Applied potential tomography for non-invasive temperature mapping in hyperthermia

Electrical Impedance Tomography for monitoring cardiac radiofrequency ablation: a scoping review of an emerging technology

Arrhythmias are common cardiac diseases which can be treated effectively by the cardiac radiofrequency ablation (CRFA). However, information regarding the lesion growth within the myocardium is critical to the procedure's safety and efficacy but still unavailable in the current catheterisation lab (CathLab). Over the last 20 years, many efforts have been made in order to track the lesion size during the procedure. Unfortunately, all the approaches have their own limitations preventing them from the clinical translation and hence making the lesion size monitoring during a CRFA still an open issue. Electrical Impedance Tomography (EIT) is an impedance imaging modality that might be able to image the thermal-related impedance changes from which the lesion size can be measured. With the availability of the patient's CT scans, for a detailed model, and the catheter-based electrodes for the internal electrodes, EIT accuracy and sensitivity to the ablated sites can be significantly improved and is worth being explored for this application. Though EIT is still new to CRFA with no in-vivo experiments being done according to our up-to-date searching, many related EIT studies and its extensive research in Hyperthermia and other ablations can reveal many hints for a possibility of the CRFA-EIT application. In this paper, we present a review on multiple aspects of EIT in CRFA. First, the expected CRFA-EIT signal range and frequency are discussed based on various measured impedance results obtained from lesions in the past. Second, the possible noise sources that can happen in a clinical CRFA procedure, along with their signal range and frequency compared to the CRFA-EIT signal, and, third, the available current solutions to separate such noises from the CRFA-EIT signal. Finally, we review the progress of EIT in thermal applications over the last two decades in order to identify the developments that EIT can take advantage of and the current drawbacks that need to be solved for a potential CRFA-EIT application.

Cardiac radiofrequency ablation tracking using electrical impedance tomography

There is a need for accessible high speed imaging of Radiofrequency (RF) cardiac electrosurgery to improve safety and efficacy of the ablation time course, where lesion information is critical to safety and efficacy but currently lacking in real time. In this paper, Electrical Impedance Tomography (EIT) using existing cardiac EP electrodes was optimised to confirm (1) that removal of measurements with low signal sensitivity leads to improved images and (2) that multiple signal thresholds are needed to track the lesion accurately over time. A novel ventricle-shaped gel phantom with realistic fluid flow to mimic blood flow, lung ventilation and myocardium conductivity was developed to study the capability and motivate transition to in-vivo measurements. When using 8 external (ECG) electrodes, 4 internal coronary sinus electrodes and 4 RF catheter-based electrodes, the optimal setup for sensitivity and dynamic tracking was 77 measurements within an error of 20%. Higher thresholds were more suitable for the earlier phase of the ablation when lesions are small while lower thresholds suited later phases. Patient-specific thresholds could be optimised in pre-surgical planning where detailed anatomical images are available. While the error reported in this initial study appears large, it is a major advance over the current situation for the cardiologist where no real-time lesion visualization is accessible in a regular EP suite/cath lab.

Normative surface skin temperature changes due to blood redistribution: A prospective study

The continuing development and manufacture of infrared devices, together with improvements in thermal body mapping techniques have simplified surface skin thermography which is being used more extensively than ever before. Normative thermography data, however, remains incomplete. A normative blood redistribution range of skin temperatures was established for use as a reference for laboratory infrared thermography (IT), thermal body mapping, and mass fever screenings. 500 healthy volunteers participated in this prospective study. To determine the maximum range of the skin temperature changes due to the posture-related physiological blood redistribution, the volunteers were asked to keep one extremity up and another extremity down whilst lying, sitting, and standing. We obtained 6000 hand and 400 foot temperature readings. The normal temperature was 29.1 ± 0.6 °C for the middle fingers and 27.8 ± 0.7 °C for the toes. The physiological temperature change during body position changes ranged from 4 to 6 °C (fingers: 27-31 °C; toes: 26-32 °C). At normal room temperature, the surface skin temperature may vary within this range due to blood redistribution. These changes reflect the individual variability of vasomotor activity. This physiological range of temperatures should be taken into account during IT and other thermography-involved investigations.

Noninvasive Treatment-Efficacy Evaluation for HIFU Therapy Based on Magneto-Acousto-Electrical Tomography

OBJECTIVE

As a novel noninvasive modality of oncotherapy or stroke treatment, high-intensity focused ultrasound (HIFU) has drawn more and more attention in the past decades. Whereas, real-time temperature monitoring and treatment-efficacy evaluation are still the key issues for HIFU therapy.

METHODS

Based on the temperature-conductivity relation of tissues with a sharp conductivity variation of irreversible thermocoagulation at 69 °C, a noninvasive method of treatment-efficacy evaluation for HIFU ablation using the magneto-acousto-electrical tomography (MAET) technology is theoretically studied. By applying the nonlinear Khokhlov-Zabolotskaya-Kuznetsov equation and Pennes equation, a cylindrical model is established to simulate the distributions of pressure, temperature, and conductivity with the consideration of harmonic components.

RESULTS

The MAET signals are simulated to analyze the characteristics of the peak amplitude and the axial interval of the two clusters generated by the conductivity boundary of HIFU ablation.

CONCLUSION

The axial interval can be used as the indictor to evaluate the size of HIFU ablation with the minimum axial width of one wavelength.

SIGNIFICANCE

The favorable results demonstrate the feasibility of real-time treatment-efficacy evaluation for HIFU therapy using the MAET technology and suggest potential applications in clinical practice.

A local region of interest imaging method for electrical impedance tomography with internal electrodes

Electrical Impedance Tomography (EIT) is a very attractive functional imaging method despite the low sensitivity and resolution. The use of internal electrodes with the conventional reconstruction algorithms was not enough to enhance image resolution and accuracy in the region of interest (ROI). We propose a local ROI imaging method with internal electrodes developed from careful analysis of the sensitivity matrix that is designed to reduce the sensitivity of the voxels outside the local region and optimize the sensitivity of the voxel inside the local region. We perform numerical simulations and physical measurements to demonstrate the localized EIT imaging method. In preliminary results with multiple objects we show the benefits of using an internal electrode and the improved resolution due to the local ROI image reconstruction method. The sensitivity is further increased by allowing the surface electrodes to be unevenly spaced with a higher density of surface electrodes near the ROI. Also, we analyse how much the image quality is improved using several performance parameters for comparison. While these have not yet been studied in depth, it convincingly shows an improvement in local sensitivity in images obtained with an internal electrode in comparison to a standard reconstruction method.

Improved hyperthermia treatment control using SAR/temperature simulation and PRFS magnetic resonance thermal imaging

PURPOSE

This article explores the feasibility of using coupled electromagnetic and thermodynamic simulations to improve planning and control of hyperthermia treatments for cancer. The study investigates the usefulness of preplanning to improve heat localisation in tumour targets in treatments monitored with PRFS-based magnetic resonance thermal imaging (MRTI).

METHODS

Heating capabilities of a cylindrical radiofrequency (RF) mini-annular phased array (MAPA) applicator were investigated with electromagnetic and thermal simulations of SAR in homogeneous phantom models and two human leg sarcomas. High frequency structure simulator (HFSS) (Ansoft) was used for electromagnetic simulations and SAR patterns were coupled into EPhysics (Ansoft) for thermal modelling with temperature-dependent variable perfusion. Simulations were accelerated by integrating tumour-specific anatomy into a pre-gridded whole body tissue model. To validate this treatment planning approach, simulations were compared with MR thermal images in both homogenous phantoms and heterogeneous tumours.

RESULTS

SAR simulations demonstrated excellent agreement with temperature rise distributions obtained with MR thermal imaging in homogeneous phantoms and clinical treatments of large soft-tissue sarcomas. The results demonstrate feasibility of preplanning appropriate relative phases of antennas for localising heat in tumour.

CONCLUSIONS

Advances in the accuracy of computer simulation and non-invasive thermometry via MR thermal imaging have provided powerful new tools for optimisation of clinical hyperthermia treatments. Simulations agree well with MR thermal images in both homogeneous tissue models and patients with lower leg tumours. This work demonstrates that better quality hyperthermia treatments should be possible when simplified hybrid model simulations are performed routinely as part of the clinical pretreatment plan.

Electrical impedance tomography

Electrical impedance tomography (EIT) is a technique which allows cross-sectional images related to the local electrical impedance within an object to be reconstructed from sets of measurements made on its surface. The main drive behind the development of EIT has been its possible application in medical imaging, as biological tissues are known to exhibit a wide range of electrical impedance and many physiological events are accompanied by electrical impedance changes. This article reviews the technical aspects of EIT as a medical imaging modality, and considers the range of applications over which it might be employed. Existing technical limitations and future developments are discussed. It is concluded that the future of EIT as a clinical diagnostic tool is likely to lie in the area of functional monitoring, where the capability of performing image-guided localized electrical impedance measurements with high acquisition speed, good sensitivity and no hazard can be exploited.

An electrical impedance tomography microscope

A circular array of 16 electrodes has been constructed for use as an electrical impedance tomography (EIT) microscope. The electrodes were made from 60 microns diameter gold wires anchored to a printed circuit board. The internal diameter of the array was 0.9 mm giving a theoretical spatial resolution of about 100 microns. For EIT imaging, the array was connected to an imaging system operating at 82 kHz. Static images of conducting and insulating filaments (cooper wire and human hair) in saline solution were obtained as well as dynamic imaging sequences of glass microspheres migrating through the array. The interelectrode impedance was typically 5 k omega and the transimpedances ranged from 14 to 210 omega.

The measurement of temperature with electron paramagnetic resonance spectroscopy

An electron paramagnetic resonance (EPR) technique, potentially suitable for in vivo temperature measurements, has been developed based on the temperature response of nitroxide stable free radicals. The response has been substantially enhanced by encapsulating the nitroxide in a medium of a fatty acid mixture inside a proteinaceous microsphere. The mixture underwent a phase transition in the temperature range required by the application. The phase change dramatically altered the shape of the EPR spectrum, providing a highly temperature sensitive signal. Using the nitroxide dissolved in a cholesterol and a long-chain fatty acid ester, we developed a mixture which provides a peakheight ratio change from 3.32 to 2.11, with a standard deviation of 0.04, for a temperature change typical in biological and medical applications, from 38 to 48 degrees C. This translated to an average temperature resolution of 0.2 degree C for our experimental system. The average diameter of the nitroxide mixture-filled microspheres was approximately 2 microns. Therefore, they are compatible with in vivo studies where the microspheres could be injected into the microvasculature having a minimum vessel diameter of the order of 8 microns. This temperature measuring method has various potential clinical applications, especially in monitoring and optimizing the treatment of cancer with hyperthermia. However, several problems regarding temperature and spatial resolution need to be resolved before this technique can be successfully used to monitor temperatures in vivo.

A 32-electrode data collection system for electrical impedance tomography

A 32-electrode data collection system for Electrical Impedance Tomography (EIT) will be presented. In this system, the demodulator is a multiplexed sample and hold (S&H) circuit followed by a voltage difference stage. This configuration provides high CMRR due to the low (almost DC) operating frequency of the signals the difference stage is required to process.

Electrical impedance tomography: a review of current literature

Electrical impedance tomography (EIT) is a relatively new imaging technique that has been developed during the past decade. The electrical properties of tissues are imaged by injecting small currents and measuring the resultant voltages. These voltages are then converted into a tomographic image using a reconstructing algorithm. The method has no known hazards and is relatively inexpensive. There are many possible clinical applications of this technique but apart from gastric emptying, most are still at the research stage as there are various technical and practical problems to be overcome. This paper describes the basic principles of EIT and reviews the English literature to try to assess its potential in clinical imaging.

Temperature field estimation using electrical impedance profiling methods. II. Experimental system description and phantom results

An electrical impedance tomography system has been developed and tested for the purpose of thermal imaging. Since impedance changes with temperature, images of impedance subtracted from normothermic baselines will provide a map of temperature data. A system was designed to be operational at 10-50 kHz and to utilize 16 external electrodes around the periphery of a tissue-equivalent phantom encompassing the region of interest. These electrodes serve as current sources for the 5 mA constant-current inputs and are also used for reading differential voltages. Hyperthermia treatments for cancer require that internal thermometry probes be inserted into the tumour volume. Linear arrays of electrodes with thermometry tracks for micro-dimension thermometry serve this function, as well as providing localized voltage measurements in the region of interest. The embedded temperature sensors provide a quality assurance and calibration standard for the linear arrays in reconstruction of impedance profiles. Results of transient heating experiments with conductive and ultrasound heating are shown where image reconstruction is performed using a finite element model. Temperature predictions in these studies were accurate to better than 1 degree C on average when using information from surface electrodes combined with internal linear arrays. Maximum temperature errors, however, was found to be > 5 degrees C which suggests that further noise reduction during data acquisition and improvements in the reconstructions algorithms are needed.

The effect of hyperthermia-induced tissue conductivity changes on electrical impedance temperature mapping

Changes in tissue electrical conductivity in the low radiofrequency range due to tissue temperature coefficients (TCS), approximately 2% degrees C-1, have been investigated by others as a non-invasive means of determining tissue temperature changes during the application of therapeutic hyperthermia. However, the occurrence of additional changes in conductivity due to non-TC effects, for example, from heat-induced oedema, or changes in cellular volume or membrane characteristics, can result in incorrect temperature determination based solely on the TC. This paper (i) presents estimates of the errors that will occur in temperature mapping using electrical impedance measurements if non-TC effects are ignored, using examples of excised and in vivo EMT6 tumours, (ii) presents a method of differentiating the onset of non-TC effects from TC effects using conductance measurements, thereby allowing for use of the TC method until the onset of non-TC effects, and (iii) suggests a means of using conductance measurements to monitor the course of hyperthermia treatments, without the use of temperature information, based on hyperthermia-induced cellular changes.

Clinical applications of electrical impedance tomography

This article is a preliminary review of the possible clinical applications of electrical impedance tomography (EIT). The applications to, for example, the central nervous, respiratory, cardiovascular and digestive systems are covered. It is concluded that the area of greatest potential application of EIT is monitoring cardiopulmonary function, but that studies on much larger groups of patients than have been carried out hitherto are required to fully assess the potential of EIT as a clinical tool.

The dielectric parameters of excised EMT-6 tumours and their change during hyperthermia

The electrical impedance from 100 Hz to 40 MHz of freshly excised EMT-6 tumours was measured periodically while the tumours were exposed to typical hyperthermia heating regimens. During hyperthermia, the EMT-6 tumour displays a characteristic response sequence which includes cellular swelling, progressive membrane damage, cellular shrinking and subsequent progressive histolysis. It was found that the changes in the tumour tissue dielectric properties reflected these hyperthermia-induced histological changes. In particular the parameters delta epsilon, sigma s and fc progressed to, reached, and retreated from extrema as the cells swelled to a maximum and then contracted. These parameters continued retreating beyond their original values as the beta-dispersion progressively collapsed during the period of progressive histolysis. The Cole-Cole parameter alpha increased during most of these histological changes, indicating a broadening of the dispersion, which suggests differential cell response during this period. Differences in the time-course between dielectric components may reflect the combined effects of cellular swelling and concurrent progressive membrane changes. Changes in rate and shape of the dielectric response with hyperthermia temperature are discussed in terms of possible cellular responses during hyperthermia.

Quantitative assessment of impedance tomography for temperature measurements in hyperthermia

The objective of this study is a non-invasive assessment of the thermal dose in hyperthermia. Electrical impedance tomography (EIT) has previously been given a first trial as a temperature monitoring method together with microwave-induced hyperthermia treatment, but it has not been thoroughly investigated. In the present work we have examined this method in order to investigate the correlation in vitro between the true spatial temperature distribution and the corresponding measured relative resistivity changes. Different hyperthermia techniques, such as interstitial water tubings, microwave-induced, laser-induced and ferromagnetic seeds have been used. The results show that it is possible to find a correlation between the measured temperature values and the tomographically measured relative resistivity changes in tissue-equivalent phantoms. But the uncertainty of the temperature coefficients, which has been observed, shows that the method has to be improved before it can be applied to clinical in vivo applications.

A dual-frequency electrical impedance tomography system

An electrical impedance tomography (EIT) system has been constructed, operating at two frequencies, 40.96 and 81.92 kHz, for investigating the practicability of the dual-frequency imaging method discussed theoretically in a previous paper. For testing the system, a phantom with a frequency-dependent electrical conductivity was designed. The properties of the phantom can be adjusted to match the frequency dependence observed in a given type of tissue. Dual-frequency images were obtained from a phantom simulating liver and also from 200 g of porcine liver in a saline tank. Prior to image reconstruction, it was necessary to apply a correction to the data to cancel the effects of stray capacitance within the electronics.

The importance of phase measurement in electrical impedance tomography

A method is described for reconstructing images of electrical conductivity and relative permittivity in electrical impedance tomography (applied potential tomography). The method relies on measurement of both the amplitude and the phase of the surface electric potential profile. The principle is demonstrated using a computer model to simulate measurements. The reconstructed images, referenced to homogeneous saline, agree qualitatively with the values of conductivity and permittivity used in the computer model. In addition, by displaying the imaginary part of the logarithm of the complex electrical conductivity, certain tissues, e.g. liver and kidney, are emphasised on the image. When the same parameter is displayed for simulated dual-frequency measurements, in which 150 kHz values are referenced against 100 kHz, liver and pancreas are emphasised. These results suggest the possibility of distinguishing between different types of soft tissue more effectively than if only signal amplitudes are measured. The phase changes in the simulated signals, on which the formation of such images depends, have a mean value of 13.3 degrees for the saline-referenced simulation but only 1.6 degrees for the dual-frequency simulation requiring accurate measurement in practice.