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Objective: Radiofrequency ablation (RFA) uses the heat generated by a high‐frequency alternating electric current, and according to Ohm's and Joule's law, the delivered current is inversely proportional to the circuit impedance. The primary objective of this study was to investigate whether tissue impedance during radiofrequency ablation (RFA) for benign thyroid nodules is related to the degree of volume reduction. Methods: This observational study included consecutive patients treated with RFA for benign thyroid nodules from February 2020 to August 2023. Technical effectiveness was defined as a volume reduction percentage (VRP) >75% at 6 months after the treatment. Multivariate logistic regression analyses were performed to identify the potential role of clinical factors and changes in tissue impedance on technique effectiveness. Results: Totally 72 patients were included with 73 benign thyroid nodules. Maximal impedance peaks reached <18 times, and mean procedural impedance ≤300 Ω were significantly associated with a volume decrease of >75% at bivariate analysis. These cutoff points were exploratory, as no existing literature suggests these variables are related to the degree of volume reduction. After adjusting for age, volume, and composition, significant associations were found for mean electrical impedance in the multivariate analysis (OR = 4.86 [confidence interval [CI] 1.29–18.26], p = 0.019). The energy adjusted by volume (delivered energy) was not associated with a VRP >75% (p = 0.7746). Conclusions: This study suggests that a mean procedural impedance

Primary lung cancer is the leading cause of cancer‐related death worldwide. Recent statistics estimate 1.8 million new cases and 1.6 million deaths per year. Despite significant advances in surgery, chemotherapy, and radiotherapy, the 5‐year survival rate remains at just 18%. Thermal ablation is an established treatment that is safe and effective. It refers to the local application of controlled heat to induce irreversible cell injury and ultimately tumor apoptosis and necrosis. This approach is particularly suitable for the treatment of small tumors in patients who are not suitable for surgery. However, the lack of suitable benchtop models to assess ablation devices complicates prognostic prediction and the development of effective treatment strategies. In this context, the development of a 3D lung tumor model is presented using a cancer cell‐laden hydrogel composed of 2% hyaluronic acid–tyramine (HA‐TA) and 0.5% agarose, resulting in a tumor mimetic of clinically relevant size. This innovative model provides a valuable platform for testing ablation devices and provides insights that can significantly improve prognostic ability and refine treatment approaches for lung cancer patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of thermal ablation (TA) for the treatment of cervical dysplasia on fertility and pregnancy outcomes among women screened for cervical cancer in Cameroon. Design: Retrospective cohort study. Setting: Dschang health district, Cameroon. Population: Participants aged 30–45 years from two screening trials conducted between 2015 and 2020 in Dschang District Hospital. Methods: Participants were primarily screened for human papillomavirus infection, triaged by visual inspection and treated by TA if needed. Between October 2021 and March 2022, interviews on subsequent fertility were conducted with participants treated by TA and a control group of untreated women. Main Outcome Measures: Pregnancy and miscarriage after screening/treatment. Results: A total of 760 participants (219 treated and 541 untreated) completed the survey, with a mean follow‐up time of 1297 days. Sixty‐two women (28.3%) treated by TA reported a pregnancy postscreening versus 165 (30.5%) in the control group (p = 0.550). Adjusted for potential confounders, the hazard ratio of pregnancy for treated compared with untreated women was 0.82 (0.54–1.24, p = 0.350). Among women reporting pregnancies with a known outcome and which were not voluntarily terminated, 18 (35.3%) treated participants had a miscarriage versus 31 (21.4%) in the control group (p = 0.048). In the adjusted model, no association remained between TA and miscarriage (1.04, 0.39–2.78, p = 0.935). Conclusions: In our study population, TA did not significantly impact fertility nor miscarriage risk. Our results support the widespread use of TA as a treatment of choice for precancerous cervical lesions in low‐income settings. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness and safety of salvage stereotactic ablative body radiotherapy (SABR) for recurrent renal cell carcinoma (RCC) after thermal ablation (TA). Materials and Methods: This study was a multi‐institutional retrospective analysis of patients with recurrent RCC following TA who received SABR between 2016 and 2020. The primary study outcome was freedom from local failure, evaluated radiographically based on Response Evaluation Criteria in Solid Tumours (RECIST) v1.1. Distant failure, cancer‐specific survival (CSS), overall survival (OS), treatment‐related toxicity and renal function changes following SABR were the secondary outcomes. The Kaplan–Meier method was used to estimate freedom from local and distant failure, CSS and OS. Results: Seventeen patients with 18 biopsy‐confirmed RCCs were included, with a median (interquartile range [IQR]) age at time of SABR of 75.2 (72.6–68.7) years, a median (IQR) tumour size of 3.5 (1.9–4.1) cm and follow‐up (reverse Kaplan–Meier method) of 3.36 (95% confidence interval [CI] 1.6–4.1) years. Six of the 17 patients had a solitary kidney. Five patients had failed repeat TA prior to SABR. The median (IQR) time from TA procedure to SABR was 3.03 (1.5–5.1) years. No patient experienced local progression, with a local control rate of 100%. Four patients, two with baseline metastatic disease, experienced distant progression. The distant progression‐free survival, CSS and OS at 3 years were 72.1% (95% CI 51.9%–100%), 92.3% (95% CI 78.9%–100%) and 82.1% (95% CI 62.1%–100%), respectively. The median (IQR) glomerular filtration rate before SABR was 58 (40–71) mL/min, and at last follow‐up, it was 48 (33–57) mL/min. No patient experienced grade 3+ toxicity or went on to develop end‐stage renal disease. Conclusion: The results showed that SABR appears to be an effective and safe salvage strategy in patients with recurrent RCC following TA. [ABSTRACT FROM AUTHOR]

Summary: Percutaneous treatment of hepatocellular carcinoma (HCC) by means of thermal ablation (TA) has been introduced in clinical guidelines as a potentially curative treatment for the early stages of the disease since the early 2000s. Due to its safety profile and cost‐effectiveness, TA can be offered as a first‐line treatment for patients with HCC smaller than 3 cm. Thermal ablative techniques are in fact widely available at many centres worldwide and include radiofrequency (RF) and microwave (MW) ablation, with the latter increasingly applied in clinical practice in the last decade. Pre‐clinical studies highlighted, as potential advantages of MW‐based ablation, the ability to achieve higher temperatures (>100°C) and larger ablation zones in shorter times, with less susceptibility to blood flow‐induced heat sink effects. Despite these advantages, there is no evidence of superior overall survival in patients treated with MW as compared to those treated with RF ablation. Local control has been proven to be superior to MW ablation with a similar complication rate. It is expected that further improvement of TA results in the treatment of HCC will result from the refinement of guidance and monitoring tools and the careful assessment of ablation margins. Thermal ablative treatments may also be performed on nodules larger than 3 cm by applying multiple devices or combining percutaneous and intra‐arterial approaches. The role of novel immunotherapy regimens in combination with ablation is also currently under evaluation in clinical trials, with several potential benefits. In this review, indications, technical principles, results, and future prospects of TA for the treatment of HCC will be examined. [ABSTRACT FROM AUTHOR]

Nonsmall cell lung cancer (NSCLC) is treated by various therapies such as surgical intervention, radiotherapy, chemotherapy, molecular targeted therapy, and immunotherapy. Currently, molecular targeted therapy, including epidermal growth factor receptor (EGFR) inhibitors and Anaplastic Lymphoma Kinase (ALK) and Kirsten Rat Sarcoma viral Oncogene (KRAS) inhibitors, has received much attention and improved the prognosis of NSCLC. Nevertheless, the terminal point of molecular targeted drugs is resistance. Drug resistance has been classified into oligoprogression and extensive progression based on the tumor lesion progression after drug resistance. There is extensive research demonstrating that local therapy (surgical resection, radiotherapy, and thermal ablation) can prolong the survival of patients with drug resistance. This review is intended to determine the efficacy of image‐guided thermal ablation in patients with NSCLC with EGFR mutation. [ABSTRACT FROM AUTHOR]

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]

Objective: Thyroidectomy is the first‐line treatment for papillary thyroid microcarcinoma (PTMC), but often involves aggressive overtreatment. Thermal ablation (TA) has been gradually used for the treatment of recurrent PTMC. However, it is not recommended for the treatment of primary PTMC according to the Korean and Italian guidelines. Therefore, this systematic review aimed to analyse the indications, efficacy, and safety of TA in the treatment of PTMC. Design: Systematic review. Patients and Measurements: A search strategy was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. A total of 27 articles were included in this study until January 2022. Results: According to current guidelines and studies, we divided the indications of TA for PTMC into six primary and three secondary indications. Laser ablation (LA) has the advantages of a small needle, accurate output energy and precision ablation, and it is safe to important organs around the lesion. The patients recover quickly after radiofrequency ablation (RFA), with no major complications, recurrence, or lymph node metastasis. The volume reduction rate after RFA was the highest, followed by microwave ablation and LA, and the improvement in patient quality of life after TA was significantly better than after thyroidectomy. Conclusions: TA is an effective alternative method for surgery in the treatment of low‐risk PTMC and has the advantages of being minimally invasive, economical, having less bleeding and having a high postoperative quality of life. [ABSTRACT FROM AUTHOR]

Non‐small cell lung cancer (NSCLC) is the most common type of lung cancer. Clinically, 40–50% of patients with NSCLC are found to have systemic metastasis at the initial diagnosis. Meanwhile, 30–75% of patients with lung cancer who have undergone radical surgical resection have local recurrence and distant metastases. However, not all distant metastases are multiple, and some are potentially curable. In this study, among the patients with NSCLC having distant organ metastasis, approximately 7% showed extrapulmonary solitary metastasis and remained in this relatively stable state for a long time. This form of metastasis is known as NSCLC oligometastases. This review describes the concept and classification of oligometastases, as well as the local treatment and prognosis of extracranial oligometastases. [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]

Up to 70% of limb amputees develop chronic postamputation neuropathic pain (CPANP) which includes phantom pain and residual limb neuropathic pain due to neuroma formation. CPANP often requires invasive procedures aimed at neuroma ablation. Five amputees received 6 noninvasive magnetic resonance‐guided high‐intensity‐focused ultrasound MRgHIFU treatments ExAblate®, Insightec, Tirat‐Carmel, Israel). Although ablative temperature (>65°C) at the neuroma was reached in only 1 patient, pain intensity dropped from 5.7 at baseline to 4.3 and back to 5.6 at 3 and 6 month follow‐up. Post‐treatment bone necrosis was demonstrated in 1 patient. Although no firm conclusion about the effectiveness of MRgHIFU for CPANP could be drawn, further studies are warranted. [ABSTRACT FROM AUTHOR]

Objective: Many large benign thyroid nodules have symptoms and cosmetic problems. This study consisted of a meta‐analysis to accurately assess the effect of thermal ablation on these nodules. Methods: The PubMed, Embase, Web of Science, and Scopus databases were systematically searched for retrospective or prospective studies of thermal ablation since June 1, 2021. The weighted mean differences of the measures were analysed before and after treatment. Results: A total of 10 eligible studies were included. By comparing the initial nodule volume with the nodular volume after thermal ablation, we found that the volume reduction rate was increased significantly after 1 month (SMD = 0.453, 95% CI: 0.323–0.583, p <.001), 3 months (SMD = 0.655, 95% CI: 0.563–0.747, p <.001), 6 months (SMD = 0.691, 95% CI: 0.607–0.774, p <.001), and 12 months (SMD = 0.694, 95% CI: 0.583–0.803), p <.001). The nodular volume was also found to decrease significantly, after 1 month (SMD = 2.381, 95% CI: 1.278–3.485, p <.001), 3 months (SMD = 5.071, 95% CI: 2.386–7.756, p <.001), 6 months (SMD = 5.363, 95% CI: 2.765–7.962, p <.001), and 12 months (SMD = 8.194, 95% CI: 2.113–14.274), p <.001). Symptom score (SMD = 4.419, 95% CI: 2.573–6.265, p <.001)and cosmetic score (SMD = 4.245, 95% CI: 2.566–5.359, p <.001) were reduced after thermal ablation. Conclusions: Thermal ablation could become an alternative to manage large benign thyroid nodules. [ABSTRACT FROM AUTHOR]

Independent of tumor type and non‐invasive or minimally‐invasive feature, current physical treatments including ultrasound therapy, microwave ablation (MWA), and radiofrequency ablation (RFA) are widely used as the local treatment methods in clinics for directly killing tumors and activating systematic immune responses. However, the activated immune responses are inadequate and incompetent for tumor recession, and the incomplete thermal ablation even aggravates the immunosuppressive tumor microenvironment (ITM), resulting in the intractable tumor recurrence and metastasis. Intriguingly, nanomedicine provides a powerful platform as they can elevate energy utilization efficiency and augment oncolytic effects for mitigating ITM and potentiating the systematic immune responses. Especially after combining with clinical immunotherapy, the anti‐tumor killing effect by activating or enhancing the human anti‐tumor immune system is reached, enabling the effective prevention against tumor recurrence and metastasis. This review systematically introduces the cutting‐edge progress and direction of nanobiotechnologies and their corresponding nanomaterials. Moreover, the enhanced physical treatment efficiency against tumor progression, relapse, and metastasis via activating or potentiating the autologous immunity or combining with exogenous immunotherapeutic agents is exemplified, and their rationales are analyzed. This review offers general guidance or directions to enhance clinical physical treatment from the perspectives of immunity activation or magnification. [ABSTRACT FROM AUTHOR]

This longitudinal study aimed at evaluating the effectiveness, acceptability and safety of the thermal ablation procedure (TA) in the treatment of cervical neoplasia. Women referred to the Gynaecology ward for symptoms or for opportunistic screening were assessed by visual inspection with acetic acid (VIA) and colposcopy. Those with lesions eligible to ablation were counselled and treated by TA. They were inquired about the level of pain during the procedure, and their level of satisfaction. Patients were followed up at 6 weeks for any complication and reassessed by VIA and colposcopy at 12 months for any persistent or recurrent lesion and for any adverse event. A total of 86 women with a positive VIA test were included in the study. The mean age was 46 years (28‐61 years). Most of the women did not complain about any adverse event during treatment; one‐third presented mild pain or cramp. At the 6‐week visit, watery discharge was the main adverse event reported. All women were highly satisfied with TA and most of them would recommend it. At the 12‐month visit, 82 women were examined (95% follow‐up rate), and the overall cure rate was 96% (low‐grade lesions: 98%; high‐grade lesions: 94%). Three women presented low‐ and high‐grade lesions that were treated by TA. No major adverse event or hospitalisation after the treatment was reported. In conclusion, TA was an effective procedure with a high cure rate at the 1‐year follow‐up visit. It was acceptable and safe, with only minor short‐term side‐effects reported and with a high satisfaction rate among the patients. [ABSTRACT FROM AUTHOR]

Thermal ablation is a well‐established successful treatment for cardiac arrhythmia, but it still presents limitations that require further studies and developments. In the rotor‐driven functional re‐entry arrhythmia, tissue heterogeneity results on the generation of spiral/scroll waves and wave break dynamics that may cause dangerous sustainable fibrillation. The selection of the target region to perform thermal ablation to mitigate this type of arrhythmia is challenging, since it considerably affects the local electrophysiology dynamics. This work deals with the numerical simulation of the thermal ablation of a cardiac muscle tissue and its effects on the dynamics of rotor‐driven functional re‐entry arrhythmia. A non‐homogeneous two‐dimensional rectangular region is used in the present numerical analysis, where radiofrequency ablation is performed. The electrophysiology problem for the propagation of the action potential in the cardiac tissue is simulated with the Fenton–Karma model. Thermal damage caused to the tissue by the radiofrequency heating is modeled by the Arrhenius equation. The effects of size and position of a heterogeneous region in the original muscle tissue were first analyzed, in order to verify the possible existence of the functional re‐entry arrhythmia during the time period considered in the simulations. For each case that exhibited re‐entry arrhythmia, six different ablation procedures were analyzed, depending on the position of the radiofrequency electrode and heating time. The obtained results revealed the effects of different model parameters on the existence and possible mitigation of the functional re‐entry arrhythmia. [ABSTRACT FROM AUTHOR]

Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image‐guided procedural techniques. The image guidance allows real‐time visualization and precision placement of a needle, catheter, wire and device to deep body structures through small incisions. Advantages include reduced risks, faster recovery and shorter hospital stays, lower costs and less patient discomfort. The range of chest interventional procedures keeps on expanding due to improved imaging facilities, better percutaneous assess devices and advancing ablation and embolization techniques. These advances permit procedures to be undertaken safely, simultaneously and effectively, hence escalating the role of IR in the treatment of chest disorders. This review article aims to cover the latest developments in some image‐guided techniques of the chest, including thermal ablation therapy of lung malignancy, targeted therapy of pulmonary embolism, angioplasty and stenting of mediastinal venous/superior vena cava occlusion, pulmonary arteriovenous malformation treatment and bronchial artery embolization for haemoptysis. [ABSTRACT FROM AUTHOR]

Various heat transmits models exhibit a thermal response in the tissue during thermal therapies. In the present work, we proposed a three‐phase‐lag (TPL) bio‐heat‐transmitting model including an external laser heating term amidst thermal treatment for the generalized coordinate system. The TPL model is based on the law of heat conduction containing heat flux, temperature gradient, and thermal displacement gradient terms. The solution is determined by implementing a discretization scheme of finite difference in the company of the Runge–Kutta (4,5) technique to examine the temperature repercussion throughout the thermal treatment of the tumor. In addition to this, the impact of various parameters such as phase lag in heat flux, temperature gradient, thermal displacement gradient, the heat generated because of blood perfusion, metabolism, and external heat source term is studied. A comparison has been shown graphically during the thermal treatment. The temperature profile is studied for different coordinate systems, and results are discussed. Moreover, validation has been made of the TPL model used in this paper with the experimental results. Thus the outcomes achieved from this study are purposeful in the therapeutical field, especially for oncologists. [ABSTRACT FROM AUTHOR]

Advanced breast cancer with recurrent and distal organ metastasis is aggressive and incurable. The current existing treatment strategies for advanced breast cancer are difficult to achieve synergistic treatment of recurrent tumors and distant metastasis, resulting in poor clinical outcomes. Herein, a synergistic therapy strategy composed of biomimetic tumor‐derived exosomes (TEX)‐Liposome‐paclitaxel (PTX) with lung homing properties and gold nanorods (GNR)‐PEG, was designed, respectively. GNR‐PEG, with well biocompatibility, cured recurrent tumors effectively by thermal ablation under the in situ NIR irradiation. Meanwhile, GNR‐mediated thermal ablation activated the adaptive antitumor immune response, significantly increased the level of CD8+ T cells in lungs and the concentration of serum cytokines (tumor necrosis factor‐α, interlekin‐6, and interferon‐γ). Subsequently, TEX‐Liposome‐PTX preferentially accumulated in lung tissues due to autologous tumor‐derived TEX with inherent specific affinity to lung, resulting in a better therapeutic effect on lung metastasis tumors with the assistance of adaptive immunotherapy triggered by GNR in vivo. The enhanced therapeutic efficacy in advanced breast cancer was a combination of thermal ablation, adaptive antitumor immunotherapy, and targeted PTX chemotherapy. Hence, the synergistic strategy based on GNR and TEX‐Liposome provides selectivity to clinical treatment of advanced breast cancer with recurrent and metastasis. [ABSTRACT FROM AUTHOR]

Objective: Thermal ablation (TA) was implemented in public sector cervical cancer prevention services in Zambia in 2012. Initially introduced as a treatment modality in primary healthcare clinics, it was later included in mobile outreach campaigns and clinical research trials. We report the feasibility, acceptability, safety, and provider uptake of TA in diverse clinical contexts. Methods: Screening services based on visual inspection with acetic acid were offered by trained nurses to non-pregnant women aged 25–59 years. Women with a type 1 transformation zone (TZ) were treated with same-visit TA. Those with a type 2 or 3 TZ, or suspicious for cancer, were managed with same-visit electrosurgical excision or punch biopsy, respectively. A provider survey was conducted. Results: Between 2012 and 2020, 2123 women were treated with TA: primary healthcare clinics, n = 746; mobile outreach clinics, n = 1127; research clinics, n = 250. Of the 996 women treated in primary healthcare and research clinics, 359 (48%) were HIV positive. Mild cramping during treatment was the most common adverse effect. No treatment interruptions occurred. No major complications were reported in the early (6 weeks) follow-up period. Providers expressed an overwhelming preference for TA over cryotherapy. Conclusion: TA was feasible, safe, and acceptable in diverse clinical contexts. It was the preferred ablation method of providers when compared with cryotherapy. [ABSTRACT FROM AUTHOR]

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]

Background: The use of ultrasound‐guided ablation procedures to treat both benign and malignant thyroid conditions is gaining increasing interest. This document has been developed as an international interdisciplinary evidence‐based statement with a primary focus on radiofrequency ablation and is intended to serve as a manual for best practice application of ablation technologies. Methods: A comprehensive literature review was conducted to guide statement development and generation of best practice recommendations. Modified Delphi method was applied to assess whether statements met consensus among the entire author panel. Results: A review of the current state of ultrasound‐guided ablation procedures for the treatment of benign and malignant thyroid conditions is presented. Eighteen best practice recommendations in topic areas of preprocedural evaluation, technique, postprocedural management, efficacy, potential complications, and implementation are provided. Conclusions: As ultrasound‐guided ablation procedures are increasingly utilized in benign and malignant thyroid disease, evidence‐based and thoughtful application of best practices is warranted. [ABSTRACT FROM AUTHOR]

Microwave ablation has been considered as a promising therapy for the treatment of liver tumors. However, many antennas proposed in previous literature generated ellipsoidal ablation and also were not suitable for percutaneous intervention due to the lack of mechanical properties. To address these problems, a closed dual‐slot antenna was investigated to generate spherical ablation and designed with zirconia tip, which facilitated its ability to puncture into tissues, and metal tube, which provided mechanical strength for percutaneous puncture. A numerical model was constructed to optimize antenna geometry and analyze antenna performance. The reflection coefficient, specific absorption rate, and temperature distribution of the closed and conventional dual‐slot antennas were all simulated by using finite element method. The two antennas were also validated with ex vivo porcine livers, finding a great agreement between simulated and experimental results. The closed dual‐slot antenna generated a more spherical ablation zone (34.0 mm × 37.2 mm vs. 29.1 mm × 48.5 mm at 50 W for 10 min) with a lower reflection coefficient (−30.3 vs. −9.5 dB) than did conventional dual‐slot antenna, and showed qualified mechanical properties for clinical application, which may be further applied to clinical percutaneous intervention to treat liver tumors effectively. [ABSTRACT FROM AUTHOR]

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 imaging (MRI) has become a popular modality in guiding minimally invasive thermal therapies, due to its advanced, nonionizing, imaging capabilities and its ability to record changes in temperature. A variety of MR thermometry techniques have been developed over the years, and proton resonance frequency (PRF) shift thermometry is the current clinical gold standard to treat a variety of cancers. It is used extensively to guide hyperthermic thermal ablation techniques such as high‐intensity focused ultrasound (HIFU) and laser‐induced thermal therapy (LITT). Essential attributes of PRF shift thermometry include excellent linearity with temperature, good sensitivity, and independence from tissue type. This noninvasive temperature mapping method gives accurate quantitative measures of the temperature evolution inside biological tissues. In this review, the current status and new developments in the fields of MR‐guided HIFU and LITT are presented with an emphasis on breast, prostate, bone, uterine, and brain treatments. Level of Evidence: 5 Technical Efficacy Stage: 3 [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether phase‐shift perfluoropetane (PFP) nanoemulsions can enhance pulsed high‐intensity focused ultrasound (HIFU) ablation. Methods: PFP was encapsulated by poly(lactic‐co‐glycolic acid) (PLGA) to form a nanometer‐sized droplet (PLGA‐PFP), which was added to an isolated perfused liver system. Meanwhile, phosphate‐buffered saline (PBS) was used as a control. The perfused liver was exposed to HIFU (150 W, t = 3/5/10 s) at various duty cycles (DCs). The ultrasound images, cavitation emissions, and temperature were recorded. Rabbits with subcutaneous VX2 tumors were exposed to HIFU (150 W) at various DCs with or without PLGA‐PFP. After ablation, necrosis volume and energy efficiency factor were calculated. Pathologic characteristics were observed. Results: Compared to the PBS control, PLGA‐PFP nanoemulsions markedly enhanced HIFU‐induced necrosis volume in both perfused livers and subcutaneous VX2 tumor‐bearing rabbits (P <.05). Inertial cavitation was much stronger in the pulsed‐HIFU exposure at 10% than that in the continuous‐wave HIFU exposure (P <.01). Peak temperature at 100% DC was significantly higher than that at 10% (P <.05). Compared to 100% DC HIFU exposure, the mean necrosis volume induced by 10 s exposure at 50% DC was significantly larger (P <.005) but lower at 10% DC in the isolated perfused livers (P <.05). In addition, the mean necrosis volume in subcutaneous VX2 tumor‐bearing rabbits was significantly increased after HIFU exposure at 10% DC when compared to those at 100% DC (P <.05). Histopathologic analysis showed liquefaction necrosis in pulsed HIFU. Conclusion: PLGA‐PFP nanoemulsions can enhance HIFU ablation in the isolated perfused livers and promote tumor ablation in the subcutaneous xenograft rabbit model. Appropriate pulsed HIFU exposure may increase the necrosis volume and reduce total ultrasound energy required for HIFU ablation. [ABSTRACT FROM AUTHOR]

Depending on the local or targeted treatment, independence on tumor type and minimally‐invasive and noninvasive feature, various thermal ablation technologies have been established, but they still suffer from the intractable paradox between safety and efficacy. It has been extensively accepted that improving energy utilization efficiency is the primary means of decreasing thermal ablation power and shortening ablation time, which is beneficial for concurrently improving both treatment safety and treatment efficiency. Recent efforts have been made to receive a significant advance in various thermal methods including non‐invasive high‐intensity focused ultrasound, minimally‐invasive radiofrequency and microwave, and non‐invasive and minimally‐invasive photothermal ablation, and so on. Especially, various nanobiotechnologies and design methodologies were employed to elevate the energy utilization efficiency for acquiring unexpected ablation outcomes accompanied with tremendously reduced power and time. More significantly, some combined technologies, for example, chemotherapy, photodynamic therapy (PDT), gaseous therapy, sonodynamic therapy (SDT), immunotherapy, chemodynamic therapy (CDT), or catalytic nanomedicine, were used to assist these ablation means to repress or completely remove tumors. We discussed and summarized the ablation principles and energy transformation pathways of the four ablation means, and reviewed and commented the progress in this field including newly developed technology or new material types with a highlight on nanobiotechnology‐inspired design principles, and provided the deep insights into the existing problems and development direction. This article is categorized under:Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic DiseaseTherapeutic Approaches and Drug Discovery > Emerging Technologies [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]

Malawi has the highest invasive cervical cancer (ICC) mortality rate worldwide, and ICC is the leading cause of cancer death among women. In 2004, Malawi adopted visual inspection with acetic acid (VIA) and ablative treatment with cryotherapy. However, screening coverage has remained low (<30%) and few women (<50%) who require ablative treatment receive it. Additional barriers include long distances to health facilities and challenges with maintaining gas supplies. Thermal ablation is a safe and effective alternative to cryotherapy. We assessed the safety and uptake of community‐based ICC screening with VIA and same‐day treatment using a handheld thermocoagulator (HTU) in rural Malawi. We held educational talks alongside community leaders and conducted VIA screening in nonclinic community settings to nonpregnant women aged 25 to 49 years without history of hysterectomy or genital cancer/precancer. Eligible women received same‐day thermal ablation and HIV testing/counseling. We collected cervical biopsies before treatment and followed up women at Weeks 6 and 12, with repeat biopsy at Week 12. Between July and August 2017, 408 (88%) of 463 eligible women underwent VIA. Overall, 7% (n = 30) of women had a positive VIA, of whom 93% (n = 28) underwent same‐day thermal ablation. Among the 30 VIA‐positive women, 5 had cervical intraepithelial neoplasia (CIN) 1, 4 had CIN 2/3 and 21 had benign histologic findings. Abnormal vaginal discharge (60%) and light vaginal bleeding (52%) were the most reported adverse events. There was high uptake of the community‐based ICC screening in the study population and treatment was safe in this setting. Similar strategies that minimize false‐positive results are urgently needed in Malawi. What's new? Malawi has the world's highest incidence and mortality rates of invasive cervical cancer. In 2004, the country adopted a screen‐and‐treat program using visual inspection with acetic acid (VIA) and ablative treatment with cryotherapy. However, women's participation remained low, and the high cost of cryotherapy means that not all who need ablative treatment can receive it. Here, the authors test the safety and uptake of a screening program with same‐day thermal ablation in a community setting. In rural Lilongwe, Malawi, 88% of eligible women participated in cervical screening, and thermal ablation was shown to be safe in a non‐clinical setting. [ABSTRACT FROM AUTHOR]

Magnetic resonance‐guided laser interstitial laser therapy (MRgLITT) and radiofrequency ablation (RFA) represent two minimally invasive methods for the treatment of drug‐refractory mesial temporal lobe epilepsy (mTLE). We performed a systematic review and a meta‐analysis to compare outcomes and complications between MRgLITT, RFA, and conventional surgical approaches to the temporal lobe (i.e., anterior temporal lobe resection [ATL] or selective amygdalohippocampectomy [sAHE]). Forty‐three studies (13 MRgLITT, 6 RFA, and 24 surgery studies) involved 554, 123, 1504, and 1326 patients treated by MRgLITT, RFA, ATL, or sAHE, respectively. Engel Class I (Engel‐I) outcomes were achieved after MRgLITT in 57% (315/554, range = 33.3%–67.4%), RFA in 44% (54/123, range = 0%–67.2%), ATL in 69% (1032/1504, range = 40%–92.9%), and sAHE in 66% (887/1326, range = 21.4%–93.3%). Meta‐analysis revealed no significant difference in seizure outcome between MRgLITT and RFA (Q = 2.74, p =.098), whereas ATL and sAHE were both superior to MRgLITT (ATL: Q = 8.92, p =.002; sAHE: Q = 4.33, p =.037) and RFA (ATL: Q = 6.42, p =.0113; sAHE: Q = 5.04, p =.0247), with better outcome in patients at follow‐up of 60 months or more. Mesial hippocampal sclerosis (mTLE + hippocampal sclerosis) was associated with significantly better outcome after MRgLITT (Engel‐I outcome in 64%; Q = 8.55, p =.0035). The rate of major complications was 3.8% for MRgLITT, 3.7% for RFA, 10.9% for ATL, and 7.4% for sAHE; the differences did not show statistical significance. Neuropsychological deficits occurred after all procedures, with left‐sided surgeries having a higher rate of verbal memory impairment. Lateral functions such as naming or object recognition may be more preserved in MRgLITT. Thermal therapies are effective techniques but show a significantly lower rate of Engel‐I outcome in comparison to ATL and sAHE. Between MRgLITT and RFA there were no significant differences in Engel‐I outcome, whereby the success of treatment seems to depend on the approach used (e.g., occipital approach). MRgLITT shows a similar rate of complications compared to RFA, whereas patients undergoing MRgLITT may experience fewer major complications compared to ATL or sAHE and might have a more beneficial neuropsychological outcome. [ABSTRACT FROM AUTHOR]

Purpose: Intraoperative T2‐weighted (T2‐w) imaging unreliably captures image contrast specific to thermal ablation after transcranial MR‐guided focused ultrasound surgery, impeding dynamic imaging feedback. Using a porcine thalamotomy model, we test the unproven hypothesis that intraoperative DWI can improve dynamic feedback by detecting lesioning within 30 minutes of transcranial MR‐guided focused ultrasound surgery. Methods: Twenty‐five thermal lesions were formed in six porcine models using a clinical transcranial MR‐guided focused ultrasound surgery system. A novel diffusion‐weighted pulse sequence monitored the formation of T2‐w and diffusion‐weighted lesion contrast after ablation. Using postoperative T2‐w contrast to indicate lesioning, apparent intraoperative image contrasts and diffusion coefficients at each lesion site were computed as a function of time after ablation, observed peak temperature, and observed thermal dose. Lesion sizes segmented from imaging and thermometry were compared. Image reviewers estimated the time to emergence of lesion contrast. Intraoperative image contrasts were analyzed using receiver operator curves. Results: On average, the apparent diffusion coefficient at lesioned sites decreased within 5 minutes after ablation relative to control sites. In‐plane lesion areas on intraoperative DWI varied from postoperative T2‐w MRI and MR thermometry by 9.6±9.7 mm2 and ‐4.0±7.1 mm2, respectively. The 0.25, 0.5, and 0.75 quantiles of the earliest times of observed T2‐w and diffusion‐weighted lesion contrast were 10.7, 21.0, and 27.8 minutes and 3.7, 8.6, and 11.8 minutes, respectively. The T2‐w and diffusion‐weighted contrasts and apparent diffusion coefficient values produced areas under the receiver operator curve of 0.66, 0.80, and 0.74, respectively. Conclusion: Intraoperative DWI can detect MR‐guided focused ultrasound surgery lesion formation in the brain within several minutes after treatment. [ABSTRACT FROM AUTHOR]

Thermal ablation is a point‐of‐care ablative treatment technique for cervical intraepithelial neoplasia (CIN). However, limited information is available about its efficacy in low‐ and middle‐income countries. We evaluated the efficacy of thermal ablation in treatment of CIN detected through high‐risk human papillomavirus (HPV) screening in China. Women positive on high‐risk HPV and having colposcopically suspected lesions eligible for ablation underwent colposcopy, biopsy and thermal ablation in one visit. Women ineligible were recalled for large loop excision of transformation zone (LLETZ) when histopathology results were high‐grade CIN. Posttreatment follow‐up at 6 months or more was with HPV test and cytology followed by colposcopy and biopsy for HPV and/or cytology‐positive women. Cure was defined as either negative cytology and HPV test or absence of histopathology proved CIN in any positive women. Of total 218 HPV‐positive women treated with thermal ablation (n = 170) or LLETZ (n = 48), 196 reported for follow‐up evaluation. For women with histologically confirmed CIN at baseline (thermal ablation‐104; LLETZ‐38), cure rates were 84.6% for thermal ablation and 86.8% for LLETZ. Cure rates after thermal ablation were 90.3% for CIN grade one (CIN1) and 76.2% for CIN grade two or worse (CIN2+). HPV clearance rate was 80.4% in women undergoing thermal ablation, which was lower for HPV16/18 compared to other oncogenic types (67.6% vs 85.7%). HPV test had a negative predictive value (NPV) of 98.7% to detect CIN2+ at follow‐up and the positive predictive value (PPV) was 40.4%. Thermal ablation is effective to treat CIN as well as to clear the high‐risk HPV infection. HPV test has high PPV and NPV in following up patients posttreatment. What's new? When premalignant cervical lesions are detected following HPV screening, thermal ablation (TA) may be an ideal point‐of‐care treatment option for lower‐income regions. But is it effective enough to warrant widespread use in these areas? In this prospective Chinese study, the authors found that the answer is yes, with the added benefit that TA may also clear high‐risk HPV infection. These results support the use of thermal ablation following colposcopy during a single clinic visit, in order to improve access to treatment of premalignant cervical lesions in regions with fewer resources. [ABSTRACT FROM AUTHOR]

2D monoelemental nanomaterials (Xenes) have shown tremendous potential for versatile biomedical applications. Bismuth, as a heavy element in pnictogens, has acquired massive research interest due to its unique optical performance, high biocompatibility, stability, and relatively low cost. However, the utilization of 2D bismuthene in nanomedicine has not been achieved because of the difficulty in engineering bismuthene with crucial structural/compositional characteristics for satisfying strict biomedical requirements. Herein, to address this Gordian knot, a facile strategy to intercalate and delaminate Bi bulk for generating mass few‐layered 2D bismuthene with high yield by employing a water molecule mediated freezing–thawing process and sodium borohydride‐triggered reduction treatment is proposed. The resulting 2D bismuthene displays good optical performance in the near‐infrared (NIR) biowindow and can be excited via red light for reactive oxygen species generation, enabling applications in multiple photonic cancer nanomedicine settings, including photothermal hyperthermia and photodynamic therapy. Utilizing the intrinsic desirable optical absorbance and strong X‐ray attenuation of bismuthene, dual photonic therapy can be conducted under the supervision of photoacoustic/computed tomography guided multimodal imaging. This research not only offers a potential mass‐production ready, cost‐effective, and eco‐efficient methodology for engineering 2D Xenes, but also exploits an innovative 2D bismuthene based photonic cancer nanomedicine. [ABSTRACT FROM AUTHOR]

Percutaneous thermal ablation is an important treatment for lung cancer and is widely used in hospitals. Puncture biopsy is generally required for pathological diagnosis before or after thermal ablation. Pathological diagnosis provides both evidence of benign and malignant lesions for ablation therapy and is of important significance for the next step in disease management. Furthermore, the sequence of ablation and biopsy affects the accuracy of pathological diagnosis, the complete ablation rate of thermal ablation, and incidence of surgery‐related complications. Ultimately, it may affect the patient's benefit from local treatment. This article reviews the research progress of traditional asynchronous biopsy followed by ablation, the emerging methods of synchronous biopsy followed by ablation, and synchronous ablation followed by biopsy in the last decade. Key points: The sequence of ablation and biopsy affects the accuracy of pathological diagnosis, the complete ablation rate of thermal ablation, and the incidence of surgical‐related complications. This article reviewed the recent 10 years' literature on the surgical sequence of biopsy and ablation for lung tumors, the advantages, disadvantages and indications of different orders were analyzed. [ABSTRACT FROM AUTHOR]

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]

Objectives: To develop a clinicopathological‐based nomogram to improve the prediction of the seeding risk of after percutaneous thermal ablation (PTA) in primary liver carcinoma (PLC). Methods: A total of 2030 patients with PLC who underwent PTA were included between April 2009 and December 2018. The patients were grouped into a training dataset (n = 1024) and an external validation dataset (n = 1006). Baseline characteristics were collected to identify the risk factors of seeding after PTA. The multivariate Cox proportional hazards model based on the risk factors was used to develop the nomogram, which was used for assessment for its predictive accuracy using mainly the Harrell's C‐index and receiver operating characteristic curve (AUC). Results: The median follow‐up time was 30.3 months (range, 3.2‐115.7 months). The seeding risk was 0.89% per tumor and 1.5% per patient in the training set. The nomogram was developed based on tumor size, subcapsular, α‐fetoprotein (AFP), and international normalized ratio (INR). The 1‐, 2‐, and 3‐year cumulative seeding rates were 0.1%, 0.7% and 1.2% in the low‐risk group, and 1.7%, 6.3% and 6.3% in the high‐risk group, respectively, showing significant statistical difference (P <.001). The nomogram had good calibration and discriminatory abilities in the training set, with C‐indexes of 0.722 (95% confidence interval [CI]: 0.661, 0.883) and AUC of 0.850 (95% CI: 0.767, 0.934). External validation with 1000 bootstrapped sample sets showed a good C‐index of 0.706 (95% CI: 0.546, 0.866) and AUC of 0.736 (95% CI: 0. 646, 0.827). Conclusions: The clinicopathological‐based nomogram could be used to quantify the probability of seeding risk after PTA in PLC. [ABSTRACT FROM AUTHOR]

Recent studies have demonstrated the effectiveness of switching bipolar radiofrequency ablation (bRFA) in treating liver cancer. Nevertheless, the clinical use of the treatment remains less common than conventional monopolar RFA – likely due to the lack of understanding of how the tissues respond thermally to the switching effect. The problem is exacerbated by the numerous possible switching combinations when bRFA is performed using bipolar needles, thus making theoretical deduction and experimental studies difficult. This article addresses this issue via computational modelling by examining if significant variation in the treatment outcome exists amongst six different electrode configurations defined by the X‐, C‐, U‐, N‐, Z‐ and O‐models. Results indicated that the tissue thermal and thermal damage responses varied depending on the electrode configuration and the operating conditions (input voltage and ablation duration). For a spherical tumour, 30 mm in diameter, complete ablation could not be attained in all configurations with 70 V input voltage and 5 minutes ablation duration. Increasing the input voltage to 90 V enlarged the coagulation zone in the X‐model only. With the other configurations, extending the ablation duration to 10 minutes was found to be the better at enlarging the coagulation zone. [ABSTRACT FROM AUTHOR]

Lung cancer is the leading cause of cancer‐related death worldwide and surgical lobectomy remains the preferred therapy for patients with early‐stage NSCLC. Medical comorbidities and advanced age preclude resection in many patients and minimally invasive ablative therapies are needed for treatment. Stereotactic ablative radiation is established as an effective modality in this patient group, although may be contraindicated in some patients with prior radiation exposure, comorbidities or centrally positioned tumours. Percutaneous ablative methods are available, although are frequently associated with significant complications. Numerous endoscopic ablative techniques are under evaluation. With a more favourable safety profile and the ability to provide diagnosis and staging information potentially within a single procedure, there is a strong rationale for development of bronchoscopic ablative modalities. In the following article, the authors aim to explore the role bronchoscopic ablation may play in treatment of peripheral lung tumours, and to describe a pathway to establishing these modalities as part of routine care. The current status of several bronchoscopic ablative options is discussed in detail. [ABSTRACT FROM AUTHOR]

Hyperthermia is a rapidly growing field in cancer therapy and many advances have been made in understanding and applying the mechanisms of hyperthermia. Secondary effects of hyperthermia have been increasingly recognized as important in therapeutic effects and multiple studies have started to elucidate their implications for treatment. Immune effects have especially been recognized as important in the efficacy of hyperthermia treatment of cancer. Both thermo‐ablative and mild hyperthermia activate the immune system, but mild hyperthermia seems to be more effective at doing so. This may suggest that mild hyperthermia has some advantages over thermo‐ablative hyperthermia and research into immune effects of mild hyperthermia should continue. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic DiseaseTherapeutic Approaches and Drug Discovery > Emerging TechnologiesImplantable Materials and Surgical Technologies > Nanoscale Tools and Techniques in Surgery [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) test, self‐sampling and thermal ablation for cervical intraepithelial neoplasia (CIN) have been developed separately to increase screening coverage and treatment compliance of cervical cancer screening programmes. A large‐scale study in rural China screened 9,526 women with their combinations to explore the optimal cervical cancer‐screening cascade in the real‐world. Participants received careHPV and polymerase chain reaction (PCR) HPV tests on self‐collected samples. Women positive on either HPV test underwent colposcopy, biopsy and thermal ablation in a single visit. Samples positive on either HPV test were retested for genotyping. Absolute and relative performance of HPV tests, triage strategies, 'colposcopy and thermal ablation' approach were statistically evaluated. PCR HPV test detected 33.3% more CIN grade two or worse (CIN2+) at a cost of 28.1% more colposcopies compared to careHPV. Sensitivities of PCR HPV and careHPV tests to detect CIN2+ were 96.7 and 72.5%. Specificities for the same disease outcome were 82.1 and 86.0%. Triaging HPV‐positive women with HPV16/18 genotyping considerably improved the positive predictive value for CIN2+ (4.8–5.0 to 18.2–19.2%). Ninety‐six women positive on HPV and having abnormal colposcopy were eligible for thermal ablation and all accepted same‐day treatment, contributing to 64.6% being treated appropriately (CIN1+ on histopathology), which reached up to 84.8% among women positive on HPV 16/18 triage. No serious side‐effects/complications were reported. The combination of PCR HPV test followed by HPV 16/18 triaging on self‐collected samples and colposcopy of triage positive women followed by immediate thermal ablation might be the appropriate screening cascade for rural China. What's new? To be effective, cervical cancer screening programs must be tailored to the needs of the target population. In rural China, screening coverage is low, and women may not return for separate diagnosis and treatment visits. Here, the authors evaluated various screening protocols under real world conditions. They found that self‐sampling, PCR HPV test and triage based on HPV16/18 genotyping, followed by colposcopy and immediate thermal ablation in a single visit, could be the most efficient screening cascade for this rural population. This plan reduced costs while increasing compliance for follow up care. [ABSTRACT FROM AUTHOR]

Purpose: Simultaneous fat‐referenced proton resonance frequency shift (FRPRFS) thermometry combined with MR elastography (MRE) is proposed, to continuously monitor thermal ablations for all types of soft tissues, including fat‐containing tissues. Fat‐referenced proton resonance frequency shift thermometry makes it possible to measure temperature even in the water fraction of fat‐containing tissues while enabling local field‐drift correction. Magnetic resonance elastography allows measuring the mechanical properties of tissues that are related to tissue structural damage. Methods: A gradient‐echo MR sequence framework was proposed that combines the need for multiple TE acquisitions for the water‐fat separation of FRPRFS, and the need for multiple MRE phase offsets for elastogram reconstructions. Feasibility was first assessed in a fat‐containing gelatin phantom undergoing moderate heating by a hot water circulation system. Subsequently, high intensity focused ultrasound heating was conducted in porcine muscle tissue ex vivo (N = 4; 2 samples, 2 locations/sample). Results: Both FRPRFS temperature maps and elastograms were updated every 4.1 seconds. In the gelatin phantom, FRPRFS was in good agreement with optical fiber thermometry (average difference 1.2 ± 1°C). In ex vivo high‐intensity focused ultrasound experiments on muscle tissue, the shear modulus was found to decrease significantly by 34.3% ± 7.7% (experiment 1, sample 1), 17.9% ± 10.0% (experiment 2, sample 1), 55.1% ± 8.7% (experiment 3, sample 2), and 34.7% ± 8.4% (experiment 4, sample 2) as a result of temperature increase (ΔT = 22.5°C ± 4.2°C, 14.0°C ± 2.8°C, 14.7°C ± 3.7°C, and 14.5°C ± 3.0°C, respectively). Conclusion: This study demonstrated the feasibility of monitoring thermal ablations with FRPRFS thermometry together with MRE, even in fat‐containing tissues. The acquisition time is similar to non‐FRPRFS thermometry combined with MRE. [ABSTRACT FROM AUTHOR]

To achieve higher coverage and effectiveness in limited‐resource settings, World Health Organization (WHO) guidelines for cervical cancer prevention recommend a screen‐and‐treat strategy with high‐risk human papillomavirus (HPV) testing. We piloted a real‐word project to examine the feasibility of this approach in rural Cameroon. Nurses from the Women's Health Program (WHP) of the Cameroon Baptist Convention Health Services (CBCHS) educated women in remote villages on cervical cancer prevention. At a follow‐up visit, they explained to nonpregnant women aged 30–65 how to self‐collect vaginal specimens for HPV testing with the careHPV assay. The cytobrush specimens were transported in coolers to a CBCHS laboratory for analysis. The nurses returned to villages to inform women of their results, examined HPV‐positive women in the primary health centers (PHCs) using visual inspection with acetic acid and Lugol's iodine (VIA/VILI) enhanced by digital cervicography (DC) to guide treatment. Of the 1,270 eligible women screened (mean age: 44.7 years), 196 (15.4%) were HPV‐positive, of whom 185 (94.4%) were examined, 16 (8.6%) were VIA/VILI‐positive, 8 (4.3%) were VIA/VILI‐inadequate, one (0.5%) was VIA/VILI‐uncertain and 161 (87.0%) were treated with thermal ablation. One woman had LEEP, and another woman with invasive cancer was treated at a referral facility. The cytobrushes broke off in the vaginas of two women (removed in the village) and in the bladder of another (surgically removed). Community‐based cervical cancer screening with self‐collected specimens for HPV testing is feasible in rural Cameroon. Education on the proper sampling procedure and follow‐up of women who are HPV‐positive are essential. What's new? In Africa, the continent with the highest burden of cervical cancer globally, nearly three quarters of cases occur in rural areas. Per the World Health Organization, HPV‐based screen‐and‐treat is a preferred strategy for cervical cancer secondary prevention in limited resource settings. However, the successful implementation of this recommendation in rural and remote areas of Africa remains uncertain. Here, the authors designed and piloted a culturally appropriate screening strategy with self‐collected HPV testing, and found that community engagement is critical to achieve success. In particular, education on the proper sampling procedure and follow‐up of women who are HPV positive are essential. [ABSTRACT FROM AUTHOR]

Electrosurgery with argon plasma coagulation is a widespread technique used in various medical fields for applications which range from hemostasis to devitalization processes. Developing tools which provide feedback concerning tissue condition during these surgeries is fundamental for improving the safety and success of this treatment. We present here a method based on diffuse reflectance spectroscopy to monitor gastric mucosal devitalization treatments. The analysis of the diffusely reflected spectra of the tissue allows us to differentiate between ablation states by using linear discriminant analysis (LDA) as a classification algorithm. An ex vivo pilot study on several swine stomachs showed promising results, with 97.8% of correctly classified ablation states on a new unseen stomach, encouraging further tests with human tissue. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the safety and efficacy of minimally invasive percutaneous thermal ablation alone or in combination with cementoplasty for pain palliation and local tumour control of renal cell carcinoma osseous metastases.Methods: Imaging-guided thermal ablation was performed in 59 renal cell carcinoma osseous metastatic tumours in 23 patients (concomitant cementoplasty in 43 tumours) selected following multidisciplinary consultations to achieve local tumour control and pain palliation (75%, 44/59) or pain palliation alone (25%, 15/59) in this retrospective study. Tumour characteristics, procedural details and complications were documented. Pain palliation was assessed using pre- and post-procedural Numeric Rating Scale scores at 1-week, 1-month, 3-month and 6-month time intervals. Pre- and post-procedural cross-sectional imaging was reviewed to assess local tumour control rates at 3-month, 6-month, and 12-month post-treatment time intervals.Results: All procedures were technically successful and performed as pre-operatively planned. The median pre- and post-procedural Numeric Rating Scale scores were 8.0 and 3.0 (at all time intervals), respectively (P < 0.001). Local tumour control rates were 100% (40/40), 100% (36/36) and 85% (28/33) at ≥3 months, ≥6 months and ≥12 months post-procedural time intervals, respectively. There was 1 minor complication (1.7%, 1/59).Conclusions: Percutaneous thermal ablation alone or in combination with cementoplasty is safe and effective for pain palliation and local tumour control of renal cell carcinoma osseous metastases. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the acceptability and safety of thermal ablation (TA) for the treatment of precancerous cervical lesions in women in Honduras.Methods: Human papillomavirus (HPV) and visual inspection with acetic acid (VIA) screen-positive eligible women received TA. After treatment, women rated the level of pain experienced during treatment using the Wong-Baker FACES® pain-rating scale from 0 to 10. Short-term safety outcomes that could require medical attention were assessed one month after treatment.Results: A total of 319 women received TA treatment. The average pain rating was 2.5 (95% CI: 2.3-2.8), and 85% rated their pain levels as less than 6. No significant differences in low (below 6) or high (6 and above) pain were found by age or number of biopsies performed, but there was a significant difference by the number of TA applications (P < 0.01). When asked if they would recommend this treatment, all women said they would. At the one-month follow-up visit, the most common reported discomforts were bleeding (10%) and cramping (8.4%); 11 women reported severe lower abdominal pain, and none required medical attention.Conclusions: TA is safe and acceptable to patients as a treatment option for precancerous cervical lesions in low-resource settings. [ABSTRACT FROM AUTHOR]

Objectives: To preliminarily evaluate the safety, effectiveness, and feasibility of microwave ablation (MWA) for substernal goiter (SSG) in select patients and to provide a relevant treatment reference for further studies. Methods: From April 2017 to December 2017, 10 patients with SSG were treated by MWA. All patients were followed for at least 3 months to observe the therapeutic effects and complications. Therapeutic effects were assessed at follow‐up for the relief of patients' symptoms, resolution of the cosmetic grade, and volume reduction rate (VRR) of SSG. Possibly related factors for the 3‐month VRR of the nodules were analyzed. Results: The study included 9 female patients and 1 male patient with a mean age ± SD of 56.8 ± 10.1 years (range, 34–70 years). The mean volume of the nodules was 52.9 ± 27.9 mL (range, 23.7–122.6 mL). The nodule volume was significantly reduced at the 3‐month follow‐up (17.5 ± 9.5 mL; P < .05). The mean 3‐month VRR of the index nodule was 66.7% ± 7.1%. A higher ablated portion‐to‐nodule ratio 1 day after MWA predicted a higher 3‐month VRR (Spearman r = 0.646; P = .044). The mean symptom score (from 4.5 ± 1.7 to 1.5 ± 1.0; P = .005) and cosmetic grade (from 3.3 ± 0.5 to 2.2 ± 0.4; P = .004) declined significantly 3 months after the procedure. No complications or unexpected side effects were observed. Conclusions: Our preliminary results support the effectiveness and safety of MWA for local control of SSG. This technology can be applied in select patients with SSG who are ineligible for surgery. [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]

Background: The study was conducted to assess the safety and efficacy of thermal ablation for the treatment of subpleural lung cancer. Methods: Eighty‐nine patients with 101 subpleural lung cancers were identified between January 2012 and July 2018 in our database and included in this study. Tumors were classified as adhering to cervical, costal, diaphragmatic, and mediastinal pleurae. Lesions were categorized based on their relationship to the pleura: close to the pleura, causing pleural indentation, and involving the pleura. The complete ablation rate, local progression‐free survival, complications, and associated factors were analyzed. Results: Subpleural lung cancers included lesions located under costal (n = 69), mediastinal (n = 17), cervical (n = 8), and diaphragmatic (n = 7) pleurae. The rate of complete ablation was 87.1% and the local progression‐free survival rates at 3, 6, 12, and 24 months were 86%, 77%, 75%, and 64%, respectively. Tumor size was the most important factor influencing technique efficacy (P < 0.05), with a complete ablation rate of only 55.6% in lung cancers measuring > 30 mm. There were nine (10.11%) major complications, including one chest abscess, five cases of pneumothorax, and three cases of hemothorax. The occurrence of major complications was associated with increased levels of pain within 48 hours post‐procedure (P < 0.05). Conclusion: Local thermal ablation is a safe and effective treatment for subpleural lung cancers. Tumor size was the most significant factor affecting technique efficacy. Post‐procedure pain indicated the possibility of major complications. [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]

Stroke, either ischemic or hemorrhagic, accounts for significantly high morbidity and mortality rates around the globe effecting millions of lives annually. For the past few decades, ultrasound has been extensively investigated to promote clot lysis for the treatment of stroke, myocardial infarction, and acute peripheral arterial occlusions, with or without the use of tPA or contrast agents. In the age of modern minimal invasive techniques, magnetic resonance imaging-guided high-intensity focused ultrasound is a new emerging modality that seems to promise therapeutic utilities for both ischemic and hemorrhagic stroke. High-intensity focused ultrasound causes thermal heating as the tissue absorbs the mechanical energy transmitted by the ultrasonic waves leading to tissue denaturation and coagulation. Several in-vitro and in-vivo studies have demonstrated the viability of this technology for sonothrombolysis in both types of stroke and have warranted clinical trials. Apart from safety and efficacy, initiation of trials would further enable answers regarding its practical application in a clinical setup. Though this technology has been under study for treatment of various brain diseases for some decades now, relatively very few neurologists and even neurosurgeons seem to be acquainted with it. The aim of this review is to provide basic understanding of this powerful technology and discuss its clinical application and potential role as an emerging viable therapeutic option for the future management of stroke. [ABSTRACT FROM AUTHOR]