重庆医科大学：《超声治疗学》课程教学课件（讲稿）第八章 高强度聚焦超声（HIFU）技术及其临床应用 HIFU Therapeutic Technology

Chap. 8-1HIFU Therapeutic TechnologyLi FaqiDepartment of Biomedical EngineeringInstitute of Ultrasonic Engineering in MedicineChongqing Medical University

Chap. 8-1 HIFU Therapeutic Technology Li Faqi Department of Biomedical Engineering Institute of Ultrasonic Engineering in Medicine Chongqing Medical University

超声治疗学>>Chap.8HIFUTherapeuticTechnology1重点和难点1.HIFU的原理、技术的特征。2.HIFU治疗机制。3.HIFU治疗设备。4.影响聚焦超声换能器的参数，如何影响。5.影响HIFU生物学效应的因素，如何影响。6.监控HIFU的影像技术有哪些，监控的基础是什么。7.临床方案。重庆医科大学生物医学工程系

超声治疗学 >>Chap. 8 HIFU Therapeutic Technology 1 重庆医科大学生物医学工程系 重点和难点 1. HIFU的原理、技术的特征。 2. HIFU治疗机制。 3. HIFU 治疗设备。 4. 影响聚焦超声换能器的参数，如何影响。 5. 影响HIFU生物学效应的因素，如何影响。 6. 监控HIFU的影像技术有哪些，监控的基础是什么。 7. 临床方案

超声治疗学>>Chap,8HIFUTherapeuticTechnology！Thermal therapies ."Those diseases that medicines donot cure are cured by knife. Thosethat the knife does not cure, arecured by fire, and those that firedoes not cure must be consideredincurable"Hippocrates (400 B.C)重庆医科大学生物医学工程系

超声治疗学 >>Chap. 8 HIFU Therapeutic Technology 1 重庆医科大学生物医学工程系 Thermal therapies . “Those diseases that medicines do not cure are cured by knife. Those that the knife does not cure, are cured by fire, and those that fire does not cure must be considered incurable” Hippocrates (400 B.C.)

超声治疗学>>Chap.8HIFUTherapeuticTechnology1Therapeutic transducerTissueHIFU noninvasiveablationoftumorlesionCoagulative necrosis at focus微淘HIFU远程监控中心OXDiagnostic transducerLesion of liver cancerTherapeutic transducer重庆医科大学生物医学工程系

超声治疗学 >>Chap. 8 HIFU Therapeutic Technology 1 重庆医科大学生物医学工程系 Tissue Coagulative necrosis at focus Therapeutic transducer Diagnostic transducer Lesion of liver cancer HIFU noninvasive ablation of tumor lesion Therapeutic transducer

超声治疗学>>Chap.8HIFUTherapeuticTechnology1History of HIFU 1927-Wood and Loomis: biological effects of high-intensity ultrasound 1942-Lynn et al:potential applications of HIFU 1954-William Fry et al:lesions in brains of cats and monkeys 1958-Frank Fry:system for treatment Parkinson's disease--interest in HIFU then diverted to other applications. 1956-Burov:high-intensity ultrasound as cancer treatment-For 3 decades -much independent research into wider applications. 1993/4-First reports of clinical use to target prostate (BPH/Ca) 1997-First clinical treatment of liver cancer, breast cancer, bone tumour恒in China.重庆医科大学生物医学工程系

超声治疗学 >>Chap. 8 HIFU Therapeutic Technology 1 重庆医科大学生物医学工程系 History of HIFU ‰ 1927–Wood and Loomis: biological effects of high-intensity ultrasound ‰ 1942–Lynn et al: potential applications of HIFU ‰ 1954–William Fry et al: lesions in brains of cats and monkeys ‰ 1958–Frank Fry: system for treatment Parkinson’s disease -interest in HIFU then diverted to other applications. ‰ 1956–Burov: high-intensity ultrasound as cancer treatment -For 3 decades -much independent research into wider applications. ‰ 1993/4–First reports of clinical use to target prostate (BPH/Ca) ‰ 1997 –First clinical treatment of liver cancer, breast cancer, bone tumour in China

超声治疗学>>Chap.8HIFUTherapeuticTechnology1TechnicalAspects ofHIFUWhat is HIFU?Highenergy(intensity)ultrasound beamBrought to tight focus at a distance from source.Absorption ofenergy leads to tissue heatingCauses very localized temperature rise at focus.Sharplydemarcated area of coagulativenecrosis. No damage to overlying and surrounding tissue.Ideal for manipulation as noninvasive tool.重庆医科大学生物医学工程系

超声治疗学 >>Chap. 8 HIFU Therapeutic Technology 1 重庆医科大学生物医学工程系 Technical Aspects of HIFU „ High energy (intensity) ultrasound beam. „ Brought to tight focus at a distance from source. „ Absorption of energy leads to tissue heating. „ Causes very localized temperature rise at focus. „ Sharply demarcated area of coagulative necrosis. „ No damage to overlying and surrounding tissue. „ Ideal for manipulation as noninvasive tool. What is HIFU?

超声治疗学>>Chap.8HIFUTherapeutic Technology]Ultrasound（in tissueIncidentBeamImageAttenuation0AbsorptionScatterAbsorption60-80%HEAT重庆医科大学生物医学工程系

超声治疗学 >>Chap. 8 HIFU Therapeutic Technology 1 重庆医科大学生物医学工程系 Ultrasound ( in tissue )

超声治疗学>>Chap.8HIFUTherapeuticTechnology1Ultrasound (Intensity or Power)DIAGNOSIS:-0.02WTissue informationPOWERWithout biological effectTHERAPY:Deliberate (beneficial)biological effect(reversible or irreversible)Functional modification~200WSURGERY:Cell killing10.000 timesmoreenergy重庆医科大学生物医学工程系

超声治疗学 >>Chap. 8 HIFU Therapeutic Technology 1 重庆医科大学生物医学工程系 Ultrasound (Intensity or Power) POWER DIAGNOSIS: Tissue information Without biological effect THERAPY: Deliberate (beneficial) biological effect (reversible or irreversible) Functional modification SURGERY: Cell killing ~0.02W ~200W 10,000 times more energy

超声治疗学>>Chap,8HIFUTherapeuticTechnology1Table 14.1Output characteristics of ultrasound devicesFrequencyTypicalTypical dutyPowerextemal probesintra-cavitary probesTypefactor(mW)Spatial peak,range (MHz)source areapeak negativespatial peak,peak negative(mm)acoustictemporal averagetemporal averageacousticpressureIntensity Iapuintensity Ispiuppressure p(MPa)(mWcm")(MPa)(mWcm2)DiagnosticPulse-echoB-mode1-20100-30000.0014-256(64)1-1330(175)0.45-5.54(2.09)0.8-284(64.60)0.66-3.5(2.32)M-mode1-20100-30000.0010.5-213(46)4.2-6.04(127)0.45-5.54(2.09)2.0-210(62.7)0.66-3.5(2.32)Doppler100>5-300.012-4Fetal heart detector100Pulsed Doppler5-100.0111-324(144)36-9080(1570)0.67-5.32(2.18)97.1-1440(747)0.97-3.53(2.26)100Colour flow5-100.0135-295(138)21-2150(429)0.46-4.25(2.41)0.97-3.53(2.26)1.14-3.04(2.47)TherapeuticPhysiotherapy30010.75-30-15000Continuouswave0.2Pulsed0.75-33000-30005000.50.5-10500012000005SurgerySource: from Henderson et al.(1995) and Whittingham (2000)重庆医科大学生物医学工程系

超声治疗学 >>Chap. 8 HIFU Therapeutic Technology 1 重庆医科大学生物医学工程系 Table 14.1 Output characteristics of ultrasound devices Equipment Frequency Typical Typical duty Power external probes intra-cavitary probes Type range (MHz) source area factor (mW) Spatial peak, peak negative spatial peak, peak negative (mm2) temporal average acoustic temporal average acoustic pressure Intensity Ispta pressure p- intensity Ispta p- (mW cm-2) (MPa) (mW cm-2) (MPa) Diagnostic Pulse-echo B-mode 1-20 100-3000 0.001 4-256(64) 1-1330(175) 0.45-5.54(2.09) 0.8-284(64.60) 0.66-3.5(2.32) M-mode 1-20 100-3000 0.001 0.5-213(46) 4.2-6.04(127) 0.45-5.54(2.09) 2.0-210(62.7) 0.66-3.5(2.32) Doppler Fetal heart detector 2-4 100 1 5-30 0.01 Pulsed Doppler 5-10 100 0.01 11-324(144) 36-9080(1570) 0.67-5.32(2.18) 97.1-1440(747) 0.97-3.53(2.26) Colour flow 5-10 100 0.01 35-295(138) 21-2150(429) 0.46-4.25(2.41) 0.97-3.53(2.26) 1.14-3.04(2.47) Therapeutic Physiotherapy Continuous wave 0.75-3 300 1 0-15000 Pulsed 0.75-3 300 0.2 0-3000 500 0.5 Surgery 0.5-10 5000 1 200000 5 Source: from Henderson et al.(1995) and Whittingham (2000)

超声治疗学>>Chap.8HIFUTherapeuticTechnology1Ultrasound (Focusing)PHERIGLENSTRANSDUCERUltrasound beamsmaybefocused by curving theELECTRICREFLECTORFOCUSINGpiezoelectric plate or byinterposing a lens or reflectorbetween aflatplate andthetarget. A phased array oftransducers is focusedelectronically重庆医科大学生物医学工程系

超声治疗学 >>Chap. 8 HIFU Therapeutic Technology 1 重庆医科大学生物医学工程系 Ultrasound (Focusing) Ultrasound beams may be focused by curving the piezoelectric plate or by interposing a lens or reflector between a flat plate and the target. A phased array of transducers is focused electronically