Sergio Silvestri

Biological effects of exposure to magnetic resonance imaging: an overview

The literature on biological effects of magnetic and electromagnetic fields commonly utilized in magnetic resonance imaging systems is surveyed here. After an introduction on the basic principles of magnetic resonance imaging and the electric and magnetic properties of biological tissues, the basic phenomena to understand the bio-effects are described in classical terms. Values of field strengths and frequencies commonly utilized in these diagnostic systems are reported in order to allow the integration of the specific literature on the bio-effects produced by magnetic resonance systems with the vast literature concerning the bio-effects produced by electromagnetic fields. This work gives an overview of the findings about the safety concerns of exposure to static magnetic fields, radio-frequency fields, and time varying magnetic field gradients, focusing primarily on the physics of the interactions between these electromagnetic fields and biological matter. The scientific literature is summarized, integrated, and critically analyzed with the help of authoritative reviews by recognized experts, international safety guidelines are also cited.

Techniques for temperature monitoring during laser-induced thermotherapy: An overview

Abstract Laser-induced thermotherapy (LITT) is a hyperthermic procedure recently employed to treat cancer in several organs. The amount of coagulated tissue depends on the temperature distribution around the applicator, which plays a crucial role for an optimal outcome: the removal of the whole neoplastic tissue, whilst preventing damage to the surrounding healthy tissue. Although feedback concerning tissue temperature could be useful to drive the physician in the adjustment of laser settings and treatment duration, LITT is usually performed without real-time monitoring of tissue temperature. During recent decades, many thermometric techniques have been developed to be used during thermal therapies. This paper provides an overview of techniques and sensors employed for temperature measurement during tissue hyperthermia, focusing on LITT, and an investigation of their performances in this application. The paper focuses on the most promising and widespread temperature monitoring techniques, splitting them into two groups: the former includes invasive techniques based on the use of thermocouples and fibre-optic sensors; the second analyses non-invasive methods, i.e. magnetic resonance imaging-, computerised tomography- and ultrasound-based thermometry. Background information on measuring principle, medical applications, advantages and weaknesses of each method are provided and discussed.

Theoretical Analysis and Experimental Evaluation of Laser-Induced Interstitial Thermotherapy in Ex Vivo Porcine Pancreas

Laser-induced interstitial thermotherapy (LITT) has been recently applied to pancreas in animal models for ablation purpose. Assessment of thermal effects due to the laser-pancreatic tissue interaction is a critical factor in validating the procedure feasibility and safety. A mathematical model based on bioheat equation and its experimental assessment was developed. The LITT procedure was performed on 40 ex vivo porcine pancreases, with an Nd:YAG (1064 nm) energy of 1000 J and power from 1.5 up to 10 W conveyed by a quartz optical fiber with 300 μm diameter. Six fiber Bragg grating sensors have been utilized to measure temperature distribution as a function of time at fixed distances from the applicator tip within pancreas undergoing LITT. Simulations and experiments show temperature variations ΔT steeply decreasing with distance from the applicator at higher power values: at 6 W, ΔT >; 40°C at 5 mm and ΔT ≅ 5°C at 10 mm. ΔT nonlinearly increases with power close to the applicator. Ablated and coagulated tissue volumes have also been measured and experimental results agree with theoretical ones. Despite the absence of data in the current literature on pancreas optical parameters, the model allowed a quite good prediction of thermal effects. The prediction of LITT effects on pancreas is necessary to assess laser dosimetry.

CT-based thermometry: An overview

Abstract The dependence of computed tomography (CT) values on temperature has been pointed out by several authors since the late 1970s. They emphasised the importance of this phenomenon on the calibration process with water equivalent phantoms of the CT scanners. Few years later the potential of CT thermometry for non-invasive temperature mapping during thermal procedures was investigated. The interest on the employment of this technique during thermal treatments has been recently renewed with the improvement of modern CT scanner performances and with the increased popularity of minimally invasive thermal techniques for cancer treatment. A good thermometry allows avoiding unintended damage of the healthy tissues during the procedure by providing a detailed tissue temperature distribution; therefore, it is recommended in order to achieve good effectiveness of the thermal treatment. Researchers have been working on this issue for more than four decades and different non-invasive solutions have been proposed, i.e., microwave thermal imaging, infrared (IR)-, ultrasound-, magnetic-resonance (MR)-, and CT-based thermometry. This review aims to summarise the essential physics and the currently available data on CT-based thermometry and to elucidate the potential use of this technique during thermal procedures. Background information on measuring principle, an investigation of the performances achieved by this technique and the thermal sensitivity of the CT-number of different organs are provided and discussed.

Micromachined Flow Sensors in Biomedical Applications

Application fields of micromachined devices are growing very rapidly due to the continuous improvement of three dimensional technologies of micro-fabrication. In particular, applications of micromachined sensors to monitor gas and liquid flows hold immense potential because of their valuable characteristics (e.g., low energy consumption, relatively good accuracy, the ability to measure very small flow, and small size). Moreover, the feedback provided by integrating microflow sensors to micro mass flow controllers is essential to deliver accurately set target small flows. This paper is a review of some application areas in the biomedical field of micromachined flow sensors, such as blood flow, respiratory monitoring, and drug delivery among others. Particular attention is dedicated to the description of the measurement principles utilized in early and current research. Finally, some observations about characteristics and issues of these devices are also reported.

EUS-guided Nd:YAG laser ablation of normal pancreatic tissue: a pilot study in a pig model.

BACKGROUND Laser ablation with a neodymium:yttrium aluminum garnet (Nd:YAG) laser can achieve a high rate of complete tissue necrosis and has been applied as a minimally invasive, palliative option in hepatocellular carcinoma, liver metastasis in colorectal cancer, and malignant thyroid nodules. OBJECTIVE To assess the in vivo feasibility of EUS-guided laser ablation with an Nd:YAG laser of normal pancreatic tissue of a porcine model. DESIGN Prospective investigation. SETTING Hospital animal laboratory. SUBJECTS Eight pigs. INTERVENTIONS EUS-guided puncture of the pancreatic tail with a laser-beam fiber. An Nd:YAG laser (1.064 nm) was used, with an output power of 2 and 3 W and a total delivered energy of 500 and 1000 J in continuous mode. MAIN OUTCOME MEASUREMENTS The 24-hour follow-up of the pigs was focused on clinical and laboratory aspects. Results of histological studies of the pancreas were obtained 24 hours after the procedure on necroscopy tissue. RESULTS There were no technical limitations to the performance of the procedure. Tissue necrosis, localized in the pancreatic parenchyma, was observed in all animals on histological examination. The volume of ablation tissue ranged from a mean of 314 mm(3) to 483 mm(3). The ablation area ranged from a mean of 49 mm(2) to 80 mm(2). No major postprocedure complications were recorded, and all the pigs survived at 24 hours. LIMITATION Animal study. CONCLUSIONS EUS-guided laser ablation of the pancreas with an Nd:YAG laser is feasible in a porcine model.

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.

Microfabricated Tactile Sensors for Biomedical Applications: A Review

During the last decades, tactile sensors based on different sensing principles have been developed due to the growing interest in robotics and, mainly, in medical applications. Several technological solutions have been employed to design tactile sensors; in particular, solutions based on microfabrication present several attractive features. Microfabrication technologies allow for developing miniaturized sensors with good performance in terms of metrological properties (e.g., accuracy, sensitivity, low power consumption, and frequency response). Small size and good metrological properties heighten the potential role of tactile sensors in medicine, making them especially attractive to be integrated in smart interfaces and microsurgical tools. This paper provides an overview of microfabricated tactile sensors, focusing on the mean principles of sensing, i.e., piezoresistive, piezoelectric and capacitive sensors. These sensors are employed for measuring contact properties, in particular force and pressure, in three main medical fields, i.e., prosthetics and artificial skin, minimal access surgery and smart interfaces for biomechanical analysis. The working principles and the metrological properties of the most promising tactile, microfabricated sensors are analyzed, together with their application in medicine. Finally, the new emerging technologies in these fields are briefly described.