Sequential activation of a segmented ground pad reduces skin heating during radiofrequency tumor ablation: optimization via computational models

Computer simulations of an irrigated radiofrequency cardiac ablation catheter and experimental validation by infrared imaging

PURPOSE

To develop and validate a three-dimensional (3-D) computer model based on accurate geometry of an irrigated cardiac radiofrequency (RF) ablation catheter with microwave radiometry capability, and to test catheter performance.

METHODS

A computer model was developed based on CAD geometry of a RF cardiac ablation catheter prototype to simulate electromagnetic heating, heat transfer, and computational fluid dynamics (blood flow, open irrigation, and natural convection). Parametric studies were performed; blood flow velocity (0-25 cm/s) and irrigation flow (0-40 ml/min) varied, both with perpendicular (PE) and parallel (PA) catheter orientations relative to tissue. Tissue Agar phantom studies were performed under similar conditions, and temperature maps were recorded via infrared camera. Computer model simulations were performed with constant voltage and with voltage adjusted to achieve maximum tissue temperatures of 95-105 °C.

RESULTS

Model predicted thermal lesion width at 5 W power was 5.8-6.4 mm (PE)/6.5-6.6 mm (PA), and lesion depth was 4.0-4.3 mm (PE)/4.0-4.1 mm (PA). Compared to phantom studies, the mean errors of the computer model were as follows: 6.2 °C(PE)/4.3 °C (PA) for maximum gel temperature, 0.7 mm (10.9%) (PE)/0.1 mm (0.8%) (PA) for lesion width, and 0.3 mm (7.7%)(PE)/0.7 mm (19.1%) (PA) for lesion depth. For temperature-controlled ablation, model predicted thermal lesion width was 7-9.2 mm (PE)/8.6-9.2 mm (PA), and lesion depth was 4.3-5.5 mm (PE)/3.4-5.4 mm (PA).

CONCLUSIONS

Computer models were able to reproduce device performance and to enable device evaluation under varying conditions. Temperature controlled ablation of irrigated catheters enables optimal tissue temperatures independent of patient-specific conditions such as blood flow.

Magnetic Resonance Mediated Radiofrequency Ablation

To introduce magnetic resonance mediated radiofrequency ablation (MR-RFA), in which the MRI scanner uniquely serves both diagnostic and therapeutic roles. In MR-RFA scanner-induced RF heating is channeled to the ablation site via a Larmor frequency RF pickup device and needle system, and controlled via the pulse sequence. MR-RFA was evaluated with simulation of electric and magnetic fields to predict the increase in local specific-absorption-rate (SAR). Temperature-time profiles were measured for different configurations of the device in agar phantoms and ex vivo bovine liver in a 1.5 T scanner. Temperature rise in MR-RFA was imaged using the proton resonance frequency method validated with fiber-optic thermometry. MR-RFA was performed on the livers of two healthy live pigs. Simulations indicated a near tenfold increase in SAR at the RFA needle tip. Temperature-time profiles depended significantly on the physical parameters of the device although both configurations tested yielded temperature increases sufficient for ablation. Resected livers from live ablations exhibited clear thermal lesions. MR-RFA holds potential for integrating RF ablation tumor therapy with MRI scanning. MR-RFA may add value to MRI with the addition of a potentially disposable ablation device, while retaining MRI's ability to provide real time procedure guidance and measurement of tissue temperature, perfusion, and coagulation.

MR Coagulation: A Novel Minimally Invasive Approach to Aneurysm Repair

PURPOSE

To demonstrate a proof of concept of magnetic resonance (MR) coagulation, in which MR imaging scanner-induced radiofrequency (RF) heating at the end of an intracatheter long wire heats and coagulates a protein solution to effect a vascular repair by embolization.

MATERIALS AND METHODS

MR coagulation was simulated by finite-element modeling of electromagnetic fields and specific absorption rate (SAR) in a phantom. A glass phantom consisting of a spherical cavity joined to the side of a tube was incorporated into a flow system to simulate an aneurysm and flowing blood with velocities of 0-1.7 mL/s. A double-lumen catheter containing the wire and fiberoptic temperature sensor in 1 lumen was passed through the flow system into the aneurysm, and 9 cm³ of protein solution was injected into the aneurysm through the second lumen. The distal end of the wire was laid on the patient table as an antenna to couple RF from the body coil or was connected to a separate tuned RF pickup coil. A high RF duty-cycle turbo spin-echo pulse sequence excited the wire such that RF energy deposited at the tip of the wire coagulated the protein solution, embolizing the aneurysm.

RESULTS

The protein coagulation temperature of 60°C was reached in the aneurysm in ∼12 seconds, yielding a coagulated mass that largely filled the aneurysm. The heating rate was controlled by adjusting pulse-sequence parameters.

CONCLUSIONS

MR coagulation has the potential to embolize vascular defects by coagulating a protein solution delivered by catheter using MR imaging scanner-induced RF heating of an intracatheter wire.

Radiofrequency ablation technique in the treatment of liver tumours: review and future issues

Thermal ablation is increasingly being used for treatment of liver tumours. Among the techniques of thermal ablation, radiofrequency ablation (RF) is undoubtedly being used most frequently because of its advantages, such as morbidity and mortality rates, effective tumour ablation, as well as being less time-consuming. This paper presents the state of the art of RF ablation technique. This includes the theoretical development, experimental study and clinical application of the radiofrequency ablation technique. First, it introduces the principle of this technique. Second, it shows the development of this technique and valuable achievements. These achievements include the device, strategy of operation and extension to other diseases. Third, it concludes future issues to be addressed in order to further advance this technique.

Principles of and advances in percutaneous ablation

Image-guided tumor ablation with both thermal and nonthermal sources has received substantial attention for the treatment of many focal malignancies. Increasing interest has been accompanied by continual advances in energy delivery, application technique, and therapeutic combinations with the intent to improve the efficacy and/or specificity of ablative therapies. This review outlines clinical percutaneous tumor ablation technology, detailing the science, devices, techniques, technical obstacles, current trends, and future goals in percutaneous tumor ablation. Methods such as chemical ablation, cryoablation, high-temperature ablation (radiofrequency, microwave, laser, and ultrasound), and irreversible electroporation will be discussed. Advances in technique will also be covered, including combination therapies, tissue property modulation, and the role of computer modeling for treatment optimization.

Considerations for Thermal Injury Analysis for RF Ablation Devices

Background:

The estimation of lesion size is an integral part of treatment planning for the clinical applications of radiofrequency ablation. However, to date, studies have not directly evaluated the impact of different computational estimation techniques for predicting lesion size. In this study, we focus on three common methods used for predicting tissue injury: (1) iso-temperature contours, (2) Cumulative equivalent minutes, (3) Arrhenius based thermal injury.

Methods:

We created a geometric model of a multi-tyne ablation electrode and simulated thermal and tissue injury profiles that result from three calculation methods after 15 minutes exposure to a constant RF voltage source. A hybrid finite element technique was used to calculate temperature and tissue injury. Time-temperature curves were used in the assessment of iso-temperature thresholds and the method of cumulative equivalent minutes. An Arrhenius-based formulation was used to calculate sequential and recursive thermal injury to tissues.

Results:

The data demonstrate that while iso-temperature and cumulative equivalent minute contours are similar in shape, these two methodologies grossly over-estimate the amount of tissue injury when compared to recursive thermal injury calculations, which have previously been shown to correlate closely with in vitro pathologic lesion volume measurement. In addition, Arrhenius calculations that do not use a recursive algorithm result in a significant underestimation of lesion volume. The data also demonstrate that lesion width and depth are inadequate means of characterizing treatment volume for multi-tine ablation devices.

Conclusions:

Recursive thermal injury remains the most physiologically relevant means of computationally estimating lesion size for hepatic tumor applications. Iso-thermal and cumulative equivalent minute approaches may produce significant errors in the estimation of lesion size.

Considerations for thermal injury analysis for RF ablation devices

BACKGROUND

The estimation of lesion size is an integral part of treatment planning for the clinical applications of radiofrequency ablation. However, to date, studies have not directly evaluated the impact of different computational estimation techniques for predicting lesion size. In this study, we focus on three common methods used for predicting tissue injury: (1) iso-temperature contours, (2) Cumulative equivalent minutes, (3) Arrhenius based thermal injury.

METHODS

We created a geometric model of a multi-tyne ablation electrode and simulated thermal and tissue injury profiles that result from three calculation methods after 15 minutes exposure to a constant RF voltage source. A hybrid finite element technique was used to calculate temperature and tissue injury. Time-temperature curves were used in the assessment of iso-temperature thresholds and the method of cumulative equivalent minutes. An Arrhenius-based formulation was used to calculate sequential and recursive thermal injury to tissues.

RESULTS

The data demonstrate that while iso-temperature and cumulative equivalent minute contours are similar in shape, these two methodologies grossly over-estimate the amount of tissue injury when compared to recursive thermal injury calculations, which have previously been shown to correlate closely with in vitro pathologic lesion volume measurement. In addition, Arrhenius calculations that do not use a recursive algorithm result in a significant underestimation of lesion volume. The data also demonstrate that lesion width and depth are inadequate means of characterizing treatment volume for multi-tine ablation devices.

CONCLUSIONS

Recursive thermal injury remains the most physiologically relevant means of computationally estimating lesion size for hepatic tumor applications. Iso-thermal and cumulative equivalent minute approaches may produce significant errors in the estimation of lesion size.

Sequential activation of ground pads reduces skin heating during radiofrequency tumor ablation: in vivo porcine results

Skin burns below ground pads during monopolar RF ablation are increasingly prevalent, thereby hindering the development of higher power RF generators capable of creating larger tumor ablation zones in combination with multiple or new applicators. Our goal was to evaluate reduction in skin temperatures via additional ground pads in an in vivo porcine model. Three ground pads placed on the animal's abdomen were activated either simultaneously or sequentially, where activation timing was adjusted to equilibrate skin temperature below each pad. Thirteen RF ablations (n = 4 simultaneous at 300 W, n = 5 sequential at 300 W, and n = 4 sequential at 375 W) were performed for 12 min via two internally cooled cluster electrodes placed in the gluteus maximus of domestic swine. Temperature rise at each pad and burn degree as determined via histology were compared. Ablation zone size was determined via T2-weighted MRI. Maximum temperature rise was significantly higher with simultaneous activation than with either of the sequential activation group (21.4 degrees C versus 8.1 degrees C or 9.6 degrees C, p < 0.01). Ablation zone diameters during simultaneous (300 W) and sequential activations (300 and 375 W) were and 6.9 +/- 0.3, 5.6 +/- 0.3, and 7.5 +/- 0.6 cm, respectively. Sequential activation of multiple ground pads results in significantly lower skin temperatures and less severe burns, as measured by histological examination.

Sequential activation of ground pads reduces skin heating during radiofrequency ablation: initial in vivo porcine results

PURPOSE

Radiofrequency (RF) ablation is a common treatment modality for inoperable liver cancer. Skin burns below ground pads during RF ablations are increasingly prevalent, hindering the development of higher-power RF generators capable of creating larger ablation zones.

MATERIALS AND METHODS

9 RF ablations (n=4 simultaneous, n=5 sequential) were performed with 300 W for 12 min via two internally cooled cluster electrodes placed in the gluteus maximus of domestic swine. Three ground pads placed on the animal's abdomen were activated either simultaneously, or sequentially where activation timing was adjusted to equilibrate skin temperature below each pad. Temperature rise at each pad was compared. Ablation zone dimensions were determined via MRI.

RESULTS

Maximum temperature rise was significantly higher with simultaneous activation than with sequential activation (21.4 vs 8.1 degress C, p<0.01). Ablation zone diameters during simultaneous and sequential activation were 6.9+/-0.3 and 5.6+/-0.3, respectively.

CONCLUSION

Sequential activation of multiple ground pads resulted in significantly lower skin temperatures during highpower RF ablation.