Hyperthermia quality assurance guidelines

Expansion of thermometry in magnetic hyperthermia cancer therapy: antecedence and aftermath

Magnetic hyperthermia cancer therapy (MHCT) is a promising antitumor therapy based on the generation of heat by magnetic nanoparticles under the influence of an alternating-current magnetic field. However, an often-overlooked factor hindering the translation of MHCT to clinics is the inability to accurately monitor temperature, thereby leading to erroneous thermal control. It is significant to address 'thermometry' during magnetic hyperthermia because numerous factors are affected by the magnetic fields employed, rendering traditional thermometry methods unsuitable for temperature estimation. Currently, there is a dearth of literature describing appropriate techniques for thermometry during MHCT. This review offers a general outline of the various modes of conventional thermometry as well as cutting-edge techniques operating at cellular/nanoscale levels (nanothermometry) as prospective thermometers for MHCT in the future.

Hyperthermia, radiation and chemotherapy: the role of heat in multidisciplinary cancer care

The compelling biologic basis for combining hyperthermia with modern cancer therapies including radiation and chemotherapy was first appreciated nearly half a century ago. Hyperthermia complements radiation as conditions contributing to radio-resistance generally enhance sensitivity to heat and sensitizing effects occur through increased perfusion/tumor oxygenation and alteration of cellular death pathways. Chemosensitization with hyperthermia is dependent on the particular mechanism of effect for each agent with synergistic effects noted for several commonly used agents. Clinically, randomized trials have demonstrated benefit including survival with the addition of hyperthermia to radiation or chemotherapy in treatment of a wide range of malignancies. Improvements in treatment delivery techniques, streamlined logistics, and greater understanding of the relationship of thermal dosimetry to treatment outcomes continue to facilitate wider clinical implementation. Evolving applications include thermal enhancement of immunotherapy, targeted drug delivery and application of principals of thermal biology towards integration of thermal ablation into multimodality oncologic care.

The role of hyperthermia in the battle against cancer

Aims and background

Hyperthermia, the heating of tumors to 41.5–43 °C, could be today considered the fourth pillar of the treatment of cancer. Employed for 20 years in Europe, the USA and Asia, hyperthermia, used in addition to radiotherapy, chemotherapy and surgery, increases both local control and overall survival, restores the chance of the surgery for inoperable tumors and allows a new low-dosage treatment of relapsed cancers previously treated with high radiotherapy dosage without increasing toxicity.

Methods

Hyperthermia can be either superficial, produced by a microwave generator, or regional, produced by a radiofrequency applicator with multiple antennas, which emanate a deep focalized or interstitial heating.

Results

The results are confirmed by phase III randomized trials, with level 1 evidence. A review of the international literature on hyperthermia, the experience of the University Hospital of Verona Radiotherapy Department (Italy) and a summary of the Symposium regarding the Evolution of Clinical Hyperthermia plus Radiotherapy during the Twentieth Congress of the French Society of Radiation Oncology (SFRO) are presented.

Conclusions

Hyperthermia is an important treatment modality in cancer treatment and its results are strongly supported by criteria of evidence-based medicine. Fifteen years of experience of the Radiation Oncology Department in Verona confirms the positive results obtained with international prospective trials, with level 1 evidence. Hyperthermia appears to be the fourth pillar beside surgery, radiotherapy and chemotherapy. Free full text available at www.tumorionline.it

RHyThM, a tool for analysis of PDOS formatted hyperthermia treatment data generated by the BSD2000/3D system

One of the systems used by hyperthermia (HT) groups for heating tumours in the pelvic region is the BSD2000 system. Previous versions of the BSD2000 operate on a PDOS machine and the majority of the currently installed BSD2000/3D systems are still running under PDOS. Availability of the PDOS formatted treatment data provided by the BSD2000/3D has some difficulties. To facilitate analysis of the PDOS formatted treatment data generated by the BSD2000/3D a programme, called RHyThM (Rotterdam Hyperthermia Thermal Modulator) has been created. The purpose of RHyThM is first to read and check the integrity and validity of the treatment data for each measurement in time and space as provided by the BSD2000/3D and secondly to register a tissue type, based on computer tomography information, for each temperature probe position. Prior to any analyses, RHyThM shows the temperature profiles enabling the user to check on probe movement and to correct for unrealistically high temperature gradients in time and space. Subsequently, this approved data set is saved in a 'mother-file' for future on-demand thermal dose analyses. A unique feature of RHyThM is that it also shows all radiofrequency (RF) power signals for inspection. Finally, to make a quick assessment of the quality of the applied HT-treatment, RHyThM reports several temperature indices for bladder, vagina and rectum as well as RF-power related quantities. In summary, RHyThM is considered a valuable tool as it quickly provides a quality index per treatment, which serves as input for the preparation of the next treatment. Further, it makes verified and improved primary data sets accessible for further analysis with advanced statistical programmes.

Thermal and SAR characterization of multielement dual concentric conductor microwave applicators for hyperthermia, a theoretical investigation

Six aperture array dual concentric conductor (DCO) microwave hyperthermia applicators were studied using theoretical models to characterize power deposition (SAR) and steady state temperature distributions in perfused tissue. SAR patterns were calculated using the finite difference time domain (FDTD) numerical method, and were used as input to a finite difference thermal modeling program based on the Pennes Bio-Heat Equation in order to calculate corresponding temperature distributions. Numerous array configurations were investigated including the use of different size DCC apertures (2, 3, and 4 cm), different spacing between apertures (1.0-2.0 cm), and different water bolus thicknesses (5-15 mm). Thermal simulations were repeated using blood perfusion values ranging from 0.5 to 5 kg/m3 s. Results demonstrate the ability of DCC array applicators to effectively and uniformly heat tissue down to a depth of 7.5-10 mm below the skin surface for a large number of different combinations of DCC element size, spacing, and water bolus thickness. Results also reveal the close correlation between SAR patterns and corresponding temperature distributions, verifying that design studies of the applicator can be performed confidently by analysis of SAR, from which the thermal behavior can be estimated. These simulations are useful in the design optimization of large microwave DCC array applicators for superficial tissue heating and for identifying appropriate aperture spacing and bolus thickness parameters for different size DCC aperture arrays and tissue blood perfusion conditions.

A multi-user networked database for analysis of clinical and temperature data from patients treated with simultaneous radiation and ultrasound hyperthermia

A database was developed using commercially available development software that allows the entry of clinical data and automatically analyses temperature and power data from a commercial ultrasound hyperthermia system. The database can be accessed via network connections by more than one authorized user, thus facilitating the entry, management, and analysis of clinical data. The software automatically estimates ultrasound induced temperature artifacts and calculates thermal dose parameters such as T90s, equivalent minutes at 43 degrees, and time at or above index temperatures using the corrected temperatures. These parameters also become part of the database. Digital photographs of treatment setup, probe placement, and tumour or normal tissue response can be included in the database for documentation and reference. Ultrasound diagnostic images that document the depth and reproducibility of probe placement can be scanned into the PC and included in the database as well. This short communication documents experiences developing this tool that may be useful to other investigators.

Comparison of fluence rate distributions made by side-firing fibers in an optical phantom

Side-firing fibers are used to provide coagulative therapy to the urologic tract. These fibers use different optical technologies to deflect the beam transverse to the fibers' optical axis. This produces emitted beams which differ in both beam direction and divergence angles. The relative optical performance of 13 fibers was studied in an optical phantom suspension. The fluence rate distribution created by each side-firing fiber was determined. The fluence rate distribution accounts for both the direct and spurious beams emitted from side-firing fibers as well as the light scattering produced by the target tissue. Based upon limited clinical dosimetry studies, the relative fluence rate distribution appears to indicate general exposure conditions for the evaluated fibers. © 1999 Society of Photo-Optical Instrumentation Engineers.

Biological rationale and clinical experience with hyperthermia

Hyperthermia (HT) as an adjunct to radiation therapy (RT) has been a focus of interest in cancer management in recent years there have been numerous randomized and nonrandomized studies conducted to assess the efficacy of HT combined with either RT or chemotherapy especially in the treatment of superficially seated malignant tumors. The major impact of HT is currently on locoregional control of tumor. Heat may be directly cytotoxic to tumor cells or inhibit repair of both sublethal and potentially lethal damage after radiation. These effects are augmented by the physiological conditions in tumor that lead to states of acidosis and hypoxia. Blood flow is often impaired in tumor relative to normal tissues, and HT may lead to a further decrease in blood flow and augment heat sensitivity. Three major areas of clinical investigation have borne the greatest fruit for HT as adjunctive therapy to RT. These include recurrent and primary breast lesions, melanoma, and head and neck neoplasms. Thermal enhancement ratio was increased in all cases and is approximately 1.4 for neck nodes, 1.5 for breast, and 2 for malignant melanoma. In general, the most important prognostic factors for complete response (CR) are RT dose, tumor size and minimal thermal parameters minimal thermal dose (t43min), mean minimal temperature (Tmin) or T90, i.e., temperature exceeded by 90% of thermal sensors]. The number of HT fractions administered per week appears to have no bearing on the overall response, which may be indicative of the effects of thermotolerance. The total number of HT fractions delivered also appears irrelevant provided adequate HT is delivered in one or two sessions. The major prognostic factors for the duration of local control were tumor histology, concurrent RT dose, tumor depth and Tmin. Although numerous single institution studies showed increased CR rates and improved local control, the efficacy of HT as an adjunct to RT should be assessed with well-designed multi-institutional randomized clinical trials. Such clinical trials are underway.

Thermoradiotherapy of superficial and subsurface tumours: analysis of thermal parameters and tumour response

Between 1988 and 1993, 57 superficial and subsurface tumours of various tumour type were treated with a 430-MHz microwave heating device. Mean (range) tumour depth of the 57 tumours was 3.0 (0.5-6.5) cm. Fifty-four tumours were treated with thermoradiotherapy. Total radiation dose ranged from 20 to 70 Gy with a mean of 53 Gy. For the remaining three tumours, thermochemotherapy was performed. Hyperthermia was given once a week, and a total of 207 heat sessions was administered. Our goal of hyperthermia treatment was to elevate all monitored tumour points > 41 degrees C for > 30 min. The mean (range) number of intratumoral thermometry points was 3.7 (2-6). The goal of hyperthermia treatment was achieved in 49% of the sessions. At the time of maximum tumour regression, complete response was noted in 53% of the tumours treated with thermoradiotherapy. Univariate analysis demonstrated that parameters including tumour type (breast cancer versus others), tumour depth, minimum tumour temperature, average tumour temperature, minimum equivalent time at 43 degrees C, and number of heat sessions achieving the treatment goal significantly affected the tumour response of the combined treatment, while total radiation dose and number of heat sessions were not significant factors for tumour response. Multivariate logistic analysis revealed that only tumour depth (< 3 versus > or = 3 cm) was a significant prognostic factor for tumour response (p = 0.029). Tumour type (breast cancer versus others) and a number of heat sessions achieving the treatment goal (0-1 versus 2-5) were found to be of borderline significance in the multivariate analysis (p = 0.075 and 0.097 respectively). The number of heat sessions achieving a minimum tumour temperature of > 41 degrees C for > 30 min seems a practical thermal parameter that influences tumour response. The present study indicates the importance of quality and quantity of heat session on the treatment outcome of thermoradiotherapy.

Use of manganin-constantan thermocouples in thermometry units designed for copper-constantan thermocouples

Commercial ultrasound hyperthermia systems typically include thermometry units designed for copper-constantan thermocouples. Replacing these copper-constantan thermocouples with manganin-constantan thermocouples is advantageous in reducing the measurement error caused by the conduction of heat along the copper wire, but their performance in these thermometry units is uncertain. The accuracy of manganin-constantan thermocouples in the Labthermics LT-100, Clini-Therm TS1200/TM100, and Physitemp TM-12 thermometry units was investigated using a temperature controlled circulating water bath monitored by a mercury thermometer having a calibration traceable to NIST. The results demonstrate that an accuracy of +/- 0.2 degrees C can be achieved with manganin-constantan thermocouples over the range 35-55 degrees C without hardware modification provided specific calibration procedures are followed. With the Labthermics LT-100, a double point calibration should be carried out at 35 and 55 degrees C. With the Clini-Therm TS1200/TM100, a self-calibration of the unit using its internal calibration well plus a single point calibration using an external temperature standard provides sufficient accuracy. The Physitemp TM-12 requires an external computer for read out and the user must provide additional software to correct for the error by either a single or multiple point calibration.

High dose-rate induced temperature artifacts: thermometry considerations for simultaneous interstitial thermoradiotherapy

PURPOSE

The goal of the present study was to investigate the effect of high dose-rate radiation on a flouroptic thermometry system commonly used during microwave hyperthermia.

METHODS AND MATERIALS

Measurements were performed by placing the flouroptic thermometry sensors at distances of < or = 1.5, 5, 10, and 15 mm from a remote afterloading high dose-rate 192Ir source in a water bath (at two different temperatures) and in a tissue equivalent radiation bolus medium. A simulated volumetric clinical setup using a radiation bolus medium was performed with thermometry sensors placed at 1.5, 7.5, 8.4, and 10.6 mm from a scanning high dose-rate source.

RESULTS

It was found that high dose-rate radiation caused thermometry artifacts greater than 1.5 degrees C within 2 min for flouroptic thermometers placed 1.5 mm from a 5 Ci activity high dose-rate source. Simple calculations showed that artifacts of this magnitude could not be due to any heating caused by the energy deposited by the high dose-rate source. The artifact decayed, but was still evident 24 h after the exposure. The effect strongly depended on distance with a 0.7 degrees C artifactual increase in temperature seen for the probe 5 mm from the high dose-rate source. Moreover, experiments performed under conditions that represented a clinical setup with a 7 Ci high dose-rate source showed that for exposure times of 10 s, at distances of 1.5 mm, significant artifacts (> 0.5 degrees C) are produced.

CONCLUSIONS

These findings indicate that high dose-rate-induced temperature artifacts should be taken into account in the quality assurance procedures for the treatment of patients with simultaneous interstitial thermoradiotherapy.

Quality assurance in various radiative hyperthermia systems applying a phantom with LED matrix

The Amsterdam phantom with LED-matrix is applied as an instrument in testing the performance of four types of radiative deep-body hyperthermia systems, which are in clinical use in Germany and The Netherlands. The devices tested were Essen's BSD-1000, Berlin's BSD-2000, Utrecht's Coaxial TEM applicator and Amsterdam's Four-waveguide-array. Photographs were taken of the matrix of dipoles loaded with light-emitting diodes (LED) to visualize the distribution of the RF power deposition or specific absorption rate (SAR) in the aperture midplane. The utility of the phantom with LED matrix for various types of radiative hyperthermia systems is demonstrated. Within this preliminary study, the influence of important parameters on the SAR-pattern in the aperture midplane was demonstrated. After corrections on the phase relation of the applicators a central focus in the SAR distribution could be realized in all systems and could also be moved in any direction. The patterns of the central focus changed in its absolute values and its proportions depending on the relative relations of phase and amplitude of the lateral applicators with respect to the top and bottom applicator. Frequency dependency was recognized for the central focus of the BSD-1000 as well as for the irradiation pattern of a single applicator for the BSD-2000. In the Coaxial TEM applicator it was demonstrated that the dimension of the open water bolus influenced the absolute value of SAR in the aperture midplane.

Quantitative colorimetric analysis of liquid crystal films (LCF) for phantom dosimetry in microwave hyperthermia

A fully quantitative analysis of liquid crystal film (LCF) color patterns, in phantom thermal dosimetry for microwave hyperthermia, is presented. An accurate determination of absorption rate density (ARD) is achieved by color image computer processing. This work is proven to be an improvement upon the semi-quantitative or qualitative descriptions of LCF colors performed essentially by visual analysis of photographs. Temperature-induced chromatic distributions are acquired as R, G, B (red, green, blue) signals by a CCD camera connected to a PC frame grabber board. These data, stored into three 512 x 512 memory buffers, are then converted to H, S, I (hue, saturation, intensity) colorimetric system. Provided a suitable calibration of the LCF, the H quantity can be transformed to temperature using a monotonic relationship. In this way, a temperature accuracy lower than 0.2 degrees C and a spatial resolution less than 1 mm are obtained. A sequence of thermal maps can be acquired and stored on disk at a maximum rate of 1 image/2 s, and then the ARD is calculated at each pixel of the map using the least squares method.

Phantom evaluation of heating of superficial tissues located above interstitial microwave antennas

PURPOSE

A technique that improves heating of superficial tissues above an implant of microwave interstitial antennas is presented.

METHODS AND MATERIALS

Adequate heating of tumor margins is achieved by extending an implant of microwave antennas beyond the tumor boundary by 1-2 cm. When the tumor infiltrates the superficial tissues including the skin, the implant cannot even reach the superficial margin of the tumor since it requires tissue to support the catheters. This may yield cold spots in the tissues above the implant. Measurements in a phantom with varying thickness of the superficial layer above the implant demonstrated inadequate Specific Absorption Rates of energy distribution in this layer. A method that improves these distributions in the superficial layers was developed and tested in this work. This method requires placing a deionized water bolus on the phantom (patient) surface. Additional microwave antennas are placed on top of the bolus above and parallel to the implanted antennas. The Specific Absorption Rates distributions were evaluated for the thicknesses of superficial layer ranging from 1.5 mm to 16 mm and two bolus thicknesses (5 and 10 mm).

RESULTS

The adequate Specific Absorption Rates distributions were achieved for all tested thicknesses of the superficial layer (1.5, 4, 8, 12, and 16 mm). The use of the 5 mm bolus versus 10 mm bolus is discussed. The use of additional antennas did not significantly increase stray radiation.

CONCLUSION

This method has the potential to optimize heating of superficial tissues located above a microwave antenna implant.

Cumulative minutes with T90 greater than Tempindex is predictive of response of superficial malignancies to hyperthermia and radiation

PURPOSE

To better define thermal parameters related to tumor response in superficial malignancies treated with combined hyperthermia and radiation therapy.

METHODS AND MATERIALS

Patients were randomized to receive one or two hyperthermia treatments per week with hyperthermia given during each week of irradiation. Hyperthermia was given for 60 min with treatments begun within 1 hr following irradiation. Power was increased to patient tolerance or normal tissue temperature of 43.0 degrees C. Irradiation was generally given 5 times per week with doses prescribed to normal tissue tolerance (generally 24-70 Gy at 1.8-2.5 Gy per fraction). Multipoint thermometry was used with temperatures obtained every 5 min.

RESULTS

One hundred eleven individual treatment fields containing 1 or more tumor nodules were completely evaluable. The complete and overall response rates were 46% and 80%, respectively. Forty-one percent of all treatment fields (51% of responding lesions) remained controlled at 2 years. Multivariate analysis revealed that the cumulative minutes that the temperature achieved by 90% of the measured tumor sites (T90) was > or = 40.0 degrees C, tumor histology, tumor volume, and radiation dose were significantly associated with complete tumor response. The complete response rate was not significantly affected by the number of hyperthermia treatments given per week. The incidence of clinically significant complications was low.

CONCLUSIONS

These results support the usefulness of the cumulative minute system in describing time-temperature relationships. The significance of thermal variables with regard to tumor response strongly supports the contention that hyperthermia can be a useful adjunct to irradiation for the local control of cancer.

Optimization of hyperthermia with CT scanning

In a prospective study CT scanning was used to evaluate the precision of thermometry catheter placement in tumours in the head and neck or on the chest wall in 30 consecutive patients prior to hyperthermia treatment. Patients had variable-sized tumours from several primary sites. Thermometry catheter placement was guided by palpation with or without a prior CT scan. Catheter placement was confirmed by CT. All lesions were less than 8 x 8 x 6 cm (L x W x D) in size. A mean of 4.2 +/- 0.2 (+/- 1 SEM, range 2-7) closed-end polyurethane catheters were inserted orthogonally by the same experienced radiation oncologist. Horizontal thermometry catheters were intended to traverse the centre and base of the tumour mass, and a vertical catheter was often inserted to intersect a horizontal catheter. After catheter placement, wire cables with 1 cm spacings were inserted into the catheters and positions determined using orthogonal films and CT scans. The success of catheter placement was judged on the following criteria: (1) catheter distribution factor (CDF = proportion of tumour CT slices transected by at least one catheter); (2) catheter hit ratio (CHR = average number of catheters in tumour per CT slice); (3) catheter miss factor (CMF = average number of catheters out of tumour per CT slice); (4) catheter placement index, CPI = [(CHR)(CDF)]-CMF; and (5) distance of nearest catheter from the visually estimated centre of tumour in the most central tumour CT scan. In the first seven lesions with 3-6 cm depth catheter insertion was guided by palpation only. In the next 23 lesions catheter insertion was guided by a prior CT scan. In the latter group, 15 lesions had depth 3-6 cm while eight lesions had depth < or = 3 cm. Catheter placement by palpation only, without the benefit of CT scan, was much less accurate in terms of the nearest catheter to the centre of the tumour (p = .001), the proportion of CT slices with catheter in tumour (CDF, p = 0.04) and the probability of a catheter being outside the tumour (CMF, p = 0.01). The catheter placement index (CPI) was a good measure of the accuracy and adequacy of catheter placement in large tumours (p = 0.04). Displacement of normal tissue structures by tumour precluded accurate catheter placement and led to a low CPI. It was difficult to accurately instrument lesions < or = 3 cm depth even with the benefit of a prior CT scan.(ABSTRACT TRUNCATED AT 400 WORDS)

Evaluation of microwave hyperthermia applicators

Hyperthermia has been used in conjunction with radiation and chemotherapy for cancer treatment. When using electromagnetic heating, applicators are critical components in contact with or in proximity to patients and can be the determining factor for effective and safe treatment. Tissue absorption of electromagnetic energy is determined by many factors. Three cases are shown to illustrate the complexity of microwave heating: 1) The BSD MA-151 applicator has good center heating on a muscle-only phantom as shown in the operation manual. When fat slabs of 0.25, 0.5, 1, and 2 cm thick were added, two hot spots near the periphery of the applicator were evident on all fat surfaces, exposed at 631 MHz. At 915 MHz, the heating was elongated on the surface of the models with 0.25- and 2-cm fat, and two hot spots were observed on the 0.5- and 1-cm fat surfaces. 2) Heating patterns of the Clini-Therm applicators on a muscle-only phantom, as indicated in the operations guide, are elliptical with their major axes perpendicular to the electric field. However, when a bolus is used, the elliptical pattern is parallel to the E field. 3) Heating patterns in cylindrical structures were studied with inhomogeneous models of limbs. Arm and thigh models consisting of fat, bone, and muscle material were heated with Clini-Therm L, M, and MS applicators at 915 MHz. In addition to the geometric effect, the results indicated that placing the applicators with E field parallel to the long axis of cylindrical structures can minimize required power, produce less heating of fats and reduce stray radiation. In conclusion, to apply penetrating microwave or other RF fields for tissue heating, one must simulate the clinical exposure conditions as closely as possible to obtain useful heating patterns.

Evaluation of an ingestible telemetric temperature sensor for deep hyperthermia applications

We have investigated the potential of an ingestible thermometric system (ITS) for use with a deep heating system. The ingestible sensor contains a temperature-sensitive quartz crystal oscillator. The telemetered signal is inductively coupled by a radiofrequency coil system to an external receiver. The sensors, covered with a protective silicon coating, are 10 mm in diameter and 20 mm long and are energized by an internal silver-oxide battery. Experimental studies were carried out to investigate the accuracy of the system and the extent of reliable operation of these sensors in an electromagnetic environment. Different measurements were repeated for five sensors. Calibration accuracy was verified by comparison with a Bowman probe in the temperature range 30 degrees C to 55 degrees C. Linear regression analysis of individual pill readings indicated a correlation within +/- 0.4 degrees C at 95% prediction intervals in the clinical temperature range of 35 degrees C to 50 degrees C. Further work is required to improve this accuracy to meet the quality assurance guidelines of +/- 0.2 degrees C suggested by the Hyperthermia Physics Center. Response times were determined by the exponential fit of heat-up and cool-down curves for each pill. All curves had correlation coefficients greater than 0.98. Time (mean +/- SE) to achieve 90% response during heat-up was 115 +/- sec. Time to cool-down to 10% of initial temperature was 114 +/- 4 sec. The effect of the external antenna and sensor spacing and the angle of orientation of the sensor relative to the antenna plane were also studied. Electromagnetic interference effects were studied by placing the sensor with a Bowman probe in a cylindrical saline phantom for the tests in an annular phase array applicator. Different power levels at three frequencies--80, 100, and 120 MHz--were used. Accurate temperature readings could not be obtained when the electromagnetic power was on because of interference effects with the receiver. However, the temperatures read with the ITS immediately after the electromagnetic power was switched off correlated well with the Bowman probe readings across the power categories and the three frequencies used. The phantom was heated to steady state, with a Bowman probe placed at the central axis of the cylinder used as control. During the heat-up period and the steady state, the mean difference (+/- SE) between the ITS and Bowman probe was 0.12 degrees C (+/- 0.05 degrees C).(ABSTRACT TRUNCATED AT 400 WORDS)

3D rendering of SAR distributions from Thermotron RF-8 using a ray casting technique

A comprehensive 3D visualization package developed for CT-based 3D radiation treatment planning has been modified to volume-render SAR data. The program accepts data from sequential thermographic thermometry measurements as well as calculated data from thermal models. In this presentation sample data obtained from a capacitive heating system 'Thermotron-RF8' is presented. This capability allows the generation of accurate standardized volumetric images of SAR and provides a valuable tool to better preplan hyperthermia treatments.

RTOG quality assurance guidelines for clinical trials using hyperthermia administered by ultrasound

Clinical quality assurance guidelines are established for RTOG hyperthermia protocols in which unfocused planar ultrasound may be used to administer hyperthermia. Measurement of temperature at a few fixed points is no longer considered to be adequate. Thermal mapping is required to obtain profiles of the temperature across the tumor dimensions, including margins of normal tissue. The thermometry strategies established for microwaves are to be adhered to with oblique insertion of the probes recommended. Two types of errors arise which are generally not present with microwaves. A measurement error, commonly referred to as a temperature artifact, arises because of absorption and/or viscous heating of the probe. Another error arises when thermocouples are used due to the conduction of heat along the wire leads, especially the copper wire. Several thermometry systems are evaluated with regard to the expected artifact and conduction errors. Acceptable systems include: a) indexing a polyurethane sheathed single sensor thermocouple in a polyurethane catheter, b) indexing a fiberoptic probe in a steel needle, c) indexing a single sensor thermocouple in a steel needle, and d) use of manganin-constantan multisensor thermocouples. Unacceptable systems include: a) fixed or static probes that do not provide profiles of the temperature across the tumor dimensions, b) copper-constantan multisensor thermocouples, and c) teflon sheathed thermocouples inserted into a teflon catheter.

RTOG quality assurance guidelines for clinical trials using hyperthermia for deep-seated malignancy

Quality assurance has been vague or lacking in many previous hyperthermia trials. Recent publications by the Hyperthermia Physics Center, the Center for Devices and Regulatory Health, and the Radiation Therapy Oncology Group have described general guidelines for quality assurance in equipment reliability and reproducibility, superficial applications, and microwave techniques. The present report details quality assurance factors that are believed to be important for hyperthermia of deep clinical sites, defined as extending at least 3 cm beyond the skin surface. This document will discuss patient and physician factors, as well as thermometric accuracy, assessment of specific absorption rates (SAR), assurance of adequate coverage of tumors by the energy deposition pattern of the treatment device, and recommended documentation of the location, quantity, and frequency of treatment, specifically oriented to deep hyperthermia. The recommendations are structured to facilitate compliance in multiinstitutional trials.

RTOG quality assurance guidelines for interstitial hyperthermia

This document specifies the current recommendations for quality assurance for hyperthermia administration with interstitial techniques as specified by the Radiation Therapy Oncology Group (RTOG). The document begins by providing a brief description of the physical principles behind the use of the three most commonly used methods of interstitial hyperthermia: radiofrequency (RF-LCF), microwave antennas, and ferromagnetic seeds. Emphasis is placed on features that effect quality assurance. Specific recommendations are provided for: a) Pretreatment planning and equipment performance checks, b) Implant considerations and documentation, c) Thermometry, and d) Safety procedures. Specific details regarding quality assurance issues that are common to all local and regional hyperthermia methods are outlined in previous documents sponsored by the RTOG. It is anticipated that technological advances may lead to future modifications of this document.

Computer-aided design and evaluation of novel catheters for conductive interstitial hyperthermia

Conductive interstitial heating is a modality in which heating elements are implanted directly into the treated tissue. One implementation of such therapy employs electrically heated catheters that are implanted in staggered, parallel rows. To explore strategies for maximising the uniformity of tissue temperature distributions achieved with heated catheters, a two-dimensional computer model with cylindrical co-ordinates was used to evaluate radially and longitudinally the temperature distributions produced by a typical interior catheter surrounded by other similar catheters. Insights from the computer model led to new designs for catheters containing multiple heating elements that produced more uniform thermal distributions, eliminating previous 'cold spots' within the treatment volume located near the ends of the catheter. The new catheter designs also include compartments for the optional placement of radioactive seeds for simultaneous thermoradiotherapy.

Practical experience in electromagnetic hyperthermia quality control procedures within the context of international guidelines

Recent international guidelines on hyperthermia (HT) quality assurance have pointed out the necessity of defining standard operative procedures and technical checks to guarantee an accurate performance of HT treatments. In the present paper, experience is described of quality control procedures that are performed in agreement with the more general guidelines concerning thermometry, sensor positioning, phantoms, applicator characterisation, and electromagnetic (EM) radiation leakage. This practical experience comes from the use of equipment for superficial and loco-regional HT working in the range 13.56-915 MHz.

A proposed standard data file format for hyperthermia treatments

One of the most critical areas of research essential to improve the clinical use of hyperthermia in cancer therapy is the determination and evaluation of temperature during therapy. In order to improve the dissemination of newly developed thermometry measurement and analysis programs and facilitate the transport of hyperthermia data files between computers for both intra- and inter- institutional use, we propose a standard file format, the Hyperthermia Data Standard (HDS), which can be used for all hyperthermia data. This data file consists of segments of which nine have been defined. The first is an initial /VERSION segment which identifies the file standard. This is followed by eight major segments: 2) a /IDENT segment which contains file and patient identification information; 3) a /TEXT segment containing additional miscellaneous documentation; 4) a /TUMOR segment which provides tumor and treatment site information; 5) a /HSETUP segment which contains treatment setup information; 6) a /FORMAT segment which defines the data segment structure; 7) a /DATA segment containing the actual thermometry data; 8) a /FOLLOWUP segment for documenting patient response; and 9) an /ANALYSIS segment containing summary information. All segments begin and end with a specified delimiter and, except for the first two (/VERSION and /IDENT), may be repeated more than once. For ease in debugging and verifying adherence to the standard, all information in the file is encoded in printable ASCII characters. All segments consist solely of records containing KEYWORDS and KEYWORD VALUES which identify specified information. Certain KEYWORDS are standard, i.e., having specified names and information formats as defined in this document. The /DATA segment consists of ASCII encoded chronological treatment thermometry and other data whose format and structure is identified in the /FORMAT segment. The /ANALYSIS segment provides the flexibility to store the results of any analysis program along with the actual data file for ease of data management. This thermometry data file standard is designed to provide both flexibility and extendability for all possible forms of hyperthermia treatment data. Furthermore, it is designed to provide a simple format which may be easily read by higher level languages. This document is intended for commercial manufacturers and others who are writing programs to document clinical hyperthermia treatments with the intention that they either use this format for their data storage or provide a means to convert their data into this format.(ABSTRACT TRUNCATED AT 400 WORDS)

Hyperthermia: principles and quality assurance

The methods of energy deposition, the power absorbtion properties of biological tissues and the basic components of a typical hyperthermia system are described. In addition, the clinical requirements of hyperthermia treatment are discussed. A perspective on treatment planning and quality control is presented.