PROJECT ACRONYM Imaging Needles
FUNDED BY ZonMW
PHD CANDIDATE Hindrik Kruit
INVOLVED RESEARCHERS Maura Dantuma, Rianne Bulthuis
SUPPORT Johan Van Hespen
SUPERVISOR Srirang Manohar
COLLABORATION TU Delft, Fraunhofer Project Centre (FPC) University Medical Centre Groningen (UMCG), Ziekenhuisgroep Twente (ZGT)
CLINICAL BACKGROUND Hepatocellular carcinoma (HCC) is an aggressive primary malignancy of the liver. Globally, around 750,000 new cases are diagnosed annually, with the number of deaths virtually identical to incidence.[2,3] HCC is the second leading cause of cancer-related mortality.[3,4]
Percutaneous radiofrequency (RF) ablation therapy is currently the method of choice for treating unresectable HCC, [4,5] as well as metastatic focal malignancies in the liver. Here RF electrode tips are deployed in an umbrella or star-shaped formation into the tumor from a percutaneous needle sheath. Passage of high-frequency AC current into the electrodes produces Joule heating resulting in coagulation necrosis. RF ablation produces lower morbidity, lower damage to surrounding tissues, reduced costs and shorter hospitalization times than surgery. However, the rates of recurrence are reported from 2% to as high as 60%. Incomplete tumor ablation is thought to be the main reason for local recurrence.
Most RF ablation procedures are performed under US guidance Small numbers are also performed under MRI or x-ray CT, with PET used post-treatment to assess the results. However, these methods have several shortcomings and drawbacks, including high-costs, inaccessibility and the inability to provide real-time feedback.
Accurate targeting of the RF needle to tumor is crucial. Further, it would be of great help if real-time or quasi real-time information were available about the extent of thermal damage in relation to the tumor tissue size. In this case, the surgeon could optimize energy delivery to obtain complete tumor eradication which would bring down local tumor recurrences and improve long-term survival.
OBJECTIVE Liver tumors and thermal lesions (coagulated zones) have a substantial optical absorption contrast compared with normal liver tissue.[19-21] Diffuse Reflectance (DR) Spectroscopy has been applied in minimally-invasive settings by inserting single or multiple optical fibers carrying CW light inside biopsy needles.[19,22,23] A drawback of these ‘optical needle’ approaches is that no or little depth/spatial resolution can be obtained.
To address this shortcoming, we developed the ‘Photoacoustic Needle (PAN)’ approach.[24,25] Here the optical fiber in the biopsy needle carries ns pulsed light into tissue. (Figure 2) When the light is absorbed by various chromophores in tissue.[26-28] US is produced by the photoacoustic (PA) effect. The PA signals are detected using the same US imager conventionally used for needle guidance. With this approach, we obtain depth-resolved imaging of optical absorption contrast regions distal to the needle, with a host of applications.[29-31].
Especially with the use of multiple light wavelengths, PAN will provide molecular discrimination capabilities to resolve liver tumors from normal tissue, and further differentiate between thermally damaged tissue and vital tumor tissue to address the clinical problems above. The implementation is developed as an add-on with laser-coupling to existing US imagers.
In this project we further these ideas while introducing others to bring the technique further.
We need highly creative, industrious and passionate students to help us move the field further. The backgrounds required are in Biomedical Engineering, Applied Physics, Technical Medicine, and Computer Science. If you are interested in making an important contribution to this area, contact the following:
- Kruit, H., Joseph Francis, K., Rascevska, E., & Manohar, S. (2021). Annular fiber probe for interstitial illumination in photoacoustic guidance of radiofrequency ablation. Sensors, 21(13), 4458.
- Lanka, P., Francis, K.J., Kruit, H., Farina, A., Cubeddu, R., Sekar, S.K.V., Manohar, S. and Pifferi, A., 2021. Optical signatures of radiofrequency ablation in biological tissues. Scientific reports, 11(1), pp.1-14.
- Francis, K. J. and Manohar, S., 2019. Photoacoustic imaging in percutaneous radiofrequency ablation: device guidance and ablation visualization. Physics in Medicine & Biology. 64 184001
- Kruit, H., Plomp, J., van Hespen, J., & Manohar, S. (2022, March). Multi-wavelength photoacoustic imaging for assessing thermal damage in radiofrequency ablation of the liver. In Photons Plus Ultrasound: Imaging and Sensing 2022 (p. PC1196022). SPIE.
- Joseph, F.K., Lanka, P., Kruit, H., Sekar, S.K.V., Farina, A., Cubeddu, R., Manohar, S. and Pifferi, A., 2020, March. Key features in the optical properties of tissue during and after radiofrequency ablation. In Multiscale Imaging and Spectroscopy (Vol. 11216, p. 112160H). International Society for Optics and Photonics.
- Lanka, P., Joseph, F.K., Kruit, H., Sekar, S.K.V., Farina, A., Cubeddu, R., Manohar, S. and Pifferi, A., 2020, April. Time domain diffuse optical spectroscopy for the monitoring of thermal treatment in biological tissue. In Optical Tomography and Spectroscopy (pp. SM2D-4). Optical Society of America.
- Joseph, F.K., Kruit, H., Rascevska, E. and Manohar, S., 2020, February. Minimally invasive photoacoustic imaging for device guidance and monitoring of radiofrequency ablation. In Photons Plus Ultrasound: Imaging and Sensing 2020 (Vol. 11240, p. 112405F). International Society for Optics and Photonics.
- K. J. Francis, E. Rascevska and S. Manohar, "Photoacoustic Imaging Assisted Radiofrequency Ablation: Illumination Strategies and Prospects," TENCON 2019 - 2019 IEEE Region 10 Conference (TENCON), 2019, pp. 118-122, doi: 10.1109/TENCON.2019.8929646.
- Lanka, P., Francis, K.J., Kruit, H., Sekar, S.K.V., Farina, A., Cubeddu, R., Manohar, S. and Pifferi, A., 2019, July. Monitoring radiofrequency ablation of biological tissue using broadband time-resolved diffuse optical spectroscopy. In Diffuse Optical Spectroscopy and Imaging VII (Vol. 11074, p. 110742M). International Society for Optics and Photonics.
- Rascevska, E., Francis, K. J. and Manohar, S., 2019, July. Annular illumination photoacoustic probe for needle guidance in medical interventions. In Opto-Acoustic Methods and Applications in Biophotonics IV (Vol. 11077, p. 110770L). International Society for Optics and Photonics.
- Francis, K. J. and Manohar, S., 2019, July. Photoacoustic assisted device guidance and thermal lesion imaging for radiofrequency ablation. In Opto-Acoustic Methods and Applications in Biophotonics IV (Vol. 11077, p. 1107715). International Society for Optics and Photonics.
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