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Taninokuchi Tomassoni M, Braccischi L, Russo M, Adduci F, Calautti D, Girolami M, Vita F, Ruffilli A, Manzetti M, Ponti F, Matcuk GR, Mosconi C, Cirillo L, Miceli M, Spinnato P. Image-Guided Minimally Invasive Treatment Options for Degenerative Lumbar Spine Disease: A Practical Overview of Current Possibilities. Diagnostics (Basel) 2024; 14:1147. [PMID: 38893672 PMCID: PMC11171713 DOI: 10.3390/diagnostics14111147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Lumbar back pain is one of the main causes of disability around the world. Most patients will complain of back pain at least once in their lifetime. The degenerative spine is considered the main cause and is extremely common in the elderly population. Consequently, treatment-related costs are a major burden to the healthcare system in developed and undeveloped countries. After the failure of conservative treatments or to avoid daily chronic drug intake, invasive treatments should be suggested. In a world where many patients reject surgery and prefer minimally invasive procedures, interventional radiology is pivotal in pain management and could represent a bridge between medical therapy and surgical treatment. We herein report the different image-guided procedures that can be used to manage degenerative spine-related low back pain. Particularly, we will focus on indications, different techniques, and treatment outcomes reported in the literature. This literature review focuses on the different minimally invasive percutaneous treatments currently available, underlining the central role of radiologists having the capability to use high-end imaging technology for diagnosis and subsequent treatment, allowing a global approach, reducing unnecessary surgeries and prolonged pain-reliever drug intake with their consequent related complications, improving patients' quality of life, and reducing the economic burden.
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Affiliation(s)
- Makoto Taninokuchi Tomassoni
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Radiology Department, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi, 40138 Bologna, Italy
| | - Lorenzo Braccischi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Radiology Department, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi, 40138 Bologna, Italy
| | - Mattia Russo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesco Adduci
- Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Davide Calautti
- Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Marco Girolami
- Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - George R. Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Cristina Mosconi
- Radiology Department, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Malpighi, 40138 Bologna, Italy
| | - Luigi Cirillo
- Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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2
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Liu K, Russo M, Ellis JS, Capua JD, Wu D, Smolinski-Zhao S, Kalva S, Arellano RS, Irani Z, Uppot R, Linderman SW, Gupta R, Aizenberg J, Srinivasan S, Som A. Transient, Image-Guided Gel-Dissection for Percutaneous Thermal Ablation. Adv Healthc Mater 2024:e2400272. [PMID: 38678431 DOI: 10.1002/adhm.202400272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/02/2024] [Indexed: 04/30/2024]
Abstract
Image-guided tumor ablative therapies are mainstay cancer treatment options but often require intra-procedural protective tissue displacement to reduce the risk of collateral damage to neighboring organs. Standard of care strategies, such as hydrodissection (fluidic injection), are limited by rapid diffusion of fluid and poor retention time, risking injury to adjacent organs, increasing cancer recurrence rates from incomplete tumor ablations, and limiting patient qualification. Herein, a "gel-dissection" technique is developed, leveraging injectable hydrogels for longer-lasting, shapeable, and transient tissue separation to empower clinicans with improved ablation operation windows and greater control. A rheological model is designed to understand and tune gel-dissection parameters. In swine models, gel-dissection achieves 24 times longer-lasting tissue separation dynamics compared to saline, with 40% less injected volume. Gel-dissection achieves anti-dependent dissection between free-floating organs in the peritoneal cavity and clinically significant thermal protection, with the potential to expand minimally invasive therapeutic techniques, especially across locoregional therapies including radiation, cryoablation, endoscopy, and surgery.
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Affiliation(s)
- Kathy Liu
- Materials Science & Mechanical Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, 02138, USA
| | - Mario Russo
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joshua S Ellis
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - John Di Capua
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Dufan Wu
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Sara Smolinski-Zhao
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Sanjeeva Kalva
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Ronald S Arellano
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Zubin Irani
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Raul Uppot
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Stephen W Linderman
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Rajiv Gupta
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joanna Aizenberg
- Materials Science & Mechanical Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, 02138, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, 02138, USA
| | - Shriya Srinivasan
- Materials Science & Mechanical Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, 02138, USA
| | - Avik Som
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, 02114, USA
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3
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Gazel D, Akdoğan H, Büyüktaş Manay A, Erinmez M, Zer Y. The potential of therapeutic hyperthermia to eradicate Staphylococcus aureus bacteria; an in vitro study. J Therm Biol 2024; 120:103812. [PMID: 38447276 DOI: 10.1016/j.jtherbio.2024.103812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 03/08/2024]
Abstract
Staphylococcus aureus is one of the most common infectious agents, causing morbidity and mortality worldwide. Most pathogenic bacteria are classified in the group of mesophilic bacteria and the optimal growth temperature of these bacteria changes between 33 and 41 °C. Increased temperature can inhibit bacterial growth and mobility, which in turn, can trigger autolysis and cause cell wall damage. Hyperthermia treatment is defined as a heat-mediated treatment method applied using temperatures higher than body temperature. Nowadays, this treatment method is used especially in the treatment of tumours. Hyperthermia treatment is divided into two groups: mild hyperthermia and ablative or high-temperature hyperthermia. Mild hyperthermia is a therapeutic technique in which tumour tissue is heated above body temperature to produce a physiological or biological effect but is often not aimed at directly causing significant cell death. The goal of this method is to achieve temperatures of 40-45 °C in human tissues for up to 2 h. Hyperthermia can be used in the treatment of infections caused by such bacterial pathogens. In addition, using hyperthermia in combination with antimicrobial drugs may result in synergistic effects and reduce resistance issues. In our study, we used two different temperature levels (37 °C and 45 °C). We assessed growth inhibition, some virulence factors, alteration colony morphologies, and antimicrobial susceptibility for several antibiotics with three methods (Kirby-Bauer, E-test and broth microdilution) under hyperthermia. In the study, we observed that hyperthermia affected the urease enzyme, antibiotic sensitivity levels showed synergy with hyperthermia, and changes occurred in colony diameters and affected bacterial growth. We hypothesise that hyperthermia might be a new therapeutic option for infectious diseases as a sole agent or in combination with different antimicrobials.
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Affiliation(s)
- Deniz Gazel
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey.
| | - Hüseyin Akdoğan
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey
| | - Ayşe Büyüktaş Manay
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey
| | - Mehmet Erinmez
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey
| | - Yasemin Zer
- Gaziantep University, Faculty of Medicine, Department of Medical Microbiology, Gaziantep, Turkey
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Lautenschlaeger P, Rathmann N, Rothfuss A, Kuhne M, Stork S, Noll M, Hetjens S, Schoenberg SO, Stallkamp J, Diehl S. Learning Needle Placement in Soft Tissue With Robot-assisted Navigation. In Vivo 2023; 37:702-708. [PMID: 36881085 PMCID: PMC10026658 DOI: 10.21873/invivo.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM The aim of this phantom study was to evaluate the learning curves of novices practicing how to place a cone-beam computed tomography (CBCT)-guided needle using a novel robotic assistance system (RAS). MATERIALS AND METHODS Ten participants performed 18 punctures each with random trajectories in a phantom setting, supported by a RAS over 3 days. Precision, duration of the total intervention, duration of the needle placement, autonomy, and confidence of the participants were measured, displaying possible learning curves. RESULTS No statistically significant differences were observed in terms of needle tip deviation during the trial days (mean deviation day 1: 2.82 mm; day 3: 3.07 mm; p=0.7056). During the trial days, the duration of the total intervention (mean duration: day 1: 11:22 min; day 3: 07:39 min; p<0.0001) and the duration of the needle placement decreased (mean duration: day 1: 03:17 min; day 3: 02:11 min; p<0.0001). In addition, autonomy (mean percentage of achievable points: day 1: 94%; day 3: 99%; p<0.0001) and confidence of the participants (mean percentage of achievable points: day 1: 78%; day 3: 91%; p<0.0001) increased significantly during the trial days. CONCLUSION The participants were already able to carry out the intervention precisely using the RAS on the first day of the trial. Throughout the trial, the participants' performance improved in terms of duration and confidence.
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Affiliation(s)
- Philipp Lautenschlaeger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nils Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;
| | | | - Markus Kuhne
- Fraunhofer IPA, Fraunhofer Project Group for Automation in Medicine and Biotechnology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Matthias Noll
- Fraunhofer Institute for Computer Graphics Research, Darmstadt, Germany
| | - Svetlana Hetjens
- Department for Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jan Stallkamp
- Mannheim Institute for Intelligent Systems in Medicine MIISM, Department for Automation in Medicine and Biotechnology, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Steffen Diehl
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Jäger L, Morales-Orcajo E, Gager A, Bader A, Dillinger A, Blutke A. Preclinical Assessment of Tissue Effects by Gastrointestinal Endoscope Tip Temperature. CURRENT THERAPEUTIC RESEARCH 2023; 98:100693. [PMID: 36820232 PMCID: PMC9937900 DOI: 10.1016/j.curtheres.2023.100693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
Background Endoscope tips are heated by their electrical and illuminating components. During the procedure, they might get in close or even direct contact with intestinal tissues. Objective To assess endoscope tip and tissue temperature as well as histopathologic changes of gastrointestinal (GI) tissues when exposed to the heated tip of GI endoscopes. Methods The endoscope tip temperatures of four GI endoscopes were measured for 30 minutes in a temperature-controlled chamber. The temperature of ex vivo porcine GI tissues was measured for 5-, 15-, and 120-minute exposure to endoscope tips within a climate chamber to control environmental factors (simulation of fever as worst-case). Exposed tissues were histopathologically examined afterward. Control samples included untreated mucosa, tissue samples exposed to endoscope tips for 120 minutes, as well as tissue samples thermally coagulated with a bipolar high-frequency probe. Results Actual endoscope tip temperatures of 59 to 86°C, dependent on the endoscope type, were measured. After 10 to 15 minutes, the maximum temperatures were reached. Maximum tissue temperatures of 44 to 46°C for 5 and 15 minutes, as well as up to 50°C for 120 minutes, were recorded dependent on tissue and endoscope type. No direct heat-induced histopathologic tissue alterations were observed in the 5- and 15-minute samples. Conclusions Both clinically relevant and a worst-case control were tested. Even though elevated temperatures were recorded, no heat-related tissue alterations were detected. This overall supports the safety profile of GI endoscopy; however, the study findings are limited by the ex vivo setting (no metabolic tissue alterations accessible, no blood flow) and small sample number.
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Affiliation(s)
- Luise Jäger
- Ambu Innovation GmbH, Augsburg, Germany,Address correspondence to: Luise Jäger, Ambu Innovation GmbH, Karl-Drais-Strasse 4B, 86159 Augsburg, Germany.
| | | | - Anna Gager
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians Universitaet München, Munich, Germany
| | | | | | - Andreas Blutke
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, Ludwig-Maximilians Universitaet München, Munich, Germany
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Basij M, John S, Bustamante D, Kabbani L, Maskoun W, Mehrmohammadi M. Integrated Ultrasound and Photoacoustic-Guided Laser Ablation Theranostic Endoscopic System. IEEE Trans Biomed Eng 2023; 70:67-75. [PMID: 35724291 PMCID: PMC10355465 DOI: 10.1109/tbme.2022.3184495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advancements in ablation techniques have paved the way towards the development of safer and more effective clinical procedures for treating various maladies such as atrial fibrillation (AF). AF is characterized by rapid, chaotic atrial activation and is commonly treated using radiofrequency applicators or laser ablation catheters. However, the lack of thermal lesion formation and temperature monitoring capabilities in these devices prevents them from measuring the treatment outcome directly. In addition, poor differentiation between healthy and ablated tissues leads to incomplete ablation, which reduces safety and causes complications in patients. Hence, a novel photoacoustic (PA)-guided laser ablation theranostic device was developed around a traditional phased-array endoscope. The proposed technology provides lesion formation, tissue distinguishing, and temperature monitoring capabilities. Our results have validated the lesion monitoring capability of the proposed technology through PA correlation maps. The tissue distinguishing capability of the theranostic device was verified by the measurable differences in the PA signal between pre-and post-ablated mice myocardial tissue. The increase in the PA signal with temperature variations caused by the ablation laser confirmed the ability of the proposed device to provide temperature feedback.
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Affiliation(s)
- Maryam Basij
- Department of Biomedical Engineering Wayne State University, Detroit, MI, USA
| | - Samuel John
- Department of Biomedical Engineering Wayne State University, Detroit, MI, USA
| | - David Bustamante
- Department of Biomedical Engineering Wayne State University, Detroit, MI, USA
| | - Loay Kabbani
- Department of Vascular Surgery, Henry Ford Health Systems, Detroit, MI, USA
| | - Waddah Maskoun
- Department of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering at Wayne State University and Scientific member of molecular imaging at Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
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Zhong X, Cao Y, Zhou P. Thermochromic Tissue-Mimicking Phantoms for Thermal Ablation Based on Polyacrylamide Gel. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1361-1372. [PMID: 35623921 DOI: 10.1016/j.ultrasmedbio.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Abstract
In recent years, thermal ablation has played an increasingly important role in treating various tumors in the clinic. A practical thermochromic phantom model can provide a favorable platform for clinical thermotherapy training of young physicians or calibration and optimization of thermal devices without risk to animals or human participants. To date, many tissue-mimicking thermal phantoms have been developed and are well liked, especially the polyacrylamide gel (PAG)-based phantoms. This review summarizes the PAG-based phantoms in the field of thermotherapy, details their advantages and disadvantages and provides a direction for further optimization. The relevant physical parameters (such as electrical, acoustic, and thermal properties) of these phantoms are also presented in this review, which can assist operators in a deeper understanding of these phantoms and selection of the proper recipes for phantom fabrication.
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Affiliation(s)
- Xinyu Zhong
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuting Cao
- Institute of Ultrasound Imaging & Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing, China
| | - Ping Zhou
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
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8
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Zhong X, Zhou P, Zhao Y, Liu W, Zhang X. A novel tissue-mimicking phantom for US/CT/MR-guided tumor puncture and thermal ablation. Int J Hyperthermia 2022; 39:557-563. [PMID: 35379066 DOI: 10.1080/02656736.2022.2056249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM This study aimed to develop a novel tumor-bearing tissue phantom model that can be used for US/CT/MR-guided tumor puncture and thermal ablation. METHODS The phantom model comprised two parts: a normal tissue-mimicking phantom and a tumor-mimicking phantom. A normal tissue phantom was prepared based on a polyacrylamide gel mixed with thermochromic ink. Moreover, a spherical phantom containing contrast agents was constructed and embedded in the tissue phantom to mimic a tumor lesion. US/CT/MR imaging features and thermochromic property of the phantom model were characterized. Finally, the utility of the phantom model for imaging-guided microwave ablation training was examined. RESULTS The tumor phantom containing contrast agents showed hyper-echogenicity, higher CT numbers, and lower T2 signal intensity compared with the normal tissue phantom in US/CT/MR images. Consequently, we could locate the position of the tumor in US/CT/MR imaging and perform an imaging-guided tumor puncture. When the temperature reached the threshold of 60 °C, the phantom exhibited a permanent color change from cream white to magenta. Based on this obvious color change, our phantom model could clearly map the thermal ablation region after thermotherapy. CONCLUSIONS We developed a novel US/CT/MR-imageable tumor-bearing tissue model that can be used for imaging-guided tumor puncture and thermal ablation. Furthermore, it allows visual assessment of the ablation region by analyzing the obvious color change. Overall, this phantom model could be a good training tool in the field of thermal ablation.
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Affiliation(s)
- Xinyu Zhong
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yongfeng Zhao
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Wengang Liu
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xinghao Zhang
- Department of Ultrasound, The Third Xiangya Hospital, Central South University, Changsha, China
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Willemen NGA, Morsink MAJ, Veerman D, da Silva CF, Cardoso JC, Souto EB, Severino P. From oral formulations to drug-eluting implants: using 3D and 4D printing to develop drug delivery systems and personalized medicine. Biodes Manuf 2021. [DOI: 10.1007/s42242-021-00157-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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10
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Emerging hyperthermia applications for pediatric oncology. Adv Drug Deliv Rev 2020; 163-164:157-167. [PMID: 33203538 DOI: 10.1016/j.addr.2020.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022]
Abstract
Local application of hyperthermia has a myriad of effects on the tumor microenvironment as well as the host's immune system. Ablative hyperthermia (typically > 55 °C) has been used both as monotherapy and adjuvant therapy, while mild hyperthermia treatment (39-45 °C) demonstrated efficacy as an adjuvant therapy through enhancement of both chemotherapy and radiation therapy. Clinical integration of hyperthermia has especially great potential in pediatric oncology, where current chemotherapy regimens have reached maximum tolerability and the young age of patients implies significant risks of late effects related to therapy. Furthermore, activation of both local and systemic immune response by hyperthermia suggests that hyperthermia treatments could be used to enhance the anticancer effects of immunotherapy. This review summarizes the state of current applications of hyperthermia in pediatric oncology and discusses the use of hyperthermia in the context of other available treatments and promising pre-clinical research.
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11
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Ghelfi J, Moreau-Gaudry A, Hungr N, Fouard C, Véron B, Medici M, Chipon E, Cinquin P, Bricault I. Evaluation of the Needle Positioning Accuracy of a Light Puncture Robot Under MRI Guidance: Results of a Clinical Trial on Healthy Volunteers. Cardiovasc Intervent Radiol 2018; 41:1428-1435. [PMID: 29876597 DOI: 10.1007/s00270-018-2001-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/26/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the accuracy of Light Puncture Robot (LPR) as a patient-mounted robot, in positioning a sham needle under MRI guidance for abdominal percutaneous interventions. MATERIALS AND METHODS This monocentric, prospective and non-controlled study was approved by the ethics review board. The study evaluated the accuracy of LPR V3 to achieve a virtual puncture in 20 healthy volunteers. Three trajectories were tried on each volunteer, under 3-T MRI guidance. RESULTS Accuracy under 5 mm in attaining a 10 cm-deep target was reached in 72% of attempts after 2 robot motions with a median error of 4.1 mm [2.1; 5.1]. Median procedure time for one trajectory was 12.9 min [10.2; 18.0] and median installation time was 9.0 min [6.0; 13.0]. CONCLUSION LPR accuracy in the deployment of a sham needle inside the MRI tunnel and its setup time are promising. Further studies need to be conducted to confirm these results before clinical trials.
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Affiliation(s)
- Julien Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
| | - Alexandre Moreau-Gaudry
- TIMC-IMAG, Univ. Grenoble-Alpes, 38000, Grenoble, France.,TIMC-IMAG, CNRS, 38000, Grenoble, France.,Inserm CIC 1406, 38000, Grenoble, France.,Pole Sante Publique, CHU Grenoble-Alpes, 38000, Grenoble, France
| | - Nikolai Hungr
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Céline Fouard
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Baptiste Véron
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Maud Medici
- Inserm CIC 1406, 38000, Grenoble, France.,CIC 1406, Univ. Grenoble-Alpes, 38000, Grenoble, France.,Pole Recherche, CHU Grenoble-Alpes, 38000, Grenoble, France
| | - Emilie Chipon
- Inserm CIC 1406, 38000, Grenoble, France.,CIC 1406, Univ. Grenoble-Alpes, 38000, Grenoble, France.,Pole Recherche, CHU Grenoble-Alpes, 38000, Grenoble, France
| | - Philippe Cinquin
- Laboratoire TIMC-IMAG (UMR CNRS 5525) - Équipe GMCAO, Faculté de Médecine - Pavillon Taillefer, 38706, La Tronche Cedex, France
| | - Ivan Bricault
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
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Gazel D, Yılmaz M. Are infectious diseases and microbiology new fields for thermal therapy research? Int J Hyperthermia 2018; 34:918-924. [PMID: 29448846 DOI: 10.1080/02656736.2018.1440015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Antimicrobial chemotherapy and surgery are classical methods for treating infectious diseases. However, there is a need for alternative methods to cure infections caused by antibiotic-resistant pathogens, recurrent or chronic infections, and unreachable local infections in which the use of drugs or surgery is anatomically and physically restricted. Several micro-organisms are known to be sensitive to mild hyperthermia, and this sensitivity is one of the potential benefits proposed for the host during an episode of fever. Additionally, some immunological or biophysical changes occur during hyperthermia. These changes may be useful for eliminating thermo-susceptible microbial pathogens using local heat therapy. There are several experimental studies proposing the use of hyperthermia to treat local infections. The infected organs or tissues may be heated up to a temperature that can inhibit invading microorganisms. Here, it is hypothesised that local heat therapy may become an alternative or adjuvant method for curing local infections. Here, we highlight the potential for local hyperthermia in the treatment of bacterial infections caused by thermo-susceptible pathogens in a systematic plan. If the proposed thermal-microbiology concepts and local thermal therapies can be adapted to clinical microbiology and infectiology, new medical fields, such as thermo-microbiology and thermo-infectiology, may be created in the future.
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Affiliation(s)
- Deniz Gazel
- a Department of Medical Microbiology, Faculty of Medicine , Gaziantep University , Gaziantep , Turkey
| | - Mehmet Yılmaz
- b Division of Hematology, Department of Internal Medicine, Faculty of Medicine , Sanko University , Gaziantep , Turkey
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Hatakeyama H, Wu SY, Lyons YA, Pradeep S, Wang W, Huang Q, Court KA, Liu T, Nie S, Rodriguez-Aguayo C, Shen F, Huang Y, Hisamatsu T, Mitamura T, Jennings N, Shim J, Dorniak PL, Mangala LS, Petrillo M, Petyuk VA, Schepmoes AA, Shukla AK, Torres-Lugo M, Lee JS, Rodland KD, Fagotti A, Lopez-Berestein G, Li C, Sood AK. Role of CTGF in Sensitivity to Hyperthermia in Ovarian and Uterine Cancers. Cell Rep 2017; 17:1621-1631. [PMID: 27806300 DOI: 10.1016/j.celrep.2016.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 09/11/2016] [Accepted: 10/05/2016] [Indexed: 12/19/2022] Open
Abstract
Even though hyperthermia is a promising treatment for cancer, the relationship between specific temperatures and clinical benefits and predictors of sensitivity of cancer to hyperthermia is poorly understood. Ovarian and uterine tumors have diverse hyperthermia sensitivities. Integrative analyses of the specific gene signatures and the differences in response to hyperthermia between hyperthermia-sensitive and -resistant cancer cells identified CTGF as a key regulator of sensitivity. CTGF silencing sensitized resistant cells to hyperthermia. CTGF small interfering RNA (siRNA) treatment also sensitized resistant cancers to localized hyperthermia induced by copper sulfide nanoparticles and near-infrared laser in orthotopic ovarian cancer models. CTGF silencing aggravated energy stress induced by hyperthermia and enhanced apoptosis of hyperthermia-resistant cancers.
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Affiliation(s)
- Hiroto Hatakeyama
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Sherry Y Wu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Yasmin A Lyons
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Sunila Pradeep
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Wanqin Wang
- Department of Cancer Systems Imaging, MDACC, Houston, TX 77030, USA
| | - Qian Huang
- Department of Cancer Systems Imaging, MDACC, Houston, TX 77030, USA
| | - Karem A Court
- Department of Chemical Engineering, University of Puerto Rico-Mayaguez, Mayaguez, PR 00681, Puerto Rico
| | - Tao Liu
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Song Nie
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | | | - Fangrong Shen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Yan Huang
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Takeshi Hisamatsu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Takashi Mitamura
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA; Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo 060-8648, Japan
| | - Nicholas Jennings
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Jeajun Shim
- Department of Systems Biology, MDACC, Houston, TX 77030, USA
| | - Piotr L Dorniak
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Lingegowda S Mangala
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA; Center for RNA Interference and Non-Coding RNAs, MDACC, Houston, TX 77030, USA
| | - Marco Petrillo
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Vladislav A Petyuk
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Athena A Schepmoes
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Anil K Shukla
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Madeline Torres-Lugo
- Department of Chemical Engineering, University of Puerto Rico-Mayaguez, Mayaguez, PR 00681, Puerto Rico
| | - Ju-Seog Lee
- Department of Systems Biology, MDACC, Houston, TX 77030, USA
| | - Karin D Rodland
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Anna Fagotti
- Department of Medicine and Surgery, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Gabriel Lopez-Berestein
- Department of Experimental Therapeutics, MDACC, Houston, TX 77030, USA; Center for RNA Interference and Non-Coding RNAs, MDACC, Houston, TX 77030, USA; Department of Cancer Biology, MDACC, Houston, TX 77030, USA
| | - Chun Li
- Department of Cancer Systems Imaging, MDACC, Houston, TX 77030, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA; Center for RNA Interference and Non-Coding RNAs, MDACC, Houston, TX 77030, USA; Department of Cancer Biology, MDACC, Houston, TX 77030, USA.
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Hatakeyama H. Recent Advances in Endogenous and Exogenous Stimuli-Responsive Nanocarriers for Drug Delivery and Therapeutics. Chem Pharm Bull (Tokyo) 2017; 65:612-617. [PMID: 28674332 DOI: 10.1248/cpb.c17-00068] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Significant progress has been achieved in the development of stimuli-responsive nanocarriers for drug delivery, diagnosis, and therapy. Various types of triggers are utilized in the development of nanocarrier delivery. Endogenous factors such as changes in pH, redox, gradient, and enzyme concentration which are linked to disease progression have been utilized for controlling biodistribution and releasing drugs from nanocarriers, as well as increasing subsequent pharmacological activity at the disease site. Nanocarriers which respond to artificially-induced exogenous factors (such as temperature, light, magnetic field, and ultrasound) have also been developed. This review aims to discuss recent advances in the design of stimuli-responsive nanocarriers which appear to have a promising future in medicine.
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Affiliation(s)
- Hiroto Hatakeyama
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University
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Macchi M, Belfiore MP, Floridi C, Serra N, Belfiore G, Carmignani L, Grasso RF, Mazza E, Pusceddu C, Brunese L, Carrafiello G. Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial. Med Oncol 2017; 34:96. [PMID: 28417355 DOI: 10.1007/s12032-017-0946-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/04/2017] [Indexed: 12/24/2022]
Abstract
The LUMIRA trial evaluated the effectiveness of radiofrequency (RFA) and microwave ablation (MWA) in lung tumours ablation and defining more precisely their fields of application. It is a controlled prospective multi-centre random trial with 1:1 randomization. Fifty-two patients in stage IV disease (15 females and 37 males, mean age 69 y.o., range 40-87) were included. We randomized the patients in two different subgroups: MWA group and RFA group. For each group, we evaluated the technical and clinical success, the overall survival and complication rate. Inter-group difference was compared using Chi-square test or Fisher's exact test for categorical variables and one-way ANOVA test for continuous variables. For RFA group, there was a significant reduction in tumour size only between 6 and 12 months (p value = 0.0014). For MWA group, there was a significant reduction in tumour size between 6 and 12 months (p value = 0.0003) and between pre-therapy and 12 months (p value = 0.0215). There were not significant differences between the two groups in terms of survival time (p value = 0.883), while the pain level in MWA group was significantly less than in RFA group (1.79 < 3.25, p value = 0.0043). In conclusion, our trial confirms RFA and MWA are both excellent choices in terms of efficacy and safety in lung tumour treatments. However, when compared to RFA therapy, MWA produced a less intraprocedural pain and a significant reduction in tumour mass.
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Affiliation(s)
- M Macchi
- Department of Radiology, Circolo e Fondazione Macchi Hospital, Insubria University, Varese, Italy
| | - M P Belfiore
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Floridi
- Radiology Department, Fatebenefratelli Hospital, Milan, Italy.
| | - N Serra
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Belfiore
- Department of Radiology, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - L Carmignani
- Interventional Radiology Unit, San Jacopo Hospital, Pistoia, Italy
| | - R F Grasso
- Department of Diagnostic and Interventional Radiology, Campus Bio-Medico University, Rome, Italy
| | - E Mazza
- Interventional Radiology Unit, Careggi Hospital, Florence, Italy
| | - C Pusceddu
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital "A. Businco", Cagliari, Italy
| | - L Brunese
- Department of Radiology, University of Molise, Campobasso, Italy
| | - G Carrafiello
- Department of Radiology, San Paolo Hospital, University of Milan, Milan, Italy
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Mikhail AS, Negussie AH, Graham C, Mathew M, Wood BJ, Partanen A. Evaluation of a tissue-mimicking thermochromic phantom for radiofrequency ablation. Med Phys 2017; 43:4304. [PMID: 27370145 DOI: 10.1118/1.4953394] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE This work describes the characterization and evaluation of a tissue-mimicking thermochromic phantom (TMTCP) for direct visualization and quantitative determination of temperatures during radiofrequency ablation (RFA). METHODS TMTCP material was prepared using polyacrylamide gel and thermochromic ink that permanently changes color from white to magenta when heated. Color vs temperature calibration was generated in matlab by extracting RGB color values from digital photographs of phantom standards heated in a water bath at 25-75 °C. RGB and temperature values were plotted prior to curve fitting in mathematica using logistic functions of form f(t) = a + b/(1 + e((c(t-d)))), where a, b, c, and d are coefficients and t denotes temperature. To quantify temperatures based on TMTCP color, phantom samples were heated to temperatures blinded to the investigators, and two methods were evaluated: (1) visual comparison of sample color to the calibration series and (2) in silico analysis using the inverse of the logistic functions to convert sample photograph RGB values to absolute temperatures. For evaluation of TMTCP performance with RFA, temperatures in phantom samples and in a bovine liver were measured radially from an RF electrode during heating using fiber-optic temperature probes. Heating and cooling rates as well as the area under the temperature vs time curves were compared. Finally, temperature isotherms were generated computationally based on color change in bisected phantoms following RFA and compared to temperature probe measurements. RESULTS TMTCP heating resulted in incremental, permanent color changes between 40 and 64 °C. Visual and computational temperature estimation methods were accurate to within 1.4 and 1.9 °C between 48 and 67 °C, respectively. Temperature estimates were most accurate between 52 and 62 °C, resulting in differences from actual temperatures of 0.6 and 1.6 °C for visual and computational methods, respectively. Temperature measurements during RFA using fiber-optic probes matched closely with maximum temperatures predicted by color changes in the TMTCP. Heating rate and cooling rate, as well as the area under the temperature vs time curve were similar for TMTCP and ex vivo liver. CONCLUSIONS The TMTCP formulated for use with RFA can be used to provide quantitative temperature information in mild hyperthermic (40-45 °C), subablative (45-50 °C), and ablative (>50 °C) temperature ranges. Accurate visual or computational estimates of absolute temperatures and ablation zone geometry can be made with high spatial resolution based on TMTCP color. As such, the TMTCP can be used to assess RFA heating characteristics in a controlled, predictable environment.
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Affiliation(s)
- Andrew S Mikhail
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Ayele H Negussie
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Cole Graham
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Manoj Mathew
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
| | - Ari Partanen
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892 and Clinical Science MR Therapy, Philips, Andover, Massachusetts 01810
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Facchini G, Spinnato P, Guglielmi G, Albisinni U, Bazzocchi A. A comprehensive review of pulsed radiofrequency in the treatment of pain associated with different spinal conditions. Br J Radiol 2017; 90:20150406. [PMID: 28186832 DOI: 10.1259/bjr.20150406] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The objective of this review was to evaluate the efficacy of pulsed radiofrequency (PRF) treatment of pain associated with different spinal conditions. The mechanisms of action and biological effects are shortly discussed to provide the scientific basis for this radiofrequency modality. METHODS We systematically searched for clinical studies on spinal clinical conditions using PRF. We searched the MEDLINE (PubMed) database. We classified the information in one table focusing on randomized controlled trials (RCTs) and other types of studies. Date of last electronic search was October 2016. RESULTS We found four RCTs that evaluated the efficacy of PRF on cervical radicular pain and five observational studies. Two trials and three observational studies were conducted in patients with facet pain. For disc-related pathology, we found one RCT with PRF applied intradiscally and three RCTs for dorsal root ganglia PRF modulation lumbosacral radicular pain. For sacroiliac joint pain, spondylolisthesis, malignancies and other minor spinal pathology, limited studies were conducted. CONCLUSION From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regard to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the absence of standardization of PRF parameters, enrolment criteria and different methods in reporting results; but, the evidence is interesting. The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF. Advances in knowledge: The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF.
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Affiliation(s)
- Giancarlo Facchini
- 1 Department of Radiology, Scientific Institute Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Paolo Spinnato
- 1 Department of Radiology, Scientific Institute Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Giuseppe Guglielmi
- 2 Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Ugo Albisinni
- 1 Department of Radiology, Scientific Institute Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alberto Bazzocchi
- 1 Department of Radiology, Scientific Institute Rizzoli Orthopaedic Institute, Bologna, Italy
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Negussie AH, Partanen A, Mikhail AS, Xu S, Abi-Jaoudeh N, Maruvada S, Wood BJ. Thermochromic tissue-mimicking phantom for optimisation of thermal tumour ablation. Int J Hyperthermia 2016; 32:239-43. [PMID: 27099078 DOI: 10.3109/02656736.2016.1145745] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to (1) develop a novel tissue-mimicking thermochromic (TMTC) phantom that permanently changes colour from white to magenta upon heating above ablative temperatures, and (2) assess its utility for specific applications in evaluating thermal therapy devices. Materials and methods Polyacrylamide gel mixed with thermochromic ink was custom made to produce a TMTC phantom that changes its colour upon heating above biological ablative temperatures (> 60 °C). The thermal properties of the phantom were characterised, and compared to those of human tissue. In addition, utility of this phantom as a tool for the assessment of laser and microwave thermal ablation was examined. Results The mass density, thermal conductivity, and thermal diffusivity of the TMTC phantom were measured as 1033 ± 1.0 kg/m(3), 0.590 ± 0.015 W/m.K, and 0.145 ± 0.002 mm(2)/s, respectively, and found to be in agreement with reported values for human soft tissues. Heating the phantom with laser and microwave ablation devices produced clearly demarcated regions of permanent colour change geographically corresponding to regions with temperature elevations above 60 °C. Conclusion The TMTC phantom provides direct visualisation of ablation dynamics, including ablation volume and geometry as well as peak absolute temperatures within the treated region post-ablation. This phantom can be specifically tailored for different thermal therapy modalities, such as radiofrequency, laser, microwave, or therapeutic ultrasound ablation. Such modality-specific phantoms may enable better quality assurance, device characterisation, and ablation parameter optimisation, or optimise the study of dynamic heating parameters integral to drug device combination therapies relying upon heat.
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Affiliation(s)
- Ayele H Negussie
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
| | - Ari Partanen
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD ;,b Clinical Science MR Therapy, Philips , Andover , MA
| | - Andrew S Mikhail
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
| | - Sheng Xu
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
| | - Nadine Abi-Jaoudeh
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
| | - Subha Maruvada
- c US Food and Drug Administration , Silver Spring , MD , USA
| | - Bradford J Wood
- a Center for Interventional Oncology, Radiology and Imaging Sciences , Clinical Center, National Institutes of Health , Bethesda , MD
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Optical Fibre Pressure Sensors in Medical Applications. SENSORS 2015; 15:17115-48. [PMID: 26184228 PMCID: PMC4541926 DOI: 10.3390/s150717115] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 12/13/2022]
Abstract
This article is focused on reviewing the current state-of-the-art of optical fibre pressure sensors for medical applications. Optical fibres have inherent advantages due to their small size, immunity to electromagnetic interferences and their suitability for remote monitoring and multiplexing. The small dimensions of optical fibre-based pressure sensors, together with being lightweight and flexible, mean that they are minimally invasive for many medical applications and, thus, particularly suited to in vivo measurement. This means that the sensor can be placed directly inside a patient, e.g., for urodynamic and cardiovascular assessment. This paper presents an overview of the recent developments in optical fibre-based pressure measurements with particular reference to these application areas.
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Ahmed MM, Hodge JW, Guha C, Bernhard EJ, Vikram B, Coleman CN. Harnessing the potential of radiation-induced immune modulation for cancer therapy. Cancer Immunol Res 2015; 1:280-4. [PMID: 24777964 DOI: 10.1158/2326-6066.cir-13-0141] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The conventional use of radiotherapy is for local tumor control. Radiotherapy of the primary tumor can prevent the development of distant metastases, but this modality is generally not effective for treating preexisting systemic disease. However, radiation-induced tumor destruction may be considered a novel strategy for in situ cancer vaccination, in which tumor antigens released from dying tumor cells may be presented in an immunostimulatory context. Moreover, radiation has been demonstrated to induce immunogenic modulation in various tumor types by altering the biology of surviving cells to render them more susceptible to T cell-mediated killing. Finally, radiotherapy typically has a favorable toxicity profile and is associated with the absence of systemic immunosuppression. Together, these properties suggest that radiotherapy may serve as an important component of combinatorial immunotherapies aimed at augmenting systemic antitumor immunity. Here, we provide an overview of the radiation-induced modulations of the immune system that may be harnessed for cancer therapy.
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Affiliation(s)
- Mansoor M Ahmed
- Authors' Affiliations: Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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Narayanan G, Bhatia S, Echenique A, Suthar R, Barbery K, Yrizarry J. Vessel patency post irreversible electroporation. Cardiovasc Intervent Radiol 2014; 37:1523-9. [PMID: 25212418 DOI: 10.1007/s00270-014-0988-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 07/26/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the effect of Irreversible Electroporation (IRE) on vessel patency in close proximity to the ablation zone. MATERIALS AND METHODS Between January 2010 and November 2013, 101 patients underwent percutaneous IRE procedures using the NanoKnife for primary and metastatic tumors in different organs. Age ranged from 24 to 83 years. A total of 129 lesions were treated. [liver (100), pancreas (18), kidney (3), pelvis (1), aorto-caval lymph nodes (2), adrenal (2), lung (1), retroperitoneal (1), surgical bed of a prior Whipple procedure (1)]. Post treatment contrast-enhanced CT and MRI scans were reviewed to evaluate caliber, patency, and flow defects of vessels in close proximity to the ablation zone (defined as vessels within 0-1 cm from the treatment zone). RESULTS A total of 158 vessels were examined for patency on follow-up. The mean distance of the vessel from the treatment zone was 2.3 ± 2.5 mm. Ten vessels within the treatment zone were encased by tumor. Mean tumor size was 2.7 + 1.5 cm. Overall mean follow-up was 10.3 months. Abnormal vascular changes were noted in 7 of 158 (4.4%) vessels. No significant association was found between distances from the treatment zone and presence of narrowing/thrombosis at the follow-up imaging. (Mann-Whitney U, p = 0.772; logistic regression: p = 0.593; odds ratio: 0.908; CI 0.637-1.294). CONCLUSION This study demonstrates safety of IRE for the treatment of tumors near the large blood vessels and tumors already encasing the vessels. Further studies to substantiate these findings are essential to validate this crucial advantage of IRE.
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Affiliation(s)
- Govindarajan Narayanan
- Department of Radiology, University of Miami-Miller School of Medicine, 1475 N.W. 12 Avenue, Miami, FL, 33136, USA,
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Saha S, Bhanja P, Partanen A, Zhang W, Liu L, Tomé W, Guha C. Low intensity focused ultrasound (LOFU) modulates unfolded protein response and sensitizes prostate cancer to 17AAG. Oncoscience 2014; 1:434-45. [PMID: 25594042 PMCID: PMC4284617 DOI: 10.18632/oncoscience.48] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/02/2014] [Indexed: 01/08/2023] Open
Abstract
The hypoxic tumor microenvironment generates oxidative Endoplasmic Reticulum (ER) stress, resulting in protein misfolding and unfolded protein response (UPR). UPR induces several molecular chaperones including heat-shock protein 90 (HSP90), which corrects protein misfolding and improves survival of cancer cells and resistance to tumoricidal therapy although prolonged activation of UPR induces cell death. The HSP90 inhibitor, 17AAG, has shown promise against various solid tumors, including prostate cancer (PC). However, therapeutic doses of 17AAG elicit systemic toxicity. In this manuscript, we describe a new paradigm where the combination therapy of a non-ablative and non-invasive low energy focused ultrasound (LOFU) and a non-toxic, low dose 17AAG causes synthetic lethality and significant tumoricidal effects in mouse and human PC xenografts. LOFU induces ER stress and UPR in tumor cells without inducing cell death. Treatment with a non-toxic dose of 17AAG further increased ER stress in LOFU treated PC and switch UPR from a cytoprotective to an apoptotic response in tumors resulting significant induction of apoptosis and tumor growth retardation. These observations suggest that LOFU-induced ER stress makes the ultrasound-treated tumors more susceptible to chemotherapeutic agents, such as 17AAG. Thus, a novel therapy of LOFU-induced chemosensitization may be designed for locally advanced and recurrent tumors.
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Affiliation(s)
- Subhrajit Saha
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Payel Bhanja
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Wei Zhang
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Laibin Liu
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Wolfgang Tomé
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA ; Montefiore Medical Center, New York, NY, USA
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York, USA ; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA ; Montefiore Medical Center, New York, NY, USA
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Tosi D, Macchi EG, Gallati M, Braschi G, Cigada A, Rossi S, Leen G, Lewis E. Fiber-optic chirped FBG for distributed thermal monitoring of ex-vivo radiofrequency ablation of liver. BIOMEDICAL OPTICS EXPRESS 2014; 5:1799-811. [PMID: 24940541 PMCID: PMC4052912 DOI: 10.1364/boe.5.001799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/13/2014] [Accepted: 03/14/2014] [Indexed: 05/19/2023]
Abstract
A linearly chirped fiber Bragg grating (LCFBG) has been used as a temperature sensor for online monitoring of radiofrequency thermal ablation (RFTA). The LCFBG acts as a distributed sensor, with spatial resolution of 75 μm. A white-light setup that records the LCFBG spectrum estimates the temperature profile in real time. Three RFTA experiments have been performed ex-vivo on porcine liver measuring the radial temperature distribution during the heating process. The analysis of thermal maps quantifies the spatial heat distribution along the measurement axis and determines the ablation efficiency.
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Affiliation(s)
- Daniele Tosi
- University of Limerick, Optical Fibre Sensors Research Centre (OFSRC), Limerick, Ireland
| | - Edoardo Gino Macchi
- Universita’ di Pavia, Dipartimento di Ingegneria Civile ed Architettura, via Ferrata 3, 27100 Pavia (PV), Italy
| | - Mario Gallati
- Universita’ di Pavia, Dipartimento di Ingegneria Civile ed Architettura, via Ferrata 3, 27100 Pavia (PV), Italy
| | - Giovanni Braschi
- Universita’ di Pavia, Dipartimento di Ingegneria Civile ed Architettura, via Ferrata 3, 27100 Pavia (PV), Italy
| | - Alfredo Cigada
- Politecnico di Milano, Dipartimento di Meccanica, via La Masa 34, 20158 Milano (MI), Italy
| | - Sandro Rossi
- IRCCS Policlinico San Matteo Foundation, VI Department of Internal Medicine, v.le Golgi 17, 27100 Pavia (PV), Italy
| | - Gabriel Leen
- University of Limerick, Optical Fibre Sensors Research Centre (OFSRC), Limerick, Ireland
| | - Elfed Lewis
- University of Limerick, Optical Fibre Sensors Research Centre (OFSRC), Limerick, Ireland
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Gazis AN, Beuing O, Franke J, Jöllenbeck B, Skalej M. Bipolar radiofrequency ablation of spinal tumors: predictability, safety and outcome. Spine J 2014; 14:604-8. [PMID: 24139752 DOI: 10.1016/j.spinee.2013.06.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 05/31/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bone metastases are often the cause of tumor-associated pain and reduction of quality of life. For patients that cannot be treated by surgery, a local minimally invasive therapy such as radiofrequency ablation can be a useful option. In cases in which tumorous masses are adjacent to vulnerable structures, the monopolar radiofrequency can cause severe neuronal damage because of the unpredictability of current flow. PURPOSE The aim of this study is to show that the bipolar radiofrequency ablation provides an opportunity to safely treat such spinal lesions because of precise predictability of the emerging ablation zone. STUDY DESIGN Prospective cohort study of 36 patients undergoing treatment at a single institution. PATIENT SAMPLE Thirty-six patients in advanced tumor stage with primary or secondary tumor involvement of spine undergoing radiofrequency ablation. OUTCOME MEASURES Prediction of emerging ablation zone. Clinical outcome of treated patients. METHODS X-ray-controlled treatment of 39 lesions by bipolar radiofrequency ablation. Magnetic resonance imaging was performed pre- and postinterventionally. Patients were observed clinically during their postinterventional stay. RESULTS The extent of the ablation zones was predictable to the millimeter because it did not cross the peri-interventional planned dorsal and ventral boundaries in any case. No complications were observed. CONCLUSIONS Ablation of tumorous masses adjacent to vulnerable structures is feasible and predictable by using the bipolar radiofrequency ablation. Damage of neuronal structures can be avoided through precise prediction of the ablation area.
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Affiliation(s)
- Angelos N Gazis
- Institute of Neuroradiology, University Hospital of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Oliver Beuing
- Institute of Neuroradiology, University Hospital of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Jörg Franke
- Department of Orthopedics, University Hospital of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Boris Jöllenbeck
- Department of Neurosurgery, University Hospital of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Martin Skalej
- Institute of Neuroradiology, University Hospital of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
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Tosi D, Macchi EG, Braschi G, Cigada A, Gallati M, Rossi S, Poeggel S, Leen G, Lewis E. Fiber-optic combined FPI/FBG sensors for monitoring of radiofrequency thermal ablation of liver tumors: ex vivo experiments. APPLIED OPTICS 2014; 53:2136-2144. [PMID: 24787172 DOI: 10.1364/ao.53.002136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/25/2014] [Indexed: 06/03/2023]
Abstract
We present a biocompatible, all-glass, 0.2 mm diameter, fiber-optic probe that combines an extrinsic Fabry-Perot interferometry and a proximal fiber Bragg grating sensor; the probe enables dual pressure and temperature measurement on an active 4 mm length, with 40 Pa and 0.2°C nominal accuracy. The sensing system has been applied to monitor online the radiofrequency thermal ablation of tumors in liver tissue. Preliminary experiments have been performed in a reference chamber with uniform heating; further experiments have been carried out on ex vivo porcine liver, which allowed the measurement of a steep temperature gradient and monitoring of the local pressure increase during the ablation procedure.
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Koethe Y, Xu S, Velusamy G, Wood BJ, Venkatesan AM. Accuracy and efficacy of percutaneous biopsy and ablation using robotic assistance under computed tomography guidance: a phantom study. Eur Radiol 2014; 24:723-30. [PMID: 24220755 PMCID: PMC3945277 DOI: 10.1007/s00330-013-3056-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/24/2013] [Accepted: 10/10/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the accuracy of a robotic interventional radiologist (IR) assistance platform with a standard freehand technique for computed-tomography (CT)-guided biopsy and simulated radiofrequency ablation (RFA). METHODS The accuracy of freehand single-pass needle insertions into abdominal phantoms was compared with insertions facilitated with the use of a robotic assistance platform (n = 20 each). Post-procedural CTs were analysed for needle placement error. Percutaneous RFA was simulated by sequentially placing five 17-gauge needle introducers into 5-cm diameter masses (n = 5) embedded within an abdominal phantom. Simulated ablations were planned based on pre-procedural CT, before multi-probe placement was executed freehand. Multi-probe placement was then performed on the same 5-cm mass using the ablation planning software and robotic assistance. Post-procedural CTs were analysed to determine the percentage of untreated residual target. RESULTS Mean needle tip-to-target errors were reduced with use of the IR assistance platform (both P < 0.0001). Reduced percentage residual tumour was observed with treatment planning (P = 0.02). CONCLUSION Improved needle accuracy and optimised probe geometry are observed during simulated CT-guided biopsy and percutaneous ablation with use of a robotic IR assistance platform. This technology may be useful for clinical CT-guided biopsy and RFA, when accuracy may have an impact on outcome. KEY POINTS • A recently developed robotic intervention radiology assistance platform facilitates CT-guided interventions. • Improved accuracy of complex needle insertions is achievable. • IR assistance platform use can improve target ablation coverage.
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Affiliation(s)
- Yilun Koethe
- Center for Interventional Oncology, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Jin C, He Z, Liu J. MRI-based finite element simulation on radiofrequency ablation of thyroid cancer. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 113:529-538. [PMID: 24411316 DOI: 10.1016/j.cmpb.2013.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/01/2013] [Accepted: 12/16/2013] [Indexed: 06/03/2023]
Abstract
In order to provide a quantitative disclosure on the RFA (radiofrequency ablation)-induced thermal ablation effects within thyroid tissues, this paper has developed a three-dimensional finite element simulation strategy based on a MRI (magnetic resonance imaging)-reconstructed model. The thermal lesion's growth was predicted and interpreted under two treatment conditions, i.e. single-cooled-electrode modality and two-cooled-electrode system. The results show that the thermal lesion's growth is significantly affected by two factors including the position of RF electrode and thermal-physiological behavior of the breathing airflow. Additional parametric studies revealed several valuable phenomena, e.g. with the electrode's movement, thermal injury with varying severity would happen to the trachea wall. Besides, the changes in airflow mass produced evident effects on the total heat flux of thyroid surface, while the changes in breathing frequency only generated minor effects that can be ignored. The present study provided a better understanding on the thermal lesions of RFA within thyroid domain, which will help guide future treatment of the thyroid cancer.
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Affiliation(s)
- Chao Jin
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, PR China
| | - Zhizhu He
- Beijing Key Laboratory of Cryo-Biomedical Engineering, and Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China
| | - Jing Liu
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, PR China; Beijing Key Laboratory of Cryo-Biomedical Engineering, and Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China.
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Deng ZS, Liu J. Chemothermal therapy for localized heating and ablation of tumor. JOURNAL OF HEALTHCARE ENGINEERING 2013; 4:409-26. [PMID: 23965596 DOI: 10.1260/2040-2295.4.3.409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Chemothermal therapy is a new hyperthermia treatment on tumor using heat released from exothermic chemical reaction between the injected reactants and the diseased tissues. With the highly minimally invasive feature and localized heating performance, this method is expected to overcome the ubiquitous shortcomings encountered by many existing hyperthermia approaches in ablating irregular tumor. This review provides a relatively comprehensive review on the latest advancements and state of the art in chemothermal therapy. The basic principles and features of two typical chemothermal ablation strategies (acid-base neutralization-reaction-enabled thermal ablation and alkali-metal-enabled thermal/chemical ablation) are illustrated. The prospects and possible challenges facing chemothermal ablation are analyzed. The chemothermal therapy is expected to open many clinical possibilities for precise tumor treatment in a minimally invasive way.
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Affiliation(s)
- Zhong-Shan Deng
- Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, China.
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Partanen A, Tillander M, Yarmolenko PS, Wood BJ, Dreher MR, Kohler MO. Reduction of peak acoustic pressure and shaping of heated region by use of multifoci sonications in MR-guided high-intensity focused ultrasound mediated mild hyperthermia. Med Phys 2013; 40:013301. [PMID: 23298120 DOI: 10.1118/1.4769116] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Ablative hyperthermia (>55 °C) has been used as a definitive treatment for accessible solid tumors not amenable to surgery, whereas mild hyperthermia (40-45 °C) has been shown effective as an adjuvant for both radiotherapy and chemotherapy. An optimal mild hyperthermia treatment is spatially accurate, with precise and homogeneous heating limited to the target region while also limiting the likelihood of unwanted thermal or mechanical bioeffects (tissue damage, vascular shutoff). Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) can noninvasively heat solid tumors under image-guidance. In a mild hyperthermia setting, a sonication approach utilizing multiple concurrent foci may provide the benefit of reducing acoustic pressure in the focal region (leading to reduced or no mechanical effects), while providing better control over the heating. The objective of this study was to design, implement, and characterize a multifoci sonication approach in combination with a mild hyperthermia heating algorithm, and compare it to the more conventional method of electronically sweeping a single focus. METHODS Simulations (acoustic and thermal) and measurements (acoustic, with needle hydrophone) were performed. In addition, heating performance of multifoci and single focus sonications was compared using a clinical MR-HIFU platform in a phantom (target = 4-16 mm), in normal rabbit thigh muscle (target = 8 mm), and in a Vx2 tumor (target = 8 mm). A binary control algorithm was used for real-time mild hyperthermia feedback control (target range = 40.5-41 °C). Data were analyzed for peak acoustic pressure and intensity, heating energy efficiency, temperature accuracy (mean), homogeneity of heating (standard deviation [SD], T10 and T90), diameter and length of the heated region, and thermal dose (CEM(43)). RESULTS Compared to the single focus approach, multifoci sonications showed significantly lower (67% reduction) peak acoustic pressures in simulations and hydrophone measurements. In a rabbit Vx2 tumor, both single focus and multifoci heating approaches were accurate (mean = 40.82±0.12 °C [single] and 40.70±0.09 °C [multi]) and precise (standard deviation = 0.65±0.05 °C [single] and 0.64±0.04 °C [multi]), producing homogeneous heating (T(10-90) = 1.62 °C [single] and 1.41 °C [multi]). Heated regions were significantly shorter in the beam path direction (35% reduction, p < 0.05, Tukey) for multifoci sonications, i.e., resulting in an aspect ratio closer to one. Energy efficiency was lower for the multifoci approach. Similar results were achieved in phantom and rabbit muscle heating experiments. CONCLUSIONS A multifoci sonication approach was combined with a mild hyperthermia heating algorithm, and implemented on a clinical MR-HIFU platform. This approach resulted in accurate and precise heating within the targeted region with significantly lower acoustic pressures and spatially more confined heating in the beam path direction compared to the single focus sonication method.The reduction in acoustic pressure and improvement in spatial control suggest that multifoci heating is a useful tool in mild hyperthermia applications for clinical oncology.
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Affiliation(s)
- Ari Partanen
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Li Y, Shi G, Wang S, Wang S, Wu R. Iodine quantification with dual-energy CT: phantom study and preliminary experience with VX2 residual tumour in rabbits after radiofrequency ablation. Br J Radiol 2013; 86:20130143. [PMID: 23884759 PMCID: PMC3755393 DOI: 10.1259/bjr.20130143] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/02/2013] [Accepted: 07/17/2013] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The purpose of our study was to validate iodine quantification in a phantom study with dual-source dual-energy CT (DECT) and to apply this technique to differentiate benign periablational reactive tissue from residual tumour in VX2 carcinoma in rabbits after radiofrequency ablation (RFA). METHODS We applied iodine quantification with DECT in a phantom and in VX2 carcinoma in rabbits after incomplete RFA to differentiate benign periablational reactive tissue from residual tumour and evaluated its efficacy in demonstrating response to therapeutic RFA. A series of tubes containing solutions of varying iodine concentration were scanned with DECT. The iodine concentration was calculated and compared with known true iodine concentration. Triple-phase contrast-enhanced DECT data on 24 rabbits with VX2 carcinoma were then assessed at Day 3 (n=6), 1 week (n=6), 2 weeks (n=6) and 3 weeks (n=6) after incomplete RFA independently by 2 readers. Dual-energy postprocessing was used to produce iodine-only images. Regions of interest were positioned on the iodine image over the lesion and, as a reference, over the aorta, to record iodine concentration in the lesion and in the aorta. The pathological specimens were sectioned in the same plane as DECT imaging, and the lesion iodine concentration and lesion-to-aorta iodine ratio of residual tumour and benign periablational reactive tissue were assessed. RESULTS There was excellent correlation between calculated and true iodine concentration (r=0.999, p<0.0001) in the phantom study. The lesion iodine concentration and lesion-to-aorta iodine ratio in residual tumour were significantly higher than in benign periablational reactive tissue in the 2-week group during the arterial phase (AP) (p<0.01) and in the 3-week group during both the AP (p<0.05) and the portal venous phase (p<0.05). There was no significant difference between them with respect to the lesion iodine concentration or lesion-to-aorta iodine ratio in the 3-day and 1-week groups. CONCLUSION Iodine quantification with DECT is accurate in a phantom study and can be used to differentiate benign periablational reactive tissue from residual tumour in VX2 carcinoma in rabbits after RFA. ADVANCES IN KNOWLEDGE Iodine quantification with DECT may help in differentiating benign periablational reactive tissue from residual tumour in VX2 carcinoma in rabbits after RFA.
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Affiliation(s)
- Y Li
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Hebei, China
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Gameiro SR, Higgins JP, Dreher MR, Woods DL, Reddy G, Wood BJ, Guha C, Hodge JW. Combination therapy with local radiofrequency ablation and systemic vaccine enhances antitumor immunity and mediates local and distal tumor regression. PLoS One 2013; 8:e70417. [PMID: 23894654 PMCID: PMC3722166 DOI: 10.1371/journal.pone.0070417] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/23/2013] [Indexed: 02/06/2023] Open
Abstract
Purpose Radiofrequency ablation (RFA) is a minimally invasive energy delivery technique increasingly used for focal therapy to eradicate localized disease. RFA-induced tumor-cell necrosis generates an immunogenic source of tumor antigens known to induce antitumor immune responses. However, RFA-induced antitumor immunity is insufficient to control metastatic progression. We sought to characterize (a) the role of RFA dose on immunogenic modulation of tumor and generation of immune responses and (b) the potential synergy between vaccine immunotherapy and RFA aimed at local tumor control and decreased systemic progression. Experimental Design Murine colon carcinoma cells expressing the tumor-associated (TAA) carcinoembryonic antigen (CEA) (MC38-CEA+) were studied to examine the effect of sublethal hyperthermia in vitro on the cells’ phenotype and sensitivity to CTL-mediated killing. The effect of RFA dose was investigated in vivo impacting (a) the phenotype and growth of MC38-CEA+ tumors and (b) the induction of tumor-specific immune responses. Finally, the molecular signature was evaluated as well as the potential synergy between RFA and poxviral vaccines expressing CEA and a TRIad of COstimulatory Molecules (CEA/TRICOM). Results In vitro, sublethal hyperthermia of MC38-CEA+ cells (a) increased cell-surface expression of CEA, Fas, and MHC class I molecules and (b) rendered tumor cells more susceptible to CTL-mediated lysis. In vivo, RFA induced (a) immunogenic modulation on the surface of tumor cells and (b) increased T-cell responses to CEA and additional TAAs. Combination therapy with RFA and vaccine in CEA-transgenic mice induced a synergistic increase in CD4+ T-cell immune responses to CEA and eradicated both primary CEA+ and distal CEA– s.c. tumors. Sequential administration of low-dose and high-dose RFA with vaccine decreased tumor recurrence compared to RFA alone. These studies suggest a potential clinical benefit in combining RFA with vaccine in cancer patients, and augment support for this novel translational paradigm.
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Affiliation(s)
- Sofia R. Gameiro
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jack P. Higgins
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Matthew R. Dreher
- Center for Interventional Oncology, Radiology, and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
| | - David L. Woods
- Center for Interventional Oncology, Radiology, and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Goutham Reddy
- Center for Interventional Oncology, Radiology, and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology, and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, United States of America
| | - James W. Hodge
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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Size- and Ligand-Specific Bioresponse of Gold Clusters and Nanoparticles: Challenges and Perspectives. STRUCTURE AND BONDING 2013. [DOI: 10.1007/430_2013_127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Partanen A, Yarmolenko PS, Viitala A, Appanaboyina S, Haemmerich D, Ranjan A, Jacobs G, Woods D, Enholm J, Wood BJ, Dreher MR. Mild hyperthermia with magnetic resonance-guided high-intensity focused ultrasound for applications in drug delivery. Int J Hyperthermia 2012; 28:320-36. [PMID: 22621734 DOI: 10.3109/02656736.2012.680173] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Mild hyperthermia (40-45 °C) is a proven adjuvant for radiotherapy and chemotherapy. Magnetic resonance guided high intensity focused ultrasound (MR-HIFU) can non-invasively heat solid tumours under image guidance. Low temperature-sensitive liposomes (LTSLs) release their drug cargo in response to heat (>40 °C) and may improve drug delivery to solid tumours when combined with mild hyperthermia. The objective of this study was to develop and implement a clinically relevant MR-HIFU mild hyperthermia heating algorithm for combination with LTSLs. MATERIALS AND METHODS Sonications were performed with a clinical MR-HIFU platform in a phantom and rabbits bearing VX2 tumours (target = 4-16 mm). A binary control algorithm was used for real-time mild hyperthermia feedback control (target = 40-41 °C). Drug delivery with LTSLs was measured with HPLC. Data were compared to simulation results and analysed for spatial targeting accuracy (offset), temperature accuracy (mean), homogeneity of heating (standard deviation (SD), T10 and T90), and thermal dose (CEM43). RESULTS Sonications in a phantom resulted in better temperature control than in vivo. Sonications in VX2 tumours resulted in mean temperatures between 40.4 °C and 41.3 °C with a SD of 1.0-1.5 °C (T10 = 41.7-43.7 °C, T90 = 39.0-39.6 °C), in agreement with simulations. 3D spatial offset was 0.1-3.2 mm in vitro and 0.6-4.8 mm in vivo. Combination of MR-HIFU hyperthermia and LTSLs demonstrated heterogeneous delivery to a partially heated VX2 tumour, as expected. CONCLUSIONS An MR-HIFU mild hyperthermia heating algorithm was developed, resulting in accurate and homogeneous heating within the targeted region in vitro and in vivo, which is suitable for applications in drug delivery.
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Affiliation(s)
- Ari Partanen
- Center for Interventional Oncology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Thaker AA, Razjouyan F, Woods DL, Haemmerich D, Sekhar K, Wood BJ, Dreher MR. Combination therapy of radiofrequency ablation and bevacizumab monitored with power Doppler ultrasound in a murine model of hepatocellular carcinoma. Int J Hyperthermia 2012; 28:766-75. [PMID: 23043501 DOI: 10.3109/02656736.2012.724517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The purpose of this study was to monitor tumour blood flow with power Doppler ultrasound following antiangiogenic therapy with bevacizumab in order to optimally time the application of radiofrequency (RF) ablation to increase ablation diameter. MATERIALS AND METHODS Athymic nude mice bearing human hepatocellular carcinoma xenografts were treated with bevacizumab and imaged daily with power Doppler ultrasound to quantify tumour blood flow. Mice were treated with RF ablation alone or in combination with bevacizumab at the optimal time, as determined by ultrasound. Ablation diameter was measured with histology and tumour microvascular density was calculated with immunohistochemistry. A computational thermal model of RF ablation was used to estimate ablation volume. RESULTS A maximum reduction of 27.8 ± 8.6% in tumour blood flow occurred on day 2 following antiangiogenic therapy, while control tumours increased 29.3 ± 17.1% (p < 0.05). Tumour microvascular density was similarly reduced by 45.1 ± 5.9% on day 2 following antiangiogenic therapy. Histology demonstrated a 13.6 ± 5.6% increase in ablation diameter (40 ± 21% increase in volume) consistent with a computational model. CONCLUSION Quantitative power Doppler ultrasound is a useful biomarker to monitor tumour blood flow following antiangiogenic treatment and to guide the application of RF ablation as a drug plus device combination therapy.
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Affiliation(s)
- Ashesh A Thaker
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Bahl A, Kapoor R, Singh PK, Bhattacharya T, Arun OS, Parsee T, Sharma SC. Locally ablative non-surgical management of colo-rectal liver metastasis. J Gastrointest Cancer 2012; 44:108-10. [PMID: 22864942 DOI: 10.1007/s12029-012-9427-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Liver is one of the commonest sites of metastasis in colorectal cancer patients. Solitary liver metastasis or oligometastasis are traditionally treated by surgical resection or chemotherapy. DISCUSSION There may be a subgroup of these patients who are not suitable for surgery or chemotherapy due to various co-morbid factors. These patients can be treated by novel minimally invasive or noninvasive ablative techniques like interstitial brachytherapy, extracranial stereotactic radiotherapy, and radiofrequency ablation.
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Affiliation(s)
- Amit Bahl
- Department of Radiation Oncology, Regional Cancer Center, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Lewis AL, Dreher MR. Locoregional drug delivery using image-guided intra-arterial drug eluting bead therapy. J Control Release 2012; 161:338-50. [PMID: 22285550 PMCID: PMC3351580 DOI: 10.1016/j.jconrel.2012.01.018] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/13/2012] [Accepted: 01/15/2012] [Indexed: 12/30/2022]
Abstract
Lipiodol-based transarterial chemoembolization (TACE) has been performed for over 3 decades for the treatment of solid tumors and describes the infusion of chemotherapeutic agents followed by embolization with particles. TACE is an effective treatment for inoperable hepatic tumors, especially hypervascular tumors such as hepatocellular carcinoma. Recently, drug eluting beads (DEBs), in which a uniform embolic material is loaded with a drug and delivered in a single image-guided step, have been developed to reduce the variability in a TACE procedure. DEB-TACE results in localization of drug to targeted tumors while minimizing systemic exposure to chemotherapeutics. Once localized in the tissue, drug is eluted from the DEB in a controlled manner and penetrates hundreds of microns of tissue from the DEB surface. Necrosis is evident surrounding a DEB in tissue days to months after therapy; however, the contribution of drug and ischemia is currently unknown. Future advances in DEB technology may include image-ability, DEB size tailored to tumor anatomy and drug combinations.
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Affiliation(s)
- Andrew L Lewis
- Biocompatibles UK Ltd, Farnham Business Park, Weydon Lane, Farnham, Surrey, GU9 8QL, UK.
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Image-based 3D modeling and validation of radiofrequency interstitial tumor ablation using a tissue-mimicking breast phantom. Int J Comput Assist Radiol Surg 2012; 7:941-8. [PMID: 22688380 DOI: 10.1007/s11548-012-0769-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 05/29/2012] [Indexed: 01/18/2023]
Abstract
PURPOSE Minimally invasive treatment of solid cancers, especially in the breast and liver, remains clinically challenging, despite a variety of treatment modalities, including radiofrequency ablation (RFA), microwave ablation or high-intensity focused ultrasound. Each treatment modality has advantages and disadvantages, but all are limited by placement of a probe or US beam in the target tissue for tumor ablation and monitoring. The placement is difficult when the tumor is surrounded by large blood vessels or organs. Patient-specific image-based 3D modeling for thermal ablation simulation was developed to optimize treatment protocols that improve treatment efficacy. METHODS A tissue-mimicking breast gel phantom was used to develop an image-based 3D computer-aided design (CAD) model for the evaluation of a planned RF ablation. First, the tissue-mimicking gel was cast in a breast mold to create a 3D breast phantom, which contained a simulated solid tumor. Second, the phantom was imaged in a medical MRI scanner using a standard breast imaging MR sequence. Third, the MR images were converted into a 3D CAD model using commercial software (ScanIP, Simpleware), which was input into another commercial package (COMSOL Multiphysics) for RFA simulation and treatment planning using a finite element method (FEM). For validation of the model, the breast phantom was experimentally ablated using a commercial (RITA) RFA electrode and a bipolar needle with an electrosurgical generator (DRE ASG-300). The RFA results obtained by pre-treatment simulation were compared with actual experimental ablation. RESULTS A 3D CAD model, created from MR images of the complex breast phantom, was successfully integrated with an RFA electrode to perform FEM ablation simulation. The ablation volumes achieved both in the FEM simulation and the experimental test were equivalent, indicating that patient-specific models can be implemented for pre-treatment planning of solid tumor ablation. CONCLUSION A tissue-mimicking breast gel phantom and its MR images were used to perform FEM 3D modeling and validation by experimental thermal ablation of the tumor. Similar patient-specific models can be created from preoperative images and used to perform finite element analysis to plan radiofrequency ablation. Clinically, the method can be implemented for pre-treatment planning to predict the effect of an individual's tissue environment on the ablation process, and this may improve the therapeutic efficacy.
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Bipolar radio frequency ablation of spinal neoplasms in late stage cancer disease: a report of three cases. Spine (Phila Pa 1976) 2012; 37:E64-8. [PMID: 21508889 DOI: 10.1097/brs.0b013e31821cc57e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To avoid neuronal damage by using the bipolar radio frequency ablation of spinal tumors. SUMMARY OF BACKGROUND DATA Radio frequency ablation of tumorous masses is an established procedure and is increasingly used as pain therapy of unresectable spine tumors. Ablation of lesions adjacent to vulnerable structures remains a challenging task because flow of current is insufficiently controlled by monopolar probes. Using this technique, a prediction of the induced necrosis accurate to the millimeter is not feasible. METHODS Three patients with metastases of the spine were treated using the bipolar radio frequency ablation. RESULTS In all 3 cases collateral damage of neuronal structures could be avoided even though tumorous masses touched the cauda equina or were very close to vulnerable structures, respectively. The induction of necrosis was predictable to the millimeter. CONCLUSION Ablation of tumorous masses adjacent to neural structures by bipolar technique, is feasible and predictable. Spinal cord damage can be avoided by exact planning of the induced necrosis.
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Colen RR, Jolesz FA. MR-Guided Focused Ultrasound of the Brain. INTERVENTIONAL MAGNETIC RESONANCE IMAGING 2012. [DOI: 10.1007/174_2012_616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Klimberg VS, Boneti C, Adkins LL, Smith M, Siegel E, Zharov V, Ferguson S, Henry-Tillman R, Badgwell B, Korourian S. Feasibility of percutaneous excision followed by ablation for local control in breast cancer. Ann Surg Oncol 2011; 18:3079-87. [PMID: 21904959 DOI: 10.1245/s10434-011-2002-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE Percutaneous ablation of breast cancer has shown promise as a treatment alternative to open lumpectomy. We hypothesized that percutaneous removal of breast cancer followed by percutaneous ablation to sterilize and widen the margins would not only provide fresh naive tissue for tumor marker and research investigation, but also better achieve negative margins after ablation. METHODS Patients diagnosed by percutaneous biopsy (ultrasound or stereotactic-guided) with breast cancer ≤1.5 cm, >1 cm from the skin, and ≤1 cm residual disease and no multicentric disease by magnetic resonance imaging were accrued to this institutional review board-approved study. Patients were randomized to laser versus radiofrequency ablation. The ultrasound-guided ablation was performed in the operating room and followed by immediate excision, whole-mount pathology with proliferating cell nuclear antigen staining, and reconstruction. RESULTS Twenty-one patients were enrolled onto the study. Fifteen patients received radiofrequency ablation, and all showed 100% ablation and negative margins. Magnetic resonance imaging was helpful in excluding multicentric disease but less so in predicting presence or absence of residual disease. Seven of these patients showed no residual tumor and eight showed residual dead tumor (0.5 ± 0.7 cm, range 0.1-2.5 cm) at the biopsy site with clear margins. The laser arm (3 patients) pathology demonstrated unpredictability of the ablation zone and residual live tumor. CONCLUSIONS This pilot study demonstrates the feasibility of a novel approach to minimally invasive therapy: percutaneous excision and effective cytoreduction, followed by radiofrequency ablation of margins for the treatment of breast cancer. Laser treatment requires further improvement.
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Affiliation(s)
- V Suzanne Klimberg
- Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA.
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Ultrasound-Guided, Video-Assisted Transdiaphragmatic Radiofrequency Ablation for Primary Liver Malignancy or Metastatic Nodules. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ultrasound-Guided, Video-Assisted Transdiaphragmatic Radiofrequency Ablation for Primary Liver Malignancy or Metastatic Nodules. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011; 6:337-40. [PMID: 22436711 DOI: 10.1097/imi.0b013e3182362738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective Percutaneous radiofrequency ablation (RFA) is among the best options in the treatment of primary liver malignancy and metastases because it is a highly effective and minimally invasive alternative to resection in small, nonresectable tumors or in poor surgical candidates and is associated with low morbidity and mortality. We evaluated the clinical feasibility and safety of thoracoscopic, ultrasound (US)-guided RFA of subdiaphragmatic liver malignancies in advanced cirrhotic patients awaiting transplantation. Methods Two patients (one female and one male) with end-stage cirrhosis who developed hepatocellular carcinoma were treated thoracoscopically by US-guided RFA. An endoscopic US probe was inserted into the right pleural space through a 10-mm working channel. An RF-operating needle applicator was inserted through a second 10-mm working port after identification of the lesion, penetrating the diaphragm toward the lesion. The procedure duration, applied energy, and generator output were recorded during the intervention. The treatment result and procedure-related complications were analyzed. Results The procedure duration was 74 and 92 minutes, respectively. A mean energy deposition of 353 joules resulted in a mean coagulation volume of 115 cm. Tumor ablation was achieved as determined by the postinterventional lack of contrast enhancement in the target region at the follow-up computed tomographic scans performed after 4 months. Conclusions RFA offers definite possibilities in the management of small-sized tumors. Thoracoscopic, US-guided transdiaphragmatic RFA has proven to be clinically feasible and safe and can be an effective modality for treating subdiaphragmatic liver lesions. Its minimally invasive nature is the most important advantage compared with surgical resection, especially for patients with high operative risk.
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Dib RE, Touma NJ, Kapoor A. Review of the efficacy and safety of radiofrequency ablation for the treatment of small renal masses. Can Urol Assoc J 2011; 3:143-9. [PMID: 19424470 DOI: 10.5489/cuaj.1048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Small renal masses are increasingly being discovered incidentally on imaging performed for another reason. The standard of care for these masses involves excision by open or laparoscopic techniques. Recently, ablative techniques such as radiofrequency ablation (RFA) and cryoablation have taken a more prominent role in the treatment algorithm for these masses. We sought to evaluate the efficacy and safety of radiofrequency ablation in the treatment of renal tumours. METHODS We conducted a review of the literature. There was no language restriction. We obtained studies from the following sources: the Cochrane Library, PubMed, EMBASE, LILACS and Current Controlled Trials. RESULTS We identified no clinical trials in the literature. Thus we described the results from case series and retrospective studies with a reasonable sample size (number of reported patients in each study > 65). Most patients undergoing RFA had T1a disease with a mean tumour size of about 3 cm. Radiofrequency ablation was usually performed percutaneously with image guidance. Reported follow-up was short and ranged from 1 to 30 months. Most series used radiographic response as a surrogate for cancer control. The rates of local recurrence of the tumour were as high as 13.0% (average 8.5%) and were slightly higher than those associated with cryoablation and partial nephrectomy. Complications included hemorrhage, ureteral strictures and loss of a renal unit. CONCLUSION Our review demonstrates that RFA is a suitable and promising therapy in patients with small renal tumours who are considered to be poor candidates for more involved surgery. However, clinical trials with long-term data are needed to establish the oncological efficacy.
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Affiliation(s)
- Regina El Dib
- Post-doctoral Urology Fellow, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
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Dasgupta S, Banerjee RK, Hariharan P, Myers MR. Beam localization in HIFU temperature measurements using thermocouples, with application to cooling by large blood vessels. ULTRASONICS 2011; 51:171-180. [PMID: 20817250 DOI: 10.1016/j.ultras.2010.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 07/16/2010] [Accepted: 07/22/2010] [Indexed: 05/29/2023]
Abstract
Experimental studies of thermal effects in high-intensity focused ultrasound (HIFU) procedures are often performed with the aid of fine wire thermocouples positioned within tissue phantoms. Thermocouple measurements are subject to several types of error which must be accounted for before reliable inferences can be made on the basis of the measurements. Thermocouple artifact due to viscous heating is one source of error. A second is the uncertainty regarding the position of the beam relative to the target location or the thermocouple junction, due to the error in positioning the beam at the junction. This paper presents a method for determining the location of the beam relative to a fixed pair of thermocouples. The localization technique reduces the uncertainty introduced by positioning errors associated with very narrow HIFU beams. The technique is presented in the context of an investigation into the effect of blood flow through large vessels on the efficacy of HIFU procedures targeted near the vessel. Application of the beam localization method allowed conclusions regarding the effects of blood flow to be drawn from previously inconclusive (because of localization uncertainties) data. Comparison of the position-adjusted transient temperature profiles for flow rates of 0 and 400ml/min showed that blood flow can reduce temperature elevations by more than 10%, when the HIFU focus is within a 2mm distance from the vessel wall. At acoustic power levels of 17.3 and 24.8W there is a 20- to 70-fold decrease in thermal dose due to the convective cooling effect of blood flow, implying a shrinkage in lesion size. The beam-localization technique also revealed the level of thermocouple artifact as a function of sonication time, providing investigators with an indication of the quality of thermocouple data for a given exposure time. The maximum artifact was found to be double the measured temperature rise, during initial few seconds of sonication.
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Affiliation(s)
- Subhashish Dasgupta
- Mechanical Engineering Department, University of Cincinnati, Cincinnati, OH 45220, USA
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Künzli BM, Abitabile P, Maurer CA. Radiofrequency ablation of liver tumors: Actual limitations and potential solutions in the future. World J Hepatol 2011; 3:8-14. [PMID: 21307982 PMCID: PMC3035700 DOI: 10.4254/wjh.v3.i1.8] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 12/07/2010] [Accepted: 12/14/2010] [Indexed: 02/06/2023] Open
Abstract
Over the past decade, radiofrequency ablation (RFA) has evolved into an important therapeutical tool for the treatment of non resectable primary and secondary liver tumors. The clinical benefit of RFA is represented in several clinical studies. They underline the safety and feasibility of this new and modern concept in treating liver tumors. RFA has proven its clinical impact not only in hepatocellular carcinoma (HCC) but also in metastatic disease such as colorectal cancer (CRC). Due to the increasing number of HCC and CRC, RFA might play an even more important role in the future. Therefore, the refinement of RFA technology is as important as the evaluation of data of prospective randomized trials that will help define guidelines for good clinical practice in RFA application in the future. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with extensive tumors. Adverse effects of RFA such as biliary tract damage, liver failure and local recurrence remain an important task today but overall the long term results of RFA application in treating liver tumors are promising. Incomplete ablation of liver tumors due to insufficient technology of ablation needles, tissue cooling by the neighbouring blood vessels, large tumor masses and ablation of tumors in close vicinity to heat sensitive organs remain difficult tasks for RFA. Future solutions to overcome these limitations of RFA will include refinement of ultrasonographic guidance (accuracy of probe placement), improvements in needle technology (e.g. needles preventing charring) and intraductal cooling techniques.
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Affiliation(s)
- Beat M Künzli
- Beat M Künzli, Paolo Abitabile, Christoph A Maurer, Department of Surgery, Kantonsspital Liestal, Liestal, CH-4416, Switzerland
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Colen RR, Jolesz FA. Future potential of MRI-guided focused ultrasound brain surgery. Neuroimaging Clin N Am 2010; 20:355-66. [PMID: 20708551 DOI: 10.1016/j.nic.2010.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Magnetic resonance image-guided focused ultrasound surgery (MRgFUS) has surfaced as a viable noninvasive image-guided therapeutic method that integrates focused ultrasound (FUS), the therapeutic component, with magnetic resonance imaging (MRI), the image guidance module, into a real-time therapy delivery system with closed-loop control of energy delivery. The main applications for MRgFUS of the brain are thermal ablations for brain tumors and functional neurosurgery, and nonthermal, nonablative uses for disruption of the blood brain barrier (BBB) or blood clot and hematoma dissolution by liquification. The disruption of the BBB by FUS can be used for targeted delivery of chemotherapy and other therapeutic agents. MRI is used preoperatively for target definition and treatment planning, intraoperatively for procedure monitoring and control, and postoperatively for validating treatment success. Although challenges still remain, this integrated noninvasive therapy delivery system is anticipated to change current treatment paradigms in neurosurgery and the clinical neurosciences.
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Affiliation(s)
- Rivka R Colen
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Arvizo R, Bhattacharya R, Mukherjee P. Gold nanoparticles: opportunities and challenges in nanomedicine. Expert Opin Drug Deliv 2010; 7:753-63. [PMID: 20408736 DOI: 10.1517/17425241003777010] [Citation(s) in RCA: 320] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Site-specific drug delivery is an important area of research that is anticipated to increase the efficacy of the drug and reduce potential side effects. Owing to this, substantial work has been done developing non-invasive and targeted tumor treatment with nanoscale metallic particles. AREAS COVERED IN THIS REVIEW This review focuses on the work done in the last few years developing gold nanoparticles as cancer therapeutics and diagnostic agents. However, there are challenges in using gold nanoparticles as drug delivery systems, such as biodistribution, pharmacokinetics and possible toxicity. Approaches to limit these issues are proposed. WHAT THE READER WILL GAIN Different approaches from several different disciplines are discussed. Potential clinical applications of these engineered nanoparticles are also presented. TAKE HOME MESSAGE As a result of their unique size-dependent physicochemical and optical properties, adaptability, subcellular size and biocompatibility, these nanosized carriers offer a suitable means of transporting small molecules as well as biomacromolecules to diseased cells/tissues.
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Affiliation(s)
- Rochelle Arvizo
- Cancer Center, Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
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Padma S, Martinie JB, Iannitti DA. Liver tumor ablation: percutaneous and open approaches. J Surg Oncol 2010; 100:619-34. [PMID: 20017157 DOI: 10.1002/jso.21364] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The global incidence of liver cancer is greater than a million cases a year. Surgical resection where applicable is still the standard of care for these patients. Various liver-directed regional therapies have been developed in an effort to treat the vast majority of unresectable liver tumors. This article reviews the principles behind various ablation therapies currently available for malignant liver tumors and their outcomes.
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Affiliation(s)
- Srikanth Padma
- Section of Hepato-Pancreatico-Biliary Surgery, Division of GI & Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA
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