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: 10047519
• 负责人: Rodney Wiersma
• 金额: $ 27.66万
• 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/10047519
• 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.

抽象的 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小 大脑的肿瘤。与传统相比 治疗，并允许进入原本困难或不愿治疗的地点 附近神经，动脉和其他重要结构的手术并发症。要达到1-2mm的精度 对于颅内SRS，金属头环用局部螺钉牢固地固定在患者的头骨上 麻醉，然后螺栓固定在治疗沙发上。不适，不便和侵入性的性质 与框架准备相关的已经被确定为严重的患者依从性，并且 当医学上指示SRS时，临床效率较差。对于某些患者，具有极端颅骨解剖或 先前的手术骨皮瓣，无法放置环。此外，帧禁止案件 希望分馏的计划是导致精确度较低的技术的使用。对于诊所，紧张 患者线性加速器（LINAC）调度，或者高的患者到LINAC卷，基于框架的SRS调度 由于必要执行CT模拟，治疗计划，LINAC，可能被证明是有问题的 同一天，SRS QA，患者设置和治疗。旨在消除框架的研究 使用热塑性面膜的使用导致SRS的准确性较低，因为掩模会导致系统性 由于在头骨背面的支点上旋转，距预期目标最多2-3mm。 此外，基于面具的固定精度高度取决于面具制造质量，技能 施加面膜的人，治疗过程中面具的收缩以及患者的身体变化 由于肿胀或体重减轻而头部。在某些情况下，这导致不确定性达到6毫米和2.5 学位。这种准确性不适用于位于临界结构（例如大脑）附近的深肿瘤 茎或较新的治疗方式，例如高度敏感的单个ISO-Center多个目标SR 旋转错误。 我们建议通过开发不需要框架的新型机器人SRS系统来解决这些问题 或面具。假设是使用实时6的自由度（6DOF）患者头运动跟踪 主动机器人控制系统可以帮助患者维持稳定的亚毫米次级头部 长时间的位置。具体目的包括：（1）开发高级实时6DOF轨迹 控制法。 （2）使用实时3D表面图像设计和构建临床机器人SRS系统 追踪。 （3）拟人化幻影，健康志愿者和患者临床试验。