Therapeutic ultrasound an overview

Therapeutic ultrasound is defined as the use of ultrasound for the treatment of diseased or injured organs or bodily structures and is quite distinct from diagnostic ultrasound. There were many early attempts in the past to use ultrasound in therapy for a variety of applications and while some of these have not been pursued others have led on to clinical applications which are now used routinely. Such progress has been made possible by a number of factors including advances in transducer design, more accurate measurement and calibration of acoustic power and careful experiments to determine the precise nature of chemical processes taking place during and following the exposure of tissue to ultrasound. Major advances have been made in some fields where ultrasound is used such as physiotherapy, surgical instruments, chemotherapy, drug delivery and more recently, high intensity focused ultrasound (HIFU). The last of these has seen enormous activity leading to the formation of the International Society of Therapeutic Ultrasound and a number of very well attended regular specialist meetings. In this review some historical perspectives of therapeutic ultrasound and progress in the field since the early 1990's will be presented.     

Nonlinear absorption in biological tissue for high intensity focused ultrasound

In recent years the propagation of the high intensity focused ultrasound (HIFU) in biological tissue is an interesting area due to its potential applications in non-invasive treatment of disease. The base principle of these applications is the heat effect generated by ultrasound absorption. In order to control therapeutic efficiency, it is important to evaluate the heat generation in biological tissue irradiated by ultrasound. In his paper, based on the Khokhlov-Zabolotkaya-Kuznetsov (KZK) equation in frequency-domain, the numerical simulations of nonlinear absorption in biological tissues for high intensity focused ultrasound are performed. We find that ultrasound thermal transfer effect will be enhanced with the increasing of initial acoustic intensity due to the high harmonic generation. The concept of extra absorption factor is introduced to describe nonlinear absorption in biological tissue for HIFU. The theoretical results show that the heat deposition induced by the nonlinear theory can be nearly two times as large as that predicated by linear theory. Then, the influence of the diffraction effect on the position of the focus in HIFU is investigated. It is shown that the sound focus moves toward the transducer compared with the geometry focus because of the diffraction of the sound wave. The position of the maximum heat deposition is shifted to the geometry focus with the increase of initial acoustic intensity because the high harmonics are less diffraction. Finally, the temperature in the porcine fat tissue changing with the time is predicated by Pennes' equation and the experimental results verify the nonlinear theoretical prediction.     

高强度聚焦超声用于肿瘤治疗的研究

高强度聚焦超声（ＨＩＦＵ）能在短时间内使病变组织的温度升至７０℃以上,导致病变组织凝固坏死,是一种具有巨大潜力的、非侵入的、有效的肿瘤治疗手段。本文对ＨＩＦＵ的动物试验、临床应用及治疗装置的研究情况进行了总结,分析了该技术尚存在的问题,最后展望了其应用前景。     

Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview

The ideal treatment of localized cancer should directly cause an irreversible and complete death of tumor cells without damage to surrounding normal tissue. High intensity focused ultrasound (HIFU) is such a potential treatment, which induces a complete coagulative necrosis of a tumor at depth through the intact skin. The idea that using an extracorporeal source of therapeutic ultrasound was introduced more than 50 years ago [J. Gen. Physiol. 26 (1942) 179]. However, up to now, most of the studies on HIFU have been dealing with animal experiments because this extracorporeal technique is very complicated in clinical applications. The purpose of this study is to introduce Chinese clinical experience of using extracorporeal HIFU for the treatment of patients with various kinds of solid tumor. From December 1997 to October 2001, a total of 1038 patients with solid tumors underwent HIFU ablation in China. Among them, 313 patients were treated at the Chongqing University of Medical Sciences, China. Pathological examination showed that the target region presented clear evidence of cellular destruction. Small blood vessels less than 2 mm in diameter were severely damaged. Follow-up diagnostic imaging revealed that there was no, or reduced, blood supply, and no uptake of radioisotope in the treated tumor after HIFU, both indicating a positive therapeutic response and an absence of viable tumor. Imaging at 6-12 months showed obvious regression of the lesion. Four-year follow-up data were significantly observed in patients with hepatocellular carcinoma, osteosarcoma, and breast cancer. An extremely low major complication rate was noted. It is concluded that HIFU ablation is a safe, effective, and feasible modality for the ablation of carcinomas.     

液体中高强度聚焦超声场及其测量

基于已知文献,文章介绍了液体中高强度聚焦超声场的基本性质,包括传播、频谱、吸收、聚焦、辐射力等特性,描述了它的物理图景和测量方法。     

Study of a peak in cavitation activity from HIFU exposures using TA fluorescence

Methods of measuring the sound field and focal region of a 1.05 MHz high intensity focused ultrasound (HIFU) are described in this paper. 1.05 MHz pulsed HIFU with intensity 2400 W/cm(2) with a 1:1 duty cycle ("on" phase equaled "off" phase) was used to irradiate terephthalic acid (TA). Pulse periods of 0.5 ms, 1 ms, 3.3 ms, 10 ms, 15 ms, 33 ms, 0.1s and 1s were used. The irradiation time was 2 min. To indicate the intensity of inertial cavitation activity, the fluorescence intensity of hydroxyterephthalic acid (HTA) was measured. The result shows that the cavitation activity of pulsed HIFU peaks at a pulse period of 10 ms, cavitation activity is significantly greater for pulse periods from 2 to 20 ms than for others.     

Laser-enhanced thermal effect of moderate intensity focused ultrasound on bio-tissues

For avoiding extra-damage to healthy tissues surrounding the focal point during high intensity focused ultrasound (HIFU) treatment in medical therapy, to reduce the ultrasonic intensity outside the focal point is expected. Thus, the heating processes induced by moderate intensity focused ultrasound (MIFU) and enhanced by combined irradiation of laser pulses for bio-tissues are studied in details. For fresh bio-tissues, the enhanced thermal effects by pulsed laser combined with MIFU irradiation are observed experimentally. To explore the mechanisms of these effects, several tissue-mimicking materials composed of agar mixed with graphite powders are prepared and studied for comparison, but the laser-enhanced thermal effects in these mimicking materials are much less than that in the fresh bio-tissues. Therefore, it is suggested that the laser-enhanced thermal effects may be mainly attributed to bio-activities and related photo-bio-chemical effects of fresh tissues.     

高强聚焦超声(HIFU)加热活体组织中的温度分布

在高强聚焦超声(HIFU)加热的情况下,利用多针射频(RF)测温装置测量活体组织内的温度分布,结果表明,温度梯度依赖于局部温度,温度越高,梯度越大。此外,本文还研究了血流对温度梯度的影响,结果似乎证实了理论预测,即血流(或血液灌注)减缓了温度(梯度)的变化。     

Ultrasound in contemporary physiotherapy practice

The use of therapeutic ultrasound as an element of physiotherapy practice is well established, but the nature of that practice has changed significantly over the last 20 years. This paper aims to review the rationale and range of applications for which this modality is employed in current practice. Whereas in the past, its primary use was as a thermal modality, it is argued that currently, it is the ‘non-thermal’ aspects of the intervention that are most commonly employed. The predominant use of therapeutic ultrasound is in relation to tissue repair and soft tissue lesion management, where the evidence would support its application in the inflammatory, proliferative and remodelling phases. The clinical outcomes appear to be dose dependent, and whilst this paper does not detail dose related clinical decision making, the broad issues are considered. The future possibilities for the use of the modality are reviewed, and although outside the immediate remit of this paper, the use of therapeutic ultrasound in fracture management is briefly considered.     

热疗用聚焦超声换能器的研究

本文通过数值计算及实际测量,研究了凹球面声透镜聚焦换能器及凹球面自聚焦换能器产生的声场,证实此两种聚焦方式均可获得理想的聚焦效果,但自聚焦方式更适合高强度聚焦超声(HIFU)加热治疗。     

Evaluation of the acoustic intensity of new ultrasound therapy equipment

International safety standards recommend a limit below 30% variation in acoustic intensity for ultrasound therapy (UST) equipment. In view of this question, the purpose of this work was to evaluate the intensity of new UST equipment in the Brazilian market. An evaluation was performed of eight models manufactured by six different national manufacturers; under continuous and pulsed conditions, at frequencies of 1.0-3.0 MHz, for a total of 48 items of equipment. The intensities were analysed according to the technical standards IEC 601-2-5, in the range 0.01-3.0 Wcm(-2), using a radiation pressure scale UPM-DT-10 (Ohmic Instruments), previously calibrated. The results demonstrated that the models Sonacel, Sonacel plus, Sonacel III, Avatar I, and Sonamed I, although they were new (unused) presented calibration errors of over 30% in more than one intensity checked, and the models SONOPULSE, PRO-SEVEN and SONOMASTER ST. are within the standards proposed. The results show that industry must improve quality control on their production lines, as well as that there is a need for a supervising body at national level. Published by Elsevier Science B.V.     

泌尿系统治疗用HIFU换能器的设计

高强度聚焦超声技术是‘种将超声能量聚焦于人体深部组织的狭小区域,形成足够高的声强,使组织瞬时在局部产生高温、无创性局部治疗肿瘤的新技术。近年来,泌尿系统疾病发病率迅速上升,尤其是前列腺疾病发病率高,相关的并发症也较多,已成为威胁男性生命健康的重要疾病。本文应用高强度聚焦超声技术,设计了治疗泌尿系统疾病的线阵换能器。仿真结果证明:该换能器的卢场能量集中,声强峰值尖锐,焦点尺十小,聚焦效果好,可以达到有效无损治疗的目的。     

A derating method for therapeutic applications of high intensity focused ultrasound

Current methods of determining high intensity focused ultrasound (HIFU) fields in tissue rely on extrapolation of measurements in water assuming linear wave propagation both in water and in tissue. Neglecting nonlinear propagation effects in the derating process can result in significant errors. A new method based on scaling the source amplitude is introduced to estimate focal parameters of nonlinear HIFU fields in tissue. Focal values of acoustic field parameters in absorptive tissue are obtained from a numerical solution to a KZK-type equation and are compared to those simulated for propagation in water. Focal wave-forms, peak pressures, and intensities are calculated over a wide range of source outputs and linear focusing gains. Our modeling indicates, that for the high gain sources which are typically used in therapeutic medical applications, the focal field parameters derated with our method agree well with numerical simulation in tissue. The feasibility of the derating method is demonstrated experimentally in excised bovine liver tissue.     

Characterization of high intensity focused ultrasound transducers using acoustic streaming

A new approach for characterizing high intensity focused ultrasound (HIFU) transducers is presented. The technique is based upon the acoustic streaming field generated by absorption of the HIFU beam in a liquid medium. The streaming field is quantified using digital particle image velocimetry, and a numerical algorithm is employed to compute the acoustic intensity field giving rise to the observed streaming field. The method as presented here is applicable to moderate intensity regimes, above the intensities which may be damaging to conventional hydrophones, but below the levels where nonlinear propagation effects are appreciable. Intensity fields and acoustic powers predicted using the streaming method were found to agree within 10% with measurements obtained using hydrophones and radiation force balances. Besides acoustic intensity fields, the streaming technique may be used to determine other important HIFU parameters, such as beam tilt angle or absorption of the propagation medium.     

Targeted damage effects of high intensity focused ultrasound (HIFU) on liver tissues of Guizhou Province miniswine

HIFU can pass through tissues and accurately damage target tissues inside organisms. This article reports on the oriented damage effects of HIFU upon miniswine internal and external liver tissues, and suggests a new conception of the 'biological focal field'. The results revealed that: (1) HIFU can be used to damage accurately liver tissues under the guide of a B-modal ultrasound device; (2) the scope of the injury is connected with sound intensity and irradiation time; and (3) the different layers of tissue through which the ultrasound has passed remain undamaged.     

A reduced-order, single-bubble cavitation model with applications to therapeutic ultrasound

Cavitation often occurs in therapeutic applications of medical ultrasound such as shock-wave lithotripsy (SWL) and high-intensity focused ultrasound (HIFU). Because cavitation bubbles can affect an intended treatment, it is important to understand the dynamics of bubbles in this context. The relevant context includes very high acoustic pressures and frequencies as well as elevated temperatures. Relative to much of the prior research on cavitation and bubble dynamics, such conditions are unique. To address the relevant physics, a reduced-order model of a single, spherical bubble is proposed that incorporates phase change at the liquid-gas interface as well as heat and mass transport in both phases. Based on the energy lost during the inertial collapse and rebound of a millimeter-sized bubble, experimental observations were used to tune and test model predictions. In addition, benchmarks from the published literature were used to assess various aspects of model performance. Benchmark comparisons demonstrate that the model captures the basic physics of phase change and diffusive transport, while it is quantitatively sensitive to specific model assumptions and implementation details. Given its performance and numerical stability, the model can be used to explore bubble behaviors across a broad parameter space relevant to therapeutic ultrasound.     

高强度聚焦超声(HIFU)——一门多学科的研究课题

高强度聚焦超声(high intensity focused ultrasound,简称HIFU)已作为一种无创外科工具而应用于门诊治疗肿瘤。文章介绍了它的基本原理、有关的研究现状和存在的问题,以及对今后研究工作的建议。文章特别强调高强度聚焦超声是一门多学科的综合研究课题,需要各方面的科学工作者通力协作。     

How BRH,FCC, CPSC,FDA & OSHA regulations affect you

United States Government regulations cover industrial, medical and consumer ultrasound products for the protection of those using the equipment. There are currently five government agencies which regulate permissible power, intensity and radiation field patterns; permissible frequency and power bands; safety standards for the protection of consumers using ultrasound devices; safety and design standards for diagnosis and therapy by physicians; and standards for the protection of workers in factories using ultrasonic equipment.     

The affection on the tissue lesions of difference frequency in dual-frequency high-intensity focused ultrasound (HIFU)

The lesions induced by dual-frequency high-intensity focused ultrasound (HIFU) in freshly excised porcine livers were investigated and compared with the lesions induced by conventional single-frequency HIFU. The results have shown that using different exposure time resulted in lesions of different sizes in both dual-frequency and single-frequency HIFU modes at the same intensity level (ISAL = 808 W cm(-2)), but the dimensions of lesions in dual-frequency mode were obviously larger than those in single-frequency mode. A much possible explanation was suggested for the results and the possibilities of applications in the future were also discussed in brief.