Table Of ContentImage-Guided Therapy Systems
ART_Vaezy_FM.indd i MTC 05/21/2009
Artech House Series
Engineering in Medicine & Biology
Series Editors
Martin L. Yarmush, Harvard Medical School
Christopher J. James, University of Southampton
Advanced Methods and Tools for ECG Data Analysis,
Gari D. Clifford, Francisco Azuaje, and Patrick E. McSharry, editors
Advances in Photodynamic Therapy: Basic, Translational, and Clinical,
Michael Hamblin and Pawel Mroz, editors
Biological Database Modeling, Jake Chen and Amandeep S. Sidhu, editors
Biomedical Informatics in Translational Research, Hai Hu, Michael Liebman,
and Richard Mural
Biomedical Surfaces, Jeremy Ramsden
Genome Sequencing Technology and Algorithms, Sun Kim, Haixu Tang, and
Elaine R. Mardis, editors
Image-Guided Therapy Systems, Shahram Vaezy and Vesna Zderic, editors
Inorganic Nanoprobes for Biological Sensing and Imaging, Hedi Mattoussi
and Jinwoo Cheon, editors
Intelligent Systems Modeling and Decision Support in Bioengineering,
Mahdi Mahfouf
Life Science Automation Fundamentals and Applications, Mingjun Zhang,
Bradley Nelson, and Robin Felder, editors
Microscopic Image Analysis for Life Science Applications, Jens Rittscher,
Stephen T. C. Wong, and Raghu Machiraju, editors
Next Generation Artificial Vision Systems: Reverse Engineering the Human
Visual System, Maria Petrou and Anil Bharath, editors
Quantitative EEG Analysis Methods and Clinical Applications
Shanbao Tong and Nitish V. Thakor, editors
Systems Bioinformatics: An Engineering Case-Based Approach, Gil Alterovitz
and Marco F. Ramoni, editors
Systems Engineering Approach to Medical Automation, Robin Felder
Translational Approaches in Tissue Engineering and Regenerative Medicine,
Jeremy Mao, Gordana Vunjak-Novakovic, Antonios G. Mikos, and
Anthony Atala, editors
ART_Vaezy_FM.indd ii MTC 05/21/2009
Image-Guided Therapy Systems
Shahram Vaezy
Vesna Zderic
Editors
artechhouse.com
ART_Vaezy_FM.indd iii MTC 05/21/2009
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A catalog record for this book is available from the U.S. Library of Congress.
British Library Cataloguing in Publication Data
A catalog record for this book is available from the British Library.
ISBN-13: 978-1-59693-109-1
Cover design by Yekaterina Ratner
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ART_Vaezy_FM.indd iv MTC 05/21/2009
Contents
Preface xv
ParT I
Introduction: Diagnosis and Therapy 1
ChaPTer 1
Diagnosis and Therapy: History, Current Status, and Future Directions 3
1.1 Ancient Times 3
1.2 Renaissance 6
1.3 Open Surgery in Modern Times 6
1.4 Image-Guided Minimally Invasive and Noninvasive Therapies 10
References 16
ChaPTer 2
Medical Imaging 17
2.1 Ultrasound 18
2.1.1 Fundamental Ultrasound 18
2.1.2 Doppler Ultrasound 19
2.1.3 Contrast Enhanced Ultrasound 20
2.1.4 New Technologies for Guidance 22
2.2 Imaging Methods Using Ionizing Radiation 24
2.2.1 Conventional Radiography 25
2.2.2 Computed Tomography 28
2.2.3 Nuclear Medicine 37
2.3 Magnetic Resonance Imaging 39
2.3.1 Conventional MRI 40
2.3.2 Functional MRI 43
2.4 Combination of Imaging Modalities 47
2.4.1 Endoscopic Retrograde Cholangio-Pancreatography 47
2.4.2 CT Myelography 48
2.4.3 MR Arthrography 49
2.4.4 Fusion Imaging 50
References 53
ParT II
Interventional Therapy Modalities 59
v
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vi Contents
ChaPTer 3
Minimally Invasive Endoscopic Surgery and Intraluminal Endoscopy:
Videoscopic-Guided Therapy Systems 61
3.1 Minimally Invasive Surgery 62
3.1.1 Origins of MIS 62
3.1.2 MIS—A System for Surgical Therapy 65
3.1.3 Integration of the MIS System: The MIS Operating Suite 70
3.1.4 Current-Day MIS: Its Uses and Limitations 72
3.2 Intraluminal Flexible Endoscopy 73
3.2.1 Origin of Intraluminal Endoscopy 73
3.2.2 Diagnostic Flexible Endoscopy 74
3.3 Future Directions: Videoendoscopic-Guided Therapy 74
References 74
ChaPTer 4
Image-Guided Radiation Therapy: From Concept to Practice 75
4.1 Therapeutic Ratio (TR) 75
4.2 Targeting 76
4.2.1 Radiography 77
4.2.2 Computerized Tomography (CT) 78
4.2.3 Magnetic Resonance Imaging (MRI) 78
4.2.4 Positron Emission Tomography (PET) 78
4.2.5 Ultrasonography (US) 78
4.3 Methods of Delivering IGRT 80
4.3.1 Setup Uncertainties 81
4.4 Delivery of IGRT 85
4.4.1 Adaptive Versus Integrated IGRT Systems 85
4.4.2 Treating Moving Targets 86
4.4.3 Megavolt Cone Beam Computerized Tomography (MVCBCT)
System 87
4.4.4 Kilovoltage Cone Beam Computerized Tomography (KVCBCT)
System 88
4.5 Quality Assurance (QA) for IGRT Systems 90
4.5.1 Safety Checks 90
4.5.2 Geometric Accuracy 90
4.5.3 Image Quality 90
4.5.4 Image Registration Accuracy 91
4.5.5 Dose Computation and Delivery 91
4.6 Conclusion 93
References 93
ChaPTer 5
Radiofrequency Ablation 97
5.1 Introduction 97
5.2 Biophysics of RF Ablation 97
5.2.1 Physics of RF Heating 97
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Contents vii
5.2.2 Power Control Algorithms 100
5.2.3 Principles of Thermal Tissue Injury 100
5.3 Cardiac RF Catheter Ablation 101
5.3.1 Clinical Background 101
5.3.2 Devices 102
5.3.3 Comparison of Cardiac RF and Cryo-Ablation 103
5.4 RF Tumor Ablation 104
5.4.1 Clinical Background 104
5.4.2 Devices 106
5.4.3 Current Limitations 106
5.4.4 Comparison of Tumor RF, Microwave, and Cryo-Ablation 106
5.5 Other Applications of RF Ablation 108
5.5.1 Endometrial Ablation 108
5.5.2 Endovascular Ablation 109
5.5.3 Corneal Ablation 109
5.5.4 Other Applications 109
References 109
ChaPTer 6
Microwave Ablation 111
6.1 Introduction 111
6.2 Physics and Physiology of Microwave Ablation 111
6.3 Current Microwave Ablation Technology 113
6.4 Clinical Applications 116
6.4.1 Liver Cancer 116
6.4.2 Lung Cancer 116
6.4.3 Kidney Cancer 117
6.5 Discussion 118
References 119
ChaPTer 7
Lasers and Photodynamic Therapy (PDT) in Imaging and Therapy 121
7.1 Lasers 121
7.1.1 Definitions 121
7.1.2 The Characteristics of Laser Light 122
7.1.3 The Laser-Tissue Interaction 122
7.1.4 Types of Lasers 124
7.1.5 Anatomo-Pathological Features of the Laser-Tissue Interaction
(Tissue Injuries) 125
7.1.6 Laser Surgery with Thermal Lasers: What Are the Advantages
over Conventional Surgical Methods? 127
7.2 The Photodynamic Processes 131
7.2.1 Photodiagnosis/Fluorescence Imaging 131
7.2.2 Photodynamic Therapy 135
7.3 Conclusion 140
References 141
Selected Bibliography 143
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viii Contents
ChaPTer 8
Image-Guided Cryotherapy: An Emphasis on Liver Tumors 145
8.1 Introduction 145
8.2 Cryobiology 146
8.3 Cryotherapy 148
8.3.1 Historical Aspects 148
8.3.2 Imaging Modalities for Percutaneous Cryotherapy 148
8.3.3 MRI-Guided Cryotherapy 149
8.4 Clinical Applications of Cryotherapy 151
8.4.1 Liver 151
8.4.2 Kidney 154
8.4.3 Gynecological Applications in Uterine Fibroids
and Breast Cancer 154
8.4.4 Prostate 155
8.5 Current Status, Limitations, and Future Aspects 155
References 156
ChaPTer 9
Gamma Knife Radiosurgery 161
9.1 History of the Gamma Knife Development 161
9.2 Mechanical Design of the Perfexion 164
9.3 Treatment Planning 167
9.3.1 Principles 167
9.3.2 Treatment Planning with the Perfexion 168
9.4 Clinical Data 168
9.4.1 Principles of Radiosurgery Dose Selection and Prediction
of Outcome 169
9.4.2 Benign Tumors 170
9.4.3 Malignant Tumors 171
9.4.4 Functional Disorders 173
9.5 Conclusion 173
References 173
ChaPTer 10
Ultrasound Mediated Drug and Gene Delivery 177
10.1 Introduction 177
10.2 Ultrasound Mechanisms for Enhancing Drug and Gene Delivery 178
10.2.1 Heat Generation 178
10.2.2 Acoustic Cavitation 179
10.2.3 Acoustic Radiation Forces 180
10.3 Applications 180
10.3.1 Sonophoresis 180
10.3.2 Blood Brain Barrier Disruption 181
10.3.3 Thrombolysis 182
10.3.4 Gene Delivery 182
10.3.5 Remote Activation/Deployment of Drugs and Genes 186
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Contents ix
10.4 Conclusion 190
Acknowledgments 190
References 190
ChaPTer 11
Therapeutic Hyperthermia 197
11.1 Introduction 197
11.2 Types of Hyperthermia 198
11.2.1 Local Hyperthermia 199
11.2.2 Regional Hyperthermia 200
11.2.3 Whole-Body Hyperthermia (WBH) 202
11.2.4 Extracellular Hyperthermia 202
11.3 Hyperthermia Devices 203
11.3.1 Techniques 203
11.3.2 External RF Applicators 205
11.3.3 Radiative EM Devices 207
11.3.4 Interstitial and Intracavitary Devices 208
11.3.5 Nanotechnology-Based Hyperthermia 209
11.4 Hyperthermia with Other Modalities 210
11.4.1 Hyperthermia and Radiation 211
11.4.2 Hyperthermia and Chemotherapy 211
11.4.3 Hyperthermia and Radiochemotherapy 212
11.5 Dosimetry for Hyperthermia 212
11.5.1 Modeling Power Deposition 212
11.5.2 Thermal Modeling 214
11.6 Imaging Techniques 216
11.6.1 Ultrasound 216
11.6.2 Magnetic Resonance Imaging 218
11.6.3 Microwave Radiometric Imaging 219
11.6.4 Terahertz Technology 220
11.7 Concluding Remarks 222
References 224
ParT III
Image-Guided Therapy 227
ChaPTer 12
Image-Guided High Intensity Focused Ultrasound 229
12.1 Basic Principles 229
12.1.1 Ultrasound Principles 230
12.1.2 Mechanisms of Bioeffects 231
12.1.3 Transducers and Ultrasound Fields 231
12.2 Treatment Approach and Systems 233
12.2.1 MRI Guidance 233
12.2.2 Ultrasound 234
12.3 Applications 236
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