Thermal ablation with configurable shapes: a comprehensive, automated model for bespoke tumor treatment

Springer Science and Business Media LLC - Tập 7 Số 1
Iwan Paolucci1, Milica Bulatović1, Stefan Weber1, Pascale Tinguely1,2
1ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
2Department of Visceral Surgery and Medicine, Inselspital University Hospital Bern, Bern, Switzerland

Tóm tắt

Abstract Background Malignant tumors routinely present with irregular shapes and complex configurations. The lack of customization to individual tumor shapes and standardization of procedures limits the success and application of thermal ablation. Methods We introduced an automated treatment model consisting of (i) trajectory and ablation profile planning, (ii) ablation probe insertion, (iii) dynamic energy delivery (including robotically driven control of the energy source power and location over time, according to a treatment plan bespoke to the tumor shape), and (iv) quantitative ablation margin verification. We used a microwave ablation system and a liver phantom (acrylamide polymer with a thermochromic ink) to mimic coagulation and measure the ablation volume. We estimated the ablation width as a function of power and velocity following a probabilistic model. Four representative shapes of liver tumors < 5 cm were selected from two publicly available databases. The ablated specimens were cut along the ablation probe axis and photographed. The shape of the ablated volume was extracted using a color-based segmentation method. Results The uncertainty (standard deviation) of the ablation width increased with increasing power by ± 0.03 mm (95% credible interval [0.02, 0.043]) per watt increase in power and by ± 0.85 mm (95% credible interval [0, 2.5]) per mm/s increase in velocity. Continuous ablation along a straight-line trajectory resulted in elongated rotationally symmetric ablation shapes. Simultaneous regulation of the power and/or translation velocity allowed to modulate the ablation width at specific locations. Conclusions This study offers the proof-of-principle of the dynamic energy delivery system using ablation shapes from clinical cases of malignant liver tumors. Relevance statement The proposed automated treatment model could favor the customization and standardization of thermal ablation for complex tumor shapes. Key points • Current thermal ablation systems are limited to ellipsoidal or spherical shapes. • Dynamic energy delivery produces elongated rotationally symmetric ablation shapes with varying widths. • For complex tumor shapes, multiple customized ablation shapes could be combined. Graphical Abstract

Từ khóa


Tài liệu tham khảo

Lin YM, Paolucci I, Brock KK, Odisio BC (2021) Image-guided ablation for colorectal liver metastasis: principles, current evidence, and the path forward. Cancers (Basel) 13:3926. https://doi.org/10.3390/cancers13163926

Chen Z, Xie H, Hu M et al (2020) Recent progress in treatment of hepatocellular carcinoma. Am J Cancer Res 10:2993–3036

Tinguely P, Laurell G, Enander A, Engstrand J, Freedman J (2023) Ablation versus resection for resectable colorectal liver metastases - health care related cost and survival analyses from a quasi-randomised study. Eur J Surg Oncol 49:416–425. https://doi.org/10.1016/j.ejso.2022.09.006

Cervantes A, Adam R, Rosello S et al (2023) Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 34:10–32. https://doi.org/10.1016/j.annonc.2022.10.003

European Association for the Study of the Liver (2018) EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236. https://doi.org/10.1016/j.jhep.2018.03.019

Hof J, Wertenbroek MW, Peeters PM et al (2016) Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases. Br J Surg 103:1055–1062. https://doi.org/10.1002/bjs.10162

Sartori S, Tombesi P, Di Vece F (2015) Radiofrequency, microwave, and laser ablation of liver tumors: time to move toward a tailored ablation technique? Hepatoma Res 1:52–57. https://doi.org/10.4103/2394-5079.155697

Brace C (2011) Thermal tumor ablation in clinical use. IEEE Pulse 2:28–38. https://doi.org/10.1109/MPUL.2011.942603

Ruiter SJS, Tinguely P, Paolucci I et al (2021) 3D quantitative ablation margins for prediction of ablation site recurrence after stereotactic image-guided microwave ablation of colorectal liver metastases: a multicenter study. Front Oncol 11:757167. https://doi.org/10.3389/fonc.2021.757167

Tinguely P, Paolucci I, Ruiter SJS et al (2021) Stereotactic and robotic minimally invasive thermal ablation of malignant liver tumors: a systematic review and meta-analysis. Front Oncol 11:713685. https://doi.org/10.3389/fonc.2021.713685

Tinguely P, Frehner L, Lachenmayer A et al (2020) Stereotactic image-guided microwave ablation for malignant liver tumors-a multivariable accuracy and efficacy analysis. Front Oncol 10:842. https://doi.org/10.3389/fonc.2020.00842

Crocetti L, de Baere T, Pereira PL, Tarantino FP (2020) CIRSE standards of practice on thermal ablation of liver tumours. Cardiovasc Intervent Radiol 43:951–962. https://doi.org/10.1007/s00270-020-02471-z

Wiggermann P, Puls R, Vasilj A et al (2012) Thermal ablation of unresectable liver tumors: factors associated with partial ablation and the impact on long-term survival. Med Sci Monit 18:CR88–92. https://doi.org/10.12659/msm.882463

Zhang R, Wu SC, Wu WW, Gao HJ, Zhou ZH (2019) Computer-assisted needle trajectory planning and mathematical modeling for liver tumor thermal ablation: a review. Math Biosci Eng 16:4846–4872. https://doi.org/10.3934/mbe.2019244

Ben-David E, Shochat M, Roth I et al (2018) Evaluation of a CT-guided robotic system for precise percutaneous needle insertion. J Vasc Interv Radiol 29:1440–1446. https://doi.org/10.1016/j.jvir.2018.01.002

Kaye EA, Cornelis FH, Petre EN et al (2019) Volumetric 3D assessment of ablation zones after thermal ablation of colorectal liver metastases to improve prediction of local tumor progression. Eur Radiol 29:2698–2705. https://doi.org/10.1007/s00330-018-5809-0

Laimer G, Schullian P, Jaschke N et al (2020) Minimal ablative margin (mam) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation. Eur Radiol 30:2463–2472. https://doi.org/10.1007/s00330-019-06609-7

Sandu RM, Paolucci I, Ruiter SJS et al (2021) Volumetric quantitative ablation margins for assessment of ablation completeness in thermal ablation of liver tumors. Front Oncol 11:623098. https://doi.org/10.3389/fonc.2021.623098

Weber S, Gavaghan K, Wimmer W et al (2017) Instrument flight to the inner ear. Sci Robot 2:4916–4916. https://doi.org/10.1126/scirobotics.aal4916

Negussie AH, Partanen A, Mikhail AS et al (2016) Thermochromic tissue-mimicking phantom for optimisation of thermal tumour ablation. Int J Hyperthermia 32:239–243. https://doi.org/10.3109/02656736.2016.1145745

Chu KF, Dupuy DE (2014) Thermal ablation of tumours: biological mechanisms and advances in therapy. Nat Rev Cancer 14:199–208. https://doi.org/10.1038/nrc3672

Paolucci I, Ruiter SJS, Freedman J et al (2022) Volumetric analyses of ablation dimensions in microwave ablation for colorectal liver metastases. Int J Hyperthermia 39:639–648. https://doi.org/10.1080/02656736.2021.1965224

Salvatier J, Wiecki TV, Fonnesbeck C (2016) Probabilistic programming in python using pymc3. PeerJ Computer Science 2:e55. https://doi.org/10.7717/peerj-cs.55

Bilica P, Christa PF, Vorontsov E et al (2019) The Liver Tumor Segmentation Benchmark (LiTS). arXiv:1–43.

IRCAD 3d-ircadb 01. Available via https://www.ircad.fr/research/3d-ircadb-01/.

Garrido-Jurado S, Muñoz-Salinas R, Madrid-Cuevas FJ, Marín-Jiménez MJ (2014) Automatic generation and detection of highly reliable fiducial markers under occlusion. Pattern Recogn 47:2280–2292. https://doi.org/10.1016/j.patcog.2014.01.005

Bale R, Widmann G, Stoffner DI (2010) Stereotaxy: breaking the limits of current radiofrequency ablation techniques. Eur J Radiol 75:32–36. https://doi.org/10.1016/j.ejrad.2010.04.013

Mohammadi AM, Schroeder JL (2014) Laser interstitial thermal therapy in treatment of brain tumors–the neuroblate system. Expert Rev Med Devices 11:109–119. https://doi.org/10.1586/17434440.2014.882225

Kim C (2018) Understanding the nuances of microwave ablation for more accurate post-treatment assessment. Future Oncol 14:1755–1764. https://doi.org/10.2217/fon-2017-0736

Akateh C, Beal EW, Whitson BA, Black SM (2018) Normothermic ex-vivo liver perfusion and the clinical implications for liver transplantation. J Clin Transl Hepatol 6:276–282. https://doi.org/10.14218/JCTH.2017.00048

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Tập 7 Số 1

Thông tin tác giả