Effect of pulse repetition frequency and scan step size on the dimensions of the lesions formed in agar by HIFU histotripsy

Histology-based quantification of boiling histotripsy outcomes via ResNet-18 network: Towards mechanical dose metrics

This work was focused on the newly developed ultrasonic approach for non-invasive surgery - boiling histotripsy (BH) - recently proposed for mechanical ablation of tissues using pulsed high intensity focused ultrasound (HIFU). The BH lesion is known to depend in size and shape on exposure parameters and mechanical properties, structure and composition of tissue being treated. The aim of this work was to advance the concept of BH dose by investigating quantitative relationships between the parameters of the lesion, pulsing protocols, and targeted tissue properties. A HIFU focus of a 1.5 MHz 256-element array driven by power-enhanced Verasonics system was electronically steered along the grid within 12 × 4 × 12 mm volume to produce volumetric lesions in porcine liver (soft, with abundant collagenous structures) and bovine myocardium (stiff, homogenous cellular) ex vivo tissues with various pulsing protocols (1-10 ms pulses, 1-15 pulses per point). Quantification of the lesion size and completeness was performed through serial histological sectioning, and a computer vision approach using a combination of manual and automated detection of fully fractionated and residual tissue based on neural network ResNet-18 was developed. Histological sample fixation led to underestimation of BH ablation rate compared to the ultrasound-based estimations, and provided similar qualitative feedback as did gross inspection. This suggests that gross observation may be sufficient for qualitatively evaluating the BH treatment completeness. BH efficiency in liver tissue was shown to be insensitive to the changes in pulsing protocol within the tested parameter range, whereas in bovine myocardium the efficiency increased with either increasing pulse length or number of pulses per point or both. The results imply that one universal mechanical dose metric applicable to an arbitrary tissue type is unlikely to be established. The dose metric as a product of the BH pulse duration and the number of pulses per sonication point (BHD1) was shown to be more relevant for initial planning of fractionation of collagenous tissues. The dose metric as a number of pulses per point (BHD2) is more suitable for the treatment planning of softer targets primarily containing cellular tissue, allowing for significant acceleration of treatment using shorter pulses.

Quantifying the Effect of Acoustic Parameters on Temporal and Spatial Cavitation Activity: Gauging Cavitation Dose

OBJECTIVE

Cavitation-enhanced delivery of therapeutic agents is under development for the treatment of cancer and neurodegenerative and cardiovascular diseases, including sonothrombolysis for deep vein thrombosis. The objective of this study was to quantify the spatial and temporal distribution of cavitation activity nucleated by Definity infused through the EKOS catheter over a range of acoustic parameters controlled by the EKOS endovascular system.

METHODS

Three insonation protocols were compared in an in vitro phantom mimicking venous flow to measure the effect of peak rarefactional pressure, pulse duration and pulse repetition frequency on cavitation activity energy, location and duration. Inertial and stable cavitation activity was quantified using passive cavitation imaging, and a metric of cavitation dose based on energy density was defined.

RESULTS

For all three insonation protocols, cavitation was sustained for the entire 30 min Definity infusion. The evolution of cavitation energy during each pulse duration was similar for all three protocols. For insonation protocols with higher peak rarefactional acoustic pressures, inertial and stable cavitation doses also increased. A complex relationship between the temporal behavior of cavitation energy within each pulse and the pulse repetition frequency affected the cavitation dose for the three insonation protocols. The relative predominance of stable or inertial cavitation dose varied according to insonation schemes. Passive cavitation images revealed the spatial distribution of cavitation activity.

CONCLUSION

Our cavitation dose metric based on energy density enabled the impact of different acoustic parameters on cavitation activity to be measured. Depending on the type of cavitation to be promoted or suppressed, particular pulsing schemes could be employed in future studies, for example, to correlate cavitation dose with sonothrombolytic efficacy.

Enhanced Shock Scattering Histotripsy With Pseudomonopolar Ultrasound Pulses

Shock scattering histotripsy involves a complex interaction between positive and negative phases of an acoustic burst to initiate a robust cavitation bubble cloud. To more precisely study these effects and optimize shock scattering histotripsy therapy, we constructed a frequency compounding transducer to generate pseudomonopolar ultrasound pulses. The transducer consisted of 113 individual piezoelectric elements with various resonant frequencies (250 kHz, 500 kHz, 750 kHz, 1 MHz, 1.5 MHz, 2 MHz, and 3 MHz). For each resonant frequency, an extremely short pulse could be generated. Pseudomonopolar peak positive pulses were generated by aligning the principal peak positive pressures of individual frequency components temporally, so that they added constructively, and destructive interference occurred outside the peak-positive-overlapped temporal window. After inverting the polarity of the excitation signals, pseudomonopolar peak negative pulses were generated similarly by aligning principal peak negative pressures. Decoupling the positive and negative acoustic phases could have significant advantages for therapeutic applications enhancing precision and avoiding cavitation at tissue interfaces by using mostly positive pressure pulses. For example, we show that 16 shock scattering bubble clouds can be generated using only peak positive pulses following a single peak negative pulse that initiates a pressure release "seed cloud" from which the first shock front is "scattered." Subsequent positive only pulses result in a precise elongated lesion within red blood cell phantoms.

High-Intensity Focused Ultrasound Ablation by the Dual-Frequency Excitation

High-intensity focused ultrasound (HIFU) has emerged as an effective and noninvasive therapeutic modality for cancer and solid tumor. Despite its promising clinical outcomes and the approval of the Food and Drug Administration of many countries, the ablation time of a large target is long, so enhancement of the lesion production is highly desired. In this study, dual-frequency (or amplitude modulation) excitation was evaluated both numerically and experimentally, and its performance was compared with that using single-frequency excitation at the same power output. The nonlinear wave propagation model was used to simulate the acoustic field of HIFU exposure, the Gilmore model was used to determine the induced bubble dynamics, and then absorbed acoustic energy and bubble-enhanced heating were put into the BioHeat equation to calculate the temperature elevation. HIFU-produced lesion in the bovine serum albumin-embedded polyacrylamide was recorded photographically. It is found that dual-frequency excitation (3.16 + 3.20MHz) can increase the lesion area by 35%-65% compared to single-frequency excitation (3.18 MHz) at the same power output. The lesion enhancement increases with the pulse repetition frequency, duty cycle, and modulation depth and decreases with the frequency difference. In summary, dual-frequency excitation can increase the bubble cavitation and the associated heating for HIFU ablation for large lesion production.

Histotripsy Treatment of S. Aureus Biofilms on Surgical Mesh Samples Under Varying Pulse Durations

Prior studies demonstrated that histotripsy generated by high-intensity tone bursts to excite a bubble cloud adjacent to a medical implant can destroy the bacteria biofilm responsible for the infection. The goal of this paper was to treat Staphylococcus aureus (S. aureus) biofilms on surgical mesh samples while varying the number of cycles in the tone burst to minimize collateral tissue damage while maximizing therapy effectiveness. S. aureus biofilms were grown on 1-cm square surgical mesh samples. The biofilms were then treated in vitro using a spherically focused transducer (1.1 MHz, 12.9-cm focal length, 12.7-cm diameter) using either a sham exposure or histotripsy pulses with tone burst durations of 3, 5, or 10 cycles (pulse repetition frequency of 333 Hz, peak compressional pressure of 150 MPa, peak rarefactional pressure of 17 MPa). After treatment, the number of colony forming units (CFUs) on the mesh and the surrounding gel was independently determined. The number of CFUs remaining on the mesh for the sham exposure (4.8 ± 0.9-log₁₀) (sample mean ± sample standard deviation-log10 from 15 observations) was statistically significantly different from the 3-cycle (1.9 ± 1.5-log₁₀), 5-cycle (2.2 ± 1.1-log₁₀), and 10-cycle exposures (1 ± 1.5-log₁₀) with an average reduction in the number of CFUs of 3.1-log₁₀. The numbers of CFUs released into the gel for both the sham and exposure groups were the same within a bound of 0.86-log₁₀, but this interval was too large to deduce the fate of the bacteria in the biofilm following the treatment.

Acoustic Cavitation Enhances Focused Ultrasound Ablation with Phase-Shift Inorganic Perfluorohexane Nanoemulsions: An In Vitro Study Using a Clinical Device

Purpose. To investigate whether acoustic cavitation could increase the evaporation of a phase-shift inorganic perfluorohexane (PFH) nanoemulsion and enhance high intensity focused ultrasound (HIFU) ablation. Materials and Methods. PFH was encapsulated by mesoporous silica nanocapsule (MSNC) to form a nanometer-sized droplet (MSNC-PFH). It was added to a tissue-mimicking phantom, whereas phosphate buffered saline (PBS) was added as a control (PBS-control). HIFU (P ac = 150 W, t = 5/10 s) exposures were performed in both phantoms with various duty cycles (DC). US images, temperature, and cavitation emissions were recorded during HIFU exposure. HIFU-induced lesions were measured and calculated. Results. Compared to PBS-control, MSNC-PFH nanoemulsion could significantly increase the volume of HIFU-induced lesion (P < 0.01). Peak temperatures were 78.16 ± 5.64°C at a DC of 100%, 70.17 ± 6.43°C at 10%, 53.17 ± 4.54°C at 5%, and 42.00 ± 5.55°C at 2%, respectively. Inertial cavitation was much stronger in the pulsed-HIFU than that in the continuous-wave HIFU exposure. Compared to 100%-DC exposure, the mean volume of lesion induced by 5 s exposure at 10%-DC was significantly larger, but smaller at 2%-DC. Conclusions. MSNC-PFH nanoemulsion can significantly enhance HIFU ablation. Appropriate pulsed-HIFU exposure could significantly increase the volume of lesion and reduce total US energy required for HIFU ablation.

Dependence of ablative ability of high-intensity focused ultrasound cavitation-based histotripsy on mechanical properties of agar

Cavitation-based histotripsy uses high-intensity focused ultrasound at low duty factor to create bubble clouds inside tissue to liquefy a region, and provides better fidelity to planned lesion coordinates and the ability to perform real-time monitoring. The goal of this study was to identify the most important mechanical properties for predicting lesion dimensions, among these three: Young's modulus, bending strength, and fracture toughness. Lesions were generated inside tissue-mimicking agar, and correlations were examined between the mechanical properties and the lesion dimensions, quantified by lesion volume and by the width and length of the equivalent bubble cluster. Histotripsy was applied to agar samples with varied properties. A cuboid of 4.5 mm width (lateral to focal plane) and 6 mm depth (along beam axis) was scanned in a raster pattern with respective step sizes of 0.75 and 3 mm. The exposure at each treatment location was either 15, 30, or 60 s. Results showed that only Young's modulus influenced histotripsy's ablative ability and was significantly correlated with lesion volume and bubble cluster dimensions. The other two properties had negligible effects on lesion formation. Also, exposure time differentially affected the width and depth of the bubble cluster volume.

Precision control of lesions by high-intensity focused ultrasound cavitation-based histotripsy through varying pulse duration

The goal of this experimental study was to explore the feasibility of acquiring controllable precision through varying pulse duration for lesions generated by cavitation-based histotripsy. Histotripsy uses high-intensity focused ultrasound (HIFU) at low duty factor to create energetic bubble clouds inside tissue to liquefy a region. It uses cavitation-mediated mechanical effects while minimizing heating, and has the advantages of real-time monitoring and lesion fidelity to treatment planning. In our study, histotripsy was applied to three groups of tissue-mimicking agar samples of different stiffnesses (29.4 ± 5.3, 44.8 ± 5.9, and 66.4 ± 7.1 kPa). B-mode imaging was used first to quantify bubble cluster dimensions in both water and agar. Then, a 4.5-mm-wide square (lateral to the focal plane) was scanned in a raster pattern with a step size of 0.75 mm in agar histotripsy experiments to estimate equivalent bubble cluster dimensions based on the histotripsyinduced damage. The 15-s exposure at each treatment location comprised 5000 sine-wave tone bursts at a spatial-peak pulseaverage intensity of 41.1 kW/cm2, with peak compressional and rarefactional pressures of 102 and 17 MPa, respectively. The results showed that bubble cluster width and length increased with pulse duration and decreased with agar stiffness. Therefore, a significant improvement in histotripsy precision could be achieved by reducing the pulse duration.