Locoregional hyperthermia of deep-seated tumours applied with capacitive and radiative systems: a simulation study.

BACKGROUND: Locoregional hyperthermia is applied to deep-seated tumours in the pelvic region. Two very different heating techniques are often applied: capacitive and radiative heating. In this paper, numerical simulations are applied to compare the performance of both techniques in heating of deep-seated tumours. METHODS: Phantom simulations were performed for small (30 × 20 × 50 cm3) and large (45 × 30 × 50 cm3), homogeneous fatless and inhomogeneous fat-muscle, tissue-equivalent phantoms with a central or eccentric target region. Radiative heating was simulated with the 70 MHz AMC-4 system and capacitive heating was simulated at 13.56 MHz. Simulations were performed for small fatless, small (i.e. fat layer typically <2 cm) and large (i.e. fat layer typically >3 cm) patients with cervix, prostate, bladder and rectum cancer. Temperature distributions were simulated using constant hyperthermic-level perfusion values with tissue constraints of 44 °C and compared for both heating techniques. RESULTS: For the small homogeneous phantom, similar target heating was predicted with radiative and capacitive heating. For the large homogeneous phantom, most effective target heating was predicted with capacitive heating. For inhomogeneous phantoms, hot spots in the fat layer limit adequate capacitive heating, and simulated target temperatures with radiative heating were 2-4 °C higher. Patient simulations predicted therapeutic target temperatures with capacitive heating for fatless patients, but radiative heating was more robust for all tumour sites and patient sizes, yielding target temperatures 1-3 °C higher than those predicted for capacitive heating. CONCLUSION: Generally, radiative locoregional heating yields more favourable simulated temperature distributions for deep-seated pelvic tumours, compared with capacitive heating. Therapeutic temperatures are predicted for capacitive heating in patients with (almost) no fat.

Treatment planning in microwave thermal ablation: clinical gaps and recent research advances.

Microwave thermal ablation (MTA) is a minimally invasive therapeutic technique aimed at destroying pathologic tissues through a very high temperature increase induced by the absorption of an electromagnetic field at microwave (MW) frequencies. Open problems, which are delaying MTA applications in clinical practice, are mainly linked to the extremely high temperatures, up to 120 °C, reached by the tissue close to the antenna applicator, as well as to the ability of foreseeing and controlling the shape and dimension of the thermally ablated area. Recent research was devoted to the characterisation of dielectric, thermal and physical properties of tissue looking at their changes with the increasing temperature, looking for possible developments of reliable, automatic and personalised treatment planning. In this paper, a review of the recently obtained results as well as new unpublished data will be presented and discussed.

Temperature dependence of thermal properties of ex vivo liver tissue up to ablative temperatures.

Thermal properties of ex vivo bovine liver were measured as a function of temperature, by heating tissue samples in a temperature-controlled oil bath over a temperature range from about 21 °C to about 113 °C. Results evidenced temperature-dependent non-linear changes of the thermal properties, with the temperature of 100 °C representing a break point: the thermal properties increased with temperature up to 99 °C and then decreased above 100 °C. The rate of increase appeared dramatic between 90 °C and 99 °C, owing to the onset of vaporisation of water contained in the tissue. In particular, at 99 °C, the thermal conductivity reported an increase of about four times with respect to the value measured at 90 °C, whilst about a two-fold increase was reported for both the volumetric heat capacity and the thermal diffusivity. Temperatures higher than 100 °C were reached only after complete vaporisation of water contained in the tissue, resulting in about 70% loss of weight from the tissue. An overall decrease of about 71% and 63% was reported for the thermal conductivity and volumetric heat capacity, respectively, in the temperature range 101 °C-113 °C. A decrease of about 25% was reported in the measured values of the thermal diffusivity in the temperature range 101 °C-108 °C, whilst a slight increase of measured values, not statistically significant, was observed in the temperature range 108 °C-113 °C. The temperature dependent changes of the thermal parameters were modelled with non-linear regression analysis to calculate the best-fit curves interpolating measured data. The proposed regression models could be used to numerically assess the changes in the thermal properties of biological tissues at supra-physiological temperatures relevant in thermal ablation procedures, as well as their effect on the prediction of the ablation zone dimensions in computational models for treatment planning.

Microwave thermal ablation using CT-scanner for predicting the variation of ablated region over time: advantages and limitations.

This study aims at investigating in real-time the structural and dynamical changes occurring in an ex vivo tissue during a microwave thermal ablation (MTA) procedure. The experimental set-up was based on ex vivo liver tissue inserted in a dedicated box, in which 3 fibre-optic (FO) temperature probes were introduced to measure the temperature increase over time. Computed tomography (CT) imaging technique was exploited to experimentally study in real-time the Hounsfield Units (HU) modification occurring during MTA. The collected image data were processed with a dedicated MATLAB tool, developed to analyse the FO positions and HU modifications from the CT images acquired over time before and during the ablation procedures. The radial position of a FO temperature probe (rFO) and the value of HU in the region of interest (ROI) containing the probe (HUo), along with the corresponding value of HU in the contralateral ROI with respect to the MTA antenna applicator (HUc), were determined and registered over time during and after the MTA procedure. Six experiments were conducted to confirm results. The correlation between temperature and the above listed predictors was investigated using univariate and multivariate analysis. At the multivariate analysis, the time, rFO and HUc resulted significant predictive factors of the logarithm of measured temperature. The correlation between predicted and measured temperatures was 0.934 (p  < 0.001). The developed tool allows identifying and registering the image-based parameters useful for predicting the temperature variation over time in each investigated voxel by taking into consideration the HU variation.

Numerical models to evaluate the temperature increase induced by ex vivo microwave thermal ablation.

Microwave thermal ablation (MTA) therapies exploit the local absorption of an electromagnetic field at microwave (MW) frequencies to destroy unhealthy tissue, by way of a very high temperature increase (about 60 °C or higher). To develop reliable interventional protocols, numerical tools able to correctly foresee the temperature increase obtained in the tissue would be very useful. In this work, different numerical models of the dielectric and thermal property changes with temperature were investigated, looking at the simulated temperature increments and at the size of the achievable zone of ablation. To assess the numerical data, measurement of the temperature increases close to a MTA antenna were performed in correspondence with the antenna feed-point and the antenna cooling system, for increasing values of the radiated power. Results show that models not including the changes of the dielectric and thermal properties can be used only for very low values of the power radiated by the antenna, whereas a good agreement with the experimental values can be obtained up to 20 W if water vaporization is included in the numerical model. Finally, for higher power values, a simulation that dynamically includes the tissue's dielectric and thermal property changes with the temperature should be performed.

A 915-MHz antenna for microwave thermal ablation treatment: physical design, computer modeling and experimental measurement.

A 915-MHz antenna design that produces specific absorption rate distributions with preferential power deposition in tissues surrounding and including the distal end of the catheter antenna is described. The design features minimal reflected microwave current from the antenna flowing up the transmission line. This cap-choke antenna consists of an annular cap and a coaxial choke which matches the antenna to the coaxial transmission line. The design minimizes heating of the coaxial cable and its performance is not affected by the depth of insertion of the antenna into tissue. The paper provides a comparison of results obtained from computer modeling and experimental measurements made in tissue equivalent phantom materials. There is excellent agreement between numerical modeling and experimental measurement. The cap-choke, matched-dipole type antenna is suitable for intracavitary microwave thermal ablation therapy.

Design and realisation of tissue-equivalent dielectric simulators for dosimetric studies on microwave antennas for interstitial ablation.

Thermal ablation therapies, based on electromagnetic field sources (interstitial or intracavitary antennas) at radio and microwave frequencies, are increasingly used in medicine due to their proven efficacy in the treatment of many diseases (tumours, stenosis, etc). Such techniques need standardized procedures, still not completely consolidated, as to analyze the behaviour of antennas for treatment optimisation. Several tissue-equivalent dielectric simulators (also named phantoms) have been developed to represent human head tissues, and extensively used in the analysis of human exposure to the electromagnetic emissions from hand-held devices; yet, very few studies have considered other tissues, as those met in ablation therapies. The objective of this study was to develop phantoms of liver and kidney tissue to experimentally characterise interstitial microwave antennas in reference conditions. Phantom properties depend on the simulated target tissue (liver or kidney) and the considered frequency (2.45 GHz in this work), addressing the need for a transparent liquid to easily control the positioning of the probe with respect to the antenna under test. An experimental set-up was also developed and used to characterise microwave ablation antenna performances. Finally, a comparison between measurements and numerical simulations was performed for the cross-validation of the experimental set-up and the numerical model. The obtained results highlight the fundamental role played by dielectric simulators in the development of microwave ablation devices, representing the first step towards the definition of a procedure for the ablation treatment planning.