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Gupta P, Heffter T, Zubair M, Hsu IC, Burdette EC, Diederich CJ. Treatment Planning Strategies for Interstitial Ultrasound Ablation of Prostate Cancer. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2024; 5:362-375. [PMID: 38899026 PMCID: PMC11186654 DOI: 10.1109/ojemb.2024.3397965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/28/2024] [Accepted: 05/03/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE To develop patient-specific 3D models using Finite-Difference Time-Domain (FDTD) simulations and pre-treatment planning tools for the selective thermal ablation of prostate cancer with interstitial ultrasound. This involves the integration with a FDA 510(k) cleared catheter-based ultrasound interstitial applicators and delivery system. METHODS A 3D generalized "prostate" model was developed to generate temperature and thermal dose profiles for different applicator operating parameters and anticipated perfusion ranges. A priori planning, based upon these pre-calculated lethal thermal dose and iso-temperature clouds, was devised for iterative device selection and positioning. Full 3D patient-specific anatomic modeling of actual placement of single or multiple applicators to conformally ablate target regions can be applied, with optional integrated pilot-point temperature-based feedback control and urethral/rectum cooling. These numerical models were verified against previously reported ex-vivo experimental results obtained in soft tissues. RESULTS For generic prostate tissue, 360 treatment schemes were simulated based on the number of transducers (1-4), applied power (8-20 W/cm2), heating time (5, 7.5, 10 min), and blood perfusion (0, 2.5, 5 kg/m3/s) using forward treatment modelling. Selectable ablation zones ranged from 0.8-3.0 cm and 0.8-5.3 cm in radial and axial directions, respectively. 3D patient-specific thermal treatment modeling for 12 Cases of T2/T3 prostate disease demonstrate applicability of workflow and technique for focal, quadrant and hemi-gland ablation. A temperature threshold (e.g., Tthres = 52 °C) at the treatment margin, emulating placement of invasive temperature sensing, can be applied for pilot-point feedback control to improve conformality of thermal ablation. Also, binary power control (e.g., Treg = 45 °C) can be applied which will regulate the applied power level to maintain the surrounding temperature to a safe limit or maximum threshold until the set heating time. CONCLUSIONS Prostate-specific simulations of interstitial ultrasound applicators were used to generate a library of thermal-dose distributions to visually optimize and set applicator positioning and directivity during a priori treatment planning pre-procedure. Anatomic 3D forward treatment planning in patient-specific models, along with optional temperature-based feedback control, demonstrated single and multi-applicator implant strategies to effectively ablate focal disease while affording protection of normal tissues.
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Affiliation(s)
- Pragya Gupta
- Department of Radiation OncologyUniversity of California San FranciscoSan FranciscoCA94115USA
| | | | - Muhammad Zubair
- Department of Neurology and Neurological SciencesStanford UniversityStanfordCA94305USA
| | - I-Chow Hsu
- Department of Radiation OncologyUniversity of California San FranciscoSan FranciscoCA94115USA
| | | | - Chris J. Diederich
- Department of Radiation OncologyUniversity of California San FranciscoSan FranciscoCA94115USA
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Szewczyk B, Tarasek M, Campwala Z, Trowbridge R, Zhao Z, Johansen PM, Olmsted Z, Bhushan C, Fiveland E, Ghoshal G, Heffter T, Tavakkolmoghaddam F, Bales C, Wang Y, Rajamani DK, Gandomi K, Nycz C, Jeannotte E, Mane S, Nalwalk J, Burdette EC, Fischer G, Yeo D, Qian J, Pilitsis J. What happens to brain outside the thermal ablation zones? An assessment of needle-based therapeutic ultrasound in survival swine. Int J Hyperthermia 2022; 39:1283-1293. [PMID: 36162814 DOI: 10.1080/02656736.2022.2126901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND In stereotactic radiosurgery, isodose lines must be considered to determine how surrounding tissue is affected. In thermal ablative therapy, such as laser interstitial thermal therapy (LITT), transcranial MR-guided focused ultrasound (tcMRgFUS), and needle-based therapeutic ultrasound (NBTU), how the surrounding area is affected has not been well studied. OBJECTIVE We aimed to quantify the transition zone surrounding the ablation core created by magnetic resonance-guided robotically-assisted (MRgRA) delivery of NBTU using multi-slice volumetric 2-D magnetic resonance thermal imaging (MRTI) and subsequent characterization of the resultant tissue damage using histopathologic analysis. METHODS Four swine underwent MRgRA NBTU using varying duration and wattage for treatment delivery. Serial MRI images were obtained, and the most representative were overlaid with isodose lines and compared to brain tissue acquired postmortem which underwent histopathologic analysis. These results were also compared to predicted volumes using a finite element analysis model. Contralateral brain tissue was used for control data. RESULTS Intraoperative MRTI thermal isodose contours were characterized and comprehensively mapped to post-operative MRI images and qualitatively compared with histological tissue sections postmortem. NBTU 360° ablations induced smaller lesion volumes (33.19 mm3; 120 s, 3 W; 30.05 mm3, 180 s, 4 W) versus 180° ablations (77.20 mm3, 120 s, 3 W; 109.29 mm3; 180 s; 4 W). MRTI/MRI overlay demonstrated the lesion within the proximal isodose lines. The ablation-zone was characterized by dense macrophage infiltration and glial/neuronal loss as demonstrated by glial fibrillary acidic protein (GFAP) and neurofilament (NF) absence and avid CD163 staining. The transition-zone between lesion and normal brain demonstrated decreased macrophage infiltration and measured ∼345 microns (n - 3). We did not detect overt hemorrhages or signs of edema in the adjacent spared tissue. CONCLUSION We successfully performed MRgRA NBTU ablation in swine and demonstrated minimal histologic changes extended past the ablation-zone. The lesion was characterized by macrophage infiltration and glial/neuronal loss which decreased through the transition-zone.
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Affiliation(s)
- Benjamin Szewczyk
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Zahabiya Campwala
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Rachel Trowbridge
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Zhanyue Zhao
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Phillip M Johansen
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Zachary Olmsted
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | | | | | | | | | | | - Charles Bales
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Yang Wang
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Dhruv Kool Rajamani
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Katie Gandomi
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Christopher Nycz
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Erin Jeannotte
- Animal Resources Facility, Albany Medical Center, Albany, NY, USA
| | - Shweta Mane
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Julia Nalwalk
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | | | - Gregory Fischer
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Desmond Yeo
- GE Global Research Center, Niskayuna, NY, USA
| | - Jiang Qian
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Julie Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA.,Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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Su H, Kwok KW, Cleary K, Iordachita I, Cavusoglu MC, Desai JP, Fischer GS. State of the Art and Future Opportunities in MRI-Guided Robot-Assisted Surgery and Interventions. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2022; 110:968-992. [PMID: 35756185 PMCID: PMC9231642 DOI: 10.1109/jproc.2022.3169146] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Magnetic resonance imaging (MRI) can provide high-quality 3-D visualization of target anatomy, surrounding tissue, and instrumentation, but there are significant challenges in harnessing it for effectively guiding interventional procedures. Challenges include the strong static magnetic field, rapidly switching magnetic field gradients, high-power radio frequency pulses, sensitivity to electrical noise, and constrained space to operate within the bore of the scanner. MRI has a number of advantages over other medical imaging modalities, including no ionizing radiation, excellent soft-tissue contrast that allows for visualization of tumors and other features that are not readily visible by other modalities, true 3-D imaging capabilities, including the ability to image arbitrary scan plane geometry or perform volumetric imaging, and capability for multimodality sensing, including diffusion, dynamic contrast, blood flow, blood oxygenation, temperature, and tracking of biomarkers. The use of robotic assistants within the MRI bore, alongside the patient during imaging, enables intraoperative MR imaging (iMRI) to guide a surgical intervention in a closed-loop fashion that can include tracking of tissue deformation and target motion, localization of instrumentation, and monitoring of therapy delivery. With the ever-expanding clinical use of MRI, MRI-compatible robotic systems have been heralded as a new approach to assist interventional procedures to allow physicians to treat patients more accurately and effectively. Deploying robotic systems inside the bore synergizes the visual capability of MRI and the manipulation capability of robotic assistance, resulting in a closed-loop surgery architecture. This article details the challenges and history of robotic systems intended to operate in an MRI environment and outlines promising clinical applications and associated state-of-the-art MRI-compatible robotic systems and technology for making this possible.
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Affiliation(s)
- Hao Su
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695 USA
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong
| | - Kevin Cleary
- Children's National Health System, Washington, DC 20010 USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD 21218 USA
| | - M Cenk Cavusoglu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106 USA
| | - Jaydev P Desai
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - Gregory S Fischer
- Department of Robotics Engineering, Worcester Polytechnic Institute, Worcester, MA 01609 USA
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Tavakkolmoghaddam F, Rajamani DK, Szewczyk B, Zhao Z, Gandomi K, Sekhar SC, Pilitsis J, Nycz C, Fischer G. NeuroPlan: A Surgical Planning Toolkit for an MRI-Compatible Stereotactic Neurosurgery Robot. ... INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS. INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS 2021; 2021:10.1109/ismr48346.2021.9661581. [PMID: 35789074 PMCID: PMC9248070 DOI: 10.1109/ismr48346.2021.9661581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The adoption of robotic image-guided surgeries has enabled physicians to perform therapeutic and diagnostic procedures with less invasiveness and higher accuracy. One example is the MRI-guided stereotactic robotic-assisted surgery for conformal brain tumor ablation, where the robot is used to position and orient a thin probe to target a desired region within the brain. Requirements such as the remote center of motion and precise manipulation, impose the use of complex kinematic structures, which result in non-trivial workspaces in these robots. The lack of workspace visualization poses a challenge in selecting valid entry and target points during the surgical planning and navigation stage. In this paper, we present a surgical planning toolkit called the "NeuroPlan" for our MRI-compatible stereotactic neurosurgery robot developed as a module for 3D Slicer software. This toolkit streamlines the current surgical workflow by rendering and overlaying the robot's reachable workspace on the MRI image. It also assists with identifying the optimal entry point by segmenting the cranial burr hole volume and locating its center. We demonstrate the accuracy of the workspace rendering and burr hole parameter detection through both phantom and MR-images acquired from previously conducted animal studies.
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Affiliation(s)
| | - Dhruv Kool Rajamani
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester MA
| | - Benjamin Szewczyk
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester MA
- Department of Neurosurgery, Albany Medical Center, Albany NY
| | - Zhanyue Zhao
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester MA
| | - Katie Gandomi
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester MA
| | | | - Julie Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany NY
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany NY
| | - Christopher Nycz
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester MA
| | - Gregory Fischer
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester MA
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