Blood-tissue surface based radiosurgical renal treatment planning

Abstract

Devices, systems, and methods for planning radiosurgical treatments for neuromodulating a portion of the renovascular system may be used to plan radiosurgical neuromodulation treatments for conditions or disease associated with elevated central sympathetic drive. The renal nerves may be located and targeted at the level of the ganglion and/or at postganglionic positions, as well as preganglionic positions. Target regions include the renal plexus, celiac ganglion, the superior mesenteric ganglion, the aorticorenal ganglion and the aortic plexus. Planning of radiosurgical treatments will optionally employ a graphical representation of a blood/tissue interface adjacent these targets.

1 . A radiosurgical method for altering neural function of a patient body, the method comprising:
 acquiring image data from a blood vessel adjacent to a nerve;   generating a three dimensional model by identifying a boundary between the blood vessel and blood flowing therein from the image data;   receiving input regarding a radiation target with reference to an image of the three dimensional model, wherein the target is offset from the blood/vessel boundary surface; and   planning an irradiation treatment of the radiation target so as to provide a neural function-altering dose of radiation at the target and a safe luminal dose of radiation at the blood/vessel boundary.   
     
     
         2 . The method of  claim 1 , wherein the nerve comprises a renal plexus, and wherein the irradiation treatment is planned so as to provide a decreasing dose gradient between the target and the blood/vessel boundary. 
     
     
         3 . The method of  claim 2 , wherein the blood vessel comprises an aorta or a renal artery. 
     
     
         4 . (canceled) 
     
     
         5 . The method of  claim 2 , wherein the target is offset from the blood/vessel boundary by an offset distance within a range from about 0.25 mm to about 6 mm and wherein the offset distance varies longitudinally along the boundary within a range from about 0.5 mm to about 3 mm. 
     
     
         6 . (canceled) 
     
     
         7 . The method of  claim 1 , further comprising adjusting a pattern of beams of the radiation to compensate for movement of the blood vessel wall, the movement due to at least one of a respiration, or a bodily shift of the patient, and wherein the pattern of beams are not adjusted in response to a heartbeat of the patient body. 
     
     
         8 . The method of  claim 1 , further comprising outputting the planned irradiation treatment onto a plurality of slices of two dimensional image data. 
     
     
         9 . The method of  claim 1 , wherein the input is received on a display, the display facilitating the input by snapping the input of the radiation target relative to a location on the three dimensional model. 
     
     
         10 . The method of  claim 9 , wherein the three dimensional model comprises a surface radially offset from the identified blood/vessel boundary surface and the display facilitates the input by snapping the input of the radiation target onto the surface of the three dimensional model. 
     
     
         11 . The method of  claim 1 , wherein the irradiation treatment comprises a plurality of intersecting beams and the method further comprises expanding the irradiation treatment of intersecting radiation beams along a longitudinal axis of the blood/vessel boundary surface such that renal nerve activity is reduced so as to treat hypertension. 
     
     
         12 . The method of  claim 1 , further comprising generating an ionizing radiation treatment plan based upon the treatment pattern and projecting a dose cloud to the three dimensional model based upon the treatment plan so as to verify the dose of radiation along the blood/vessel boundary is sufficiently low to inhibit hyperplasia. 
     
     
         13 . The method of  claim 1 , wherein the lesion pattern comprises one or more annular circumferential segments. 
     
     
         14 . The method of  claim 1 , wherein the nerves comprise at least one of a celiac ganglion, a superior mesenteric ganglion, an aorticorenal ganglion, nerves in the renal ostium region, and nerves in the renal artery branching region. 
     
     
         15 . A radiosurgical system for denervation of a patient body, the system comprising:
 an image capture device for acquiring image data from a blood vessel adjacent to a nerve;   a display; and   a processor system coupling the image capture device to the display, the processor comprising:   a modeling module configured for identifying a three dimensional boundary surface between blood and the blood vessel from the image data and for transmitting three dimensional model data to the display in response thereto;   an input module for receiving user input data relative to the three dimensional model so as to identify a radiation target offset from the blood/vessel boundary surface; and   a planning module configured for planning a pattern of ionizing radiation treatment beams in response to the radiation target so as to reduce nerve activity within the nerve and to limit radiation along the blood/vessel boundary.   
     
     
         16 . The system of  claim 15 , wherein the nerve comprises a renal plexus, and wherein the planning module is configured to plan the irradiation treatment so as to provide a decreasing dose between the target and the blood/vessel boundary. 
     
     
         17 . The system of  claim 16 , wherein the blood vessel comprises an aorta or a renal artery. 
     
     
         18 . (canceled) 
     
     
         19 . The system of  claim 16 , wherein the target is offset from the blood/vessel boundary by an offset distance within a range from about 0.25 mm to about 6 mm. 
     
     
         20 . The system of  claim 19 , wherein the offset distance varies longitudinally along the boundary within a range from about 0.5 mm and 3.0 mm. 
     
     
         21 . The system of  claim 15 , wherein the planning module is configured to output the ionizing radiation treatment pattern for denervation of the adjacent nerve onto a plurality slices of two dimensional image data. 
     
     
         22 . The system of  claim 15 , wherein the user input data is received on the display, the display facilitating the input by snapping the input of the radiation target relative to a location on the three dimensional model. 
     
     
         23 . The system of  claim 22 , wherein the three dimensional model data comprises a surface radially offset from the identified blood/vessel boundary surface and the display facilitates the input by snapping the input of the radiation target onto the surface of the three dimensional model. 
     
     
         24 . The system of  claim 15 , wherein the planning module is further configured to expand a treatment pattern of intersecting radiation beams along a longitudinal axis of the blood/vessel boundary surface such that renal nerve activity is reduced so as to treat hypertension. 
     
     
         25 . The system of  claim 15 , wherein the planning module is configured to generate an ionizing radiation treatment plan based upon the user input and is further configured to project a dose cloud to the three dimensional model based upon the treatment pattern so as to verify the dose of radiation along the blood/vessel boundary is sufficiently low to inhibit hyperplasia. 
     
     
         26 . The system of  claim 15 , wherein the target comprises one or more annular circumferential segments and wherein the nerves comprise at least one of a celiac ganglion, a superior mesenteric ganglion, an aorticorenal ganglion, nerves in the renal ostium region, and nerves in the renal artery branching region. 
     
     
         27 . (canceled) 
     
     
         28 . A non-transitory computer readable medium with computer executable instruction stored thereon for developing a radiosurgical renal denervation treatment plan, the method comprising:
 acquiring image data from a blood vessel adjacent to a nerve;   generating a three dimensional model by identifying a boundary surface between the blood vessel and blood flowing therein from the image data;   receiving input regarding a radiation target with reference to an image of the three dimensional model, wherein the target is offset from the blood/vessel boundary surface; and   planning an irradiation treatment of the radiation target so as to provide a neural function-altering dose of radiation at the target and a safe luminal dose of radiation at the blood/vessel boundary;   generating an ionizing radiation treatment plan based upon the user input;   projecting a dose cloud to the three dimensional model based on the treatment plan; and   outputting information regarding the planned lesion pattern and the dose cloud onto the two dimensional image data slices.   
     
     
         29 . The method of  claim 28 , wherein the nerves comprise at least one of a renal plexus, a celiac ganglion, a superior mesenteric ganglion, an aorticorenal ganglion, nerves in the renal ostium region, and nerves in the renal artery branching region. 
     
     
         30 . The method of  claim 29 , wherein the surface is a layer between an epithelial cell layer and an outer edge of the blood vessel adventitia. 
     
     
         31 . The method of  claim 28 , further comprising evaluating the dose cloud to ensure the safe luminal dose of radiation at the blood/vessel boundary.