In situ temperature measurements with thermocouple probes during laser interstitial thermotherapy (LITT): quantification and correction of a measurement artifact

Non-Fourier Bioheat Transfer Analysis in Brain Tissue During Interstitial Laser Ablation: Analysis of Multiple Influential Factors

This work presents the dual-phase lag-based non-Fourier bioheat transfer model of brain tissue subjected to interstitial laser ablation. The finite element method has been utilized to predict the brain tissue's temperature distributions and ablation volumes. A sensitivity analysis has been conducted to quantify the effect of variations in the input laser power, treatment time, laser fiber diameter, laser wavelength, and non-Fourier phase lags. Notably, in this work, the temperature-dependent thermal properties of brain tissue have been considered. The developed model has been validated by comparing the temperature obtained from the numerical and ex vivo brain tissue during interstitial laser ablation. The ex vivo brain model has been further extended to in vivo settings by incorporating the blood perfusion effects. The results of the systematic analysis highlight the importance of considering temperature-dependent thermal properties of the brain tissue, non-Fourier behavior, and microvascular perfusion effects in the computational models for accurate predictions of the treatment outcomes during interstitial laser ablation, thereby minimizing the damage to surrounding healthy tissue. The developed model and parametric analysis reported in this study would assist in a more accurate and precise prediction of the temperature distribution, thus allowing to optimize the thermal dosage during laser therapy in the brain.

On the role of polymeric hydrogels in the thermal response of gold nanorods under NIR laser irradiation

Hydrogels are 3D cross-linked networks of polymeric chains designed to be used in the human body. Nowadays they find widespread applications in the biomedical field and are particularly attractive as drug delivery vectors. However, despite many good results, their release performance is sometimes very quick and uncontrolled, being forced by the high in vivo clearance of body fluids. In this direction, the development of novel responsive nanomaterials promises to overcome the drawbacks of common hydrogels, inducing responsive properties in three-dimensional polymeric devices. In this study, we synthesized and then loaded gold nanorods (Au NRs) within an agarose-carbomer (AC)-based hydrogel obtained from a microwave-assisted polycondensation reaction between carbomer 974P and agarose. The photothermal effect of the composite device was quantified in terms of maximum temperature and spatial-temporal temperature distribution, also during consecutive laser irradiations. This work shows that composite Au NRs loaded within AC hydrogels can serve as a stable photothermal treatment agent with enhanced photothermal efficiency and good thermal stability after consecutive laser irradiations. These results confirm that the composite system produced can exhibit an enhanced thermal effect under NIR laser irradiation, which is expected to lead to great therapeutic advantages for the localized treatment of different diseases.

Intra-articular temperature monitoring during radiofrequency ablation in ex-vivo bovine hip joints via Fiber Bragg grating sensors

PURPOSE

Radiofrequency ablation is an increasingly used surgical option for ablation, resection and coagulation of soft tissues in joint arthroscopy. One of the major issues of thermal ablation is the temperature monitoring across the target areas, as cellular mortality is a direct consequence of thermal dosimetry. Temperatures from 45 °C to 50 °C are at risk of damage to chondrocytes. One of the most reliable tools for temperature monitoring is represented by fiber optic sensors, as they allow accurate and real-time temperature measurement via a minimally invasive approach. The aim of this study was to determine, by fiber Bragg grating sensors (FBGs), the safety of radiofrequency ablation in tissue heating applied to ex-vivo bovine hip joints.

METHODS

Ex vivo bovine hips were subjected to radiofrequency ablation, specifically in the acetabular labrum, for a total of two experiments. The WEREWOLF System (Smith + Nephew, Watford, UK) was employed in high operating mode and in a controlled ablation way. One optical fiber embedding seven FBGs was used to record multipoint temperature variations. Each sensor was 1 mm in length with a distance from edge to edge with each other of 2 mm.

RESULTS

The maximum variation was recorded in both the tests by the FBG1 (i.e., the closest one to the electrode tip) and was lower than to 2.8 °C. The other sensors (from FBG2 to FBG7) did not record a significant temperature change throughout the duration of the experiment (maximum up to 0.7 °C for FBG7).

CONCLUSIONS

No significant increase in temperature was observed at any of the seven sites. The sensor nearest to the radiofrequency source exhibited the highest temperature rise, but the variation was only 3 °C. The minimal temperature increase registered at the measurement sites, according to existing literature, is not expected to be cytotoxic. FBGs demonstrate the potential to fulfil the strict requirements for temperature measurements during arthroscopic surgery.

Nanoparticle-assisted, image-guided laser interstitial thermal therapy for cancer treatment

Laser interstitial thermal therapy (LITT) guided by magnetic resonance imaging (MRI) is a new treatment option for patients with brain and non-central nervous system (non-CNS) tumors. MRI guidance allows for precise placement of optical fiber in the tumor, while MR thermometry provides real-time monitoring and assessment of thermal doses during the procedure. Despite promising clinical results, LITT complications relating to brain tumor procedures, such as hemorrhage, edema, seizures, and thermal injury to nearby healthy tissues, remain a significant concern. To address these complications, nanoparticles offer unique prospects for precise interstitial hyperthermia applications that increase heat transport within the tumor while reducing thermal impacts on neighboring healthy tissues. Furthermore, nanoparticles permit the co-delivery of therapeutic compounds that not only synergize with LITT, but can also improve overall effectiveness and safety. In addition, efficient heat-generating nanoparticles with unique optical properties can enhance LITT treatments through improved real-time imaging and thermal sensing. This review will focus on (1) types of inorganic and organic nanoparticles for LITT; (2) in vitro, in silico, and ex vivo studies that investigate nanoparticles' effect on light-tissue interactions; and (3) the role of nanoparticle formulations in advancing clinically relevant image-guided technologies for LITT. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Neurological Disease Implantable Materials and Surgical Technologies > Nanoscale Tools and Techniques in Surgery.

Temperature Monitoring in Hyperthermia Treatments of Bone Tumors: State-of-the-Art and Future Challenges

Bone metastases and osteoid osteoma (OO) have a high incidence in patients facing primary lesions in many organs. Radiotherapy has long been the standard choice for these patients, performed as stand-alone or in conjunction with surgery. However, the needs of these patients have never been fully met, especially in the ones with low life expectancy, where treatments devoted to pain reduction are pivotal. New techniques as hyperthermia treatments (HTs) are emerging to reduce the associated pain of bone metastases and OO. Temperature monitoring during HTs may significantly improve the clinical outcomes since the amount of thermal injury depends on the tissue temperature and the exposure time. This is particularly relevant in bone tumors due to the adjacent vulnerable structures (e.g., spinal cord and nerve roots). In this Review, we focus on the potential of temperature monitoring on HT of bone cancer. Preclinical and clinical studies have been proposed and are underway to investigate the use of different thermometric techniques in this scenario. We review these studies, the principle of work of the thermometric techniques used in HTs, their strengths, weaknesses, and pitfalls, as well as the strategies and the potential of improving the HTs outcomes.

A Micron-Sized Laser Photothermal Effect Evaluation System and Method

The photothermal effects of lasers have played an important role in both medical laser applications and the development of cochlear implants with optical stimulation. However, there are few methods to evaluate the thermal effect of micron-sized laser spots interacting with other tissues. Here, we present a multi-wavelength micro-scale laser thermal effect measuring system that has high temporal, spatial and temperature resolutions, and can quantitatively realize evaluations in real time. In this system, with accurate 3D positioning and flexible pulsed laser parameter adjustments, groups of temperature changes are systematically measured when the micron-sized laser spots from six kinds of wavelengths individually irradiate the Pd/Cr thermocouple junction area, and reference data of laser spot thermal effects are obtained. This work develops a stable, reliable and universal tool for quantitatively exploring the thermal effect of micron-sized lasers, and provides basic reference data for research on light-stimulated neuron excitement in the future.

Highly efficient optical fiber sensor for instantaneous measurement of elevated temperature in dental hard tissues irradiated with an Nd:YaG laser

In this in vitro experiment, the effect of 1.064 µm pulsed laser on both enamel- and dentin-dental tissues has been investigated. A total of fifty-five dental hard tissue samples were exposed to Nd:YAG laser that possesses a pulse width of 9 ns and 850 mJ of total energy. An optical fiber sensor was put behind the samples to measure the temperature instantaneously. A novel, to the best of our knowledge, fiber sensor has been proposed and used to measure the heat generated in dental hard tissues instantaneously after the application of laser irradiation on the tissue surface. This optical sensor exhibits a fast response time of about 1 ms and high sensitivity with about 1.975 nm/°C. The findings of this study in decreasing the probability of pulpal necrosis structure while handling the tooth, whether for ablation, welding, or tooth resurfacing purposes, may establish standards for dentists and laser manufacturers (healthcare professionals) that should be followed.

Quasi-distributed fiber optic sensor-based control system for interstitial laser ablation of tissue: theoretical and experimental investigations

This work proposes the quasi-distributed real-time monitoring and control of laser ablation (LA) of liver tissue. To confine the thermal damage, a pre-planning stage of the control strategy based on numerical simulations of the bioheat-transfer was developed to design the control parameters, then experimentally assessed. Fiber Bragg grating (FBG) sensors were employed to design the automatic thermometry system used for temperature feedback control for interstitial LA. The tissue temperature was maintained at a pre-set value, and the influence of different sensor locations (on the direction of the beam propagation and backward) on the thermal outcome was evaluated in comparison with the uncontrolled case. Results show that the implemented computational model was able to properly describe the temperature evolution of the irradiated tissue. Furthermore, the realized control strategy allowed for the accurate confinement of the laser-induced temperature increase, especially when the temperature control was actuated by sensors located in the direction of the beam propagation, as confirmed by the calculated fractions of necrotic tissues (e.g., 23 mm³ and 53 mm³ for the controlled and uncontrolled LA, respectively).

Laser-induced optothermal response of gold nanoparticles: From a physical viewpoint to cancer treatment application

Gold nanoparticles (GNPs)-based photothermal therapy (PTT) is a promising minimally invasive thermal therapy for the treatment of focal malignancies. Although GNPs-based PTT has been known for over two decades and GNPs possess unique properties as therapeutic agents, the delivery of a safe and effective therapy is still an open question. This review aims at providing relevant and recent information on the usage of GNPs in combination with the laser to treat cancers, pointing out the practical aspects that bear on the therapy outcome. Emphasis is given to the assessment of the GNPs' properties and the physical mechanisms underlying the laser-induced heat generation in GNPs-loaded tissues. The main techniques available for temperature measurement and the current theoretical simulation approaches predicting the therapeutic outcome are reviewed. Topical challenges in delivering safe thermal dosage are also presented with the aim to discuss the state-of-the-art and the future perspective in the field of GNPs-mediated PTT.

Distributed Sensing Network Enabled by High-Scattering MgO-Doped Optical Fibers for 3D Temperature Monitoring of Thermal Ablation in Liver Phantom

Thermal ablation is achieved by delivering heat directly to tissue through a minimally invasive applicator. The therapy requires a temperature control between 50-100 °C since the mortality of the tumor is directly connected with the thermal dosimetry. Existing temperature monitoring techniques have limitations such as single-point monitoring, require costly equipment, and expose patients to X-ray radiation. Therefore, it is important to explore an alternative sensing solution, which can accurately monitor temperature over the whole ablated region. The work aims to propose a distributed fiber optic sensor as a potential candidate for this application due to the small size, high resolution, bio-compatibility, and temperature sensitivity of the optical fibers. The working principle is based on spatial multiplexing of optical fibers to achieve 3D temperature monitoring. The multiplexing is achieved by high-scattering, nanoparticle-doped fibers as sensing fibers, which are spatially separated by lower-scattering level of single-mode fibers. The setup, consisting of twelve sensing fibers, monitors tissue of 16 mm × 16 mm × 25 mm in size exposed to a gold nanoparticle-mediated microwave ablation. The results provide real-time 3D thermal maps of the whole ablated region with a high resolution. The setup allows for identification of the asymmetry in the temperature distribution over the tissue and adjustment of the applicator to follow the allowed temperature limits.

Closed-Loop Temperature Control Based on Fiber Bragg Grating Sensors for Laser Ablation of Hepatic Tissue

Laser ablation (LA) of cancer is a minimally invasive technique based on targeted heat release. Controlling tissue temperature during LA is crucial to achieve the desired therapeutic effect in the organs while preserving the healthy tissue around. Here, we report the design and implementation of a real-time monitoring system performing closed-loop temperature control, based on fiber Bragg grating (FBG) spatial measurements. Highly dense FBG arrays (1.19 mm length, 0.01 mm edge-to-edge distance) were inscribed in polyimide-coated fibers using the femtosecond point-by-point writing technology to obtain the spatial resolution needed for accurate reconstruction of high-gradient temperature profiles during LA. The zone control strategy was implemented such that the temperature in the laser-irradiated area was maintained at specific set values (43 and 55 °C), in correspondence to specific radii (2 and 6 mm) of the targeted zone. The developed control system was assessed in terms of measured temperature maps during an ex vivo liver LA. Results suggest that the temperature-feedback system provides several advantages, including controlling the margins of the ablated zone and keeping the maximum temperature below the critical values. Our strategy and resulting analysis go beyond the state-of-the-art LA regulation techniques, encouraging further investigation in the identification of the optimal control-loop.

Monitoring tissue temperature during photothermal therapy for cancer

Phototherapies offer promising alternatives to traditional cancer therapies. Phototherapies mainly rely on manipulation of target tissue through photothermal, photochemical, or photomechanical interactions. Combining phototherapy with immunotherapy has the benefit of eliciting a systemic immune response. Specifically, photothermal therapy (PTT) has been shown to induce apoptosis and necrosis in cancer cells, releasing tumor associated antigenic peptides while sparing healthy host cells, through temperature increase in targeted tissue. However, the tissue temperature must be monitored and controlled to minimize adverse thermal effects on normal tissue and to avoid the destruction of tumor-specific antigens, in order to achieve the desired therapeutic effects of PTT. Techniques for monitoring PTT have evolved from post-treatment quantification methods like enzyme linked immunosorbent assay, western blot analysis, and flow cytometry to modern methods capable of real-time monitoring, such as magnetic resonance thermometry, computed tomography, and photoacoustic imaging. Monitoring methods are largely chosen based on the type of light delivery to the target tissue. Interstitial methods of thermometry, such as thermocouples and fiber-optic sensors, are able to monitor temperature of the local tumor environment. However, these methods can be challenging if the phototherapy itself is interstitially administered. Increasingly, non-invasive therapies call for non-invasive monitoring, which can be achieved through magnetic resonance thermometry, computed tomography, and photoacoustic imaging techniques. The purpose of this review is to introduce the feasible methods used to monitor tissue temperature during PTT. The descriptions of different techniques and the measurement examples can help the researchers and practitioners when using therapeutic PTT.

Photothermal Response of Polyhydroxy Fullerenes

Photothermal therapy, utilizing photonic nanoparticles, has gained substantial interest as an alternative to systemic cancer treatments. Several different photothermal nanoparticles have been designed and characterized for their photothermal efficiency. However, a standardized experimental methodology to determine the photothermal efficiency is lacking leading to differences in the reported values for the same nanoparticles. Here, we have determined the role of different experimental parameters on the estimation of photothermal efficiency. Importantly, we have demonstrated the role of laser irradiation time and nanoparticle concentration as the two critical factors that can lead to errors in the estimation of photothermal efficiency. Based on the optimized parameters, we determined the photothermal conversion efficiency of polyhydroxy fullerenes to be 69%. Further, the photothermal response of polyhydroxy fullerenes was found to be stable with repeated laser irradiation and no changes in the molecular structure were observed. Given its high photothermal efficiency and superior stability, polyhydroxy fullerenes are an ideal candidate for photothermal therapy.

Photoacoustic temperature imaging based on multi-wavelength excitation

Building further upon the high spatial resolution offered by ultrasonic imaging and the high optical contrast yielded by laser excitation of photoacoustic imaging, and exploiting the temperature dependence of photoacoustic signal amplitudes, this paper addresses the question whether the rich information given by multispectral optoacoustic tomography (MSOT) allows to obtain 3D temperature images. Numerical simulations and experimental results are reported on agarose phantoms containing gold nanoparticles and the effects of shadowing, reconstruction flaws, etc. on the accuracy are determined.

Multi-fiber distributed thermal profiling of minimally invasive thermal ablation with scattering-level multiplexing in MgO-doped fibers

We propose a setup for multiplexed distributed optical fiber sensors capable of resolving temperature distribution in thermo-therapies, with a spatial resolution of 2.5 mm over multiple fibers interrogated simultaneously. The setup is based on optical backscatter reflectometry (OBR) applied to optical fibers having backscattered power significantly larger than standard fibers (36.5 dB), obtained through MgO doping. The setup is based on a scattering-level multiplexing, which allows interrogating all the sensing fibers simultaneously, thanks to the fact that the backscattered power can be unambiguously associated to each fiber. The setup has been validated for the planar measurement of temperature profiles in ex vivo radiofrequency ablation, obtaining the measurement of temperature over a surface of 96 total points (4 fibers, 8 sensing points per cm2). The spatial resolution obtained for the planar measurement allows extending distributed sensing to surface, or even three-dimensional, geometries performing temperature sensing in the tissue with millimeter resolution in multiple dimensions.

Penetrating effect of high-intensity infrared laser pulses through body tissue

Researchers have utilized infrared (IR) lasers as energy sources in laser therapy for curing skin diseases and skin injuries with remarkable effects. Preliminary experiments have also shown that high-intensity IR laser pulses could penetrate thick body tissues, resulting in remarkable effects for recovery from injuries in deep muscles and cartilage tissues. However, for deep-level IR laser therapy, it is unclear how much of the laser power density penetrates the body tissues at certain depths and which of the three major effects of laser irradiation, namely, laser-induced photo-chemical effect, photo-thermal effect and mechanical dragging effect, play a key role in the curing process. Thus, in this study, we developed micro-sized thin-film thermocouple (TFTC) arrays on freestanding Si₃N₄ thin-film windows as sensors for laser power density and local temperature. These devices showed excellent linear responses in output voltage to laser power density with wavelengths in the range of 325-1064 nm, and also indicated the local temperature at the laser spot. We systematically measured the penetrating effect and thermal effect through thick porcine tissues for high-intensity IR pulses with a laser system used in clinical treatment and subtracted the attenuation parameters for the porcine skin, fat and muscle tissue from the experimental data. The results offered reliable quantitative references for safe irradiation doses of high-intensity IR laser pulses in practical laser therapy.

Magnetic Resonance-compatible needle-like probe based on Bragg grating technology for measuring temperature during Laser Ablation

Temperature monitoring in tissue undergone Laser Ablation (LA) may be particularly beneficial to optimize treatment outcome. Among many techniques, fiber Bragg grating (FBG) sensors show valuable characteristics for temperature monitoring in this medical scenario: good sensitivity and accuracy, and immunity from electromagnetic interferences. Their main drawback is the sensitivity to strain, which can entail measurement error for respiratory and patient movements. The aims of this work are the design, the manufacturing and the characterization of a needle-like probe which houses 4 FBGs. Three FBGs have sensitive length of 1 mm and are used as temperature sensors; one FBG with length of 10 mm is used as reference and to sense eventual strain. The optical fiber housing the FBGs was encapsulated within a needle routinely used in clinical practice to perform MRI-guided biopsy. Two materials were used for the encapsulation: i) thermal paste for the 3 FBGs used for temperature monitoring, to maximize the thermal exchange with the needle; ii) epoxy resin for the reference FBG, to improve its sensitivity to strain. The static calibration of the needle-like probe was performed to estimate the thermal sensitivity of each FBG; the step response was investigated to estimate the response time. FBGs 1 mm long have thermal sensitivity of 0.01 nm·°C(-1), whereas the reference FBG presents 0.02 nm·°C(-1). For all FBGs, the response time was in the order of 100 ms. Lastly, experiments were performed on ex vivo swine liver undergoing LA to i) evaluate the possible presence of measurement artifact, due to the direct absorption of laser light by the needle and ii) assess the feasibility of the probe in a quasi clinical scenario.

Laser ablation of the biliary tree: in vivo proof of concept as potential treatment of unresectable cholangiocarcinoma

OBJECTIVES

The palliative treatment of cholangiocarcinoma is based on stent placement with well-known procedure-related complications. Consequently, alternative energy-based techniques were put forward with controversial long-term results. This study aims to evaluate the safety and effectiveness of biliary tree laser ablation (LA) in terms of: (i) absence of perforation, (ii) temperature increase, (iii) induced thermal damage in in vivo models.

MATERIALS AND METHODS

The common bile duct and cystic ducts of two pigs were ablated with a diode laser (circumferential irradiation pattern) for 6 and 3 min at 7 W. Laser settings were chosen from previous ex vivo experiments. Local temperature was monitored through a fibre Bragg grating (FBG) sensor embedded into the laser delivery probe. Histopathological analysis of the ablated specimen was performed through in situ endomicroscopy, haematoxylin and eosin (H&E) and nicotinamide adenine dinucleotide (NADH) stains.

RESULTS

Temperature reached a plateau of 53 °C with consequent thermal damage on the application area, regardless of laser settings and application sites. No perforation was detected macroscopically or microscopically. At the H&E stain, wall integrity was always preserved. The NADH stain allowed to evaluate damage extension. It turned out that the ablation spreading width depended on application time and duct diameter. In situ endomicroscopy revealed a clear distinction between ablated and non-ablated areas.

CONCLUSIONS

The temperature distribution obtained through LA proved to induce a safe and effective intraductal coagulative necrosis of biliary ducts. These results represent the basis for further experiments on tumour-bearing models for the treatment of obstructive cholangiocarcinoma.

Laser Ablation for Cancer: Past, Present and Future

Laser ablation (LA) is gaining acceptance for the treatment of tumors as an alternative to surgical resection. This paper reviews the use of lasers for ablative and surgical applications. Also reviewed are solutions aimed at improving LA outcomes: hyperthermal treatment planning tools and thermometric techniques during LA, used to guide the surgeon in the choice and adjustment of the optimal laser settings, and the potential use of nanoparticles to allow biologic selectivity of ablative treatments. Promising technical solutions and a better knowledge of laser-tissue interaction should allow LA to be used in a safe and effective manner as a cancer treatment.

Image-guided thermal ablation with MR-based thermometry

Thermal ablation techniques such as radiofrequency, microwave, high intensity focused ultrasound (HIFU) and laser have been used as minimally invasive strategies for the treatment of variety of cancers. MR thermometry methods are readily available for monitoring thermal distribution and deposition in real time, leading to decrease of incidents of normal tissue damage around targeted lesion. HIFU and laser-induced thermal therapy (LITT) are the two widely accepted tumor ablation techniques because of their compatibility with MR systems. MRI provides multiple temperature dependent parameters for thermal imaging, such as signal intensity, T1, T2, diffusion coefficient, magnetization transfer, proton resonance frequency shift (PRFS, including phase imaging and spectroscopy) as well as frequency shift of temperature sensitive contrast agents. Absolute temperature mapping techniques, including both spectroscopic imaging using metabolites as a reference and phase imaging using fat as a reference, are immune to susceptibility effects and are not dependent on phase differences. These techniques are intrinsically more reliable than relative temperature measurement by phase mapping methods. If the limitation of low temporal and spatial resolution could be overcome, these methods may be preferred for MR-guided thermal ablation systems. As of today, the most popular MR thermal imaging method applied in tumor thermal ablation surgery is, however, still PRFS based phase mapping technique, which only provides relative temperature change and is prone to motion artifacts.

Real-time temperature monitoring with fiber Bragg grating sensor during diffuser-assisted laser-induced interstitial thermotherapy

High-sensitivity temperature sensors have been used to validate real-time thermal responses in tissue during photothermal treatment. The objective of the current study was to evaluate the feasible application of a fiber Bragg grating (FBG) sensor for diffuser-assisted laser-induced interstitial thermotherapy (LITT) particularly to treat tubular tissue disease. A 600 - ? m core-diameter diffuser was employed to deliver 980-nm laser light for coagulation treatment. Both a thermocouple and a FBG were comparatively tested to evaluate temperature measurements in ex vivo liver tissue. The degree of tissue denaturation was estimated as a function of irradiation times and quantitatively compared with light distribution as well as temperature development. At the closer distance to a heat source, the thermocouple measured up to 41% higher maximum temperature than the FBG sensor did after 120-s irradiation (i.e., 98.7 ° C ± 6.1 ° C for FBG versus 131.0 ° C ± 5.1 ° C for thermocouple; p < 0.001 ). Ex vivo porcine urethra tests confirmed the real-time temperature measurements of the FBG sensor as well as consistently circumferential tissue denaturation after 72-s irradiation ( coagulation thickness = 2.2 ± 0.3 ?? mm ). The implementation of FBG can be a feasible sensing technique to instantaneously monitor the temperature developments during diffuser-assisted LITT for treatment of tubular tissue structure.

Fiber Optic Sensors for Temperature Monitoring during Thermal Treatments: An Overview

During recent decades, minimally invasive thermal treatments (i.e., Radiofrequency ablation, Laser ablation, Microwave ablation, High Intensity Focused Ultrasound ablation, and Cryo-ablation) have gained widespread recognition in the field of tumor removal. These techniques induce a localized temperature increase or decrease to remove the tumor while the surrounding healthy tissue remains intact. An accurate measurement of tissue temperature may be particularly beneficial to improve treatment outcomes, because it can be used as a clear end-point to achieve complete tumor ablation and minimize recurrence. Among the several thermometric techniques used in this field, fiber optic sensors (FOSs) have several attractive features: high flexibility and small size of both sensor and cabling, allowing insertion of FOSs within deep-seated tissue; metrological characteristics, such as accuracy (better than 1 °C), sensitivity (e.g., 10 pm·°C⁻¹ for Fiber Bragg Gratings), and frequency response (hundreds of kHz), are adequate for this application; immunity to electromagnetic interference allows the use of FOSs during Magnetic Resonance- or Computed Tomography-guided thermal procedures. In this review the current status of the most used FOSs for temperature monitoring during thermal procedure (e.g., fiber Bragg Grating sensors; fluoroptic sensors) is presented, with emphasis placed on their working principles and metrological characteristics. The essential physics of the common ablation techniques are included to explain the advantages of using FOSs during these procedures.

A Needlelike Probe for Temperature Monitoring During Laser Ablation Based on Fiber Bragg Grating: Manufacturing and Characterization

Temperature distribution monitoring in tissue undergoing laser ablation (LA) could be beneficial for improving treatment outcomes. Among several thermometric techniques employed in LA, fiber Bragg grating (FBG) sensors show valuable characteristics, although their sensitivity to strain entails measurement error for patient respiratory movements. Our work describes a solution to overcome this issue by housing an FBG in a surgical needle. The metrological properties of the probes were assessed in terms of thermal sensitivity (0.027 nm °C−1 versus 0.010 nm °C−1 for epoxy liquid encapsulated probe and thermal paste one, respectively) and response time (about 100 ms) and compared with properties of nonencapsulated FBG (sensitivity of 0.010 nm °C−1, response time of 43 ms). The error due to the strain caused by liver movements, simulating a typical respiratory pattern, was assessed: the strain induces a probes output error less than 0.5 °C, which is negligible when compared to the response of nonencapsulated FBG (2.5 °C). The metallic needle entails a measurement error, called artifact, due to direct absorption of the laser radiation. The analysis of the artifact was performed by employing the probes for temperature monitoring on liver undergoing LA. Experiments were performed at two laser powers (i.e., 2 W and 4 W) and at nine distances between the probes and the laser applicator. The artifact decreases with the distance and increases with the power: it exceeds 10 °C at 4 W, when the encapsulated probes are placed at 3.6 mm and 0 deg from the applicator, and it is lower than 1 °C for distance higher than 5 mm and angle higher than 30 deg.

Monitoring of temperature increase and tissue vaporization during laser interstitial thermotherapy of ex vivo swine liver by computed tomography

Laser interstitial thermotherapy (LITT) is a minimally invasive technique used to thermally destroy tumour cells. Being based on hyperthermia, LITT outcome depends on the temperature distribution inside the tissue. Recently, CT scan thermometry, based on the dependence of the CT number (HU) on tissue temperature (T) has been introduced during LITT; it is an attractive approach to monitor T because it overcomes the concerns related to the invasiveness. We performed LITT on nine ex vivo swine livers at three different laser powers, (P=1.5 W, P=3 W, P=5 W) with a constant treatment time t=200 s; HU is averaged on two ellipsoidal regions of interest (ROI) of 0.2 cm2, placed at two distances from the applicator (d=3.6 mm and d=8.7 mm); a reference ROI was placed away from the applicator (d=30 mm). The aim of this study is twofold: 1) to evaluate the effect of the T increase in terms of HU variation in ex vivo swine livers undergoing LITT; and 2) to estimate the P value for tissue vaporization. To the best of our knowledge, this is the first study focused on the HU variation in swine livers undergoing LITT at different P. The reported findings could be useful to assess the effect of LITT on the liver in terms of both T changes and tissue vaporization, with the aim to obtain an effective therapy.

Thermal therapeutic method for selective treatment of deep-lying tissue by combining laser and high-intensity focused ultrasound energy

Photothermal therapy is performed by delivering laser radiation into the target lesion containing tissue chromophores so as to induce localized heating. For high treatment efficacy, the laser wavelength should be selected to maximize the absorption of incident laser radiation in the tissue chromophores. However, even with the optimal laser wavelength, both the absorption and the scattering of laser energy in tissue openly hamper treatment efficacy in deep-lying lesions. To overcome the limitation, we propose a dual thermal therapeutic method in which both laser and acoustic energies are transmitted to increase therapeutic depth while maintaining high target selectivity of photothermal therapy. Through skin-mimicking phantom experiments, it was verified that the two different energies are complementary in elevation of tissue temperature, and the treatment depth using laser radiation is increased along with acoustic energy.

Optical fiber-based MR-compatible sensors for medical applications: an overview

During last decades, Magnetic Resonance (MR)--compatible sensors based on different techniques have been developed due to growing demand for application in medicine. There are several technological solutions to design MR-compatible sensors, among them, the one based on optical fibers presents several attractive features. The high elasticity and small size allow designing miniaturized fiber optic sensors (FOS) with metrological characteristics (e.g., accuracy, sensitivity, zero drift, and frequency response) adequate for most common medical applications; the immunity from electromagnetic interference and the absence of electrical connection to the patient make FOS suitable to be used in high electromagnetic field and intrinsically safer than conventional technologies. These two features further heightened the potential role of FOS in medicine making them especially attractive for application in MRI. This paper provides an overview of MR-compatible FOS, focusing on the sensors employed for measuring physical parameters in medicine (i.e., temperature, force, torque, strain, and position). The working principles of the most promising FOS are reviewed in terms of their relevant advantages and disadvantages, together with their applications in medicine.

Techniques for temperature monitoring during laser-induced thermotherapy: an overview

Laser-induced thermotherapy (LITT) is a hyperthermic procedure recently employed to treat cancer in several organs. The amount of coagulated tissue depends on the temperature distribution around the applicator, which plays a crucial role for an optimal outcome: the removal of the whole neoplastic tissue, whilst preventing damage to the surrounding healthy tissue. Although feedback concerning tissue temperature could be useful to drive the physician in the adjustment of laser settings and treatment duration, LITT is usually performed without real-time monitoring of tissue temperature. During recent decades, many thermometric techniques have been developed to be used during thermal therapies. This paper provides an overview of techniques and sensors employed for temperature measurement during tissue hyperthermia, focusing on LITT, and an investigation of their performances in this application. The paper focuses on the most promising and widespread temperature monitoring techniques, splitting them into two groups: the former includes invasive techniques based on the use of thermocouples and fibre-optic sensors; the second analyses non-invasive methods, i.e. magnetic resonance imaging-, computerised tomography- and ultrasound-based thermometry. Background information on measuring principle, medical applications, advantages and weaknesses of each method are provided and discussed.

Theoretical analysis and experimental evaluation of laser-induced interstitial thermotherapy in ex vivo porcine pancreas

Laser-induced interstitial thermotherapy (LITT) has been recently applied to pancreas in animal models for ablation purpose. Assessment of thermal effects due to the laser-pancreatic tissue interaction is a critical factor in validating the procedure feasibility and safety. A mathematical model based on bioheat equation and its experimental assessment was developed. The LITT procedure was performed on 40 ex vivo porcine pancreases, with an Nd:YAG (1064 nm) energy of 1000 J and power from 1.5 up to 10 W conveyed by a quartz optical fiber with 300 μm diameter. Six fiber Bragg grating sensors have been utilized to measure temperature distribution as a function of time at fixed distances from the applicator tip within pancreas undergoing LITT. Simulations and experiments show temperature variations Δ T steeply decreasing with distance from the applicator at higher power values: at 6 W, ∆T > 40 °C at 5 mm and Δ T is approximately equal to 5 °C at 10 mm. Δ T nonlinearly increases with power close to the applicator. Ablated and coagulated tissue volumes have also been measured and experimental results agree with theoretical ones. Despite the absence of data in the current literature on pancreas optical parameters, the model allowed a quite good prediction of thermal effects. The prediction of LITT effects on pancreas is necessary to assess laser dosimetry.

Use of a near-infrared diode laser to activate mouse cutaneous nociceptors in vitro

A skin-nerve preparation is useful for study of heat transduction mechanisms of A- and C-high threshold primary afferents (nociceptors), but the small dimension and liquid environment of the skin organ bath do not readily accommodate conventional noxious heat delivery systems. For these reasons, a 980 nm (near-infrared) diode laser was tested for activation and differentiation of cutaneous afferents. Current to the laser driver was varied. Exposure time and area, angle of approach, and stand-off distance from the bath solution surface were held constant. Seventy-eight fibers were classified by: conduction velocity, mechanical threshold, and responsiveness to laser radiation. A subset of the sampled fibers was also tested for sensitivity to convective heat. Most C (30/43) and a few A (6/25) nociceptors responded to laser irradiation. All low mechanical threshold primary afferents (10/10) were unresponsive to laser irradiation. Laser-sensitive fibers responded to convective heat, whereas laser-insensitive fibers did not. Laser-induced responses were consistent with literature reports of responses to traditional heat stimulation. Laser stimulation proved to be a rapid, unobtrusive method for reproducible heat stimulation of primary afferents of the mouse skin-nerve preparation. It is effective for defining subpopulations of primary afferent fibers and holds promise as a tool for gauging modification of C-fiber activity.

Relationships of skin depths and temperatures when varying pulse repetition frequencies from 2.0-microm laser light incident on pig skin

Human perception of 2.0-microm infrared laser irradiation has become significant in such disparate fields as law enforcement, neuroscience, and pain research. Several recent studies have found damage thresholds for single-pulse and continuous wave irradiations at this wavelength. However, the only publication using multiple-pulse irradiations was investigating the cornea rather than skin. Literature has claimed that the 2.0-microm light characteristic thermal diffusion time was as long as 300-ms. Irradiating the skin with 2.0-microm lasers to produce sensation should follow published recommendations to use pulses on the order of 10 to 100 ms, which approach the theoretical thermal diffusion time. Therefore, investigation of the heating of skin for a variety of laser pulse combinations was undertaken. Temperatures of ex vivo pig skin were measured at the surface and at three depths from pulse sequences of six different duty factors. Differences were found in temperature rise per unit exposure that did not follow a linear relation to duty factor. The differences can be explained by significant heat conduction during the pulses. Therefore, the common heat modeling assumption of thermal confinement during a pulse may need to be experimentally verified if the pulse approaches the theoretical thermal confinement time.

Thermal interaction of short-pulsed laser focused beams with skin tissues

Time-dependent thermal interaction is developed in a skin tissue cylinder subjected to the irradiation of a train of short laser pulses. The skin embedded with a small tumor is stratified as three layers: epidermis, dermis and subcutaneous fat with different optical, thermal and physiological properties. The laser beam is focused to the tumor site by an objective lens for thermal therapy. The ultrafast radiation heat transfer of the focused beam is simulated by the transient discrete ordinates method. The transient Pennes bio-heat equation is solved numerically by the finite volume method with alternating direction implicit scheme. Emphasis is placed on the characterization of the focused beam propagation and absorption and the temperature rise in the focal spot. The effects of the focal spot size and location, the laser power, and the bio-heat equation are investigated. Comparisons with collimated irradiation are conducted. The focused beam can penetrate a greater depth and produce higher temperature rise at the target area, and thus reduce the possibility of thermal damage to the surrounding healthy tissue. It is ideal for killing cancerous cells and small tumors.

Thermal responses of ex vivo human skin during multiple cryogen spurts and 1,450 nm laser pulses

BACKGROUND AND OBJECTIVE

Although cryogen spray cooling (CSC) is used to minimize the risk of epidermal damage during laser dermatologic surgery, concern has been expressed that CSC may induce cryo-injury. The objective of this study is to measure temperature variations at the epidermal-dermal junction in ex vivo human skin during three clinically relevant multiple cryogen spurt-laser pulse sequences (MCS-LPS).

STUDY DESIGN/MATERIALS AND METHODS

The epidermis of ex vivo human skin was separated from the dermis and a thin-foil thermocouple (13 microm thickness) was inserted between the two layers. Thermocouple depth and epidermal thickness were measured using optical coherence tomography (OCT). Skin specimens were preheated to 30 degrees C before the MCS-LPS were initiated. Three MCS-LPS patterns, with total cryogen spray times of 38, 30, and 25 milliseconds respectively, were applied to the specimens in combination with laser fluences of 10 and 14 J/cm(2), while the thermocouple recorded the temperature changes at the epidermal-dermal junction.

RESULTS

The thermocouple effectively recorded fast temperature changes during three MCS-LPS patterns. The lowest temperatures measured corresponded to the sequences with longer pre-cooling cryogen spurts. No sub-zero temperatures were measured for any of the MCS-LPS patterns under study.

CONCLUSIONS

The three clinically relevant MCS-LPS patterns evaluated in this study do not cause sub-zero temperatures in ex vivo human skin at the epidermal-dermal junction and, therefore, are unlikely to cause significant cryogen induced epidermal injury.

Characterization of measurement artefacts in fluoroptic temperature sensors: Implications for laser thermal therapy at 810 nm

BACKGROUND AND OBJECTIVES

Fluoroptic sensors are used to measure interstitial temperatures but their utility for monitoring laser interstitial thermal therapy (LITT) is unclear because these sensors exhibit a measurement artefact when exposed to the near-infrared (NIR) treatment light. This study investigates the cause of the artefact to determine whether fluoroptic sensors can provide reliable temperature measurements during LITT.

STUDY DESIGN/MATERIALS AND METHODS

The temperature rise measured by a fluoroptic sensor irradiated in non-absorbing media (air and water) was considered an artefact. Temperature rise was measured as a function of distance from a laser source. Two different sensor designs and several laser powers were investigated. A relationship between fluence rate and measurement artefact in water was determined and coupled with a numerical simulation of LITT in liver to estimate the error in temperature measurements made by fluoroptic sensors in tissue in proximity to the laser source. The effect of ambient light on the performance of sensors capped with a transparent material ("clear-capped sensors") was also investigated.

RESULTS

The temperature rise recorded in air by both clear- and black-capped fluoroptic sensors decreased with distance from a laser source in a manner similar to fluence rate. Sensor cap material, laser power, and the thermal properties of the surrounding medium affected the magnitude of the artefact. Numerical simulations indicated that the accuracy of a clear-capped fluoroptic sensor used to monitor a typical LITT treatment in liver is > 1 degrees C provided the sensor is further than approximately 3 mm from the source. It was also shown that clear-capped fluoroptic sensors are affected by ambient light.

CONCLUSIONS

The measurement artefact experienced by both black-capped and clear-capped fluoroptic sensors irradiated by NIR light scales with fluence rate and is due to direct absorption of the laser light, which results in sensor self-heating. Clear-capped fluoroptic sensors can be used to accurately monitor LITT in tissue but should be shielded from ambient light.

Radiance-based monitoring of the extent of tissue coagulation during laser interstitial thermal therapy

Optical monitoring relates the dynamic changes in measured light intensity to the extent of treatment-induced coagulation that occurs during laser interstitial thermal therapy. We utilized a two-region Monte Carlo simulation to elucidate the nature of the changes in interstitial radiance and fluence that result from the formation of a volume of thermal coagulation surrounding a cylindrical emitter. Using simulation results, we demonstrate that radiance sensors are more sensitive than traditional fluence sensors to coagulation-induced scattering changes. Radiance measurements take advantage of directional detection angles that are more receptive to the onset and passing of the coagulation boundary. We performed experiments with albumen phantoms to demonstrate the practicality of the radiance method for monitoring interstitial laser thermal therapy.

Thermal analysis of laser interstitial thermotherapy inex vivofibro-fatty tissue using exponential functions

A therapeutic procedure to treat small, surface breast tumours up to 10 mm in radius plus a 5 mm margin of healthy, surrounding tissue using laser interstitial thermotherapy (LITT) is currently being investigated. The purpose of this study is to analyse and model the thermal and coagulative response of ex vivo fibro-fatty tissue, a model for breast tissue, during experimental laser interstitial thermotherapy at 980 nm. Laser radiation at 980 nm was delivered interstitially through a diffusing tip optical fibre inserted into a fibro-fatty tissue model to produce controlled heating at powers ranging from 3.2 to 8.0 W. Tissue temperature was measured with thermocouples placed at 15 positions around the fibre. The induced coagulation zone was measured on gross anatomical sections. Thermal analysis indicates that a finite sum of exponential functions is an approximate solution to the heat conduction equation that more accurately predicts the time-temperature dependence in tissue prior to carbonization (T < 100 degrees C) during LITT than the traditional model using a single exponential function. Analysis of the ellipsoid coagulation volume induced in tissue indicates that the 980 nm wavelength does not penetrate deep enough in fibro-fatty tissue to produce a desired 30 mm diameter (14.1 x 10(3) mm3) coagulation volume without unwanted tissue liquefaction and carbonization.

MRI thermodosimetry in laser-induced interstitial thermotherapy

BACKGROUND AND OBJECTIVES

The aim of this study was to establish a correlation between a thermal measurement and a magnetic resonance imaging (MRI) signal during laser-induced interstitial thermotherapy (LITT) in liver.

STUDY DESIGN/MATERIALS AND METHODS

Pig liver was irradiated for 15 minutes with a diode laser at two different powers, 0.5 W (450 J) and 1.5 W (1,350 J). Tissue temperature was monitored every 20 seconds using thermocouples. Thermosensitive MRI sequences (T(1)-weighted Turbo-Flash) were acquired with the same irradiation parameters. Correlation between MRI signals (SI) and temperature measures was defined at two different distances from the fiber (5 and 10 mm).

RESULTS

At 0.5 W, temperatures rose progressively up to a maximum increase of 9.5 degrees C at 5 mm and 4 degrees C at 10 mm after 15 minutes. The corresponding MRI signal decreased progressively to -27.6 SI at 5 mm and -18.5 SI at 10 mm. At 1.5 W, temperatures rose dramatically at 5 mm, reaching a plateau. The temperature elevation measured at the end of the irradiation was of 30 degrees C whereas at 10 mm it was only 14.5 degrees C. The MRI signal varied accordingly, remaining inversely proportional to temperature (-76 SI at 5 mm and -35.5 SI at 10 mm).

CONCLUSIONS

An inversely proportional relationship was observed between MRI signal in sequential Turbo-Flash and temperature. MRI should allow to analyze heat diffusion in the liver, and thus to monitor real-time LITT treatments.

Laser interstitial thermotherapy (LITT) monitoring using high-resolution digital mammography: theory and experimental studies

Laser interstitial thermotherapy (LITT) is a minimally-invasive laser hyperthermia procedure for the treatment of localized tumours. Real-time monitoring of LITT is essential to control the extent of tumour destruction and ensure safe and effective treatments. The feasibility of using high-resolution digital x-ray mammography to monitor LITT of breast cancer was evaluated. Tissue phantoms including polyacrylamide hydrogel and cadaver porcine tissue were heated using a 980 nm diode laser delivered through optical fibres with diffusing tips. Digital images of the tissue phantoms were recorded with a high-resolution digital stereotactic breast biopsy system during heating. The recorded images were processed and analysed to detect heat-induced changes. No changes were detected during heating of the hydrogel. Pixel-by-pixel subtraction of the initial image from images taken during laser heating shows observable thermally-induced changes around the fibre during laser irradiation that correlate with the thermal denaturation zone observed by gross anatomy. These experiments demonstrate that high-resolution digital x-ray mammography can be used to detect heat-induced tissue changes during experimental LITT in fibro-fatty tissue.