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Background: Multiparametric MRI (mpMRI) is an effective tool for detecting and staging prostate cancer (PCa), guiding interventional therapy, and monitoring PCa treatment outcomes. MRI-guided focal laser ablation (FLA) therapy is an alternative, minimally invasive treatment method to conventional therapies, which has been demonstrated to control low-grade, localized PCa while preserving patient quality of life. The therapeutic success of FLA depends on the accurate placement of needles for adequate delivery of ablative energy to the target lesion.We previously developed an MR-compatible mechatronic system for prostate FLA needle guidance and validated its performance in open-air and clinical 3T in-bore experiments using virtual targets. Purpose: To develop a robust MRI-to-mechatronic system registration method and evaluate its in-bore MR-guided needle delivery accuracy in tissue-mimicking prostate phantoms. Methods: The improved registration multifiducial assembly houses thirty-six aqueous gadolinium-filled spheres distributed over a 7.3 × 7.3 × 5.2 cm volume. MRI-guided needle guidance accuracy was quantified in agar-based tissue-mimicking prostate phantoms on trajectories (N = 44) to virtual targets covering the mechatronic system’s range of motion. 3T gradient-echo recalled (GRE) MRI images were acquired after needle insertions to each target, and the airfilled needle tracks were segmented. Needle guidance error was measured as the shortest Euclidean distance between the target point and the segmented needle trajectory, and angular error was measured as the angle between the targeted trajectory and the segmented needle trajectory. These measurements were made using both the previously designed four-sphere registration fiducial assembly on trajectories (N = 7) and compared with the improved multifiducial assembly using a Mann–Whitney U test. Results: The median needle guidance error of the system using the improved registration fiducial assembly at a depth of 10 cm was 1.02 mm with an interquartile range (IQR) of 0.42–2.94 mm.The upper limit of the one-sided 95% prediction interval of needle guidance error was 4.13 mm. The median (IQR) angular error was 0.0097 rad (0.0057–0.015 rad) with a one-sided 95% prediction interval upper limit of 0.022 rad. The median (IQR) positioning error using the previous four-sphere registration fiducial assembly was 1.87 mm (1.77–2.14 mm). This was found to be significantly different (p = 0.0012) from the median (IQR) positioning error of 0.28 mm (0.14–0.95 mm) using the new registration fiducial assembly on the same trajectories. No significant difference was detected between the medians of the angular errors (p = 0.26). Conclusion: This is the first study presenting an improved registration method and validation in tissue-mimicking phantoms of our remotely actuated Med Phys. MR-compatible mechatronic system for delivery of prostate FLA needles. Accounting for the effects of needle deflection, the system was demonstrated to be capable of needle delivery with an error of 4.13 mm or less in 95% of cases under ideal conditions, which is a statistically significant improvement over the previous method. The system will next be validated in a clinical setting. [ABSTRACT FROM AUTHOR]

Background: The size of catheter‐based ultrasound devices for delivering ultrasound energy to deep‐seated tumors is constrained by the access pathway which limits their therapeutic capabilities. Purpose: To devise and investigate a deployable applicator suitable for minimally‐invasive delivery of therapeutic ultrasound, consisting of a 2D cylindrical sectored‐ring ultrasound phased array, integrated within an expandable paraboloid‐shaped balloon‐based reflector. The balloon can be collapsed for compact delivery and expanded close to the target position to mimic a larger‐diameter concentric‐ring sector‐vortex array for enhanced dynamic control of focal depth and volume. Methods: Acoustic and biothermal simulations were employed in 3D generalized homogeneous and patient‐specific heterogeneous models, for three‐phased array transducers with 32, 64, and 128 elements, composed of sectored 4, 8, and 16 tubular ring transducers, respectively. The applicator performance was characterized as a function of array configuration, focal depth, phasing modes, and balloon reflector geometry. A 16‐element proof‐of‐concept phased array applicator assembly, consisting of four tubular transducers each divided into four sectors, was fabricated, and characterized with hydrophone measurements along and across the axis, and ablations in ex vivo tissue. Results: Simulation results indicated that transducer arrays (1.5 MHz, 9 mm OD × 20 mm long), balloon sizes (41–50 mm expanded diameter, 20–60 mm focal depth), phasing mode (0–4) and sonication duration (30 s) can produce spatially localized acoustic intensity focal patterns (focal length: 3–22 mm, focal width: 0.7–8.7 mm) and ablative thermal lesions (width: 2.7–16 mm, length: 6–46 mm) in pancreatic tissue across a 10–90 mm focal depth range. Patient‐specific studies indicated that 0.1, 0.46, and 1.2 cm3 volume of tumor can be ablated in the body of the pancreas for 120 s sonications using a single axial focus (Mode 0), or four, and eight simultaneous foci in a toroidal pattern (Mode 2 and 4, respectively). Hydrophone measurements demonstrated good agreement with simulation. Experiments in which chicken meat was thermally ablated indicated that volumetric ablation can be produced using single or multiple foci. Conclusions: The results of this study demonstrated the feasibility of a novel compact ultrasound applicator design capable of focusing, deep penetration, electronic steering, and volumetric thermal ablation. The proposed applicator can be used for compact endoluminal or laparoscopic delivery of localized ultrasound energy to deep‐seated targets. [ABSTRACT FROM AUTHOR]

PurposeCatheter-based ultrasound applicators can generate thermal ablation of tissues adjacent to body lumens, but have limited focusing and penetration capabilities due to the small profile of integrated transducers required for the applicator to traverse anatomical passages. This study investigates a design for an endoluminal or laparoscopic ultrasound applicator with deployable acoustic reflector and fluid lens components, which can be expanded after device delivery to increase the effective acoustic aperture and allow for deeper and dynamically adjustable target depths. Acoustic and biothermal theoretical studies, along with benchtop proof-of-concept measurements, were performed to investigate the proposed design.MethodsThe design schema consists of an array of tubular transducer(s) situated at the end of a catheter assembly, surrounded by an expandable water-filled conical balloon with a secondary reflective compartment that redirects acoustic energy distally through a plano-convex fluid lens. By controlling the lens fluid volume, the convex surface can be altered to adjust the focal length or collapsed for device insertion or removal. Acoustic output of the expanded applicator assembly was modeled using the rectangular radiator method and secondary sources, accounting for reflection and refraction at interfaces. Parametric studies of transducer radius (1-5 mm), height (3-25 mm), frequency (1.5-3 MHz), expanded balloon diameter (10-50 mm), lens focal length (10-100 mm), lens fluid (silicone oil, perfluorocarbon), and tissue attenuation (0-10 Np/m/MHz) on beam distributions and focal gain were performed. A proof-of-concept applicator assembly was fabricated and characterized using hydrophone-based intensity profile measurements. Biothermal simulations of endoluminal ablation in liver and pancreatic tissue were performed for target depths between 2 and 10 cm.ResultsSimulations indicate that focal gain and penetration depth scale with the expanded reflector-lens balloon diameter, with greater achievable performance using perfluorocarbon lens fluid. Simulations of a 50 mm balloon OD, 10 mm transducer outer diameter (OD), 1.5 MHz assembly in water resulted in maximum intensity gain of ~170 (focal dimensions: ~12 mm length × 1.4 mm width) at ~5 cm focal depth and focal gains above 100 between 24 and 84 mm depths. A smaller (10 mm balloon OD, 4 mm transducer OD, 1.5 MHz) configuration produced a maximum gain of 6 at 9 mm depth. Compared to a conventional applicator with a fixed spherically focused transducer of 12 mm diameter, focal gain was enhanced at depths beyond 20 mm for assembly configurations with balloon diameters ≥ 20 mm. Hydrophone characterizations of the experimental assembly (31 mm reflector/lens diameter, 4.75 mm transducer radius, 1.7 MHz) illustrated focusing at variable depths between 10-70 mm with a maximum gain of ~60 and demonstrated agreement with theoretical simulations. Biothermal simulations (30 s sonication, 75 °C maximum) indicate that investigated applicator assembly configurations, at 30 mm and 50 mm balloon diameters, could create localized ellipsoidal thermal lesions increasing in size from 10 to 55 mm length × 3-6 mm width in liver tissue as target depth increased from 2 to 10 cm.ConclusionsPreliminary theoretical and experimental analysis demonstrates that combining endoluminal ultrasound with an expandable acoustic reflector and fluid lens assembly can significantly enhance acoustic focal gain and penetration from inherently smaller diameter catheter-based applicators.

Purpose: To develop a deep neural network for accelerating magnetic resonance elastography (MRE) acquisition, to validate the ability to generate reliable MRE results with the down‐sampled k‐space data, and to demonstrate the feasibility of the proposed method in monitoring the stiffness changes during thermal ablation in a phantom study. Materials and methods: MRE scans were performed with 60 Hz excitation on porcine ex‐vivo liver gel phantoms in a 0.36T MRI scanner to generate the training dataset. The acquisition protocol was based on a spin‐echo MRE pulse sequence with tailored motion‐sensitive gradients to reduce echo time (TE). A U‐Net based deep neural network was developed and trained to interpolate the missing data from down‐sampled k‐space. We calculated the errors of 80 sets magnitude/phase images reconstructed from the zero‐filled, compressive sensing (CS) and deep learning (DL) method for comparison. The peak signal‐to‐noise rate (PSNR) and structural similarity index (SSIM) of the magnitude/phase images were also calculated for comparison. The stiffness changes were recorded before, during, and after ablation. The mean stiffness values over the region of interest (ROI) were compared between the elastograms reconstructed from the fully sampled k‐space and interpolated k‐space after thermal ablation. Results: The mean absolute error (MAE), PSNR, and SSIM of the proposed DL approach were significantly better than the results from the zero‐filled method (p < 0.0001) and CS (p < 0.0001). The stiffness changes before and after thermal ablation assessed by the proposed approach (before: 7.7±1.1 kPa, after: 11.9±4.0 kPa, 4.2‐kPa increase) gave close agreement with the values calculated from the fully sampled data (before: 8.0±1.0 kPa, after: 12.6±4.2 kPa, 4.6‐kPa increase). In contrast, the stiffness changes computed from the zero‐filled method (before: 4.9±1.4 kPa, after: 5.6±2.8 kPa, 0.7‐kPa increase) were substantially underestimated. Conclusion: This study demonstrated the capability of the proposed DL method for rapid MRE acquisition and provided a promising solution for monitoring the MRI‐guided thermal ablation. [ABSTRACT FROM AUTHOR]

PurposeEndoluminal ultrasound may serve as a minimally invasive option for delivering thermal ablation to pancreatic tumors adjacent to the stomach or duodenum. The objective of this study was to explore the basic feasibility of this treatment strategy through the design, characterization, and evaluation of proof-of-concept endoluminal ultrasound applicators capable of placement in the gastrointestinal (GI) lumen for volumetric pancreas ablation under MR guidance.MethodsTwo variants of the endoluminal applicator, each containing a distinct array of two independently powered transducers (10 × 10 mm 3.2 MHz planar; or 8 × 10 × 20 mm radius of curvature 3.3 MHz curvilinear geometries) at the distal end of a meter long flexible catheter assembly, were designed and fabricated. Transducers and circulatory water flow for acoustic coupling and luminal cooling were contained by a low-profile polyester balloon covering the transducer assembly fixture. Each applicator incorporated miniature spiral MR coils and mechanical features (guiding tips and hinges) to facilitate tracking and insertion through the GI tract under MRI guidance. Acoustic characterization of each device was performed using radiation force balance and hydrophone measurements. Device delivery into the upper GI tract, adjacent to the pancreas, and heating characteristics for treatment of pancreatic tissue were evaluated in MR-guided ex vivo and in vivo porcine experiments. MR guidance was utilized for anatomical target identification, tracking/positioning of the applicator, and MR temperature imaging (MRTI) for PRF-based multislice thermometry, implemented in the real-time RTHawk software environment.ResultsForce balance and hydrophone measurements indicated efficiencies of 48.8% and 47.8% and -3 dB intensity beam-widths of 3.2 and 1.2 mm for the planar and curvilinear transducers, respectively. Ex vivo studies on whole-porcine carcasses revealed capabilities of producing ablative temperature rise (ΔT > 15 °C) contours in pancreatic tissue 4-40 mm long and 4-28 mm wide for the planar transducer applicator (1-13 min sonication duration, ∼4 W/cm(2) applied acoustic intensity). Curvilinear transducers produced more selective heating, with a narrower ΔT > 15 °C contour length and width of up to 1-24 mm and 2-7 mm, respectively (1-7 min sonication duration, ∼4 W/cm(2) applied acoustic intensity). Active tracking of the miniature spiral coils was achieved using a Hadamard encoding tracking sequence, enabling real-time determination of each coil's coordinates and automated prescription of imaging planes for thermometry. In vivo MRTI-guided heating trials in three pigs demonstrated capability of ∼20 °C temperature elevation in pancreatic tissue at 2 cm depths from the applicator, with 5-7 W/cm(2) applied intensity and 6-16 min sonication duration. Dimensions of thermal lesions in the pancreas ranged from 12 to 28 mm, 3 to 10 mm, and 5 to 10 mm in length, width, and depth, respectively, as verified through histological analysis of tissue sections. Multiple-baseline reconstruction and respiratory-gated acquisition were demonstrated to be effective strategies in suppressing motion artifacts for clear evolution of temperature profiles during MRTI in the in vivo studies.ConclusionsThis study demonstrates the technical feasibility of generating volumetric ablation in pancreatic tissue using endoluminal ultrasound applicators positioned in the stomach lumen. MR guidance facilitates target identification, device tracking/positioning, and treatment monitoring through real-time multislice PRF-based thermometry.

Thermal ablation is a form of hyperthermia in which oncologic control can be achieved by briefly inducing elevated temperatures, typically in the range 50–80°C, within a target tissue. Ablation modalities include high intensity focused ultrasound, radiofrequency ablation, microwave ablation, and laser interstitial thermal therapy which are all capable of generating confined zones of tissue destruction, resulting in fewer complications than conventional cancer therapies. Oncologic control is contingent upon achieving predefined coagulation zones; therefore, intraoperative assessment of treatment progress is highly desirable. Consequently, there is a growing interest in the development of ablation monitoring modalities. The first section of this review presents the mechanism of action and common applications of the primary ablation modalities. The following section outlines the state‐of‐the‐art in thermal dosimetry which includes interstitial thermal probes and radiologic imaging. Both the physical mechanism of measurement and clinical or pre‐clinical performance are discussed for each ablation modality. Thermal dosimetry must be coupled with a thermal damage model as outlined in Section 4. These models estimate cell death based on temperature‐time history and are inherently tissue specific. In the absence of a reliable thermal model, the utility of thermal monitoring is greatly reduced. The final section of this review paper covers technologies that have been developed to directly assess tissue conditions. These approaches include visualization of non‐perfused tissue with contrast‐enhanced imaging, assessment of tissue mechanical properties using ultrasound and magnetic resonance elastography, and finally interrogation of tissue optical properties with interstitial probes. In summary, monitoring thermal ablation is critical for consistent clinical success and many promising technologies are under development but an optimal solution has yet to achieve widespread adoption. [ABSTRACT FROM AUTHOR]

Magnetic resonance‐guided focused ultrasound (MRgFUS) is a completely non‐invasive technology that has been approved by FDA to treat several diseases. This report, prepared by the American Association of Physicist in Medicine (AAPM) Task Group 241, provides background on MRgFUS technology with a focus on clinical body MRgFUS systems. The report addresses the issues of interest to the medical physics community, specific to the body MRgFUS system configuration, and provides recommendations on how to successfully implement and maintain a clinical MRgFUS program. The following sections describe the key features of typical MRgFUS systems and clinical workflow and provide key points and best practices for the medical physicist. Commonly used terms, metrics and physics are defined and sources of uncertainty that affect MRgFUS procedures are described. Finally, safety and quality assurance procedures are explained, the recommended role of the medical physicist in MRgFUS procedures is described, and regulatory requirements for planning clinical trials are detailed. Although this report is limited in scope to clinical body MRgFUS systems that are approved or currently undergoing clinical trials in the United States, much of the material presented is also applicable to systems designed for other applications. [ABSTRACT FROM AUTHOR]

Purpose: Prostate cancer is the most common non‐cutaneous cancer among men in the United States and is the second leading cause of cancer death in American men. (Siegel et al. [2019] CA: A Cancer J Clin.69(1):7‐34.) Focal laser ablation (FLA) has the potential to control small tumors while preserving urinary and erectile function by leaving the neurovascular bundles and urethral sphincters intact. Accurate needle guidance is critical to the success of FLA. Multiparametric magnetic resonance images (mpMRI) can be used to identify targets, guide needles, and assess treatment outcomes. The purpose of this work was to design and evaluate the accuracy of an MR‐compatible mechatronic system for in‐bore transperineal guidance of FLA ablation needles to localized lesions in the prostate. Methods: The mechatronic system was constructed entirely of non‐ferromagnetic materials, with actuation controlled by piezoelectric motors and optical encoders. The needle guide hangs between independent front and rear two‐link arms, which allows for horizontal and vertical translation as well as pitch and yaw rotation of the guide with a 6.0 cm range of motion in each direction. Needles are inserted manually through a chosen hole in the guide, which has been aligned with the target in the prostate. Open‐air positioning error was evaluated using an optical tracking system (0.25 mm RMS accuracy) to measure 125 trajectories in free space. Correction of systematic bias in the system was performed using 85 of the trajectories, and the remaining 40 were used to estimate the residual error. The error was calculated as the horizontal and vertical displacement between the axis of the desired and measured trajectories at a typical needle insertion depth of 10 cm. MR‐compatibility was evaluated using a grid phantom to assess image degradation due to the presence of the system, and induced force, heating, and electrical interference in the system were assessed qualitatively. In‐bore positioning error was evaluated on 25 trajectories. Results: Open‐air mean positioning error at the needle tip was 0.80 ± 0.36 mm with a one‐sided 95% confidence interval of 1.40 mm. The mean deviation of needle trajectories from the planned direction was 0.14 ± 0.06∘. In the MR bore, the mean positioning error at the needle tip was 2.11 ± 1.05 mm with a one‐sided 95% prediction interval of 3.84 mm. The mean angular error was 0.49 ± 0.26∘. The system was found to be compatible with the MR environment under the specified gradient‐echo sequence parameters used in this study. Conclusion: A complete system for delivering needles to localized prostate tumors was developed and described in this work, and its compatibility with the MR environment was demonstrated. In‐bore MRI positioning error was sufficiently small for targeting small localized prostate tumors. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate multiple applicator implant configurations of interstitial ultrasound devices for large volume ablation of liver tumors.MethodsA 3D bioacoustic-thermal model using the finite element method was implemented to assess multiple applicator implant configurations for thermal ablation with interstitial ultrasound energy. Interstitial applicators consist of linear arrays of up to four 10 mm-long tubular ultrasound transducers, each under separate and dynamic power control, enclosed within a water-cooled delivery catheter (2.4 mm OD). The authors considered parallel implants with two and three applicators (clustered configuration), spaced 2-3 cm apart, to simulate open surgical placement. In addition, the authors considered two applicator implants with applicators converging and diverging at angles of ∼20°, 30°, and 45° to simulate percutaneous placement. Heating experiments (10-15 min) were performed and compared against simulations employing the same experimental parameters. To estimate the performance of parallel, multiple applicator configurations in an in vivo setting, simulations were performed taking into account a range of blood perfusion levels (0, 5, 12, and 15 kg m(-3) s(-1)) that may occur in tumors of varying vascularity. The impact of tailoring the power supplied to individual transducer elements along the length of applicators is explored for applicators inserted in non-parallel (converging and diverging) configurations. Thermal dose (t(43) > 240 min) and temperature thresholds (T > 52 °C) were used to define the ablation zones, with dynamic changes to tissue acoustic and thermal properties incorporated within the model.ResultsExperiments in ex vivo bovine liver yielded ablation zones ranging between 4.0-5.6 cm × 3.2-4.9 cm, in cross section. Ablation zone dimensions predicted by simulations with similar parameters to the experiments were in close agreement (within 5 mm). Simulations of in vivo heating showed that 15 min heating and interapplicator spacing less than 3 cm are required to obtain contiguous, complete ablation zones. The ability to create complete ablation zone profiles for nonparallel implants was illustrated by tailoring applied power levels along the length of applicators.ConclusionsParallel implants consisting of three interstitial ultrasound applicators in a triangular configuration yield complete ablation zones measuring up to 6.2 cm × 5.7 cm after 15 min heating. At larger interapplicator spacing, the level of blood perfusion in the tumor may yield indentations along the periphery of the ablation zone. Tailoring applied power along the length of the applicator can accommodate for nonparallel implants, without compromising safety.

Purpose: To develop an image processing methodology for noninvasive three‐dimensional (3D) quantification of microwave thermal ablation zones in vivo using x‐ray computed tomography (CT) imaging without injection of a contrast enhancing material. Methods: Six microwave (MW) thermal ablation procedures were performed in three pigs. The ablations were performed with a constant heating duration of 8 min and power level of 30 W. During the procedure images from sixty 1 mm thick slices were acquired every 30 s. At the end of all ablation procedures for each pig, a contrast‐enhanced scan was acquired for reference. Special algorithms for addressing challenges stemming from the 3D in vivo setup and processing the acquired images were prepared. The algorithms first rearranged the data to account for the oblique needle orientation and for breathing motion. Then, the gray level variance changes were analyzed, and optical flow analysis was applied to the treated volume in order to obtain the ablation contours and reconstruct the ablation zone in 3D. The analysis also included a special correction algorithm for eliminating artifacts caused by proximal major blood vessels and blood flow. Finally, 3D reference reconstructions from the contrast‐enhanced scan were obtained for quantitative comparison. Results: For four ablations located >3 mm from a large blood vessel, the mean dice similarity coefficient (DSC) and the mean absolute radial discrepancy between the contours obtained from the reference contrast‐enhanced images and the contours produced by the algorithm were 0.82 ± 0.03 and 1.92 ± 1.47 mm, respectively. In two cases of ablation adjacent to large blood vessels, the average DSC and discrepancy were: 0.67 ± 0.6 and 2.96 ± 2.15 mm, respectively. The addition of the special correction algorithm utilizing blood vessels mapping improved the mean DSC and the mean absolute discrepancy to 0.85 ± 0.02 and 1.19 ± 1.00 mm, respectively. Conclusions: The developed algorithms provide highly accurate detailed contours in vivo (average error < 2.5 mm) and cope well with the challenges listed above. Clinical implementation of the developed methodology could potentially provide real time noninvasive 3D accurate monitoring of MW thermal ablation in‐vivo, provided that the radiation dose can be reduced. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to quantitatively analyze tissue deformation during radiofrequency (RF) and microwave ablation for varying output energy levels. Methods: A total of 46 fiducial markers which were classified into outer, middle, and inner lines were positioned into a single plane around an RF or microwave ablation applicator in each ex vivo bovine liver sample (8 cm × 6 cm × 4 cm, n = 18). Radiofrequency (500 kHz; ~35 W average) or microwave (2.4 GHz; 50–100 W output, ~35–70 W delivered) ablation was performed for 10 min (n = 4–6 each setting). CT images were acquired over the entire liver volume every 15 s. Principle strain magnitude and direction were determined from fiducial marker displacement. Normal and shear strain were then calculated such that negative strain denoted contraction and positive strain denoted expansion. Temporal variations, the final magnitudes, and angles of the strain were compared across energy delivery settings, using one‐way ANOVA with post hoc Tukey's tests. Results: On average, tissue strain rates peak at around 1 min and decayed exponentially over time. No evidence of tissue expansion was observed. The tissue strains from RF and 50 W, 75 W, and 100 W microwave ablation at 10 min were −8.5%, −38.9%, −54.4%, and −65.7%, respectively, from the inner region and −3.6%, −23.7%, −41.8%, and −44.3%, respectively, from the outer region. Negative strain magnitude was positively correlated to energy delivery in the inner region (Spearman's ρ = −0.99). Microwaves at higher powers (75–100 W) induced significantly more strain than at lower power (50 W) or after RF ablation (P < 0.01). Principal strain angles ranged from 0.8° to −8.1°, indicating that tissue deformed more in the direction transverse to the applicator than along the direction of the applicator. Conclusions: The influence of output energy on tissue deformation during RF and microwave ablation was analyzed. Microwave ablation created significantly greater contraction than RF ablation with similar energy delivery. During microwave ablation, more contraction was noted at higher power levels and in proximity to the antenna. Contraction primarily transverse to the antenna produces ablation zones that are more elongated than the original tissue volume. [ABSTRACT FROM AUTHOR]

Purpose: Prostate cancer is the most common noncutaneous cancer among men in the USA. Focal laser thermal ablation (FLA) has the potential to control small tumors while preserving urinary and erectile function by leaving the neurovascular bundles and urethral sphincters intact. Accurate needle guidance is critical to the success of FLA. Multiparametric magnetic resonance images (mpMRI) can be used to identify targets, guide needles, and assess treatment outcomes. In this study, we evaluated the location of ablation zones relative to targeted lesions in 23 patients who underwent FLA therapy in a phase II trial. The ablation zone margins and unablated tumor volume were measured to determine whether complete coverage of each tumor was achieved, which would be considered a clinically successful ablation. Methods: Preoperative mpMRI was acquired for each patient 2–3 months preceding the procedure and the prostate and lesion(s) were manually contoured on 3 T T2‐weighted axial images. The prostate and ablation zone(s) were also manually contoured on postablation 1.5 T T1‐weighted contrast‐enhanced axial images acquired immediately after the procedure intraoperatively. The lesion surface was nonrigidly registered to the postablation image using an initial affine registration followed by nonrigid thin‐plate spline registration of the prostate surfaces. The margins between the registered lesion and ablation zone were calculated using a uniform spherical distribution of rays, and the volume of intersection was also calculated. Each prostate was contoured five times to determine the segmentation variability and its effect on intersection of the lesion and ablation zone. Results: Our study showed that the boundaries of the segmented tumor and ablation zone were close. Of the 23 lesions that were analyzed, 11 were completely covered by the ablation zone and 12 were partially covered. A shift of 1.0, 2.0, and 2.6 mm would result in 19, 21, and all tumors completely covered by the ablation zone, respectively. The median unablated tumor volume across all tumors was 0.1 mm3 with an IQR of 3.7 mm3, which was 0.2% of the median tumor volume (46.5 mm3 with an IQR of 46.3 mm3). The median extension of the tumors beyond the ablation zone, in cases which were partially ablated, was 0.9 mm (IQR of 1.3 mm), with the furthest tumor extending 2.6 mm. Conclusion: In all cases, the boundary of the tumor was close to the boundary of the ablation zone, and in some cases, the boundary of the ablation zone did not completely enclose the tumor. Our results suggest that some of the ablations were not clinically successful and that there is a need for more accurate needle tracking and guidance methods. Limitations of the study include errors in the registration and segmentation methods used as well as different voxel sizes and contrast between the registered T2 and T1 MRI sequences and asymmetric swelling of the prostate postprocedurally. [ABSTRACT FROM AUTHOR]

Purpose: To correlate the accumulated thermal dose (ATD) with lesion size in magnetic resonance (MR)‐guided focused ultrasound (MRgFUS) thalamotomy to help guide future clinical treatments. Materials and Methods: Thirty‐six patients with medication‐refractory essential tremor were treated using a commercial MRgFUS brain system (ExAblate 4000, InSightec) in a 3T MR scanner (MR750, GE Healthcare). Intraoperative MR‐thermometry was performed to measure the induced temperature and thermal dose distributions (thermal coefficient = −0.00909 ppm/°C). The ATD was calculated over multiple sonications with appropriate corrections for spatial‐shifting artifacts. The ATD profile sizes obtained for dose values of 17, 40, 100, 200, and 240 cumulative equivalent minutes at 43°C (CEM) were correlated with the corresponding lesion sizes measured via axial T1‐ and T2‐weighted MR images acquired 1 day post‐treatment. Results: Of a total of 232 included sonications, 83 required corrections for off‐resonance‐induced spatial‐shifting artifacts (correction range = [1.1,2.2] mm). The mean lesion sizes measured on T2‐weighted MR images (6.2 ± 1.3 mm, mean ± SD) were 15% larger than those measured on corresponding T1‐weighted MR images (5.3 ± 1.2 mm, mean ± SD). The ATD values that provided the best correlations with the measured lesion sizes on T2‐ and T1‐weighted MR images were 100 and 200 CEM, respectively. Conclusion: The ATD was correlated with lesion size measured 1 day following MRgFUS thalamotomy for essential tremor. These data provide useful information for predicting brain lesion size and determining treatment endpoints in future clinical MRgFUS procedures. [ABSTRACT FROM AUTHOR]

Purpose During magnetic resonance ( MR)-guided thermal therapies, water proton resonance frequency shift ( PRFS)-based MR temperature imaging can quantitatively monitor tissue temperature changes. It is widely known that the PRFS technique is easily perturbed by tissue motion, tissue susceptibility changes, magnetic field drift, and modality-dependent applicator-induced artifacts. Here, a referenceless Gaussian process modeling ( GPM)-based estimation of the PRFS is investigated as a methodology to mitigate unwanted background field changes. The GPM offers a complementary trade-off between data fitting and smoothing and allows prior information to be used. The end result being the GPM provides a full probabilistic prediction and an estimate of the uncertainty. Methods GPM was employed to estimate the covariance between the spatial position and MR phase measurements. The mean and variance provided by the statistical model extrapolated background phase values from nonheated neighboring voxels used to train the model. MR phase predictions in the heating ROI are computed using the spatial coordinates as the test input. The method is demonstrated in ex vivo rabbit liver tissue during focused ultrasound heating with manually introduced perturbations (n = 6) and in vivo during laser-induced interstitial thermal therapy to treat the human brain (n = 1) and liver (n = 1). Results Temperature maps estimated using the GPM referenceless method demonstrated a RMS error of <0.8°C with artifact-induced reference-based MR thermometry during ex vivo heating using focused ultrasound. Nonheated surrounding areas were <0.5°C from the artifact-free MR measurements. The GPM referenceless MR temperature values and thermally damaged regions were within the 95% confidence interval during in vivo laser ablations. Conclusions A new approach to estimation for referenceless PRFS temperature imaging is introduced that allows for an accurate probabilistic extrapolation of the background phase. The technique demonstrated reliable temperature estimates in the presence of the background phase changes and was demonstrated useful in the in vivo brain and liver ablation scenarios presented. [ABSTRACT FROM AUTHOR]

Purpose Intra-procedural contrast-enhanced computed tomography ( CECT) has been proposed to monitor the growth of thermal ablations. The primary challenge with multiple CT acquisitions is reducing radiation dose while maintaining sufficient image quality. The purpose of this study was to evaluate the feasibility of applying local highly constrained backprojection reconstruction ( HYPR- LR) on periodic CECT images acquired with low-dose protocols, and to determine whether the ablations visible on CT were commensurate to gross pathology. Methods Low-dose ( [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to noninvasively and automatically estimate both the radius of the ablated liver tissue and the radius encircling the treated zone, which also defines where the tissue is definitely untreated during a microwave (MW) thermal ablation procedure. Methods: Fourteen ex vivo bovine fresh liver specimens were ablated at 40 W using a 14 G microwave antenna, for durations of 3, 6, 8, and 10 min. The tissues were scanned every 5 s during the ablation using an x-ray CT scanner. In order to estimate the radius of the ablation zone, the acquired images were transformed into a polar presentation by displaying the Hounsfield units (HU) as a function of angle and radius. From this polar presentation, the average HU radial profile was analyzed at each time point and the ablation zone radius was estimated. In addition, textural analysis was applied to the original CT images. The proposed algorithm identified high entropy regions and estimated the treated zone radius per time. The estimated ablated zone radii as a function of treatment durations were compared, by means of correlation coefficient and root mean square error (RMSE) to gross pathology measurements taken immediately post-treatment from similarly ablated tissue. Results: Both the estimated ablation radii and the treated zone radii demonstrated strong correlation with the measured gross pathology values (R² ≥ 0.89 and R² ≥ 0.86, respectively). The automated ablation radii estimation had an average discrepancy of less than 1 mm (RMSE = 0.65 mm) from the gross pathology measured values, while the treated zone radii showed a slight overestimation of approximately 1.5 mm (RMSE = 1.6 mm). Conclusions: Noninvasive monitoring ofMWablation using x-ray CT and image analysis is feasible. Automatic estimations of the ablation zone radius and the radius encompassing the treated zone that highly correlate with actual ablation measured values can be obtained. This technique can therefore potentially be used to obtain real time monitoring and improve the clinical outcome. [ABSTRACT FROM AUTHOR]

Purpose: The relationship between microwave ablation system operating frequency and ablation performance is not currently well understood. The objective of this study was to comparatively assess the differences in microwave ablation at 915 MHz and 2.45 GHz. Methods: Analytical expressions for electromagnetic radiation from point sources were used to compare power deposition at the two frequencies of interest. A 3D electromagnetic-thermal bioheat transfer solver was implemented with the finite element method to characterize power deposition and thermal ablation with asymmetrical insulated dipole antennas (single-antenna and dual-antenna synchronous arrays). Simulation results were validated against experiments in ex vivo tissue. Results: Theoretical, computational, and experimental results indicated greater power deposition and larger diameter ablation zones when using a single insulated microwave antenna at 2.45 GHz; experimentally, 32±4.1 mm and 36.3±1.0 mm for 5 and 10 min, respectively, at 2.45 GHz, compared to 24±1.7 mm and 29.5±0.6 mm at 915 MHz, with 30 W forward power at the antenna input port. In experiments, faster heating was observed at locations 5 mm (0.91 vs 0.49 .C/s) and 10 mm (0.28 vs 0.15 .C/s) from the antenna operating at 2.45 GHz. Larger ablation zones were observed with dual-antenna arrays at 2.45 GHz; however, the differences were less pronounced than for single antennas. Conclusions: Single- and dual-antenna arrays systems operating at 2.45GHzyield larger ablation zone due to greater power deposition in proximity to the antenna, as well as greater role of thermal conduction. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to explore frequency considerations for large-volume, deep thermal ablations with focused ultrasound. Though focal patterns, focal steering rate, and the size of focal clusters have all been explored in this context, frequency studies have generally explored shallower depths and hyperthermia applications. This study examines both treatment efficiency and near-field heating rate as functions of frequency and depth. Methods: Flat, 150 mm transducer arrays were simulated to operate at frequencies of 250, 500, 750, 1000, 1250, and 1500 kHz. Each array had ?/2 interelement spacing yielding arrays of 2000-70 000 piston-shaped elements arranged in concentric rings. Depths of 50, 100, and 150 mm were explored, with attenuation (a) values of 2.5-10 (Np/m)/MHz. Ultrasound propagation was simulated with the Rayleigh-Sommerfeld integral over a volume of homogeneous simulated tissue. Absorbed power density was determined from the acoustic pressure which, in turn, was modeled with the Pennes bioheat transfer equation. Using this knowledge of temperature over time, thermal dose function of Sapareto and Dewey was used to model the resulting bioeffect of each simulated sonication. Initially, single foci at each depth, frequency, and a were examined with either fixed peak temperatures or fixed powers. Based on the size of the resulting, single foci lesions, larger compound sonications were designed with foci packed together in multiple layers and rings. For each depth, focal patterns were chosen to produce a similar total ablated volume for each frequency. These compound sonications were performed with a fixed peak temperature at each focus. The resulting energy efficiency (volume ablated per acoustic energy applied), near-field heating rate (temperature increase in the anterior third of the simulation space per unit volume ablated), and near- and far-field margins were assessed. Results: Lesions of comparable volume were created with different frequencies at different depths. The results reflect the interconnected nature of frequency as it effects focal size (decreasing with frequency), peak pressure (generally increasing with frequency), and attenuation (also increasing with frequency). The ablation efficiency was the highest for a = 5 (Np/m)/MHz at a frequency of 750 kHz at each depth. For a = 10 (Np/m)/MHz, efficiency was the highest at 750 kHz for a depth of 50 mm, and 500 kHz at depths of 100 and 150 mm. At all sonication depths, near-field heating was minimized with lower frequencies of 250 and 500 kHz. Conclusions: Large-volume ablations are most efficient at frequencies of 500-750 kHz at depths of 100-150 mm. When one considers that near-field heat accumulation tends to be the rate limiting factor in large-volume ablations like uterine fibroid surgery, the results show that frequencies as low as 500 kHz are favored for their ability to reduce heating in the near-field. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the spatial distribution and temporal development of liver tissue contraction during high-temperature ablation by using intraprocedural computed tomography (CT) imaging. Methods: A total of 46 aluminum fiducial markers were positioned in a 60 × 45 mm grid, in a single plane, around a microwave ablation antenna in each of six ex vivo bovine liver samples. Ablations were performed for 10 min at 100 W. CT data of the liver sample were acquired every 30 s during ablation. Fiducial motion between acquisitions was tracked in postprocessing and used to calculate measures of tissue contraction and contraction rates. The spatial distribution and temporal evolution of contraction were analyzed. Results: Fiducial displacement indicated that the zone measured postablation was 8.2± 1.8 mm (~20%) smaller in the radial direction and 7.1 ± 1.0 mm (~10%) shorter in the longitudinal direction than the preablation tissue dimension. Therefore, the total ablation volume was reduced from its preablation value by approximately 45%. Very little longitudinal contraction was noted in the distal portion of the ablation zone. Central tissues contracted more than 60%, which was near an estimated limit of ~70% based on initial water content. More peripheral tissues contracted only 15% in any direction. Contraction rates peaked during the first 60 s of heating with a roughly exponential decay over time. Conclusions: Ablation zones measured posttreatment are significantly smaller than the pretreatment tissue dimensions. Tissue contraction is spatially dependent, with the greatest effect occurring in the central ablation zone. Contraction rate peaks early and decays over time. [ABSTRACT FROM AUTHOR]

Purpose: The dynamic mode decomposition (DMD) method is used to provide a reliable forecasting of tumor ablation treatment simulation in real time, which is quite needed in medical practice. To achieve this, an extended Pennes bioheat model must be employed, taking into account both the water evaporation phenomenon and the tissue damage during tumor ablation. Methods: A meshless point collocation solver is used for the numerical solution of the governing equations. The results obtained are used by the DMD method for forecasting the numerical solution faster than the meshless solver. The procedure is first validated against analytical and numerical predictions for simple problems. The DMD method is then applied to three-dimensional simulations that involve modeling of tumor ablation and account for metabolic heat generation, blood perfusion, and heat ablation using realistic values for the various parameters. Results: The present method offers very fast numerical solution to bioheat transfer, which is of clinical significance in medical practice. It also sidesteps the mathematical treatment of boundaries between tumor and healthy tissue, which is usually a tedious procedure with some inevitable degree of approximation. The DMD method provides excellent predictions of the temperature profile in tumors and in the healthy parts of the tissue, for linear and nonlinear thermal properties of the tissue. Conclusions: The low computational cost renders the use of DMD suitable for in situ real time tumor ablation simulations without sacrificing accuracy. In such a way, the tumor ablation treatment planning is feasible using just a personal computer thanks to the simplicity of the numerical procedure used. The geometrical data can be provided directly by medical image modalities used in everyday practice. [ABSTRACT FROM AUTHOR]

Gold nanoparticles can be engineered to target cancerous cells and at the same time designed to absorb specific wavelengths of light. Consequently, with the presence of optically tunable gold nanoparticles such as gold nanoshells, light can be effectively converted to heat via photothermal effect well enough to raise the temperature of medium surrounding gold nanoshells for thermal ablation or hyperthermia treatments of cancers. In this study, the authors proposed a new computational method to estimate thermal response of gold nanoshells embedded in a tissue-like medium when illuminated by a near-infrared (NIR) laser. Specifically, the light transport theory with diffusion approximation was initially applied to model the temperature rise within a medium without gold nanoshells as a result of the dissipation of the NIR laser power throughout the medium. After then, the heat generated by individual gold nanoshells due to photothermal effect was calculated and combined with the results for the medium without gold nanoshells to estimate the global elevation of temperature within the gold nanoshell-laden medium. The current computational model was tested for its validity using two different phantom examples, one of which was similar to a previously reported phantom experiment. The test demonstrated the capability of the current model in terms of producing qualitatively reasonable results, while it also revealed a number of potential differences in the assumptions for the current model and previous experiment. After an adjustment in the model parameters to properly take into account such differences, the computational results and the experimental data matched reasonably well within the average percentage difference of 10%. [ABSTRACT FROM AUTHOR]

Heat therapies such as hyperthermia and thermoablation are very promising approaches in the treatment of cancer. Compared with available hyperthermia modalities, magnetic fluid hyperthermia (MFH) yields better results in uniform heating of the deeply situated tumors. In this approach, fluid consisting of superparamagnetic particles (magnetic fluid) is delivered to the tumor. An alternating (ac) magnetic field is then used to heat the particles and the corresponding tumor, thereby ablating it. However, one of the most serious shortcomings of this technique is the unwanted heating of the healthy tissues. This results from the magnetic fluid diffusion from the tumor to the surrounding tissues or from incorrect localization of the fluids in the target tumor area. In this study, the authors demonstrated that by depositing appropriate static (dc) magnetic field gradients on the alternating (ac) magnetic fields, focused heating of the magnetic particles can be achieved. A focused hyperthermia system was implemented by using two types of coils: dc and ac coils. The ac coil generated the alternating magnetic field responsible for the heating of the magnetic particles; the dc coil was used to superimpose a static magnetic field gradient on the alternating magnetic field. In this way, focused heating of the particles was obtained in the regions where the static field was dominated by the alternating magnetic field. In vitro experiments showed that as the magnitude of the dc solenoid currents was increased from 0 to 1.8 A, the specific absorption rate (SAR) of the superparamagnetic particles 2 cm apart from the ac solenoid center decreased by a factor of 4.5, while the SAR of the particles at the center was unchanged. This demonstrates that the hyperthermia system is capable of precisely focusing the heat at the center. Additionally, with this approach, shifting of the heat focus can be achieved by applying different amounts of currents to individual dc solenoids. In vivo experiments were performed with adult rats, where magnetic fluids were injected percutaneously into the tails (with homogeneous fluid distribution inside the tails). Histological examination showed that, as we increased the dc solenoid current from 0.5 to 1.8 A, the total burned volume decreased from 1.6 to 0.2 cm3 verifying the focusing capability of the system. The authors believe that the studies conducted in this work show that MFH can be a much more effective method with better heat localization and focusing abilities. [ABSTRACT FROM AUTHOR]

Purpose: Finite element method (FEM) models are commonly used to simulate radio frequency (RF) tumor ablation. Prior FEM models of RF ablation have either ignored the temperature dependent effect of microvascular perfusion, or implemented the effect using simplified algorithms to reduce computational complexity. In this FEM modeling study, the authors compared the effect of different microvascular perfusion algorithms on ablation zone dimensions with two commercial RF electrodes in hepatic tissue. They also examine the effect of tissue type and inter-patient variation of perfusion on ablation zone dimensions. Methods and Materials: The authors created FEM models of an internally cooled and multi-tined expandable electrode. RF voltage was applied to both electrodes (for 12 or 15 min, respectively) such that the maximum temperature in the model was 105 °C. Temperature dependent microvascular perfusion was implemented using three previously reported methodologies: cessation above 60 °C, a standard first-order Arrhenius model with decreasing perfusion with increasing degree of vascular stasis, and an Arrhenius model that included the effects of increasing perfusion at the ablation zone boundary due to hyperemia. To examine the effects of interpatient variation, simulations were performed with base line and ±1 standard deviation values of perfusion. The base line perfusion was also varied to simulate the difference between normal and cirrhotic liver tissue. Results: The ablation zone volumes with the cessation above 60 °C perfusion algorithm and with the more complex Arrhenius model were up to 70% and 25% smaller, respectively, compared to the standard Arrhenius model. Ablation zone volumes were up to ∼175% and ∼100% different between the simulations where -1 and +1 standard deviation values of perfusion were used in normal and cirrhotic liver tissue, respectively. Conclusions: The choice of microvascular perfusion algorithm has significant effects on final ablation zone dimensions in FEM models of RF ablation. The authors also found that both interpatient variation in base line tissue perfusion and the reduction in perfusion due to cirrhosis have considerable effect on ablation zone dimensions. [ABSTRACT FROM AUTHOR]