Preclinical prototype validation and characterization of a thermobrachytherapy system for interstitial hyperthermia and high-dose-rate brachytherapy.

Background and purpose: Integrating simultaneous interstitial hyperthermia in high-dose-rate brachytherapy treatments (HDR-BT) is expected to lead to enhanced therapeutic effect. However, there is currently no device available for such an integration. In this study, we presented and validated the thermobrachytherapy (TBT) preclinical prototype system that is able to seamlessly integrate into the HDR-BT workflow. Materials and methods: The TBT system consisted of an advanced radiofrequency power delivery and control system, dual-function interstitial applicators, and integrated connection and impedance matching system. The efficiency and minimum heating ability of the system was calculated performing calorimetric experiments. The effective-heating-length and heating pattern was evaluated using single-applicator split phantom experiments. The heating independence between applicators, the ability of the system to adaptable and predictable temperature steering was evaluated using multi-applicator split phantom experiments. Results: The system satisfied interstitial hyperthermia requirements. It demonstrated 50 % efficiency and ability to reach 6 °C temperature increase in 6 min. Effective-heating-length of the applicator was 43.7 mm, following the initial design. Heating pattern interference between applicators was lower than recommended. The system showed its ability to generate diverse heating patterns by adjusting the phase and amplitude settings of each electrode, aligning well with simulations (minimum agreement of 88 %). Conclusions: The TBT preclinical prototype system complied with IHT requirements, and agreed well with design criteria and simulations, hence performing as expected. The preclinical prototype TBT system can now be scaled to an in-vivo validation prototype, including an adaptable impedance matching solution, appropriate number of channels, and ensuring biocompatibility and regulatory compliance.

Investigating the Working Mechanism of Transcranial Direct Current Stimulation.

BACKGROUND: Transcranial direct current stimulation (tDCS) is used to modulate neuronal activity, but the exact mechanism of action (MOA) is unclear. This study investigates tDCS-induced modulation of the corticospinal excitability and the underlying MOA. By anesthetizing the scalp before applying tDCS and by stimulating the cheeks, we investigated whether stimulation of peripheral and/or cranial nerves contributes to the effects of tDCS on corticospinal excitability. MATERIALS AND METHODS: In a randomized cross-over study, four experimental conditions with anodal direct current stimulation were compared in 19 healthy volunteers: 1) tDCS over the motor cortex (tDCS-MI), 2) tDCS over the motor cortex with a locally applied topical anesthetic (TA) on the scalp (tDCS-MI + TA), 3) DCS over the cheek region (DCS-C), and 4) sham tDCS over the motor cortex(sham). tDCS was applied for 20 minutes at 1 mA. Motor evoked potentials (MEPs) were measured before tDCS and immediately, 15, 30, 45, and 60 minutes after tDCS. A questionnaire was used to assess the tolerability of tDCS. RESULTS: A significant MEP amplitude increase compared with baseline was found 30 minutes after tDCS-MI, an effect still observed 60 minutes later; no time∗condition interaction effect was detected. In the other three conditions (tDCS-MI + TA, DCS-C, sham), no significant MEP modulation was found. The questionnaire indicated that side effects are significantly lower when the local anesthetic was applied before stimulation than in the other three conditions. CONCLUSIONS: The significant MEP amplitude increase observed from 30 minutes on after tDCS-MI supports the modulatory effect of tDCS on corticospinal neurotransmission. This effect lasted one hour after stimulation. The absence of a significant modulation when a local anesthetic was applied suggests that effects of tDCS are not solely established through direct cortical stimulation but that stimulation of peripheral and/or cranial nerves also might contribute to tDCS-induced modulation.

Personalized tDCS for Focal Epilepsy-A Narrative Review: A Data-Driven Workflow Based on Imaging and EEG Data.

Conventional transcranial electric stimulation(tES) using standard anatomical positions for the electrodes and standard stimulation currents is frequently not sufficiently selective in targeting and reaching specific brain locations, leading to suboptimal application of electric fields. Recent advancements in in vivo electric field characterization may enable clinical researchers to derive better relationships between the electric field strength and the clinical results. Subject-specific electric field simulations could lead to improved electrode placement and more efficient treatments. Through this narrative review, we present a processing workflow to personalize tES for focal epilepsy, for which there is a clear cortical target to stimulate. The workflow utilizes clinical imaging and electroencephalography data and enables us to relate the simulated fields to clinical outcomes. We review and analyze the relevant literature for the processing steps in the workflow, which are the following: tissue segmentation, source localization, and stimulation optimization. In addition, we identify shortcomings and ongoing trends with regard to, for example, segmentation quality and tissue conductivity measurements. The presented processing steps result in personalized tES based on metrics like focality and field strength, which allow for correlation with clinical outcomes.

A Novel Framework for the Optimization of Simultaneous ThermoBrachyTherapy.

In high-dose-rate brachytherapy (HDR-BT) for prostate cancer treatment, interstitial hyperthermia (IHT) is applied to sensitize the tumor to the radiation (RT) dose, aiming at a more efficient treatment. Simultaneous application of HDR-BT and IHT is anticipated to provide maximum radiosensitization of the tumor. With this rationale, the ThermoBrachyTherapy applicators have been designed and developed, enabling simultaneous irradiation and heating. In this research, we present a method to optimize the three-dimensional temperature distribution for simultaneous HDR-BT and IHT based on the resulting equivalent physical dose (EQDphys) of the combined treatment. First, the temperature resulting from each electrode is precomputed. Then, for a given set of electrode settings and a precomputed radiation dose, the EQDphys is calculated based on the temperature-dependent linear-quadratic model. Finally, the optimum set of electrode settings is found through an optimization algorithm. The method is applied on implant geometries and anatomical data of 10 previously irradiated patients, using reported thermoradiobiological parameters and physical doses. We found that an equal equivalent dose coverage of the target can be achieved with a physical RT dose reduction of 20% together with a significantly lower EQDphys to the organs at risk (p-value < 0.001), even in the least favorable scenarios. As a result, simultaneous ThermoBrachyTherapy could lead to a relevant therapeutic benefit for patients with prostate cancer.

Simultaneous ThermoBrachytherapy: Electromagnetic Simulation Methods for Fast and Accurate Adaptive Treatment Planning.

The combination of interstitial hyperthermia treatment (IHT) with high dose rate brachytherapy (HDR-BT) can improve clinical outcomes since it highly enhances the efficiency of cell kill, especially when applied simultaneously. Therefore, we have developed the ThermoBrachy applicators. To effectively apply optimal targeted IHT, treatment planning is considered essential. However, treatment planning in IHT is rarely applied as it is regarded as difficult to accurately calculate the deposited energy in the tissue in a short enough time for clinical practice. In this study, we investigated various time-efficient methods for fast computation of the electromagnetic (EM) energy deposition resulting from the ThermoBrachy applicators. Initially, we investigated the use of an electro-quasistatic solver. Next, we extended our investigation to the application of geometric simplifications. Furthermore, we investigated the validity of the superpositioning principle, which can enable adaptive treatment plan optimization without the need for continuous recomputation of the EM field. Finally, we evaluated the accuracy of the methods by comparing them to the golden standard Finite-Difference Time-Domain calculation method using gamma-index analysis. The simplifications considerably reduced the computation time needed, improving from >12 h to a few seconds. All investigated methods showed excellent agreement with the golden standard by showing a >99% passing rate with 1%/0.5 mm Dose Difference and Distance-to-Agreement criteria. These results allow the proposed electromagnetic simulation method to be used for fast and accurate adaptive treatment planning.

An Approximate Electromagnetic Model for Optimizing Wireless Charging of Biomedical Implants.

OBJECTIVE: Computational modeling is increasingly used to design charging systems for implanted medical devices. The design of these systems must often satisfy conflicting requirements, such as charging speed, specific absorption rate (SAR) and coil size. Fast electromagnetic solvers are pivotal for enabling multi-criteria optimization. In this paper, we present an analytical model based on the quasi-static approximation as a fast, yet sufficiently accurate tool for optimizing inductive charging systems. METHODS: The approximate model was benchmarked against full-wave simulations to validate accuracy and improvement in computation time. The coupling factor of two test coils was measured for lateral and axial displacements and the SAR was measured experimentally in a PAA phantom. RESULTS: The approximate model takes only 11 seconds to compute a single iteration, while the full-wave model takes 5 hours to compute the same case. The maximum difference with full-wave simulations was less than 24% and the mean difference less than 2%. Adding a novel figure of merit into the multi-criterion optimization resulted in a 16% higher charging speed. The measured results of the SAR and coupling factor are within a 5 mm coil offset margin. CONCLUSION: The proposed approximate model succeeds as a rapid prototyping tool, enabling fast and sufficiently accurate optimization for wireless charging systems. SIGNIFICANCE: The approximate model is the first of its kind to compute both the coupling factor and the SAR near conducting structures fast enough to enable optimization of charging speed.

Design of the novel ThermoBrachy applicators enabling simultaneous interstitial hyperthermia and high dose rate brachytherapy.

OBJECTIVE: In High Dose Rate Brachytherapy for prostate cancer there is a need for a new way of increasing cancer cell kill in combination with a stable dose to the organs at risk. In this study, we propose a novel ThermoBrachy applicator that offers the unique ability to apply interstitial hyperthermia while simultaneously serving as an afterloading catheter for high dose rate brachytherapy for prostate cancer. This approach achieves a higher thermal enhancement ratio than in sequential application of radiation and hyperthermia and has the potential to decrease the overall treatment time. METHODS: The new applicator uses the principle of capacitively coupled electrodes. We performed a proof of concept experiment to demostrate the feasibility of the proposed applicator. Moreover, we used electromagnetic and thermal simulations to evaluate the power needs and temperature homogeneity in different tissues. Furthermore we investigated whether dynamic phase and amplitude adaptation can be used to improve longitudinal temperature control. RESULTS: Simulations demonstrate that the electrodes achieve good temperature homogeneity in a homogenous phantom when following current applicator spacing guidelines. Furthermore, we demonstrate that by dynamic phase and amplitude adaptation provides a great advancement for further adaptability of the heating pattern. CONCLUSIONS: This newly designed ThermoBrachy applicator has the potential to revise the interest in interstitial thermobrachytherapy, since the simultaneous application of radiation and hyperthermia enables maximum thermal enhancement and at maximum efficiency for patient and organization.

Analyzing Developing Brain-On-Chip Cultures with the CALIMA Calcium Imaging Tool.

Brain-on-chip (BoC) models are tools for reproducing the native microenvironment of neurons, in order to study the (patho)physiology and drug-response of the brain. Recent developments in BoC techniques focus on steering neurons in their activity via microfabrication and via computer-steered feedback mechanisms. These cultures are often studied through calcium imaging (CI), a method for visualizing the cellular activity through infusing cells with a fluorescent dye. CAlciumImagingAnalyser 2.0 (CALIMA 2.0) is an updated version of a software tool that detects and analyzes fluorescent signals and correlates cellular activity to identify possible network formation in BoC cultures. Using three previous published data sets, it was demonstrated that CALIMA 2.0 can analyze large data sets of CI-data and interpret cell activity to help study the activity and maturity of BoC cultures. Last, an analysis of the processing speed shows that CALIMA 2.0 is sufficiently fast to process data sets with an acquisition rate up to 5 Hz in real-time on a medium-performance computer.

Low-Power Wireless Data Transfer System for Stimulation in an Intracortical Visual Prosthesis.

There is a growing interest to improve the quality of life of blind people. An implanted intracortical prosthesis could be the last resort in many cases of visual impairment. Technology at this moment is at a stage that implementation is at sight. Making the data communication to and from the implanted electrodes wireless is beneficial to avoid infection and to ease mobility. Here, we focus on the stimulation side, or downlink, for which we propose a low-power non-coherent digital demodulator on the implanted receiver. The experimentally demonstrated downlink is on a scaled-down version at a 1 MHz carrier frequency showing a data rate of 125 kbps. This provides proof of principle for the system with a 12 MHz carrier frequency and a data rate of 4 Mbps, which consumes under 1 mW at the receiver side in integrated circuit (IC) simulation. Due to its digital architecture, the system is easily adjustable to an ISM frequency band with its power consumption scaling linearly with the carrier frequency. The tested system uses off-the-shelf coils, which gave sufficient bandwidth, while staying within safe SAR limits. The digital receiver achieved a reduction in power consumption by skipping clock cycles of redundant bits. The system shows a promising pathway to a low-power wireless-enabled visual prosthesis.

Low-Power BPSK Inductive Data Link for an Implanted Intracortical Visual Prosthesis.

In making visually impaired people see again, for most cases the only option is to stimulate the visual cortex. In building such a system, it is desired that the communication to/from the implant and powering be done wirelessly to avoid infections. For the downlink, which is sending stimulation data to the implanted electrode, bandpass-sampled binary phase shift keying (BPSK) is chosen due to its potential for low-power consumption at its digital receiver. However, since an inductive link is most suited, designing practical inductive links with a flat band region to avoid poor phase transition and also refining the reset timing for imperfect transition times as well as designing low-power custom 1- bit Analog-to-digital converter is crucial. The bandpass-sampled BPSK system is designed and simulated at circuit level in Cadence using 180 nm CMOS technology at data rates of 0.5-4 Mbps and carrier frequency of 5-12 MHz. The improved bandpass-sampled BPSK system meets the requirements on data-rate, low-power consumption and robustness and is an integral part of the overall wireless communication and powering of the implanted intracortical visual prosthesis.

An MR-compatible antenna and application in a murine superficial hyperthermia applicator.

In this work, a novel magnetic resonance (MR)-compatible microwave antenna was designed and validated in a small animal superficial hyperthermia applicator. The antenna operates at 2.45 GHz and matching is made robust against production and setup inaccuracies. To validate our theoretical concept, a prototype of the applicator was manufactured and tested for its properties concerning input reflection, sensitivity for setup inaccuracies, environment temperature stability and MR-compatibility. The experiments show that the applicator indeed fulfils the requirements for MR-guided hyperthermia investigation in small animals: it creates a small heating focus (<1 cm3), has a stable and reliable performance (S11< -15 dB) for all working conditions and is MR-compatible.