Continuous-mode 448 kHz capacitive resistive monopolar radiofrequency induces greater deep blood flow changes compared to pulsed mode shortwave: a crossover study in healthy adults

This document is the Accepted Manuscript version of the following article: Binoy Kumaran, Anthony Herbland and Tim Watson, ‘Continuous-mode 448 kHz capacitive resistive monopolar radiofrequency induces greater deep blood flow changes compared to pulsed mode shortwave: a crossover study in healthy adults’, European Journal of Physiotheraphy, first published online 20 April 2017. The version of record is available online at doi: http://dx.doi.org/10.1080/21679169.2017.1316310. © 2017 Informa UK Limited, trading as Taylor & Francis Group.Aims: Radiofrequency-based electrophysical agents (EPAs) have been used in therapy practice over several decades (e.g. shortwave therapies). Currently, there is insufficient evidence supporting such EPAs operating below shortwave frequencies. This laboratory-based study investigated the deep physiological effects of 448 kHz capacitive resistive monopolar radiofrequency (CRMRF) and compared them to pulsed shortwave therapy (PSWT). Methods: In a randomized crossover study, 17 healthy volunteers initially received four treatment conditions: high, low and placebo dose conditions receiving 15-min CRMRF treatment and a control condition receiving no intervention. Fifteen participants additionally received high-dose PSWT as fifth condition, for comparison. Pre- and post-treatment measurements of deep blood flow and tissue extensibility were obtained using Doppler ultrasound and sonoelastography. Group data were compared using analysis of variance model. Statistical significance was set at p ≤ .05, 0.8 power, and 95% confidence interval. Results: Significant increases in volume and intensity of deep blood flow were obtained with CRMRF over placebo, control (p = .003) and PSWT (p < .001). No significant changes in blood flow velocity or tissue extensibility were noted for any condition. Conclusions: Deep blood flow changes with CRMRF were more pronounced than that with PSWT, placebo or control. Potential greater therapeutic benefits need to be confirmed with comparative clinical studies.Peer reviewe

Automatic control of finite element models for temperature-controlled radiofrequency ablation

BACKGROUND: The finite element method (FEM) has been used to simulate cardiac and hepatic radiofrequency (RF) ablation. The FEM allows modeling of complex geometries that cannot be solved by analytical methods or finite difference models. In both hepatic and cardiac RF ablation a common control mode is temperature-controlled mode. Commercial FEM packages don't support automating temperature control. Most researchers manually control the applied power by trial and error to keep the tip temperature of the electrodes constant. METHODS: We implemented a PI controller in a control program written in C++. The program checks the tip temperature after each step and controls the applied voltage to keep temperature constant. We created a closed loop system consisting of a FEM model and the software controlling the applied voltage. The control parameters for the controller were optimized using a closed loop system simulation. RESULTS: We present results of a temperature controlled 3-D FEM model of a RITA model 30 electrode. The control software effectively controlled applied voltage in the FEM model to obtain, and keep electrodes at target temperature of 100°C. The closed loop system simulation output closely correlated with the FEM model, and allowed us to optimize control parameters. DISCUSSION: The closed loop control of the FEM model allowed us to implement temperature controlled RF ablation with minimal user input

Parameter Estimation for Personalization of Liver Tumor Radiofrequency Ablation

International audienceMathematical modeling has the potential to assist radiofrequency ablation (RFA) of tumors as it enables prediction of the extent of ablation. However, the accuracy of the simulation is challenged by the material properties since they are patient-specific, temperature and space dependent. In this paper, we present a framework for patient specific radiofrequency ablation modeling of multiple lesions in the case of metastatic diseases. The proposed forward model is based upon a computational model of heat diffusion, cellular necrosis and blood flow through vessels and liver which relies on patient images. We estimate the most sensitive material parameters, those need to be personalized from the available clinical imaging and data. The selected parameters are then estimated using inverse modeling such that the point to-mesh distance between the computed necrotic area and observed lesions is minimized. Based on the personalized parameters, the ablation of the remaining lesions are predicted. The framework is applied to a dataset of seven lesions from three patients including pre- and post-operative CT images. In each case, the parameters were estimated on one tumor and RFA is simulated on the other tumor(s) using these personalized parameters, assuming the parameters to be spatially invariant within the same patient. Results showed significantly good correlation between predicted and actual ablation extent (average point-to-mesh errors of 4.03 mm)

A 63 element 1.75 dimensional ultrasound phased array for the treatment of benign prostatic hyperplasia

BACKGROUND: Prostate cancer and benign prostatic hyperplasia are very common diseases in older American men, thus having a reliable treatment modality for both diseases is of great importance. The currently used treating options, mainly surgical ones, have numerous complications, which include the many side effects that accompany such procedures, besides the invasive nature of such techniques. Focused ultrasound is a relatively new treating modality that is showing promising results in treating prostate cancer and benign prostatic hyperplasia. Thus this technique is gaining more attention in the past decade as a non-invasive method to treat both diseases. METHODS: In this paper, the design, construction and evaluation of a 1.75 dimensional ultrasound phased array to be used for treating prostate cancer and benign prostatic hyperplasia is presented. With this array, the position of the focus can be controlled by changing the electrical power and phase to the individual elements for electronically focusing and steering in a three dimensional volume. The array was designed with a maximum steering angle of ± 13.5° in the transverse direction and a maximum depth of penetration of 11 cm, which allows the treatment of large prostates. The transducer piezoelectric ceramic, matching layers and cable impedance have been designed for maximum power transfer to tissue. RESULTS: To verify the capability of the transducer for focusing and steering, exposimetry was performed and the results correlated well with the calculated field. Ex vivo experiments using bovine tissue were performed with various lesion sizes and indicated the capability of the transducer to ablate tissue using short sonications. CONCLUSION: A 1.75 dimensional array, that overcame the drawbacks associated with one-dimensional arrays, has been designed, built and successfully tested. Design issues, such as cable and ceramic capacitances, were taken into account when designing this array. The final prototype overcame also the problem of generating grating lobes at unwanted locations by tapering the array elements

Thermal modeling of lesion growth with radiofrequency ablation devices

BACKGROUND: Temperature is a frequently used parameter to describe the predicted size of lesions computed by computational models. In many cases, however, temperature correlates poorly with lesion size. Although many studies have been conducted to characterize the relationship between time-temperature exposure of tissue heating to cell damage, to date these relationships have not been employed in a finite element model. METHODS: We present an axisymmetric two-dimensional finite element model that calculates cell damage in tissues and compare lesion sizes using common tissue damage and iso-temperature contour definitions. The model accounts for both temperature-dependent changes in the electrical conductivity of tissue as well as tissue damage-dependent changes in local tissue perfusion. The data is validated using excised porcine liver tissues. RESULTS: The data demonstrate the size of thermal lesions is grossly overestimated when calculated using traditional temperature isocontours of 42°C and 47°C. The computational model results predicted lesion dimensions that were within 5% of the experimental measurements. CONCLUSION: When modeling radiofrequency ablation problems, temperature isotherms may not be representative of actual tissue damage patterns