Cervical cancer radiotherapy assistance system, cervical cancer radiotherapy assistance method, and cervical cancer radiotherapy assistance program

Abstract

According to the present invention, provided is a cervical cancer radiotherapy assistance system for assisting intertissue irradiation combined with intracavity irradiation of cervical cancer, the cervical cancer radiotherapy assistance system comprising: an assistance information acquisition device for acquiring patient assistance information when an image of a patient is captured before the intertissue irradiation combined with intracavity irradiation, and for acquiring the patient assistance information when the image of the patient is captured before the intertissue irradiation combined with intracavity irradiation; the patient auxiliary information comprises a reference point serving as a coordinate system reference and at least comprises one of an image of the patient, a contour map of a tumor, a contour map of organs around the tumor, a contour map of a needle implantation area, barycentric coordinates of the needle implantation area and dose distribution; and a mixed reality display device that introduces a virtual reference point corresponding to the reference point and patient assistance information into a virtual world, creates a three-dimensional model of the patient, and displays the three-dimensional model of the patient on the body of the patient in a superimposed manner by keeping the reference point and the virtual reference point consistent.

Description

Technical Field

[0001] The present invention relates to a radiotherapy auxiliary system, a radiotherapy auxiliary method and a radiotherapy auxiliary program for cervical cancer. Background Art

[0002] Traditionally, radiotherapy for cervical cancer has usually used a combination of external irradiation and intracavitary irradiation.

[0003] The external irradiation is the use of Figure 1A The irradiation device 1 shown in the figure is a treatment method for irradiating the body from outside the body. In this external irradiation, Figure 1B As shown, in addition to the primary cervical tumor 2, the entire pelvic cavity including the uterus, parametrial tissue, vagina, ovaries, and pelvic lymph nodes is irradiated.

[0004] The intracavitary irradiation is to Figure 2 The radioactive isotope particles, called a brachytherapy source, are mounted on wires, as shown. Figure 3C As shown, the intracavitary applicator 3 is inserted into the patient's body cavity (uterine cavity, vaginal cavity), and the intracavitary irradiation device 4 emits a large dose of irradiation to the primary tumor near the cervix, which has a great effect on controlling the primary tumor. Figure 3A FIG. 3 is an example diagram of the intracavitary applicator 3 . Figure 3B FIG. 4 is an exemplary diagram of the intracavity irradiation device 4 .

[0005] like Figure 4 As shown in the figure, after cervical cancer progresses, the tumor will invade the paracervical tissue on the side of the cervix and grow larger. There are cases where the dose of intracavitary irradiation to the tumor may be insufficient, resulting in poor treatment effect. It is well known that for such cases, based on the intracavitary applicator, the Figure 5 The needle-shaped hollow applicator 5 shown in the figure is inserted into the tumor invasion site through the vaginal wall or perineum to emit a brachytherapy source to perform combined intracavitary and interstitial brachytherapy (hereinafter also referred to as "IC / IS-BT") (see Figure 6 ), thereby significantly improving the therapeutic effect (for example, see Non-Patent Document 1).

[0006]

Prior art literature

[0007]

Non-patent literature

[0008] Non-Patent Literature 1: "Optimization of Dose Distribution for Combined Intra-Tissue Irradiation and Intra-Cavity Irradiation for Cervical Cancer," Journal of the Japanese Society of Radiological Technology, Vol. 74, No. 4, April 2018 Summary of the Invention

[0009] [Problems to be solved by the invention]

[0010] Currently, when performing interstitial irradiation combined with intracavitary irradiation, the operator inserts the insertion needle applicator into the tissue while referring to the ultrasound image during the operation (see Figure 7 ). However, the ultrasound image displays a single cross-section in real time, and the ability to depict the tumor and surrounding organs is also limited. Therefore, the insertion position of the implant needle applicator and the number of implant needle applicators are mostly determined by the operator's experience, and it is not uncommon for the implant needle applicator to be improperly inserted. In addition, even skilled doctors may need to reinsert the implant needle applicator to correct its insertion position, resulting in problems such as prolonged operation time and bleeding. In addition, there is also the risk of the implant needle applicator accidentally puncturing the intestines and other surrounding organs.

[0011] Given the above reasons, among medical institutions in Japan that perform intracavitary irradiation for cervical cancer, only about 40% (in 2020) implement combined interstitial irradiation and intracavitary irradiation. The lack of operator experience and the difficulty of operation are one of the factors hindering the popularization of this combined interstitial irradiation and intracavitary irradiation. This is the current situation.

[0012] The purpose of the present invention is to provide a cervical cancer radiotherapy assistance system, a cervical cancer radiotherapy assistance method and a cervical cancer radiotherapy assistance program that can provide visual assistance for needle insertion in interstitial irradiation combined with intracavitary irradiation for treating cervical cancer.

[0013]

Methods to solve the problem

[0014] The means to solve the above problems are as follows:

[0015] <1> A cervical cancer radiotherapy assisting system for providing assistance in interstitial irradiation combined with intracavitary irradiation for cervical cancer, characterized in that the system comprises:

[0016] an auxiliary information acquisition device, which acquires patient auxiliary information when capturing an image of the patient before the interstitial irradiation combined with intracavitary irradiation, the patient auxiliary information including a reference point serving as a reference of a coordinate system and at least one of the patient image, a contour map of the tumor, a contour map of organs surrounding the tumor, a contour map of the needle insertion area, coordinates of the center of gravity of the needle insertion area, and a dose distribution; and

[0017] The mixed reality display device imports the virtual reference point corresponding to the reference point and the above-mentioned auxiliary information into the virtual world to create a three-dimensional model of the patient. By making the reference point and the virtual reference point consistent, the three-dimensional model of the patient is displayed overlappingly on the patient.

[0018] <2> The cervical cancer radiotherapy auxiliary system according to <1> is characterized in that the needle insertion area is an insufficient dose area in the tumor, and the method for obtaining this area is to use a treatment planning system to draw a contour map of the tumor on the patient's image, formulate an intracavitary irradiation treatment plan, calculate the dose distribution, draw a contour map of the area above the planned dose in the calculated dose distribution, and subtract the area above the planned dose from the contour map of the tumor.

[0019] <3> The cervical cancer radiotherapy auxiliary system according to <2> is characterized in that needle insertion is performed based on the contour map of the needle insertion area in the three-dimensional model of the patient and the center of gravity coordinates of the needle insertion area in the patient's body displayed superimposed on the patient using the mixed reality display device.

[0020] <4> The cervical cancer radiotherapy assisting system according to any one of <1> to <3>, wherein the cervical cancer is a giant cervical cancer in which the tumor invades paracervical tissue and grows larger.

[0021] <5> The cervical cancer radiotherapy support system according to any one of <1> to <4>, wherein the reference point is information stored in a two-dimensional code.

[0022] <6> The cervical cancer radiotherapy assisting system according to any one of <1> to <5>, wherein the patient image is a CT image of the patient.

[0023] <7> The cervical cancer radiotherapy assistance system according to any one of <1> to <6>, characterized in that the mixed reality display device includes a device that supports mixed reality (MR).

[0024] <8> A method for assisting cervical cancer radiotherapy by providing assistance for interstitial irradiation combined with intracavitary irradiation, characterized in that the method has the following features:

[0025] an auxiliary information acquisition step, when capturing an image of the patient before the interstitial irradiation combined with intracavitary irradiation, acquiring patient auxiliary information, the patient auxiliary information including a reference point serving as a reference of a coordinate system and including at least one of the patient image, a contour image of the tumor, a contour image of organs surrounding the tumor, a contour image of the needle insertion area, coordinates of the center of gravity of the needle insertion area, and a dose distribution; and

[0026] The mixed reality display process imports the virtual reference point corresponding to the reference point and the above-mentioned auxiliary information into the virtual world to create a three-dimensional model of the patient. By making the reference point and the virtual reference point consistent, the three-dimensional model of the patient is displayed overlappingly on the patient.

[0027] <9> A cervical cancer radiotherapy auxiliary program for providing auxiliary treatment of cervical cancer by combining interstitial irradiation with intracavitary irradiation, characterized in that a computer is caused to perform the following operations:

[0028] When capturing an image of a patient before interstitial irradiation combined with intracavitary irradiation, patient auxiliary information is obtained, the patient auxiliary information including a reference point serving as a reference of a coordinate system and including at least one of the patient image, a contour map of a tumor, a contour map of organs surrounding the tumor, a contour map of a needle insertion area, coordinates of a center of gravity of the needle insertion area, and a dose distribution.

[0029] The virtual reference point corresponding to the reference point and the auxiliary information are imported into the virtual world to create a three-dimensional model of the patient. By making the reference point and the virtual reference point consistent, the three-dimensional model of the patient is displayed overlappingly on the patient.

[0030] Effects of the Invention

[0031] The present invention can provide a cervical cancer radiotherapy assistance system, a cervical cancer radiotherapy assistance method and a cervical cancer radiotherapy assistance program that provide visual assistance for needle insertion in interstitial irradiation combined with intracavitary irradiation for treating cervical cancer. BRIEF DESCRIPTION OF THE DRAWINGS

[0032] Figure 1A This is an example diagram of irradiation equipment used for external beam irradiation of cervical cancer.

[0033] Figure 1B This diagram illustrates the irradiation range of external beam radiation for cervical cancer.

[0034] Figure 2 It is a brachytherapy source map used for intracavitary irradiation of cervical cancer.

[0035] Figure 3A This is an example diagram of intracavitary irradiation equipment used for intracavitary irradiation of cervical cancer.

[0036] Figure 3B This is an example diagram of an intracavitary applicator used for intracavitary irradiation of cervical cancer.

[0037] Figure 3C This is an illustration of intracavitary irradiation for cervical cancer.

[0038] Figure 4 This is a case illustration showing that after cervical cancer progresses, the tumor invades the paracervical tissue on the side of the cervix and grows larger. The dose of intracavitary irradiation to the tumor is insufficient, resulting in poor treatment effect.

[0039] Figure 5 This is an example diagram of an implant needle applicator.

[0040] Figure 6 This is a diagram showing a state where interstitial irradiation combined with intracavitary irradiation is performed.

[0041] Figure 7 It is a diagram showing an ultrasonic image during interstitial irradiation combined with intracavitary irradiation.

[0042] Figure 8 FIG. 1 is a diagram showing a state where an operator wears a head mounted display (HMD).

[0043] Figure 9 This figure shows a state where a QR code (registered trademark) is placed within an imaging range and a CT image of a patient is captured.

[0044] Figure 10A This is an elevational dose distribution map showing the needle insertion area and the coordinates of the center of gravity of the needle insertion area as auxiliary information.

[0045] Figure 10B This is a cross-sectional dose distribution map showing the needle insertion area and the coordinates of the center of gravity of the needle insertion area as auxiliary information.

[0046] Figure 11 This is a diagram showing a state where auxiliary information is projected onto a patient.

[0047] Figure 12A It is a CT image of the patient as auxiliary information.

[0048] Figure 12B This is a diagram showing the outlines of the tumor and surrounding organs as auxiliary information.

[0049] Figure 12C This is a diagram showing the patient's CT image and dose distribution as auxiliary information.

[0050] Figure 13 This is an example diagram of the hardware configuration of the cervical cancer radiotherapy auxiliary system of the present invention.

[0051] Figure 14 This is an example diagram of the functional configuration of the cervical cancer radiotherapy auxiliary system of the present invention.

[0052] Figure 15 This is a flowchart showing an example of the processing flow of the cervical cancer radiotherapy assistance method of the present invention. DETAILED DESCRIPTION

[0053] (Radiotherapy assistive system and radiotherapy assistive method for cervical cancer)

[0054] The cervical cancer radiotherapy auxiliary system of the present invention has an auxiliary information acquisition device, a mixed reality display device, and other devices as needed.

[0055] The cervical cancer radiotherapy auxiliary method of the present invention includes an auxiliary information acquisition process and a mixed reality display process, and may include other processes as needed.

[0056] The cervical cancer radiotherapy auxiliary method of the present invention can be appropriately implemented through the cervical cancer radiotherapy auxiliary system of the present invention, the auxiliary information acquisition process can be implemented through the auxiliary information acquisition device, the mixed reality display process can be implemented through the mixed reality display device, and the other processes can be implemented through the other devices.

[0057] The cervical cancer radiotherapy auxiliary system and cervical cancer radiotherapy auxiliary method of the present invention are intended to provide visual assistance for needle insertion in interstitial irradiation combined with intracavitary irradiation of cervical cancer. During the operation, needle insertion position information that previously required empirical judgment can be obtained by visual methods, thereby compensating for the operator's lack of experience, reducing the difficulty of operation, and lowering the introduction and implementation threshold of interstitial irradiation combined with intracavitary irradiation. It is a groundbreaking new technology that is expected to significantly increase the popularity of interstitial irradiation combined with intracavitary irradiation.

[0058] The interstitial irradiation combined with intracavitary irradiation described here refers to a treatment method that combines intracavitary irradiation with interstitial irradiation for cases of giant cervical cancer with large and irregular tumors, where intracavitary irradiation is expected to produce insufficient dose in the high-risk clinical target volume.

[0059] In order to solve the above-mentioned problems, the inventors of the present invention conducted repeated research and developed a new cervical cancer radiotherapy auxiliary system that combines the real world and the virtual world, projects the patient's auxiliary information onto the patient, and provides visual assistance for needle insertion during interstitial irradiation and intracavitary irradiation of giant cervical cancer.

[0060] Therefore, by using the cervical cancer radiotherapy auxiliary system of the present invention, the real world and the virtual world are combined, the auxiliary information is projected onto the patient, and safe and rapid needle insertion can be achieved under the guidance of mixed reality (MR).

[0061] In radiotherapy for cervical cancer, a treatment planning system (RTPS) can be used to formulate a treatment plan. The obtained patient auxiliary information can be imported into the virtual world to create a three-dimensional model of the patient. This model can be combined with the real world, and the outline of the needle insertion area and the coordinates of the center of gravity of the needle insertion area can be superimposed on the patient and projected to provide visual assistance for needle insertion.

[0062] In addition, the treatment planning system (RTPS) can be used to virtually configure the insertion needle at the needle insertion position determined by the cervical cancer radiotherapy auxiliary system of the present invention to simulate the dose to the tumor and adjacent surrounding organs.

[0063] <Auxiliary Information Acquisition Process and Auxiliary Information Acquisition Device>

[0064] The auxiliary information acquisition process is a process for acquiring patient auxiliary information when taking an image of the patient before the interstitial irradiation combined with intracavitary irradiation. The patient auxiliary information includes a reference point serving as a reference of a coordinate system, and at least includes the patient's image, a contour map of the tumor, a contour map of organs surrounding the tumor, a contour map of the needle insertion area, the coordinates of the center of gravity of the needle insertion area, and one of the dose distributions. The process is implemented by an auxiliary information acquisition device.

[0065] The auxiliary information acquisition device includes, for example, an X-ray computed tomography (CT) device, a radiotherapy planning system, and the like.

[0066] The radiotherapy planning system is a computer with a dose distribution simulation function. Based on the patient's internal body information obtained from patient images, the system identifies the tumor and surrounding organs as three-dimensional shape data, and simulates the patient's internal dose distribution under arbitrary irradiation conditions (irradiation direction, irradiation shape, etc.) through numerical calculation.

[0067] This patient image is taken while the patient is fixed on a dedicated fixation tool in order to reduce the patient's body movements during treatment.

[0068] Preferably, the patient image is a CT image taken by an X-ray computed tomography (CT) device. Alternatively, a cone-beam CT device, a magnetic resonance imaging (MRI) device, a positron emission tomography-computed tomography (PET-CT) device, or a combination of the above devices may be used instead of the CT device.

[0069] Preferably, the reference point is information stored in a two-dimensional code. The two-dimensional code may be, for example, a QR code (registered trademark).

[0070] The auxiliary information can be obtained by importing the patient image taken by the CT device into the radiotherapy planning system through the auxiliary information acquisition device.

[0071] The auxiliary information may be, for example, patient images, tumor contours, contours of organs surrounding the tumor, contours of the needle insertion area, coordinates of the center of gravity of the needle insertion area, dose distribution, etc. The above information may be used alone or in combination of two or more.

[0072] The image of the patient may be, for example, a CT image of the patient, an MRI image of the patient, or the like.

[0073] The contour map of the tumor and the contour map of organs surrounding the tumor can be obtained by using a treatment planning system (RTPS) to draw the contours of the tumor and organs based on the obtained CT image of the patient.

[0074] The needle insertion area is an insufficient dose area in the tumor. The method for obtaining this area is to use a treatment planning system to draw a contour map of the tumor on the patient's image, formulate an intracavitary irradiation treatment plan, calculate the dose distribution, draw a contour map of the area above the planned dose in the calculated dose distribution, and subtract the area above the planned dose from the tumor contour map.

[0075] Other information may include, for example, the irradiation angle, the irradiation position, the position and angle of radiation distribution in the body, the type of radiation, the radiation dose, and the like.

[0076] <Mixed reality display process and mixed reality display device>

[0077] The mixed reality display process is to import the virtual reference point corresponding to the reference point and the above-mentioned auxiliary information into the virtual world to create a three-dimensional model of the patient, and by making the reference point and the virtual reference point consistent, the three-dimensional model of the patient is displayed overlappingly on the patient, and the process is implemented through a mixed reality display device.

[0078] Through the mixed reality display device, the coordinate systems of the real space and the virtual space are kept consistent with each other based on the reference point and the virtual reference point, and the three-dimensional model of the patient can be displayed overlappingly on the patient.

[0079] When making a three-dimensional model of the patient, the virtual reference points corresponding to the obtained reference points and the auxiliary information can be used, for example, through a combination of 3D model editing software such as InVesalius, MeshLab or Blender. InVesalius can only convert the patient's auxiliary information data from the DICOM file into an STL (Standard Triangulated Language) file. In addition, MeshLab and Blender cannot process DICOM files, but can edit the mesh of the three-dimensional model converted to an STL file and convert it into an OBJ file. It is also possible to directly use the DICOM file as a three-dimensional model for auxiliary information.

[0080] DICOM is a standard for the format of medical images captured by CT equipment and other devices, as well as for the communication protocols between medical imaging devices that process these images. DICOM-RT, a DICOM standard for radiotherapy information, offers excellent fidelity, readability, and ease of storage, meeting the "quality assurance of auxiliary information" essential for mixed reality (MR). The combination of MR and DICOM RT files offers extensive applicability and versatility.

[0081] The mixed reality display device recommends using a device that supports Mixed Reality (MR).

[0082] MR is a technology that combines the virtual world on a computer with the real world and projects it into the field of vision, also known as extended reality (XR).

[0083] Devices that support this MR can be virtual reality (MR) dedicated head-mounted displays (HMDs), etc.

[0084] To achieve visualization in MR, a commercially available head-mounted display (HMD) for mixed reality (MR) similar to sunglasses can be installed on the operator's head to project the computer's virtual world into the field of vision while enabling recognition of the real world.

[0085] The head-mounted display (HMD) is equipped with a camera that identifies real-world fiducials and aligns them with those in the virtual world. This allows the display to project auxiliary information imported into the virtual world into the real world. Furthermore, the operator's line of sight can be aligned with the position of the auxiliary information.

[0086] When using a head-mounted display (HMD), it is recommended to use Hololens 2 (manufactured by Microsoft) which does not require a controller.

[0087] In addition, if Figure 8 As shown, after the operator installs the head-mounted display (HMD) 6 on the head, it will not form an obstacle like a fixed camera on the ceiling. Moreover, there is no need to add a camera in the treatment room, which reduces construction costs.

[0088] <Other processes and other equipment>

[0089] The other steps are not particularly limited and can be selected as appropriate according to the purpose, for example, a communication step, an input step, etc.

[0090] The other devices are not particularly limited and can be selected as appropriate according to the purpose, for example, communication devices, input devices, etc.

[0091] The following describes the structure of the present invention in detail. Furthermore, to meet the requirements of use, a head-mounted display (HMD) was used, Hololens 2 (manufactured by Microsoft). The Unity engine and mixed reality (MR) toolkit were used in development.

[0092] Importing treatment plan information into the virtual world

[0093] like Figure 9As shown, a QR code (registered trademark) 7 is placed within the imaging range, and a CT scan is performed on a patient 8. The resulting CT images are then contoured using the treatment planning system (RTPS) to create a tumor and surrounding organ contour map. This contour map is then imported into the virtual world as a DICOMRT file (DICOM RT Structure Set). Importing treatment plan information into the virtual world takes approximately 10 to 30 minutes, but using a contouring aid, the contouring of the tumor and surrounding organs can be automated.

[0094] Then, using self-made Python code, the patient's CT images (DICOM RT Image) and the outlines of the tumor and surrounding organs (DICOM RT Structure Set) were converted into STL files, a three-dimensional shape data format that can be recognized by a head-mounted display (HMD), and imported into the virtual world.

[0095] When the patient's CT image is set in the virtual world, the QR code (registered trademark) serving as the reference point in the patient's CT image is aligned with the virtual reference point corresponding to the acquired reference point.

[0096] The positional relationship between the patient's CT image and the contour map of the tumor and surrounding organs is associated. After the patient's CT image is set in the virtual world, the contour map of the tumor and surrounding organs is automatically drawn.

[0097] Identification and visualization of the needle insertion area

[0098] Based on the intraoperative CT images of the patient captured in the "Importing Treatment Planning Information into the Virtual World" section, a treatment plan for intracavitary irradiation only is created using the Treatment Planning System (RTPS) and dose distribution is calculated. This process is automated.

[0099] The area below the required dose within the tumor volume is the insufficient dose area in the tumor, i.e. the needle insertion area 9 ( Figure 10A and Figure 10B The needle insertion area 9 is automatically extracted in the treatment planning system (RTPS), saved as a DICOM RT Structure Set, converted into an STL (Standard Triangulated Language) file, etc., and imported into the virtual world. At the same time, the coordinates 10 of the center of gravity of the needle insertion area 9 ( Figure 10A and Figure 10B The star mark in the figure is also imported into the virtual world as auxiliary information.

[0100] Furthermore, the insertion needle can be virtually placed in the needle insertion area on the treatment planning system (RTPS), and the expected dose distribution for combined interstitial and intracavitary irradiation can be calculated by RTPS and projected onto the patient to evaluate its appropriateness.

[0101] When integrating the real world and the virtual world, the QR code (registered trademark) set in the <Importing Treatment Plan Information into the Virtual World> is used as a reference point. In the cervical cancer radiotherapy auxiliary system of the present invention, a 10cm×10cm QR code (registered trademark) is used. Figure 9 As shown, a QR code (registered trademark) 7 is arranged on a 12 cm x 12 cm flat fixture, leaving a 1 cm blank to improve recognition capability.

[0102] The upper left corner of the QR code (registered trademark) 7 in the real world becomes the origin (virtual reference point) of the virtual world on the computer. The 10cm side length of the QR code (registered trademark) 7 is used to integrate with the virtual world ruler. Create C# script code to make the virtual reference point track the reference point, and integrate the virtual world with the real world through the head-mounted display (HMD). In this way, Figure 11 As shown, auxiliary information 11 including the tumor, surrounding organs, outline of the needle insertion area, coordinates of the center of gravity of the needle insertion area, dose distribution, etc. can be displayed (projected) on the patient 8 in an overlapping manner.

[0103] Fusion of the Real and Virtual Worlds

[0104] The patient auxiliary information in the cervical cancer radiotherapy auxiliary system of the present invention can be, for example, the patient's CT image or MRI image, tumor, surrounding organs, contour map of the needle insertion area, center of gravity coordinates of the needle insertion area, dose distribution, etc.

[0105] Figure 12A This is the patient's CT image. Figure 12B It is an outline of the tumor, organ, and needle insertion area. Figure 12C Here is a CT image of the patient with the dose distribution superimposed.

[0106] The projected auxiliary information can be switched between Translucent display (with adjustable transmittance) and Solid display as appropriate. Figures 12A to 12C The outline is displayed as solid, and the dose distribution is displayed as translucent. Furthermore, you can switch between showing and hiding at will, and you can also display auxiliary information for multiple patients in combination.

[0107] For example, when it's necessary to understand the patient's internal three-dimensional structure during surgery, CT or MRI images of the patient are displayed. Alternatively, when it's necessary to understand the positional relationship of organs near a tumor, an outline of the surrounding organs is displayed. Furthermore, during needle insertion, an outline of the needle insertion area and the coordinates of its center of gravity are displayed.

[0108] In addition, the dose distribution during intracavitary irradiation and combined intracavitary irradiation can be virtually calculated and displayed (projected) on the patient in an overlapping manner to intuitively confirm the patient's internal dose.

[0109] <Example>

[0110] The following describes in detail embodiments of the cervical cancer radiotherapy auxiliary system and cervical cancer radiotherapy auxiliary method of the present invention with reference to the drawings.

[0111] (1) After inserting the applicator into the patient's cavity, Figure 9 As shown, a QR code (registered trademark) is set and a CT image of the patient is taken.

[0112] A 10 cm x 10 cm QR code (registered trademark) 7 is used to ensure that the three-dimensional coordinate systems of the real world and the virtual world are consistent. The upper left edge of the real-world QR code (registered trademark) 7 becomes the origin of the virtual world on the computer.

[0113] When arranging the QR code (registered trademark) 7, a mounting jig having a 10 cm x 10 cm flat surface was prepared, and the QR code (registered trademark) 7 was mounted on the upper surface of the mounting jig.

[0114] (2) Based on the obtained patient CT images, the treatment planning system (RTPS) is used to draw the contour map of the tumor and surrounding organs as the DICOM RT Structure Set.

[0115] DICOM is a standard that defines the format of medical images captured by CT equipment and other devices, as well as the communication protocol between medical imaging devices that process these images. DICOM-RT is a standard that defines information in the field of radiotherapy within DICOM.

[0116] (3) Develop a treatment plan for intracavitary irradiation in the treatment planning system (RTPS), calculate and plot the dose distribution, and save it as DICOM RT Dose.

[0117] (4) Based on the dose distribution calculated in (3) above, a contour map of the area that reaches a dose above the planned dose is automatically drawn and subtracted from the contour map of the tumor to identify the area in the tumor where the dose is insufficient, i.e., the needle insertion area.

[0118] (5) Draw the outline of the identified needle insertion area and save it as a DICOM RT Structure Set. In addition, the centroid coordinates of the needle insertion area are calculated by the treatment planning system (RTPS) and used as auxiliary information.

[0119] (6) Through the treatment planning system (RTPS), a virtual insertion needle is configured in the needle insertion area determined by the cervical cancer radiotherapy auxiliary system of the present invention, the dose distribution is calculated, and the irradiation dose to the tumor and surrounding organs is simulated before irradiation.

[0120] (7) Using self-made Python code, the treatment plan information saved via DICOM (patient’s CT images, tumor and organ contours, dose distribution, etc.) was converted into an STL (Standard Triangulated Language) file, imported into the virtual world, and a three-dimensional model of the patient was created.

[0121] (8) The patient's three-dimensional model is configured so that the reference points in the virtual world and the QR code (registered trademark) serving as the reference points on the patient's CT image are consistent. When a head-mounted display (HMD) is used to display mixed reality (MR), the patient's three-dimensional model is matched with the patient in the real world and projected onto the patient.

[0122] (9) Auxiliary information is imported into the patient's three-dimensional model for display, so that it overlaps with the real-world patient. The auxiliary information may include, for example, the patient's CT image, the tumor, surrounding organs, the outline of the needle insertion area, the coordinates of the center of gravity of the needle insertion area, and the dose distribution.

[0123] (10) Under the guidance of mixed reality (MR), the outline of the needle insertion area and the center of gravity coordinates of the needle insertion area in the auxiliary information are displayed, and the needle insertion is performed.

[0124] (Radiotherapy-assisted procedure for cervical cancer)

[0125] The cervical cancer radiotherapy auxiliary program of the present invention is a cervical cancer radiotherapy auxiliary program that provides assistance for interstitial irradiation combined with intracavitary irradiation for cervical cancer, and enables the computer to perform the following operations:

[0126] When capturing an image of the patient before the interstitial irradiation combined with intracavitary irradiation, patient auxiliary information is obtained, the patient auxiliary information including a reference point serving as a reference of a coordinate system and including at least one of the patient image, a contour map of the tumor, a contour map of organs surrounding the tumor, a contour map of the needle insertion area, coordinates of the center of gravity of the needle insertion area, and a dose distribution.

[0127] The virtual reference point corresponding to the reference point and the auxiliary information are imported into the virtual world to create a three-dimensional model of the patient. By making the reference point and the virtual reference point consistent, the three-dimensional model of the patient is displayed overlappingly on the patient.

[0128] The cervical cancer radiotherapy assistance program of the present invention may be, for example, a program that causes a computer to execute the cervical cancer radiotherapy assistance method of the present invention. Furthermore, the preferred embodiment of the cervical cancer radiotherapy assistance program of the present invention may be, for example, the same as the preferred embodiment of the cervical cancer radiotherapy assistance method of the present invention.

[0129] The cervical cancer radiotherapy auxiliary program of the present invention can be produced using various known programming languages ​​according to the computer system configuration, type and version of the operating system used.

[0130] The cervical cancer radiotherapy auxiliary program of the present invention can be stored in a storage medium such as a built-in hard disk, an external hard disk, etc., and can also be stored in a storage medium such as a CD-ROM, a DVD-ROM, an MO disk, a USB disk, etc.

[0131] In addition, when the cervical cancer radiotherapy auxiliary program of the present invention is stored in the above-mentioned storage medium, it can be used directly through the storage medium reading device of the computer system as needed, or installed on the hard disk for use. In addition, the cervical cancer radiotherapy auxiliary program of the present invention can also be stored in an external storage area (other computers, etc.) that the computer system can access through an information communication network. In this case, the cervical cancer radiotherapy auxiliary program of the present invention stored in the external storage area can be used directly from the external storage area through the information communication network as needed, or installed on the hard disk for use.

[0132] In addition, the cervical cancer radiotherapy auxiliary program of the present invention can also be divided according to the treatment and stored in multiple storage media at will.

[0133] <Computer-readable storage medium>

[0134] The computer-readable storage medium related to the present invention stores the cervical cancer radiotherapy auxiliary program of the present invention.

[0135] The computer-readable storage medium related to the present invention is not particularly limited and can be selected according to the purpose, for example, a built-in hard disk, an external hard disk, a CD-ROM, a DVD-ROM, an MO disk, a USB disk, etc.

[0136] In addition, the computer-readable storage medium related to the present invention may also be a plurality of storage media that store the cervical cancer radiotherapy auxiliary program processing of the present invention in an arbitrarily divided manner.

[0137] The following describes the technical examples disclosed in the present invention in more detail using device configuration examples and flow charts.

[0138] Figure 13 This is an example diagram of the hardware configuration of the cervical cancer radiotherapy auxiliary system of the present invention.

[0139] exist Figure 13 In the cervical cancer radiotherapy auxiliary system 100 of the present invention shown, for example, the control unit 101, the main storage device 102, the auxiliary storage device 103, the I / O interface 104, the communication interface 105, the input device 106, the output device 107, and the display device 108 are connected via a system bus 109.

[0140] The control unit 101 performs operations (arithmetic operations, comparison operations, etc.), hardware and software control, etc. The control unit 101 can be, for example, a CPU (Central Processing Unit), or a part of the equipment used in the cervical cancer radiotherapy auxiliary system of the present invention, or a combination of the two.

[0141] The control unit 101 can, for example, implement various functions by executing a program (eg, the cervical cancer radiotherapy auxiliary program of the present invention) loaded into the main storage device 102 or the like.

[0142] The processing performed by the control function unit in the cervical cancer radiotherapy auxiliary system of the present invention can be performed by the control unit 101, for example.

[0143] The main storage device 102 stores various programs and data required for executing the programs. The main storage device 102 may be a device having at least one of a ROM (Read Only Memory) and a RAM (Random Access Memory), for example.

[0144] ROM stores various programs such as BIOS (Basic Input / Output System). ROM is not particularly limited and can be selected according to the purpose. For example, it can be a master ROM, PROM (Programmable ROM), etc.

[0145] When various programs stored in the ROM, auxiliary storage device 103, etc. are executed by the control unit 101, the RAM functions as, for example, an expansion memory. There are no particular limitations on the RAM and it can be selected as appropriate depending on the purpose. For example, it can be DRAM (Dynamic Random Access Memory) or SRAM (Static Random Access Memory).

[0146] There are no particular limitations on the auxiliary storage device 103. As long as it can store various types of information, it can be selected based on the intended purpose. For example, it can be a solid-state drive (SSD), a hard disk drive (HDD), etc. Alternatively, the auxiliary storage device 103 can be a portable storage device such as a CD drive, a DVD drive, or a BD (Blu-ray Disc (registered trademark)) drive.

[0147] In addition, the cervical cancer radiotherapy auxiliary program of the present invention is (for example) stored in the auxiliary storage device 103 , loaded into the RAM (main memory) of the main storage device 102 , and executed by the control unit 101 .

[0148] The I / O interface 104 is used to connect to various external devices. For example, the I / O interface 104 can input and output data from CD-ROMs (Compact Disc ROMs), DVD-ROMs (Digital Versatile Disk ROMs), MO disks (Magneto-Optical Disks), and USB flash drives (Universal Serial Bus flash drives).

[0149] The communication interface 105 is not particularly limited, and well-known devices may be used as appropriate. For example, it may be a wireless or wired communication device.

[0150] The input device 106 is not particularly limited as long as it can receive various requests and information input for the cervical cancer radiotherapy support system 100 of the present invention. Well-known devices may be used as appropriate, such as a keyboard, mouse, touch screen, microphone, etc. Furthermore, if the input device 106 is a touch screen (touch display), the input device 106 may also function as the display device 108.

[0151] The output device 107 is not particularly limited, and a well-known device such as a printer can be used as appropriate.

[0152] The display device 108 is not particularly limited, and a well-known device can be used as appropriate. For example, it can be a liquid crystal display, an organic EL display, etc.

[0153] Figure 14 This is an example of the functional configuration of the cervical cancer radiotherapy auxiliary system of the present invention.

[0154] like Figure 14 As shown, the cervical cancer radiotherapy auxiliary system 100 of the present invention has a communication function unit 120 , an input function unit 130 , an output function unit 140 , a display function unit 150 , a storage function unit 160 , and a control function unit 170 .

[0155] The communication function unit 120 can, for example, transmit and receive various data with an external device. The communication function unit 120 can also, for example, receive auxiliary information of a patient from an external device.

[0156] The input function unit 130 receives, for example, various instructions for the cervical cancer radiotherapy support system 100 of the present invention. In addition, the input function unit 130 receives, for example, information such as patient attributes.

[0157] The output function unit 140 prints out the patient's auxiliary information results and the like, for example.

[0158] The display function unit 150 displays, for example, auxiliary information of the patient, three-dimensional model information of the patient, and the like on a display.

[0159] The storage function unit 160 stores, for example, various programs, an auxiliary information DB 161 for storing acquired patient auxiliary information, and a three-dimensional model DB 162 for storing patient three-dimensional model information created based on the acquired patient auxiliary information.

[0160] The control function unit 170 includes an auxiliary information acquisition unit 171 and a mixed reality display unit 172. The control function unit 170 controls the overall operation of the cervical cancer radiotherapy support system 100 of the present invention while executing various programs stored in the storage function unit 160, for example.

[0161] The auxiliary information acquisition unit 171 acquires patient auxiliary information, for example, when taking an image of a patient before radiotherapy. The patient auxiliary information includes a reference point serving as a reference of a coordinate system, and at least includes the image of the patient, a contour map of the tumor, a contour map of organs surrounding the tumor, a contour map of the needle insertion area, the coordinates of the center of gravity of the needle insertion area, and one of the dose distributions.

[0162] The mixed reality display unit 172, for example, imports virtual reference points and auxiliary information corresponding to the reference points into the virtual world to create a three-dimensional model of the patient, and by making the reference points and the virtual reference points consistent, the three-dimensional model of the patient is displayed overlappingly on the patient.

[0163] Here, Figure 15 This is a flow chart showing an example of the processing flow of the cervical cancer radiotherapy auxiliary method of the present invention. Figure 14 , the processing flow of the cervical cancer radiotherapy auxiliary method of the present invention is described.

[0164] In step S101, the auxiliary information acquisition unit 171 in the control function unit 170 of the cervical cancer radiotherapy auxiliary system 100 acquires patient auxiliary information when taking an image of the patient before interstitial irradiation combined with intracavitary irradiation. The patient auxiliary information includes a reference point as a reference of the coordinate system, and at least includes the image of the patient, the contour map of the tumor, the contour map of the organs around the tumor, the contour map of the needle insertion area, the center of gravity of the needle insertion area, and one of the dose distribution, and is handed over to S102 for processing.

[0165] In step S102, the mixed reality display unit 172 in the control function unit 170 of the cervical cancer radiotherapy auxiliary system 100 imports the virtual reference point corresponding to the reference point and auxiliary information into the virtual world to create a three-dimensional model of the patient. By making the reference point and the virtual reference point consistent, the three-dimensional model of the patient is overlapped and displayed on the patient, and then the processing is ended.

[0166] The cervical cancer radiotherapy assistance method and cervical cancer radiotherapy assistance system of the present invention using the cervical cancer radiotherapy assistance program of the present invention can achieve the following significant effects.

[0167] (1) By using the cervical cancer radiotherapy auxiliary system of the present invention, the needle insertion position information in interstitial irradiation combined with intracavitary irradiation, which previously required empirical judgment, can be obtained visually during surgery, thereby compensating for the operator's lack of experience.

[0168] (2) By using the cervical cancer radiotherapy auxiliary system of the present invention, the difficulty of operation can be reduced, and the introduction and implementation threshold of interstitial irradiation combined with intracavitary irradiation can be lowered, which is conducive to improving the popularity of interstitial irradiation combined with intracavitary irradiation.

[0169] (3) By using the cervical cancer radiotherapy auxiliary system of the present invention, it is expected to shorten the operation time of interstitial irradiation combined with intracavitary irradiation, reduce the risk of bleeding, etc.

[0170] (4) By using the cervical cancer radiotherapy auxiliary system of the present invention, when performing interstitial irradiation combined with intracavitary irradiation, needle insertion can be performed while identifying adjacent peripheral organs as contour information, thereby minimizing the risk of the insertion needle accidentally puncturing the intestine and other peripheral organs.

[0171] (5) By using the cervical cancer radiotherapy auxiliary system of the present invention, the treatment planning system (RTPS) can virtually configure the insertion needle at the determined needle insertion position, and evaluate the necessity of needle insertion and the appropriateness of the needle insertion position.

[0172] (6) By using the cervical cancer radiotherapy auxiliary system of the present invention, the radiation dose to the tumor and surrounding organs when interstitial irradiation combined with intracavitary irradiation is simulated before irradiation.

[0173] (7) By using the cervical cancer radiotherapy auxiliary system of the present invention, safe and accurate needle insertion can be achieved in interstitial irradiation combined with intracavitary irradiation, which is expected to improve the treatment effect of giant cervical cancer (increase tumor control rate and reduce disease incidence).

[0174] (8) By using the cervical cancer radiotherapy auxiliary system of the present invention, it is expected to solve the problems of insufficient instructors and insufficient personal capabilities in small-scale institutions.

[0175] This international application claims the benefit of Japanese Patent Application No. 2022-016883, filed on February 7, 2022, and the entire contents of Japanese Patent Application No. 2022-016883 are incorporated by reference into this international application.

[0176]

Explanation of symbols

[0177] 1 Irradiation equipment

[0178] 2 Tumors

[0179] 3 Intracavitary applicator

[0180] 4 Intracavity irradiation equipment

[0181] 5 Implant needle applicator

[0182] 6 Head-mounted displays

[0183] 7 QR Code (registered trademark)

[0184] 8 patients

[0185] 9-pin implant area

[0186] 10 Barycentric coordinates

[0187] 11 Auxiliary Information

Claims

1. A cervical cancer radiotherapy auxiliary system that provides auxiliary treatment for cervical cancer by combining interstitial irradiation with intracavitary irradiation, characterized in that: The system has: an auxiliary information acquisition device, which acquires auxiliary patient information when capturing an image of the patient before the interstitial irradiation combined with intracavitary irradiation, wherein the auxiliary patient information includes a reference point serving as a reference of a coordinate system and includes at least one of the patient image, a contour map of the tumor, a contour map of organs surrounding the tumor, a contour map of the needle insertion area, coordinates of the center of gravity of the needle insertion area, and a dose distribution; and The mixed reality display device imports the virtual reference points corresponding to the above-mentioned reference points and the above-mentioned auxiliary information into the virtual world to create a three-dimensional model of the patient. By making the reference points and the virtual reference points consistent, the three-dimensional model of the patient is displayed overlappingly on the patient.

2. The cervical cancer radiotherapy auxiliary system according to claim 1, characterized in that: The needle insertion area is an insufficient dose area in the tumor. The method for obtaining this area is to use a treatment planning system to draw a contour map of the tumor on the patient's image, formulate an intracavitary irradiation treatment plan, calculate the dose distribution, draw a contour map of the area above the planned dose in the calculated dose distribution, and subtract the area above the planned dose from the contour map of the tumor.

3. The cervical cancer radiotherapy auxiliary system according to claim 2, characterized in that: Needle insertion is performed based on a contour image of the needle insertion area in the three-dimensional model of the patient and the coordinates of the center of gravity of the needle insertion area, which are displayed overlappingly on the patient using the mixed reality display device.

4. The cervical cancer radiotherapy auxiliary system according to any one of claims 1 to 3, characterized in that: The cervical cancer is a giant cervical cancer in which the tumor invades the paracervical tissue and becomes larger.

5. The cervical cancer radiotherapy auxiliary system according to any one of claims 1 to 4, characterized in that: The reference point is information stored in the two-dimensional code.

6. The cervical cancer radiotherapy auxiliary system according to any one of claims 1 to 5, characterized in that: The image of the patient is a CT image of the patient.

7. The cervical cancer radiotherapy auxiliary system according to any one of claims 1 to 6, characterized in that: The mixed reality display device includes a device that supports mixed reality (MR).

8. A method for assisting cervical cancer radiotherapy by combining interstitial irradiation with intracavitary irradiation, characterized in that: The method has: an auxiliary information acquisition step, when capturing an image of the patient before the interstitial irradiation combined with intracavitary irradiation, acquiring auxiliary patient information, wherein the auxiliary patient information includes a reference point serving as a reference of a coordinate system and includes at least one of the patient image, a contour image of the tumor, a contour image of organs surrounding the tumor, a contour image of the needle insertion area, coordinates of the center of gravity of the needle insertion area, and a dose distribution; and The mixed reality display process imports the virtual reference points corresponding to the reference points and the auxiliary information into the virtual world to create a three-dimensional model of the patient. By making the reference points and the virtual reference points consistent, the three-dimensional model of the patient is displayed overlappingly on the patient.

9. A cervical cancer radiotherapy adjuvant program that provides auxiliary treatment for cervical cancer by combining interstitial irradiation with intracavitary irradiation, characterized in that: Causes the computer to do the following: When capturing an image of the patient before the interstitial irradiation combined with intracavitary irradiation, patient auxiliary information is obtained, the patient auxiliary information including a reference point serving as a reference of a coordinate system and at least including one of the image of the patient, a contour map of the tumor, a contour map of organs surrounding the tumor, a contour map of the needle insertion area, coordinates of the center of gravity of the needle insertion area, and a dose distribution. The virtual reference points corresponding to the reference points and the auxiliary information are imported into the virtual world to create a three-dimensional model of the patient. By making the reference points and the virtual reference points consistent, the three-dimensional model of the patient is displayed overlappingly on the patient.

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