A comparison of ultrasonic beams for thermal treatment of ocular tumors

OCULAR TEMPERATURE DISTRIBUTION: A MATHEMATICAL PERSPECTIVE

Mathematical modeling has proven to be a viable alternative for investigating the temperature distribution inside the human eye. This is due to its ability to overcome the limitations infrared (IR) thermography; the leading method in ocular temperature measurement. A wide range of mathematical studies on the ocular temperature distribution during various conditions have been published in the literature. In this paper, we carry out an in-depth review of the various mathematical models of the eye that have been developed in the past. Various problems and the implications from the mathematical predictions of these studies are discussed. The future directions of studies in ocular temperature distribution are deliberated.

An acoustic backscatter-based method for localization of lesions induced by high-intensity focused ultrasound

Ultrasound B-mode visualization of lesions produced in soft tissues using high-intensity focused ultrasound (HIFU) has been shown to be challenging when there is no cavitation activity and, therefore, no hyperechogenecity in the focal region. We investigated a method for the visualization and localization of HIFU-induced lesions after HIFU delivery was complete based on the change in backscattered radio-frequency (RF) signals. A HIFU transducer was used with focal dimension of 8 mm by 2 mm working at 5 MHz. HIFU was applied at different intensities to produce lesions in ex vivo chicken breast, with or without the generation of hyperecho in B-mode images. We compared lesion locations obtained from our RF-processing method, from measurement of physical lesions after exposure and from the B-mode images, if exposures had resulted in hyperecho. The results showed that the RF amplitude decreased as a function of time immediately after stopping the HIFU exposure. The lesions were clearly visualized in two-dimensional (2-D) images of the decay rate of RF amplitude, no matter with or without hyperecho. In experiments with hyperecho, when comparing to physical lesion locations, there was no statistically significant difference in the localization accuracy between the RF-based and the hyperecho-based method (p = 0.76). In cases without hyperecho, the distance between RF-based locations and measured lesion locations was 3.37 +/- 1.59 mm (mean +/- standard deviation). The axial and lateral difference were 2.00 +/- 2.31 mm and 0.85 +/- 2.15 mm, respectively, and no statistically significant difference was found between lesion coordinates (axial: p = 0.37 and lateral: p = 0.15). We demonstrated the feasibility of our proposed RF-based method for the localization of HIFU-induced lesions immediately after HIFU treatment. Using the decay rate in RF amplitude as the signature of lesion formation, our method can detect lesion locations even without the appearance of hyperecho.

MR imaging-guided interventions in the genitourinary tract: an evolving concept

MR imaging-guided interventions are well established in routine patient care in many parts of the world. There are many approaches, depending on magnet design and clinical need, based on MR imaging providing excellent inherent tissue contrast without ionizing radiation risk for patients. MR imaging-guided minimally invasive therapeutic procedures have advantages over conventional surgical procedures. In the genitourinary tract, MR imaging guidance has a role in tumor detection, localization, and staging and can provide accurate image guidance for minimally invasive procedures. The advent of molecular and metabolic imaging and use of higher strength magnets likely will improve diagnostic accuracy and allow targeted therapy to maximize disease control and minimize side effects.

MR imaging-guided interventions in the genitourinary tract: an evolving concept

MR imaging-guided interventions are well established in routine patient care in many parts of the world. There are many approaches, depending on magnet design and clinical need, based on MR imaging providing excellent inherent tissue contrast without ionizing radiation risk for patients. MR imaging-guided minimally invasive therapeutic procedures have advantages over conventional surgical procedures. In the genitourinary tract, MR imaging guidance has a role in tumor detection, localization, and staging and can provide accurate image guidance for minimally invasive procedures. The advent of molecular and metabolic imaging and use of higher strength magnets likely will improve diagnostic accuracy and allow targeted therapy to maximize disease control and minimize side effects.

Quantitative echography in the follow-up of patients treated with proton-beam irradiation for primary choroidal melanomas

Quantitative ultrasonic characterization yields information that is correlated to the tissue microstructure and increases the diagnostic potential of ultrasound. The measurement of acoustic properties of melanomas in vivo has not yet been reported after proton-beam irradiation. This prospective study was conducted on a cohort of 50 patients diagnosed with primary malignant melanoma to assess in vivo the ability of quantitative echography to detect changes in choroidal malignant melanomas after proton-beam irradiation and to follow the ultrasonographic changes during 24 months posttreatment. Echographic evaluations of these patients were performed at diagnosis and repeated every 6 months after treatment over a 2-y period. The acoustic parameters included in this work are derived from the calibrated tissue backscatter spectra (spectral slope, spectral intercept and apparent integrated backscatter) of a selected tumor volume after correction of the apparatus transfer function and beam diffraction. Clinical parameters resulting from conventional echography were also quantified and included mainly tumor height, tumor vascularity and internal reflectivity. Spectral intercept and apparent integrated backscatter were found to be the most useful to evaluate changes in melanomas after treatment. Significant (p < 0.05) differences of these parameter values were observed between pre- and postproton therapy. In particular, significant changes (compared with baseline) were observed for these parameters, even when the tumor size after treatment was not significantly different from baseline. The results suggest that quantitative spectrum analysis of frequency-dependent backscatter can provide information about the structural modifications of choroidal malignant melanomas as a result of proton-beam irradiation.

Ultrasonic tissue characterization via 2-D spectrum analysis: theory and in vitro measurements

A theoretical model is described for application in ultrasonic tissue characterization using a calibrated 2-D spectrum analysis method. This model relates 2-D spectra computed from ultrasonic backscatter signals to intrinsic physical properties of tissue microstructures, e.g., size, shape, and acoustic impedance. The model is applicable to most clinical diagnostic ultrasound systems. Two experiments employing two types of tissue architectures, spherical and cylindrical scatterers, are conducted using ultrasound with center frequencies of 10 and 40 MHz, respectively. Measurements of a tissue-mimicking phantom with an internal suspension of microscopic glass beads are used to validate the theoretical model. Results from in vitro muscle fibers are presented to further elucidate the utility of 2-D spectrum analysis in ultrasonic tissue characterization.

A review of magnetic resonance imaging-guided focused ultrasound surgery of uterine fibroids

Uterine fibroids are a significant cause of morbidity for women of reproductive age. Over the past decade, minimally invasive treatment options are becoming increasingly popular. A new, Food and Drug Administration-approved noninvasive treatment option is magnetic resonance-guided focused ultrasound surgery, which has the potential to become a treatment of choice for selected patients. We review the technical aspects of the procedure of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids, potential difficulties with treatment planning, and clinical trial results to date. We also describe current developments in treatment imaging and treatment optimization.

Use of a bovine eye lens for observation of HIFU-induced lesions in real-time

Study of coagulative lesion formation by high intensity focused ultrasound (HIFU) in tissue usually requires performing a sequence of experiments under different exposure conditions followed by tissue sectioning. This paper, inspired by the pioneering work of Frederic L. Lizzi, reports on the use of the bovine eye lens as a laboratory model to observe visually the development of HIFU-induced lesions. The first part of this work describes the measurement of the lens shape, density, sound speed and attenuation. The measured values were within the range of previously published values. In the second part, HIFU-induced lesion development was observed in real-time and compared with good agreement with theoretical simulation. Theoretical modeling included acoustic propagation, absorptive heating and thermal dose, as well as the experimentally measured lens characteristics. Thus, the transparent eye lens can be used as a laboratory phantom to facilitate the understanding of HIFU treatment in other tissues.

MR guided focused ultrasound: technical acceptance measures for a clinical system

Magnetic resonance (MR) guided focused ultrasound (MRgFUS) is a hybrid technique which offers efficient and safe focused ultrasound (FUS) treatments of uterine fibroids under MR guidance and monitoring. As a therapy device, MRgFUS requires systematic testing over a wide range of operational parameters prior to use in the clinical environment. We present technical acceptance tests and data for the first clinical MRgFUS system, ExAblate 2000 (InSightec Inc., Haifa, Israel), that has been FDA approved for treating uterine fibroids. These tests characterize MRgFUS by employing MR temperature measurements in tissue mimicking phantoms. The coronal scan plane is empirically demonstrated to be most reliable for measuring temperature elevations resulting from high intensity ultrasound (US) pulses ('sonications') and shows high sensitivity to changes in sonication parameters. Temperatures measured in the coronal plane were used as a measure of US energy deposited within the focal spot for a range of sonication parameters used in clinical treatments: spot type, spot length, output power, sonication duration, US frequency, and depth of sonication. In addition, MR images acquired during sonications were used to measure effective diameters and lengths of available sonication spot types and lengths. At a constant 60 W output power, the effective spot type diameters were measured to vary between 4.7 +/- 0.3 mm and 6.6 +/- 0.4 mm; treatment temperatures were found to decrease with increasing spot diameter. Prescribing different spot lengths was found to have no effect on the measured length or on measured temperatures. Tests of MRgFUS positioning accuracy determined errors in the direction parallel to the propagation of the US beam to be significantly greater than those in the perpendicular direction; most sonication spots were erroneously positioned towards the FUS transducer. The tests reported here have been demonstrated to be sufficiently sensitive to detect water leakage inside the FUS transducer. The data presented could be used for comparison by those conducting acceptance tests on other clinical MRgFUS systems.

Intraluminal high intensity ultrasound treatment in the esophagus under fast MR temperature mapping: in vivo studies

New curative and palliative treatments are needed to respond to the poor prognosis of esophageal cancer. The purpose of this study was to determine whether magnetic resonance imaging (MRI) and MR thermometry can be used to monitor the thermal ablation induced by an intraluminal high-intensity ultrasound applicator positioned in the esophagus. Experiments were performed in vivo in 2 pig esophagi (25 thermal lesions per pig). Respiratory gated or cardiac gated MR thermometry was performed with segmented echo-planar imaging gradient echo sequences. All MR acquisitions were performed without susceptibility artifacts or radiofrequency interference with the ultrasound device. The experimental procedure proposed for accurate measurement of temperature in the esophagus was found to achieve an SD of +/- 1.5 degrees C for respiratory gating and +/- 3.1 degrees C for cardiac gating. Gd-enhanced T(1)-weighted images were used to depict coagulation necrosis. Autopsy was performed immediately after the treatment. Ultrasound effects were inspected visually, and the dimensions of the lesions in the liver neighboring the esophagus were compared with those determined on the MRI images. The visually assessed thermal lesions showed good correlation with the MRI data (10% mean volume difference). The feasibility of esophageal thermal ablation using intraluminal high-intensity ultrasound and of on-line MR temperature monitoring was demonstrated.

MRI-guided focused ultrasound surgery of uterine leiomyomas

Uterine fibroids are the most common pelvic tumors in women and are a significant cause of morbidity for women of reproductive age. Today, there are a variety of less invasive alternatives available to hysterectomy, such as myomectomy, hormonal therapy, uterine artery embolization, and more recently magnetic resonance-guided focused ultrasound surgery (MRgFUS). With this technique, ultrasound waves are focused through intact skin of the anterior abdominal wall resulting in localized thermal tissue ablation, monitored by online MR temperature control. By using an effective combination of image guidance and energy delivery, MRgFUS therefore allows for preservation of uterine function while obviating the need for a minimally invasive procedure or surgery.

Intraluminal ultrasound applicator compatible with magnetic resonance imaging "real-time" temperature mapping for the treatment of oesophageal tumours: an ex vivo study

High intensity ultrasound has shown considerable ability to produce precise and deep thermal coagulation necrosis. Focused, cylindrical, spherical or plane transducers have been used to induce high temperatures in tissues to coagulate proteins and kill cells. Recently magnetic resonance imaging (MRI) has been used, with extracorporeal or intracavitary focused transducers and cylindrical interstitial applicators, to monitor temperature distribution and provide feedback during heating procedures. If intraluminal applicators are used, the active part is in contact with the region of interest and it is essential to provide an accurate view of heat deposition and the extent of coagulation necrosis close to the transducer. The purpose of this study was to develop a 10 mm diameter intraluminal ultrasound applicator, designed to treat oesophageal cancers and compatible with MRI "real-time" temperature mapping. The active part of the ultrasound applicator, covered by a latex balloon, is a 15 X 8 mm2 plane transducer, which is in contact with the tumours during treatment. Each ultrasound exposure generates coagulation necrosis, in an area with the approximate shape of a rectangular parallelepiped up to 10 mm deep. When the exposures were repeated by rotating the applicator on its axis, sector-based or cylindrical volumes of necrosis could be produced, matching the shape of oesophageal cancers. Ex vivo trials were performed to demonstrate the applicator's compatibility with a clinical MRI scanner (1.5 T). MRI signals were acquired without any magnetic susceptibility distortion, even close to the applicator. Fast (0.72 images per second) 2D temperature mapping was performed during ultrasound exposure, using temperature-related proton resonance frequency shift at a resolution of 0.5 degrees C. Coagulation necrosis viewed with inversion recovery sequences, were in good agreement with the qualitative macroscopic observations made for the few cases tested in this study.

Attenuation of porcine tissues in vivo after high-intensity ultrasound treatment

The attenuation of ultrasound (US) waves in biologic tissues is an important determinant of energy absorption and wave propagation; thus, important in optimization of high-intensity focused US (HIFU) therapy. We measured attenuation of selected porcine tissues (liver, spleen and abdominal wall) in vivo in the frequency range of 1 to 5 MHz, using the pulse-transmission method, before and after HIFU treatment. In all tissues, an increase in attenuation was observed with increasing frequency. The attenuation coefficient was higher in HIFU-treated tissues than in the untreated tissues. The lowest attenuation was measured in the liver, both in normal and HIFU-treated cases. Mechanisms that may be responsible for the observed attenuation coefficient increase in HIFU-treated tissues include thermally induced change in the tissue macromolecular structure and presence of gas/vapor bubbles due to cavitation and/or boiling.

Acoustic field of a wedge-shaped section of a spherical cap transducer

The acoustic pressure field at an arbitrary point in space is derived for a wedge-shaped section of a spherical cap transducer using the spatial impulse response (SIR) method. For a spherical surface centered at the origin, a wedge shape is created by taking cuts in the X-Y and X-Z planes and removing the smallest surface component. Analytic expressions are derived for the SIR based on spatial location. The expressions utilize the SIR solutions for a spherical cap transducer [Arditi et al., Ultrason. Imaging 3, 37-61 (1981)] with additional terms added to account for the reduced surface area of the wedge. Results from the numerical model are compared to experimental measurements from a wedge transducer with an 8-cm outer diameter and 9-cm geometric focus. The experimental and theoretical -3-dB beamwidths agreed to within 10% +/- 5%. The SIR model for a wedge-shaped transducer is easily extended to other spherically curved transducer geometries that consist of combinations of wedge sections and spherical caps.

Radiation-force technique to monitor lesions during ultrasonic therapy

This report describes a monitoring technique for high-intensity focused ultrasound (US), or HIFU, lesions, including protein-denaturing lesions (PDLs) and those made for noninvasive cardiac therapy and tumor treatment in the eye, liver and other organs. Designed to sense the increased stiffness of a HIFU lesion, this technique uniquely utilizes the radiation force of the therapeutic US beam as an elastographic push to detect relative stiffness changes. Feasibility was demonstrated with computer simulations (treating acoustically induced displacements, concomitant heating, and US displacement-estimation algorithms) and pilot in vitro experimental studies, which agree qualitatively in differentiating HIFU lesions from normal tissue. Detectable motion can be induced by a single 5 ms push with temperatures well below those needed to form a lesion. Conversely, because the characteristic heat diffusion time is much longer than the characteristic relaxation time following a push, properly timed multiple therapy pulses will form lesions while providing precise control during therapy.

Image-guided acoustic therapy

The potential role of therapeutic ultrasound in medicine is promising. Currently, medical devices are being developed that utilize high-intensity focused ultrasound as a noninvasive method to treat tumors and to stop bleeding (hemostasis). The primary advantage of ultrasound that lends the technique so readily to use in noninvasive therapy is its ability to penetrate deep into the body and deliver to a specific site thermal or mechanical energy with submillimeter accuracy. Realizing the full potential of acoustic therapy, however, requires precise targeting and monitoring. Fortunately, several imaging modalities can be utilized for this purpose, thus leading to the concept of image-guided acoustic therapy. This article presents a review of high-intensity focused ultrasound therapy, including its mechanisms of action, the imaging modalities used for guidance and monitoring, some current applications, and the requirements and technology associated with this exciting and promising field.

Optimization of power deposition and a heating strategy for external ultrasound thermal therapy

The purpose of this paper is to examine the thermal dose distribution, to configure the optimal absorbed power deposition, and to design an appropriate heating strategy for ultrasound thermal therapy. This work employs simulation programs, which are based on the transient bio-heat transfer equation and an ideal absorbed power deposition or an ideal temperature elevation within a cube of tissue, to study the optimal absorbed power deposition. Meanwhile, a simplified model of a scanned ultrasound transducer power deposition (a cone with convergent/divergent shape) is used to investigate the heating strategy for a large tumor with a sequence of heating pulses. The distribution of thermal dose equivalence defined by Sapareto and Dewey is used to evaluate the heating result for a set of given parameters. The parameters considered are the absorbed power density, heating duration, temperature elevation, blood perfusion, and the size of heating cube. The results demonstrate that the peak temperature is the key factor determining the thermal dose for this short-duration heating. Heat conduction has a very strong influence on the responses of temperature and thermal dose for a small heating cube and the boundary portion of a large heating cube. Hence, for obtaining the same therapeutic result, a higher power density is required for these two conditions to compensate the great temperature difference between the heating cube and the surrounding tissue. The influence of blood perfusion on the thermal dose is negligible on the boundary portion of the heating cube, while in the central portion it may become a crucial factor as a lower power density is used in this portion to save the delivered energy. When using external ultrasound heating method to treat a large tumor, the size of heating unit, the sequence of heating pulses, and the cooling-time interval between the consecutive heating pulses are the important factors to be determined to have an appropriate treatment within a reasonable overall treatment time.