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VilasBoas-Ribeiro I, Curto S, van Rhoon GC, Franckena M, Paulides MM. MR Thermometry Accuracy and Prospective Imaging-Based Patient Selection in MR-Guided Hyperthermia Treatment for Locally Advanced Cervical Cancer. Cancers (Basel) 2021; 13:cancers13143503. [PMID: 34298716 PMCID: PMC8303939 DOI: 10.3390/cancers13143503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Monitoring and controlling the temperature distribution combined with precise energy delivery are key components for hyperthermia treatment success. Magnetic resonance (MR) imaging is used clinically to monitor the temperature of the treated volume non-invasively. However, there are no comprehensive systematic studies on MR thermometry accuracy during deep pelvic hyperthermia, and the few investigational studies suffer from a high probability of bias due to lacking objective criteria for data inclusion. This study presents the first systematic analysis and defines an imaging-based criterion for prospective patient selection to standardize clinical MR thermometry accuracy assessments. Abstract The efficacy of a hyperthermia treatment depends on the delivery of well-controlled heating; hence, accurate temperature monitoring is essential for ensuring effective treatment. For deep pelvic hyperthermia, there are no comprehensive and systematic reports on MR thermometry. Moreover, data inclusion generally lacks objective selection criteria leading to a high probability of bias when comparing results. Herein, we studied whether imaging-based data inclusion predicts accuracy and could serve as a tool for prospective patient selection. The accuracy of the MR thermometry in patients with locally advanced cervical cancer was benchmarked against intraluminal temperature. We found that gastrointestinal air motion at the start of the treatment, quantified by the Jaccard similarity coefficient, was a good predictor for MR thermometry accuracy. The results for the group that was selected for low gastrointestinal air motion improved compared to the results for all patients by 50% (accuracy), 26% (precision), and 80% (bias). We found an average MR thermometry accuracy of 2.0 °C when all patients were considered and 1.0 °C for the selected group. These results serve as the basis for comprehensive benchmarking of novel technologies. The Jaccard similarity coefficient also has good potential to prospectively determine in which patients the MR thermometry will be valuable.
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Affiliation(s)
- Iva VilasBoas-Ribeiro
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
- Correspondence:
| | - Sergio Curto
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
| | - Gerard C. van Rhoon
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
- Department of Radiation Science and Technology, Faculty of Applied Sciences, Delft University of Technology, 2629 JB Delft, The Netherlands
| | - Martine Franckena
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
| | - Margarethus M. Paulides
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
- Center for Care and Cure Technologies Eindhoven (C3Te), Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
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Jeong H, Restivo MC, Jezzard P, Hess AT. Assessment of radio-frequency heating of a parallel transmit coil in a phantom using multi-echo proton resonance frequency shift thermometry. Magn Reson Imaging 2020; 77:57-68. [PMID: 33359425 PMCID: PMC7889491 DOI: 10.1016/j.mri.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/27/2020] [Accepted: 12/20/2020] [Indexed: 10/25/2022]
Abstract
We propose a workflow for validating parallel transmission (pTx) radio-frequency (RF) magnetic field heating patterns using Proton-Resonance Frequency shift (PRF)-based MR thermometry. Electromagnetic (EM) and thermal simulations of a 7 T 8-channel dipole coil were done using commercially available software (Sim4Life) to assess RF heating. The fabrication method for a phantom with electrical properties matched to human tissue is also described, along with methods for its electrical and thermal characterisation. Energy was deposited to specific transmit channels, whilst acquiring 3D PRF data using a pair of interleaved RF shim transmit modes. A multi-echo readout and pre-scan stabilisation protocol were used for increased sensitivity and to correct for measurement-to-measurement instabilities. The electrical properties of the phantom were found to be within 10% of the intended values. Adoption of a 14-min stabilisation scan gave sufficient suppression of any evolving background spatial variation in the B0 field to achieve <0.001 °C/mm thermometry drift over 10 min of subsequent scanning. Using two RF shim transmit modes enabled full phantom coverage and combining multiple echo times enabled a 13-54% improvement in the RMSE sensitivity to temperature changes. Combining multiple echoes reduced the peak RMSE by 45% and visually reduced measurement-to-measurement instabilities. A reference fibre optic probe showed temperature deviations from the PRF-estimated temperature to be smaller than 0.5 °C. Given the importance of RF safety in pTx applications, this workflow enables accurate validation of RF heating simulations with minimal additional hardware requirements.
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Affiliation(s)
- Hongbae Jeong
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew C Restivo
- Laboratory of Imaging Technology, Biochemistry and Biophysics Centre, NHLBI, NIH, Bethesda, MD, United States
| | - Peter Jezzard
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Aaron T Hess
- Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom; British Heart Foundation Centre for Research Excellence, Oxford, United Kingdom.
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Clinical Performance and Future Potential of Magnetic Resonance Thermometry in Hyperthermia. Cancers (Basel) 2020; 13:cancers13010031. [PMID: 33374176 PMCID: PMC7794787 DOI: 10.3390/cancers13010031] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Hyperthermia is a treatment for cancer patients, which consists of heating the body to 43 °C. The temperature during treatment is usually measured by placing temperature probes intraluminal or invasively. The only clinically used option to measure temperature distributions non-invasively and in 3D is by MR thermometry (MRT). However, in order to be able to replace conventional temperature probes, MRT needs to become more reliable. In this review paper, we propose standardized performance thresholds for MRT, based on our experience of treating nearly 4000 patients. We then review the literature to assess to what extent these requirements are already being met in the clinic today and identify common problems. Lastly, using pre-clinical results in the literature, we assess where the biggest potential is to solve the problems identified. We hope that by standardizing MRT parameters as well as highlighting current and promising developments, progress in the field will be accelerated. Abstract Hyperthermia treatments in the clinic rely on accurate temperature measurements to guide treatments and evaluate clinical outcome. Currently, magnetic resonance thermometry (MRT) is the only clinical option to non-invasively measure 3D temperature distributions. In this review, we evaluate the status quo and emerging approaches in this evolving technology for replacing conventional dosimetry based on intraluminal or invasively placed probes. First, we define standardized MRT performance thresholds, aiming at facilitating transparency in this field when comparing MR temperature mapping performance for the various scenarios that hyperthermia is currently applied in the clinic. This is based upon our clinical experience of treating nearly 4000 patients with superficial and deep hyperthermia. Second, we perform a systematic literature review, assessing MRT performance in (I) clinical and (II) pre-clinical papers. From (I) we identify the current clinical status of MRT, including the problems faced and from (II) we extract promising new techniques with the potential to accelerate progress. From (I) we found that the basic requirements for MRT during hyperthermia in the clinic are largely met for regions without motion, for example extremities. In more challenging regions (abdomen and thorax), progress has been stagnating after the clinical introduction of MRT-guided hyperthermia over 20 years ago. One clear difficulty for advancement is that performance is not or not uniformly reported, but also that studies often omit important details regarding their approach. Motion was found to be the common main issue hindering accurate MRT. Based on (II), we reported and highlighted promising developments to tackle the issues resulting from motion (directly or indirectly), including new developments as well as optimization of already existing strategies. Combined, these may have the potential to facilitate improvement in MRT in the form of more stable and reliable measurements via better stability and accuracy.
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Riley RS, Day ES. Gold nanoparticle-mediated photothermal therapy: applications and opportunities for multimodal cancer treatment. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2017; 9:10.1002/wnan.1449. [PMID: 28160445 PMCID: PMC5474189 DOI: 10.1002/wnan.1449] [Citation(s) in RCA: 356] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 11/04/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022]
Abstract
Photothermal therapy (PTT), in which nanoparticles embedded within tumors generate heat in response to exogenously applied laser light, has been well documented as an independent strategy for highly selective cancer treatment. Gold-based nanoparticles are the main mediators of PTT because they offer: (1) biocompatibility, (2) small diameters that enable tumor penetration upon systemic delivery, (3) simple gold-thiol bioconjugation chemistry for the attachment of desired molecules, (4) efficient light-to-heat conversion, and (5) the ability to be tuned to absorb near-infrared light, which penetrates tissue more deeply than other wavelengths of light. In addition to acting as a standalone therapy, gold nanoparticle-mediated PTT has recently been evaluated in combination with other therapies, such as chemotherapy, gene regulation, and immunotherapy, for enhanced anti-tumor effects. When delivered independently, the therapeutic success of molecular agents is hindered by premature degradation, insufficient tumor delivery, and off-target toxicity. PTT can overcome these limitations by enhancing tumor- or cell-specific delivery of these agents or by sensitizing cancer cells to these additional therapies. All together, these benefits can enhance the therapeutic success of both PTT and the secondary treatment while lowering the required doses of the individual agents, leading to fewer off-target effects. Given the benefits of combining gold nanoparticle-mediated PTT with other treatment strategies, many exciting opportunities for multimodal cancer treatment are emerging that will ultimately lead to improved patient outcomes. WIREs Nanomed Nanobiotechnol 2017, 9:e1449. doi: 10.1002/wnan.1449 For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Rachel S. Riley
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Emily S. Day
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
- Helen F. Graham Cancer Center & Research Institute, Newark, DE, USA
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Stauffer PR, van Rhoon GC. Overview of bladder heating technology: matching capabilities with clinical requirements. Int J Hyperthermia 2016; 32:407-16. [PMID: 26939993 DOI: 10.3109/02656736.2016.1141239] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Moderate temperature hyperthermia (40-45°C for 1 h) is emerging as an effective treatment to enhance best available chemotherapy strategies for bladder cancer. A rapidly increasing number of clinical trials have investigated the feasibility and efficacy of treating bladder cancer with combined intravesical chemotherapy and moderate temperature hyperthermia. To date, most studies have concerned treatment of non-muscle-invasive bladder cancer (NMIBC) limited to the interior wall of the bladder. Following the promising results of initial clinical trials, investigators are now considering protocols for treatment of muscle-invasive bladder cancer (MIBC). This paper provides a brief overview of the devices and techniques used for heating bladder cancer. Systems are described for thermal conduction heating of the bladder wall via circulation of hot fluid, intravesical microwave antenna heating, capacitively coupled radio-frequency current heating, and radiofrequency phased array deep regional heating of the pelvis. Relative heating characteristics of the available technologies are compared based on published feasibility studies, and the systems correlated with clinical requirements for effective treatment of MIBC and NMIBC.
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Affiliation(s)
- Paul R Stauffer
- a Department of Radiation Oncology , Thomas Jefferson University , Philadelphia , Pennsylvana , USA and
| | - Gerard C van Rhoon
- b Department of Radiation Oncology , Erasmus Medical Centre Cancer Institute , Rotterdam , The Netherlands
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Datta NR, Ordóñez SG, Gaipl US, Paulides MM, Crezee H, Gellermann J, Marder D, Puric E, Bodis S. Local hyperthermia combined with radiotherapy and-/or chemotherapy: recent advances and promises for the future. Cancer Treat Rev 2015; 41:742-53. [PMID: 26051911 DOI: 10.1016/j.ctrv.2015.05.009] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/16/2015] [Accepted: 05/20/2015] [Indexed: 02/08/2023]
Abstract
Hyperthermia, one of the oldest forms of cancer treatment involves selective heating of tumor tissues to temperatures ranging between 39 and 45°C. Recent developments based on the thermoradiobiological rationale of hyperthermia indicate it to be a potent radio- and chemosensitizer. This has been further corroborated through positive clinical outcomes in various tumor sites using thermoradiotherapy or thermoradiochemotherapy approaches. Moreover, being devoid of any additional significant toxicity, hyperthermia has been safely used with low or moderate doses of reirradiation for retreatment of previously treated and recurrent tumors, resulting in significant tumor regression. Recent in vitro and in vivo studies also indicate a unique immunomodulating prospect of hyperthermia, especially when combined with radiotherapy. In addition, the technological advances over the last decade both in hardware and software have led to potent and even safer loco-regional hyperthermia treatment delivery, thermal treatment planning, thermal dose monitoring through noninvasive thermometry and online adaptive temperature modulation. The review summarizes the outcomes from various clinical studies (both randomized and nonrandomized) where hyperthermia is used as a thermal sensitizer of radiotherapy and-/or chemotherapy in various solid tumors and presents an overview of the progresses in loco-regional hyperthermia. These recent developments, supported by positive clinical outcomes should merit hyperthermia to be incorporated in the therapeutic armamentarium as a safe and an effective addendum to the existing oncological treatment modalities.
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Affiliation(s)
- N R Datta
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - S Gómez Ordóñez
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - U S Gaipl
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | - M M Paulides
- Department of Radiation Oncology, Hyperthermia Unit, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - H Crezee
- Department of Radiation Oncology, Academic Medical Centre, University of Amsterdam, The Netherlands.
| | - J Gellermann
- Praxis/Zentrum für Strahlentherapie und Radioonkologie, Janusz-Korczak-Str. 12, 12627 Berlin, Germany.
| | - D Marder
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - E Puric
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - S Bodis
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland.
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Salgaonkar VA, Diederich CJ. Catheter-based ultrasound technology for image-guided thermal therapy: current technology and applications. Int J Hyperthermia 2015; 31:203-15. [PMID: 25799287 DOI: 10.3109/02656736.2015.1006269] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Catheter-based ultrasound (CBUS) is applied to deliver minimally invasive thermal therapy to solid cancer tumours, benign tissue growth, vascular disease, and tissue remodelling. Compared to other energy modalities used in catheter-based surgical interventions, unique features of ultrasound result in conformable and precise energy delivery with high selectivity, fast treatment times, and larger treatment volumes. We present a concise review of CBUS technology being currently utilized in animal and clinical studies or being developed for future applications. CBUS devices have been categorised into interstitial, endoluminal and endovascular/cardiac applications. Basic applicator designs, site-specific evaluations and possible treatment applications have been discussed in brief. Particular emphasis has been given to ablation studies that incorporate image guidance for applicator placement, therapy monitoring, feedback control, and post-procedure assessment. Examples of devices included here span the entire spectrum of the development cycle from preliminary simulation-based design studies to implementation in clinical investigations. The use of CBUS under image guidance has the potential for significantly improving precision and applicability of thermal therapy delivery.
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Affiliation(s)
- Vasant A Salgaonkar
- Department of Radiation Oncology, University of California , San Francisco, California , USA
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Salgaonkar VA, Prakash P, Rieke V, Ozhinsky E, Plata J, Kurhanewicz J, Hsu ICJ, Diederich CJ. Model-based feasibility assessment and evaluation of prostate hyperthermia with a commercial MR-guided endorectal HIFU ablation array. Med Phys 2014; 41:033301. [PMID: 24593742 DOI: 10.1118/1.4866226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Feasibility of targeted and volumetric hyperthermia (40-45 °C) delivery to the prostate with a commercial MR-guided endorectal ultrasound phased array system, designed specifically for thermal ablation and approved for ablation trials (ExAblate 2100, Insightec Ltd.), was assessed through computer simulations and tissue-equivalent phantom experiments with the intention of fast clinical translation for targeted hyperthermia in conjunction with radiotherapy and chemotherapy. METHODS The simulations included a 3D finite element method based biothermal model, and acoustic field calculations for the ExAblate ERUS phased array (2.3 MHz, 2.3 × 4.0 cm(2), ∼1000 channels) using the rectangular radiator method. Array beamforming strategies were investigated to deliver protracted, continuous-wave hyperthermia to focal prostate cancer targets identified from representative patient cases. Constraints on power densities, sonication durations and switching speeds imposed by ExAblate hardware and software were incorporated in the models. Preliminary experiments included beamformed sonications in tissue mimicking phantoms under MR temperature monitoring at 3 T (GE Discovery MR750W). RESULTS Acoustic intensities considered during simulation were limited to ensure mild hyperthermia (Tmax < 45 °C) and fail-safe operation of the ExAblate array (spatial and time averaged acoustic intensity ISATA < 3.4 W/cm(2)). Tissue volumes with therapeutic temperature levels (T > 41 °C) were estimated. Numerical simulations indicated that T > 41 °C was calculated in 13-23 cm(3) volumes for sonications with planar or diverging beam patterns at 0.9-1.2 W/cm(2), in 4.5-5.8 cm(3) volumes for simultaneous multipoint focus beam patterns at ∼0.7 W/cm(2), and in ∼6.0 cm(3) for curvilinear (cylindrical) beam patterns at 0.75 W/cm(2). Focused heating patterns may be practical for treating focal disease in a single posterior quadrant of the prostate and diffused heating patterns may be useful for heating quadrants, hemigland volumes or even bilateral targets. Treatable volumes may be limited by pubic bone heating. Therapeutic temperatures were estimated for a range of physiological parameters, sonication duty cycles and rectal cooling. Hyperthermia specific phasing patterns were implemented on the ExAblate prostate array and continuous-wave sonications (∼0.88 W/cm(2), 15 min) were performed in tissue-mimicking material with real-time MR-based temperature imaging (PRFS imaging at 3.0 T). Shapes of heating patterns observed during experiments were consistent with simulations. CONCLUSIONS The ExAblate 2100, designed specifically for thermal ablation, can be controlled for delivering continuous hyperthermia in prostate while working within operational constraints.
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Affiliation(s)
- Vasant A Salgaonkar
- Thermal Therapy Research Group, Radiation Oncology, University of California San Francisco, 1600 Divisadero Street, Suite H-1031, San Francisco, California 94143
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, 2077 Rathbone Hall, Manhattan, Kansas 66506
| | - Viola Rieke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, California 94143
| | - Eugene Ozhinsky
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, California 94143
| | - Juan Plata
- Department of Radiology, Stanford University, 1201 Welch Road, Stanford, California 94305
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, California 94143
| | - I-C Joe Hsu
- Thermal Therapy Research Group, Radiation Oncology, University of California San Francisco, 1600 Divisadero Street, Suite H-1031, San Francisco, California 94143
| | - Chris J Diederich
- Thermal Therapy Research Group, Radiation Oncology, University of California San Francisco, 1600 Divisadero Street, Suite H-1031, San Francisco, California 94143
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Fast PRF-based MR thermometry using double-echo EPI: in vivo comparison in a clinical hyperthermia setting. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2014; 28:305-14. [PMID: 25381180 DOI: 10.1007/s10334-014-0467-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/13/2014] [Accepted: 10/14/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To develop and test in a clinical setting a double-echo segmented echo planar imaging (DEPI) pulse sequence for proton resonance frequency (PRF)-based temperature monitoring that is faster than conventional PRF thermometry pulse sequences and not affected by thermal changes in tissue conductivity. MATERIALS AND METHODS Four tumor patients underwent between one and nine magnetic resonance (MR)-guided regional hyperthermia treatments. During treatment, the DEPI sequence and a FLASH PRF sequence were run in an interleaved manner to compare the results from both sequences in the same patients and same settings. Temperature maps were calculated based on the phase data of both sequences. Temperature measurements of both techniques were compared using Passing and Bablok regression and the Bland-Altman method. RESULTS The temperature results from the DEPI and FLASH sequences, on average, do not differ by more than ΔT = 1 °C. DEPI images showed typically more artifacts and approximately a twofold lower signal-to-noise ratio (SNR), but a sufficient temperature precision of 0.5°, which would theoretically allow for a fivefold higher frame rate. CONCLUSION The results indicate that DEPI can replace slower temperature measurement techniques for PRF-based temperature monitoring during thermal treatments. The higher acquisition speed can be exploited for hot spot localization during regional hyperthermia as well as for temperature monitoring during fast thermal therapies.
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Davis RM, Viglianti BL, Yarmolenko P, Park JY, Stauffer P, Needham D, Dewhirst MW. A method to convert MRI images of temperature change into images of absolute temperature in solid tumours. Int J Hyperthermia 2014; 29:569-81. [PMID: 23957326 DOI: 10.3109/02656736.2013.790091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE During hyperthermia (HT), the therapeutic response of tumours varies substantially within the target temperature range (39-43 °C). Current thermometry methods are either invasive or measure only temperature change, which limits the ability to study tissue responses to HT. This study combines manganese-containing low temperature sensitive liposomes (Mn-LTSL) with proton resonance frequency shift (PRFS) thermometry to measure absolute temperature in tumours with high spatial and temporal resolution using MRI. METHODS Liposomes were loaded with 300 mM MnSO(4). The phase transition temperature (T(m)) of Mn-LTSL samples was measured by differential scanning calorimetry (DSC). The release of manganese from Mn-LTSL in saline was characterised with inductively coupled plasma atomic emission spectroscopy. A 2T GE small animal scanner was used to acquire dynamic T1-weighted images and temperature change images of Mn-LTSL in saline phantoms and fibrosarcoma-bearing Fisher-344 rats receiving hyperthermia after Mn-LTSL injection. RESULTS The T(m) of Mn-LTSL in rat blood was 42.9 ± 0.2 °C (DSC). For Mn-LTSL samples (0.06 mM-0.5 mM Mn(2+) in saline) heated monotonically from 30 °C to 50 °C, a peak in the rate of MRI signal enhancement occurred at 43.1° ± 0.3 °C. The same peak in signal enhancement rate was observed during heating of fibrosarcoma tumours (N = 3) after injection of Mn-LTSL, and the peak was used to convert temperature change images into absolute temperature. Accuracies of calibrated temperature measurements were in the range 0.9-1.8 °C. CONCLUSION The release of Mn(2+) from Mn-LTSL affects the rate of MR signal enhancement which enables conversion of MRI-based temperature change images to absolute temperature.
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Affiliation(s)
- Ryan M Davis
- Graduate Program of Biomedical Engineering, Duke University, Durham, NC, USA
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Paulides MM, Stauffer PR, Neufeld E, Maccarini PF, Kyriakou A, Canters RAM, Diederich CJ, Bakker JF, Van Rhoon GC. Simulation techniques in hyperthermia treatment planning. Int J Hyperthermia 2013; 29:346-57. [PMID: 23672453 PMCID: PMC3711016 DOI: 10.3109/02656736.2013.790092] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract Clinical trials have shown that hyperthermia (HT), i.e. an increase of tissue temperature to 39-44 °C, significantly enhance radiotherapy and chemotherapy effectiveness [1]. Driven by the developments in computational techniques and computing power, personalised hyperthermia treatment planning (HTP) has matured and has become a powerful tool for optimising treatment quality. Electromagnetic, ultrasound, and thermal simulations using realistic clinical set-ups are now being performed to achieve patient-specific treatment optimisation. In addition, extensive studies aimed to properly implement novel HT tools and techniques, and to assess the quality of HT, are becoming more common. In this paper, we review the simulation tools and techniques developed for clinical hyperthermia, and evaluate their current status on the path from 'model' to 'clinic'. In addition, we illustrate the major techniques employed for validation and optimisation. HTP has become an essential tool for improvement, control, and assessment of HT treatment quality. As such, it plays a pivotal role in the quest to establish HT as an efficacious addition to multi-modality treatment of cancer.
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Affiliation(s)
- Margarethus M Paulides
- Hyperthermia Unit, Department of Radiation Oncology, Daniel den Hoed Cancer Centre, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Li Z, Vogel M, Maccarini PF, Stakhursky V, Soher BJ, Craciunescu OI, Das S, Arabe OA, Joines WT, Stauffer PR. Improved hyperthermia treatment control using SAR/temperature simulation and PRFS magnetic resonance thermal imaging. Int J Hyperthermia 2010; 27:86-99. [PMID: 21070140 DOI: 10.3109/02656736.2010.501509] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE This article explores the feasibility of using coupled electromagnetic and thermodynamic simulations to improve planning and control of hyperthermia treatments for cancer. The study investigates the usefulness of preplanning to improve heat localisation in tumour targets in treatments monitored with PRFS-based magnetic resonance thermal imaging (MRTI). METHODS Heating capabilities of a cylindrical radiofrequency (RF) mini-annular phased array (MAPA) applicator were investigated with electromagnetic and thermal simulations of SAR in homogeneous phantom models and two human leg sarcomas. High frequency structure simulator (HFSS) (Ansoft) was used for electromagnetic simulations and SAR patterns were coupled into EPhysics (Ansoft) for thermal modelling with temperature-dependent variable perfusion. Simulations were accelerated by integrating tumour-specific anatomy into a pre-gridded whole body tissue model. To validate this treatment planning approach, simulations were compared with MR thermal images in both homogenous phantoms and heterogeneous tumours. RESULTS SAR simulations demonstrated excellent agreement with temperature rise distributions obtained with MR thermal imaging in homogeneous phantoms and clinical treatments of large soft-tissue sarcomas. The results demonstrate feasibility of preplanning appropriate relative phases of antennas for localising heat in tumour. CONCLUSIONS Advances in the accuracy of computer simulation and non-invasive thermometry via MR thermal imaging have provided powerful new tools for optimisation of clinical hyperthermia treatments. Simulations agree well with MR thermal images in both homogeneous tissue models and patients with lower leg tumours. This work demonstrates that better quality hyperthermia treatments should be possible when simplified hybrid model simulations are performed routinely as part of the clinical pretreatment plan.
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Affiliation(s)
- Zhen Li
- Department of Electric and Computer Engineering, School of Engineering
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Craciunescu OI, Stauffer PR, Soher BJ, Wyatt CR, Arabe O, Maccarini P, Das SK, Cheng KS, Wong TZ, Jones EL, Dewhirst MW, Vujaskovic Z, MacFall JR. Accuracy of real time noninvasive temperature measurements using magnetic resonance thermal imaging in patients treated for high grade extremity soft tissue sarcomas. Med Phys 2010; 36:4848-58. [PMID: 19994492 DOI: 10.1118/1.3227506] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To establish accuracy of real time noninvasive temperature measurements using magnetic resonance thermal imaging in patients treated for high grade extremity soft tissue sarcomas. METHODS Protocol patients with advanced extremity sarcomas were treated with external beam radiation therapy and hyperthermia. Invasive temperature measures were compared to noninvasive magnetic resonance thermal imaging (MRTI) at 1.5 T performed during hyperthermia. Volumetric temperature rise images were obtained using the proton resonance frequency shift (PRFS) technique during heating in a 140 MHz miniannular phased array applicator. MRTI temperature changes were compared to invasive measurements of temperature with a multisensor fiber optic probe inside a #15 g catheter in the tumor. Since the PRFS technique is sensitive to drifts in the primary imaging magnetic field, temperature change distributions were corrected automatically during treatment using temperature-stable reference materials to characterize field changes in 3D. The authors analyzed MRT images and compared, in evaluable treatments, MR-derived temperatures to invasive temperatures measured in extremity sarcomas. Small regions of interest (ROIs) were specified near each invasive sensor identified on MR images. Temperature changes in the interstitial sensors were compared to the corresponding ROI PRFS-based temperature changes over the entire treatment and over the steady-state period. Nonevaluable treatments (motion/imaging artifacts, noncorrectable drifts) were not included in the analysis. RESULTS The mean difference between MRTI and interstitial probe measurements was 0.91 degrees C for the entire heating time and 0.85 degrees C for the time at steady state. These values were obtained from both tumor and normal tissue ROIs. When the analysis is done on just the tumor ROIs, the mean difference for the whole power on time was 0.74 degrees C and during the period of steady state was 0.62 degrees C. CONCLUSIONS The data show that for evaluable treatments, excellent correlation (deltaT < 1 degrees C) of MRTI-ROI and invasive measurements can be achieved, but that motion and other artifacts are still serious challenges that must be overcome in future work.
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Affiliation(s)
- Oana I Craciunescu
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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