Accuracy of Electrode Placement in IRE Treatment with Navigated Guidance

Stillström, David; Sandu, Raluca-Maria; Freedman, Jacob

doi:10.1007/s00270-020-02762-5

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…23 A recent optimization study of electric fields from the external device highlighted the importance of minimizing the anisotropy of electric field components while maintaining field intensity, 24 supporting the use of rotating fields in IMT. Similarly, both deep brain stimulation (DBS) to treat neurological disorders [25][26][27][28][29][30] and irreversible electroporation (IRE) to ablate tumor volumes [31][32][33][34][35] require electric field and implanted electrode trajectory planning to reach the target volume. Stereoelectroencephalography (SEEG) uses multiple depth electrodes implanted in the brain to identify seizure zones, with robotic and computer assisted trajectory planning gaining interest.…”

Section: Introductionmentioning

confidence: 99%

Planning system for the optimization of electric field delivery using implanted electrodes for brain tumor control

et al. 2022

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Background: The use of non-ionizing electric fields from low-intensity voltage sources (< 10 V) to control malignant tumor growth is showing increasing potential as a cancer treatment modality. A method of applying these low-intensity electric fields using multiple implanted electrodes within or adjacent to tumor volumes has been termed as intratumoral modulation therapy (IMT). Purpose: This study explores advancements in the previously established IMT optimization algorithm, and the development of a custom treatment planning system for patient-specific IMT.The practicality of the treatment planning system is demonstrated by implementing the full optimization pipeline on a brain phantom with robotic electrode implantation, postoperative imaging, and treatment stimulation. Methods: The integrated planning pipeline in 3D Slicer begins with importing and segmenting patient magnetic resonance images (MRI) or computed tomography (CT) images. The segmentation process is manual, followed by a semi-automatic smoothing step that allows the segmented brain and tumor mesh volumes to be smoothed and simplified by applying selected filters. Electrode trajectories are planned manually on the patient MRI or CT by selecting insertion and tip coordinates for a chosen number of electrodes. The electrode tip positions and stimulation parameters (phase shift and voltage) can then be optimized with the custom semi-automatic IMT optimization algorithm where users can select the prescription electric field, voltage amplitude limit, tissue electrical properties, nearby organs at risk, optimization parameters (electrode tip location, individual contact phase shift and voltage), desired field coverage percent, and field conformity optimization. Tables of optimization results are displayed, and the resulting electric field is visualized as a field-map superimposed on the MR or CT image, with 3D renderings of the brain, tumor, and electrodes. Optimized electrode coordinates are transferred to robotic electrode implantation software to enable planning and subsequent implantation of the electrodes at the desired trajectories. Results: An IMT treatment planning system was developed that incorporates patient-specific MRI or CT, segmentation, volume smoothing, electrode trajectory planning, electrode tip location and stimulation parameter optimization, and results visualization. All previous manual pipeline steps operating on diverse software platforms were coalesced into a single semi-automated 3D Slicerbased user interface.Brain phantom validation of the full system implementation was successful in preoperative planning, robotic electrode implantation, and postoperative treatment planning to adjust stimulation parameters based on

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Section: Introductionmentioning

confidence: 99%

Planning system for the optimization of electric field delivery using implanted electrodes for brain tumor control

et al. 2022

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“…To get full effect the electrodes should be placed as parallel as possible (15,16). The placement is guided by ultrasound (US), contrast enhanced ultrasound (CEUS), US images fused with computed tomography (CT) or magnetic resonance imaging (MRI), CT, MRI, or CT based stereotactic navigation systems (17)(18)(19) (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

Change in tissue resistance after irreversible electroporation in liver tumors as an indicator of treatment success - A multi-center analysis with long term follow-up

Frühling,

Stillström,

Holmquist

et al. 2024

European Journal of Surgical Oncology

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“…To optimise the electrode placement different methods of computer assisted guidance have been developed and shown superior results compared to conventional CT-guided electrode placement 14 – 16 . Our group has previously presented data on safety, efficacy and accuracy of stereotactic CT guided navigation in IRE treatment 17 , 18 .…”

Section: Introductionmentioning

confidence: 99%

Stereotactic navigation versus ultrasound guidance in placing IRE applicators in a liver phantom

Stillström

Eigl²,

Freedman

2021

Sci Rep

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The aim of this study was to compare the accuracy of stereotactic CT-guided navigation and ultrasound guided navigation for placing electrodes in Irreversible electroporation in a liver phantom. A liver phantom with multiple tumours was used and interventionists placed four IRE electrodes around each tumour guided either by stereotactic CT-guided navigation or ultrasound. The goal was to place them in a perfect 20 × 20 mm square with parallel electrodes. After each treatment, a CT-scan was performed. The accuracy in pairwise electrode distance, pairwise parallelism and time per tumour was analysed. Eight interventionists placed four electrodes around 55 tumours, 25 with ultrasound and 30 with stereotactic CT-guided navigation. 330 electrode pairs were analysed, 150 with ultrasound and 180 with stereotactic CT-navigation. The absolute median deviation from the optimal distance was 1.3 mm (range 0.0 to 11.3 mm) in the stereotactic CT-navigation group versus 7.1 mm (range 0.3 to 18.1 mm) in the Ultrasound group (p < 0.001). The mean angle between electrodes in each pair was 2.7 degrees (95% CI 2.4 to 3.1 degrees) in the stereotactic CT-navigation group and 5.5 degrees (95% CI 5.0 to 6.1 degrees) in the Ultrasound group (p < 0.001). The mean time for placing the electrodes was 15:11 min (95% CI 13:05 to 17:18 min) in the stereotactic CT-navigation group and 6:40 min (95% CI 5:28 to 7:52 min) in the Ultrasound group. The use of stereotactic CT-navigation in placing IRE-electrodes in a liver phantom is more accurate, but more time consuming, compared to ultrasound guidance.

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Accuracy of Electrode Placement in IRE Treatment with Navigated Guidance

Cited by 5 publications

References 22 publications

Planning system for the optimization of electric field delivery using implanted electrodes for brain tumor control

Planning system for the optimization of electric field delivery using implanted electrodes for brain tumor control

Change in tissue resistance after irreversible electroporation in liver tumors as an indicator of treatment success - A multi-center analysis with long term follow-up

Stereotactic navigation versus ultrasound guidance in placing IRE applicators in a liver phantom

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