Precisely Shaped Acoustic Ablation of Tumors Utilizing Steerable Needle and 3D Ultrasound Image Guidance

摘要

Many recent studies have demonstrated the efficacy of interstitial ablative approaches for the treatment of hepatic tumors. Despite these promising results, current systems remain highly dependent on operator skill, and cannot treat many tumors because there is little control of the size and shape of the zone of necrosis, and no control over ablator trajectory within tissue once insertion has taken place. Additionally, tissue deformation and target motion make it extremely difficult to place the ablator device precisely into the target. Irregularly shaped target volumes typically require multiple insertions and several overlapping (thermal) lesions, which are even more challenging to accomplish in a precise, predictable, and timely manner without causing excessive damage to surrounding normal tissues.In answer to these problems, we have developed a steerable acoustic ablator called the ACUSITT with the ability of directional energy delivery to precisely shape the applied thermal dose . In this paper, we address image guidance for this device, proposing an innovative method for accurate tracking and tool registration with spatially-registered intra-operative three-dimensional US volumes, without relying on an external tracking device. This method is applied to guidance of the flexible, snake-like, lightweight, and inexpensive ACUSITT to facilitate precise placement of its ablator tip within the liver, with ablation monitoring via strain imaging. Recent advancements in interstitial high-power ultrasound applicators enable controllable and penetrating heating patterns which can be dynamically altered. This paper summarizes the design and development of the first synergistic system that integrates a novel steerable interstitial acoustic ablation device with a novel trackerless 3DUS guidance strategy.