CA2197970A1 - Afterloader provided with remote control unit - Google Patents
Afterloader provided with remote control unitInfo
- Publication number
- CA2197970A1 CA2197970A1 CA002197970A CA2197970A CA2197970A1 CA 2197970 A1 CA2197970 A1 CA 2197970A1 CA 002197970 A CA002197970 A CA 002197970A CA 2197970 A CA2197970 A CA 2197970A CA 2197970 A1 CA2197970 A1 CA 2197970A1
- Authority
- CA
- Canada
- Prior art keywords
- wire
- treatment
- afterloader
- inactive
- radioactive source
- Prior art date
- Legal status (The legal status 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 status listed.)
- Abandoned
Links
- 238000011282 treatment Methods 0.000 claims abstract description 80
- 230000002285 radioactive effect Effects 0.000 claims abstract description 36
- 230000003287 optical effect Effects 0.000 claims description 12
- 238000004891 communication Methods 0.000 claims description 8
- 230000005855 radiation Effects 0.000 claims description 3
- 230000003213 activating effect Effects 0.000 claims 2
- 230000001105 regulatory effect Effects 0.000 claims 1
- 230000032258 transport Effects 0.000 description 38
- 201000010099 disease Diseases 0.000 description 6
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 6
- 230000006870 function Effects 0.000 description 5
- 238000000034 method Methods 0.000 description 5
- 238000003825 pressing Methods 0.000 description 5
- 230000007246 mechanism Effects 0.000 description 4
- 238000004088 simulation Methods 0.000 description 4
- 206010028980 Neoplasm Diseases 0.000 description 3
- 201000011510 cancer Diseases 0.000 description 3
- 230000000994 depressogenic effect Effects 0.000 description 3
- 230000007935 neutral effect Effects 0.000 description 3
- 235000012976 tarts Nutrition 0.000 description 3
- 241001481828 Glyptocephalus cynoglossus Species 0.000 description 2
- 238000002725 brachytherapy Methods 0.000 description 2
- 238000013461 design Methods 0.000 description 2
- 238000002594 fluoroscopy Methods 0.000 description 2
- 238000005259 measurement Methods 0.000 description 2
- 239000012857 radioactive material Substances 0.000 description 2
- 208000037803 restenosis Diseases 0.000 description 2
- SFNPDDSJBGRXLW-UHFFFAOYSA-N (3-methylsulfanylbutan-2-ylideneamino) n-methylcarbamate Chemical compound CNC(=O)ON=C(C)C(C)SC SFNPDDSJBGRXLW-UHFFFAOYSA-N 0.000 description 1
- 101800000535 3C-like proteinase Proteins 0.000 description 1
- 101800002396 3C-like proteinase nsp5 Proteins 0.000 description 1
- 208000026097 Factitious disease Diseases 0.000 description 1
- 235000018734 Sambucus australis Nutrition 0.000 description 1
- 244000180577 Sambucus australis Species 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 230000000881 depressing effect Effects 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 125000001153 fluoro group Chemical group F* 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 238000000053 physical method Methods 0.000 description 1
- 229920006111 poly(hexamethylene terephthalamide) Polymers 0.000 description 1
- 101150050071 proY gene Proteins 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- HLCHESOMJVGDSJ-UHFFFAOYSA-N thiq Chemical compound C1=CC(Cl)=CC=C1CC(C(=O)N1CCC(CN2N=CN=C2)(CC1)C1CCCCC1)NC(=O)C1NCC2=CC=CC=C2C1 HLCHESOMJVGDSJ-UHFFFAOYSA-N 0.000 description 1
- 238000013519 translation Methods 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
- 238000012795 verification Methods 0.000 description 1
- SYOKIDBDQMKNDQ-XWTIBIIYSA-N vildagliptin Chemical compound C1C(O)(C2)CC(C3)CC1CC32NCC(=O)N1CCC[C@H]1C#N SYOKIDBDQMKNDQ-XWTIBIIYSA-N 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
- A61N5/1007—Arrangements or means for the introduction of sources into the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
- A61N5/1007—Arrangements or means for the introduction of sources into the body
- A61N2005/1008—Apparatus for temporary insertion of sources, e.g. afterloaders
Abstract
A remote control device used with an afterloader for advancing and retracting a dummy wire as well as a treatment wire into and out of a patient which is to be treated with a radioactive element or elements. The remote unit is provided with displays for showing the advancement of a treatment or dummy wire as well as indicating a treatment time. A sensor is provided to indicate that a transport tube through which a treatment or dummy wire will be advanced into the patient is properly connected to the afterloader.
Description
- 21 97~70 -~ Ft~ n~R PROVIDED WIl~ ~EMOTE CON'rROI. ~NI'r Fleld of the Inve21tlon The prese~t invention relates to remote afterloading de~ices ~sed to position radioactive treatment source wire~
in~ide patients afflicted with can~er or other diReases.
R~r~oUND OF ~SHE ~v~ lON
Radiation is used to treae ~an~er and other diseases of ehe body~ Brachytherapy, is a general term for the radiation treatment of cancer at clo~e distances in~ide che body. ~uring brachytherapy, a radioactive source or sources are po~litioned in the area needing treatment. Depending on the type of therapy, the radioaceive sources are placed permanently in~ide the body during surgery, or tran~port tubes (treatment caeheters) are placed in the body w~ich are later temporarily loaded with radioactive sources. This temporary afterloading of radioa~tive material either invol~es ~ human handling the radioactive material and receiving radiation exposure, or a machine called a "remote afterloader" that will load and unload the radioactive ~aterial into and from the tranQport tubes. An individual opera~es the afterloader from a remote location so the individua~
~i~l not recei~e any radiaeion exposure. The focus of this application will be on field of remote afterloaders.
RemoCe afterloaders are devices generally u~ed in the cancer field to accurately advance and retract a flexible drive member coneaining a radioactive 60urce over a ~pecified distance for a spe~ified time period. A remote ~fterloader generally consists of a flexible simulation drive member, a flexible drive ~ember containing a radioa~tive element, controller~ and drive mechanisms to operate bo~h type~ o~ flexible ~embers, a shielding safe for the radioacti~e element, an internal timer, and an exit port attachsd to a rotatlng wheel tha~ allows multiple tran~port tu~es (previously placed lnto the patient) to ~e hooked up to the device at the same time. The remote aftexloader usually sends out ~he ~imulation member to ~heck the patency of the transport tube without subje~ting the patient to undue radiation exposure, and than sends out the radioactive element. After the treatment is performed in the fir~t transport tube, the afterloader 2,1 q'1~70 .
retract~ the source into the ~hielding ~afe inside the afterload-er, ~ wheel turns and aligns a slot containing the seco~d tran5port tube to an e~it port. The remote afterloader than repeats its function sending and retracting the simulation member and radioactive member through this second tube. The procedure i6 repeated ~ntil the function i~ carried out through all the ~pecified transport tube~. Since the remote afterloaders u6e a fixed, short length radioacti~e 90urce, the afterloaders must multi-~tep this source many times inside each transport tube to ~0 cover the di~eased area.
The current remote afterloader~ on the market require the following complicated pro~edure~ before any treatment can take place:
Initially, by hand, phyQical mea~urement~ must be made of each transport tube after it has been positioned inside the body using a simulation member, fluoro~copy, and a calibrated ruler. These mea~urementQ must accurately relate the physi~al distance ~he radioactive source needs to ~ra~el from the distal end of each tube to the i~side of e~ch transport tube to treat the di~ease in~ide the body.
Secondly, two 90 degree X-Rays showing all the trans-port tube~ inside the ~ody ~UCt be made and digi~ized into a treatment plannin~ computer. The physical length measurement6 taken pr.ior to the X-rays, must be matched up with each digitized 2 5 transport tube in the treatment planning computer and the physical length measurements along with other treat~ent data must be entered for each transport tube.
The computer than compiles all the data and a treatment plan is formed and stored on a ma~netic computer dis~.
This computer disk containing the treatment plan i~
than entered into a treatment computer that pr~rams and operate~
the remote afterloader. Finally, the treatment take~ place.
In mo~t cases, the~ above setup steps take thirty minute~ or more. The use of remote afterloader~ were primarily designed for the treat~ent of cancer but can be u~ed in other treatments of diseases. There are critical factors that will not allow the current remote afterloaders to be uQed in the trea~ment ~ 1 9 7 9 70 .
of certain types of disea-ces. ~he main li~iting factor is the long setup time required for treatment. In treatment~ where time i9 of the es~ence, Ruch as restenosi~ uQed to treat heart patient~, a long setup time could literally mean life or death for the patient. The present in~ention allows a specially de~igned remote a~terloader to perform it9 duty in a much less ti~e period, eliminating many of the time con~uming Rteps.
Other limiting fac~ors of prior axt treat~ent after-loader~ are ~he phy~ical size and amount of equipment neces~ary to operate a remote afterloader. In many ~reatment facilities, there i3 not enough room for this amount and size of equipment.
~ack of cert~in safety feature~, such as an indirect but not a direct transport tube sensing device to ensure thae the tran~port tube is properly conne~ted to the afterloader, human error when measuring and tran~lating treatment distance, no control of ~he ~peed in which the drive members move, no ~eans to fine tune the position of the drive mem~ers once they reach their target area, along with the lack of other sa~ety feature8 ~ake the current remote afterloaders limited in use and effectiveness.
Thu~, there exists a need for a simple, compact, portable, self-contained remote afterloader that can ~reat a patient with little or no setup time, and contain~ i~pr~ed safety ~eatures.
It is an obje~t of the present invention to provide a portable, ~elf-~ont~ined, remote afterloader that will be easy to maneu~er and i~ compact in ~ize.
~t is another obj ect ol~ the present invention to provide ~n~held controls instead of bulky workQtation~ and computers.
It is another object o~ the present in~ention to provide safety ~eatures of an improved afterloader that can directly sense proper connection of the transport tube ~treatment catheter) to the afterloader It is another object of the present invention to 3 5 provide direc~ control of the speed in which the drive member~
move in and out of the afterloader.
2 i 9 79 70 , It i~ another object of the pre~ent inven~ion to allow for direct measurement and translation of the treatment distance, eliminating chance of human error.
Sti~l another object of the pre~ent invention is to 5 allow for fine tune adjuctment of the drive ~ember on~e it has rea~hed its inte~ded target.
2 I q797G
SU~MARY OF TH~ ~Nv~..~lON
The~e and other deficiencieQ o~ the prior art are ~ddressed by the present in~ention which i~ directed to a remote afterloader that i~ self-contained, compact in size, requires very little setup time and haQ improved safety features..
The remote afterloader wi~l be a Qimple one channel device employing a single treatment tube that will be used primarily for treatment of disease at short distances from the radial center of a fixed lengt~ -~ource. For example, 99~ of ~he resteno6is in heart patients are- 1.5 centimeter~ or le~s in length. A fixed len~th, reusable, radioactive ~ource which is thr~e centimeters in length would ~e able to treat greater than 99% of the ~a~cular disease encountered at the time of the anyioplasty. Ocher afterloading devices micro-~tep a 0.5 ~5 millimeter or le58 (in length) radioactive source and requixe two X-Ray~ 3howing all the tran~port tube~ positioned in the ~ody, from 90 degree angle~. a digiti~er to con~ert the X-Rays which are transmitted to a treatment planning computer and a ~eparate treatment computer to operate the remote afterloader. The remote afterloader according to t~e present invent~on will eliminate all of thi~, since a simple ~hart (based on the activity and length ;~ ~ of the ~ou~ce) would ea~ily display the treatment time required for each radius distance.
Current remote afterloaders req~ire a physical measurement to be made o~ ea~h tran~port ~or treatment) tube, by taking a ~imulation wire, and positioning t~e wire in~ide the tran~port tube by u~e o~ fluoroscopy, mar~ing the wi~e where is exits the tran~port tube, and phy~ically measuring the wire on a calibrated ruler. The~e ~easurementQ mu~t ~e recorded and matched up precisely with each transport tube in ehe X-Ray film~, and entered into the digitized treatment planning computer prlor to a treatment plan being generated.
The remote afterlo.ader, according to the present inv~ntion, eliminates all of the above ~teps. ~he transport (treatment~ tu~e i9 connected to the afterloader and by simply u8ing one of the two hand-held re~ote controls, a dummy (simula-tion) drive member iq advanced into po~ition through a connector 21 Ct7q7G
port of the afterloader and into the body of the patient ~y direct verification ~nder fluo~oscopy. At thi~ point, a ~memorize/home" button is pre~sed and the af~erloader memorizes ~hig position and retracts the si.mulation ~ember to the "zero~
(parked or home) position. The treatment ti~e i~ set either using the remote control unie or b~ u~ing an external ti~er on the afterloader. The operator than ~tands back a safe distance or behind a shield, activates the "active" mode on the remo~e control, pre~ses the nt~eatment" button and t~e active member 1~ including the radioactive source i~ automatically advanced to the memorized pos~tion. At the end of the treatment time, the . radioactive ~ource portion of the acti~e member i-~ automati~ally retracted into the shielding safe in~ide che afterloader. To ensure that the active member iB properly advanced from its 15 n zero" (parked or ho~e) po~ition, the proximal end of ~oth the dummy wire and the active wire ~hould be po~itioned within the afterloader at an equa~ distance fxom the connector port.
Furthermore, the length of the dummy wire and the active ~ire should be equal. Althoug~ only one remote control i~ ~ece~sary, 2~ it i~ strictly for a safety backup ~nd for convenience that two remote contro~ units are provided.
Instead of bulky equipment such as the digiti~er, planning computer, treatme~t comp~ter, and printers, all that i~
neces~ary to operate the remote afterloader i~ a ~imple hand-held remote control. Thi~ ~emote control provide~ many uni~ue features that are simple to u~e. One feature ic a toggle switch that will allow one to ~witch from the dummy (~i~ulation) mode to ~he active (radioactive) mode. An appropriate use for this feature, is after the ~memori2e" button ha~ b~en acti~ated and one wants to double check the treatment po~ition. ~s long as the toggle switch i8 in the dummy mode, the dummy member will ~o to the memorized position (the treatmen~ timer will not ~tart in the du~my mode). ~f everything l~ok~ good, the toggle switch is placed in the active mode and the treaement and timer begin~ once the radioactive member reaches the memorized position.
Another feature oi the remote control i8 a ~irect input on the ~peed in which the remote afterloader advance~ and ,- 2is79~0 retract~ the drive members. By simply turning a knob or pre~sing a counter encompa~sing a speed control for the drive member, ~he speed of the drive mem~er instantly decrease~ or increases. Thi~
is especially u5eful i~ a fine tune po~ition adjustment of a drive member is needed. At any time, the position o$ the dummy or active member, can be fine tuned if nece~sary, ~y si~ply pressing the advance or retract button on che remote control.
Thi~ fine tuning feature would allow che drive member to be advanced or retrac~ed only a small distance, ~uch as a fraction ~f a millimeter. This is accomplished by 8etting the speed control at a very low speed and quickly pres~ins the advance bu~on or retract button. A.c long a~ the 6peed control is 5et at this very low Yalue when either t~e advance button or the retract button very quickly, the drive member will move only a very ~ma~l or precise distance. Repeating this fine tuning procedure will place the drive member precisely where indicated.
The remote control also feature~ a direct di~tance display of the driYe ~ember a~ it i-~ moving, ~ di~pl~y o~ the treatment timer ~s it is counting down, a~ well as an emergency retract button. When the e~ergency retract button is pre~sed, che timer in~tantly stops and the acti~e member retracts into t~e ~hiclded safe. If the afterloader is operating prope~ly, pressing the treatment buteon again will send the active member to the proper location and the timer will re~ume from where it lef~ o~f once the active ~ember reachec its treatment position.
There axe ~everal safety features uced ~o assure that ~oth of drive r~r~ rs ~re parked precisely in po~ition in the afterloader, The remote afterloader contains optical sensors behind the parked Ihome or zero) po-~ition. Prior eo each treatment, the dri~e mech~nism "zeros~ each dri~e member by retracting the dsive member (dummy or active treatment wires) until the optical ~enRors do not ~ense the drive member. At thi~
point, the drive mechani8m im~ediately StopQ and ad~ances the drive member until it is ~ensed by the optical sen~or, and than 3s advance~ the drivel ~r a ~ecified distance to the home (zero) position, ~n encoding sy~tem is also connected to each drive member as another backup safety deYice. During ~he aforemen--- 21 qi970 tioned zeroing procedure, ~f the optical ~ensors were to fail, the encoding ~ystem would noe allow the retraction of the drive member~ pa6t a certain point. For e~ample, the optical sen-~or a3sociated with the ~ctive dri~e member is located inside the shielding ~afe, but distal to the radioactive ~e~ment of the acti~e drive member. If the optical sensor was to fail, the encoding ~ystem would not allow the radioactive segment to be retracted from the distal end of the.~afe. The encoding sy~tem would register an ~error and code n~mber" on the distance display 0 window of the remote control, indicatin~ the problem. The radioacti~e core would still be ~afely contained inside the ~hieldin~ safe of the afterloader.
Anot~er ~fety feature is that, during the retraction o~ a drive member fro~ a transport tu~e, the encoding sy~tem will temporarily stop the drive member at the same number of counts from where it started and then the zeroing feature will be implemented. For example, if ~he encoding system counted 5020 ~ounts for a dri~e me~ber when it was advanced forward, i~ will count down to exactly 5020 coun~s on the retraction, stop the l~e~ent~ and the zeroing function will take o~er. This is a sa~eguard fro~ the member being recracted too fast into the afterloader and overriding the zeroing capa~ilities.
The encoding sys~em also ~onitors che dri~e me~ber for slippa~e and accuracy. The encoding system corrects for both many times a ~econd ~a the drive me~ber i8 being advanced and re~racted.
Prior art afterloaders use an indirect method to check ~hat a eransport tube is proper~y connected. A separace ~onnector grip~ a transport tube and then lock~ it into the afterloader. This connec~or ha~ a plunger that extends from the connector~ diseal end when a transpo~t tube is placed into the connector' 8 proximal end. A optical sensor in~ide the aftex-loader 6enses this extended plunger and indi~ates to the after-loader i~ is po~sible to send out the drive membex. A ~he connector become~ weak, or fu}l of debris, the p7unger ca~ extend and indicate ehat a transport tube is in place when in actuality, a transport ~ube i~ not even pre-cent. There are many times when - 2197~70 a transport tube ha~ fallen out of this type of connector due to a weak ~ip or improper hook-up. If the machine sends out a radioacti~e member and no transport tube is present a dangerouQ
~ituation can occur.
s ~o eliminate ehe problem, the pre~ent invention employs a direct sen~ing ,..nchani.sm that will indicate that the transport tube is properly connected directly to t~e afte~loader. The hub of the transport tube will slide into the ~onnector port o~ the afterloader, ~onnect to the dri~e tube through which the drive member exits, and depre~ a pres~ure sensor or mechanical switch.
A locking mechanism on the afterloader ~uch a~ a Qloteed plate, will lock againQt the outside of the hub or onto the transport tube to hold the cransport tube in place. A grippi~g apparatu~
similar to the device that holds a drill bit in~ide a drill could also be u~ed to l~ck onto the tubing to lock ehe transport tube to the af terloader . The pre~sure sensor or mechanical switch m~ indicate a certain a~ount of pressure, or be depressed, or electronics of the afterloader will cause ~he drive me~be s to be in their zero ~parked) positions. Unless the transport tube is ~roperly positioned, the afterloader will not allow the drive members to move from their zero position.
21 ~7570 }o ~RIE~ D~SCRIPT~ON QF THE DRAWIN~S
For a more complete understanding of the pre~ent inven-tion, and the advanta~e~ thereof, reference is now made to ehe follo~ing descriptions taken in conjun~tion with the acco~panying drawing~, in which:
P~GURE 1 is a view of the remote control unit of the present invention 6howin~ the display~ and functions;
~rauRE 2 i~ a similar vieW of the remote control in Fig~re 1, ~howing a different mean~ to pl~y~am ~he speed in ~hich the drive member~ travel;
FIgURE 3 i~ a partial cros~-section of the co~nector port exiting ~he end of the remote afterloader, showing a pressure or mechanical switeh, a locking mechani~m in the open position, and a eran~por~ tu~e ready to ~e connected to the remo~e afterloa~eri PI¢~RE 4 i~ a partial cross-~ection demonstrating the proper connection of the transport tube to the remote after-loader:
FIG~RB S is a frontal view ~howing a first embodiment ~25 of the locking me~han~m holding the transport tube in place;
, ~ FIGURE 6 i~ a frontal view chowlng a second embodiment of the locking mechanism holding the transport catheter in place;
and FIG~RE 7 is a ~chematic view of the afterloader connected to a pa~ient.
- 2 i 9~7û
DSTAl'T ~ DESCRIPTIO~ QF 1~ rK~ OD~MF.N~r~
The present invention relates to the ~mpro~ed design and manufactuxe of re~ote afterloaders. The invention relates to a nov~l, compact, ~ightweight, ea~lly p~rta~le, self-con-tained, afterloading unit that ~an easily fit into the trunk ofa small car and be mo~ed from site to site. Afterloading ~nits on the market today are too bulky or cumbersome to be ea~ily tranQportcd. All current afterloading units are ~ery expensive, bulky in size, and require a great amount of extra equipment including computers, a di~itizer, and printers. They also require a ~pecial hook-up to wor~stations in order for the afterloader to operate correctly.
The set-up proce~ure for prior art af terloaders i5 complicated an~ time consuming, making them unu~able for treating many types of disease~ in ~hich time i~ a critical factor. The present in~ention is a ~imp~er design with very little ~et-up ti~e and improved ~afety fea~ures. The pre~ent inven~ion is operated either through direct A~ power or by an uninterrupted power supply (UPS), in case of a power failu~e. Although the present invention i~ designed primarily for th~ treatment of vascular restenosis, it can be u~ed to t~eat other diseases of ' the body, -Ruch as ca~cer.
Referring now to the drawings, and initially to FIGURE
l, it is empha~ized that the Figures, ~r drawings, are not 2~ intended to be to ~cale. ~IGURE 1 illustrate~ a hand-held remote control unit 10. This i~ the only eguipment needed to operate the remote afterloader. The remote control unit l~ incl~de~
several di~plays and unique features pertaining to the u~e of remotely controlling the operation of the afterloader, For example, a direct distance readout 12 of a flexible drive member a~ it travels thxough ~he t~an~por~ ~ube i-~ pro~ided. The distance readout can be programmed to display count~, centime-ters, inche~, or fractions the~eof. A ~econd display feature 14 provides a direct readout of treatment time. It will count down fro~ the total time in seconds to perform a treatment procedure.
The count down timer can be programmed by depressing the 2i q7970 corresponding buttons 16 below the di~play or by an external count down timer on the afterloading unit.
The remote control unit includes a toggle switch 18 or similar device that will enable the operator to control eieher 5 the dummy (~imulation) dri~e member Or the aceive (radioacti~e) drive me~ber. A neutral position is also provided that allows the a~terloader to be ~u~ned on and prevent~ any communication ~etween the remo~e control and the afterloader. A green light 20 or oeher colored or similar display device i8 ill~mina~ed when 10 the toggle switch 18 i-~ in the dummy mode, and a red light 22 or other colored or ~imilar display device is illumiAated w~en the toggle switch 18 i~ in the active mode. A ~reen li~h~ 21 or other colored or similar display device is illumi~ated when the dummy drive mem~er is in its "parked" (home) position inside the afterloader. A green light 23 or other colored or ~imilar display device is illuminated when the active dri~e member in its ~parked~ (home) position i~side the afterl~ader. When the dummy member i5 mo~ing, the green light 20 will fla~h. When the ac~i~e member i~ moving, the red light 22 will fla~h. No lights other than the parked lights 21 and 23 (if the drive members are in their parked ~home) po~ition) will be illuminated if the toggle ~witch 1~ is in the neutral position. To advance either the dummy or the a~tive me~ber, the toggle switch 18 mu3t be in the correct corresponding mode and ~n advance button or similar 25 control 24 must be depressed or eng~ged. To retract either the du~my or t~e active member, the toggle 8witch 1~ mu~t be in the correct corre~ponding mode and the retraet ~utton 26 or ~imilar detrice must be depressed or engaged.
The ~peed in which the drive me~hanism3 advance a~d retrace t~e dummy or active member i~ controlled from a rotatable knob 28 ~rheostat1 as in P~¢uRE 1, or from a --erie~ of program~a-ble push buttons 32 a~ indicated by the remote unit 11 shown in ~G~R~ 2. This feature is very important for fine tuning che placement of either the dummy or the acti~re menber. The actual ~peed o~ the dri~e ~echanisms controlled by the ~peed control 32 i~ ~llu-~trate~ in di~play 30.
13 2 1 9797ù
The next control i~ a push ~utton 34 labelled "Memorize / Home". T~i~ control is used once the exact placement of the du~y member in the ~imulated treatment position i~ obtained.
Normal u~e of the control~ will ~e a~ ~llows: The dis~al end 5 of a trancport tube will be placed inside the body and the proY; -1 end will be connected to t~e remote afterlo~der. The to~gle 6witch 18 will be placed in the dummy position. Depre~-cion o~ the ad~ance butt~n 24 and turning or programming the speed control will dri~e the d~mmy member lnto position ~ithin 1~ the body of the patien~. Fluoroscopy i8 used to monitor the ll.O~ -nt of both of the drive members. ~s the dummy member approaches the target area in the body, it i~ advisable to decrease the speed so a precise placement of the dummy member in the treatment area can be obtained. Releasing the advance or retract button 24 or 26 i~medi~tely stOp~ the member movement.
Once optimal placement ls achieved, the memorize / home button 34 i~ depre~sed which would immediately memorize the exact po~ition of the dummy member ~nd retracts the dummy member ~o it~
zero (parked or home) poQition. The trea~ment time~ 16 is ~et for the total treatment time. The position of ~he dum~y member can be checked a~ many times as needed by pressing a treatment button 36. The count down timer will not ~tart ~ long as the toggle switc~ 18 is in the dummy (or neutral) position. The real tre~tment begins by placing the toggle switch 18 in the acti~e po~ition ~nd pressing the treat~ent button 36. The afterloader automati~ally advances the active member to the memorized position. Once the active member is in position, the count do~n timer ~tart~. When the count down timer reache~ zexo, as shown in display 14, the afterloader automatically retrac~ the 3~ radioactive ~egment of the active member into a shielding safe located inside the afterloader.
If an emergency develops, presQing an emergency stop button 3~ automatically stop~ ~he timer and recracts the active member into the shielding safe inside the remote afterloader.
Once the emergency has p~s~ed, the positioning can be re~hecked by placing the to~gle switch in the dummy ~ode and pre~sing the treatment button 36. If everything is in order, the treatment . 21q7~70 can resu~e where it left off, by placing the toggle switch in the active mode and pressing the treatment bueton 36. The acti~e member will travel to the memorized position and the treatment timer will resume where it left off.
A final -~afeguard on the remote control i~ a key lock 40. A key must be inserted into a sdot 42 in the remote contxol and turned co ~he ~On" poQition or no cc~lJnications from ehe re~ote control to the afterloader i~.possible.
~I~URE 3 illustrates a sensing device that directly senses the presence of a transport tube (treat~ent catheter) 44 provided with an enlarged hub ~6 at one end. A connec~or port on the remote afterloader has a place to hook the transport tube 44 from the patient to the remote afterloader. A mechanical switch 48 provided with a pre~ure sen~ing device 50 is located inside the connector port of the remote afterloader and iq in direct co~munication~ with the electronics that are responsible for the~..ove.~,cnt of che dri~e member~ via wires 52. Alternative-ly, non-hard wired communication can be u~ed. FIGURB 3 ~hows the mechanical ~wit~h or pres~ure sensing device ~n the open ~0 position. In thi~ open position t~e afterloader will not allow the drive mem~er~ to move from their zero (home) po~ition~.
F~GU~E 3 alQo shows a locking mecha~ism 56 that will hold the tranCport t~be 46 in place. In thi~ figure the locking mechanism in the unlocked position.
~I~URE 4 illu5trates the correct ~ook-up between the tran~port tube 44 and the remote aftexloader. The pressure sensing device SO of the switch 4~ i8 depres~ed and the transport tube i~ loc~ed fir~ly to the afterloader by a slide plate 5~ with an opening too small to allow the hu~ 46 of the t~an~port tube 3~ to pull through. Since the pre~sure ~en~or is depre~ed, a signal is sent to the controller electronics to allow movement of one of the drive ~embers through an exit por~ S4 and chen through the transport tube 44- ~he s~gnals are monitored many times a s~cond ~y the controller electronic~ for some reason ~he dri~e ~em~er tdummy or active) was adv~nced and the transport tube becomes detached fro~ the connector port, the sen~or 50 would immediately detect that no transport tube was present and ~ i 9i9 jo signal the controller to im~ediately retract the d~ive ~ember to its zero ~ho~e or p~r~ed~ po~ition. An error message with a code number (indicating ~he problem are~) would ~how up on the distance o~ count display 12.
5FIGURE 5 ~llu~trates the locking device a~ described in FIGURE 4 flrmly holding the transport tube in the locked po~ition. The locking device include~ the sliding plate 5~ that ~its into horizonal guiding channels 60, 62 located adjacene to the exit port o~ the remote afterloader. The ~lidin~ plate locontain~ ~ lip 64 ~ox proper Qea~ing in the top horizontal gu~ding ch~nnel 60. The 61iding plate can contain an opening large enough to allo~ the tubing section of the transpor~ tube to pa~s, but ~ot the hub of the transport tube, or it can bite -or grip onto the wall of the ~ublng section of the tran~port 15tube. Thi3 opening i8 created by providing two horizo~tal portions 66, 6~ connected to a vertical portion 70.
FIGU~E 6 illustrates a locking device ~imilar in function to FIGURE 5 In~tead of a ~liding plate that ~its into horizonal channel~, a rotating plate 72 will re~t o~ a stopper ~o74, which linec it up with a threaded hole on the remote after-. loader and the end of the rota~ing plate locks Lo this t~readed hole by meanQ of a threaded screw. Thi~ rotating plate, like the locking device i~ FIGURE 5, can contain an opening large enough to allow the tubing section of the transport tube to pass, but 25not the hub of the transport tube, or it can bite or grip onto the wall of the tubing ~ection of the tran~port tlube.
FIG~RE 7 illu~trate-~ an afterloader 76 whi~h is used in conjunction with the remote controller of the precent inventio~ to treat a patient with radioactive material. This 30afterloader i~ powered by an uni~terruptable power ~upply ~UPS) 102 which is connected to the afterloader 76 by a standard wi~e or cable 108. The UPS 102 is connected, by a standard wire or cable llo to a ~tandard plug 1~4 which would be inserted into an electrical outlet. Bo~h the UPS lOZ ~9 well as the remote units 3510, 11 ~oted by 112 in FIGURE 7) are connected to a controller unit 106 ~ia a st~d~rd wire or cable 114. ~he control~e~ 106 is provided within the afterloader un~t and would include . - 21~/9i~0 suitable electronics including a ~olid 8tate memory unit for controllin~ the operation of the afterloader. It is noted that the controller 106 could be pro~ided with an internal power supply, such a~ a serie~ of rechargeable ~atteries. In this S instance, the UPS 102 becomeQ unneces~ary. Furthermore, a wireless communication link can be establ~shed between the remote unit 112 and the controller 106, eliminatin~ the need for wire or cable 114. Typica~ly, an infrared or radio freq~ency ~ignal can be utilized in this mode.
The af~erloader ~6 include~ a dum~y wire 116 which would be inserted ~n~o a patient to deter~i~e the correct treatment position. ThiQ wire 116 is provided on a pulley 9~.
Drive rollers 90, g2 would allow the dummy wire 116 to be advanced through the afterloade~, out of a connector 9B shown in FIGS. 3 and 4 and into the patient through treatment tube or cathete~ 100. One or both of the drive roller~ 90, 92 can be pro~ided with an encoder used to di~play the exac~ po ition o~
the du~my wire 116 within the body of the patient. The encoder would read the ~oving wire ~y direct co~tact or by direct attachment to a movin~ ~echanism that is in direct contacc with the moving w~re. The encoder is in direct contact wich the controller 106 by a wire 118 or other means of conveying i~formation from the encoder to the controller 106. An opcical ~en~or or mechanical switch 122 detects the proxi~al end o~ the wire and sends a si~nal to the controller 106 via a wire 126.
The controller 106 uses this information in combination with the - ~ signal~ from the encode~ to position the dummy wire in it6 "zero"
or ~parked" home po~ition. The distal end of the ~ire wraps a~ound a pulley 94 which moves in uni~on with the drive rollers 90, 92. The controller 106 use~ signal~ fro~ the encoder to control the movement of the pulley 94 via a wire 131 ~o that excesa wire can be safely stored in a coiled manner until needed.
The pulley ~ystem has a ~orward built-in brake system th~t will not allow the drive rollers to advance the wire co~pletely ~rom ~5 the pulley. The pulley also contain6 ~ reverse built-in brake $ystem that will not allow the rollers to retract the wire beyond it-Q home po~ition. Shis brake ~ystem could be a mechanical lock ~ 97970 .
that will only allow a set amount of rotation before a peg or rod wou~d rest against'an adjustable ~determined by the overall length of the wire) stop and not allow fur~her rotation. When the peg rest8 against the stop, a signal is sent to the control-ler to immediately stop rotation of the drive roller. At thispoint, if neces~ary, the operator can send a signal from the remote unit 112 to the controller 106 to retract the wire if the forward ~rake system is enga~ed, or send the ~ignal to advance the wire if the reverse ~rake sy~tem is engaged.
The afterloader al80 includes an aetive treatment wire 118. a pulley 78, drive rollers 82, 84, at least one encoder, an~
an optical sensor or mechanical switch 8B which would operate in the manner just described with respect to the dummy wire transport system. Information from an encoder provided proximate to the rollers 82, a4 is transmitted through the controller 10~
by a wire 120. Additionally, information from the optical sensor 88 i~ transmitted to the controller 106 via a standard wlre 124.
The controller 106 use~ signals from the encoder to control the movement of the pulley 78 via wire ~30 60 that exce6s wire can be ~afely stored in a coiled mannex until needed. A shielded safe ~6 i~ included through which the treatment wire 118 will pass. This treatment wire includes a radioactive element or elements which would be used to treat the patient. When the treatment wire i9 retracted ~nto the afterloader, the radioactive element or elements would ~e stored in the safe 86 when the treatment wire i~ in it~ home position. It is noted that the optical sensor ~ is located prox~mal to the shielded ~afe ~6, but could be positioned in the shielded safe.
The a~orementioned emerging stop button 38 wou~d 3~ operate in conjunction with either an emergency retrac~ion device 80 for retracting the radioactive treatment wire 11~ into ~he safe 80, or with retraction device ~6 for retracting the in~ctive dummy wire 116 to its home ~osition within the afterloader.
Theqe retraction devices can also be operated manually.
The pre~ent invention has thus been descri~ed, but it i8 desired to be understood that it is not conf1ned to the particular forms or uses as shown and de6cribed, the same being 2 1 9/~70 merely illustr~tive, and that the invention may be carried out in other ways without departing from the 5pirit of the invention.
Therefore, the right is broadly claimed to employ all equivalent instrumentalitie5 coming within the ~cope of the claims. It i~
S also maintained that the particular embodiments herein shown and descr~bed are only some of the many that can be employed to obtain the results and o~jects of the present invention.
in~ide patients afflicted with can~er or other diReases.
R~r~oUND OF ~SHE ~v~ lON
Radiation is used to treae ~an~er and other diseases of ehe body~ Brachytherapy, is a general term for the radiation treatment of cancer at clo~e distances in~ide che body. ~uring brachytherapy, a radioactive source or sources are po~litioned in the area needing treatment. Depending on the type of therapy, the radioaceive sources are placed permanently in~ide the body during surgery, or tran~port tubes (treatment caeheters) are placed in the body w~ich are later temporarily loaded with radioactive sources. This temporary afterloading of radioa~tive material either invol~es ~ human handling the radioactive material and receiving radiation exposure, or a machine called a "remote afterloader" that will load and unload the radioactive ~aterial into and from the tranQport tubes. An individual opera~es the afterloader from a remote location so the individua~
~i~l not recei~e any radiaeion exposure. The focus of this application will be on field of remote afterloaders.
RemoCe afterloaders are devices generally u~ed in the cancer field to accurately advance and retract a flexible drive member coneaining a radioactive 60urce over a ~pecified distance for a spe~ified time period. A remote ~fterloader generally consists of a flexible simulation drive member, a flexible drive ~ember containing a radioa~tive element, controller~ and drive mechanisms to operate bo~h type~ o~ flexible ~embers, a shielding safe for the radioacti~e element, an internal timer, and an exit port attachsd to a rotatlng wheel tha~ allows multiple tran~port tu~es (previously placed lnto the patient) to ~e hooked up to the device at the same time. The remote aftexloader usually sends out ~he ~imulation member to ~heck the patency of the transport tube without subje~ting the patient to undue radiation exposure, and than sends out the radioactive element. After the treatment is performed in the fir~t transport tube, the afterloader 2,1 q'1~70 .
retract~ the source into the ~hielding ~afe inside the afterload-er, ~ wheel turns and aligns a slot containing the seco~d tran5port tube to an e~it port. The remote afterloader than repeats its function sending and retracting the simulation member and radioactive member through this second tube. The procedure i6 repeated ~ntil the function i~ carried out through all the ~pecified transport tube~. Since the remote afterloaders u6e a fixed, short length radioacti~e 90urce, the afterloaders must multi-~tep this source many times inside each transport tube to ~0 cover the di~eased area.
The current remote afterloader~ on the market require the following complicated pro~edure~ before any treatment can take place:
Initially, by hand, phyQical mea~urement~ must be made of each transport tube after it has been positioned inside the body using a simulation member, fluoro~copy, and a calibrated ruler. These mea~urementQ must accurately relate the physi~al distance ~he radioactive source needs to ~ra~el from the distal end of each tube to the i~side of e~ch transport tube to treat the di~ease in~ide the body.
Secondly, two 90 degree X-Rays showing all the trans-port tube~ inside the ~ody ~UCt be made and digi~ized into a treatment plannin~ computer. The physical length measurement6 taken pr.ior to the X-rays, must be matched up with each digitized 2 5 transport tube in the treatment planning computer and the physical length measurements along with other treat~ent data must be entered for each transport tube.
The computer than compiles all the data and a treatment plan is formed and stored on a ma~netic computer dis~.
This computer disk containing the treatment plan i~
than entered into a treatment computer that pr~rams and operate~
the remote afterloader. Finally, the treatment take~ place.
In mo~t cases, the~ above setup steps take thirty minute~ or more. The use of remote afterloader~ were primarily designed for the treat~ent of cancer but can be u~ed in other treatments of diseases. There are critical factors that will not allow the current remote afterloaders to be uQed in the trea~ment ~ 1 9 7 9 70 .
of certain types of disea-ces. ~he main li~iting factor is the long setup time required for treatment. In treatment~ where time i9 of the es~ence, Ruch as restenosi~ uQed to treat heart patient~, a long setup time could literally mean life or death for the patient. The present in~ention allows a specially de~igned remote a~terloader to perform it9 duty in a much less ti~e period, eliminating many of the time con~uming Rteps.
Other limiting fac~ors of prior axt treat~ent after-loader~ are ~he phy~ical size and amount of equipment neces~ary to operate a remote afterloader. In many ~reatment facilities, there i3 not enough room for this amount and size of equipment.
~ack of cert~in safety feature~, such as an indirect but not a direct transport tube sensing device to ensure thae the tran~port tube is properly conne~ted to the afterloader, human error when measuring and tran~lating treatment distance, no control of ~he ~peed in which the drive members move, no ~eans to fine tune the position of the drive mem~ers once they reach their target area, along with the lack of other sa~ety feature8 ~ake the current remote afterloaders limited in use and effectiveness.
Thu~, there exists a need for a simple, compact, portable, self-contained remote afterloader that can ~reat a patient with little or no setup time, and contain~ i~pr~ed safety ~eatures.
It is an obje~t of the present invention to provide a portable, ~elf-~ont~ined, remote afterloader that will be easy to maneu~er and i~ compact in ~ize.
~t is another obj ect ol~ the present invention to provide ~n~held controls instead of bulky workQtation~ and computers.
It is another object o~ the present in~ention to provide safety ~eatures of an improved afterloader that can directly sense proper connection of the transport tube ~treatment catheter) to the afterloader It is another object of the present invention to 3 5 provide direc~ control of the speed in which the drive member~
move in and out of the afterloader.
2 i 9 79 70 , It i~ another object of the pre~ent inven~ion to allow for direct measurement and translation of the treatment distance, eliminating chance of human error.
Sti~l another object of the pre~ent invention is to 5 allow for fine tune adjuctment of the drive ~ember on~e it has rea~hed its inte~ded target.
2 I q797G
SU~MARY OF TH~ ~Nv~..~lON
The~e and other deficiencieQ o~ the prior art are ~ddressed by the present in~ention which i~ directed to a remote afterloader that i~ self-contained, compact in size, requires very little setup time and haQ improved safety features..
The remote afterloader wi~l be a Qimple one channel device employing a single treatment tube that will be used primarily for treatment of disease at short distances from the radial center of a fixed lengt~ -~ource. For example, 99~ of ~he resteno6is in heart patients are- 1.5 centimeter~ or le~s in length. A fixed len~th, reusable, radioactive ~ource which is thr~e centimeters in length would ~e able to treat greater than 99% of the ~a~cular disease encountered at the time of the anyioplasty. Ocher afterloading devices micro-~tep a 0.5 ~5 millimeter or le58 (in length) radioactive source and requixe two X-Ray~ 3howing all the tran~port tube~ positioned in the ~ody, from 90 degree angle~. a digiti~er to con~ert the X-Rays which are transmitted to a treatment planning computer and a ~eparate treatment computer to operate the remote afterloader. The remote afterloader according to t~e present invent~on will eliminate all of thi~, since a simple ~hart (based on the activity and length ;~ ~ of the ~ou~ce) would ea~ily display the treatment time required for each radius distance.
Current remote afterloaders req~ire a physical measurement to be made o~ ea~h tran~port ~or treatment) tube, by taking a ~imulation wire, and positioning t~e wire in~ide the tran~port tube by u~e o~ fluoroscopy, mar~ing the wi~e where is exits the tran~port tube, and phy~ically measuring the wire on a calibrated ruler. The~e ~easurementQ mu~t ~e recorded and matched up precisely with each transport tube in ehe X-Ray film~, and entered into the digitized treatment planning computer prlor to a treatment plan being generated.
The remote afterlo.ader, according to the present inv~ntion, eliminates all of the above ~teps. ~he transport (treatment~ tu~e i9 connected to the afterloader and by simply u8ing one of the two hand-held re~ote controls, a dummy (simula-tion) drive member iq advanced into po~ition through a connector 21 Ct7q7G
port of the afterloader and into the body of the patient ~y direct verification ~nder fluo~oscopy. At thi~ point, a ~memorize/home" button is pre~sed and the af~erloader memorizes ~hig position and retracts the si.mulation ~ember to the "zero~
(parked or home) position. The treatment ti~e i~ set either using the remote control unie or b~ u~ing an external ti~er on the afterloader. The operator than ~tands back a safe distance or behind a shield, activates the "active" mode on the remo~e control, pre~ses the nt~eatment" button and t~e active member 1~ including the radioactive source i~ automatically advanced to the memorized pos~tion. At the end of the treatment time, the . radioactive ~ource portion of the acti~e member i-~ automati~ally retracted into the shielding safe in~ide che afterloader. To ensure that the active member iB properly advanced from its 15 n zero" (parked or ho~e) po~ition, the proximal end of ~oth the dummy wire and the active wire ~hould be po~itioned within the afterloader at an equa~ distance fxom the connector port.
Furthermore, the length of the dummy wire and the active ~ire should be equal. Althoug~ only one remote control i~ ~ece~sary, 2~ it i~ strictly for a safety backup ~nd for convenience that two remote contro~ units are provided.
Instead of bulky equipment such as the digiti~er, planning computer, treatme~t comp~ter, and printers, all that i~
neces~ary to operate the remote afterloader i~ a ~imple hand-held remote control. Thi~ ~emote control provide~ many uni~ue features that are simple to u~e. One feature ic a toggle switch that will allow one to ~witch from the dummy (~i~ulation) mode to ~he active (radioactive) mode. An appropriate use for this feature, is after the ~memori2e" button ha~ b~en acti~ated and one wants to double check the treatment po~ition. ~s long as the toggle switch i8 in the dummy mode, the dummy member will ~o to the memorized position (the treatmen~ timer will not ~tart in the du~my mode). ~f everything l~ok~ good, the toggle switch is placed in the active mode and the treaement and timer begin~ once the radioactive member reaches the memorized position.
Another feature oi the remote control i8 a ~irect input on the ~peed in which the remote afterloader advance~ and ,- 2is79~0 retract~ the drive members. By simply turning a knob or pre~sing a counter encompa~sing a speed control for the drive member, ~he speed of the drive mem~er instantly decrease~ or increases. Thi~
is especially u5eful i~ a fine tune po~ition adjustment of a drive member is needed. At any time, the position o$ the dummy or active member, can be fine tuned if nece~sary, ~y si~ply pressing the advance or retract button on che remote control.
Thi~ fine tuning feature would allow che drive member to be advanced or retrac~ed only a small distance, ~uch as a fraction ~f a millimeter. This is accomplished by 8etting the speed control at a very low speed and quickly pres~ins the advance bu~on or retract button. A.c long a~ the 6peed control is 5et at this very low Yalue when either t~e advance button or the retract button very quickly, the drive member will move only a very ~ma~l or precise distance. Repeating this fine tuning procedure will place the drive member precisely where indicated.
The remote control also feature~ a direct di~tance display of the driYe ~ember a~ it i-~ moving, ~ di~pl~y o~ the treatment timer ~s it is counting down, a~ well as an emergency retract button. When the e~ergency retract button is pre~sed, che timer in~tantly stops and the acti~e member retracts into t~e ~hiclded safe. If the afterloader is operating prope~ly, pressing the treatment buteon again will send the active member to the proper location and the timer will re~ume from where it lef~ o~f once the active ~ember reachec its treatment position.
There axe ~everal safety features uced ~o assure that ~oth of drive r~r~ rs ~re parked precisely in po~ition in the afterloader, The remote afterloader contains optical sensors behind the parked Ihome or zero) po-~ition. Prior eo each treatment, the dri~e mech~nism "zeros~ each dri~e member by retracting the dsive member (dummy or active treatment wires) until the optical ~enRors do not ~ense the drive member. At thi~
point, the drive mechani8m im~ediately StopQ and ad~ances the drive member until it is ~ensed by the optical sen~or, and than 3s advance~ the drivel ~r a ~ecified distance to the home (zero) position, ~n encoding sy~tem is also connected to each drive member as another backup safety deYice. During ~he aforemen--- 21 qi970 tioned zeroing procedure, ~f the optical ~ensors were to fail, the encoding ~ystem would noe allow the retraction of the drive member~ pa6t a certain point. For e~ample, the optical sen-~or a3sociated with the ~ctive dri~e member is located inside the shielding ~afe, but distal to the radioactive ~e~ment of the acti~e drive member. If the optical sensor was to fail, the encoding ~ystem would not allow the radioactive segment to be retracted from the distal end of the.~afe. The encoding sy~tem would register an ~error and code n~mber" on the distance display 0 window of the remote control, indicatin~ the problem. The radioacti~e core would still be ~afely contained inside the ~hieldin~ safe of the afterloader.
Anot~er ~fety feature is that, during the retraction o~ a drive member fro~ a transport tu~e, the encoding sy~tem will temporarily stop the drive member at the same number of counts from where it started and then the zeroing feature will be implemented. For example, if ~he encoding system counted 5020 ~ounts for a dri~e me~ber when it was advanced forward, i~ will count down to exactly 5020 coun~s on the retraction, stop the l~e~ent~ and the zeroing function will take o~er. This is a sa~eguard fro~ the member being recracted too fast into the afterloader and overriding the zeroing capa~ilities.
The encoding sys~em also ~onitors che dri~e me~ber for slippa~e and accuracy. The encoding system corrects for both many times a ~econd ~a the drive me~ber i8 being advanced and re~racted.
Prior art afterloaders use an indirect method to check ~hat a eransport tube is proper~y connected. A separace ~onnector grip~ a transport tube and then lock~ it into the afterloader. This connec~or ha~ a plunger that extends from the connector~ diseal end when a transpo~t tube is placed into the connector' 8 proximal end. A optical sensor in~ide the aftex-loader 6enses this extended plunger and indi~ates to the after-loader i~ is po~sible to send out the drive membex. A ~he connector become~ weak, or fu}l of debris, the p7unger ca~ extend and indicate ehat a transport tube is in place when in actuality, a transport ~ube i~ not even pre-cent. There are many times when - 2197~70 a transport tube ha~ fallen out of this type of connector due to a weak ~ip or improper hook-up. If the machine sends out a radioacti~e member and no transport tube is present a dangerouQ
~ituation can occur.
s ~o eliminate ehe problem, the pre~ent invention employs a direct sen~ing ,..nchani.sm that will indicate that the transport tube is properly connected directly to t~e afte~loader. The hub of the transport tube will slide into the ~onnector port o~ the afterloader, ~onnect to the dri~e tube through which the drive member exits, and depre~ a pres~ure sensor or mechanical switch.
A locking mechanism on the afterloader ~uch a~ a Qloteed plate, will lock againQt the outside of the hub or onto the transport tube to hold the cransport tube in place. A grippi~g apparatu~
similar to the device that holds a drill bit in~ide a drill could also be u~ed to l~ck onto the tubing to lock ehe transport tube to the af terloader . The pre~sure sensor or mechanical switch m~ indicate a certain a~ount of pressure, or be depressed, or electronics of the afterloader will cause ~he drive me~be s to be in their zero ~parked) positions. Unless the transport tube is ~roperly positioned, the afterloader will not allow the drive members to move from their zero position.
21 ~7570 }o ~RIE~ D~SCRIPT~ON QF THE DRAWIN~S
For a more complete understanding of the pre~ent inven-tion, and the advanta~e~ thereof, reference is now made to ehe follo~ing descriptions taken in conjun~tion with the acco~panying drawing~, in which:
P~GURE 1 is a view of the remote control unit of the present invention 6howin~ the display~ and functions;
~rauRE 2 i~ a similar vieW of the remote control in Fig~re 1, ~howing a different mean~ to pl~y~am ~he speed in ~hich the drive member~ travel;
FIgURE 3 i~ a partial cros~-section of the co~nector port exiting ~he end of the remote afterloader, showing a pressure or mechanical switeh, a locking mechani~m in the open position, and a eran~por~ tu~e ready to ~e connected to the remo~e afterloa~eri PI¢~RE 4 i~ a partial cross-~ection demonstrating the proper connection of the transport tube to the remote after-loader:
FIG~RB S is a frontal view ~howing a first embodiment ~25 of the locking me~han~m holding the transport tube in place;
, ~ FIGURE 6 i~ a frontal view chowlng a second embodiment of the locking mechanism holding the transport catheter in place;
and FIG~RE 7 is a ~chematic view of the afterloader connected to a pa~ient.
- 2 i 9~7û
DSTAl'T ~ DESCRIPTIO~ QF 1~ rK~ OD~MF.N~r~
The present invention relates to the ~mpro~ed design and manufactuxe of re~ote afterloaders. The invention relates to a nov~l, compact, ~ightweight, ea~lly p~rta~le, self-con-tained, afterloading unit that ~an easily fit into the trunk ofa small car and be mo~ed from site to site. Afterloading ~nits on the market today are too bulky or cumbersome to be ea~ily tranQportcd. All current afterloading units are ~ery expensive, bulky in size, and require a great amount of extra equipment including computers, a di~itizer, and printers. They also require a ~pecial hook-up to wor~stations in order for the afterloader to operate correctly.
The set-up proce~ure for prior art af terloaders i5 complicated an~ time consuming, making them unu~able for treating many types of disease~ in ~hich time i~ a critical factor. The present in~ention is a ~imp~er design with very little ~et-up ti~e and improved ~afety fea~ures. The pre~ent inven~ion is operated either through direct A~ power or by an uninterrupted power supply (UPS), in case of a power failu~e. Although the present invention i~ designed primarily for th~ treatment of vascular restenosis, it can be u~ed to t~eat other diseases of ' the body, -Ruch as ca~cer.
Referring now to the drawings, and initially to FIGURE
l, it is empha~ized that the Figures, ~r drawings, are not 2~ intended to be to ~cale. ~IGURE 1 illustrate~ a hand-held remote control unit 10. This i~ the only eguipment needed to operate the remote afterloader. The remote control unit l~ incl~de~
several di~plays and unique features pertaining to the u~e of remotely controlling the operation of the afterloader, For example, a direct distance readout 12 of a flexible drive member a~ it travels thxough ~he t~an~por~ ~ube i-~ pro~ided. The distance readout can be programmed to display count~, centime-ters, inche~, or fractions the~eof. A ~econd display feature 14 provides a direct readout of treatment time. It will count down fro~ the total time in seconds to perform a treatment procedure.
The count down timer can be programmed by depressing the 2i q7970 corresponding buttons 16 below the di~play or by an external count down timer on the afterloading unit.
The remote control unit includes a toggle switch 18 or similar device that will enable the operator to control eieher 5 the dummy (~imulation) dri~e member Or the aceive (radioacti~e) drive me~ber. A neutral position is also provided that allows the a~terloader to be ~u~ned on and prevent~ any communication ~etween the remo~e control and the afterloader. A green light 20 or oeher colored or similar display device i8 ill~mina~ed when 10 the toggle switch 18 i-~ in the dummy mode, and a red light 22 or other colored or ~imilar display device is illumiAated w~en the toggle switch 18 i~ in the active mode. A ~reen li~h~ 21 or other colored or similar display device is illumi~ated when the dummy drive mem~er is in its "parked" (home) position inside the afterloader. A green light 23 or other colored or ~imilar display device is illuminated when the active dri~e member in its ~parked~ (home) position i~side the afterl~ader. When the dummy member i5 mo~ing, the green light 20 will fla~h. When the ac~i~e member i~ moving, the red light 22 will fla~h. No lights other than the parked lights 21 and 23 (if the drive members are in their parked ~home) po~ition) will be illuminated if the toggle ~witch 1~ is in the neutral position. To advance either the dummy or the a~tive me~ber, the toggle switch 18 mu3t be in the correct corresponding mode and ~n advance button or similar 25 control 24 must be depressed or eng~ged. To retract either the du~my or t~e active member, the toggle 8witch 1~ mu~t be in the correct corre~ponding mode and the retraet ~utton 26 or ~imilar detrice must be depressed or engaged.
The ~peed in which the drive me~hanism3 advance a~d retrace t~e dummy or active member i~ controlled from a rotatable knob 28 ~rheostat1 as in P~¢uRE 1, or from a --erie~ of program~a-ble push buttons 32 a~ indicated by the remote unit 11 shown in ~G~R~ 2. This feature is very important for fine tuning che placement of either the dummy or the acti~re menber. The actual ~peed o~ the dri~e ~echanisms controlled by the ~peed control 32 i~ ~llu-~trate~ in di~play 30.
13 2 1 9797ù
The next control i~ a push ~utton 34 labelled "Memorize / Home". T~i~ control is used once the exact placement of the du~y member in the ~imulated treatment position i~ obtained.
Normal u~e of the control~ will ~e a~ ~llows: The dis~al end 5 of a trancport tube will be placed inside the body and the proY; -1 end will be connected to t~e remote afterlo~der. The to~gle 6witch 18 will be placed in the dummy position. Depre~-cion o~ the ad~ance butt~n 24 and turning or programming the speed control will dri~e the d~mmy member lnto position ~ithin 1~ the body of the patien~. Fluoroscopy i8 used to monitor the ll.O~ -nt of both of the drive members. ~s the dummy member approaches the target area in the body, it i~ advisable to decrease the speed so a precise placement of the dummy member in the treatment area can be obtained. Releasing the advance or retract button 24 or 26 i~medi~tely stOp~ the member movement.
Once optimal placement ls achieved, the memorize / home button 34 i~ depre~sed which would immediately memorize the exact po~ition of the dummy member ~nd retracts the dummy member ~o it~
zero (parked or home) poQition. The trea~ment time~ 16 is ~et for the total treatment time. The position of ~he dum~y member can be checked a~ many times as needed by pressing a treatment button 36. The count down timer will not ~tart ~ long as the toggle switc~ 18 is in the dummy (or neutral) position. The real tre~tment begins by placing the toggle switch 18 in the acti~e po~ition ~nd pressing the treat~ent button 36. The afterloader automati~ally advances the active member to the memorized position. Once the active member is in position, the count do~n timer ~tart~. When the count down timer reache~ zexo, as shown in display 14, the afterloader automatically retrac~ the 3~ radioactive ~egment of the active member into a shielding safe located inside the afterloader.
If an emergency develops, presQing an emergency stop button 3~ automatically stop~ ~he timer and recracts the active member into the shielding safe inside the remote afterloader.
Once the emergency has p~s~ed, the positioning can be re~hecked by placing the to~gle switch in the dummy ~ode and pre~sing the treatment button 36. If everything is in order, the treatment . 21q7~70 can resu~e where it left off, by placing the toggle switch in the active mode and pressing the treatment bueton 36. The acti~e member will travel to the memorized position and the treatment timer will resume where it left off.
A final -~afeguard on the remote control i~ a key lock 40. A key must be inserted into a sdot 42 in the remote contxol and turned co ~he ~On" poQition or no cc~lJnications from ehe re~ote control to the afterloader i~.possible.
~I~URE 3 illustrates a sensing device that directly senses the presence of a transport tube (treat~ent catheter) 44 provided with an enlarged hub ~6 at one end. A connec~or port on the remote afterloader has a place to hook the transport tube 44 from the patient to the remote afterloader. A mechanical switch 48 provided with a pre~ure sen~ing device 50 is located inside the connector port of the remote afterloader and iq in direct co~munication~ with the electronics that are responsible for the~..ove.~,cnt of che dri~e member~ via wires 52. Alternative-ly, non-hard wired communication can be u~ed. FIGURB 3 ~hows the mechanical ~wit~h or pres~ure sensing device ~n the open ~0 position. In thi~ open position t~e afterloader will not allow the drive mem~er~ to move from their zero (home) po~ition~.
F~GU~E 3 alQo shows a locking mecha~ism 56 that will hold the tranCport t~be 46 in place. In thi~ figure the locking mechanism in the unlocked position.
~I~URE 4 illu5trates the correct ~ook-up between the tran~port tube 44 and the remote aftexloader. The pressure sensing device SO of the switch 4~ i8 depres~ed and the transport tube i~ loc~ed fir~ly to the afterloader by a slide plate 5~ with an opening too small to allow the hu~ 46 of the t~an~port tube 3~ to pull through. Since the pre~sure ~en~or is depre~ed, a signal is sent to the controller electronics to allow movement of one of the drive ~embers through an exit por~ S4 and chen through the transport tube 44- ~he s~gnals are monitored many times a s~cond ~y the controller electronic~ for some reason ~he dri~e ~em~er tdummy or active) was adv~nced and the transport tube becomes detached fro~ the connector port, the sen~or 50 would immediately detect that no transport tube was present and ~ i 9i9 jo signal the controller to im~ediately retract the d~ive ~ember to its zero ~ho~e or p~r~ed~ po~ition. An error message with a code number (indicating ~he problem are~) would ~how up on the distance o~ count display 12.
5FIGURE 5 ~llu~trates the locking device a~ described in FIGURE 4 flrmly holding the transport tube in the locked po~ition. The locking device include~ the sliding plate 5~ that ~its into horizonal guiding channels 60, 62 located adjacene to the exit port o~ the remote afterloader. The ~lidin~ plate locontain~ ~ lip 64 ~ox proper Qea~ing in the top horizontal gu~ding ch~nnel 60. The 61iding plate can contain an opening large enough to allo~ the tubing section of the transpor~ tube to pa~s, but ~ot the hub of the transport tube, or it can bite -or grip onto the wall of the ~ublng section of the tran~port 15tube. Thi3 opening i8 created by providing two horizo~tal portions 66, 6~ connected to a vertical portion 70.
FIGU~E 6 illustrates a locking device ~imilar in function to FIGURE 5 In~tead of a ~liding plate that ~its into horizonal channel~, a rotating plate 72 will re~t o~ a stopper ~o74, which linec it up with a threaded hole on the remote after-. loader and the end of the rota~ing plate locks Lo this t~readed hole by meanQ of a threaded screw. Thi~ rotating plate, like the locking device i~ FIGURE 5, can contain an opening large enough to allow the tubing section of the transport tube to pass, but 25not the hub of the transport tube, or it can bite or grip onto the wall of the tubing ~ection of the tran~port tlube.
FIG~RE 7 illu~trate-~ an afterloader 76 whi~h is used in conjunction with the remote controller of the precent inventio~ to treat a patient with radioactive material. This 30afterloader i~ powered by an uni~terruptable power ~upply ~UPS) 102 which is connected to the afterloader 76 by a standard wi~e or cable 108. The UPS 102 is connected, by a standard wire or cable llo to a ~tandard plug 1~4 which would be inserted into an electrical outlet. Bo~h the UPS lOZ ~9 well as the remote units 3510, 11 ~oted by 112 in FIGURE 7) are connected to a controller unit 106 ~ia a st~d~rd wire or cable 114. ~he control~e~ 106 is provided within the afterloader un~t and would include . - 21~/9i~0 suitable electronics including a ~olid 8tate memory unit for controllin~ the operation of the afterloader. It is noted that the controller 106 could be pro~ided with an internal power supply, such a~ a serie~ of rechargeable ~atteries. In this S instance, the UPS 102 becomeQ unneces~ary. Furthermore, a wireless communication link can be establ~shed between the remote unit 112 and the controller 106, eliminatin~ the need for wire or cable 114. Typica~ly, an infrared or radio freq~ency ~ignal can be utilized in this mode.
The af~erloader ~6 include~ a dum~y wire 116 which would be inserted ~n~o a patient to deter~i~e the correct treatment position. ThiQ wire 116 is provided on a pulley 9~.
Drive rollers 90, g2 would allow the dummy wire 116 to be advanced through the afterloade~, out of a connector 9B shown in FIGS. 3 and 4 and into the patient through treatment tube or cathete~ 100. One or both of the drive roller~ 90, 92 can be pro~ided with an encoder used to di~play the exac~ po ition o~
the du~my wire 116 within the body of the patient. The encoder would read the ~oving wire ~y direct co~tact or by direct attachment to a movin~ ~echanism that is in direct contacc with the moving w~re. The encoder is in direct contact wich the controller 106 by a wire 118 or other means of conveying i~formation from the encoder to the controller 106. An opcical ~en~or or mechanical switch 122 detects the proxi~al end o~ the wire and sends a si~nal to the controller 106 via a wire 126.
The controller 106 uses this information in combination with the - ~ signal~ from the encode~ to position the dummy wire in it6 "zero"
or ~parked" home po~ition. The distal end of the ~ire wraps a~ound a pulley 94 which moves in uni~on with the drive rollers 90, 92. The controller 106 use~ signal~ fro~ the encoder to control the movement of the pulley 94 via a wire 131 ~o that excesa wire can be safely stored in a coiled manner until needed.
The pulley ~ystem has a ~orward built-in brake system th~t will not allow the drive rollers to advance the wire co~pletely ~rom ~5 the pulley. The pulley also contain6 ~ reverse built-in brake $ystem that will not allow the rollers to retract the wire beyond it-Q home po~ition. Shis brake ~ystem could be a mechanical lock ~ 97970 .
that will only allow a set amount of rotation before a peg or rod wou~d rest against'an adjustable ~determined by the overall length of the wire) stop and not allow fur~her rotation. When the peg rest8 against the stop, a signal is sent to the control-ler to immediately stop rotation of the drive roller. At thispoint, if neces~ary, the operator can send a signal from the remote unit 112 to the controller 106 to retract the wire if the forward ~rake system is enga~ed, or send the ~ignal to advance the wire if the reverse ~rake sy~tem is engaged.
The afterloader al80 includes an aetive treatment wire 118. a pulley 78, drive rollers 82, 84, at least one encoder, an~
an optical sensor or mechanical switch 8B which would operate in the manner just described with respect to the dummy wire transport system. Information from an encoder provided proximate to the rollers 82, a4 is transmitted through the controller 10~
by a wire 120. Additionally, information from the optical sensor 88 i~ transmitted to the controller 106 via a standard wlre 124.
The controller 106 use~ signals from the encoder to control the movement of the pulley 78 via wire ~30 60 that exce6s wire can be ~afely stored in a coiled mannex until needed. A shielded safe ~6 i~ included through which the treatment wire 118 will pass. This treatment wire includes a radioactive element or elements which would be used to treat the patient. When the treatment wire i9 retracted ~nto the afterloader, the radioactive element or elements would ~e stored in the safe 86 when the treatment wire i~ in it~ home position. It is noted that the optical sensor ~ is located prox~mal to the shielded ~afe ~6, but could be positioned in the shielded safe.
The a~orementioned emerging stop button 38 wou~d 3~ operate in conjunction with either an emergency retrac~ion device 80 for retracting the radioactive treatment wire 11~ into ~he safe 80, or with retraction device ~6 for retracting the in~ctive dummy wire 116 to its home ~osition within the afterloader.
Theqe retraction devices can also be operated manually.
The pre~ent invention has thus been descri~ed, but it i8 desired to be understood that it is not conf1ned to the particular forms or uses as shown and de6cribed, the same being 2 1 9/~70 merely illustr~tive, and that the invention may be carried out in other ways without departing from the 5pirit of the invention.
Therefore, the right is broadly claimed to employ all equivalent instrumentalitie5 coming within the ~cope of the claims. It i~
S also maintained that the particular embodiments herein shown and descr~bed are only some of the many that can be employed to obtain the results and o~jects of the present invention.
Claims (12)
1. A control unit used to remotely operate an after-loader provided with a radioactive source wire, an inactive treatment wire, a connector port through which the radioactive source wire and the treatment wire would travel, and an electronic controller provided with a memory, the control unit comprising:
a communications device between the control unit and the electronic controller;
a first control device provided in the control unit for activating movement of the inactive treatment wire;
a second control device provided in the control unit for entering the distance traveled of the inactive source wire into the electronic controller when the inactive source wire is advanced to a treatment site in a patient;
a third control device provided in the control unit for advancing the radioactive source wire the same distance entered into the electronic controller by said second control device enabling the radioactive source wire to be advanced to the treatment site in a patient.
a communications device between the control unit and the electronic controller;
a first control device provided in the control unit for activating movement of the inactive treatment wire;
a second control device provided in the control unit for entering the distance traveled of the inactive source wire into the electronic controller when the inactive source wire is advanced to a treatment site in a patient;
a third control device provided in the control unit for advancing the radioactive source wire the same distance entered into the electronic controller by said second control device enabling the radioactive source wire to be advanced to the treatment site in a patient.
2. The control unit in accordance with claim 1 further including a means for incrementally adjusting the position of the radioactive source wire and the inactive treatment wire.
3. A device for treating a patient including:
an afterloader unit provided with a radioactive source wire, an inactive treatment wire, an exit port through which said radiation source wire and said inactive treatment wire pass, a first encoder for sensing the distance said inactive treatment wire travels, a second encoder for sensing the distance said radioactive source wire would travel, an electronic controller provided with a memory connected to said first encoder and said second encoder;
a communication device; and a control unit in communication with said electronic controller through said communication device, said control unit provided at a location remote from said afterloader, said control unit further provided with a first control device for activating the movement of said inactive treatment wire, a second control device for entering the distance traveled of said inactive treatment wire into said electronic controller when said inactive source wire is advanced to a treatment site in a patient, and a third control device for advancing said radioactive source wire the exact distance entered into said electronic controller initiated by said second control device enabling said radioactive source wire to be advanced to the treatment site in a patient.
an afterloader unit provided with a radioactive source wire, an inactive treatment wire, an exit port through which said radiation source wire and said inactive treatment wire pass, a first encoder for sensing the distance said inactive treatment wire travels, a second encoder for sensing the distance said radioactive source wire would travel, an electronic controller provided with a memory connected to said first encoder and said second encoder;
a communication device; and a control unit in communication with said electronic controller through said communication device, said control unit provided at a location remote from said afterloader, said control unit further provided with a first control device for activating the movement of said inactive treatment wire, a second control device for entering the distance traveled of said inactive treatment wire into said electronic controller when said inactive source wire is advanced to a treatment site in a patient, and a third control device for advancing said radioactive source wire the exact distance entered into said electronic controller initiated by said second control device enabling said radioactive source wire to be advanced to the treatment site in a patient.
4. The device in accordance with claim 3 further including a connector for attaching a treatment tube to said exit port of said afterloader, said connector provided with a mechanical sensor which is directly impinged upon by the treatment tube when the treatment tube is properly inserted into said afterloader through said exit port, said mechanical sensor in communication with said electronic controller.
5. The device in accordance with claim 4 wherein said connector is further provided with a locking means for positively attaching the treatment tube to said afterloader.
6. The device in accordance with claim 5 wherein said afterloader includes first and second channels provided above and below said exit port through which said locking means pass.
7. The device in accordance with claim 3 further including a shielded safe in which said radioactive source wire is stored.
8. The device in accordance with claim 7 further including a first optical sensor for determining the position of said radioactive source wire when it is at its home position and a second optical sensor for determining the position of said inactive treatment wire when it is at its home position.
9. The device in accordance with claim 3 further including a means for retracting said radioactive source and said inactive treatment wire to their respective home position upon sensing a power failure on a failure of said electronic controller.
10. The device in accordance with claim 9 wherein said means for retracting said radioactive source and said inactive treatment wire is a mechanical crank for rotation only in a retraction direction.
11. The control unit or device in accordance with any of the preceding claims further including a speed control device for regulating the speed of movement of the radioactive source wire and the inactive treatment wire.
12. The control unit or device in accordance with any of the preceding claims further including a fourth control device for immediately retracting the radioactive source wire or the inactive treatment wire to its respective home position.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US08/603,272 | 1996-02-20 | ||
| US08/603,272 US5800333A (en) | 1996-02-20 | 1996-02-20 | Afterloader provided with remote control unit |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2197970A1 true CA2197970A1 (en) | 1997-08-21 |
Family
ID=24414727
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002197970A Abandoned CA2197970A1 (en) | 1996-02-20 | 1997-02-19 | Afterloader provided with remote control unit |
Country Status (5)
| Country | Link |
|---|---|
| US (1) | US5800333A (en) |
| EP (1) | EP0791374B1 (en) |
| CA (1) | CA2197970A1 (en) |
| DE (1) | DE69728921T2 (en) |
| ES (1) | ES2216078T3 (en) |
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-
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- 1997-02-20 EP EP97102819A patent/EP0791374B1/en not_active Expired - Lifetime
- 1997-02-20 ES ES97102819T patent/ES2216078T3/en not_active Expired - Lifetime
- 1997-02-20 DE DE69728921T patent/DE69728921T2/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| DE69728921T2 (en) | 2005-04-07 |
| EP0791374A2 (en) | 1997-08-27 |
| ES2216078T3 (en) | 2004-10-16 |
| DE69728921D1 (en) | 2004-06-09 |
| EP0791374A3 (en) | 1999-03-31 |
| EP0791374B1 (en) | 2004-05-06 |
| US5800333A (en) | 1998-09-01 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| FZDE | Discontinued | ||
| FZDE | Discontinued |
Effective date: 20050221 |