Research and development of hyperthermia machines for present and future clinical needs

An Easy-to-Use Microwave Hyperthermia System Combined with Spatially Resolved MR Temperature Maps: Phantom and Animal Studies

BACKGROUND

Hyperthermia has been used in multimodal cancer treatments, and in randomized, controlled studies, hyperthermia is an effective cancer therapy. For clinical accuracy and safety, however, temperature monitoring during treatment is essential. We aimed to develop a convenient microwave hyperthermia system combined with spatially resolved real-time temperature monitoring to improve its efficacy and safety.

MATERIALS AND METHODS

Using an MR-compatible irradiation-type microwave applicator, agar phantoms, thigh muscles of rabbit, and subcutaneous VX2 tumors of rabbit were heated in combination with noninvasive MR temperature maps. For MR temperature calculation, a proton resonance frequency method was used. After determination of temperature coefficients and evaluation of the precision in MR thermometry, distribution of microwave heating over time was examined for each substance.

RESULTS

The temperature coefficients of phantoms, rabbit muscles, and VX2 tumors were -0.00977, -0.00976, and -0.01027 ppm/ degrees C, respectively. The 95% limits of agreement of MR and fluoroptic thermometry in the three subjects were +0.318/-0.339 degrees C, +0.693/-0.661 degrees C, and +0.564/-0.526 degrees C, respectively. Concerning VX2 tumor, the average tumor temperature was 42.60 +/- 0.14 degrees C and the surface of skin was 43.27 +/- 0.45 degrees C in the 60-min experimental period.

CONCLUSIONS

With this easy-to-use microwave hyperthermia system, effective hyperthermia was accomplished in phantoms and living animals in combination with MR temperature maps.

Treatment delivery software for a new clinical grade ultrasound system for thermoradiotherapy

A detailed description of a clinical grade Scanning Ultrasound Reflector Linear Array System (SURLAS) applicator was given in a previous paper [Med. Phys. 32, 230-240 (2005)]. In this paper we concentrate on the design, development, and testing of the personal computer (PC) based treatment delivery software that runs the therapy system. The SURLAS requires the coordinated interaction between the therapy applicator and several peripheral devices for its proper and safe operation. One of the most important tasks was the coordination of the input power sequences for the elements of two parallel opposed ultrasound arrays (eight 1.5 cm x 2 cm elements/array, array 1 and 2 operate at 1.9 and 4.9 MHz, respectively) in coordination with the position of a dual-face scanning acoustic reflector. To achieve this, the treatment delivery software can divide the applicator's treatment window in up to 64 sectors (minimum size of 2 cm x 2 cm), and control the power to each sector independently by adjusting the power output levels from the channels of a 16-channel radio-frequency generator. The software coordinates the generator outputs with the position of the reflector as it scans back and forth between the arrays. Individual sector control and dual frequency operation allows the SURLAS to adjust power deposition in three dimensions to superficial targets coupled to its treatment window. The treatment delivery software also monitors and logs several parameters such as temperatures acquired using a 16-channel thermocouple thermometry unit. Safety (in particular to patients) was the paramount concern and design criterion. Failure mode and effects analysis (FMEA) was applied to the applicator as well as to the entire therapy system in order to identify safety issues and rank their relative importance. This analysis led to the implementation of several safety mechanisms and a software structure where each device communicates with the controlling PC independently of the others. In case of a malfunction in any part of the system or a violation of a user-defined safety criterion based on temperature readings, the software terminates treatment immediately and the user is notified. The software development process consisting of problem analysis, design, implementation, and testing is presented in this paper. Once the software was finished and integrated with the hardware, the therapy system was extensively tested. Results demonstrated that the software operates the SURLAS as intended with minimum risk to future patients.

Hyperthermia induces T1 relaxation and blood flow changes in tumors. A MRI thermometry study in vivo

Regional hyperthermia in combination with chemotherapy and/or radiotherapy has proven to be an effective treatment concept for locally advanced deep-seated tumors. Simultaneous MR-imaging could be a promising approach for therapy optimization. Purpose of this study was the in vivo investigation of temperature induced longitudinal relaxation time (T(1)) and blood flow changes in a tumor model. Using a 1.5 Tesla MR system, the T(1) sensitivity on temperature and the onset of tissue changes at temperatures >44 degrees C were investigated in muscle samples. Also, fourteen Syrian Golden Hamsters with amelanotic melanoma A-MEL-3 were examined during heating of the tumors. Temperature induced blood flow and T(1) changes were determined continuously during hyperthermia. Changes of T(1) correlated linearly with temperature over a wide range (27-44 degrees C) in the tissue sample. Tissue changes became notable above 44 degrees C. In the tumor model, relative changes of T(1) (unlike blood flow) showed linear correlation with temperature over the entire range of hyperthermia relevant temperatures (32-44 degrees C). For a low thermal dose, T(1) allows the assessment of temperature changes in tumors in vivo. At higher thermal doses, in addition to temperature changes, T(1) also shows tissue changes. Both temperature and tissue changes supply important information for hyperthermia.

T1 relaxation time at 0.2 Tesla for monitoring regional hyperthermia: feasibility study in muscle and adipose tissue

The purpose of this study was to characterize T(1), particularly in the hyperthermia temperature range (ca. 37-44 degrees C), in order to control regional hyperthermia with MR monitoring using 0.2 Tesla, and to improve T(1) mapping. A single-slice and a new multislice "T One by Multiple Read-Out Pulses" (TOMROP) pulse sequence were used for fast T(1) mapping in a clinical MRI hyperthermia hybrid system. Temporal stability, temperature sensitivity, and reversibility of T(1) were investigated in a polyamidacryl gel phantom and in samples of muscle and adipose tissues from turkey and pig, and verified in patients. In the gel phantom a high linear correlation between T(1) and temperature (R(2) = 0.97) was observed. In muscle and adipose tissue, T(1) and temperature had a linear relationship below a breakpoint of 43 degrees C. Above this breakpoint muscle tissue showed irreversible tissue changes; these effects were not visible in adipose tissue. The ex vivo results were confirmed in vivo under clinical conditions. T(1) mapping allows the characterization of hyperthermia-related tissue response in healthy tissue. T(1), in combination with fast mapping, is suitable for controlling regional hyperthermia at 0.2 T within the hybrid system.