Microwave catheter design

Intracavitary Applicator for Sequential Delivery of Localized Hyperthermia Through Non-Metallic Uterine Tandem

In this article, we report the design and demonstration of a flexible coaxial wire antenna with a low profile flexible choke for delivering localized hyperthermia (HT) treatment to the cervix through a custom designed uterine tandem applicator. Resistive and magnetic materials were investigated for determining the flexible choke design suited for intracavitary HT treatment at 915 MHz. Measurements of the intracavitary antenna with the flexible choke in tissue mimicking phantom and ex-vivo bovine muscle through the non-metallic uterine tandem prototype confirm the ability to deliver localized HT to the cervix at 915 MHz and 50 mm insertion depth.

Safety and Efficacy of Percutaneous Liver Microwave Ablation Using a Fully Water-Cooled Choke Ring Antenna: First Multicenter Clinical Report

INTRODUCTION

The safety and efficacy of a microwave ablation (MWA) system for the liver with novel technologies in field control, antenna cooling through the inner part of the choke ring, and dual temperature monitoring were evaluated in this multicenter retrospective study.

MATERIAL AND METHODS

Ablation characteristics and efficacy were assessed on follow-up imaging (computed tomography or magnetic resonance imaging). Safety was evaluated according to CTCAE classification.

RESULTS

Eighty-seven liver tumors (65 metastases and 22 hepatocellular carcinomas) measuring 17.8 ± 7.9 mm were treated in 68 patients. Ablation zones measured 35.6 ± 11 mm in longest diameter. The coefficients of variation of the longest and shortest ablation diameters were 30.1% and 26.4%, respectively. The mean sphericity index of the ablation zone was 0.78 ± 0.14. Seventy-one ablations (82%) had a sphericity index above 0.66. At 1 month, all tumors demonstrated complete ablation with margins of 0-5 mm, 5-10 mm, and greater than 10 mm achieved in 22%, 46%, and 31% of tumors, respectively. After a median follow-up of 10 months, local tumor control was achieved in 84.7% of treated tumors after a single ablation and in 86% after one patient received a second ablation. One grade 3 complication (stress ulcer) occurred, but was unrelated to the procedure. Ablation zone size and geometry in this clinical study were in accordance with previously reported in vivo preclinical findings.

CONCLUSION

Promising results were reported for this MWA device. The high spherical index, reproducibility, and predictability of the resulting treatment zones translated to a high percentage of adequate safety margins, providing good local control rate.

Efficacy of Lung-Tuned Monopole Antenna for Microwave Ablation: Analytical Solution and Validation in a Ventilator-Controlled ex Vivo Porcine Lung Model

The goal of this study was to optimize a lung-tuned monopole antenna to deliver microwave energy at 2.45 GHz into a novel ventilator-controlled ex vivo lung model. An analytic and parametric approach was utilized to create an optimized monopole antenna that was impedance-matched to aerated lung tissue. This lung-tuned antenna was then fabricated using a copper 0.085" semi-rigid copper coaxial cable. For validation, the lung-tuned antenna was inserted centrally into lobes of a ex vivo porcine lung that was fully inflated to physiologically appropriate volumes. Microwave ablations were then created at 50 and 100 W for 1 minute and 5 minutes. Reflected power, cross sectional ablation sizes and spherical shape of the lung-tuned antenna were compared against a liver-tuned antenna in the ventilator-controlled ex vivo lung tissue. The study showed that the lung-tuned antennas delivered energy significantly more efficiently, with less reflected power, compared to the conventionally-used liver-tuned antennas at 50 W at 1 minute (11.8±3.0 vs 16.3±3.1 W; p value=0.03) and 5 minutes (16.2±2.8 vs 19.4±2.9 W; p value=0.04), although this was only true using 100 W at the 1 minute time point (29.0±3.5 vs 38.0±5.3 W; p value=0.02). While overall ablation zone sizes were comparable between the two types of antenna, the lung-tuned antenna did create a significantly more spherical ablation zone compared to the liver-tuned antenna at the 1 minute, 50 W setting (aspect ratio: 0.43±0.07 vs 0.38±0.04; p value=0.04). In both antenna groups, there was a significant rise in the ablation zone aspect ratio between 1 and 5 minutes, indicating that higher power and time settings can increase the spherical shape of ablation zones when using tuned antennas. Adapting this combined analytic and parametric approach to antenna design can be implemented in adaptive tissue-tuning for real-time microwave ablation optimization in lung tissue.

A review of antenna designs for percutaneous microwave ablation

Microwave (MW) antenna is a key element in microwave ablation (MWA) treatments as the means that energy is delivered in a focused manner to the tumor and its surrounding area. The energy delivered results in a rise in temperature to a lethal level, resulting in cell death in the ablation zone. The delivery of energy and hence the success of MWA is closely dependent on the structure of the antennas. Therefore, three design criteria, such as expected ablation zone pattern, efficiency of energy delivery, and minimization of the diameter of the antennas have been the focus along the evolution of the MW antenna. To further improve the performance of MWA in the treatment of various tumors through inventing novel antennas, this article reviews the state-of-the-art and summarizes the development of MW antenna designs regarding the three design criteria.

Irrigated Microwave Catheter Ablation Can Create Deep Ventricular Lesions Through Epicardial Fat With Relative Sparing of Adjacent Coronary Arteries

BACKGROUND

Radiofrequency ablation depth can be inadequate to reach intramural or epicardial substrate, and energy delivery in the pericardium is limited by penetration through epicardial fat and coronary anatomy. We hypothesized that open irrigated microwave catheter ablation can create deep myocardial lesions endocardially and epicardially though fat while acutely sparing nearby the coronary arteries.

METHODS

In-house designed and constructed irrigated microwave catheters were tested in in vitro phantom models and in 15 sheep. Endocardial ablations were performed at 140 to 180 W for 4 minutes; epicardial ablations via subxiphoid access were performed at 90 to 100 W for 4 minutes at sites near coronary arteries.

RESULTS

Epicardial ablations at 90 to 100 W produced mean lesion depth of 10±4 mm, width 18±10 mm, and length 29±8 mm through median epicardial fat thickness of 1.2 mm. Endocardial ablations at 180 W reached depths of 10.7±3.3 mm, width of 16.6±5 mm, and length of 20±5 mm. Acute coronary occlusion or spasm was not observed at a median separation distance of 2.7 mm (IQR, 1.2-3.4 mm). Saline electrodes recorded unipolar and bipolar electrograms; microwave ablation caused reductions in voltage and changes in electrogram morphology with loss of pace-capture. In vitro models demonstrated the heat sink effect of coronary flow, as well as preferential microwave coupling to myocardium and blood as opposed to lung and epicardial fat phantoms.

CONCLUSIONS

Irrigated microwave catheter ablation may be an effective ablation modality for deep ventricular lesion creation with capacity for fat penetration and sparing of nearby coronary arteries because of cooling endoluminal flow. Clinical translation could improve the treatment of ventricular tachycardia arising from mid myocardial or epicardial substrates.

Antenna Designs for Microwave Tissue Ablation

Microwave (MW) ablation has emerged as a minimally invasive therapeutic modality and is in clinical use for treatment of unresectable tumors and cardiac arrhythmias, neuromodulation, endometrial ablation, and other applications. Components of image-guided MW ablation systems include high-power MW sources, ablation applicators that deliver power from the generator to the target tissue, cooling systems, energy-delivery control algorithms, and imaging guidance systems tailored to specific clinical indications. The applicator incorporates a MW antenna that radiates MW power into the surrounding tissue. A variety of antenna designs have been developed for MW ablation with the objective of efficiently transferring MW power to tissue, with a radiation pattern well matched to the size and shape of the targeted tissue. Here, we survey advances in percutaneous, endocavitary, and endoscopic antenna designs as an integral element of MW ablation applicators for a diverse set of clinical applications.

Characteristics of a Surgical Snare Using Microwave Energy

Currently, minimally invasive treatments that insert various treatment devices into an endoscope are actively being performed. A high-frequency (HF) snare is commonly used as an energy device inserted into an endoscope. However, using a high-frequency snare, problems usually occur, such as the obstruction of the visual field caused by smoke. On the other hand, microwave heating produces less smoke and provides a better visual field. In this study, a snare using microwave energy inserted into an endoscope is proposed, and its characteristics are evaluated.

Creation of short microwave ablation zones: in vivo characterization of single and paired modified triaxial antennas

PURPOSE

To characterize modified triaxial microwave antennas configured to produce short ablation zones.

MATERIALS AND METHODS

Fifty single-antenna and 27 paired-antenna hepatic ablations were performed in domestic swine (N = 11) with 17-gauge gas-cooled modified triaxial antennas powered at 65 W from a 2.45-GHz generator. Single-antenna ablations were performed at 2 (n = 16), 5 (n = 21), and 10 (n = 13) minutes. Paired-antenna ablations were performed at 1-cm and 2-cm spacing for 5 (n = 7 and n = 8, respectively) and 10 minutes (n = 7 and n = 5, respectively). Mean transverse width, length, and aspect ratio of sectioned ablation zones were measured and compared.

RESULTS

For single antennas, mean ablation zone lengths were 2.9 cm ± 0.45, 3.5 cm ± 0.55, and 4.2 cm ± 0.40 at 2, 5, and 10 minutes, respectively. Mean widths were 1.8 cm ± 0.3, 2.0 cm ± 0.32, and 2.5 cm ± 0.25 at 2, 5, and 10 minutes, respectively. For paired antennas, mean length at 5 minutes with 1-cm and 2-cm spacing and 10 minutes with 1-cm and 2-cm spacing was 4.2 cm ± 0.9, 4.9 cm ± 1.0, 4.8 cm ± 0.5, and 4.8 cm ± 1.3, respectively. Mean width was 3.1 cm ± 1.0, 4.4 cm ± 0.7, 3.8 cm ± 0.4, and 4.5 cm ± 0.7, respectively. Paired-antenna ablations were more spherical (aspect ratios, 0.72-0.79 for 5-10 min) than single-antenna ablations (aspect ratios, 0.57-0.59). For paired-antenna ablations, 1-cm spacing appeared optimal, with improved circularity and decreased clefting compared with 2-cm spacing (circularity, 0.85 at 1 cm, 0.78 at 2 cm).

CONCLUSIONS

Modified triaxial antennas can generate relatively short, spherical ablation zones. Paired-antenna ablations were rounder and larger in transverse dimension than single antenna ablations, with 1-cm spacing optimal for confluence of the ablation zone.

Microwave ablation devices for interventional oncology

Microwave ablation is one of the several options in the ablation armamentarium for the treatment of malignancy, offering several potential benefits when compared with other ablation, radiation, surgical and medical treatment modalities. The basic microwave system consists of the generator, power distribution system and antennas. Often under image (computed tomography or ultrasound) guidance, a needle-like antenna is inserted percutaneously into the tumor, where local microwave electromagnetic radiation is emitted from the probe's active tip, producing frictional tissue heating, capable of causing cell death by coagulation necrosis. Half of the microwave ablation systems use a 915 MHz generator and the other half use a 2450 MHz generator. To date, there are no completed clinical trials comparing microwave devices head-to-head. Prospective comparisons of microwave technology with other treatment alternatives, as well as head-to-head comparison with each microwave device, is needed if this promising field will garner more widespread support and use in the oncology community.

Modeling and simulation of novel antenna for the treatment of hepatocellular carcinoma using finite element method

In this article, new interstitial antenna operating at a frequency of 2.45 GHz for the treatment of hepatocellular carcinoma (HCC) using microwave ablation has been investigated. This antenna is basically an asymmetrical miniaturized choke dipole antenna with a pointed needle at the tip. A commercial finite element method (FEM) package, COMSOL Multiphysics 3.4a, has been used to simulate the performance of needle tip choke antenna. The performance of the antenna has been evaluated numerically, taking into account the specific absorption rate, antenna impedance matching and geometry of the obtained thermal lesion, and the temperature distribution plot obtained shows that maximum temperature was attained in this simulation. The antenna is also capable of creating a spherical-shaped ablation zone. The size and shape of the ablation zone can be slightly adjusted by adjusting the choke position in order to maintain spherical ablation zones.

Numerical Calculations of Heating Patterns around a Coaxial-Slot Antenna for Microwave Hyperthermia - Aiming at Treatment of Brain Tumor and Bile Duct Carcinoma-

Hyperthermia is one of the modalities for cancer treatment, utilizing the difference of thermal sensitivity between tumor and normal tissue. The authors have developed a coaxial-slot antenna for microwave hyperthermia. In this paper, calculated results of temperature distributions around the coaxial-slot antenna for the treatment of brain tumor and bile duct carcinoma are described.

A minimally invasive antenna for microwave ablation therapies: design, performances, and experimental assessment

A new coaxial antenna for microwave ablation therapies is proposed. The antenna design includes a miniaturized choke and an arrowhead cap to facilitate antenna insertion into the tissues. Antenna matching and the shape and dimension of the area of ablated tissue (thermal lesion) obtained in ex vivo conditions are evaluated both numerically and experimentally, finding an optimal agreement between numerical and experimental data. Results show that the antenna is well matched, and that it is able to produce a thermal lesion with an average length of 6.5 cm and an average diameter of 4.5 cm in ex vivo bovine liver when irradiates 60 W for 10 min. Finally, the dependence of antenna performances on possible changes in the antenna's structure is investigated, finding an optimal stability with respect to manufacturing tolerances and highlighting the fundamental role played by the antenna's choke.

Microwave tumor ablation: mechanism of action, clinical results, and devices

Microwave ablation uses dielectric hysteresis to produce direct volume heating of tissue. Microwaves are capable of propagating through many tissue types, even those with high impedance such as lung or bone, with less susceptibility to "heat-sink" effects along vessels. Microwaves are highly conducive to the use of multiple applicators, showing the synergy seen with other energies, but also the potential capability for phasing of the electromagnetic field. As a result, larger, more customizable ablation zones may be created in less time. Although multiple microwave ablation systems are currently available, further study and continued development are needed.

Preliminary Study of Coagulation Monitoring by Antenna for Treatment during Microwave Coagulation Therapy

Microwave coagulation therapy (MCT) has been employed mainly for treatment of small size tumors. In the treatment, thin microwave antenna is inserted into the tumor and microwave energy heats up the tumor up to at least 60°C for generation of enough coagulated volume including the target tumor. During the microwave radiation, reflection coefficient of treatment antenna changes significantly. In this paper, possibility of coagulation monitoring was found observing the reflection coefficient change of the antenna by numerical calculations and measurements.

Practical evaluations on heating characteristics of thin microwave antenna for intracavitary thermal therapy

Microwave thermal therapy is one of the modalities for cancer treatment. There are several schemes of microwave heating. The authors have been studying thin coaxial antenna for intracavitary microwave heating aiming at the treatment of bile duct carcinoma. Up to now, the heating characteristics of the antenna are investigated by numerical simulation and experiment for finding a possibility of the treatment. In this study, in order to consider practical situations of the treatment, heating characteristics of the antenna inserted into a metallic stent is evaluated by numerical simulations. Moreover, the relation between coagulation size of the tissue and the radiation power from the antenna is investigated experimentally. It must be considered, when the input power of the antenna is high (around several tens of watts). From these investigations, some useful results for practical treatments were found.

An optimal sliding choke antenna for hepatic microwave ablation

Microwave ablation (MWA) is a minimally invasive technique increasingly used for thermal therapy of liver tumors. Effective MWA requires efficient interstitial antennas that destroy tumors and a margin of healthy tissue, in situ, while minimizing damage to the rest of the organ. Previously, we presented a method for optimizing MWA antenna designs by coupling finite element method models of antennas with a real-coded, multiobjective genetic algorithm. We utilized this procedure to optimize the design of a minimally invasive choke antenna that can be used to create near-spherical ablation zones of adjustable size (radius 1-2 cm) by adjusting treatment durations and a sliding structure of the antenna. Computational results were validated with experiments in ex vivo bovine liver. The optimization procedure yielded antennas with reflection coefficients below -30 dB, which were capable of creating spherical ablation zones up to 2 cm in radius using 100 W input power at 2.45 GHz with treatment durations under 2 min.

Transperineal microwave thermoablation in patients with obstructive benign prostatic hyperplasia: a phase I clinical study with a new mini-choked microwave applicator

PURPOSE

To evaluate the tolerability and safety of a newly designed probe for trans-perineal microwave thermoablation (TPMT) of the prostate in patients with benign prostatic hyperplasia (BPH), and the in vivo microwave effects on prostatic tissue.

PATIENTS AND METHODS

Nine patients with obstructive BPH who were candidates for open prostatectomy were selected for this study. Under local anesthesia and transrectal ultrasound monitoring, all patients underwent a single standardized application of TPMT. The visual analog scale (VAS) and Short Form-36 health survey (SF-36) questionnaire were administered to each patient prior to, during, and 1 month after TPMT in order to evaluate pain and quality of life. Then the International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) questionnaires were administered to each patient at baseline and 1 month after prostatectomy in order to evaluate sexual and urinary function, respectively. Then all patients were divided into three groups and underwent open prostatectomy 7, 15, and 30 days after TPMT, respectively. The prostatic adenomas were then evaluated by a pathologist.

RESULTS

No adverse events from TPMT treatment were noted. In particular, no patients reported local, pelvic, or abdominal pain during the procedure or subsequent alterations of defecation rhythm, ano-rectal/intestinal problems, or hematuria. No differences in quality of life or in sexual function were reported. The diameters of the lesions obtained with TPMT treatment ranged from 16 to 18.1 mm in all patients. Quasi-spheroid lesions with a well-defined area of complete coagulative necrosis were documented in all removed adenomas 7, 15, and 30 days after TMPT.

CONCLUSIONS

The AMICA-PROBE is a safe, well-tolerated, and repeatable method to treat BPH with microwave thermotherapy. The spheroid lesions obtained demonstrated the maximal control over the radial and longitudinal coagulative effects of the therapy. Phase II studies are needed to further evaluate the efficacy of this new probe.

Measurement of safe thermal therapy levels: the case of ultrasonic waveguide interstitial applicator array

This paper addresses the issue of heat toxicity using as an example heating with ultrasonic interstitial waveguide four-applicator array. We show that the experimental heating curves are closely followed by the ones from our FEA modeling using realistically shaped model. The thermal dose was calculated at locations considered to be at the border of the safe dose and compared to 20 CEM(43) considered in literature as the safety threshold. We found some discrepancy between the two on comparison. In the paper, we propose an approach that leads to compromise between them; at the same time it helps to define the threshold temperature for each case.

A floating sleeve antenna yields localized hepatic microwave ablation

We report a novel coaxial antenna for hepatic microwave ablation. This device uses a floating sleeve, that is, a metal conductor electrically isolated from the outer connector of the antenna coaxial body, to achieve a highly localized specific absorption rate pattern that is independent of insertion depth. This floating sleeve coaxial dipole antenna has low power reflection in the 2.4-GHz IMS band. Ex vivo experiments confirm our numerical simulation results. Index Terms-Ablation, coaxial aperture antennas, finite element methods, floating sleeve, microwave heating.

Antenna design for microwave hepatic ablation using an axisymmetric electromagnetic model

Background

An axisymmetric finite element method (FEM) model was employed to demonstrate important techniques used in the design of antennas for hepatic microwave ablation (MWA). To effectively treat deep-seated hepatic tumors, these antennas should produce a highly localized specific absorption rate (SAR) pattern and be efficient radiators at approved generator frequencies.

Methods and results

As an example, a double slot choked antenna for hepatic MWA was designed and implemented using FEMLAB™ 3.0.

Discussion

This paper emphasizes the importance of factors that can affect simulation accuracy, which include boundary conditions, the dielectric properties of liver tissue, and mesh resolution.

Analysis of a novel expanded tip wire (ETW) antenna for microwave ablation of cardiac arrhythmias

A novel expanded tip wire (ETW) catheter antenna is proposed for microwave ablation for the treatment of atrial fibrillation (AF). The antenna is designed as an integral part of coaxial cable so that it can be inserted via a 6F catheter. A numerical model based on the rotationally symmetric finite-difference time-domain technique incorporating the generalized perfectly matched layer as the absorbing boundary condition has been utilized to accurately model the interaction between the antenna and the myocardium. Numerical and in-vitro experimental results are presented for specific absorption rate, return loss and heating pattern produced by the antenna. Both numerical modeling and in-vitro experimentation show that the proposed ETW antenna produces a well-defined electric field distribution that provides continuous long and linear lesions for the treatment of AF.

A coaxial antenna with miniaturized choke for minimally invasive interstitial heating

We present a new coaxial antenna for microwave interstitial coagulative therapy, working at 2450 MHz and endowed with a miniaturized sleeve choke in order to reduce back heating effects and make the system response less dependent on the antenna insertion depth into the tissue; the way the choke is implemented makes the overall transversal size minimum and allows small adjustments of the choke section length even during operation. We describe the main technical features of the antenna and show experimental results clearly proving the choke effectiveness. Numerical simulations well agree with experimental data, confirming the suitability of the proposed device for minimally invasive medical applications.