High-intensity Focused Ultrasound: Ready for Primetime

Division of Urology, University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mailstop C302, Aurora, CO 80045, USA.
Urologic Clinics of North America (Impact Factor: 1.2). 02/2010; 37(1):27-35, Table of Contents. DOI: 10.1016/j.ucl.2009.11.010
Source: PubMed


Prostate cancer (CaP) is the second most common cause of cancer deaths in the United States and the incidence of CaP has remained constant at 165 cases per 100,000 men. Since 1990, the age-adjusted death rate has decreased by 31%. In this article, the authors review the current literature on the experimental therapy for HIFU. The HIFU technique, its mechanism of action, patient selection, current efficacy studies, complications, follow-up after HIFU treatment, and future developments are discussed.

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Available from: Kyle O Rove, Feb 25, 2014
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    • "The volume of destroyed tissue within the focal region, resulted from bioeffects of thermal ablation and cavitation, is referred to as a ''lesion''. HIFU has become a potential alternative to conventional therapies for primary and metastatic tumors, especially for those patients who are not suitable candidates for surgical resection due to certain criteria, such as old age, poor health condition, multiple tumors, tumor size, or tumor location with respect to a key vessel [1] [2] [3] [4] [5] [6]. HIFU has many advantages including being non-invasive, having a large penetration depth, lower operating cost, superior selectiveness and easier power control when compared with other physical methods for tissue ablation, such as lasers, microwaves or radio frequency (RF) fields. "
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    ABSTRACT: An integrated computational framework was developed in this study for modeling high-intensity focused ultrasound (HIFU) thermal ablation. The temperature field was obtained by solving the bioheat transfer equation (BHTE) through the finite element method; while, the thermal lesion was considered as a denatured material experiencing phase transformation and modeled with the latent heat. An equivalent attenuation coefficient, which considers the temperature-dependent properties of the target material and the ultrasound diffraction due to bubbles, was proposed in the nonlinear thermal transient analysis. Finally, a modified thermal dose formulation was proposed to predict the lesion size, shape and location. In-vitro thermal ablation experiments on transparent tissue phantoms at different energy levels were carried out to validate this computational framework. The temperature histories and lesion areas from the proposed model show good correlation with those from the in-vitro experiments. Copyright © 2015 Elsevier B.V. All rights reserved.
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    ABSTRACT: Image-guided ablation of tumors is assuming an increasingly important role in many oncology services as a minimally invasive alternative to conventional surgical interventions for patients who are not good candidates for surgery. Laser-induced thermal therapy (LITT) is a percutaneous tumor-ablation technique that utilizes high-power lasers placed interstitially in the tumor to deliver therapy. Multiple laser fibers can be placed into the treatment volume and, unlike other interstitial heating techniques, can be fired simultaneously to rapidly treat large volumes of tissue. Modern systems utilize small, compact, high-power laser diode systems with actively cooled applicators to help keep tissue from charring during procedures. Additionally, because this approach to thermal therapy is easily made magnetic resonance (MR) compatible, the incorporation of magnetic resonance imaging (MRI) for treatment planning, targeting, monitoring, and verification has helped to expand the number of applications in which LITT can be applied safely and effectively. We provide an overview of the clinically used technology and algorithms that provide the foundations for current state-of-the-art MR-guided LITT (MRgLITT), including procedures in the brain, liver, bone, and prostate as examples. In addition to advances in imaging and delivery, such as the incorporation of nanotechnology, next-generation MRgLITT systems are anticipated to incorporate an increasing presence of in silico-based modeling of MRgLITT procedures to provide human-assisted computational tools for planning, MR model-assisted temperature monitoring, thermal-dose assessment, and optimal control.
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