Development of a portable and compact robotic system for frameless and maskless stereotactic radiosurgery

开发用于无框架和无面罩立体定向放射外科的便携式紧凑型机器人系统

• 批准号: 10307093
• 负责人: Rodney Wiersma
• 金额: $ 33.22万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-12-04 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10307093
• 关键词: 3-Dimensional; 3D Print; Advanced Development; Anatomy; Arteries; Back; Body Weight decreased; Brain; Brain Neoplasms; Brain Stem; Cephalic; Clinic; Clinical; Clinical Research; Clinical Trials; Complex; Coupling; Development; Dose; Environment; Freedom; Gel; Head; Hour; Image; Immobilization; Joints; Laws; Lead; Linear Accelerator Radiotherapy Systems; Local anesthesia; Masks; Medical; Metals; Methods; Modality; Motion; Nature; Nerve; Operative Surgical Procedures; Patients; Persons; Positioning Attribute; Preparation; Problem Solving; Radiation; Radiation Dose Unit; Radiation therapy; Radiosurgery; Research; Risk; Robot; Robotics; Rotation; Schedule; Site; Structure; Surface; Surgical Flaps; Surgical complication; Swelling; System; Techniques; Testing; Therapeutic; Time; Uncertainty; Validation; base; bone; brain tissue; compliance behavior; cranium; design and construction; face mask; healthy volunteer; improved; meetings; novel; patient population; patient safety; portability; robot control; robotic system; simulation; skills; success; therapy outcome; traditional therapy; treatment planning; tumor; volunteer

ABSTRACT Stereotactic radiosurgery (SRS) is a non-surgical technique used to treat functional abnormalities and small tumors of the brain. It delivers precisely targeted radiation in fewer high dose treatments than traditional therapy and allows access to sites that would otherwise be difficult or inadvisable to treat due to potential surgical complications to nearby nerves, arteries, and other vital structures. To achieve the 1-2mm precision for intracranial SRS, a metal head ring is rigidly fixated to the patient’s skull using screws under local anesthesia, and then bolted to the treatment couch. The discomfort, inconvenience, and invasive nature associated with the frame preparation have been identified as a serious cause of poor patient compliance and poor clinical efficiencies when SRS is medically indicated. For certain patients, with extreme cranial anatomy or prior surgical bone flaps, ring placement is not possible. In addition, the frame prohibits cases when a hypo- fractionated scheduled is desired leading to the use of techniques with far less accuracy. For clinics, with tight patient linear accelerator (LINAC) scheduling, or high patient to LINAC volumes, frame based SRS scheduling can prove to be problematic due to the necessity of performing the CT simulation, treatment planning, LINAC SRS QA, patient setup, and treatment on the same day. Research aimed at eliminating the frame through the use of thermoplastic face masks have resulted in SRS with less accuracy as mask flex can lead to systematic drift of up to 2-3mm away from the intended target due to rotation about the fulcrum at the back of the skull. Additionally, mask based immobilization accuracy is highly dependent on mask manufacturing quality, skill of the person applying the mask, shrinkage of the mask during treatment, and physical changes of the patient’s head due to swelling or weight loss. In certain cases this has led to uncertainties as large as 6 mm and 2.5 degrees. Such accuracies are not suitable for deep tumors located near critical structures such as the brain stem or for newer treatment modalities such as single iso-center multiple target SRS which are highly sensitive to rotational errors. We propose to solve these problems by developing a novel robotic SRS system that does not require a frame or mask. The hypothesis is that the use of real-time 6 degree of freedom (6DOF) patient head motion tracking and active robotic control systems can assist patients in maintaining a stable sub-millimeter sub-degree head position for long periods of time. Specific aims include: (1) To develop an advanced real-time 6DOF trajectory control law. (2) Design and construction of a clinical robotic SRS system using real-time 3D surface image tracking. (3) Anthropomorphic phantom, healthy volunteer and patient clinical trials.

摘要 立体定向放射外科(SRS)是一种非手术技术，用于治疗功能异常和微小的 脑部肿瘤。与传统的高剂量治疗相比，它以更少的高剂量提供精确的定向辐射 治疗，并允许进入因潜在危险而难以或不宜治疗的部位 周围神经、动脉和其他重要结构的外科并发症。要达到1-2 mm的精度 对于颅内SRS，使用局部下的螺丝钉将金属头环坚固地固定在患者的头骨上 麻醉，然后用螺栓固定在治疗沙发上。不适、不便和侵犯性 与框架准备相关的已被确定为患者依从性差的严重原因 当医学上有SRS指征时，临床效率较低。对于某些患者，具有极端的颅骨解剖或 在手术前骨瓣、环的放置是不可能的。此外，该框架禁止在以下情况下- 分级调度是可取的，导致使用的技术的精确度要低得多。对于诊所，具有紧凑的 患者直线加速器(LINAC)调度，或高患者到直线加速器容量，基于帧的SRS调度 由于需要执行CT模拟、治疗计划、直线加速器 SRS QA、患者设置和治疗在同一天。旨在通过消除框架的研究 使用热塑性口罩会导致SRS的准确性降低，因为口罩的弯曲可能会导致系统性 由于绕着头骨后部的支点旋转，偏离预定目标2-3 mm。 此外，基于口罩的固定精度高度依赖于口罩的制造质量、技能 戴口罩的人，治疗过程中口罩的收缩，以及患者身体的变化 头部因肿胀或体重减轻。在某些情况下，这会导致高达6 mm和2.5 mm的不确定度 学位。这种准确性不适用于位于关键结构附近的深部肿瘤，如大脑 或用于较新的治疗方式，如高度敏感的单等中心多靶点SRS 到旋转误差。 我们建议通过开发一种不需要框架的新型机器人SRS系统来解决这些问题 或者戴面具。假设使用实时六自由度(6DOF)患者头部运动跟踪 而主动机器人控制系统可以帮助患者保持一个稳定的亚毫米以下的头部 持仓时间较长。具体目标包括：(1)开发一种先进的实时六自由度轨迹 控制律。(2)基于实时三维表面图像的临床机器人SRS系统的设计与实现 追踪。(3)拟人体模、健康志愿者和患者临床试验。