EP1827505A2 - Radioimaging - Google Patents
RadioimagingInfo
- Publication number
- EP1827505A2 EP1827505A2 EP05803158A EP05803158A EP1827505A2 EP 1827505 A2 EP1827505 A2 EP 1827505A2 EP 05803158 A EP05803158 A EP 05803158A EP 05803158 A EP05803158 A EP 05803158A EP 1827505 A2 EP1827505 A2 EP 1827505A2
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- radioactive
- emission
- camera
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01T—MEASUREMENT OF NUCLEAR OR X-RADIATION
- G01T1/00—Measuring X-radiation, gamma radiation, corpuscular radiation, or cosmic radiation
- G01T1/16—Measuring radiation intensity
- G01T1/161—Applications in the field of nuclear medicine, e.g. in vivo counting
- G01T1/1615—Applications in the field of nuclear medicine, e.g. in vivo counting using both transmission and emission sources simultaneously
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/41—Detecting, measuring or recording for evaluating the immune or lymphatic systems
- A61B5/414—Evaluating particular organs or parts of the immune or lymphatic systems
- A61B5/415—Evaluating particular organs or parts of the immune or lymphatic systems the glands, e.g. tonsils, adenoids or thymus
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- A61B5/414—Evaluating particular organs or parts of the immune or lymphatic systems
- A61B5/418—Evaluating particular organs or parts of the immune or lymphatic systems lymph vessels, ducts or nodes
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- A61B6/03—Computerised tomographs
- A61B6/037—Emission tomography
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- A61B6/4208—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector
- A61B6/425—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector using detectors specially adapted to be used in the interior of the body
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- A61B6/4208—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector
- A61B6/4258—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis characterised by using a particular type of detector for detecting non x-ray radiation, e.g. gamma radiation
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- A61B6/4291—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with arrangements for detecting radiation specially adapted for radiation diagnosis the detector being combined with a grid or grating
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- A61B8/4416—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to combined acquisition of different diagnostic modalities, e.g. combination of ultrasound and X-ray acquisitions
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- G—PHYSICS
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- G01T1/16—Measuring radiation intensity
- G01T1/161—Applications in the field of nuclear medicine, e.g. in vivo counting
- G01T1/164—Scintigraphy
- G01T1/1641—Static instruments for imaging the distribution of radioactivity in one or two dimensions using one or several scintillating elements; Radio-isotope cameras
- G01T1/1642—Static instruments for imaging the distribution of radioactivity in one or two dimensions using one or several scintillating elements; Radio-isotope cameras using a scintillation crystal and position sensing photodetector arrays, e.g. ANGER cameras
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- G01T—MEASUREMENT OF NUCLEAR OR X-RADIATION
- G01T1/00—Measuring X-radiation, gamma radiation, corpuscular radiation, or cosmic radiation
- G01T1/29—Measurement performed on radiation beams, e.g. position or section of the beam; Measurement of spatial distribution of radiation
- G01T1/2914—Measurement of spatial distribution of radiation
- G01T1/2985—In depth localisation, e.g. using positron emitters; Tomographic imaging (longitudinal and transverse section imaging; apparatus for radiation diagnosis sequentially in different planes, steroscopic radiation diagnosis)
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
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- A61B5/7285—Specific aspects of physiological measurement analysis for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal
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- A61B6/501—Clinical applications involving diagnosis of head, e.g. neuroimaging, craniography
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- A61B6/502—Clinical applications involving diagnosis of breast, i.e. mammography
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- A61B6/507—Clinical applications involving determination of haemodynamic parameters, e.g. perfusion CT
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- A—HUMAN NECESSITIES
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- A61B6/548—Remote control of the apparatus or devices
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- A61B6/00—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment
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- A61B6/582—Calibration
- A61B6/583—Calibration using calibration phantoms
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0825—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of the breast, e.g. mammography
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- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
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- A61B8/543—Control of the diagnostic device involving acquisition triggered by a physiological signal
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01R—MEASURING ELECTRIC VARIABLES; MEASURING MAGNETIC VARIABLES
- G01R33/00—Arrangements or instruments for measuring magnetic variables
- G01R33/20—Arrangements or instruments for measuring magnetic variables involving magnetic resonance
- G01R33/44—Arrangements or instruments for measuring magnetic variables involving magnetic resonance using nuclear magnetic resonance [NMR]
- G01R33/48—NMR imaging systems
- G01R33/4808—Multimodal MR, e.g. MR combined with positron emission tomography [PET], MR combined with ultrasound or MR combined with computed tomography [CT]
- G01R33/481—MR combined with positron emission tomography [PET] or single photon emission computed tomography [SPECT]
Definitions
- the present invention relates to nuclear imaging, and more particularly, to systems, methods, and cameras for radioactive-emission detection and measurements, without coincidence, with sensitivity which meets, and even outperforms that of PET, in terms of speed and spatial resolution, and with a high spectral resolution not available in PET.
- Radionuclide imaging aims at obtaining an image of a radioactively labeled substance, that is, a radiopharmaceutical, within the body, following administration, generally, by injection.
- the substance is chosen so as to be picked up by active pathologies to a different extent from the amount picked up by the surrounding, healthy tissue; in consequence, the pathologies are operative as radioactive-emission sources and may be detected by radioactive-emission imaging.
- a pathology may appear as a concentrated source of high radiation, that is, a hot region, as may be associated with a tumor, or as a region of low-level radiation, which is nonetheless above the background level, as may be associated with carcinoma.
- a reversed situation is similarly possible.
- Dead tissue has practically no pick up of radiopharmaceuticals, and is thus operative as 1 a cold region.
- the mechanism of localization of a radiopharmaceutical in a particular organ of interest depends on various processes in the organ of interest such as antigen- antibody reactions, physical trapping of particles, receptor site binding, removal of intentionally damaged cells from circulation, and transport of a chemical species across a cell membrane and into the cell by a normally operative metabolic process.
- a summary of the mechanisms of localization by radiopharmaceuticals is found in http ://www. lunis . luc. edu/nucmed/rutorial/radpharm/i.htm.
- radionuclide for labeling antibodies depends upon the chemistry of the labeling procedure and the isotope nuclear properties, such as the number of gamma rays emitted, their respective energies, the emission of other particles such as beta or positrons, the isotope half-life, and the decay scheme.
- PET imaging positron emitting radio-isotopes are used for labeling, and the imaging camera detects coincidence photons, the gamma pair of 0.511 Mev, traveling in opposite directions. Each coincident detection defines a line of sight, along which annihilation takes place. As such, PET imaging collects emission events, which occurred in an imaginary tubular section enclosed by the PET detectors.
- a gold standard for PET imaging is PET NH 3 rest myocardial perfusion imaging with N- 13- ammonia (NH 3 ), at a dose level of 740 MBq, with attenuation correction. Yet, since the annihilation gamma is of 0.511 Mev, regardless of the radio-isotope, PET imaging does not provide spectral information, and does not differentiate between radio ⁇ isotopes.
- each detecting unit which represents a single image pixel, has a collimator that defines the solid angle from which radioactive emission events may be detected.
- PET imaging collects emission events, in the imaginary tubular section enclosed by the PET detectors, while SPECT imaging is limited to the solid collection angles defined by the collimators, generally, PET imaging has a higher sensitivity and spatial resolution than does SPECT. Therefore, the gold standard for spatial and time resolutions in nuclear imaging are defined for PET.
- Radiopharmaceuticals are a powerful labeling tool, yet the radiation dose to the patients needs to be taken into account.
- the becquerel (Bq) is the unit of radioactivity.
- One Bq is 1 disintegration per second (dps).
- the curie (Ci) is the old standard unit for measuring radioactivity of a given radioactive sample and is equivalent to the activity of 1 gram of radium, originally defined as the amount of material that produces 3.7 x 10 10 dps.
- 1 GBq 27 millicuries.
- the rad is a unit of absorbed radiation dose in terms of the energy deposited in a living tissue, and is equal to an absorbed dose of 0.01 joules of energy per kilogram of tissue.
- the biologically effective dose in rems is the dose in rads multiplied by a "quality factor" which is an assessment of the effectiveness of that particular type and energy of radiation. Yet, for gamma and beta rays, the quality factor is 1, and rad and rem are equal.
- the relative biological effectiveness (rem) may be as high as 20, so that one rad is equivalent to 20 rems.
- the recommended maximum doses of radiopharmaceuticals are 5 rems for a whole body dose and 15 rads per organ, while the allowable dose for children is one tenth of the adult level. The per-organ criterion protects organs where accumulation takes place.
- radiopharmaceuticals for which removal is primarily by the liver should be administered at a lower dose than those for which removal is partly by the liver and partly by the kidney, because in the former, a single organ is involved with the removal, and in the latter, there is sharing of the removal.
- radiopharmaceuticals which have a long half life
- radiopharmaceuticals which have radioactive daughters
- Radioimaging methods, devices and radiopharmaceuticals therefor are provided.
- the present invention is of radioimaging cameras characterized by unprecedented high sensitivity allowing for high resolution image aquizition for use in diagnostics; algorithms and systems operable in conjunction with the camera, the algorithms and systems include, but are not limited to, predermined view selection algothim and system, active vision (on flight view selection) algothim and system, closed loop administration of a radiopharmaceuticallgothim and system, expert system diagnostic algothim and system, automatic dose preparation algorithm and kinetic parameter extraction algothim and system; low dose radiopharmaceuticals; combinations of radiopharmaceuticals either as compositions (cocktails) and/or kits; an administering device of radiopharmaceuticals, which may include syringes, pumps and IV lines; mixers for mixing different radiopharmaceuticals; and an ERP system for controlling and monitoring each one or more of the above.
- the present invention emerges from the development of a radioimaging camera characterized by unprecedented sensitivity.
- the sensitivity of the camera is attributed, as is further detailed hereiunder, to at least the following constructual features: (a) a plurality of detecting units; (b) movability of the detecting units one with respect to the other; (c) thus allowing concetrated focus on a region-of-interest by the individual detecting units; and (d) weiring diagaram with minimal multiplexing, thereby preventing saturation thereof.
- the inventors of the present invention developed low dose preparations of radiopharmaceuticals and compositions and kits comprising two or more radiopharmaceuticals adapted for use in conjunction with the camera and all other aspects of the invention.
- the probe system includes multiple blocks of detectors positioned in a structure encircling the imaged area, each is able to rotate about a longitudinal axis substantially parallel to the main axis of the subject. In a further example case of 10 such blocks of detectors, each covering a
- substantially all detectors are able to simultaneously image the region of interest containing the point source and thus obtaining one out of every 500 of the emitted photons. It is known to the skilled in the art that further opening the energy window of the detector to about 15%, enables acquisition of about one out of 250 photons of the photons emission in an experimental setting similar to the previous example.
- each such detector having multiple pixels is of about 5 cm wide or more, thus producing a region of interest of at least 5 cm in diameter, from which said sensitivity and said resolution is being obtained even without the need to move any of the detectors.
- each detector is about 10cm wide, thus enabling regions of interest of even bigger diameters at said resolution and sensitivity with a smaller detector motion such that bigger objects are continuously viewed by the detector with only small angular detector motion.
- the detectors array may encircle the imaged subject to the extent of 360 deg, for example by having two hemi circles from both sides of the subject.
- the sensitivity in such case is estimated be about 1 in 125.
- additional detectors may be positioned to obtain views not perpendicular to the subject's main longitudinal axis, for example by upper view (e.g. from the shoulders) and abdominal view of the target region (in the case of cardiac mapping). It is estimated that such addition may increase the sensitivity but a factor of about x2.
- an example embodiment of the present invention is estimated to be able to image a volume of about 5cm diameter located about 150mm from the detectors, with energy window of 15%, producing spatial resolution of about 5mm in approximately lOOsec, with a total sensitivity of about 1 photons being detected out of 65 emitted.
- FIGS. IA - IB schematically illustrate detecting units and blocks for radioactive emission detection
- FIG. 2 schematically illustrates the basic component of a system, comprising a radioactive-emission camera and a position-tracking device, both in communication with a data-processing system;
- FIGS. 3A - 3B schematically illustrate the manner of operating the radioactive-emission camera with the position-tracking device
- FIGS. 4 A — 4C schematically illustrate extracorporeal and intracorporeal radioactive-emission camera operative with position-tracking devices
- FIGS. 5 A — 5F present the principles of modeling, for obtaining an optimal set of views, in accordance with the present invention
- FIGS. 6 A and 6B pictorially illustrate a view and viewing parameters associated with it, in accordance with definitions of the present invention
- FIGS. 7 A - 7C schematically illustrate anatomical constraints, which are to be modeled, in accordance with the present invention
- FIG. 8 illustrates, in flowchart form, a method of predefining a set of views for functional imaging, tailored for imaging a specific body structure, and optimized with respect to the functional information gained about the body structure, in accordance with the present invention
- FIGS. 9A - 9F schematically illustrate possible models and collections of views, for a body structure, in accordance with the present invention.
- FIG. 10 illustrates, in flowchart form, a method of functional imaging, tailored for imaging from esophagus, and optimized with respect to the functional information gained about the body structure, in accordance with the present invention
- FIG. 11 schematically illustrates the process of modeling in two iterations, for zooming in on a pathological feature, in accordance with the present invention
- FIG. 12 illustrates, in flowchart form, a method of several iterations for zooming in on a pathological feature, when performing in vivo measurements, in accordance with the present invention
- FIGS. 13 A — 13E schematically illustrate possible camera designs, and the process of obtaining views based on a model and a camera design, in accordance with the present invention
- FIG. 14 illustrates, in flowchart form, a method of selecting a camera design optimized with respect to information gained about a body structure, in accordance with the present invention
- FIG. 15 illustrates, in flowchart form, a method of selecting a camera design, based on the rate of data collection and other design considerations, in accordance with the present invention
- FIGS. 16A - 16L schematically illustrate viewing of an elliptical modeled volume, by the radioactive-emission camera, in accordance with the present invention
- FIGS. 17A — 17N schematically illustrate various detecting units and blocks, which may be incorporated in camera designs, in accordance with the present invention
- FIGS. 18A - 18D schematically illustrate possible motions of a radioactive- emission camera, for a single detecting unit and a single block, in accordance with the present invention
- FIGS. 19 A - 19E schematically illustrate other possible motions of a radioactive-emission camera, for a single block, in accordance with the present invention
- FIGS. 2OA - 2OH schematically illustrate possible motions of a radioactive- emission camera, having a plurality of pairs of radioactive-emission blocks
- FIGS. 21A - 21D schematically illustrate other possible motions of a radioactive-emission camera, having a plurality of pairs of radioactive-emission blocks;
- FIGS. 22 A — 22X schematically illustrate a radioactive-emission camera system, comprising a plurality of assemblies, motions of individual blocks, and characteristics of an optimal camera, in accordance with the present invention
- FIG 22 Y - 22AA schematically illustrate a center of viewing, for a given camera design, in accordance with the present invention
- FIGS. 23A - 23D schematically illustrate a radioactive-emission camera system, in accordance with the present invention
- FIGS. 24 A - 24C schematically illustrate the modeling of a prostate as a process of two iterations, for zooming in on a pathology, in accordance with the present invention
- FIGS. 25 A - 25 E schematically illustrate the external appearance and the internal structure of the radioactive-emission camera for the prostate, in accordance with an embodiment of the present invention
- FIG. 26 illustrates further the internal structure of the radioactive-emission camera for the prostate, in accordance with an embodiment of the present invention
- FIG. 27 schematically illustrates the radioactive-emission camera for the prostate, integrated with an ultrasound camera, in accordance with another embodiment of the present invention
- FIG. 28 schematically illustrates an ultrasound wave impinging on a prostate, in accordance with the present invention
- FIGS. 29 A - 29C illustrate the co-registering of a radioactive-emission image and an ultrasound image, in accordance with the present invention
- FIG. 30 schematically illustrates the radioactive-emission camera for the prostate, integrated with a surgical needle, in accordance with another embodiment of the present invention
- FIGS. 31 and 32 schematically illustrates the operation of the surgical needle of FIG. 30.
- FIG. 33 schematically illustrates the modeling of the female reproductive system as a process of two iterations, for zooming in on a pathology, in accordance with the present invention
- FIGS. 34 A - 34R schematically illustrate the external appearance and the internal structure of the radioactive-emission camera for the female reproduction tract, in accordance with an embodiment of the present invention
- FIGS. 35A - 35Q schematically illustrate the external appearance and the internal structure of the radioactive-emission camera for the esophagus, in accordance with an embodiment of the present invention
- FIG 36 j V- schematically illustrates body organs, including an esophagus.
- FIGS. 37-39 schematically illustrate the modeling of the heart as a process of two iterations, in accordance with the present invention.
- FIGS. 40-45 schematically illustrate the basic components of a cardiac camera system, in accordance with an embodiment of the present invention
- FIG. 46 schematically illustrates the external appearance of a radioactive- emission-camera system for the heart, in accordance with an embodiment of the present invention
- FIGS. 47 and 48 schematically illustrate the internal structure of the radioactive-emission camera for the heart, in accordance with an embodiment of the present invention
- FIGS. 49 A and 49B schematically illustrate the internal structure of the radioactive-emission camera for the heart, in accordance with an embodiment of the present invention
- FIG. 50 schematically illustrates the construction of radiation detection blocks, in accordance with an embodiment of the present invention.
- FIG. 51 schematically illustrates a cardiac model, in accordance with an embodiment of the present invention
- FIGS. 52A-52E schematically illustrate radiation detection blocks arranged for viewing a cardiac model, in accordance with an embodiment of the present invention
- FIG. 53 schematically illustrates a dual imaging system for radioactive- emissions in tandem with a three-dimensional structural imager, in accordance with an embodiment of the present invention
- FIG. 54 schematically illustrates a dual imaging system for radioactive- emissions in tandem with a three-dimensional structural imager, in accordance with an embodiment of the present invention
- FIGS. 55A-55C schematically illustrate the internal structure of the radioactive-emission camera for the dual imaging system, in accordance with an embodiment of the present invention
- FIGS. 56A-56B schematically illustrate the internal structure of the radioactive-emission camera for the dual imaging system, in accordance with an embodiment of the present invention
- FIGS. 57A-57B schematically illustrate a cranial model, in accordance with an embodiment of the present invention
- FIG. 58 schematically illustrates a cranial model, in accordance with an embodiment of the present invention.
- FIGS. 59A-59C schematically illustrate an imaging system for radioactive- emissions of the head, in accordance with an embodiment of the present invention
- FIGS. 60A-60J schematically illustrate the internal structure of the radioactive-emission camera for the head, in accordance with an embodiment of the present invention
- FIG. 61 A and 6 IB schematically illustrate a breast model, in accordance with an embodiment of the present invention
- FIGS. 62A-62C schematically illustrate an imaging system for radioactive- emissions of the breast, in accordance with an embodiment of the present invention
- FIGS. 63A-63D schematically illustrate an imaging camera for radioactive- emissions of the breast, in accordance with an embodiment of the present invention
- FIGS. 64A-64K schematically illustrate an imaging system for radioactive- emissions of the breast, in accordance with an embodiment of the present invention
- FIGS. 64L-64M illustrates, in flowchart form, a method of examining a breast, in accordance with the present invention
- FIGS. 65A-65C schematically illustrate an imaging camera for radioactive- emissions of the breast, in accordance with an embodiment of the present invention
- FIGS. 66A-66G schematically illustrate an imaging system for radioactive- emissions of the breast, in accordance with an embodiment of the present invention
- FIGS. 67A-67B schematically illustrate effect of distance on detection efficiency of a radiation detector
- FIGS. 68A-68D schematically illustrate effect of distance on resolution of a radiation detector
- FIGS. 69A-69D schematically illustrate "wasteful viewing" by an array of radiation detectors
- FIGS. 7OA - 7OC describe experimental results with grid point sources.
- FIGS. 71 schematically illustrates a non- wasteful radiation detector array, in accordance with an embodiment of the present invention.
- FIGS. 72A-72E schematically illustrate non-wasteful radiation detector arrays, in accordance with an embodiment of the present invention.
- FIGS. 73A and 73B schematically illustrate non-wasteful radiation detector arrays, in accordance with an embodiment of the present invention
- FIGS. 74 A and 74B schematically illustrate the use of a non- wasteful radiation detector array, in accordance with an embodiment of the present invention
- FIG. 75A and 75B illustrate Teboroxime physiological behavior, according to Garcia et al. (Am. J. Cardiol. 51 st Annual Scientific Session, 2002).
- FIGs 76A - 80D schematically illustrate experimental data with the camera of the present invention.
- FIG. 81 is a description of advantageous and disadvanatageous viweing positions according to the present invention.
- FIG. 82 is a simplified flowchart of a method of performing radioactive- emission measurements of a body structure, according to a preferred embodiment of the present invention.
- FIG. 83 shows an object shaped as a cylinder with a front protrusion, and having a high-emittance portion (hotspot).
- FIG. 84a illustrates an object having two high-emission regions of interest.
- FIG. 84b illustrates the added information provided by each of views V A to
- FIGS. 85a and 85b are simplified flowcharts of iterative methods of performing radioactive-emission measurements of a body structure, according to a first and a second preferred embodiment of the present invention.
- FIGS. 86a and 86b are simplified flowcharts of methods for dynamically defining further views, according to a first and a second preferred embodiment of the present invention.
- FIG. 87 is a simplified flowchart of an iterative method for selecting further views, according to a preferred embodiment of the present invention.
- FIG. 88 is a simplified flowchart of a single iteration of a view selection method, according to a preferred embodiment of the present invention.
- FIG. 89 is a simplified flowchart of a method for dynamically defining further views, according to a third preferred embodiment of the present invention.
- FIG. 90 is a simplified block diagram of measurement unit for performing radioactive-emission measurements of a body structure, according to a preferred embodiment of the present invention.
- FIG. 91 is a simplified flowchart of a method for measuring kinetic parameters of a radiopharmaceutical in a body, according to a preferred embodiment of the present invention.
- FIG. 92 is a schematic representation of a dynamic model of a voxel, according to a first preferred embodiment of the present invention.
- FIG. 93 is a schematic representation of a dynamic model of a voxel, according to a second preferred embodiment of the present invention.
- FIG. 94 is a schematic representation of a dynamic model of a voxel, according to a third preferred embodiment of the present invention.
- FIG. 95 is a circuit diagram of a series RLC electronic circuit.
- FIG. 96 is a simplified flowchart of a method for measuring kinetic parameters of a radiopharmaceutical in an organ of a body, according to a preferred embodiment of the present invention.
- FIG. 97 is a simplified flowchart of a process for obtaining the drug formulation, according to a preferred embodiment of the present invention.
- FIG. 98 is a simplified flowchart of a method of radiopha ⁇ iiaceuticaldministration and imaging, according to a first preferred embodiment of the present invention.
- FIG. 99 is a simplified flowchart of a method of radiopharmaceuticaldministration and imaging, according to a second preferred embodiment of the present invention.
- FIG. lOO is a simplified block diagram of a radiopharmaceutical management system, according to a preferred embodiment of the present invention.
- FIG. 101 is a simplified block diagram of an exemplary embodiment of a radiopharmaceutical handling module.
- FIG. 102 is a block diagram of an exemplary embodiment of an imaging module.
- FIG. 103 is a simplified illustrative diagram of a single-reservoir controllable syringe.
- FIG. 104 is a simplified illustrative diagram of a multiple-reservoir controllable syringe.
- FIG. 105 is a simplified illustrative diagram of an administration device for controlled injection of multiple substances into a patient under the supervision of an imaging module, according to a preferred embodiment of the present invention.
- FIG. 106 is a simplified block diagram of a dose preparation system, according to a preferred embodiment of the present invention.
- FIG. 107 is a simplified flow chart, illustrating a process for imaging a patient using multiple kinetic parameters and measuring the distance between respective kinetic parameters, to relate the patient or individual voxels or groups of voxels to existing groups, thereby to arrive at a decision, regarding the patient or individual voxels or groups of voxels, according to the present invention.
- FIG. 108 illustrates dynamic behavior of a parameter
- FIG. 109 A-D illustrate different behaviors over time of different kinetic parameters.
- FIG. HOA illustrates dynamic behavior of an absorption parameter with a dead or diseased membrane
- FIG. HOB illustrates the dynamic behavior of the same parameter with a healthy membrane.
- FIGs 11 IA and 11 IB are of cardiac electrical cycles;
- FIGs 112A and 112B are of cardiac and respiratory gating in accordance with a first embodiment, in accordance with the present invention.
- FIGs 113 A - 113C are of cardiac and respiratory gating in accordance with a first embodiment, in accordance with the present invention.
- FIGS. 114A, 114B and 114C are of typical cardiac volumes and pressures, superimposed against the ECG tracing of FIG IB and the time scale 10 of FIG 3 A, in accordance with the present invention
- FIG 115 is a graph of cardiac volume versus pressure over time and exemplary volumetric images, in accordance with the present invention.
- FIG 116 is of a cardiac probe, in accordance with the present invention.
- FIG. 117 is a flowchart diagram of a method for calibrating a radiological imaging system by detecting radiation from one or more calibration sources, according to various exemplary embodiments of the invention.
- FIG. 118 is a flowchart diagram of a method for calibrating a radiological imaging system by detecting radiation from one or more radiopharmaceuticals, according to various exemplary embodiments of the invention.
- FIG. 119 is a schematic illustration of a device for calibrating a radiological imaging system, according to various exemplary embodiments of the invention.
- FIG. 120 is a schematic illustration of a device for administering radiopharmaceuticals to a subject, according to various exemplary embodiments of the invention.
- FIGS. 121a-e are schematic illustrations of a system for generating a three- dimensional image of a target region of a subject, according to various exemplary embodiments of the invention.
- FIG. 122 is a flowchart diagram of a method for constructing a three- dimensional image of a target region of a subject, according to various exemplary embodiments of the invention.
- FIG. 123 is a flowchart diagram of a method for constructing a radiological image of a target region of a subject, according to various exemplary embodiments of the invention.
- FIG. 124 is a flowchart diagram of a method for calculating intensity attenuation of a radiological image, according to various exemplary embodiments of the invention.
- FIG. 125 is a schematic diagram of a configuration for acquiring and/or using multi-parametric information, in accordance with an exemplary embodiment of the invention.
- FIG. 126 is a flowchart of a method of acquiring and/or using multi-parametric information, in accordance with an exemplary embodiment of the invention.
- FIG. 127 is a simplified space indicating a diagnosis and a normal physiological state, in accordance with an exemplary embodiment of the invention.
- FIG. 128 shows a simplified two dimensional space showing a complex diagnosis, in accordance with an exemplary embodiment of the invention.
- FIG. 129 is a simplified diagram showing a single detector detecting from a target region
- FIG. 130 is a simplified diagram showing two detector positions (not necessarily simultaneously) allowing three-dimensional information to be obtained from a target region
- FIGS. 131A-131D show a series of four time absorption characteristics for different radiopharmaceuticals within different tissues
- FIG. 132 is a simplified schematic diagram showing a device for driving an imaging head and allowing control of the imaging head by the image analyzer device;
- FIG. 133 is a simplified flow chart illustrating the image analysis process carried out by the analyzer in FIG. 132 in the case of a single marker;
- FIGS. 134A-134D illustrate two sets of successive images of the same target area taken using two different markers respectively, according to a preferred embodiment of the present invention
- FIG. 135A is a simplified flow chart illustrating a procedure according to a preferred embodiment of the present invention using two or more markers for firstly identifying an organ and secondly determining the presence or otherwise of a pathology within that organ;
- FIG. 135B is a simplified flow chart showing a generalization of FIG 135A for the general case of two specific patterns
- FIG. 136 is a simplified flow chart illustrating a procedure according to a preferred embodiment of the present invention using two or more markers for identifying a region of low emissivity within a target area and using that identification to control imaging resources to better image the identified region
- FIGS. 137 A - 137D illustrate two sets of successive images of the same target area taken using two different markers, in a similar way to that shown in FIG. 134, except that this time the regions of interest are one inside the other; and
- FIGS. 138A-B illustrates differential diagnosis using simultaneous imaging of two different radiopharmaceuticals.
- FIGS. 139 A-B is a table illustrating various radiopharmaceutical combinations and their uses in nuclear imaging.
- FIG 140 is a flowchart for imaging two isotopes that provide inappropriate cross talk, in accordance with the present invention.
- FIG 141 schematically represents a time line for myocardial perfusion, in accordance with the present invention.
- FIGs 142a - 142C schematically illustrate photopeaks of Tc 99m , Tl 201 , and cross talk of Tc 99m at the Tl 201 energy window.
- FIG. 143 is a camera electrical diagram showing an electronic block diagram indicating the high limits of the system.
- the monolithic crystal of camera is divided to 40x2 blocks each of which is not affecting the others.
- the conventional camera-every photon paralyzes the camera until cleared.
- FIG. 144 describes a decay curve of Mo-99 to Tc-99m and to Tc-99;
- FIG. 145 describes the build up of Tc-99m and Tc-99 with the decay of Mo- 99.
- FIG. 146 describes a standard elution curve
- FIG. 147 describes a recommended low-dose elution curve.
- FIGS. 148A-V are tables describing protocols according to the present invention.
- the present invention is of radioimaging cameras characterized by unprecedented high sensitivity allowing for high resolution image aquizition for use in diagnostics; algorithms and systems operable in conjunction with the camera, the algorithms and systems include, but are not limited to, predermined view selection algothim and system, active vision (on flight view selection) algothim and system, closed loop administration of a radiopharmaceuticallgothim and system, expert system diagnostic algothim and system, automatic dose preparation algorithm and kinetic parameter extraction algothim and system; low dose radiopharmaceuticals; combinations of radiopharmaceuticals either as compositions (cocktails) and/or kits; an administering device of radiopharmaceuticals, which may include syringes, pumps and IV lines; mixers for mixing different radiopharmaceuticals; and an ERP system for controlling and monitoring each one or more of the above.
- the present invention emerges from the development of a radio imaging camera characterized by unprecedented sensitivity.
- the sensitivity of the camera is attributed, as is further detailed hereiunder, to at least the following constructual features: (a) a plurality of detecting units; (b) movability of the detecting units one with respect to the other; (c) thus allowing concetrated focus on a region-of-interest by the individual detecting units; and (d) weiring diagaram with minimal multiplexing, thereby preventing saturation thereof.
- the inventors of the present invention developed low dose preparations of radiopharmaceuticals and compositions and kits comprising two or more radiopharmaceuticals adapted for use in conjunction with the camera and all other aspects of the invention.
- FIGS. IA and IB schematically illustrate a detecting unit 12 and a block 90 of detecting units 12, respectively.
- the detecting unit 12 is formed of a single-pixel detector 91, having a thickness T d and a diameter D or, in the case of a non-circular detector, a diameter equivalent. Alternatively, several pixels may be summed up so as to operate, in effect, as a single pixel. Both the detector diameter D and the detector thickness ⁇ a affect the detecting efficiency.
- the detector diameter D determines the surface area on which radioactive emission impinges; the greater the surface area, the greater the efficiency.
- the detector thickness T d affects the stopping power of the detector. High-energy gamma rays may go through a thin detector; the probability of their detection increases with an increase in the detector thickness ⁇ a.
- Figure IA illustrates a single-pixel detector 91, which by itself cannot generate an image; rather, all counts are distributed over the surface area of the detector 91.
- the block 90 includes a plurality of the detecting unit 12, formed by dividing the detector 91 into a plurality of electrically insulated pixels 106, each associated with a collimator 96.
- the collimators 96 are of the diameter or diameter equivalent D, a length L, and a septum thickness ⁇ .
- the collimators 96 may be, for example, of lead, tungsten or another material which substantially blocks gamma and beta rays.
- the collimators 96 may be shaped as tubes, rectangular grids, or grids of anyother polygon. Wide-angle or narrow-angle collimators are also possible.
- the collimator's geometry and specifically, the ratio of D/L, provides the detecting unit 12 with a collection solid angle ⁇ analogous to the viewing solid angle of an optical camera.
- the collection solid angle ⁇ limits the radioactive-emission detection to substantially only that radioactive emission which impinges on the detector 91 after passing through a "corridor" of the collimator 96 (although in practice, some high-energy gamma rays may penetrate the collimator's walls).
- the collection angle ⁇ is essentially a solid angle of 4 ⁇ steradians.
- the collimator's geometry affects both the detection efficiency and the image resolution, which are defined as follows: i.
- the detection efficiency is the ratio of measured radiation to emitted radiation; and ii.
- the image resolution is the capability of making distinguishable closely adjacent manifestations of a pathology, or the capability to accurately determine the size and shape of individual manifestations of a pathology.
- Figure 2 schematically illustrates the basic component of a system 120 comprising a radioactive-emission camera 122, operative as a detection system, and a position-tracking device 124, both in communication with a data-processing system 126.
- the radioactive-emission camera 122 is associated with a first coordinate system 128, and the position-tracking device 124 is associated with a second coordinate system 128', wherein the position-tracking device 124 monitors the position of the radioactive-emission camera 122 as a function of time.
- the data- processing system 126 processes the measurements of both the radioactive-emission camera 122 and the position-tracking device 124 and combines them to form the image.
- FIG. 3 A schematically illustrates a manner of operating the radioactive- emission camera 122 with the position-tracking device 124 of the system 120.
- the radioactive-emission camera 122 moves about an area of radioactive emission 110, for example, in the direction of an arrow 118, so as to measure a radioactive emission distribution 112, as a function of time, while the position-tracking device 124 monitors the position of the camera 122.
- the radioactive-emission camera 122 may be a single-pixel detector of high efficiency, which is incapable, by itself, of producing images.
- a data-processing system 126 processes a radioactive-count-rate input 121 together with a position-tracking input 123, using algorithms 125, to reconstruct an image 110' of the area of radioactive emission 110 for example, on a display unit 129.
- Imaging according to this concept is illustrated in Figure 3B.
- the area of radioactive emission 110 is located in a two-dimensional coordinate system u;v, and includes two hot points 115.
- the camera 122 moves from a position P(I), at a time t(l), to a position P(2), at a time t(2), while measuring the radioactive emission distribution 112 of the area of radioactive emission 110, including the hot points 115.
- miniBirdTM An example of a suitable position-tracking device 124 for use with system 120 is the miniBirdTM, which is a magnetic tracking and location system commercially available from Ascension Technology Corporation, P.O. Box 527, Burlington, Vermont 05402 USA (http://www.ascension-tech.com/graphic.htm).
- the miniBirdTM measures the real-time position and orientation (in six degrees of freedom) of one or more miniaturized sensors, so as to accurately track the spatial location of cameras, instruments, and other devices.
- the dimensions of the miniBirdTM are 18 mm x 8 mm x 8 mm for the Model 800 and 10 mm x 5 mm x 5 mm the Model 500.
- optical tracking systems which may be used are NDI-POLARIS of Northern Digital Inc., Ontario, Canada, which provides passive or active systems, a magnetic tracking device of NDI-AURORA, an infrared tracking device of E-PEN system, or an ultrasonic tracking device of E-PEN system.
- the position-tracking device may be an articulated-arm position-tracking device, an accelerometer-based position-tracking device, a potentiometer-based position- tracking device, or a radio-frequency-based position-tracking device.
- Figure 4A schematically illustrates one embodiment of system 120, including a hand-held, extracorporeal device 170, which includes the camera 122, having a detector 132 and a collimator 134.
- the system 120 also includes a controller 130 and a position-tracking device 124, wherein the camera 122 and the position-tracking device 124 are associated with the data-processing system 126 discussed above with reference to Figures 2 — 3B.
- FIG 4B schematically illustrates another embodiment of system 120 wherein an intracorporeal camera device 180 includes the radioactive-emission camera 122 mounted on a catheter 136.
- the camera 122 includes the detector 132, the collimator 134, and the position-tracking device 124, wherein the camera 122 and the position tracking device 124 are associated with the data-processing system 126 discussed above with reference to Figures 2 - 3B.
- the camera 122 is configured so as to penetrate a tissue 135, via a Trocar valve 138.
- a structural imager 137 such as an ultrasound imager or an MRI camera may further be included.
- Figure 4C schematically illustrates yet another embodiment of system wherein an intracorporeal camera device 190 is adapted for rectal insertion.
- the device 190 includes the radioactive-emission camera 122, which includes a plurality of the detectors 132 and the collimators 134 associated with the position-tracking device 124.
- the intracorporeal 190 device may be further adapted for motion along the x and ⁇ directions.
- the intracorporeal device 190 may include a motor 154 for moving the device 190 in the x and ⁇ directions, such that, once inserted into a rectum, it may be propelled therealong.
- a suitable motor 154 may be obtained, for example, from B-K Medical A/S, of Gentofte, DK, and may be adapted to transmit information to the data-processing system 126, regarding the exact position and orientation of the intracorporeal device. 190.
- the motor 154 may be used in place of the position-tracking device 124. Alternatively, it may be used in addition thereto.
- the intracorporeal device 190 may further include the structural imager 137, such as an ultrasound imager or an MRI.
- Figures 5A - 5F present the principles of modeling, for obtaining an optimal set of views, in accordance with the present invention.
- Figure 5A schematically illustrates a body section 230 having a region-of- interest (ROI) 200.
- the region-of-interest 200 may be associated with a body structure 215 having a specific radioactive-emission-density distribution, possibly suggestive of a pathological feature, this feature termed herein organ target 213. Additionally, there may be certain physical viewing constraints associated with the region-of-interest 200.
- Figure 5C illustrates, in flowchart form, a method 205 for best identifying an optimal and permissible set of views for measuring the radioactive-emissions of the region-of-interest 200, such that a three- dimensional image thereof may be reconstructed.
- the method 205 includes the following steps: in a box 206: modeling the region-of-interest 200 as a model 250 of a volume U, wherein U is the region-of-interest volume, and wherein the volume U may include one or several radioactive-emission sources, operative as modeled organ targets HS located within anatomical constraints AC, as seen in Figure 5B; in a box 207: obtaining an optimal and permissible set of views for the modeled volume U Figure 5B; and in a box 208: applying the optimal set of views to the in-vivo region-of- interest 200 and the body structure 215 of Figure 5 A.
- the model 250 of the region-of-interest 200 may be based on general medical information of the body structure 215 and common pathological features associated with it. Additionally, the model may be based on information related to a specific patient, such as age, sex, weight, and body type. Furthermore, in order to facilitate generation of the model 250, a structural image, such as by ultrasound or MRI, may be used for providing information about the size and location of the body structure 215 in relation to the body section 230.
- Figures 5D - 5F schematically illustrate three types of the modeled organ targets HS, as follows: i. a region of concentrated radiation, or a hot region, for example, as may be associated with a malignant tumor and as seen in Figure 5D; ii. a region of low-level radiation, which is nonetheless above background level, for example, as may be associated with carcinoma and as seen in Figure 5E; and iii. a region of little radiation, or a cold region, below the background level, for example, as may be associated with dead tissue and as seen in Figure 5F.
- Figures 6A and 6B pictorially illustrate a view and viewing parameters associated therewith, in accordance with the present invention.
- Figure 6A illustrates the volume U, subdivided into voxels u.
- the volume U is defined in a six-degree coordinate system x;y;z; ⁇ ; ⁇ ; ⁇ having a point of origin P0(x0; y ⁇ ; z ⁇ ; ⁇ O; ⁇ 0; ⁇ O).
- a detecting unit 102 is positioned at a location and orientation Pl(xl; yl; zl; ⁇ l; ⁇ l; ⁇ l).
- the detecting unit 102 has a detector 104, formed of a specific detector material having a thickness ⁇ ⁇ i, and a collimator 108, having a diameter D and a length L and defining a collection angle ⁇ .
- Figure 6B schematically illustrates the emission rate of the volume U, as a function of time, given that a radioactive material of a specific half-life has been administered at a time TO.
- a view may thus be defined as a group of nonzero probabilities of detecting a radioactive emission associated with all the voxels that form a sector S ( Figure 6A).
- a view is sometimes referred to as a projection, and the two terms are synonymous.
- a view defined over a sector S can be naturally extended to be defined over the set of all voxels, by simply associating a zero probability with every voxel outside the sector S. This makes possible the application of mathematical operations over the entire volume U.
- a view is dependent on the following viewing parameters: Location and orientation parameters:
- Detecting-unit parameters The location and orientation of the detecting unit 12 in a six-dimensional space, Pl(xl; yl; zl; col; ⁇ l; ⁇ l), with respect to the origin P0(x0; y ⁇ ; z ⁇ ; ⁇ O; ⁇ 0; ⁇ O) of the volume U. Detecting-unit parameters:
- the collection angle ⁇ which, together with the location and orientation parameters Pl(xl; yl; zl; ⁇ l; ⁇ l; ⁇ l) with respect to the origin P0(x0; y ⁇ ; z ⁇ ; ⁇ O; ⁇ O; ⁇ O), define the sector S;
- the detector material which affects the detector efficiency
- the detector thickness ⁇ j which affects the detector's stopping power, hence, its efficiency
- Attenuation parameters Attenuation properties of all the voxels within the sector S, as they affect the probabilities that radioactive emissions from a specific voxel will reach the detector, wherein different voxels within the sector S may have different attenuation properties, since several types of tissue may be involved.
- Radiopharmaceutical parameters The half life tm of the radiopharmaceutical, the types of radioactive emission, whether gamma or beta, and the energies of the radioactive emissions, which affect the probability of detection.
- kinetic profile means a collection of one or more parameters descibing the rate of distributin due to flow, uptake, bioclerance, diffusion, active transport, metabolism and the like.
- a kinetic profile is either definable in general or per patient, per organ, per tissue and under various contitions, such as pathologies and stimulations.
- Time parameters TO is the time of administrating the radiopharmaceutical
- Tl is the time since administration
- the duration of the measurement is ATI, which affects the number of emissions that occur during the radioactive-emission measurement.
- Some of these viewing parameters are fixed for a particular situation. Specifically, the tissue attenuation parameters are given. Additionally, the time Tl since administration of the radiopharmaceutical is generally governed by the blood pool radioactivity, since it is generally necessary to wait until the blood pool radioactivity dies out for low-level detection to be possible. For the remaining viewing parameters, optimization may be carried out.
- the remaining viewing parameters may be divided into two categories: i. viewing parameters in the design of a radioactive-emission camera; ii. viewing parameters for an optimal set of views, for a given camera.
- Figures 7A — 7C schematically illustrate anatomical constraints, which may hinder measurements.
- Figure 7A schematically illustrates the region-of-interest 200, for which a three-dimensional radioactive-emission image is desired.
- the region-of-interest 200 is in free space, with no constraints to limit accessibility to it.
- a radioactive- emission camera 210 may travel, for example, along tracks 202 and 204, and any other track, unhindered.
- the region-of-interest 200 is associated with the body structure 215, such as a prostrate, in vivo.
- the radioactive-emission camera 210 may be inserted transrectally, so as to travel in a rectum 206, for example, in the direction of an arrow 208. Its ability to image the prostrate is limited by anatomical constraints.
- the region-of-interest 200 is associated with the body structure 215, such as a heart, a breast, or another organ, in vivo, and the radioactive-emission camera 210 may be an extracorporeal camera, which may perform radioactive- emission measurements from outside the body, on an extracorporeal surface 214, for example when moving along a track 212.
- the radioactive-emission camera 210 may be an extracorporeal camera, which may perform radioactive- emission measurements from outside the body, on an extracorporeal surface 214, for example when moving along a track 212.
- Figure 8 illustrates, in flowchart form, a method 300 of predefining a set of views for functional imaging, tailored for imaging a specific body structure, and optimized with respect to the functional information gained about the body structure, in accordance with the present invention.
- Figure 8 is an expansion of Figure 5C.
- the method 300 comprises: in a box 302: providing a model of the body structure 215, based on its geometry; in a box 304: providing a model of anatomical constraints, which limit accessibility to the body structure; in a box 306: providing a collection of views of the modeled body structure obtained within the modeled anatomical constraints; in a box 308: providing a scoring function, by which any set of at least one view, from a collection of views, is scorable with a score that rates information obtained from the modeled body structure by the set; in a box 310: forming sets of views from the collection of views and scoring them with the scoring function; and in a box 312: selecting a set of views, from the collection of views, based on their scores, as the predefined set of views.
- the model of the body structure is based on anatomical knowledge regarding its size, shape, and weight. In fact, different models may be provided, for example, for different ages, sexes, weights, and body types, such as heavy-built, medium-built, or small-built.
- the body structure is modeled assuming that there is no radioactive emission throughout its volume.
- the body structure may be modeled with one or more modeled organ targets, simulating different pathological features.
- the modeled organ targets may be hot regions, of a radioactive-emission intensity higher than the background level, regions of low-level radioactive-emission intensity, which is nonetheless above the background level, and cold regions, of a radioactive-emission intensity lower than the background level. These may be distributed in accordance with medical records, which teach of sites within the body structure that may be more susceptible to certain pathologies.
- the model of anatomical constraints which limit accessibility to the body structure is based on anatomical knowledge, and different models may be provided, for example, for different ages, sexes, weights, and body types.
- the collection of views may be obtained by several methods. It may be calculated analytically for the modeled body, based on the view parameters.
- computer simulations of the modeled body and the view parameters may provide the collection of views. Additionally or alternatively, measurements may be performed using a point source and a detecting unit of appropriate parameters, at different locations and orientations of the detecting unit, so as to simulate the desired geometries.
- the measurements may be performed in air, but corrected analytically or by computer simulations, for tissue attenuation.
- Figures 9A - 9F schematically illustrate possible models and collections of views for a body structure, in accordance with the present invention.
- Figure 9 A schematically illustrates four views, formed by sectors Sl, S2, S3, and S4 through the volume U, which has an even distribution of radioactive emission.
- Figure 9B schematically illustrates three views, formed by sectors Sl, S2, and S3, through the volume U, which includes a modeled pathological feature, which is the modeled organ target, HS.
- Figure 9C schematically illustrates three views, formed by sectors Sl, S2, and S3 through the volume U, which includes a modeled organ target, HS', of the same type as that of the modeled organ target HS, (that is, either a hot region or a cold region) but somewhat displaced along the x;y;z coordinate system. Additionally, the modeled organ target HS of Figure 9B is superimposed in Figure 9C, for illustrative purposes, in order to show the displacement, deltal, of modeled organ target HS' from modeled organ target HS.
- Figure 9D schematically illustrates three views, formed by sectors Sl, S2, and S3 through the volume U, which includes a modeled organ target, HS", of the same type as that of the modeled organ targets HS and HS', but somewhat displaced along the x;y;z coordinate system from them. Additionally, the modeled organ targets HS of Figure 9B and HS' of Figure 9C are superimposed in Figure 9D, for illustrative purposes, in order to show the displacements delta2 and delta3, vis a vis HS" of
- Figure 9E schematically illustrates three views, formed by sectors Sl, S2, and
- FIG. 9F schematically illustrates four possible models of organs, shown as elliptical volumes, each with a slightly different distribution of modeled organ targets.
- the modeled organ targets may be termed emmitance models.
- an emmitance model is based on a particular radiopharmaceutical, which fixes both the rate of emission and the change in the rate of emission with time, determining the difference between the modeled organ target and the background level, as a function of time.
- radiopharmaceuticals To study the effect of different radiopharmaceuticals on the views, one may provide different emmitance models, based on different radiopharmaceuticals and different elapsed times relative to their administration.
- the scoring function is based on information theoretic measures that rate the quality of the data which each set of views provides.
- the information theoretic measure of uniformity requires that the probability of detecting a radioactive emission from each voxel, by one of the views, be substantially equal, i.e., substantially uniform for all the voxels.
- a voxel may have a high influence on the counts that are measured while, in another view, the same voxel may have a low influence on the counts that are measured.
- a voxel u(l;l;l) in relation to the views associated with the sectors S2 and S4.
- the voxel u(l;l;l) has a high influence on the counts that are measured by the view associated with the sector S4, but a low influence on the counts that are measured by the view associated with the sector S2.
- the aim of uniformity is to identify a set of views that will balance the influence of each voxel for the entire set of views.
- the information theoretic measure of separability rates resolution, or the ability to distinguish between a pair of close models of the body structure, each having substantially identical dimensions, so as to define substantially identical volumes U having slightly different distributions of modeled organ targets.
- Figures 9B and 9C a pair of models of substantially identical volumes are illustrated in Figures 9B and 9C, wherein the respective modeled organ targets are HS, whose center is at a location (x;y;z)Hs and HS', whose center is at a location (x;y;z) ⁇ s'-
- the displacement along the x axis is delta 1, which may be measured, for example, in mm.
- a score in terms of separability, is given for the pair of models, the score relateing to a resolution as defined by the difference between the location of the two models.
- the difference is deltal, so the score given by the information theoretic measure of separability will relate specifically to a resolution as defined by deltal along the x-axis, relative to the locations of HS and HS'.
- Other portions of the volume U and other displacements may have different resolutions.
- volume U includes the modeled organ target HS", whose center is at a location (x;y;z) ⁇ s".
- HS is displaced from HS of Figure 9B, along the z-axis, the displacement denoted delta2, and is also displaced from HS' of Figure 9C, along the x- and z- axes, the displacement denoted delta3.
- Scores in terms of separability, may be given to all the pairing combinations, i.e., to the models of Figures 9B - 9C, with regard to deltal; to the models of Figures 9B - 9D, with regard to delta2; and to the models of Figures 9C - 9D, with regard to delta3.
- An optimal set of views may be selected based on the average scores for all the pairing combinations; for example, the optimal set may be that whose average score for all the pairing combinations is the highest. Alternatively, a weighted average may be applied. It will be appreciated that more than one modeled organ target may be included in the volume U. It will be further appreciated that a set of views may be selected so as to provide high resolution for portions of the volume U known to be susceptible to pathologies, and so as to provide low resolution for portions of the volume U known to be generally free of pathological features.
- any pair of models of organs having different distributions of modeled organ targets may be utilized for identifying an optimal set of views in terms of separability.
- Reliability The information theoretic measure of reliability rates repeatability in measurement, so that repeated reconstructions are not substantially different.
- Reliability may be scored with respect to a single model of a body structure, having a specific distribution of modeled organ targets, for example, any one of the models of Figures 9B - 9E.
- several models of substantially identical volumes are provided, such as, for example, the four models of Figures 9B - 9E.
- Substantially identical sets of views may be applied to all the models and may be scored with respect to reliability.
- the optimal set is selected based on its average score for the plurality of the models.
- the optimal set may be that whose average score for the plurality of the models is the highest.
- the four models of organs of Figure 9F, each of which has a slightly different distribution of modeled organ targets, may also be used for identifying an optimal set of views in terms of reliability.
- Weighted Combination A weighted combination of several information theoretic measures may also be used.
- a plurality of models may be provided, all having substantially identical dimensions and volumes, as follows: i. a first model of the volume U, free of modeled organ targets, as seen in Figure 9 A, for scoring sets of views in terms of uniformity; ii.
- At least one pair of models of the volume U with slightly different distributions of modeled organ targets, as seen in any pair of Figures 9B - 9C, 9B - 9D, and (or) 9C - 9D, for scoring sets of views in terms of separability; iii. at least one model of the volume U, with a given distribution of modeled organ targets, as seen in any one of Figures 9B, 9C, 9D, and (or) 9E, for scoring sets of views in terms of reliability.
- Identical sets of views may be applied to all the models of the volume U, and each view may be scored in terms of uniformity, separability, and reliability.
- An optimal set of views may be selected based on a summation of the three scores, or based on a weighted average of the three scores.
- Some approaches for selecting an optimal set are based on determining a required quality of reconstruction, and finding a set of views that meets that requirement. Others are based on fixing the size for the set (i.e., the number of views in the set) and maximize the quality of the reconstruction for the given set size. Still other approaches define both a desired size for the set and a desired quality of reconstruction and search for a set of the desired size, which meets the desired quality of reconstruction.
- an information theoretic measure is chosen, for example, separability, and an initial set of a minimal number of views is defined.
- the set is gradually built up, so that with every addition, a view is picked so as to maximize the chosen information theoretic measure of the set.
- separability is the chosen information theoretic measure
- an initial set of view Sl is defined
- the additions of views S2 and S3 may then be compared in order to determine with which of them separability is maximized.
- the addition of S3 will maximize the chosen information theoretic measure of the set.
- the advantage of the method of the present invention of predefining a set of views based on a model of a body structure, using an information theoretic measure, so as to optimize the functional information from the views of the corresponding body structure, in vivo, becomes apparent when compared with the prior art alternatives.
- the prior art relies on obtaining random views, in vivo, or views dictated by anatomical constraints, with no rigorous approach to the manner by which they are chosen.
- the method of the present invention of predefining a set of views, based on a model of a body structure, using an information theoretic measure, so as to optimize the functional information from the views of the corresponding body structure, in vivo, is further illustrated hereinbelow, with reference to Figure 10.
- Figure 10 illustrates, in flowchart form, a method 320 of functional imaging, tailored for imaging a body structure optimized with respect to the functional information gained about the body structure, by using the predefined optimal set of views, in accordance with the present invention.
- the method 320 comprises: in a box 322: providing a model of a body structure, based on its geometry; in a box 324: providing a model of anatomical constraints, which limit accessibility to the body structure; in a box 326: providing a collection of views of the modeled body structure, obtained within the modeled anatomical constraints; in a box 328: providing a scoring function, by which any set of at least one view, from a collection of views is scorable with a score that rates information, obtained from the modeled body structure by the set; in a box 330: forming sets of views from the collection of views and scoring them, with the scoring function; in a box 332: selecting a set of views from the collection of views of the modeled body structure, based on its score, as the
- the region-of-interest 200 may include an organ, such as a heart or a pancreas, a gland, such as a thyroid gland or a lymph gland, blood vessels, for example, the coronary artery or the pulmonary artery, a portion of an organ, such as a left atrium of a heart, a bone, a ligament, a joint, a section of the body, such as a chest or an abdomen, or a whole body.
- an organ such as a heart or a pancreas
- a gland such as a thyroid gland or a lymph gland
- blood vessels for example, the coronary artery or the pulmonary artery
- a portion of an organ such as a left atrium of a heart, a bone, a ligament, a joint
- a section of the body such as a chest or an abdomen, or a whole body.
- a still more powerful approach may be achieved by taking the method of the present invention through second and third iterations, so as to zoom in on suspected pathological features that are identified.
- a suspected pathological feature is identified, a second, inner region-of-interest, limited to the region of the pathological feature and its surrounding anatomical structure, can be identified and modeled.
- An optimal pathology set of views, specifically for the second, inner region-of-interest may be predefined, based on information theoretic measures, as before. This is illustrated hereinbelow, with reference to Figures 11 and 12.
- Figures 11 pictorially illustrates a method 340 for zooming in on a suspected pathological feature, as a process of two or more iterations, in accordance with the present invention, as follows:
- the region-of-interest 200, associated with the body structure 215, is defined for the body section 230.
- the model 250 of the volume U is provided for the region-of-interest 200, possibly with one or several of the modeled organ targets HS, and within the anatomical constraints AC, for obtaining the optimal set of views for the region-of- interest 200.
- the optimal set of views is then applied to the body section 230.
- a model 250' of a volume U' is provided for the second, inner region- of-interest 200', preferably, with at least one modeled organ target HS, simulating the suspected organ target 213, for obtaining an optimal pathology set of views for the region-of-interest 200'.
- the second, pathology set of views is then applied to the body section 230.
- Figure 12 illustrates, in flowchart form, the method 340, for zooming in on a suspected pathological feature of the body structure, as a process of two iterations, in accordance with the present invention.
- the method 340 comprises: in a box 342: providing a model of a body structure, based on its geometry; in a box 344: providing a model of anatomical constraints, which limit accessibility to the body structure; in a box 346: providing a first collection of views of the modeled body structure, obtained within the modeled anatomical constraints; in a box 348: providing a first scoring function, by which any set of at least one view, from a collection of views, is scorable with a score that rates information, obtained from the modeled body structure by the set; in a box 350: forming sets of views from the first collection of views, and scoring them, with the first scoring function; in a box 352: selecting a set of views from the first collection of views of the modeled body structure, based on its score, as the predefined set of views; in a box 354: performing radioactive-emission measurements of an in-vivo body structure that corresponds to the body structure that has been modeled, selectively at the predefined set of views; in a
- the model of the suspected pathological feature may be provided responsive to a patient's complaint, a physician's examination, or based on input from another imaging system, for example, x-rays, CT, MRI, ultrasound, and gamma scanning, for example, with a hand-held gamma camera, rather then based on the findings of the first set of measurements, of the step 356, hereinabove.
- another imaging system for example, x-rays, CT, MRI, ultrasound, and gamma scanning, for example, with a hand-held gamma camera, rather then based on the findings of the first set of measurements, of the step 356, hereinabove.
- — 15 illustrate methods of designing cameras and camera systems, optimized with respect to information gained about a body structure.
- Figures 13A - 13E schematically illustrate possible designs of the radioactive-emission camera 10, and the process of obtaining views for a given camera design, in accordance with the present invention.
- FIGS 13A - 13C schematically illustrate the radioactive-emission camera 10 as a radioactive-emission camera 226 arranged for measuring the radioactive- emission-density distribution of three bodies, Ul, U2 and U3.
- the volume Ul of Figure 13 A has been modeled with no modeled organ targets, in order to score the radioactive-emission camera 226 in terms of uniformity.
- the volume U2 of Figure 13B includes two modeled organ targets, HSl and HS2, and may be used for scoring the radioactive-emission camera 226 in terms of reliability.
- the volume U3 of Figure 13C includes two modeled organ targets, HSl and HS2', so as to form a pair with the volume U2 of Figure 13B, and the pair may be used for scoring the radioactive-emission camera 226 in terms of separability. Additionally, the volume U3 may be used to obtain a second score in terms of reliability, and the two reliability scores may be averaged. It will be appreciated that additional bodies, of different radioactive emission density distributions may be used, for obtaining additional scores in terms of reliability, and for forming additional pairs, for additional scores in terms of separability, wherein the scores in terms of each scoring function may be averaged. Additionally, the scores of the three functions may be combined, for example, as a sum, or as a weighted average. It will be appreciated that only one of the scoring functions, or only two of the scoring functions may be used. Additionally or alternatively, another scoring function or other scoring functions may be used.
- the camera 226 has two detecting units 222A and 222B whose collimators are arranged in parallel.
- the two detecting units 222 A and 222B are adapted for motion in the directions of +x, within the camera 226, as shown by arrows 224 and 228, so as to provide coverage of a plane within the bodies Ul U2 and U3, in parallel sectors.
- the two detecting units 222A and 222B may be rotated in the direction of ⁇ , as shown by an arrow 217, and return in the -x direction of the arrow 228. In this manner, complete coverage of the whole body is provided.
- a representative collection of views of the camera 226 may be defined as a set of views of the bodies Ul, U2, and U3, taken at predetermined increments of ⁇ x and ⁇ .
- a set formed of parallel sectors may score poorly in terms of uniformity since radioactive emissions from voxels closer to the detecting unit have higher probabilities of being detected than radioactive emissions from voxels far from the detecting unit. Additionally, a set formed of parallel sectors may score poorly in terms of separability, since it cannot distinguish between two models, which only differ in the depth of a pathological feature, along the z-axis.
- Figure 13D schematically illustrate the radioactive-emission camera 10 as a radioactive-emission camera 220, arranged for measuring the radioactive-emission- density distribution of the volume U2, which may be used for scoring the radioactive- emission camera 220 in terms of reliability.
- the camera 220 has the two detecting units 222A and 222B, arranged to sweep a plane within the volume U2, in a windshield-wiper-like manner, along ⁇ , as illustrated by arrows 216 and 218.
- the detecting units 222 A and 222B rotate a few degrees along ⁇ , as illustrated by the arrow 217, and sweeping along ⁇ is repeated in the new orientation. In this manner, coverage of the whole volume U2 is performed, from two locations and a large plurality of orientations.
- a representative collection of views of the camera 220 may be defined as a set of views of the volume U2, taken at predetermined increments of ⁇ and ⁇ . The significance of the present embodiment, is as follows: i.
- the different detecting units 222A and 222B provide views from different orientations; and ii.
- the different detecting units 222A and 222B may change their view orientations.
- a score may be applied to' this set, based on the information theoretic measure of reliability.
- the camera 220 may be arranged for measuring the radioactive-emission-density distribution of the volume Ul ( Figure 13A) and of the volume U3 ( Figure 13C), and possibly also of other bodies, in order to score the radioactive-emission camera 220 also in terms of uniformity and separability.
- the scores of the three functions may be combined, for example, as a sum, or as a weighted average. It will be appreciated that only one of the scoring functions, or only two of the scoring functions may be used. Additionally or alternatively, another scoring function or other scoring functions may be used.
- the set of representative collection of views of the present example is likely to score more highly in terms of separability than that of the camera 226 of Figure 13A, as it provides views from different locations and orientations.
- the detecting units 222 A and 222B of the camera 220 are further adapted for motion in the directions of ⁇ x, within the camera 220, as shown by the arrows 224 and 228.
- the set of representative collection of views of the present example is likely to score more highly in terms of all three information theoretic measures, than those of the camera of Figures 13A - 13C and of the camera of Figure 13D, as the present example provides views from a large plurality of locations and orientations.
- the information theoretic measures may be used for scoring representative collections of views of suggested camera designs, and an optimal camera design may be chosen based on this score, as described hereinbelow, with reference to Figure 14, hereinbelow.
- Figure 14 illustrates, in flowchart form, a method 370 for identifying a camera optimized with respect to information gained about the body structure.
- the method 370 comprises: in a box 372: providing a model of a body structure, based on its geometry; in a box 374: providing a model of anatomical constraints, which limit accessibility to the body structure; in a box 375: providing representative collections of views of the modeled body structure, within the modeled anatomical constraints, for different camera designs; in a box 376: providing a scoring function, by which each representative collection of views, associated with a specific camera design, is scorable with a score that rates information, obtained from the body structure; in a box 377: scoring the representative collections of views, with the scoring function; and in a box 378: selecting a camera design, based on the score of its representative collection of views.
- Figure 4C hereinabove, cannot be used for the windshield-wiper-like motion, shown in Figure 13D, by the arrows 216 and 218; however, this type of coverage has proved very valuable.
- the method 370 may, however, be suitable for another camera design.
- the rate of data collection is important both because it may be associated with patient discomfort and because it affects the number of patients that may be examined in a period of time. Where data collection with one camera design may take an hour and with another camera design may take 10 minutes, the design of the faster camera is highly advantageous. Complexity and cost are important because they affect the accessibility of the camera to the general public.
- a design scoring function may be provided, for rating each camera design with a design score, based on any one or a combination of the secondary issues.
- the design scoring function may be used for selecting a camera design from several that have been found acceptable in terms of the quality of the data, by the method 370 of Figure 14.
- Figure 15 illustrates, in flowchart form, a method 380 of selecting a camera design, optimized with respect to information gained about a body structure and secondary issues, in accordance with the present invention.
- the method 380 comprises: in a box 382: providing a model of a body structure, based on its geometry; in a box 384: providing a model of anatomical constraints, which limit accessibility to the body structure; in a box 385: providing representative collections of views of the modeled body structure, within the modeled anatomical constraints, for different camera designs; in a box 386: providing a scoring function, by which each representative collection of views, associated with a specific camera design, is scorable with a score that rates information, obtained from the body structure; in a box 387: scoring the representative collections of views, with the scoring function; in a box 388: identifying several camera designs as acceptable, based on the scores of their representative collections of view; in a box 390: providing a design scoring function, by which each camera design is scorable,
- a combined scoring function which takes all these factors into account, may be used.
- many different camera designs may provide substantially the same information, but are different in terms of their secondary considerations, that is, at different rates of data collection, different costs and different complexity of their designs, for example, in terms of the number of motors and motion-transfer systems.
- these may score similarly in terms of functional information, and a design scoring function may be used to choose from amongst them.
- Figures 16A — 16L schematically illustrate
- Figures 16A - 16K show the spanning of the elliptical model 250 of the volume U, along an x-z plane, by the sweeping views.
- Figure 16L is a pictorial representation of the camera 10 of Figures 2OA - 2OH and the elliptical model 250 of the volume U, in accordance with the present invention.
- the views, obtained in Figures 16A - 16K may be used both for: i. a collection of views for the volume U, from which an optimal set of views may be chosen, specific to a body structure, in accordance with the teachings of Figures 8, 10, and 12, hereinabove, and ii. a representative collection of views of the camera 10, for optimizing a camera design, in accordance with the teachings of Figures 14 and 15, hereinabove.
- the present invention there may be several imaging schemes connected with the motion of the detecting units, blocks and/or assemblies as follows:
- the detecting units, blocks and/or assemblies are moved to a position and collect photon emission data while stationary (herein referred to as the Stop-Go imaging scheme).
- a motion of each detecting unit or block or assembly is at a predetermined angle per move (after each move data is collected while the detecting unit or block or assembly is stationary) and characterized by half the angle phase shift when scanning in opposite directions, so as to scan the scanned region every half angle (herein referred to as the
- a motion of each detecting unit or block or assembly is without pause between minimum and maximum sweeping angles (herein referred to as the Sweeping Imaging Scheme).
- a prescan according to the present invention can be performed by any imaging device, including, but not limited to, ultrasound and MRI or by a physical inspection of the subject undergoing diagnosis.
- a prescan can be performed by the camera of the present invention preferably using the interlacing imaging scheme as is further described above or by broad view selection as is further described below.
- Figures 18A and 18B schematically illustrate the radioactive-emission camera 10, of the single detecting unit 12 (see Figures IA and 17A).
- the single detecting unit 12 has a motion with respect to the overall structure 20, which is a combination of a rotational motion around the x-axis, in the direction of ⁇ , denoted by an arrow 44, and a translational motion along the x- axis, denoted by an arrow 46.
- a spiral trace 48 is formed, for example, on an inner surface of a body lumen 232, as seen in Figure 18B.
- the motions of the detecting unit 12 are contained within the overall structure 20, so that the external surface of the camera 10 remains stationary.
- the external surface of the camera may be formed of a carbon fiber, a plastic, or another material, which is substantially transparent to nuclear radiation.
- Figures 18C and 18D schematically illustrate the radioactive-emission camera 10, of the single block 90 ( Figures IB and 17E). Note that all the detecting units 12 of the single block 90 move as a single body.
- the single block 90 has a motion with respect to the overall structure 20, which is a combination of the rotational motion around the x-axis, in the direction of ⁇ , denoted by the arrow 44, and the translational motion along the x-axis, denoted by the arrow 46.
- a plurality of spiral traces 49 is formed, for example, on an inner surface of a body lumen, as seen in Figure 18D.
- the motions of the block 90 are contained within the overall structure 20, so that the external surface of the camera 10 remains stationary, wherein the external surface of the camera is substantially transparent to nuclear radiation.
- Figures 19A - 19E schematically illustrate the radioactive-emission camera 10, of the single block 90 of a plurality of the detecting units 12.
- the single block 90 has a motion with respect to the overall structure 20, which is performed in steps, as follows: i. the windshield-wiper like oscillatory motion, around the radius r, in the direction of + ⁇ , as denoted by the arrow 50; ii. the translational motion along the x-axis, by an amount ⁇ x, to a new measuring position, as denoted by the arrow 46; iii. after traversing the length of the camera, a rotational motion around the x-axis, in the direction of ⁇ , by an amount ⁇ , as denoted by the arrow 44, in order to perform the same measurements at a new measuring position of ⁇ .
- a plurality of broken line traces 59 is formed, as seen in
- the motions of the block 90 are contained within the overall structure 20, so that the external surface of the camera 10 remains stationary, wherein the external surface of the camera is substantially transparent to nuclear radiation.
- Figures 2OA - 2OH schematically illustrate the radioactive-emission camera 10, having at least one pair, or a plurality of pairs of blocks 90, adapted for the windshield- wiper like oscillatory motion, around the radius r, as denoted by the arrows 50.
- the oscillatory motions may be synchronized in an antipodal manner, so as to be diametrically opposed to each other, as shown in
- the resultant traces are the plurality of broken line traces 59, as seen in Figure 2OG.
- the camera 10 of Figures 2OA - 2OF and 2OH provides views which are essentially the same as those of Figures 19A - 19E 5 but in a more efficient way, since a plurality of blocks is involved.
- the different blocks 90 provide views from different orientations; and ii.
- the different blocks 90 may change their view orientations.
- the motions of the blocks 90 are contained within the overall structure 20, so that the external surface of the camera 10 remains stationary, wherein the external surface of the camera is substantially transparent to nuclear radiation.
- an internal structure 21 may contain all the blocks 90, configured to move together, as a rigid structure, while the overall structure 20 and the external surface of the camera 10 remain stationary.
- the single detecting units 12 may be used in place of the single blocks 90.
- FIGS 21A - 21D schematically illustrate the radioactive-emission camera 10, having at least one pair, or a plurality of pairs of blocks 90, adapted for the windshield-wiper like oscillatory motion, around the radius r, as denoted by the arrow 50.
- the oscillatory motions are preferably synchronized in an antipodal manner, so as to be diametrically opposed to each other, as in, for example, figure 2OB. It will be appreciated that the oscillatory motions need not be synchronized in an antipodal manner. Rather, all the blocks 90 may move in synchronized motion, or each block 90 may move independently. It will be appreciated that an odd number of blocks 90 is also possible.
- the resultant traces are the plurality of broken line traces 59, as seen in Figure 2 ID.
- the camera 10 of Figures 21 A - 21C provides views which are essentially the same as those of Figure 19E, and of Figure 2OG, but in a different manner.
- the different blocks 90 provide views from different orientations; and ii.
- the different blocks 90 may change their view orientations.
- the motions of the blocks 90 are contained within the overall structure 20, so that the external surface of the camera 10 remains stationary, wherein the external surface of the camera is substantially transparent to nuclear radiation.
- the detecting units 12 may be used in place of the blocks 90.
- FIGS 22A - 22C and 22E - 22G schematically illustrate the radioactive-emission camera 95, comprising the plurality of assemblies 92, each assembly 92 being similar in construction to the structure 21 of Figure 2OH, in accordance with the present invention.
- the plurality of assemblies 92 are preferably arranged in parallel, and their rotational motions, around the x-axis, may be synchronized in an antipodal manner, so as to be diametrically opposed to each other, as shown in Figures 22C, by arrows 62, and in Figure 22G, by arrows 64. It will be appreciated that the rotational motion around the x-axis need not be synchronized in an antipodal manner, and may be performed in parallel, or independently. Thus, the resultant traces are a large plurality of the broken line traces 66 and
- the camera 95 provides views which are essentially the same as those of Figures 19E, 2OG, and 21D, but far more efficiently, since a plurality of assemblies is involved.
- the different blocks 90 provide views from different orientations; ii.
- the different blocks 90 may change their view orientations; iii.
- the different assemblies 92 provide views from different orientations; and iv.
- the different assemblies 92 may change their view orientations.
- the motions of the blocks 90 and of the assemblies 92 are contained within the overall structure 20, so that the external surface of the camera 95 remains stationary, wherein the external surface of the camera 95 is substantially transparent to nuclear radiation.
- camera 95 may include a plurality of assemblies 92, which are not parallel to each other.
- the assemblies 92 may be at right angles to each other, or at some other angle.
- assemblies 92 may include the detecting units 12 rather then the blocks 90.
- Figures 221 - 22X schematically illustrate possible individual motions for blocks 90, in accordance with the present invention.
- each of the blocks 90 may be in communication with two motion providers, for providing the oscillatory motion about the r-axis, as seen by the arrows 50, and for providing the rotational motion around the x-axis, as seen by the arrows 44.
- a first set of measurements is performed as the blocks 90 oscillate about the r- axis, as seen in Figure 22 J.
- the blocks 90 then rotate around the x-axis, to a new measuring position, as seen in Figure 22K.
- a second set of measurements is performed at the new position, as the blocks 90 oscillate about the r-axis, as seen in Figure 22M.
- the blocks then rotate around the x-axis, to a new measuring position, as shown in Figure 22K, and so on.
- each of the blocks 90 may be in communication with two motion providers, for providing an oscillatory motion about the x-axis as seen by an arrow 61, and a rotational motion around the x- axis, as seen by an arrows 63.
- the resultant trace is star shaped, as seen by the lines 65 of Figure 220.
- a tertiary motion provider may be included, for providing a cluster 67 of overlapping lines, for a substantially complete coverage of a region, for example, as seen in Figure 22P by a cluster 67 of the overlapping star-shaped lines 65. It will be appreciated that many other forms of motion may be provided, and may include one, two, three or more motion providers.
- Figures 22Q and 22R illustrate another set of dual motions and corresponding measurements for an individual one of the blocks 90, while Figures 22S and 22T illustrate those of a set of a tertiary motion, by three motion providers.
- each block 90, or detecting unit 12 may be provided with at least one, and preferably, two, three, or possibly as many as six degrees of motion, for example, rotational motion around the x, y, and z, axis, or oscillatory motion about these axes, and possibly also translational motion, along the x, and (or) y, and (or) the z-axis.
- each block 90 may be preprogrammed to view each portion of the body section 230, in accordance with some predetermined schedule, dedicated to the specific block 90.
- one of the blocks 90 may perform oscillatory motion, while an adjacent one of the blocks 90 may perform rotational motion.
- Figures 22Y and 22AA schematically illustrate a center of viewing 200A, for a given camera design, in accordance with the present invention.
- the detecting units 12, or blocks 90, or assemblies 92 move or sweep across the region-of-interest volume U, for example, as illustrated by the arrows 203, different portions of the volume U are viewed at different. frequencies and duration.
- the region which is viewed most heavily may be defined as the center of viewing 200A. It is surrounded by regions, which are viewed somewhat less. In essence, a shell-like viewing structure may be formed, with decreasing viewing intensities, as the distance from the center of viewing 200A increases. This is illustrated, for example, by the center of viewing 200A and surrounding shells 201, 209, and 211.
- the center of viewing 200A may be a region of uniform viewing, rather than a mere point.
- the region 201 may be a region of uniform viewing, which forms the center, of viewing 200A.
- the camera and method of the present invention are operative with an overall system, in which computer controlled motion providers govern the motions of the detecting units or of the overall camera.
- the computer may be any one of a personal computer, a laptop, a palmtop, or another computer, adapted for communication with the camera, or a microcomputer, built into the camera. Additionally, a combination of a microcomputer, built into the camera, and an external computer such as a personal computer, a laptop, a palmtop, or the like, may be used.
- Figures 23 A - 23D schematically illustrate a radioactive-emission camera system 400 in accordance with the present invention.
- the camera system 400 includes the camera 10, having a controller 404, in communication with one or several motion providers 76, for sending signals of the locations and orientations of views to the one or several motion providers 76.
- the one or several motion providers 76 govern the motions of one or several of the detecting units 12.
- the one or several of the detecting units 12 collect the measurements at the predefined locations and orientations and communicate the data to the controller 404. Signals of new locations and orientations are then communicated by the controller 404 to the one or several motion providers 76.
- Each of the motion providers 76 may control the motion of one of the detecting units 12 or of a plurality of the detecting units 12.
- the controller 404 registers the location and orientation of each of the detecting unit 12 as it moves.
- a position-tracking device may be associated with each of the detecting units 12.
- a position-tracking device 418 is associated with the camera 10 as a whole, for registering its position with respect to, for example, the body structure 215 ( Figure 5A).
- a power supply 410 powers the camera 10. Alternatively, power may be supplied from the grid.
- a transceiver or transmitter 402 reports the measurements to an external computer (not shown).
- a cable (not shown) may be used.
- the controller 404 includes a microcomputer, or the like, and performs the data analysis.
- the transceiver 402 may be adapted to receive input data relating to the personal details of the patient, such as the age, sex, weight, body type, and the like, in order to adjust the model of the body structure, hence the locations and orientations of the predefined, optimal set of views, to the particular patient.
- the transceiver 402 may be adapted to receive input data from an ultrasound imager, for providing information such as location, size of the body structure and the like, by ultrasound imaging, in order to adjust the model of the body structure, hence the locations and orientations of the predefined, optimal set of views, to the particular patient.
- the motion of the one or several motion providers 76 relates to motion of the detecting units 12, with respect to the camera overall structure 20 ( Figure 20H), for example, by the motion of detecting units 222A and 222B ( Figure 13E), with respect to the overall structure 220, as shown by the arrows 216 and 218.
- the motion of the one or several motion providers 76 may relate to motion of the overall structure 20 or 220 as a whole, for example, as taught with reference to Figure 13E, . by the motion the camera 220, as shown by the arrows 224 and 228. It will be appreciated that the controller 404, while being part of the system
- the camera 10 includes the blocks 90, each comprising a plurality of the detecting units 12, each block 90 moving as a single body.
- the individual motion of the blocks 90 is governed by a secondary motion provider 78.
- all of the blocks 90 form an assembly 92, which moves by the motion provider 76, for example, within an internal structure 21, as illustrated hereinbelow with reference to Figure 2OH.
- the secondary motion provider 78 may provide the motion described by the arrows 50 of Figures 2OB and 2OC or 2OF and 2OF, hereinbelow while the motion provider 76 may provide the motion described by the arrow 52 of Figure 2OH, hereinabove. It will be appreciated that the multiple motions may be provided to the detecting units 12, rather then to the blocks 90.
- a tertiary motion provider may also be used and that many arrangements for providing the motions are possible, and known.
- At least two assemblies 92 may be provided, each with a dedicated motion provider 76 and a dedicated secondary motion provider 78. It will be appreciated that the multiple motions may be provided to the detecting units 12, rather then to the blocks 90. It will be appreciated that tertiary motion providers may also be used and that many arrangements for providing the motions are possible, and known.
- the controller 404 while being part of the system 400, may not be part of the actual camera 10. For example, it may be an external computer, communicating with the camera 10 either by cables or via a transceiver.
- Figures 24A - 32 schematically illustrate the radioactive-emission camera 10, for the prostate, in accordance with an embodiment of the present invention.
- Figures 24A - 24C schematically illustrate the modeling of a prostate and a location of pathology, as a process of two iterations, for zooming in on the pathology, in accordance with the present invention.
- Figure 24 A schematically illustrates a body section 230, which includes a prostate 260, which has sections 262, 264 and 266, and a pathology 265 in section
- the body section 230 includes a rectum 268, from which the prostate 260 may be viewed.
- Figure 24B schematically illustrates the model 200 of the body section 230, including the prostate 260, of sections 262, 264 and 266, and the rectum 268.
- An optimal set of views is predefined based on the model 200 and a first scoring function.
- the first scoring function may be based on regions of interest similar to the pathology
- Measurements of radioactive emission are then taken at the predefined views, in vivo, for the prostate 260.
- a second model 250 of the section 264 is made, for zooming in on the pathology 265, and a second optimal set of views is predefined, based on the second model 250 of the section 264 and a second scoring function, for zooming in on the pathology 265.
- Measurements of radioactive emission are then taken at the predefined second set of views, in vivo, for the section 264 and the pathology 265.
- FIGS 25A - 25E illustrate an external appearance and an internal structure, of the camera 10.
- the radioactive-emission camera 10 for the prostate has an extracorporeal portion 80 and an intracorporeal portion 82, which is adapted for insertion into a rectum.
- the overall structure 20 of the intracorporeal portion 82 is preferably shaped generally as a cylinder and defines a longitudinal axis along the x- axis, and a radius, perpendicular to the longitudinal axis.
- the intracorporeal portion 82 preferably includes two pairs of assemblies 90, arranged in the overall structure 20. It will be appreciated that another number of assemblies, for example, a single pair, or three pairs, is similarly possible. An odd number of assemblies is similarly possible.
- the camera 10 of the present example is analogous to the camera 10 of Figure 23C and Figures 2OA - 2OF and 2OH, and particularly, to Figure 20H.
- the rotational motion, in the direction of the arrow 52 of Figure 2OH, is provided by a motor 88 ( Figure 25C) and a main shaft 85.
- the motor 88 may be an electric motor, for example, a servo motor.
- the motor 88 and main shaft 85 together, form a motion provider 76 for the rotational motion in the direction of the arrow 52 of Figure 2OH.
- the oscillatory motion, in the direction of the arrows 50 of Figure 2OB, is provided by a secondary motor 86, a secondary shaft 84 and a motion transfer link 74.
- the secondary motor 86 may also be an electric motor, for example, a servo motor.
- the significance of the present embodiment is as follows: i.
- the different assemblies 90 provide views from different orientations; and ii.
- the different assemblies 90 may change their view orientations independent of each other.
- the external surface of the intracorporeal portion 82 ( Figure 25A) remains stationary, while the internal structure 21 ( Figure 25C) rotates around the x-axis.
- the external surface of the intracorporeal portion 82 may be formed of a carbon fiber, a plastic, or another material, which is substantially transparent to nuclear radiation.
- FIG. 25E illustrates further the internal structure of the radioactive-emission camera for the prostate, in accordance with an embodiment of the present invention, showing the assemblies 90 within the overall structure 20.
- Each assembly may be a single detecting unit 12, or a plurality of the detecting units 12, for example, 36 of the detecting units 12, for example, as an array of 6X6, or 99 of the detecting units 12, for example, as an array of 11 X 9, or another number of the detecting units 12, arranged as an array or arranged in another geometry.
- Figure 26 illustrates further the internal structure of the radioactive-emission camera for the prostate, in accordance with an embodiment of the present invention, showing the oscillatory motion (in the direction of the arrows 50 of Figures 2OA, and 20C) of the assemblies 90 within the overall structure 20.
- FIGS 27 - 28 schematically illustrate the radioactive-emission camera 10, for the prostate, in accordance with another embodiment of the present invention.
- the camera 10 further includes an ultrasound transducer 85, arranged, for example, at the tip of the intracorporeal portion 82.
- Figure 27 illustrates the external appearance of the camera 10 with the ultrasound transducer 85 at its tip.
- Figure 28 illustrates the ultrasound wave 87, impinging on the prostate 260.
- Figures 29A - 29C illustrate the co-registering of a radioactive-emission image and an ultrasound image, to illustrate the functional information of the radioactive- emission image with the structural information of the ultrasound image.
- the ultrasound image is seen in Figure 29A
- the radioactive-emission image is seen in Figure 29B
- the co-registering of the two is seen in Figure 29C.
- Figure 30 schematically illustrates the radioactive-emission camera 10, for the prostate, in accordance with another embodiment of the present invention.
- the camera 10 further includes an ultrasound transducer 85, and a surgical needle 83, in a needle guide 81, arranged alongside the camera 10, for obtaining a biopsy or for other minimally invasive procedures.
- Figure 30 schematically illustrates the surgical needle 83 as it penetrates the prostate 260 from the rectum 268.
- Figures 31 and 32 schematically illustrate the manner of guiding the needle 83.
- a track 89 shows the surgeon the direction of the needle, while the camera 10 produces the functional image of the pathology 265 in the prostate 260.
- the surgeon can align the track 89 with the pathology 265, as shown in Figure 32. Once aligned, he can insert the needle 83, as shown in Figure 30.
- Figure 33 pictorially illustrates the method 340 for zooming in on a suspected pathological feature in a woman's reproductive system, as a process of two or more iterations, in accordance with the present invention, as follows:
- the method 340 may be described, pictorially, as follows:
- the region-of-interest 200, associated with a woman's reproductive system 270, is defined for the body section 230 having the body structure 215.
- the model 250 of the volume U is provided for the region-of-interest 200, possibly with one or several of the modeled organ targets HS, and within the anatomical constraints AC, for obtaining the optimal set of views for the region-of- interest 200.
- the optimal set of views is then applied to the body section 230.
- a model 250' of a volume U' is provided for the second, inner region- of-interest 200', preferably, with at least one modeled organ target HS, simulating the suspected organ target 213, for obtaining an optimal pathology set of views for the region-of-interest 200'.
- the second, pathology set of views is then applied to the body section 230.
- Figures 34 A - 34R schematically illustrate radioactive-emission measuring cameras 600, tailored for imaging the woman's reproductive system 270 and optimized with respect to the functional information gained, regarding the body structures of the woman's reproductive system, such as the cervix 274, the uterus 276, the ovaries 278, and the fallopian tubes 280 (Figure 33), in accordance with preferred embodiments of the present invention.
- Figure 34A schematically illustrates the basic radioactive-emission measuring camera 600, for a body lumen, for example, the vagina 272, the cervix 274, the uterus 276, the rectum (not shown), or the sigmoid colon (not shown).
- the camera 600 includes an extracorporeal portion 610, which preferably comprises a control unit, and an intracorporeal portion 630, having proximal and distal ends 631 and 633, with respect to an operator (not shown).
- the control unit of the extracorporeal portion 610 may include control buttons 612 and possibly a display screen 614, and may provide connections with a computer station. It may receive power from a grid or be battery operated.
- the control unit of the extracorporeal portion 610 may further include a computer or a microcomputer. It will be appreciated that the control unit may be incorporated with the intracorporeal section 630, and operated remotely.
- the intracorporeal portion 630 defines a cylindrical coordinate system of x;r, wherein x is the longitudinal axis.
- the plurality of blocks 90 along the length of the intracorporeal portion 630 is housed in an internal structure 21 ( Figure 20H).
- Each of the blocks 90 is adapted for the windshield-wiper like oscillatory motion, around the radius r, as denoted by the arrows 50.
- the oscillatory motions may be synchronized in an antipodal manner, so as to be diametrically opposed to each other, as shown hereinabove in Figures 2OB and 2OE, by the arrows 54, and as shown hereinabove in Figures 2OC and 2OF by the arrows 56.
- other motions are also possible.
- the blocks 90 may move together, or independently. It will be appreciated that an odd number of blocks 90 is also possible.
- the internal structure 21 is adapted for rotational motion around the x-axis, in the direction of ⁇ , wherein after each step of oscillatory motion at a certain orientation of ⁇ , the internal structure rotates by a step to a new orientation of ⁇ , and the oscillatory motion is repeated.
- the controller or the computer registers the locations and orientations of each detecting unit or block and correlates the measurements with the corresponding positions and orientations.
- a position-tracking device 635 may also be used, for providing information regarding the position of the camera 600 relative to a known reference. For example, if a structural scan, or another scan by another imager has been made, the position- tracking device 635 may be used to register that scan with the measurements of the camera 600.
- the camera 600 may include detecting units 12 rather then blocks 90.
- the overall structure 20 remains stationary and is substantially transparent to nuclear radiation, formed, for example, of a hydrocarbon material.
- the intracorporeal portion 630 may further include dedicated electronics 634 and motion providers 636, such as miniature motors and motion transfer systems, as known.
- FIGS 34B and 34C schematically illustrate side and distal views, respectively, of the radioactive-emission measuring camera 600, having an ultrasound imager 640 at its distal tip 633.
- the ultrasound imager 640 may provide a structural image which may be correlated with the functional image. Additionally, it may be used for providing the size and location of the body structure for modeling. Furthermore, it may be used for providing attenuation correction to the radioactive emission measurements.
- Figures 34D and 34E schematically illustrate side and distal views, respectively, of the radioactive-emission measuring camera 600, having an MRI imager 642 at its distal tip 633.
- the MRI imager 642 may provide a structural image which may be correlated with the functional image. Additionally, it may be used for providing the size and location of the body structure for modeling. Furthermore, it may be used for providing attenuation correction to the radioactive emission measurements.
- Figures 34F - 341 schematically illustrate the radioactive-emission measuring camera 600, having a distal block 9OA at its distal tip 633.
- the distal block 9OA at the distal tip is also adapted for oscillatory motion, but about the x-axis, as seen by an arrow 53. When combined with the rotational motion around the x-axis, it produces traces 55 in the shape of a star, in the body section 230, as seen in Figure 34K.
- FIGS 34L - 34Q schematically illustrates the radioactive-emission measuring camera 600, for a body lumen, having the distal block 90A at its distal tip 633, adapted for a deployed and a retracted position, and for oscillatory motion about the x-axis, when deployed.
- the camera 600 further has the ultrasound imager 640 at its distal tip 633, as a ring, similarly having a deployed and a retracted position.
- Figures 34N - 34P illustrate the distal block 9OA deployed, and the ultrasound imager 640 retracted.
- the ultrasound imager 640 does not obstruct the oscillatory motion of the distal block 9OA at the distal tip 633.
- Figure 34Q illustrates the distal block 9OA retracted and the ultrasound imager deployed so the distal block 9OA does not obstruct the view of the ultrasound imager. It will be appreciated that the ultrasound image is to be taken once, from the distal tip 633, while the radioactive-emission measurements are to be taken at a plurality of orientations, from the distal tip 633.
- Figure 34R illustrates the camera 600 with a cable 620 connecting the intracorporeal portion 630 and the extracorporeal portion 610, for example, for imaging the ovaries and the fallopian tubes from the sigmoid colon.
- the cameras 600 of the present invention may also be moved manually, both linearly, into the body lumen and rotationally, around its longitudinal axis, preferably while the position-tracking device 635 ( Figure 34A) registers its position.
- a camera with a single block or a single detecting unit may also be used.
- Figures 35 A - 35Q schematically illustrate radioactive-emission measuring cameras 600, adapted for the esophagus, in accordance with preferred embodiments of the present invention.
- Figure 35 A schematically illustrates the basic radioactive-emission measuring camera 600, for the esophagus.
- the camera 600 includes an extracorporeal portion 610, which comprises a control unit, and an intracorporeal portion 630, having proximal and distal ends 631 and 633, with respect to an operator (not shown).
- a flexible cable 620 connects between them.
- the control unit 610 may include control buttons 612 and possibly a display screen 614, and may provide connections with a computer station. It may receive power from a grid or be battery operated.
- the control unit 610 may further include a computer or a microcomputer.
- the intracorporeal portion 630 is constructed essentially as the camera 10 of Figures 23C and Figures 2OA - 2OH, and specifically, Figure 2OH.
- the intracorporeal section 630 defines a cylindrical coordinate system of x;r, wherein x is the longitudinal axis.
- the plurality of blocks 90 along the intracorporeal portion 630 is housed in an internal structure 21.
- Each of the blocks 90 is adapted for the windshield-wiper like oscillatory motion, around the radius r, as denoted by the arrows 50.
- the oscillatory motions may be synchronized in an antipodal manner, so as to be diametrically opposed to each other, as shown hereinabove in Figures 2OB and 2OE, by the arrows 54, and as shown hereinabove in Figures 2OC and 2OF by the arrows 56.
- other motions are also possible.
- the blocks 90 may move together, or independently. It will be appreciated that an odd number of blocks 90 is also possible.
- the internal structure 21 is adapted for rotational motion around the x-axis, in the direction of ⁇ , wherein after each step of oscillatory motion at a certain orientation of ⁇ , the internal structure 21 rotates by a step to a new orientation of ⁇ , and the oscillatory motion is repeated.
- a plurality of broken line traces 59 are formed, in the body section 230, as seen in Figure 35J.
- the controller or the computer registers the locations and orientations of each detecting unit or block and correlates the measurements with the corresponding positions and orientations.
- a position-tracking device 635 may also be used, for providing information regarding the position of the camera relative to a known reference. It will be appreciated that the camera 600 may include detecting units 12 rather then blocks 90.
- the overall structure 20 remains stationary, and has an external surface, which is substantially transparent to nuclear radiation.
- a ball bearing 632 may be used at the connecting point with the cable 620, to enable the rotational motion.
- the intracorporeal section 630 may further include dedicated electronics 634 and motion providers 636, such as miniature motors and motion transfer systems, as known. Alternatively, the motion may be transferred via the cable 620.
- FIGS 35B and 35C schematically illustrate side and distal views, respectively, of the radioactive-emission measuring camera 600, for the esophagus, having an ultrasound imager 640 at its distal tip 633.
- the ultrasound imager 640 may provide a structural image which may be correlated with the functional image.
- it may be used for providing the size and location of the relevant organ for modeling. Furthermore, it may be used for providing attenuation correction to the radioactive emission measurements.
- Figures 35D and 35E schematically illustrate side and distal views, respectively, of the radioactive-emission measuring camera 600, for the esophagus, having an MRI imager 642 at its distal tip 633.
- the MRI imager 642 may provide a structural image which may be correlated with the functional image. Additionally, it may be used for providing the size and location of the relevant organ for modeling. Furthermore, it may be used for providing attenuation correction to the radioactive emission measurements.
- Figures 35F - 351 schematically illustrate the radioactive-emission measuring camera 600, for the esophagus, having a block 90 at its distal tip 633.
- the block 90 at the distal tip is also adapted for oscillatory motion, but about the x-axis, as seen by an arrow 53. When combined with the rotational motion around the x-axis, it produces traces 55 in the shape of a star, in the body section 230, as seen in Figure 35K.
- Figures 35L - 35Q schematically illustrates the radioactive-emission measuring camera 600, for the esophagus, having a block 90 at its distal tip 633, adapted for a deployed and a retracted position, and for oscillatory motion about the x-axis, when deployed.
- the camera 600 further has the ultrasound imager 640 at its distal tip 633, as a ring, similarly having a deployed and a retracted position.
- Figures 35N - 35P illustrate the block 90 deployed, and the ultrasound imager
- the ultrasound imager 640 does not obstruct the oscillatory motion of the block 90 at the distal tip 633.
- Figure 35Q illustrates the block 90 retracted and the ultrasound imager deployed so the block 90 does not obstruct the view of the ultrasound imager. It will be appreciated that the ultrasound image is to be taken once, from the distal tip 633, while the radioactive-emission measurements are to be taken at a plurality of orientations, from the distal tip 633.
- Figures 36A and 36B schematically illustrates the body section 230, showing an esophagus 650.
- the radioactive-emission measuring camera 600 for the esophagus ( Figures 35A - 35Q), is adapted for oral insertion, through a mouth 652, and is further designed for identifying pathological features in a neck area 654, for example, as relating to the vocal cords, the thyroid gland, the submandibular glands. Additionally, it is designed for identifying pathological features in the trachea 656, the lungs 658, the heart 660, the breasts, the stomach 662, the pancreas 664, and the liver 666, as well as other relevant organs and glands, for example, the lymph glands.
- the camera system of the present invention allows imaging of internal organs from a close proximity. Additionally, it is particularly advantageous for overweight people and for women with large breasts, for whom extracorporeal imaging, for example, extracorporeal cardiac imaging by nuclear emission measurements, is ineffective, because of losses in the tissue.
- Figures 35A - 35Q may be MyoviewTM(technetium Tc-99m tetrofosmin), a cardiac imaging agent, of GE Healthcare, GE Medical Systems, http://www.gehealthcare.com/contact/contact_details.html#diothers.
- cardiac imaging is performed with Teboroxime, for example, for myocardial perfusion imaging.
- Teboroxime for example, for myocardial perfusion imaging.
- the radioactive-emission measuring camera 600, for the esophagus of the present invention may also be used in parallel with the cardiac camera system 500 of Example 12, described hereinbelow.
- Figures 37- 39 schematically illustrate the body section 230, as a heart, which includes the region-of-interest 200, associated with the organ 215, being the heart, which includes an aorta 242, a left atrium 244 and a right atrium 246.
- Figure 38 schematically illustrates a second, inner region-of-interest 200', associated with the aorta 242.
- Figure 39 schematically illustrates a second, inner region-of-interest 200', associated with the left atrium 244.
- Figures 40 - 52E schematically illustrate a cardiac camera system 500, in accordance with a preferred embodiment of the present invention.
- FIGS 40 - 45 schematically illustrate the basic components of the cardiac camera system 500, in accordance with the present invention. These include an operator computer station 510, a chair 520, and a radioactive-emission camera assembly 530.
- computer station 510 may be further adapted for input of an ultrasound imager 535, for example, a handheld ultrasound imager 535, possibly with a position- tracking device 537, or a 3-D ultrasound imager.
- the data provided by the ultrasound imager 535 may be used in the modeling of the heart.
- the data of the ultrasound imager may be co-registered with the radioactive emission measurements, on the same frame of reference, for providing co-registration of structural and functional images.
- the imager 535 may be an MRI imager.
- Figure 44 schematically illustrate a camera 530A, which includes shoulder sections 530B, for viewing the heart essentially from a base of the cylindrical volume, in accordance with the present invention.
- Figure 45 schematically illustrate cameras 530B, formed as shoulder sections for viewing the heart essentially from a base of the cylindrical volume, in accordance with an alternative embodiment of the present invention. Views from the shoulders, either as in Figure 44 or 45 provides information not blocked or hidden by the chest.
- Figure 46 schematically illustrates the chair 520 and the camera assembly 530, arranged for operation, in accordance with a preferred embodiment of the present invention.
- the chair 520 is in a partial reclining position
- the camera assembly 530 is designed to face it, opposite the chest of a person sitting on the chair
- the camera assembly 530 includes a housing, operative as the overall structure, which is substantially transparent to radioactive emission.
- a skeleton which is open on the side facing a patient, may be usedd as the overall structure.
- FIGS 47 — 48 schematically illustrate possible inner structures of the camera assembly, in accordance with preferred embodiments of the present invention.
- Figure 47 schematically illustrates the inner structure of the camera assembly
- the camera assembly 530 defines an internal frame of reference 80, while each assembly 92 has a reference cylindrical coordinate system of x;r, with rotation around x denoted by ⁇ and rotation around r denoted by ⁇ , wherein the oscillatory motion about r is denoted by the arrow 50.
- the motion of the camera assembly 530 corresponds to that described hereinabove, with reference to Figures 2OA - 2OH and 22A - 22H, as follows:
- the plurality of blocks 90 is adapted for the windshield-wiper like oscillatory motion, around the radius r, as denoted by the arrow 50.
- the oscillatory motions may be synchronized in an antipodal manner, so as to be diametrically opposed to each other, as shown hereinabove in Figures 2OB and 2OE, by the arrows 54, and as shown hereinabove in Figures 2OC and 2OF by the arrows 56.
- other motions are also possible.
- the blocks 90 may move together, or independently. It will be appreciated that an odd number of blocks 90 is also possible.
- the plurality of assemblies 92 are preferably arranged in parallel, and their rotational motions, around the x-axis, in the direction of ⁇ , may also be synchronized in an antipodal manner, so as to be diametrically opposed to each other, as shown hereinabove, in Figures 22C, by arrows 62, and as shown hereinabove in Figure 22G, by arrows 64.
- other motions are also possible.
- the assemblies 92 may move together, or independently. It will be appreciated that an odd number of assemblies 92 is also possible.
- the resultant traces are a large plurality of the broken line traces 59, as seen hereinabove, with reference to Figures 22D and 22H, on the chest of the patient.
- the different blocks 90 provide views from different orientations; ii.
- the different blocks 90 may change their view orientations; iii.
- the different assemblies 92 provide views from different orientations; and iv.
- the different assemblies 92 may change their view orientations.
- the motions of the blocks 90 and of the assemblies 92 are contained within the overall structure 20, so that the external surface of the camera assembly 530 remains stationary, wherein the external surface of the camera assembly
- the overall structure may be a skeleton, open on the side facing the patient.
- the oscillatory motions need not be synchronized in an antipodal manner. Rather, the blocks 90 may move together, or independently. It will be appreciated that an odd number of blocks 90 is also possible.
- camera 530 may include a plurality of assemblies 92, which are not parallel to each other.
- the assemblies 92 may be at right angles to each other, or at some other angle.
- the assemblies 92 may include detecting units 12 rather then blocks 90, for example, as in the camera 10 of Figures 2OA - 2OG.
- Figure 48 schematically illustrates a section 531 of the camera assembly 530, showing the inner structure thereof, in accordance with another embodiment of the present invention.
- the camera assembly 530 may include the overall structure 20, and a single one of the assemblies 92, within the overall structure 20, having the dedicated motion provider 76, the dedicated secondary motion provider 78, and the rows of blocks 90.
- the camera assembly 530 includes a tertiary motion provider 77, for sliding the assembly 90 laterally, in the directions of the arrow 75, along the chest of the patient
- FIGS 49A and 49B schematically illustrate the assembly 92 and the block
- the assembly 92 is constructed in a manner similar to the camera 10 of Figures 2OA - 2OH, and specifically Figure 2OH, and according to Figure 23D, hereinabove.
- the assembly 92 includes a row of at least two blocks 90, each adapted for oscillatory motion about r.
- the blocks 90 are arranged within the internal structure 21.
- a motor 88 and a shaft 85 form the motion provider 76, while a secondary motor 86 and a secondary shaft 84 form the secondary motion provider 78, for the oscillatory motion about r.
- a plurality of motion transfer systems 74 for example gear systems, equal in number to the number of blocks 90, transfer the motion of the secondary motion provider 78 to the blocks 90.
- the motion transfer systems 74 for example, of gears, make it possible to provide the row of blocks 90 with any one of parallel oscillatory motion, antipodal oscillatory motion, or independent motion, depending on the gear systems associated with each block 90. It will be appreciated that other motion transfer systems, as known, may be used.
- detecting units 12 may be used in place of blocks 90.
- adjacent blocks 9OA and 9OB may move in an antipodal manner and adjacent blocks 9OC and 9OD may move in an antipodal manner, while adjacent blocks 9OB and 9OC may move in parallel. It will be appreciated that many other arrangements are similarly possible. For example, all the pairing combinations of the blocks 90 may move in an antipodal manner, all the blocks 90 may move in parallel, or the blocks 90 may move independently. It will be appreciated that an odd number of blocks 90 may be used in the assembly 92.
- FIG 50 schematically illustrates the block 90, in accordance with a preferred embodiment of the present invention.
- the block 90 includes a frame 93, which houses the detector material 91, which is preferably pixelated, and the collimators 96. Additionally, the frame 93 houses dedicated electronics 97, preferably on a PCB board 99. Furthermore, where several modules of the detector material 91 need to be used, a structural element 89 may be provided to hold the different modules of the detector material 91 together. It will be appreciated that a single pixel detector may be used. Alternatively, a single module of a pixelated detector may be used. Alternatively, the block 90 may be constructed as any of the examples taught with reference to Figures 17A- 17N, or as another block, as known.
- FIGURE 51 schematically illustrates the cardiac model 250, in accordance with a preferred embodiment of the present invention.
- the cardiac model 250 includes the volume U, for example, as a cylinder, and the anatomical constraints AC.
- the rows of blocks 90 are arranged around the volume U, as permissible by the anatomical constraints AC.
- FIGURES 52A - 52E schematically illustrate the blocks 90, arranged for viewing the cardiac model 250, in accordance with a preferred embodiment of the present invention.
- the block 90 is shown with the frame 93, which houses the detector material 91, which is preferably pixelated, and the collimators 96. Additionally, the frame 93 houses the dedicated electronics 97, on the PCB board 99.
- FIG 52B fields of view 98 of the blocks 90 are seen for a situation wherein adjacent blocks 9OA and 9OB move in an antipodal manner, while adjacent blocks 9OB and 9OC move in a nearly parallel manner.
- the figure illustrates that when moving in an antipodal manner, the blocks 90 do not obstruct each other's field of view 98. Yet, when moving in a parallel manner, or a near parallel manner, obstruction may occur.
- all the pairing combinations of the blocks 90 may move in an antipodal manner, all the blocks 90 may move in parallel, or the blocks 90 may move independently. It will be appreciated that an odd number of blocks 90 may be used in the assembly 92.
- Figure 52D illustrates possible dimensions for the cardiac model 250.
- the dimensions are in mm. It will be appreciated that other dimensions are similarly possible.
- the model 250 may be based on general medical information of the organ 215 and common pathological features associated with it. Additionally, the model may be based on information related to a specific patient, such as age, sex, weight, and body type.
- a structural image such as by ultrasound or MRI, may be used for providing information about the size and location of the heart 215 in relation to the body section 230 ( Figure 5A), for generating the model 250.
- Figure 52E schematically illustrates a possible arrangement of the blocks 90 for viewing the volume U of the model 250, within the anatomical constrains AC.
- the significance of the present invention, as illustrated by Figures and 52E is that all the blocks maintain a close proximity to the modeled volume U, and to the region-of- interest, in vivo, even as they move. This is in sharp contrast to the prior art, for example, as taught by US Patent 6,597,940, to Bishop, et al, and US Patent 6,671,541, to Bishop, in which the blocks are fixed within a rigid overall structure, so that as some of the blocks are placed in close proximity to the body, others are forced away from the body, and their counting efficiency deteriorates.
- the radiopharmaceuticals associated with the camera of Figures 40 — 52E may be Myoview (technetium Tc-99m tetrofosmin), a cardiac imaging agent, of GE Healthcare, GE Medical Systems, http://www.gehealthcare.com/contact/contact_details.html#diothers.
- esophagus imaging is performed with Teboroxime as the radiopharmaceutical.
- cardiac imaging in accordance with the present invention relates to the imaging of the whole heart, or to a portion of the heart, or to blood vessels near the heart, for example, the coronary artery.
- FIG. 53 schematically illustrates a dual imaging system 700 for radioactive-emissions in tandem with a three-dimensional structural imager, in accordance with a preferred embodiment of the present invention.
- the dual imaging system 700 includes a three-dimensional structural imager 720, preferably, on a structural-imager gantry 722, and a radioactive-emission measuring camera 730, preferably, on a camera gantry 732.
- a patient 750 may lie on a bed 740, which is adapted for motion into the radioactive-emission measuring camera 730 and the three-dimensional structural imager 720, on a bed gantry 742.
- a control unit 710 controls the operation of the dual system 700, including the three-dimensional structural imager 720, the radioactive-emission measuring camera 730, and the bed 740.
- the control unit 710 may also analyze the data.
- control units may be used, one for controlling the three- dimensional structural imager 720 and another for controlling the radioactive- emission measuring camera 730.
- control system of the radioactive-emission measuring camera 730 generally controls the order of the operation of the dual system 700, wherein the radioactive-emission measuring may be performed before or after the structural imaging. It will be further appreciated that the radioactive-emission measuring camera
- the three-dimensional structural imager 720 may be, for example, a CT or an
- MRI which defines a frame of reference, wherein the radioactive-emission measuring camera 730 is co-registered to the frame of reference.
- the structural image may be used for providing tissue information for attenuation correction of the functional image, resulting in a more accurate functional image.
- the radioactive-emission measuring camera 730 may be constructed as one arc 730A, preferably adapted for viewing a full width of a body from a single position of the camera 730.
- the radioactive-emission measuring camera 730 may be constructed as two arcs 730A and 730B, which are adapted for viewing a full circumference of a body, from a single position of the camera 730.
- the camera 730 may have other geometries, for example, a circle, an ellipse, a polygon, a plurality of arcs forming a circle, or a plurality of sections, forming a polygon, or other shapes.
- the bed 740 is formed as a stretcher, with a sheet 744, which is substantially transparent to radioactive emission, for example, of a hydrocarbon material.
- Figure 54 schematically illustrates a cross-sectional view of dual imaging system 700 for radioactive-emissions in tandem with a three-dimensional structural imager, in accordance with a preferred embodiment of the present invention.
- the gantry 732 of the camera 730 is adapted for vertical motion, as described by the arrows 734, so as to bring the camera 730 closer to the patient 750.
- the gantry 722 of the three-dimensional structural imager 720 may be adapted for rotation, as described by an arrow 724.
- the bed 740 is preferably adapted for motion into and out of the camera 730 and the three-dimensional structural imager 720.
- the rate of imaging by the three-dimensional structural imager 720 and by the radioactive-emission measuring camera is substantially the same, so the bed moves into the two imagers at a constant speed.
- the camera 730 formed of portions 730A and 730B, as illustrated in Figures 53 and 54 may also be a radioactive- emission measuring PET camera. Additionally, while the patient 750 appears lying, the patient may be sitting standing, lying on the back or lying on the stomach.
- the body structure that may be imaged may be an organ, such as a heart or a pancreas, a gland, such as a thyroid gland or a lymph gland, blood vessels, for example, the coronary artery or the pulmonary artery, a portion of an organ, such as an aorta or a left atrium of a heart, a bone, a ligament, a joint, a section of the body, such as a chest or an abdomen, or a whole body.
- an organ such as a heart or a pancreas
- a gland such as a thyroid gland or a lymph gland
- blood vessels for example, the coronary artery or the pulmonary artery
- a portion of an organ such as an aorta or a left atrium of a heart
- a bone such as a bone, a ligament, a joint
- a section of the body such as a chest or an abdomen, or a whole body.
- the radiopharmaceuticals associated with the camera of the present invention be any one of the following: 1. anti-CEA, a monoclonal antibody fragment, which targets CEA - produced and shed by colorectal carcinoma cells - and may be labeled by Tc-99m or by other radioisotopes, for example, iodine isotopes (Jessup JM, 1998, Tumor markers - prognostic and therapeutic implications for colorectal carcinoma, Surgical
- In-111-Satumomab Pendetide designed to target TAG- 72, a mucin-like glycoprotein, expressed in human colorectal, gastric, ovarian, breast and lung cancers, but rarely in healthy human adult tissues [Molinolo A; Simpson JF; et al., 1990, Enhanced tumor binding using immunohistochemical analyses by second generation anti-tumor-associated glycoprotein 72 monoclonal antibodies versus monoclonal antibody B72.3 in human tissue, Cancer Res., 50(4): 1291-8];
- Lipid- Associated Sialic Acid a tumor antigen, used for colorectal carcinoma, with a similar sensitivity as anti-CEA monoclonal antibody fragment but a greater specificity for differentiating between benign and malignant lesions (Ebril KM, Jones JD, Klee GG, 1985, Use and limitations of serum total and lipid-bound sialic acid concentrations as markers for colorectal cancer, Cancer; 55:404-409); 4.
- MMP-7 Matrix Metaloproteinase-7
- a proteins enzyme believed to be involved in tumor invasion and metastasis (Mori M, Barnard GF et al., 1995, Overexpression of matrix metalloproteinase-7 mRNA in human colon carcinoma, Cancer; 75: 1516-1519);
- Ga-67 citrate used for detection of chronic inflammation (Mettler FA, and Guiberteau MJ, Eds., 1998, Inflammation and infection imaging, Essentials of nuclear medicine, Fourth edition, Pgs: 387-403);
- Nonspecific-polyclonal immunoglobulin G (IgG), which may be labeled with both In-I l l or Tc-99m, and which has a potential to localize nonbacterial infections (Mettler FA, and Guiberteau MJ, ibid); 7. Radio-labeled leukocytes, such as such as In-111 oxine leukocytes and
- Tc-99m HMPAO leukocytes which are attracted to sites of inflammation, where they are activated by local chemotactic factors and pass through the endothelium into the soft tissue [Mettler FA, and Guiberteau MJ, ibid; Corstens FH; van der Meer JW, 1999, Nuclear medicine's role in infection and inflammation, Lancet; 354 (9180): 765-70]; and
- Tc-99m bound to Sodium Pertechnetate which is picked up by red blood cells, and may be used for identifying blood vessels and vital organs, such as the liver and the kidneys, in order to guide a surgical instrument without their penetration.
- radionuclides may be, for example:
- FDG fluoro-deoxyglucose
- the dual imaging and any whole body imaging may be performed with Teboroxime as the radiopharmaceutical.
- Figures 55A - 55C schematically illustrate possible inner structures of the camera 730, in accordance with preferred embodiments of the present invention.
- Figure 55A schematically illustrates the inner structure of the camera 730, showing the overall structure 20 and the parallel lines of the assemblies 92, possibly of an even number, each with the row of blocks 90, possibly arranged in pairs.
- Each of the assemblies 92 preferably includes the dedicated motion provider 76, for providing the rotational motion around x, and the dedicated secondary motion provider 78, for providing the oscillatory motion about r in the direction of the arrow 50.
- the camera 730 defines an internal frame of reference 80, while each assembly 92 has a reference cylindrical coordinate system of x;r, with rotation around x denoted by ⁇ and rotation around r denoted by ⁇ , wherein the oscillatory motion about r is denoted by the arrow 50.
- the motions of the assemblies 92 and the blocks 90 correspond to those described hereinabove, with reference to Figures 2OA - 2OH and 22A - 22H, as follows:
- the plurality of blocks 90 is adapted for the windshield-wiper like oscillatory motion, around the radius r, as denoted by the arrow 50.
- the oscillatory motions may be synchronized in an antipodal manner, so as to be diametrically opposed to each other, as shown hereinabove in Figures 2OB and 2OE, by the arrows 54, and as shown hereinabove in Figures 2OC and 2OF by the arrows 56.
- other motions are also possible.
- the blocks 90 may move together, or independently. It will be appreciated that an odd number of blocks 90 is also possible.
- the plurality of assemblies 92 are preferably arranged in parallel, and their rotational motions, around the x-axis, in the direction of ⁇ , may also be synchronized in an antipodal manner, so as to be diametrically opposed to each other, as shown hereinabove, in Figures 22C, by arrows 62, and as shown hereinabove in Figure 22G, by arrows 64.
- other motions are also possible.
- the assemblies 92 may move together, or independently. It will be appreciated that an odd number of assemblies 92 is also possible.
- the resultant traces are a large plurality of the broken line traces 59, as seen hereinabove, with reference to Figures 22D and 22H, on the skin of the patient.
- the different blocks 90 provide views from different orientations; ii.
- the different blocks 90 change their view orientations; iii.
- the different assemblies 92 provide views from different orientations; and iv.
- the different assemblies 92 change their view orientations.
- the operational manner of the camera 730 is described hereinbelow with reference to Figure 23D, for the at least two assemblies 92.
- the motions of the blocks 90 and of the assemblies 92 are contained within the overall structure 20, so that the overall structure 20 of the camera 730 remains stationary, wherein the external surface of the camera 730 is substantially transparent to nuclear radiation.
- the overall structure may be a skeleton, open on the side facing the patient.
- the oscillatory motions need not be synchronized in an antipodal manner. Rather, the blocks 90 may move together, or independently. It will be appreciated that an odd number of blocks 90 is also possible.
- the camera 730 may include a plurality of assemblies 92, which are not parallel to each other.
- the assemblies 92 may be at right angles to each other, or at some other angle.
- the assemblies 92 may include detecting units 12 rather then blocks 90, for example, as in the camera 10 of Figures 2OA - 2OG.
- Figure 55B schematically illustrates a section 731 of the camera 730, showing the inner structure thereof, in accordance with another embodiment of the present invention.
- the camera 730 may include the overall structure 20, and a single one of the assemblies 92, within the overall structure 20, having the dedicated motion provider 76, the dedicated secondary motion provider 78, and the rows of blocks 90.
- the camera 730 includes a tertiary motion provider 77, for sliding the assembly 90 laterally, in the directions of an arrow 75.
- Figure 55C schematically illustrates an alternative arrangement of the blocks 90 around the volume U of the model 250, wherein each of the blocks 90 is provided with motion around the x-axis, in the direction of ⁇ , and with the oscillatory motion about r, preferably in the y-z plane, as illustrated by the arrow 50. Accordingly, the assemblies 92 need not be used. Rather, each of the blocks 90 may communicate with two motion providers which provide it with the two types of motion.
- Figures 56A and 56B schematically illustrate the assembly 92 and the block
- the assembly 92 is constructed in a manner similar to the camera 10 of Figure 2OH, and according to Figure 23D, hereinabove.
- the assembly 92 includes a row of at least two blocks 90, each adapted for oscillatory motion about r.
- the blocks 90 are arranged within the internal structure 21.
- a motor 88 and a shaft 85 form the motion provider 76, while a secondary motor 86 and a secondary shaft 84 form the secondary motion provider 78, for the I
- a plurality of motion transfer systems 74 for example gear systems, equal in number to the number of blocks 90, transfer the motion of the secondary motion provider 78 to the blocks 90.
- the motion transfer systems 74, of gears make it possible to provide the row of blocks 90 with any one of parallel oscillatory motion, antipodal oscillatory motion, or independent motion, depending on the gear systems associated with each block 90. It will be appreciated that other motion transfer systems, as known, may be used.
- detecting units 12 may be used in place of blocks 90.
- adjacent blocks 9OA and 9OB may move in an antipodal manner and adjacent blocks 9OC and 9OD may move in an antipodal manner, while adjacent blocks 9OB and 9OC may move in parallel.
- all the pairing combinations of the blocks 90 may move in an antipodal manner, all the blocks 90 may move in parallel, or the blocks 90 may move independently. It will be appreciated that an odd number of blocks 90 may be used in the assembly 92.
- Brain cancer is the leading cause of cancer-related death in patients younger than age 35, and in the United States, the annual incidence of brain cancer generally is 15-20 cases per 100,000 people.
- brain tumors There are two types of brain tumors: primary brain tumors that originate in the brain and metastatic (secondary) brain tumors that originate from cancer cells that have migrated from other parts of the body. Approximately 17,000 people in the United States are diagnosed with primary cancer each year; nearly 13,000 die of the disease. Amongst children, the annual incidence of primary brain cancer is about 3 per 100,000.
- Primary Brain Tumors are generally named according to the type of cells or the part of the brain in which they begin. The most common are gliomas, which begin in glial cells, and of which there are several types, as follows:
- Astrocytoma a tumor which arises from star-shaped glial cells called astrocytes, which most often arises in the cerebrum in adults, whereas, in children, it occurs in the brain stem, the cerebrum, and the cerebellum;
- Brain stem glioma a tumor that occurs in the lowest part of the brain and is diagnosed in young children as well as in middle-aged adults;
- Ependymoma a tumor most common in middle-aged adults, which arises from cells that line the ventricles or the central canal of the spinal cord, and also occurs in children and young adults;
- Oligodendroglioma a rare tumor, which arises from cells that make the fatty substance that covers and protects nerves and usually occurs in the cerebrum, grows slowly and generally does not spread into surrounding brain tissue. Some types of brain tumors do not begin in glial cells. The most common of these are:
- Medulloblastoma also called a primitive neuroectodermal tumor, a tumor which usually arises in the cerebellum and is the most common brain tumor in children; Meningioma, which arises in the meninges and usually grows slowly;
- Schwannoma also called an acoustic neuroma, and occurring most often in adults, it is a tumor that arises from a Schwann cell, of the cells that line the nerve that controls balance and hearing, in the inner ear;
- Craniopharyngioma a tumor which grows at the base of the brain, near the pituitary gland, and most often occurs in children;
- Germ cell tumor of the brain a tumor which arises from a germ cell, generally, in people younger than 30, the most common type of which is a germinoma;
- Pineal region tumor a rare brain tumor, which arises in or near the pineal gland, located between the cerebrum and the cerebellum. Certain inherited diseases are associated with brain tumors, for example,
- Multiple endocrine neoplasia type 1 (pituitary adenoma), Neurofibromatosis type 2 (brain and spinal cord tumors), Retinoblastoma (malignant retinal glioma), Tuberous sclerosis (primary brain tumors), and Von Hippel-Lindau disease (retinal tumor, CNS tumors).
- tumor suppressor genes i.e., genes that suppress the development of malignant cells
- Vinyl chloride is a carcinogen, used in the manufacturing of plastic products such as pipes, wire coatings, furniture, car parts, and house wares, and is present in tobacco smoke. Manufacturing and chemical plants may release vinyl chloride into the air or water, and it may leak into the environment as a result of improper disposal. People who work in these plants or live in close proximity to them have an increased risk for brain cancer.
- Brain tumors can obstruct the flow of cerebrospinal fluid (CSF), which results in the accumulation of CSF (hydrocephalus) and increased intracranial pressure (IICP). Nausea, vomiting, and headaches are common symptoms. They can damage vital neurological pathways and invade and compress brain tissue. Symptoms usually develop over time and their characteristics depend on the location and size of the tumor.
- CSF cerebrospinal fluid
- IICP intracranial pressure
- Nausea, vomiting, and headaches are common symptoms. They can damage vital neurological pathways and invade and compress brain tissue. Symptoms usually develop over time and their characteristics depend on the location and size of the tumor.
- the first step in diagnosing brain cancer involves evaluating symptoms and taking a medical history. If there is any indication that there may be a brain tumor, various tests are done to confirm the diagnosis, including a complete neurological examination, imaging tests, and biopsy.
- Figures 57 A - 57F present the principles of modeling, for obtaining an optimal set of views, for a body organ 215, in accordance with the present invention.
- Figure 57 A schematically illustrates a body section 230, illustrating the organ 215, being the brain 215.
- the brain 215 is enclosed within a skull 830 and includes: a cerebellum 802, the part of the brain below the back of the cerebrum, which regulates balance, posture, movement, and muscle coordination; a corpus callosum 804, which is a large bundle of nerve fibers that connect the left and right cerebral hemispheres; a frontal lobe of the cerebrum 806, which is the top, front regions of each of the cerebral hemispheres, and is used for reasoning, emotions, judgment, and voluntary movement; a medulla oblongata 808, which is the lowest section of the brainstem (at the top end of the spinal cord) and controls automatic functions including heartbeat, breathing, and the like; a occipital lobe of the cerebrum 810, which is the region at the back of each cerebral hemisphere, at the back of the head, and contains the centers of vision and reading ability;
- the brain 215 may include a pathological feature 213, termed herein an organ target 213.
- a region-of- interest (ROI) 200 may be defined so as to encompass the brain 215 and the pathological feature 213.
- the region-of-interest 200 of Figure 57A is modeled as a model 250 of a volume U, and the organ target 213 is modeled as a modeled organ targets HS. Additionally, there are certain physical viewing constraints, associated with the region-of-interest 200, which are modeled as anatomical constraints AC. In the present case, the skull 830 creates viewing constraints, and generally, imaging the brain is performed extracorporeally.
- Figure 58 pictorially illustrates a method
- the method 340 may be described, pictorially, as follows:
- the region-of-interest 200, associated with the organ 215, such as the brain 215, is defined for the body section 230.
- the model 250 of the volume U is provided for the region-of-interest 200, possibly with one or several of the modeled organ targets HS, and within the anatomical constraints AC, for obtaining the optimal set of views for the region-of- interest 200.
- the optimal set of views is then applied to the region-of-interest 200, encompassing the brain 215 of the body section 230.
- a second, inner region-of-interest 200' is defined, encircling the suspected pathological feature.
- the second region-of-interest 200' is defined so as to encircle the occipital lobe 810 of the cerebrum.
- a model 250' of a volume U' is provided for the second, inner region- of-interest 200', preferably, with at least one modeled organ target HS, simulating the suspected organ target 213, for obtaining an optimal pathology set of views for the region-of-interest 200'.
- the second, pathology set of views is then applied to the second, inner region-of-interest 200' of the body section 230.
- the second, pathology set of views is then applied to the occipital lobe 810 of the cerebrum, in vivo.
- Figures 59A - 6OJ schematically illustrate a camera system 850 for the brain, in accordance with a preferred embodiment of the present invention.
- Figures 59A - 59C schematically illustrate the radioactive-emission camera for the brain, in accordance with the present invention.
- radioactive-emission camera 850 for the brain is shaped as a helmet 860, adapted for wearing on a head 862.
- the helmet 860 is preferably mounted on a gantry 870, which may be adjustable in the directions of arrows 872,
- the helmet 860 may be worn directly on the head 862, for example, like a motorcycle helmet.
- a chair 880 may be provided for the comfort of the patient.
- the radioactive-emission camera 850 for the brain is operable with a control unit 890, which may be a desktop computer, a laptop, or the like.
- the control unit 890 is preferably used both for controlling the motions of the detecting units 12, blocks 90 and assemblies 92 of the radioactive-emission camera 850 for the brain and for analyzing the data.
- the radioactive-emission camera 850 for the brain may be supplied merely as the camera helmet 860 and a data storage device, such as a CD 892, a disk 892, or the like, containing the appropriate software, for operation with an existing computer, at the site. It will be appreciated that the present camera system for the brain may also be used as a PET system, for coincident counting.
- the radioactive-emission camera 850 for the brain may be operable with a structural imager, as taught by commonly owned PCT publication WO2004/042546, whose disclosure is incorporated herein by reference.
- the structural imager may be a handheld ultrasound imager, possibly with a position- tracking device, a 3-D imager such as an ultrasound imager, a CT imager, or an MRI imager, as known.
- the data provided by the structural imager may be used for any one or a combination of the following: i. obtaining accurate dimensional data for modeling the brain 215, as taught with reference to Figures 57A - 58 and 11 - 12; ii.
- Figures 60A - 6OK schematically illustrate inner structures of the camera 850 in accordance with several embodiments of the present invention.
- Figure 6OA schematically illustrates the assembly 92, comprising, for example four of the blocks 90, adapted for oscillatory motion about the r-axis, as illustrated by the arrows 50, and adapted for rotational motion about the x-axis, as illustrated by the arrow 62, as taught, for example, with reference to Figures 22A - 22H.
- detecting units 12 may be used in place of blocks 90.
- Figure 6OB schematically illustrates a possible cross sectional view of the camera 850 ( Figure 59C), showing an arrangement of the assemblies 92, laterally around the head 862.
- Figure 6OC schematically illustrates a top view of the camera 850, showing an arrangement of the assemblies 92, laterally around the head 862. It will be appreciated that the number of the blocks 90 may vary around the head 862.
- Figures 6OD and 6OE schematically illustrate other possible cross sectional views of the camera 850, showing arrangements of the assemblies 92, vertically around the head 862.
- Figure 6OF schematically illustrates the camera 850 formed as the helmet 860, with the assemblies 92, arranged as illustrated by the cross sectional view of Figure 6OE. It will be appreciated that other arrangements are similarly possible.
- the camera helmet 860 inentes an overall structure 864.
- the motions of the blocks 90 and of the assemblies 92 are contained within the overall structure 864.
- the proximal side of the overall structure 864 with respect to the head 862 ( Figure 59C) is transparent to nuclear radiation.
- the proximal side with respect to the head 862 is open.
- Figure 6OG schematically illustrates another arrangement of the blocks 90 around the head 862, wherein the blocks 90 are not arranged in assemblies 92; rather each block 90 moves as an individual body. It will be appreciated that the detecting units 12 may be used in place of the blocks 90.
- Figures 6OH - 6OK schematically illustrate possible rotational motions of the blocks 90, each of the blocks 90 moving as an individual body for obtaining views of different orientations.
- the block 90 rotates around x as seen by an arrow 852 and at each position around x, oscillates about x, as seen by an arrow
- the resultant traces are seen in Figure 601 as a star of line traces 854.
- the block 90 rotates around y as seen by an arrow 853 and at each position around y, oscillates about x, as seen by the arrow 851.
- the resultant traces are seen in Figure 6OK, as line traces 855.
- the assembly 92 includes a row of at least two blocks 90, each adapted for oscillatory motion about r.
- the blocks 90 are arranged within the internal structure 21.
- a motor 88 and a shaft 85 form the motion provider 76, while a secondary motor 86 and a secondary shaft 84 form the secondary motion provider 78, for the oscillatory motion about r.
- a plurality of motion transfer systems 74 for example gear systems, equal in number to the number of blocks 90, transfer the motion of the secondary motion provider 78 to the blocks 90.
- the motion transfer systems 74, of gears make it possible to provide the row of blocks 90 with any one of parallel oscillatory motion, antipodal oscillatory motion, or independent motion, depending on the gear systems associated with each block 90. It will be appreciated that other motion transfer systems, as known, may be used.
- detecting units 12 may be used in place of blocks 90.
- adjacent blocks 9OA and 9OB may move in an antipodal manner and adjacent blocks 9OC and 9OD may move in an antipodal manner, while adjacent blocks 9OB and 9OC may move in parallel.
- all the pairing combinations of the blocks 90 may move in an antipodal manner, all the blocks 90 may move in parallel, or the blocks 90 may move independently. It will be appreciated that an odd number of blocks 90 may be used in the assembly 92.
- imaging in accordance with the present invention relates to the imaging of the whole brain, or to a portion of the brain, or to blood vessels near the brain, for example, the coronary artery.
- the radiopharmaceuticals associated with the camera of the present invention may be Tc99m-d, 1-hexamethyl propylene amine oxime (1 -HMPAO) commercially known as Ceretec by GE-Amersham, or Tc-99m-ECD, commercially known as Neurolite, and made by Bristol Myers Squibb.
- the present invention applies to the two types of brain tumors: primary brain tumors, which originate in the brain and metastatic (secondary) brain tumors that originate from cancer cells that have migrated from other parts of the body.
- the primary brain tumors may be gliomas, which begin in glial cells, and of which there are several types, as follows:
- Astrocytoma a tumor which arises from star-shaped glial cells called astrocytes, and which in adults, most often arises in the cerebrum, whereas in children, it occurs in the brain stem, the cerebrum, and the cerebellum.
- Brain stem glioma a tumor that occurs in the lowest part of the brain, and is diagnosed in young children as well as in middle-aged adults.
- Ependymoma a tumor, most common in middle-aged adults, which arises from cells that line the ventricles or the central canal of the spinal cord and which occurs in children and young adults.
- Oligodendroglioma a rare tumor, which arises from cells that make the fatty substance that covers and protects nerves and usually occurs in the cerebrum, grows slowly and generally does not spread into surrounding brain tissue.
- the present invention applies to other types of brain tumors, which do not begin in glial cells.
- the most common of these are:
- Medulloblastoma also called a primitive neuroectodermal tumor, a tumor which usually arises in the cerebellum and is the most common brain tumor in children.
- Meningioma which arises in the meninges and usually grows slowly.
- Schwannoma also called an acoustic neuroma, and occurring most often in adults, it is a tumor that arises from a Schwann cell, of the cells that line the nerve that controls balance and hearing, in the inner ear.
- Craniopharyngioma a tumor which grows at the base of the brain, near the pituitary gland, and most often occurs in children.
- Germ cell tumor of the brain a tumor which arises from a germ cell, generally, in people younger than 30, the most common type of which is a germinoma.
- Pineal region tumor a rare brain tumor, which arises in or near the pineal gland, located between the cerebrum and the cerebellum.
- the present invention applies to tumors associated with certain inherited diseases, for example, Multiple endocrine neoplasia type 1 (pituitary adenoma), Neurofibromatosis type 2 (brain and spinal cord tumors), Retinoblastoma (malignant retinal glioma), Tuberous sclerosis (primary brain tumors), and Von Hippel-Lindau disease (retinal tumor, CNS tumors), and genetic mutations and deletions of tumor suppressor genes (i.e., genes that suppress the development of malignant cells), which increase the risk for some types of brain cancer.
- diseases for example, Multiple endocrine neoplasia type 1 (pituitary adenoma), Neurofibromatosis type 2 (brain and spinal cord tumors), Retinoblastoma (malignant retinal glioma), Tuberous sclerosis (primary brain tumors), and Von Hippel-Lindau disease (retinal tumor, CNS tumors), and genetic mutations
- the present invention applies to tumors associated with exposure to vinyl chloride.
- the present invention applies to secondary brain cancer, for example, originating from the lungs, the breasts, or other parts of the body.
- the present invention further applies to other types brain tumors, which may be malignant or benign, blood clots in the brain, and other brain pathologies. It will be appreciated that many other cameras and camera systems may be considered and the examples here are provided merely to illustrate the many types of combinations that may be examined, in choosing and scoring a camera design, both in terms of information and in terms of secondary considerations, such as rate of data collection, cost, and complexity of the design.
- the method 340 may be described, pictorially, as follows:
- the region-of-interest 200, associated with the organ 215, such as the breast 215, is defined for the body section 230.
- the optimal set of views is then applied to the region-of-interest 200, encompassing the breast 215 of the body section 230.
- III When the suspected organ target 213 is identified, in vivo, in the breast
- a second, inner region-of-interest 200' is defined, encircling the suspected pathological feature.
- a second model 250' of a second volume U' is provided for the second, inner region-of- interest 200', preferably, with at least one modeled organ target HS, simulating the suspected organ target 213, for obtaining an optimal pathology set of views for the second region-of-interest 200'.
- the second, pathology set of views is then applied to the second, inner region-of-interest 200' of the body section 230.
- the method 340 may be described, pictorially, as follows:
- the region-of-interest 200, associated with the organ 215, such as the breast 215, is defined for the body section 230, when compressed between two plates 902 and 904, for example, mammograph plates.
- the model 250 of the volume U is provided for the region-of-interest
- the modeled organ targets HS possibly with one or several of the modeled organ targets HS, and within the anatomical constraints AC, representing the mammograph plates, for obtaining the optimal set of views for the region-of-interest 200.
- the optimal set of views is then applied to the region-of-interest 200, encompassing the organ 215 of the body section 230.
- a second model 250' of a second volume U' is provided for the second, inner region-of-interest 200', preferably, with at least one modeled organ target HS, simulating the suspected organ target 213, for obtaining an optimal pathology set of views for the second region-of-interest 200'.
- the second, pathology set of views is then applied to the second, inner region-of-interest 200' of the body section 230.
- this camera system may also be used as a PET.
- FIGS 61 A - 6 IB schematically illustrate the modeling of a breast in accordance with the present invention.
- the breast is tested when compressed, as described hereinbelow.
- Mammography is currently the most effective method of screening for breast cancer, for the detection of early non-palpable tumors. In essence, it involves compressing the breast between two plates, a support plate and a compression plate, and passing x-rays through the compressed breast.
- the compression is desirous both in order to spread the breast fatty tissue thin, to reduce its attenuation, and in order to fix the breast tissue, with respect to a frame of reference, so that the x-ray image may be correlated with a surgical tool frame of reference, such as a biopsy needle frame of reference, for guiding the surgical tool to a suspected location on the x-ray image, without the breast tissue moving between the taking of the x-ray image and the guiding of the surgical tool.
- a surgical tool frame of reference such as a biopsy needle frame of reference
- stereotactic mammography meaning that the x-ray head is rotated with respect to the plates, so as to provide at least two views of the fixed breast, compressed between the plates, from at least two angles, for stereo imaging.
- each breast is imaged separately, generally, both in a vertical direction and from the side (laterally), preferably, stereotactically. In other words, generally, at least four views of each breast are taken, two vertically and two laterally.
- a surgical instrument for example, a biopsy needle, or an ablation device, such as a cryosurgery device, an ultrasound ablation device, a knife, or a laser ablation device, may be built onto the mammograph, its frame of reference correlated with that of the x-ray image.
- an ablation device such as a cryosurgery device, an ultrasound ablation device, a knife, or a laser ablation device
- Figure 62A schematically illustrates the basic mammograph 900, showing a structural support 929, which defines a frame of reference 80, and which includes a support plate 902 and a compression plate 904, the compression plate 904 being adapted for motion along an arrow 906, so as to compress a breast 909 on the support plate 902.
- An x-ray tube 905 is preferably arranged so as to move within a track 907, for obtaining x-ray images of the compressed breast 909 from at least two views, so as to obtain stereotactic viewing, for depth evaluation.
- a film 901 is preferably arranged under the breast 909, for example, under the support plate 902, for registering the x- ray image.
- the mammograph 900 is preferably adapted for rotation, as illustrated by an arrow 908, for compressing a breast from at least two orientations, for example vertically and laterally.
- FIGS 62B and 62C schematically illustrate a system 925 of an ultrasound imager 915, operative with the two plates 902 and 904, in accordance with the present invention.
- the importance of performing ultrasound between two plates, as in the case of x-rays, is that the two plates fix the breast with respect to the frame of reference 80, and in fact, convert the breast to a rigid-like tissue, so that any suspicious findings can be located by the surgical tool 903.
- the ultrasound imager 915 is arranged to slide along tracks 917, for example, on the compression plate 904, while a layer of gel 913 or hydrogel 913, between the compression plate 904 and the breast 909 ensures good contact for ultrasound imaging. In this manner, an ultrasound image, correlated to the frame of reference 80, when the breast is under compression, may be obtained.
- the ultrasound imager 915 may be built onto the structural support 929, its frame of reference correlated with the frame of reference 80, using position tracking devices or a linkage system, as known.
- Figures 63 A - 63E schematically illustrate a radioactive-emission camera 1000 for the breast, for operation with the mammograph 900 of Figure 62A, or for operation with another system, wherein a breast is compressed between two plates, in accordance with the present invention.
- Figure 63 A schematically illustrates an external appearance of the radioactive- emission camera 1000, for the breast.
- the camera 1000 has a driving portion 990 and an imaging portion 980, enclosed in a sheath 985.
- the imaging portion 980 defines cylindrical coordinates 987 of a longitudinal axis along the x-axis, and an r-axis, perpendicular to the longitudinal axis.
- Figures 63B - 63C schematically illustrate an internal structure of the radioactive-emission camera 1000, for the breast.
- the imaging portion 980 includes several of the blocks 90, for example, between two and six of the blocks 90, arranged within the sheath 985. It will be appreciated that another number, which may be larger or smaller, and which may be odd or even, may be employed.
- Figure 63B the motions experienced by the blocks 90 are illustrated with respect to the cylindrical coordinates 987 of x;r.
- a first motion is a rotational motion of all the blocks 90, moving as a single body, with the shaft 85 and the internal structure 21, around the x-axis, in the direction between + ⁇ and - ⁇ , as illustrated by the arrow 52.
- the first motion is powered by the motor 88.
- a second motion is an oscillatory motion of the individual blocks 90, powered by the secondary motor 86, the secondary shaft 84, and the motion transfer link 74, the motion transfer link 74 moving in a linear, sliding motion, as shown by the arrow 71.
- the rotational motion in the direction of the arrow 52 is provided by a motor 88 and the shaft 85, which together form the motion provider 76.
- the motor 88 may be an electric motor, for example, a servo motor.
- the oscillatory motion in the direction of the arrow 50 is provided by a secondary motor 86, a secondary shaft 84 and a motion transfer link 74.
- the secondary motor 86 may also be an electric motor, for example, a servo motor.
- the different blocks 90 provide views from different orientations; and ii.
- the different blocks 90 may change their view orientations independent of each other.
- the sheath 985 of the imaging portion 980 ( Figures 63A and 63B) remains stationary, while the internal structure 21 ( Figure 63C) rotates around the x-axis.
- the sheath 985 may be formed of a carbon fiber, a plastic, or another material, which is substantially transparent to nuclear radiation.
- Figures 63D and 63E illustrate further the oscillatory motion of the blocks 90, within the sheath 985, as described by the arrows 50, by showing the blocks 90 at different positions, along their oscillatory travel.
- Figures 63D and 63E further illustrate a viewing side 986 and a back side 988 for the camera 1000.
- Figures 64A - 64M schematically illustrate systems 910, which include the radioactive-emission cameras 1000 for the breast, operating with systems, in which a breast is compressed between two plates, for example, as in the mammograph 900, in accordance with the present invention.
- the cameras 1000 are mounted onto the two plates, the compression plate 904, and the support plate 902, such that their viewing sides 986 face each other.
- the cameras 1000 are aligned with the x-axis, as seen.
- the cameras 1000 may be aligned with the y- axis.
- the cameras 1000 may be mounted only on one plate, the compression plate 904 or the support plate 902.
- one or several of the cameras 1000 may be mounted as edge cameras, for positioning at edges 992 and 994, supplementing the cameras 1000 mounted on the plates, for obtaining views from the sides of the compressed breast.
- FIG. 64D An alternative embodiment is illustrated in Figure 64D, wherein a single one of the cameras 1000 may be mounted on each of the plates 902 and 904, the camera 1000 being adapted for travel along a track 914, in a direction of an arrow 918, by a dedicated motion provider 916, thus providing the views that a plurality of the cameras 1000 would have provided, as illustrated in Figures 64 A - 64B.
- edge cameras 1000 may be added to the embodiment of Figure 64D, in a manner similar to that of Figure 64C.
- Figure 64E schematically illustrates a control unit 890, for controlling the motions of the blocks 90 (or the detecting units 12, when not arranged in blocks) of the cameras 1000 and for analyzing the measurements and constructing the images.
- a single control unit is used both for the x-ray imager, or the ultrasound imager 915, on the one hand, and the radioactive-emission cameras 1000, on the other.
- individual control units may be used, one for each modality.
- the system 910 for the breast is provided with a storage device 892, such as a CD or a disk, which contains the software for operating the system 910 for the breast with an existing computer on the site.
- the control unit 890 may be a PC, a laptop, a palmtop, a computer station operating with a network, or any other computer as known.
- frames may be provided for mounting the radioactive-emission cameras 1000 on the plates 902 and 904.
- a frame 912 may be provided for either the support plate 902 or the compression plate 904, designed for accepting the cameras 1000 lengthwise, by inserting the cameras 1000 in holes 926.
- the frame 912 may be designed for accepting the cameras 1000 widthwise.
- a frame 922 is designed for accepting the cameras 1000 widthwise or lengthwise, wherein the frame 922 further includes an edge section 924, for supporting the edge cameras of Figure 64C.
- two complementary frames may be provided, one designed as the frame 922, for accepting the cameras 1000 lengthwise
- Figure 64H and the other, designed as the frame 912, for accepting the cameras 1000 lengthwise (or widthwise) along the plate.
- a frame 923 may be designed for accepting a single one of the cameras 1000, lengthwise, adapted for sliding widthwise along the plate, in a channel 928, by the dedicated motion provider 916.
- the frame 923 may be designed for accepting the camera 1000 widthwise, adapted for sliding lengthwise.
- a frame 927 may be designed for accepting a single one of the cameras 1000, for example, lengthwise, adapted for sliding widthwise along the plate, in a channel 928, by the dedicated motion provider 916, wherein the frame 927 further includes the edge section 924, for supporting the edge camera 1000 of Figure 64C.
- nuclear imaging by radioactive- emissions, co-registered with x-ray mammography may be obtained by a method 1010, illustrated in Figure 64L, in flowchart form, as follows: in a box 1012: the breast is compressed between the plates; in a box 1014: an x-ray mammography is performed, as seen in Figure 62 A, preferably from at least two orientations of the x-ray tube 905; in a box 1016: the cameras 1000 are mounted on the plates, and radioactive- emission measurements are performed; in a box 1018: where necessary, the surgical tool 903 may be employed, while the breast is still compressed between the two plates. It will be appreciated that the order of the steps of boxes 1014 and 1016 may be reversed.
- the images of the x-ray mammography and the nuclear imaging are co-registered and analyzed together.
- a method 1020 illustrated in Figure 64M, in flowchart form, applies, as follows: in a box 1022: a hydrogel layer is placed between one of the plates, for example, the compression plate 904 and the breast, or a gel is spread over the breast, so as to serve as an ultrasound interface between the plate and the breast; in a box 1024: the breast is compressed between the plates; in a box 1026: the cameras 1000 are mounted on the plates, and radioactive- emission measurements are performed; in a box 1028: the cameras 1000 are replaced by an ultrasound imager, for example as illustrated in Figures 62B or 62C, and ultrasound imaging is performed; in a box 1030: where necessary, the surgical tool 903 may be employed, while the breast is still compressed between the two plates.
- the images of the x-ray mammography and the nuclear imaging are co-registered and analyzed together.
- Figures 65 A — 65C schematically illustrate a radioactive-emission camera 930, for imaging a breast under vacuum, in accordance with another preferred embodiment of the present invention.
- the camera 930 includes a vacuum cup 934, shaped as a cone and connected to a vacuum system 932, for creating a vacuum in a cavity 935 within.
- the vacuum in the cavity is used both to stretch the breast so as to spread the fatty tissue thin and to fix the breast tissue with respect to a frame of reference, so a surgical device may be employed, where needed, while the breast tissue remains fixed in place.
- a vacuum ring 936 for example of natural or synthetic rubber, helps maintain the vacuum in the cup 934.
- the vacuum cup 934 defines the frame of reference 80 and a plurality of the blocks 90 are arranged along the walls 938 of the suction cup 934, each adapted for at least one, and preferably two rotational motions, for example, as illustrated with reference to Figures 221 - 22M and Figures 22Q - 22R, or Figures 22N - 22P, for imaging a breast in the cavity 935.
- the blocks 90 may be arranged in the assemblies 92, as illustrated with reference to Figures 22A - 22H.
- a surgical tool may be attached to the camera 930, and correlated to its frame of reference, for example as taught with reference to Figure 62B.
- the motions of the blocks 90 are preferably automatic, controlled by the control unit 890 ( Figure 64C).
- the inner walls 938 of the cup 934 are substantially transparent to radioactive emission.
- FIG 65B schematically illustrates an embodiment wherein a vacuum cylinder 934 is used in place of a conical cup, and the blocks 90 are arranged in assemblies 92, for example, as illustrated with reference to Figures 16E and 24A - 24H.
- Figure 65C schematically illustrates an embodiment wherein the vacuum cylinder 934 is used, and a single one of the assemblies 92 is arranged for traveling around the cylinder 934, in the direction of an arrow 940, by a motion provider 942.
- Figures 66A - 66F schematically illustrate a radioactive-emission camera 950, for imaging the breasts in the natural state, in accordance with another preferred embodiment of the present invention.
- the radioactive-emission camera 950 for imaging the breasts in a natural state, is designed as an extracorporeal unit which may be positioned against the breasts, operating as taught with reference to any one of Figures 2OA - 22R.
- the radioactive-emission camera 950 for imaging the breasts is attached to a gantry 952, which may provide adjustments as seen by arrows 954 and 956.
- the patient may be positioned on a chair 960, as seen in figure
- the control unit 890 may be used for controlling the motions of the blocks 90 ( Figures 22A - 22H or 221 - 22R) or the detecting units 12, when not arranged in blocks, and for analyzing the measurements and constructing the images.
- the radioactive-emission camera 910 for the breast is supplied with a storage device 892, which contains the software for operating the radioactive- emission camera 910 for the breast with an existing computer on the site.
- the control unit 890 may be a PC, a laptop, a palmtop, a computer station operating with a network, or any other computer as known.
- Figure 66D schematically illustrates a woman 970 being examined by the radioactive-emission camera 950, when seated on the chair 960. It will be appreciated that the examination may also be conducted when the woman 970 is standing or lying on a bed.
- Figure 66E schematically illustrates the inner structure radioactive-emission camera 950 in accordance with a preferred embodiment of the present invention.
- Figure 66E shows the overall structure 20, the parallel lines of assemblies 92, possibly of an even number, each with a dedicated motion provider 76 and a dedicated secondary motion provider 78, and the rows of blocks 90, possibly arranged in pairs, along the assemblies 92.
- the camera 950 defines the frame of reference 80, while each assembly 92 has a reference cylindrical coordinate system of x;r, with rotation around x denoted by the arrow 62 and oscillatory motion about r, denoted by the arrow 50.
- Figure 66F schematically illustrates the model 250 of the two breasts, modeled as the volumes U, and the anatomical constraints associated with them, for determining an optimal set of views for radioactive-emission measurements.
- imaging in accordance with the present invention relates to the imaging of the whole breast, or to a portion of the breast, the armpits near the breasts, (and) or the two breasts.
- the radiopharmaceuticals associated with the radioactive-emission camera for the breast may be Tc-99m bound to Sestamibi, a small protein molecule, made for example, by Bristol Myers Squibb, and marketed as Miraluma, used widely for breast cancer detection.
- the present invention applies to detecting and differentiating between various types of breast disorders, for example as illustrated in Figure 66G, hereinabove, as follows. i. fibroadenomas 8, which are fibrous, benign growths in breast tissue. ii.
- cysts 9 which are fluid-filled sacs and may disappear sometimes by themselves, or a doctor may draw out the fluid with a needle.
- a breast abscess 11 which is a collection of pus, resulting from an infection.
- fibrocystic breast disease 13 which is a common condition characterized by an increase in the fibrous and glandular tissues in the breasts, resulting in small, nodular cysts, noncancerous lumpiness, and tenderness, wherein treatment of the cysts may be all that is needed.
- a tumor 15 which may be precancerous or cancerous, and which usually shows up as a white area on a mammogram even before it can be felt.
- the tumor 15 may appear as a white area with radiating arms.
- a cancerous tumor 15 may have no symptoms or may cause swelling, tenderness, discharge from the nipple 4, indentation of the nipple 4, or a dimpled appearance 17 in the skin over the tumor.
- the present invention applies to detecting various types of breast cancers, such as: i. ductal cancer, which affects the cells of the ducts; ii. lobular cancer, which begins in the lobes or lobules of the breast; and iii. inflammatory breast cancer, which is an uncommon type of breast cancer and causes the breast to be warm, red, and swollen. It will be appreciated that the present invention further applies to other types breast disorders, which may be cancerous, precancerous, or benign.
- the present invention applies to secondary breast cancer, for example, originating from the lungs, or other parts of the body.
- the radioactive-emission camera for the breast may be designed for and used on a single breast or designed for and used simultaneously on the two breasts. It will be appreciated that although breast cancer in men and children is rare, the present invention may be used for the detection of breast cancer in men and children as well.
- the following section reviews the overall camera performance for different camera designs and illustrates configurations which conform to body contours, so as to be as close as possible to the anatomical constraints ( Figure 5B). Additionally, the importance of distance between the organ target 213 and the detecting block 90 is explained.
- the camera performance is considered with respect to the following: i. detecting efficiency; ii. acquisition time; iii. spatial resolution;
- Figures 67A and 67B schematically illustrate the solid angle by which the radiation emission source 213 "sees" the detecting block 90.
- the solid angle is ⁇ l and at the distance of R2, the solid angle is ⁇ 2, wherein an inverse relation exists between Rl and R2 and ⁇ l and ⁇ 2, such that when R2 > Rl then ⁇ l> ⁇ 2.
- the detecting efficiency is a function of the ratio of the detecting area ⁇ r 2 to the area of the sphere 4 ⁇ R 2 , so as to behave as a function of r 2 /R 2 .
- the detecting efficiency decreases, proportionally to R 2 . It will be appreciated that a similar analysis is valid for the detecting unit 12, on a pixel basis, as well.
- Radioactive emission may be described by the Poisson distribution, for which the counting error for N counts is described by N l/2 .
- the counting error is 10,000 m , or 100, which is 1% of N.
- a minimal level of counts must be obtained.
- 10,000 counts must be obtained; for an accuracy level of 0.1%, 1,000,000 counts must be obtained, and so on.
- the counting efficiency falls proportionally to R 2 and the number of counts per minutes falls proportionally to R 2 , and so the acquisition time required to reach a predetermined number of counts, for a predetermined accuracy level, increases proportionally to R 2 .
- Figures 68A — 68B schematically illustrate the effect of the distance R on the spatial resolution.
- the organ target 213 has a radius q, which may be, for example, of the order of magnitude of the radius r of the detecting block 90, so that q
- the organ target 213 may have a distribution of activity, for example, a high- level portion 213 A, a medium-level radiation portion 213B, and a relatively low-level radiation portion 213C.
- the organ target 213 is barely viewed by more than one pixel, resulting in a low-resolution image.
- the organ target 213 is viewed by less than one pixel, resulting in a very low-resolution image.
- the number of pixels in the block 90 provides for a spatial resolution capability.
- the distance between the detecting block 90 and the organ target 213 should be as small as possible.
- Figures 69A - 69D schematically illustrate different view arrangements.
- Figure 69 A illustrates four blocks 9OA, 9OB, 9OC, and 9OD for viewing the organ target 213, the blocks arranged around the body section 230.
- the block 9OA at the distance Rl from the organ target 213, is as close as possible to the external surface of the body section 230, such that it is substantially touching it. Therefore, the block 9OA is at an optimal viewing position for the organ target 213.
- the block 9OB is at a distance R2 from the organ target 213, where R2 > Rl, but it is still in position to view the target 213, rom that distance. Therefore, the block 9OB is at a suboptimal position for viewing the organ target 213.
- the block 9OC does not view the organ target 213, yet it does view the body section 230, so it may also be considered at a suboptimal position.
- the block 9OD does not view the body section 230, so the view of the block 9OD is wasteful, in that it does not provide any information regarding the body section 230.
- Blocks which substantially touch the surface of the body section 230 will always provide some information about it. Yet blocks 90 that are distant from the body section 230 may view areas altogether outside the body section 230, so their contribution is wasteful.
- Figures 69B - 69D illustrate the use of a rigid camera of the prior art, for example, as taught by US Patents 6,597,940 and 6,671,541, both to Bishop et al.
- Figure 69B-C as the blocks 9OA and 9OB are brought into close proximity with the body section 230, blocks 9OC, 9OD, 9OE and 9OF are moved away from it, and their views become suboptimal or even wasteful.
- blocks 9OF and 9OE are brought into close proximity with the body section 230, blocks 9OD, 9OC, 9OB and 9OA are moved away from it, and their views become suboptimal or even wasteful
- FIG. 71 schematically illustrates an adjustable PET camera 1150, in accordance with the present invention.
- the PET camera 1150 is formed of a plurality of the blocks 90, placed substantially on the body section 230. Such a camera, when completely surrounding the body section
- Figures 72A - 72E schematically illustrate adjustable cameras 1160 and 1170 A-B mounted on adjustable overall structures, for conforming to contours of the body section 230, in accordance with the present invention.
- the cameras 1160 and 1170 A-B include hinges
- Figure 72 A illustrates the camera 1160 prior to the adjustment
- Figure 72B illustrates the camera 1160 after adjustment.
- Figure 72C illustrates the camera 1170, as may be used for coincident imaging or another whole body imaging.
- Figure 72D schematically illustrates the viewing range of the camera 1160, in accordance with the present embodiment.
- Figure 72E schematically illustrates a pictorial view of the camera 1160, of the present embodiment.
- Figures 73A - 73B schematically illustrate adjustable cameras 1100, in accordance with another embodiment of the present invention.
- Figure 73 A illustrates the blocks 90 mounted on a flexible structure 1180 such as cloth, vinyl or the like.
- Each assembly 90 preferably includes a position tracking device 1116 and at least one but preferably two or more motion providers, such as motion providers 1114 and 1112, to provide the assembly 90 with at least one, but preferably two, three, or possibly up to six degrees of motion.
- Figure 73B illustrates the blocks 90 linked by chains 1120, to provide the adjustable character.
- each block 90 may include a MinibirdTM.
- two cameras may track the position of each block 90.
- other tracking methods may be used.
- FIG. 74A - 74B schematically illustrate adjustable cameras 1200, in accordance with still another embodiment of the present invention.
- the cameras 1200 are constructed as detecting modules 1216, which contain blocks 90 or detecting units 12[12 NOT IN THESE DRAWINGS], the detecting modules 1216 being arranged on tracks 1212 which are are associated with a coordinate system 1214.
- Each of the detecting modules 1216 includes an encoder
- the modules move along the tracks 1212 by means of a motion provider (not shown) while sending information regarding their coordinates together with measurements taken to the data-processing system 126 ( Figures 2 and 3A).
- each block 90 of the adjustable camera construction ( Figures 71 - 73B) or each detecting unit 12, where single-pixel detecting units 12 are used may be provided with at least one, and preferably, two, three, or as many as six degrees of motion such as, for example, rotational motion around the x, y, and z, axis, oscillatory motion about these axes, or translational motion along these axes.
- each block 90 may be preprogrammed to view each portion of the body section 230, in accordance with some predetermined schedule. For example, one of the blocks 90 may perform oscillatory motion, while an adjacent one of the blocks 90 may perform rotational motion.
- one block or detector may spend a long time (within a predetermined limit) in one region, while another may spend less time and move on to another angle and position so as to provide a new view.
- one block 90 or detecting unit 12 may use large steps, while another may use fine steps.
- the present invention is thus unlike current systems, where the detecting units or blocks are fixed, with respect to each other, so individual optimization by block or by detecting unit is not possible.
- the blocks along the camera may be designed differently and may include different collimators,for the different portions of the body section 230, such as those taught with reference to Figures 17C — 17F. .
- the blocks 90 at the edge may have wide-angle collimators and those that are in the central portion of the blocks 90 may have narrow collimators.
- An overall camera design may be based on the following criteria: i. a distance from the surface of the body section 230 to the detecting unit 12 or the block 90 which is no greater than 5 cm and, preferably, no greater than 3 cm,and, more preferably, no greater than 2 cm. ii. wasteful viewing for less than 50% of the viewing of each detecting unit 12 or block 90 and, preferably, less than 30% of the viewing time and, more preferably, less than 20 % of the viewing time. iii. Substantially no detecting unit 12 or block 90 is positioned so as not to view the body structure at all. iv.
- a collimator collection solid angle which is configured to view substantially a whole organ, such as a heart, or substantially a large portion of the organ.
- a block size along the rotational axis, for the block 90 of less than 10 cm and, preferably, of less than 6 cm and, more preferably, of less than 2 mm.
- Figures 75A and 75B illustrate Teboroxime physiological behavior, according to Garcia et al. (Am. J. Cardiol. 51 st Annual Scientific Session, 2002).
- Figures 76A - 8OD illustrate experimental results of the camera of the present invention and results of a conventional gamma camera, in terms of resolution, speed, and contrast.
- the detectors used were 16x16 pixilated (2.54x2.54 mm in size) CZT arrays made by Imarad, Rehovot, Israel and driven by the XA controller system made by IDEAS asa., Norway.
- Test No 1 Speed and Resolution Performances of the camera of the present invention and of the conventional gamma camera were compared by equivalent setups, as follows:
- a center of viewing was at a distance of 150 mm from the collimators' distal end with respect to an operator.
- a 5 mili Curie Cobalt 57 line source was placed at a distance of 1 cm from the center of viewing, so as to be off center for the viewing.
- a total of 13.5 million photon counts were taken.
- a 5 mili Curie Cobalt 57 line source was placed at a distance of 1 cm from the center of rotation, so as to be off center for the rotation, and the same number of counts, 13.5 million photon counts, was taken.. Acquisition time was 600 seconds.
- the camera of the present invention was about 12 times more sensitive than the conventional gamma camera.
- the image of the source was reconstructed using dedicated reconstruction algorithms based on the EM method and developed by the inventors.
- the reconstruction algorithms used on the conventional unit were OSEM/MLEM based.
- Figure 76A represents results with the camera of the present invention.
- Figure 76B represents results of the conventional gamma camera.
- the measured FWHM (Full Width at Half Maximum) resolutions are shown in Table 1, as follows:
- Test No. 2 Resolution as a Function of Scattering Distance
- a standard NEMA cylindrical phantom was filled with water, and a 5 mili Curie Cobalt 57 line source of 190 mm in length and 1 mm in diameter was placed at its center, as illustrated in Figure 76C.
- the cylindrical phantom was placed at a distance R from the distal end of the cameras' collimators.
- Reconstruction images from two 40-second acquisitions were performed and analyzed, wherein the first acquisition was based on equal angle span for all views (Fixed Angle Spans), and the second acquisition was based on adjusted angle viewing, for viewing equal sectors of the region-of-interest (Fixed ROI).
- a maximal intensity projection (MIP) of the reconstruction without attenuation correction is given in Figure 76D, based on the combined total of the two acquisitions.
- the x-z and the y-z planes each show the line source as a line, and the x-y plane provides a cross-sectional view of the line.
- Figure 76E illustrates the reconstructed cross-sectional intensity of the line source for the fixed scan angle and Fixed ROI cases, respectively, and for varying distances R from the camera. As expected, the FWHM increases with increasing R.
- Figures 76F and 76G schematically show NEMA resolutions in the x and y directions, respectively, for the fixed-angle span acquisition
- Figures 76H and 761 schematically show NEMA resolutions in the x and y directions, respectively, for the fixed-ROI acquisition.
- Table 1 below provides resolution numbers for the pre- and post-attenuation correction results, as follows:
- Test No. 4 Resolution, Acquisition Time, and Contrast
- two sources, A and B were placed in a cylindrical Perspex phantom, designed to allow the insertion of sources of different sizes and intensities.
- the cylindrical Perspex phantom was placed with its center at the center of viewing of the camera.
- the distance from the distal end of the collimators to the center of the phantom cylinder was 100 cm.
- the resulting measured contrasts are 2.6:1 and 1.6:1 for the 3:1 and 2:1 input contrasts, respectively, in the case of the camera of the present invention.
- Figure 79D represents the reconstructed results using the conventional camera, for which the acquisition time to reach the 1.4 million counts was 20 minutes.
- the 3:1 target was reconstructed as a 1.3:1 ratio while the 2:1 target was indistinguishable from the background radiation.
- the main reason for this loss of contrast is the poor spatial resolution of the conventional camera when compared to that of the camera of the present invention.
- Test No. 5 Reconstruction of Complex Objects - Torso Phantom Acquisition A standard torso phantom of Anthropomorphic Torso Phantom Model ECT/TOR/P, produced by Data Spectrum Corporation, USA, was provided, as seen in Figure 80A.
- the radioisotope Tc-99m was used as the tracer.
- the activity of the various organs was: Cardio - 0.5mCi, Background - 2mCi (0.19mCi/liter) and Liver - 0.23mCi (0.19mCi/liter).
- An acquisition time of 1.25 minutes was used for the camera of the present invention, and an acquisition time of 12.5 minutes was used for the conventional camera. In both cases, 2.5 M counts were obtained.
- Figure 80B illustrates the results using the camera of the present invention.
- Figure 8OC illustrates the results using the conventional gamma camera.
- the sensitivity ratio was thus 10:1.
- the reconstruction is visibly better in the case of the camera of the current invention.
- Figure 8OD illustrates a reconstructed three-dimensional image of the heart, from the phantom, using the camera of the present invention.
- a cold area of 1 cm x 1 cm x 0.5 cm at a left side of the heart is clearly seen. Other cold areas are similarly visible.
- the probe system includes multiple blocks of detectors positioned in a structure encircling the imaged area, each is able to rotate about a longitudinal axis substantially parallel to the main axis of the subject.
- substantially all detectors are able to simultaneously image the region of interest containing the point source and thus obtaining one out of every 500 of the emitted photons. lit is known to the skilled in the art that further opening the energy window of the detector to about 15%, enables acquisition of about one out of 250 photons of the photons emission in an experimental setting similar to the previous example.
- each such detector having multiple pixels is of about
- each detector is about 10cm wide, thus enabling regions of interest of even bigger diameters at said resolution and sensitivity with a smaller detector motion such that bigger objects are continuously viewed by the detector with only small angular detector motion.
- the detectors array may encircle the imaged subject to the extent of 360 deg, for example by having two hemi circles from both sides of the subject.
- the sensitivity in such case is estimated be about 1 in 125.
- additional detectors may be positioned to obtain views not perpendicular to the subject's main longitudinal axis, for example by upper view (e.g. from the shoulders) and abdominal view of the target region (in the case of cardiac mapping). It is estimated that such addition may increase the sensitivity but a factor of about x2.
- an example embodiment of the present invention is estimated to be able to image a volume of about 5 cm diameter located about 150mm from the detectors, with energy window of 15%, producing spatial resolution of about 5mm in approximately lOOsec, with a total sensitivity of about 1 photons being detected out of 65 emitted. It will be recognized by a person skilled in the art that a system built around the principles of this invention can thus reach the sensitivity necessary to detect substantially more than one photon from every 100 emitted.
- This result for an imaging system provides more than 100 time better sensitivity than commercially available cameras that have a sensitivity ranging from substantially from 170 counts/microCurie/minute (or 1 photon in 8500 photons emitted for a Low resolution low energy collimator to about 1 photon in every 15000 emitted for a high resolution medium energy collimator) , while maintaining similar energy windows, and potentially similar or better resolution.
- Fig 7OC shows the FWHM diameter and the FWTM (Full Width Tenth Maximum) diameter for all points in the volume. It ois noted that the resolutions measured according to the NEMA standards are substantially under 10mm throughout the volume and do not exceed 15mm for all points, a performance equal to or superior to existing nuclear cameras for similar fields of View.
- the total net acquisition time for each point was 120 seconds and the typical count rate for ,most points (with the exception of positions that could not be viewed by all columns due to mechanical limitations), and the collected number of photons was substantially 7-8million counts for most positions fully viewed, yielding a sensitivity of 1 photon out of 1500 emitted in the energy window of 5%.
- Figure 143 describes an example of a system that includes multiple detection, amplificationa and signal processing paths, threby avoiding saturation due to single hot source in space.
- Gamma-Ray photon (A) is hitting a pixelized CZT crystal.
- a hit is named 'Event'.
- the crystal is part of a 'CZT MODULE' (B) containing the CZT crystal divided into 256 pixels and 2 ASICS each receiving events from 128 pixels.
- the ASIC is OMS 'XAIM3.4' made by Orbotech Medical Systems, Rehovot, Israel, together with the CZT crystal.
- the 2 ASICs share a common output and transmit the data to 'ADC PCB' (C) that handles in parallel 4 'CZT MODULES'.
- the system is capable of further increasing the accepted event rate by channeling every 2 ASICS through a single ADC.
- the 'ADC PCB' transmits the data to the 'NRG PCB' (D) that handles in parallel 10 'ADC PCBS', but could be further replicated should one want to further decrease "dead time".
- the 'NRG PCB' transmits the data to the 'PC (E) where it is stored.
- 40 'CZT MODULE' containing a total of 10240 pixels are transmitting in parallel to the PC.
- the bottle neck, and hence the only constraint, of the system data flow is the ASICS in the 'CZTMODULE' and it's connection to the 'ADCPCB ': 1.
- An ASIC (128 pixels) can process only one photon hit within 3.5uSec, or 285,000 events/sec over 128 pixels, i.e. over 2200 events/px/sec-an exceedingly high rate.
- Figures 17A - 17H schematically illustrate detecting units 12 and blocks 90 that may be considered for possible camera designs.
- Figures 17A and 17B schematically illustrate side and top views, respectively, of the basic detecting unit 12 (see also Figure IA), having a detector 91 and a collimator 96, formed as a tube, of a collection angle ⁇ l.
- Figures 17C and 17D schematically illustrate side and top views, respectively, of the detecting unit 12, with the collimator 96 formed as a wide angle collimator, of a collection angle 62.
- FIGS 17E and 17F schematically illustrate side and top views, respectively, of the block 90 (see also Figure IB) of the detecting units 12, with the collimator 96 formed as a grid, and each of the detecting unit 12 having a collection angle 63.
- the detecting unit 12 has a collection angle 63.
- Figures 17G and 17H schematically illustrate side and top views, respectively, of the block 90 of the detecting units 12, with the collimator 96 formed as a grid, with two sizes of the detecting units 12, as follows: small detecting units 94 A, of collection angles 64, at the center of the grid, and large detecting units 94B, of collection angles 65, at the periphery. It will be appreciated that other arrangements of detecting units of different sizes may be used. It will be appreciated that a combination of these may be used.
- the block 90 may include wide-angle collimators (Figure 17C) at the periphery and normal collimators of 90-degrees (Figure 17A) at the center.
- the camera 10 may contain blocks 90 and (or) detecting units 12 of different collection angles.
- Figures 171 and 17J schematically illustrate a detecting unit 12A with an adjustable collimator 96Z, for adjusting the collection angle, in accordance with the present invention.
- the detecting unit 12A includes the detector 91 and an adjustor 91 A at the bottom of the collimator 96Z.
- the collimator 96Z is formed of a plurality of petal collimators 96A, 96B, 96C, and so on, wherein the collimator 96Z may be partially open, as shown in Figure 171, or fully open, as shown in Figure 17 J, by the action of the adjustor 9 IA, which may be, for example, a rotating knob, controlled by the data-processing system 126 ( Figures 2, 3A).
- the extent of opening of the collimator 96Z is adjustable, so it may be essentially closed, with the petal collimators 96A, 96B, 96C and so on substantially vertical with the detector 91, partially open, or fully open, much like a flower.
- Figures 17K - 17N schematically illustrate the block 90, wherein the detector
- 91 is a single-pixel scintillation detector, such as NaI(Tl), LSO, GSO, CsI, CaF, or the like, operative with photomultipliers 103.
- the block 90 having proximal and distal ends 109 and 111, respectively, vis a vis an operator (not shown), is formed of the scintillation detector 91, of a single pixel, and the collimators 96, to create the detecting units 12.
- a plurality of photomultipliers 103 is associated with the single pixel scintillation detector 91, and with dedicated algorithms, as known, their output can provide a two dimensional image of the scintillations in the single pixel scintillation detector 91. In essence, this is an Anger camera, as known.
- Two optional proximal views 109 of the photomultipliers 103 are seen in Figures 17M and 17N, as a square grid arrangement, and as an arrangement of tubes.
- the detector may be a room temperature, solid-state CdZnTe (CZT) detector, configured as a single-pixel or a multi-pixel detector, obtained, for example, from eV
- CZT solid-state CdZnTe
- a detector thickness X d may range from about 0.5 mm to about
- another solid-state detector such as CdTe, HgI, Si, Ge, or the like, or a scintillation detector (such as NaI(Tl), LSO, GSO, CsI, CaF, or the like, or a combination of a scintillation detector and a photomultiplier, to form an Anger camera, or another detector as known, may be used.
- a scintillation detector such as NaI(Tl), LSO, GSO, CsI, CaF, or the like, or a combination of a scintillation detector and a photomultiplier, to form an Anger camera, or another detector as known, may be used.
- a combination of scintillation materials and photodiode arrays may be used.
- the methods of the present invention apply to pathological features that may be modeled as regions of concentrated radiations, or hot regions, regions of low-level radiation, which is nonetheless above background level, and regions of little radiation, or cold regions, below the background level. However, in general, for identifying a pathological feature of the heart, they relate to cold regions. It will be appreciated that the methods of the present inventions may be operable by computer systems and stored as computer programs on computer- readable storage media.
- the body may be an animal body or a human body.
- the radioactive-emission-camera systems, cameras and methods of the present invention may be used with commonly owned US Applications 20040015075 and 20040054248 and commonly owned PCT publication WO2004/042546, all of whose disclosures are incorporated herein by reference. These describe systems and methods for scanning a radioactive-emission source with a radioactive-emission camera of a wide-aperture collimator, and at the same time, monitoring the position of the radioactive-emission camera, at very fine time intervals, to obtain the equivalence of fine-aperture collimation. In consequence, high- efficiency, high-resolution, images of a radioactive-emission source are obtained.
- radioactive-emission-camera systems, cameras and methods of the present invention may be used with commonly owned US Patent 6,173,201 to Front, whose disclosure is incorporated herein by reference, as well as by M. W. Vannier and D. E. Gayou, "Automated registration of multimodality images", Radiology, vol. 169 pp. 860-861 (1988); J. A. Correia, "Registration of nuclear medicine images, J. Nucl. Med., vol. 31 pp. 1227-1229 (1990); J-C Liehn, A. Loboguerrero, C. Perault and L.
- a first functional image scan based for example, on anti-CEA monoclonal antibody fragment, labeled by iodine isotopes, may be acquired for targeting CEA - produced and shed by colorectal carcinoma cells for detecting a pathological feature, such as colorectal carcinoma; ii.
- a second functional image based for example, on nonspecific- polyclonal immunoglobulin G (IgG), which may be labeled with Tc 99m , may be acquired for locating blood vessels and vital structures, such as the heart, or the stomach, co-registered with the first functional image and the pathological feature detected on it, in order to locate the pathological feature in reference to blood vessels and vital organs; and iii. a structural image, such as an ultrasound image, may be used for general structural anatomy, co-registered with the first and second functional images, in order to locate the pathological feature in reference to bones and the general anatomic structure.
- IgG immunoglobulin G
- a physician may locate the pathological feature in reference to the blood vessels, vital organs, and the bones, and guide a minimally invasive surgical instrument to the pathological feature, while avoiding the blood vessels, vital organs, and bones.
- the minimally invasive surgical instrument may be a biopsy needle, a wire, for hot resection, a knife for cold resection, an instrument of focused energy, to produce ablation, for example, by ultrasound, or by laser, an instrument for cryosurgery, an instrument for cryotherapy, or an instrument for brachytherapy, wherein seeds of a radioactive metal are planted close to a tumor, for operating as a radioactive source near the tumor.
- PCT publication WO2004/042546 further discloses that the surgical instrument may be visible on at least one of the images, for example, on the structural image, to enable the physician to see the instrument, the pathological feature, and the surrounding anatomy on the display 129 ( Figure 3A). Additionally, the surgical instrument may be radioactively labeled, to be visible also on the functional image.
- PCT publication WO2004/042546 further disclose various extracorporeal and intracorporeal systems, of radioactive-emission cameras, and structural imagers such as an ultrasound camera or an MRI camera.
- radioactive-emission-camera systems, cameras and methods of the present invention may be used together with position tracking devices, for enhanced image acquisition, they may be used together with structural imager and structural imaging for correlating functional and structural images, and they may be used for guiding minimally invasive surgical instruments, such as a biopsy needle, a wire, for hot resection, a knife for cold resection, an instrument of focused energy, to produce ablation, for example, by ultrasound, or by laser, an instrument for cryosurgery, an instrument for cryotherapy, or an instrument for brachytherapy.
- minimally invasive surgical instruments such as a biopsy needle, a wire, for hot resection, a knife for cold resection, an instrument of focused energy, to produce ablation, for example, by ultrasound, or by laser, an instrument for cryosurgery, an instrument for cryotherapy, or an instrument for brachytherapy.
- a structural image such as by ultrasound may further be used and in order to provide information about the size and location of the body structure 215 for the purpose of creating the model 250 ( Figure 5A).
- a structural image such as by ultrasound may further be used and in order to provide information about tissue attenuation, for example, as taught in conjunction by commonly owned PCT publication WO2004/042546, whose disclosure is incorporated herein by reference. The information may then be used to correct the radioactive-emission measurements.
- radioactive-emission imaging of a body structure is a three-stage process. First the radiopharmaceutical is administered. Then measurements are taken at a set of predetermined views, that is at predetermined locations, orientations, and durations. Finally, the data is analyzed to reconstruct the emission distribution of the volume and an image of the body structure is formed. The imaging process is sequential, and there is no assessment of the quality of the reconstructed image until after the measurement process is completed. Where a poor quality image is obtained, the measurements must be repeated, resulting in inconvenience to the patient and inefficiency in the imaging process.
- the present invention teaches using radioactive-emission measurements to define views for further radioactive-emission measurements of a body structure, to be performed during the current measurement process.
- the methods teach analyzing the previously obtained measurement results to determine which further views are expected to provide a high quality of information.
- the analysis may be based directly on the photon counts obtained for the current or recent measurements and/or on a reconstruction of the body structure performed upon the completion of a set of measurements.
- the present embodiments address the problem of ensuring that the quality of data gathered during the measurement process is adequate to provide a high quality image.
- the collected data and/or the image reconstructed from the collected data is analyzed the while the measurement process is taking place. Based on the analysis, further views are defined.
- each view is associated with known values of the viewing parameter(s)
- selecting a view effectively specifies known viewing parameter values.
- the defined further views thus define a set of viewing parameter values, which are used during the current measurement process in order to collect data which yields a high-quality reconstruction of the body structure.
- the following embodiments are of a method for determining further views for the imaging of a body structure, and are not confined to a specific reconstruction algorithm. Further views are preferably defined based on one or more of the following:
- Step 200 radioactive-emission measurements of the body structure are performed at predetermined views, preferably in vivo. Preferably the measurements are performed for diagnostic purposes. These predetermined views are selected prior to the measurement process, based on a model of the body structure being imaged. In the model more and less informative viewing directions have been identified.
- the predetermined views of step 200 preferably include those views expected to be informative, based on an analysis of the model.
- the body structure is all or a portion of: a prostate, a heart, a brain, a breast, a uterus, an ovary, a liver, a kidney, a stomach, a colon, a small intestine, an oral cavity, a throat, a gland, a lymph node, the skin, another body organ, a limb, a bone, another part of the body, and a whole body.
- the radioactive-emission measurements are analyzed.
- the analysis includes one or more of: 1) Analyzing detector photon count(s)
- step 220 further views for measurements are dynamically defined, based on the analysis performed in step 210.
- each of the views is associated with viewing parameters selected from the group consisting of: detector unit location, detector unit orientation, collection angle, and measurement duration.
- Defining a view consists of providing a value for each of the parameters associated with the given view.
- the analysis (step 210) and/or dynamic view definition (step 220) may take into account external parameters including: measurement duration, time elapsed from the administration of the pharmaceutical to the measurement, radiopharmaceutical half life, radioactive emission type, and radioactive emission energy.
- a photon count analysis ensures that the photon count at a given view yields an acceptable measurement error.
- the radiative emissions of the body structure being imaged is a Poisson process.
- the Poisson noise grows inversely to the square root of the number of photons detected. In other words, if N photons are collected from a given view, the resulting signal to noise ratio (SNR) equals:
- the unprocessed detector photon count at a given view thus provides significant information regarding the quality of the information obtained at a given view. If the photon count is too low, it may be desired to continue to collect photons at the current location/orientation in order to obtain a satisfactory SNR. Alternatively, it may be determined that enough photons have already been collected, and to terminate the current view and move on to the next view.
- the analysis is preferably performed by defining a global or local required measurement error, and comparing the square root of the obtained photon count to the required measurement error.
- Photon count analysis can be applied to the current and/or previous views. When a photon count of a current view is found to be too low, the duration of the current view is preferably extended in order to obtain the required error value. When a photon count of a past view is found to be too low, an emission measurement at substantially the same location and orientation but having a longer duration than previously is preferably performed. Alternately or additionally, the collection angle at the given location/orientation is preferably increased.
- a detector photon count is analyzed to identify detector saturation at a given view. Preferably, when a detector is determined to have saturated, a new view or views are selected to reinforce those views that have saturated. In an alternate preferred embodiment, further views are defined to avoid highly-radiating portions of the body structure.
- a photon collection rate at a given view is analyzed to determine if it is within a specified range.
- the photon count rate is used to identify regions of high or low interest.
- a region of high interest may be identified by a high photon rate, indicative of a tumor.
- a region of high interest may be identified in heart imaging by a low photon rate, indicative of non-functional tissues.
- further views are preferably defined by selecting views to concentrate on regions of high interest and/or to avoid regions of low interest. It is thus possible to zoom in on a suspected pathology without repeating the emission measurement process.
- the analyzing of step 210 includes reconstructing a radioactive-emission density distribution of the body structure. Reconstruction may be performed according to any applicable technique known in the art. The reconstruction is then used as the basis for further analysis.
- Reconstruction based on the data collected from the predetermined views provides information regarding the quality of information obtained from the preceding measurements, and which further views are likely to be most informative. Selecting new views based on reconstruction is intended to bring us into viewing from the more informative views or combinations of views.
- FIGURES 83 and 84a-84b which pictorially illustrate how different views provide differing types and quality of information.
- Figure 3 shows an object 300 shaped as a cylinder with a front protrusion, and having a high-emittance portion (hotspot) 310.
- Four views of object 300 are shown, which can be seen to provide different levels of information.
- Front views, such as V 1 provide little information regarding the shape of object 300 and have relatively little attenuation between the detector and hotspot 310.
- Side views, such as V 2 provide edge information regarding the object shape or profile, and when correlated with front views help locate hotspot 310 spatially within object 300.
- Top views, such as V 3 provide information regarding the cylinder edge region 320.
- FIGURES 84a and 84b demonstrate how the proper selection of views may improve the quality of information obtained for the body structure, for example in distinguishing between two regions of interest within a given volume.
- Figure 84a illustrates an object 400 having two high-emission regions of interest (ROI), 410 and 420.
- ROI regions of interest
- FIG. 84a illustrates an object 400 having two high-emission regions of interest (ROI), 410 and 420.
- ROI regions of interest
- Figure 84a in practice they will each have a finite collection angle ⁇ .
- the position of ROIs 410 and 420 are assumed to have been estimated based on a model of object 400 and/or a previously performed prescan.
- the goal of the present invention is to select an additional new view or views which increase the information we have regarding the separation of ROIs 410 and 420 within object 400.
- ROI 410 with intensity I 1 ROI 410 with intensity I 1
- ROI 420 with intensity I 2 ROI 420 with intensity I 2
- a low-emission region 430 between the two ROIs with intensity I 3 The detected intensity at a given detector is proportional to "A , where I n is the emission intensity of region n and t ⁇ is the distance of region r ni n from detector Vj.
- Figure 84b illustrates the added information provided by each of the shown views, V A to V F .
- Views V B and Vc collect emissions from all three regions, and are therefore least informative.
- Views V D and V E collect emissions from only low emittance region 430, and therefore provide most, information regarding the location of each ROI within the volume and the separation between ROIs 410 and 420.
- Views V A and V F pass only through a single ROI, and therefore provide an intermediate level of information. It is a goal of the present invention to determine, while the emission measurements of the body structure are taking place, that views in the vicinity of V D and VE are highly informative, and to add these further views to the measurement process.
- a body structure reconstruction can be utilized in several ways to define further views.
- a first way is to identify interesting portions of the contour and structure of the reconstruction. For example, it is seen in Figure 83 that top views are informative about edge region 320. Further top view measurements will therefore be informative re edge region 320, and may enable defining the edge more accurately.
- the reconstruction is analyzed to identify textural edges within the reconstruction, and view definition preferably includes selecting views at an angle to the textural edges.
- the angle is a substantially sharp angle in order to provide information regarding the edge.
- the reconstruction is analyzed to identify volumetric boundaries within the reconstruction, and view definition preferably includes selecting views at an angle to the volumetric boundaries. It is expected that the defined views will provide information regarding the boundary and differences in surrounding tissues on either side of the boundary.
- the angle is a substantially sharp angle.
- Another way to utilize the reconstruction to define further views is to identify suspected organ targets within the reconstruction, and to select further view(s) in close proximity to the suspected organ targets.
- a suspected organ target is typically detected by identifying portions of the reconstruction whose emission intensity distribution and spatial characteristics are typical of a suspect region.
- a suspected organ target is defined as a high- emittance portion of the reconstruction. In a second preferred embodiment, a suspected organ target is defined as a low-emittance portion of the reconstruction.
- the further views are used immediately for radioactive-emission measurements.
- the results of the new measurements are then used in another analysis to define new further views for additional measurements.
- the radioactive-emission measurements may then be said to be performed iteratively.
- FIG. 85 a is a simplified flowchart of an iterative method of performing radioactive-emission measurements of a body structure, according to a first preferred embodiment of the present invention.
- radioactive-emission measurements of the body structure are performed at predetermined views.
- an analysis is performed of the previously performed emission measurements.
- a decision is made whether to continue with further measurements. If yes, in step 530 further views are defined based on the analysis. Subsequent iterations continue until the decision to end the emission measurement process.
- the analysis performed at a given stage may include consideration of all or on part of the measurements performed during one or more previous iterations, in addition to the new measurements.
- Figure 85b is a simplified flowchart of a iterative method of performing radioactive-emission measurements of a body structure, according to a second preferred embodiment of the present invention.
- a reconstruction of the body structure is formed in step 505.
- the analysis step 510 is then performed utilizing data provided by the reconstruction(s) .
- analysis step 210 includes determining an accuracy of the reconstruction.
- Accuracy is preferably determined by analyzing the variance of the reconstructions formed over multiple iterations.
- further views are defined in step 220 to concentrate on the region for which higher accuracy is required. Regions of the reconstruction having low variance provide a high degree of confidence regarding the accuracy of the reconstruction in the given region (where a portion may include the entirety of the body structure being imaged). Further views may be added to the current measurements until the variance is reduced to a required level.
- analysis step 210 includes determining a resolution of the reconstruction.
- Resolution is preferably determined by analyzing the full width at half maximum (FWHM) of peak values of the reconstruction.
- the FWHM is given by the distance between points at which the reconstructions reaches half of a peak value.
- further views are defined in step 220 to concentrate on the region for which higher resolution is required.
- An additional way to define future views using the reconstruction is on an information-theoretic basis.
- a quality function expressing an information theoretic measure is defined.
- the quality function rates the information that is obtainable from the body structure when one or more permissible views are added to current measurement process.
- quality functions based on information- theoretic measures are discussed in detail below.
- the quality function is used to rate potential further views. The measurement process may then continue at those further views whose addition to the previous views yields a high rating.
- Figure 86a is a simplified flowchart of a method for dynamically defining further views, according to a first preferred embodiment of the present invention.
- step 610 a quality function is provided.
- the quality function expresses an information-theoretic measure which rates the quality of information obtainable from potential further views.
- a set of further views is selected to maximize the quality function.
- the selected further views fulfill certain constraints; for example the further views may be selected from a predefined set or may be located in the vicinity of a region of interest within the body structure.
- the quality function is evaluated independently for a single reconstruction of the emission intensity of the body structure.
- quality functions may be defined which calculate the score for a given set in relation to one or more reconstructions and/or emittance models.
- emittance models may be devised to reflect expected or typical emission patterns for the given object.
- the following discussion describes the evaluation of information-theoretic quality functions based on emittance models only. It is to be understood that at least one of the emittance models is a reconstruction of the body structure based on past measurements. Any remaining emittance models are provided externally, and may be based on general medical knowledge or on information gathered during a previous round of emission measurements of the body structure.
- FIG. 86b is a simplified flowchart of a method for dynamically defining further views, according to a second preferred embodiment of the present invention.
- the current method differs from the method of Figure 86a by the addition of steps 605-606.
- step 605 a set of one or more emittance models is provided (where the set includes one or more reconstructions of the body structure).
- An emittance model specifies the radiative intensity of each voxel in the body structure.
- some of the viewing parameters affect the radiative intensity of the voxels in the volume, for example the type of radiopharmaceuticalnd the time since administration of the radiopharmaceutical. Therefore, the emittance models provided in step 605 preferably correspond to the relevant viewing parameters.
- a collection of possible further views of the body structure is provided.
- the collection of views includes possible further views for future measurements, preferably based on anatomical and other constraints.
- the quality function provided in step 610 may utilize multiple emission models.
- one or more of the emittance models contains at least one high-emittance portion (i.e. hot region).
- a prostate containing a tumor for example, may be modeled as an ellipsoid volume with one or more high-emittance portions.
- one or more of the emittance models contains at least one low-emittance portion.
- a diseased heart may therefore be modeled as a heart-shaped volume with low-emittance portions.
- an emittance model need not contain high- or low- emittance portions, but may have a uniform intensity or a slowly varying intensity.
- the quality function implements a separability criterion. The implementation and evaluation of the separability criterion for active view determination is performed substantially as is further described herein..
- the quality function implements a reliability criterion.
- the implementation and evaluation of the reliability criterion for active view determination is performed substantially as described herein.
- Maximization of the quality function may be performed utilizing any method known in the art such as simulated annealing and gradient ascent.
- SA simulated annealing
- each point of the search space is compared to a state of some physical system.
- the quality function to be maximized is interpreted as the internal energy of the system in that state. Therefore the goal is to bring the system from an arbitrary initial state to a state with the minimum possible energy.
- the neighbors of each state and the probabilities of making a transition from each step to its neighboring states are specified.
- the SA heuristic probabilistically decides between moving the system to a neighboring state s' or staying put in states.
- the probabilities are chosen so that the system ultimately tends to move to states of lower energy. Typically this step is repeated until the system reaches and acceptable energy level.
- F(xQ) ⁇ F(x ⁇ ) ⁇ Ffa) ⁇ ...
- the set of views selected with the quality function is increased by at least one randomly selected view.
- the randomly selected view(s) increase the probability that the quality of information obtained with the further views is maximized globally rather than locally.
- selecting the best set of size N from amongst a large set of candidate projections is computationally complex. Since the size of the collection of views and of the required set may be large, a brute force scheme might not be computationally feasible.
- a so-called “greedy algorithm” is used to incrementally construct larger and larger sets, until the required number of further views is defined. When multiple further views are required, it is computationally complex to maximize the quality function over all possible combinations of further views.
- the greedy algorithm reduces the computational burden by selecting the further views one at a time. The algorithm starts with a current set of views, and for each iteration determines a single view that yields the maximum improvement of the set score (hence the name "greedy").
- a collection of views of the body structure is provided.
- the collection of views includes possible further views for future measurements, preferably based on anatomical and other constraints.
- the set of views used for the previous emission measurements is established as a current set of views.
- the view set is incrementally increased by a single further view during each iteration, until the required number of further views has been selected.
- Figure 88 is a simplified flowchart of a single iteration of the view selection method of Figure 87, according to a preferred embodiment of the present invention. The method of Figure 88 expands the current set of views by a single view.
- the method begins with a current set of views, which is the predetermined set (step 1010 above) for the first iteration of the greedy algorithm, or the set formed at the end of the previous iteration (step 1120 below) for all subsequent iterations.
- a respective expanded set is formed for each view not yet in the current set of views.
- a given view's expanded set contains all the views of the current set of views as well as the given view.
- a respective score is calculated for each of the expanded sets using the quality function.
- the view which yielded the highest-scoring expanded set is selected as a further view, to be used for further radioactive emission measurements.
- step 1130 the current set is equated to the highest-scoring expanded set by adding the selected view to the current set.
- the newly formed current set serves as an input to the subsequent iteration, until the desired number of views is attained.
- Figure 89 is a simplified flowchart of a method for dynamically defining further views, according to a third preferred embodiment of the present invention.
- step 1210 a collection of possible further views for performing radioactive-emission measurements of the body structure are provided. Each of the views is associated with at least one viewing parameter.
- the viewing parameters consist of at least one the following: detector unit location, detector unit orientation, collection angle, and measurement duration.
- step 1220 at least one quality function is provided.
- Each quality function is for evaluating sets of views, essentially as described above.
- a single quality function may be used to select several sets of views, where each set of views contains a different number of views.
- step 1230 multiple sets of further views (where a set may include a single further view) are formed from the collection of views, using the quality function(s) provided in step 1220.
- each of the sets is formed using a different one of the quality functions.
- one or more of the quality functions are used to form more than one set of views, where sets formed with the same quality function have differing numbers of views.
- step 1240 a selected set of views is obtained from the sets formed in step 1230.
- the final set of views is obtained by choosing one of the sets formed in step 1230 using a set selection criterion. For example, a respective set is formed in step 1230 for the separability and reliability criteria independently.
- a set selection criterion which calculates an overall performance rating for a given set taking both criteria into account is defined, and the formed set with the highest overall rating is selected as the final set.
- the selected set of views is obtained by merging the sets formed in step 1230 according to the relative importance of the respective quality function used to form each set.
- the method further consists of providing at least one emittance model and/or reconstruction representing the radioactive-emission density distribution of the volume, and of evaluating with at least one of the quality functions of step 1220 is performed in relation to the emittance models.
- the selected set yields a group of parameter values for performing effective detection of the intensity distribution of the body structure. For example, if each view is associated with a view location parameter the selected set defines a set of locations for collecting emission data from an object, in order to provide a high- quality reconstruction of the intensity distribution of the body structure.
- Measurement unit 1300 includes probe 1310, analyzer 1320 and view definer 1330.
- Probe 1310 performs the radioactive-emission measurements of the body structure.
- Radioactive-emission-measuring probe 1310 preferably comprises several detecting units, which may be of different geometries and different collection angles ⁇ , within a housing. Preferably, the orientation and/or collection angle of the individual collimators is controllable.
- Analyzer 1320 analyzes the radioactive-emission measurements obtained from probe 1310.
- View definer 1330 dynamically defines further views for measurements, based on the analysis provided by analysis unit 1320. The analysis and view definition are performed substantially as described above.
- the abovedescribed methods for radioactive-emission measurements of a body structure begin by performing measurements at a predetermined set of views. The results of the initial measurements are then analyzed and further views are defined.
- the initial set of views is preferably selected based on information theoretic measures that quantify the quality of the data fed to the reconstruction algorithm, in order to obtain the best data for reconstructing a three-dimensional image of the body structure, as described herein.
- the following section concentrates on the second step of the process, namely, obtaining the optimal and permissible set of initial views for performing the radioactive-emission measurements of the body structure.
- the initial predetermined set of views is denoted herein the optimal set of views.
- the initial predetermined set of views is preferably selected in accordance with the method of the view selection as described herein.
- the initial predetermined set of views is selected on the basis of one or a combination of the separability, reliability, and uniformity criteria.
- the abovedescribed methods may each be embodied as a computer program stored on a computer-readable storage medium.
- computer-readable storage medium contains a set of instructions for defining views for radioactive-emission measurements of the body structure.
- An analysis routine analyzes the radioactive-emission measurements obtained from a radioactive- emission-measuring probe, and a view definition routine dynamically defines further views for measurements, based on the analyzing.
- the abovedescribed view set selection techniques present a way to resolve the current conflict between the relatively large-pixel detectors needed for measurement speed and data processing considerations, with the small-pixel detectors needed until now to obtain a high-resolution reconstruction.
- the data obtained using the selected set of views enables a high-resolution reconstruction from a smaller number of measurements. Additionally, reconstructing the intensity distribution from a smaller quantity of collected data simplifies the computational process.
- the abovedescribed embodiments are particularly suitable for medical imaging purposes, where a high-resolution image is needed and it is desired to minimize the difficulties of the patient undergoing the diagnostic testing or treatment.
- Dynamic modeling is a technique in which the parameters of a dynamic system are represented in mathematical language. Dynamic systems are generally represented with difference equations or differential equations. Measurements obtained from the modeled system can then be used to evaluate the values of parameters of interest that cannot be measured directly.
- the system being modeled is the body structure (or portion thereof) being imaged.
- the emittance from a given voxel is affected by the chemical properties of the radiopharmaceuticals well as by the half-life of the tracer, as well as by the nature of the body structure being imaged.
- the chemical properties of the antibody to which the tracer is attached govern factors such as binding to the tissue, accumulation, and clearance rate.
- FIG. 91 is a simplified flowchart of a method for measuring kinetic parameters of a radiopharmaceutical in a body, according to a preferred embodiment of the present invention.
- the radiopharmaceutical is administered to the body.
- the body or a portion of the body are imaged.
- a model is provided for obtaining kinetic parameters from the imaging is provided.
- the kinetic parameters are obtained by applying the measurements to the provided model in order to extract the value of the required parameter(s).
- the kinetic parameters may provide information on factors such as actual uptake, rate of uptake, accumulation, and clearance of the radiopharmaceutical, which in turn provide information about the health of tissue in the voxel.
- the obtained parameter values can thus be analyzed to evaluate the health of the imaged body structure and of other portions of the body (for example renal functioning). (See description of expert system)
- the parameter values can also be analyzed and used to control future administration of the radiopharmaceutical (See description of closed loop injection system).
- the parameters obtained in step 6040 preferably include at least one of: local (in- voxel) representation of blood pool, blood flow, and diffusion to and/or from the local tissue as representative of function (e.g. viability).
- local (in- voxel) representation of blood pool preferably includes at least one of: local (in- voxel) representation of blood pool, blood flow, and diffusion to and/or from the local tissue as representative of function (e.g. viability).
- the analysis is of one voxel versus the rest of the body, not of the entire organ.
- the dynamic model relates the per pixel emission levels to factors such as the blood in voxel, the tissue in voxel (and uptake from blood), and blood re-fill (perfusion/flow).
- the concentration of tracer in the global blood pool can be recovered separately by one or more of: modeling the known kinetics given the exact injected dose, measuring the concentration at a pre-identified blood region using the imaging equipment, or by taking blood samples over time. It is also assumed that the concentration of the tracer in the global blood may be controlled in a complex fashion by various injection profiles, such as:
- Constant drip 3 Smart injection - in which the radiopharmaceutial is injected in a controlled manner over time.
- the smart injection profile may be predetermined, or responsive to external events and/or feedback from the imaging equipment (see closed loop description). For example, rather than injecting a single bolus dose of radiopharmaceutical, one can inject a tenth of the dose for each of a series of ten injections. Examples of smart injection profiles are described below.
- a final assumption is that each voxel is large enough so that variables may be defined to relate to the voxel structure in global terms.
- the dynamic models described below are for voxels having a millimetric size, which are therefore significantly larger than the blood vessels (unlike during imaging of blood vessels).
- the models therefore include parameters for both blood and tissue parameters.
- a very high-resolution reconstruction i.e. sub- millimetric
- a different model should be applied to handle voxels which are pure blood (e.g. voxels inside coronaries).
- Vt Volume of tissue in voxel.
- Vb Volume of blood within the capillaries in the given voxel.
- Vb is normally constant for a given tissue type, but may vary for different tissue types such as blood vessel, connective tissue, or tumor before or after angiogenesis
- V - Voxel volume is the sum of the tissue volume and blood volume within the voxel:
- V Vt+Vb (1)
- V is a fixed value dictated by the imaging equipment (i.e. camera) performing the radioactive-emission measurements.
- Rb Density of blood within the voxel.
- Rb is the ratio of the volume of the blood in the voxel to the total voxel volume:
- the diameter of a capillary is about 10-15um.
- the capillaries are spaced about 50-150 um apart. Therefore, it is reasonable to assume that healthy tissue has Rb ⁇ 1-5%
- C - Tracer concentration in voxel as measured by the imaging equipment.
- Cg - Tracer concentration in global blood The concentration in the global blood supply is assumed to be given.
- C may be determined with a separate model, or by measuring the global blood concentration directly.
- a full model of Cg should reflect many of the patient's conditions, including cardiac output, prior diseases (such as metabolic disorders or diabetes), hyper/hypo-fluid volume, hyper/hypo-blood pressure, liver and/or kidney function, drugs (diuretics), and so forth.
- Figure 92 is a schematic representation of a dynamic model of a voxel, according to a first preferred embodiment of the present invention.
- the present embodiment (denoted herein model 1) assumes symmetric diffusion (i.e. the tracer diffusion coefficients into and out of the voxel are equal), and that there is no accumulation of the tracer within the voxel.
- Figure 92 illustrates the role of each of the parameters described above.
- the radioactive pharmaceutical is introduced into the global blood pool 6110 by injection according to an injection profile 6120.
- the radiopharmaceutical is conveyed to the voxel via the circulatory system 6125.
- the radiopharmaceutical flows through the voxel via the capillaries 6130 running through the voxel at flow rate F.
- Diffusion from the capillaries 6130 to the voxel tissue 6140 (uptake) and from the voxel tissue 6140 to the capillaries 6130 (release) occurs with a common diffusion coefficient Kd.
- Kd is an effective coefficient which takes into account both the uptake and outtake diffusion coefficients, and the surface area to volume ratio of the capillaries 6130.
- the remainder of the pharmaceutical is dispersed to the rest of the body for uptake and clearance 6145. Similar or identical components are indicated with the same reference numbers throughout the figures.
- Model 1 assumes tracer delivery to the voxel by diffusion to and from the local tissue, rather than by accumulation and dissolution. Therefore, model 1 can serve for applications with materials like Thallium and CardioTech, but not with Mibi which accumulates due to different diffusion rates in and out of the tissue. Models 2 and 3, which are presented below, allow for accumulation, and are therefore more suitable for radiopharmaceuticals such as Mibi.
- Equations 3-5 present the relationship between the kinetic parameters for model 1:
- FIG 93 is a schematic representation of a dynamic model of a voxel, according to a second preferred embodiment of the present invention.
- the present embodiment (denoted herein model 2) assumes symmetric diffusion, with a diffusion coefficient of Kd.
- Kd is an effective coefficient which takes into account both the uptake and outtake diffusion coefficients, and the surface area to volume ratio of the capillaries 6130.
- model 2 assumes that a fraction 6150 of the tracer concentration within the tissue is accumulated and is not diffused back to blood (for example by metabolism).
- the tracer accumulation within the voxel occurs at a rate of A. Equations 6-9 present the relationship between the kinetic parameters for model 2:
- FIG. 94 is a schematic representation of a dynamic model of a voxel, according to a third preferred embodiment of the present invention.
- the present embodiment assumes asymmetric diffusion, with uptake and release occurring according to the blood concentration (vs. zero) for uptake, and to the tissue concentration (vs. zero) for release, not according to the difference in concentrations (blood vs. tissue) as in model 1.
- Transport to the tissue is modeled by a diffusion coefficient of Kin, depending only on the outside concentration of capillary blood.
- Outgoing transport is modeled by a diffusion coefficient of Kout for outgoing transport, depending only on the internal (tissue) concentration. This way, accumulation is described by a high Kin and a low Kout.
- Kin and Kout are effective coefficients, which account for the surface area to volume ratio of capillaries.
- Equations 10-12 present the relationship between the kinetic parameters for model 3:
- Models 2 and 3 are suitable for use with tracers like Thallium and Mibi, since they do not assume symmetric diffusion to/from the local tissue, but rather allow accumulation.
- Kd+A may correspond to viability and metabolism (Model 2)
- the kinetic parameters for the voxel are obtained by applying the measured values to the provided model and extracting the value of the required parameters.
- Parameter extraction may be performed utilizing any technique known in the art, such as numerical analysis. Repeated measurements may be made of the given voxel, and the parameters calculated with increasing accuracy.
- parameter extraction the dynamic system is provided in step 6030 as an analogous RLC electronic circuit.
- An RLC circuit is an electrical circuit consisting of resistors (R), inductors (L), and capacitors (C), connected in series and/or in parallel. Any voltage or current in an RLC circuit can be described by a second-order differential equation. Since all of the abovedescribed models present the voxel kinetic parameters as a second order system, the dynamic model provided in step 6030 may be described as an arrangement of resistors, capacitors, and inductors.
- Voltage analysis of an RLC circuit is based on expressing the voltage over each of the circuit elements as a function of the circuit current as follows:
- RLC circuit 6160 consists of resistor 6165, inductor 6170, and capacitor 6175 connected in series, with an input voltage provided by voltage source
- the total voltage drop over the circuit is the sum of the voltage drop over each of the circuit elements, so that:
- the dynamic model as an RLC circuit enables using well-known circuit analysis techniques to derive the values of the desired parameters based on the measurements, and to analyze the behavior of the dynamic system.
- the voltage, V represents the administered radiopharmaceutical
- dV/dt represents the rate of change of the administered radiopharmaceutical, that is the administration protocol.
- the circuit function (e.g. the right hand side of equation 17) is analogous to the obtained image. Since the obtained image is dependent on 0, the probability that a photon emitted by the given voxel is detected by the imaging equipment, the circuit function is a function of 0.
- the RLC analogy can thus be used in order to determine the radiopharmaceutical input function, dV/dt, which optimizes 0.
- Motion-related events may include one or more of expiration, inspiration, cardiac movement, stomach contraction, gastro-intestinal movement, joint movement, organ movement, and so forth.
- motion-synchronized injection may be used to inject and/or acquire during a relatively stable time period or a relatively motion-intensive time period.
- Physiological events may include a change in the activity of an organ or tissue (such as O 2 /CO 2 concentration), glucose concentration, changes in perfusion, electrical activity (ECG, EMG, EEG, etc.), neuronal activity, muscular activity, gland activity, and so forth.
- Synchronized to an external event for example to an external stimulation (e.g. by motion, sound, or light) or drug administration. Synchronizing with a drug administration may be useful for procedures such as imaging of cerebral perfusion events (like in functional MRI), so that a small bolus may be injected per stimulus and the region that uptakes the radiopharmaceutical will be more likely to be related to the stimulus.
- Responsive to the radiopharmaceutical concentration in the blood By monitoring the level of the radiopharmaceutical in the blood (either by drawing blood samples or by determining the level with the camera or other measurement system) it is possible to control the pattern in the blood, for example to keep a desired level, a desired slope, cycles, and so forth.
- the frequency domain when used for the final analysis it may be beneficial to have the injection profile in one or more fixed periods (frequencies) selected to fit the expected kinetic profile, and to keep the concentration in the blood controlled so as to produce a desired spectral performance of the blood concentration, for example an approximately sinusoidal, saw-tooth, other harmonic form.
- a desired spectral performance of the blood concentration for example an approximately sinusoidal, saw-tooth, other harmonic form.
- synchronized to an event it is meant that the injection timing is substantially linked to the timing of the event; for example the injection is performed at the time of the event, at a predetermined delay after it, or at a predicted time before the event.
- Such synchronization may allow summing and/or averaging the collected data in a synchronized fashion, similar to gating. Such summing/averaging enables the analysis and amplification of information related to the desired event, while all events which are not synchronized become "blurred", and have less influence on the final result. For example, an injection profile of once every two seconds allows data accumulated for a dynamic event synchronized to a two second period to be collected and averaged.
- FIG 96 is a simplified flowchart of a method for measuring kinetic parameters of a radiopharmaceutical in an organ of a body, according to a preferred embodiment of the present invention.
- the present method differs from the method of Figure 91 in that it images a specific organ of the body.
- the radiopharmaceutical is administered to the body.
- the organ is imaged.
- a model is provided for obtaining kinetic parameters from the imaging is provided.
- step 6240 the kinetic parameters are obtained by applying the measurements to the provided model and extracting the value of the required parameter(s).
- a further preferred embodiment of the present invention is a drug formulation for a radiopharmaceutical.
- FIG 97 is a simplified flowchart of a process for obtaining the drug formulation, according to a preferred embodiment of the present invention.
- step 6310 kinetic parameters for the radiopharmaceuticalre provided.
- step 6320 the formulation is determined, based on the provided kinetic parameters. The values of the kinetic parameters are preferably obtained by the method of Figure 91 described above.
- C is modeled as a concentration.
- C may be modeled as a count rate.
- a conversion ratio from concentration to count rate which depends on several factors. Factors influencing the conversion may include: mg of matter to number of molecules, the radiopharmaceutical half-life (which determines the average time for a photon to be emitted per molecule), and the rate of isotope decay. If the half-life is short, there is a reduction in available isotopes over the time of acquisition. Modeling the count rate may therefore be easier, and allow later conversion to concentrations.
- the time for a compound to become widespread in the body is in the time scale of about one minute.
- the sharp slope in concentration observed immediately following injection lasts only a few seconds before various organs begin uptaking the compound. It is therefore preferable to allow scanning and reconstruction of volumes of interest in a time resolution of about 5-10 seconds.
- the model equations include relatively few parameters, it is assumed that with acquisition of a few minutes long (1, 2, 5, 10 minutes) the number of time points obtained per voxel is in the range of 10-20 (preferably 50 or more), which is expected to enable stable estimation of the kinetic parameters. With radiopharmaceuticals having slower uptake and release activity it may be preferred to have longer acquisition times, such as 20, 30, or 60 minutes.
- the analysis and determination of parameter values may be performed in the time domain, the frequency domain, or in any other transform domain.
- analysis is performed by solving the differential equation, either analytically or numerically, in order to reach a model which best fits the acquired data.
- Various numerical tools are known to fit equations of this complexity to a given data set.
- An example of frequency domain analysis is presented below.
- the analytical solution may include integration over the input Cg, which may not be available with sufficient accuracy. In such cases, numerical methods for fitting the differential equations may prove more stable and accurate.
- frequency domain analysis will be particularly effective when the data is acquired in a frequency representation. It is expected that time domain analysis will be particularly effective when the data is obtained over time. Alternative approaches may be tested by converting the data from one form to the other, and the more stable approach may be selected.
- the model above may further include interstitial volume, so that substances move from capillaries to the interstitial domain and from there to the cells, and vice versa. Transfer to and from the interstitial domain may be added to the equations. In many cases the difference in concentration between the interstitial volume and the capillaries. is insignificant, thus they may be modeled as one domain.
- the general blood concentration, Cg may differ from one location to another, for example between veins and arteries. Therefore, it may be preferable to measure the blood concentration by a sample from the arteries or by measuring the concentration inside the left chambers of the heart.
- Frequency domain analysis allows the use of techniques for measuring the frequency response to a periodic injection protocol, similarly to the way frequency response is evaluated in passive electrical circuitries.
- the frequency response may be measured by injecting the radiopharmaceuticalt several frequencies, and then determining the amplitude of the response at a given frequency, the phase response, or the comparative amplitudes at several frequencies. The results are then compared with the model of the frequency response and parameters of interest are extracted (e.g. resistors and capacitor values in electrical circuitry, or diffusion coefficients and blood flow, F, in the voxel dynamic model).
- Equations 10-12 the Fourier transform equivalents of Equations 10-12 are:
- Equation 21 which relates the concentration in the voxel of interest (C) to the concentration in the arterial blood (Cg) in the frequency domain:
- C and Cg can be measured in several frequencies, enabling the extraction of F, Kin, and Kout.
- Equation 21 is useful for analyzing the value of the kinetic parameters.
- w « Kout that is the case in which rate of clearance is much faster than the rates of changes in the blood flow.
- Equation 21 For w « Kout, Equation 21 becomes:
- Equation 22 provides a highly important relationship, as the ratio between two measurements, each with two different low frequencies wl and w2 (i.e. two slow derivatives of concentration changes), provide a direct measure of flow rate:
- the ability to perform analysis of the image while imaging takes place provides many avenues for dynamically controlling the measurement process, so as to optimize the imaging.
- the present embodiments address the analysis of radioactive- emission measurements obtained during a current measurement process in order to control the administration of the radiopharmaceutical in real-time.
- Controlling the administration of the radiopharmaceutical in real-time enables the development of protocols for continuous administration of the radiopharmaceutical, or of repeated administrations while imaging is taking place.
- Continuing the administration of the radiopharmaceutical during testing allows the use of radiopharmaceuticals with a high clearance rate such as teboroxine, whose rapid clearance from the body has made its use for imaging impractical until now.
- Figure 98 is a simplified flowchart of a method of radiopharmaceuticaldministration and imaging, according to a first preferred embodiment of the present invention.
- the present method is of a stepwise imaging process, which performs a repetitive process of administration followed by imagining and analysis.
- a first administration of a radiopharmaceutical to a body is performed, in accordance with a first administration protocol.
- the first administration protocol may require a single injection of a specified quantity of the radiopharmaceutical.
- a first imaging of at least a portion of the body is performed.
- the first administration protocol is evaluated, based on the first imaging. The evaluation is preferably based on the detector photon counts and/or on a reconstruction of the body structure as described below.
- a second administration protocol is determined, based on the evaluating.
- the second administration protocol may be identical to the first administration protocol.
- at least one additional administration of the radiopharmaceutical to the body is performed, in accordance with the second administration protocol.
- at least one additional imaging is conducted.
- Figure 99 is a simplified flowchart of a method of radiopharmaceuticaldministration and imaging, according to a second preferred embodiment of the present invention.
- the present method (denoted herein the dynamic method) evaluates the measurement data while the radioactive-emission measurements are being made, so that the administration of the radiopharmaceutical is controlled simultaneously with the imaging.
- a radiopharmaceutical is administered to a body, in accordance with an initial administration protocol.
- step 10120 at least a portion of the body is imaged.
- a whilst-imaging administration protocol is provided, based on the imaging.
- the whilst-imaging protocol indicates the manner in which the radiopharmaceutical is to be administered while the imaging is taking place.
- the imaging process need not be interrupted in order to administer additional quantities of the radiopharmaceutical.
- step 10140 imaging is performed simultaneously with the administration of the radiopharmaceutical, in accordance with the whilst-imaging administration protocol.
- the second administration protocol and the whilst-imaging protocol form a feedback signal which controls radiopharmaceuticaldministration.
- the injection system is a controllable system
- the second administration protocol or whilst-imaging protocol (denoted herein the new protocol) is provided by an evaluation and control unit as a control signal for the injection system.
- the control signal for the stepwise method may consist of a series of pulses, with the imaging being performed between the pulses.
- An example of a control signal for the dynamic method is a linear input, where the dosage is steadily increased until it is determined that a desired level has been reached.
- the injection system, imaging equipment, and evaluation and control unit effectively form a closed loop system, with the control signal providing feedback to the injection system. See the dynamic modeling description for additional examples of administration protocols.
- the determination of the new protocol is preferably based on detector photon counts and/or reconstructed images obtained from previous measurements, similarly to active view determination see active vision description.
- determination of the new protocol is based all or in part on the unprocessed detector photon counts. For example, during evaluation (step 10020 of Figure 98) it may be determined that the detector has saturated. The new protocol would then be to allow the radiopharmaceutical to clear and then to apply a smaller dose.
- determination of the new protocol is based all or in part on the analysis of one or more reconstructions. For example, it may be desired to maintain a steady state. A series of reconstructions is analyzed dynamically, in order to determine when steady state is reached. The analysis is preferably based on dynamic modeling - see dynamic modeling description. Reaching steady state may be determined from the dynamic model by evaluating Ct, the tracer concentration in tissue within the voxel, and adjusting the radiopharmaceuticaldministration in order to maintain Ct at a desired level. Closed loop administration opens up many new possiblities for radioactive- emission imaging studies. It is anticipated that techniques for controling closed loop administration will be optimized based on future studies of responses to different administration protocols.
- the present invention relates to the management of radiopharmaceutical substances used for body structure imaging. More particularly, the present invention relates to a system and method for managing the radiopharmaceutical handling processes and the actual imaging processes in a unified manner, so that the managed processes work together in a coordinated manner.
- ERP systems are information management systems that integrate and automate many of the business practices associated with the operations or production aspects of a company into a single system.
- ERP systems are customarily used by large organizations to provide a single system that can manage the manufacturing, logistics, distribution, inventory, and other business processes across departments in the enterprise.
- ERP systems generally have a modular structure, with each module handling a different aspect of the business processes.
- the modules are designed to work together, generally using a common database, so as to coordinate all the business processes to work seamlessly together.
- the preferred embodiments described below extend the ERP concept by providing a management system which not only supervises the processes involved in ensuring that the radiopharmaceutical is available for the imaging process, but also actively supervises the imaging procedure in order to ensure that the proper substance is administered to the correct individual and in the correct quantity.
- Management system 9700 includes radiopharmaceutical handling module 9710 and imaging module 9720, both of which preferably utilize a common database 9730.
- Radiopharmaceutical handling module 9730 coordinates all processes which relate to radiopharmaceutical handling prior to the imaging process, preferably including one or more of: procurement (from outside supplier or by generating in- house), inventory (storage), dose preparation, disposal, reporting, and any additional processes required to ensure that a required radiopharmaceutical is available for the imaging procedure. Some processes may be specific to a particular radiopharmaceutical.
- Imaging module 9720 coordinates all processes relating to the actual imaging process, preferably including one or more of: patient admission, radiopharmaceuticaldministration, communication with camera and/or administration device, and any additional processes required for performing the imaging.
- the radiopharmaceutical is administered by a remotely-controllable administration device with communication capabilities, as described below. Proper design of management system 9700 will ensure that adequate safety procedures are in place at all times.
- Radiopharmaceutical handling module 9710 has a modular structure.
- a central component of radiopharmaceutical handling module 9710 is inventory module 9730.
- Inventory module 9730 tracks the types and quantities of the radiopharmaceuticals currently in storage.
- Inventory module 9730 is responsible for ensuring that all necessary radiopharmaceuticals are available. When inventory module 9730 identifies that stocks of a given radiopharmaceuticalre lower than needed, inventory module 9730 notifies procurement module 9740 that additional quantities should be procured. Procurement module 9740 obtains the necessary radiopharmaceutical, via order module 9741 and/ or via generating module 9742. Order module 9741 places orders with external suppliers and tracks delivery. Generating module 9742 manages the generation of those radiopharmaceuticals which can be generated in house (such as Technicium 99m).
- inventory module 9730 coordinates with disposal module 9750, which manages the disposal process. Both procurement module 9740 and disposal module 9750 operate in accordance with the per country requirements for radiopharmaceutical use. Reporting module 9760 reports to the nuclear regulatory commission as required, based on information obtained from procurement, disposal, and other modules.
- Dose preparation module 9770 manages all tasks related to the preparation of the radiopharmaceutical doses as required. For a given imaging procedure, dose preparation module 9770 preferably provides instructions to a dose preparation system (see Figure 106) for preparing the necessary dose, preferably including calculating the required dosage to be dispensed based on factors such as the type of imaging procedure, time of dose preparation, scheduled imaging time, and patient related factors such as age, weight, medical condition and so forth. Dose preparation module 9770 tracks the number of patient doses drawn from the inventory (e.g. mother vial) and updates inventory module 9730 accordingly.
- the inventory e.g. mother vial
- dose preparation module 9770 issues a machine-readable radiopharmaceutical label to be attached to the dose, identifying the radiopharmaceutical type, isotope type, preparation date and time, time dose should be administered, intended patient, and the intended imaging procedure.
- the radiopharmaceutical label may consist of any means of attaching the required information to a given dose, such as a printed label or bar code.
- the radiopharmaceutical label includes a memory and wireless communication device (in such case the radiopharmaceutical label is denoted herein a smart label or RFID), to enable direct communication and information transfer between dose preparation module 9770 and the management system.
- dose it is intended to include both a single radiopharmaceuticalnd a cocktail of radiopharmaceuticals, as required by the imaging procedure.
- Admission module 9810 supervises patient admission. At the time of patient arrival, patient details such as name, ID number, purpose of visit (type of study), and medical history are entered, and a patient file is created. Admission module 9810 then generates the patient tag, which is a machine-readable tag to be worn or carried by the patient, and which contains relevant patient details such as the patient details, intended radiopharmaceutical dose, and intended imaging scheme.
- the patient tag is a smart tag 9830 which includes a transceiver, memory, and optionally indicator as described below.
- admission module 9810 also notifies ERP module 9820 that the patient has been admitted, and provides the patient file, including details of the intended study, to ERP module 9820.
- ERP module 9820 manages all aspects of the imaging process, by coordinating between admission module 9820, patient tag, smart label 9840, camera 9850, and administration device 9860, in concert with radiopharmaceutical handling module 9710.
- Note-ERP is a specific term which is not completely applicable to the functions of this module. It may be advisable to change name of this module. I left the current name in case it appears elsewhere in the application.
- ERP module 9820 orders and obtains the required radiopharmaceutical dose from dose preparation module 9770.
- the dose is supplied with a smart label 9840.
- ERP module 9820 determines when imaging can begin by comparing data obtained from smart tag 9830 (dose), smart label 9840 (patient), and camera 9850, During imaging, ERP module 9820 activates camera 9850 and controls dose administration by administration device 9860.
- Preferably communication between the various modules is wireless, according to wireless protocols such as Bluetooth, WiFi, W-LAN, and IEEE 802.11.
- Camera 9850 includes a controller, communication element (such as a transceiver) for communicating with ERP module 9820, a memory, and an indicator controller, and optionally locking mechanism.
- Camera 9850 is preferably activated by ERP module 9820, when ERP module 9820 determines that the imaging process may be initiated. The interlock prevents camera activation, if the imaging study has not been verified by ERP module 9820. ERP module 9820 then controls the camera 9850 in accordance with the requirements of the current imaging study. For example, ERP module 9820 may instruct the camera 9850 to sequentially perform emission measurements at a specified set of views. When imaging is initiated, a light or beep may be provided by the indicator, to notify imaging personnel that imaging is about to begin.
- Administration device 9860 includes a memory and communication element (such as a transceiver) for communicating with ERP module 9820, and possibly other system components.
- Administration device 9860 may be any device used to administer a radiopharmaceutical, including a manual syringe, a controllable-syringe, an IV drip, a pump, or a closed-loop administration system (see closed loop description).
- Controllable embodiments of administration device 9860 such as those of FIGURES 103-105, include components (such as a motor) for automatically administering and regulating the dose to the patient according to instructions provided by ERP module 9820.
- Administration device 9860 may be preprogrammed with the required administration profile or may be under online control.
- administration device 9860 is responsive to responsive to external events and/or feedback from the imaging equipment such as those of the smart injection profile (see dynamic modeling description).
- Administration device 9860 may also include an indicator, similar to that of camera 9850.
- Administration device 9860 may be a bedside unit or a portable unit which can be carried by the patient.
- ERP module 9820 Prior to administration, ERP module 9820 obtains the required dose with a smart label 9840, and sends the dose to the injection point.
- the radiopharmaceutical is administered by injection prior to imaging, for example a day early.
- ERP module 9820 prepares or updates the patient's tag, with the details of the type and dose of radiopharmaceutical that was administered, and preferably the patient file opened at admission. The following day, at the scheduled time, the patient arrives at the injection point with the smart tag 9830. At the injection point, ERP module 9820 performs a recognition test.
- ERP module 9820 determines that imaging may commence. Alternately or additionally, ERP module 9820 may require manual authorization to begin the imaging process, possibly by requiring that a personnel member press "START" button on a computerized camera control screen. ERP module 9820 may additionally review medical test results, such as an ECG, for the given patient, to ensure that the test results permit performing the imaging. Administration is performable only after ERP module 9820 has unlocked any interlock mechanism or controllable valve on the administration device 9860. Additionally, an indication may be provided by indicators on the smart tag 9830, administration device 9860 and/or camera 9850. The recognition test ensures that the correct dose is administered to the patient. Any mismatch between the patient, the radiopharmaceutical, and the intended imaging study prevents radiopharmaceutical from being administered.
- ERP module 9820 When dynamic studies are performed it is highly important to image the time period immediately following administration, when the recently administered radiopharmaceutical causes a rising concentration of the radiopharmaceutical in the blood and in the tissue. Therefore, after recognition ERP module 9820 first activates the camera 9850, and authorizes radiopharmaceuticaldministration only after the camera 9850 is ready. Administration may be performed manually, by preprogramming, or under the control of ERP module 9820 when a controllable syringe (or other administration device) is used. Upon injection a report is sent to ERP module 9820, and at least the patient tag, or both the patient's tag and the ERP, are updated that injection took place.
- the radiopharmaceutical is administered at the time of the imaging study.
- ERP module 9820 first performs recognition, to ensure a match between the scheduled study, imaging protocol, patient's smart tag 9830, and syringe smart label 9840.
- ERP module 9820 activates the camera 9850.
- ERP module 9820 initiates administration by the administration device 9860, according to either a predetermined administration protocol or to a protocol provided dynamically during the imaging process, possibly via feedback from the camera (i.e. closed loop).
- FIGURES 103 and 104 are simplified illustrative diagrams of controllable radiopharmaceuticaldministration devices, according to a first and second preferred embodiment of the present invention.
- the administration device is a single-reservoir controllable syringe 9861.
- Controllable syringe 9861 consists of a reservoir 9862, with an injection volume between about 0.5 to 30 milliliters, surrounded by protective shielding 9863.
- Smart label 9864 is attached to the shielding, and is communication with transceiver 9865.
- Transceiver 9865 additionally communicates with the ERP module, for example during recognition and while obtaining administration protocol instructions.
- Transceiver 9865 conveys the administration protocol instructions to controller 9866.
- Controller 9866 controls motor 9867 in order to inject the pharmaceutical and unlocks controllable valve 9868 (also denoted the interlock) on needle 9869.
- Flow rate gate 9870 monitors the dose as it is administered, and provides information about the actual administered dose to one or more of the smart label, smart tag, camera, ERP module and controller 9866.
- Controllable syringe is preferably able to administer various injection profiles, such as bolus, pulsatile, sinusoidal, or closed loop. Labeling information is optionally additionally provided on the syringe as a barcode 9871 or printed label.
- Controllable syringe 9861 optionally further includes indicator 9872, for providing a visual or audible indication that the radiopharmaceutical is being administered.
- the administration device is a multiple-reservoir controllable syringe 9880.
- Multiple-reservoir controllable syringe 9880 contains multiple reservoirs 9881.1-9881.n for the separate storage of different radiopharmaceuticals.
- Multiple-reservoir controllable syringe 9880 further contains a mechanism for separately controlling administration by each of reservoirs 9881.1- 988 l.n.
- the control mechanism shown in Figure 104 is a slide 9882 under the control of controller 9866, which prevents administration from all reservoirs other than the one called for by the administration protocol.
- a trigger signal is provided by the syringe to the ERP module, indicating that the injection has started and marking the time point in the patient file.
- a trigger is additionally provided to mark the end of injection, thereby indicating the duration of administration.
- a trigger may be provided to indicate the start and/or finish of each of the administrations. The trigger indicating that administration has started may be obtained by noting when communication is interrupted between the ERP module and a transmitter placed on the plunger portion of the syringe, as the transmitter signal is blocked by the shielding around the reservoir.
- the administration device 9910 comprises a controller 9912 which receives data from a program and uses the data to operate a series of syringes 9914 each provided with a different tracer or cocktail of tracers. Each syringe contains a substance which needs to be injected at a certain dose at a certain time.
- a valve unit 9916 comprises one or more controllable or one-directional valves which can be used to regulate the amount of substance that reaches the patient or prevent mixing. One valve is provided per syringe.
- administration device 9910 is similar to a parallel battery of single-reservoir syringes all controlled by a central controller.
- the dosage can be controlled by controlling the valves.
- Control can be provided based on measuring of the uptake of the radiopharmaceuticals by the body and/or based on data from flow meters situated respectively on each one of the valves. Measurement and control can also be carried out via the syringes themselves, by controlling the plunger.
- Uptake and clearance of the radiopharmaceuticals may be monitored by measurements of physiological reference points such as blood, saliva, and secretion systems, such as urine, breath, fecal, sweat. These measurements can serve to estimate pharmacokinetics of the radiopharmaceuticals in the body organs, and to predict optimal imaging timing. This can be achieved by commonly used devices and kits, or by imaging. Imaging can tell if enough of the substance has for example reached the liver. Imaging preferably uses a controllable camera under the control of a management system, however it can use a standard camera or other stand-alone imaging device. Based on these estimates, it is also possible to determine expected level of uptake of the radiopharmaceuticals in the target organ, and thus determine pathologies based on absolute uptake levels in the target organs.
- physiological reference points such as blood, saliva, and secretion systems, such as urine, breath, fecal, sweat.
- administration device 9910 allows for injection during the time of imaging, thereby permitting dynamic evaluations, for example imaging and measurement of blood flow, and imaging of blood vessels, including both major blood vessels and ranging down to the smallest capillaries. Furthermore the system may permit synchronized imaging of different systems, thus imaging of a kind that shows up blood flow which is synchronized with a different imaging operation for bone, so that the two can be matched up.
- the administration device of Figure 105 may be shielded to prevent radioactive contamination of the environment.
- Dose preparation system 9920 is preferably controlled by dose preparation module 9770 of the management system.
- Dose preparation system 9920 comprises a controller 9922 which receives as input the identity of the patient for whom the present preparation is being made, the patient history, especially pertinent information such as age, weight, sensitivities, morbidity etc, and the imaging procedure that the doctor desires to carry out.
- the imaging procedure may be a detailed procedure or simply indicate the imaging that it is desired to carry out.
- the controller 9922 designs a cocktail of substances or a series of substances to carry out the desired imaging, and uses constraints from the physical properties of the substances, from the patient history and from other sources such as safety and efficacy requirements.
- the controller 9922 is able to determine what constitutes an appropriate dose for a patient of the given weight and age, and is able to determine at what times different substances should be administered to the patient in order to achieve optimal imaging.
- certain of the isotopes may be administered together and need to be combined in a single preparation. In other cases certain isotopes may need to be taken at different times and thus need to be prepared and packaged separately.
- the controller 9922 may be connected to a combiner 9924 which mixes a single carrier substance with a single isotope, possibly drawn from a mother vial.
- the controller 9922 preferably informs the inventory module of the quantities of substances which have been used to prepare the dose.
- the mixture is passed to first quality control unit 9926 where it is checked for safety and efficacy.
- a labeler unit 9932 produces a label indicating the patient ID, the imaging program, timing information, and other information as described above, and the label and mixture are combined into vial 9934.
- the label may be a smart label or a radio frequency identifier (RFID) or a barcode or a printed label as convenient.
- RFID may also be usable for identifying the patient.
- the same patient may be provided with a series of vials, each for injection at a different time. Each vial may contain one or more isotopes as appropriate. The vials are inserted into the syringes of Figure 104.
- Figure 106 shows a dose preparation system for providing a mixture of carrier substances, tracers and isotopes in a manner suitable to fit a prescribed diagnosis, customized per patient.
- the system and processes include the evaluation, verification, customization, and combination of the radiopharmaceuticals used in nuclear imaging.
- the system produces a cocktail of different radiopharmaceuticals, at various dosages, that is customized to one or more specific patient injections.
- control functions are provided by the dose preparation module of the management system.
- controller 9922 of dose preparation system 9920 controls dose preparation, and updates the dose preparation module.
- controller 9922 receives data concerning a specific patient undergoing an imaging procedure. Data includes:
- Physiological tests e.g. blood, saliva, and secretion systems, such as urine, breath, fecal, sweat
- Controller 9922 processes the information and customizes the radiopharmaceutical cocktail according to patient specifications.
- the time for radiopharmaceutical pick up and removal, as well as optimal timing for injection-to- measurement delta, is all customized. This information is provided for multiple injections in series or in parallel as well.
- the system includes a verification unit that performs quality control checks on the raw materials such as the tracer and isotope kits. For example, the unit verifies that a specific tracer isotope meets manufacturer purity standards, required activity levels and identification requirements.
- the system may include combiner 9924 that combines an individual carrier substance or tracer to a specific radioisotope.
- the system may include mixing unit 9928 that combines and stores multiple radiopharmaceuticals that have already undergone an initial verification process in first quality control unit 9926.
- the system preferably has a radiopharmaceutical cocktail verification and identification unit, or labeling unit 9932 that, in combination with second quality control unit 9930, verifies the presence of the correct substances, at the correct dosages.
- the labeling unit 9932 provides a bar code or chip for the patient and the vial 9934 and contains information concerning the prescription, dose preparation, timing, injection(s), gamma camera calibration, and analysis of results. All this information is linked to the patient smart tag.
- the data stored on the smart tag can be read or retrieved in various locations:
- the smart tag In an exemplary embodiment of the invention the smart tag
- RFID/chip/barcode is read by the administration device and camera, which is in communication with and under the control of the MRP module.
- the present invention relates to diagnostic nuclear medicine and, more particularly, to packaged dose units of diagnostic radiopharmaceuticals kits and to methods of using same in nuclear imaging.
- Diagnostic nuclear medicine began more than 50 years ago and has evolved into a major medical branch. Its practitioners use low activity levels of radioactive materials in a safe way to gain information about health and disease by administering small amounts of radioactive materials, known as diagnostic radiopharmaceuticals, into the body by injection, swallowing, or inhalation. Following uptake of the radioactive source, a radiation-emission collecting probe, which may be configured for extracorporeal or intracorporeal use, is employed for locating the position of the active area.
- Nuclear imaging is one of the most important tools of diagnostic medicine wherein an estimated 12-14 million nuclear medicine procedures are performed each year in the United States alone. Diagnostic nuclear imaging is therefore crucial for studies which determine the cause of a medical problem based on organ function, in contrast to radiographic studies, which determine the presence of disease based on static structural appearance.
- Diagnostic radiopharmaceuticals and radiotracers are often designed or selected capable of selective binding to specific receptors by means of a binding moiety, such as an antibody, a specific inhibitor or other target-specific ligand. These targeted markers can therefore concentrate more rapidly in areas of interest, such as inflamed tissues, tumors, malfunctioning organs or an organ undergoing heightened expression of certain proteins.
- a blood circulating radiopharmaceutical is picked up by a specific organ or pathological tissue to a different extent than by other or non-pathological tissue.
- a highly vascularized tissue e.g., of a growing tumor
- an ischemic tissue may concentrate less of the radiopharmaceutical than the surrounding tissues.
- Nuclear imaging relies on these general phenomena of varied distribution of radiopharmaceuticalccording to different tissue as well as different pathologies.
- specific tissue types e.g., tumor tissues
- specific tissue types may be distinguished from other tissues in radioactive-emission imaging.
- Radiopharmaceuticals which may be used in the process of differential diagnosis of pathologies may be conjugated to targeting (recognition binding) moieties and include a wide range of radioisotopes as mentioned below.
- Such radiopharmaceuticals therefore include recognition moieties such as, for example, monoclonal antibodies (which bind to a highly specific pre-determined target), fibrinogen (which is converted into fibrin during blood clotting), glucose and other chemical moieties and agents.
- diagnostic conjugated radiopharmaceuticals include, for example, 2-[ I8 F]fluoro-2-deoxy--D-glucose ( 18 FDG), m In-Pentetreotide ([" 1 In-DTP A-D-Phe'j-octreotide), i-3-[ 123 I]-Iodo- ⁇ - methyl-tyrosine (IMT), O-(2-[ 18 F]fluoroethyl)-Z-tyrosine (Z-[ 18 F]FET), 111 In- Capromab Pendetide (CYT-356, Prostascint) and ⁇ ⁇ n-Satumomab Pendetide (Oncoscint).
- PET positron emission tomography
- SPECT single photon emission computed tomography
- Radioisotopes that emit both high energy gamma and/or low energy gamma, beta and/or positron radiation and which can be used per se or as a part of a compound as radiopharmaceuticals include, without limitation, technetium-99m ( 99m Tc), gallium-67 ( 67 Ga), thallium-201 ( 201 Tl), indium-I l l ( 111 In), iodine-123 ( 123 I), iodine-125 ( 125 I), iodine-131 ( 131 I), xenon-133 ( 133 Xe), and fluorine-18 ( 18 F). All these isotopes, except 99m Tc, 131 I and 133 Xe, are produced in particle accelerators.
- the main limitation associated with diagnostic nuclear imaging is the risk associated with humans coming in contact with radioactive materials.
- Henri Becquerel recognized the risks involved in exposure to radioactive isotopes.
- a short time after he had carried a sample of uranium in his pocket he observed that the underlying skin developed first erythema (reddening of the skin) and then tissue necrosis, which he attributed to the radioactive properties of the specimen.
- Ionizing radiation sources can produce pathological damage by direct cell damage or by producing free radicals which are formed through ionization or excitation reactions and which destruct the chemical integrity of biological molecules such as DNA and proteins, leading to cell death and cancer.
- Radiation damage to DNA is due primarily to indirect action of radicals, which leads to the lethal and mutagenic effects attributed to ionizing radiation.
- the same effect is harnessed therapeutically as more rapidly dividing cells are more sensitive to ionizing radiation.
- radioisotopes and radiopharmaceuticals such as heavy metals, and some targeting (recognition binding) moieties of radiotracers are chemically and/or metabolically toxic, and can disrupt enzymatic reactions and other metabolic processes in the body.
- EDE effective dose equivalence
- rem Roentgen Equivalent Man
- Sv Sievert
- the Sievert symbol Sv or millisievert (mSv) is an SI (International Standards and Units Organization) derived unit of equivalent dose or effective dose of radiation, and so is dependent upon the biological effects of radiation as opposed to the physical aspects, which are characterized by the absorbed dose, measured in grays (see, definition below).
- the millisievert (mSv) is commonly used to measure the effective dose in diagnostic medical procedures, e.g., X-rays, nuclear medicine, positron emission tomography (PET) and computed tomography (CT).
- PET positron emission tomography
- CT computed tomography
- the natural background effective dose rate varies considerably from place to place, but typically is around 3.5 mSv/year.
- the Becquerel (symbol Bq) is the SI derived unit of radioactivity, defined as the activity of a quantity of radioactive material in which one nucleus decays per second. It is therefore equivalent to second "1 .
- the older unit of radioactivity was the curie (Ci), defined as 3.7xlO 10 becquerels or 37 GBq. It was named after Henri Becquerel, who shared a Nobel Prize with Marie Curie for their work in discovering radioactivity.
- the number of becquerels changes with time.
- amounts of radioactive material are given after adjustment for some period of time. For example, one might quote a ten-day adjusted figure, that is, the amount of radioactivity that will still be present after ten days. This deemphasizes short-lived isotopes.
- the curie (symbol Ci) or millicurie (mCi) is a former unit of radioactivity, defined as 3.7* 10 10 decays per second. This is roughly the activity of 1 gram of the radium isotope 226 Ra, a substance studied by the pioneers of radiology, Marie and Pierre Curie.
- the Ci has been replaced by Bq.
- One Bq 2.7027x 10 "u Ci
- the gray (symbol Gy) or milligray (mGy) is the SI unit of energy for the absorbed dose of radiation.
- One gray is the absorption of one joule of radiation energy by one kilogram of matter.
- the gray replaced the rad, which was not coherent with the SI system.
- One Gy equals 100 rads.
- Rem symbol rem is the amount of ionizing radiation required to produce the same biological effect as one rad of high-penetration x-rays.
- Radiation absorbed dose is a unit of radiation dose or the amount of radiation absorbed per unit mass of material. Rad was superseded in the SI by the Gy. The United States is the only country to still use the rad. Rads are often converted to units of rem by multiplication with quality factors to account for biological damage produced by different forms of radiation. The quality factor for X- rays is 1, so rads and rems are equivalent.
- EDE effective dose equivalence
- brain perfusion SPECT imaging performed by administration of a 20 mCi dose of 99m Tc is equivalent to 0.7 rem.
- This EDE value is similar to that received during a radionuclide bone scan, is 1.5 times that received from a CT of the abdomen and the pelvis, and is 43 % of the annual average background radiation in the United States.
- Table 2 presents typical doses from several commonly practiced nuclear medicine exams and scans based on a 70 kg individual, and provide information on prior art diagnostic radiopharmaceutical doses utilized to carry out these scans.
- radiopharmaceuticals changes in cases of patients with lower mass, such as fetuses, infants and children. If a pregnant patient undergoes a diagnostic nuclear medicine procedure, the embryo/fetus will be exposed to radiation. Typical embryo/fetus radiation doses for more than 80 radiopharmaceuticals have been determined by Russell et al. ⁇ Health Phys., 1997, 73: 756-769). For the most common diagnostic procedures in nuclear medicine, the doses range from 0.5 x 10 "4 to 3.8 rad, the highest doses being for 67 Ga. Most procedures result in a dose that is a factor of 10 or more lower than the 3.8 rad dose.
- radioactive-emission imaging stems from the weighing of risks and benefits, namely the conflict between the requirement to limit the use of potentially harmful radioactive isotopes on one hand, and the need to generate sufficient photons from the diagnosed subject in order to produce a meaningful image on a camera or detector of limited sensitivity, on the other.
- radioisotopes Although low amounts of such radioisotopes are typically administered so as to not exceed recommended doses, currently available detectors require substantial and potentially hazardous amounts of radioisotopes in order to efficiently detect emission. This problem is intensified in cases where a patient is required to undergo several diagnostic procedures over the time of disease treatment, and more so in cases where the patient is a pregnant woman, an infant or a child.
- Another limitation of the currently used techniques is the relatively short time periods which are available to the practitioner to collect diagnostic nuclear images due to decay of the radioisotopes (most diagnostic radiopharmaceuticals are characterized by short half-life), and rapid clearance of the diagnostic radiopharmaceuticals from the body by natural bio-processes. Moreover, the rapid decay and clearance of the radiopharmaceuticals prevents sufficient diagnosis of a dynamic system such as the body, wherein a series of images must be taken, so as to characterize a constantly changing environment. In these cases, a static image will not suffice but rather a series of images, much like in a movie. Again, this limitation could have been partially lessened if high dosage could be administered or images could be collected by more sensitive devices.
- the present inventors have recently devised and constructed single and multi- collector emission detection probes which have vastly improved emission collection capabilities which enable highly sensitive and/or short-termed image capture. These novel emission detection/collection systems are at least ten-fold more efficient than presently utilized systems (the ratio of measured radiation to emitted radiation is at least 10 to 100-fold higher than prior art systems).
- the present inventors have now envisioned that the exceptional performance of the abovementioned device, can be efficiently utilized in diagnostic nuclear medicine and imaging, by opening a path to the desired minimization of exposure to ionizing radiation of patients and staff members and/or to the desired high resolution imaging.
- the present invention is of diagnostic radiopharmaceutical dose units and methods of using same in diagnostic nuclear imaging.
- the present invention can be used to image specific tissue such as pathological tissue and acquire dynamic imagery while minimizing the harmful effects of radiation caused by use of ionizing radiation sources in diagnostic radiopharmaceuticals.
- the present invention can further be used to image tissues while utilizing otherwise inefficient radiopharmaceuticals (e.g., having inherent low emission rate) and/or to perform dynamic imagery during short time periods and/or in high resolution.
- radioactive substances which produce ionizing radiation is necessary for advanced methods of pathologic diagnosis and for planning an optimal treatment regime of a growing number of medical conditions.
- Use of radioactive substances allows the practice of minimally invasive surgical techniques, which save the patients most of the trauma, pain, suffering, hospitalization, recovery and adverse complications associated with conventional "open surgical" procedures.
- diagnostic radiopharmaceuticals in diagnostic nuclear medicine is associated with some risk since it exposes the probed subject as well as the medical and technical staff to harmful radiation, and further posses the obligation of expensive and complicated disposal of radioactive materials.
- a patient undergoing a nuclear medicine procedure will receive a radiation dose. Under present international guidelines it is assumed that any radiation dose, however small, presents a risk.
- An effective dose of a nuclear medicine investigation is typically expressed by units of millisieverts (mSv).
- the effective dose resulting from an investigation is influenced by the amount of radioactivity administered in megabecquerels (MBq), the physical properties of the diagnostic radiopharmaceutical used (e.g., the type of ionizing radiation, the rate of emission and decay), its distribution in the body (e.g., the accumulation of the emitting agent per tissue) and its rate of clearance from the body.
- effective doses can range from 0.006 mSv for a 3 MBq for 51 Cr- EDTA measurement of glomerular filtration rate (measurement of the kidneys' waste filtration and removal) to 37 mSv for a 150 MBq 201 Tl non-specific tumor imaging procedure.
- the common bone scan with 600 MBq of "" 1 Tc-MDP has an effective dose of 3 mSv.
- the present inventors have developed a system which employs emission probes that are highly efficient in collecting emissions and thus enable, in combination with dedicated processing algorithms, more sensitive and accurate emission mapping.
- the present inventors have now uncovered that the use of such probes facilitates the use of substantially lower amounts of diagnostic radiopharmaceuticals than those presently utilized and thus enables packaging and diagnostic use of novel radiopharmaceutical dose units of substantially lower radioactivity.
- the probe and imaging systems described in previous disclosures of the present inventors enable, for the first time, use of substantially lower doses of various diagnostic radiopharmaceuticals in nuclear imaging.
- a diagnostic pharmaceutical kit which can be utilized in nuclear imaging techniques.
- the kit contains a packaged dose unit of a diagnostic radiopharmaceutical having an effective dose equivalence (EDE) of 2.5 millirem (mrem) or less per kg body weight of a subject.
- EDE effective dose equivalence
- This packaged dose is considerably lower than the packaged dose of the prior art, and is in line with the general motivation to reduce to a minimum the exposure of the subject to substances which emit ionizing radiation.
- the EDE of the packaged dose unit of the present invention is 0.01 - 2 millirem per kg body weight of a subject, and more preferably it is 0.01 - 1 millirem per kg body weight of a subject.
- the diagnostic pharmaceutical kit of the present invention contains a packaged dose unit of a diagnostic radiopharmaceutical having an effective dose equivalence (EDE) of 150 millirem (mrem) or less, which is a typical whole-body dose for a 70 kg person.
- EDE effective dose equivalence
- the EDE of the packaged whole-body dose unit of the present invention is 15 - 100 millirem per 70 kg subject, more preferably 15 - 50 millirem per 70 kg subject.
Abstract
Description
Claims
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