Catheter-based ultrasound devices and MR thermal monitoring for conformal prostate thermal therapy.
Catheter-based ultrasound applicators have been developed for delivering hyperthermia or high-temperature thermal ablation of cancer and benign disease of the prostate. These devices allow for control of heating along the length and angular expanse during therapy delivery. Four types of transurethral applicators were devised for thermal treatment of prostate combined with MR thermal monitoring: sectored tubular transducer devices with directional heating patterns and rotation; planar and curvilinear devices with narrow heating patterns and rotation; and multi-sectored tubular devices capable of dynamic angular control without applicator movement. Interstitial devices (2.4 mm OD) have been developed for percutaneous implantation with directional or dynamic angular control. In vivo experiments in canine prostate under MR temperature imaging were used to evaluate these devices and develop treatment delivery strategies. MR thermal imaging was used to monitor temperature and thermal dose in multiple slices through the target volume. Multi-sectored transurethral applicators can dynamically control the angular heating profile and target large regions of the gland in short treatment times without applicator manipulation. The sectored tubular, planar, and curvilinear transurethral devices produce directional coagulation zones, extending 15-20 mm radial distance to the outer prostate capsule. Sequential rotation under motor control and modulated dwell time can be used to tightly conform thermal ablation to selected regions. Interstitial implants with directional devices can be used to effectively ablate targeted regions of the gland while protecting the rectum. The MR derived 52 degrees C and lethal thermal dose contours (t43=240 min) effectively defined the extent of thermal damage and provided a means for real-time control of the applicators. Catheter-based ultrasound devices, combined with MR thermal monitoring, can produce relatively fast (5-40 min) and precise thermal ablation of prostate.
Diederich
Chris J
CJ
Thermal Therapy Research Group, Radiation Oncology Department, University of California at San Francisco, CA 94143, USA. cdiederich@radonc.ucsf.edu
Nau
Will H
WH
Kinsey
Adam
A
Ross
Tony
T
Wootton
Jeff
J
Juang
Titania
T
Butts-Pauly
Kim
K
Rieke
Viola
V
Chen
Jing
J
Bouley
Donna M
DM
Sommer
Graham
G
D000818:Animals; D001831:Body Temperature; D017115:Catheter Ablation / Q000295:instrumentation*; D002404:Catheterization / Q000295:instrumentation; D004285:Dogs; D004867:Equipment Design; D006358:Hot Temperature; D006801:Humans; D006979:Hyperthermia, Induced / Q000295:instrumentation* / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011467:Prostate / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000601:surgery / Q000628:therapy*; D013696:Temperature; D014464:Ultrasonic Therapy / Q000295:instrumentation*