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M'Rad Y, Charbonnier C, de Oliveira ME, Guillemin PC, Crowe LA, Kössler T, Poletti PA, Boudabbous S, Ricoeur A, Salomir R, Lorton O. Computer-Aided Intra-Operatory Positioning of an MRgHIFU Applicator Dedicated to Abdominal Thermal Therapy Using Particle Swarm Optimization. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2024; 5:524-533. [PMID: 39050977 PMCID: PMC11268946 DOI: 10.1109/ojemb.2024.3410118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/30/2024] [Accepted: 05/29/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE Transducer positioning for liver ablation by magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) is challenging due to the presence of air-filled organs or bones on the beam path. This paper presents a software tool developed to optimize the positioning of a HIFU transducer dedicated to abdominal thermal therapy, to maximize the treatment's efficiency while minimizing the near-field risk. METHODS A software tool was developed to determine the theoretical optimal position (TOP) of the transducer based on the minimization of a cost function using the particle swarm optimization (PSO). After an initialization phase and a manual segmentation of the abdomen of 5 pigs, the program randomly generates particles with 2 degrees of freedom and iteratively minimizes the cost function of the particles considering 3 parameters weighted according to their criticality. New particles are generated around the best position obtained at the previous step and the process is repeated until the optimal position of the transducer is reached. MR imaging data from in vivo HIFU ablation in pig livers was used for ground truth comparison between the TOP and the experimental position (EP). RESULTS As compared to the manual EP, the rotation difference with the TOP was on average -3.1 ± 7.1° and the distance difference was on average -7.1 ± 5.4 mm. The computational time to suggest the TOP was 20s. The software tool is modulable and demonstrated consistency and robustness when repeating the calculation and changing the initial position of the transducer.
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Affiliation(s)
- Yacine M'Rad
- University of Geneva, Faculty of MedicineImage Guided Interventions Laboratory (GR-949)CH-1211GenevaSwitzerland
| | | | | | - Pauline Coralie Guillemin
- University of Geneva, Faculty of MedicineImage Guided Interventions Laboratory (GR-949)CH-1211GenevaSwitzerland
| | | | - Thibaud Kössler
- University Hopsitals of GenevaOncology Department1205GenevaSwitzerland
| | | | - Sana Boudabbous
- University of Geneva, Faculty of MedicineImage Guided Interventions Laboratory (GR-949)CH-1211GenevaSwitzerland
- University Hospitals of GenevaRadiology Department1205GenevaSwitzerland
| | - Alexis Ricoeur
- University of Geneva, Faculty of MedicineImage Guided Interventions Laboratory (GR-949)CH-1211GenevaSwitzerland
- University Hospitals of GenevaRadiology Department1205GenevaSwitzerland
| | - Rares Salomir
- University of Geneva, Faculty of MedicineImage Guided Interventions Laboratory (GR-949)CH-1211GenevaSwitzerland
- University Hospitals of GenevaRadiology Department1205GenevaSwitzerland
| | - Orane Lorton
- University of Geneva, Faculty of MedicineImage Guided Interventions Laboratory (GR-949)CH-1211GenevaSwitzerland
- University Hospitals of GenevaRadiology Department1205GenevaSwitzerland
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Payen T, Crouzet S, Guillen N, Chen Y, Chapelon JY, Lafon C, Catheline S. Passive Elastography for Clinical HIFU Lesion Detection. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:1594-1604. [PMID: 38109239 DOI: 10.1109/tmi.2023.3344182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
High-intensity Focused Ultrasound (HIFU) is a promising treatment modality for a wide range of pathologies including prostate cancer. However, the lack of a reliable ultrasound-based monitoring technique limits its clinical use. Ultrasound currently provides real-time HIFU planning, but its use for monitoring is usually limited to detecting the backscatter increase resulting from chaotic bubble appearance. HIFU has been shown to generate stiffening in various tissues, so elastography is an interesting lead for ablation monitoring. However, the standard techniques usually require the generation of a controlled push which can be problematic in deeper organs. Passive elastography offers a potential alternative as it uses the physiological wave field to estimate the elasticity in tissues and not an external perturbation. This technique was adapted to process B-mode images acquired with a clinical system. It was first shown to faithfully assess elasticity in calibrated phantoms. The technique was then implemented on the Focal One® clinical system to evaluate its capacity to detect HIFU lesions in vitro (CNR = 9.2 dB) showing its independence regarding the bubbles resulting from HIFU and in vivo where the physiological wave field was successfully used to detect and delineate lesions of different sizes in porcine liver. Finally, the technique was performed for the very first time in four prostate cancer patients showing strong variation in elasticity before and after HIFU treatment (average variation of 33.0 ± 16.0 % ). Passive elastography has shown evidence of its potential to monitor HIFU treatment and thus help spread its use.
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Lorton O, Guillemin PC, M’Rad Y, Peloso A, Boudabbous S, Charbonnier C, Holman R, Crowe LA, Gui L, Poletti PA, Ricoeur A, Terraz S, Salomir R. A Novel Concept of a Phased-Array HIFU Transducer Optimized for MR-Guided Hepatic Ablation: Embodiment and First In-Vivo Studies. Front Oncol 2022; 12:899440. [PMID: 35769711 PMCID: PMC9235567 DOI: 10.3389/fonc.2022.899440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose High-intensity focused ultrasound (HIFU) is challenging in the liver due to the respiratory motion and risks of near-/far-field burns, particularly on the ribs. We implemented a novel design of a HIFU phased-array transducer, dedicated to transcostal hepatic thermo-ablation. Due to its large acoustic window and strong focusing, the transducer should perform safely for this application. Material and Methods The new HIFU transducer is composed of 256 elements distributed on 5 concentric segments of a specific radius (either 100, 111, or 125 mm). It has been optimally shaped to fit the abdominal wall. The shape and size of the acoustic elements were optimized for the largest emitting surface and the lowest symmetry. Calibration tests have been conducted on tissue-mimicking gels under 3-T magnetic resonance (MR) guidance. In-vivo MR-guided HIFU treatment was conducted in two pigs, aiming to create thermal ablation deep in the liver without significant side effects. Imaging follow-up was performed at D0 and D7. Sacrifice and post-mortem macroscopic examination occurred at D7, with the ablated tissue being fixed for pathology. Results The device showed −3-dB focusing capacities in a volume of 27 × 46 × 50 mm3 as compared with the numerical simulation volume of 18 × 48 × 60 mm3. The shape of the focal area was in millimeter-range agreement with the numerical simulations. No interference was detected between the HIFU sonication and the MR acquisition. In vivo, the temperature elevation in perivascular liver parenchyma reached 28°C above physiological temperature, within one breath-hold. The lesion was visible on Gd contrast-enhanced MRI sequences and post-mortem examination. The non-perfused volume was found in pig #1 and pig #2 of 8/11, 6/8, and 7/7 mm along the LR, AP, and HF directions, respectively. No rib burns or other near-field side effects were visually observed on post-mortem gross examination. High-resolution contrast-enhanced 3D MRI indicated a minor lesion on the sternum. Conclusion The performance of this new HIFU transducer has been demonstrated in vitro and in vivo. The transducer meets the requirement to perform thermal lesions in deep tissues, without the need for rib-sparing means.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Orane Lorton,
| | - Pauline C. Guillemin
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yacine M’Rad
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andrea Peloso
- Visceral Surgery Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Sana Boudabbous
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Caecilia Charbonnier
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Research Department, Artanim Foundation, Geneva, Switzerland
| | - Ryan Holman
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lindsey A. Crowe
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Laura Gui
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Alexis Ricoeur
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Sylvain Terraz
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
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Morchi L, Mariani A, Diodato A, Tognarelli S, Cafarelli A, Menciassi A. Acoustic Coupling Quantification in Ultrasound-Guided Focused Ultrasound Surgery: Simulation-Based Evaluation and Experimental Feasibility Study. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3305-3316. [PMID: 33004236 DOI: 10.1016/j.ultrasmedbio.2020.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 07/17/2020] [Accepted: 08/30/2020] [Indexed: 05/07/2023]
Abstract
Adequate acoustic coupling between the therapeutic transducer and the patient's body is essential for safe and efficient focused ultrasound surgery (FUS). There is currently no quantitative method for acoustic coupling verification in ultrasound-guided FUS. In this work, a quantitative method was developed and a related metric was introduced: the acoustic coupling coefficient. This metric associates the adequacy of the acoustic coupling with the reflected signals recorded through an imaging probe during a low-energy sonication. The acoustic coupling issue was simulated in silico and validated through in vitro tests. Our results indicated a sigmoidal behavior of the introduced metric as the contact surface between the coupling system and the patient's skin increases. The proposed method could be a safety-check criterion for verifying the adequacy of the acoustic coupling before starting the FUS treatment, thus ensuring efficient energy transmission to the target and preventing damage to both the patient and the instrumentation.
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Affiliation(s)
- Laura Morchi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Andrea Mariani
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alessandro Diodato
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy; River Global Scientific Lab, srl, Pisa, Italy
| | - Selene Tognarelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Andrea Cafarelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy; River Global Scientific Lab, srl, Pisa, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
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Lorton O, Guillemin PC, Mori N, Crowe LA, Boudabbous S, Terraz S, Becker CD, Cattin P, Salomir R, Gui L. Self-Scanned HIFU Ablation of Moving Tissue Using Real-Time Hybrid US-MR Imaging. IEEE Trans Biomed Eng 2018; 66:2182-2191. [PMID: 30530308 DOI: 10.1109/tbme.2018.2885233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE High intensity focused ultrasound (HIFU) treatment in the abdominal cavity is challenging due to the respiratory motion. In the self-scanning HIFU ablation method, the focal spot is kept static and the heating pattern is obtained through natural tissue motion. This paper describes a novel approach for modulating the HIFU power during self-scanning in order to compensate for the effect of tissue motion on thermal buildup. METHODS The therapy, using hybrid ultrasound (US)/magnetic resonance (MR) imaging, consists of detecting and tracking speckle on US images in order to predict the next tissue position, and modulating the HIFU power according to the tissue speed in order to obtain a rectilinear pattern of uniform temperature elevation. Experiments were conducted on ex vivo tissue subjected to a breathing-like motion generated by an MR-compatible robot and sonicated by a phased array HIFU transducer. RESULTS US and MR data were free from interferences. For both periodic and non-periodic motion, MR temperature maps showed a substantial improvement in the uniformity of the temperature elevation by using acoustic power modulation. CONCLUSION The presented method does not require a learning stage and enables a duty cycle close to 100%, higher average acoustic intensity and avoidance of side lobe effects versus performing HIFU beam steering to compensate tissue motion. SIGNIFICANCE To our knowledge, the proposed method provides the first experimental validation of the self-scanning HIFU ablation paradigm via a real-time hybrid MRI/US imaging, opening the path toward self-scanning in vivo therapies.
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Tan J, Mougenot C, Pichardo S, Drake JM, Waspe AC. Motion compensation using principal component analysis and projection onto dipole fields for abdominal magnetic resonance thermometry. Magn Reson Med 2018; 81:195-207. [PMID: 30058167 DOI: 10.1002/mrm.27368] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE High intensity focused ultrasound (HIFU) has the potential to locally and non-invasively treat cancer with fewer side effects than alternative therapies. However, motion and tissue heterogeneity in the abdomen can compromise the HIFU focus and confound current thermometry methods. METHODS The proposed thermometry method combines principal component analysis (PCA), as a multi-baseline technique, and projection onto dipole fields (PDF), as a near-referenceless method. PCA forgoes tracking tools by projecting incoming images onto a subspace spanning the motion history. PDF is subsequently used to synthesize the naturally feasible components of the residual phase using a magnetic dipole model. This leaves only the phase shifts that are induced by HIFU. RESULTS With in vivo measurements, in porcine and human kidneys, the mean pixel-wise temperature SD was 0.86 ± 0.41°C in selected regions of interest (ROIs) across all data sets, without any user-interaction or supplementary tracking tools. This is an improvement over a benchmark hybrid method, which scored 1.36 ± 1.20°C on the same data. Uncorrected subtraction of the data yielded a score of 3.02 ± 2.87°C. CONCLUSION The PCA-PDF hybrid method achieves superior artifact correction by exploiting the motion history and intrinsic magnetic susceptibility of the underlying tissue.
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Affiliation(s)
- Jeremy Tan
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Centre for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Samuel Pichardo
- Radiology and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - James M Drake
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Centre for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam C Waspe
- Centre for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Abstract
The unique ability of magnetic resonance imaging to measure temperature noninvasively, in vivo, makes it an attractive tool for monitoring interventional procedures, such as radiofrequency or microwave ablation in real-time. The most frequently used approach for magnetic resonance-based temperature measurement is proton resonance frequency (PRF) thermometry. Although it has many advantages, including tissue-independence and real-time capability, the main drawback is its motion sensitivity. This is likely the reason PRF thermometry in moving organs, such as the liver, is not commonly used in the clinical arena. In recent years, however, several developments suggest that motion-corrected thermometry in the liver is achievable. The present article summarizes the diverse attempts to correct thermometry in the liver. Therefore, the physical principle of PRF is introduced, with additional references for necrosis zone estimation and how to deal with fat phase modulation, and main magnetic field drifts. The primary categories of motion correction are presented, including general methods for motion compensation and library-based approaches, and referenceless thermometry and hybrid methods. Practical validation of the described methods in larger patient groups will be necessary to establish accurate motion-corrected thermometry in the clinical arena, with the goal of complete liver tumor ablation.
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Diodato A, Cafarelli A, Schiappacasse A, Tognarelli S, Ciuti G, Menciassi A. Motion compensation with skin contact control for high intensity focused ultrasound surgery in moving organs. ACTA ACUST UNITED AC 2018; 63:035017. [DOI: 10.1088/1361-6560/aa9c22] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Zachiu C, Denis de Senneville B, Dmitriev ID, Moonen CTW, Ries M. A framework for continuous target tracking during MR-guided high intensity focused ultrasound thermal ablations in the abdomen. J Ther Ultrasound 2017; 5:27. [PMID: 29043083 PMCID: PMC5632838 DOI: 10.1186/s40349-017-0106-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/28/2017] [Indexed: 01/20/2023] Open
Abstract
Background During lengthy magnetic resonance-guided high intensity focused ultrasound (MRg-HIFU) thermal ablations in abdominal organs, the therapeutic work-flow is frequently hampered by various types of physiological motion occurring at different time-scales. If left un-addressed this can lead to an incomplete therapy and/or to tissue damage of organs-at-risk. While previous studies focus on correction schemes for displacements occurring at a particular time-scale within the work-flow of an MRg-HIFU therapy, in the current work we propose a motion correction strategy encompassing the entire work-flow. Methods The proposed motion compensation framework consists of several linked components, each being adapted to motion occurring at a particular time-scale. While respiration was addressed through a fast correction scheme, long term organ drifts were compensated using a strategy operating on time-scales of several minutes. The framework relies on a periodic examination of the treated area via MR scans which are then registered to a reference scan acquired at the beginning of the therapy. The resulting displacements were used for both on-the-fly re-optimization of the interventional plan and to ensure the spatial fidelity between the different steps of the therapeutic work-flow. The approach was validated in three complementary studies: an experiment conducted on a phantom undergoing a known motion pattern, a study performed on the abdomen of 10 healthy volunteers and during 3 in-vivo MRg-HIFU ablations on porcine liver. Results Results have shown that, during lengthy MRg-HIFU thermal therapies, the human liver and kidney can manifest displacements that exceed acceptable therapeutic margins. Also, it was demonstrated that the proposed framework is capable of providing motion estimates with sub-voxel precision and accuracy. Finally, the 3 successful animal studies demonstrate the compatibility of the proposed approach with the work-flow of an MRg-HIFU intervention under clinical conditions. Conclusions In the current study we proposed an image-based motion compensation framework dedicated to MRg-HIFU thermal ablations in the abdomen, providing the possibility to re-optimize the therapy plan on-the-fly with the patient on the interventional table. Moreover, we have demonstrated that even under clinical conditions, the proposed approach is fully capable of continuously ensuring the spatial fidelity between the different phases of the therapeutic work-flow.
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Affiliation(s)
- Cornel Zachiu
- Imaging Division, UMC Utrecht, Heidelberglaan 100, Utrecht, 3508 GA Netherlands
| | - Baudouin Denis de Senneville
- Imaging Division, UMC Utrecht, Heidelberglaan 100, Utrecht, 3508 GA Netherlands.,Institut de Mathématiques de Bordeaux, CNRS UMR5251/Université de Bordeaux, Talence Cedex, Bordeaux, 33405 France
| | - Ivan D Dmitriev
- Imaging Division, UMC Utrecht, Heidelberglaan 100, Utrecht, 3508 GA Netherlands
| | - Chrit T W Moonen
- Imaging Division, UMC Utrecht, Heidelberglaan 100, Utrecht, 3508 GA Netherlands
| | - Mario Ries
- Imaging Division, UMC Utrecht, Heidelberglaan 100, Utrecht, 3508 GA Netherlands
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Zachiu C, Ries M, Ramaekers P, Guey JL, Moonen CTW, de Senneville BD. Real-time non-rigid target tracking for ultrasound-guided clinical interventions. ACTA ACUST UNITED AC 2017; 62:8154-8177. [DOI: 10.1088/1361-6560/aa8c66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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11
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Celicanin Z, Manasseh G, Petrusca L, Scheffler K, Auboiroux V, Crowe LA, Hyacinthe JN, Natsuaki Y, Santini F, Becker CD, Terraz S, Bieri O, Salomir R. Hybrid ultrasound-MR guided HIFU treatment method with 3D motion compensation. Magn Reson Med 2017; 79:2511-2523. [PMID: 28944490 DOI: 10.1002/mrm.26897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE Treatments using high-intensity focused ultrasound (HIFU) in the abdominal region remain challenging as a result of respiratory organ motion. A novel method is described here to achieve 3D motion-compensated ultrasound (US) MR-guided HIFU therapy using simultaneous ultrasound and MRI. METHODS A truly hybrid US-MR-guided HIFU method was used to plan and control the treatment. Two-dimensional ultrasound was used in real time to enable tracking of the motion in the coronal plane, whereas an MR pencil-beam navigator was used to detect anterior-posterior motion. Prospective motion compensation of proton resonance frequency shift (PRFS) thermometry and HIFU electronic beam steering were achieved. RESULTS The 3D prospective motion-corrected PRFS temperature maps showed reduced intrascan ghosting artifacts, a high signal-to-noise ratio, and low geometric distortion. The k-space data yielded a consistent temperature-dependent PRFS effect, matching the gold standard thermometry within approximately 1°C. The maximum in-plane temperature elevation ex vivo was improved by a factor of 2. Baseline thermometry acquired in volunteers indicated reduction of residual motion, together with an accuracy/precision of near-harmonic referenceless PRFS thermometry on the order of 0.5/1.0°C. CONCLUSIONS Hybrid US-MR-guided HIFU ablation with 3D motion compensation was demonstrated ex vivo together with a stable referenceless PRFS thermometry baseline in healthy volunteer liver acquisitions. Magn Reson Med 79:2511-2523, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Zarko Celicanin
- Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Gibran Manasseh
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lorena Petrusca
- Hepatobiliary and Pancreatic Interventional Radiology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Klaus Scheffler
- MRC Department, MPI for Biological Cybernetics, Tübingen, Germany.,Department of Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany
| | - Vincent Auboiroux
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Clinatec/LETI/CEA, 38054, Grenoble, France
| | - Lindsey A Crowe
- Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Jean-Noel Hyacinthe
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,School of Health Sciences, HES-SO, University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland
| | | | - Francesco Santini
- Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christoph D Becker
- Hepatobiliary and Pancreatic Interventional Radiology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Sylvain Terraz
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Oliver Bieri
- Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
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12
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Schwenke M, Strehlow J, Demedts D, Haase S, Barrios Romero D, Rothlübbers S, von Dresky C, Zidowitz S, Georgii J, Mihcin S, Bezzi M, Tanner C, Sat G, Levy Y, Jenne J, Günther M, Melzer A, Preusser T. A focused ultrasound treatment system for moving targets (part I): generic system design and in-silico first-stage evaluation. J Ther Ultrasound 2017; 5:20. [PMID: 28748092 PMCID: PMC5523151 DOI: 10.1186/s40349-017-0098-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/11/2017] [Indexed: 12/25/2022] Open
Abstract
Background Focused ultrasound (FUS) is entering clinical routine as a treatment option. Currently, no clinically available FUS treatment system features automated respiratory motion compensation. The required quality standards make developing such a system challenging. Methods A novel FUS treatment system with motion compensation is described, developed with the goal of clinical use. The system comprises a clinically available MR device and FUS transducer system. The controller is very generic and could use any suitable MR or FUS device. MR image sequences (echo planar imaging) are acquired for both motion observation and thermometry. Based on anatomical feature tracking, motion predictions are estimated to compensate for processing delays. FUS control parameters are computed repeatedly and sent to the hardware to steer the focus to the (estimated) target position. All involved calculations produce individually known errors, yet their impact on therapy outcome is unclear. This is solved by defining an intuitive quality measure that compares the achieved temperature to the static scenario, resulting in an overall efficiency with respect to temperature rise. To allow for extensive testing of the system over wide ranges of parameters and algorithmic choices, we replace the actual MR and FUS devices by a virtual system. It emulates the hardware and, using numerical simulations of FUS during motion, predicts the local temperature rise in the tissue resulting from the controls it receives. Results With a clinically available monitoring image rate of 6.67 Hz and 20 FUS control updates per second, normal respiratory motion is estimated to be compensable with an estimated efficiency of 80%. This reduces to about 70% for motion scaled by 1.5. Extensive testing (6347 simulated sonications) over wide ranges of parameters shows that the main source of error is the temporal motion prediction. A history-based motion prediction method performs better than a simple linear extrapolator. Conclusions The estimated efficiency of the new treatment system is already suited for clinical applications. The simulation-based in-silico testing as a first-stage validation reduces the efforts of real-world testing. Due to the extensible modular design, the described approach might lead to faster translations from research to clinical practice.
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Affiliation(s)
- Michael Schwenke
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany
| | - Jan Strehlow
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany
| | - Daniel Demedts
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany
| | - Sabrina Haase
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany
| | - Diego Barrios Romero
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany
| | - Sven Rothlübbers
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany.,Mediri, Heidelberg, Germany
| | - Caroline von Dresky
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany
| | - Stephan Zidowitz
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany
| | - Joachim Georgii
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany
| | - Senay Mihcin
- Institute for Medical Science and Technology, Dundee, Scotland
| | - Mario Bezzi
- Universita Degli Studi Di Roma La Sapienza, Rome, Italy
| | - Christine Tanner
- Computer Vision Laboratory, Eidgenössische Technische Hochschule, Zurich, Switzerland
| | - Giora Sat
- GE Medical Systems Israel, Haifa, Israel
| | | | - Jürgen Jenne
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany.,Mediri, Heidelberg, Germany
| | - Matthias Günther
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany.,Mediri, Heidelberg, Germany
| | - Andreas Melzer
- Institute for Medical Science and Technology, Dundee, Scotland.,Innovation Center Computer Assisted Surgery, Leipzig, Germany
| | - Tobias Preusser
- Fraunhofer Institute for Medical Image Computing MEVIS, Am Fallturm 1, Bremen, 28359 Germany.,Jacobs University, Bremen, Germany
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van Breugel JMM, de Greef M, Wijlemans JW, Schubert G, van den Bosch MAAJ, Moonen CTW, Ries MG. Thermal ablation of a confluent lesion in the porcine kidney with a clinically available MR-HIFU system. Phys Med Biol 2017; 62:5312-5326. [PMID: 28557798 DOI: 10.1088/1361-6560/aa75b3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The incidence of small renal masses (SRMs) sized <4 cm has increased over the decades (as co-findings/or due to introduction of cross sectional imaging). Currently, partial nephrectomy (PN) or watchful waiting is advised in these patients. Ultimately, 80-90% of these SRMs require surgical treatment and PN is associated with a 15% complication rate. In this aging population, with possible comorbidities and poor health condition, both PN and watchful waiting are non-ideal treatment options. This resulted in an increased need for early, non-invasive treatment strategies such as MR-guided high intensity focused ultrasound (MR-HIFU). (i) To investigate the feasibility of creating a confluent lesion in the kidney using respiratory-gated MR-HIFU under clinical conditions in a pre-clinical study and (ii) to evaluate the reproducibility of the MR-HIFU ablation strategy. Healthy pigs (n = 10) under general anesthesia were positioned on a clinical MR-HIFU system with integrated cooling. A honeycomb pattern of seven overlapping ablation cells (4 × 4 × 10 mm3, 450 W, <30 s) was ablated successively in the cortex of the porcine kidney. Both MR thermometry and acoustic energy delivery were respiratory gated using a pencil beam navigator on the contralateral kidney. The non-perfused volume (NPV) was visualized after the last sonication by contrast-enhanced (CE) T 1-weighted MR (T 1 w) imaging. Cell viability staining was performed to visualize the extent of necrosis. RESULTS a median NPV of 0.62 ml was observed on CE-T 1 w images (IQR 0.58-1.57 ml, range 0.33-2.75 ml). Cell viability staining showed a median damaged volume of 0.59 ml (IQR 0.24-1.35 ml, range 0-4.1 ml). Overlooking of the false rib, shivering of the pig, and too large depth combined with a large heat-sink effect resulted in insufficient heating in 4 cases. The NPV and necrosed volume were confluent in all cases in which an ablated volume could be observed. Our results demonstrated the feasibility of creating a confluent volume of ablated kidney cortical tissue in vivo with MR-HIFU on a clinically available system using respiratory gating and near-field cooling and showed its reproducibility.
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Affiliation(s)
- J M M van Breugel
- Center for Imaging Sciences, University Medical Center Utrecht, Utrecht, Netherlands
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14
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Seo J, Koizumi N, Mitsuishi M, Sugita N. Ultrasound image based visual servoing for moving target ablation by high intensity focused ultrasound. Int J Med Robot 2016; 13. [PMID: 27995752 PMCID: PMC5724706 DOI: 10.1002/rcs.1793] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/29/2016] [Accepted: 10/31/2016] [Indexed: 01/16/2023]
Abstract
Background Although high intensity focused ultrasound (HIFU) is a promising technology for tumor treatment, a moving abdominal target is still a challenge in current HIFU systems. In particular, respiratory‐induced organ motion can reduce the treatment efficiency and negatively influence the treatment result. In this research, we present: (1) a methodology for integration of ultrasound (US) image based visual servoing in a HIFU system; and (2) the experimental results obtained using the developed system. Materials and methods In the visual servoing system, target motion is monitored by biplane US imaging and tracked in real time (40 Hz) by registration with a preoperative 3D model. The distance between the target and the current HIFU focal position is calculated in every US frame and a three‐axis robot physically compensates for differences. Because simultaneous HIFU irradiation disturbs US target imaging, a sophisticated interlacing strategy was constructed. Results In the experiments, respiratory‐induced organ motion was simulated in a water tank with a linear actuator and kidney‐shaped phantom model. Motion compensation with HIFU irradiation was applied to the moving phantom model. Based on the experimental results, visual servoing exhibited a motion compensation accuracy of 1.7 mm (RMS) on average. Moreover, the integrated system could make a spherical HIFU‐ablated lesion in the desired position of the respiratory‐moving phantom model. Conclusions We have demonstrated the feasibility of our US image based visual servoing technique in a HIFU system for moving target treatment.
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Affiliation(s)
- Joonho Seo
- Korea Institute of Machinery and Materials, Daegu, South Korea
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15
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Loeve AJ, Al-Issawi J, Fernandez-Gutiérrez F, Langø T, Strehlow J, Haase S, Matzko M, Napoli A, Melzer A, Dankelman J. Workflow and intervention times of MR-guided focused ultrasound – Predicting the impact of new techniques. J Biomed Inform 2016; 60:38-48. [DOI: 10.1016/j.jbi.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 12/28/2015] [Accepted: 01/01/2016] [Indexed: 12/30/2022]
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MRI-Guided HIFU Methods for the Ablation of Liver and Renal Cancers. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:43-63. [DOI: 10.1007/978-3-319-22536-4_3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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17
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Holbrook AB, Ghanouni P, Santos JM, Dumoulin C, Medan Y, Pauly KB. Respiration based steering for high intensity focused ultrasound liver ablation. Magn Reson Med 2015; 71:797-806. [PMID: 23460510 DOI: 10.1002/mrm.24695] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Respiratory motion makes hepatic ablation using high intensity focused ultrasound (HIFO) challenging. Previous HIFU liver treatment had required apnea induced during general anesthesia. We describe and test a system that allows treatment of the liver in the presence of breathing motion. METHODS Mapping a signal from an external respiratory bellow to treatment locations within the liver allows the ultrasound transducer to be steered in real time to the target location. Using a moving phantom, three metrics were used to compare static, steered, and unsteered sonications: the area of sonications once a temperature rise of 15°C was achieved, the energy deposition required to reach that temperature, and the average rate of temperature rise during the first 10 s of sonication. Steered HIFU in vivo ablations of the porcine liver were also performed and compared to breath-hold ablations. RESULTS For the last phantom metric, all groups were found to be statistically significantly different (P ≤ 0.003). However, in the other two metrics, the static and unsteered sonications were not statistically different (P > 0.9999). Steered in vivo HIFU ablations were not statistically significantly different from ablations during breath-holding. CONCLUSIONS A system for performing HIFU steering during ablation of the liver with breathing motion is presented and shown to achieve results equivalent to ablation performed with breath-holding.
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Affiliation(s)
- Andrew B Holbrook
- Department of Radiology, Stanford University, Stanford, California, USA
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Sagias G, Yiallouras C, Ioannides K, Damianou C. An MRI-conditional motion phantom for the evaluation of high-intensity focused ultrasound protocols. Int J Med Robot 2015; 12:431-41. [PMID: 27593511 DOI: 10.1002/rcs.1709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The respiratory motion of abdominal organs is a serious obstacle in high-intensity focused ultrasound (HIFU) treatment with magnetic resonance imaging (MRI) guidance. In this study, a two-dimensional (2D) MRI-conditional motion phantom device was developed in order to evaluate HIFU protocols in synchronized and non-synchronized ablation of moving targets. MATERIALS AND METHODS The 2D phantom device simulates the respiratory motion of moving organs in both the left-right and craniocaudal directions. The device consists of MR-conditional materials which have been produced by a three-dimensional (3D) printer. RESULTS The MRI compatibility of the motion phantom was tested successfully in an MRI scanner. In vitro experiments were carried out to evaluate HIFU ablation protocols that are minimally affected by target motion. CONCLUSION It was shown that only in synchronized mode does HIFU produce thermal lesions, as tested on a gel phantom mimicking the moving target. The MRI-conditional phantom device was shown to be functional for its purpose and can be used as an evaluation tool for testing HIFU protocols for moving targets in an MRI environment. Copyright © 2015 John Wiley & Sons, Ltd.
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Strehlow J, Xiao X, Domschke M, Schwenke M, Karakitsios I, Mihcin S, Schwaab J, Levy Y, Preusser T, Melzer A. US-tracked steered FUS in a respiratory ex vivo ovine liver phantom. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2015. [DOI: 10.1515/cdbme-2015-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Organ motion is a major problem for Focused Ultrasound Surgery (FUS) of liver tumors. We present a liver phantom mimicking human respiratory motion (20 mm range, 3 − 7 s/cycle) and the evaluation of an ultrasound-tracked steered FUS system on that phantom. Temperature curves are recorded while sonicating in moving and static phantom. The temperature curves correlate well and show the ability of the system to compensate breathing like motion.
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Affiliation(s)
- Jan Strehlow
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Xu Xiao
- IMSaT, Institute for Medical Science and Technology, Dundee, United Kingdom
| | - Markus Domschke
- IMSaT, Institute for Medical Science and Technology, Dundee, United Kingdom
| | - Michael Schwenke
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | | | - Senay Mihcin
- IMSaT, Institute for Medical Science and Technology, Dundee, United Kingdom
| | | | - Yoav Levy
- InSightec Limited, Tirat Carmel, Israel
| | | | - Andreas Melzer
- IMSaT, Institute for Medical Science and Technology, Dundee, United Kingdom
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Schwenke M, Strehlow J, Haase S, Jenne J, Tanner C, Langø T, Loeve AJ, Karakitsios I, Xiao X, Levy Y, Sat G, Bezzi M, Braunewell S, Guenther M, Melzer A, Preusser T. An integrated model-based software for FUS in moving abdominal organs. Int J Hyperthermia 2015; 31:240-50. [DOI: 10.3109/02656736.2014.1002817] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Alkhorayef M, Mahmoud MZ, Alzimami KS, Sulieman A, Fagiri MA. High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment. Pol J Radiol 2015; 80:131-41. [PMID: 25806099 PMCID: PMC4360749 DOI: 10.12659/pjr.892341] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/27/2014] [Indexed: 11/25/2022] Open
Abstract
Background High-intensity focused ultrasound (HIFU) applies high-intensity focused ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation. This study intended to review HIFU to explain the fundamentals of HIFU, evaluate the evidence concerning the role of HIFU in the treatment of prostate cancer (PC), review the technologies used to perform HIFU and the published clinical literature regarding the procedure as a primary treatment for PC. Material/Methods Studies addressing HIFU in localized PC were identified in a search of internet scientific databases. The analysis of outcomes was limited to journal articles written in English and published between 2000 and 2013. Results HIFU is a non-invasive approach that uses a precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of PC. Clinical research on HIFU therapy for localized PC began in the 1990s, and the majority of PC patients were treated with the Ablatherm device. Conclusions HIFU treatment for localized PC can be considered as an alternative minimally invasive therapeutic modality for patients who are not candidates for radical prostatectomy. Patients with lower pre-HIFU PSA level and favourable pathologic Gleason score seem to present better oncologic outcomes. Future advances in technology and safety will undoubtedly expand the HIFU role in this indication as more of patient series are published, with a longer follow-up period.
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Affiliation(s)
- Mohammed Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mustafa Z Mahmoud
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Salman bin Abdulaziz University, Al-Kharj, Saudi Arabia ; Department of Basic Sciences, College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Khalid S Alzimami
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdelmoneim Sulieman
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Salman bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Maram A Fagiri
- Department of Basic Sciences, College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
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Petrusca L, Salomir R, Manasseh G, Becker CD, Terraz S. Spatio-temporal quantitative thermography of pre-focal interactions between high intensity focused ultrasound and the rib cage. Int J Hyperthermia 2015; 31:421-32. [PMID: 25753370 DOI: 10.3109/02656736.2015.1009501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this paper is to quantitatively investigate the thermal effects generated by the pre-focal interactions of a HIFU beam with a rib cage, in the context of minimally invasive transcostal therapy of liver malignancies. MATERIALS AND METHODS HIFU sonications were produced by a phased-array MR-compatible transducer on Turkey muscle placed on a sheep thoracic cage specimen. The thoracic wall was positioned in the pre-focal zone 3.5 to 6.5 cm below the focus. Thermal monitoring was simultaneously performed using fluoroptic sensors inserted into the medullar cavity of the ribs and high resolution MR-thermometry (voxel: 1 × 1 × 5 mm3, four multi-planar slices). RESULTS MR-thermometry data indicated nearly isotropic distribution of the thermal energy at the ribs' surface. The temperature elevation at the focus was comparable with the pericostal temperature elevation around unprotected ribs, while being systematically inferior, by more than a factor of four on average, to the intra-medullar values. The spatial profiles of the pericostal and intra-medullar thermal build-up measurements could be smoothly connected using a Gaussian function. The dynamics of the post-sonication thermal relaxation as determined by fluoroptic measurements was demonstrated to be theoretically coherent with the experimental observations. CONCLUSION The experimental findings motivate further efforts for the transfer towards clinical routine of effective rib-sparing strategies for hepatic HIFU.
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Affiliation(s)
- Lorena Petrusca
- Hepatobiliary Interventional Radiology, Faculty of Medicine, University of Geneva , Geneva, Switzerland
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Ebbini ES, ter Haar G. Ultrasound-guided therapeutic focused ultrasound: current status and future directions. Int J Hyperthermia 2015; 31:77-89. [PMID: 25614047 DOI: 10.3109/02656736.2014.995238] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This paper reviews ultrasound imaging methods for the guidance of therapeutic focused ultrasound (USgFUS), with emphasis on real-time preclinical methods. Guidance is interpreted in the broadest sense to include pretreatment planning, siting of the FUS focus, real-time monitoring of FUS-tissue interactions, and real-time control of exposure and damage assessment. The paper begins with an overview and brief historical background of the early methods used for monitoring FUS-tissue interactions. Current imaging methods are described, and discussed in terms of sensitivity and specificity of the localisation of the FUS effects in both therapeutic and sub-therapeutic modes. Thermal and non-thermal effects are considered. These include cavitation-enhanced heating, tissue water boiling and cavitation. Where appropriate, USgFUS methods are compared with similar methods implemented using other guidance modalities, e.g. magnetic resonance imaging. Conclusions are drawn regarding the clinical potential of the various guidance methods, and the feasibility and current status of real-time implementation.
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Affiliation(s)
- Emad S Ebbini
- Electrical and Computer Engineering, University of Minnesota Twin Cities , Minneapolis, Minnesota , USA and
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24
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Anzidei M, Marincola BC, Bezzi M, Brachetti G, Nudo F, Cortesi E, Berloco P, Catalano C, Napoli A. Magnetic resonance-guided high-intensity focused ultrasound treatment of locally advanced pancreatic adenocarcinoma: preliminary experience for pain palliation and local tumor control. Invest Radiol 2014; 49:759-65. [PMID: 24932986 DOI: 10.1097/rli.0000000000000080] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the feasibility of magnetic resonance-guided focused ultrasound (MRgFUS) ablation for pain palliation and local tumor control in selected patients with unresectable primary pancreatic adenocarcinoma. MATERIALS AND METHODS After providing dedicated informed consent, 7 patients with histologically proven unresectable pancreatic adenocarcinoma underwent MRgFUS treatment on a dedicated 3-T unit featuring a dedicated ablation system. All lesions were evaluated for device accessibility before the treatment. Procedures of MRgFUS were performed with the patients under general anesthesia with constant controlled respiration. Clinical assessment included evaluation of symptom severity using a visual analog scale before and after the treatment. Imaging follow-up, including both computed tomographic and magnetic resonance examinations, was performed immediately after the treatment and at 3 and 6 months to evaluate the effects of MRgFUS on the targeted tumor and the occurrence, if any, of procedure-related complications. RESULTS The MRgFUS ablation was successfully performed in 6 patients; no adverse events were observed during or after the procedure. In a single patient, lesion accessibility was limited at treatment time, and the procedure was suspended. The visual analog scale score decreased in all patients from a mean (SD) of 7 (1) to 3 (1) after the treatment. Follow-up imaging results revealed negligible (n = 1) or no (n = 5) tumor regrowth within the ablation area. One patient died because of a metastatic disease 13 months after the treatment, whereas the other 5 are nonprogressing survivors at 6 and 8 months after the treatment. CONCLUSIONS Our preliminary clinical experience suggests that MRgFUS is a feasible and repeatable ablative technique in selected patients with unresectable and device-accessible pancreatic adenocarcinoma.
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Affiliation(s)
- Michele Anzidei
- From the Departments of *Radiological, Oncological and Pathological Sciences, and †Surgery and Transplantation "P. Stefanini," Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Sherwood V, Civale J, Rivens I, Collins DJ, Leach MO, ter Haar GR. Development of a hybrid magnetic resonance and ultrasound imaging system. BIOMED RESEARCH INTERNATIONAL 2014; 2014:914347. [PMID: 25177702 PMCID: PMC4142177 DOI: 10.1155/2014/914347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/11/2014] [Accepted: 07/16/2014] [Indexed: 12/29/2022]
Abstract
A system which allows magnetic resonance (MR) and ultrasound (US) image data to be acquired simultaneously has been developed. B-mode and Doppler US were performed inside the bore of a clinical 1.5 T MRI scanner using a clinical 1-4 MHz US transducer with an 8-metre cable. Susceptibility artefacts and RF noise were introduced into MR images by the US imaging system. RF noise was minimised by using aluminium foil to shield the transducer. A study of MR and B-mode US image signal-to-noise ratio (SNR) as a function of transducer-phantom separation was performed using a gel phantom. This revealed that a 4 cm separation between the phantom surface and the transducer was sufficient to minimise the effect of the susceptibility artefact in MR images. MR-US imaging was demonstrated in vivo with the aid of a 2 mm VeroWhite 3D-printed spherical target placed over the thigh muscle of a rat. The target allowed single-point registration of MR and US images in the axial plane to be performed. The system was subsequently demonstrated as a tool for the targeting and visualisation of high intensity focused ultrasound exposure in the rat thigh muscle.
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Affiliation(s)
- Victoria Sherwood
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - John Civale
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - Ian Rivens
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - David J. Collins
- Department of Clinical Magnetic Resonance, CRUK and EPSRC Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - Martin O. Leach
- Department of Clinical Magnetic Resonance, CRUK and EPSRC Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
| | - Gail R. ter Haar
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 123 Old Brompton Road, London SW7 3RP, UK
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Vijayan S, Klein S, Hofstad EF, Lindseth F, Ystgaard B, Langø T. Motion tracking in the liver: Validation of a method based on 4D ultrasound using a nonrigid registration technique. Med Phys 2014; 41:082903. [DOI: 10.1118/1.4890091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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27
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Basic science research in pediatric radiology - how to empower the leading edge of our field. Pediatr Radiol 2014; 44:935-9. [PMID: 25060618 DOI: 10.1007/s00247-014-2958-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 12/12/2013] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Abstract
Basic science research aims to explore, understand and predict phenomena in the natural world. It spurs the discovery of fundamentally new principles and leads to new knowledge and new concepts. By comparison, applied research employs basic science knowledge toward practical applications. In the clinical realm, basic science research and applied research should be closely connected. Basic science discoveries can build the foundation for a broad range of practical applications and thereby bring major benefits to human health, education, environment and economy. This article explains how basic science research impacts our field, it describes examples of new research directions in pediatric imaging and it outlines current challenges that we need to overcome in order to enable the next groundbreaking discovery.
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Petrusca L, Auboiroux V, Goget T, Viallon M, Muller A, Gross P, Becker CD, Salomir R. A nonparametric temperature controller with nonlinear negative reaction for multi-point rapid MR-guided HIFU ablation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1324-1337. [PMID: 24893259 DOI: 10.1109/tmi.2014.2310704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Magnetic resonance-guided high intensity focused ultrasound (MRgHIFU) is a noninvasive method for thermal ablation, which exploits the capabilities of magnetic resonance imaging (MRI) for excellent visualization of the target and for near real-time thermometry. Oncological quality of ablation may be obtained by volumetric sonication under automatic feedback control of the temperature. For this purpose, a new nonparametric (i.e., model independent) temperature controller, using nonlinear negative reaction, was designed and evaluated for the iterated sonication of a prescribed pattern of foci. The main objective was to achieve the same thermal history at each sonication point during volumetric MRgHIFU. Differently sized linear and circular trajectories were investigated ex vivo and in vivo using a phased-array HIFU transducer. A clinical 3T MRI scanner was used and the temperature elevation was measured in five slices simultaneously with a voxel size of 1 ×1 ×5 mm(3) and temporal resolution of 4 s. In vivo results indicated a similar thermal history of each sonicated focus along the prescribed pattern, that was 17.3 ± 0.5 °C as compared to 16 °C prescribed temperature elevation. The spatio-temporal control of the temperature also enabled meaningful comparison of various sonication patterns in terms of dosimetry and near-field safety. The thermal build-up tended to drift downwards in the HIFU transducer with a circular scan.
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Respiratory-gated MRgHIFU in upper abdomen using an MR-compatible in-bore digital camera. BIOMED RESEARCH INTERNATIONAL 2014; 2014:421726. [PMID: 24716196 PMCID: PMC3925565 DOI: 10.1155/2014/421726] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/25/2013] [Accepted: 11/26/2013] [Indexed: 11/28/2022]
Abstract
Objective. To demonstrate the technical feasibility and the potential interest of using a digital optical camera inside the MR magnet bore for monitoring the breathing cycle and subsequently gating the PRFS MR thermometry, MR-ARFI measurement, and MRgHIFU sonication in the upper abdomen.
Materials and Methods. A digital camera was reengineered to remove its magnetic parts and was further equipped with a 7 m long USB cable. The system was electromagnetically shielded and operated inside the bore of a closed 3T clinical scanner. Suitable triggers were generated based on real-time motion analysis of the images produced by the camera (resolution 640 × 480 pixels, 30 fps). Respiratory-gated MR-ARFI prepared MRgHIFU ablation was performed in the kidney and liver of two sheep in vivo, under general anaesthesia and ventilator-driven forced breathing.
Results. The optical device demonstrated very good MR compatibility. The current setup permitted the acquisition of motion artefact-free and high resolution MR 2D ARFI and multiplanar interleaved PRFS thermometry (average SNR 30 in liver and 56 in kidney). Microscopic histology indicated precise focal lesions with sharply delineated margins following the respiratory-gated HIFU sonications.
Conclusion. The proof-of-concept for respiratory motion management in MRgHIFU using an in-bore digital camera has been validated in vivo.
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Miller RM, Kim Y, Lin KW, Cain CA, Owens GE, Xu Z. Histotripsy cardiac therapy system integrated with real-time motion correction. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:2362-73. [PMID: 24063958 PMCID: PMC3881374 DOI: 10.1016/j.ultrasmedbio.2013.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 06/28/2013] [Accepted: 08/01/2013] [Indexed: 05/25/2023]
Abstract
Histotripsy has shown promise in non-invasive cardiac therapy for neonatal and fetal applications. However, for cardiac applications in general, and especially in the adult heart, cardiac and respiratory motion may affect treatment accuracy and efficacy. In this article, we describe a histotripsy-mediated cardiac therapy system integrated with a fast motion tracking algorithm and treatment monitoring using ultrasound imaging. Motion tracking is performed by diamond search block matching in real-time ultrasound images using a reference image of the moving target, refined by Kalman filtering. As proof of feasibility, this algorithm was configured to track 2-D target motion and then electronically adjust the focus of a 1-MHz annular therapy array to correct for axial motion. This integrated motion tracking system is capable of sub-millimeter accuracy for displacements of 0-15 mm and velocities of 0-80 mm/s, with a maximum error less than 3 mm. Tissue phantom tests indicated that treatment efficiency and lesion size using motion tracking over displacements of 0-15 mm and velocities of 0-42 mm/s are comparable to those achieved when treating stationary targets. In vivo validation was conducted in an open-chest canine model, where the system provided 24 min of motion-corrected histotripsy therapy in the live beating heart, generating a targeted lesion on the atrial septum. Based on this proof of feasibility and the natural extension of these techniques to three dimensions, we anticipate a full motion correction system would be feasible and beneficial for non-invasive cardiac therapy.
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Affiliation(s)
- Ryan M. Miller
- Department of Biomedical Engineering, University of Michigan Ann Arbor
| | - Yohan Kim
- Department of Biomedical Engineering, University of Michigan Ann Arbor
| | - Kuang-Wei Lin
- Department of Biomedical Engineering, University of Michigan Ann Arbor
| | - Charles A. Cain
- Department of Biomedical Engineering, University of Michigan Ann Arbor
| | - Gabe E. Owens
- Department of Biomedical Engineering, University of Michigan Ann Arbor
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan Ann Arbor
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan
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31
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Celicanin Z, Auboiroux V, Bieri O, Petrusca L, Santini F, Viallon M, Scheffler K, Salomir R. Real-time method for motion-compensated MR thermometry and MRgHIFU treatment in abdominal organs. Magn Reson Med 2013; 72:1087-95. [DOI: 10.1002/mrm.25017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/27/2013] [Accepted: 10/07/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Zarko Celicanin
- Department of Radiology, Division of Radiological Physics; University of Basel Hospital; Basel Switzerland
- MRC Department; MPI for Biological Cybernetics; Tübingen Germany
| | | | - Oliver Bieri
- Department of Radiology, Division of Radiological Physics; University of Basel Hospital; Basel Switzerland
| | - Lorena Petrusca
- Radiology Department; University of Geneva; Geneva Switzerland
| | - Francesco Santini
- Department of Radiology, Division of Radiological Physics; University of Basel Hospital; Basel Switzerland
| | - Magalie Viallon
- Radiology Department; University of Geneva; Geneva Switzerland
| | - Klaus Scheffler
- MRC Department; MPI for Biological Cybernetics; Tübingen Germany
- Department of Biomedical Magnetic Resonance; University of Tübingen; Tübingen Germany
| | - Rares Salomir
- Radiology Department; University of Geneva; Geneva Switzerland
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32
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Muller A, Petrusca L, Auboiroux V, Valette PJ, Salomir R, Cotton F. Management of Respiratory Motion in Extracorporeal High-Intensity Focused Ultrasound Treatment in Upper Abdominal Organs: Current Status and Perspectives. Cardiovasc Intervent Radiol 2013; 36:1464-1476. [DOI: 10.1007/s00270-013-0713-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 05/08/2013] [Indexed: 12/25/2022]
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33
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Magnetic Resonance–Guided Shielding of Prefocal Acoustic Obstacles in Focused Ultrasound Therapy. Invest Radiol 2013; 48:366-80. [DOI: 10.1097/rli.0b013e31827a90d7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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34
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Hybrid Ultrasound/Magnetic Resonance Simultaneous Acquisition and Image Fusion for Motion Monitoring in the Upper Abdomen. Invest Radiol 2013; 48:333-40. [DOI: 10.1097/rli.0b013e31828236c3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Targeted manipulation of apoptotic pathways by using High Intensity Focused Ultrasound in cancer treatment. Cancer Lett 2013; 338:204-8. [PMID: 23612069 DOI: 10.1016/j.canlet.2013.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/15/2013] [Indexed: 11/23/2022]
Abstract
Apoptosis, or programmed cell death, is a mechanism of cell death, which has been exploited for the treatment of cancers over the past few years. The understanding of apoptosis pathways (intrinsic and extrinsic) has led to discovery of treatment strategies which selectively target the cancer cells and spare the normal ones. This article reviews the current understanding of the apoptotic pathways which are utilized for targeting cancer cells using High Intensity Focused Ultrasound (HIFU).
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