Catheter-based ultrasound technology for image-guided thermal therapy: Current technology and applications

Figures & data

Table 1. Summary of selected interstitial CBUS devices, their design features, performance evaluations and clinical utilisations.

CBUS device	General design features	Performance	Site-specific evaluations	Clinical utilisation
Interstitial: sectored tubular arrays	Multiple sectored tubular transducer array; 6–8 MHz; 10–15 mm segments; 1.5–2.4 mm OD; Sector-based angular control; Integrated catheter or internal cooling	Lesion dimensions 15–20 mm radial, 10–40 mm length; Ablation and HT; MRTI, CT, US, fluoroscopy guidance	In vivo canine brain [10,37] and prostate [36], porcine liver [31], ovine [21] and rabbit spine [22]	Prostate and cervix hyperthermia with HDR brachytherapy [38]
Interstitial: multi-faced	7-sided catheter assembly w/array of 1 mm × 1 mm transducers; 6 MHz; 8 mm active length; OD = 3.2 mm; angular control through power activation on each face; external cooling sheath	Radial treatment depth >15 mm; MR-compatible with MRTI in 1.5 T	Brain [11]
Interstitial and Intraductal rotating planar	3.8–4 mm OD catheter, 8–10 mm length × 2.8–3.0 mm planar transducer segment ∼5 or 10 MHz, motorised rotation; integrated cooling sheath	∼20 mm radial × 8 mm length penetration, rotation for angular control; endoscopic intraluminal or interstitial; fluoroscopy or US guidance	Porcine biliary tract [84,85] and liver [30,84]	Bile duct carcinoma [124]
Interstitial: dual-mode	Dual-mode linear array, 32 rect. elements, 2.3 × 49 mm^2; 3.1 or 4.8 MHz; Motorised rotational control; Balloon cooling	Lesion dimensions ∼18 mm radial, ∼5 mm wide, ∼15 mm length; Dual-mode with US B-mode imaging	In vivo rabbit liver [14,15]
Interstitial: dual mode with mechanical rotation	Dual-mode linear array; 5 rect. elements, 3 × 20 mm^2, 5–6 MHz, cylindrical focus ∼14 mm; Motorised rotational control; Balloon cooling	Lesion dimensions 19 mm depth, ∼9 mm wide; dual-mode with US therapy with all 5 elements; B-mode imaging with central transducer	Porcine liver in vivo [18]

rect., Rectangular.

Table 2. Summary of selected endoluminal CBUS devices, their design features, performance evaluations and clinical utilisations.

CBUS device	General design features	Performance	Site-specific evaluations	Clinical utilisation
Endoluminal: sectored tubular arrays	Transurethral or endocervical configurations; Multi-sectored tubular transducers, 6–8 MHz, 6–10 mm length segments, 2.5–3.5 mm OD transducers; Sector-based angular control; Cooling balloon or sheath	Transurethral prostate lesion dimensions 15–20 mm radial, 90–120° sectors, × 6–30 mm length; Endocervical hyperthermia ∼20 mm radial, 180 or 120° sectors, × 20–30 mm length	Prostate: Canine in vivo for treating BPH or focal cancer [50]	Cervix Hyperthermia with HDR brachytherapy [38,51]
Endoluminal: planar, rotating	Transurethral configuration with linear array, 1–8 rect., 4.7 and/or 9.7 MHz (dual frequency); 20–40 mm length × 4 mm wide, 6 mm OD; Motorised rotational control; Integrated cooling sheath and membrane	Penetration depth ∼20 mm; Integrated with MRTI-based feedback control; Lesion depth control over rotation; ± 1 mm conformal target boundary	Prostate: canine in vivo [82]	Prostate cancer ablation [55]
Endoluminal: planar with integrated US imaging	Single rect. therapy transducer, 10 MHz; Single rect. imaging element, 12 MHz; 10 mm OD for oesophageal placement; Imaging probe can be deployed and retracted through a channel within the device; Motorised rotational control	Penetration depth ∼10 mm; integrated US imaging for guidance	Esophagus: swine in vivo [83]	Esophageal tumours [59]

rect., Rectangular.

Table 3. Summary of selected endovascular CBUS devices, their design features, performance evaluations and clinical utilisations.

CBUS device	General design features	Performance	Site-specific evaluations	Clinical utilisation
Endovascular: pulmonary vein isolation	Endocardial access for placement within pulmonary vein; Single tubular transducer, 6–8 MHz; Delivery catheter: 2.7–4.7 mm OD; Cooling balloon, multi-chamber balloon w/parabolic reflector.	Penetration depth ∼6 mm CT/fluoroscopic guidance during endocardial access.	Ablation of tissue around pulmonary vein ostium: in vivo canine [90]	Treatment of atrial fibrillation [91,94,95]
Endovascular: renal denervation	Configured for vascular placement within renal artery; 360° tubular transducer, 1 mm OD × 6 mm long transducer, 8–9 MHz; 2 mm OD catheter with 6 mm expandable cooling balloon	Penetration depth ∼7–10 mm × 360°, with sparing of renal artery; Fluoroscopic guidance	Ablation of sympathetic nerves surrounding renal artery, decrease in blood pressure; In vivo porcine [98]	Treatment of resistant hypertension [97]

Figure 1. Figure panels include examples showing selected applications of interstitial CBUS from multiple studies. (A) Prototypes of interstitial devices with sectored tubular transducers with 13-g, 14-g delivery catheters; these catheters are also used in HDR brachytherapy [38]. (B) Photograph of single-element dual-mode ultrasound applicator prototype, and an M-mode image created by the same applicator showing the hypoechoic region corresponding to ablation [17,18]. (C) Example of MR thermometry during interstitial ablation of prostate (in vivo canine) with multiple devices, and post-procedure histology showing good correlation between localised tissue damage and temperature maps [36]. (D) Example of brain tumour ablation and MRTI with an interstitial applicator in a canine subject in vivo to illustrate image-guided device placement and real-time thermometry [10].

Figure 2. This figure shows four examples of endoluminal applicators. (A) Schematic showing a transurethral applicator with multiple planar elements for prostate cancer ablation under MRTI [55]. Image courtesy of Dr. Rajiv Chopra (University of Texas, Southwestern). (B) Example of transurethral prostate ablation for BPH treatment with a multi-sectored tubular transurethral device under MRTI and post ablation CE-MRI in a canine subject in vivo demonstrating selective targeting of transition zone in the prostate [49]. (C) Schematic of a bi-directional endocervical applicator with sectored tubular transducers integrated within a tandem holder used in clinical HDR brachytherapy [51]. (D) Prototype for a transesophageal cardiac ablation applicator with a large HIFU treatment array and central imaging transducer [63]. Image courtesy of Dr. Cyril Lafon (INSERM, France) and Dr. Elodie Constanciel (CIGITI, Sick Kids Hospital, Canada).

Figure 3. Schematic (A) and prototype (B) of a tip-firing cardiac ablation catheter designed for treating atrial fibrillation by ablating tissue around the pulmonary vein circumference. Here, acoustic energy generated by the cylindrical transducer element is reflected by the air-water interface created by the outer air-filled balloon and the inner water-filled coupling balloon [90].

Figure 4. (A) Prototype of a renal denervation device designed for circumferential ablation of nerves surrounding the renal artery (Image courtesy of Recor Medical, Palo Alto, CA). (B) Circumferential ablation demonstrated in a gel phantom by the same device (Image courtesy of Recor Medical, Palo Alto, CA).

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