U.S. patent application number 13/243709 was filed with the patent office on 2012-01-19 for method for transurethral delivery of thermal therapy to tissue.
This patent application is currently assigned to THE REGENTS OF THE UNIVERSITY OF CALIFORNIA. Invention is credited to Chris J. Diederich.
Application Number | 20120016273 13/243709 |
Document ID | / |
Family ID | 27491842 |
Filed Date | 2012-01-19 |
United States Patent
Application |
20120016273 |
Kind Code |
A1 |
Diederich; Chris J. |
January 19, 2012 |
METHOD FOR TRANSURETHRAL DELIVERY OF THERMAL THERAPY TO TISSUE
Abstract
An apparatus for applying thermal energy to a prostate gland,
comprising a support tube having a longitudinal passageway, a power
lead channeled through the longitudinal central passageway and an
ultrasound crystal disposed around at least part of the support
tube. The ultrasound crystal is coupled to the power lead which
provides the power to energize the ultrasound crystal and generate
ultrasound energy providing thermal therapy to the prostate gland.
The ultrasound crystal further includes inactivated portions for
reducing ultrasound energy directed to the rectal wall of the
patient. A sealant is disposed in contact with the ultrasound
crystal allowing vibration necessary for efficient ultrasound
energy radiation for the thermal therapy of the prostate gland.
Inventors: |
Diederich; Chris J.;
(Novato, CA) |
Assignee: |
THE REGENTS OF THE UNIVERSITY OF
CALIFORNIA
Oakland
CA
|
Family ID: |
27491842 |
Appl. No.: |
13/243709 |
Filed: |
September 23, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10397070 |
Mar 24, 2003 |
8025688 |
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13243709 |
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08858912 |
May 19, 1997 |
6537306 |
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10397070 |
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08332997 |
Nov 1, 1994 |
5733315 |
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08858912 |
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08291336 |
Aug 17, 1994 |
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08332997 |
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08083967 |
Jun 25, 1993 |
5391197 |
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08291336 |
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07976232 |
Nov 13, 1992 |
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08083967 |
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Current U.S.
Class: |
601/3 |
Current CPC
Class: |
A61B 18/18 20130101;
A61B 2018/00547 20130101; A61B 18/24 20130101; A61B 2017/00274
20130101; A61F 7/12 20130101; A61N 5/04 20130101; A61F 2007/0095
20130101; A61B 2090/0481 20160201; A61B 2017/00092 20130101; A61B
2090/0472 20160201; A61B 2017/00106 20130101; A61B 2090/378
20160201; A61B 90/04 20160201; A61B 2018/00017 20130101; A61B
2090/3925 20160201; A61N 7/022 20130101; A61N 7/02 20130101; A61B
2017/22065 20130101; A61B 2017/22051 20130101; A61B 2090/049
20160201; A61B 18/1815 20130101 |
Class at
Publication: |
601/3 |
International
Class: |
A61N 7/02 20060101
A61N007/02 |
Claims
1. A method for applying thermal therapy to a prostate gland of a
patient, the method comprising: inserting an ultrasound applicator
within the urethra adjacent to a tissue target region in the
patient; delivering power to the ultrasound applicator to generate
ultrasound energy; and directing the ultrasound energy to
selectively treat a region of the prostate gland.
2. A method as recited in claim 1, wherein directing the ultrasound
energy comprises shaping a distribution pattern of the ultrasound
energy to produce an angular treatment pattern.
3. A method as recited in claim 2, wherein the pattern is shaped to
localize the ultrasound energy to an anterior and lateral region in
the patient's tissue.
4. A method as recited in claim 2, wherein the pattern is shaped to
protect a region of rectal mucosa.
5. A method as recited in claim 4, wherein selectively treating a
region of the prostate gland comprises heating sub-mucosal layers
of urethral tissue while avoiding damage to the mucosal layer.
6. A method as recited in claim 5, wherein the pattern is shaped to
avoid heating a region of rectal mucosa.
7. A method as in recited claim 1, further comprising controlling
the ultrasound energy pattern to control the extent of a
longitudinal energy distribution.
8. A method as in recited claim 7, further comprising dynamically
altering the longitudinal energy distribution.
9. A method as recited in claim 8, wherein the energy pattern is
dynamically altered in response to one or more of the following:
tissue heterogeneities; thermally induced changes in blood
perfusion; or to tailor the size of the treatment region.
10. A method as recited in claim 1, wherein inserting an ultrasound
catheter comprises transurethral delivery of the ultrasound
applicator.
11. A method as recited in claim 1, further comprising delivering a
cooling fluid to the ultrasound applicator to selectively cool a
non-target region of the patient.
12. A method as recited in claim 1, further comprising: measuring
the tissue temperature during treatment; and adjusting the delivery
of ultrasound energy in response to the tissue temperature
measurement.
13. A method for transurethral delivery of thermal therapy to a
prostate gland of a patient, the method comprising: inserting an
ultrasound applicator within the urethra adjacent to a tissue
target region in the patient; delivering power to the ultrasound
transducer to generate ultrasound energy; and directing the
ultrasound energy to selectively treat a region of the prostate
gland.
14. A method as recited in claim 13, wherein directing the
ultrasound energy comprises shaping an ultrasound energy
distribution pattern generated by the ultrasound transducer to
produce an angular treatment pattern.
15. A method as recited in claim 13, wherein the ultrasound
applicator further comprises an outer cover surrounding the
ultrasound transducer, the method further comprising delivering a
cooling fluid to the ultrasound applicator, the fluid disposed
between the ultrasound transducer and the outer cover, wherein the
fluid selectively cools a non-target region of the patient.
16. A method as recited in claim 13, wherein directing the
ultrasound energy comprises translating the ultrasound applicator
within the tissue target region of the patient to selectively treat
a region of the prostate gland.
17. A method as recited in claim 13, wherein directing the
ultrasound energy comprises rotating the ultrasound applicator
within the tissue target region of the patient to selectively treat
a region of the prostate gland.
18. A method for transurethral delivery of thermal therapy to a
prostate gland of a patient, the method comprising: inserting an
ultrasound applicator within the urethra adjacent to a tissue
target region in the patient, the ultrasound applicator comprising
a support member and a plurality of spaced-apart ultrasound
transducers coupled thereof; delivering power to the ultrasound
transducers to generate ultrasound energy; and directing the
ultrasound energy to selectively treat a region of the prostate
gland.
19. A method as recited in claim 18, wherein delivering power to
the ultrasound transducers comprises delivering power to individual
transducers, and wherein directing the ultrasound energy comprises
controlling an ultrasound energy distribution pattern to control
the extent of longitudinal energy distribution.
20. A method as recited in clam 19, wherein the extent of
longitudinal energy distribution is dynamically altered in response
to one or more of the following: tissue heterogeneities; thermally
induced changes in blood perfusion; or to tailor the size of the
treatment region.
21. A method as recited in claim 18, wherein the ultrasound
applicator further comprises an outer cover surrounding the
ultrasound transducers, the method further comprising delivering a
cooling fluid to the ultrasound applicator, the fluid disposed
between the ultrasound transducers and the outer cover, wherein the
fluid selectively cools a non-target region of the patient.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a division of U.S. patent application
Ser. No. 10/397,070 filed on Mar. 24, 2003, now U.S. Pat. No.
8,025,688, incorporated herein by reference in its entirety, which
is a continuation of U.S. patent application Ser. No. 08/858,912
filed on May 19, 1997, now U.S. Pat. No. 6,537,306, incorporated
herein by reference in its entirety, which is a continuation of
U.S. patent application Ser. No. 08/332,997 filed on Nov. 1, 1994,
now U.S. Pat. No. 5,733,315, incorporated herein by reference in
its entirety, which is a continuation-in-part of U.S. patent
application Ser. No. 08/291,336 filed on Aug. 17, 1994, now
abandoned, incorporated herein by reference in its entirety, which
is a continuation-in-part of U.S. patent application Ser. No.
08/083,967, filed Jun. 25, 1993, now U.S. Pat. No. 5,391,197,
incorporated herein by reference in its entirety, which is a
continuation-in-part of U.S. patent application Ser. No. 07/976,232
filed on Nov. 13, 1992, now abandoned, incorporated herein by
reference in its entirety.
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT
[0002] Not Applicable
INCORPORATION-BY-REFERENCE OF MATERIAL SUBMITTED ON A COMPACT
DISC
[0003] Not Applicable
BACKGROUND OF THE INVENTION
[0004] 1. Field of the Invention
[0005] The present invention relates generally to an apparatus and
method for performing a thermotherapy patient treatment protocol.
More particularly, the invention relates to a novel apparatus and
method for heating the prostate gland for therapeutic purposes.
[0006] 2. Description of Related Art
[0007] Thermotherapy treatment is a relatively new method of
treating diseased and/or undesirably enlarged human prostate
tissues. Hyperthermia treatment is well known in the art, involving
the maintaining of a temperature between about 41.5.degree. through
45.degree. C. Thermotherapy, on the other hand, usually requires
energy application to achieve a temperature above 45.degree. C. for
the purposes of coagulating the target tissue. Tissue coagulation
beneficially changes the density of the tissue. As the tissue
shrinks, forms scars and is reabsorbed, the impingement of the
enlarged tissues, such as an abnormal prostate, is substantially
lessened.
[0008] The higher temperatures required by thermotherapy require
delivery of larger amounts of energy to the target prostate
tissues. At the same time, it is important to shield nontarget
tissues from the high thermotherapy temperatures used in the
treatment. Providing safe and effective thermotherapy, therefore,
requires devices which have further capabilities compared to those
which are suitable for hyperthermia.
[0009] Though devices and methods for treating benign prostatic
hyperplasia have evolved dramatically in recent years, significant
improvements have not occurred and such progress is badly needed.
As recently as 1983, medical textbooks recommended surgery for
removing impinging prostatic tissues and four different surgical
techniques were utilized. Suprapubic prostatectomy was a
recommended method of removing the prostate tissue through an
abdominal would. Significant blood loss and the concomitant hazards
of any major surgical procedure were possible with this
approach.
[0010] Perineal prostatectomy was an alternatively recommended
surgical procedure which involved gland removal through an incision
n the perineum. Infection, incontinence, impotence or rectal injury
were more likely with this method than with alternative surgical
procedures.
[0011] Transurethral resection of the prostate gland has been
another recommended method of treating benign prostatic
hyperplasia. This method required inserting a rigid tube into the
urethra. A loop of wire connected with electrical current was
rotated in the tube to remove shavings of the prostate at the
bladder orifice. In this way, no incision was needed. However,
strictures were more frequent and repeat operations were sometimes
necessary.
[0012] The other recommended surgical technique for treatment of
benign prostatic hyperplasia was retropubic prostatectomy. This
required a lower abdominal incision through which the prostate
gland was removed. Blood loss was more easily controlled with this
method, but inflammation of the pubic bone was more likely.
[0013] With the above surgical techniques, the medical textbooks
noted the vascularity of the hyperplastic prostate gland and the
corresponding dangers of substantial blood loss and shock. Careful
medical attention was necessary following these medical
procedures.
[0014] The problems previously described led medical researchers to
develop alternative methods for treating benign pro static
hyperplasia. Researchers began to incorporate heat sources in Foley
catheters after discovering that enlarged mammalian tissues
responded favorably to increased temperatures. Examples of devices
directed to treatment of prostate tissue include U.S. Pat. No.
4,662,383 (Harada). U.S. Pat. No. 4,967,765 (Turner), U.S. Pat. No.
4,662,383 (Sogawa) and German Patent No. DE 2407559 C3 (Dreyer).
Though these references disclosed structure which embodied
improvements over the surgical techniques, significant problems
still remained unsolved. Recent research has indicated that
enlarged prostate glands are most effectively treated with higher
temperatures than previously thought. Complete utilization of this
discovery has been tempered by difficulties in shielding rectal
wall tissues and other nontarget tissues. While shielding has been
addressed in some hyperthermia prior art devices, the higher energy
field intensities associated with thermotherapy necessitate
structures having further capabilities beyond those suitable for
hyperthermia. For example, the symmetrical microwave-based devices
disclosed in the above-referenced patents have generally produced
relatively uniform cylindrical energy fields. Even at the lower
energy field intensities encountered in hyperthermia treatment,
unacceptably high rectal wall temperatures have limited treatment
periods and effectiveness. Further while shielding using
radioreflective fluids has been disclosed in the prior art (see for
example European Patent Application No. 89,403,199) the location of
such radioreflective fluid appears to increase energy field
intensity at the bladder and rectal wall. This is contrary to one
of the objects of the present invention.
[0015] In addition, efficient and selective cooling of the devices
is rarely provided. This increases patient discomfort and increases
the likelihood of healthy tissue damage. These problems have
necessitated complex and expensive temperature monitoring systems
along the urethral wall.
[0016] Finally, the symmetrical designs of the above-referenced
devices do not allow matching of the energy field to the shape of
the abnormally enlarged prostate gland. Ideally, the energy field
reaching the tissues should be asymmetric and generally should
expose the upper and lateral (side) impinging lobes of the prostate
gland to the highest energy. In addition, the field is ideally
substantially elliptical such that the energy reaching the
sphincters is minimized.
BRIEF SUMMARY OF THE INVENTION
[0017] It is therefore an object of the invention to provide an
improved apparatus and method suitable for ultrasound treatment of
tissue.
[0018] It is a further object of the invention to provide an
improved apparatus and method for thermotherapy treatment which
provides a smaller probe with higher ultrasound energy output on
target tissues.
[0019] It is yet a further object of the invention to provide a
novel method and apparatus having high ultrasound energy output on
target tissues while producing substantially no energy output
directed to nontarget tissues.
[0020] It is yet another object of the invention to provide an
improved applicator designed to be inserted into an orifice of a
male patient, wherein the applicator includes a small diameter
ultrasound probe.
[0021] It is a still further object of the invention to provide a
novel means for dynamic monitoring of the treatment temperature
distribution and to use such information to aid in the control of
the deposited power level and its distribution.
[0022] It is another object of the invention to provide and
improved ultrasonic applicator which can be inserted into the
urethra and can be positioned with respect to the prostate and
maintained in position during treatment.
[0023] It is a further object of the invention to provide an
improved method and apparatus using ultrasound energy for the
treatment of prostate disease and, more particularly to provide an
ultrasound applicator consisting of multiple transducers which can
be inserted into the urethra or rectum and direct the energy in
such a manner as to selectively treat the prostate gland.
[0024] It is yet another object of the invention to provide a novel
method and apparatus utilizing ultrasound energy to achieve
therapeutic temperatures in the prostate with better control of
power deposition spatially within the prostate gland than is
possible with prior art devices.
[0025] It is an additional object of the invention to provide an
array of ultrasound transducers producing an energy field having a
gap or "dead zone" whereby tissues (such as the rectum, the distal
sphincter and the verumontanum) are protected from energy
transmission.
[0026] It is a further object of the invention to provide improved
control of both the ultrasonic power level and the distribution of
the power deposited in the prostate in a dynamic fashion which
compensates for physiological changes (temperature, blood flow
effects) that can occur during therapy and accommodates
operator-desired alterations in the therapeutic energy distribution
within the prostate
[0027] It is another object of the invention to provide an improved
thermotherapy device which includes a collimated irradiation of a
target zone generally and selective cooling of nontarget
tissues.
[0028] It is still an additional object of the invention to provide
an improved thermotherapy device which reduces tissue damage and
discomfort by providing more effective cooling to nontarget
tissues.
[0029] It is an additional object of the invention to provide an
improved thermotherapy apparatus having one or more extended, and
nondistensible but expandable balloons.
[0030] It is an additional object of the invention to provide an
improved thermotherapy device which includes ultrasound transducers
or other energy sources capable of producing a substantially
asymmetric energy output field, thus minimizing energy reaching the
rectal wall in benign pro static hyperplasia thermotherapy
treatment.
[0031] It is still a further object of the invention to provide an
improved thermotherapy apparatus which produces an energy field
shaped in accordance with the enlarged mammalian gland to be
treated.
[0032] Other advantages and features of the invention, together
with the organization and manner of operation thereof, will become
apparent from the following detailed description when taken in
conjunction with the accompanying drawings, wherein like elements
have like numerals throughout the drawings.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING(S)
[0033] FIG. 1 illustrates a schematic view of a thermotherapy
device constructed in accordance with one form of the
invention;
[0034] FIG. 2 shows an isometric view of an ultrasound crystal
having a portion of its electrode coating removed;
[0035] FIG. 3 illustrates an end view of the ultrasound crystal
constructed in accordance with the invention and shown in FIG.
2;
[0036] FIG. 4 shows an isometric view of an ultrasound crystal
including two score lines creating a region rendered incapable of
radiating ultrasound energy;
[0037] FIG. 5 shows a top view of the template implant for in vivo
thermometry placement with respect to the applicator for thermal
dosimetry measurements;
[0038] FIG. 6 illustrates a front view of the template implant for
in vivo thermometry placement with respect to the applicator for
thermal dosimetry measurements;
[0039] FIG. 7 illustrates simulated temperature profiles from a 2.5
mm diameter ultrasound applicator within a 6 mm diameter
water-cooled delivery catheter with T.sub.c equal to 20.degree.
C.;
[0040] FIG. 8 illustrates acoustic output power levels as a
function of electrical input power for four individual tubular
array transducers driven at peak resonant frequency;
[0041] FIGS. 9A-9D show longitudinal temperature profiles measured
in pig thigh muscle at A) 0.5 cm; B) 1 cm; C) 2.0 cm; and D) 3.0 cm
radial depths;
[0042] FIG. 10 illustrates tangential temperature profiles measured
in the pig thigh muscle across the central heating zone;
[0043] FIGS. 11A-11E illustrate angular temperature profiles at a)
Probe #1, 0.5 cm depth; b) Probe #2, 2 cm depth; c) Probe #3, 1.0
cm; d) Probe #4, 3.0 cm and e) Probe #5, 1.0 cm;
[0044] FIGS. 12A-12E show a different plot format of angular
temperature at a) Probe #1, 0.5 cm depth; b) Probe #2, 2 cm depth;
c) Probe #3, 1.0 cm; d) Probe #4, 3.0 cm and e) Probe #5, 1.0
cm;
[0045] FIGS. 13A-13D illustrate radial temperature profiles in the
pig thigh muscle after ten minutes of therapy for low power tests
(FIGS. 13A and 13C) and high power tests (FIGS. 13B and 13D);
[0046] FIG. 14 shows a front view of an ultrasound applicator
constructed in accordance with one form of the invention;
[0047] FIG. 15A illustrates an end view of an ultrasound crystal
useful in one form of the intervention; and
[0048] FIG. 15B shows a front view of the crystal shown in FIG.
15A.
DETAILED DESCRIPTION OF THE INVENTION
[0049] Referring now to the figures and more particularly to FIG.
1, a thermotherapy device constructed in accordance with the
invention is indicated generally at 10. Throughout the application
when referring to "thermotherapy," this terminology shall be meant
to include both thermotherapy treatment as well as hyperthermia
treatment unless specifically stated to exclude one therapy.
[0050] The thermotherapy device includes a delivery system 12 which
is coupled to the degassed and temperature regulated water flow 14
as well as RF amplifiers 16 and more fully described in U.S. patent
application Ser. No. 08/083,967. While five tubular ultrasound
transducers 18 are shown for non-limiting, illustrative purposes,
it will be apparent to one skilled in the art that the number and
configuration of ultrasound transducers can be varied depending on
the particular application involved.
[0051] The delivery system can take a number of forms, though
preferably a delivery system such as the one described in U.S.
patent application Ser. No. 07/976,232 is used. The critical
parameters of the delivery system 12 include the ability to provide
degassed and temperature related water flow into the delivery
system adjacent prostate tissue to be treated, as well as enabling
individual control of each of the ultrasound transducers 18.
[0052] The ultrasound transducers 18 are preferably substantially
cylindrical in shape. Conventional transducers 18 having this shape
radiate a substantially symmetrical energy field. This has been
found to be undesirable in prostate treatment as explained in
detail in U.S. patent application Ser. No. 08/083,967. As described
therein, the primary problem with a symmetrical energy field is
heating of the rectal wall during prostate treatment. Irreversible
damage to the rectal wall can result from such an energy field if
power levels are sufficient to effectively treat areas of the
prostate. Accordingly, the ultrasound transducers 18 are modified
in accordance with one form of the invention.
[0053] The ultrasound transducers 18 are modified to create a
portion incapable of producing virtually any ultrasound energy.
This can be accomplished in one of two ways in accordance with this
form of the invention. The first method (as shown in FIGS. 2 and 3)
involves removing the electrode coating 20 from a portion of the
ultrasound crystal 22. As used herein, the term "ultrasound
crystal" shall refer to the nickel-plated piezo ceramic structure
which is unconnected to a housing 24, power leads 26 or the RF
amplifiers 16. The term "ultrasound transducer; shall refer to the
ultrasound crystal 22 coupled to power leads 26 and mounted on a
housing 24. Removing part of the electrode coating 20 as shown in
FIGS. 2 and 3 provides a means for protecting the rectal wall of
the patent from undesirably heating by shaping the energy field.
This enables energy levels, and therefore the heating temperatures
of the prostate, to be increased for more effective thermal
therapy.
[0054] An alternative way of producing a portion which is
substantially incapable of producing ultrasound energy is to score
the electrode portion 21 of the ultrasound crystal 22. While the
depth of the score lines 25 can be varied, preferably the scoring
extends to a depth of 40-50% of the depth of the ultrasound crystal
22 exterior. The scoring can be accomplished using conventional
cutting tools such as a diamond saw.
[0055] While a variety of ultrasound transducer housings 24 and
delivery systems 12 can be used, preferably a delivery system 12
produced by Dornier Medical Systems, Inc. and sold commercially is
used. The delivery system 12 can be reamed out to fit the size of
ultrasound transducer housing assembly 30 as desired.
[0056] The ultrasound transducer housing assembly 30 can comprise a
wide variety of configurations. Preferably, the assembly 30 is
produced by producing apertures 31 in a thin walled tube 32,
through which the power leads 34 for the ultrasound crystal 22 are
run as shown in FIG. 14. The thin walled tube 32 can comprise a
variety of biocompatible, noncorrosive materials, although
preferably No. 304 stainless steel (thin needles stock) is used.
The wires are run through the apertures 31, and an ultrasound
crystal 22 is slid over the power leads 34, and soldered thereto.
Any number of crystals 22 can be mounted this way, depending on the
length of the thin wall tube 32 and the application desired. Next,
silicone sealant 38 such as that sold commercially by General
Electric as Silicon II Glue Seal and Gasket is deposited between
the ultrasound crystals 22 and over the thin walled tube 32. The
silicone sealant 38 acts as an adhesive, but allows the vibration
necessary for efficient ultrasound energy radiation. The silicone
sealant 38 also provides a water tight seal. While the assembly
could be used in this form, preferably the assembly 30 is covered
with shrink-wrap material 40 such as "SPIROBOUND" heat-shrink
tubing which shrinks when exposed to heat. The shrink-wrap is
exposed to a conventional heat source such as a propane torch in a
controlled manner, and one obtains even shrinkage and a good seal
by technique such as rotating the assembly 30 while heating. The
resulting assembly is robust and highly efficient.
[0057] While a variety of ultrasound crystals 22 can be used,
preferably the ultrasound crystal 22 shown in FIGS. 15A and 15B is
used. For additional transducer details, please see FIGS. 14A and
14B. This ultrasound crystal 22 is preferably provided by Stavely
Sensors, Inc. of East Hartford, Conn. Or Valpey-Fischer Corp of
Hopkinton, Mass., and produces extremely high power output for a
small sized transducer.
EXAMPLE
[0058] In accordance with this form of the invention, a
transurethral multielement ultrasound applicator was used as a
means of improving heating penetration, spatial localization, and
dynamic control to afford better treatments for cancer and BPH.
This structure provided longitudinal control of heating to cover
the anterior-lateral portion of the prostate while sparing the
region around the rectum and verumontanum. Computer simulations,
acoustic measurements, and in vivo thermal dosimetry studies
confirmed the usefulness of this form of the invention.
[0059] For a nonlimiting, illustrative example, prototype
applicators were fabricated with four tubular transducer elements
(each 6 mm long, 2.5 mm OD) attached to form a segmented array.
Separation between elements was approximately 0.5 mm. Each
transducer was modified to produce uniform coverage of the anterior
and lateral portions of the prostate and to ensure that no acoustic
energy would be delivered to the rectum during clinical use. The
multielement applicator was designed to be inserted within a
modified catheter delivery system previously developed for
microwave BPH therapy (Dornier Medical Systems, Inc.), with annular
counter-current flow for water coupling of the acoustic energy and
temperature regulation of the catheter/urethra interface. (The
cooling provided by the delivery system protects the urethra). The
heating performance of these ultrasound applicator was evaluated
using computer simulation programs to calculate the acoustic fields
and corresponding thermal distributions in tissue. The power
deposition (<q>) of these cylindrical sources in tissue can
be approximated by the following expression:
q = 2 .alpha. I o fr o r - 2 .alpha. / ( r - r o ) ( 1 )
##EQU00001##
where I.sub.o is the intensity at the transducer surface, r.sub.o
is the radius of the transducer, r is the radial distance from the
center of the transducer, .alpha. is the amplitude attenuation
coefficient, and f is the frequency (MHz).
[0060] The temperature distributions resulting from the compiled
power disposition patterns were calculated using the bio-heat
transfer equation (BHTE), a descriptive model of tissue thermal
characteristics:
.gradient.2(kT)-.alpha.bcb(T-Ta)+<q>=0 (2)
where k is the tissue thermal conductivity, w is the blood
perfusion rate, c.sub.b is the specific heat of tissue, T is the
tissue temperature and T.sub.a is the arterial blood temperature.
The steady-state solution to this equation was computed using the
finite difference technique with successive over-relaxation.
Typical values used were: .alpha.=5 Np m.sup.-1 MHz.sup.-1, k=0.528
W m.sup.-1 .degree.C..sup.-1, w=1-10 kg m.sup.-3 s.sup.-1, c=3680 J
kg.sup.-1 .degree.C..sup.-1, p=1000 kg m.sup.-3. A perfusion of
w=2.0 kg m.sup.-3 s.sup.-1 represents a moderately perfused tissue
(resting muscle); most tumors range from 0.1-5.0 kg m.sup.-3
s.sup.-1. These simulations were configured to accurately model the
presence of applicator water cooling of the applicator/tissue
interface. The acoustic force-balance technique adapted for
cylindrical radiators was used to measure the acoustic output power
from these tubular transducers as a function of drive frequency and
applied electrical power.
[0061] A 100 lb female farm pig was anesthetized using 1.5%
Isoflourane and 0.6 1/min 02. A 0.5 inch thick Plexiglas template
was used to ensure alignment of the thermometry probe tracks with
the catheter delivery system (see FIGS. 5 and 6 for set up). 20 g.
needles were inserted through the template for thermometry tracks
at radial distances of 0.5 to 3.0 cm from the catheter wall but
aligned with the axis of the delivery system. A tangential
thermometry track was inserted orthogonal to the axis of the
delivery system, 5 cm deep within the thigh, and glancing the
surface of the catheter delivery system. Multijunction thermocouple
probes were inserted within the needles and moved in 0.5 cm
increments to obtain temperature maps along the length of the
applicator. The approximate radial depth of sensed needles from the
outer surface of the delivery catheter was 0.5, 1.0, 2.0 and 3.0
cm.
[0062] A multichannel RF amplifier system was used to power each
transducer within the applicator. The frequency sweep on center
frequency for each transducer was adjusted to produce a uniform
pressure disturbance as visualized on the surface of water. A flow
rate of 220 ml/min of 35.degree. C. degassed water was maintained
to the delivery system for the duration of the experiment.
[0063] The applicator was aligned within the catheter so that the
"dead zone" aimed at #6 (probe track 6) and the central heating
zone was aimed at #3. 2 watts of RF power was applied to each
transducer element of the applicator until a pseudo steady-state
was achieved after 5 minutes. Temperature maps were obtained for
all thermometry probes, and then the power was turned off. The
applicator was then rotated counter clockwise by 30.degree. within
the delivery system. After the tissue cooled back to equilibrium
(10-20 min) the process was repeated. This sequence was repeated
until the pseudo-steady-state temperature profiles were measured
for each thermometry tract as the applicator was rotated in
30.degree. increments for a total of 180.degree..
[0064] Simulated radial temperature profiles (see FIG. 7)
illustrated that effective heating is possible to 2 cm depth with
concurrent cooling to protect the urethral mucosa
(T.sub.c=20.degree. C., 7 MHz ultrasound). These experimental
results (see FIG. 9) demonstrate the distinct advantage of
multielement ultrasound applicators over other techniques: the
power deposition along the applicator length can be adjusted to
produce more desirable (elongated) temperature distributions such
as adjusting heating length and accommodating dynamic changes in
blood perfusion and tissue heterogeneity.
[0065] The acoustic efficiencies of these cylindrical ultrasound
transducers was between 55-60% at the peak resonant frequency.
These efficiencies are high for such very small crystals. FIG. 8
demonstrates that acoustic power levels of almost 12 w per
transducer are attainable with this applicator design.
[0066] The temperature distributions produced by this applicator in
pig thigh muscle were measured using low temperature repetitive
heating trials. (This was necessary to ensure repeatability between
heating sessions and to avoid thermal damage to the tissue). The
longitudinal temperature profiles at varying radial depths from the
applicator surface are shown in FIGS. 9A-E, demonstrating that
within the central heating zone the therapeutic region extends
towards the ends of the applicator and is fairly uniform, while
isolated from the "rectal" region. The tangential profiles (FIG.
10) measured across the central heating zone illustrate a radial
extension of the heated region 2-3 cm diameter. From a series of
measurements at different rotational angles, the steady-state peak
(longitudinal) temperature rise as a function of applicator
rotational angle at varying depths are shown in FIGS. 11A-E,
illustrating the preferential localization of the heating to the
anterior and lateral regions while protecting the rectum (located
at zero degrees on the plots). Further data relating to temperature
rise as a function of alignment angle and longitudinal distance
along the application are plotted in FIGS. 12A-E.
[0067] Finally, the applicator was repositioned to the initial
startup orientation, and 8-10 acoustic watts of power was applied
to each transducer in order to thermally ablate the "target" region
an pseudo steady state temperatures were obtained. The radial
temperature distribution achieved during the ablative sequence is
shown in FIG. 12.
[0068] These results verified the usefulness of using the
transurethral ultrasound applicator of present invention for
thermal therapy of the prostate. Theses applicators, inserted
within a water-cooled delivery-catheter, can produce heated regions
extending more than 2 cm in radial depth, while sparing the
urethral mucosa. A significant advantage of multi-transducer
ultrasound applicators is that the longitudinal power deposition
(heating pattern) can be dynamically altered in response to tissue
heterogeneities, thermally induced changes in blood perfusion, and
to tailor the size of the treated region. In addition, the beam
distributions from these applicators can be shaped in order to
produce desired circumferential or angular heating patterns which
can protect the rectal mucosa while localizing the energy
deposition to the anterior and lateral sections. This is a
significant improvement over previous designs using single antenna
microwave energy sources, which produce more elliptical or
"football shaped" distributions which can not be adjusted. The in
vivo thermal dosimetry experiments also show that therapeutic
temperatures in excess of 80.degree. C. can be obtained with the
present invention.
[0069] While preferred embodiments have been illustrated and
described, it should be understood that changes and modifications
can be made therein without departing from the invention in its
broad aspects. Various feature of the invention are defined in the
following claims.
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