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Atrial fibrillation (AF) is the most frequent cardiac arrhythmia. Left atrial catheter ablation is currently performed to treat this disease. Several energy sources are used, such as radio-frequency or cryotherapy. The main target of this procedure is to isolate the pulmonary veins. However, significant complications caused by the invasive procedure are described, such as stroke, tamponade, and atrioesophageal fistula, and a second intervention is often needed to avoid atrial fibrillation recurrence. For these reasons, a minimally-invasive device allowing performance of more complex treatments is still needed. High-intensity focused ultrasound (HIFU) can cause deep tissue lesions without damaging intervening tissues. Left atrial ultrasound-guided transesophageal HIFU ablation could have the potential to become a new ablation technique. The goal of this study was to design and test a minimally-invasive ultrasound-guided transesophageal HIFU probe under realistic treatment conditions. First, numerical simulations were conducted to determine the probe geometry, and to validate the feasibility of performing an AF treatment using a HIFU mini-maze (HIFUMM) procedure. Then, a prototype was manufactured and characterized. The 18-mm-diameter probe head housing contained a 3-MHz spherical truncated HIFU transducer divided into 8 rings, with a 5-MHz commercial transesophageal echocardiography (TEE) transducer integrated in the center. Finally, ex vivo experiments were performed to test the impact of the esophagus layer between the probe and the tissue to treat, and also the influence of the lungs and the vascularization on lesion formation. First results show that this prototype successfully created ex vivo transmural myocardial lesions under ultrasound guidance, while preserving intervening tissues (such as the esophagus). Ultrasound-guided transesophageal HIFU can be a good candidate for treatment of AF in the future.

Interstitial ultrasound applicators can be a minimally invasive alternative for treating targets that are unresectable or are inaccessible by extracorporeal methods. Dual-mode transducers for ultrasound imaging and therapy were developed to address the constraints of a miniaturized applicator and real-time treatment monitoring. We propose an original treatment strategy that combines ultrasound imaging and therapy using a dual-mode transducer rotating at 8 revolutions per second. Real-time B-mode imaging was interrupted to emit high-intensity ultrasound over a selected therapy aperture. A full 360 degrees image was taken every 8th rotation to image the therapy aperture. Numerical simulations were performed to study the effect of rotation on tissue heating, and to study the effect of the treatment sequence on transducer temperature. With the time-averaged transducer surface intensity held at 12 W/cm(2) to maintain transducer temperature below 66 degrees C, higher field intensities and deeper lesions were produced by narrower therapy apertures. A prototype system was built and tested using in vitro samples of porcine liver. Lesions up to 8 mm were produced using a time-averaged transducer surface intensity of 12 W/cm(2) applied for a period of 240 s over a therapy aperture of 40 degrees. Apparent strain imaging of the therapy aperture improved the contrast between treated and spared tissues, which could not be differentiated on B-mode images. With appropriate limits on the transducer output, real-time imaging and deep thermal ablation are feasible and sustainable using a rotating dual-mode transducer.

The study investigates a new sonication strategy with high-intensity focused ultrasound (HIFU), aiming for improvement of the original Ablatherm procedure in the prostate cancer treatment. The currently implemented and clinically used method (defined as reference) uses a single-element transducer, operated with 60% duty cycle. To implement the novel strategy, the active surface was split into two sectors, which can be powered either sequentially (for temporal switching) or simultaneously (equivalent to a single-element transducer). Numerical simulations were used to predict the lesion shape and to determine for the novel strategy the best set of treatment parameters among the 99 explored cases. The same pattern for the focal point trajectory was executed irrespectively to the sector activating mode. The theoretical duty cycle reached 100% for the sector switching strategy. The HIFU device was built MRI compatible, and consisted of two mirror symmetrical sectors operating at 3 MHz, shaped as a truncated spherical cap. The two sonication strategies were experimentally tested on fresh samples of degassed porcine liver, using fast MR thermometry (proton resonance frequency shift method with voxel size 0.85 x 0.85 x 4.25 mm (3), 2 s/dynamic, 0.5 ( degrees ) C temperature accuracy, two orthogonal slices). A practical value of 87.5% overall duty cycle could be experimentally implemented. The performance of the two sonication strategies was comparatively assessed based on: cumulated thermal dose derived from MR temperature maps, postoperatory MR morphological images sensitive to tissue contrast changes (inversion-recovery T1-weighted turbo spin-echo, voxel size 0.5 x 0.5 x 4 mm (3)) and postoperatory macroscopic tissue examination. Using a sector-switching sonication strategy for prostate cancer treatment-induced lesions of similar size and shape as for the reference approach. When considering the available reserve of duty cycle and the exact lesion size, we concluded the treatment time was reduced by 20% with the new sector switching strategy at equal performance. Further in vivo studies are considered mandatory for preclinical validation.

New clinical concepts in lithotripsy demand small shock heads. Reducing the size of piezoelectric shock heads will be possible only if the pressure generated at the surface of each transducer can be increased so that the total pressure at the focus remains the same. To solve this problem, different solutions were proposed. For example, it has been demonstrated that piezocomposite material, as opposed to piezoceramic material, allows the generation of a higher surface pressure before breaking, mainly because radial modes are dramatically reduced. In addition, in a previous paper, we showed the feasibility of generating high-pressure pulse waves without increasing the transducer voltage by using sandwiched transducers, which are a stack of two or more transducers. Some discrepancies appeared, however, between the pressure measured at the surface of the front transducer and the arithmetic sum of the pressures generated by each transducer constituting the stack. In fact, development of such stacked transducers capable of generating surface pressures in the range of 2 to 5 MPa is very complex, which may explain why no aging tests have been reported in the literature thus far. In the first part of this paper, we theoretically determine the importance of the electroacoustical coupling between the two transducers on the generated surface pressure. We show that pressure losses due to these electroacoustical couplings are less than 5%. Experimental measurements done on a stacked transducer assembled and tightened in a castor oil-filled tank are in excellent accordance with the theoretical measurements. Using this assembly technique, it was possible to obtain, on average, out of four elements, a pressure of 7.5 MPa for the duration of 4 million shocks, which would allow the treatment of approximately 1000 patients.

The aim of this study is to demonstrate the feasibility of a new spherically curved 1.5-D phased array for the treatment of localized prostatic cancer. The device is designed to conform to the Ablatherm machine (EDAP-Technomed, France), a commercially available machine in which high intensity focused ultrasound (HIFU) treatment for prostate cancer is administered transrectally. It uses high intensity electronically focused ultrasound to steer a beam along two axes, allowing enough depth to be reached to treat large prostates and eliminating two degrees of mechanical movement. Through computer simulation, it was determined that a curved 1.5-D configuration offered the optimal design. Two configurations were then proposed, and their ability to steer a beam within a target volume centered on the geometric focus of the transducer was simulated. An eight-element prototype was constructed to test the piezo-composite material and its electro-acoustical efficiency. Then, an array was constructed, and a multi-channel amplifier and control system were added, to permit remote operation. Acoustical and electrical measurements were made to verify performance. Finally, the 1.5-D array was tested in vitro on samples of pig liver to confirm the ability to induce lesions.

Existing methods for the modeling of piezoelectric transducer response are generally frequency domain-based. The major disadvantage of this type of model is that they cannot take into account the electrical elements present in the emitting or receiving circuit whose values vary with respect to time. The need for a method that accounts for time-varying elements arises, for example, when the circuit comprises active electrical elements, such as diodes, or when the transducer is excited by capacitive discharge via a switch. Indeed, in this last example, it is known that the output impedance of the generator depends on the state of the switch: if it is off, its value is high; if it is on, its value is low. A time domain-based method is presented to compute the electro-acoustical response of a piezoelectric transducer and its electrical circuit, taking into account the presence of time-varying elements. An application to a current example makes it possible to show the influence of these elements on waveforms and the capacity of our model to account for them.