Ex vivo validation of microwave thermal ablation simulation using different flow coefficients in the porcine liver.

The purpose of the study was to validate the simulation model for a microwave thermal ablation in ex vivo liver tissue. The study aims to show that heat transfer due to the flow of tissue water during ablation in ex vivo tissue is not negligible. Ablation experiments were performed in ex vivo porcine liver with microwave powers of 60 W to 100 W. During the procedure, the temperature was recorded in the liver sample at different distances to the applicator using a fiber-optic thermometer. The position of the probes was identified by CT imaging and transferred to the simulation. The simulation of the heat distribution in the liver tissue was carried out with the software CST Studio Suite. The results of the simulation with different flow coefficients were compared with the results of the ablation experiments using the Bland-Altman analysis. The analysis showed that the flow coefficient of 90,000 W/(K*m3) can be considered as the most suitable value for clinically used powers. The presented simulation model can be used to calculate the temperature distribution for microwave ablation in ex vivo liver tissue.

A thermometry software tool for monitoring laser-induced interstitial thermotherapy.

The purpose of this study was to develop a thermometry software tool for temperature monitoring during laser-induced interstitial thermotherapy (LITT). C++ programming language and several libraries including DICOM Toolkit, Grassroots DICOM library, Insight Segmentation and Registration Toolkit, Visualization Toolkit and Quasar Toolkit were used. The software's graphical user interface creates windows displaying the temperature map and the coagulation extent in the tissue, determined by the magnetic resonance imaging (MRI) thermometry with the echo planar imaging sequence and a numerical simulation based on the radiation and heat transfer in biological tissues, respectively. The software was evaluated applying the MRI-guided LITT to ex vivo pig liver and simultaneously measuring the temperature through a fiber-optic thermometer as reference. Using the software, the temperature distribution determined by the MRI method was compared with the coagulation extent simulation. An agreement was shown between the MRI temperature map and the simulated coagulation extent. Furthermore, the MRI-based and simulated temperatures agreed with the measured one - a correlation coefficient of 0.9993 and 0.9996 was obtained, respectively. The precision of the MRI temperature amounted to 2.4°C. In conclusion, the software tool developed in the present study can be applied for monitoring and controlling the LITT procedure in ex vivo tissues.

Comparison of X-ray-Mammography and Planar UWB Microwave Imaging of the Breast: First Results from a Patient Study.

Hemispherical and cylindrical antenna arrays are widely used in radar-based and tomography-based microwave breast imaging systems. Based on the dielectric contrast between healthy and malignant tissue, a three-dimensional image could be formed to locate the tumor. However, conventional X-ray mammography as the golden standard in breast cancer screening produces two-dimensional breast images so that a comparison between the 3D microwave image and the 2D mammogram could be difficult. In this paper, we present the design and realisation of a UWB breast imaging prototype for the frequency band from 1 to 9 GHz. We present a refined system design in light of the clinical usage by means of a planar scanning and compare microwave images with those obtained by X-ray mammography. Microwave transmission measurements were processed to create a two-dimensional image of the breast that can be compared directly with a two-dimensional mammogram. Preliminary results from a patient study are presented and discussed showing the ability of the proposed system to locate the tumor.

Planar Microwave Sensor for Theranostic Therapy of Organic Tissue Based on Oval Split Ring Resonators.

Microwave sensors in medical environments play a significant role due to the contact-less and non-invasive sensing mechanism to determine dielectric properties of tissue. In this work, a theranostic sensor based on Split Ring Resonators (SRRs) is presented that provides two operation modes to detect and treat tumor cells, exemplary in the liver. For the detection mode, resonance frequency changes due to abnormalities are evaluated, and in the treatment mode, microwave ablation is performed. The planar sensor structure can be integrated into a needle like a surgery tool that evokes challenges concerning size limitations and biocompatibility. To meet the size requirements and provide a reasonable operating frequency, properties of oval shaped SRRs are investigated. By elongating the radius of the SRR in one direction, the resonance frequency can be decreased significantly compared to circular SRR by a factor of two below 12 GHz. In order to validate the detection and treatment characteristics of the sensor, full wave simulations and measurements are examined. Clear resonance shifts are detected for loading the sensor structures with phantoms mimicking healthy and malignant tissue. For treatment mode evaluation, ex vivo beef liver tissue was ablated leading to a lesion zone 1.2 cm × 1 cm × 0.3 cm with a three minute exposure of maximum 2.1 W.

Theranostic microwave applicator suitable for minimal invasive therapy of malignant tissue.

A microwave applicator is presented that realizes the theranostic approach by providing two operation modes to detect and treat tumor cells, exemplary in the liver. The tool is based on a planar sensor structure with Split Ring Resonators (SRR) as key elements. For the detection, changes in dielectric properties caused by tissue abnormalities are evaluated by analyzing shifts in the resonance frequency of the SRR. For the treatment mode, the input power is amplified to the specific resonance frequency and microwave ablation is performed. The device is designed to fit into a needle like operation tool for minimal invasive therapies. From this requirement, challenges concerning size limitation, packaging, and bio compatibility can be derived. Therefore, novel shapes of the SRR and substrate materials are investigated by full wave simulations and measurements. Material models and phantoms mimicking dielectric properties of healthy and malignant tissue are introduced. Clear resonance shifts of 100 MHz are detected for loading the sensor with corresponding phantoms. In order to examine the treatment mode characteristics, thermal simulations and measurements exhibit a significant temperature increase up to 62 °C for an input power of 500 mW.

Estimation of anisotropy coefficient of swine pancreas, liver and muscle at 1064 nm based on goniometric technique.

Optical properties of tissues are required for theoretical modeling of Laser Ablation in tumor therapy. The light scattering characteristic of tissues is described by the anisotropy coefficient, g. The relationship between the angular distribution of scattered light and g is given by the Henyey-Greenstein (HG) phase function. This work describes the estimation of anisotropy coefficients of ex vivo swine pancreas, liver and muscle at 1064 nm. The intensities of scattered light at fixed angles were measured under repeatability conditions. Experimental data were fitted with a two-term HG, estimating the anisotropy coefficients for the forward (e.g., 0.956 for pancreas, 0.964 for liver and 0.968 for muscle) and the backward (e.g., -0.481 for pancreas, -0.414 for liver and -0.372 for muscle) scattering. Experimental set up employed to estimate the anisotropy coefficient of biological tissues. The image on the left depicts the holder used to house tissue, laser fiber and photodetector; on the left an example of scattered light beam is shown, as well as the effect due to Snell's law.

Thermal ablation of liver metastases from colorectal cancer: radiofrequency, microwave and laser ablation therapies.

Surgery is currently considered the treatment of choice for patients with colorectal cancer liver metastases (CRLM) when resectable. The majority of these patients can also benefit from systemic chemotherapy. Recently, local or regional therapies such as thermal ablations have been used with acceptable outcomes. We searched the medical literature to identify studies and reviews relevant to radiofrequency (RF) ablation, microwave (MW) ablation and laser-induced thermotherapy (LITT) in terms of local progression, survival indexes and major complications in patients with CRLM. Reviewed literature showed a local progression rate between 2.8 and 29.7 % of RF-ablated liver lesions at 12-49 months follow-up, 2.7-12.5 % of MW ablated lesions at 5-19 months follow-up and 5.2 % of lesions treated with LITT at 6-month follow-up. Major complications were observed in 4-33 % of patients treated with RF ablation, 0-19 % of patients treated with MW ablation and 0.1-3.5 % of lesions treated with LITT. Although not significantly different, the mean of 1-, 3- and 5-year survival rates for RF-, MW- and laser ablated lesions was (92.6, 44.7, 31.1 %), (79, 38.6, 21 %) and (94.2, 61.5, 29.2 %), respectively. The median survival in these methods was 33.2, 29.5 and 33.7 months, respectively. Thermal ablation may be an appropriate alternative in patients with CRLM who have inoperable liver lesions or have operable lesions as an adjunct to resection. However, further competitive evaluation should clarify the efficacy and priority of these therapies in patients with colorectal cancer liver metastases.

Temperature imaging of laser-induced thermotherapy (LITT) by MRI: evaluation of different sequences in phantom.

The purpose of this study was to evaluate magnetic resonance (MR) temperature imaging of the laser-induced thermotherapy (LITT) comparing the proton resonance frequency (PRF) and T 1 thermometry methods. LITT was applied to a liver-mimicking acrylamide gel phantom. Temperature rise up to 70 °C was measured using a MR-compatible fiber-optic thermometer. MR imaging was performed by a 1.5-T scanner utilizing fast gradient echo sequences including a segmented echo planar imaging (seg-EPI) sequence for PRF and the following sequences for T 1 method: fast low-angle shot (FLASH), inversion recovery turbo flash (IRTF), saturation recovery turbo flash (SRTF), and true fast imaging (TRUFI). Temperature-induced change of the pixel values in circular regions of interest, selected on images under the temperature probe tip, was recorded. For each sequence, a calibration constant could be determined to be -0.0088 ± 0.0002 ppm °C(-1) (EPI), -1.15 ± 0.03 °C(-1) (FLASH), -1.49 ± 0.03 °C(-1) (IRTF), -1.21 ± 0.03 °C(-1) (SRTF), and -2.52 ± 0.12 °C(-1) (TRUFI). These constants were evaluated in further LITT experiments in phantom comparing the calculated temperatures with the fiber optic-measured ones; temperature precisions of 0.60 °C (EPI), 0.81 °C (FLASH), 1.85 °C (IRTF), 1.95 °C (SRTF), and 3.36 °C (TRUFI) were obtained. Furthermore, performing the Bland-Altman analysis, temperature accuracy was determined to be 0.23 °C (EPI), 0.31 °C (FLASH), 1.66 °C (IRTF), 1.19 °C (SRTF), and 3.20 °C (TRUFI). In conclusion, the seg-EPI sequence was found to be more convenient for MR temperature imaging of LITT due to its relatively high precision and accuracy. Among the T 1 method sequences, FLASH showed the highest accuracy and robustness.

Magnetic resonance temperature imaging of laser-induced thermotherapy: assessment of fast sequences in ex vivo porcine liver.

AIM: To evaluate magnetic resonance sequences for T(1) and proton resonance frequency (PRF) thermometry during laser-induced thermotherapy (LITT) in liver tissue. MATERIALS & METHODS: During LITT (1064 nm; 30 W; 3-cm diffuser; 2-3 min) in ex vivo porcine liver, temperature was measured (25-70°C) utilizing a fiberoptic thermometer and MRI was performed with a 1.5-T scanner through the following sequences: segmented echo planar imaging (seg-EPI) for the PRF method; fast low-angle shot (FLASH), inversion-recovery turbo FLASH (IRTF), saturation-recovery turbo FLASH (SRTF) and true-fast imaging (TRUFI) for the T(1) method. Phase angle and signal amplitude (regarding PRF/T(1)) was recorded in regions of interest, on images under fiberoptic probe tips. Sequences' thermal coefficients were determined by calibrating phase angle and signal amplitude against temperature and subsequently validated. RESULTS: Coefficients of -0.0089 ± 0.0003 ppm °C(-1) (seg-EPI) and -0.917 ± 0.046, -1.166 ± 0.058, -1.038 ± 0.054 and -1.443 ± 0.118°C(-1) (FLASH, IRTF, SRTF and TRUFI, respectively) were obtained. Precisions of 0.71, 1.34, 2.07, 2.44 and 3.21°C and, through Bland-Altman analysis, accuracies of -0.67, 0.79, 1.65, 1.57 and 2.13°C (seg-EPI, FLASH, IRTF, SRTF and TRUFI, respectively) were determined. CONCLUSION: The PRF method with seg-EPI sequence is preferred for thermometry during LITT owing to higher precision and accuracy. Among T(1)-method sequences, FLASH showed higher accuracy and robustness.

Effect of contrast material on radiation dose in an adult cardiac dual-energy CT using retrospective ECG-gating.

The purpose of this study was to determine the effect of contrast material and retrospective ECG-gating on radiation dose in an adult cardiac dual-energy computed tomography (DECT). Sixty-two patients underwent CT cardiac examination with a Somatom Definition Flash DECT using tube voltages of 100 kV without filter and 140 kV with a tin filter (mean effective mA s: arterial 72.39 and 62.94, venous 93.21 and 78.45, and late phase 134.5 and 118.2). The arterial and late phases were examined with retrospective ECG-gating, but gating was not used for the venous phase. Seventy milliliters (70 ml) iodinated contrast material (CM) was injected into the patient during examination. The effective doses (ED) were calculated from dose-length-product (DLP) and computed tomographic dose index volume (CTDIvol) using the latest k-factor (0.028). Pearson's correlation coefficient was used for statistical tests on continuous variables. Mean CTDIvol and DLP were lower in the late phase (10.15 ± 1.5 mGy and 202.9 ± 23 mGy cm) compared to the arterial phase (19.69 ± 3 mGy and 394 ± 90 mGy cm). Differences between the arterial and late phase were statistically significant (p = 0.005), and mean values for the late phase were 48.5% lower than mean values for the arterial phase. Mean CTDIvol and DLP were lower in venous (7.72 ± 1 mGy and 154.3 ± 17 mGy cm) compared to late phase (10.15 ± 1.5 mGy and 202.9 ± 23 mGy cm). The difference between venous and late phase was statistically significant (p < 0.001). The mean results for the venous phase were 24% lower than those for the late phase. This study shows that contrast material (CM) absorbs radiation significantly and increases dose by 48.5% in an adult cardiac dual-energy CT with retrospective ECG-gating. Care must be taken to determine the type, concentration, and volume of CM used for the scan. The dual-energy non-ECG-gated technique decreased radiation dose by 24% compared to the ECG-gated technique. ECG-gated cardiac examination should be limited to patients with strong clinical indications. SNR and HU increased with decreasing energy. The image noise values showed a negligible difference in the arterial and late phase datasets, and this did not affect the diagnostic quality of the image evaluation.

Repetitive chemoembolization of hypovascular liver metastases from the most common primary sites.

AIM: To evaluate tumor response in patients with hypovascular liver metastases from the most common primary sites treated with chemoembolization. MATERIALS & METHODS: Chemoembolization was performed in 190 patients (five groups) who had hypovascular liver metastases from the colon (n = 66), breast (n = 40), uveal malignant melanoma (n = 20), pancreas (n = 48) and stomach (n = 16). Surgical resection of primary sites had been performed for all included patients. Tumor response, survival statistics from the first chemoembolization using Kaplan-Meier method and progression rate of embolized lesions were evaluated by analysis of variance with Tukey's post hoc test. RESULTS: Multiple comparison between the groups showed no statistical significant difference in local tumor response (H: 9.23; p > 0.05). Survival indices of the patients, including survival rate, progression-free survival rate, median survival time and time to progression, demonstrated significant difference between the groups during the follow-up period (H: 9.7; p = 0.045). The progression rate of treated liver metastases from colon, breast, uvea, pancreas and stomach were 16.6, 17.5, 30.0, 25.0 and 32.0%, respectively (p = 0.002). CONCLUSION: Hypovascular liver metastases treated with chemoembolization may demonstrate equal local response, but are significantly different in rate of progression and survival.

The influence of Nd:YAG laser irradiation on Fluoroptic® temperature measurement: an experimental evaluation.

The aim of this study was to experimentally evaluate temperature monitoring with a Fluoroptic® temperature probe in the presence of laser irradiation from a Nd:YAG laser, which is mainly used for clinical MR-guided laser-induced interstitial thermotherapy. Temperature measurements were performed using a Fluoroptic® probe in comparison to a thermocouple probe in a gel phantom and an ex vivo pig liver at distances of 6.5 to 14 mm to the laser applicator (laser energy of 30.8 W). To evaluate the artifacts in the temperature measurement, the laser was turned on and off three times during the entire experiment. A comparison of the fiber-optic measurements with MR thermometry was also performed in pig liver by means of the proton resonance frequency method at a distance of 6 mm. Depending on the distance, the temperature measured by the fiber-optic probe deviated from the thermocouple probe temperature. The phantom deviations of 0.4 to 34.3 % were observed. The differences in the liver were smaller and ranged from 1.6 to 5.2 %. The Bland-Altman mean of differences between MR and fiber-optic temperature measurements was 0.02 °C and the 95 % limits of agreement value was ± 2.25°C. During laser application, considerable artifacts occurred in the Fluoroptic® measurements in short distances which was induced by laser energy absorption by the probe coating. No artifacts were verifiable at a distance of 14 mm in both mediums. The good conformity with MR thermometry resulted from the shorter turn-on times of the laser since the laser irradiation had only a minor effect on the measurements.

Radiation dose and image quality of X-ray volume imaging systems: cone-beam computed tomography, digital subtraction angiography and digital fluoroscopy.

OBJECTIVE: Radiation dose and image quality estimation of three X-ray volume imaging (XVI) systems. METHODS: A total of 126 patients were examined using three XVI systems (groups 1-3) and their data were retrospectively analysed from 2007 to 2012. Each group consisted of 42 patients and each patient was examined using cone-beam computed tomography (CBCT), digital subtraction angiography (DSA) and digital fluoroscopy (DF). Dose parameters such as dose-area product (DAP), skin entry dose (SED) and image quality parameters such as Hounsfield unit (HU), noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were estimated and compared using appropriate statistical tests. RESULTS: Mean DAP and SED were lower in recent XVI than its previous counterparts in CBCT, DSA and DF. HU of all measured locations was non-significant between the groups except the hepatic artery. Noise showed significant difference among groups (P < 0.05). Regarding CNR and SNR, the recent XVI showed a higher and significant difference compared to its previous versions. Qualitatively, CBCT showed significance between versions unlike the DSA and DF which showed non-significance. CONCLUSION: A reduction of radiation dose was obtained for the recent-generation XVI system in CBCT, DSA and DF. Image noise was significantly lower; SNR and CNR were higher than in previous versions. The technological advancements and the reduction in the number of frames led to a significant dose reduction and improved image quality with the recent-generation XVI system. KEY POINTS: • X-ray volume imaging (XVI) systems are increasingly used for interventional radiological procedures. • More modern XVI systems use lower radiation doses compared with earlier counterparts. • Furthermore more modern XVI systems provide higher image quality. • Technological advances reduce radiation dose and improve image quality.

A liver-mimicking MRI phantom for thermal ablation experiments.

PURPOSE: To develop a liver-mimicking MRI gel phantom for use in the development of temperature mapping and coagulation progress visualization tools needed for the thermal tumor ablation methods, including laser-induced interstitial thermotherapy (LITT) and radiofrequency ablation (RFA). METHODS: A base solution with an acrylamide concentration of 30 vol. % was prepared. Different components were added to the solution; among them are bovine hemoglobin and MR signal-enhancing contrast agents (Magnevist as T1 and Lumirem as T2 contrast agent) for adjustment of the optical absorption and MR relaxation times, respectively. The absorption was measured in samples with various hemoglobin concentrations (0%-7.5%) at different temperatures (25-80 degrees C) using the near-infrared spectroscopy, measuring the transmitted radiation through the sample. The relaxation times were measured in samples with various concentrations of T1 (0.025%-0.325%) and T2 (0.4%-1.6%) contrast agents at different temperatures (25-75 degrees C), through the MRI technique, acquiring images with specific sequences. The concentrations of the hemoglobin and contrast agents of the gel were adjusted so that its absorption coefficient and relaxation times are equivalent to those of liver. To this end, the absorption and relaxation times of the gel samples were compared to reference values, measured in an ex vivo porcine liver at different temperatures through the same methods used for the gel. For validation of the constructed phantom, the absorption and relaxation times were measured in samples containing the determined amounts of the hemoglobin and contrast agents and compared with the corresponding liver values. To qualitatively test the heat resistance of the phantom, it was heated with the LITT method up to approximately 120 degrees C and then was cut to find out if it has been melted. RESULTS: In contrast to liver, where the absorption change with temperature showed a sigmoidal form with a jump at T approximately equal 45 degrees C, the absorption of the gel varied slightly over the whole temperature range. However, the gel absorption presented a linear increase from approximately 1.8 to approximately 2.2 mm(-1) with the rising hemoglobin concentration. The gel relaxation times showed a linear decrease with the rising concentrations of the respective contrast agents. Conversely, with the rising temperature, both T1 and T2 increased linearly and showed almost the same trends as in liver. The concentrations of hemoglobin and T1 and T2 contrast agents were determined as 3.92 +/- 0.42 vol. %, 0.098 +/- 0.023 vol. %, and 2.980 +/- 0.067 vol. %, respectively. The measured ex vivo liver T1 value increased from approximately 300 to approximately 530 ms and T2 value from approximately 45 to approximately 52 ms over the temperature range. The phantom validation experiments resulted in absorption coefficients of 2.0-2.1 mm(-1) with variations of 1.5%-2.95% compared to liver below 50 degrees C, T1 of 246.6-597.2 ms and T2 of 40.8-67.1 ms over the temperature range of 25-75 degrees C. Using the Bland-Altman analysis, a difference mean of -6.1/1.9 ms was obtained for T1/T2 between the relaxation times of the phantom and liver. After heating the phantom with LITT, no evidence of melting was observed. CONCLUSIONS: The constructed phantom is heat-resistant and MR-compatible and can be used as an alternative to liver tissue in the MR-guided thermal ablation experiments with laser to develop clinical tools for real-time monitoring and controlling the thermal ablation progress in liver.