K. W. Chan

RF heating of implanted spinal fusion stimulator during magnetic resonance imaging

Radio frequency (RF) heating of an implanted spinal fusion stimulator (SpF) during magnetic resonance imaging (MRI) was studied on a full-size human phantom. Heating during MRI scans (GE Signa 4X, 1.5 T) was measured with RF-transparent fiberoptic sensors. With the implant correctly connected, the maximum temperature rises were less than 2/spl deg/C during the 26 min that the scans were at maximum RF power. At the tip of a broken stimulator lead (connecting the SpF generator and its electrodes), the maximum temperature rise was 11-14/spl deg/C. Regular 4-min scans of the spinal cord produced similar temperature rises at the broken tip. After the generator and the leads were removed, heating at the electrode connector tip was less than 1.5/spl deg/C. The control temperature rises at the same locations, without the stimulator, were less than 0.5/spl deg/C. This study shows that spinal fusion stimulator heating is within the Food and Drug Administration safety guideline of 2/spl deg/C. However, if a lead wire is broken, it is unsafe during MRI scans. Radiological examinations will be necessary to ensure the integrity of the implant.

Development of a rat head exposure system for simulating human exposure to RF fields from handheld wireless telephones.

The aim of this project was to develop an animal exposure system for the biological effect studies of radio frequency fields from handheld wireless telephones, with energy deposition in animal brains comparable to those in humans. The finite-difference time-domain (FDTD) method was initially used to compute specific absorption rate (SAR) in an ellipsoidal rat model exposed with various size loop antennas at different distances from the model. A 3 x 1 cm rectangular loop produced acceptable SAR patterns. A numerical rat model based on CT images was developed by curve-fitting Hounsfield Units of CT image pixels to tissue dielectric properties and densities. To design a loop for operating at high power levels, energy coupling and impedance matching were optimized using capacitively coupled feed lines embedded in a Teflon rod. Sprague Dawley rats were exposed with the 3 x 1 cm loop antennas, tuned to 837 or 1957 MHz for thermographically determined SAR distributions. Point SARs in brains of restrained rats were also determined thermometrically using fiberoptic probes. Calculated and measured SAR patterns and results from the various exposure configurations are in general agreement. The FDTD computed average brain SAR and ratio of head to whole body absorption were 23.8 W/kg/W and 62% at 837 MHz, and 22.6 W/kg/W and 89% at 1957 MHz. The average brain to whole body SAR ratio was 20 to 1 for both frequencies. At 837 MHz, the maximum measured SAR in the restrained rat brains was 51 W/kg/W in the cerebellum and 40 W/kg/W at the top of the cerebrum. An exposure system operating at 837 MHz is ready for in vivo biological effect studies of radio frequency fields from portable cellular telephones. Two-tenths of a watt input power to the loop antenna will produce 10 W/kg maximum SAR, and an estimated 4.8 W/kg average brain SAR in a 300 g medium size rat.

Changes in heating patterns of interstitial microwave antenna arrays at different insertion depths

The changes in heating patterns of interstitial microwave antennas at different insertion depths were investigated in a static phantom at 915 MHz. Antennas for the Clini-Therm Mark VI system were inserted 5-15 cm into muscle-equivalent material, through nylon catheters. The phantom was heated with arrays of antennas at 2 cm spacings for 60 s at 15 W per antenna. Midplane and transverse heating patterns were determined thermographically with the antennas inserted parallel or perpendicular to the split of the phantom. Hot spots, independent of heating near the junction plane, were observed in the midplane of the 2 x 2 and 2 x 4 arrays at 2.8 cm from the insertion end. The magnitudes of these hot spots were reduced by 40-45 per cent as insertion depth was increased from 7 to 10.5 cm. With insertion depths of more than 11.5 cm the hot spots gradually diminished and heating occurred mostly near the junction plane. The observed heating patterns were caused by changes in impedance of the antenna arrays at different insertion depths. The impedance mismatch had resulted in different wave propagation within the tissue material which produced different radiation patterns. During treatments, because heating varies with insertion depth, great care must be exercised in monitoring temperatures.

Interstitial thermoradiotherapy with ferromagnetic implants for locally advanced and recurrent neoplasms

PURPOSE The University of Arizona, University of California at San Francisco, City of Hope Medical Center, and University of Wisconsin participated in a Phase I/II protocol to assess the heating ability and the toxicity of interstitial thermoradiotherapy using ferromagnetic implantation. METHODS AND MATERIALS Forty-four patients with advanced primary or recurrent extra-cranial solid malignancies were enrolled in this study. Fourteen gauge catheters were implanted into tumors and, once in the department of Radiation Oncology, loaded with ferromagnetic seeds to deliver a 60 min hyperthermia treatment. Multi-point thermometry was continuously used throughout the heating sessions for all patients, sampling the periphery as well as the core of the tumor. After 192Iridium brachytherapy, 18 patients then had an additional treatment. The mean radiation dose while on protocol was 50.0 Gy, with total doses (including prior radiotherapy) ranging from 20.3-151.8 Gy (median = 88.7 Gy). Response and toxicity were assessed by inspection, palpation, and/or radiologic studies. Forty-one patients were evaluable for response, and there were 55 analyzable hyperthermia treatment sessions. RESULTS The complete response rate was 61% (25/41). The partial response rate was 31.7% and only 7.3% failed to respond. Median duration of local control has not yet been reached. The mean maximum, minimum, and mean time-averaged temperatures for all in-tissue sensors were 43.7 degrees C, 38.7 degrees C, and 41.0 degrees C, respectively. Tumor size was the only factor significantly correlated with temperatures or with complete response rate; larger tumors attained higher temperatures but smaller tumors had a higher response probability. Nineteen patients (43%) experienced toxicities, however there was only a 7% (3/44) rate of serious complications (Grade 3 or 4). Prior treatment with hyperthermia was the only factor significantly correlated with serious toxicity. CONCLUSION These results, a 93% total response with only 7% serious toxicity, are encouraging especially in the context of the patient population treated. Phase II/III studies involving ferromagnetic implantation are warranted.

Intracatheter hyperthermia and iridium-192 radiotherapy in the treatment of bile duct carcinoma.

We report a case of a patient with locally advanced bile duct carcinoma treated with 4500 cGy external beam radiotherapy, followed 3 weeks later by intracatheter 915 MHz microwave hyperthermia and radiotherapy delivered through a biliary U-tube placed at the time of surgery. Heating was to 43-45 degrees C for 1 hour followed immediately by intracatheter Iridium-192 seeds to deliver 5000 cGy over a 72 hour period. Prior to treatment, a thermal dosimetry study in phanton was conducted, using the same type of U-tube catheter tubing as in the patient. Orthogonal X rays of the patients porta hepatis region were used to reconstruct the catheter geometry in the phantom. Proper insertion depth was determined thermographically to obtain maximum heating at the center of the tumor. The maximum SAR was 8.8 watts per kilogram per watt input. During the treatment, the average power applied was 30 W. Six months after therapy, the patient is asymptomatic. Although alkaline phosphatase, SGOT and SGPT have remained elevated, bilirubin has returned to normal and computerized tomographic scans and cholangiograms remain stable. A duodenal ulcer developed after therapy and is healing well with conservative medical management. This case demonstrates that hyperthermia applied through biliary drainage catheters is technically feasible and clinically tolerated. We believe the use of intracatheter hyperthermia in conjunction with external and/or intracatheter radiotherapy in selected patients with unresectable bile duct carcinomas warrants further study.

Changes in heating patterns due to perturbations by thermometer probes at 915 and 434 MHz

The changes in heating patterns due to perturbations by thermometer probes in microwave fields were investigated in static phantoms at 915 and 434 MHz. Thermograms taken parallel to the plane of E and H fields, at depths of up to 2 cm, indicated heating changes of +25 to -45 per cent at 915 MHz and +/- 15 per cent at 434 MHz. The amount of perturbation is dependent on the length, size and location of the probes in the RF fields and their orientations to the electric field. If proper probe placement techniques are not observed when metallic probes are involved, hot and cool spots can be generated and shifted to sites that are not measured. Therefore misleading temperatures can result when changes in heating patterns are not detected. Perturbation also varies with applicator designs and phantom geometry. If thermistors and thermocouples are used, the effects of perturbation should be investigated with individual applicators under applicable clinical conditions.

Perturbations due to the use of catheters with non-perturbing thermometry probes

Perturbations due to the use of catheters with non-perturbing thermometry probes were investigated in static phantom at 915 MHz. Fibre optic probes for the Luxtron and Clini-Therm thermometry systems, and Vitek probes for the BSD hyperthermia systems, were inserted in closed-end catheters at depths up to 2 cm in the phantom and exposed parallel to the E-field. The probes alone produced 0-12 per cent changes in heating and catheters alone were 0-20 per cent. When the probes were inserted in catheters, perturbations were 0-12 per cent at the surface and 1 cm depth, and 5-15 per cent at 2 cm depth. Even with non-perturbing probes it is important to place catheters perpendicular to the E-field during microwave hyperthermia.

Evaluation of captive bolus applicators

Three square (L, M, MS) and one rectangular (HN) applicators with captive boluses were provided by the Clini-Therm Corporation for evaluation. Surface cooling is achieved by attaching a mineral oil captive bolus to the built in water-circulating tubes at the aperture of the applicators. These applicators were tested on a phantom with a 2-cm fat slab over 10-cm-thick muscle. Surface and sagittal heating patterns were obtained using a thermograph. All captive-bolus applicators have heating patterns similar to that of the regular Clini-Therm applicators. Due to hot spots at the edges of the applicators where the E fields terminate, these modified applicators should not be placed in direct contact with patients when boluses are not used. Tests with Clini-Therm regular water bolus instead of the captive oil bolus indicated that the orientation of water flow should be parallel to the E field to minimize perturbation of the heating patterns. Thermal conduction studies showed that the captive bolus reacts too slowly for skin temperature control. The modified captive bolus applicators did not improve the performance of the system.

FDTD simulations of Clini-Therm applicators on inhomogeneous planar tissue models

A finite-difference time-domain (FDTD) algorithm was used to compute SAR distributions in planar fat-muscle phantom exposed to the Clini-Therm microwave applicators. The models consisted of a 30 X 30 X 7.5 cm phantom and a 15 X 15 cm, 10 X 10 cm or 7.5 X 7.5 cm aperture dielectric slab loaded applicator. The phantom was either filled with muscle material or with 1.0 cm fat on 6.5 cm muscle. A mineral oil bolus was placed on the fat-muscle model with its integrated water channels parallel to the electric or magnetic field. The FDTD resolution was 3 mm and the applicators were excited with a Gaussian pulse. The computations required 6000-8000 time steps to reach steady state, with 45-48 Mwords on a Cray Y-MP C-90 in 1000-1200 CPU seconds. The electric field components at 915 MHz were obtained by summing the Fourier coefficients at each grid point during each time step and SAR was determined. The results were qualitatively compared to existing and published thermographic heating patterns with good agreement. The computed electric field distributions had provided a three dimensional view into the problem space to investigate and understand wave propagation phenomena in complex inhomogeneous configurations that were not feasible with experimental models.

Use of thermocouples in the intense fields of ferromagnetic implant hyperthermia

Thermocouples have been used in the intense fields of ferromagnetic implant hyperthermia for extensive temperature measurements. Electromagnetic interference at 100 kHz is minimized with feed-through filters mounted on a copper plate in a shielded assembly. The thermocouples are temperature compensated in the software by monitoring the temperature of the copper plate. D-shell connectors are used for multiple sensor thermocouple connections and to provide proper shield termination of external cables. The technical approaches of grounding, shielding and filtering are examined, and experiments have been conducted to determine the proper usage of thermocouple during ferromagnetic implant treatments. The dependence of filter performance on thermocouple impedance and the effect of D-shell connections on temperature accuracy have been studied. The results indicate that self-heating due to electromagnetic energy coupled into 51 microns thermocouple leads and unbalanced current along 76 microns leads are insignificant at 100 kHz. But severe heating has been observed in 511 and 813 microns leads, especially in high-conductivity copper wires. By using 25-50 microns thermocouple leads, better than 0.1 degree C accuracy and 0.05 degree C resolution have been achieved during ferromagnetic hyperthermia. At field strength of 1500 A/m, artifacts of 0.03-0.05 degree C are observed.