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Ultrasound Dosimetry in the HIFU Ablation for Patients with Uterine Fibroids

Author: ChenJinYun
Tutor: WangZhiBiao;ChenWenZhi
School: Chongqing Medical University
Course: Obstetrics and Gynaecology
Keywords: The high- intensity focused ultrasound (HIFU) Ultrasound ablation Uterine fibroids Energy efficiency factor (EEF)
CLC: R737.33
Type: PhD thesis
Year: 2009
Downloads: 189
Quote: 1
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Abstract


Uterine fibroids are the most common benign tumor of the female reproductive system. High Intensity Focused Ultrasound direct effect on the tumor after focused ultrasound beam, causing the fibroid tissue coagulation necrosis, thereby preventing the growth of fibroids to shrink or disappear, mitigate or alleviate fibroids cause symptoms or signs. First ultrasound ablation of uterine fibroids treatment planning system (treatment planning system, TPS) treatment planning, TPS, including adjuvant therapy, ultrasound transducer 3D conformal scanning technology and treatment dose delivery. The treatment clinically appropriate technology to promote the standardization of dosimetry key ultrasound ablation dosimetry study is considered under the premise of the effectiveness, safety and treatment efficiency, to quantify ultrasound ablation of biological effects, to establish the relationship between volume and treatment dose ablation ultrasound ablation energy efficiency. Ultrasonic energy deposition in biological tissues biological focal region (biological focal region, BFR), through BFR mobile to achieve tumor thermal ablation. BFR can be predicted by theory. Energy efficiency factor (energy efficiency factor, EEF) quantitative indicators for the interaction of ultrasound with biological tissue, the same ultrasonic transducer, the factors include: the target depth surface the distance to the surface of the skin, the target tissue structure and function of state, tissue sound environment, scanning, and adjuvant therapy. The purpose of this study is to summarize ultrasound ablation of uterine fibroids dosimetry data, to establish EEF dose model for the treatment of clinical predictors of treatment of a certain volume of tumor dose. The basis of the development and optimization of providing dosimetry for ultrasound ablation for the treatment of uterine fibroids TPS. Purpose by magnetic resonance imaging ultrasound ablation results, summarize ultrasound ablation of uterine fibroids dosimetric data on the basis of safety and efficacy, to establish EEF dose model for clinical predictors of treatment of a certain volume of tumor treatment dose. The basis of the development and optimization of providing dosimetry for ultrasound ablation for the treatment of uterine fibroids TPS. Materials and Methods. Study from December 2006 to January 2009, the First Affiliated Hospital of Chongqing Medical uterine fibroids 142 patients, aged 21 to 51 years, with an average of 38.8 ± 5.6 years. Inclusion criteria (1) in patients with clinical diagnosis of uterine fibroids further confirmed by ultrasound and magnetic resonance imaging; (2) pre-menopausal women; (3) uterine fibroid-related symptoms or psychological impact eager to get treatment, refused surgery, requiring preserve the uterus; fibroids, fibroids (4) treatment system airborne ultrasound can show the maximum diameter gt; 1.5cm, intramural fibroids pedunculated subserosal and submucosal uterine fibroids; (5) The accurate exchange treatment process feelings; (6) agree to sedation ultrasound ablation. Exclusion criteria were (1) cervical fibroids; (2) Consolidated gynecological diseases (such as vaginitis, pelvic inflammatory disease, tumors, etc.); (3) menstrual women, pregnant women (positive pregnancy test) and lactating women; (4) connective tissue disease or high-dose abdominal radiotherapy; (5), uncontrolled diabetes, liver and kidney function abnormal; (6) severe heart and cerebrovascular disease: unstable angina, within six months, myocardial infarction, arrhythmia need drug control, severe hypertension and heart failure; cerebral infarction, cerebral hemorrhage (7) within six months; (8), nuclear magnetic resonance and gadolinium allergy patients. 2 Rotary device JC focused ultrasound tumor therapy system Chongqing sea? (HIFU) Technology Co., Ltd. developed therapy ultrasound transducer center combination of ultrasound imaging probe. Therapeutic ultrasound transducer frequency of 0.8 MHz, adjustable power 0 W ~ 400 W, physics focal region of 1.5 mm × 1.5 mm × 10 mm circular degassed water (lt; 3 ppm) coupling. Airborne imaging ultrasound parameters: frequency of 3.5MHz. Magnetic resonance imaging system Magnetom Symphony PRACTICAL RADIOLOGY Tim system (Siemens, Germany). Set sequences: T1-weighted spin-echo sequence (TR 502ms, TE 12ms, slice thickness of 4 mm layer from 1 mm); T2-weighted spin-echo sequence (TR 4,000 ms, TE 98ms, slice thickness 6 mm layer from 0.875 mm ); enhanced T1-weighted gradient echo sequence (TR 5.13ms, TE 2.37ms, thickness of 2.5mm layer distance 0.5 mm), coil: the Body Matrx / large Loop coil. Experimental drugs contrast contrast agent gadodiamide Injection (of Europe is Movies gadodiamid) - 0.5 mmol / ml, a dose of 15 of 20 ml. 3 Research Methods 3.1 pre-treatment imaging assessment of selected patients after pelvic ultrasound and magnetic resonance imaging (MRI) was assessed. The CDFI grading standards of the blood supply of uterine fibroids: 0: fibroids no blood flow signal; Grade I: a small amount of blood flow within the fibroids, showing 1 to 2 punctate blood flow; Ⅱ: fibroids in the amount of blood flow, we can see a major blood vessels, longer than the radius of the fibroids or see 2 to 3 small blood vessels; Ⅲ: fibroids rich blood flow, visible blood vessels or blood vessels more than four interconnected; Ⅳ: fibroids surrounding vessels were mesh enveloping the entire fibroids (holding ball sign), and within the dendritic multiple branches stretching fibroids, vascular interwoven into a network, or vessel diameter of 3 mm or more. T2WI signal strength of uterine fibroids classification: Class I, low signal: the fibroids signal is less than or equal to skeletal muscle; Ⅱ class, and other the signal: fibroids signal is less than or equal to the myometrium, higher than skeletal muscle; class III mixed high and low signal: fibroids signal than myometrium were lower than the myometrium signal mixed; IV class, high signal: fibroids signal uniformly higher than the uterine smooth muscle of mixed signal or high signal-based. 3.2 ultrasound ablation treatment preparation: ① bowel preparation: treatment the day before catharsis, treatment that morning cleansing enema; (2) Skin preparation: lower abdominal skin preparation, degreasing, degassing; the ③ bladder prepare: indwelling catheter before treatment. Implementation of sedation: fentanyl citrate and midazolam in combination, to control the depth of sedation reached ramsy 3 ~ 4 Ji analgesic effect require the patient pain scores less than 4 is divided into good. Ultrasound ablation: ① the ablation range: for intratumoral ablation, focus range: from the endometrium 15 mm; from the the fibroids pseudocapsule 5 mm; distance near the sacrum fibroids deep surface 15 mm; shallow surface 10 from the nearly abdominal wall fibroids mm; treatment layer distance: the layer from 5 mm; 5 mm dot pitch; ② ablation procedures: the patient prone on the couch, lower abdominal focused ultrasound transducer above the front wall in the degassed water before treatment airborne ultrasound imaging positioning to ensure safe and sound channel, to avoid intestinal injury and other non-target tissue; to adjust therapeutic dose according to the patient on acoustic irradiation caused sensory response and real-time ultrasound imaging gray change, point scan and line scan combined with the completion of treatment, target lumpy hyperechoic change or the overall grayscale obvious increase to the end of treatment. After treatment, the patients in the observation room to rest for two hours, and may be accompanied by family members from the hospital to go home. OUTCOME MEASURES: ① therapeutic dose parameters: duration of treatment, irradiation time, treatment of power; ② The acceptability: pain scores; ③ security indicators: adverse reactions. 3.3 after treatment 0 to 3 months after treatment imaging evaluation, line enhanced MRI with the treatment of the MR imaging parameters and scanning sequence. 3.4 treatment of complications of evaluation criteria based on international intervention the SIR classification radiation therapy developed by the Association. 3.5 Dosimetry Analysis Method dose energy efficiency factor (energy effect factor, EEF) said: EEF = η. Pt / V (J/mm3) η represents the focusing coefficient (= 0.7), P is sound power (W), the t is irradiated required time, V is the volume of avascular area (non-perfused volume, NPV) (mm3), EEF unit volume ablation energy (J/mm3). 3.6 Statistical Methods SPSS13.0 statistical software for statistical analysis. Results 1. Ablation results of 142 patients (168 fibroids) to accept a one-time ultrasound ablation. The average diameters of 4.4 ± 1.6 (1.5 ~ 12.3) cm, the average volume of 62.57 ± 85.87 (1.9 to 747.1) cm3. The average treatment time of 2.7 ± 1.3 hours (14 to 471 minutes), exposure time of 33 ± 19 minutes (79 minutes). Volume ablation rate of 84.70 ± 22.96% (165 fibroids have enhanced MRI results). 2. Treatment tolerance evaluation of pain score of 0 to 4 accounted for 85% of the research object. Complications and side effects, 33.10% (47/142) of patients experienced varying degrees of adverse reactions, 94.92% of the complications of SIR AB class, the SIR DF class without Interventional Radiology Association complications. Class B complications in two cases, lower abdominal pain within 24 hours after the patients required pain treatment; superficial Ⅱ ° burns of the skin of the patients groin area, give local dressing processing; SIR the C Class complications, including 3 patients, need prolonged hospitalization, 2 patients after treatment one day a body temperature higher than 38.5 ℃, returned to normal after treatment within 48 hours; patients with urinary retention, indwelling catheter, within 48 hours of recovery urinate. 4. Lack of correlation between dosimetry findings abdominal tissue (thickness less than 50mm) with uterine fibroids ultrasound ablation dose required; uterine muscle of uterine fibroids the size, location, blood supply, grading, T2WI signal strength and sound channel wall thickness and unit organization ultrasound ablation required dose linear relationship. Conclusion 1. Sedation under ultrasound ablation of uterine fibroids can reach full ablation. Energy efficiency factor (EEF) is a direct reflection of uterine fibroids ultrasound ablation energy efficiency of the regularity of the relationship, EEF can be used as quantitative indicators of uterine fibroids dose studies. 3 In the clinical data are available, the position, size, uterine fibroids, blood for grading and T2WI signal strength can be used as prediction ablation dose indicators. Dose of ultrasound ablation of uterine fibroids model: (1) ultrasound, MRI combined with predicted dose model: χ1 = the fibroids position (anterior wall = 1, the posterior wall = 2), χ2 = myoma diameter (cm), x3 = the the fibroids Adler blood for grading 1, χ4 = fibroids T2WI signal strength (2) ultrasound image characteristics predictive model: [χ1 = the fibroids position (anterior wall = 1, the posterior wall = 2), χ2 = myoma diameter (cm), of x3 = fibroids Adler blood for grading 1] (3) MRI image characteristics predicted dose model: [χ1 = fibroids position (anterior = 1, the posterior wall = 2), χ2 = the fibroids diameter (cm ), x3 = fibroids T2WI signal intensity] y = 3.052 6.095 · X1 -0.383 · X2 2.827 · X3 5.135? X4 y = 6.202 5.557 · X1 -0.180 · X2 2.144 · X3 Y = 8.759 6.816 · X1 -0.332 · X2 4.881 · x3

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CLC: > Medicine, health > Oncology > Genitourinary tumors > Female genital tumors > Uterine tumors
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