U.S. patent number 3,811,426 [Application Number 05/362,613] was granted by the patent office on 1974-05-21 for method and apparatus for the in-vessel radiation treatment of blood.
This patent grant is currently assigned to The United States of America as represented by the United States Atomic. Invention is credited to Gordon G. Culver, William F. Riemath.
United States Patent |
3,811,426 |
Culver , et al. |
May 21, 1974 |
METHOD AND APPARATUS FOR THE IN-VESSEL RADIATION TREATMENT OF
BLOOD
Abstract
An apparatus and a corresponding method for the in-vivo
radio-therapy of blood by irradiation of the blood within the blood
vessel. The device includes a wire which has a straight section and
small oppositely facing loops at each of its two ends. An active
radioisotope-layer is deposited over the center portion of the
straight section of the wire and this radioisotope-layer is
sealingly covered with a coating-layer to prevent any leaking of
the radioisotope into the blood. The wire is adapted for surgical
implantation diagonally transverse a blood vessel in a manner so
that the active radioisotope-layer lies fully within the blood
vessel, while the end of the wire projects such that the two loops
lie fully exterior to the blood vessel. Following the depositing of
the radioisotope-layer and the coating-layer on the wire and
sterilization of the wire, the device is surgically implanted
diagonally transverse the blood vessel and is anchored in place
with respect to the blood vessel by suturing through the loops.
Inventors: |
Culver; Gordon G. (Klamath
Falls, OR), Riemath; William F. (Pasco, WA) |
Assignee: |
The United States of America as
represented by the United States Atomic (Washington,
DC)
|
Family
ID: |
23426788 |
Appl.
No.: |
05/362,613 |
Filed: |
May 21, 1973 |
Current U.S.
Class: |
600/3;
250/493.1 |
Current CPC
Class: |
A61N
5/1002 (20130101); A61N 2005/1019 (20130101) |
Current International
Class: |
A61N
5/10 (20060101); A61n 005/10 () |
Field of
Search: |
;128/1.1,1.2,2A,260,335.5 ;250/454,456,492,493 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Attorney, Agent or Firm: Horan; John A. Churm; Arthur A.
Fisher; Robert J.
Claims
The embodiments of the invention in which an exclusive property or
privilege is claimed are defined as follows:
1. An in-vivo radioisotope blood irradiator for in-vessel radiation
treatment of blood comprising: a wire including a straight section
and a small oppositely facing loop at each of the two ends thereof;
an active radioisotope-layer deposited over the center portion of
said straight section of the wire; and a coating-layer sealingly
covering said active radioisotope-layer; said wire adapted for
implantation diagonally transverse a blood vessel in a manner so
that said active layer lies fully within said vessel and said ends
project such that said two loops lie fully exterior to said
vessel.
2. The blood irradiator of claim 1 further comprising suture means
associated with each of said loops for anchoring said wire with
respect to said blood vessel.
3. The blood irradiator of claim 1 wherein said wire is stainless
steel spring wire about 0.01 inch in diameter and slightly in
excess of 2 inches in length, said loops are about 0.04 inch in
diameter, the centers of said two loops are about 2 inches apart,
and the active radioisotope-layer is deposited over the center 1
inch of said wire.
4. The blood irradiator of claim 3 wherein said active
radioisotope-layer comprises .sup.238 PuO.sub.2 and said
coating-layer comprises platinum.
5. A method for in-vivo radiotherapy of blood by irradiation of the
blood within a blood vessel comprising:
a. depositing a layer of an active radioisotope on the center
portion of a wire which includes a straight section and a small
oppositely facing loop at each of the two ends thereof;
b. depositing a coating-layer over said active radioisotope-layer
so as to sealingly cover said radioisotope;
c. sterilizing said wire; and
d. implanting said wire in said blood vessel by surgically
inserting the wire diagonally transverse said blood vessel in a
manner so that said active layer lies fully within said vessel and
said ends project such that said two loops lie fully exterior to
said vessel.
6. The method of claim 5 further comprising: suturing through said
loops to anchor said wire with respect to said blood vessel.
7. The method of claim 5 wherein a layer of .sup.238 PuO.sub.2 is
deposited on the center portion of a stainless steel wire by
electroplating from a solution containing .sup.238 PuO.sub.2 and a
thin coating-layer of platinum is deposited over said .sup.238
PuO.sub.2 by vacuum sputtering.
Description
CONTRACTUAL ORIGIN OF THE INVENTION
The invention described herein was made in the course of, or under,
a contact with the UNITED STATES ATOMIC ENERGY COMMISSION.
BACKGROUND OF THE INVENTION
The present invention relates to radiotherapy and radiation
treatment of blood and is particularly concerned with the in-vivo
radiation treatment of blood. Specifically, the present invention
is concerned with the radiation treatment of blood within the blood
vessel. Still more particularly, the present invention relates to a
method and a device for implantating a radiation source within the
blood vessel which reduces the amount of shielding required and
hence the complexity of the device and simplifies surgical
procedure.
Radiotherapy including radiation treatment of blood as a potential
cure or control of various diseases is well known in the art,
radiotherapy being extensively used in the treatment of various
forms of cancer. In particular, radiotherapy as a treatment for the
control of leukemia has been studied and undertaken in the
past.
Suppression of lymphocyte levels in circulating blood following
irradiation of the total body with low doses of ionizing radiation
is well known. It has been demonstrated that irradiation of blood
in an exterior loop (extracorporeal irradiation of blood)
suppresses lymphocyte levels without damage to other body tissues.
It has consequently been shown that extracorporeal irradiation of
blood is an effective adjunct or alternative to drug therapy for
treating some forms of leukemia.
Immune reactions initiated by lymphocytes are usually the ultimate
reason for failure of organ transplants. Current methods of
suppressing these immune reactions include use of drug therapy,
antilymphocyte antibodies, and irradiation. Typically, more than
one of these approaches is used since there are problems associated
with each.
Acceptance times of skin allografts have been extended by
extracorporeal irradiation of blood and this technique has been
evaluated for its applicability for immunosuppression relative to
renal allografts. Significant reduction in early rejection eposodes
and a significantly higher frequency of six-month renal graft
survival has been reported for extracorporeal irradiation of
blood-treated groups.
Most treatments of both experimental animals and humans have been
accomplished by shunting blood through large fixed equipment such
as cobalt-60, cesium-137 or X-ray sources, thereby necessitating
specialized facilities. With the relatively long treatment regimes
required, this severely limits the numbers of patients who can
receive treatment and requires the inconvenience and expense of
hospitalization. A small, inexpensive, portable irradiator is
needed for the above reasons and also to permit chronic exposures
of patients prior to and subsequent to kidney transplants.
A small implantable irradiator which would permit direct in-vivo
irradiation of the blood is also desirable. One such portable
irradiator consists of a small tube of shielding material coated on
the inside with a radioactive isotope which is further coated to
prevent leakage into the blood system. Small sections of an artery
or vein are surgically removed and this tube inserted in
substitution therefor, the insertion being accomplished by suturing
the blood vessel to small fiber tubes located on each end of the
device. These devices then serve as a small section of the blood
vessel.
Alternatives to these devices are desirable as the surgical
procedures involved in inserting them as a substitution for a
section of a blood vessel are complex and these devices require
shielding to prevent the undesirable radiation of surrounding
tissues.
Therefore, it is an object of the present invention to provide a
method and an apparatus for radiotherapy of blood.
It is a further object of the present invention to provide a method
and apparatus for in-vivo irradiation of blood.
An additional object of the present invention is to provide a
method and apparatus for the irradiation treatment of blood within
the blood vessel itself.
Another object of the present invention is to provide a device
which is less complex and requires less or no shielding and which
can be implanted by simplified surgical procedures.
Other objects and advantages of the present invention will become
apparent upon reading the following description and with particular
reference to the specific embodiment described hereinbelow.
SUMMARY OF THE INVENTION
In accordance with the present invention, a method and apparatus is
provided for in-vivo radiotherapy of blood by irradiation of the
blood within a blood vessel. A layer from an active radioisotope is
deposited on the center portion of a wire which includes a straight
section and small oppositely facing loops at each of its two ends.
A coating-layer is deposited over the active radioisotope-layer to
sealingly cover the radioisotope and prevent leaking of the
radioisotope into the blood. Following sterilization of the device,
the device is implanted in a blood vessel by surgically inserting
the wire diagonally transverse a blood vessel in a manner such that
the active layer lies fully within the blood vessel while the ends
project such that the two loops lie fully exterior to the blood
vessel. The device is anchored in place with respect to the blood
vessel by suturing to the blood vessel through the loops at the end
of the wire.
BRIEF DESCRIPTION OF THE DRAWINGS
An understanding of the features and operation of the present
invention can be obtained from a reading of the following
description and with reference to the drawing which is a sectional
view through a blood vessel showing the device partially in section
implanted in accordance with the present invention.
DETAILED DESCRIPTION OF THE INVENTION
Referring now to the drawing, there is shown a device in accordance
with the present invention implanted through a blood vessel. A wire
indicated generally at 11 includes a straight section 12 and two
loops 14 and 16, one located on each end of the straight section 12
of the wire 11. Loops 14 and 16 are oppositely facing loops,
meaning these loops lie on or project from opposite sides of
straight section 12.
The central portion of the straight section 12 of the wire 11 has
deposited thereon an active radioisotope-layer 18. A coating-layer
20 coats the central portion of the straight section 12 and
sealingly covers the radioisotope-layer 18 so as to prevent any
leaking of the radioisotope from the device into the
bloodstream.
The device is shown as implanted in a blood vessel 22. The device
is adapted for implantation diagonally transverse blood vessel 22
and is implanted in a manner such that active layer 18 lies fully
within blood vessel 22, i.e., active layer 18 lies within the
interior 24 of the blood vessel 22 between the walls thereof. The
device is further implanted such that the loops 14 and 16 at the
two ends of the straight section 12 lie fully outside and exterior
to the blood vessel 22. The device is anchored in place with
respect to the blood vessel such as by sutures 26 and 28 through
loops 14 and 16, respectively. The device is anchored in order to
prevent the undesirable loss of the device in the body and to
prevent undesirable movement relative to the blood vessel 22.
The active radioisotope-layer 18 can be deposited on the center
portion of the wire in any manner known and practiced in the art
including, among others, electroplating from a solution containing
the radioisotope. Similarly, the coating-layer can be deposited
over the active radioisotope-layer in various manners well known in
the art including, among others, vacuum sputtering of a metal.
Following depositing of the coating-layer and prior to
implantation, the device must be sterilized, sterilization by gamma
irradiation being one of the many possible methods which can be
employed. The device is then implanted in a blood vessel by
surgically inserting the device so as to lie diagonally transverse
the blood vessel, as described hereinabove. While various means of
surgical implantation can be used, two examples of surgical methods
which have been found particularly adaptable to the present device
are insertion through the blood vessel in a hypodermic needle
followed by withdrawal of the hypodermic needle, leaving the device
in place, and insertion of the device across the blood vessel
through two surgical incisions in the wall of the blood vessel, the
incisions being made on opposite sides of the blood vessel and
diagonally spaced so as to accommodate the device diagonally
thereacross. If the device is implanted by the latter method
wherein incisions are made in the blood vessel wall, the sutures
used to close the surgical incisions in the blood vessel can also
be employed to anchor the device in place with respect to the blood
vessel by making the sutures through the loops on the respective
two ends of the straight section.
This device offers versatility in that the choice of the
radioisotope to be used can be made based upon the desired
intensity of radiation and the desired energy of radiation. Since
the coating-layer can be made very thin as by vacuum sputtering a
metal, it is possible to use either alpha emitters or beta emitters
for the radioisotope. Since the device is inserted directly into
the bloodstream and is surrounded by blood, extensive radiation
shielding is not required, as the radiation emitted will be
absorbed by the blood itself with no damage to surrounding tissues.
This device permits surgical implantation by means of much simpler
surgical procedures and is therefore far less traumatic than other
known implantation procedures.
DESCRIPTION OF PARTICULAR EMBODIMENT
While the invention is hereinafter described in connection with a
particular specific embodiment, it will be understood that it is
not intended to limit the invention to only that specific
embodiment, but it is intended to cover all alternatives,
modifications and equivalents as may be included within the spirit
and scope of the invention as defined by the appended claims.
A device was constructed and implanted in accordance with the
present invention. The device was formed of a Type 302 stainless
steel spring wire 0.010 inch in diameter and just over 2 inches
long. The wire was formed with opposing 0.040-inch-diameter loops
at each end, the centers of the loops being 2 inches apart.
The wire was ultrasonically cleaned in approximately 10 percent
solution of Delex -- a commercial detergent -- and ultrasonically
rinsed in distilled water twice, followed by a tripple rinse in
reagent-grade acetone, and thoroughly air-dried.
A layer of .sup.238 PuO.sub.2 was electroplated on the center 1
inch of the straight section of the wire. Electroplating was based
on procedures recommended by Handley and Cooper, Analytical
Chemistry, Vol. 41, No. 2, February 1969, page 381. Similar
procedures have been used in the past for production of standard
samples of other radioactive actinides.
The electroplating cell was filled with approximately 10 cc of
dimethyl sulfoxide. A D-C power supply was connected to a platinum
anode and the irradiator wire serving as a cathode with small
alligator clips. A magnetic stirrer was adjusted to rotate the
stirring bar such as to give good mixing without causing a
noticeable vortex in the liquid. 80 micrograms of dried .sup.238
PuO.sub.2 was dissolved in 25 microliters of 6 N nitric acid and
transferred to the cell. The power supply was adjusted so as to
apply 3.5 volts across the cell and adjusted so that the current
flow through the cell was 0.1 milliamp. The current was applied and
continued for 20 minutes. In order to prevent redissolution of some
of the .sup.238 PuO.sub.2, the liquid was decanted with a syringe
to below the level of the wire before reducing the voltage.
While the current, voltage and electrode spacing are probably not
critical and are interdependent as in any cell, in order to obtain
very smooth deposits, it is important to adjust the current flow
and stirring speed to prevent the formation of bubbles on the wire.
On previous attempts using higher voltage and current, a few
bubbles were produced on the wire, resulting in deposits which
appeared thicker to the naked eye and were black. On microscopic
examination, these deposits were found to be rough with high peaks
and with the appearance of a sponge. On such a deposit, a
containment layer thick enough to assure a nonsmearable device
would cause a large reduction in available alpha energy.
In the present example, after removal of the wire from the cell,
the wire active area deposit had the appearance of a satinfinished
stainless steel with a slight brownish tint, very similar to a
mildly baked stainless-steel vacuum system. An examination through
a high-powered reading glass showed a smooth velvety deposit
apparently well adhering and of high density. At this time, the
alpha radiation level from the wire was measured using a "yellow
face Juno" and a reading of approximately 60 rads per hour
uncorrected as read on the Juno was obtained.
Sputter deposition of each coating or containment layer was done in
two steps in a MRC Model 8620 RF sputtering system located in a
glove box. The active wire was mounted on a simple holding fixture
consisting of two support wires silver-brazed to a 5-inch stainless
steel disk and bent to support the wires 1/4 inch above the disk.
It was necessary to open the chamber and to turn the wire over to
sputter the containment on the reverse side. The chamber was
evacuated to 3 .times. 10.sup.-.sup.7 Torr before back-filling to
4.5 millitorr of argon. The first platinum containment layer of
approximately 7,500 A was sputter-deposited at a power of 250 watts
on a 5-inch-diameter target, zero bias, 800 volts RF peak to peak.
The 7,500 A estimate is based on deposition rates for platinum
previously established at 3.22 microns per hour at 500 watts by
metallographic techniques. The chamber was vented to argon, opened,
the wire turned over, and pumped down and platinum sputtered on the
other side.
After the first complete containment layer had been sputtered on,
the wire was removed to an open-faced hood and smearability and
activity checked. After a light rub on the wire, a Q-tip counted
200-300 disintegrations per minute. Alpha activity on the yellow
face Juno had dropped to 25 rads per hour uncorrected. The wire was
then carefully rubbed with tweezer tips which had been wrapped with
optical lens paper in order to knock off any high peaks of
plutonium oxide.
The wire was then placed back in a sputtering chamber and
approximately 3,500 A of platinum was deposited using the same
sputtering conditions as for the first containment layer. After
sputtering, the wire was smeared with Q-tips and facial tissue and
only background count was noted, which is less than 25
disintegrations per minute. The alpha activity as read on the
yellow face Juno was 12.5 rads per hour on one side and 15 rads per
hour on the other side.
An alpha-energy analysis was run on the completed device, using a
400-channel alpha-energy analyzer. The results showed the absence
of any alphas having the 5.5 MeV energy characteristic of
Pu.sup.238, which was convincing evidence that the activity is
contained until such time that the platinum containment is either
damaged through handling or eroded away by the blood flow. A peak
was located at about 4.82 MeV and calculation of the thickness of
the containment layer based on the energy analysis indicated a
thickness in reasonable agreement with that projected from the
deposition rate data.
Following sterilization with 400,000 rads of gamma radiation, the
device was implanted in a beagle dog. In the present case,
insertion was accomplished, while the dog was anesthetized as for
any surgery, by passing a long steel needle obliquely through the
artery and drawing the irradiator device through the needle by
means of a suture thread and suturing, through the loops of the
device at both ends, to the wall of the blood vessel following
removal of the steel needle. With this technique, there is little
disturbance of the blood vessel. Radiographs taken subsequent to
implantation showed the wire continuing in place. The other
surgical procedure contemplated for use with the present device
will be to dissect the descending aorta, make two small slits on
opposite sides of the blood vessel and 2 inches diagonally apart,
insert the wire and anchor it with sutures also used to close the
slits. This procedure is much simplified over the previously used
method of removing a part of the aorta and suturing in its place a
multilayered tube with woven fiber ends.
Two of the devices were implanted in dogs. The first device was
nonradioactive and was implanted to develop techniques and to check
thrombic effects of the wire itself. The device with the
radioactive layer was subsequently implanted. After 65 days, there
was no gross evidence of thrombic effect in either animal but total
absence of clotting can be confirmed only after the animal is
sacrificed. While Pu.sup.238 was used as the source in the present
instance, it is possible that because of the very short range of
alpha particles and the difficulty of detecting any leakage, should
a leakage subsequently develop, it is possible that beta emitters
will prove to be preferable as the active radioisotope. A beta
emitter would provide a radiation which is sufficiently penetrating
to give a sufficiently high dose rate to the blood and yet is not
so penetrating that it would be damaging to surrounding tissue. Use
of more penetrating beta radiation would also have the advantage
that a thicker containment layer could be used, insuring its
integrity and containment of the radioisotope without reducing the
radiation level to unacceptably low values.
* * * * *