High-Intensity Focused Ultrasound Ablation by the Dual-Frequency Excitation

Nonlinear effects of dual-frequency focused ultrasound on the on-demand regulation of acoustic droplet vaporization

Dual-frequency ultrasound has been widely employed to enhance and regulate acoustic droplet vaporization (ADV) but the role of ultrasonic nonlinear effects on it remains unclear. The main objective of this study is to investigate the influence of nonlinear effects on the control of ADV nucleation under different dual-frequency focused ultrasound conditions. ADV nucleation of PFC nanodroplets activated by nonlinear dual-frequency ultrasound was modeled and parametric studies were conducted to investigate the influence of dual-frequency ultrasound frequency and acoustic power on the degree of nonlinearity (DoN), nucleation rates and dimensions of the nucleation region in a wide parameter range. The results showed that the ultrasonic nonlinearity caused a significant decrease in peak negative pressure due to waveform distortion, which leads to a lower nucleation rate in the nonlinear model compared to that in the linear model. Furthermore, the distributions of nucleation regions were also affected by the interaction between waves of different frequencies and cloud-like spatial distributions were produced, which could be modulated by the dual-frequency ultrasound parameters and have great potentials in the spatial regulation of the ADV and customized treatment protocols in clinical applications. In addition, represented by 1.5 MHz + 3 MHz, such a dual-frequency combination of fundamental and second harmonic could effectively enhance ultrasonic nonlinear effects with relatively lower peak negative pressure and higher DoN. Therefore, nonlinear effect of the dual-frequency ultrasound plays an important role in the ADV regulation, which should be considered in the numerical model and practical applications.

Multi-frequency therapeutic ultrasound: A review

Focused ultrasound is a noninvasive, radiation-free and real-time therapeutic approach to treat deep-seated targets, which benefits numerous diseases otherwise requiring surgeries. Treatment efficiency is one of the key factors determining therapeutic outcomes, but improving it solely by increasing the total power can be limited by the performance of general ultrasound devices. To address this, multi-frequency therapeutic ultrasound, using additional ultrasound waves of different frequencies on top of the standard single-frequency wave, provides a promising method for treatment efficiency enhancement with limited power. Several applications and numerical works have demonstrated its superiority on treatment enhancement. This paper presents an overview of the mechanisms, implementations, applications and decisive parameters of the multi-frequency therapeutic ultrasound, which could help to pave the way for better understanding and further developing this technology in the future.

Effect of pulse parameters on ablation efficiency in dual-frequency HIFU therapy

High-intensity focused ultrasound (HIFU) has now been widely used to ablate various benign and malignant tumors. But it is still critical to increase the ablation efficiency in many clinical applications. Dual-frequency HIFU has been proven to be more efficient in ablation, but the principle on selecting the pulse parameters in this method remains to be explored. In this study, the in vitro lesion areas under different pulse repetition frequencies (PRFs), duty ratios, and frequency differences were compared, cavitation activity was also monitored during HIFU exposure. The results showed that different pulse parameters caused different types of lesions. In HIFU therapy, those pulse parameters that maximize the thermal effect, reduce heat dissipation and generate sufficient cavitation activities should be considered. But the method of evaluating or predicting the damage by using the cavitation dose is only applicable to mechanical damage.

On-demand regulation and enhancement of the nucleation in acoustic droplet vaporization using dual-frequency focused ultrasound

Acoustic droplet vaporization (ADV) plays an important role in focused ultrasound theranostics. Better understanding of the relationship between the ultrasound parameters and the ADV nucleation could provide an on-demand regulation and enhancement of ADV for improved treatment outcome. In this work, ADV nucleation was performed in a dual-frequency focused ultrasound configuration that consisted of a continuous low-frequency ultrasound and a short high-frequency pulse. The combination was modelled to investigate the effects of the driving frequency and acoustic power on the nucleation rate, efficiency, onset time, and dimensions of the nucleation region. The results showed that the inclusion of short pulsed high-frequency ultrasound significantly increased the nucleation rate with less energy, reduced the nucleation onset time, and changed the length-width ratio of the nucleation region, indicating the dual-frequency ultrasound mode yields an efficient enhancement of the ADV nucleation, compared to a single-frequency ultrasound mode. Furthermore, the acoustic and temperature fields varied independently with the dual-frequency ultrasound parameters. This facilitated the spatial and temporal control over the ADV nucleation, and opens the door to the possibility to realize on-demand regulation of the ADV occurrence in ultrasound theranostics. In addition, the improved energy efficacy that is obtained with the dual-frequency configuration lowered the requirements on hardware system, increasing its flexibility and could facilitate its implementation in practical applications.

Thermochromic Tissue-Mimicking Phantoms for Thermal Ablation Based on Polyacrylamide Gel

In recent years, thermal ablation has played an increasingly important role in treating various tumors in the clinic. A practical thermochromic phantom model can provide a favorable platform for clinical thermotherapy training of young physicians or calibration and optimization of thermal devices without risk to animals or human participants. To date, many tissue-mimicking thermal phantoms have been developed and are well liked, especially the polyacrylamide gel (PAG)-based phantoms. This review summarizes the PAG-based phantoms in the field of thermotherapy, details their advantages and disadvantages and provides a direction for further optimization. The relevant physical parameters (such as electrical, acoustic, and thermal properties) of these phantoms are also presented in this review, which can assist operators in a deeper understanding of these phantoms and selection of the proper recipes for phantom fabrication.

Enhancing cavitation dynamics and its mechanical effects with dual-frequency ultrasound

Objective. Acoustic cavitation and its mechanical effects (e.g. stress and strain) play a primary role in ultrasound applications. Introducing encapsulated microbubbles as cavitation nuclei and utilizing dual-frequency ultrasound excitation are highly effective approaches to reduce cavitation thresholds and enhance cavitation effects. However, the cavitation dynamics of encapsulated microbubbles and the resultant stress/strain in viscoelastic tissues under dual-frequency excitation are poorly understood, especially for the enhancement effects caused by a dual-frequency approach. The goal of this study was to numerically investigate the dynamics of a lipid-coated microbubble and the spatiotemporal distributions of the stress and strain under dual-frequency excitation. Approach. The Gilmore–Zener bubble model was coupled with a shell model for the nonlinear changes of both shell elasticity and viscosity to accurately simulate the cavitation dynamics of lipid-coated microbubbles in viscoelastic tissues. Then, the spatiotemporal evolutions of the cavitation-induced stress and strain in the surrounding tissues were characterized quantitatively. Finally, the influences of some paramount parameters were examined to optimize the outcomes. Main results. We demonstrated that the cavitation dynamics and associated stress/strain were prominently enhanced by a dual-frequency excitation, highlighting positive correlations between the maximum bubble expansion and the maximum stress/strain. Moreover, the results showed that the dual-frequency ultrasound with smaller differences in its frequencies and pressure amplitudes could enhance the bubble oscillations and stress/strain more efficiently, whereas the phase difference manifested small influences under these conditions. Additionally, the dual-frequency approach seemed to show a stronger enhancement effect with the shell/tissue viscoelasticity increasing to a certain extent. Significance. This study might contribute to optimizing the dual-frequency operation in terms of cavitation dynamics and its mechanical effects for high-efficient ultrasound applications.

Enhanced HIFU Theranostics with Dual-Frequency-Ring Focused Ultrasound and Activatable Perfluoropentane-Loaded Polymer Nanoparticles

High-intensity focused ultrasound (HIFU) has been widely used in tumor ablation in clinical settings. Meanwhile, there is great potential to increase the therapeutic efficiency of temporary cavitation due to enhanced thermal effects and combined mechanical effects from nonlinear vibration and collapse of the microbubbles. In this study, dual-frequency (1.1 and 5 MHz) HIFU was used to produce acoustic droplet vaporization (ADV) microbubbles from activatable perfluoropentane-loaded polymer nanoparticles (PFP@Polymer NPs), which increased the therapeutic outcome of the HIFU and helped realize tumor theranostics with ultrasound contrast imaging. Combined with PFP@Polymer NPs, dual-frequency HIFU changed the shape of the damage lesion and reduced the acoustic intensity threshold of thermal damage significantly, from 216.86 to 62.38 W/cm². It produced a nearly 20 °C temperature increase in half the irradiation time and exhibited a higher tumor inhibition rate (84.5% ± 3.4%) at a low acoustic intensity (1.1 MHz: 23.77 W/cm²; 5 MHz: 0.35 W/cm²) in vitro than the single-frequency HIFU (60.2% ± 11.9%). Moreover, compared with the traditional PFP@BSA NDs, PFP@Polymer NPs showed higher anti-tumor efficacy (81.13% vs. 69.34%; * p < 0.05) and better contrast-enhanced ultrasound (CEUS) imaging ability (gray value of 57.53 vs. 30.67; **** p < 0.0001), probably benefitting from its uniform and stable structure. It showed potential as a highly efficient tumor theranostics approach based on dual-frequency HIFU and activatable PFP@Polymer NPs.

A Logic AND-Gated Sonogene Nanosystem for Precisely Regulating the Apoptosis of Tumor Cells

To date, many methods have been developed for inducing tumor cell death, such as using chemical drugs and radiation. However, all of them have a common problem, a lack of mechanisms for precisely regulating the death of tumor cells. It often leads to nonspecific death and systemic side effects. Therefore, the efficacy and further application of these traditional methods are limited. In this paper, a logic AND-gated sonogene nanosystem was designed for precisely regulating the apoptosis of tumor cells. The running of this system required two essential parts, MscL I92L channel protein and ultrasound. Ultrasound could open the MscL I92L protein channel which when expressed on cells triggers the influx and outflux of small molecules through the channel. When the channel is kept open for a long time, Ca²⁺ influx becomes excessive which in turn activates the Ca²⁺ apoptosis pathway of cells. The expression of MscL I92L protein and the applying of ultrasound constituted the logic AND gate which could implement the precise regulation to apoptosis. This strategy would help reduce nonspecific triggers and side effects. In this system, cationic nanoliposomes were prepared as the carrier for effectively delivering MscL I92L plasmids to tumor cells in vivo. We investigated the apoptosis-promoting effect of this system in different tumor cell lines (HeLa, B16, and 4T1). The results demonstrated that the apoptosis rate was highest in the B16 cell line (the early apoptosis rate was 11.9% and the late apoptosis rate was 59.1%) when the cells were subjected to consistent ultrasound (6 MHz, 15 W) for 30 min. This logic AND-gated sonogene nanosystem is expected to provide a new strategy and development direction for tumor therapy.