path crosses BS biological structures (Figure 4).
PCT/FR1993/000081 1992-01-28 1993-01-27 Apparatus for treating a target such as a lesion with a tracer element WO1993014712A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR9200884A FR2686499A1 (en) 1992-01-28 1992-01-28 APPARATUS FOR TREATING A TARGET, SUCH AS A DAMAGE WITHIN THE BODY OF A MAMMAL, PARTICULARLY A HUMAN BEING, USING A MARKING ELEMENT IMPLANTED IN OR IN THE VICINITY OF THE TARGET TO CONTROL THERAPY OF THE SAME TARGET.
FR92/00884 1992-01-28

Publications (1)

Publication Number Publication Date
WO1993014712A1 true WO1993014712A1 (en) 1993-08-05

Family

ID=9426042

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/FR1993/000081 WO1993014712A1 (en) 1992-01-28 1993-01-27 Apparatus for treating a target such as a lesion with a tracer element

Country Status (2)

Country Link
FR (1) FR2686499A1 (en)
WO (1) WO1993014712A1 (en)

Cited By (39)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1998038919A2 (en) * 1997-03-04 1998-09-11 Biotrack, Inc. Medical sensing and imaging system
US6161034A (en) * 1999-02-02 2000-12-12 Senorx, Inc. Methods and chemical preparations for time-limited marking of biopsy sites
US6662041B2 (en) 1999-02-02 2003-12-09 Senorx, Inc. Imageable biopsy site marker
US6725083B1 (en) 1999-02-02 2004-04-20 Senorx, Inc. Tissue site markers for in VIVO imaging
US6731966B1 (en) 1997-03-04 2004-05-04 Zachary S. Spigelman Systems and methods for targeting a lesion
US6862470B2 (en) 1999-02-02 2005-03-01 Senorx, Inc. Cavity-filling biopsy site markers
US7787936B2 (en) 2004-01-23 2010-08-31 Traxyz Medical, Inc. Methods and apparatus for performing procedures on target locations in the body
US7983734B2 (en) 2003-05-23 2011-07-19 Senorx, Inc. Fibrous marker and intracorporeal delivery thereof
US7981051B2 (en) 2005-08-05 2011-07-19 Senorx, Inc. Biopsy device with fluid delivery to tissue specimens
US8157862B2 (en) 1997-10-10 2012-04-17 Senorx, Inc. Tissue marking implant
US8311610B2 (en) 2008-01-31 2012-11-13 C. R. Bard, Inc. Biopsy tissue marker
US8343071B2 (en) 2004-12-16 2013-01-01 Senorx, Inc. Biopsy device with aperture orientation and improved tip
US8361082B2 (en) 1999-02-02 2013-01-29 Senorx, Inc. Marker delivery device with releasable plug
US8401622B2 (en) 2006-12-18 2013-03-19 C. R. Bard, Inc. Biopsy marker with in situ-generated imaging properties
US8437834B2 (en) 2006-10-23 2013-05-07 C. R. Bard, Inc. Breast marker
US8447386B2 (en) 2003-05-23 2013-05-21 Senorx, Inc. Marker or filler forming fluid
US8486028B2 (en) 2005-10-07 2013-07-16 Bard Peripheral Vascular, Inc. Tissue marking apparatus having drug-eluting tissue marker
US8498693B2 (en) 1999-02-02 2013-07-30 Senorx, Inc. Intracorporeal marker and marker delivery device
US8579931B2 (en) 1999-06-17 2013-11-12 Bard Peripheral Vascular, Inc. Apparatus for the percutaneous marking of a lesion
US8634899B2 (en) 2003-11-17 2014-01-21 Bard Peripheral Vascular, Inc. Multi mode imaging marker
US8668737B2 (en) 1997-10-10 2014-03-11 Senorx, Inc. Tissue marking implant
US8670818B2 (en) 2008-12-30 2014-03-11 C. R. Bard, Inc. Marker delivery device for tissue marker placement
US8718745B2 (en) 2000-11-20 2014-05-06 Senorx, Inc. Tissue site markers for in vivo imaging
US8784433B2 (en) 2002-06-17 2014-07-22 Senorx, Inc. Plugged tip delivery tube for marker placement
USD715442S1 (en) 2013-09-24 2014-10-14 C. R. Bard, Inc. Tissue marker for intracorporeal site identification
USD715942S1 (en) 2013-09-24 2014-10-21 C. R. Bard, Inc. Tissue marker for intracorporeal site identification
USD716451S1 (en) 2013-09-24 2014-10-28 C. R. Bard, Inc. Tissue marker for intracorporeal site identification
USD716450S1 (en) 2013-09-24 2014-10-28 C. R. Bard, Inc. Tissue marker for intracorporeal site identification
US8915864B2 (en) 2005-08-05 2014-12-23 Senorx, Inc. Biopsy device with fluid delivery to tissue specimens
US9095325B2 (en) 2005-05-23 2015-08-04 Senorx, Inc. Tissue cutting member for a biopsy device
US9149341B2 (en) 1999-02-02 2015-10-06 Senorx, Inc Deployment of polysaccharide markers for treating a site within a patient
US9327061B2 (en) 2008-09-23 2016-05-03 Senorx, Inc. Porous bioabsorbable implant
US9408592B2 (en) 2003-12-23 2016-08-09 Senorx, Inc. Biopsy device with aperture orientation and improved tip
US9579077B2 (en) 2006-12-12 2017-02-28 C.R. Bard, Inc. Multiple imaging mode tissue marker
US9820824B2 (en) 1999-02-02 2017-11-21 Senorx, Inc. Deployment of polysaccharide markers for treating a site within a patent
US9848956B2 (en) 2002-11-18 2017-12-26 Bard Peripheral Vascular, Inc. Self-contained, self-piercing, side-expelling marking apparatus
US10010380B2 (en) 1998-06-22 2018-07-03 Devicor Medical Products, Inc. Biopsy localization method and device
US10342635B2 (en) 2005-04-20 2019-07-09 Bard Peripheral Vascular, Inc. Marking device with retractable cannula
US11872413B2 (en) 2017-06-19 2024-01-16 Assistance Publique Hopitaux De Paris Control method for the treatment of brain tissue using an ultrasonic probe and an implanted acoustic window on the cranium

Families Citing this family (20)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5411026A (en) * 1993-10-08 1995-05-02 Nomos Corporation Method and apparatus for lesion position verification
US6175760B1 (en) 1998-02-17 2001-01-16 University Of Iowa Research Foundation Lesion localizer for nuclear medicine
WO2002039917A1 (en) 1998-05-14 2002-05-23 Calypso Medical, Inc. Systems and methods for locating and defining a target location within a human body
US20020193685A1 (en) 2001-06-08 2002-12-19 Calypso Medical, Inc. Guided Radiation Therapy System
US9682253B2 (en) 2002-06-05 2017-06-20 Varian Medical Systems, Inc. Integrated radiation therapy systems and methods for treating a target in a patient
US9248003B2 (en) 2002-12-30 2016-02-02 Varian Medical Systems, Inc. Receiver used in marker localization sensing system and tunable to marker frequency
US7912529B2 (en) 2002-12-30 2011-03-22 Calypso Medical Technologies, Inc. Panel-type sensor/source array assembly
US7926491B2 (en) 2002-12-31 2011-04-19 Calypso Medical Technologies, Inc. Method and apparatus for sensing field strength signals to estimate location of a wireless implantable marker
US7684849B2 (en) 2003-12-31 2010-03-23 Calypso Medical Technologies, Inc. Marker localization sensing system synchronized with radiation source
US9623208B2 (en) 2004-01-12 2017-04-18 Varian Medical Systems, Inc. Instruments with location markers and methods for tracking instruments through anatomical passageways
US9586059B2 (en) 2004-07-23 2017-03-07 Varian Medical Systems, Inc. User interface for guided radiation therapy
US8437449B2 (en) 2004-07-23 2013-05-07 Varian Medical Systems, Inc. Dynamic/adaptive treatment planning for radiation therapy
WO2006023055A2 (en) 2004-07-23 2006-03-02 Calypso Medical Technologies, Inc. Systems and methods for real time tracking of targets in radiation therapy and other medical applications
US7899513B2 (en) 2004-07-23 2011-03-01 Calypso Medical Technologies, Inc. Modular software system for guided radiation therapy
US8095203B2 (en) 2004-07-23 2012-01-10 Varian Medical Systems, Inc. Data processing for real-time tracking of a target in radiation therapy
WO2006016368A2 (en) 2004-08-12 2006-02-16 Navotek Medical Ltd. Localization of a radioactive source within a body of a subject
ATE499055T1 (en) * 2007-12-18 2011-03-15 Storz Medical Ag NAVIGATION WITH FOCUSED PRESSURE WAVE TREATMENT
WO2009149409A1 (en) 2008-06-05 2009-12-10 Calypso Medical Technologies, Inc. Motion compensation for medical imaging and associated systems and methods
US10043284B2 (en) 2014-05-07 2018-08-07 Varian Medical Systems, Inc. Systems and methods for real-time tumor tracking
US9919165B2 (en) 2014-05-07 2018-03-20 Varian Medical Systems, Inc. Systems and methods for fiducial to plan association

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3919592A1 (en) * 1988-08-19 1990-02-22 Olympus Optical Co ULTRASONIC TREATMENT SYSTEM
DE3902249A1 (en) * 1989-01-26 1990-08-02 Bodenseewerk Geraetetech Method of fixing the position of predetermined sites in the human body
EP0382392A1 (en) * 1989-02-06 1990-08-16 C.R. Bard, Inc. Ultrasound targeting system for shockwave lithotripsy
DE3940260A1 (en) * 1989-03-04 1990-09-13 Werner Weitschies Position determining appts. for objects or body constituents - introduces ferromagnetic substances to enable location of objects due to their magnetic field using field sensors
EP0429148A1 (en) * 1989-11-15 1991-05-29 George S. Allen Method and apparatus for imaging the anatomy
EP0444680A1 (en) * 1990-02-28 1991-09-04 Kabushiki Kaisha Toshiba Apparatus for performing medical treatment by using electroacoustic transducer element

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE3919592A1 (en) * 1988-08-19 1990-02-22 Olympus Optical Co ULTRASONIC TREATMENT SYSTEM
DE3902249A1 (en) * 1989-01-26 1990-08-02 Bodenseewerk Geraetetech Method of fixing the position of predetermined sites in the human body
EP0382392A1 (en) * 1989-02-06 1990-08-16 C.R. Bard, Inc. Ultrasound targeting system for shockwave lithotripsy
DE3940260A1 (en) * 1989-03-04 1990-09-13 Werner Weitschies Position determining appts. for objects or body constituents - introduces ferromagnetic substances to enable location of objects due to their magnetic field using field sensors
EP0429148A1 (en) * 1989-11-15 1991-05-29 George S. Allen Method and apparatus for imaging the anatomy
EP0444680A1 (en) * 1990-02-28 1991-09-04 Kabushiki Kaisha Toshiba Apparatus for performing medical treatment by using electroacoustic transducer element

Cited By (82)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6731966B1 (en) 1997-03-04 2004-05-04 Zachary S. Spigelman Systems and methods for targeting a lesion
WO1998038919A3 (en) * 1997-03-04 1998-12-30 Biotrack Inc Medical sensing and imaging system
US6119033A (en) * 1997-03-04 2000-09-12 Biotrack, Inc. Method of monitoring a location of an area of interest within a patient during a medical procedure
WO1998038919A2 (en) * 1997-03-04 1998-09-11 Biotrack, Inc. Medical sensing and imaging system
US9039763B2 (en) 1997-10-10 2015-05-26 Senorx, Inc. Tissue marking implant
US8668737B2 (en) 1997-10-10 2014-03-11 Senorx, Inc. Tissue marking implant
US8157862B2 (en) 1997-10-10 2012-04-17 Senorx, Inc. Tissue marking implant
US10010380B2 (en) 1998-06-22 2018-07-03 Devicor Medical Products, Inc. Biopsy localization method and device
US6996433B2 (en) 1999-02-02 2006-02-07 Senorx, Inc. Imageable biopsy site marker
US8498693B2 (en) 1999-02-02 2013-07-30 Senorx, Inc. Intracorporeal marker and marker delivery device
US6993375B2 (en) 1999-02-02 2006-01-31 Senorx, Inc. Tissue site markers for in vivo imaging
US9149341B2 (en) 1999-02-02 2015-10-06 Senorx, Inc Deployment of polysaccharide markers for treating a site within a patient
US7047063B2 (en) 1999-02-02 2006-05-16 Senorx, Inc. Tissue site markers for in vivo imaging
US7565191B2 (en) 1999-02-02 2009-07-21 Senorx, Inc. Tissue site markers for in vivo imaging
US9044162B2 (en) 1999-02-02 2015-06-02 Senorx, Inc. Marker delivery device with releasable plug
US9237937B2 (en) 1999-02-02 2016-01-19 Senorx, Inc. Cavity-filling biopsy site markers
US6161034A (en) * 1999-02-02 2000-12-12 Senorx, Inc. Methods and chemical preparations for time-limited marking of biopsy sites
US6725083B1 (en) 1999-02-02 2004-04-20 Senorx, Inc. Tissue site markers for in VIVO imaging
US8219182B2 (en) 1999-02-02 2012-07-10 Senorx, Inc. Cavity-filling biopsy site markers
US8965486B2 (en) 1999-02-02 2015-02-24 Senorx, Inc. Cavity filling biopsy site markers
US10172674B2 (en) 1999-02-02 2019-01-08 Senorx, Inc. Intracorporeal marker and marker delivery device
US6662041B2 (en) 1999-02-02 2003-12-09 Senorx, Inc. Imageable biopsy site marker
US8361082B2 (en) 1999-02-02 2013-01-29 Senorx, Inc. Marker delivery device with releasable plug
US9649093B2 (en) 1999-02-02 2017-05-16 Senorx, Inc. Cavity-filling biopsy site markers
US6567689B2 (en) 1999-02-02 2003-05-20 Senorx, Inc. Methods and chemical preparations for time-limited marking of biopsy sites
US9820824B2 (en) 1999-02-02 2017-11-21 Senorx, Inc. Deployment of polysaccharide markers for treating a site within a patent
US9861294B2 (en) 1999-02-02 2018-01-09 Senorx, Inc. Marker delivery device with releasable plug
US6862470B2 (en) 1999-02-02 2005-03-01 Senorx, Inc. Cavity-filling biopsy site markers
US6427081B1 (en) 1999-02-02 2002-07-30 Senorx, Inc. Methods and chemical preparations for time-limited marking of biopsy sites
US8626270B2 (en) 1999-02-02 2014-01-07 Senorx, Inc. Cavity-filling biopsy site markers
US9579159B2 (en) 1999-06-17 2017-02-28 Bard Peripheral Vascular, Inc. Apparatus for the percutaneous marking of a lesion
US8579931B2 (en) 1999-06-17 2013-11-12 Bard Peripheral Vascular, Inc. Apparatus for the percutaneous marking of a lesion
US8718745B2 (en) 2000-11-20 2014-05-06 Senorx, Inc. Tissue site markers for in vivo imaging
US8784433B2 (en) 2002-06-17 2014-07-22 Senorx, Inc. Plugged tip delivery tube for marker placement
US10813716B2 (en) 2002-11-18 2020-10-27 Bard Peripheral Vascular, Inc. Self-contained, self-piercing, side-expelling marking apparatus
US9848956B2 (en) 2002-11-18 2017-12-26 Bard Peripheral Vascular, Inc. Self-contained, self-piercing, side-expelling marking apparatus
US9801688B2 (en) 2003-05-23 2017-10-31 Senorx, Inc. Fibrous marker and intracorporeal delivery thereof
US8447386B2 (en) 2003-05-23 2013-05-21 Senorx, Inc. Marker or filler forming fluid
US8626269B2 (en) 2003-05-23 2014-01-07 Senorx, Inc. Fibrous marker and intracorporeal delivery thereof
US10045832B2 (en) 2003-05-23 2018-08-14 Senorx, Inc. Marker or filler forming fluid
US8639315B2 (en) 2003-05-23 2014-01-28 Senorx, Inc. Marker or filler forming fluid
US8880154B2 (en) 2003-05-23 2014-11-04 Senorx, Inc. Fibrous marker and intracorporeal delivery thereof
US10299881B2 (en) 2003-05-23 2019-05-28 Senorx, Inc. Marker or filler forming fluid
US7983734B2 (en) 2003-05-23 2011-07-19 Senorx, Inc. Fibrous marker and intracorporeal delivery thereof
US8634899B2 (en) 2003-11-17 2014-01-21 Bard Peripheral Vascular, Inc. Multi mode imaging marker
US9408592B2 (en) 2003-12-23 2016-08-09 Senorx, Inc. Biopsy device with aperture orientation and improved tip
US7787936B2 (en) 2004-01-23 2010-08-31 Traxyz Medical, Inc. Methods and apparatus for performing procedures on target locations in the body
US8360990B2 (en) 2004-12-16 2013-01-29 Senorx, Inc. Biopsy device with aperture orientation and improved tip
US10105125B2 (en) 2004-12-16 2018-10-23 Senorx, Inc. Biopsy device with aperture orientation and improved tip
US11246574B2 (en) 2004-12-16 2022-02-15 Senorx, Inc. Biopsy device with aperture orientation and improved tip
US8343071B2 (en) 2004-12-16 2013-01-01 Senorx, Inc. Biopsy device with aperture orientation and improved tip
US10357328B2 (en) 2005-04-20 2019-07-23 Bard Peripheral Vascular, Inc. and Bard Shannon Limited Marking device with retractable cannula
US10342635B2 (en) 2005-04-20 2019-07-09 Bard Peripheral Vascular, Inc. Marking device with retractable cannula
US11278370B2 (en) 2005-04-20 2022-03-22 Bard Peripheral Vascular, Inc. Marking device with retractable cannula
US10478161B2 (en) 2005-05-23 2019-11-19 Senorx, Inc. Tissue cutting member for a biopsy device
US9095325B2 (en) 2005-05-23 2015-08-04 Senorx, Inc. Tissue cutting member for a biopsy device
US11426149B2 (en) 2005-05-23 2022-08-30 SenoRx., Inc. Tissue cutting member for a biopsy device
US9750487B2 (en) 2005-05-23 2017-09-05 Senorx, Inc. Tissue cutting member for a biopsy device
US7981051B2 (en) 2005-08-05 2011-07-19 Senorx, Inc. Biopsy device with fluid delivery to tissue specimens
US10064609B2 (en) 2005-08-05 2018-09-04 Senorx, Inc. Method of collecting one or more tissue specimens
US10874381B2 (en) 2005-08-05 2020-12-29 Senorx, Inc. Biopsy device with fluid delivery to tissue specimens
US8915864B2 (en) 2005-08-05 2014-12-23 Senorx, Inc. Biopsy device with fluid delivery to tissue specimens
US8486028B2 (en) 2005-10-07 2013-07-16 Bard Peripheral Vascular, Inc. Tissue marking apparatus having drug-eluting tissue marker
US8437834B2 (en) 2006-10-23 2013-05-07 C. R. Bard, Inc. Breast marker
US9901415B2 (en) 2006-12-12 2018-02-27 C. R. Bard, Inc. Multiple imaging mode tissue marker
US10682200B2 (en) 2006-12-12 2020-06-16 C. R. Bard, Inc. Multiple imaging mode tissue marker
US9579077B2 (en) 2006-12-12 2017-02-28 C.R. Bard, Inc. Multiple imaging mode tissue marker
US11471244B2 (en) 2006-12-12 2022-10-18 C.R. Bard, Inc. Multiple imaging mode tissue marker
US8401622B2 (en) 2006-12-18 2013-03-19 C. R. Bard, Inc. Biopsy marker with in situ-generated imaging properties
US9042965B2 (en) 2006-12-18 2015-05-26 C. R. Bard, Inc. Biopsy marker with in situ-generated imaging properties
US8311610B2 (en) 2008-01-31 2012-11-13 C. R. Bard, Inc. Biopsy tissue marker
US10786604B2 (en) 2008-09-23 2020-09-29 Senorx, Inc. Porous bioabsorbable implant
US9327061B2 (en) 2008-09-23 2016-05-03 Senorx, Inc. Porous bioabsorbable implant
US11833275B2 (en) 2008-09-23 2023-12-05 Senorx, Inc. Porous bioabsorbable implant
US10258428B2 (en) 2008-12-30 2019-04-16 C. R. Bard, Inc. Marker delivery device for tissue marker placement
US8670818B2 (en) 2008-12-30 2014-03-11 C. R. Bard, Inc. Marker delivery device for tissue marker placement
US11779431B2 (en) 2008-12-30 2023-10-10 C. R. Bard, Inc. Marker delivery device for tissue marker placement
USD715442S1 (en) 2013-09-24 2014-10-14 C. R. Bard, Inc. Tissue marker for intracorporeal site identification
USD715942S1 (en) 2013-09-24 2014-10-21 C. R. Bard, Inc. Tissue marker for intracorporeal site identification
USD716451S1 (en) 2013-09-24 2014-10-28 C. R. Bard, Inc. Tissue marker for intracorporeal site identification
USD716450S1 (en) 2013-09-24 2014-10-28 C. R. Bard, Inc. Tissue marker for intracorporeal site identification
US11872413B2 (en) 2017-06-19 2024-01-16 Assistance Publique Hopitaux De Paris Control method for the treatment of brain tissue using an ultrasonic probe and an implanted acoustic window on the cranium

Also Published As

Publication number Publication date
FR2686499A1 (en) 1993-07-30

Similar Documents

Publication Publication Date Title
WO1993014712A1 (en) Apparatus for treating a target such as a lesion with a tracer element
AU2006203008B2 (en) Monitoring of percutaneous mitral valvuloplasty
EP0581704B1 (en) Method for determining the position of an organ
JP4971634B2 (en) Method and system for aligning medical information related to a first coordinate system in a second coordinate system using an MPS system
JP4836122B2 (en) Surgery support apparatus, method and program
US6317616B1 (en) Method and system to facilitate image guided surgery
CA3082046A1 (en) Robotic device for a minimally invasive medical intervention on soft tissues
CN105101895B (en) Instrument positioning in guided high dose rate plesioradiotherapy
FR2627075A1 (en) METHOD, IMPLANTS AND APPARATUS FOR PRODUCING IMAGES OF ORGANS OR THE ORGANISM
FR2779339A1 (en) MATCHING METHOD AND APPARATUS FOR ROBOTIC SURGERY, AND MATCHING DEVICE COMPRISING APPLICATION
FR2949316A1 (en) CONTROL SYSTEM AND METHOD FOR PRECISE GUIDANCE TO THE PROSTATE OF A PERCUTANEOUS NEEDLE
CA3212798A1 (en) Medical robot for placement of medical instruments under ultrasound guidance
FR3067610B1 (en) ENSEMBLE FOR IMAGING AND / OR TREATING CEREBRAL FABRIC
CN114901152A (en) Annular array ultrasonic imaging
US20230414299A1 (en) Tissue interface system
CA3129081A1 (en) Synchronisation device and method for determining an instant of the respiratory cycle of a patient, and assembly comprising a medical robot
WO2022263764A1 (en) Robot equipped with an ultrasound probe for time-real-time guidance in percutaneous interventions
KR20070015883A (en) Monitoring of percutaneous mitral valvuloplsasty
MXPA06008664A (en) Monitoring of percutaneous mitral valvuloplasty
Mustufa An image-guided robotic assistant for microsurgery of the inner ear

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): CA JP US

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): AT BE CH DE DK ES FR GB GR IE IT LU MC NL PT SE

DFPE Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101)
122 Ep: pct application non-entry in european phase
NENP Non-entry into the national phase

Ref country code: CA