Scott Almquist

Treatment envelope evaluation in transcranial magnetic resonance-guided focused ultrasound utilizing 3D MR thermometry

BackgroundCurrent clinical targets for transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) are all located close to the geometric center of the skull convexity, which minimizes challenges related to focusing the ultrasound through the skull bone. Non-central targets will have to be reached to treat a wider variety of neurological disorders and solid tumors. Treatment envelope studies utilizing two-dimensional (2D) magnetic resonance (MR) thermometry have previously been performed to determine the regions in which therapeutic levels of FUS can currently be delivered. Since 2D MR thermometry was used, very limited information about unintended heating in near-field tissue/bone interfaces could be deduced.MethodsIn this paper, we present a proof-of-concept treatment envelope study with three-dimensional (3D) MR thermometry monitoring of FUS heatings performed in a phantom and a lamb model. While the moderate-sized transducer used was not designed for transcranial geometries, the 3D temperature maps enable monitoring of the entire sonication field of view, including both the focal spot and near-field tissue/bone interfaces, for full characterization of all heating that may occur. 3D MR thermometry is achieved by a combination of k-space subsampling and a previously described temporally constrained reconstruction method.ResultsWe present two different types of treatment envelopes. The first is based only on the focal spot heating—the type that can be derived from 2D MR thermometry. The second type is based on the relative near-field heating and is calculated as the ratio between the focal spot heating and the near-field heating. This utilizes the full 3D MR thermometry data achieved in this study.ConclusionsIt is shown that 3D MR thermometry can be used to improve the safety assessment in treatment envelope evaluations. Using a non-optimal transducer, it is shown that some regions where therapeutic levels of FUS can be delivered, as suggested by the first type of envelope, are not necessarily safely treated due to the amount of unintended near-field heating occurring. The results presented in this study highlight the need for 3D MR thermometry in tcMRgFUS.

Phase aberration simulation study of MRgFUS breast treatments.

PURPOSE This simulation study evaluates the effects of phase aberration in breast MR-guided focused ultrasound (MRgFUS) ablation treatments performed with a phased-array transducer positioned laterally to the breast. A quantification of these effects in terms of thermal dose delivery and the potential benefits of phase correction is demonstrated in four heterogeneous breast numerical models. METHODS To evaluate the effects of varying breast tissue properties on the quality of the focus, four female volunteers with confirmed benign fibroadenomas were imaged using 3T MRI. These images were segmented into numerical models with six tissue types, with each tissue type assigned standard acoustic properties from the literature. Simulations for a single-plane 16-point raster-scan treatment trajectory centered in a fibroadenoma in each modeled breast were performed for a breast-specific MRgFUS system. At each of the 16 points, pressure patterns both with and without applying a phase correction technique were determined with the hybrid-angular spectrum method. Corrected phase patterns were obtained using a simulation-based phase aberration correction technique to adjust each elements transmit phase to obtain maximized constructive interference at the desired focus. Thermal simulations were performed for both the corrected and uncorrected pressure patterns using a finite-difference implementation of the Pennes bioheat equation. The effect of phase correction was evaluated through comparison of thermal dose accumulation both within and outside a defined treatment volume. Treatment results using corrected and uncorrected phase aberration simulations were compared by evaluating the power required to achieve a 20 °C temperature rise at the first treatment location. The extent of the volumes that received a minimum thermal dose of 240 CEM at 43 °C inside the intended treatment volume as well as the volume in the remaining breast tissues was also evaluated in the form of a dose volume ratio (DVR), a DVR percent change between corrected and uncorrected phases, and an additional metric that measured phase spread. RESULTS With phase aberration correction applied, there was an improvement in the focus for all breast anatomies as quantified by a reduction in power required (13%-102%) to reach 20 °C when compared to uncorrected simulations. Also, the DVR percent change increased by 5%-77% in seven out of eight cases, indicating an improvement to the treatment as measured by a reduction in thermal dose deposited to the nontreatment tissues. Breast compositions with a higher degree of heterogeneity along the ultrasound beam path showed greater reductions in thermal dose delivered outside of the treatment volume with correction applied than beam trajectories that propagated through more homogeneous breast compositions. An increasing linear trend was observed between the DVR percent change and the phase-spread metric (R(2) = 0.68). CONCLUSIONS These results indicate that performing phase aberration correction for breast MRgFUS treatments is beneficial for the small-aperture transducer (14.4 × 9.8 cm) evaluated in this work. While all breast anatomies could benefit from phase aberration correction, greater benefits are observed in more heterogeneous anatomies.

Incorporating tissue absorption and scattering in rapid ultrasound beam modeling

We have developed a new approach for modeling the propagation of an ultrasound beam in inhomogeneous tissues such as encountered with high-intensity focused ultrasound (HIFU) for treatment of various diseases. This method, called the hybrid angular spectrum (HAS) approach, alternates propagation steps between the space and the spatial frequency domains throughout the inhomogeneous regions of the body; the use of spatial Fourier transforms makes this technique considerably faster than other modeling approaches (about 10 sec for a 141 x 141 x 121 model). In HIFU thermal treatments, the acoustic absorption property of the tissues is of prime importance since it leads to temperature rise and the achievement of desired thermal dose at the treatment site. We have recently added to the HAS method the capability of independently modeling tissue absorption and scattering, the two components of acoustic attenuation. These additions improve the predictive value of the beam modeling and more accurately describes the thermal conditions expected during a therapeutic ultrasound exposure. Two approaches to explicitly model scattering were developed: one for scattering sizes smaller than a voxel, and one when the scattering scale is several voxels wide. Some anatomically realistic examples that demonstrate the importance of independently modeling absorption and scattering are given, including propagation through the human skull for noninvasive brain therapy and in the human breast for treatment of breast lesions.

A full-wave phase aberration correction method for transcranial high-intensity focused ultrasound brain therapies

Transcranial high-intensity focused ultrasound has recently been used to noninvasively treat several types of brain disorders. However, due to the large differences in acoustic properties of skulls and the surrounding soft tissue, it can be a challenge to adequately focus an ultrasonic beam through the skull. We present a novel, fast, full-wave method of correcting the aberrations caused by the skull by phasing the elements of a phased-array transducer to create constructive interference at the target. Because the method is full-wave, it also allows for trajectory planning by determining the phases required for multiple target points with negligible additional computational costs. Experimental hydrophone scans with an ex vivo skull sample using a 256-element 1-MHz transducer show an improvement of 6.2% in peak pressure at the focus and a reduction of side-lobe pressure by a factor of 2.31. Additionally, mispositioning of the peak pressure from the intended treatment location is reduced from 2.3 to 0.5 mm.

Experimental assessment of phase aberration correction for breast MRgFUS therapy

Abstract Purpose: This study validates that phase aberrations in breast magnetic resonance-guided focussed ultrasound (MRgFUS) therapies can be corrected in a clinically relevant time frame to generate more intense, smaller and more spatially accurate foci. Materials and methods: Hybrid angular spectrum (HAS) ultrasound calculations in an magnetic resonance imaging (MRI)-based tissue model, were used to compute phase aberration corrections for improved experimental MRgFUS heating in four heterogeneous breast-mimicking phantoms (n = 18 total locations). Magnetic resonance(MR) temperature imaging was used to evaluate the maximum temperature rise, focus volume and focus accuracy for uncorrected and phase aberration-corrected sonications. Thermal simulations assessed the effectiveness of the phase aberration correction implementation. Results: In 13 of 18 locations, the maximum temperature rise increased by an average of 30%, focus volume was reduced by 40% and focus accuracy improved from 4.6 to 3.6 mm. Mixed results were observed in five of the 18 locations, with focus accuracy improving from 6.1 to 2.5 mm and the maximum temperature rise decreasing by 8% and focus volume increasing by 10%. Overall, the study demonstrated significant improvements (p < 0.005) in maximum temperature rise, focus volume and focus accuracy. Simulations predicted greater improvements than observed experimentally, suggesting potential for improvement in implementing the technique. The complete phase aberration correction procedure, including model generation, segmentation and phase aberration computations, required less than 45 min per sonication location. Conclusion: The significant improvements demonstrated in this study i.e., focus intensity, size and accuracy from phase aberration correction have the potential to improve the efficacy, time-efficiency and safety of breast MRgFUS therapies.

Simulation of hemispherical transducers for transcranial HIFU treatments using the hybrid angular spectrum approach

Transcranial focused ultrasound is emerging as a promising treatment modality for a variety of disorders including essential tremor and glioblastoma. However, traditional full-wave methods of simulating ultrasound pressure fields for these treatments, such as FDTD, are computationally intensive. The situation is exacerbated by the large area insonified by the transcranial transducers, which are typically hemispherical to spread the intensity over a large area of the skull and prevent burns. The Hybrid Angular Spectrum (HAS) approach [1] has been used to rapidly model ultrasonic beam propagation. Here we present a method for adapting the HAS technique to hemispherical transducers.

Performance of a simulation-based phase aberration correction technique in transcranial ultrasound modeling

Due to its irregular geometry and acoustic properties, the presence of the skull in transcranial focused ultrasound therapies can lead to considerable beam phase aberration, resulting in distorted focal spots. There are several possible techniques for correcting this phase aberration with a phased-array transducer, the most accurate of which (although invasive) is hydrophone-based time reversal. There are also simulation-based approaches, and here we exploit the time-advantages of the Hybrid Angular Spectrum (HAS) numerical method and apply it to two models of the skull: a 3D-printed plastic skull analog and a segment of a human skull for which a CT scan has been obtained. We compare the focused pressure patterns—obtained via hydrophone scans—for the cases of no phase correction, hydrophone-based phase correction, and simulation-based (HAS) phase correction. We show the degree to which the correction methods improve the focal spot quality, pressure amplitude, and localization accuracy. The very good resul...

Simulation of therapeutic ultrasound treatments using the hybrid angular spectrum technique

Numerical simulations play an important role in therapeutic ultrasound treatments. Simulations can help with transducer design, retroactively analyze temperature patterns for insight into treatment effectiveness, and ultimately be used for patient treatment planning. Our group has developed a rapid 3D simulation tool for ultrasound beam propagation named the hybrid angular spectrum (HAS) method. HAS is an extension of the traditional angular spectrum approach that uses fast Fourier transforms to alternate between the spatial frequency domain and the space domain as the beam propagates through inhomogeneous tissue regions. In this presentation, we briefly cover the physical and algorithmic principles underlying the HAS technique, then give examples of its use in two promising high-intensity focused ultrasound (HIFU) applications. First, we employ it to retrospectively predict the heating efficiency of transcranial treatments of 14 patients undergoing treatment for essential tremor using a large phased-arra...