Imaging Technology News - October 2008 - (Page 44)

Advances In MR-GUIDED ULTRASOUND MR Guides Ultrasound in Outpatient Treatments Noninvasive, image-guided therapy assures accuracy for more treatments. By Suzanne LeBlang, M.D. and Arthur Chan, Ph.D. ExAblate developed by InSightec is used for incisionless surgery for uterine fibroids with GE Healthcare’s 3T MRI systems. M ore women are learning about an imaging technique that offers a noninvasive alternative to hysterectomy for women with uterine fibroids and they are finding this procedure to be very accessible in outpatient centers. Both interventional radiologists and OB/GYN doctors are applying magnetic resonance-guided focused ultrasound (MRgFUS), which uses focused beams of ultrasound with intensities of up to 5000W/cm to ablate tumors inside the body. The energy is thousands of times stronger than diagnostic ultrasound since the ultrasound energy is focused similarly to how a magnifying glass focuses light. With MRgFUS, effects are noted only at the targeted region and surrounding tissue is spared. In addition, as this procedure utilizes only MRI and ultrasound there are no harmful radiation effects to the patient. to firstly, define the target/lesion for treatment; secondly, provide real-time thermal imaging as the therapy; and thirdly provide immediate posttreatment measures of tissue necrosis. Although the long-term durability of this method is not known, experts anticipate that MRgFUS will become a broadly applied thermal ablation method for many tumors and multiple diseases, allowing for noninvasive, image-based, individualized treatments. special MRI patient table on which the patient lies.The sonications range in energy from 1.5 to 5kJ, and last 15-30 seconds in duration. Between sonications, a cooling period of 45-90 seconds prevents heating of tissue outside the targeted focal region. Rapid Recovery, Low Risk For both patients and the healthcare system as a whole, there are significant benefits to this noninvasive procedure particularly against currently alternative procedures for the fibroids, which include hysterectomy, myomectomy and uterine artery embolization. As awareness about the procedure increases, more women view MRgFUS as a preferred or desirable option for treating their fibroids due to the noninvasiveness of the procedure and the quick recovery time.Many patients would actually choose the ‘watchful waiting’ option rather than a more invasive surgical procedure.The burden of uterine fibroids on healthcare costs for women who choose to live with fibroid symptoms is significant.There is evidence to show that women are seeking minimally invasive alternatives to hysterectomy, motivated by a trend toward later child-bearing and the desire to minimize recovery time.2 In another study, women Real-Time Treatment Uterine fibroids, common benign masses in the uterus, affect 20-40 percent of Caucasian women over 35 years old and a significantly higher number of African and Afro-Caribbean women. Fibroids can be painful and cause urinary frequency, abnormal or heavy bleeding and pain during intercourse and possibly infertility. The patient lies inside a magnetic resonance imaging (MRI) scanner, with real-time MR images employed to scan patient anatomy and tumor location.The MRI images are used to aid the physician in developing a treatment plan, and also for providing temperature feedback after each sonication, ensuring that temperatures are sufficiently elevated for cell death. Post treatment contrast-enhanced MRI images are obtained to confirm the amount of ablated or dead tissue inside the fibroid. This image-guided procedure requires no incisions, light conscious sedation, and mild pain relief (Diazemuls, pethidine, paracetamol and Voltarol Suppository). Prior to treatment, the physician outlines the fibroid tumor to be treated as well as sensitive structures outside the uterus (such as bowel, pubic bone and sacral nerves). The system’s computer generates a treatment plan indicating the number of individual bursts of high-intensity ultrasound (called sonications) required to complete treatment, the optimal size and shape of the spots, and ensures that the US beam does not pass through any of the marked sensitive structures outside the uterus. During the treatment, sonications are delivered into the body by a focused ultrasound transducer. The transducer is housed inside a water bath in a Widespread Adoption, Applications Worldwide, over 4,000 procedures have been performed for various indications. Today, the primary indication for MRgFUS and the only one approved in the U.S. by the FDA for commercial use is for uterine fibroids. However, the procedure also has the CE mark for fibroid and bone metastasis treatments in Europe, with National Institute of Health and Clinical Excellence (NICE) guidelines published in the UK. Other applications of this technology that are currently under investigation are breast tumors, liver tumors and prostate cancer. Thus far, there is only one FDA-approved MRgFUS system, ExAblate developed by InSightec, which is used for incisionless surgery for uterine fibroids with GE Healthcare’s 1.5T and 3.0T MRI systems. Notably, this technique demonstrates the application of imaging in therapy and its ability Table 1: The LOS for fibroid treatments.1 Procedure Hysterectomy Myomectomy UAE Procedure Length of Stay (LOS) – days 2.97 2.74 1.3 Procedure cost (U.S. $, mean) Hysterectomy Myomectomy UAE 44 Ultrasound-Guided Treatment Targets Prostate Another recent development involves the use of ultrasound-guided HIFU (high-intensity focused ultrasound) for prostate cancer treatment. One therapeutic ultrasound developer, EDAP TMS SA, is launching HIFU services for prostate cancer treatment using a robotic HIFU at a treatment center in the Netherlands. The Ablatherm-HIFU system device will enable the center to be at the forefront of the treatment of prostate cancer with the latest technologies. “I have been impressed with the technology and the minimally invasive approach. Our first patients were successfully treated with no complications. I look forward to expanding the number of treatment volumes at Amphia Ziekenhis to those patients suffering from localized prostate cancer,” said Harald Janssen, M.D., head of the urology department at Amphia Ziekenhis Hospital in Breda, The Netherlands. For more information: www.edaptms.com, www.hifuplanet.com and www.pcaresearch.com 12-month total payer cost (U.S. $, mean) 10,044 9,652 10,519 A&E visit 1-12M post-procedure (%) 15.2 16.1 16.8 Hospital admission 1-12M post procedure (%) 5.6 6.0 8.8 7,707 7,299 5,968 | ITN | October 2008 | ITNonline.net http://www.edaptms.com http://www.hifuplanet.com http://www.hifuplanet.com http://www.pcaresearch.com http://www.ITNonline.net

Table of Contents Feed for the Digital Edition of Imaging Technology News - October 2008

Imaging Technology News - October 2008 Contents RSNA Low-Field MRI Systems Contrast Media Injectors AM-LCDs Special Report - Agents Target Neurological Diseases and Disorders IT Laser Imagers Monitors Meet Radiology Suite Needs MR Guides Ultrasound in Outpatient Treatments Replacing a Legacy PACS PACS SAs: Titles and Salaries

Imaging Technology News - October 2008

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