An automated method for mapping human tissue permittivities by MRI in hyperthermia treatment planning

Characterization of white matter lesions in multiple sclerosis using proton density and T1-relaxation measures

PURPOSE

Although lesion dissemination in time is a defining characteristic of multiple sclerosis (MS), there is a limited understanding of lesion heterogeneity. Currently, conventional sequences such as fluid attenuated inversion recovery (FLAIR) and T1-weighted (T1W) data are used to assess MS lesions qualitatively. Estimating water content could provide a measure of local tissue rarefaction, or reduced tissue density, resulting from chronic inflammation. Our goal was to utilize the proton spin density (PD), derived from a rapid, multi-contrast STAGE (strategically acquired gradient echo) protocol to characterize white matter (WM) lesions seen on T2W, FLAIR and T1W data.

MATERIALS AND METHODS

Twenty (20) subjects with relapsing-remitting MS were scanned at 3 T using T1W, T2-weighted, FLAIR and strategically acquired gradient echo (STAGE) sequences. PD and T1 maps were derived from the STAGE data. Disease severity scores, including Extended Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC), were correlated with total, high PD and high T1 lesion volumes. A probability map of high PD regions and all lesions across all subjects was generated. Five perilesional normal appearing WM (NAWM) bands surrounding the lesions were generated to compare the median PD and T1 values in each band with the lesional values and the global WM.

RESULTS

T1W intensity was negatively correlated with PD as expected (R = -0.87, p < 0.01, R2 = 0.756) and the FLAIR signal was suppressed for high PD volumes within the lesions, roughly for PD ≥ 0.85. The threshold for high PD and T1 regions was set to 0.909 and 1953.6 ms, respectively. High PD regions showed a high probability of occurrence near the boundary of the lateral ventricles. EDSS score and nine-hole peg test (dominant and non-dominant hand) were significantly correlated with the total lesion volume and the volumes of high PD and T1 regions (p < 0.05). There was a significant difference in PD/T1 values between the high PD/T1 regions within the lesions and the remaining lesional tissue (p < 0.001). In addition, the PD values of the first NAWM perilesional band directly adjacent to the lesional boundary displayed a significant difference (p < 0.05) compared to the global WM.

CONCLUSION

Lesions with high PD and T1s had the highest probability of occurrence at the boundary of the lateral ventricles and likely represent chronic lesions with significant local tissue rarefaction. Moreover, the perilesional NAWM exhibited subtly increasing PD and T1 values from the NAWM up to the lesion boundary. Unlike on the T1 maps, the perilesional band adjacent to the lesion boundary possessed a significantly higher PD value than the global WM PD values. This shows that PD maps were sensitive to the subtle changes in NAWM surrounding the lesions.

Multi-parameter quantitative mapping of R1, R2*, PD, and MTsat is reproducible when accelerated with Compressed SENSE

Multi-parameter mapping (MPM) magnetic resonance imaging (MRI) provides quantitative estimates of the longitudinal and effective transverse relaxation rates R1 and R2*, proton density (PD), and magnetization transfer saturation (MTsat). Thereby, MPM enables better comparability across sites and time than conventional weighted MRI. However, for MPM, several contrasts must be acquired, resulting in prolonged measurement durations and thus preventing MPM's application in clinical routines. State-of-the-art imaging acceleration techniques such as Compressed SENSE (CS), a combination of compressed sensing and sensitivity encoding, can be used to reduce the scan time of MPM. However, the accuracy and precision of the resulting quantitative parameter maps have not been systematically evaluated. In this study, we therefore investigated the effect of CS acceleration on the fidelity and reproducibility of MPM acquisitions. In five healthy volunteers and in a phantom, we compared MPM metrics acquired without imaging acceleration, with the standard acceleration (SENSE factor 2.5), and with Compressed SENSE with acceleration factors 4 and 6 using a 32-channel head coil. We evaluated the reproducibility and repeatability of accelerated MPM using data from three scan sessions in gray and white matter volumes-of-interest (VOIs). Accelerated MPM provided precise and accurate quantitative parameter maps. For most parameters, the results of the CS-accelerated protocols correlated more strongly with the non-accelerated protocol than the standard SENSE-accelerated protocols. Furthermore, for most VOIs and contrasts, coefficients of variation were lower when calculated from data acquired with different imaging accelerations within a single scan session than from data acquired in different scan sessions. These results suggest that MPM with Compressed SENSE acceleration factors up to at least 6 yields reproducible quantitative parameter maps that are highly comparable to those acquired without imaging acceleration. Compressed SENSE can thus be used to considerably reduce the scan duration of R1, R2*, PD, and MTsat mapping, and is highly promising for clinical applications of MPM.

Advanced patient-specific hyperthermia treatment planning

Hyperthermia treatment planning (HTP) is valuable to optimize tumor heating during thermal therapy delivery. Yet, clinical hyperthermia treatment plans lack quantitative accuracy due to uncertainties in tissue properties and modeling, and report tumor absorbed power and temperature distributions which cannot be linked directly to treatment outcome. Over the last decade, considerable progress has been made to address these inaccuracies and therefore improve the reliability of hyperthermia treatment planning. Patient-specific electrical tissue conductivity derived from MR measurements has been introduced to accurately model the power deposition in the patient. Thermodynamic fluid modeling has been developed to account for the convective heat transport in fluids such as urine in the bladder. Moreover, discrete vasculature trees have been included in thermal models to account for the impact of thermally significant large blood vessels. Computationally efficient optimization strategies based on SAR and temperature distributions have been established to calculate the phase-amplitude settings that provide the best tumor thermal dose while avoiding hot spots in normal tissue. Finally, biological modeling has been developed to quantify the hyperthermic radiosensitization effect in terms of equivalent radiation dose of the combined radiotherapy and hyperthermia treatment. In this paper, we review the present status of these developments and illustrate the most relevant advanced elements within a single treatment planning example of a cervical cancer patient. The resulting advanced HTP workflow paves the way for a clinically feasible and more reliable patient-specific hyperthermia treatment planning.

Silent 3D MR sequence for quantitative and multicontrast T1 and proton density imaging

This study aims to develop a silent, fast and 3D method for T1 and proton density (PD) mapping, while generating time series of T1-weighted (T1w) images with bias-field correction. Undersampled T1w images at different effective inversion times (TIs) were acquired using the inversion recovery prepared RUFIS sequence with an interleaved k-space trajectory. Unaliased images were reconstructed by constraining the signal evolution to a temporal subspace which was learned from the signal model. Parameter maps were obtained by fitting the data to the signal model, and bias-field correction was conducted on T1w images. Accuracy and repeatability of the method was accessed in repeated experiments with phantom and volunteers. For the phantom study, T1 values obtained by the proposed method were highly consistent with values from the gold standard method, R² = 0.9976. Coefficients of variation (CVs) ranged from 0.09% to 0.83%. For the volunteer study, T1 values from gray and white matter regions were consistent with literature values, and peaks of gray and white matter can be clearly delineated on whole-brain T1 histograms. CVs ranged from 0.01% to 2.30%. The acoustic noise measured at the scanner isocenter was 2.6 dBA higher compared to the in-bore background. Rapid and with low acoustic noise, the proposed method is shown to produce accurate T1 and PD maps with high repeatability by reconstructing sparsely sampled T1w images at different TIs using temporal subspace. Our approach can greatly enhance patient comfort during examination and therefore increase the acceptance of the procedure.

Deep Learning-Based Development of Personalized Human Head Model With Non-Uniform Conductivity for Brain Stimulation

Electromagnetic stimulation of the human brain is a key tool for neurophysiological characterization and the diagnosis of several neurological disorders. Transcranial magnetic stimulation (TMS) is a commonly used clinical procedure. However, personalized TMS requires a pipeline for individual head model generation to provide target-specific stimulation. This process includes intensive segmentation of several head tissues based on magnetic resonance imaging (MRI), which has significant potential for segmentation error, especially for low-contrast tissues. Additionally, a uniform electrical conductivity is assigned to each tissue in the model, which is an unrealistic assumption based on conventional volume conductor modeling. This study proposes a novel approach for fast and automatic estimation of the electric conductivity in the human head for volume conductor models without anatomical segmentation. A convolutional neural network is designed to estimate personalized electrical conductivity values based on anatomical information obtained from T1- and T2-weighted MRI scans. This approach can avoid the time-consuming process of tissue segmentation and maximize the advantages of position-dependent conductivity assignment based on the water content values estimated from MRI intensity values. The computational results of the proposed approach provide similar but smoother electric field distributions of the brain than that provided by conventional approaches.

Test-retest reliability of myelin imaging in the human spinal cord: Measurement errors versus region- and aging-induced variations

PURPOSE

To implement a statistical framework for assessing the precision of several quantitative MRI metrics sensitive to myelin in the human spinal cord: T1, Magnetization Transfer Ratio (MTR), saturation imposed by an off-resonance pulse (MTsat) and Macromolecular Tissue Volume (MTV).

METHODS

Thirty-three healthy subjects within two age groups (young, elderly) were scanned at 3T. Among them, 16 underwent the protocol twice to assess repeatability. Statistical reliability indexes such as the Minimal Detectable Change (MDC) were compared across metrics quantified within different cervical levels and white matter (WM) sub-regions. The differences between pathways and age groups were quantified and interpreted in context of the test-retest repeatability of the measurements.

RESULTS

The MDC was respectively 105.7ms, 2.77%, 0.37% and 4.08% for T1, MTR, MTsat and MTV when quantified over all WM, while the standard-deviation across subjects was 70.5ms, 1.34%, 0.20% and 2.44%. Even though particular WM regions did exhibit significant differences, these differences were on the same order as test-retest errors. No significant difference was found between age groups for all metrics.

CONCLUSION

While T1-based metrics (T1 and MTV) exhibited better reliability than MT-based measurements (MTR and MTsat), the observed differences between subjects or WM regions were comparable to (and often smaller than) the MDC. This makes it difficult to determine if observed changes are due to variations in myelin content, or simply due to measurement error. Measurement error remains a challenge in spinal cord myelin imaging, but this study provides statistical guidelines to standardize the field and make it possible to conduct large-scale multi-center studies.

Simulation and experimental study of DC electric field distribution characteristics of rat hippocampal slices in vitro

Direct current (DC) electric field is a noninvasive neuromodulation tool that can inhibit or facilitate excitability of neurons. Despite its efficacy, the dielectric constant of artificial cerebrospinal fluid and the position and direction of brain slices and other factors can affect the field intensity and distribution acting on the surface of rat hippocampus slices, thus causing errors. In this study, we describe a new analytical method optimized for DC electric fields acting on brain slices, and the design of an external DC electric field stimulator to allow scientific evaluation of brain slices. We investigated parameters regarding the uniformity of electric field distribution and identified the maximal parameters using the finite element method. Then, we selected and simplified slice images using magnetic resonance imaging data and calculated the electric field intensity of the original and simplified models. The electric field simulator induced action potential and excitatory postsynaptic current with intensities of 1, 5, and 10 V/m. This study describes the development of a new electric field stimulator and successfully demonstrates its practicability for scientific evaluation of tissue slices.

Hyperthermia treatment planning for cervical cancer patients based on electrical conductivity tissue properties acquired in vivo with EPT at 3 T MRI

Introduction The reliability of hyperthermia treatment planning (HTP) is strongly dependent on the accuracy of the electric properties of each tissue. The values currently used are mostly based on ex vivo measurements. In this study, in vivo conductivity of human muscle, bladder content and cervical tumours, acquired with magnetic resonance-based electric properties tomography (MR-EPT), are exploited to investigate the effect on HTP for cervical cancer patients. Methods Temperature-based optimisation of five different patients was performed using literature-based conductivity values yielding certain antenna settings, which are then used to compute the temperature distribution of the patient models with EPT-based conductivity values. Furthermore, the effects of altered bladder and muscle conductivity were studied separately. Finally, the temperature-based optimisation was performed with patient models based on EPT conductivity values. Results The tumour temperatures for all EPT-based dielectric patient models were lower compared to the optimal tumour temperatures based on literature values. The largest deviation was observed for patient 1 with ΔT90 = -1.37 °C. A negative impact was also observed when the treatment was optimised based on the EPT values. For four patients ΔT90 was less than 0.6 °C; for one patient it was 1.5 °C. Conclusions Electric conductivity values acquired by EPT are higher than commonly used from literature. This difference has a substantial impact on cervical tumour temperatures achieved during hyperthermia. A higher conductivity in the bladder and in the muscle tissue surrounding the tumour leads to higher power dissipation in the bladder and muscle, and therefore to lower tumour temperatures.

Electrical conductivity and permittivity maps of brain tissues derived from water content based on T1 -weighted acquisition

PURPOSE

To develop an electrical properties tomography (EPT) technique that can provide in vivo electrical conductivity and permittivity images of biological tissue without performing complex-valued radiofrequency field measurements.

THEORY AND METHODS

Electrical conductivity and permittivity images are modeled as a monotonic function of tissues' water content (W) under the principle of Maxwell's mixture theory. Water content maps are estimated from two spin-echo images having different repetition times (TRs). For the modeling functions, physically measured parameters (electrical properties, water content, and T₁ ) of brain cerebrospinal fluid (CSF), gray matter, and white matter are used as landmark literature references. The formulations are validated by a developed electrolyte-protein phantom and by human brain studies at 3 Tesla (T).

RESULTS

The electrical properties (EPs) of the phantom estimated by the proposed method match well with the values measured on the bench. The conductivity and permittivity maps from all experiments show uncompromised spatial resolution without boundary artifacts and higher contrast when compared with water content maps.

CONCLUSIONS

Human brain and phantom EP images suggest that water content is a dominating factor in determining the electrical properties of tissues. Despite possible literature inaccuracies, the proposed method offers EP maps that can provide complementary information to current approaches, to facilitate EPT scans in clinical applications. Magn Reson Med 77:1094-1103, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Current state of the art of regional hyperthermia treatment planning: a review

Locoregional hyperthermia, i.e. increasing the tumor temperature to 40–45 °C using an external heating device, is a very effective radio and chemosensitizer, which significantly improves clinical outcome. There is a clear thermal dose-effect relation, but the pursued optimal thermal dose of 43 °C for 1 h can often not be realized due to treatment limiting hot spots in normal tissue. Modern heating devices have a large number of independent antennas, which provides flexible power steering to optimize tumor heating and minimize hot spots, but manual selection of optimal settings is difficult. Treatment planning is a very valuable tool to improve locoregional heating. This paper reviews the developments in treatment planning software for tissue segmentation, electromagnetic field calculations, thermal modeling and optimization techniques. Over the last decade, simulation tools have become more advanced. On-line use has become possible by implementing algorithms on the graphical processing unit, which allows real-time computations. The number of applications using treatment planning is increasing rapidly and moving on from retrospective analyses towards assisting prospective clinical treatment strategies. Some clinically relevant applications will be discussed.

Simulation techniques in hyperthermia treatment planning

Abstract Clinical trials have shown that hyperthermia (HT), i.e. an increase of tissue temperature to 39-44 °C, significantly enhance radiotherapy and chemotherapy effectiveness [1]. Driven by the developments in computational techniques and computing power, personalised hyperthermia treatment planning (HTP) has matured and has become a powerful tool for optimising treatment quality. Electromagnetic, ultrasound, and thermal simulations using realistic clinical set-ups are now being performed to achieve patient-specific treatment optimisation. In addition, extensive studies aimed to properly implement novel HT tools and techniques, and to assess the quality of HT, are becoming more common. In this paper, we review the simulation tools and techniques developed for clinical hyperthermia, and evaluate their current status on the path from 'model' to 'clinic'. In addition, we illustrate the major techniques employed for validation and optimisation. HTP has become an essential tool for improvement, control, and assessment of HT treatment quality. As such, it plays a pivotal role in the quest to establish HT as an efficacious addition to multi-modality treatment of cancer.

Measuring the absolute water content of the brain using quantitative MRI

Methods for quantitative imaging of the brain are presented and compared. Highly precise and accurate mapping of the absolute water content and distribution, as presented here, requires a significant number of corrections and also involves mapping of other MR parameters. Here, either T(1) and T(2)(*) or T(2) is mapped, and several corrections involving the measurement of temperature, transmit and receive B(1) inhomogeneities and signal extrapolation to zero TE are applied. Information about the water content of the whole brain can be acquired in clinically acceptable measurement times (10 or 20 min). Since water content is highly regulated in the healthy brain, pathological changes can be easily identified and their evolution or correlation with other manifestations of the disease investigated. In addition to voxel-based total water content, information about the different environments of water can be gleaned from qMRI. The myelin water fraction can be extracted from the fit of very high-SNR multiple-echo T(2) decay curves with a superposition of a large number of exponentials. Diseases involving de- or dysmyelination can be investigated and lead to novel observations regarding the water compartmentalisation in tissue, despite the limited spatial coverage. In conclusion, quantitative MRI is emerging as an unparalleled tool for the study of the normal and diseased brain, replacing the customary time-space environment of the sequential mixed-contrast MRI with a multi-NMR-parametric space in which tissue microscopy is increasingly revealed.

On verification of hyperthermia treatment planning for cervical carcinoma patients

PURPOSE

The aim of this study was to verify hyperthermia treatment planning calculations by means of measurements performed during hyperthermia treatments. The calculated specific absorption rate (SAR(calc)) was compared with clinically measured SAR values, during 11 treatments in seven cervical carcinoma patients.

METHODS

Hyperthermia treatments were performed using the 70 MHz AMC-4 waveguide system. Temperatures were measured using multisensor thermocouple probes. One invasive thermometry catheter in the cervical tumour and two non-invasive catheters in the vagina were used. For optimal tissue contact and fixation of the catheters, a gynaecological tampon was inserted, moisturized with distilled water (4 treatments), or saline (6 treatments) for better thermal contact. During one treatment no tampon was used. At the start of treatment the temperature rise (DeltaT(meas)) after a short power pulse was measured, which is proportional to SAR(meas). The SAR(calc) along the catheter tracks was extracted from the calculated SAR distribution and compared with the DeltaT(meas)-profiles.

RESULTS

The correlation between DeltaT(meas) and SAR(calc) was on average R = 0.56 +/- 0.28, but appeared highly dependent on the wetness of the tampon (preferably with saline) and the tissue contact of the catheters. Correlations were strong (R approximately 0.85-0.93) when thermal contact was good, but much weaker (R approximately 0.14-0.48) for cases with poor thermal contact.

CONCLUSION

Good correlations between measurements and calculations were found when tissue contact of the catheters was good. The main difficulties for accurate verification were of clinical nature, arising from improper use of the gynaecological tampon. Poor thermal contact between thermocouples and tissue caused measurement artefacts that were difficult to correlate with calculations.

Sensitivity of voxel-based morphometry analysis to choice of imaging protocol at 3 T

The objective of this study was to determine which 3D T(1)-weighted acquisition protocol at 3 T is best suited to voxel-based morphometry (VBM), and to characterize the sensitivity of VBM to choice of acquisition. First, image quality of three commonly used protocols, FLASH, MP-RAGE and MDEFT, was evaluated in terms of SNR, CNR, image uniformity and point spread function. These image metrics were estimated from simulations, phantom imaging and human studies. We then performed a VBM study on nine subjects scanned twice using the three protocols to evaluate differences in grey matter (GM) density and scan-rescan variability between the protocols. These results reveal the relative bias and precision of the tissue classification obtained using the different protocols. MDEFT achieved the highest CNR between white and grey matter, and the lowest GM density variability of the three sequences. Each protocol is also characterized by a distinct regional bias in GM density due to the effect of transmission field inhomogeneity on image uniformity combined with spatially variant GM T(1) values and the sequence's T(1) contrast function. The required population sample size estimates to detect a difference in GM density in longitudinal VBM studies, i.e. based only on methodological variance, were lowest for MDEFT. Although MP-RAGE requires more subjects than FLASH, its higher cortical CNR improves the accuracy of the tissue classification results, particularly in the motor cortex. For cross-sectional VBM studies, the variance in morphology across the population is likely to be the primary source of variability in the power analysis.

Prospective treatment planning to improve locoregional hyperthermia for oesophageal cancer

BACKGROUND

In the Academic Medical Center (AMC) Amsterdam, locoregional hyperthermia for oesophageal tumours is applied using the 70 MHz AMC-4 phased array system. Due to the occurrence of treatment-limiting hot spots in normal tissue and systemic stress at high power, the thermal dose achieved in the tumour can be sub-optimal. The large number of degrees of freedom of the heating device, i.e. the amplitudes and phases of the antennae, makes it difficult to avoid treatment-limiting hot spots by intuitive amplitude/phase steering.

AIM

Prospective hyperthermia treatment planning combined with high resolution temperature-based optimization was applied to improve hyperthermia treatment of patients with oesophageal cancer.

METHODS

All hyperthermia treatments were performed with 'standard' clinical settings. Temperatures were measured systemically, at the location of the tumour and near the spinal cord, which is an organ at risk. For 16 patients numerically optimized settings were obtained from treatment planning with temperature-based optimization. Steady state tumour temperatures were maximized, subject to constraints to normal tissue temperatures. At the start of 48 hyperthermia treatments in these 16 patients temperature rise (DeltaT) measurements were performed by applying a short power pulse with the numerically optimized amplitude/phase settings, with the clinical settings and with mixed settings, i.e. numerically optimized amplitudes combined with clinical phases. The heating efficiency of the three settings was determined by the measured DeltaT values and the DeltaT-ratio between the DeltaT in the tumour (DeltaToes) and near the spinal cord (DeltaTcord). For a single patient the steady state temperature distribution was computed retrospectively for all three settings, since the temperature distributions may be quite different. To illustrate that the choice of the optimization strategy is decisive for the obtained settings, a numerical optimization on DeltaT-ratio was performed for this patient and the steady state temperature distribution for the obtained settings was computed.

RESULTS

A higher DeltaToes was measured with the mixed settings compared to the calculated and clinical settings; DeltaTcord was higher with the mixed settings compared to the clinical settings. The DeltaT-ratio was approximately 1.5 for all three settings. These results indicate that the most effective tumour heating can be achieved with the mixed settings. DeltaT is proportional to the Specific Absorption Rate (SAR) and a higher SAR results in a higher steady state temperature, which implies that mixed settings are likely to provide the most effective heating at steady state as well. The steady state temperature distributions for the clinical and mixed settings, computed for the single patient, showed some locations where temperatures exceeded the normal tissue constraints used in the optimization. This demonstrates that the numerical optimization did not prescribe the mixed settings, because it had to comply with the constraints set to the normal tissue temperatures. However, the predicted hot spots are not necessarily clinically relevant. Numerical optimization on DeltaT-ratio for this patient yielded a very high DeltaT-ratio ( approximately 380), albeit at the cost of excessive heating of normal tissue and lower steady state tumour temperatures compared to the conventional optimization.

CONCLUSION

Treatment planning can be valuable to improve hyperthermia treatments. A thorough discussion on clinically relevant objectives and constraints is essential.

A new method for fast quantitative mapping of absolute water content in vivo

The presence of brain edema, in its various forms, is an accompanying feature of many diseased states. Although the localized occurrence of brain edema may be demonstrated with MRI, the quantitative determination of absolute water content, an aspect that could play an important role in the objective evaluation of the dynamics of brain edema and the monitoring of the efficiency of treatment, is much more demanding. We present a method for the localized and quantitative measurement of absolute water content based on the combination of two fast multi-slice and multi-time point sequences QUTE and TAPIR for mapping the T(2)* and T(1) relaxation times, respectively. Incorporation of corrections for local B(1) field miscalibrations, temperature differences between the subject and a reference probe placed in the FOV, receiver profile inhomogeneities and T(1) saturation effects are included and allow the determination of water content with anatomical resolution and a precision >98%. The method was validated in phantom studies and was applied to the localized in vivo measurement of water content in a group of normal individuals and a patient with brain tumor. The results demonstrate that in vivo measurement of regional absolute water content is possible in clinically relevant measurement times with a statistical and systematic measurement error of <2%.

High-resolution temperature-based optimization for hyperthermia treatment planning

In regional hyperthermia, optimization techniques are valuable in order to obtain amplitude/phase settings for the applicators to achieve maximal tumour heating without toxicity to normal tissue. We implemented a temperature-based optimization technique and maximized tumour temperature with constraints on normal tissue temperature to prevent hot spots. E-field distributions are the primary input for the optimization method. Due to computer limitations we are restricted to a resolution of 1 x 1 x 1 cm3 for E-field calculations, too low for reliable treatment planning. A major problem is the fact that hot spots at low-resolution (LR) do not always correspond to hot spots at high-resolution (HR), and vice versa. Thus, HR temperature-based optimization is necessary for adequate treatment planning and satisfactory results cannot be obtained with LR strategies. To obtain HR power density (PD) distributions from LR E-field calculations, a quasi-static zooming technique has been developed earlier at the UMC Utrecht. However, quasi-static zooming does not preserve phase information and therefore it does not provide the HR E-field information required for direct HR optimization. We combined quasi-static zooming with the optimization method to obtain a millimetre resolution temperature-based optimization strategy. First we performed a LR (1 cm) optimization and used the obtained settings to calculate the HR (2 mm) PD and corresponding HR temperature distribution. Next, we performed a HR optimization using an estimation of the new HR temperature distribution based on previous calculations. This estimation is based on the assumption that the HR and LR temperature distributions, though strongly different, respond in a similar way to amplitude/phase steering. To verify the newly obtained settings, we calculate the corresponding HR temperature distribution. This method was applied to several clinical situations and found to work very well. Deviations of this estimation method for the AMC-4 system were typically smaller than 0.2 degrees C in the volume of interest, which is accurate enough for treatment planning purposes.

RF dosimetry: a comparison between power absorption of female and male numerical models from 0.1 to 4 GHz

Realistic numerical models of human subjects and their surrounding environment represent the basic points of radiofrequency (RF) electromagnetic dosimetry. This also involves differentiating the human models in men and women, possibly with different body shapes and postures. In this context, the aims of this paper are, firstly, to propose a female dielectric anatomical model (fDAM) and, secondly, to compare the power absorption distributions of a male and a female model from 0.1 to 4 GHz. For realizing the fDAM, a magnetic resonance imaging tomographer to acquire images and a recent technique which avoids the discrete segmentation of body tissues into different types have been used. Simulations have been performed with the FDTD method by using a novel filtering-based subgridding algorithm. The latter is applied here for the first time to dosimetry, allowing an abrupt mesh refinement by a factor of up to 7. The results show that the whole-body-averaged specific absorption rate (WBA-SAR) of the female model is higher than that of the male counterpart, mainly because of a thicker subcutaneous fat layer. In contrast, the maximum averaged SAR over 1 g (1gA-SAR) and 10 g (10gA-SAR) does not depend on gender, because it occurs in regions where no subcutaneous fat layer is present.

Comparisons of peak SAR levels in concentric sphere head models of children and adults for irradiation by a dipole at 900 MHz

The aim of this study is to examine the scale and significance of differences in peak specific energy absorption rate (SAR) in the brains of children and adults exposed to radiofrequency emissions from mobile phones. Estimates were obtained by method of multipole analysis of a three layered (scalp/cranium/brain) spherical head exposed to a nearby 0.4 lambda dipole at 900 MHz. A literature review of head parameters that influence SAR induction revealed strong indirect evidence based on total body water content that there are no substantive age-related changes in tissue conductivity after the first year of life. However, it was also found that the thickness of the ear, scalp and cranium do decrease on average with decreasing age, though individual variability within any age group is very high. The model analyses revealed that compared to an average adult, the peak brain 10 g averaged SAR in mean 4, 8, 12 and 16 year olds (yo) is increased by a factor of 1.31, 1.23, 1.15 and 1.07, respectively. However, contrary to the expectations of a recent prominent expert review, the UK Stewart Report, the relatively small scale of these increases does not warrant any special precautionary measures for child mobile phone users since: (a) SAR testing protocols as contained in the CENELEC (2001) standard provide an additional safety margin which ensures that allowable localized SAR limits are not exceeded in the brain; (b) the maximum worst case brain temperature rise (approximately 0.13 to 0.14 degrees C for an average 4 yo) in child users of mobile phones is well within safe levels and normal physiological parameters; and (c) the range of age average increases in children is less than the expected range of variation seen within the adult population.

A semi-automatic method for developing an anthropomorphic numerical model of dielectric anatomy by MRI

Complex permittivity values have a dominant role in the overall consideration of interaction between radiofrequency electromagnetic fields and living matter, and in related applications such as electromagnetic dosimetry. There are still some concerns about the accuracy of published data and about their variability due to the heterogeneous nature of biological tissues. The aim of this study is to provide an alternative semi-automatic method by which numerical dielectric human models for dosimetric studies can be obtained. Magnetic resonance imaging (MRI) tomography was used to acquire images. A new technique was employed to correct nonuniformities in the images and frequency-dependent transfer functions to correlate image intensity with complex permittivity were used. The proposed method provides frequency-dependent models in which permittivity and conductivity vary with continuity--even in the same tissue--reflecting the intrinsic realistic spatial dispersion of such parameters. The human model is tested with an FDTD (finite difference time domain) algorithm at different frequencies; the results of layer-averaged and whole-body-averaged SAR (specific absorption rate) are compared with published work, and reasonable agreement has been found. Due to the short time needed to obtain a whole body model, this semi-automatic method may be suitable for efficient study of various conditions that can determine large differences in the SAR distribution, such as body shape, posture, fat-to-muscle ratio, height and weight.

Mapping the absolute value of M0 using dipolar field effects

The ability to map the spatial variation of the absolute, rather than the relative value of the equilibrium magnetization could be advantageous in many areas of NMR. However, direct measurement of M(0) is usually difficult because of the multiparametric dependence of the NMR signal. Here we propose a technique for mapping the spatial variation of the absolute value of M(0), independent of relaxation weighting and flip angle calibration. This method, which works best at high field strengths, is based on the effect of the dipolar field due to the nuclear magnetization that is normally neglected in liquid-state NMR. The experimental implementation of this sequence at 3.0 T is described, and its initial application to the measurement of the water content of brain tissue is outlined.

The significance of accurate dielectric tissue data for hyperthermia treatment planning

For hyperthermia treatment planning, dielectric properties of several tissue types are required. Since it is difficult to perform patient specific dielectric imaging, default values based on literature data are used. However, these show a large spread (approximately 50%). Consequently, it is important to know what limit this spread imposes on the accuracy of the SAR and subsequently on the temperature distributions. Hyperthermia treatment plans performed with different values for the dielectric properties were compared. This showed that a spread of 50% resulted in the average absolute difference of approximately 20% in both SAR and temperature distributions (heat sink approach) for regional hyperthermia. For interstitial hyperthermia, a spread of 25% resulted in the averaged absolute difference of approximately 10% in the SAR distributions and 5% in the temperature distributions (heat sink approach). Considering other problems that hamper hyperthermia treatment planning, it can be concluded that default values for the dielectric properties suffice.

Hyperthermia treatment planning

The development of hyperthermia, the treatment of tumours with elevated temperatures in the range of 40-44 degrees C with treatment times over 30 min, greatly benefits from the development of hyperthermia treatment planning. This review briefly describes the state of the art in hyperthermia technology, followed by an overview of the developments in hyperthermia treatment planning. It particularly highlights the significant problems encountered with heating realistic tissue volumes and shows how treatment planning can help in designing better heating technology. Hyperthermia treatment planning will ultimately provide information about the actual temperature distributions obtained and thus the tumour control probabilities to be expected. This will improve our understanding of the present clinical results of thermoradiotherapy and thermochemotherapy, and will greatly help both in optimizing clinical heating technology and in designing optimal clinical trials.

Evaluation of segmentation algorithms for generation of patient models in radiofrequency hyperthermia

Time-efficient and easy-to-use segmentation algorithms (contour generation) are a precondition for various applications in radiation oncology, especially for planning purposes in hyperthermia. We have developed the three following algorithms for contour generation and implemented them in an editor of the HyperPlan hyperthermia planning system. Firstly, a manual contour input with numerous correction and editing options. Secondly, a volume growing algorithm with adjustable threshold range and minimal region size. Thirdly, a watershed transformation in two and three dimensions. In addition, the region input function of the Helax commercial radiation therapy planning system was available for comparison. All four approaches were applied under routine conditions to two-dimensional computed tomographic slices of the superior thoracic aperture, mid-chest, upper abdomen, mid-abdomen, pelvis and thigh; they were also applied to a 3D CT sequence of 72 slices using the three-dimensional extension of the algorithms. Time to generate the contours and their quality with respect to a reference model were determined. Manual input for a complete patient model required approximately 5 to 6 h for 72 CT slices (4.5 min/slice). If slight irregularities at object boundaries are accepted, this time can be reduced to 3.5 min/slice using the volume growing algorithm. However, generating a tetrahedron mesh from such a contour sequence for hyperthermia planning (the basis for finite-element algorithms) requires a significant amount of postediting. With the watershed algorithm extended to three dimensions, processing time can be further reduced to 3 min/slice while achieving satisfactory contour quality. Therefore, this method is currently regarded as offering some potential for efficient automated model generation in hyperthermia. In summary, the 3D volume growing algorithm and watershed transformation are both suitable for segmentation of even low-contrast objects. However, they are not always superior to user-friendly manual programs for contour generation. When the volume growing algorithm is used, the contours have to be postprocessed with suitable filters. The watershed transformation has a large potential if appropriately developed to 3D sequences and 3D interaction features. After all, the practicality and feasibility of every segmentation method critically depend on various details of the user software as pointed out in this article.