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Atkinson-Clement C, Kaiser M. Optimizing Transcranial Focused Ultrasound Stimulation: An Open-source Tool for Precise Targeting. Neuromodulation 2024:S1094-7159(24)00627-5. [PMID: 39093260 DOI: 10.1016/j.neurom.2024.06.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Cyril Atkinson-Clement
- Precision Imaging, School of Medicine, University of Nottingham, UK; National Institute for Health and Care Research, Biomedical Research Centre, University of Nottingham, UK.
| | - Marcus Kaiser
- Precision Imaging, School of Medicine, University of Nottingham, UK; National Institute for Health and Care Research, Biomedical Research Centre, University of Nottingham, UK; Rui Jin Hospital, Shanghai Jiao Tong University, Shanghai, China
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2
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Kong D, Liu G, Cheng B, Qi X, Zhu J, He Q, Xing H, Gong Q. A novel transcranial MR Guided focused ultrasound method based on the ultrashort echo time skull acoustic model and phase retrieval techniques. Sci Rep 2024; 14:11876. [PMID: 38789537 DOI: 10.1038/s41598-024-62500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
Transcranial ultrasound stimulation (TUS) has been clinically applied as a neuromodulation tool. Particularly, the phase array ultrasound can be applied in TUS to non-invasively focus on the cortex or deep brain. However, the vital phase distortion of the ultrasound induced by the skull limits its clinical application. In the current study, we aimed to develop a hybrid method that combines the ultrashort echo time (UTE) magnetic resonance imaging (MRI) sequences with the prDeep technique to achieve focusing ventral intermediate thalamic nucleus (VIM). The time-reversal (TR) approach of the UTE numerical acoustic model of the skull combined with the prDeep algorithm was used to reduce the number of iterations. The skull acoustic model simulation therapy process was establish to valid this method's prediction and focus performance, and the classical TR method were considered as the gold standard (GS). Our approach could restore 75% of the GS intensity in 25 iteration steps, with a superior the noise immunity. Our findings demonstrate that the phase aberration caused by the skull can be estimated using phase retrieval techniques to achieve a fast and accurate transcranial focus. The method has excellent adaptability and anti-noise capacity for satisfying complex and changeable scenarios.
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Affiliation(s)
- Dechen Kong
- College Of Physics, Sichuan University, Chengdu, China
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Gaojie Liu
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bochao Cheng
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, 610041, China
| | - Xu Qi
- Radiotherapy Physics & Technology Center, Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jiayu Zhu
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Qiang He
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Haoyang Xing
- College Of Physics, Sichuan University, Chengdu, China.
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Xiamen West China Hospital, Sichuan University, Xiamen, China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
- Xiamen West China Hospital, Sichuan University, Xiamen, China
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3
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Bancel T, Béranger B, Daniel M, Didier M, Santin M, Rachmilevitch I, Shapira Y, Tanter M, Bardinet E, Fernandez Vidal S, Attali D, Galléa C, Dizeux A, Vidailhet M, Lehéricy S, Grabli D, Pyatigorskaya N, Karachi C, Hainque E, Aubry JF. Sustained reduction of essential tremor with low-power non-thermal transcranial focused ultrasound stimulations in humans. Brain Stimul 2024; 17:636-647. [PMID: 38734066 DOI: 10.1016/j.brs.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Transcranial ultrasound stimulation (TUS) is a non-invasive brain stimulation technique; when skull aberrations are compensated for, this technique allows, with millimetric accuracy, circumvention of the invasive surgical procedure associated with deep brain stimulation (DBS) and the limited spatial specificity of transcranial magnetic stimulation. OBJECTIVE /hypothesis: We hypothesize that MR-guided low-power TUS can induce a sustained decrease of tremor power in patients suffering from medically refractive essential tremor. METHODS The dominant hand only was targeted, and two anatomical sites were sonicated in this exploratory study: the ventral intermediate nucleus of the thalamus (VIM) and the dentato-rubro-thalamic tract (DRT). Patients (N = 9) were equipped with MR-compatible accelerometers attached to their hands to monitor their tremor in real-time during TUS. RESULTS VIM neurostimulations followed by a low-duty cycle (5 %) DRT stimulation induced a substantial decrease in the tremor power in four patients, with a minimum of 89.9 % reduction when compared with the baseline power a few minutes after the DRT stimulation. The only patient stimulated in the VIM only and with a low duty cycle (5 %) also experienced a sustained reduction of the tremor (up to 93.4 %). Four patients (N = 4) did not respond. The temperature at target was 37.2 ± 1.4 °C compared to 36.8 ± 1.4 °C for a 3 cm away control point. CONCLUSIONS MR-guided low power TUS can induce a substantial and sustained decrease of tremor power. Follow-up studies need to be conducted to reproduce the effect and better to understand the variability of the response amongst patients. MR thermometry during neurostimulations showed no significant thermal rise, supporting a mechanical effect.
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Affiliation(s)
- Thomas Bancel
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France
| | - Benoît Béranger
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Maxime Daniel
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France
| | - Mélanie Didier
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Mathieu Santin
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | | | | | - Mickael Tanter
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France
| | - Eric Bardinet
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Sara Fernandez Vidal
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - David Attali
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France; Université Paris Cité, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014, Paris, France
| | - Cécile Galléa
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Alexandre Dizeux
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France
| | - Marie Vidailhet
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France; Department of Neurology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Stéphane Lehéricy
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France; Department of Neuroradiology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - David Grabli
- Department of Neurology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Nadya Pyatigorskaya
- ICM-Paris Brain Institute, Centre de NeuroImagerie de Recherche-CENIR, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France; Department of Neuroradiology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Carine Karachi
- Department of Neurosurgery, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Elodie Hainque
- Department of Neurology, Hôpital de la Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Jean-François Aubry
- Physics for Medicine Paris, Inserm U1273, ESPCI Paris, CNRS UMR 8063, PSL University, Paris, France.
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4
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Angla C, Chouh H, Mondou P, Toullelan G, Perlin K, Brulon V, De Schlichting E, Larrat B, Gennisson JL, Chatillon S. New semi-analytical method for fast transcranial ultrasonic field simulation. Phys Med Biol 2024; 69:095017. [PMID: 38537292 DOI: 10.1088/1361-6560/ad3882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
Objective.To optimize and ensure the safety of ultrasound brain therapy, personalized transcranial ultrasound simulations are very useful. They allow to predict the pressure field, depending on the patient skull and probe position. Most transcranial ultrasound simulations are based on numerical methods which have a long computation time and a high memory usage. The goal of this study is to develop a new semi-analytical field computation method that combines realism and computation speed.Approach.Instead of the classic ray tracing, the ultrasonic paths are computed by time of flight minimization. Then the pressure field is computed using the pencil method. This method requires a smooth and homogeneous skull model. The simulation algorithm, so-called SplineBeam, was numerically validated, by comparison with existing solvers, and experimentally validated by comparison with hydrophone measured pressure fields through anex vivohuman skull.Main results.SplineBeam simulated pressure fields were close to the experimentally measured ones, with a focus position difference of the order of the positioning error and a maximum pressure difference lower than 6.02%. In addition, for those configurations, SplineBeam computation time was lower than another simulation software, k-Wave's, by two orders of magnitude, thanks to its capacity to compute the field only at the focal spot.Significance.These results show the potential of this new method to compute fast and realistic transcranial pressure fields. The combination of this two assets makes it a promising tool for real time transcranial pressure field prediction during ultrasound brain therapy interventions.
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Affiliation(s)
- C Angla
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
- Université Paris-Saclay, CNRS, Inserm, CEA, BioMaps, F-91190, Orsay, France
| | - H Chouh
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
| | - P Mondou
- Université Paris-Saclay, CNRS, CEA, Neurospin F-91191, Gif-sur-Yvette, France
| | - G Toullelan
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
| | - K Perlin
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
| | - V Brulon
- Université Paris-Saclay, CNRS, Inserm, CEA, BioMaps, F-91190, Orsay, France
| | - E De Schlichting
- CHU Grenoble-Alpes, Service de Neurochirurgie, F-38700, Grenoble, France
| | - B Larrat
- Université Paris-Saclay, CNRS, CEA, Neurospin F-91191, Gif-sur-Yvette, France
| | - J-L Gennisson
- Université Paris-Saclay, CNRS, Inserm, CEA, BioMaps, F-91190, Orsay, France
| | - S Chatillon
- Université Paris-Saclay, CEA List, F-91120, Palaiseau, France
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Rosnitskiy PB, Khokhlova TD, Schade GR, Sapozhnikov OA, Khokhlova VA. Treatment Planning and Aberration Correction Algorithm for HIFU Ablation of Renal Tumors. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2024; 71:341-353. [PMID: 38231825 PMCID: PMC11003458 DOI: 10.1109/tuffc.2024.3355390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
High-intensity focused ultrasound (HIFU) applications for thermal or mechanical ablation of renal tumors often encounter challenges due to significant beam aberration and refraction caused by oblique beam incidence, inhomogeneous tissue layers, and presence of gas and bones within the beam. These losses can be significantly mitigated through sonication geometry planning, patient positioning, and aberration correction using multielement phased arrays. Here, a sonication planning algorithm is introduced, which uses the simulations to select the optimal transducer position and evaluate the effect of aberrations and acoustic field quality at the target region after aberration correction. Optimization of transducer positioning is implemented using a graphical user interface (GUI) to visualize a segmented 3-D computed tomography (CT)-based acoustic model of the body and to select sonication geometry through a combination of manual and automated approaches. An HIFU array (1.5 MHz, 256 elements) and three renal cell carcinoma (RCC) cases with different tumor locations and patient body habitus were considered. After array positioning, the correction of aberrations was performed using a combination of backpropagation from the focus with an ordinary least squares (OLS) optimization of phases at the array elements. The forward propagation was simulated using a combination of the Rayleigh integral and k-space pseudospectral method (k-Wave toolbox). After correction, simulated HIFU fields showed tight focusing and up to threefold higher maximum pressure within the target region. The addition of OLS optimization to the aberration correction method yielded up to 30% higher maximum pressure compared to the conventional backpropagation and up to 250% higher maximum pressure compared to the ray-tracing method, particularly in strongly distorted cases.
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6
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Shen F, Fan F, Li F, Wang L, Wang R, Wang Y, Liu T, Wei C, Niu H. An efficient method for transcranial ultrasound focus correction based on the coupling of boundary integrals and finite elements. ULTRASONICS 2024; 137:107181. [PMID: 37847943 DOI: 10.1016/j.ultras.2023.107181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/21/2023] [Accepted: 10/08/2023] [Indexed: 10/19/2023]
Abstract
Transcranial focused ultrasound is a novel technique for the noninvasive treatment of brain diseases. The success of the treatment greatly depends on achieving precise and efficient intraoperative focus. However, compensating for aberrated ultrasound waves caused by the skull through numerical simulation-based phase corrections is a challenging task due to the significant computational burden involved in solving the acoustic wave equation. In this article, we propose a promising strategy using the coupling of the boundary integral equation method (BIEM) and the finite element method (FEM) to overcome the above limitation. Specifically, we adopt the BIEM to obtain the Robin-to-Dirichlet maps on the boundaries of the skull and then couple the maps to the FEM matrices via a dual interpolation technique, resulting in a computational domain including only the skull. Three simulation experiments were conducted to evaluate the effectiveness of the proposed method, including a convergence test and two skull-induced aberration corrections in 2D and 3D ultrasound. The results show that the method's convergence is guaranteed as the element size decreases, leading to a decrease in pressure error. The computation times for simulating a 500 kHz ultrasound field on a regular desktop computer were found to be 0.47 ± 0.01 s in the 2D case and 43.72 ± 1.49 s in the 3D case, provided that lower-upper decomposition (approximately 13 s in 2D and 2.5 h in 3D) was implemented in advance. We also demonstrated that more accurate transcranial focusing can be achieved by phase correction compared to the noncorrected results (with errors of 1.02 mm vs. 6.45 mm in 2D and 0.28 mm vs. 3.07 mm in 3D). The proposed strategy is valuable for enabling online ultrasound simulations during treatment, facilitating real-time adjustments and interventions.
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Affiliation(s)
- Fei Shen
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Fan Fan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Fengji Li
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Li Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Rui Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yue Wang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Tao Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Cuibai Wei
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing 100050, China
| | - Haijun Niu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
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7
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Eleni Karakatsani M, Estrada H, Chen Z, Shoham S, Deán-Ben XL, Razansky D. Shedding light on ultrasound in action: Optical and optoacoustic monitoring of ultrasound brain interventions. Adv Drug Deliv Rev 2024; 205:115177. [PMID: 38184194 PMCID: PMC11298795 DOI: 10.1016/j.addr.2023.115177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
Monitoring brain responses to ultrasonic interventions is becoming an important pillar of a growing number of applications employing acoustic waves to actuate and cure the brain. Optical interrogation of living tissues provides a unique means for retrieving functional and molecular information related to brain activity and disease-specific biomarkers. The hybrid optoacoustic imaging methods have further enabled deep-tissue imaging with optical contrast at high spatial and temporal resolution. The marriage between light and sound thus brings together the highly complementary advantages of both modalities toward high precision interrogation, stimulation, and therapy of the brain with strong impact in the fields of ultrasound neuromodulation, gene and drug delivery, or noninvasive treatments of neurological and neurodegenerative disorders. In this review, we elaborate on current advances in optical and optoacoustic monitoring of ultrasound interventions. We describe the main principles and mechanisms underlying each method before diving into the corresponding biomedical applications. We identify areas of improvement as well as promising approaches with clinical translation potential.
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Affiliation(s)
- Maria Eleni Karakatsani
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Héctor Estrada
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Zhenyue Chen
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Shy Shoham
- Department of Ophthalmology and Tech4Health and Neuroscience Institutes, NYU Langone Health, NY, USA
| | - Xosé Luís Deán-Ben
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland.
| | - Daniel Razansky
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland.
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Kim C, Eames M, Paeng DG. Improving Sonication Efficiency in Transcranial MR-Guided Focused Ultrasound Treatment: A Patient-Data Simulation Study. Bioengineering (Basel) 2023; 11:27. [PMID: 38247904 PMCID: PMC10813010 DOI: 10.3390/bioengineering11010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
The potential improvement in sonication efficiency achieved by tilting the focused ultrasound (FUS) transducer of the transcranial MR-guided FUS system is presented. A total of 56 cases of patient treatment data were used. The relative position of the clinical FUS transducer to the patient's head was reconstructed, and region-specific skull density and porosity were calculated based on the patient's CT volume image. The total transmission coefficient of acoustic waves emitted from each channel was calculated. Then, the total energy penetrating the human skull-which represents the sonication efficiency-was estimated. As a result, improved sonication efficiency was by titling the FUS transducer to a more appropriate angle achieved in all 56 treatment cases. This simulation result suggests the potential improvement in transcranial-focused ultrasound treatment by simply adjusting the transducer angle.
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Affiliation(s)
- Changsoo Kim
- Research Institute for Basic Sciences, Jeju National University, Jeju 63243, Republic of Korea;
| | - Matthew Eames
- Focused Ultrasound Foundation, Charlottesville, VA 22903, USA;
- Department of Radiology, University of Virginia, Charlottesville, VA 22903, USA
| | - Dong-Guk Paeng
- Focused Ultrasound Foundation, Charlottesville, VA 22903, USA;
- Ocean System Engineering, Jeju National University, Jeju 63243, Republic of Korea
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9
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Xu P, Wu N, Shen G. A rapid element pressure field simulation method for transcranial phase correction in focused ultrasound therapy. Phys Med Biol 2023; 68:235015. [PMID: 37934058 DOI: 10.1088/1361-6560/ad0a59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/07/2023] [Indexed: 11/08/2023]
Abstract
Transcranial focused ultrasound ablation has emerged as a promising technique for treating neurological disorders. The clinical system exclusively employed the ray tracing method to compute phase aberrations induced by the human skull, taking into account computational time constraints. However, this method compromises slightly on accuracy compared to simulation-based methods. This study evaluates a fast simulation method that simulates the time-harmonic pressure field within the region of interest for effective phase correction. Experimental validation was carried out using a 512-element, 670 kHz hemispherical transducer for fourex vivoskulls. The ray tracing method achieved a restoration ratio of 64.81% ± 4.33% of acoustic intensity normalized to hydrophone measurements. In comparison, the rapid simulation method demonstrated improved results with a restoration ratio of 73.10% ± 7.46%, albeit slightly lower than the full-wave simulation which achieved a restoration ratio of 75.87% ± 5.40%. The rapid simulation methods exhibited computational times that were less than five minutes for parallel computation with 8 threads. The incident angle was calculated, and a maximum difference of 6.8 degrees was found when the fixed position of the skull was changed. Meanwhile, the restoration ratio of acoustic intensity was validated to be above 70% for different target positions away from the geometrical focus of the transducer. The favorable balance between time consumption and correction accuracy makes this method valuable for clinical treatment applications.
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Affiliation(s)
- Peng Xu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Nan Wu
- Shanghai Shende Green Medical Era Healthcare Technology Co., Ltd., Shanghai, People's Republic of China
| | - Guofeng Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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10
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Yeats E, Hall TL. Aberration correction in abdominal histotripsy. Int J Hyperthermia 2023; 40:2266594. [PMID: 37813397 PMCID: PMC10637766 DOI: 10.1080/02656736.2023.2266594] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
In transabdominal histotripsy, ultrasound pulses are focused on the body to noninvasively destroy soft tissues via cavitation. However, the ability to focus is limited by phase aberration, or decorrelation of the ultrasound pulses due to spatial variation in the speed of sound throughout heterogeneous tissue. Phase aberration shifts, broadens, and weakens the focus, thereby reducing the safety and efficacy of histotripsy therapy. This paper reviews and discusses aberration effects in histotripsy and in related therapeutic ultrasound techniques (e.g., high intensity focused ultrasound), with an emphasis on aberration by soft tissues. Methods for aberration correction are reviewed and can be classified into two groups: model-based methods, which use segmented images of the tissue as input to an acoustic propagation model to predict and compensate phase differences, and signal-based methods, which use a receive-capable therapy array to detect phase differences by sensing acoustic signals backpropagating from the focus. The relative advantages and disadvantages of both groups of methods are discussed. Importantly, model-based methods can correct focal shift, while signal-based methods can restore substantial focal pressure, suggesting that both methods should be combined in a 2-step approach. Aberration correction will be critical to improving histotripsy treatments and expanding the histotripsy treatment envelope to enable non-invasive, non-thermal histotripsy therapy for more patients.
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Affiliation(s)
- Ellen Yeats
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States
| | - Timothy L. Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States
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Liu H, Sigona MK, Manuel TJ, Chen LM, Dawant BM, Caskey CF. Evaluation of synthetically generated computed tomography for use in transcranial focused ultrasound procedures. J Med Imaging (Bellingham) 2023; 10:055001. [PMID: 37744953 PMCID: PMC10514703 DOI: 10.1117/1.jmi.10.5.055001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 07/06/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose Transcranial focused ultrasound (tFUS) is a therapeutic ultrasound method that focuses sound through the skull to a small region noninvasively and often under magnetic resonance imaging (MRI) guidance. CT imaging is used to estimate the acoustic properties that vary between individual skulls to enable effective focusing during tFUS procedures, exposing patients to potentially harmful radiation. A method to estimate acoustic parameters in the skull without the need for CT is desirable. Approach We synthesized CT images from routinely acquired T1-weighted MRI using a 3D patch-based conditional generative adversarial network and evaluated the performance of synthesized CT (sCT) images for treatment planning with tFUS. We compared the performance of sCT with real CT (rCT) images for tFUS planning using Kranion and simulations using the acoustic toolbox, k-Wave. Simulations were performed for 3 tFUS scenarios: (1) no aberration correction, (2) correction with phases calculated from Kranion, and (3) phase shifts calculated from time reversal. Results From Kranion, the skull density ratio, skull thickness, and number of active elements between rCT and sCT had Pearson's correlation coefficients of 0.94, 0.92, and 0.98, respectively. Among 20 targets, differences in simulated peak pressure between rCT and sCT were largest without phase correction (12.4 % ± 8.1 % ) and smallest with Kranion phases (7.3 % ± 6.0 % ). The distance between peak focal locations between rCT and sCT was < 1.3 mm for all simulation cases. Conclusions Real and synthetically generated skulls had comparable image similarity, skull measurements, and acoustic simulation metrics. Our work demonstrated similar results for 10 testing cases comparing MR-sCTs and rCTs for tFUS planning. Source code and a docker image with the trained model are available at https://github.com/han-liu/SynCT_TcMRgFUS.
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Affiliation(s)
- Han Liu
- Vanderbilt University, Department of Computer Science, Nashville, Tennessee, United States
| | - Michelle K. Sigona
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University, Institute of Imaging Science, Nashville, Tennessee, United States
| | - Thomas J. Manuel
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University, Institute of Imaging Science, Nashville, Tennessee, United States
| | - Li Min Chen
- Vanderbilt University, Institute of Imaging Science, Nashville, Tennessee, United States
- Vanderbilt University, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States
| | - Benoit M. Dawant
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
| | - Charles F. Caskey
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University, Institute of Imaging Science, Nashville, Tennessee, United States
- Vanderbilt University, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States
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12
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Drainville RA, Chatillon S, Moore D, Snell J, Padilla F, Lafon C. A simulation study on the sensitivity of transcranial ray-tracing ultrasound modeling to skull properties. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:1211-1225. [PMID: 37610718 DOI: 10.1121/10.0020761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
In transcranial focused ultrasound therapies, such as treating essential tremor via thermal ablation in the thalamus, acoustic energy is focused through the skull using a phased-array transducer. Ray tracing is a computationally efficient method that can correct skull-induced phase aberrations via per-element phase delay calculations using patient-specific computed tomography (CT) data. However, recent studies show that variations in CT-derived Hounsfield unit may account for only 50% of the speed of sound variability in human skull specimens, potentially limiting clinical transcranial ultrasound applications. Therefore, understanding the sensitivity of treatment planning methods to material parameter variations is essential. The present work uses a ray-tracing simulation model to explore how imprecision in model inputs, arising from clinically significant uncertainties in skull properties or considerations of acoustic phenomena, affects acoustic focusing quality through the skull. We propose and validate new methods to optimize ray-tracing skull simulations for clinical treatment planning, relevant for predicting intracranial target's thermal rise, using experimental data from ex-vivo human skulls.
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Affiliation(s)
| | | | - David Moore
- Focused Ultrasound Foundation, Charlottesville, Virginia 22903, USA
| | - John Snell
- Histosonics, Ann Arbor, Michigan 48103, USA
| | - Frederic Padilla
- Focused Ultrasound Foundation, Charlottesville, Virginia 22903, USA
| | - Cyril Lafon
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
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13
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Yuan Y, Zhao Y, Zhang N, Xiao Y, Jin J, Feng N, Shen Y. Full-Waveform Inversion for Breast Ultrasound Tomography Using Line-Shape Modeled Elements. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1070-1081. [PMID: 36737306 DOI: 10.1016/j.ultrasmedbio.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The objective of the work described here was to incorporate the spatial shapes of the transducer elements into the framework of the full-waveform inversion. METHODS An element is treated as its cross-section in the 2-D imaging plane, that is, a line segment. The elements are not simply modeled as a set of point sources on their surface to avoid staircasing artifacts. By use of the Fourier collocation method, an element is spatially represented as the discrete convolution between its spatial distribution and a band-limited delta function. The excitation pulses on the emitters and recorded signals on the receivers are then weighted based on the discrete convolution results. Digital and physical experiments are implemented to validate the method. DISCUSSION It is meaningful to model the shapes of the elements if their spatial sizes are similar to or larger than the acoustic wavelengths. It should, however, be noted that because this article focuses on 2-D imaging, the inter-plane effects are not considered. CONCLUSION The approach helps reduce the root mean square errors and increase the structural similarity of the reconstructed images. It also helps to improve the stability of convergence and to accelerate the convergence speed.
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Affiliation(s)
- Yu Yuan
- Control Theory and Engineering, School of Astronautics, Harbin Institute of Technology, Harbin, China
| | - Yue Zhao
- Control Theory and Engineering, School of Astronautics, Harbin Institute of Technology, Harbin, China.
| | - Nuomin Zhang
- Control Theory and Engineering, School of Astronautics, Harbin Institute of Technology, Harbin, China
| | - Yang Xiao
- Control Theory and Engineering, School of Astronautics, Harbin Institute of Technology, Harbin, China
| | - Jing Jin
- Control Theory and Engineering, School of Astronautics, Harbin Institute of Technology, Harbin, China
| | - Naizhang Feng
- Control Theory and Engineering, School of Astronautics, Harbin Institute of Technology, Harbin, China
| | - Yi Shen
- Shenzhen Engineering Lab for Medical Intelligent Wireless Ultrasonic Imaging Technology, Harbin Institute of Technology, Harbin, China
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14
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Jing B, Strassle Rojas S, Lindsey BD. Effect of skull porosity on ultrasound transmission and wave mode conversion at large incidence angles. Med Phys 2023; 50:3092-3102. [PMID: 36810723 DOI: 10.1002/mp.16318] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Transcranial ultrasound imaging and therapy depend on the efficient transmission of acoustic energy through the skull. Multiple previous studies have concluded that a large incidence angle should be avoided during transcranial-focused ultrasound therapy to ensure transmission through the skull. Alternatively, some other studies have shown that longitudinal-to-shear wave mode conversion might improve transmission through the skull when the incidence angle is increased above the critical angle (i.e., 25° to 30°). PURPOSE The effect of skull porosity on the transmission of ultrasound through the skull at varying incidence angles was investigated for the first time to elucidate why transmission through the skull at large angles of incidence is decreased in some cases but improved in other cases. METHODS Transcranial ultrasound transmission at varying incidence angles (0°-50°) was investigated in phantoms and ex vivo skull samples with varying bone porosity (0% to 28.54% ± 3.36%) using both numerical and experimental methods. First, the elastic acoustic wave transmission through the skull was simulated using micro-computed tomography data of ex vivo skull samples. The trans-skull pressure was compared between skull segments having three levels of porosity, that is, low porosity (2.65% ± 0.03%), medium porosity (13.41% ± 0.12%), and high porosity (26.9%). Next, transmission through two 3D-printed resin skull phantoms (compact vs. porous phantoms) was experimentally measured to test the effect of porous microstructure alone on ultrasound transmission through flat plates. Finally, the effect of skull porosity on ultrasound transmission was investigated experimentally by comparing transmission through two ex vivo human skull segments having similar thicknesses but different porosities (13.78% ± 2.05% vs. 28.54% ± 3.36%). RESULTS Numerical simulations indicated that an increase in transmission pressure occurs at large incidence angles for skull segments having low porosities but not for those with high porosity. In experimental studies, a similar phenomenon was observed. Specifically, for the low porosity skull sample (13.78% ± 2.05%), the normalized pressure was 0.25 when the incidence angle increased to 35°. However, for the high porosity sample (28.54% ± 3.36%), the pressure was no more than 0.1 at large incidence angles. CONCLUSIONS These results indicate that the skull porosity has an evident effect on the transmission of ultrasound at large incidence angles. The wave mode conversion at large, oblique incidence angles could enhance the transmission of ultrasound through parts of the skull having lower porosity in the trabecular layer. However, for transcranial ultrasound therapy in the presence of highly porous trabecular bone, transmission at a normal incidence angle is preferable relative to oblique incidence angles due to the higher transmission efficiency.
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Affiliation(s)
- Bowen Jing
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Stephan Strassle Rojas
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Brooks D Lindsey
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
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15
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Angla C, Larrat B, Gennisson JL, Chatillon S. Transcranial ultrasound simulations: A review. Med Phys 2023; 50:1051-1072. [PMID: 36047387 DOI: 10.1002/mp.15955] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022] Open
Abstract
Transcranial ultrasound is more and more used for therapy and imaging of the brain. However, the skull is a highly attenuating and aberrating medium, with different structures and acoustic properties among samples and even within a sample. Thus, case-specific simulations are needed to perform transcranial focused ultrasound interventions safely. In this article, we provide a review of the different methods used to model the skull and to simulate ultrasound propagation through it.
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Affiliation(s)
| | - Benoit Larrat
- Université Paris Saclay, CNRS, CEA, DRF/JOLIOT/NEUROSPIN/BAOBAB, Gif-sur-Yvette, France
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16
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Mohammadjavadi M, Ash RT, Li N, Gaur P, Kubanek J, Saenz Y, Glover GH, Popelka GR, Norcia AM, Pauly KB. Transcranial ultrasound neuromodulation of the thalamic visual pathway in a large animal model and the dose-response relationship with MR-ARFI. Sci Rep 2022; 12:19588. [PMID: 36379960 PMCID: PMC9666449 DOI: 10.1038/s41598-022-20554-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Neuromodulation of deep brain structures via transcranial ultrasound stimulation (TUS) is a promising, but still elusive approach to non-invasive treatment of brain disorders. The purpose of this study was to confirm that MR-guided TUS of the lateral geniculate nucleus (LGN) can modulate visual evoked potentials (VEPs) in the intact large animal; and to study the impact on cortical brain oscillations. The LGN on one side was identified with T2-weighted MRI in sheep (all male, n = 9). MR acoustic radiation force imaging (MR-ARFI) was used to confirm localization of the targeted area in the brain. Electroencephalographic (EEG) signals were recorded, and the visual evoked potential (VEP) peak-to-peak amplitude (N70 and P100) was calculated for each trial. Time-frequency spectral analysis was performed to elucidate the effect of TUS on cortical brain dynamics. The VEP peak-to-peak amplitude was reversibly suppressed relative to baseline during TUS. Dynamic spectral analysis demonstrated a change in cortical oscillations when TUS is paired with visual sensory input. Sonication-associated microscopic displacements, as measured by MR-ARFI, correlated with the TUS-mediated suppression of visual evoked activity. TUS non-invasively delivered to LGN can neuromodulate visual activity and oscillatory dynamics in large mammalian brains.
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Affiliation(s)
| | - Ryan T Ash
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Ningrui Li
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Pooja Gaur
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Jan Kubanek
- Department of Biomedical Engineering, The University of Utah, Salt Lake City, Utah, USA
| | - Yamil Saenz
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Gary H Glover
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Gerald R Popelka
- Department of Radiology, Stanford University, Stanford, CA, USA
- Department of Otolaryngology, Stanford University, Stanford, CA, USA
| | | | - Kim Butts Pauly
- Department of Radiology, Stanford University, Stanford, CA, USA.
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA.
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17
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Lu N, Hall TL, Sukovich JR, Choi SW, Snell J, McDannold N, Xu Z. Two-step aberration correction: application to transcranial histotripsy. Phys Med Biol 2022; 67:10.1088/1361-6560/ac72ed. [PMID: 35609619 PMCID: PMC9234948 DOI: 10.1088/1361-6560/ac72ed] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/11/2022]
Abstract
Objective: Phase aberration correction is essential in transcranial histotripsy to compensate for focal distortion caused by the heterogeneity of the intact skull bone. This paper improves the 2-step aberration correction (AC) method that has been previously presented and develops an AC workflow that fits in the clinical environment, in which the computed tomography (CT)-based analytical approach was first implemented, followed by a cavitation-based approach using the shockwaves from the acoustic cavitation emission (ACE).Approach:A 700 kHz, 360-element hemispherical transducer array capable of transmit-and-receive on all channels was used to transcranially generate histotripsy-induced cavitation and acquire ACE shockwaves. For CT-AC, two ray-tracing models were investigated: a forward ray-tracing model (transducer-to-focus) in the open-source software Kranion, and an in-house backward ray-tracing model (focus-to-transducer) accounting for refraction and the sound speed variation in skulls. Co-registration was achieved by aligning the skull CT data to the skull surface map reconstructed using the acoustic pulse-echo method. For ACE-AC, the ACE signals from the collapses of generated bubbles were aligned by cross-correlation to estimate the corresponding time delays.Main results:The performance of the 2-step method was tested with 3 excised human calvariums placed at 2 different locations in the transducer array. Results showed that the 2-step AC achieved 90 ± 7% peak focal pressure compared to the gold standard hydrophone correction. It also reduced the focal shift from 0.84 to 0.30 mm and the focal volume from 10.6 to 2.0 mm3on average compared to the no AC cases.Significance:The 2-step AC yielded better refocusing compared to either CT-AC or ACE-AC alone and can be implemented in real-time for transcranial histotripsy brain therapy.
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Affiliation(s)
- Ning Lu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, United States of America
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, United States of America
| | - Jonathan R Sukovich
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, United States of America
| | - Sang Won Choi
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, United States of America
| | - John Snell
- Focused Ultrasound Foundation, Charlottesville, United States of America
| | - Nathan McDannold
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, United States of America
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18
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Schoen S, Kilinc MS, Lee H, Guo Y, Degertekin FL, Woodworth GF, Arvanitis C. Towards controlled drug delivery in brain tumors with microbubble-enhanced focused ultrasound. Adv Drug Deliv Rev 2022; 180:114043. [PMID: 34801617 PMCID: PMC8724442 DOI: 10.1016/j.addr.2021.114043] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/27/2021] [Accepted: 11/04/2021] [Indexed: 02/06/2023]
Abstract
Brain tumors are particularly challenging malignancies, due to their location in a structurally and functionally distinct part of the human body - the central nervous system (CNS). The CNS is separated and protected by a unique system of brain and blood vessel cells which together prevent most bloodborne therapeutics from entering the brain tumor microenvironment (TME). Recently, great strides have been made through microbubble (MB) ultrasound contrast agents in conjunction with ultrasound energy to locally increase the permeability of brain vessels and modulate the brain TME. As we elaborate in this review, this physical method can effectively deliver a wide range of anticancer agents, including chemotherapeutics, antibodies, and nanoparticle drug conjugates across a range of preclinical brain tumors, including high grade glioma (glioblastoma), diffuse intrinsic pontine gliomas, and brain metastasis. Moreover, recent evidence suggests that this technology can promote the effective delivery of novel immunotherapeutic agents, including immune check-point inhibitors and chimeric antigen receptor T cells, among others. With early clinical studies demonstrating safety, and several Phase I/II trials testing the preclinical findings underway, this technology is making firm steps towards shaping the future treatments of primary and metastatic brain cancer. By elaborating on its key components, including ultrasound systems and MB technology, along with methods for closed-loop spatial and temporal control of MB activity, we highlight how this technology can be tuned to enable new, personalized treatment strategies for primary brain malignancies and brain metastases.
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Affiliation(s)
- Scott Schoen
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - M. Sait Kilinc
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Hohyun Lee
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Yutong Guo
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - F. Levent Degertekin
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Graeme F. Woodworth
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA,Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, College Park, MD 20742, USA,Fischell Department of Bioengineering A. James Clarke School of Engineering, University of Maryland
| | - Costas Arvanitis
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA,Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA
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