FR2493695A1 - Reproducible positioning support for patient under radiating source - has removable support with body positioning devices adjusted on mobile frame in two orthogonal positions - Google Patents

Abstract

The appts. allows the position of the patient in relation to an irradiating source to be exactly reproducible from one session to the next, and has a mobile base structure (1) independent of the irradiating source, together with a removable support (2). This support may be a table or a chair, attached to the structure (1) and fitted with various devices used to hold parts of the patient's body in a reproducible position. Pref. the base structure (1) has two elevator arms (4) in which vertical position is adjustable along a frame (5) fitted with retractable rollers used to guide the structure (1) in two orthogonal directions and to fix it in position. The positioning of the structure (1) may be accomplished by using a laser reference beam.

Description

Device for positioning and maintaining a patient in a determined and reproducible position relative to an irradiation head.

 Radiotherapy or radiological investigation requires placing the patient in a well-determined position relative to an irradiation head so as, especially in radiotherapy, to precisely direct the irradiation on the part of the body to be reached. It is also necessary to be able to reproduce this determined position throughout the course of treatment either to undertake the same irradiation, or on the contrary to have a reference position from which irradiation will be carried out from a different angle.

 To meet these precision requirements, known installations include; a fixed or mobile irradiation head and an associated treatment table capable of moving precisely relative to the head. The guide means of this table constitute an extremely heavy infrastructure for installation (ground rails, concrete bases, etc.) which is a significant factor in its price. In addition, since the displacement relationships between the table and the irradiation head are always known precisely, this does not always imply a good position of the patient relative to the head. Nothing has been planned for the precise and easily reproducible positioning of the patient on the table. This operation is generally the responsibility of an operator who, manually, attempts to reproduce a reference situation previously identified .

 Many factors negatively influence this operation. Indeed, a radiotherapy installation is very busy with patients. However, it is not possible, because of the functional connections of the table and the head, to prepare the patients in masked time compared to a time of irradiation. The preparation time is therefore a downtime of the complete installation which should be reduced to the maximum, hence a risk of approximate installation. In addition, due to the nature of the table, it is always necessary to transfer the patient to place it on the latter. This manipulation is often very delicate, painful, for bedridden or semi-ambulatory patients and involves significant risks of fracture. Their precise placement is even more difficult to obtain.

 moreover, since the treatment tables are used for several types of care (irradiation of the head, neck, breast, lungs, esophagus, etc.), they are rarely equipped with specific equipment for a particular type. irradiation and, to the extent that they are provided, it should be er. carry out assembly or disassembly as and when patients pass.

 your present invention intends to remedy all these drawbacks by proposing a device for installing the patients in a precise and easily reproducible manner relative to the dtirradiatior head. of a radiotherapy installation. It also allows the preparation of the patients in masked time compared to the treatment time proper, an ease of care and transfer of the impotent or bedridden patients, while using only light equipment, easily maneuverable and made completely independent of the fiae installation supporting the irradiation head.Finally, it makes it possible to specialize the support of the patient according to the affection that needs to be treated and to make its installation more pleasant both in terms of physical comfort than in terms of psychological relaxation.

 To this end, the invention therefore relates to a device for positioning and maintaining a patient in a determined and easily reproducible position relative to a source of irradiation with a diagnostic or therapeutic effect.

 According to one of the essential characteristics of the invention, this device is constituted by a basic structure which is mobile and independent with respect to the irradiation source to which a patient support provided with Ùns to adjust its position is removably coupled. with respect to said basic structure and to reproduce this position.

 In a preferred embodiment, the above-mentioned basic structure is constituted by two parallel and horizontal lifting arms movable vertically and cantilevered, adjustable along a chassis which is equipped at its base with retractable rolling members ensuring its guidance in two orthogonal directions and its immobilization. 1 will be advantageous that the aforementioned chassis comprises at its base retractable stabilizing elements to increase the lift surface.

 For a first application of the invention, the aforementioned support consists of a plate provided, its lower part, with elements intended to cooperate with said base structure. In a first variant, said plate is in three parts articulated transversely to each other.

 Advantageously, the aforementioned tray comprises a housing of adjustable dimensions for the patient's head provided with means for placing and maintaining in position said head. This housing can be provided on an adjustable headrest element at one end of the plarea. This can have a convex shape so as to clear the lateral access points of a patient's neck.

 In another application, each of the ends of the plate comprises at least one lateral portion capable of being placed perpendicular to the longitudinal axis of the plate, then discovering in this position an opening for the passage of the radiation. Lateral means are provided for fixing the adjustment or restraining devices for the patient.

 Finally, it may be advantageous to have between these plates and said base structure an intermediate element making it possible to move said plates relative to said structure in a horizontal plane or in various inclinations, in particular in order to make fine adjustments.

 Another support of the invention is constituted by a seat comprising a lateral frame for its attachment to the arms of the basic structure, said frame being provided with an articulation with two immobilizable degrees of freedom while the seat back is equipped with means for maintaining the patient's head and bust in a determined position.

 The invention will be better understood during the description given below by way of purely indicative and nonlimiting example which will make it possible to identify the advantages and secondary characteristics thereof.

Reference will be made to the accompanying drawings, in which
- Figure 1 illustrates by an overall diagram a preferred embodiment of the invention;
- Figure 2 illustrates by a diagram seen from above certain specific provisions of the basic structure;
- Figure 3 is a schematic top view of a first tray according to the invention;
- Figure 4 illustrates a second plate according to the invention;
- Figure 5 is a diagram # ma of a first headrest according to the invention;
- Figure 6 is a partial diagram of another tray according to the invention with a second tufa;
- Figure 7 schematically shows a tray for the radiological treatment of the breast;
- Figure 8 illustrates a patient support in the form of a seat.

 Referring first to FIG. 17, an embodiment of the device according to the invention is seen, consisting of a movable base structure 1 and a support 2 coupled to the base structure by means 3. More precisely, the aforementioned basic structure comprises two horizontal arms such as 4 movable vertically along a blackcurrant 5 equipped at its base with rolling members of which we see in 6 a part. These members are more fully described with reference to FIG. 2. The elevation of the horizontal arms 4 is ensured in known manner by means of a hydraulic cylinder 7 secured to the chassis acting on a sliding structure Sa carrying a pulley 8 for winding d 'a chain 9 harnessed to a fixed point by one of its ends and to the arms 4 by its other end.

 At the base and at the front of the chassis 5, the structure has horizontal stabilizing lugs 10 whose length and orientation are adjustable (see FIG. 2) to adapt the support surface of the structure to the nature of the load carried by the arms 4. At the rear, the basic structure is shaped as a support platform for a set of elements 11 comprising a battery of electric accumulators, a hydraulic tank, a pump, a hydraulic motor , a vacuum pump as well as control elements for these motor elements.

 In Figure 2, the structure 1 of Figure 1 is shown schematically in top view. Under the aforementioned rear platform, there are rolling members 6 which can be, for example, constituted by rollers mounted free in pivoting about a vertical axis and rolling members.

 Similar rollers are also arranged under the stabilizers 10. In addition, the casings 5 is equipped with wheels or rollers 12 and 13. The rollers 12 have a very precise orientation and constitute guide elements for the casts in a first direction A. rollers 13 perform the same function for a second direction B perpendicular to the first. These rollers 12 and 13 are respectively coupled to devices allowing their selective activation or deactivation, for example by retracting them inside the platform of the chassis out of contact with the ground.

Thus, in this position of the rollers 12 and 13, the contact with the ground of the basic structure 1 is only ensured by the rolling members 6 which are crazy on their vertical pivot axis and the operation of the apparatus can be carried out in all directions. By putting into service, by lowering, the rollers 12, these are therefore brought into contact with the ground and oppose any movement other than that in the direction A above. Similarly, when the contact rollers 13 are brought into contact with the ground, under a certain pressure to create sufficient adhesion, the only possible movement of the device is in the direction B.

 It can therefore be seen that the aforementioned selective commissioning makes it possible to advance the apparatus in two orthogonal directions in order to approach precisely a final position, after a rough approach on the members 6. This final position can be fixedly identified in the space where the device evolves in relation to the irradiation head. The means used for this reference location can be constituted by a light or laser beam, by marking on the ground or by any known means. The immobilization of the device in this position will be ensured by the simultaneous commissioning of the rollers 12 and 13. It will be noted, 3 words about the movement of this device, that it will be advantageous to provide an adequate floor covering (hard and plan) like a bakelite or the like. Always with reference to FIG. 2, it will be noted that the stabilizers 10 may consist of two parts 10a and lOb hinged together in lOc. This articulation makes it possible to place the part lOb along the part lOa at right angles to the latter or in its extension. For these three positions the joint can be blocked. Furthermore, the arm lOa can also be articulated in lOd on the chassis 5 and thus debate between the position shown and one or more other lockable positions, in which it diverges towards the front of the casings. This arrangement makes it possible to adjust the lift surface as a function of the load and the position of the patient with respect to the frames. It also makes it possible to reduce the size of the apparatus for its use when empty or centrally loaded.

 Figure 3 shows a tray 2 on which one can place a patient, which is equipped at its lower part with slides 14 and 15 forming the means 3 above. These slides can receive the arms 4 and include mutual locking means. It will be noted that the slides 15 allow a grip at the end of the plate, which is advantageous for moving the device in corridors or through doors. In this case, the stabilizers 10 will have their configuration of maximum extension.

This end grip also allows the support and the salad to be treated to be completely cantilevered and thus authorize the total rotation around the patient of the irradiation head to carry out cyclotherapy.

 In Figure 4, the plate 2 shown has three parts 2a 2b 2e articulated together, the part 2b being equipped with slides 14. The end parts are capable of being inclined to part 2b and maintained in inclination either by means of a rack 16 operated manually, either by means of a small removable jack 17 fixed under the plate and supplied by the source of pressurized fluid which comprises the basic structure 1.

 FIG. 5 shows a headrest placed at the end of a plate 8. This headrest 18 constitutes a housing for the head of an elongated patient (prone) whose depth can be adjusted by means of adjustable supports 19 and 20 for, respectively, the forehead and the chin, thus ensuring the positioning of the head which is also held by a stop 21 also adjustable. The attachment 22 of this headrest to the plate 2 can also be adjustable. Such a headrest can also be used in the supine position by adapting the supports and stop 19, 20 and 21 in a different arrangement.

 In FIG. 6, it will be noted that one of the ends of the. plate 2 is convex in shape 23 allowing lateral access for radiation for the regions of the patient's body (0RL sphere) located in the vicinity of this convex part. In this same figure, there is shown the other end of a plate 2 provided with a notch 24 and a headrest 25 in which a cushion 26 full of granulated material has been placed in which, after the patient has put his head down, we create a vacuum to solidify the imprint of the patient's head. By keeping this vacuum permanently, you can use the cushion for each of the patient's sessions. The reproduction of its position is then immediate. You can also cancel this vacuum after each session, the headrest then being used for all patients. The notch 24 allows the patient in lateral decubitus position to pass his arm under the tray, which improves his comfort and the ease of his maintenance. position.

 In Figure 7, there is shown a plate 2 having a side portion 27 which can be moved apart to be orthogonal to the longitudinal direction of the plate. The tray laterally comprises at this level means symbolized at 28 for fixing adjustment and compression accessories of the patient to be treated. This tray is suitable for breast treatment, the part 27 spread (or attached) perpendicularly forming a support for the patient's arm and discovering an opening for the passage of radiation. The means 28 make it possible to fix gland retention plates necessary for the treatment as a function of the incidence of the radiation. This tray will advantageously take the form of a relax seat, which promotes the patient's relaxation as much as possible. To be able to use the same tray to treat a patient's right or left, two parts must be provided such that 27 is symmetrical with respect to a longitudinal axis of the plate, or symmetrical with respect to a transverse axis.

 In the first case, it will be necessary to be able to take the tray on each side, the second case only involves the patient turning over.

 Finally, in FIG. 8, there is shown schematically a support in the form of a seat 29 coupled to a frame 30 which cooperates with the lifting arms 4. This frame has two orthogonal articulations 31 and 32, immobilizable, making it possible to orient the patient in a chosen inclination with respect to the radiation. The back of the seat is further provided with a device 33 for holding the patient's head constituted by a plurality of elements coupled to one another in a removable manner so that, the patient being in position, it can be partially withdrawn and let pass radiation. Finally, the seat has lateral patient retaining elements symbolized at 34 and playing the role of low-flanks when the seat is tilted.

 In addition to the elements described above, it should be noted that the supports according to the invention can be adapted to other types of basic structure already existing. In addition, it is not outside the scope of the invention to provide between the supports and the basic structures of the intermediate mechanisms allowing certain degrees of freedom (planar or rotational displacements) of the supports relative to the structure. These mechanisms can be constituted by sets of cradles or articulation elements known in themselves.

 Among the advantages offered by the invention compared to existing devices, it should be noted that the tables which it relates have no reserve on the ground, which makes them very accessible. In addition, the flexibility of use of the device makes it possible to optimally optimize its orientation with respect to the ray source and to seek and bring patients who have been able to be prepared in position on trays, or even for bedridden in their bed arranged like a tray. As the trays according to the invention are specific to the condition being treated, their dimensions can be adapted to the position of the patient, which leads to trays shorter than a universal tray, as there are at present on existing installations.

 The aforementioned trays can also advantageously constitute emergency tables.

 Finally, the invention makes it possible to considerably improve the physical and psychological comfort of the patient and, consequently, their better maintenance in a precise position on which the success and efficiency of the irradiation depend.

 The invention finds an interesting application in the field of medical equipment.

Claims (12)

1. Device for positioning and maintaining a patient in a determined position that is easily reproducible with respect to a source of irradiation with a diagnostic or therapeutic effect, characterized in that it consists of a movable basic structure (1) independent from the radiation source to which the patient support (2) is removably coupled with means (2a, 2c, 18, 19, 20, 21, 24, 27, 30, 31, 32) for adjusting its position relative to said base structure and reproduce this position. 2. Device according to claim 1, characterized in that the above-mentioned basic structure is constituted by two lifting arms (4) parallel and horizontal movable vertically and cantilevered, adjustable along a frame (5) which is equipped at its base with retractable rolling members (12, 13) ensuring its guidance in two orthogonal directions and its immobilization. 3. Device according to claim 2, characterized in that the aforesaid chassis comprises at its base stabilizing elements (10) retractable. 4. Device according to any one of the preceding claims, characterized in that the aforesaid support consists of a plate provided with elements (14 15) at its lower part intended to cooperate with said base structure, 5. Device according to claim 4, characterized in that said plate is in three parts (2a, 2b, 2c) articulated transversely to each other. 6. Device according to claim 4 or claim 5 characterized in that the tray comprises a housing of adjustable dimensions for the and of the patient provided with means (19, 20, 21) for placing and maintaining in position said toto 7. Device according to claim 6, characterized in that this housing is provided on a faceplate element (18) added adjustable to one of the ends of the plate. 8. Device according to claim 7 characterized in that said fixing end of the headrest (18, 25) is provided with a notch (24).  9. Device according to any one of claims  7 and 8, characterized in that said end of the plate is shaped  convex (23).  10. Device according to any one of claims 5 to 9, characterized in that each of the plate end parts comprises a lateral portion (27) capable of being placed perpendicular to the longitudinal axis of the plate then providing an opening in the shelf for radiation.  11. Device according to any one of claims 4 to 10, characterized in that it comprises an intermediate element between the base structure and the plate allowing the movement of the latter relative to said structure,  12. Device according to any one of claims  1 to 3, characterized in that the aforesaid support is constituted by a  seat (29) comprising a frame (30) for fixing to the arms (4)  of said base structure, said frame being provided with articulation  tions (31, 32) immobilizable, while the seat back is equipped with holding devices (33, 34) of the head and the bust of the pa  holds in a determined position.