A comparison of methods for focusing the field of a HIFU array transducer through human ribs

A forward model, which predicts the scattering by human ribs of a multi-element high-intensity focused ultrasound transducer, was used to investigate the efficacy of a range of focusing approaches described in the literature. This forward model is based on the boundary element method and was described by Gélat et al (2011 Phys. Med. Biol. 56 5553-81; 2012 Phys. Med. Biol. 57 8471-97). The model has since been improved and features a complex surface impedance condition at the surface of the ribs. The inverse problem of focusing through the ribs was implemented on six transducer array-rib topologies and five methods of focusing were investigated, including spherical focusing, binarized apodization based on geometric ray tracing, phase conjugation and the decomposition of the time-reversal operator method. The excitation frequency was 1 MHz and the array was of spherical-section type. Both human and idealized rib topologies were considered. The merit of each method of focusing was examined. It was concluded that the constrained optimization approach offers greater potential than the other focusing methods in terms of maximizing the ratio of acoustic pressure magnitudes at the focus to those on the surface of the ribs whilst taking full advantage of the dynamic range of the phased array.

Thermal therapeutic method for selective treatment of deep-lying tissue by combining laser and high-intensity focused ultrasound energy

Photothermal therapy is performed by delivering laser radiation into the target lesion containing tissue chromophores so as to induce localized heating. For high treatment efficacy, the laser wavelength should be selected to maximize the absorption of incident laser radiation in the tissue chromophores. However, even with the optimal laser wavelength, both the absorption and the scattering of laser energy in tissue openly hamper treatment efficacy in deep-lying lesions. To overcome the limitation, we propose a dual thermal therapeutic method in which both laser and acoustic energies are transmitted to increase therapeutic depth while maintaining high target selectivity of photothermal therapy. Through skin-mimicking phantom experiments, it was verified that the two different energies are complementary in elevation of tissue temperature, and the treatment depth using laser radiation is increased along with acoustic energy.

[Focal therapy-a new era in the treatment of prostate cancer]

Treatment options for prostate cancer are currently widely discussed in the media and by urologic associations. International studies showed that current treatment options may significantly affect the quality of life (including incontinence and erectile dysfunction) while only offering marginal survival benefits. Low to medium risk patients in particular don't seem to be ideal candidates for radical treatment by surgery of radio therapy. For this large group of patients focal therapy offers additional valuable treatment option. Malignant prostate tissue can be specifically ablated by High-Intensity Focused Ultrasound (HIFU). Thus, the cancer can be controlled without removing the whole prostate and with minimal side effects. Multimodal magnetic resonance tomography, specific biopsies and monitoring contribute to the safety of this new treatment strategy.

Assessing the relationship between the inter-rod coupling and the efficiency of piezocomposite high-intensity focused ultrasound transducers

The electroacoustic conversion efficiency of the ultrasonic transducer is a critical performance index for high-power applications. The material properties, volume fraction (VF) and aspect ratio (AR) are typically regarded as the design parameters of the piezocomposite transducer. We hypothesized that the spacing between piezoelectric rods was also a dominant factor. Therefore, the inter-rod coupling effects on the efficiency of 1-3 piezocomposite ultrasonic transducers were investigated in this study. The efficiencies of six flat and three curved 1.0 MHz PZT4 epoxy composite transducers with different geometric parameters were measured. Finite element transient analyses of the inter-rod electrical-mechanical coupling in the composites were carried out to explain the measured results. The experimental results showed that for 0.47 AR, the 79% VF transducers had lower efficiency than the 64% VF and 53% VF transducers. For 0.19 AR, the efficiency of the 59% VF transducer was not greater than the efficiency of the 39% VF transducer. Numerical analyses demonstrated that the positive peak voltage induced by the coupling of the side rods was more than twice the level induced by the coupling of the diagonal rods for any spacing. The diagonal coupling voltage peak did not change for spacings larger than 0.2 mm. Moreover, for spacings of 0.05 and 0.1 mm, the inter-rod coupling caused 24% and 20% waveform shifts of the driving voltage, respectively, while the 0.2 mm spacing coupling caused a 14% reduction in the amplitude of the driving voltage. As a result, the asymmetry of the driving voltage degraded the efficiency of the composite transducers and became more severe when the spacing was decreased. We concluded that the efficiency loss induced by inter-rod coupling as a function of spacing should be considered when designing piezocomposite transducers.

Review of high-power ultrasound-industrial applications and measurement methods

Applications involving high-power ultrasound are expanding rapidly as ultrasonic intensification opportunities are identified in new fields. This is facilitated through new technological developments and an evolution of current systems to tackle challenging problems. It is therefore important to continually update both the scientific and commercial communities on current system performance and limitations. To achieve this objective, this paper addresses two key aspects of high-power ultrasonic systems. In the first part, the review of high-power applications focuses on industrial applications and documents the developing technology from its early cleaning applications through to the advanced sonochemistry, cutting, and water treatment applications used today. The second part provides a comprehensive overview of measurement techniques used in conjunction with high-power ultrasonic systems. This is an important and evolving field which enables design and process engineers to optimize the behavior and/or operation of key metrics of system performance, such as field distribution or cavitation intensity.

Histotripsy beyond the intrinsic cavitation threshold using very short ultrasound pulses: microtripsy

Histotripsy produces tissue fractionation through dense energetic bubble clouds generated by short, high-pressure, ultrasound pulses. Conventional histotripsy treatments have used longer pulses from 3 to 10 cycles, wherein the lesion-producing bubble cloud generation depends on the pressure-release scattering of very high peak positive shock fronts from previously initiated, sparsely distributed bubbles (the shock-scattering mechanism). In our recent work, the peak negative pressure (P-) for generation of dense bubble clouds directly by a single negative half cycle, the intrinsic threshold, was measured. In this paper, the dense bubble clouds and resulting lesions (in red blood cell phantoms and canine tissues) generated by these supra-intrinsic threshold pulses were studied. A 32-element, PZT-8, 500-kHz therapy transducer was used to generate very short (<2 cycles) histotripsy pulses at a pulse repetition frequency (PRF) of 1 Hz and P- from 24.5 to 80.7 MPa. The results showed that the spatial extent of the histotripsy-induced lesions increased as the applied P- increased, and the sizes of these lesions corresponded well to the estimates of the focal regions above the intrinsic cavitation threshold, at least in the lower pressure regime (P- = 26 to 35 MPa). The average sizes for the smallest reproducible lesions were approximately 0.9 × 1.7 mm (lateral × axial), significantly smaller than the -6-dB beamwidth of the transducer (1.8 × 4.0 mm). These results suggest that, using the intrinsic threshold mechanism, well-confined and microscopic lesions can be precisely generated and their spatial extent can be estimated based on the fraction of the focal region exceeding the intrinsic cavitation threshold. Because the supra-threshold portion of the negative half cycle can be precisely controlled, lesions considerably less than a wavelength are easily produced, hence the term microtripsy.

Dual-beam histotripsy: a low-frequency pump enabling a high-frequency probe for precise lesion formation

Histotripsy produces tissue fractionation through dense energetic bubble clouds generated by short, high-pressure, ultrasound pulses. When using pulses shorter than 2 cycles, the generation of these energetic bubble clouds only depends on where the peak negative pressure (P-) exceeds the intrinsic threshold of the medium (26 to 30 MPa in soft tissue with high water content). This paper investigates a strategic method for precise lesion generation in which a low-frequency pump pulse is applied to enable a sub-threshold high-frequency probe pulse to exceed the intrinsic threshold. This pump-probe method of controlling a supra-threshold volume can be called dual-beam histotripsy. A 20-element dual-frequency (500-kHz and 3-MHz elements confocally aligned) array transducer was used to generate dual-beam histotripsy pulses in red blood cell phantoms and porcine hepatic tissue specimens. The results showed that when sub-intrinsic-threshold pump (500-kHz) and probe (3-MHz) pulses were applied together, dense bubble clouds (and resulting lesions) were only generated when their peak negative pressures combined constructively to exceed the intrinsic threshold. The smallest reproducible lesion varied with the relative amplitude between the pump and probe pulses, and, with a higher proportion of the probe pulse, smaller lesions could be generated. When the propagation direction of the probe pulse relative to the pump pulse was altered, the shape of the produced lesion changed based on the region that exceeded intrinsic threshold. Because the low-frequency pump pulse is more immune to attenuation and aberrations, and the high-frequency probe pulse can provide precision in lesion formation, this dual-beam histotripsy approach would be very useful in situations in which precise lesion formation is required through a highly attenuative and aberrative medium, such as transcranial therapy. This is particularly true if a small low-attenuation acoustic window is available for the high-frequency probe transducer.

[Ultrasonic dissection and coagulation by attachment ("Harmonic Focus" in anatomic resection of the lung]

The authors aimed to evaluate the efficacy of application of ultrasound dissection technology and coagulation by using "Harmonic Focus" (HF) instrument, while performing anatomical resection of the lung in open thoracic surgery. The method was carried out in serial 20 patients with lung cancer, whom the lung anatomical resection was performed. A long attachment (17 cm) with curved branches was applied. There were 11 lobectomies and 9 pneumoectomies. The application of HF allowed the dissection of pleural adhesions, pulmonary ligament, a separation of roots of the lung elements, lymphatic nodes of roots of the lung and mediastinum, in spite of being very close to vessels. A fatty tissue of the mediastinum was removed quickly and practically without blood. The HF considerably accelerated the process of vessel treatment, especially, while performing the lobectomy. At the same time, the attempts of application of HF instrument for separation of interlobal fissure resulted in not quite satisfactory aerostasis and hemostasis. The duration of the lobectomy was 127 +/- 35 minutes at the average and in the case of pneumoectomy, it consisted of 120 +/- 45 minutes. An intraoperative hemorrhage was 300 +/- 145 ml. A quantity of exudates was 440 +/- 280 ml by drainage on the first day. The pleural cavity drainage was used during 3 +/- 1 days. The HF instrument, which was applied for ultrasonic dissection and coagulation, was characterized by multifunctionality and simplicity of usage. It was recommended for a wide application in the thoracic surgery for performing the anatomical lung resections by thoracotomy method.

Resonance tracking and vibration stablilization for high power ultrasonic transducers

Resonant frequency shift and electrical impedance variation are common phenomena in the application of high power ultrasonic transducers, e.g. in focused ultrasound surgery and in cutting. They result in low power efficiency and unstable vibration amplitude. To solve this problem, a driving and measurement system has been developed to track the resonance of high power transducers and to stabilise their vibration velocity. This has the ability to monitor the operating and performance parameters of the ultrasonic transducers in real time. The configuration of the system, with its control algorithm implemented in LabVIEW (National Instruments, Newbury, UK), ensures flexibility to suit different transducers and load conditions. In addition, with different programs, it can be utilised as a high power impedance analyser or an instantaneous electrical power measurement system for frequencies in the MHz range. The effectiveness of this system has been demonstrated in detailed studies. With it, high transducer performance at high power can be achieved and monitored in real time.

Histotripsy cardiac therapy system integrated with real-time motion correction

Histotripsy has shown promise in non-invasive cardiac therapy for neonatal and fetal applications. However, for cardiac applications in general, and especially in the adult heart, cardiac and respiratory motion may affect treatment accuracy and efficacy. In this article, we describe a histotripsy-mediated cardiac therapy system integrated with a fast motion tracking algorithm and treatment monitoring using ultrasound imaging. Motion tracking is performed by diamond search block matching in real-time ultrasound images using a reference image of the moving target, refined by Kalman filtering. As proof of feasibility, this algorithm was configured to track 2-D target motion and then electronically adjust the focus of a 1-MHz annular therapy array to correct for axial motion. This integrated motion tracking system is capable of sub-millimeter accuracy for displacements of 0-15 mm and velocities of 0-80 mm/s, with a maximum error less than 3 mm. Tissue phantom tests indicated that treatment efficiency and lesion size using motion tracking over displacements of 0-15 mm and velocities of 0-42 mm/s are comparable to those achieved when treating stationary targets. In vivo validation was conducted in an open-chest canine model, where the system provided 24 min of motion-corrected histotripsy therapy in the live beating heart, generating a targeted lesion on the atrial septum. Based on this proof of feasibility and the natural extension of these techniques to three dimensions, we anticipate a full motion correction system would be feasible and beneficial for non-invasive cardiac therapy.

A comparison of acoustic cavitation detection thresholds measured with piezo-electric and fiber-optic hydrophone sensors

A Fabry-Perot interferometer fiber-optic hydrophone (FOH) was investigated for use as an acoustic cavitation detector and compared with a piezo-ceramic passive cavitation detector (PCD). Both detectors were used to measure negative pressure thresholds for broadband emissions in 3% agar and ex vivo bovine liver simultaneously. FOH-detected half- and fourth-harmonic emissions were also studied. Three thresholds were defined and investigated: (i) onset of cavitation; (ii) 100% probability of cavitation; and (iii) a time-integrated threshold where broadband signals integrated over a 3-s exposure duration, averaged over 5-10 repeat exposures, become statistically significantly greater than noise. The statistical sensitiviy of FOH broadband detection was low compared with that of the PCD (0.43/0.31 in agar/liver). FOH-detected fourth-harmonic data agreed best with PCD broadband (sensitivity: 0.95/0.94, specificity: 0.89/0.76 in agar/liver). The FOH has potential as a cavitation detector, particularly in applications where space is limited or during magnetic resonance-guided studies.

Ultrasound-heated photoacoustic flowmetry

We report the development of photoacoustic flowmetry assisted by high-intensity focused ultrasound (HIFU). This novel method employs HIFU to generate a heating impulse in the flow medium, followed by photoacoustic monitoring of the thermal decay process. Photoacoustic flowmetry in a continuous medium remains a challenge in the optical diffusive regime. Here, both the HIFU heating and photoacoustic detection can focus at depths beyond the optical diffusion limit (~1 mm in soft tissue). This method can be applied to a continuous medium, i.e., a medium without discrete scatterers or absorbers resolvable by photoacoustic imaging. Flow speeds up to 41 mm·s-1 have been experimentally measured in a blood phantom covered by 1.5-mm-thick tissue.

On the lateral resolution of focused ultrasonic fields from spherically curved transducers

Focused ultrasonic fields produced by spherically curved transducers occur in many areas, as, for example, in medical ultrasonics. Recently, transducers with a central hole have increasingly appeared in practice. The present paper theoretically investigates the lateral field distribution in the geometric focal plane, based on an approach with the Rayleigh integral. Results for the lateral width of the focal maximum in that plane are presented. It turns out that the appearance of a central hole leads to a reduction in the lateral width of the focal maximum, contrary to the behavior of the longitudinal width of that maximum shown earlier.

Quantitative assessment of acoustic intensity in the focused ultrasound field using hydrophone and infrared imaging

With the popularity of ultrasound therapy in clinics, characterization of the acoustic field is important not only to the tolerability and efficiency of ablation, but also for treatment planning. A quantitative method was introduced to assess the intensity distribution of a focused ultrasound beam using a hydrophone and an infrared camera with no prior knowledge of the acoustic and thermal parameters of the absorber or the configuration of the array elements. This method was evaluated in both theoretical simulations and experimental measurements. A three-layer model was developed to calculate the acoustic field in the absorber, the absorbed acoustic energy during the sonication and the consequent temperature elevation. Experiments were carried out to measure the acoustic pressure with the hydrophone and the temperature elevation with the infrared camera. The percentage differences between the derived results and the simulation are <4.1% for on-axis intensity and <21.1% for -6-dB beam width at heating times up to 360 ms in the focal region of three phased-array ultrasound transducers using two different absorbers. The proposed method is an easy, quick and reliable approach to calibrating focused ultrasound transducers with satisfactory accuracy.

MR-guided HIFU treatment of symptomatic uterine fibroids using novel feedback-regulated volumetric ablation: effectiveness and clinical practice

PURPOSE

To evaluate a novel feedback-regulated volumetric sonication method in MRguided HIFU treatment of symptomatic uterine fibroids.

MATERIALS AND METHODS

27 fibroids with an average volume of 124.9 ± 139.8 cc in 18 women with symptomatic uterine fibroids were ablated using the new HIFU system Sonalleve (1.5 TMR system Achieva, Philips). 21 myomas in 13 women were reevaluated 6 months later. Standard (treatment) cells (TC) and feedback-regulated (feedback) cells (FC) with a diameter of 4, 8, 12, and 16 mm were used and compared concerning sonication success, diameter of induced necrosis, and maximum achieved temperature. The non-perfused volume ratio (NPV related to myoma volume) was quantified. The fibroid volume was measured before, 1 month, and 6 months after therapy. Symptoms were quantified using a specific questionnaire (UFS-QoL).

RESULTS

In total, 205 TC and 227 FC were applied. The NPV ratio was 23 ± 15 % (2 – 55). The TC were slightly smaller than intended (-3.9 ± 52 %; range, -100 – 81), while the FC were 20.1 ± 25.3 % bigger (p = 0.02). Feedback mechanism is less diversifying in diameter (p < 0.001). Overall, the FC correlate well with the planned treatment diameter (r = 0.79), other than the TC (r = 0.38). Six months after therapy, the fibroid volume was reduced by 45 ± 21 % (5 – 100) (p = 0.001). The symptoms decreased significantly (p = 0.001). No serious adverse events were recorded.

CONCLUSION

Use of volumetric sonication leads to homogenous heating and sufficient necrosis. It is a safe and effective therapy for treating symptomatic uterine fibroids. Successful sonication of feedback cells leads to more contiguous necrosis in diameter

Experimental methods for improved spatial control of thermal lesions in magnetic resonance-guided focused ultrasound ablation

Magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU, or MRgFUS) is a hybrid technology that was developed to provide efficient and tolerable thermal ablation of targeted tumors or other pathologic tissues, while preserving the normal surrounding structures. Fast 3-D ablation strategies are feasible with the newly available phased-array HIFU transducers. However, unlike fixed heating sources for interstitial ablation (radiofrequency electrode, microwave applicator, infra-red laser applicator), HIFU uses propagating waves. Therefore, the main challenge is to avoid thermo-acoustical adverse effects, such as energy deposition at reflecting interfaces and thermal drift of the focal lesion toward the near field. We report here our investigations on some novel experimental solutions to solve, or at least to alleviate, these generally known tolerability problems in HIFU-based therapy. Online multiplanar MR thermometry was the main investigational tool extensively used in this study to identify the problems and to assess the efficacy of the tested solutions. We present an improved method to cancel the beam reflection at the exit window (i.e., tissue-to-air interface) by creating a multilayer protection, to dissipate the residual HIFU beam by bulk scattering. This study evaluates selective de-activation of transducer elements to reduce the collateral heating at bone surfaces in the far field, mainly during automatically controlled volumetric ablation. We also explore, using hybrid US/MR simultaneous imaging, the feasibility of using disruptive boiling at the focus, both as a far-field self-shielding technique and as an enhanced ablation strategy (i.e., boiling core controlled HIFU ablation).

Design and evaluation of a transesophageal HIFU probe for ultrasound-guided cardiac ablation: simulation of a HIFU mini-maze procedure and preliminary ex vivo trials

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia. Left atrial catheter ablation is currently performed to treat this disease. Several energy sources are used, such as radio-frequency or cryotherapy. The main target of this procedure is to isolate the pulmonary veins. However, significant complications caused by the invasive procedure are described, such as stroke, tamponade, and atrioesophageal fistula, and a second intervention is often needed to avoid atrial fibrillation recurrence. For these reasons, a minimally-invasive device allowing performance of more complex treatments is still needed. High-intensity focused ultrasound (HIFU) can cause deep tissue lesions without damaging intervening tissues. Left atrial ultrasound-guided transesophageal HIFU ablation could have the potential to become a new ablation technique. The goal of this study was to design and test a minimally-invasive ultrasound-guided transesophageal HIFU probe under realistic treatment conditions. First, numerical simulations were conducted to determine the probe geometry, and to validate the feasibility of performing an AF treatment using a HIFU mini-maze (HIFUMM) procedure. Then, a prototype was manufactured and characterized. The 18-mm-diameter probe head housing contained a 3-MHz spherical truncated HIFU transducer divided into 8 rings, with a 5-MHz commercial transesophageal echocardiography (TEE) transducer integrated in the center. Finally, ex vivo experiments were performed to test the impact of the esophagus layer between the probe and the tissue to treat, and also the influence of the lungs and the vascularization on lesion formation. First results show that this prototype successfully created ex vivo transmural myocardial lesions under ultrasound guidance, while preserving intervening tissues (such as the esophagus). Ultrasound-guided transesophageal HIFU can be a good candidate for treatment of AF in the future.

High-speed observation of bubble cloud generation near a rigid wall by second-harmonic superimposed ultrasound

Cavitation bubbles are known to accelerate therapeutic effects of ultrasound. Although negative acoustic pressure is the principle factor of cavitation, positive acoustic pressure has a role for bubble cloud formation at a high intensity of focused ultrasound when cavitation bubbles provide pressure release surfaces converting the pressure from highly positive to negative. In this study, the second-harmonic was superimposed onto the fundamental acoustic pressure to emphasize either peak positive or negative pressure. The peak negative and positive pressure emphasized waves were focused on a surface of an aluminum block. Cavitation bubbles induced near the block were observed with a high-speed camera by backlight and the size of the cavitation generation region was measured from the high-speed images. The negative pressure emphasized waves showed an advantage in cavitation inception over the positive pressure emphasized waves. In the sequence of the negative pressure emphasized waves immediately followed by the positive pressure emphasized waves, cavitation bubbles were generated on the block by the former waves and the cavitation region were expanded toward the transducer in the latter waves with high reproducibility. The sequence demonstrated its potential usefulness in enhancing the effects of therapeutic ultrasound at a high acoustic intensity.

Computational study on the propagation of strongly focused nonlinear ultrasound in tissue with rib-like structures

The presence of a rib cage is a significant hindrance to the potential applications of focused ultrasound as a noninvasive extracorporeal surgery modality for various internal organs. Here the influence of ribs on the propagation of strongly focused high-intensity nonlinear ultrasound beam inside the body is studied. Based on the spheroidal beam equation, a three-dimensional numerical algorithm is developed to solve the nonlinear acoustic field generated by a focused ultrasonic transducer with a large aperture angle. Idealized ribs, of rectangular cross sectional, with high absorption and impedance, and various dimensions, are used to simulate human anatomical configurations. The changes in the spatial distribution of acoustic intensity and the reduction of the acoustic pressure amplitude and heat deposition rate due to the presence of "ribs" are investigated. It is somewhat surprising that in some cases, the axial peak positions shift less than 2 mm and more than 80% of the sound energy can propagate through the space of the rib cage in the strongly focused sound field. This study also includes quantitative analyses of the effects of different rib configurations and transducers of various f-numbers. The results can be used as reference information for further study and clinical applications.

Surface vibration and nearby cavitation of an ex vivo bovine femur exposed to high intensity focused ultrasound

The acoustic pressure distribution, thermal ablation, and sonochemiluminescence (SCL) generated by cavitation near the surface of an ex vivo bovine femur were investigated at normal and oblique incidences of high intensity focused ultrasound (HIFU), as were the characteristics of bone surface vibrations. The acoustic pressure at the HIFU focus, the width of thermal ablation, and the SCL intensity in the pre-focal region were 1.3 MPa, 7 mm, and 454 electrons, respectively, in the control group at normal incidence, and they respectively increased to 1.5 MPa, 12 mm and 968 electrons in the presence of the bone. At oblique incidence from the left, the acoustic pressure at 3 mm to the right of the HIFU focus was 0.6 MPa and decreased to 0.4 MPa at 3 mm to the left of the focus. The thermal ablation was 20 mm in width and extended along the front surface of the bone to the right of the HIFU focus. The SCL intensity on the right of the HIFU focus was 394 electrons and was 362 electrons on the left. The presence of bone would directionally change the spatial distribution of acoustic pressure, thermal and cavitation effects for oblique incidence of HIFU.

Infrared mapping of ultrasound fields generated by medical transducers: feasibility of determining absolute intensity levels

Considerable progress has been achieved in the use of infrared (IR) techniques for qualitative mapping of acoustic fields of high intensity focused ultrasound (HIFU) transducers. The authors have previously developed and demonstrated a method based on IR camera measurement of the temperature rise induced in an absorber less than 2 mm thick by ultrasonic bursts of less than 1 s duration. The goal of this paper was to make the method more quantitative and estimate the absolute intensity distributions by determining an overall calibration factor for the absorber and camera system. The implemented approach involved correlating the temperature rise measured in an absorber using an IR camera with the pressure distribution measured in water using a hydrophone. The measurements were conducted for two HIFU transducers and a flat physiotherapy transducer of 1 MHz frequency. Corresponding correction factors between the free field intensity and temperature were obtained and allowed the conversion of temperature images to intensity distributions. The system described here was able to map in good detail focused and unfocused ultrasound fields with sub-millimeter structure and with local time average intensity from below 0.1 W/cm(2) to at least 50 W/cm(2). Significantly higher intensities could be measured simply by reducing the duty cycle.

Characterization of a multi-element clinical HIFU system using acoustic holography and nonlinear modeling

High-intensity focused ultrasound (HIFU) is a treatment modality that relies on the delivery of acoustic energy to remote tissue sites to induce thermal and/or mechanical tissue ablation. To ensure the safety and efficacy of this medical technology, standard approaches are needed for accurately characterizing the acoustic pressures generated by clinical ultrasound sources under operating conditions. Characterization of HIFU fields is complicated by nonlinear wave propagation and the complexity of phased-array transducers. Previous work has described aspects of an approach that combines measurements and modeling, and here we demonstrate this approach for a clinical phased-array transducer. First, low amplitude hydrophone measurements were performed in water over a scan plane between the array and the focus. Second, these measurements were used to holographically reconstruct the surface vibrations of the transducer and to set a boundary condition for a 3-D acoustic propagation model. Finally, nonlinear simulations of the acoustic field were carried out over a range of source power levels. Simulation results were compared with pressure waveforms measured directly by hydrophone at both low and high power levels, demonstrating that details of the acoustic field, including shock formation, are quantitatively predicted.

Phase-shift perfluorocarbon agents enhance high intensity focused ultrasound thermal delivery with reduced near-field heating

Ultrasound contrast agents are known to enhance high intensity focused ultrasound (HIFU) ablation, but these perfluorocarbon microbubbles are limited to the vasculature, have a short half-life in vivo, and may result in unintended heating away from the target site. Herein, a nano-sized (100-300 nm), dual perfluorocarbon (decafluorobutane/dodecafluoropentane) droplet that is stable, is sufficiently small to extravasate, and is convertible to micron-sized bubbles upon acoustic activation was investigated. Microbubbles and nanodroplets were incorporated into tissue-mimicking acrylamide-albumin phantoms. Microbubbles or nanodroplets at 0.1 × 10(6) per cm(3) resulted in mean lesion volumes of 80.4 ± 33.1 mm(3) and 52.8 ± 14.2 mm(3) (mean ± s.e.), respectively, after 20 s of continuous 1 MHz HIFU at a peak negative pressure of 4 MPa, compared to a lesion volume of 1.0 ± 0.8 mm(3) in agent-free control phantoms. Magnetic resonance thermometry mapping during HIFU confirmed undesired surface heating in phantoms containing microbubbles, whereas heating occurred at the acoustic focus of phantoms containing the nanodroplets. Maximal change in temperature at the target site was enhanced by 16.9% and 37.0% by microbubbles and nanodroplets, respectively. This perfluorocarbon nanodroplet has the potential to reduce the time to ablate tumors by one-third during focused ultrasound surgery while also safely enhancing thermal deposition at the target site.

Transcostal high-intensity focused ultrasound treatment using phased array with geometric correction

In the high-intensity focused ultrasound treatment of liver tumors, ultrasound propagation is affected by the rib cage. Because of the diffraction and absorption of the bone, the sound distribution at the focal plane is altered, and more importantly, overheating on the rib surface might occur. To overcome these problems, a geometric correction method is applied to turn off the elements blocked by the ribs. The potential of steering the focus of the phased-array along the propagation direction to improve the transcostal treatment was investigated by simulations and experiments using different rib models and transducers. The ultrasound propagation through the ribs was computed by a hybrid method including the Rayleigh-Sommerfeld integral, k-space method, and angular spectrum method. A modified correction method was proposed to adjust the output of elements based on their relative area in the projected "shadow" of the ribs. The simulation results showed that an increase in the specific absorption rate gain up to 300% was obtained by varying the focal length although the optimal value varied in each situation. Therefore, acoustic simulation is required for each clinical case to determine a satisfactory treatment plan.

Microbubble behavior in an ultrasound field for high intensity focused ultrasound therapy enhancement

The enhancement of heating due to inertial cavitation has been focused to reduce the long treatment time of conventional high-intensity focused ultrasound (HIFU) therapy. The influences of the physical properties of surrounding tissues, initial void fraction, and spatial distribution of bubbles on microbubble-enhanced HIFU are examined. A bubble dynamics equation based on the Keller-Miksis equation is employed in consideration of the elasticity of surrounding tissue. The mixture phase and bubbles are coupled by the Euler-Lagrange method to take into account the interaction between ultrasound and bubbles. As a result, the temperature around the target increases with the initial void fraction. But at the high void fraction of 10(-5), ultrasound is too attenuated to heat the target, and the heating region moves to the transducer side. On the other hand, both the viscosity and shear elasticity of the surrounding media reduce the attenuation of ultrasound propagation through the bubbly mixture. Numerical results show that localized heating is induced with increasing viscosity or shear elasticity, though it depends on the pressure amplitudes. In addition, it was numerically confirmed that the localization of the microbubble distribution is important to obtain efficient localized heating.