JP2018093927A - Head fixing position determination aid and head fixing position determination support kit using the same - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a head fixing position determination aid that can perform fixing position determination easily and accurately by reproducing a head fixing position in an MRI diagnosis on a treatment bed in a radiation treatment, and can reproduce a head fixing position, which is positioned first, easily and accurately even in repeatedly performed radiation treatments, and to provide a head fixing position determination support kit using the aid.SOLUTION: A head fixing position determination aid for supporting head fixing position determination for a patient receiving a radiation treatment for the head includes: a temple support member 1 having a temple clamping part for clamping skull temporal regions of the patient; a jaw support member 2 for clamping a jaw part of the patient; and a connection member 3 for connecting the temple support member and the jaw support member in a manner where a distance between the temple support member 1 and the jaw support member 2 may be changed.SELECTED DRAWING: Figure 3

Description

  The present invention relates to a head-fixed position that can easily improve positioning accuracy when determining a head-fixed position used for positioning of an irradiation site at the time of radiation irradiation in radiation therapy for a head tumor and a head-and-neck tumor. The present invention relates to a determination aid and a head fixing position determination support kit using the same.

  In the field of diagnosis of intracranial lesions such as metastatic brain tumors and meningioma and head tumors, CT (computer tomography) devices, CT-PET devices, and MRI (magnetic resonance imaging) devices are used. Since these devices capture images by scanning the head, it is necessary to fix the head at a predetermined position so that the head does not move during scanning.

  In addition, radiation therapy, which is one of the cancer treatments, requires accurate doses to the tumor and minimizes the dose to normal tissues around the tumor as much as possible. It is important to go accurately and improve the irradiation accuracy. In particular, in stereotaxic radiation therapy, in which irradiation is performed in several tens of times during the treatment period, if an error occurs in patient positioning, an accurate dose cannot be administered to the irradiation volume, resulting in a risk to surrounding normal tissues. Therefore, it is necessary to match the patient's position and the fixed position of the head every time. For these reasons, various positioning aids and fixtures have been proposed.

  For example, in Japanese Patent Laid-Open No. 8-711168 (Patent Document 1), a treatment bed having a surface for placing a patient in a supine position, and the patient's height direction on the treatment bed can be moved in the Y and Z directions with the height direction of the patient as the X axis. There has been proposed a positioning device for a head or the like, which has a simple frame, a mouthpiece attached to the frame, and a mechanism capable of controlling and driving the mouthpiece. According to this, the head of the patient under treatment can be fixedly held at a fixed position, and errors such as positional deviation can be reduced. In addition, when the mouthpiece is meshed with the patient, the head can be positioned and fixed so that the head does not move, and radiation can be accurately irradiated to the lesion position on the head.

Japanese Patent Laid-Open No. 2002-136613 (Patent Document 2) discloses an adjustable headrest that supports a patient's head during radiotherapy as a table plate, an adjustable feed screw rotatably connected to the table plate, An adjustable headrest having a base plate that is screwably coupled to a feed screw and a uniframe having a molded member for supporting the patient's head removably attached to the base plate has been proposed Yes.
The vertical height of the head is adjusted with the adjustment knob and the operation feed screw. Further, the moldable member of the uniframe matches the front contour of the patient's head so that the patient's head can be accurately positioned.

  However, as a head fixing means, a fixture provided with a position adjusting means for improving the fixing accuracy such as a metal stand, a slider, a screw, etc. can be used for a CT apparatus. It cannot be used for an MRI apparatus in which all signals are collected electromagnetically.

  As a non-metallic head fixture that can also be used for fixing a head at the time of examination using an MRI apparatus, for example, in Japanese Patent No. 3808215 (Patent Document 3), a medical examination device is used for an air mat made of urethane foam. There has been proposed a head fixture provided with a fixing belt that can be detachably fastened to the head mounting portion.

Japanese Patent Laid-Open No. 2001-170071 (Patent Document 4) proposes a sheet composed of a low-melting-point thermoplastic material that is softened by heating at about 50 to 70 ° C. and can be greatly elongated. By using such a sheet, it is possible to produce a shell that conforms to the front contour of the patient's head by forming the sheet along the shape of the face, head, etc. of the individual patient.
By attaching the shell made in this way at the time of radiation treatment, irradiation is performed at the radiation irradiation position determined at the start of radiation therapy without adjusting the head fixed position such as positioning each time. It becomes possible.

In Japanese Patent Application Laid-Open No. 2007-503865 (Patent Document 5), as a patient repositioning device and a repositioning method, each pair of side support structures that support a patient is connected by a link mechanism, Devices have been proposed that are automatically centered on a support panel longitudinal axis that represents the centerline of the patient supported on the support panel.
The patient support panel is or is conventionally attachable with auxiliary means that can be seen in the diagnostic image, such as a visible scale or marker, so that the support panel can be attached to it. It has been described that its own reference coordinate system can be positioned relative to hospital facilities for diagnosis and radiotherapy (paragraph 0019).

JP-A-8-711168 JP 2002-136613 A Japanese Patent No. 3808215 Japanese Patent Laid-Open No. 2001-170071 JP 2007-503865 A

In the radiotherapy plan, it is necessary to specify the tumor site, irradiation dose, and irradiation site. In such a radiation therapy plan, image data acquisition is performed using a scanner such as CT or MRI in order to accurately confirm the position of the affected part in the therapeutic treatment.
MRI is generally used for diagnosis of the presence or absence of a tumor because MRI is superior in tissue resolution and is advantageous for determining a target site that cannot be visualized with a CT image.

As described above, since an MRI apparatus having excellent tissue resolution is usually used for the diagnosis of the presence / absence of a tumor part and location, a CT image is obtained based on image data acquired by MRI in a radiation treatment plan. The target position is determined by superimposing with.
For this reason, it is important how accurately the head position at the time of MRI image diagnosis can be reproduced on the bed for radiation therapy.

However, since the MRI examination using a strong magnetic field is affected by radiation, the room for performing MRI diagnosis and the room for performing radiation therapy are independent.
In addition, since metal members cannot be used in MRI and the scanning space is limited, a fixture provided with a position adjusting means or the like for improving the fixing accuracy cannot be used together with the MRI apparatus.
Furthermore, since the treatment bed used for MRI image diagnosis and the treatment bed used for radiation therapy are separate, the state in which the head is fixed at the time of MRI diagnosis and the state fixed at the time of radiation treatment do not completely match.

  For this reason, even if a head-fixing shell is prepared for each individual patient for radiation therapy, if the fixed state at the time of MRI diagnosis cannot be reproduced at the time of manufacturing the head-fixing shell, the affected part position is shifted. There is a risk that.

  At the medical site, identify and fix the affected area while confirming using the CT device based on the image of the tumor position identified by the MRI image diagnosis in the supine state on the treatment bed for radiation therapy in the radiation treatment room However, if the deviation from the state at the time of acquiring the MRI image is large, it is difficult to achieve the identification and fixation of the affected area with high accuracy.

In addition, the head-fixing shell manufactured by molding enables fine movement of the skull when the head is not completely fixed in the radiation treatment bed and the head holding part. May cause a shift. Due to weight loss during stereotactic radiotherapy in which irradiation is performed divided into multiple times, the adhesion with the shell for fixing the head is reduced, which may affect the fixation accuracy.
In stereotactic radiotherapy where the positional accuracy error is within 2 mm for intracranial lesions, the displacement and error due to such fine gaps that may occur during the treatment period may be problematic.

  The present invention has been made in view of the circumstances as described above. The object of the present invention is to reproduce the head fixed position at the time of MRI diagnosis on the treatment bed at the time of radiation treatment, and to perform the fixed positioning easily and easily. A head fixing position determination aid that can easily and accurately reproduce the head positioning position that was initially positioned, even during repeated radiotherapy, and head fixing position support using this To provide a kit.

The head fixing position determination assisting tool of the present invention is a head fixing position determining assisting tool that assists in determining the head fixing position of a patient receiving radiation therapy of the head,
A temporal support member having a temporal clamping part for clamping the skull side of the patient;
A jaw support member for holding the patient's jaw; and a connecting member for connecting the temporal support member and the jaw support member such that the distance between the temporal support member and the jaw support member can be varied. It is characterized by being.

It is preferable that the temporal support member is a plastic flat plate having an outline that forms a concave portion serving as a temporal clamping part, and is provided with a scale indicating the temporal clamping position of the patient.
Further, the chin support member is preferably a plastic flat plate having a contour that forms a concave portion to be a clamping portion of the chin portion, and the concave portion has an opening portion of the concave portion as a long side and a bottom portion of the concave portion as a short side. It is preferably an isosceles trapezoidal shape as a side.

  It is preferable that the connecting member is a support column fixed to a right and left equally-distributed position of the temporal support member, and the jaw support member is slidably attached to the support member.

  Further, the head fixing position determination assisting tool of the present invention adjusts the connecting member so as to be horizontal with respect to the bed in a state where the head of the patient's skull lying on the bed is sandwiched. It is preferable that an adjustment tool is further provided. The horizontal adjustment tool may be a horizontal indicator attached to the temporal support member.

  The connecting member sandwiches the patient's temporality with the temporal support part, and supports the patient's jaw with the jaw support member, with the center line extending from the head to the jaw part of the patient's face. The centering instruction | indication part shown may be provided.

  The head fixing position determination support kit of the present invention includes the head fixing position determination assisting tool of the present invention as described above; a first head holding pillow having a cervical holding part and a occipital holding part of a patient; There is provided a plastic second head holding pillow having a neck holding portion and a back head holding portion having the same shape as the neck holding portion and the back head holding portion of the head holding pillow.

  The first head-holding pillow is a pillow used to fix the head during radiation therapy, and the second head-holding pillow is placed on the head placement portion of the diagnostic imaging apparatus. The recessed portion into which the convex head fixing portion formed on the head mounting portion can be fitted against the neck holding portion and the back head holding portion of the second head holding pillow. It is preferable that it is recessed in the side to do.

Since the head fixing position determination assisting device of the present invention is portable and has no restrictions on the place of use, it can be used for both image data acquisition and radiotherapy positioning. Is excellent. In addition, when the head is fixed, the face can be easily directed to the front with high accuracy, so that the accuracy of centering during positioning at the time of image data acquisition and radiotherapy can be improved.
Further, the head fixing position determination support kit of the present invention uses the head holding pillow having the neck holding part and the occipital holding part having the same shape at the time of image diagnosis and at the time of radiotherapy. By using in combination with the determination assisting tool, the head-fixed state at the time of image diagnosis can be reproduced with high accuracy at the time of radiotherapy.

It is a figure which shows the structure of the head fixed position determination auxiliary tool of 1st embodiment of this invention. It is a front view of the temporal support member used in the first embodiment. It is a figure which shows the use condition of the head fixed position determination auxiliary tool of 1st embodiment. It is a figure for demonstrating the method to correct a head position using a temporal support member. It is a figure which shows an example of the 1st pillow for head holding | maintenance used for the head fixed position determination assistance kit of this invention. It is a figure which shows an example of the 2nd pillow for head holding used for the head fixed position determination assistance kit of this invention. It is a figure for demonstrating the head fixed position determination assistance kit of this invention. It is a figure for demonstrating correction | amendment of a bed. FIG. 8A shows a state in which the first head holding pillow is installed on the radiation therapy bed, and FIG. 8B shows the adjustment plate and the second head holding pillow on the MRI bed. The state where the pillow is set is shown.

[Head fixing position determination aid]
One embodiment of the head fixing position determination aid of the present invention will be described with reference to FIGS.

  In the head fixing position determination assisting tool shown in FIG. 1, a temporal support member 1 made of a plastic flat plate as shown in FIG. 2 and a chin support member 2 made of a plastic flat plate are parallel to each other. Thus, it is attached to a prism-shaped plastic column 3. The support column 3 is a connecting member that connects the temporal support member 1 and the chin support member 2 so that the distance (D) between the temporal support member 1 and the chin support member 2 can be varied.

As shown in FIG. 2, the temporal support member 1 has a contour in which a recess 11 having an isosceles trapezoidal shape is formed in a substantially rectangular plastic flat plate 10. The corners of the flat plate 10 are appropriately rounded (R).
The isosceles trapezoidal concave portion 11 is formed so as to distribute the flat plate 10 evenly on the left and right sides. The short side 11a serving as the upper base of the trapezoid serves as the bottom of the concave portion 11 and the long side 11b serving as the lower base of the trapezoid is formed. It is an opening of the recess 11.

As shown in FIG. 3, the concave portion 11 includes a clamping unit that clamps the cranial head of a patient who is in a supine state on a bed to receive image data acquisition or radiotherapy by an MRI apparatus, a CT apparatus, or the like. Become.
Hereinafter, the recess 11 may be referred to as “the temporal clamping unit 11”.
Further, with respect to the flat plate 10 constituting the temporal support member 1, the flat plate 10 is erected so as to stand upright with respect to the state shown in FIG. Based on the sandwiched state, the bottom side corresponding to the side on the floor side is the lower edge 10B, the upper side corresponding to the side on the patient's face side is the upper edge 10U, and the left and right sides connecting the lower edge 10B and the upper edge 10U The sides are referred to as a left edge 10L and a right edge 10R, respectively.

  The left edge 10L and the right edge 10R of the plastic flat plate 10 are inclined from the middle toward the hypotenuse of the isosceles trapezoid forming the recess 11, so that the recess hypotenuse 11c or 11c ′ and the left edge 10L or the right edge 10R. And forms a tapered insertion portion.

  Between the short side 11a of the isosceles trapezoidal recess 11 and the upper edge 10U of the plastic flat plate, the isosceles trapezoidal recess 11 is attached and fixed at a position 1C where the left and right are equally distributed. .

Scales are attached to the hypotenuses 11c and 11c ′ of the recesses to be the temporal nipping portions 11 and the side edges 10L and 10R of the flat plate 10.
In this scale, the left and right oblique sides, that is, the oblique sides 11c and 11c ′ of the temporal clamping part, and both side edges 10L and 10R of the flat plate 10 are equal. Accordingly, by matching the left and right scales at the clamping part, in the clamping state, the lateral support member 1 is shifted to the left and right (for example, the right edge is on the chin side, the left edge is on the forehead side), and the left and right inclinations. When there is (for example, a state in which the altitudes from the floor surface at the left end and the right end are not equal), the patient's face can be corrected to face the front in a supine state.

A horizontal indicator 12 is attached to the upper edge 10U of the flat plate 10 at a position separated from the attachment position of the column 3 along the right edge 10R.
As the horizontal indicator 12, what is generally called a posture indicator or a level can be used, and serves as an index for sensing the presence or absence of left and right inclinations of the flat plate 10 in a state where the temporal region is sandwiched.

The horizontal indicator 12 used in the present embodiment is a bubble tube level in which a colored liquid 12a is filled and sealed in a sealed container 12c leaving some space, and the colored liquid 12a is a bubble 12b which is a residual space below. It is possible to know which of the left and right sides is tilted downward based on the characteristic of moving upward.
For example, FIG. 4 (the column is omitted for convenience) shows a state in which the temporal support member 1 is offset toward the left side of the patient and holds the left side. Since the bubbles 12b of the horizontal indicator 12 are offset toward the left edge 10L, it can be recognized that the temporal support member 1 is inclined downward toward the right side with the left side of the flat plate 10 facing upward.

  The chin support member 2 is composed of a plastic flat plate 20 that is substantially similar to the temporal support member 1, and an isosceles trapezoidal recess that serves as a chin clamping portion 21 is formed on the substantially square flat plate 20. Between the short side 21a of the isosceles trapezoid and the upper edge 20U of the flat plate 20, a rectangular column insertion port 22 through which the column 3 can penetrate is provided at the left and right equally distributed position of the recess. 3 is inserted. The support insertion hole 22 is in a fitted state having a clearance that allows the chin support member 2 to slide on the support 3. The chin support member 2 can adjust the distance D between the temporal support member 1 and the chin support member 2 by sliding the column 3.

  Scales are attached to the hypotenuses 21c and 21c 'of the isosceles trapezoid jaw holding part 21 of the jaw support member 2. Therefore, when the jaw is clamped, the scales of the left and right hypotenuses are matched so that correction can be made when the jaw support member 2 is inclined to the left or right.

The support column 3 is formed of a plastic quadrangular column, and a straight line serving as the centering instruction unit 31 is written along the longitudinal direction at the center of the upper surface of the support column 3 on the upper surface portion of the quadrangular column.
The centering instruction unit 31 indicates a center serving as an index when marking the center line of the patient's face with laser light. In the present embodiment, it is a straight line connecting the left and right equal distribution position 1C of the temporal support member 1 and the left and right distribution equal position 2C of the chin support member 2.

As shown in FIG. 3, the head fixing position determination assisting tool having the above-described configuration clamps the patient's temporal region by the temporal clamping unit 11 of the temporal supporting member 1, and It is used so that the jaw is clamped by the jaw clamping part 21.
First, in a state where the temporal support is clamped by the temporal support member 1, the horizontal indicator 12 and the scale are read so that the temporal (cheekbone) is clamped at equal intervals from the center of the face to the left and right. . Further, the chin support member 2 corrects the left / right inclination by reading the scale so that the face is directed to the front. Thus, the face position can be fixed by fixing the left and right cheekbones and the left and right four points of the chin.
Since the face is clamped at four points of the left and right symmetrical positions of the temporal and chin, it can be fixed in a state where the left and right inclinations and shifts of the face are eliminated.

  In such a state, the head fixing position determination assisting tool is in a state in which the support column 3 is in a horizontal state with respect to the face of the patient in the supine state, and the nipping and fixing by the four points and the support column 3 is performed with the face facing frontward. It is possible to prevent the face from tilting left or right. And the centering instruction | indication part 31 of the support | pillar 3 is parallel to the centerline which passes along a nasal column of a patient's face. Therefore, when marking the center of the face with a laser beam or the like during positioning, the positioning centering can be determined by matching the marking laser beam with the straight line constituting the centering instruction unit 31.

The head fixing position determination aid of the present invention can be composed entirely of non-metal without using metal parts as components.
Examples of the plastic that is a constituent material of the flat plates 10 and 20 and the support column 3 include olefin resins such as polypropylene and polystyrene, thermoplastic resins such as polyester, polycarbonate, and polyamide, or phenol resins, urea resins, polyureas, polyimides, epoxy resins, and the like. These thermosetting resins can be used.

  Thus, by using no metal as a constituent material of the head fixing position determination aid, it can be used in the MRI apparatus room. Moreover, although the space | interval of a temporal clamping position and a jaw clamping position changes with individuals, since the chin support member 2 is slidably attached to the support | pillar 3 which is a connection part, it is general-purpose according to an individual's face size. It is possible to fix the head position. Furthermore, since it is a simple portable instrument that adjusts the face position and head position with the scale and horizontal indicator, it can be used in various situations and places, such as when acquiring image data with an MRI device or during radiotherapy. It can be used in Therefore, the head can be fixed in different rooms as in MRI diagnosis and radiotherapy.

  In addition, the shape of the head fixing position determination aid of the present invention, particularly the temporal support member and the chin support member, and the shape of the support column are not limited to those shown in FIG. In short, by supporting the four points of the left and right temporal regions and chin, the temporal support member and jaw support member that can fix the head, and the connection that can center the face between the temporal support member and jaw support member Any member provided with a member may be used. Moreover, in the said embodiment, although the centering instruction | indication part was the straight line marked on the support | pillar which is a connection member, this invention is not limited to this. For example, the centering instruction portion may be a groove that is recessed along the longitudinal direction of the support column, and a convex portion that fits into the groove may protrude from the support column insertion port of the chin support member. In this case, the groove of the centering instruction portion can also serve as a guide rail. The configuration and shape of the centering instruction unit can be appropriately designed according to the configuration of the connecting member.

  In addition, as for the horizontal indicator, the bubble tube level is used in the above embodiment, but the present invention is not limited to this. What is necessary is just to be able to adjust the horizontal state of a temporal support member. Further, in the above embodiment, the horizontal indicator is attached to the temporal support member.However, the present invention is not limited to this, and the temporal support member, preferably the temporal support member, Furthermore, as long as the centering instruction unit can indicate that it is in a horizontal state, it may be provided in any part of the head fixing position determination aid.

  Moreover, the scale of a temporal clamping part, a jaw clamping part, the right edge of a flat plate, and the scale of a left edge are not essential. Because it is fixed by four-point support by the connected temporal support member and chin support member, even if there is no scale, the horizontal edge is held in a horizontal state by holding the upper edge in a horizontal state so that it is clamped and fixed evenly on the left and right It is possible. However, the reproduction by the scale is simple and effective for reproducing the fixed position at different places.

[Head fixing position determination support kit]
The head fixing position determination support kit of the present invention including the head fixing position determination assisting tool of the present invention is used for centering the head position, and for reproducing the head centering position at the time of radiotherapy positioning. It is useful.

The head fixing position determination support kit of the present invention is the above-mentioned head fixing position determination assisting tool of the present invention;
A first head holding pillow having a patient's neck holding part and a back head holding part; and a neck holding part and a back head holding part having the same shape as the neck holding part and the back head holding part of the first head holding pillow. A second head holding pillow made of plastic.

  Generally, since the bed for radiation therapy is a flat plate, a pillow that holds the head and neck and the back of the head is set to fix the head of the patient. On the other hand, in the MRI apparatus, a bowl-shaped concave surface portion serving as a convex neck holding portion and a back head holding portion is provided on the head coil floor so that the head coil itself can fix the head. For this reason, in order to make the head fixed state such as the head position at the time of radiotherapy and the tilt angle of the head at the time of image diagnosis coincide with each other with high accuracy, It is preferable that the portion matches the head fixing position at the time of image diagnosis (the shape of the head holding portion of the head coil floor of the MRI apparatus). However, the manufacturer of the MRI apparatus is not the same as the manufacturer of the radiation therapy bed and the head-holding pillow used therefor because they are different companies.

  Under such circumstances, a second holding portion having a neck holding portion and a back head holding portion having the same shape as the neck holding portion and the back head holding portion of the head holding pillow (first head holding pillow) used during radiation therapy. If the head holding pillow can be used at the time of image diagnosis, the head fixed state can be easily matched. That is, the head fixing position determination support kit of the present invention includes a neck holding portion and a occipital head holding portion of a head holding pillow (first head holding pillow) used for radiotherapy for head fixing at the time of image diagnosis. Is characterized in that a second head holding pillow having a neck holding part and a back head holding part having the same shape as is used. In the second head holding pillow, the recessed portion that can be fitted to the head holding portion of the head coil floor of the MRI apparatus opposes the neck holding portion and the back head holding portion of the second head fixing pillow. It is preferable that it is recessed on the side.

  The fitted state is not limited to the fitted state, and may be a loosely fitted state as long as the head holding pillow is stably placed on the head coil floor and can be detached.

[Head holding pillow]
Hereinafter, a head holding pillow that is preferably used in combination with the head fixing position determination aid of the present invention will be described. FIG. 5 shows an example of a first head holding pillow used to fix a patient's head lying on a radiation therapy bed. FIG. 6 shows an embodiment of a second head holding pillow that is used by being set on a head fixing portion formed in a convex shape on the floor surface of the head mounting portion of the diagnostic imaging apparatus.

  The first head-holding pillow 40 shown in FIG. 5 is an integrally molded product made of plastic, and a convex portion that becomes the neck holding portion 41 and a bowl-shaped concave curved surface portion that becomes the rear head holding portion 42 are continuously formed. Has the shape. The concave curved surface portion serving as the occipital region holding portion 42 is a concave portion recessed in a bowl shape from the side edge toward the central portion, and holds the occipital portion of the average head of an adult patient, but is smaller than the entire occipital region, It is a size that holds the back of the head. By making the cervical holding part 41 higher than the occipital part holding part 42 and configuring the occipital part holding part 42 with a bowl-shaped concave curved surface part, the movement of the cervical part is suppressed, and the head is brought to a normal position during radiotherapy. Can be fixed.

  A center line (marking center line) 43 that divides each of the neck holding part 41 and the back head holding part 42 symmetrically into two is attached to the surface of the head holding pillow 40. The marking center line 43 indicates a center line that should pass through the nasal column of the face when the patient places the head on the concave curved surface portion that is the occipital region holding portion 42.

  Further, the bottom side of the head holding pillow 40 that comes into contact with the radiation therapy bed is placed on the outer periphery so that the head holding pillow 40 can be stably placed on the radiation therapy bed. 44 is formed. A fixing tool insertion hole 44a for fixing the first head holding pillow 40 on the bed for radiation therapy using a screw or a fixing pin is provided in the bag 44. By inserting a screw or a fixing pin through the fixing tool insertion hole 44a and fixing the first head holding pillow to the bed for radiation therapy, the patient's head can be fixed more stably.

  The second head holding pillow 45 shown in FIG. 6 is a plastic pillow placed on a head placement portion of an image diagnostic apparatus such as an MRI apparatus. The neck holding part 46 and the back head holding part 47 in the second head holding pillow 45 have the same shape as the neck holding part 41 and the back head holding part 42 of the first head holding pillow 40, respectively. Thereby, the reproducibility precision at the time of radiation therapy can be improved about head fixed states, such as a head position at the time of image diagnosis, and the inclination of a head.

  A center line (marking center line) 48 that bisects the neck holding part 46 and the back head holding part 47 in a bilaterally symmetrical manner is attached to the surface of the second head holding pillow 45. The marking center line 48 indicates a center line that should pass through the nasal column of the face when the patient places the head on the concave curved surface portion that is the occipital region holding portion 47.

  The inside of the second head holding pillow 45 is a recess 49 that can be detachably set on the head mounting portion of the diagnostic imaging apparatus. Thereby, even if the floor surface of the head mounting portion of the diagnostic imaging apparatus has a convex shape as the head fixing portion, the second head holding pillow 45 is fitted so as to fit the convex shape. It can be set to be removable. The shape of the recessed part 49 should just be a shape which can fit the convex shape formed in the floor surface of the head mounting part of an image bed apparatus. In the second head holding pillow 45, it is preferable that there is no rib (rib) corresponding to the hook 44 of the first head holding pillow 40.

  Such a second head holding pillow 45 is not particularly limited, and is produced by thermoforming or press molding into a predetermined shape using a plastic sheet having a thickness of about 0.5 to 5 mm as a molding material. be able to.

  Examples of the constituent material of the second head holding pillow 45 include olefin resins such as polypropylene and polystyrene, thermoplastic resins such as polyester, polycarbonate, and polyamide, or phenol resins, urea resins, polyureas, polyimides, and epoxy resins. A thermosetting resin is mentioned. The head holding pillow 45 can be produced as an integrally molded product using these resin materials.

  Although the constituent material of the first head holding pillow 40 is not particularly limited, a resin material exemplified in the second head holding pillow 45 can be used, and the first head holding pillow 40 is manufactured as an integrally molded product of the resin material. be able to.

  Since the second head holding pillow 45 is made of plastic, it can be used when acquiring image data by the MRI apparatus. Since it has the recessed part 49 which can be set to a head coil so that attachment or detachment is possible, it can be stably set to the head mounting part of a head coil. The second head holding pillow 45 used at the time of image diagnosis and the first head holding pillow 40 used at the time of radiation therapy are the neck-shaped holding portions 41 and 46 and the occipital head holding portion 42, which have the same shape. 47, the head-fixed state (angle, inclination, etc.) at the time of image diagnosis can be highly reproduced at the time of radiation therapy.

[Use of the head fixing position determination support kit]
Tests that can utilize the head-fixation positioning support kit of the present invention include MRI examinations, CT examinations, CT examinations that are performed in the diagnosis of intracranial lesions such as metastatic brain tumors and meningiomas and tumors of the head or neck. -Examination that requires the patient to lie on the bed and center and fix the head position, like a PET exam. The head fixing position determination support kit of the present invention is useful as an auxiliary tool for centering in these inspections.
In addition, it is useful for positioning for creating a radiotherapy plan, and for reproducing the head fixed position at the time of radiotherapy performed by being divided into a plurality of times.
In particular, it is useful for reproducing the head fixed position at the time of MRI examination performed on a bed different from the radiation therapy bed.

Hereinafter, a method for using the head fixing position determination support kit will be specifically described.
(1) Determination of head fixing position at the time of inspection

  FIG. 7 shows an adjustment scale 52 attached to the inner wall surface of the head mounting portion 51 of the head coil 50 set on the bed at the time of MRI examination. The state which set the pillow 45 for 2nd head holding | maintenance is shown.

  The adjustment scale 52 has scales at equal intervals from the 0 to the upstream side of the tape and the downstream side of the tape, with the central position in the longitudinal direction being 0 on the surface of the flexible adhesive tape (the surface having no adhesive layer). It is a thing. When such an adjustment scale 52 is attached to the inner wall surface of the head placement portion 51 so that the center 50C of the head placement portion 51 and the 0 point of the adjustment scale 52 coincide, the center of the head coil A scale passing through the line is set to 0, and the scales on the upstream side and the downstream side of the tape are in a left-right distribution state.

The second head holding pillow 45 is set so that the neck holding portion 46 is on the patient's body side. At this time, by marking with a laser beam or the like so that the marking center line 48 of the head holding pillow 45 coincides with the center line 50C of the head mounting portion 51 (the zero point position of the adjustment scale). While checking, the head holding pillow 45 is set. When the head coil of the head coil portion of the MRI apparatus is convex for supporting the head and neck, the convex portion is covered by the concave portion 49 of the head holding pillow 45. A head holding pillow 45 is used to fit.
This makes it easy to match the center line of the patient's head, that is, the line passing through the nasal column of the face, with the center line of the head placement unit 51.

The patient lies on his back so that the second head holding pillow 45 holds the head of the patient to be diagnosed. In this state, the frontal state of the patient's face is performed using the head fixing position determination assisting tool of the present invention. That is, the left-right shift and the left-right inclination of the patient's head position are corrected using the head fixing position determination assisting tool.
Specifically, using the head fixing position determination assisting device of the present invention, the face is adjusted so that the line passing through the nose of the face (the center line of the face) matches the center line of the head holding pillow 45. It is directed to the front, and is performed as follows.

  First, the patient's temporal region is clamped by the temporal support member. Since the right edge 10R and the left edge 10L, which are the insertion ends, taper toward the concave opening of the temporal nipping portion 11, insertion between the head coil 50 and the head is easy. The temporal support member 1 may be inserted between the head coil 50 and the head until the temporal clamping unit 11 clamps the patient's temporal region.

Next, so that the temporal support member 1 can be clamped at a correct position, the flat plate 10 is shifted left and right (deviation from a position that is symmetrical with respect to the center line) and tilted (from the horizontal state of the upper edge 10U). (Deviation) is corrected.
The horizontal displacement of the flat plate 10 is such that the scales of the left edge 10L and the right edge 10R of the temporal support member 1 are equal, and the adjustment scale 52 is in the contact position between the temporal support member 1 and the head coil 50. By making the left and right scales equal, the displacement from the symmetrical position can be corrected.

  In the clamping state, the horizontal state of the flat plate 10 can be confirmed by the horizontal indicator 12 attached to the temporal support member 1. The inclination of the flat plate 10 may be corrected based on the horizontal indicator 12. Further, by checking the left edge 10L, the right edge 10R of the temporal support member 1 and the scales attached to the oblique sides of the temporal clamping part 11, the height position of the clamping part (the part where the clamping part and the cheekbone abut) is confirmed. Therefore, the left and right height positions can be adjusted by adjusting the left and right scales to be equal.

  When the temporal support member 1 is clamped at a position that is symmetrical with respect to the face and the horizontal state of the flat plate 10 can be confirmed, the jaw support member 2 is slid along the support column 3 to clamp the jaw. When the jaw is clamped by the jaw clamping unit 21, the lateral displacement and the horizontal state of the temporal support member 1 can be finely corrected by adjusting the scales of the oblique sides of the jaw clamping unit 21 to be equal on the left and right oblique sides. it can. In this way, the head is fixed at the four points of the cheekbone and chin. In such a fixed state, the centering instruction part 31 of the support column 3 coincides with the center line of the head and the face by adjusting the position of the temporal supporting member 1.

  Next, it is confirmed that the centering instruction unit 31 coincides with the face center line (a line passing through the nose column of the face), and the center of the head is the center line 50C of the head placement unit 51 (the head holding pillow 45). Confirm that it matches the marking center line 48). Thus, the centering instruction section 31 of the support column 3 can coincide with the center line of the face, and the center position of the head and the center position 50C of the head coil 50 of the MRI can be matched.

  As described above, when the image data is acquired by the MRI apparatus, the center position of the head when the patient is in the supine state on the bed is matched, so that positioning determination for radiotherapy is easy and accurate. Get higher. The coincidence of the center position of the head when the patient is in the supine state on the bed is to fix the patient's face accurately to the front position. By using the head position determination assisting tool of the present invention, it is possible to easily correct the inclination of the patient's face position in either the left or right direction and to face the front position.

The confirmation of the center position match may be performed by marking the center of the face with a laser beam.
At the time of positioning, the center of the face is marked with a laser beam or the like. If the marking laser beam and the straight line constituting the centering instructing unit 31 coincide, It can be judged that they are clamped evenly.

  When the head fixing position is determined, the head fixing position determining aid is removed. During the acquisition of the image data, the head fixing position determining aid is removed.

(2) Positioning of radiation therapy (determination of radiation irradiation position)
During radiation therapy, the irradiation position is positioned. Since such positioning is determined based on image diagnostic data, it is important to reproduce the head fixed position at the time of image data acquisition by MRI at the time of radiotherapy positioning. In such reproduction, the center position of the face, usually the center line passing through the nasal column from the forehead to the chin, is aligned with the head coil center position at the time of MRI data acquisition, and used as a reference centering position for radiotherapy positioning. Can be performed.

First, the first head holding pillow 40 is set on the bed for radiation therapy. The patient places the back head on the set head holding pillow 40 and is in a supine state.
The first head holding pillow 40 and the second head holding pillow 45 used at the time of image diagnosis have head and neck holding portions 41 and 46 and occipital head holding portions 42 and 47 having the same shape, respectively. Therefore, in a state where the patient's head is fixed by the head holding pillow 40, the head fixed state at the time of MRI diagnosis can be reproduced. Such reproduction can be reproduced with high accuracy by correcting the right and left tilt and deviation of the head using the head fixing position determination assisting tool used for determining the head fixing position for image data acquisition. Specifically, this is performed as follows.

  As performed at the time of image diagnosis, first, the skull-side head is clamped by the temporal support member 1. When the cheekbone is clamped, the scale of the concave portion which is the temporal clamping unit 11 is clamped so as to coincide with the scale at the time of image data acquisition. The horizontal state of the temporal support member 1 at this time can be confirmed with the horizontal indicator 12. When the cheekbone is clamped in a state where the left and right inclination and displacement are corrected by the temporal clamping unit 11, the jaw support member 2 is then slid along the support column 3 to clamp the jaw.

When pinching the chin, confirm that there is no left / right tilt by matching the left and right scales.
By matching the four fixed points of the cheekbone and chin with the four fixed points at the time of MRI diagnosis, the centering instruction part 31 of the column 3 matches the center line 43 of the holding pillow 40 for fixing the head. Become. This means that the fixed position at the time of MRI diagnosis can be reproduced with respect to the fixed position of the head of the patient who is lying on the radiation therapy bed.
As described above, the head fixing position at the time of MRI image acquisition is also reproduced in the radiation therapy bed.

  When the head is fixed, it is confirmed using a laser beam or the like that the center of the face coincides with the centering instruction unit 31. If they do not match, the head is moved as appropriate to match, and the center of the face is matched with the centering instruction unit 31.

  When the head fixing position at the time of MRI diagnosis can be reproduced, the head fixing position determination assisting tool is removed, and the irradiation position is positioned based on the MRI image data.

(3) Reproduction of radiation irradiation position In the case of stereotactic radiotherapy in which radiation irradiation is performed in a plurality of times, it is necessary to reproduce the head fixed position as determined by positioning. The reproduction of the head fixed position is performed by using the support kit of the present invention, that is, the first head holding pillow 40 and the head fixed position determination assisting tool. This can usually be achieved by modification.

Specifically, the patient is placed in a supine state by placing the back of the head on the head holding pillow 40 set in the same manner as the bed for radiation therapy.
In this state, the temporal support member 1 holds the patient's temporal region. At this time, the horizontal state of the temporal support member 1 is maintained, and the lateral displacement and inclination of the flat plate 10 are corrected, and then the jaw is held by the jaw support member 2. By aligning the four support positions of the face by the temporal support member 1 and the chin support member 2 with the position at the time of positioning, the centering instruction part 31 of the support column 3 matches the centering at the time of positioning. Will be.
In this way, in a state where the patient's head is fixed by the head holding pillow 40, the head fixing position at the time of positioning, and further, the head fixing position at the time of MRI diagnosis is reproduced. .

Conventionally, as a head fixture, a head and neck shell that covers the neck and shoulders produced for each patient has been generally used. At the time of radiotherapy, wearing the created head and neck shell makes it possible to reproduce the position of the patient who was initially positioned.
However, when stereotactic radiotherapy is used for a long period of time, the head and neck shell may not match the size of the patient due to an increase or decrease in the weight of the patient. In particular, since the patient is almost always thinned by the influence of radiation therapy, a gap is generated between the head and the shell even in the case of the head and neck shell that was initially made to be in close contact. For this reason, the head of the patient may be slightly displaced with the head and neck shell attached, and there may be a deviation from the irradiation position when positioning.
In this regard, in the head fixing position determination support kit of the present invention, the head can be fixed, and the head can be centered each time radiation is irradiated using the head fixing position determination assisting tool. Weight gain and loss of is not a problem. Moreover, in the case of the head fixing position determination assisting device of the present invention, the head is fixed based on the distance between the left and right cheekbones and the distance between the cheekbones and the jaws, which hardly change due to weight loss or the like. These intervals are based on the skeleton, and are excellent in reproducibility because there is almost no change in the skeleton during radiotherapy (usually about several weeks to several months). For this reason, the centering position can be reproduced by determining the gap between the left and right cheekbones and the clamping position.

In addition, it is desirable to increase the fixing accuracy of the pillow position as a method for further increasing the accuracy of reproduction by the support kit of the present invention.
Since the bed of the MRI apparatus and the bed for radiation therapy are usually separate, the cushioning property of the body holding part, the tilt of the bed, etc. may be different. In particular, in the MRI bed, in order to prevent the patient from moving during the scanning, for example, as shown in FIG. 8B, the surface of the bed 62 is gently moved from the lower shoulder blade of the bed 62 to the buttocks. Is often recessed. In addition, the bed 62 in FIG.8 (b) has shown the longitudinal direction cross section.
On the other hand, as shown in FIG. 8A, the bed 61 for radiation therapy is generally a flat plate. Thus, when the shape of the bed (particularly the patient's body support surface) is different, the patient's body position is different. For this reason, even if the head holding pillow 40 used at the time of radiotherapy and the head holding pillow 45 used at the time of image diagnosis have the same head and neck holding part and occipital part holding part, the angle of the head May deviate slightly. As such correction, as shown in FIG. 8B, an adjustment plate 63 having a surface corresponding to the body support surface of the radiation therapy bed is preferably placed on the bed 62 of the MRI apparatus. In this case, it is preferable to select the thickness of the adjustment plate 63 so as to be equal to the height (H) of the neck from the surface of the adjustment plate 63.

  The head fixing position determination assisting tool and the head fixing position determination support kit using the same according to the present invention are simple instruments and have no restrictions on the place of use. Therefore, by combining MRI inspection, CT inspection, CT-PET centering, positioning for creating a radiation treatment plan, and reproduction of the head position in the case of radiation split irradiation, the head Since the fixed position can be easily reproduced with high accuracy, it is useful in the medical field of radiation therapy.

1 Temporal support member 2 Jaw support member 3 Post (connecting member)
10 Flat plate 10U Upper side (upper edge) of flat plate
10B Flat base (lower edge)
11 Concave part (temporal clamping part)
11a Short side (recess bottom)
11b Long side (recess opening)
12 Horizontal indicator (bubble tube level)
12a Colored liquid 12b Air bubbles 20 Flat plate 21 Recessed part (jaw clamping part)
22 Column insertion port 31 Centering instruction part 40 First head holding pillow 41 Neck holding part 42 Rear head holding part 43 Marking center line 44 鍔 45 Second head holding pillow 46 Neck holding part 47 Rear head holding part 48 Marking center line 49 Recess for fitting 50 MRI head coil 51 Head placement part 52 Adjustment scale 61 Radiation treatment bed 62 MRI apparatus bed 63 Adjustment plate

Claims (10)

A head fixing position determination assisting tool for assisting in determining a head fixing position of a patient receiving radiation therapy of the head,
A temporal support member having a temporal clamping part for clamping the skull side of the patient;
A chin support member that clamps the jaw of the patient; and a connecting member that connects the temporal support member and the chin support member such that the distance between the temporal support member and the chin support member can be varied. Head fixing position determination aid.   The said temporal support member is a plastic flat plate which has the outline which forms the recessed part used as the clamping part of the said temporal part, Comprising: The scale which shows the said patient's temporal clamping position is attached | subjected. Head fixing position determination aid.   3. The head fixing position determination assisting device according to claim 1, wherein the chin supporting member is a plastic flat plate having a contour that forms a concave portion serving as a clamping portion of the chin portion.   The head fixing position determination assisting device according to claim 2 or 3, wherein the recess has an isosceles trapezoidal shape having an opening of the recess as a long side and a bottom of the recess as a short side. The connecting member is a support post fixed to the left and right equal distribution position of the temporal support member,
The head fixing position determination aid according to any one of claims 1 to 4, wherein the jaw support member is slidably attached to the support column.   The horizontal adjustment tool which adjusts so that the said connection member may become horizontal with respect to the said bed in the state which clamped the skull side head of the said patient who is supine on the bed, Any one of Claims 1-5 The head fixing position determining aid according to crab.   The head fixing position determination assisting device according to claim 6, wherein the horizontal adjustment tool is a horizontal indicator attached to the temporal support member.   The connecting member sandwiches the patient's temporality with the temporal support part, and supports the patient's jaw with the jaw support member, with the center line extending from the head to the jaw part of the patient's face. The head fixing position determination assisting tool according to any one of claims 1 to 7, further comprising a centering instruction section. The head fixing position determination aid according to any one of claims 1 to 8;
A first head holding pillow having a patient's neck holding part and a back head holding part; and a neck holding part and a back head holding part having the same shape as the neck holding part and the back head holding part of the first head holding pillow. A head fixing position determination support kit provided with a plastic second head holding pillow. The first head holding pillow is a pillow used for fixing the head during radiotherapy,
The second head holding pillow is a pillow placed on the head placement portion of the diagnostic imaging apparatus, and covers the convex head fixing portion formed on the head placement portion. The head fixing position support kit according to claim 9, wherein a recessed portion that can be fitted is recessed on a side facing the neck holding portion and the back head holding portion of the second head holding pillow.

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