Incidence of lung nodules has surged due to improved lung cancer screening programs. Although localized microwave ablation (MWA) has been shown to be a minimally invasive safe, effective, cost and time efficient treatment for non-surgical candidates, it remains an underutilized curative modality for early-stage lung cancer patients, due in part to professed superiority of radiation for local tumor control, or prevention of local tumor progression (LTP). Identification of lesions that may be more amenable to effective MWA treatment may lead to improved outcomes. To aid physicians in optimizing patient selection, we developed a machine learning model to predict LTP after MWA treatment. Our model utilizes specialized 3D three-channel data: pre-ablation CT data (channel 1), post-ablation CT data depicting the resulting ablation zone (channel 2) and overlapping data of the tumor and ablation zone (channel 3). By spatially registering pre- and post-ablation CTs, we establish a clear spatial relationship between the tumor and ablation zone. Our neural network, trained on 55 MWA-treated lung-cancer patients, achieved a C-statistic (AUC) of 0.849 compared to 0.78 of prior approaches in 5-fold cross-validation. Notably, this performance was achieved without incorporating tabular features such as cancer type or ablation margin, highlighting strengths of the specialized 3D three-channels images. Combined with our past work, where we demonstrated the potential for accurate prediction of ablation zone boundaries during procedure planning, our research presents promising preliminary results for assisting physicians in predicting LTP following localized MWA treatment. The ability to identify good responders to MWA may provide a tool for patient selection, enhance patient outcome, and expand the utilization of this safe, effective treatment option.
The use of percutaneous and bronchoscopic microwave ablation to treat both primary and secondary lung tumors has been growing recently. These ablation systems are typically accompanied by an ablation planning system to optimize the treatment outcome by ensuring adequate margin in the expected ablation zone during the planning phase. The planning system utilizes pre-operative CT scan to identify the tumor and recommend microwave probe position. Radiomics is a process of converting medical images into higher-dimensional data and subsequent mining of data to reveal underlying pathophysiology for enhancing clinical decision support making. Radiomics analysis have shown promises in capturing distinct tumor characteristics and predicting prognosis of the tumor. Here, we present a new method to predict microwave ablation zones by supplementing a bioheat transfer model of microwave tissue ablation with microwave sensitive radiomics features. We hypothesize that supplementing traditional bioheat transfer modeling with microwave sensitive radiomics features will generate a more accurate and personalized ablation prediction that will lead to better treatment outcome. Inputs to the bioheat transfer modeling approach include the geometry of the target tumor, physical characteristics of the tissue, and dimensions of the microwave ablation applicator. The radiomics algorithm extracts characteristics of the targeted tumor’s size and shape, as well as texture characteristics, from pre-operative CT images. We employed cascaded segmentation based on RetinaNet and U-Net to obtain a tumor’s size and shape. Then, a segmented tumor is employed for texture analysis through a set of regression convolutional neural networks. These tumor characteristics are employed as radiomics features for more accurate dose prediction and margin for microwave ablation treatment. We present the preliminary results of a study using images from clinical lung tumor cases to predict ablation treatment outcome, with patient-specific tissue biophysical properties based on radiomics features.
Thermal ablation is a dominant therapeutic option for minimally invasive treatment of menorrhagia. Compared to other energy modalities for ablation, microwaves offer the advantages of conformal energy delivery to tissue within short times. The objective of endometrial ablation is to destroy the endometrial lining of the uterine cavity, with the clinical goal of achieving reduction in bleeding. Previous efforts have demonstrated clinical use of microwaves for endometrial ablation. A considerable shortcoming of most systems is that they achieve ablation of the target by translating the applicator in a point-to-point fashion. Consequently, treatment outcome may be highly dependent on physician skill. Global endometrial ablation (GEA) not only eliminates this operator dependence and simplifies the procedure but also facilitates shorter and more reliable treatments. The objective of our study was to investigate antenna structures and microwave energy delivery parameters to achieve GEA. Another objective was to investigate a method for automatic and reliable determination of treatment end-point. A 3D-coupled FEM electromagnetic and heat transfer model with temperature and frequency dependent material properties was implemented to characterize microwave GEA. The unique triangular geometry of the uterus where lateral narrow walls extend from the cervix to the fundus forming a wide base and access afforded through an endocervical approach limit the overall diameter of the final device. We investigated microwave antenna designs in a deployed state inside the uterus. The impact of ablation duration on treatment outcome was investigated. Prototype applicators were fabricated and experimentally evaluated in ex vivo tissue to verify the simulation results and demonstrate proof-of-concept.
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