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Hynynen K, Jones RM. Image-guided ultrasound phased arrays are a disruptive technology for non-invasive therapy. Phys Med Biol 2016; 61:R206-48. [PMID: 27494561 PMCID: PMC5022373 DOI: 10.1088/0031-9155/61/17/r206] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Focused ultrasound offers a non-invasive way of depositing acoustic energy deep into the body, which can be harnessed for a broad spectrum of therapeutic purposes, including tissue ablation, the targeting of therapeutic agents, and stem cell delivery. Phased array transducers enable electronic control over the beam geometry and direction, and can be tailored to provide optimal energy deposition patterns for a given therapeutic application. Their use in combination with modern medical imaging for therapy guidance allows precise targeting, online monitoring, and post-treatment evaluation of the ultrasound-mediated bioeffects. In the past there have been some technical obstacles hindering the construction of large aperture, high-power, densely-populated phased arrays and, as a result, they have not been fully exploited for therapy delivery to date. However, recent research has made the construction of such arrays feasible, and it is expected that their continued development will both greatly improve the safety and efficacy of existing ultrasound therapies as well as enable treatments that are not currently possible with existing technology. This review will summarize the basic principles, current statures, and future potential of image-guided ultrasound phased arrays for therapy.
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Affiliation(s)
- Kullervo Hynynen
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada. Department of Medical Biophysics, University of Toronto, Toronto, Canada. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
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Abstract
The prehospital treatment of severe extremity bleeding has remained unchanged for years and relies on compression with absorbent gauze dressings. Advances in haemostasis technology have identified several new methods of improving bleeding control. These are examined with a view to possible inclusion in a new prehospital dressing aimed at reducing the degree of exsanguination and associated mortality and morbidity from a major extremity injury.
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Affiliation(s)
- JP Garner
- Biomedical Sciences, Dstl Porton Down, Salisbury, UK,
| | - RFR Brown
- Biomedical Sciences, Dstl Porton Down, Salisbury, UK
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Martínez-Valdez R, Ramos Fernández A, Vera Hernandez A, Leija Salas L. Design of a low power hybrid HIFU applicator for haemostasis based on acoustic propagation modelling. Int J Hyperthermia 2015; 32:121-31. [PMID: 26708742 DOI: 10.3109/02656736.2015.1112437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to design an applicator for haemostasis usage needing lower acoustic intensities (<880 W/cm(2)) than in previous devices intended for it, which is based on ultrasound propagation FEM modelling using a 2-MHz HIFU transducer. MATERIALS AND METHODS Acoustic field characterisation and numerical simulations in water were performed with and without the proposed applicator. Parameters such as form factor, ellipsoidal shape ratio, and Euclidean distance were used (among others) to compare simulated data with transducer measurements without applicator. A low density polyethylene cone was manufactured from geometries validated from acoustic field modelling. The hollow cone was filled with 10% polyacrylamide gel as a coupling medium with liver phantom or chicken liver. Focal temperature was measured with a thermocouple embedded in the phantom for 1-20 W driving powers for 120 s. Standing wave ratios (SWR) were used as coupling indexes. Ex vivo experimentation in chicken liver was made at 10-20 W. RESULTS Simulated acoustic patterns showed good concordance with measurements. Experimental focal distance was 20.72 ± 0.24 mm, while the simulated was 19.79 mm (≈4% error). SWR at low power were: 2.01 with transducer emitting in air, 1.53 at applicator tip, and 1.35 after phantom placement. Average SWR at high power was 1.31. Similarity of percentages for data comparison in focal plane was over 60%. Maximum temperature measured at focus was 88.7 °C with 20 W after 85 s. CONCLUSIONS Temperatures reached at focus suggest that this applicator has good efficiency, which notably reduces the power typically needed for haemostasis effect.
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Affiliation(s)
- Raquel Martínez-Valdez
- a Department of Electrical Engineering , Bioelectronics Section, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional , Cinvestav , Mexico City , Mexico , and
| | - Antonio Ramos Fernández
- b R&D Group 'Sistemas y Tecnologías Ultrasónicas', Instituto de Tecnologías Físicas y de la Información , CSIC , Madrid , Spain
| | - Arturo Vera Hernandez
- a Department of Electrical Engineering , Bioelectronics Section, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional , Cinvestav , Mexico City , Mexico , and
| | - Lorenzo Leija Salas
- a Department of Electrical Engineering , Bioelectronics Section, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional , Cinvestav , Mexico City , Mexico , and
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Abstract
We generally think of bubbles as benign and harmless and yet they can manifest the most remarkable range of physical effects. Some of those effects are the stuff of our everyday experience as in the tinkling of a brook or the sounds of breaking waves at the beach. But even these mundane effects are examples of the ability of bubbles to gather, focus and radiate energy (acoustic energy in the above examples). In other contexts that focusing of energy can lead to serious technological problems as when cavitation bubbles eat great holes through ships' propeller blades or cause a threat to the integrity of the spillways at the Hoover Dam. In liquid-propelled rocket engines, bubbles pose a danger to the stability of the propulsion system, and in artificial heart valves they can cause serious damage to the red blood cells. In perhaps the most extraordinary example of energy focusing, collapsing cavitation bubbles can emit not only sound, but also light with black body radiation temperatures equal to that of the sun (Brennen 1995 Cavitation and bubble dynamics). But, harnessed carefully, this almost unique ability to focus energy can also be put to remarkably constructive use. Cavitation bubbles are now used in a remarkable range of surgical and medical procedures, for example to emulsify tissue (most commonly in cataract surgery or in lithotripsy procedures for the reduction of kidney and gall stones) or to manipulate the DNA in individual cells. By creating cavitation bubbles non-invasively thereby depositing and focusing energy non-intrusively, one can generate minute incisions or target cancer cells. This paper will begin by briefly reviewing the history of cavitation phenomena and will end with a vision of the new horizons for the amazing cavitation bubble.
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Abstract
Ultrasound therapy has been investigated for over half a century. Ultrasound can act on tissue through a variety of mechanisms, including thermal, shockwave and cavitation mechanisms, and through these can elicit different responses. Ultrasound therapy can provide a non-invasive or minimally invasive treatment option, and ultrasound technology has advanced to the point where devices can be developed to investigate a wide range of applications. This review focuses on non-cancer clinical applications of therapeutic ultrasound, with an emphasis on treatments that have recently reached clinical investigations, and preclinical research programmes that have great potential to impact patient care.
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Traumatic intra-abdominal hemorrhage control: has current technology tipped the balance toward a role for prehospital intervention? J Trauma Acute Care Surg 2015; 78:153-63. [PMID: 25539217 DOI: 10.1097/ta.0000000000000472] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The identification and control of traumatic hemorrhage from the torso remains a major challenge and carries a significant mortality despite the reduction of transfer times. This review examines the current technologies that are available for abdominal hemorrhage control within the prehospital setting and evaluates their effectiveness. METHODS A systematic search of online databases was undertaken. Where appropriate, evidence was highlighted using the Oxford levels of clinical evidence. The primary outcome assessed was mortality, and secondary outcomes included blood loss and complications associated with each technique. RESULTS Of 89 studies, 34 met the inclusion criteria, of which 29 were preclinical in vivo trials and 5 were clinical. Techniques were subdivided into mechanical compression, endovascular control, and energy-based hemostatic devices. Gas insufflation and manual pressure techniques had no associated mortalities. There was one mortality with high intensity focused ultrasound. The intra-abdominal infiltration of foam treatment had 64% and the resuscitative endovascular balloon occlusion of the aorta had 74% mortality risk reduction. In the majority of cases, morbidity and blood loss associated with each interventional procedure were less than their respective controls. CONCLUSION Mortality from traumatic intra-abdominal hemorrhage could be reduced through early intervention at the scene by emerging technology. Manual pressure or the resuscitative endovascular balloon occlusion of the aorta techniques have demonstrated clinical effectiveness for the control of major vessel bleeding, although complications need to be carefully considered before advocating clinical use. At present, fast transfer to the trauma center remains paramount. LEVEL OF EVIDENCE Systematic review, level IV.
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Yu H, Burke CT. Comparison of percutaneous ablation technologies in the treatment of malignant liver tumors. Semin Intervent Radiol 2014; 31:129-37. [PMID: 25071303 PMCID: PMC4078184 DOI: 10.1055/s-0034-1373788] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tumor ablation is a minimally invasive technique used to deliver chemical, thermal, electrical, or ultrasonic damage to a specific focal tumor in an attempt to achieve substantial tumor destruction or complete eradication. As the technology continues to advance, several image-guided tumor ablations have emerged to effectively manage primary and secondary malignancies in the liver. Percutaneous chemical ablation is one of the oldest and most established techniques for treating small hepatocellular carcinomas. However, this technique has been largely replaced by newer modalities including radiofrequency ablation, microwave ablation, laser-induced interstitial thermotherapy, cryoablation, high-intensity-focused ultrasound ablation, and irreversible electroporation. Because there exist significant differences in underlying technological bases, understanding each mechanism of action is essential for achieving desirable outcomes. In this article, the authors review the current state of each ablation method including technological and clinical considerations.
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Affiliation(s)
- Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles T. Burke
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Feng G, Liu J, Zhao X, Wei J, Ou W, Xiao S, Hu Z, Wei H, Liu Z. Hemostatic effects of microbubble-enhanced low-intensity ultrasound in a liver avulsion injury model. PLoS One 2014; 9:e95589. [PMID: 24788757 PMCID: PMC4006836 DOI: 10.1371/journal.pone.0095589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/28/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Microbubble-enhanced therapeutic ultrasound (MEUS) can block the blood flow in the organs. The aim of this study was to evaluate the hemostatic effect of microbubble-enhanced pulsed, low-intensity ultrasound in a New Zealand White rabbit model of avulsion trauma of the liver. The therapeutic ultrasound (TUS) transducer was operated with the frequency of 1.2 MHz and an acoustic pressure of 3.4 MPa. Microbubble-(MB) enhanced ultrasound (MEUS) (n = 6) was delivered to the distal part of the liver where the avulsion was created. Livers were treated by TUS only (n = 4) or MB only (n = 4) which served as controls. Bleeding rates were measured and contrast enhanced ultrasound (CEUS) was performed to assess the hemostatic effect, and liver hemoperfusion before and after treatment. Generally, bleeding rates decreased more than 10-fold after the treatment with MEUS compared with those of the control group (P<0.05). CEUS showed significant declines in perfusion. The peak intensity value and the area under the curve also decreased after insonation compared with those of the control group (P<0.05). Histological examination showed cloudy and swollen hepatocytes, dilated hepatic sinusoids, perisinusoidal spaces with erythrocyte accumulation in small blood vessels, obvious hemorrhage around portal areas and scattered necrosis in liver tissues within the insonation area of MEUS Group. In addition, necrosis was found in liver tissue 48 h after insonation. We conclude that MEUS might provide an effective hemostatic therapy for serious organ trauma such as liver avulsion injury.
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Affiliation(s)
- Guiying Feng
- Department of Medical Ultrasound, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jianhua Liu
- Department of Medical Ultrasound, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaochen Zhao
- Department of Ultrasound, Xinqiao Hospital, the Third Military Medical University, Chongqing, China
| | - Jinglu Wei
- Department of Medical Ultrasound, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wencai Ou
- Department of Medical Ultrasound, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shuyi Xiao
- Department of Medical Ultrasound, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhiwen Hu
- Department of Medical Ultrasound, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hongqin Wei
- Department of Medical Ultrasound, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zheng Liu
- Department of Ultrasound, Xinqiao Hospital, the Third Military Medical University, Chongqing, China
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Dervishi E, Aubry JF, Delattre JY, Boch AL. [Focused ultrasound therapy: current status and potential applications in neurosurgery]. Neurochirurgie 2013; 59:201-9. [PMID: 24210288 DOI: 10.1016/j.neuchi.2013.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 05/19/2013] [Accepted: 06/09/2013] [Indexed: 01/26/2023]
Abstract
High Intensity Focused Ultrasound (HIFU) therapy is an innovative approach for tissue ablation, based on high intensity focused ultrasound beams. At the focus, HIFU induces a temperature elevation and the tissue can be thermally destroyed. In fact, this approach has been tested in a number of clinical studies for the treatment of several tumors, primarily the prostate, uterine, breast, bone, liver, kidney and pancreas. For transcranial brain therapy, the skull bone is a major limitation, however, new adaptive techniques of phase correction for focusing ultrasound through the skull have recently been implemented by research systems, paving the way for HIFU therapy to become an interesting alternative to brain surgery and radiotherapy.
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Affiliation(s)
- E Dervishi
- Équipe de neuro-oncologie expérimentale, Inserm, UMRS 975, CNRS 7225, institut du cerveau et de la moelle épinière, groupe hospitalier La Pitié Salpêtrière-Charles-Foix, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris, France.
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Zhu J, Zhu H, Mei Z, Jin C, Ran L, Zhou K, Yang W, Zhang L, She C. High-intensity focused ultrasound ablation for treatment of hepatocellular carcinoma and hypersplenism: preliminary study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1855-1862. [PMID: 24065267 DOI: 10.7863/ultra.32.10.1855] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this work was to preliminarily investigate the efficacy and safety of high-intensity focused ultrasound treatment of hepatocellular carcinoma and hypersplenism. Nine patients with hepatocellular carcinoma complicated by hypersplenism (5 male and 4 female; median age, 56 years; range, 51-66 years) were treated with ultrasound-guided high-intensity focused ultrasound. Complications were recorded. Laboratory examination and magnetic resonance imaging were used to evaluate the efficacy. After high-intensity focused ultrasound treatment, mean spleen ablation ± SD of 28.76% ± 6.1% was discovered; meanwhile, the white blood cell count, platelet count, and liver function of the patients were substantially improved during the follow-up period. In addition, symptoms such as epistaxis and gingival bleeding were ameliorated or even eliminated, and the quality of life was improved. Follow-up imaging showed a nonperfused volume in the spleen and an absence of a tumor blood supply at the treated lesions in the liver. For the first time to our knowledge, high-intensity focused ultrasound ablation was used to treat hepatocellular carcinoma complicated by hypersplenism. High-intensity focused ultrasound may be an effective and safe alternative for treatment of hepatocellular carcinoma complicated by hypersplenism, but further studies are necessary to clarify the mechanisms.
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Affiliation(s)
- Jing Zhu
- College of Biomedical Engineering, Chongqing Medical University, 400016 Chongqing, China.
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Peitzman AB, Richardson JD. Surgical treatment of injuries to the solid abdominal organs: a 50-year perspective from the Journal of Trauma. ACTA ACUST UNITED AC 2011; 69:1011-21. [PMID: 21068605 DOI: 10.1097/ta.0b013e3181f9c216] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew B Peitzman
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Medel R, Crowley RW, McKisic MS, Dumont AS, Kassell NF. Sonothrombolysis: an emerging modality for the management of stroke. Neurosurgery 2009; 65:979-93; discussion 993. [PMID: 19834413 DOI: 10.1227/01.neu.0000350226.30382.98] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Ischemic stroke and intracranial hemorrhage remain a persistent scourge in Western civilization. Therefore, novel therapeutic modalities are desperately needed to expand the current limitations of treatment. Sonothrombolysis possesses the potential to fill this void because it has experienced a dramatic evolution from the time of early conceptualization in the 1960s. This process began in the realm of peripheral and cardiovascular disease and has since progressed to encompass intracranial pathologies. Our purpose is to provide a comprehensive review of the historical progression and existing state of knowledge, including underlying mechanisms as well as evidence for clinical application of ultrasound thrombolysis. METHODS Using MEDLINE, in addition to cross-referencing existing publications, a meticulous appraisal of the literature was conducted. Additionally, personal communications were used as appropriate. RESULTS This appraisal revealed several different technologies close to broad clinical use. However, fundamental questions remain, especially in regard to transcranial high-intensity focused ultrasound. Currently, the evidence supporting low intensity ultrasound's potential in isolation, without tissue plasminogen, remains uncertain; however, possibilities exist in the form of microbubbles to allow for focal augmentation with minimal systemic consequences. Alternatively, the literature clearly demonstrates, the efficacy of high-intensity focused ultrasound for independent thrombolysis. CONCLUSION Sonothrombolysis exists as a promising modality for the noninvasive or minimally invasive management of stroke, both ischemic and hemorrhagic. Further research facilitating clinical application is warranted.
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Affiliation(s)
- Ricky Medel
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Dogra VS, Zhang M, Bhatt S. High-Intensity Focused Ultrasound (HIFU) Therapy Applications. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.cult.2009.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Fruehauf JH, Back W, Eiermann A, Lang MC, Pessel M, Marlinghaus E, Melchert F, Volz-Köster S, Volz J. High-intensity focused ultrasound for the targeted destruction of uterine tissues: experiences from a pilot study using a mobile HIFU unit. Arch Gynecol Obstet 2007; 277:143-50. [PMID: 17823809 DOI: 10.1007/s00404-007-0435-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 07/30/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND High intensity focused ultrasound (HIFU) is a novel method which offers the non-invasive ablation of tissues without harming overlying organs or skin. It has been introduced successfully in urology for the ablation of prostatic hyperplasia and seems to be promising in the treatment of uterine fibroids. In this study we aimed to examine the feasibility and possible side effects of HIFU treatment of uterine tissues using an experimental mobile HIFU unit with ultrasound guidance. METHODS For these experiments, a 1.07 MHz ultrasound source was used which allows treatment depths between 0 and 10 cm. In 12 patients scheduled to have abdominal hysterectomy, 5-60 impulses of HIFU were applied through the intact skin upon uterine tissues directly prior to the surgical procedure. Tissue intensities lay between 3,200 and 6,300 W/cm(2) and a fixed pulse length of 4 s was used. RESULTS No side effects were encountered other than one first-degree skin burn and the treatment was well tolerated. Histology showed clearly demarcated coagulative necrosis in the targeted tissues. Treatment was concluded in less than 45 min for each patient. CONCLUSION Focused ultrasound is an effective method to selectively destroy tissue within the uterus and the transabdominal access route is very feasible. This study shows that a mobile ultrasound source can be used safely and effectively to destroy uterine tissues, such as fibroids, without major side effects.
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Affiliation(s)
- Johannes H Fruehauf
- Department of Obstetrics and Gynaecology, University Hospital Mannheim, Mannheim, Germany.
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Abstract
Therapeutic applications of ultrasound predate its use in imaging. A range of biological effects can be induced by ultrasound, depending on the exposure levels used. At low levels, beneficial, reversible cellular effects may be produced, whereas at high intensities instantaneous cell death is sought. Therapy ultrasound can therefore be broadly divided into "low power" and "high power" applications. The "low power" group includes physiotherapy, fracture repair, sonophoresis, sonoporation and gene therapy, whereas the most common use of "high power" ultrasound in medicine is probably now high intensity focused ultrasound. Therapeutic effect through the intensity spectrum is obtained by both thermal and non-thermal interaction mechanisms. At low intensities, acoustic streaming is likely to be significant, but at higher levels, heating and acoustic cavitation will predominate. While useful therapeutic effects are now being demonstrated clinically, the mechanisms by which they occur are often not well understood.
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Affiliation(s)
- Gail ter Haar
- Joint Physics Department, Institute of Cancer Research, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK.
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Frenkel V, Li KCP. Potential role of pulsed-high intensity focused ultrasound in gene therapy. Future Oncol 2006; 2:111-9. [PMID: 16556078 DOI: 10.2217/14796694.2.1.111] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
As the understanding of human cancer biology increases, new potential strategies for gene therapy are being proposed and evaluated. However, safe and efficient gene transfer continues to be the major hurdle for its implementation in the clinic. Preclinical studies have shown how pulsed-high intensity focused ultrasound (HIFU) exposures can be combined with different modes of administration (local, intravascular and systemic) to improve local delivery of genes and other therapeutic agents. Using image guidance, exposures are given, where short pulses of energy create predominantly mechanical/structural effects in the tissues as opposed to thermal ones. The result is an increase in both extravasation and interstitial diffusion of macromolecules, which occur non-destructively and reversibly. Ultrasound contrast agents can also be added, which enhance acoustic cavitation activity and consequently sonoporation. By being able to locally increase the uptake and expression of DNA, pulsed-HIFU holds much promise to further the use and applications of gene therapy for treating cancer and other pathological conditions.
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Affiliation(s)
- Victor Frenkel
- Diagnostic Radiology Department, Clinial Center, National Institutes of Health, Bethesda, MD, USA.
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Abstract
High-intensity focused ultrasound (HIFU) has been used to ablate benign and malignant prostate tissue for several decades. This review summarizes the technology and available clinical trials to date. Continued technological advances combined with well-designed clinical trials could allow HIFU to become part of the arsenal against prostate cancer.
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Affiliation(s)
- Thomas A Gardner
- Department of Urology, Indiana University Medical Center, Indianapolis 46202, USA.
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Abstract
It seems clear that thermal-based therapies of prostate cancer have the potential to completely eradicate the prostate gland. Technical modifications continue to improve our ability to use these modalities more effectively, which can be seen in the ever decreasing morbidity from damage to adjacent structures. These treatments offer potential major advantages over surgery and radiation-based treatment modalities.
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Affiliation(s)
- Michael O Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Hynynen K, McDannold N. MRI guided and monitored focused ultrasound thermal ablation methods: a review of progress. Int J Hyperthermia 2005; 20:725-37. [PMID: 15675668 DOI: 10.1080/02656730410001716597] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
This paper reviews the current status in using magnetic resonance imaging (MRI) to guide and monitor thermal coagulation of tumours using focused ultrasound. The patient treatment procedure with a second generation phased array system will be described. Several clinical trials have found that patient treatments are feasible and that MRI thermometry allows noninvasive monitoring of clinical treatments. Overall, this emerging modality holds significant potential for non-invasive tumour treatment of both benign and malignant tumours.
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Affiliation(s)
- K Hynynen
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Vaezy S, Vaezy S, Starr F, Chi E, Cornejo C, Crum L, Martin RW. Intra-operative acoustic hemostasis of liver: production of a homogenate for effective treatment. ULTRASONICS 2005; 43:265-269. [PMID: 15567203 DOI: 10.1016/j.ultras.2004.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2004] [Indexed: 05/24/2023]
Abstract
OBJECTIVE We have shown that High-Intensity Focused Ultrasound (HIFU) can effectively control bleeding from injuries to solid organs such as liver, spleen, and lung. Achievement of hemostasis was augmented when a homogenate of tissue and blood was formed. The objective of this study was to investigate quantitatively the effect of homogenate production on HIFU application time for hemostasis. Possible mechanisms involved in homogenate production were also studied. METHODS Ten anesthetized rabbits had laparotomy and liver exposure. Liver incisions, 15-25 mm long and 3-4 mm deep, were made followed immediately by HIFU application. Two electrical powers of 80 and 100 W corresponding to focal acoustic intensities of 2264 and 2829 W/cm(2), respectively were used. Tissue and homogenate temperatures were measured. Smear and histological tissue sample analysis using light microscopy were performed. RESULTS In treatments with homogenate formation, hemostasis was achieved in 76+/-1.3 s (Mean+/-Standard Error Mean: SEM) at 80 W. In treatments without homogenate formation (at 80 W), hemostasis was achieved in 106+/-0.87 s. At 100 W, hemostasis was achieved in 46+/-0.3 s. The time required for homogenate formation, at 80 and 100 W were 60+/-2.5 and 23+/-0.3 s, respectively. The homogenate temperature was 83 degrees C (SEM 0.6 degrees C), and the non-homogenate tissue temperature at the treatment site was 60 degrees C (SEM 0.4 degrees C). The smear and histological analysis showed significant blood components and cellular debris in the homogenate, with some intact cells. CONCLUSION The HIFU-induced homogenate of blood and tissue resulted in a statistically significant shorter HIFU application time for hemostasis. The incisions with homogenate had higher temperatures as compared to incisions without homogenate. Further studies of the correlation between homogenate formation and temperature must be done, as well as studies on the long-term effects of homogenate in achieving hemostasis.
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Affiliation(s)
- Sara Vaezy
- Applied Physics Laboratory, Center for Medical and Industrial Ultrasound, 1013 NE 40th Street, Seattle, WA 98105-6698, USA.
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Kirkpatrick AW, Campbell MR, Jones JA, Broderick TJ, Ball CG, McBeth PB, McSwain NE, Hamilton DR, Holcomb JB. Extraterrestrial hemorrhage control: Terrestrial developments in technique, technology, and philosophy with applicability to traumatic hemorrhage control in long-duration spaceflight. J Am Coll Surg 2005; 200:64-76. [PMID: 15631922 DOI: 10.1016/j.jamcollsurg.2004.08.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2004] [Accepted: 08/27/2004] [Indexed: 12/27/2022]
Affiliation(s)
- Andrew W Kirkpatrick
- Departments of Critical Care Medicine and Surgery, and Calgary Brain Institute, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada.
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Deng CX, Dogra V, Exner AA, Wang H, Bhatt S, Zhou Y, Stowe NT, Haaga JR. A feasibility study of high intensity focused ultrasound for liver biopsy hemostasis. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:1531-1537. [PMID: 15588964 DOI: 10.1016/j.ultrasmedbio.2004.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Revised: 08/02/2004] [Accepted: 08/13/2004] [Indexed: 05/24/2023]
Abstract
This study was conducted to demonstrate the feasibility of high intensity focused ultrasound (HIFU) application to control post-liver-biopsy hemorrhage. Anesthetized Yorkshire pigs (n = 3; mean weight = 23.0 kg) were used and the liver organ was exposed surgically by an open laparotomy. Core biopsies were performed on the hepatic parenchyma with 14-gauge (n = 41) and 18-gauge (n = 33) core biopsy needles. The focus of HIFU (4.23 MHz) field was applied for 15 to 45 s to the needle entry site in the liver immediately after needle retraction. Blood loss from a biopsy site was determined using surgical sponges as absorbent applied at the site. Mean blood loss for control sites was 6.16 g (14-gauge, n = 20) and 1.22 g (18-gauge, n = 10). Virtually no blood loss was measured for biopsies after HIFU application (n = 44) for using needles of both sizes. Our results indicate that intraoperative HIFU application could successfully induce hemostasis after liver biopsy in a porcine model.
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Affiliation(s)
- Cheri X Deng
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106-7207, USA.
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24
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Cornejo CJ, Vaezy S, Jurkovich GJ, Paun M, Sharar SR, Martin RW. High-Intensity Ultrasound Treatment of Blunt Abdominal Solid Organ Injury: An Animal Model. ACTA ACUST UNITED AC 2004; 57:152-6. [PMID: 15284566 DOI: 10.1097/01.ta.0000088009.93307.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is effective in producing hemostasis in injuries from organ lacerations and punctures in animals but has not been evaluated in impact injuries. METHOD High-energy blows were applied to 11 heparinized and anesthetized pigs, resulting in solid organ injury. HIFU was applied to injuries via laparotomy. The animals were closed, administered saline, observed under general anesthesia for 3.6 +/- 0.4 hours, reopened, and inspected, and abdominal free fluid was aspirated. RESULTS Organ hemostasis was achieved (mean +/- SD) with 15 +/- 6 minutes of HIFU treatment and 54 +/- 3 minutes of operating time, and 18.8 +/- 13.1 mL/kg of blood was recovered from the abdomen. One animal died from an untreated occult injury to a large vein. HIFU-treated sites were hemostatic at relaparotomy, with 8.6 +/- 6.2 mL/kg abdominal serosanguinous fluid recovered. CONCLUSION HIFU is effective in producing hemostasis by direct treatment of injured parenchyma in blunt trauma.
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Affiliation(s)
- Carol J Cornejo
- Department of Surgery, Harborview Medical Center, Univeristy of Washington, Seattle, Washington, USA
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25
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Nizard J, Pessel M, De Keersmaecker B, Barbet JP, Ville Y. High-intensity focused ultrasound in the treatment of postpartum hemorrhage: an animal model. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2004; 23:262-266. [PMID: 15027015 DOI: 10.1002/uog.1007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To investigate the use of high-intensity focused ultrasound (HIFUS) to reduce uterine artery blood flow in ewes in the postpartum period. METHODS HIFUS was applied to the uterine arteries of seven ewes in the postpartum period. Arterial flow velocities were measured before and after the procedure at the site of HIFUS application (target), as well as 3 cm upstream and 3 cm downstream from the target. The uterine arteries were then removed for macroscopic and histological examination. RESULTS Maximum flow velocities in the target area increased after the procedure by 350% and those upstream from the target decreased by 65%. Macroscopically, the vessel diameter was shown to have reduced at the site of HIFUS application. Microscopically, both the endothelium and media showed thermal lesions. Tissues surrounding the arteries were macroscopically and microscopically normal. CONCLUSION Exposure of uterine arteries to HIFUS reduces the vessel diameter and thus induces a dramatic increase in the maximum flow velocities within the target area. HIFUS may have a role in the treatment of postpartum hemorrhage.
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Affiliation(s)
- J Nizard
- Department of Obstetrics and Gynecology, CHIPS, Poissy, France
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26
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Poliachik SL, Chandler WL, Ollos RJ, Bailey MR, Crum LA. The relation between cavitation and platelet aggregation during exposure to high-intensity focused ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2004; 30:261-9. [PMID: 14998678 DOI: 10.1016/j.ultrasmedbio.2003.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2003] [Revised: 09/29/2003] [Accepted: 10/14/2003] [Indexed: 05/13/2023]
Abstract
Our previous study showed that high-intensity focused ultrasound (HIFU) is capable of producing "primary acoustic hemostasis" in the form of ultrasound (US)-induced platelet activation, aggregation and adhesion to a collagen-coated surface. In the current study, 1.1 MHz continuous-wave HIFU was used to investigate the role of cavitation as a mechanism for platelet aggregation in samples of platelet-rich plasma. A 5 MHz passive cavitation detector was used to monitor cavitation activity and laser aggregometry was used to measure platelet aggregation. Using spatial average intensities from 0 to 3350 W/cm2, the effects of HIFU-induced cavitation on platelet aggregation were investigated by enhancing cavitation activity through use of US contrast agents and by limiting cavitation activity through use of an overpressure system. Our results show that increased cavitation activity lowers the intensity threshold to produce platelet aggregation and decreased cavitation activity in the overpressure system raises the intensity threshold for platelet aggregation.
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Affiliation(s)
- Sandra L Poliachik
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, USA.
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27
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Vaezy S, Noble ML, Keshavarzi A, Paun M, Prokop AF, Cornejo C, Sharar S, Chi EY, Crum LA, Martin RW. Liver hemostasis with high-intensity ultrasound: repair and healing. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:217-225. [PMID: 14992358 DOI: 10.7863/jum.2004.23.2.217] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Previous studies have shown that high-intensity focused ultrasound can effectively control bleeding from injuries of liver, spleen, and blood vessels. This study investigated long-term hemostasis and tissue repair after high-intensity focused ultrasound treatment in liver. METHODS A total of 21 rabbits were randomly assigned to 2 groups: high-intensity focused ultrasound treatment (n = 14) and sham treatment (n = 7). All animals had sterile laparotomy and liver exposure. The high-intensity focused ultrasound-treated animals received liver incisions, 20 to 25 mm long and 4 to 6 mm deep, followed immediately by high-intensity focused ultrasound application until complete hemostasis was achieved. After recovery, sonographic images, blood samples, and histologic samples were collected immediately and on days 1, 3, 7, 14, 28, and 60 after treatment. RESULTS All 14 liver injuries were hemostatic after an average +/- SD of 78 +/- 44 seconds of high-intensity focused ultrasound application, with no rebleeding at any time point after the treatment. Subsequent blood analysis showed no significant difference in serial hematologic or coagulation measures between the high-intensity focused ultrasound and sham groups. Alanine aminotransferase and aspartate aminotransferase levels increased immediately after surgery by as much as 285% up to day 3 and returned to normal values by day 7. Hematocrit and white blood cell counts showed no statistically significant difference from normal values at all time points. Histologic examination up to 60 days after treatment revealed scarring and liver tissue regeneration at the treatment site. CONCLUSIONS High-intensity focused ultrasound appears to provide long-lasting hemostasis of acute liver injury. Healing and repair mechanisms after high-intensity focused ultrasound application appear to be intact.
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Affiliation(s)
- Shahram Vaezy
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA 98105, USA.
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Kennedy JE, Ter Haar GR, Cranston D. High intensity focused ultrasound: surgery of the future? Br J Radiol 2003; 76:590-9. [PMID: 14500272 DOI: 10.1259/bjr/17150274] [Citation(s) in RCA: 385] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
For 50 years, high intensity focused ultrasound (HIFU) has been a subject of interest for medical research. HIFU causes selective tissue necrosis in a very well defined volume, at a variable distance from the transducer, through heating or cavitation. Over the past decade, the use of HIFU has been investigated in many clinical settings. This literature review aims to summarize recent advances made in the field. A Medline-based literature search (1965-2002) was conducted using the keywords "HIFU" and "high intensity focused ultrasound". Additional literature was obtained from original papers and published meeting abstracts. The most abundant clinical trial data comes from studies investigating its use in the treatment of prostatic disease, although early research looked at applications in neurosurgery. More recently horizons have been broadened, and the potential of HIFU as a non-invasive surgical tool has been demonstrated in many settings including the treatment of tumours of the liver, kidney, breast, bone, uterus and pancreas, as well as conduction defects in the heart, for surgical haemostasis, and the relief of chronic pain of malignant origin. Further clinical evaluation will follow, but recent technological development suggests that HIFU is likely to play a significant role in future surgical practice.
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Affiliation(s)
- J E Kennedy
- Department of Urology, Churchill Hospital, Oxford, Head of Therapeutic Ultrasound, Royal Marsden Hospital, Sutton and Consultant Urologist, Churchill Hospital, Oxford, UK
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29
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Martin RW, Vaezy S, Proctor A, Myntti T, Lee JBJ, Crum LA. Water-cooled, high-intensity ultrasound surgical applicators with frequency tracking. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2003; 50:1305-1317. [PMID: 14609070 DOI: 10.1109/tuffc.2003.1244747] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
High-intensity, focused ultrasound (HIFU) applicators have been developed for arresting bleeding with the ultimate intent of use in surgery. The design uses a tapered titanium component for transmission coupling of the ultrasound energy from a spherically curved transducer to biological tissues. The nominal operating frequency is 5.5 MHz, in a highly resonant mode (quality factor of 327 with water load). Liquid cooling is used to remove energy loss important at net applied power greater than 18 W/cm2 at the surface of the piezoelectric element. A downward resonance frequency shift (>20 kHz) occurs, even with cooling, as the applicator warms with normal operation. A feedback technique is used for maintaining the excitation near optimum resonance. Standing wave ratios of the applied power of 1.6 or less are thus sustained. The system and applicators have been found to be highly robust, effective in achieving hemostasis in the hemorrhaging liver, spleen, lung, or blood vessels in rabbit and pig experiments. One unit has been operated for over 1.7 hours in treating organ hemorrhage in blunt trauma experiments with nine swine with electrical net power of up to 158 W (31 W/cm2 across the transducer) and intensity of 2560 W/cm2 at focus.
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Affiliation(s)
- Roy W Martin
- University of Washington, Seattle, WA 98195, USA.
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Prokop AF, Vaezy S, Noble ML, Kaczkowski PJ, Martin RW, Crum LA. Polyacrylamide gel as an acoustic coupling medium for focused ultrasound therapy. ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:1351-1358. [PMID: 14553813 DOI: 10.1016/s0301-5629(03)00979-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A hydrogel acoustic coupling medium was investigated as a practical alternative to water for clinical applications of focused ultrasound (US) therapy. Material characterization and functional testing of polyacrylamide gel couplers were performed. Acoustic, bulk and thermal properties were measured. Conical couplers were designed and fabricated to fit a 3.5-MHz, spherically concave transducer for functional tests, including Schlieren imaging, power efficiency measurements and in vivo hemostasis experiments. Polyacrylamide was shown to have favorable acoustic properties that varied linearly with acrylamide concentration from 10% to 20% weight in volume. Attenuation coefficient, sound speed and impedance ranged from 0.08 to 0.14 dB/cm at 1 MHz, 1546 to 1595 m/s and 1.58 to 1.68 Mrayl, respectively. An intraoperative in vivo hemostasis experiment in a sheep model demonstrated that the gel-coupled transducer was capable of inducing hemostasis in actively bleeding splenic and hepatic incisions. The results of this study show that polyacrylamide may be a promising coupling material for focused US therapy.
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Affiliation(s)
- Adrian F Prokop
- Bioengineering, University of Washington, Seattle, WA 98105, USA
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31
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Hwang JH, Vaezy S, Martin RW, Cho MY, Noble ML, Crum LA, Kimmey MB. High-intensity focused US: a potential new treatment for GI bleeding. Gastrointest Endosc 2003; 58:111-5. [PMID: 12838236 DOI: 10.1067/mge.2003.322] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND High-intensity focused US has been shown to achieve hemostasis in lacerated large veins and arteries. High-intensity focused US was studied as a potential endoscopic treatment for GI bleeding. METHODS A segment of the auricular vein of the rabbit was lacerated longitudinally and then treated with a high-intensity focused US transducer driven at 3.9 MHz (focal intensity of 750 W/cm(2)) in 15 animals until hemostasis was achieved. Sham treatment was delivered to 3 vessels. Rabbits were euthanized on days 0, 2, 7, 14, and 28 to allow for histologic evaluation of the response to treatment. RESULTS Hemostasis was achieved in all treated vessels and in none of the sham treatments. Mean treatment time was 13 seconds. Histology initially demonstrated acute thermal injury with subsequent thrombus formation and chronic inflammation leading to replacement of the vessel by fibrous scar tissue. CONCLUSIONS High-intensity focused US causes hemostasis in acutely bleeding veins and results in occlusion of treated vessel with subsequent granulation tissue formation.
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Affiliation(s)
- Joo Ha Hwang
- Department of Medicine, Division of Gastroenterology, Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle 98195-6424, USA
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32
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Noble ML, Vaezy S, Keshavarzi A, Paun M, Prokop AF, Chi EY, Cornejo C, Sharar SR, Jurkovich GJ, Martin RW, Crum LA. Spleen hemostasis using high-intensity ultrasound: survival and healing. THE JOURNAL OF TRAUMA 2002; 53:1115-20. [PMID: 12478037 DOI: 10.1097/00005373-200212000-00014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have shown that high-intensity focused ultrasound (HIFU) can effectively control bleeding of incised livers and spleens and punctured vessels. This current study investigated the long-term safety of HIFU in splenic hemostasis. METHODS A total of 21 rabbits were randomly assigned to two groups: HIFU treatment (n = 14), and sham treatment (n = 7). All animals underwent sterile laparotomy and splenic exposure. The HIFU-treated animals received splenic incisions, 8 to 10 mm long and 4 to 5 mm deep, and immediate 9.6-MHz HIFU until hemostasis was achieved. After recovery, ultrasound images, blood samples, and histologic samples were collected on days 0, 1, 3, 7, 14, 28, and 60. RESULTS All 14 splenic injuries were hemostatic after an average of 96 seconds of HIFU application. There was evidence of rebleeding in one animal between days 3 and 7 posttreatment. Subsequent blood analysis showed no significant difference in serial hematologic or coagulation measures between HIFU and sham groups. Histologic examination up to 60 days posttreatment revealed scarring and spleen tissue regeneration at the treatment site. CONCLUSION HIFU provides an effective and safe method of achieving hemostasis after acute splenic injury.
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Affiliation(s)
- Misty L Noble
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle 98105, USA
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Abstract
The potential role of therapeutic ultrasound in medicine is promising. Currently, medical devices are being developed that utilize high-intensity focused ultrasound as a noninvasive method to treat tumors and to stop bleeding (hemostasis). The primary advantage of ultrasound that lends the technique so readily to use in noninvasive therapy is its ability to penetrate deep into the body and deliver to a specific site thermal or mechanical energy with submillimeter accuracy. Realizing the full potential of acoustic therapy, however, requires precise targeting and monitoring. Fortunately, several imaging modalities can be utilized for this purpose, thus leading to the concept of image-guided acoustic therapy. This article presents a review of high-intensity focused ultrasound therapy, including its mechanisms of action, the imaging modalities used for guidance and monitoring, some current applications, and the requirements and technology associated with this exciting and promising field.
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Affiliation(s)
- S Vaezy
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington 98105-6698, USA.
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Leone M, Portier F, Antonini F, Chaumoître K, Albanèse J, Martin C. [Strategies diagnosis of polytraumatized adult patients with coma]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21:50-66. [PMID: 11878125 DOI: 10.1016/s0750-7658(01)00550-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review the diagnostic strategy of management of multiple trauma patient during the first hours. DATA SOURCES Extraction from Pubmed database of French and English articles on the management of multiple trauma patient published for ten years. DATA SELECTION The collected articles were reviewed and selected according to their quality and originality. The more recent data were selected. DATA SYNTHESIS The first hours of management of multiple trauma patients are a particular challenge. The first dilemma is to drive the patient toward an adequate structure. In case of poor haemodynamic tolerance, the patient will be drive in the nearest hospital. When haemodynamic parameters are restored, multiple trauma patient has to be receive in a high level hospital by a trained medical team with an anesthesiologist, intensivist, neurosurgeon, general surgeon and radiologist. The initial assessment may have two priorities: quality and speed. The total body CT scan is actually the answer to these priorities.
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Affiliation(s)
- M Leone
- Département d'anesthésie-réanimation et centre de traumatologie, CHU Nord, bd P-Dramard, 13915 Marseille, France
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35
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Poliachik SL, Chandler WL, Mourad PD, Ollos RJ, Crum LA. Activation, aggregation and adhesion of platelets exposed to high-intensity focused ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2001; 27:1567-1576. [PMID: 11750756 DOI: 10.1016/s0301-5629(01)00444-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Using platelet-rich plasma, we investigated the effect of 1.1-MHz continuous wave high-intensity focused ultrasound (HIFU) on platelet activation, aggregation and adhesion to a collagen-coated surface. Platelets were exposed for durations of 10-500 s at spatial average intensities of up to 4860 W/cm(2). To avoid heating effects, the average temperature in the HIFU tank was maintained at 33.8 +/- 4.0 degrees C during platelet experiments. Flow cytometry, laser aggregometry, environmental scanning electron microscopy and passive cavitation detection were used to observe and to quantify platelet activation, aggregation, adhesion to a collagen-coated surface and associated cavitation. It was determined that HIFU can activate platelets, stimulate them to aggregate and promote their adherence to a collagen-coated surface. In principle, HIFU can stimulate primary, or platelet-related, hemostasis. Cavitation was monitored by a passive cavitation detector during aggregation trials and was quantified to provide a relative measure of the amount of cavitation that occurred in each aggregation trial. Regression analysis shows a weak correlation (r(2) = 0.11) between aggregation and ultrasound intensity, but a substantial correlation (r(2) = 0.76) between aggregation and cavitation occurrence.
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Affiliation(s)
- S L Poliachik
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 430th Street, Seattle, WA 98105, USA.
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36
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Goettler CE, Fallon WF. Blunt thoraco-abdominal injury. Curr Opin Anaesthesiol 2001; 14:237-43. [PMID: 17016408 DOI: 10.1097/00001503-200104000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent advances in blunt thoraco-abdominal trauma management include improvements in imaging, particularly in trauma bay ultrasound. Indications for non-operative management have expanded for solid organ and aortic injury. The physiology of abdominal compartment syndrome continues to be defined, with resulting improvements in care.
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Affiliation(s)
- C E Goettler
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Abstract
Effective local ablation of large tumors with radiofrequency has been made possible by recent advancements. Tumor ablation with radiofrequency has been described mainly in the liver, but also recently in the kidney, adrenal gland, lung, and breast. A rapidly growing splenic metastasis from renal cell carcinoma was effectively treated percutaneously, with US guidance. Focal splenic disease may not be a common indication for ablation; however, further work is necessary to evaluate the safety and efficacy of this procedure in this setting.
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Affiliation(s)
- B J Wood
- Special Procedures/Diagnostic Radiology Department, Clinical Center, and National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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38
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Vaezy S, Marti R, Mourad P, Crum L. Hemostasis using high intensity focused ultrasound. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1999; 9:79-87. [PMID: 10099169 DOI: 10.1016/s0929-8266(99)00014-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
High intensity focused ultrasound (HIFU) has been shown to be an effective method of hemostasis, in animal studies, for both solid organs and blood vessels. Two distinct effects of HIFU, thermal and mechanical, appear to contribute to hemostasis. Acoustic hemostasis may provide an effective method in surgery and prehospital settings for treating trauma and elective surgery patients. A review of the methodology is given.
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Affiliation(s)
- S Vaezy
- Department of Bioengineering, University of Washington, Box 357962, Seattle, WA 98195, USA.
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