What is HIFU?
HIFU Physics

What is HIFU?

High Intensity Focused Ultrasound uses heat in a focused manner to burn and destroy affected tissue with the goal of preserving healthy prostate tissue. Much like a magnifying glass can concentrate sunlight to burn through an object, HIFU uses focused sound waves to target cancerous areas of the prostate. The benefit to patients is that the HIFU procedure is outpatient, treats only the cancerous areas, does not destroy the rest of the prostate, takes only 1-3 hours,there are no incisions or needle tracks, and no radiation.

HIFU also avoids the life altering side effects such as erectile dysfunction and loss of bladder control that often accompanies surgical removal, radiation or cryosurgery(freezing)  of the prostate. Clinical trials of HIFU began in the early 1990s in Europe, Japan and USA. The ultrasound energy produced by HIFU is absorbed by targeted tissue and converted into heat. During high intensity focussed ultrasound a spherical transducer is used to generate ultrasound waves that converge to a focal point. The concentration of pressure waves at the focal point causes energy absorption and tissue heating. The energy generated is 10,000 times higher than that for imaging and the precise nature of the focused beam results in millimeter destruction of tissues with well demarcated edges.

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Current HIFU Technology is based on 3 Distinct Effects

By applying a series of these lesions larger volumes of cancer tissue can be effectively treated at desired locations sparing  adjacent normal tissue and preserving function. The precise nature of HIFU technology allows partial and focal therapy of only the involved areas.

Imaging

  • 3-10 MHz

  • << Parallel >> beam 

  • Very Low Power (0.02 W)

HIFU Therapy

  • 3 MHz

  • Focused Ultrasound 

  • Very High Power (200W)

  • 10,000 times more than imaging

Thermal Effect - A “thermal dose” causes tissue coagulation and leads to irreversible tissue damage through coagulative necrosis. The focused ultrasound waves of HIFU are capable of inducing sharp increases in temperature (around 70-90 degrees C). A few seconds of sonification, extends the lesion for 19 to 26mm.

Mechanical Effect - As temperature rises there is generation of micro gas bubbles, collapse of cavities and rupture of cell walls.

 

Cooling Effect - the degassed solution in the patented Ablasonic Fluid that circulates around the rectal probe keeps the rectal wall cool and monitored. The structures such as rectum, external sphincter and nerves are spared due to the steep temperature gradient between the destroyed tissue and surrounding areas.

HIFU may also trigger an immune response in the body by disturbing the microenvironment of prostate cancer cells.(1,2)

References:

1.More Than Just Tumor Destruction: Immunomodulation by Thermal Ablation of Cancer. Clinical and Developmental Immunology. 2011: 160250

 

2.High intensity focused ultrasound ablation and antitumor immune response. The Journal of the Acoustical Society of America.2013 134 (2): 1695–701.

Ablatherm Robotic HIFU System

Robotic probe system is incorporated into table to provide stability, ease of use and transportability

Robotic Movement of HIFU Probe allows millimeter precision of tissue treatment

Patented Ablasonic Fluid Infusion Keeps Rectum Cool and Avoids Injury

Ablatherm Device
  • Effectively ablates prostate cancer tissue

  • Highly precise with millimeter accuracy and  lesion demarcation

  • Radiation free

  • Robotically controlled and reproducible

  • Noninvasive.

  • Ablatherm HIFU Ablates cancer cells effectively and does not seed metastasis.*

  • Three dimensional robotic motion

    • 3 translations and 2 rotations

    • Image recognition software detects rectal wall, fine tunes the probe position

*Chapelon J.. et al. Cancer Research 1992, 52: 6353-6357; 2. Oosterhof G et al. Eur Urol 1997, 32: 91-95

  • Integrated ultrasound transducers avoid compromise

    • 7.5 MHz imaging

    • 3 MHz ablation

  • Patented AblasonicTM fluid for consistent ultrasound transmission

  • 25cc/hour ablation speed

http://www.edap-tms.com/en/products-services/prostate-cancer/ablatherm-hifu

The endorectal probe containing the transrectal ultrasound scanner is placed in a latex balloon, filled with a cooling fluid, and introduced in the rectum. Following the target volume measurement by the operator, treatment is performed from apex to base of the prostate; usually 4 volumes are defined in order to treat the entire prostate. At the end of the HIFU treatment a catheter is placed for a few days.

The Ablatherm machine consists of a treatment module that includes the patient’s bed, the probe positioning system, the ultrasound generator, the cooling system for the rectal wall, and the ultrasound scanner used for treatment localization. An endorectal probe that incorporates both an imaging transducer at 7.5 MHz and a treatment transducer working at 3 MHz. 

 

Numerous safety features are incorporated to stabilize the rectal wall during transducer movement, maintain a permanent control of the distance between therapy transducer and rectal wall and a patient motion detector that stops treatment if the patient moves during firing sequence. HIFU is delivered as a single session therapy under anesthesia for a duration of 1 to 3 hours. 

 

The Ablatherm system has undergone vigorous clinical trials in the US at many centers including Memorial Sloan Kettering, MD Anderson Cancer Center, Vanderbilt University, Virginia Urology, Duke University, Florida Health Foundation, Texas Urology, University of Colorado, Hackensack University, Medical College at Wisconsin, University of North Carolina,and University of Southern California. Most recently a system was installed at Cleveland Clinic. It has also been used by HIFU Solution  at Henry Ford Hospital and most recently at  the University of Minnesota.