Experimental brain hyperthermia: techniques for heat delivery and thermometry

Thermochromic tissue-mimicking phantom for optimisation of thermal tumour ablation

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.

Treatment of malignant glioma using hyperthermia

Thirty pathologically diagnosed patients with grade III–IV primary or recurrent malignant glioma (tumor diameter 3–7 cm) were randomly divided into two groups. The control group underwent conventional radiotherapy and chemotherapy. In the hyperthermia group, primary cases received hyperthermia treatment, and patients with recurrent tumors were treated with hyperthermia in com-bination with radiotherapy and chemotherapy. Hyperthermia treatment was administered using a 13.56-MHz radio frequency hyperthermia device. Electrodes were inserted into the tumor with the aid of a CT-guided stereotactic apparatus and heat was applied for 1 hour. During 3 months after hyperthermia, patients were evaluated with head CT or MRI every month. Gliomas in the hyper-thermia group exhibited growth retardation or growth termination. Necrosis was evident in 80% of the heated tumor tissue and there was a decrease in tumor diameter. Our findings indicate that ra-dio frequency hyperthermia has a beneficial effect in the treatment of malignant glioma.

Thermal aspects of exposure to radiofrequency energy: report of a workshop

This special issue contains papers presented at an international workshop entitled 'Thermal Aspects of Radio Frequency Exposure' convened in Gaithersburg, Maryland, USA on 11-12 January 2010, and co-sponsored by the Mobile Manufacturers Forum, the GSM Association, and the US Food and Drug Administration. The goals of the workshop were to (1) identify appropriate health endpoints associated with thermal hazards and their time-dependence thresholds, and (2) outline future directions for research that might lead to an improved understanding of health and safety implications of human exposure to radiofrequency energy and design of improved exposure limits for this energy. This present contribution summarises some of the major conclusions of the speakers, and offers comments by one of the present authors on proposed research priorities and the implications of the material presented at the workshop for setting improved thermally based limits for human exposure to RF energy.

Interstitial microwave transition from hyperthermia to ablation: historical perspectives and current trends in thermal therapy

This work reviews the transition from hyperthermia to ablation for cancer treatment with interstitial microwave (MW) antennas. Early work utilising MW energy for thermal treatment of cancer tissue began in the late 1970s using single antennas applied interstitially or the use of multiple interstitial antennas driven with the same phase and equal power at 915 or 2450 MHz. The original antenna designs utilised monopole or dipole configurations. Early work in thermal therapy in the hyperthermia field eventually led to utilisation of these antennas and methods for MW ablation of tumours. Efforts to boost the radiated MW power levels while decreasing antenna shaft temperatures led to incorporation of internally cooled antennas for ablation. To address larger tumours, MW treatment utilised arrays that were simultaneously activated by either non-synchronous or synchronous phase operation, benefiting both hyperthermia and ablation strategies. Numerical modelling was used to provide treatment planning guidance for hyperthermia treatments and is expected to provide a similar benefit for ablation therapy. Although this is primarily a review paper, some new data are included. These new data show that three antennas with 2.5 cm spacing at 45 W/channel and 10 min resulted in a volume of 89.8 cm(3) when operated synchronously, but only 53.4 cm(3) non-synchronously. Efficiency was 1.1 (synchronous) versus 0.7 (non-synchronous). MW systems, treatment planning, and image guidance continue to evolve to provide better tools and options for clinicians and patients in order to provide better approach and targeting optimisation with the goal of improved treatment for the patient.

Methods to produce hyperthermia-induced brain dysfunction

The recent increase in the frequency and intensity of killer heat waves across the globe has aroused worldwide medical attention to exploring therapeutic strategies to attenuate heat-related morbidity and/or mortality. Death due to heat-related illnesses often exceeds >50% of heat victims. Those who survive are crippled with lifetime disabilities and exhibit profound cognitive, sensory, and motor dysfunction akin to premature neurodegeneration. Although more than 50% of the world populations are exposed to summer heat waves; our understanding of detailed underlying mechanisms and the suitable therapeutic strategies have still not been worked out. One of the basic reasons behind this is the lack of a reliable experimental model to simulate clinical hyperthermia. This chapter describes a suitable animal model to induce hyperthermia in rats (or mice) comparable to the clinical situation. The model appears to be useful for studying the effects of heat-related illnesses on changes in various organs and systems, including the central nervous system (CNS). Since hyperthermia is often associated with profound brain dysfunction, additional methods to examine some crucial parameters of brain injury, e.g., blood-brain barrier (BBB) breakdown and brain edema formation, are also described.

Application of High Amplitude Alternating Magnetic Fields for Heat Induction of Nanoparticles Localized in Cancer

OBJECTIVE

Magnetic nanoparticles conjugated to a monoclonal antibody can be i.v. injected to target cancer tissue and will rapidly heat when activated by an external alternating magnetic field (AMF). The result is necrosis of the microenvironment provided the concentration of particles and AMF amplitude are sufficient. High-amplitude AMF causes nonspecific heating in tissues through induced eddy currents, which must be minimized. In this study, application of high-amplitude, confined, pulsed AMF to a mouse model is explored with the goal to provide data for a concomitant efficacy study of heating i.v. injected magnetic nanoparticles.

METHODS

Thirty-seven female BALB/c athymic nude mice (5-8 weeks) were exposed to an AMF with frequency of 153 kHz, and amplitude (400-1,300 Oe), duration (1-20 minutes), duty (15-100%), and pulse ON time (2-1,200 seconds). Mice were placed in a water-cooled four-turn helical induction coil. Two additional mice, used as controls, were placed in the coil but received no AMF exposure. Tissue and core temperatures as the response were measured in situ and recorded at 1-second intervals.

RESULTS

No adverse effects were observed for AMF amplitudes of < or = 700 Oe, even at continuous power application (100% duty) for up to 20 minutes. Mice exposed to AMF amplitudes in excess of 950 Oe experienced morbidity and injury when the duty exceeded 50%.

CONCLUSION

High-amplitude AMF (up to 1,300 Oe) was well tolerated provided the duty was adjusted to dissipate heat. Results presented suggest that further tissue temperature regulation can be achieved with suitable variations of pulse width for a given amplitude and duty combination. These results suggest that it is possible to apply high-amplitude AMF (> 500 Oe) with pulsing for a time sufficient to treat cancer tissue in which magnetic nanoparticles have been embedded.

Magnetic resonance imaging of thermal coagulation effects in a phantom for calibrating thermal therapy devices

A material has been developed and tested that permanently records thermal response patterns from heating devices. The material consists of a mixture of polyacrylamide and 18% w/w bovine serum albumin. Thermal denaturation is complete when the local temperature exceeds 70 degrees C, causing a large reduction in the T2 of the material. Three-dimensional distributions of "thermal damage" can be assessed using standard magnetic resonance imaging sequences. The material works well with microwave heating devices and is adaptable for use with ultrasound, radio-frequency, or laser heating devices. Suggested uses include characterizing heating devices prior to treatment and developing new clinical applications for thermal therapies.

Prostate cancer: MR imaging and thermometry during microwave thermal ablation-initial experience

Percutaneous interstitial microwave thermoablation of locally recurrent prostate carcinoma was continually guided with magnetic resonance (MR) imaging. Phase images and data were obtained with a rapid gradient-echo technique and were used to derive tissue temperature change on the basis of proton-resonance shift. Thermally devitalized regions correlated well with the phase image findings. MR imaging-derived temperatures were linearly related to the fluoroptic tissue temperatures. MR imaging can be used to guide thermoablation.

MRI monitoring of interstitial microwave-induced heating and thermal lesions in rabbit brain in vivo

The purpose of this experiment was to use MRI to monitor microwave heating and thermal damage of brain tissue in vivo. Interstitial microwave antennas were implanted into the cerebral hemispheres of seven anesthetized rabbits. Variable power of 30 to 100 W was applied for periods of 5 to 15 minutes and tissue temperature was monitored continuously. MR images were obtained throughout the procedure at 20-second intervals, using a spoiled gradient-echo sequence, without significant artifact. Magnitude, phase, and complex difference images all demonstrated temperature-related signal changes during heating. The findings were better visualized on the phase and complex difference images. Phase difference image analysis revealed an approximately linear relationship between phase change and temperature. Post-treatment thermal lesions measured up to 2.0 cm in size on pathologic specimens and exhibited a zonal pattern on spin-echo MR images.

Quantitative assessment of variables that influence soft-tissue electrovaporization in a fluid environment

OBJECTIVES

To evaluate the process of soft-tissue electrovaporization and to study variables that affect tissue clearance rates in a laboratory setting, in order to identify parameters that can optimize transurethral electrovaporization of the prostate.

METHODS

Fresh bovine skeletal muscle, equivalent in impedance and surface properties to the human prostate, was submerged in 3.3% sorbitol solution and electrovaporized with a grooved monopolar electrode attached to the weighted arm of a linear actuator. The effects of excursion rate, applied mechanical load, power setting, electrode configuration, and generator performance on the volume of tissue removed, were assessed.

RESULTS

Tissue removal increased significantly when electrode excursion rate was slowed from 25 to 15 mm/s (P < 0.05) and then to 10 mm/s (P < 0.05); when the load was increased from 20 to 50 g (P < 0.005); and when dial power was increased from 120 to 150 W (P < 0.01). Tissue removal was generator dependent. There was no significant difference between the Force 40 and the Force 2 (P > 0.4), but a new computer-controlled constant power output generator (Force FX) did significantly improve tissue vaporization at an equivalent power setting (P < 0.005 and P < 0.01, respectively). Tissue removal was also dependent upon electrode configuration, with the VaporTrode-Grooved Bar removing significantly more tissue than either an ungrooved roller bar of equivalent size or 2-mm smooth roller ball, respectively, both after a single pass (P < 0.001 and P < 0.05) and after five repeated passes (P < 0.05 and P < 0.005). The histologic depth of tissue thermal effect was less than 1 mm, but it was 38% greater for the VaporTrode-Grooved Bar (0.68 mm) than for the standard cutting loop (0.5 mm, P < 0.01).

CONCLUSIONS

Using a novel method to quantify tissue removal, we have demonstrated that electrode configuration, excursion rate, applied load, power setting, and generator performance are interdependent factors that influence the efficacy of the electrovaporization process in a fluid environment.

Interstitial laser thermotherapy in neurosurgery: a review

One of the most recent laser treatment modalities in neurosurgery is interstitial laser thermotherapy (ILTT). In this review, experimental and clinical studies concerning intracranial ILTT are discussed. Two methods for intra-operative control of the laser induced lesions are described; i.e., computer-controlled power delivery, using a thermocouple that is positioned interstitially at the periphery of the tumour to maintain the desired temperature at that point, and MRI, to visualise the extent of the thermal lesions induced by ILTT. The results show that ILTT using a Nd: YAG laser is easy and relatively effective in the treatment of small deep-seated brain tumours with minimal risk and complications. This review is concluded with suggestions for further improvement of this treatment modality.

Hyperthermia induces ultrastructural changes in mouse pial microvessels

BACKGROUND

Pial microvessels' responses to local hyperthermia revealed the development of in vivo spontaneous thrombosis. The cellular and subcellular changes which contribute to such events remained unexplored. Therefore, the effect of regional hyperthermia (43 degrees C) on mouse pial microvessels was studied at the ultrastructural level.

METHODS

A simple cranial window assembly, including an artificial cerebrospinal fluid delivery and heating system to ensure a precise brain regional temperature, was used. The animal core body temperature was maintained at 37 degrees C. Topical and transvessel bimodal fixation of microvessels was done with a phosphate buffered mixture of glutaraldehyde and paraformaldehyde, followed by a standard electron microscopy procedure.

RESULTS

When the pial microvessels of control (37 degrees C) animals were examined, no evidence of cellular damage was discerned. Endothelial cells including luminal membrane were unchanged. Degranulated platelets or platelet aggregates were not seen. However, numerous platelets in association with scattered red blood cells and occasional white blood cells could be observed in a close proximity, but not adhered, to the endothelial wall of hyperthermic (43 degrees C) brains. Platelets displayed a variety of forms consistent with the onset of platelet activation. Discoid platelets containing granules and spheroid degranulated platelets and those with large pseudopodia were recognized. The venular endothelial surface revealed conspicuous endothelial change, with the presence of endothelial denudation. The site of platelet aggregation in both venules and arterioles was accompanied by focal endothelial lucency and denudation vacuole formation, luminal membrane rupture, and swelling of the nuclear envelope.

CONCLUSIONS

These findings demonstrate the extent of damage to the pial microvasculature in response to a local hyperthermic exposure. The results emphasize that changes in the endothelium may represent the earliest signs of oncoming vascular pathology.

Local cerebral hyperthermia induces spontaneous thrombosis and arteriolar constriction in the pia mater of the mouse

The effect of local cerebral hyperthermia on responses of pial microvessels of the mouse was investigated. A set protocol was followed, involving the performance of a craniotomy on anaesthetized animals and using intravital microscope-television closed circuitry. Controlled hyperthermic exposure was applied regionally by heating the brain surface with irrigating artificial cerebrospinal fluid. Microvascular responses such as changes in diameter, thrombosis and embolism were monitored and video-taped observations were further viewed and analysed. When both brain surface and core body temperatures were kept at 37 degrees C, no changes in pial microvessels were noted. With core body temperature kept at 37 degrees C and at a brain surface temperature of 43.1 degrees C, passing emboli and arteriolar constriction were observed. A few minutes later, visible thrombosis was prevalent. Further spontaneous thrombo-embolic activity continued and at the end of a 50-min hyperthermic exposure, arterioles attained a constriction of 37%. Thrombus formation was sometimes massive enough to occlude fully the microvessel. The protocol followed in this study can be adopted to other small animal species and for a variety of experimental procedures involving hyperthermia and the pial microcirculation.

Effect of phase modulation on the temperature distribution of a microwave hyperthermia antenna array in vivo

Perfused, canine skeletal muscle and the brain tumour of a cancer patient were heated with an array of four parallel, interstitial antennas placed on the corners of a 2-cm square and driven at 915 MHz. The temperature distributions along the axial and diagonal catheters were measured with equal-phase driving of the antennas and with several time-varying schemes of driving phase differences among the antennas. When equal-phase driving was replaced by a rotating scheme of 90 degrees driving phase differences, the tissue area in the junction plane heated above a normalized index temperature of 0.6 increased by a factor of about 1.25. With a rotating phase of 135 degrees, the same area increased by a factor of about 1.6. The axial temperature distribution was not affected significantly by driving phase.

Brain hyperthermia: I. Interstitial microwave antenna array techniques--the Dartmouth experience

PURPOSE

Microwave antennas of various designs were inserted into arrays of nylon catheters implanted in brain tumors with the goal of raising temperatures throughout the target volume to 43.0 degrees C.

METHODS AND MATERIALS

All antennas were flexible, and included dipole, choke dipole, modified dipole, and helical designs driven at 915 or 2450 MHz. Antennas were tested in brain-equivalent phantom in arrays. Phase shifting and phase rotation techniques were incorporated into the treatment system to steer power in the tumor, assisted by a treatment planning computer that predicted power deposition patterns and temperature distributions. Choke antennas were designed and tested to reduce a dependence of the central power location on depth of insertion into tissue. Temperature data analysis used only central and orthogonal axes mapping data measured at 2.0 mm intervals.

RESULTS

A total of 23 patients were treated, using from one to six microwave antennas. Minimum tumor temperatures, averaged over the 60 min treatment, ranged from 37.2-44.3 degrees C (mean 40.0 degrees C) and maximum average tumor temperatures ranged from 46.5-60.1 degrees C (mean 49.1 degrees C). The percentage of all measured temperatures reaching therapeutic levels (> or = 43.0 degrees C) was 70.9. T90, the temperature at which 90% of all measured temperatures equaled or exceeded, was 40.8 degrees C, and T50 was 44.2 degrees C.

CONCLUSION

Patient data analysis showed that the array of four dipole antennas spaced 2.0 cm apart were capable of heating a volume of 5.9 cm (along the central array axis) x 2.8 cm x 2.8 cm.

Effect of hyperthermia on the central nervous system: a review

Experimental data show that nervous tissue is sensitive to heat. Animal data indicate that the maximum tolerated heat dose after local hyperthermia of the central nervous system (CNS) lies in the range of 40-60 min at 42-42 x 5 degrees C or 10-30 min at 43 degrees C. No conclusions concerning the heat sensitivity of nervous tissue can be derived from clinical studies using localized hyperthermia. The choice whether or not to exceed the critical heat dose, as derived from laboratory studies, in clinical practice is very much dependent on the clinical situation such as the anatomical site and volume of the tissue involved, and prior therapy. Data on clinical application of whole body hyperthermia (WBH) show that nervous tissue can withstand a slightly higher heat dose than after localized heating, which might be the result of developing thermal resistance during treatment. Expression of thermotolerance was observed in the spinal cord of laboratory animals. After WBH in man at a maximum between 40 and 43 degrees C for 6 h-30 min CNS complications were reported, but other complications seemed to be more life-threatening. Most studies indicate that impairment of the CNS after WBH was not due to direct heat injury to the brain or spinal cord, but was secondary as a result of physiological changes. Heat, at least if applied shortly after X-rays, enhances the response of nervous tissue to radiation. Neurotoxicity of chemotherapeutic drugs does not seem to be a limiting complication in hyperthermia if combined with chemotherapy, but only few data are available. The limited clinical experience shows that safe hyperthermic treatment of CNS malignancies or tumours located close to the CNS seems feasible under appropriate technical conditions with adequate thermometry and taking the sensitivity of the surrounding normal nervous tissue into account.

Pattern of response to interstitial hyperthermia and brachytherapy for malignant intracranial tumour: a CT analysis

Interstitial microwave hyperthermia in combination with iridium-192 brachytherapy has been administered to 23 cases of malignant brain tumours in a phase one clinical trial to assess the feasibility and safety of this treatment. In order to quantify the acute and long-term response of tumour and surrounding brain to this treatment, a morphometric computed tomography scan analysis was performed in 18 evaluable patients. Volumes defined by the outer margin of the contrast-enhancing rim, by the hypodense necrotic region within the enhancing rim and by the surrounding hypodensity region were calculated from computer measurements. Hyperthermia equipment performance (HEP) was calculated for the evaluation of heating. After the treatments, the volume of the inner hypodensity region decreased in seven patients and the volume increased in 11 patients. In five patients, the outer margin of the contrast-enhancing lesion showed an initial increase in volume followed by a decrease and in these patients higher HEP and longer survival were observed significantly. The volume of the surrounding hypodensity region varied following treatments, but in most instances, the region subsequently increased in the interval immediately prior to death. Contribution of heat effect to these changes are discussed and the significance of aggressive heating, which provides transient opening of blood brain barrier, is shown.

Techniques for intraoperative hyperthermia with ultrasound: the Dartmouth experience with 19 patients

Over the course of 3 years, tumours of 19 patients were heated with ultrasound in the operating room during surgical resection. Immediately following intraoperative radiation therapy, thermocouples were inserted into tumour and adjacent normal structures. Patients were then given a 60-min heat treatment with ultrasound after a 10-15-min heatup period. Temperatures were measured at a total of 133 fixed locations for the 19 patient series. Temperature mapping was done in the tumour volume when logistically feasible. Treatment sites included colorectal (n = 3), portahepatus (n = 1), pancreas (n = 7), liver (n = 1), pelvis (n = 3), sacrum (n = 2), and abdomen (n = 2). A sterile, constant-volume water circulating system was utilized to control surface temperatures. Three generations of completely immersible transducers were designed over the course of this study with a 4-cm height specification. Since the ultrasound transducer was assembled on the sterile field during surgery, a 1, 2 or 3 MHz ceramic element was placed in either a 6, 8 or 10 cm diameter aluminium housing to conform the acoustic field to the tumour size. Average of the maximum temperatures attained was 46.6 degrees C. Temperature with which 90% of all measured points equalled or exceeded (T90) was 39.2 degrees C. The T50 was 42.9 degrees C. This compared favourably with T90 and T50 of 38.8 and 41.9 degrees C, respectively, in our outpatient clinic series, in which superficial tumours were treated with a similar external applicator, and patient tolerance was often a treatment limitation.

Interstitial microwave hyperthermia and brachytherapy for malignancies of the vulva and vagina. I: Design and testing of a modified intracavitary obturator

A vaginal obturator was fabricated to be used in combination with implanted catheters to provide microwave hyperthermia and brachytherapy to the vulva and vaginal wall. This site is difficult to heat or irradiate solely with interstitial techniques. The obturator was modified to provide grooves for the mounting of interstitial catheters into the outer wall and was matched with a template for circumferential implants. Power deposition tests were done using arrays of three microwave antenna designs: dipole (hA = hB = 3.9 cm), helical (3.9 cm coil, shorted), and modified dipole (1.0 cm helix on dipole tip) to test the performance of the obturator. The obturator and four non-obturator catheters were positioned in muscle-equivalent phantom. Two obturator catheters along with two free-standing catheters formed the obturator array. Four freestanding catheters formed the non-obturator array. Power deposition or specific absorption rate (SAR) measurements were made along the central axis, bisect, and diagonal transect of each array. SAR results showed that antennas in the obturator wall radiated as dipole theory predicts, although with less power density when compared to antennas in the same catheters spaced 1.8 cm from the obturator. This could be compensated for by increasing the power to the antennas in the obturator by 42%. Adjacent pairs of antennas were placed 90 degrees out of phase for 0.25 sec and rotated around the array. Phase rotation demonstrated that the central array SAR peaks could be lowered from 100% to 50% SAR, with dipole antennas thus resulting in lowered peak temperatures and the ability to heat larger volumes by improving the distribution of power. With helical antennas, there was 50% SAR at the array center when operated coherently without phase rotation. Three patients were treated with the obturator and a custom-made template using dipole antennas, and temperatures were measured in five obturator catheters. Therapeutic heating was measured in the catheters on the obturator between antennas in contact with the vaginal mucosa.

Design of an automated temperature mapping system for ultrasound or microwave hyperthermia

An automated temperature mapping system was designed to accomplish the following goals: remote control mapping; a maximum position error of 0.5 mm; mapping simultaneously on several channels; real-time screen display on a dedicated computer; to be inexpensive, and have a simple patient interface and set up. A four channel, microstepper system was fabricated for less than $1000 and controlled by an IBM-AT computer. The system utilizes direct drive of Luxtron fibre-optic probes fed through thin flexible Teflon tubing which allows for patient movement. The driving and control software were written in the programming language "C". Mapping parameters for each independent channel include start and stop positions and map increment. The software permits the user to automatically find the maximum temperature along a track in three passes of 2.0, 1.0 and 0.5 mm steps. The latter two passes take five or seven readings centred about the maximum of the previous pass. A high resolution monitor plots the temperatures in real time, overlaying the previous map in a new colour. A screen dump was written to drive a colour printer with the plot information. The computer evaluates each plot to safeguard against any shift in the maximum location. Visualization of orthogonal pullbacks provides rapid feedback and aids in the repositioning of superficial hyperthermia transducers. The time saved over the previous manual mapping methods easily justifies the additional set up time.

Comparison of six microwave antennas for hyperthermia treatment of cancer: sar results for single antennas and arrays

Interstitial techniques of inserting catheters into tumors for the purpose of applying therapeutic irradiation and hyperthermia are in widespread use. Several miniature microwave antenna designs are currently used for these treatments. These include multisection, hot-tip, 2- and 3-node, dipole and helical antennas, all of which are commercially available. The antenna designs are diverse enough to have a dramatic effect on the power deposition patterns either as single antennas or when used in arrays. Aside from the dipole antenna, most of the antennas have never been evaluated experimentally or theoretically in arrays, although the array configuration is used in the vast majority of all clinical treatments. Power deposition or SAR (specific absorption rate) tests were run in muscle equivalent phantom. Single antennas were evaluated at 400 points in a plane and isoSAR contours drawn, normalized to maximum SAR. Single antennas were also compared in large and small diameter catheters to evaluate catheter dependent antenna performance. The dipole, multisection, hot-tip and helical antennas were evaluated in arrays of four antennas located at the corners of a square, spaced 2.0 cm apart. Arrays of antennas were evaluated at 441 points in three planes orthogonal to the antenna axes. Results in the single antenna studies showed that the dipole was less affected by snugness of catheter fit than the multisection, hot-tip or helical antennas. In large catheters, the latter three antennas showed more extreme tip heating performance. The 2- and 3-node antennas deposited only 20% SAR in the distal 30 mm of antenna length. In arrays, the multisection, hot-tip, and dipole antennas all yielded 80-90% SAR centrally in the central measurement plane. Comparing the three antennas, the dipole array deposited 20% more power centrally in a plane near the insertion point, and the multisection and hot-tip antenna designs deposited 10% more central power in a plane near the antenna tips. The helical antenna array deposited only 30% SAR centrally in the plane near the antenna tips and in the central plane. Only 10% SAR was measured centrally near the insertion point, as expected for tip-heating antennas. Finally, the clinical significance of the results is discussed as applied to human tumors undergoing hyperthermia treatments.

Analysis and testing of a concentric ring applicator for ultrasound hyperthermia with clinical results

A planar ultrasound transducer was modified by etching concentric circles on one surface of a piezoelectric ceramic to create four rings. The 10 cm diameter transducer had four active rings and an unenergized centre. The transducer housing was designed to be completely immersed in fluid, suitable for intraoperative hyperthermia. The transducer was resonant at 1.0 MHz and was tested in a water tank and in an acoustic absorbing medium where the steady-state temperatures were measured. A comparison between a single 10 cm element and the concentric ring modification with all rings at equal power density showed the performance to be nearly identical. In vivo experiments in canine thigh verified the phantom predictions as individual rings were energized. Theoretical intensity calculations were made and compared favourably to water tank test results. Clinical hyperthermia treatments for chest wall and head and neck tumours showed that the temperature distribution could be highly modified by adjusting the power to individual rings while holding the transducer stationary. Automated temperature mapping parallel to the transducer face was used to compare a single element applicator to the concentric ring applicator in clinical treatments on the same lesion. The concentric ring applicator was radially adjustable and was found to be advantageous in lowering the central peak temperatures and flattening the temperature distribution in tumours. A comparison between the single element clinical and operating room series showed that when pain is removed as a treatment limiting factor, higher central tumour temperatures are possible and more of the tumour volume achieves therapeutic temperatures. The concentric ring design improves the temperature distribution such that the higher central temperatures will not be necessary.