Extensive surgical procedure or liver transplant still remains the gold standard for treating slow-growing tumors in liver.
But only few candidates are suitable for such procedure due to poor liver function, tumors in unresectable locations or presence of other liver diseases. In such situations, minimally invasive surgery may be the best therapeutic procedure. The use of RF, laser and ultrasound ablation techniques has gained considerable interest over the past several years to
treat liver diseases. The success of such minimally invasive procedure depends on accurately targeting the desired region
and guiding the entire procedure. The purpose of this study is to use ultrasound imaging and GPS tracking system to accurately place a steerable acoustic ablator and multiple temperature sensors in porcine liver in situ. Temperature
sensors were place at eight different locations to estimate thermal distribution in the three-dimensional treated volume.
Acoustic ablator of center frequency of 7 MHz was used for the experiments. During therapy a maximum temperature of
60-65 °C was observed at a distance 8-10 mm from the center of the ablation transducer. The dose distribution was
analyzed and compared with the gross pathology of the treated region. Accurate placement of the acoustic applicator and
temperature sensors were achieved using the combined image-guidance and the tracking system. By combining
ultrasound imaging and GPS tracking system accurate placement of catheter based acoustic ablation applicator can be achieved in livers in situ.
Preferential heating of bone due to high ultrasound attenuation may enhance thermal ablation performed with cathetercooled
interstitial ultrasound applicators in or near bone. At the same time, thermally and acoustically insulating cortical
bone may protect sensitive structures nearby. 3D acoustic and biothermal transient finite element models were
developed to simulate temperature and thermal dose distributions during catheter-cooled interstitial ultrasound ablation
near bone. Experiments in ex vivo tissues and tissue-mimicking phantoms were performed to validate the models and to
quantify the temperature profiles and ablated volumes for various distances between the interstitial applicator and the
bone surface. 3D patient-specific models selected to bracket the range of clinical usage were developed to investigate
what types of tumors could be treated, applicator configurations, insertion paths, safety margins, and other parameters.
Experiments show that preferential heating at the bone surface decreases treatment times compared to when bone is
absent and that all tissue between an applicator and bone can be ablated when they are up to 2 cm apart. Simulations
indicate that a 5-7 mm safety margin of normal bone is needed to protect (thermal dose < 6 CEM43°C and T < 45°C) sensitive structures behind ablated bone. In 3D patient-specific simulations, tumors 1.0-3.8 cm (L) and 1.3-3.0 cm (D) near or within bone were ablated (thermal dose > 240 CEM43°C) within 10 min without damaging the nearby spinal cord, lungs, esophagus, trachea, or major vasculature. Preferential absorption of ultrasound by bone may provide
improved localization, faster treatment times, and larger treatment zones in tumors in and near bone compared to other
heating modalities.
Catheter based ultrasound ablation devices have been suggested as the least minimally invasive procedure for thermal
therapy. The success of such procedures depends on accurately delivering the thermal dose to the tissue. One of the main
challenges of such therapy is to deliver thermal therapy at the target location without damaging the surrounding tissue or major vessels and veins. To achieve such multi-directional capability, a multi-angular beam pattern is required. The
purpose of this study was to build a multi-sectored tubular ultrasonic transducer and control the directionality of the
acoustic power delivered to the tissue by each sector simultaneously. Multi-zoned tubular ultrasonic transducer arrays
with three active sectors were constructed. Using these transducer configurations, a multi-angular ablation pattern was
created in ex vivo chicken breast tissue. Experiments were conducted by activating two and three zones separately to investigate the ablation pattern of each case. Simulations results were presented by solving the Penne bio-heat equation using finite element method. The simulation results were compared with ex vivo results with respect to temperature and dose distribution in the tissue. Thermocouples located at 15 mm radially from the applicator indicated a peak
temperature of greater than 52-55° C and thermal dose of 103-104 EQ mins at 43°C. It was observed through visual inspection that the proposed technology could ablate a specific tissue region or multiple regions selectively while not damaging the desired surrounding tissue. Good agreement between experimental and simulation results was obtained.
The concern with interstitial ablative therapy for a treatment of hepatic tumors has been growing. In spite of advances in
these therapies, there are several technical challenges due to tissue deformation and target motion: localization of the
tumor and monitoring for ablator's tip and thermal dose in heated tissue. In the previous work, a steerable acoustic
ablator, called ACUSITT, for targeting of ablation tip accurately into tumor area has been developed. However, real-time
monitoring techniques for providing image feedback of the ablation tip positioning and thermal dose deposited in the
tissue by heating are still needed. In this paper, a new software framework for real-time monitoring ablative therapy
during pre- and intra-operation is presented. The software framework provides ultrasound Brightness Mode (B-Mode)
image and elastography simultaneously and with real-time. A position of ablator's tip and a region of heated tissue are
monitored on B-Mode image, because the image represents tissue morphology. Furthermore, ultrasound elasticity image
is used for finding a boundary and region of tumor on pre-ablation, and monitoring thermal dose in tissue during ablation.
By providing B-Mode image and elastography at the same time, reliable information for monitoring thermal therapy can
be offered.
The objective of our work is a system that enables both mechanically and electronically shapable thermal energy
deposition in soft tissue ablation. The overall goal is a system that can percutaneously (and through a single
organ surface puncture) treat tumors that are large, multiple, geometrically complex, or located too close to
vital structures for traditional resection. This paper focuses on mechanical steering and image guidance aspects
of the project. Mechanical steering is accomplished using an active cannula that enables repositioning of the
ablator tip without complete retraction. We describe experiments designed to evaluate targeting accuracy of the
active cannula (also known as a concentric tube robot) in soft tissues under tracked 3D ultrasound guidance.
Motivation: In prostate brachytherapy, intra-operative dosimetry would be ideal to allow for rapid evaluation of
the implant quality while the patient is still in the treatment position. Such a mechanism, however, requires 3-D
visualization of the currently deposited seeds relative to the prostate. Thus, accurate, robust, and fully-automatic
seed segmentation is of critical importance in achieving intra-operative dosimetry. Methodology: Implanted
brachytherapy seeds are segmented by utilizing a region-based implicit active contour approach. Overlapping
seed clusters are then resolved using a simple yet effective declustering technique. Results: Ground-truth
seed coordinates were obtained via a published segmentation technique. A total of 248 clinical C-arm images
from 16 patients were used to validate the proposed algorithm resulting in a 98.4% automatic detection rate
with a corresponding 2.5% false-positive rate. The overall mean centroid error between the ground-truth and
automatic segmentations was measured to be 0.42 pixels, while the mean centroid error for overlapping seed
clusters alone was measured to be 0.67 pixels. Conclusion: Based on clinical data evaluation and validation,
robust, accurate, and fully-automatic brachytherapy seed segmentation can be achieved through the implicit
active contour framework and subsequent seed declustering method.
Motivation: In prostate brachytherapy, real-time dosimetry would be ideal to allow for rapid evaluation of the implant
quality intra-operatively. However, such a mechanism requires an imaging system that is both real-time and which
provides, via multiple C-arm fluoroscopy images, clear information describing the three-dimensional position of the
seeds deposited within the prostate. Thus, accurate tracking of the C-arm poses proves to be of critical importance to the
process. Methodology: We compute the pose of the C-arm relative to a stationary radiographic fiducial of known
geometry by employing a hybrid registration framework. Firstly, by means of an ellipse segmentation algorithm and a
2D/3D feature based registration, we exploit known FTRAC geometry to recover an initial estimate of the C-arm pose.
Using this estimate, we then initialize the intensity-based registration which serves to recover a refined and accurate
estimation of the C-arm pose. Results: Ground-truth pose was established for each C-arm image through a published and
clinically tested segmentation-based method. Using 169 clinical C-arm images and a ±10° and ±10 mm random
perturbation of the ground-truth pose, the average rotation and translation errors were 0.68° (std = 0.06°) and 0.64 mm
(std = 0.24 mm). Conclusion: Fully automated C-arm pose estimation using a 2D/3D hybrid registration scheme was
found to be clinically robust based on human patient data.
Purpose: Ultrasound (US) elevation beamwidth causes a certain type of image artifact around the anechoic
areas of the tissue. It is generally assumed that the US image is of zero thickness, which contradicts the
fact that the acoustic beam can only be mechanically focused at a depth resulting in a finite, non-uniformed
elevation beamwidth. We suspect that elevation beamwidth artifacts contribute to target reconstruction error
in computer-assisted interventions. This paper introduces a method for characterization of the beamwidth for
transrectal ultrasound (TRUS) used in prostate brachythyerapy. In particular, we measure how the US sectionthickness
varies along the beam's axial depth. Method: We developed a beam-profiling device (a TRUS-bridge
phantom) specifically tailored for standard brachytherapy ultrasound imaging systems to generate a complete
section-thickness profile of a given TRUS transducer. The device was designed in CAD software and prototyped
by a 3D printer. Result: The experimental results demonstrated that the TRUS beam in the elevation direction
is focused closely to the transducer and theoretically the transducer would provide a better elevational resolution
within that range. Conclusion: We presented a beam profiling phantom to measure the section-thickness of a
transrectal ultrasound transducer for operating room use. However, there are some limitations which need to
be addressed, for example, phantom sterilization and the speed of sound in the current medium of experiment
which is not the same as that of biological tissues.
Radiofrequency (RF) ablation has emerged as an effective method for treating liver tumors under 3 cm in diameter.
Multiple applicator devices and techniques - using RF, microwave and other modalities - are under development for
thermal ablation of large and irregularly-shaped liver tumors. Interstitial ultrasound (IUS) applicators, comprised of
linear arrays of independently powered tubular transducers, enable 3D control of the spatial power deposition profile and
simultaneous ablation with multiple applicators. We evaluated IUS applicator configurations (parallel, converging and
diverging implants) suitable for percutaneous and laparascopic placement with experiments in ex vivo bovine tissue and
computational models. Ex vivo ablation zones measured 4.6±0.5 x 4.2±0.5 × 3.3±0.5 cm3 and 5.6±0.5 × 4.9±0.5 x
2.8±0.3 cm3 using three parallel applicators spaced 2 and 3 cm apart, respectively, and 4.0±0.3 × 3.2±0.4 × 2.9±0.2 cm3 using two parallel applicators spaced 2 cm apart. Computational models indicate in vivo ablation zones up to 4.5 × 4.4 × 5.5 cm3 and 5.7 × 4.8 × 5.2 cm3, using three applicators spaced 2 and 3 cm apart, respectively. Converging and diverging
implant patterns can also be employed for conformal ablation of irregularly-shaped tumor margins by tailoring power
levels along each device. Simultaneously powered interstitial ultrasound devices can create tailored ablation zones
comparable to currently available RF devices and similarly sized microwave antennas.
E. Clif Burdette, Carol Lichtenstiger, Laurie Rund, Mallika Keralapura, Chad Gossett, Randy Stahlhut, Paul Neubauer, Bruce Komadina, Emery Williams, Chris Alix, Tor Jensen, Lawrence Schook, Chris Diederich
Heat therapy has long been used for treatments in dermatology and sports medicine. The use of laser, RF, microwave,
and more recently, ultrasound treatment, for psoriasis, collagen reformation, and skin tightening has gained considerable
interest over the past several years. Numerous studies and commercial devices have demonstrated the efficacy of these
methods for treatment of skin disorders. Despite these promising results, current systems remain highly dependent on
operator skill, and cannot effectively treat effectively because there is little or no control of the size, shape, and depth of
the target zone. These limitations make it extremely difficult to obtain consistent treatment results. The purpose of this
study was to determine the feasibility for using acoustic energy for controlled dose delivery sufficient to produce
collagen modification for the treatment of skin tissue in the dermal and sub-dermal layers. We designed and evaluated a
curvilinear focused ultrasound device for treating skin disorders such as psoriasis, stimulation of wound healing,
tightening of skin through shrinkage of existing collagen and stimulation of new collagen formation, and skin cancer.
Design parameters were examined using acoustic pattern simulations and thermal modeling. Acute studies were
performed in 201 freshly-excised samples of young porcine underbelly skin tissue and 56 in-vivo treatment areas in 60-
80 kg pigs. These were treated with ultrasound (9-11MHz) focused in the deep dermis. Dose distribution was analyzed
and gross pathology assessed. Tissue shrinkage was measured based on fiducial markers and video image registration
and analyzed using NIH Image-J software. Comparisons were made between RF and focused ultrasound for five energy
ranges. In each experimental series, therapeutic dose levels (60degC) were attained at 2-5mm depth. Localized collagen
changes ranged from 1-3% for RF versus 8-15% for focused ultrasound. Therapeutic ultrasound applied at high
frequencies can achieve temperatures and dose distributions which concentrate in a depth profile that coincides with the
location of maximum structural collagen content in skin tissues. Using an appropriate transducer configuration produces
coverage of significant lateral area, thus making this a practical approach for treatment of skin disorders.
Numerous studies have demonstrated the efficacy of interstitial ablative approaches for the treatment of renal and hepatic
tumors. Despite these promising results, current systems remain highly dependent on operator skill, and cannot treat
many tumors because there is little control of the size and shape of the zone of necrosis, and no control over ablator
trajectory within tissue once insertion has taken place. Additionally, tissue deformation and target motion make it
extremely difficult to accurately place the ablator device into the target. Irregularly shaped target volumes typically
require multiple insertions and several sequential thermal ablation procedures. This study demonstrated feasibility of
spatially tracked image-guided conformal ultrasound (US) ablation for percutaneous directional ablation of diseased
tissue. Tissue was prepared by suturing the liver within a pig belly and 1mm BBs placed to serve as needle targets. The
image guided system used integrated electromagnetic tracking and cone-beam CT (CBCT) with conformable needlebased
high-intensity US ablation in the interventional suite. Tomographic images from cone beam CT were transferred
electronically to the image-guided tracking system (IGSTK). Paired-point registration was used to register the target
specimen to CT images and enable navigation. Path planning is done by selecting the target BB on the GUI of the realtime
tracking system and determining skin entry location until an optimal path is selected. Power was applied to create
the desired ablation extent within 7-10 minutes at a thermal dose (>300eqm43). The system was successfully used to
place the US ablator in planned target locations within ex-vivo kidney and liver through percutaneous access. Targeting
accuracy was 3-4 mm. Sectioned specimens demonstrated uniform ablation within the planned target zone. Subsequent
experiments were conducted for multiple ablator positions based upon treatment planning simulations. Ablation zones in
liver were 73cc, 84cc, and 140cc for 3, 4, and 5 placements, respectively. These experiments demonstrate the feasibility
of combining real-time spatially tracked image guidance with directional interstitial ultrasound ablation. Interstitial
ultrasound ablation delivered on multiple needles permit the size and shape of the ablation zone to be "sculpted" by
modifying the angle and intensity of the active US elements in the array. This paper summarizes the design and
development of the first system incorporating thermal treatment planning and integration of a novel interstitial acoustic
ablation device with integrated 3D electromagnetic tracking and guidance strategy.
Many recent studies have demonstrated the efficacy of interstitial ablative approaches for the treatment of hepatic tumors. Despite these promising results, current systems remain highly dependent on operator skill, and cannot treat many tumors because there is little control of the size and shape of the zone of necrosis, and no control over ablator trajectory within tissue once insertion has taken place. Additionally, tissue deformation and target motion make it extremely difficult to place the ablator device precisely into the target. Irregularly shaped target volumes typically require multiple insertions and several overlapping (thermal) lesions, which are even more challenging to accomplish in a precise, predictable, and timely manner without causing excessive damage to surrounding normal tissues.
In answer to these problems, we have developed a steerable acoustic ablator called the ACUSITT with the ability of directional energy delivery to precisely shape the applied thermal dose . In this paper, we address image guidance for this device, proposing an innovative method for accurate tracking and tool registration with spatially-registered intra-operative three-dimensional US volumes, without relying on an external tracking device. This method is applied to guid-ance of the flexible, snake-like, lightweight, and inexpensive ACUSITT to facilitate precise placement of its ablator tip within the liver, with ablation monitoring via strain imaging. Recent advancements in interstitial high-power ultrasound applicators enable controllable and penetrating heating patterns which can be dynamically altered. This paper summarizes the design and development of the first synergistic system that integrates a novel steerable interstitial acoustic ablation device with a novel trackerless 3DUS guidance strategy.
Steerability in percutaneous medical devices is highly desirable, enabling a needle or needle-like instrument to avoid
sensitive structures (e.g. nerves or blood vessels), access obstructed anatomical targets, and compensate for the
inevitable errors induced by registration accuracy thresholds and tissue deformation during insertion. Thus, mechanisms
for needle steering have been of great interest in the engineering community in the past few years, and several have been
proposed. While many interventional applications have been hypothesized for steerable needles (essentially anything
deliverable via a regular needle), none have yet been demonstrated as far as the authors are aware. Instead, prior studies
have focused on model validation, control, and accuracy assessment. In this paper, we present the first integrated
steerable needle-interventional device. The ACUSITT integrates a multi-tube steerable Active Cannula (AC) with an
Ultrasonic Interstitial Thermal Therapy ablator (USITT) to create a steerable percutaneous device that can deliver a
spatially and temporally controllable (both mechanically and electronically) thermal dose profile. We present our initial
experiments toward applying the ACUSITT to treat large liver tumors through a single entry point. This involves
repositioning the ablator tip to several different locations, without withdrawing it from the liver capsule, under 3D
Ultrasound image guidance. In our experiments, the ACUSITT was deployed to three positions, each 2cm apart in a conical pattern to demonstrate the feasibility of ablating large liver tumors 7cm in diameter without multiple parenchyma punctures.
Motivation: In prostate brachytherapy, transrectal ultrasound (TRUS) is used to visualize the anatomy, while implanted
seeds can be seen in C-arm fluoroscopy or CT. Intra-operative dosimetry optimization requires localization of the
implants in TRUS relative to the anatomy. This could be achieved by registration of TRUS images and the implants
reconstructed from fluoroscopy or CT. Methods: TRUS images are filtered, compounded, and registered on the
reconstructed implants by using an intensity-based metric based on a 3D point-to-volume registration scheme. A
phantom was implanted with 48 seeds, imaged with TRUS and CT/X-ray. Ground-truth registration was established
between the two. Seeds were reconstructed from CT/X-ray. Seven TRUS filtering techniques and two image similarity
metrics were analyzed as well. Results: For point-to-volume registration, noise reduction combined with beam profile
filter and mean squares metrics yielded the best result: an average of 0.38 ± 0.19 mm seed localization error relative to
the ground-truth. In human patient data C-arm fluoroscopy images showed 81 radioactive seeds implanted inside the
prostate. A qualitative analysis showed clinically correct agreement between the seeds visible in TRUS and
reconstructed from intra-operative fluoroscopy imaging. The measured registration error compared to the manually
selected seed locations by the clinician was 2.86 ± 1.26 mm. Conclusion: Fully automated seed localization in TRUS
performed excellently on ground-truth phantom, adequate in clinical data and was time efficient having an average
runtime of 90 seconds.
C-arm X-ray fluoroscopy-based radioactive seed localization for intraoperative dosimetry of prostate brachytherapy is an
active area of research. The fluoroscopy tracking (FTRAC) fiducial is an image-based tracking device composed of
radio-opaque BBs, lines, and ellipses that provides an effective means for pose estimation so that three-dimensional
reconstruction of the implanted seeds from multiple X-ray images can be related to the ultrasound-computed prostate
volume. Both the FTRAC features and the brachytherapy seeds must be segmented quickly and accurately during the
surgery, but current segmentation algorithms are inhibitory in the operating room (OR). The first reason is that current
algorithms require operators to manually select a region of interest (ROI), preventing automatic pipelining from image
acquisition to seed reconstruction. Secondly, these algorithms fail often, requiring operators to manually correct the
errors. We propose a fast and effective ROI-free automatic FTRAC and seed segmentation algorithm to minimize such
human intervention. The proposed algorithm exploits recent image processing tools to make seed reconstruction as easy
and convenient as possible. Preliminary results on 162 patient images show this algorithm to be fast, effective, and
accurate for all features to be segmented. With near perfect success rates and subpixel differences to manual
segmentation, our automatic FTRAC and seed segmentation algorithm shows promising results to save crucial time in
the OR while reducing errors.
KEYWORDS: Ultrasonography, 3D image processing, Tissues, Thermography, Acoustics, Data acquisition, 3D acquisition, Stereoscopy, Visualization, Liver cancer
Three dimensional heat-induced echo-strain imaging is a potentially useful tool for monitoring the formation of thermal
lesions during ablative therapy. Heat-induced echo-strain, known as thermal strain, is due to the changes in the speed of
propagating ultrasound signals and to tissue expansion during heat deposition. This paper presents a complete system for
targeting and intraoperative monitoring of thermal ablation by high intensity focused acoustic applicators. A special
software interface has been developed to enable motor motion control of 3D mechanical probes and rapid acquisition of
3D-RF data (ultrasound raw data after the beam-forming unit). Ex-vivo phantom and tissue studies were performed in a
controlled laboratory environment. While B-mode ultrasound does not clearly identify the development of either necrotic
lesions or the deposited thermal dose, the proposed 3D echo-strain imaging can visualize these changes, demonstrating
agreement with temperature sensor readings and gross-pathology. Current results also demonstrate feasibility for realtime
computation through a parallelized implementation for the algorithm used. Typically, 125 frames per volume can
be processed in less than a second. We also demonstrate motion compensation that can account for shift within frames
due to either tissue movement or positional error in the US 3D imaging probe.
Purpose: Brachytherapy (radioactive seed insertion) has emerged as one of the most effective treatment options
for patients with prostate cancer, with the added benefit of a convenient outpatient procedure. The main
limitation in contemporary brachytherapy is faulty seed placement, predominantly due to the presence of intra-operative
edema (tissue expansion). Though currently not available, the capability to intra-operatively monitor
the seed distribution, can make a significant improvement in cancer control. We present such a system here.
Methods: Intra-operative measurement of edema in prostate brachytherapy requires localization of inserted
radioactive seeds relative to the prostate. Seeds were reconstructed using a typical non-isocentric C-arm, and
exported to a commercial brachytherapy delivery system. Technical obstacles for 3D reconstruction on a non-isocentric
C-arm include pose-dependent C-arm calibration; distortion correction; pose estimation of C-arm
images; seed reconstruction; and C-arm to TRUS registration.
Results: In precision-machined hard phantoms with 40-100 seeds and soft tissue phantoms with 45-87 seeds,
we correctly reconstructed the seed implant shape with an average 3D precision of 0.35 mm and 0.24 mm,
respectively. In a DoD Phase-1 clinical trial on 6 patients with 48-82 planned seeds, we achieved intra-operative
monitoring of seed distribution and dosimetry, correcting for dose inhomogeneities by inserting an average of
4.17 (1-9) additional seeds. Additionally, in each patient, the system automatically detected intra-operative seed
migration induced due to edema (mean 3.84 mm, STD 2.13 mm, Max 16.19 mm).
Conclusions: The proposed system is the first of a kind that makes intra-operative detection of edema (and
subsequent re-optimization) possible on any typical non-isocentric C-arm, at negligible additional cost to the
existing clinical installation. It achieves a significantly more homogeneous seed distribution, and has the potential
to affect a paradigm shift in clinical practice. Large scale studies and commercialization are currently underway.
Uterine myomas (fibroids) are the most common pelvic tumors occurring in women, and are the leading cause of
hysterectomy. Symptoms can be severe, and traditional treatments involve either surgical removal of the uterus
(hysterectomy), or the fibroids (myomectomy). Interstitial ultrasound technologies have demonstrated potential for
hyperthermia and high temperature thermal therapy in the treatment of benign and malignant tumors. These ultrasound
devices offer favorable energy penetration allowing large volumes of tissue to be treated in short periods of time, as well
as axial and angular control of heating to conform thermal treatment to a targeted tissue, while protecting surrounding
tissues from thermal damage. The goal of this project is to evaluate interstitial ultrasound for controlled thermal
coagulation of fibroids. Multi-element applicators were fabricated using tubular transducers, some of which were
sectored to produce 180° directional heating patterns, and integrated with water cooling. Human uterine fibroids were
obtained after routine myomectomies, and instrumented with thermocouples spaced at 0.5, 1.0, 1.5, 2.0, 2.5 and 3.0 cm
from the applicator. Power levels ranging from 8-15 W per element were applied for up to 15 minute heating periods.
Results demonstrated that therapeutic temperatures >50° C and cytotoxic thermal doses (t43) extended beyond 2 cm
radially from the applicator (>4 cm diameter). It is anticipated that this system will make a significant contribution
toward the treatment of uterine fibroids.
Purpose: C-arm fluoroscopy is ubiquitous in contemporary surgery, but it lacks the ability to accurately reconstruct 3D information. A major obstacle in fluoroscopic reconstruction is discerning the pose of the X-ray image, in 3D space. Optical/magnetic trackers are prohibitively expensive, intrusive and cumbersome. Method: We present single-image-based fluoroscope tracking (FTRAC) with the use of an external radiographic fiducial consisting of a mathematically optimized set of points, lines, and ellipses. The fiducial encodes six degrees of freedom in a single image by creating a unique view from any direction. A non-linear optimizer can rapidly compute the pose of the fiducial using this image. The current embodiment has salient attributes: small
dimensions (3 x 3 x 5 cm), it need not be close to the anatomy of interest and can be segmented automatically. Results: We tested the fiducial and the pose recovery method on synthetic data and also experimentally on a precisely machined mechanical phantom. Pose recovery had an error of 0.56 mm in translation and 0.33° in orientation. Object reconstruction had a mean error of 0.53 mm with 0.16 mm STD. Conclusion: The method offers accuracies similar to commercial tracking systems, and is sufficiently robust for intra-operative quantitative
C-arm fluoroscopy.
Purpose: Intraoperative dosimetric quality assurance in prostate brachytherapy critically depends on discerning the 3D locations of implanted seeds. The ability to reconstruct the implanted seeds intraoperatively will allow us to make immediate provisions for dosimetric deviations from the optimal implant plan. A method for seed reconstruction from segmented C-arm fluoroscopy images is proposed. Method: The 3D coordinates of the implanted seeds can be calculated upon resolving the correspondence of seeds in multiple X-ray images. We formalize seed-matching as a network flow problem, which has salient features: (a) extensively studied exact solutions, (b) performance claims on the space-time complexity, (c) optimality bounds on the final solution. A fast implementation is realized using the Hungarian algorithm. Results: We prove that two images can correctly match only about 67% of the seeds, and that a third image renders the matching problem to be of non-polynomial complexity. We utilize the special structure of the problem and propose a pseudo-polynomial time algorithm. Using three images, MARSHAL achieved 100% matching in simulation experiments; and 98.5% in phantom experiments. 3D reconstruction error for correctly matched seeds has a mean of 0:63 mm, and 0:91 mm for incorrectly matched seeds. Conclusion: Both on synthetic data and in phantom experiments, matching rate and reconstruction accuracy were found to be sufficient for prostate brachytherapy. The algorithm is extendable to deal with arbitrary number of images without loss in speed or accuracy. The algorithm is sufficiently generic to be used for establishing correspondences across any choice of features in different imaging modalities.
The purpose of this study was to determine the feasibility of using a transurethral ultrasound applicator in combination with implantable ultrasound applicators for inducing thermal coagulation and necrosis of localized cancer lesions or BPH within the prostate gland. The concept being evaluated is the potential to treat target zones in the anterior and lateral portions of the prostate with the transurethral applicator, while simultaneously treating regions of extracapsular extension and zones in the posterior prostate with the directive implantable applicators in combination with a rectal cooling bolus. Biothermal computer simulations, acoustic characterizations, and in vivo thermal dosimetry experiments were used to evaluate the performance of each applicator type and combinations thereof. The preliminary results of this investigation demonstrate that implantable ultrasound applicators, in combination with a transurethral ultrasound applicator, have the potential to provide thermal coagulation and necrosis of small or large regions within the prostate gland, while sparing thermally sensitive rectal tissue.
A mammographic stereotactic core biopsy instrument can be adapted for laser hyperthermic ablation of breast cancer. The object of this study is to characterize laser endohyperthermia ex-vivo and in-vivo to develop a reliable approach leading to human trials. Light of a Nd:YAG laser passed through a fiberoptic cable to a diffusing quartz tip upon entering surrounding tissues can bring about very high temperatures. This approach concentrating on the heat distribution to fat and fibrofatty tissue, first analyzed a physical model into which both the quartz tip and thermocouple needles were placed. Temperature recordings in volume through a time course demonstrated a progressive thermal increase around the tip. Additional light distribution studies in several media demonstrated the tip's output. The technique transferred to ex-vivo human breast and porcine fibrofatty tissue showed similar findings leading to an in-vivo analysis of subcutaneous porcine fibrofatty tissue. A step-down energy program beginning at 20 watts and decreasing to 15 watts, 10 watts, and to 7 watts, at 30 second intervals was held at the latter power for the remainder of 6 minutes. Three such cycles appear to be the optimal treatment program to develop temperatures between 60 degrees Celsius and 80 degrees Celsius (approximately equals 9700 joules). In-vivo experiments conducted on 5 occasions revealed no skin change. At necropsy the treated tissues demonstrated a circular sharply defined 3 cm volume of necrosis with no change in adjacent tissue. Time-temperature correlations between ex-vivo and in-vivo tissues showed great similarity. Nd:YAG laser energy distributed to a quartz tip through a fiberoptic cable is capable of uniform, complete tissue destruction to a 1 1/2 cm radius with no change beyond that field. This technique with further refinement will be appropriate to the treatment of small breast cancers that have been stereotactically biopsied.
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