title: Multiple applicator hepatic ablation with interstitial ultrasound devices: theoretical and experimental investigation.
abstract: OBJECTIVE
  To evaluate multiple applicator implant configurations of interstitial ultrasound devices for large volume ablation of liver tumors.
  
  
  METHODS
  A 3D bioacoustic-thermal model using the finite element method was implemented to assess multiple applicator implant configurations for thermal ablation with interstitial ultrasound energy. Interstitial applicators consist of linear arrays of up to four 10 mm-long tubular ultrasound transducers, each under separate and dynamic power control, enclosed within a water-cooled delivery catheter (2.4 mm OD). The authors considered parallel implants with two and three applicators (clustered configuration), spaced 2-3 cm apart, to simulate open surgical placement. In addition, the authors considered two applicator implants with applicators converging and diverging at angles of ∼20°, 30°, and 45° to simulate percutaneous placement. Heating experiments (10-15 min) were performed and compared against simulations employing the same experimental parameters. To estimate the performance of parallel, multiple applicator configurations in an in vivo setting, simulations were performed taking into account a range of blood perfusion levels (0, 5, 12, and 15 kg m(-3) s(-1)) that may occur in tumors of varying vascularity. The impact of tailoring the power supplied to individual transducer elements along the length of applicators is explored for applicators inserted in non-parallel (converging and diverging) configurations. Thermal dose (t(43) > 240 min) and temperature thresholds (T > 52 °C) were used to define the ablation zones, with dynamic changes to tissue acoustic and thermal properties incorporated within the model.
  
  
  RESULTS
  Experiments in ex vivo bovine liver yielded ablation zones ranging between 4.0-5.6 cm × 3.2-4.9 cm, in cross section. Ablation zone dimensions predicted by simulations with similar parameters to the experiments were in close agreement (within 5 mm). Simulations of in vivo heating showed that 15 min heating and interapplicator spacing less than 3 cm are required to obtain contiguous, complete ablation zones. The ability to create complete ablation zone profiles for nonparallel implants was illustrated by tailoring applied power levels along the length of applicators.
  
  
  CONCLUSIONS
  Parallel implants consisting of three interstitial ultrasound applicators in a triangular configuration yield complete ablation zones measuring up to 6.2 cm × 5.7 cm after 15 min heating. At larger interapplicator spacing, the level of blood perfusion in the tumor may yield indentations along the periphery of the ablation zone. Tailoring applied power along the length of the applicator can accommodate for nonparallel implants, without compromising safety.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, CA, USA. prakashp@k-state.edu
authors.forename: Punit
authors.initials: P
authors.lastname: Prakash
authors.forename: Vasant A
authors.initials: VA
authors.lastname: Salgaonkar
authors.forename: E
authors.initials: E
authors.lastname: Clif Burdette
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Diederich
mesh_terms: D000818:Animals; D002417:Cattle; D003198:Computer Simulation; D017076:Computer-Aided Design; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006498:Hepatectomy / Q000295:instrumentation*; D057086:High-Intensity Focused Ultrasound Ablation / Q000295:instrumentation*; D008099:Liver / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D008954:Models, Biological; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*