Francesco Giurazza

Experimental assessment of CT-based thermometry during laser ablation of porcine pancreas.

Laser interstitial thermotherapy (LITT) is employed to destroy tumors in organs, and its outcome strongly depends on the temperature distribution inside the treated tissue. The recent introduction of computed tomography (CT) scan thermometry, based on the CT number dependence of the tissue with temperature, overcomes the invasiveness of other techniques used to monitor temperature during LITT. The averaged CT number (ROI = 0.02 cm(2)) of an ex vivo swine pancreas is monitored during LITT (Nd:YAG laser power of 3 W, treatment time: 120 s) at different distances from the applicator (from 4 to 30 mm). The averaged CT number shows a clear decrease during treatment: it is highest at 4 mm from the applicator (mean variation in the whole treatment of -0.256 HU s(-1)) and negligible at 30 mm, since the highest temperature increase is present close to the applicator (i.e., 45 °C at 4 mm and 25 °C at 6 mm). To obtain the relationship between CT numbers and pancreas temperature, the reference temperature was measured by 12 fiber Bragg grating sensors. The CT number decreases as a function of temperature, showing a nonlinear trend with a mean thermal sensitivity of -0.50 HU °C(-1). Results here reported are the first assessment of pancreatic CT number dependence on temperature, at the best of our knowledge. Findings can be useful to further investigate CT scan thermometry during LITT on the pancreas.

Determination of stature from skeletal and skull measurements by CT scan evaluation

The aim of this article is to find a correlation between height and femur/skull measurements through Computed Tomography (CT) scans and derive regression equations for total skeletal height estimation in the Caucasian population. We selected 200 Caucasian patients from March 2010 to July 2011 who had to perform a CT scan for cancer restaging. The mean age is 64.5 years. Both sexes are represented by the same number of persons. Patients have executed a total body CT scan with contrast; once scan accomplished, we measured height through a digital scales. We analyzed CT scans of each patient, obtaining multiplanar reconstruction in sagittal and coronal planes with 1mm of thickness, and we measured 10 diameters of skull and femur. Then we performed a single and a multiple regression analysis considering the three diameters that better correlated with height. The skeletal diameters with the highest correlation coefficients with stature were femur lengths, length of cranial base (Ba-N), and distance from the posterior extremity of the cranial base to the inferior point of the nasal bone (Ba-NB). Although both femur and skull are skeletal segments used for stature estimation, in our sample femur gave stronger correlation with height than skull. h=35.7+1.48·BaN+2.32·BaNB+2.53·FEM and h=3.06·FEM+72.6 are the formulae that provided the most accurate stature assessment using multiple and single regression analysis respectively.

Stature estimation from scapular measurements by CT scan evaluation in an Italian population

This study evaluated the correlation between scapula size and stature and developed standard equations in order to estimate stature by CT scan evaluation. A total of 200 healthy Italian subjects (100 men and 100 women, mean age 64.2±12.8years) underwent thoracic CT scan evaluation during pulmonary screening in our department; we measured the stature of each patient with standard anthropometric instruments and then analyzed images to calculate the longitudinal scapular length (LSL) and the transverse scapular length (TSL). The correlation between stature and each parameter measured was analyzed by dividing the population into two groups, males and females, and was examined by simple regression analysis using Pearsons correlation coefficient (r). Each anthropometric variable showed a significant difference between males and females (p value <0.001). The correlation coefficients (r-values) were LSL=0.74 and TSL=0.51 in males and LSL=0.70 and TSL=0.48 in females. In both sexes the r-values showed a significant correlation between stature and LSL. Our study demonstrates that scapulae can be used for stature estimation; in our sample LSL was found to have a better correlation with stature then TSL. hm=4.247*LSL+93.74 and hf=4.031*LSL+92.38 are the formulae that provide the most accurate stature assessment in males and females respectively.

Temperature monitoring during microwave ablation in ex vivo porcine livers

OBJECTIVE The aim of the present study was to assess the temperature map and its reproducibility while applying two different MWA systems (915 MHz vs 2.45 GHz) in ex vivo porcine livers. MATERIALS AND METHODS Fifteen fresh pig livers were treated using the two antennae at three different settings: treatment time of 10 min and power of 45 W for both systems; 4 min and 100 W for the 2.45 GHz system. Trends of temperature were recorded during all procedures by means of fiber optic-based probes located at five fixed distances from the antenna, ranging between 10 mm and 30 mm. Each trial was repeated twice to assess the reproducibility of temperature distribution. RESULTS Temperature as function of distance from the antenna can be modeled by a decreasing exponential trend. At the same settings, temperature obtained with the 2.45 GHz system was higher than that obtained with the 915 MHz thus resulting into a wider area of ablation (diameter 17 mm vs 15 mm). Both systems showed good reproducibility in terms of temperature distribution (root mean squared difference for both systems ranged between 2.8 °C and 3.4 °C). CONCLUSIONS When both MWA systems are applied, a decreasing exponential model can predict the temperature map. The 2.45 GHz antenna causes higher temperatures as compared to the 915 MHz thus, resulting into larger areas of ablation. Both systems showed good reproducibility although better results were achieved with the 2.45 GHz antenna.

Magnetic resonance-based thermometry during laser ablation on ex-vivo swine pancreas and liver

Laser Ablation (LA) is a minimally-invasive procedure for tumor treatment. LA outcomes depend on the heat distribution inside tissues and require accurate temperature measurement during the procedure. Magnetic resonance imaging (MRI) allows a non-invasive and three-dimensional thermometry of the organ undergoing LA. In this study, the temperature distribution within two swine pancreases and three swine livers undergoing LA (Nd:YAG, power: 2 W, treatment time: 4 min) was monitored by a 1.5-T MR scanner, utilizing two T1-weighted sequences (IRTF and SRTF). The signal intensity in four regions of interest, placed at different distances from the laser applicator, was related to temperature variations monitored in the same regions by twelve fiber Bragg grating sensors. The relationship between the signal intensity and temperature increase was calculated to obtain the calibration curve and to evaluate accuracy, sensibility and precision of each sequence. This is the first study of MR-based thermometry during LA on pancreas. More specifically, the IRTF sequence provides the highest temperature sensitivity in both liver (1.8 ± 0.2 °C(-1)) and pancreas (1.8 ± 0.5 °C(-1)) and the lowest precision and accuracy. SRTF sequence on pancreas presents the highest accuracy and precision (MODSFRT = -0.1 °C and LOASFRT = [-2.3; 2.1] °C).

Error of a Temperature Probe for Cancer Ablation Monitoring Caused by Respiratory Movements: Ex Vivo and In Vivo Analysis

Hyperthermal techniques are spreading as an alternative to conventional surgery for cancer removal. A real-time temperature feedback can be used to adjust the treatment settings, in order to improve the clinical outcomes. In this paper, we experimentally assessed the feasibility for distributed temperature monitoring of a custom probe, which consists of a needle embedding six fiber Bragg gratings (FBGs). Since FBGs are also sensitive to strain, we focused on the analysis of the measurement error (artifact) caused by respiratory movements. We assessed the artifact both on ex vivo pig liver and lung (by mimicking the movement of these organs caused by respiration) and on in vivo trial on pig liver. Lastly, we proposed an algorithm to detect and minimize the artifact during ex vivo liver laser ablation. During both ex vivo and in vivo trials, the probe insertion within the organ was easy and safe. The artifact was significant (up to 3 °C), but the correction algorithm allows minimizing the error. The main advantages of the proposed probe are: 1) spatially resolved temperature monitoring (in six points of the tissue by inserting a single needle) and 2) the needle is magnetic resonance (MR)-compatible, hence can be used during MR-guided procedure. Even if the model is close to humans, further trials are required to investigate the feasibility of the probe for clinical applications.

Design and Feasibility Assessment of a Magnetic Resonance-Compatible Smart Textile Based on Fiber Bragg Grating Sensors for Respiratory Monitoring

Comfortable and easy to wear systems are gaining popularity for monitoring physiological parameters. Among others, smart textiles based on fiber optic sensors have shown promising results for respiratory monitoring and applications in magnetic resonance (MR) environment. The aim of this paper was to design, fabricate, and assess on healthy volunteers a smart textile based on fiber Bragg grating (FBG) sensors for respiratory monitoring. The new design was driven by the chest wall kinematics analysis performed by a marked-based motion capture system. The proposed textile shows promising performances for the non-intrusive monitoring of both compartmental and global volumetric parameters over time. Moreover, the use of FBGs makes the system MR-compatible. This feature was tested on two volunteers. The system did neither cause any image artifacts nor discomfort to the volunteers. This promising result encourages future developments to investigate the feasibility of the proposed smart textile for long-term observation of respiratory parameters, for patients monitoring during MR scan, and during sport activities in athletes.

Treatment of Early-Stage Pressure Ulcers by Using Autologous Adipose Tissue Grafts

Assessing pressure ulcers (PUs) in early stages allows patients to receive safer treatment. Up to now, in addition to clinical evaluation, ultrasonography seems to be the most suitable technique to achieve this goal. Several treatments are applied to prevent ulcer progression but none of them is totally effective. Furthermore, the in-depth knowledge of fat regenerative properties has led to a wide use of it. With this study the authors aim at introducing a new approach to cure and prevent the worsening of early-stage PUs by using fat grafts. The authors selected 42 patients who showed clinical and ultrasonographic evidence of early-stage PUs. Values of skin thickness, fascial integrity, and subcutaneous vascularity were recorded both on the PU area and the healthy trochanteric one, used as control region. Fat grafting was performed on all patients. At three months, abnormal ultrasonographic findings, such as reduction of cutaneous and subcutaneous thickness, discontinuous fascia, and decrease in subcutaneous vascularity, all were modified with respect to almost all the corresponding parameters of the control region. Results highlight that the use of fat grafts proved to be an effective treatment for early-stage PUs, especially in the care of neurological and chronic bedridden patients.

Emerging clinical applications of computed tomography

X-ray computed tomography (CT) has recently been experiencing remarkable growth as a result of technological advances and new clinical applications. This paper reviews the essential physics of X-ray CT and its major components. Also reviewed are recent promising applications of CT, ie, CT-guided procedures, CT-based thermometry, photon-counting technology, hybrid PET-CT, use of ultrafast-high pitch scanners, and potential use of dual-energy CT for material differentiations. These promising solutions and a better knowledge of their potentialities should allow CT to be used in a safe and effective manner in several clinical applications.

Smart Textile Based on 12 Fiber Bragg Gratings Array for Vital Signs Monitoring

Over the last decades, wearable systems have gained interest for vital signs monitoring. Among several technologies, fiber Bragg grating (FBG) sensors are becoming popular for some advantages, such as high sensitivity, magnetic resonance compatibility, and the capability of performing distributed measurements. The aim of this paper is twofold: the description of the design and the fabrication of a smart textile based on an array of 12 FBGs; its feasibility assessment for monitoring respiratory parameters (i.e., respiratory rate, respiratory period, and inspiratory and expiratory periods) and heart rate on healthy volunteers in two positions (standing and supine). The increased number of FBGs embedded in this system with respect to previous developed prototypes aims at improving its accuracy in the estimation of the mentioned parameters. Future testing will be performed to investigate if the proposed solution allows improving the measurements of respiratory volumes exchanges and in new scenarios (e.g., sports medicine, including walking, running, and cycling activities).