Hyperthermia treatment planning

Photothermal therapy of xenografted tumor by carbon nanoparticles-Fe(II) complex

Due to the unique structure, carbon nanomaterials could convert near-infrared (NIR) light into heat efficiently in tumor ablation using photothermal therapy (PTT). However, none of them has been applied in clinical treatment, because they have not been approved for clinical evaluations and the precise temperature control facility is scarce. In this study, we designed a temperature-responsive controller for PTT and used carbon nanoparticles-Fe(II) complex (CNSI-Fe) as photothermal conversion agent (PTA) for PTT of tumor in vitro and in vivo. CNSI-Fe was an innovative drug under the evaluations in clinical trials. CNSI-Fe showed excellent photothermal conversion ability in water to increase the water temperature by 40 °C within 5 min under irradiation of 808 nm laser at 0.5 W/cm2. The temperature was precisely controlled at 52 °C for both in vitro and in vivo tumor inhibition. CNSI-Fe with NIR irradiation showed higher tumor cell inhibition than CNSI. In tumor bearing mice, CNSI-Fe with NIR irradiation achieved an inhibition rate of 84.7 % and 71.4 % of them were completely cured. Mechanistically, CNSI-Fe under NIR irradiation induced the radical generation, oxidative damage and ferroptosis to kill tumor. In addition, CNSI-Fe showed good biosafety during PTT according to hematological, serum biological and histopathological examinations. These results indicated that the combination of chemotherapy and PTT provided higher antitumor efficiency using CNSI-Fe as PTA.

Combining deep learning and 3D contrast source inversion in MR-based electrical properties tomography

Magnetic resonance electrical properties tomography (MR-EPT) is a technique used to estimate the conductivity and permittivity of tissues from MR measurements of the transmit magnetic field. Different reconstruction methods are available; however, all these methods present several limitations, which hamper the clinical applicability. Standard Helmholtz-based MR-EPT methods are severely affected by noise. Iterative reconstruction methods such as contrast source inversion electrical properties tomography (CSI-EPT) are typically time-consuming and are dependent on their initialization. Deep learning (DL) based methods require a large amount of training data before sufficient generalization can be achieved. Here, we investigate the benefits achievable using a hybrid approach, that is, using MR-EPT or DL-EPT as initialization guesses for standard 3D CSI-EPT. Using realistic electromagnetic simulations at 3 and 7 T, the accuracy and precision of hybrid CSI reconstructions are compared with those of standard 3D CSI-EPT reconstructions. Our results indicate that a hybrid method consisting of an initial DL-EPT reconstruction followed by a 3D CSI-EPT reconstruction would be beneficial. DL-EPT combined with standard 3D CSI-EPT exploits the power of data-driven DL-based EPT reconstructions, while the subsequent CSI-EPT facilitates a better generalization by providing data consistency.

Heat Transfer in Biological Spherical Tissues during Hyperthermia of Magnetoma

Hyperthermia therapy is now being used to treat cancer. However, understanding the pattern of temperature increase in biological tissues during hyperthermia treatment is essential. In recent years, many physicians and engineers have studied the use of computational and mathematical models of heat transfer in biological systems. The rapid progress in computing technology has intrigued many researchers. Many medical procedures also use engineering techniques and mathematical modeling to ensure their safety and assess the risks involved. One such model is the modified Pennes bioheat conduction equation. This paper provides an analytical solution to the modified Pennes bioheat conduction equation with a single relaxation time by incorporating in it the (MGT) equation. The suggested model examines heat transport in biological tissues as forming an infinite concentric spherical region during magnetic fluid hyperthermia. To investigate thermal reactions caused by temperature shock, specifically the influence of heat generation through heat treatment on a skin tumor [AEGP9], the Laplace transformation, and numerical inverse transformation methods are used. This model was able to explain the effects of different therapeutic approaches such as cryotherapy sessions, laser therapy, and physical occurrences, transfer, metabolism support, and blood perfusion. Comparison of the numerical results of the suggested model with those in the literature confirmed the validity of the model's numerical results.

ESHO benchmarks for computational modeling and optimization in hyperthermia therapy

BACKGROUND

The success of cancer hyperthermia (HT) treatments is strongly dependent on the temperatures achieved in the tumor and healthy tissues as it correlates with treatment efficacy and safety, respectively. Hyperthermia treatment planning (HTP) simulations have become pivotal for treatment optimization due to the possibility for pretreatment planning, optimization and decision making, as well as real-time treatment guidance.

MATERIALS AND METHODS

The same computational methods deployed in HTP are also used for in silico studies. These are of great relevance for the development of new HT devices and treatment approaches. To aid this work, 3 D patient models have been recently developed and made available for the HT community. Unfortunately, there is no consensus regarding tissue properties, simulation settings, and benchmark applicators, which significantly influence the clinical relevance of computational outcomes.

RESULTS AND DISCUSSION

Herein, we propose a comprehensive set of applicator benchmarks, efficacy and safety optimization algorithms, simulation settings and clinical parameters, to establish benchmarks for method comparison and code verification, to provide guidance, and in view of the 2021 ESHO Grand Challenge (Details on the ESHO grand challenge on HTP will be provided at https://www.esho.info/).

CONCLUSION

We aim to establish guidelines to promote standardization within the hyperthermia community such that novel approaches can quickly prove their benefit as quickly as possible in clinically relevant simulation scenarios. This paper is primarily focused on radiofrequency and microwave hyperthermia but, since 3 D simulation studies on heating with ultrasound are now a reality, guidance as well as a benchmark for ultrasound-based hyperthermia are also included.

Improved patient-specific hyperthermia planning based on parametrized electromagnetic and thermal models for the SIGMA-30 applicator

OBJECTIVE

To create an improved planning method for pediatric regional hyperthermia (RHT) using the SIGMA-30 applicator (SIGMA-30).

MATERIALS AND METHODS

An electromagnetic model of SIGMA-30 was generated for use with the finite-difference time-domain (FDTD) method. Applying special MATLAB-based algorithms, voxel models of a pediatric patient with pelvic rhabdomyosarcoma were created from Computed-Tomography (CT) contours for use with the FDTD method and the finite-difference (FD) method capable of using either temperature-independent or temperature-dependent perfusion models for solving the Bioheat Transfer Equation (BHTE). Patient models were parametrized regarding, first, the positioning in the applicator, second, the absorbed power range and, third, different perfusion models, resulting in the so-called Parametrized Treatment Models (PTMs). A novel dedicated optimization procedure was developed based on quantitative comparison of numerical calculations against temperature and power measurements from two RHT therapies.

RESULTS

Using measured data, a realistic absorbed power range in the patient model was estimated. Within this range, several FDTD and BHTE runs were performed and, applying the aforementioned optimization scheme, the best PTMs and perfusion models were identified for each therapy via a retrospective comparison with measurements in 14 temperature sensor positions: 5 in the tumor, 8 in rectum and one in bladder.

CONCLUSION

A novel dedicated optimization procedure for identification of suitable patient-specific electromagnetic and thermal models, which can be used for improved patient planning, was developed and evaluated by comparison with treatment-derived measurements using SIGMA-30. The optimization procedure can be extended to other hyperthermia applicators and to other patient types, including adults.

In silico assessment of collateral eddy current heating in biocompatible implants subjected to magnetic hyperthermia treatments

Purpose: Bearing partially or fully metallic passive implants represents an exclusion criterion for patients undergoing a magnetic hyperthermia procedure, but there are no specific studies backing this restrictive decision. This work assesses how the secondary magnetic field generated at the surface of two common types of prostheses affects the safety and efficiency of magnetic hyperthermia treatments of localized tumors. The paper also proposes the combination of a multi-criteria decision analysis and a graphical representation of calculated data as an initial screening during the preclinical risk assessment for each patient.Materials and methods: Heating of a hip joint and a dental implant during the treatment of prostate, colorectal and head and neck tumors have been assessed considering different external field conditions and exposure times. The Maxwell equations including the secondary field produced by metallic prostheses have been solved numerically in a discretized computable human model. The heat exchange problem has been solved through a modified version of the Pennes' bioheat equation assuming a temperature dependency of blood perfusion and metabolic heat, i.e. thermorregulation. The degree of risk has been assessed using a risk index with parameters coming from custom graphs plotting the specific absorption rate (SAR) vs temperature increase, and coefficients derived from a multi-criteria decision analysis performed following the MACBETH approach.Results: The comparison of two common biomaterials for passive implants - Ti6Al4V and CoCrMo - shows that both specific absorption rate (SAR) and local temperature increase are found to be higher for the hip prosthesis made by Ti6Al4V despite its lower electrical and thermal conductivity. By tracking the time evolution of temperature upon field application, it has been established that there is a 30 s delay between the time point for which the thermal equilibrium is reached at prostheses and tissues. Likewise, damage may appear in those tissues adjacent to the prostheses at initial stages of treatment, since recommended thermal thresholds are soon surpassed for higher field intensities. However, it has also been found that under some operational conditions the typical safety rule of staying below or attain a maximum temperature increase or SAR value is met.Conclusion: The current exclusion criterion for implant-bearing patients in magnetic hyperthermia should be revised, since it may be too restrictive for a range of the typical field conditions used. Systematic in silico treatment planning using the proposed methodology after a well-focused diagnostic procedure can aid the clinical staff to find the appropriate limits for a safe treatment window.

Feasibility of Temperature Control by Electrical Impedance Tomography in Hyperthermia

We present a simulation study investigating the feasibility of electrical impedance tomography (EIT) as a low cost, noninvasive technique for hyperthermia (HT) treatment monitoring and adaptation. Temperature rise in tissues leads to perfusion and tissue conductivity changes that can be reconstructed in 3D by EIT to noninvasively map temperature and perfusion. In this study, we developed reconstruction methods and investigated the achievable accuracy of EIT by simulating HT treatmentlike scenarios, using detailed anatomical models with heterogeneous conductivity distributions. The impact of the size and location of the heated region, the voltage measurement signal-to-noise ratio, and the reference model personalization and accuracy were studied. Results showed that by introducing an iterative reconstruction approach, combined with adaptive prior regions and tissue-dependent penalties, planning-based reference models, measurement-based reweighting, and physics-based constraints, it is possible to map conductivity-changes throughout the heated domain, with an accuracy of around 5% and cm-scale spatial resolution. An initial exploration of the use of multifrequency EIT to separate temperature and perfusion effects yielded promising results, indicating that temperature reconstruction accuracy can be in the order of 1 ∘C. Our results suggest that EIT can provide valuable real-time HT monitoring capabilities. Experimental confirmation in real-world conditions is the next step.

Fiber Optic Sensors-Based Thermal Analysis of Perfusion-Mediated Tissue Cooling in Liver Undergoing Laser Ablation

The current challenge in the field of thermo-ablative treatments of tumors is to achieve a balance between complete destruction of malignant cells and safeguarding of the surrounding healthy tissue. Blood perfusion plays a key role for thermal ablation success, especially in the case of highly vascularized organs like liver. This work aims at monitoring the temperature within perfused swine liver undergoing laser ablation (LA). Temperature was measured through seven arrays of Fiber Bragg Grating sensors (FBGs) around the laser applicator. To mimic reality, blood perfusion within the ex-vivo liver was simulated using artificial vessels. The influence of blood perfusion on LA was carried out by comparing the temperature profiles in two different spatial configurations of vessels and fibers. The proposed setup permitted to accurately measure the heat propagation in real-time with a temperature resolution of 0.1 °C and to observe a relevant tissue cooling near to the vessel up to 65%.

Impact of Number of Segmented Tissues on SAR Prediction Accuracy in Deep Pelvic Hyperthermia Treatment Planning

Simple Summary

Hyperthermia treatment planning is the process of optimizing treatment quality using pre-treatment simulations. Although it has become a powerful tool, prediction accuracy is strongly dependent on the patient model. For deep hyperthermia in the pelvis, it is common that only four tissue categories are discriminated (bone, fat, muscle-like, and tumor). For the head and neck region, more tissues have been shown to be required for good prediction accuracy. Delineating is a labor-intensive and difficult process. Hence, it is important to find the optimum between accuracy and labor, but for deep pelvic hyperthermia, there are no published studies showing the impact of the number of tissues. We studied the trade-off between the segmentation detail needed and segmentation feasibility. Our findings indicate that including high water content tissues can impact simulation accuracy. Although our results, in general, underline the suitability of our current clinical protocol, they help to prioritize improvements for specific cases.

Abstract

In hyperthermia, the general opinion is that pre-treatment optimization of treatment settings requires a patient-specific model. For deep pelvic hyperthermia treatment planning (HTP), tissue models comprising four tissue categories are currently discriminated. For head and neck HTP, we found that more tissues are required for increasing accuracy. In this work, we evaluated the impact of the number of segmented tissues on the predicted specific absorption rate (SAR) for the pelvic region. Highly detailed anatomical models of five healthy volunteers were selected from a virtual database. For each model, seven lists with varying levels of segmentation detail were defined and used as an input for a modeling study. SAR changes were quantified using the change in target-to-hotspot-quotient and maximum SAR relative differences, with respect to the most detailed patient model. The main finding of this study was that the inclusion of high water content tissues in the segmentation may result in a clinically relevant impact on the SAR distribution and on the predicted hyperthermia treatment quality when considering our pre-established thresholds. In general, our results underline the current clinical segmentation protocol and help to prioritize any improvements.

Role of Simulations in the Treatment Planning of Radiofrequency Hyperthermia Therapy in Clinics

Hyperthermia therapy is a treatment modality in which tumor temperatures are elevated to higher temperatures to cause damage to cancerous tissues. Numerical simulations are integral in the development of hyperthermia treatment systems and in clinical treatment planning. In this study, simulations in radiofrequency hyperthermia therapy are reviewed in terms of their technical development and clinical aspects for effective clinical use. This review offers an overview of mathematical models and the importance of tissue properties; locoregional mild hyperthermia therapy, including phantom and realistic human anatomy models; phase array systems; tissue damage; thermal dose analysis; and thermoradiotherapy planning. This review details the improvements in numerical approaches in treatment planning and their application for effective clinical use. Furthermore, the modeling of thermoradiotherapy planning, which can be integrated with radiotherapy to provide combined hyperthermia and radiotherapy treatment planning strategies, are also discussed. This review may contribute to the effective development of thermoradiotherapy planning in clinics.

Mathematical simulation of temperature distribution in tumor tissue and surrounding healthy tissue treated by laser combined with indocyanine green

Background

Photothermal therapy is a local treatment method for cancer and the heat energy generated from it could destroy the tumor cells. This study is aimed to investigate the temperature distribution in tumor tissue and surrounding health tissue of tumor bearing mice applying mathematical simulation model. Tumor bearing mice treated by laser combined with or without indocyanine green. Monte Carlo method and the Pennes bio-heat equation were used to calculate the light distribution and heat energy. COMSOL Multiphysic was adopted to construct three dimensional temperature distribution model.

Results

This study revealed that the data calculated by simulation model is in good agreement with the surface temperature monitored by infrared thermometer. Effected by the optical parameters and boundary conditions of tissue, the highest temperature of tissue treated by laser combined with indocyanine green was about 65 °C which located in tumor tissue and the highest temperature of tissue treated by laser was about 43 °C which located under the tumor tissue. The temperature difference was about 20 °C. Temperature distribution in tissue was not uniform. The temperature difference in different parts of tumor tissue raised up to 15 °C. The temperature of tumor tissue treated by laser combined with indocyanine green was about 20 °C higher than that of the surrounding healthy tissue.

Conclusions

Reasonably good matching between the calculated temperature and the measured temperature was achieved, thus demonstrated great utility of our modeling method and approaches for deepening understand in the temperature distribution in tumor tissue and surrounding healthy tissue during the laser combined with photosensitizer. The simulation model could provide guidance and reference function for the effect of photothermal therapy.

Electronic supplementary material

The online version of this article (10.1186/s12976-019-0107-3) contains supplementary material, which is available to authorized users.

Developments in Electrical-Property Tomography Based on the Contrast-Source Inversion Method

The main objective of electrical-property tomography (EPT) is to retrieve dielectric tissue parameters from B ^ 1 + data as measured by a magnetic-resonance (MR) scanner. This is a so-called hybrid inverse problem in which data are defined inside the reconstruction domain of interest. In this paper, we discuss recent and new developments in EPT based on the contrast-source inversion (CSI) method. After a short review of the basics of this method, two- and three-dimensional implementations of CSI-EPT are presented along with a very efficient variant of 2D CSI-EPT called first-order induced current EPT (foIC-EPT). Practical implementation issues that arise when applying the method to measured data are addressed as well, and the limitations of a two-dimensional approach are extensively discussed. Tissue-parameter reconstructions of an anatomically correct male head model illustrate the performance of two- and three-dimensional CSI-EPT. We show that 2D implementation only produces reliable reconstructions under very special circumstances, while accurate reconstructions can be obtained with 3D CSI-EPT.

Focused Ultrasound Hyperthermia for Targeted Drug Release from Thermosensitive Liposomes: Results from a Phase I Trial

Purpose To demonstrate the feasibility and safety of using focused ultrasound planning models to determine the treatment parameters needed to deliver volumetric mild hyperthermia for targeted drug delivery without real-time thermometry. Materials and Methods This study was part of the Targeted Doxorubicin, or TARDOX, phase I prospective trial of focused ultrasound-mediated, hyperthermia-triggered drug delivery to solid liver tumors ( ClinicalTrials.gov identifier NCT02181075). Ten participants (age range, 49-68 years; average age, 60 years; four women) were treated from March 2015 to March 2017 by using a clinically approved focused ultrasound system to release doxorubicin from lyso-thermosensitive liposomes. Ultrasonic heating of target tumors (treated volume: 11-73 cm³ [mean ± standard deviation, 50 cm³ ± 26]) was monitored in six participants by using a minimally invasive temperature sensor; four participants were treated without real-time thermometry. For all participants, CT images were used with a patient-specific hyperthermia model to define focused ultrasound treatment plans. Feasibility was assessed by comparing model-prescribed focused ultrasound powers to those implemented for treatment. Safety was assessed by evaluating MR images and biopsy specimens for evidence of thermal ablation and monitoring adverse events. Results The mean difference between predicted and implemented treatment powers was -0.1 W ± 17.7 (n = 10). No evidence of focused ultrasound-related adverse effects, including thermal ablation, was found. Conclusion In this 10-participant study, the authors confirmed the feasibility of using focused ultrasound-mediated hyperthermia planning models to define treatment parameters that safely enabled targeted, noninvasive drug delivery to liver tumors while monitored with B-mode guidance and without real-time thermometry. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Dickey and Levi-Polyachenko in this issue.

Iron Oxide Nanoparticles: Innovative Tool in Cancer Diagnosis and Therapy

Although cancer is one of the most dangerous and the second most lethal disease in the world, current therapy including surgery, chemotherapy, radiotherapy, etc., is highly insufficient not in the view of therapy success rate or the amount of side effects. Accordingly, procedures with better outcomes are highly desirable. Iron oxide nanoparticles (IONPs) present an innovative tool-ideal for innovation and implementation into practice. This review is focused on summarizing some well-known facts about pharmacokinetics, toxicity, and the types of IONPs, and furthermore, provides a survey of their use in cancer diagnosis and therapy.

Computational study of the effects of arterial bifurcation on the temperature distribution during cryosurgery

BACKGROUND

Thermally significant blood flows into locally cooled diseased tissues and warm them during cryosurgery so that the iceball is often hard to cover the whole diseased volume. This paper is aimed at investigating the effects of large arterial bifurcation on the temperature distribution during cryosurgery through simulation method.

METHODS

A parametric geometry model is introduced to construct a close-to-real arterial bifurcation. The three-dimensional transient conjugate heat transfer between bifurcated artery and solid tissues with phase change during cryosurgery is performed by finite volume method.

RESULTS

The discussion was then made on the effects of the relative position between cryoprobe and artery bifurcation, the inlet velocity of root artery and the layout of multiple cryoprobes on the temperature distribution and iceball evolution. The results show that the thermal interaction between blood flow and iceball growth near bifurcation is considerable complex. The thermal effects of bifurcation could modulate the iceball morphology, severely weaken its freezing volume and prevent the blood vessel from being frozen.

CONCLUSION

The present work is expected to be valuable in optimizing cryosurgery scheme of the situation that the bifurcated artery is embedded into the disease tissue.

Asymmetric Assembling of Iron Oxide Nanocubes for Improving Magnetic Hyperthermia Performance

Magnetic hyperthermia (MH) based on magnetic nanoparticles (MNPs) is a promising adjuvant therapy for cancer treatment. Particle clustering leading to complex magnetic interactions affects the heat generated by MNPs during MH. The heat efficiencies, theoretically predicted, are still poorly understood because of a lack of control of the fabrication of such clusters with defined geometries and thus their functionality. This study aims to correlate the heating efficiency under MH of individually coated iron oxide nanocubes (IONCs) versus soft colloidal nanoclusters made of small groupings of nanocubes arranged in different geometries. The controlled clustering of alkyl-stabilized IONCs is achieved here during the water transfer procedure by tuning the fraction of the amphiphilic copolymer, poly(styrene-co-maleic anhydride) cumene-terminated, to the nanoparticle surface. It is found that increasing the polymer-to-nanoparticle surface ratio leads to the formation of increasingly large nanoclusters with defined geometries. When compared to the individual nanocubes, we show here that controlled grouping of nanoparticles-so-called "dimers" and "trimers" composed of two and three nanocubes, respectively-increases specific absorption rate (SAR) values, while conversely, forming centrosymmetric clusters having more than four nanocubes leads to lower SAR values. Magnetization measurements and Monte Carlo-based simulations support the observed SAR trend and reveal the importance of the dipolar interaction effect and its dependence on the details of the particle arrangements within the different clusters.

Facile transformation of FeO/Fe3O4 core-shell nanocubes to Fe3O4 via magnetic stimulation

Here, we propose the use of magnetic hyperthermia as a means to trigger the oxidation of Fe1-xO/Fe3-δO4 core-shell nanocubes to Fe3-δO4 phase. As a first relevant consequence, the specific absorption rate (SAR) of the initial core-shell nanocubes doubles after exposure to 25 cycles of alternating magnetic field stimulation. The improved SAR value was attributed to a gradual transformation of the Fe1-xO core to Fe3-δO4, as evidenced by structural analysis including high resolution electron microscopy and Rietveld analysis of X-ray diffraction patterns. The magnetically oxidized nanocubes, having large and coherent Fe3-δO4 domains, reveal high saturation magnetization and behave superparamagnetically at room temperature. In comparison, the treatment of the same starting core-shell nanocubes by commonly used thermal annealing process renders a transformation to γ-Fe2O3. In contrast to other thermal annealing processes, the method here presented has the advantage of promoting the oxidation at a macroscopic temperature below 37 °C. Using this soft oxidation process, we demonstrate that biotin-functionalized core-shell nanocubes can undergo a mild self-oxidation transformation without losing their functional molecular binding activity.

Magnetomotive Optical Coherence Elastography for Magnetic Hyperthermia Dosimetry Based on Dynamic Tissue Biomechanics

Magnetic nanoparticles (MNPs) have been used in many diagnostic and therapeutic biomedical applications over the past few decades to enhance imaging contrast, steer drugs to targets, and treat tumors via hyperthermia. Optical coherence tomography (OCT) is an optical biomedical imaging modality that relies on the detection of backscattered light to generate high-resolution cross-sectional images of biological tissue. MNPs have been utilized as imaging contrast and perturbative mechanical agents in OCT in techniques called magnetomotive OCT (MM-OCT) and magnetomotive elastography (MM-OCE), respectively. MNPs have also been independently used for magnetic hyperthermia treatments, enabling therapeutic functions such as killing tumor cells. It is well known that the localized tissue heating during hyperthermia treatments result in a change in the biomechanical properties of the tissue. Therefore, we propose a novel dosimetric technique for hyperthermia treatment based on the viscoelasticity change detected by MM-OCE, further enabling the theranostic function of MNPs. In this paper, we first review the basic principles and applications of MM-OCT, MM-OCE, and magnetic hyperthermia, and present new preliminary results supporting the concept of MM-OCE-based hyperthermia dosimetry.

A Thermofluid Analysis of the Magnetic Nanoparticles Enhanced Heating Effects in Tissues Embedded with Large Blood Vessel during Magnetic Fluid Hyperthermia

The thermal effect developed due to the heating of magnetic nanoparticles (MNPs) in presence of external magnetic field can be precisely controlled by the proper selection of magnetic absorption properties of the MNPs. The present paper deals with the numerical simulation of temperature field developed within or outside the tumor, in the presence of an external alternating magnetic field, using a thermofluidic model developed using ANSYS FLUENT®. A three-layer nonuniform tissue structure with one or two blood vessels surrounding the tumor is considered for the present simulation. The results obtained clearly suggest that the volumetric distribution pattern of MNPs within the tumor has a strong influence on the temperature field developed. The linear pattern of volumetric distribution has a strong effect over the two other types of distribution considered herein. Various other important factors like external magnetic field intensity, frequency, vascular congestion, types of MNP material, and so forth are considered to find the influence on the temperature within the tumor. Results show that proper selection of these parameters has a strong influence on the desired therapeutic temperature range and thus it is of utmost importance from the efficacy point of view of magnetic fluid hyperthermia (MFH).

The relevance of MRI for patient modeling in head and neck hyperthermia treatment planning: a comparison of CT and CT-MRI based tissue segmentation on simulated temperature

PURPOSE

In current clinical practice, head and neck (H&N) hyperthermia treatment planning (HTP) is solely based on computed tomography (CT) images. Magnetic resonance imaging (MRI) provides superior soft-tissue contrast over CT. The purpose of the authors' study is to investigate the relevance of using MRI in addition to CT for patient modeling in H&N HTP.

METHODS

CT and MRI scans were acquired for 11 patients in an immobilization mask. Three observers manually segmented on CT, MRI T1 weighted (MRI-T1w), and MRI T2 weighted (MRI-T2w) images the following thermo-sensitive tissues: cerebrum, cerebellum, brainstem, myelum, sclera, lens, vitreous humor, and the optical nerve. For these tissues that are used for patient modeling in H&N HTP, the interobserver variation of manual tissue segmentation in CT and MRI was quantified with the mean surface distance (MSD). Next, the authors compared the impact of CT and CT and MRI based patient models on the predicted temperatures. For each tissue, the modality was selected that led to the lowest observer variation and inserted this in the combined CT and MRI based patient model (CT and MRI), after a deformable image registration. In addition, a patient model with a detailed segmentation of brain tissues (including white matter, gray matter, and cerebrospinal fluid) was created (CT and MRIdb). To quantify the relevance of MRI based segmentation for H&N HTP, the authors compared the predicted maximum temperatures in the segmented tissues (Tmax) and the corresponding specific absorption rate (SAR) of the patient models based on (1) CT, (2) CT and MRI, and (3) CT and MRIdb.

RESULTS

In MRI, a similar or reduced interobserver variation was found compared to CT (maximum of median MSD in CT: 0.93 mm, MRI-T1w: 0.72 mm, MRI-T2w: 0.66 mm). Only for the optical nerve the interobserver variation is significantly lower in CT compared to MRI (median MSD in CT: 0.58 mm, MRI-T1w: 1.27 mm, MRI-T2w: 1.40 mm). Patient models based on CT (Tmax: 38.0 °C) and CT and MRI (Tmax: 38.1 °C) result in similar simulated temperatures, while CT and MRIdb (Tmax: 38.5 °C) resulted in significantly higher temperatures. The SAR corresponding to these temperatures did not differ significantly.

CONCLUSIONS

Although MR imaging reduces the interobserver variation in most tissues, it does not affect simulated local tissue temperatures. However, the improved soft-tissue contrast provided by MRI allows generating a detailed brain segmentation, which has a strong impact on the predicted local temperatures and hence may improve simulation guided hyperthermia.

Design, development and microwave inter-comparison of dual slot antenna configurations for localized hepatic tumor management

Slot antennas are generally preferred for localized liver cancer treatment modalities due to desired radiation characteristics. An iterative thermal/microwave numerical routine is used to analyze regular and miniature slot antenna configurations at 5.8 GHz. A thermal/microwave solver determines the specific absorption rate to malignant tissues as a pre- processing step to compute microwave solution in terms of propagation wave number, return loss and insertion loss. The regular and miniature dual slots antenna geometries were then developed to estimate the return loss characteristics against antennas slot lengths at a constant frequency of 5.8 GHz. Results reveal that the regular geometry has return loss less than -5 dB as compared to <-25 dB return loss for miniature slot antenna configuration. Furthermore, 5.8 GHz antenna geometry provides physical size reduction up to 50 %, lower fabrication cost and is a better minimally invasive choice due to further packed thermal ablation spots.

Super-Paramagnetic Nanoparticles with Spinel Structure: A Review of Synthesis and Biomedical Applications

The study of ceramic materials has attracted the attention of many researchers due to the possibility of their use in nanotechnology. The spinel ferrites form a large group of materials with a broad range of applications. Some examples include electronic devices such as high-frequency transformer cores, antenna rods, induction-tuners, among many others. However, when the ferritic materials display superparamagnetic behavior, their potential for biological applications like drug delivery, hyperthermia, resonance magnetic imaging and magnetic separation, become amazingly high. Therefore, the superparamagnetism is a characteristic strongly desired for spinel ferrites. Since this phenomenon is size-dependent, the methodologies to synthesize these materials has emerged as a crucial step in order to obtain the desired properties. In this regarding, several synthetic processes have been developed. For example, co-precipitation is a fast and cheap method to synthesize superparamagnetic spinel ferrites. However, methodologies involving microwave, ultrasound or polymers frequently result in these kind of materials. Therefore, this review brings a brief historic introduction about spinel ferrites as well as essential concepts to understand their structure and magnetic properties. In addition to this, recent advances in synthesis and applications of the superparamagnetic spinel ferrites are mentioned. Contents of Paper

Interstitial ultrasound ablation of vertebral and paraspinal tumours: parametric and patient-specific simulations

PURPOSE

Theoretical parametric and patient-specific models are applied to assess the feasibility of interstitial ultrasound ablation of tumours in and near the spine and to identify potential treatment delivery strategies.

METHODS

3D patient-specific finite element models (n = 11) of interstitial ultrasound ablation of tumours associated with the spine were generated. Gaseous nerve insulation and various applicator configurations, frequencies (3 and 7 MHz), placement trajectories, and tumour locations were simulated. Parametric studies with multilayered models investigated the impacts of tumour attenuation, tumour dimension, and the thickness of bone insulating critical structures. Temperature and thermal dose were calculated to define ablation (>240 equivalent minutes at 43 °C (EM43 °C)) and safety margins (<45 °C and <6 EM43 °C), and to determine performance and required delivery parameters.

RESULTS

Osteolytic tumours (≤44 mm) encapsulated by bone could be successfully ablated with 7 MHz interstitial ultrasound (8.1-16.6 W/cm(2), 120-5900 J, 0.4-15 min). Ablation of tumours (94.6-100% volumetric) 0-14.5 mm from the spinal canal was achieved within 3-15 min without damaging critical nerves. 3 MHz devices provided faster ablation (390 versus 930 s) of an 18 mm diameter osteoblastic (high bone content) volume than 7 MHz devices. Critical anatomy in proximity to the tumour could be protected by selection of appropriate applicator configurations, active sectors, and applied power schemas, and through gaseous insulation. Preferential ultrasound absorption at bone surfaces facilitated faster, more effective ablations in osteolytic tumours and provided isolation of ablative energies and temperatures.

CONCLUSIONS

Parametric and patient-specific studies demonstrated the feasibility and potential advantages of interstitial ultrasound ablation treatment of paraspinal and osteolytic vertebral tumours.

Model-based feasibility assessment and evaluation of prostate hyperthermia with a commercial MR-guided endorectal HIFU ablation array

PURPOSE

Feasibility of targeted and volumetric hyperthermia (40-45 °C) delivery to the prostate with a commercial MR-guided endorectal ultrasound phased array system, designed specifically for thermal ablation and approved for ablation trials (ExAblate 2100, Insightec Ltd.), was assessed through computer simulations and tissue-equivalent phantom experiments with the intention of fast clinical translation for targeted hyperthermia in conjunction with radiotherapy and chemotherapy.

METHODS

The simulations included a 3D finite element method based biothermal model, and acoustic field calculations for the ExAblate ERUS phased array (2.3 MHz, 2.3 × 4.0 cm(2), ∼1000 channels) using the rectangular radiator method. Array beamforming strategies were investigated to deliver protracted, continuous-wave hyperthermia to focal prostate cancer targets identified from representative patient cases. Constraints on power densities, sonication durations and switching speeds imposed by ExAblate hardware and software were incorporated in the models. Preliminary experiments included beamformed sonications in tissue mimicking phantoms under MR temperature monitoring at 3 T (GE Discovery MR750W).

RESULTS

Acoustic intensities considered during simulation were limited to ensure mild hyperthermia (Tmax < 45 °C) and fail-safe operation of the ExAblate array (spatial and time averaged acoustic intensity ISATA < 3.4 W/cm(2)). Tissue volumes with therapeutic temperature levels (T > 41 °C) were estimated. Numerical simulations indicated that T > 41 °C was calculated in 13-23 cm(3) volumes for sonications with planar or diverging beam patterns at 0.9-1.2 W/cm(2), in 4.5-5.8 cm(3) volumes for simultaneous multipoint focus beam patterns at ∼0.7 W/cm(2), and in ∼6.0 cm(3) for curvilinear (cylindrical) beam patterns at 0.75 W/cm(2). Focused heating patterns may be practical for treating focal disease in a single posterior quadrant of the prostate and diffused heating patterns may be useful for heating quadrants, hemigland volumes or even bilateral targets. Treatable volumes may be limited by pubic bone heating. Therapeutic temperatures were estimated for a range of physiological parameters, sonication duty cycles and rectal cooling. Hyperthermia specific phasing patterns were implemented on the ExAblate prostate array and continuous-wave sonications (∼0.88 W/cm(2), 15 min) were performed in tissue-mimicking material with real-time MR-based temperature imaging (PRFS imaging at 3.0 T). Shapes of heating patterns observed during experiments were consistent with simulations.

CONCLUSIONS

The ExAblate 2100, designed specifically for thermal ablation, can be controlled for delivering continuous hyperthermia in prostate while working within operational constraints.

Comparison of magnetic nanoparticle and microwave hyperthermia cancer treatment methodology and treatment effect in a rodent breast cancer model

PURPOSE

The purpose of this study was to compare the efficacy of iron oxide/magnetic nanoparticle hyperthermia (mNPH) and 915 MHz microwave hyperthermia at the same thermal dose in a mouse mammary adenocarcinoma model.

MATERIALS AND METHODS

A thermal dose equivalent to 60 min at 43 °C (CEM60) was delivered to a syngeneic mouse mammary adenocarcinoma flank tumour (MTGB) via mNPH or locally delivered 915 MHz microwaves. mNPH was generated with ferromagnetic, hydroxyethyl starch-coated magnetic nanoparticles. Following mNP delivery, the mouse/tumour was exposed to an alternating magnetic field (AMF). The microwave hyperthermia treatment was delivered by a 915 MHz microwave surface applicator. Time required for the tumour to reach three times the treatment volume was used as the primary study endpoint. Acute pathological effects of the treatments were determined using conventional histopathological techniques.

RESULTS

Locally delivered mNPH resulted in a modest improvement in treatment efficacy as compared to microwave hyperthermia (p = 0.09) when prescribed to the same thermal dose. Tumours treated with mNPH also demonstrated reduced peritumoral normal tissue damage.

CONCLUSIONS

Our results demonstrate similar tumour treatment efficacy when tumour heating is delivered by locally delivered mNPs and 915 MHz microwaves at the same measured thermal dose. However, mNPH treatments did not result in the same type or level of peritumoral damage seen with the microwave hyperthermia treatments. These data suggest that mNP hyperthermia is capable of improving the therapeutic ratio for locally delivered tumour hyperthermia. These results further indicate that this improvement is due to improved heat localisation in the tumour.

Compensating for magnetic field inhomogeneity in multigradient-echo-based MR thermometry

PURPOSE

MR thermometry (MRT) is a noninvasive method for measuring temperature that can potentially be used for radio frequency (RF) safety monitoring. This application requires measuring absolute temperature. In this study, a multigradient-echo (mGE) MRT sequence was used for that purpose. A drawback of this sequence, however, is that its accuracy is affected by background gradients. In this article, we present a method to minimize this effect and to improve absolute temperature measurements using MRI.

THEORY

By determining background gradients using a B0 map or by combining data acquired with two opposing readout directions, the error can be removed in a homogenous phantom, thus improving temperature maps.

METHODS

All scans were performed on a 3T system using ethylene glycol-filled phantoms. Background gradients were varied, and one phantom was uniformly heated to validate both compensation approaches. Independent temperature recordings were made with optical probes.

RESULTS

Errors correlated closely to the background gradients in all experiments. Temperature distributions showed a much smaller standard deviation when the corrections were applied (0.21°C vs. 0.45°C) and correlated well with thermo-optical probes.

CONCLUSION

The corrections offer the possibility to measure RF heating in phantoms more precisely. This allows mGE MRT to become a valuable tool in RF safety assessment.

The possible use of combined electrical impedance and ultrasound velocity measurements for the non-invasive measurement of temperature during mild hyperthermia

This paper explores the possibility of using combined measurements of electrical impedance and changes in ultrasound time of flight for determining deep body temperature during mild hyperthermia. Simultaneous electrical impedance spectra (1 kHz-1024 kHz) and ultrasound time-of-flight measurements were made on layered sheep liver and fat tissue samples as the temperature was increased from 30-50 °C. The change in propagation velocity for 100% fat and 100% liver samples was found to vary linearly with temperature and the temperature coefficient of the time-of-flight was shown to vary linearly with the % fat in the sample (0.009% °C-1%-1). Tetrapolar impedance measurements normalized to 8 kHz were shown to have a small sensitivity to temperature for both liver (0.001% °C-1 ≤ 45 °C) and fat (0.002% °C-1 ≤ 512 kHz) and the best linear correlation between the normalized impedance and the % fat in the sample was found at 256 kHz (gradient 0.026%-1, r2 = 0.65). A bootstrap analysis on 15 layered tissue samples evaluated using the normalized impedance at 256 kHz to determine the % fat in the sample and the temperature coefficient of the time of flight to determine the temperature. The results showed differences (including some large differences) between the predicted and measured temperatures and an error evaluation identified the possible origins of these.

Simulation techniques in hyperthermia treatment planning

Abstract Clinical trials have shown that hyperthermia (HT), i.e. an increase of tissue temperature to 39-44 °C, significantly enhance radiotherapy and chemotherapy effectiveness [1]. Driven by the developments in computational techniques and computing power, personalised hyperthermia treatment planning (HTP) has matured and has become a powerful tool for optimising treatment quality. Electromagnetic, ultrasound, and thermal simulations using realistic clinical set-ups are now being performed to achieve patient-specific treatment optimisation. In addition, extensive studies aimed to properly implement novel HT tools and techniques, and to assess the quality of HT, are becoming more common. In this paper, we review the simulation tools and techniques developed for clinical hyperthermia, and evaluate their current status on the path from 'model' to 'clinic'. In addition, we illustrate the major techniques employed for validation and optimisation. HTP has become an essential tool for improvement, control, and assessment of HT treatment quality. As such, it plays a pivotal role in the quest to establish HT as an efficacious addition to multi-modality treatment of cancer.

Modelling of endoluminal and interstitial ultrasound hyperthermia and thermal ablation: applications for device design, feedback control and treatment planning

Endoluminal and catheter-based ultrasound applicators are currently under development and are in clinical use for minimally invasive hyperthermia and thermal ablation of various tissue targets. Computational models play a critical role in device design and optimisation, assessment of therapeutic feasibility and safety, devising treatment monitoring and feedback control strategies, and performing patient-specific treatment planning with this technology. The critical aspects of theoretical modelling, applied specifically to endoluminal and interstitial ultrasound thermotherapy, are reviewed. Principles and practical techniques for modeling acoustic energy deposition, bioheat transfer, thermal tissue damage, and dynamic changes in the physical and physiological state of tissue are reviewed. The integration of these models and applications of simulation techniques in identification of device design parameters, development of real time feedback-control platforms, assessing the quality and safety of treatment delivery strategies, and optimisation of inverse treatment plans are presented.

Design and evaluation of a hybrid radiofrequency applicator for magnetic resonance imaging and RF induced hyperthermia: electromagnetic field simulations up to 14.0 Tesla and proof-of-concept at 7.0 Tesla

This work demonstrates the feasibility of a hybrid radiofrequency (RF) applicator that supports magnetic resonance (MR) imaging and MR controlled targeted RF heating at ultrahigh magnetic fields (B₀≥7.0T). For this purpose a virtual and an experimental configuration of an 8-channel transmit/receive (TX/RX) hybrid RF applicator was designed. For TX/RX bow tie antenna electric dipoles were employed. Electromagnetic field simulations (EMF) were performed to study RF heating versus RF wavelength (frequency range: 64 MHz (1.5T) to 600 MHz (14.0T)). The experimental version of the applicator was implemented at B₀ = 7.0T. The applicators feasibility for targeted RF heating was evaluated in EMF simulations and in phantom studies. Temperature co-simulations were conducted in phantoms and in a human voxel model. Our results demonstrate that higher frequencies afford a reduction in the size of specific absorption rate (SAR) hotspots. At 7T (298 MHz) the hybrid applicator yielded a 50% iso-contour SAR (iso-SAR-50%) hotspot with a diameter of 43 mm. At 600 MHz an iso-SAR-50% hotspot of 26 mm in diameter was observed. RF power deposition per RF input power was found to increase with B₀ which makes targeted RF heating more efficient at higher frequencies. The applicator was capable of generating deep-seated temperature hotspots in phantoms. The feasibility of 2D steering of a SAR/temperature hotspot to a target location was demonstrated by the induction of a focal temperature increase (ΔT = 8.1 K) in an off-center region of the phantom. Temperature simulations in the human brain performed at 298 MHz showed a maximum temperature increase to 48.6C for a deep-seated hotspot in the brain with a size of (19×23×32)mm³ iso-temperature-90%. The hybrid applicator provided imaging capabilities that facilitate high spatial resolution brain MRI. To conclude, this study outlines the technical underpinnings and demonstrates the basic feasibility of an 8-channel hybrid TX/RX applicator that supports MR imaging, MR thermometry and targeted RF heating in one device.

Temperature superposition for fast computation of 3D temperature distributions during optimization and planning of interstitial ultrasound hyperthermia treatments

PURPOSE

A temperature superposition method has been developed for fast optimisation and planning of interstitial hyperthermia treatments with convectively cooled multi-transducer ultrasound applicators integrated within high dose rate (HDR) brachytherapy catheters.

METHODS

Steady-state temperature distributions produced by individual tubular transducers capable of directional heating were pre-computed using finite element models (FEM) methods. The composite temperature distributions generated by multi-applicator implants were approximated as superposition sums of the pre-computed temperature profiles. Composite temperature distributions produced by the multi-applicator implants were also computed using accurate but computationally expensive FEM methods (considered here as the validation standard). Both methods were used for temperature calculation on a range of test implant geometries and representative patient cases (HDR implants in prostate (n = 13) and cervix (n = 2)), with optimised treatment plans created for the latter.

RESULTS

Difference between temperatures calculated by the superposition and FEM methods was below 0.37°C (95% confidence interval) in test implants at clinically relevant acoustic intensities (0.3-2.0 W/cm²) and blood perfusion (2 kg/m³/s). Difference in 41°C isothermal volumes was below 8.3%. Superposition-based optimisations followed by FEM forward calculations (hybrid plans) were completed 4-7 times faster than FEM-only plans (FEM optimisation + FEM forward). Mean T₉₀, T₅₀ and T₁₀ values from both plans were within 0.3°C, 0.4°C and 0.45°C respectively, and the mean acoustic intensities were within 0.23 W/cm².

CONCLUSIONS

Temperature superposition provides a fast technique for forward or optimised planning of interstitial ultrasound hyperthermia treatments with calculations comparable to more accurate but time consuming FEM methods.

Modeling focused ultrasound exposure for the optimal control of thermal dose distribution

Preclinical studies indicate that focused ultrasound at exposure conditions close to the threshold for thermal damage can increase drug delivery at the focal region. Although these results are promising, the optimal control of temperature still remains a challenge. To address this issue, computer-simulated ultrasound treatments have been performed. When the treatments are delivered without taking into account the cooling effect exerted by the blood flow, the resulting thermal dose is highly variable with regions of thermal damage, regions of underdosage close to the vessels, and areas in between these two extremes. When the power deposition is adjusted so that the peak thermal dose remains close to the threshold for thermal damage, the thermal dose is more uniformly distributed but under-dosage is still visible around the thermally significant vessels. The results of these simulations suggest that, for focused ultrasound, as for other delivery methods, the only way to control temperature is to adjust the average energy deposition to compensate for the presence of thermally significant vessels in the target area. By doing this, we have shown that it is possible to reduce the temperature heterogeneity observed in focused ultrasound thermal treatments.

Celastrol inhibits aminoglycoside-induced ototoxicity via heat shock protein 32

Hearing loss is often caused by death of the mechanosensory hair cells of the inner ear. Hair cells are susceptible to death caused by aging, noise trauma, and ototoxic drugs, including the aminoglycoside antibiotics and the antineoplastic agent cisplatin. Ototoxic drugs result in permanent hearing loss for over 500 000 Americans annually. We showed previously that induction of heat shock proteins (HSPs) inhibits both aminoglycoside- and cisplatin-induced hair cell death in whole-organ cultures of utricles from adult mice. In order to begin to translate these findings into a clinical therapy aimed at inhibiting ototoxic drug-induced hearing loss, we have now examined a pharmacological HSP inducer, celastrol. Celastrol induced upregulation of HSPs in utricles, and it provided significant protection against aminoglycoside-induced hair cell death in vitro and in vivo. Moreover, celastrol inhibited hearing loss in mice receiving systemic aminoglycoside treatment. Our data indicate that the major heat shock transcription factor HSF-1 is not required for celastrol-mediated protection. HSP32 (also called heme oxygenase-1, HO-1) is the primary mediator of the protective effect of celastrol. HSP32/HO-1 inhibits pro-apoptotic c-Jun N-terminal kinase (JNK) activation and hair cell death. Taken together, our data indicate that celastrol inhibits aminoglycoside ototoxicity via HSP32/HO-1 induction.

Improved hyperthermia treatment control using SAR/temperature simulation and PRFS magnetic resonance thermal imaging

PURPOSE

This article explores the feasibility of using coupled electromagnetic and thermodynamic simulations to improve planning and control of hyperthermia treatments for cancer. The study investigates the usefulness of preplanning to improve heat localisation in tumour targets in treatments monitored with PRFS-based magnetic resonance thermal imaging (MRTI).

METHODS

Heating capabilities of a cylindrical radiofrequency (RF) mini-annular phased array (MAPA) applicator were investigated with electromagnetic and thermal simulations of SAR in homogeneous phantom models and two human leg sarcomas. High frequency structure simulator (HFSS) (Ansoft) was used for electromagnetic simulations and SAR patterns were coupled into EPhysics (Ansoft) for thermal modelling with temperature-dependent variable perfusion. Simulations were accelerated by integrating tumour-specific anatomy into a pre-gridded whole body tissue model. To validate this treatment planning approach, simulations were compared with MR thermal images in both homogenous phantoms and heterogeneous tumours.

RESULTS

SAR simulations demonstrated excellent agreement with temperature rise distributions obtained with MR thermal imaging in homogeneous phantoms and clinical treatments of large soft-tissue sarcomas. The results demonstrate feasibility of preplanning appropriate relative phases of antennas for localising heat in tumour.

CONCLUSIONS

Advances in the accuracy of computer simulation and non-invasive thermometry via MR thermal imaging have provided powerful new tools for optimisation of clinical hyperthermia treatments. Simulations agree well with MR thermal images in both homogeneous tissue models and patients with lower leg tumours. This work demonstrates that better quality hyperthermia treatments should be possible when simplified hybrid model simulations are performed routinely as part of the clinical pretreatment plan.

Current devices for high-performance whole-body hyperthermia therapy

For late-stage cancer, whole-body hyperthermia (WBH) is highly regarded by physicians as a promising alternative to conventional therapies. Although WBH is still under scrutiny due to potential toxicity, its benefits are incomparable, as diversified devices and very promising treatment protocols in this area are advanced into Phase II and III clinical trials. Following the introduction of the WBH principle, this paper comprehensively reviews the state-of-art high-performance WBH devices based on the heat induction mechanisms - radiation, convection and conduction. Through analyzing each category's physical principle and heat-induction property, the advantages and disadvantages of the devices are evaluated. Technical strategies and critical scientific issues are summarized. For future developments, research directions worth pursuing are presented in this article.

An in vitro and in vivo investigation of the biological behavior of a ferrimagnetic cement for highly focalized thermotherapy

The cancer treatment by local hyperthermia, using a high frequency electromagnetic field is an extensively studied subject. For this propose it was developed a ferrimagnetic cement (FC) to be injected directly into the tumor. In this study it was determined the FC injectability, its capability to generate heat when placed within a magnetic field and its interaction with a modified simulated body fluid using SEM/EDS and XRD. The FC biological response was assessed by the intramuscular implantation in rats and histological analysis of the surrounding tissues. The results suggest that FC can be injected directly into the tumor, its temperature can be increased when exposed to a magnetic field and the surface of the immersed samples quickly becomes coated with precipitate denoting its ionic change with the surrounding medium. The histological analysis revealed a transient local inflammatory reaction, similar to the control material, only slightly more abundant during the first weeks, with a gradual decrease over the implantation time. Based on these results, we concluded that FC might be useful for highly focalized thermotherapy, with a good potential for clinical use.

Benefits of superficial hyperthermia treatment planning: Five case studies

PURPOSE

To demonstrate the benefits of treatment planning in superficial hyperthermia.

MATERIALS AND METHODS

Five patient cases are presented, in which treatment planning was applied to troubleshoot treatment-limiting hotspots, to select the optimum applicator type and orientation, to assess the risk associated with metallic implants, to assess the feasibility of heating a deeper seated tumour, and to analyse the effective SAR coverage resulting from arrays of multiple incoherent applicators. FDTD simulation tools were used to investigate treatment options, either based on segmented or simplified anatomies.

RESULTS

The background, approach and model implementation are presented per case. SAR cross-sections, profiles and isosurfaces are visualized to predict the effective SAR coverage of the target and the location of the maximum power absorption. In addition, the followed treatment strategy and the implications for the clinical treatment are given: for example, higher temperatures, relief of treatment limiting hot-spots or increased power input.

CONCLUSIONS

Treatment planning in superficial hyperthermia can be applied to improve clinical routine. Its application supports the selection of the optimum technique in non-standard cases, leading to direct benefits for the patient. In addition, treatment planning has shown to be an excellent tool for education and training for hyperthermia technicians and physicians.

Theoretical Modeling for Hepatic Microwave Ablation

Thermal tissue ablation is an interventional procedure increasingly being used for treatment of diverse medical conditions. Microwave ablation is emerging as an attractive modality for thermal therapy of large soft tissue targets in short periods of time, making it particularly suitable for ablation of hepatic and other tumors. Theoretical models of the ablation process are a powerful tool for predicting the temperature profile in tissue and resultant tissue damage created by ablation devices. These models play an important role in the design and optimization of devices for microwave tissue ablation. Furthermore, they are a useful tool for exploring and planning treatment delivery strategies. This review describes the status of theoretical models developed for microwave tissue ablation. It also reviews current challenges, research trends and progress towards development of accurate models for high temperature microwave tissue ablation.

Theoretical modeling for hepatic microwave ablation

Thermal tissue ablation is an interventional procedure increasingly being used for treatment of diverse medical conditions. Microwave ablation is emerging as an attractive modality for thermal therapy of large soft tissue targets in short periods of time, making it particularly suitable for ablation of hepatic and other tumors. Theoretical models of the ablation process are a powerful tool for predicting the temperature profile in tissue and resultant tissue damage created by ablation devices. These models play an important role in the design and optimization of devices for microwave tissue ablation. Furthermore, they are a useful tool for exploring and planning treatment delivery strategies. This review describes the status of theoretical models developed for microwave tissue ablation. It also reviews current challenges, research trends and progress towards development of accurate models for high temperature microwave tissue ablation.

A literature survey on indicators for characterisation and optimisation of SAR distributions in deep hyperthermia, a plea for standardisation

PURPOSE

To evaluate the predictive value of SAR indicators by assessing the correlation of a SAR indicator with the corresponding predicted temperature. Ultimately, this should lead to a number of verified SAR indicators for characterization and optimization of a predicted SAR distribution.

METHODS

A literature survey is followed by an evaluation of the SAR indicators on their functionality, using a set of heuristic classification criteria. To obtain an objective assessment of the predictive value for SAR characterisation, all SAR indicators are evaluated by correlating the value of the SAR indicator to the predicted target temperature when heated with the BSD2000 Sigma 60 applicator. Two methods were followed. First, the specificity of the SAR indicator to target temperature was assessed for each of the 36 patient-specific models, using 30 randomly chosen phase and amplitude settings. Secondly, each SAR indicator was used as a goal function to assess its suitability for optimisation purposes.

RESULTS

Only a selected number of SAR indicators correlate well with tumour/target-temperature. Hence, for target-related properties, an adequate set of SAR indicators is found in the literature. For hotspots, modifications are desirable. For optimisation purposes, improved objective functions have been defined.

CONCLUSIONS

From the correlation of the SAR indicators with tumour temperature, a preferred set of SAR indicators is derived: For target heating, 'average SAR ratio', 'Hotspot-target SAR ratio', and 'homogeneity coefficient' provide suitable objective criteria, while for hotspot reduction, 'Hotspot-target SAR ratio' is considered the most useful indicator. For optimisation procedures, 'Hotspot-target SAR ratio' is currently the most suitable objective function.

Flow patterns and heat convection in a rectangular water bolus for use in superficial hyperthermia

This paper investigates both numerically and experimentally the spatio-temporal effects of water flow in a custom-made water bolus used for superficial hyperthermia generated by a 915-MHz, 4 x 3 microwave applicator array. Similar hyperthermia models referenced in the literature use a constant water temperature and uniform heat flux to describe conduction and convection energy exchange within the heating apparatus available to cool the tissue surface. The results presented in this paper show that the spatially varying flow pattern and rate are vital factors for the overall heat control applicability of the 5 mm thick bolus under study. Regions with low flow rates and low heat convection clearly put restrictions on the maximum microwave energy possible within the limits of skin temperature rise under the bolus. Our analysis is illustrated by experimental flow front studies using a contrast liquid set-up monitored by high definition video and complemented by numerical analysis of liquid flow and heat exchange within the rectangular water bolus loaded by malignant tissue. Important factors for the improvement of future bolus designs are also discussed in terms of diameter and configuration of the water input and output tubing network.

Prostate thermal therapy with high intensity transurethral ultrasound: the impact of pelvic bone heating on treatment delivery

PURPOSE

This study was designed to assess pelvic bone temperature during typical treatment regimens of transurethral ultrasound thermal ablation of the prostate to establish guidelines for limiting bone heating.

METHODS

Treatment with transurethral planar, curvilinear, and sectored tubular applicators was simulated using an acoustic and biothermal pelvic model that accommodates applicator sweeping, boundary temperature control, and changes in perfusion and attenuation with thermal dose to more accurately model ultrasound energy penetration. The effects of various parameters including power and frequency (5-10 MHz) on bone heating were assessed for a range of prostate cross-sections (3-5 cm) and bone distances (1-3 cm).

RESULTS

All devices can produce significant bone heating (temperatures >50 degrees C, thermal dose >240 EM(43 degrees C)) without optimization of applied frequency or power for bone <3 cm from the prostate boundary. In small glands ( approximately 3 cm) increasing operating frequency of curvilinear and planar devices can increase bone temperatures, whereas the tubular applicator can be used at 10 MHz to avoid likely bone damage. In larger prostates (4-5 cm wide) increasing frequency reduces bone heating but can substantially increase treatment time. Lowering power can reduce bone temperature but may increase thermal dose by increasing treatment duration. All applicators can be used to treat glands 4-5 cm with limited bone heating by selecting appropriate power and frequency.

CONCLUSIONS

Pubic bone heating during ultrasound thermal therapy of the prostate can be substantial in certain situations. Successful realization of this therapy will require patient-specific treatment planning to optimally determine power and frequency in order to minimize bone heating.