Radiosensitisation by olaparib through focused ultrasound delivery in a diffuse midline glioma model.

BACKGROUND AND PURPOSE: Diffuse midline glioma H3K27-altered (DMG) is an aggressive, inoperable, predominantly paediatric brain tumour. Treatment strategies are limited, resulting in a median survival of only 11 months. Currently, radiotherapy (RT), often combined with temozolomide, is considered the standard of care but remains palliative, highlighting the urgency for new therapies. Radiosensitisation by olaparib, an inhibitor of PARP1 and subsequently PAR-synthesis, is a promising treatment option. We assessed whether PARP1 inhibition enhances radiosensitivity in vitro and in vivo following focused ultrasound mediated blood-brain barrier opening (FUS-BBBO). METHODS: Effects of PARP1 inhibition were evaluated in vitro using viability, clonogenic, and neurosphere assays. In vivo olaparib extravasation and pharmacokinetic profiling following FUS-BBBO was measured by LC-MS/MS. Survival benefit of FUS-BBBO combined with olaparib and RT was assessed using a patient-derived xenograft (PDX) DMG mouse model. RESULTS: Treatment with olaparib in combination with radiation delayed tumour cell proliferation in vitro through the reduction of PAR. Prolonged exposure of low olaparib concentration was more efficient in delaying cell growth than short exposure of high concentration. FUS-BBBO increased olaparib bioavailability in the pons by 5.36-fold without observable adverse effects. A Cmax of 54.09 µM in blood and 1.39 µM in the pontine region was achieved following administration of 100 mg/kg olaparib. Although RT combined with FUS-BBBO mediated olaparib extravasation delayed local tumour growth, survival benefits were not observed in an in vivo DMG PDX model. CONCLUSIONS: Olaparib effectively radiosensitises DMG cells in vitro and reduces primary tumour growth in vivo when combined with RT. Further studies are needed to investigate the therapeutic benefit of olaparib in suitable preclinical PDX models.

Two-color synchrotron X-ray spectroscopy based on transverse resonance island buckets.

We report on a novel multi-color method of X-ray spectroscopy at a Synchrotron radiation source that uses two simultaneously filled electron orbits in an electron storage ring to generate multiple soft or tender X-ray beams of different wavelength. To establish the second orbit, we use nonlinear beam dynamics in the so called TRIBs-transverse resonance island buckets-mode of the BESSY II storage ring, where a second electron orbit winds around the regular one leading to transversely separated source points. X-ray beams of multiple colors are generated by imaging the individual source points via different pathways through a monochromator. The particular colors can be varied by changing the traversal electron beam positions through storage-ring parameters and/or via the monochromator dispersion. As a proof of principle, X-ray absorption spectroscopy is performed on thin Fe films in transmission as well as a scanning transmission measurement on a Fe3GeTe2 sample of inhomogeneous thickness normalizing resonant signals with the pre-edge intensity. Using the extraordinary pointing fidelity of successive X-ray macro-pulses arriving at MHz repetition rates, a detection of tiny contrasts in diluted systems, contrast enhancement in X-ray microscopy as well as fast dynamics studies come into reach.

Impact of preoperative antibiotic use in preventing complications of cochlear implantation surgery.

OBJECTIVE: To examine the impact of preoperative antibiotic prophylaxis on the occurrence of postoperative complications. MATERIALS AND METHODS: Data of 491 patients undergoing cochlear implantation were included in a non-randomized retrospective comparative cohort study. Demographic data, cochlear implant and surgical details, use of preoperative antibiotics and occurrence of postoperative complications were analyzed using a binary logistic regression model. RESULTS: There were 317 patients (64.56%) who did not receive preoperative antibiotic prophylaxis and 174 (35.44%) patients who received preoperative antibiotic prophylaxis with ceftriaxone. The overall rate of complications requiring surgical treatment was 2.85%. Younger patient age was identified as a positive predictive factor for administering preoperative antibiotic prophylaxis (p<0.001, OR 1.05 CI 95% 1.0124-1.0826). No difference in complication rate was observed between the two groups. No correlation between sex, age, manufacturer, surgeon and postoperative complications were noted (p=0.45). CONCLUSION: There is insufficient evidence to inform decision making regarding preoperative intravenous ceftriaxone use for prevention of infection after cochlear implantation surgery, with data failing to show that administration of preoperative antibiotics leads to a decrease in complication rate. Considering a very low overall complication rate, with few complications related to infection, routine use of preoperative antibiotic prophylaxis should be analyzed further.

Quantitative investigation of dose accumulation errors from intra-fraction motion in MRgRT for prostate cancer.

Accurate spatial dose delivery in radiotherapy is frequently complicated due to changes in the patient's internal anatomy during and in-between therapy segments. The recent introduction of hybrid MRI radiotherapy systems allows unequaled soft-tissue visualization during radiation delivery and can be used for dose reconstruction to quantify the impact of motion. To this end, knowledge of anatomical deformations obtained from continuous monitoring during treatment has to be combined with information on the spatio-temporal dose delivery to perform motion-compensated dose accumulation (MCDA). Here, the influence of the choice of deformable image registration algorithm, dose warping strategy, and magnetic resonance image resolution and signal-to-noise-ratio on the resulting MCDA is investigated. For a quantitative investigation, four 4D MRI-datasets representing typical patient observed motion patterns are generated using finite element modeling and serve as a gold standard. Energy delivery is simulated intra-fractionally in the deformed image space and, subsequently, MCDA-processed. Finally, the results are substantiated by comparing MCDA strategies on clinically acquired patient data. It is shown that MCDA is needed for correct quantitative dose reconstruction. For prostate treatments, using the energy per mass transfer dose warping strategy has the largest influence on decreasing dose estimation errors.

Deep correction of breathing-related artifacts in real-time MR-thermometry.

Real-time MR-imaging has been clinically adapted for monitoring thermal therapies since it can provide on-the-fly temperature maps simultaneously with anatomical information. However, proton resonance frequency based thermometry of moving targets remains challenging since temperature artifacts are induced by the respiratory as well as physiological motion. If left uncorrected, these artifacts lead to severe errors in temperature estimates and impair therapy guidance. In this study, we evaluated deep learning for on-line correction of motion related errors in abdominal MR-thermometry. For this, a convolutional neural network (CNN) was designed to learn the apparent temperature perturbation from images acquired during a preparative learning stage prior to hyperthermia. The input of the designed CNN is the most recent magnitude image and no surrogate of motion is needed. During the subsequent hyperthermia procedure, the recent magnitude image is used as an input for the CNN-model in order to generate an on-line correction for the current temperature map. The method's artifact suppression performance was evaluated on 12 free breathing volunteers and was found robust and artifact-free in all examined cases. Furthermore, thermometric precision and accuracy was assessed for in vivo ablation using high intensity focused ultrasound. All calculations involved at the different stages of the proposed workflow were designed to be compatible with the clinical time constraints of a therapeutic procedure.

Anatomically-adaptive multi-modal image registration for image-guided external-beam radiotherapy.

Image-guided radiotherapy (IGRT) allows observation of the location and shape of the tumor and organs-at-risk (OAR) over the course of a radiation cancer treatment. Such information may in turn be used for reducing geometric uncertainties during therapeutic planning, dose delivery and response assessment. However, given the multiple imaging modalities and/or contrasts potentially included within the imaging protocol over the course of the treatment, the current manual approach to determining tissue displacement may become time-consuming and error prone. In this context, variational multi-modal deformable image registration (DIR) algorithms allow automatic estimation of tumor and OAR deformations across the acquired images. In addition, they require short computational times and a low number of input parameters, which is particularly beneficial for online adaptive applications, which require on-the-fly adaptions with the patient on the treatment table. However, the majority of such DIR algorithms assume that all structures across the entire field-of-view (FOV) undergo a similar deformation pattern. Given that various anatomical structures may behave considerably different, this may lead to the estimation of anatomically implausible deformations at some locations, thus limiting their validity. Therefore, in this paper we propose an anatomically-adaptive variational multi-modal DIR algorithm, which employs a regionalized registration model in accordance with the local underlying anatomy. The algorithm was compared against two existing methods which employ global assumptions on the estimated deformations patterns. Compared to the existing approaches, the proposed method has demonstrated an improved anatomical plausibility of the estimated deformations over the entire FOV as well as displaying overall higher accuracy. Moreover, despite the more complex registration model, the proposed approach is very fast and thus suitable for online scenarios. Therefore, future adaptive IGRT workflows may benefit from an anatomically-adaptive registration model for precise contour propagation and dose accumulation, in areas showcasing considerable variations in anatomical properties.

Patch-based field-of-view matching in multi-modal images for electroporation-based ablations.

Various multi-modal imaging sensors are currently involved at different steps of an interventional therapeutic work-flow. Cone beam computed tomography (CBCT), computed tomography (CT) or Magnetic Resonance (MR) images thereby provides complementary functional and/or structural information of the targeted region and organs at risk. Merging this information relies on a correct spatial alignment of the observed anatomy between the acquired images. This can be achieved by the means of multi-modal deformable image registration (DIR), demonstrated to be capable of estimating dense and elastic deformations between images acquired by multiple imaging devices. However, due to the typically different field-of-view (FOV) sampled across the various imaging modalities, such algorithms may severely fail in finding a satisfactory solution. In the current study we propose a new fast method to align the FOV in multi-modal 3D medical images. To this end, a patch-based approach is introduced and combined with a state-of-the-art multi-modal image similarity metric in order to cope with multi-modal medical images. The occurrence of estimated patch shifts is computed for each spatial direction and the shift value with maximum occurrence is selected and used to adjust the image field-of-view. The performance of the proposed method - in terms of both registration accuracy and computational needs - is analyzed in the practical case of on-line irreversible electroporation procedures. In total, 30 pairs of pre-/per-operative IRE images are considered to illustrate the efficiency of our algorithm. We show that a regional registration approach using voxel patches provides a good structural compromise between the voxel-wise and "global shifts" approaches. The method was thereby beneficial for CT to CBCT and MRI to CBCT registration tasks, especially when highly different image FOVs are involved. Besides, the benefit of the method for CT to CBCT and MRI to CBCT image registration is analyzed, including the impact of artifacts generated by percutaneous needle insertions. Additionally, the computational needs using commodity hardware are demonstrated to be compatible with clinical constraints in the practical case of on-line procedures. The proposed patch-based workflow thus represents an attractive asset for DIR at different stages of an interventional procedure.

Generation of intense and coherent sub-femtosecond X-ray pulses in electron storage rings.

Temporally short X-ray pulses are an indispensable tool for the study of electron transitions close to the Fermi energy and structural changes in molecules undergoing chemical reactions which take place on a time-scale of hundreds of femtoseconds. The time resolution of experiments at 3rd generation light sources which produce intense synchrotron radiation is limited fundamentally by the electron-bunch length in the range of tens of picoseconds. Here we propose a new scheme for the generation of intense and coherent sub-femtoseconds soft X-ray pulses in storage rings by applying the Echo-Enabled Harmonic Generation (EEHG) method. Many issues for obtaining the EEHG structure such as two modulators and a radiator are solved by a paradigm shift in an achromatic storage ring cell. Numerical demonstration of the feasibility of the scheme for the BESSY II beam parameters is presented.

Correlation of pre-operative computed tomography, intra-operative findings and surgical outcomes in revision tympanomastoidectomy.

OBJECTIVE: To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy. METHODS: This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans. RESULTS: Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05). CONCLUSION: Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.

Hypertrophic recurring lichen planus of the external auditory canal.

INTRODUCTION: We report a case of unilateral progressive primary hypertrophic lichen planus of the external auditory canal requiring several surgical interventions to deal with constant pruritus, otorrhoea, stenosis and conductive hearing loss. CASE SUMMARY: A 58-year-old woman was initially treated with meatoplasty for suspected chronic obliterating otitis externa. She remained symptom-free for 5 years, before the disease recurred, affecting other body surfaces as well. Otorrhoea, conductive hearing loss and pruritus worsened, and a canal wall down tympanomastoidectomy was performed, removing the skin of the external auditory canal and the tympanic membrane completely. Lichen planus was confirmed histopathologically. DISCUSSION: Very few surgical results have been published on stenosis of the external auditory canal caused by lichen planus. Complete medial external auditory canal skin elevation and removal with postoperative split-skin grafting is advised for initial treatment. We discuss treatment options and surgical outcome after initial surgical failure.

Transverse resonance island buckets for synchrotron-radiation based electron time-of-flight spectroscopy.

At the Metrology Light Source (MLS), the compact electron storage ring of the Physikalisch-Technische Bundesanstalt (PTB) with a circumference of 48 m, a specific operation mode with two stable closed orbits for stored electrons was realized by transverse resonance island buckets. One of these orbits is closing only after three turns. In combination with single-bunch operation, the new mode was applied for electron time-of-flight spectroscopy with an interval of the synchrotron radiation pulses which is three times the revolution period at the MLS of 160 ns. The achievement is of significant importance for PTB's future programs of angular-resolved electron spectroscopy with synchrotron radiation and similar projects at other compact electron storage rings. The scheme applied here for selecting the photons originating from a particular orbit by optical imaging has been used before in fs slicing applications and may be relevant for the BESSY VSR project of the Helmholtz-Zentrum Berlin.

Accelerating multi-modal image registration using a supervoxel-based variational framework.

For the successful completion of medical interventional procedures, several concepts, such as daily positioning compensation, dose accumulation or delineation propagation, rely on establishing a spatial coherence between planning images and images acquired at different time instants over the course of the therapy. To meet this need, image-based motion estimation and compensation relies on fast, automatic, accurate and precise registration algorithms. However, image registration quickly becomes a challenging and computationally intensive task, especially when multiple imaging modalities are involved. In the current study, a novel framework is introduced to reduce the computational overhead of variational registration methods. The proposed framework selects representative voxels of the registration process, based on a supervoxel algorithm. Costly calculations are hereby restrained to a subset of voxels, leading to a less expensive spatial regularized interpolation process. The novel framework is tested in conjunction with the recently proposed EVolution multi-modal registration method. This results in an algorithm requiring a low number of input parameters, is easily parallelizable and provides an elastic voxel-wise deformation with a subvoxel accuracy. The performance of the proposed accelerated registration method is evaluated on cross-contrast abdominal T1/T2 MR-scans undergoing a known deformation and annotated CT-images of the lung. We also analyze the ability of the method to capture slow physiological drifts during MR-guided high intensity focused ultrasound therapies and to perform multi-modal CT/MR registration in the abdomen. Results have shown that computation time can be reduced by 75% on the same hardware with no negative impact on the accuracy.

Imaging of nuclear magnetic resonance spin-lattice relaxation activation energy in cartilage.

Samples of human and bovine cartilage have been examined using magnetic resonance imaging to determine the proton nuclear magnetic resonance spin-lattice relaxation time, T1, as a function of depth within through the cartilage tissue. T1 was measured at five to seven temperatures between 8 and 38°C. From this, it is shown that the T1 relaxation time is well described by Arrhenius-type behaviour and the activation energy of the relaxation process is quantified. The activation energy within the cartilage is approximately 11 ± 2 kJ mol-1 with this notably being less than that for both pure water (16.6 ± 0.4 kJ mol-1) and the phosphate-buffered solution in which the cartilage was immersed (14.7 ± 1.0 kJ mol-1). It is shown that this activation energy increases as a function of depth in the cartilage. It is known that cartilage composition varies with depth, and hence, these results have been interpreted in terms of the structure within the cartilage tissue and the association of the water with the macromolecular constituents of the cartilage.

Anatomically plausible models and quality assurance criteria for online mono- and multi-modal medical image registration.

Medical imaging is currently employed in the diagnosis, planning, delivery and response monitoring of cancer treatments. Due to physiological motion and/or treatment response, the shape and location of the pathology and organs-at-risk may change over time. Establishing their location within the acquired images is therefore paramount for an accurate treatment delivery and monitoring. A feasible solution for tracking anatomical changes during an image-guided cancer treatment is provided by image registration algorithms. Such methods are, however, often built upon elements originating from the computer vision/graphics domain. Since the original design of such elements did not take into consideration the material properties of particular biological tissues, the anatomical plausibility of the estimated deformations may not be guaranteed. In the current work we adapt two existing variational registration algorithms, namely Horn-Schunck and EVolution, to online soft tissue tracking. This is achieved by enforcing an incompressibility constraint on the estimated deformations during the registration process. The existing and the modified registration methods were comparatively tested against several quality assurance criteria on abdominal in vivo MR and CT data. These criteria included: the Dice similarity coefficient (DSC), the Jaccard index, the target registration error (TRE) and three additional criteria evaluating the anatomical plausibility of the estimated deformations. Results demonstrated that both the original and the modified registration methods have similar registration capabilities in high-contrast areas, with DSC and Jaccard index values predominantly in the 0.8-0.9 range and an average TRE of 1.6-2.0 mm. In contrast-devoid regions of the liver and kidneys, however, the three additional quality assurance criteria have indicated a considerable improvement of the anatomical plausibility of the deformations estimated by the incompressibility-constrained methods. Moreover, the proposed registration models maintain the potential of the original methods for online image-based guidance of cancer treatments.

Real-time non-rigid target tracking for ultrasound-guided clinical interventions.

Biological motion is a problem for non- or mini-invasive interventions when conducted in mobile/deformable organs due to the targeted pathology moving/deforming with the organ. This may lead to high miss rates and/or incomplete treatment of the pathology. Therefore, real-time tracking of the target anatomy during the intervention would be beneficial for such applications. Since the aforementioned interventions are often conducted under B-mode ultrasound (US) guidance, target tracking can be achieved via image registration, by comparing the acquired US images to a separate image established as positional reference. However, such US images are intrinsically altered by speckle noise, introducing incoherent gray-level intensity variations. This may prove problematic for existing intensity-based registration methods. In the current study we address US-based target tracking by employing the recently proposed EVolution registration algorithm. The method is, by construction, robust to transient gray-level intensities. Instead of directly matching image intensities, EVolution aligns similar contrast patterns in the images. Moreover, the displacement is computed by evaluating a matching criterion for image sub-regions rather than on a point-by-point basis, which typically provides more robust motion estimates. However, unlike similar previously published approaches, which assume rigid displacements in the image sub-regions, the EVolution algorithm integrates the matching criterion in a global functional, allowing the estimation of an elastic dense deformation. The approach was validated for soft tissue tracking under free-breathing conditions on the abdomen of seven healthy volunteers. Contact echography was performed on all volunteers, while three of the volunteers also underwent standoff echography. Each of the two modalities is predominantly specific to a particular type of non- or mini-invasive clinical intervention. The method demonstrated on average an accuracy of ∼1.5 mm and submillimeter precision. This, together with a computational performance of 20 images per second make the proposed method an attractive solution for real-time target tracking during US-guided clinical interventions.

Evaluation of a novel therapeutic focused ultrasound transducer based on Fermat's spiral.

The purpose of this study was to evaluate a novel phased array transducer design rule for therapeutic focused ultrasound applications. This design rule uses the discretized Fermat's spiral to determine the positioning of the transducer elements for a given number of elements and f-number. Using this principle, three variations of Fermat's spiral were generated, aimed at (1) grating lobe minimization, (2) side lobe minimization, and (3) an optimized element packing efficiency. For each spiral, sparse layouts using identical circular elements and fully populated layouts based on additional Voronoi tessellation were evaluated numerically. Evaluation criteria included the element size distribution, beam steering capabilities, focal plane pressure distribution, prefocal pressure distribution, and practical considerations. Finally, one Voronoi-tessellated design with a focal length and aperture diameter of 16 cm and a natural frequency of 1.3 MHz was evaluated experimentally through hydrophone measurements. The numerical evaluation showed that while sparse arrays possess superior beam steering capabilities for a given number of elements, the focal point quality and prefocal pressure distribution is substantially more favorable when using the Voronoi-tessellated designs. Beam steering was shown to be feasible with the tessellated designs for lateral deflections up to 10 mm and axial deflections up to 20 mm. The experimental evaluation showed that such a transducer is capable of inducing 40.00 MPa rarefactional and 237.50 MPa compressional peak pressure levels at 800 W instantaneous acoustic output power under free-field conditions, making the system potentially relevant for thermal ablation therapy, histotripsy applications, and shockwave-enhanced heating.

Thermal ablation of a confluent lesion in the porcine kidney with a clinically available MR-HIFU system.

The incidence of small renal masses (SRMs) sized <4 cm has increased over the decades (as co-findings/or due to introduction of cross sectional imaging). Currently, partial nephrectomy (PN) or watchful waiting is advised in these patients. Ultimately, 80-90% of these SRMs require surgical treatment and PN is associated with a 15% complication rate. In this aging population, with possible comorbidities and poor health condition, both PN and watchful waiting are non-ideal treatment options. This resulted in an increased need for early, non-invasive treatment strategies such as MR-guided high intensity focused ultrasound (MR-HIFU). (i) To investigate the feasibility of creating a confluent lesion in the kidney using respiratory-gated MR-HIFU under clinical conditions in a pre-clinical study and (ii) to evaluate the reproducibility of the MR-HIFU ablation strategy. Healthy pigs (n = 10) under general anesthesia were positioned on a clinical MR-HIFU system with integrated cooling. A honeycomb pattern of seven overlapping ablation cells (4 × 4 × 10 mm3, 450 W, <30 s) was ablated successively in the cortex of the porcine kidney. Both MR thermometry and acoustic energy delivery were respiratory gated using a pencil beam navigator on the contralateral kidney. The non-perfused volume (NPV) was visualized after the last sonication by contrast-enhanced (CE) T 1-weighted MR (T 1 w) imaging. Cell viability staining was performed to visualize the extent of necrosis. RESULTS: a median NPV of 0.62 ml was observed on CE-T 1 w images (IQR 0.58-1.57 ml, range 0.33-2.75 ml). Cell viability staining showed a median damaged volume of 0.59 ml (IQR 0.24-1.35 ml, range 0-4.1 ml). Overlooking of the false rib, shivering of the pig, and too large depth combined with a large heat-sink effect resulted in insufficient heating in 4 cases. The NPV and necrosed volume were confluent in all cases in which an ablated volume could be observed. Our results demonstrated the feasibility of creating a confluent volume of ablated kidney cortical tissue in vivo with MR-HIFU on a clinically available system using respiratory gating and near-field cooling and showed its reproducibility.

EVolution: an edge-based variational method for non-rigid multi-modal image registration.

Image registration is part of a large variety of medical applications including diagnosis, monitoring disease progression and/or treatment effectiveness and, more recently, therapy guidance. Such applications usually involve several imaging modalities such as ultrasound, computed tomography, positron emission tomography, x-ray or magnetic resonance imaging, either separately or combined. In the current work, we propose a non-rigid multi-modal registration method (namely EVolution: an edge-based variational method for non-rigid multi-modal image registration) that aims at maximizing edge alignment between the images being registered. The proposed algorithm requires only contrasts between physiological tissues, preferably present in both image modalities, and assumes deformable/elastic tissues. Given both is shown to be well suitable for non-rigid co-registration across different image types/contrasts (T1/T2) as well as different modalities (CT/MRI). This is achieved using a variational scheme that provides a fast algorithm with a low number of control parameters. Results obtained on an annotated CT data set were comparable to the ones provided by state-of-the-art multi-modal image registration algorithms, for all tested experimental conditions (image pre-filtering, image intensity variation, noise perturbation). Moreover, we demonstrate that, compared to existing approaches, our method possesses increased robustness to transient structures (i.e. that are only present in some of the images).

Equation of State of Ultracold Fermions in the 2D BEC-BCS Crossover Region.

We report the experimental measurement of the equation of state of a two-dimensional Fermi gas with attractive s-wave interactions throughout the crossover from a weakly coupled Fermi gas to a Bose gas of tightly bound dimers as the interaction strength is varied. We demonstrate that interactions lead to a renormalization of the density of the Fermi gas by several orders of magnitude. We compare our data near the ground state and at finite temperature with predictions for both fermions and bosons from quantum Monte Carlo simulations and Luttinger-Ward theory. Our results serve as input for investigations of close-to-equilibrium dynamics and transport in the two-dimensional system.

Increasing the HIFU ablation rate through an MRI-guided sonication strategy using shock waves: feasibility in the in vivo porcine liver.

This study investigated whether an MR-guided pulsed HIFU ablation strategy could be implemented under clinical conditions, using a transducer designed for uterine fibroid ablation, to obtain an ablation rate that is sufficiently high for clinical abdominal HIFU therapy in highly perfused organs. A pulsed HIFU ablation strategy, aimed at increasing the energy absorption in the HIFU focal area by local shock wave formation in the non-linear pressure regime, was compared to an energy-equivalent continuous wave sonication strategy in the linear pressure regime. Both ablation strategies were used for transcutaneous sonication of pre-defined treatment cells in the livers of 5 pigs in vivo. Temperature evolution in both the target area as well as the pre-focal muscle layer was monitored simultaneously using MR thermometry. Local energy absorption and thermal dose volumes were shown to be increased using the pulsed ablation strategy, while preserving healthy tissue in the near field of the acoustic beam. Respiratory motion compensation of both acoustic energy delivery and MR thermometry was applied through gating based on MR navigator echoes. Histopathology showed that confluent vacuolated thermal lesions were created when the pulsed ablation strategy was used. Additionally, it was shown that the heat sink effect caused by the presence of larger vessels could be overcome. The pulsed HIFU ablation strategy achieved an ablation rate of approximately 4 ml per hour in the in vivo porcine liver, without causing undesired damage to healthy tissues in the near field.