Microwave ablation of lung tumors: A probabilistic approach for simulation-based treatment planning.

PURPOSE: Microwave ablation (MWA) is a clinically established modality for treatment of lung tumors. A challenge with existing application of MWA, however, is local tumor progression, potentially due to failure to establish an adequate treatment margin. This study presents a robust simulation-based treatment planning methodology to assist operators in comparatively assessing thermal profiles and likelihood of achieving a specified minimum margin as a function of candidate applied energy parameters. METHODS: We employed a biophysical simulation-based probabilistic treatment planning methodology to evaluate the likelihood of achieving a specified minimum margin for candidate treatment parameters (i.e., applied power and ablation duration for a given applicator position within a tumor). A set of simulations with varying tissue properties was evaluated for each considered combination of power and ablation duration, and for four different scenarios of contrast in tissue biophysical properties between tumor and normal lung. A treatment planning graph was then assembled, where distributions of achieved minimum ablation zone margins and collateral damage volumes can be assessed for candidate applied power and treatment duration combinations. For each chosen power and time combination, the operator can also visualize the histogram of ablation zone boundaries overlaid on the tumor and target volumes. We assembled treatment planning graphs for generic 1, 2, and 2.5 cm diameter spherically shaped tumors and also illustrated the impact of tissue heterogeneity on delivered treatment plans and resulting ablation histograms. Finally, we illustrated the treatment planning methodology on two example patient-specific cases of tumors with irregular shapes. RESULTS: The assembled treatment planning graphs indicate that 30 W, 6 min ablations achieve a 5-mm minimum margin across all simulated cases for 1-cm diameter spherical tumors, and 70 W, 10 min ablations achieve a 3-mm minimum margin across 90% of simulations for a 2.5-cm diameter spherical tumor. Different scenarios of tissue heterogeneity between tumor and lung tissue revealed 2 min overall difference in ablation duration, in order to reliably achieve a 4-mm minimum margin or larger each time for 2-cm diameter spherical tumor. CONCLUSIONS: An approach for simulation-based treatment planning for microwave ablation of lung tumors is illustrated to account for the impact of specific geometry of the treatment site, tissue property uncertainty, and heterogeneity between the tumor and normal lung.

NIRS-based monitoring of kidney graft perfusion.

INTRODUCTION: Acute early vascular complications are rare, but serious complications after kidney transplantation. They often result in graft loss. For this reason, shortening the diagnostic process is crucial. Currently, it is standard procedure to monitor renal graft perfusion using Doppler ultrasound (DU). With respect to acute vascular complications, the main disadvantage of this type of examination is its periodicity. It would be of great benefit if graft blood perfusion could be monitored continuously during the early postoperative period. It appears evident that a well-designed near infrared spectroscopy (NIRS) monitoring system could prove very useful during the early post-transplantation period. Its role in the immediate diagnosis of vascular complications could result in a significant increase in graft salvage, thus improving the patient's overall quality of life and lowering morbidity and mortality for renal graft recipients. The aim of this study was to design, construct and test such a monitoring system. MATERIALS AND METHODS: We designed a rough NIRS-based system prototype and prepared a two-stage laboratory experiment based on a laboratory pig model. In the first stage, a total of 10 animals were used to verify and optimize the technical aspects and functionality of the prototype sensor by testing it on the animal kidneys in-vivo. As a result of these tests, a more specific prototype was designed. During the second stage, we prepared a unique laboratory model of a pig kidney autotransplantation and tested the system for long-term functionality on a group of 20 animals. Overall sensitivity and specificity were calculated, and a final prototype was prepared and completed with its own analytic software and chassis. RESULTS: We designed and constructed a NIRS-based system for kidney graft perfusion monitoring. The measurement system provided reliable performance and 100% sensitivity when detecting acute diminished blood perfusion of the transplanted kidneys in laboratory conditions. CONCLUSION: The system appears to be a useful tool for diagnosing diminished blood perfusion of kidney transplants during the early postoperative period. However, further testing is still required. We believe that applying our method in current human transplantation medicine is feasible, and we are confident that our prototype is ready for human testing.

Bronchoscopically delivered microwave ablation in an in vivo porcine lung model.

BACKGROUND: Percutaneous microwave ablation is clinically used for inoperable lung tumour treatment. Delivery of microwave ablation applicators to tumour sites within lung parenchyma under virtual bronchoscopy guidance may enable ablation with reduced risk of pneumothorax, providing a minimally invasive treatment of early-stage tumours, which are increasingly detected with computed tomography (CT) screening. The objective of this study was to integrate a custom microwave ablation platform, incorporating a flexible applicator, with a clinically established virtual bronchoscopy guidance system, and to assess technical feasibility for safely creating localised thermal ablations in porcine lungs in vivo. METHODS: Pre-ablation CTs of normal pigs were acquired to create a virtual model of the lungs, including airways and significant blood vessels. Virtual bronchoscopy-guided microwave ablation procedures were performed with 24-32 W power (at the applicator distal tip) delivered for 5-10 mins. A total of eight ablations were performed in three pigs. Post-treatment CT images were acquired to assess the extent of damage and ablation zones were further evaluated with viability stains and histopathologic analysis. RESULTS: The flexible microwave applicators were delivered to ablation sites within lung parenchyma 5-24 mm from the airway wall via a tunnel created under virtual bronchoscopy guidance. No pneumothorax or significant airway bleeding was observed. The ablation short axis observed on gross pathology ranged 16.5-23.5 mm and 14-26 mm on CT imaging. CONCLUSION: We have demonstrated the technical feasibility for safely delivering microwave ablation in the lung parenchyma under virtual bronchoscopic guidance in an in vivo porcine lung model.

Broadband lung dielectric properties over the ablative temperature range: Experimental measurements and parametric models.

PURPOSE: Computational models of microwave tissue ablation are widely used to guide the development of ablation devices, and are increasingly being used for the development of treatment planning and monitoring platforms. Knowledge of temperature-dependent dielectric properties of lung tissue is essential for accurate modeling of microwave ablation (MWA) of the lung. METHODS: We employed the open-ended coaxial probe method, coupled with a custom tissue heating apparatus, to measure dielectric properties of ex vivo porcine and bovine lung tissue at temperatures ranging between 31 and 150  ∘ C, over the frequency range 500 MHz to 6 GHz. Furthermore, we employed numerical optimization techniques to provide parametric models for characterizing the broadband temperature-dependent dielectric properties of tissue, and their variability across tissue samples, suitable for use in computational models of microwave tissue ablation. RESULTS: Rapid decreases in both relative permittivity and effective conductivity were observed in the temperature range from 94 to 108  ∘ C. Over the measured frequency range, both relative permittivity and effective conductivity were suitably modeled by piecewise linear functions [root mean square error (RMSE) = 1.0952 for permittivity and 0.0650 S/m for conductivity]. Detailed characterization of the variability in lung tissue properties was provided to enable uncertainty quantification of models of MWA. CONCLUSIONS: The reported dielectric properties of lung tissue, and parametric models which also capture their distribution, will aid the development of computational models of microwave lung ablation.

Suppression of overlearning in independent component analysis used for removal of muscular artifacts from electroencephalographic records.

This paper addresses the overlearning problem in the independent component analysis (ICA) used for the removal of muscular artifacts from electroencephalographic (EEG) records. We note that for short EEG records with high number of channels the ICA fails to separate artifact-free EEG and muscular artifacts, which has been previously attributed to the phenomenon called overlearning. We address this problem by projecting an EEG record into several subspaces with a lower dimension, and perform the ICA on each subspace separately. Due to a reduced dimension of the subspaces, the overlearning is suppressed, and muscular artifacts are better separated. Once the muscular artifacts are removed, the signals in the individual subspaces are combined to provide an artifact free EEG record. We show that for short signals and high number of EEG channels our approach outperforms the currently available ICA based algorithms for muscular artifact removal. The proposed technique can efficiently suppress ICA overlearning for short signal segments of high density EEG signals.

Analysis of minimally invasive directional antennas for microwave tissue ablation.

PURPOSE: Microwave ablation (MWA) applicators capable of creating directional heating patterns offer the potential of simplifying treatment of targets in proximity to critical structures and avoiding the need for piercing the tumour volume. This work reports on improved directional MWA antennas with the objectives of minimising device diameter for percutaneous use (≤ ∼13 gauge) and yielding larger ablation zones. METHODS: Two directional MWA antenna designs, with a modified monopole radiating element and spherical and parabolic reflectors are proposed. A 3D-coupled electromagnetic heat transfer with temperature-dependent material properties was implemented to characterise MWA at 40 and 77 W, for 5 and 10 min. Simulations were also used to assess antenna impedance matching within liver, kidney, lung, bone and brain tissue. The two antenna designs were fabricated and experimentally evaluated with ablations in ex vivo tissue at the two power levels and treatment durations (n = 5 repetitions for each group). RESULTS: The computed specific absorption rate (SAR) patterns for both antennas were similar, although simulations indicated slightly greater forward penetration for the parabolic antenna. Based on simulations for antennas inserted within different tissues, the proposed antenna design appears to offer good impedance matching for a variety of tissue types. Experiments in ex vivo tissue showed radial ablation depths of 19 ± 0.9 mm in the forward direction for the applicator with spherical reflector and 18.7 ± 0.7 mm for the applicator with parabolic reflector. CONCLUSION: These results suggest the applicator may be suitable for creating localised directional ablation zones for treating small and medium-sized targets with a percutaneous approach.

Sensitivity of microwave ablation models to tissue biophysical properties: A first step toward probabilistic modeling and treatment planning.

PURPOSE: Computational models of microwave ablation (MWA) are widely used during the design optimization of novel devices and are under consideration for patient-specific treatment planning. The objective of this study was to assess the sensitivity of computational models of MWA to tissue biophysical properties. METHODS: The Morris method was employed to assess the global sensitivity of the coupled electromagnetic-thermal model, which was implemented with the finite element method (FEM). The FEM model incorporated temperature dependencies of tissue physical properties. The variability of the model was studied using six different outputs to characterize the size and shape of the ablation zone, as well as impedance matching of the ablation antenna. Furthermore, the sensitivity results were statistically analyzed and absolute influence of each input parameter was quantified. A framework for systematically incorporating model uncertainties for treatment planning was suggested. RESULTS: A total of 1221 simulations, incorporating 111 randomly sampled starting points, were performed. Tissue dielectric parameters, specifically relative permittivity, effective conductivity, and the threshold temperature at which they transitioned to lower values (i.e., signifying desiccation), were identified as the most influential parameters for the shape of the ablation zone and antenna impedance matching. Of the thermal parameters considered in this study, the nominal blood perfusion rate and the temperature interval across which the tissue changes phase were identified as the most influential. The latent heat of tissue water vaporization and the volumetric heat capacity of the vaporized tissue were recognized as the least influential parameters. Based on the evaluation of absolute changes, the most important parameter (perfusion) had approximately 40.23 times greater influence on ablation area than the least important parameter (volumetric heat capacity of vaporized tissue). Another significant input parameter (permittivity) had 22.26 times higher influence on the deviation of ablation edge shape from a sphere than one of the less important parameters (latent heat of liver tissue vaporization). CONCLUSIONS: Dielectric parameters, blood perfusion rate, and the temperature interval across which the tissue changes phase were found to have the most significant impact on MWA model outputs. The latent heat of tissue water vaporization and the volumetric heat capacity of the vaporized tissue were recognized as the least influential parameters. Uncertainties in model outputs identified in this study can be incorporated to provide probabilistic maps of expected ablation outcome for patient-specific treatment planning.

Statistical evaluation of coherence estimated from optimally beamformed signals.

In this paper we investigate a situation where we want to perform a coherence analysis of two signal sources, one of which is measured directly, and the other is measured through a sensor array affected by noise. To extract the latter signal, we suggest the use of the optimal beamforming with reference. We note, however, that this approach results in a coherence estimate that is noticeably biased, and cannot be evaluated by the known statistical tests. We therefore derive a new statistical test, that allows the evaluation of the biased coherence estimate. We illustrate the applicability of our methodology on the coherence analysis of EEG and EMG signals. We note that the suggested approach has several advantages over the surface Laplacian, which is a spatial filter commonly used in the EEG-EMG coherence analysis.

Potential approximation in realistic Laplacian computation.

OBJECTIVE: This paper aims to improve the shortcomings of the extant methodologies for realistic Laplacian (RL) computation, and correct the erroneous claims published in the past. METHODS: We implemented several variants of RL computation methods, using various potential approximation techniques and different regularization approaches. The individual variants of the RL computation were tested using simulations based on a realistic head model computed with the boundary element method (BEM). The results which disagreed with previously published works were further analyzed, and the reasons for the disagreement were identified. RESULTS: We identified the best regularization techniques for the surface potential approximation, and we showed that once these techniques are used there is often little difference between various potential approximations, which is in contrast with previous claims that promoted the radial basis function (RBF) approximation. Further, our analysis shows that the RBF approximation suffers from Runge phenomenon, which cannot be mitigated simultaneously for both deep and shallow sources; therefore, its good performance is guarantied only if a priori knowledge about the source depth is available. CONCLUSIONS: The previously published methodology for RL computation was not optimal. Improvements are possible if the newly suggested approach is used. SIGNIFICANCE: The methodology presented in our paper allows more efficient utilization of the RL, providing a useful tool for processing of high density EEG recordings. Presented techniques allow to achieve high EEG spatial resolution, and avoid unnecessary spatial blurring caused by the problems in the previously published RL methodology.

Electrode position scaling in realistic laplacian computation.

This note discusses the effects of the electrode position scaling on the realistic Laplacian (RL) computation. It is shown that when the RL is estimated with the help of Tikhonov regularization and the generalized cross-validation (GCV) criterion, improper electrode position scaling may influence the GCV criterion, which results in the decrease of RL precision. We identify what the proper scaling should be, and we provide a closer examination of how the GCV criterion is affected by the electrode position scaling.

Regularization techniques in realistic Laplacian computation.

This paper explores regularization options for the ill-posed spline coefficient equations in the realistic Laplacian computation. We investigate the use of the Tikhonov regularization, truncated singular value decomposition, and the so-called lambda-correction with the regularization parameter chosen by the L-curve, generalized cross-validation, quasi-optimality, and the discrepancy principle criteria. The provided range of regularization techniques is much wider than in the previous works. The improvement of the realistic Laplacian is investigated by simulations on the three-shell spherical head model. The conclusion is that the best performance is provided by the combination of the Tikhonov regularization and the generalized cross-validation criterion-a combination that has never been suggested for this task before.