Radiofrequency tissue ablation inside of metal stent – A thermographic study

Biliary stents are used to treat obstructions that occur in the bile ducts. The stents can be blocked by new tissue in a few months after their implanting. This complication can be solved by using radiofrequency ablation. The present article deals with monitoring of the process of monopolar thermoablation of a metal stent by using an infrared camera ex vivo. The metallic EGIS Biliary stents 10 mm × 80 mm were used in experiments; radiofrequency ablation due by catheter EndoHPB 8F at 460 kHz was used. The Flir B200 thermocamera was used for monitoring. The results show an increase in temperature of the stent's material during thermoablation process. It is believed that the metal stent becomes an active electrode. The results show an increase in temperature of the stent and the surrounding tissue during the treatment. Temperature distribution measured on stent was affected by power applied and obviously non-homogeneous. The maximum temperature values were observed at the ends of the stent. The temperature value of the stent during termoablation depended also on the position of the second (inactive) surface electrode. Results of this study have shown that there are many factors able to affect the final temperature or process of tissue ablation inside of the stent and around the stent. Infrared camera seems to be an appropriate instrument for observing the distribution and changes in temperature during ex vivo radiofrequency ablation.     

Investigation of the influence of blood flow rate on large vessel cooling in hepatic radiofrequency ablation.

Radiofrequency (RF) ablation using high-frequency current has become an important treatment method for patients with non-resectable liver tumors. Tumor recurrence is associated with tissue cooling in the proximity of large blood vessels. This study investigated the influence of blood flow rate on tissue temperature and lesion size during monopolar RF ablation at a distance of 10 mm from single 4- and 6-mm vessels using two different approaches: 1) an ex vivo blood perfusion circuit including an artificial vessel inserted into porcine liver tissue was developed; and 2) a finite element method (FEM) model was created using a novel simplified modeling technique for large blood vessels. Blood temperatures at the inflow/outflow of the vessel and tissue temperatures at 10 and 20 mm from the electrode tip were measured in the ex vivo set-up. Tissue temperature, blood temperature and lesion size were analyzed under physiological, increased and reduced blood-flow conditions. The results show that changes in blood flow rate in large vessels do not significantly affect tissue temperature and lesion size far away from the vessel. Monopolar ablation could not produce lesions surrounding the vessel due to the strong heat-sink effect. Simulated tissue temperatures correlated well with ex vivo measurements, supporting the FEM model.     

Comparison of Ablation Zones among Different Tissues Using 2450-MHz Cooled-Shaft Microwave Antenna: Results in Ex Vivo Porcine Models

Background

For complete tumor ablation in different tissues, it is necessary to investigate the exact coagulation zone of microwave ablation in different tissues. The aim of this study was to compare the extent of microwave ablation zone in muscle, liver and adipose tissue in ex vivo porcine models and assess the shape of microwave coagulation zone among these tissues.

Materials and Methods

Microwave ablations were performed in ex vivo porcine muscle, liver and adipose tissue using 2450-MHz cooled-shaft microwave antenna. The content of water, fat and protein in these three tissues was determined. Two power increments (40 and 80 W) and five time increments (1, 3, 5, 7, and 10 minutes) were used in this study. Diameters and shapes of the ablation zones were assessed on gross specimens.

Results

The average percentages of water, fat and protein in these three tissues were significantly different (P < 0.001), respectively. The long-axis and short-axis diameters among these three tissues at each time-power combination were not significantly different (P > 0.05). The coagulation zones were all elliptical in muscle, liver and adipose tissue. When microwave ablation was performed in the tissue containing both muscle and adipose tissue, the coagulation zone was also elliptical. Regardless of the output power, the ellipticity index (EI) value of 1 minute treatment duration was higher than that of 10 minutes treatment duration (P < 0.05). Furthermore, the EI value did not decrease significantly when the treatment duration was more than 5 minutes (P > 0.05).

Conclusion

The extent of microwave ablation zones was not significantly different among completely different tissues. Microwave ablations with ≥ 5 minutes time duration can induce coagulation zones with clinical desirable shape. Future clinical studies are still required to determine the role of microwave ablation in different tissues.     

Tissue temperature feedback control of power: the key to successful ablation

Multiple ablation technologies are used to treat atrial fibrillation during cardiac operations. All such ablation technologies use locally induced temperature extremes (>50°C or <-20°C) to kill tissue and create a lesion pattern in the atria which blocks activation pathways that initiate and sustain atrial fibrillation. The technologies used to heat tissue have included radiofrequency (RF), microwave, high-intensity focused ultrasound, and infrared laser. RF accounts for more than 95% of the heating-based ablation technology used by cardiac surgeons. Energy delivery with RF is easier to control than with some other technologies, the heating produced by the energy source is well understood, and manufacturing costs are not excessive. Whichever heating technology is used, control of energy delivery is required to ensure both safe and effective heating of the targeted tissue. All targeted tissue needs to be heated above 50°C to achieve cell death. However, the targeted tissue should not be heated above 100°C, as this can cause perforation due to a steam pop. In addition, adjacent noncardiac tissues must not be damaged during the ablation procedure. The best method to achieve this control uses direct measurement of tissue temperature, because the tissue temperature defines both the safe and effective limits for the ablative process.     

Endoluminal application of glass‐capped diffuser for ex vivo endovenous photocoagulation

Endovenous laser ablation (EVLA) has frequently been used to treat varicose veins for 20 years. In spite of 90?95% occlusion rates, clinical complications such as burn and ecchymosis still occur due to excessive thermal injury to perivenous tissue. In the current study, a glass‐capped diffusing applicator is designed to validate the feasibility of EVLA as an effective therapeutic device by applying circumferential light distribution. The proposed device is evaluated with a flat fiber as a reference in terms of temperature elevation, fiber degradation, and degree of coagulative necrosis after 532 nm‐assisted EVLA at 100 J/cm. The diffusing fiber generates a 40% lower maximum temperature with a 90% lower transient temperature change in blood, compared to the flat fiber. Due to low irradiance (13.5 kW/cm²) and wide light distribution, the diffuser tip experiences no significant thermal degradation while severe carbonization occurs at the flat fiber tip. Ex vivo tissue tests verify that the diffusing fiber induces circumferential and consistent tissue denaturation to the vein wall (107.8 ± 7.8 µm) along with 19% vessel shrinkage. The proposed glass‐capped diffusing applicator can be a feasible therapeutic device for EVLA with minimal complications by entailing low maximum temperatures and uniform tissue denaturation in the venous tissue.

     

Perfused phantom models of microwave irradiated tissue

The theoretical basis, practical design considerations, and prototype testing of a perfused model suitable for simulation studies of microwave heated tissue are presented. A parallel tube heat exchanger configuration is used to simulate the internal convection effects of blood flow. The global thermal response of the phantom, on a scale of several tube spacings, is shown theoretically to be nearly identical to that predicted by Pennes' bioheat equation, which is known to give a reasonable representation of tissue under many conditions. A parametric study is provided for the relationships between the tube size, spacing and material properties and the simulated perfusion rate. A prototype with a physiologically reasonable perfusion rate was tested using a typical hyperthermia applicator. The measured thermal response of the phantom compares favorably with the numerical solution of the bioheat equation under the same irradiation conditions. This similarity sheds light on the unexpected success of the bioheat equation for modeling the thermal response of real tissue.     

Studies on the three-dimensional temperature transients in the canine prostate during transurethral microwave thermal therapy

Thermal therapy of benign prostatic hyperplasia requires accurate prediction of the temperature distribution induced by the heating within the prostatic tissue. In this study, the Pennes bioheat transfer equation was used to model the transient heat transfer inside the canine prostate during transurethral microwave thermal therapy. Incorporating the specific absorption rate of microwave energy in tissue, a closed-form analytical solution was obtained. Good agreement was found between the theoretical predictions and in-vivo experimental results. Effects of blood perfusion and the cooling at the urethral wall on the temperature rise were investigated within the prostate during heating. The peak intraprostatic temperatures attained by application of 5, 10, or 15 W microwave power were predicted to be 38 degrees C, 41 degrees C, and 44 degrees C. Results from this study will help optimize the thermal dose that can be applied to target tissue during the therapy.     

Concentric photothermal coagulation with basket‐integrated optical device for treatment of tracheal stenosis

A basket‐integrated optical device is developed to consistently treat tubular tissue by centering an optical diffuser in the lumen. Four nitinol arms in conjunction with the optical diffusing applicator are deployed to induce homogeneous circumferential light emission and concentric photothermal coagulation on tracheal tissue. A 1470‐nm laser light is employed for the tissue testing at various irradiation conditions and evaluated in terms of thermal gradient and temperature evolution. Preliminary experiments on liver tissue demonstrate the concentric development of the radial thermal coagulation in the tissue (eccentric ratio = ~5.5%). The interstitial tissue temperature increases with the total amount of energy delivery (around 65°C). Ex vivo trachea testing yields up to 16.5% tissue shrinkage due to dehydration as well as uniform ablation of the cilia and goblet cells in a mucosa layer under 7‐W irradiation for 10 s. The proposed optical device may be a feasible therapeutic method to entail the circumferential coagulation in the tubular tissues in a reliable manner.      

The effects of fat layer on temperature distribution during microwave atrial fibrillation catheter ablation

Abstract

To investigate the effects of fat layer on the temperature distribution during microwave atrial fibrillation catheter ablation in the conditions of different ablation time; 3D finite element models (fat layer and no fat layer) were built, and temperature distribution was obtained based on coupled electromagnetic-thermal analysis at 2.45?GHz and 30?W of microwave power. Results shown: in the endocardial ablation, the existence of the fat layer did not affect the shape of the 50?°C contour before 30?s. The increase speed of depth became quite slowly in the model with fat layer after 30?s. When ablation depth needed fixed, there are no significant effect on effectively ablation depth whether fat layer over or not. However, the existence of fat layer makes the temperature lower in the myocardium, and maximum temperature point closer to the myocardium surface. What is more, in the model with fat layer, effective ablation reach lower maximum temperature and the shallower depth of 50?°C contour. But there are larger ablation axial length and transverse width. In this case, doctor should ensure safety of normal cardiac tissue around the target tissue. In the epicardial ablation, the existence of fat layer seriously affects result of the microwave ablation. The epicardial ablation needs more heating time to create lesion. But epicardial ablation can be better controlled in the shape of effective ablation area because of the slowly increase of target variables after the appearing of 50?°C contour. Doctor can choose endocardial or epicardial ablation in different case of clinic requirement.     

Effect of microwave radiation on Bacillus subtilis spores

AIMS: To compare the killing efficacy and the effects exerted by microwaves and conventional heating on structural and molecular components of Bacillus subtilis spores. METHODS AND RESULTS: A microwave waveguide applicator was developed to generate a uniform and measurable distribution of the microwave electric-field amplitude. The applicator enabled the killing efficacy exerted by microwaves on B. subtilis spores to be evaluated in comparison with conventional heating at the same temperature value. The two treatments produced a similar kinetics of spore survival, while remarkably different effects on spore structures were seen. The cortex layer of the spores subjected to conductive heating was 10 times wider than that of the untreated spores; in contrast, the cortex of irradiated spores did not change. In addition, the heated spores were found to release appreciable amounts of dipicolinic acid (DPA) upon treatment, while extracellular DPA was completely undetectable in supernatants of the irradiated spores. These observations suggest that microwave radiation may promote the formation of stable complexes between DPA and other spore components (i.e. calcium ions); thus, making any release of DPA from irradiated spores undetectable. Indeed, while a decrease in measurable DPA concentrations was not produced by microwave radiation on pure DPA solutions, a significant lowering in DPA concentration was detected when this molecule was exposed to microwaves in the presence of either calcium ions or spore suspensions. CONCLUSIONS: Microwaves are as effective as conductive heating in killing B. subtilis spores, but the microwave E-field induces changes in the structural and/or molecular components of spores that differ from those attributable only to heat. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides information on the effect of microwaves on B. subtilis spore components.     

Simulation and investigation of quantum dot effects as internal heat-generator source in breast tumor site

The Pennes bio-heat transfer equation, which introduces the exchange magnitude of heat transfer between tissue and blood, is often used to solve the temperature distribution for thermal imaging and sensing. Near-infrared light has the ability to be used as a non-invasive means of diagnostic imaging within the woman's breast. Due to the diffusive nature of light in different tissue, computational model-based methods are required for functional imaging within the breast. In this article, the time-dependent bio-heat transfer is solved by a numerical method. In our model, the heat generation source (intrinsic and extrinsic) involves laser, metabolism, and quantum dot that the metabolism and heat generated by QDs are considered as intrinsic. We supposed the injected quantum dots would target the tumor site by a passive targeting process and then by interaction of laser radiation and quantum dot, the photoluminescence of quantum dot is converted to heat in the tumor site. The extra generated heat can impact on the extracted heat profile. One of the important applications of this research has led to a sensitivity improvement of the imaging system, which is potentially useful in the diagnosis and detection of breast cancer.     

Effect of input waveform pattern and large blood vessel existence on destruction of liver tumor using radiofrequency ablation: finite element analysis

Much research has been directed at improving the effectiveness of the radiofrequency (RF) ablation of hepatocellular carcinomas. In that point of view, this study was performed to provide comprehensive information of the relation between RF waveforms and thermodynamic response of the tissue with the consideration of four different types of RF waveforms (half-sine, half-square, half-exponential, and damped-sine) to maximize the amount of tumor tissue removed while maintaining the advantages of RF ablation. For the aim of this study, finite element models incorporating results from previous numerical models were used and validated with ex vivo experiments. From analyses of the entire results, we concluded that this study may prove valuable as a first step in providing comprehensive information of the relation between various RF waveforms and thermodynamic responses within the tissue during the RF ablation process. This study may also contribute toward studies to determine an optimum RF waveform capable of maximizing the amount of tumor tissue removed while maintaining the advantages of RF ablation.     

Evaluation of the effectiveness of transurethral radio frequency hyperthermia in the canine prostate: temperature distribution analysis

The heating pattern of a transurethral radio frequency (RF) applicator and its induced steady-state temperature field in the prostate during transurethral hyperthermia treatment were investigated in this study. The specific absorption rate (SAR) of the electromagnetic energy was first quantified in a tissue-equivalent gel phantom. It was used in conjunction with the Pennes bioheat transfer equation to model the steady-state temperature field in prostate during the treatment. Theoretical predictions were compared to in vivo temperature measurements in the canine prostate and good agreement was found to validate the model. The prostatic tissue temperature rise and its relation to the effect of blood perfusion were analyzed. Blood perfusion is found to be an important factor for removal of heat especially at the higher RF heating level. To achieve a temperature above 44 degrees C within 10 percent of the prostatic tissue volume, the minimum RF power required ranges from 5.5 W to 36.4 W depending on the local blood perfusion rate (omega = 0.2-1.5 ml/gm/min). The corresponding histological results from the treatment suggest that to obtain better treatment results, either higher RF power level or longer treatment time (> 180 minutes) is necessary. This is consistent with the predictions from the theoretical model developed in this study.     

Equations of heat distribution within the body

A vector integral equation describing heat distribution within the body has been derived. The factors considered are heat conduction, forced convection via the circulatory system, environmental exchange, metabolic heat production, and change in heat content. The vector partial differential equation and alternative forms incorporating boundary conditions were also developed. A difference equation based on a first-order approximation to the fundamental equations was derived to form the basis of a model for heat distribution within the body. It has been shown that factors involving conduction and convection must be considered independently unless the temperature of the blood flowing from a region of the body is equal to the average temperature of the tissue in that region. If this relation between tissue and blood temperature does exist, only a single temperature from each eleeent is needed to describe the heat distribution. In this latter case, models which ascribe all heat transfer to “equivalent” conduction or to convection can give valid predictions.     

Does microwave irradiation have other than thermal effects on histological staining of the mammalian CNS? A light microscopical study of microwave stimulated staining under isothermal conditions in man and rat.

The question whether or not microwave irradiation exerts other than thermal effects on histological staining is still a matter of controversy. The present study was undertaken to reveal or reject such a so far hypothetical non-thermal irradiation effect. A device was developed, which enables exposure of histological sections or tissue pieces to microwave irradiation under isothermal conditions, i.e. with synchronous removal of the internal heat produced. Three classical neuroanatomical staining methods were tested on human and rat CNS. As control, identical procedures were performed without simultaneous microwave irradiation. The experiments were performed at three different temperature levels ranging from 5 to 50 degrees C. In none of the cases studied was a light microscopically appreciable difference observed between the microwave and non-microwave versions of a stain at the same temperature. The hypothesis of a separate non-thermal effect of microwave irradiation on histological staining is therefore rejected.     

Does ex vivo labelling of proliferating cells in colonic and vaginal mucosa reflect the S-phase fraction in vivo?

The ex vivo labelling of DNA-synthesizing epithelial cells in colonic and vaginal mucosa was compared with in vivo labelling. For this purpose, in vivo S-phase cells were labelled with [3H]thymidine (Tdr) and ex vivo labelling was continued by culturing tissue specimens in bromodeoxyuridine (BrdU). Various methods of tissue culture were employed in order to improve diffusion of medium (and BrdU) in the tissue. BrdU and 3H-TdR labelling were evaluated by immunohistochemistry and autoradiography respectively. Ex vivo labelling resulted in a patchy distribution of labelled cells, which did not correspond with the 3H-TdR labelling pattern obtained in vivo. Under the described conditions ex vivo labelling does not appear to be a reliable for estimation of the proliferative activities in vivo.     

Microwave thermotherapy of prostatic enlargement--analysis of radiometric thermometry using a hybrid bio-heat equation

The radiometric temperature measurement included in a commercial device for transurethral microwave thermotherapy (TUMT) of the prostate was investigated utilizing both phantom experiments and computer simulations. Two finite element (FE) models were developed. One is in part based on the experimental results, and serves as a complement to the experiments, while the other describes a perfused tissue situation for which the hybrid bio-heat equation was used to model the thermal effects of blood perfusion. The aim of the study was to investigate how the radiometric thermometer is affected by the temperature close to the antenna, and to analyze the relation between blood perfusion, temperature distribution and radiometric temperature measurement. It was found that the radiometric temperature was affected to a greater extent by the temperature very close to the antenna, in contrast to what has been expected in previous studies. The blood perfusion was found to mainly affect the temperature distribution outside the maximum temperature (located 2-3 mm outside the cooled catheter). Thus, the relation between the radiometric temperature and the temperature in the treated area is relatively weak.     

Temperature evolution in tissues embedded with large blood vessels during photo-thermal heating

During laser-assisted photo-thermal therapy, the temperature of the heated tissue region must rise to the therapeutic value (e.g., 43 °C) for complete ablation of the target cells. Large blood vessels (larger than 500 micron in diameter) at or near the irradiated tissues have a considerable impact on the transient temperature distribution in the tissue. In this study, the cooling effects of large blood vessels on temperature distribution in tissues during laser irradiation are predicted using finite element based simulation. A uniform flow is assumed at the entrance and three-dimensional conjugate heat transfer equations in the tissue region and the blood region are simultaneously solved for different vascular models. A volumetric heat source term based on Beer–Lambert law is introduced into the energy equation to account for laser heating. The heating pattern is taken to depend on the absorption and scattering coefficients of the tissue medium. Experiments are also conducted on tissue mimics in the presence and absence of simulated blood vessels to validate the numerical model. The coupled heat transfer between thermally significant blood vessels and their surrounding tissue for three different tissue-vascular networks are analyzed keeping the laser irradiation constant. A surface temperature map is obtained for different vascular models and for the bare tissue (without blood vessels). The transient temperature distribution is seen to differ according to the nature of the vascular network, blood vessel size, flow rate, laser spot size, laser power and tissue blood perfusion rate. The simulations suggest that the blood flow through large blood vessels in the vicinity of the photothermally heated tissue can lead to inefficient heating of the target.     

Reconfigurable tapered coaxial slot antenna for hepatic microwave ablation

ABSTRACT

Microwave ablation is rapidly being rediscovered and developed for treating many cancers of liver, lung, kidney and bone, as well as arrhythmias and other medical conditions. The microwaves ablate tissue by heating it to cytotoxic temperatures. The microwave antenna design suffers the challenges of effective coupling and penetration into body tissues, uncontrolled power deposition due to applicator construction limitations affecting uniform heating of target region, and narrowband operation leading to mismatch for many patients and detrimental heating. To meet out the requirements of wideband operation and localized lesion reconfigurable linearly tapered slot interstitial wideband antenna has been proposed for working in the 1.38?GHz to 4.31?GHz frequency band. The performance of the antenna is evaluated by using FEM-based HFSS software. The slot height and taper height are reconfigured for parametric analysis achieving maximum impedance matching and spherical ablation zone without requiring any additional adjustable structures. The tapering of the slot in coaxial antenna generates current distribution at the edges of the slot for maximizing specific absorption rate.     

Thermochemical Ablation Therapy of VX2 Tumor Using a Permeable Oil-Packed Liquid Alkali Metal

Objective

Alkali metal appears to be a promising tool in thermochemical ablation, but, it requires additional data on safety is required. The objective of this study was to explore the effectiveness of permeable oil-packed liquid alkali metal in the thermochemical ablation of tumors.

Methods

Permeable oil-packed sodium–potassium (NaK) was prepared using ultrasonic mixing of different ratios of metal to oil. The thermal effect of the mixture during ablation of muscle tissue ex vivo was evaluated using the Fluke Ti400 Thermal Imager. The thermochemical effect of the NaK-oil mixture on VX2 tumors was evaluated by performing perfusion CT scans both before and after treatment in 10 VX2 rabbit model tumors. VX2 tumors were harvested from two rabbits immediately after treatment to assess their viability using trypan blue and hematoxylin and eosin (H.E.) staining.

Results

The injection of the NaK–oil mixture resulted in significantly higher heat in the ablation areas. The permeable oil controlled the rate of heat released during the NaK reaction with water in the living tissue. Perfusion computed tomography and its parameter map confirmed that the NaK–oil mixture had curative effects on VX2 tumors. Both trypan blue and H.E. staining showed partial necrosis of the VX2 tumors.

Conclusions

The NaK–oil mixture may be used successfully to ablate tumor tissue in vivo. With reference to the controlled thermal and chemical lethal injury to tumors, using a liquid alkali in ablation is potentially an effective and safe method to treat malignant tumors.