Radiofrequency ablation (RFA) procedures for liver cancer treatment are hindered by high tumor recurrence. This is thought to be due to the intrinsic limitation of the heating mechanism and insufficient real-time feedback from imaging modalities. Most RFA procedures are performed under ultrasound (US) imaging and there are limitations in accurate device guidance and ablation monitoring. We propose photoacoustic (PA) imaging as a potential add-on to US imaging to address these limitations. Specifically, we present two interstitial PA imaging methods. Firstly, an annular fiber probe that can encapsulate an RFA device in its lumen. This device enables RFA device guidance, visualization of major blood vessels and targeting tumor tissue. Secondly, we used a cylindrical diffuser-based interstitial illumination to differentiate coagulated and native tissue. We present our results on RFA device guidance and ablation visualization using these approaches. The contrast provided by PA imaging for RFA needle and multiple electrodes is compared against that of US images. The difference between coagulated and native ex vivo liver tissue using PA imaging is studied. Finally, we propose a protocol to incorporate the minimally invasive PA imaging for the clinical RFA procedures. We would like to conclude with a note on how the proposed approach can potentially improve the outcome of RFA procedures.
During percutaneous medical interventions, accurate needle placement and advancing to the target of interest is required to avoid complications and to improve clinical outcomes. Therefore, we present a novel photoacoustic (PA) imaging-based approach as a complement to conventional ultrasound (US) imaging for visualization and guidance of interventional needles. To overcome the limitations associated with light penetration with the conventional extracorporeal illumination, we propose an interstitial light delivery to the target of interest by use of a custom-made annular illumination probe (AIP). This probe accommodates an interventional needle (14 gauge) within its lumen, allowing to advance both tools and acquire real-time PAUS images simultaneously. The light is delivered utilizing 72 multimode optical fibers arranged around the circumference of the hollow center of the AIP. Preliminary results show that PA images obtained with the AIP provide with good complementary contrast to the US imaging for visualization of the interventional needles and its guidance to an absorbing target within chicken breast tissue.
During high-dose-rate (HDR) interstitial brachytherapy of gynecologic malignancies, precise placement of multiple needles is necessary to provide optimal dose to the tumor while avoiding overexposing nearby healthy organs, such as the bladder and rectum. Needles are currently placed based on preoperative imaging and clinical examination but there is currently no standard for intraoperative image guidance. We propose the use of a three-dimensional (3D) ultrasound (US) system incorporating three scanning geometries: 3D transrectal US (TRUS), 360° 3D sidefire transvaginal US (TVUS), and 3D endfire TVUS, to provide an accessible and versatile tool for intraoperative image guidance during interstitial gynecologic brachytherapy. Images are generated in 12 - 20 s by rotating a conventional two-dimensional US probe, providing a reconstructed 3D image immediately following acquisition. Studies of needles in patient images show mean differences in needle positions of 3.82 ± 1.86 mm and 2.36 ± 0.97 mm in TRUS and sidefire TVUS, respectively, when compared to the clinical x-ray computed tomography (CT) images. A proof-of-concept phantom study of the endfire TVUS mode demonstrated a mean positional difference of 1.91 ± 0.24 mm. Additionally, an automatic needle segmentation tool was tested on a 360° 3D TVUS patient image resulting in a mean angular difference of 0.44 ± 0.19 ° and mean positional difference of 0.78 ± 0.17 mm when compared to manually segmented needles. The implementation of 3D US image guidance during HDR interstitial gynecologic brachytherapy provides a versatile intraoperative system with the potential for improved implant quality and reduced risk to nearby organs.