Modelling of endoluminal and interstitial ultrasound hyperthermia and thermal ablation: Applications for device design, feedback control and treatment planning

AbstractPrecision medicine is a new frontier in healthcare that uses scientific methods to customize medical treatment to the individual genes, anatomy, physiology, and lifestyle of each person. In cardiovascular health, precision medicine has emerged as a promising paradigm to enable cost-effective solutions that improve quality of life and reduce mortality rates. However, the exact role in precision medicine for human heart modeling has not yet been fully explored. Here, we discuss the challenges and opportunities for personalized human heart simulations, from diagnosis to device design, treatment planning, and prognosis. With a view toward personalization, we map out the history of anatomic, physical, and constitutive human heart models throughout the past three decades. We illustrate recent human heart modeling in electrophysiology, cardiac mechanics, and fluid dynamics and highlight clinically relevant applications of these models for drug development, pacing lead failure, heart failure, ventricular assist devices, edge-to-edge repair, and annuloplasty. With a view toward translational medicine, we provide a clinical perspective on virtual imaging trials and a regulatory perspective on medical device innovation. We show that precision medicine in human heart modeling does not necessarily require a fully personalized, high-resolution whole heart model with an entire personalized medical history. Instead, we advocate for creating personalized models out of population-based libraries with geometric, biological, physical, and clinical information by morphing between clinical data and medical histories from cohorts of patients using machine learning. We anticipate that this perspective will shape the path toward introducing human heart simulations into precision medicine with the ultimate goals to facilitate clinical decision making, guide treatment planning, and accelerate device design.

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Optimisation-based thermal treatment planning for catheter-based ultrasound hyperthermia

International Journal of Hyperthermia ◽

10.3109/02656730903341332 ◽

2010 ◽

Vol 26 (1) ◽

pp. 39-55 ◽

Cited By ~ 27

Author(s):

Xin Chen ◽

Chris J. Diederich ◽

Jeffery H. Wootton ◽

Jean Pouliot ◽

I-Chow Hsu

Keyword(s):

Thermal Treatment ◽

Treatment Planning ◽

Ultrasound Hyperthermia

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Careful treatment planning enables safe ablation of liver tumors adjacent to major blood vessels by percutaneous irreversible electroporation (IRE)

Radiology and Oncology ◽

10.1515/raon-2015-0031 ◽

2015 ◽

Vol 49 (3) ◽

pp. 234-241 ◽

Cited By ~ 58

Author(s):

Bor Kos ◽

Peter Voigt ◽

Damijan Miklavcic ◽

Michael Moche

Keyword(s):

Electric Field ◽

Blood Vessels ◽

Treatment Planning ◽

Hepatic Vein ◽

Thermal Ablation ◽

Pulse Generator ◽

Liver Tumors ◽

Irreversible Electroporation ◽

Distance Ratio ◽

Contrast Enhanced Ct

AbstractBackground.Irreversible electroporation (IRE) is a tissue ablation method, which relies on the phenomenon of electroporation. When cells are exposed to a sufficiently electric field, the plasma membrane is disrupted and cells undergo an apoptotic or necrotic cell death. Although heating effects are known IRE is considered as non-thermal ablation technique and is currently applied to treat tumors in locations where thermal ablation techniques are contraindicated.Materials and methods.The manufacturer of the only commercially available pulse generator for IRE recommends a voltage-to-distance ratio of 1500 to 1700 V/cm for treating tumors in the liver. However, major blood vessels can influence the electric field distribution. We present a method for treatment planning of IRE which takes the influence of blood vessels on the electric field into account; this is illustrated on a treatment of 48-year-old patient with a metastasis near the remaining hepatic vein after a right side hemi-hepatectomy.Results.Output of the numerical treatment planning method shows that a 19.9 cm3irreversible electroporation lesion was generated and the whole tumor was covered with at least 900 V/cm. This compares well with the volume of the hypodense lesion seen in contrast enhanced CT images taken after the IRE treatment. A significant temperature raise occurs near the electrodes. However, the hepatic vein remains open after the treatment without evidence of tumor recurrence after 6 months.Conclusions.Treatment planning using accurate computer models was recognized as important for electrochemotherapy and irreversible electroporation. An important finding of this study was, that the surface of the electrodes heat up significantly. Therefore the clinical user should generally avoid placing the electrodes less than 4 mm away from risk structures when following recommendations of the manufacturer.

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