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J J Lagendijk

Publications and source records attributed to J J Lagendijk.

70 records · Page 4Linked to original sources
PubMedDate not supplied

The significance of accurate dielectric tissue data for hyperthermia treatment planning.

For hyperthermia treatment planning, dielectric properties of several tissue types are required. Since it is difficult to perform patient specific dielectric imaging, default values based on literature data are used. However, these show a large spread (approximately 50%). Consequently, it is important to know what limit this spread imposes on the accuracy of the SAR and subsequently on the temperature distributions. Hyperthermia treatment plans performed with different values for the dielectric properties were compared. This showed that a spread of 50% resulted in the average absolute difference of approximately 20% in both SAR and temperature distributions (heat sink approach) for regional hyperthermia. For interstitial hyperthermia, a spread of 25% resulted in the averaged absolute difference of approximately 10% in the SAR distributions and 5% in the temperature distributions (heat sink approach). Considering other problems that hamper hyperthermia treatment planning, it can be concluded that default values for the dielectric properties suffice.

Brain Neoplasms↗
PubMedDate not supplied

Spatial steering with quadruple electrodes in 27 MHz capacitively coupled interstitial hyperthermia.

PURPOSE: The 27 MHz Multi Electrode Current Source (MECS) interstitial hyperthermia system uses probes consisting of multiple independent electrodes, 10-20 mm long, to steer the 3-D power deposition. Seven point thermocouples integrated into the probes provide matching 3-D temperature feedback data. To improve spatial steering the number of independent segments was increased; the feasibility and reliability of four independent electrodes integrated into a single probe were evaluated, with special attention to efficiency and to interference between separate electrodes. METHODS: The contribution of secondary coupling on the apparent electrode impedance and the dependence of cross coupling on the distance between leads, thermocouple and electrodes are computed using simple analytical models. The effect of this secondary coupling was assessed experimentally by comparing power delivery by dual and quadruple electrodes, and by quadruple electrodes in different electrode configurations (segment length 10 or 20 mm) in a nylon catheter in a muscle equivalent medium. RESULTS: Cross coupling with the thermocouple and other electrodes was computed to be of the same magnitude as the primary coupling for a quadruple electrode. Fortunately, this does not affect operation of the electrode, there was no difference in performance between quadruple and dual electrodes, and the output power was effectively independent of the electrode configuration. CONCLUSION: Quadruple MECS electrodes for improved 3-D power control are feasible.

Electrodes↗
PubMedDate not supplied

Design of a clinical deep-body hyperthermia system based on the 'coaxial TEM' applicator.

The design of a clinical deep-body hyperthermia system based on the 'coaxial TEM' applicator is presented. The 'coaxial TEM' applicator produces a radiative circumferential RF field, and the adjustable aperture width of this applicator allows the optimization of field dimensions and penetration depth. A new type of open water bolus, in which the patient is almost freely floating, avoids physical stresses on the patient, provides an optimal coupling of the EM energy into the patient, and may limit aberrant heating. A convenient patient position is possible with this system and discomfort is expected to be minimal. Preliminary phantom experiments with the clinical applicator resulted in typical SAR distributions of a radiative circumferential field applicator with the central interference at maximum.

Electromagnetic Fields↗
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Perfusion analyses in advanced breast carcinoma during hyperthermia.

Blood flow in tumours and healthy tissue determines the ability of obtaining satisfactory temperature distributions in clinical hyperthermia, as well as the success of hyperthermia and radiation treatment. During the hyperthermia treatment, diagnostic data related to tissue blood flow can be determined by analysing the relationship between the amount of power absorbed in the tissue and the resulting temperature rise. The interpretation of the perfusion data (PERF) is highly complicated by the lack of an adequate theory to describe the heat transport in vascularized tissues. In vascularized breast tissues about 10 times as much power is needed to maintain therapeutic temperatures as is necessary in a stationary breast phantom. This large difference in maintenance power levels indicates the extreme importance of blood flow in tissue heat transport. PERF has been determined in 23 patients with advanced breast tumours. In this series (a) perfusion typically did not change during the stationary part of the individual hyperthermic sessions, (b) minimum tumour PERF was not related to tumour volume, and (c) there was no relation between tumour PERF and the ability to heat tumours. PERF can both increase and decrease after successful hyperthermia.

Absorption↗
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Thermoradiotherapy of primary breast carcinoma.

Since 1981, 40 patients with advanced breast carcinoma have been treated with megavoltage radiotherapy combined with hyperthermia. The irradiation dose to the primary tumour was 50 Gy/25 fractions, five fractions per week. Hyperthermia (aim: 44 degrees C/30 min) was applied once a week, 30 minutes after the midweek radiation fraction. Tumour response did not correlate with the chance of long-term local control. The likelihood of 3-year local control was 46 per cent and 3-year survival was 52 per cent. The local tumour control rate decreased with increasing T stage and was related to non-uniformity of the temperature distribution in the heated volume. It was concluded that (a) the radiation dose should be increased and (b) the temperature uniformity should be improved.

Adult↗
PubMedDate not supplied

Specific absorption rate steering by patient positioning in the 'Coaxial TEM' system: phantom investigation.

Cylindrical and elliptical homogenous phantoms were used to investigate, both theoretically and experimentally, the effect of phantom positioning on the specific absorption rate (SAR) distribution of the 'Coaxial TEM' system. Theoretical predictions indicated that the maximum of the SAR distribution was stationary around the central axis of the applicator system, irrespective of the position of the phantom. Therefore the maximum SAR can be located at different phantom sites as required. Although two-dimensional models give a qualitative insight in the phenomena studied, they lack quantitive agreement. The steering capacity has been confirmed experimentally and is now clinically applied by positioning the tumour mass according to these insights.

Evaluation Studies as Topic↗
PubMedDate not supplied

Temperature and SAR measurements in deep-body hyperthermia with thermocouple thermometry.

Multisensor (7-14) thermocouple thermometry is used at our department for temperature measurement with our 'Coaxial TEM' regional hyperthermia system. A special design of the thermometry system with high resolution (0.005 degrees C) and fast data-acquisition (all channels within 320 ms) together with a pulsed power technique allows assessment of specific absorption rate (SAR) information in patients along catheter tracks. A disadvantage of thermocouple thermometry, EM interference, is almost entirely eliminated by application of absorbing ferrite beads around the probe leads. We investigated the effect of remaining disturbance on the temperature decay after power-off, both experimentally in phantoms and in the clinic, and with numerical simulations. Probe and tissue characteristics influence the response time tau dist of the decay of the disturbance. In our clinical practice a normal pulse sequence is 50 s power-on, 10 s power-off: a response time longer than the power-off time results in a deflection of the temperature course at the start. Based on analysis of temperature decays correction of temperature is possible. A double-pulse technique is introduced to provide an initial correction of temperature, and fast information about accuracy. Sometimes disturbance with a relatively long response time occurs, probably due to a bad contact between probe, catheter and/or tissue. Thermocouple thermometry proved to be suitable to measure the SAR along a catheter track. This is used to optimize the SAR distribution by patient positioning before treatment. A clinical example illustrates this.

Body Temperature↗
PubMedDate not supplied

Dose uniformity in scanned focused ultrasound hyperthermia.

Scanned focused ultrasound (SFUS) is unique amongst noninvasive methods of inducing hyperthermia in that the absorbed power (SAR) distribution may be controlled at a scale of 0.5 cm or better. This high degree of spatial control of SAR implies that differences in local tissue cooling due to heterogeneity in perfusion, variations in the density of discrete thermally significant vessels and even local cooling around single large vessels may be compensated during SFUS treatments. In this paper we calculate thermal dose distributions arising from three different SFUS techniques: (1) the high-temperature short-duration (HTSD) ultrasound technique; (2) conventional systems employing a fixed scan and fixed SAR simulated by a uniform SAR; and (3) we optimize the SAR distribution using information from angiography and thermal models. These techniques are tested in the same anatomy having discrete vessels, a non-uniform vessel density and with little, if any, preheating of the incoming blood (i.e. the worst-case situation). The application of a uniform SAR to this volume resulted in a highly non-uniform thermal dose distribution. The situation is clearly improved in HTSD hyperthermia; however, the desired accuracy of positioning within the tumour is high, and to minimize background heating the focus must be stepped slowly and preferably in a semi-random pattern through the target volume. The third technique which employs spatial control over SAR resulted in the greatest uniformity in thermal dose. However, the use of this technique requires the input of the complete three-dimensional discrete vessel network and the availability of a tested three-dimensional discrete vessel thermal model.

Biophysical Phenomena↗
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Regional hyperthermia of pelvic tumours using the Utrecht 'Coaxial TEM' system: a feasibility study.

Between August 1989 and July 1992 a total of 22 patients (64 treatments) with inoperable or recurrent deep seated pelvic tumours were treated with regional hyperthermia and radiotherapy. The 70 Mhz Coaxial TEM applicator with its characteristic open waterbolus was used as heating device. The main objective of this pilot study was to evaluate the feasibility, toxicity and temperature data. The results showed that the major treatment limiting factors were insufficient power and systemic stress. Local pain was observed in only 10% of all treatments. Most of the treatments resulted in elevated systemic temperatures with the overall mean maximum oesophagus temperature reaching 38.9 +/- 0.7 degrees C, however, in only 6% of these treatments this was found to be treatment limiting. From the measured data the following intratumoral temperatures were calculated: T90 = 39.9 +/- 1.0 degrees C; T50 = 40.7 +/- 1.0 degrees C; T10 = 41.4 +/- 1.0 degrees C. In addition, the overall mean average normal tissue temperatures were determined: Trectum = 40.8 +/- 0.7 degrees C; Tvagina = 41.3 +/- 0.9 degrees C; Turethra = 40.8 +/- 0.9 degrees C. The temperatures in normal tissue were frequently higher than in tumour, indicating that a large volume was heated. The open waterbolus allows strong cooling, but the strategy was changed during the study: higher systemic temperatures were allowed to improve the pelvic temperatures. This pilot study proved that the open waterbolus is clinically a success, because it offers patient comfort and SAR-steering by patient repositioning, and that regional hyperthermia with the Coaxial TEM is feasible.

Adult↗
PubMedDate not supplied

Numerical analysis of capacitively coupled electrodes for interstitial hyperthermia.

Multi electrode current source interstitial hyperthermia (MECS-IHT) employs individually controlled, 27 MHz radiofrequency electrodes inserted into plastic brachytherapy catheters. In order to get a firm understanding of the physical behaviour of the electrodes and to verify the current source approximation in our hyperthermia treatment planning system we have investigated (1) the electrical properties of the electrode-catheter-tissue system, and (2) the impact of inhomogeneity of the electrical properties of the tissue in the vicinity of the electrodes. The results validate the use of the ideal current source approximation in the treatment planning SAR model. The models predict the presence of a significant heat source inside the electrode wall when lossy catheter materials are used, producing a conductive heating component in addition to the SAR in the tissue. For a given catheter spacing this conductive component will produce a more heterogeneous temperature distribution. Thus, low-loss catheter materials like polyethylene and Teflon are recommended. The SAR is highly localized near the catheter. Calculations concerning a fat-muscle interface show that the SAR is higher in the fatty tissue than in the muscle tissue; 3D SAR control by individually controlled electrode segments is essential in such a situation.

Animals↗
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The influence of vasculature on temperature distributions in MECS interstitial hyperthermia: importance of longitudinal control.

The quality of temperature distributions that can be generated with the Multi Electrode Current Source (MECS) interstitial hyperthermia (IHT) system, which allows 3D control of the temperature distribution, has been investigated. For the investigations, computer models of idealised anatomies containing discrete vessels, were used. A 7-catheter hexagonal implant geometry with a nearest neighbour distance of 15 mm was used. In each interstitial catheter with a diameter of 2.1 mm a number of 1 up to 4 electrodes were placed along an 'active section' with a length of 50 mm. The electrode segments had lengths of 50, 20, 12 and 9 mm respectively. Both single vessel and vessel network situations were analysed. This study shows that even in situations with discrete vasculature and perfusion heterogeneity it remains possible to obtain satisfactory temperature distributions with the MECS IHT system. Due to its 3D spatial control the temperature homogeneity in the implant can be made quite satisfactory.

Blood Vessels↗
PubMedDate not supplied

ESHO quality assurance guidelines for regional hyperthermia.

The Technical Committee and the Clinical Committee of the ESHO evaluated the experience of the institutes which are active in clinical regional hyperthermia using radiative equipment. Based on this evaluation, QA guidelines have been formulated. The focus of these guidelines lies on what must be done not on how it should be done. Subjects covered are: treatment planning, treatment, treatment documentation, requirements and characterization of equipment, safety aspects, hyperthermia staff requirements and instrumentation for quality assurance.

Europe↗