www.debenedetti1547.org

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www.debenedetti1547.org
The HIFU Treatment for Localized Prostate Cancer
AblathermINTEGRATED IMAGING
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www.ar
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Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
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Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
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Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
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Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
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Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
8
Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
9
Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
10
Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
11
Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
12
Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
13
Ablatherm HIFU step by step
The device
The probe
Robotized
Placement
Scanning
3D imaging
Planning
Firing phase
Ultrasound
Final aspect
End
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Ultrasound Waves Generation
Physical Principle
Treatment Description
Plane transducer Ultrasound waves emission by
transducer electro-mechanical vibrations



Acoustical pressure
-
-
-
Tissue motion
Tissue heating
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Focused Ultrasound Waves
Physical Principle
Treatment Description
Focused transducer Emitting ultrasound waves
Acoustical pressure
Tissue heating Over 85C
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Tissue Lesion Formation
Physical Principle
Treatment Description
Thermal effects Cavitation effects
Time exposure Tissue lesion
Temperature Simulation INSERM U 557
HIC Technology HIFU INDUCED CAVITATION
Thermal Dose Simulation INSERM U 557
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Local Increase of Tissue Temperature
Physical Principle
Treatment Description
Two different approaches to reach the destruction
threshold
Temp.
Temp.
BPH
CANCER
HIFU
HYPERTHERMIA
Time
Time

• High Temperature (gt85 C)

• Low Temperature (lt 45 C)

• Short Time (lt 5 Sec.)

• Long Duration (gt1 Hr)

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Transducer Positioning
Treatment Description
Physical Principle

• Precise lesion positioning
• with dynamic focusing
• Sparing ofsurrounding tissue

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Lesion Distribution within the Prostate
Treatment Description
Physical Principle

• Each shot consists of a burst of ultrasound
  waves with a duration of 5 seconds
• The focal volume is very small 19-24 mm in
  length by 1.7 mm in diameter

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Lesion Distribution within the Prostate
Treatment Description
Physical Principle
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Lesion Distribution within the Prostate
Treatment Description
Physical Principle
The firing head moves until the whole targeted
volume is treated
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History of the Ablatherm Project

• 1989 Preliminary experiments on rats kidneys
• and technology development
• 1990 Cancer treatment - feasibility Dunning
  tumors
• 1991 Endorectal approach - feasibility canine
  prostate
• 1993 Treatment efficacy - evaluation PCa
• 1995 Device safety improvements
• 1996 European Multicentric Study
• 2000 Mark Ablatherm Maxis
• 2005 Mark Ablatherm Integrated Imaging

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CE Mark Ablatherm
Marked January 2000
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In excess 9000 treatments in 100 sites in Europe
2000
1000
Patients treated with Ablatherm every year
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Ablatherm HIFU
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Device Description
Probe
General Description
Treatment Module
Probe Module
Command Module
Imaging and Firing System
Electronics and safeties
User Interface
RF Power
Motors
Cooling
Disposable
Computer
Endorectal Probe
Patient Support
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Endorectal Probe
Probe
General Description
2 functions, 2 transducersintegrated in ONE
probe Imaging Treatment
Real-time ultrasound imaging. 7.5 MHz
high-definition image. Electronic array
technology.
A 3 MHz transducer. Dynamic positioning with
respect to rectal wall. Wide opening.
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Integrated imaging
Probe
General Description
High resolutionimaging system
2 different transducers with anIntegrated
imaging 7.5 MHz probe
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Imaging Treating Simultaneously
Probe
General Description
Imaging Firing
From a transversal real-time image,the 7.5 MHz
electronic ultrasound transducer can providean
accurate 3D reconstructionof the treatment area.
High-energy ultrasound waves are focused through
the rectal wall to the targeted prostate area.
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Indications
Positioning
Summary
Treatment
Candidate for RPP EBRT failure Recurrence
after previous HIFU
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Main Steps of a Treatment
Positioning
Summary
Treatment

• Probe preparation (Ablapak disposable)
• Patient installation (Immobilization)
• Prostate localization (Apex identification)
• - Longitudinal imaging
• - Transversal imaging
• Treatment (Safety controls)
• Patient removal
• Probe cleaning and disinfection

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Patient Installation (Immobilization)
Positioning
Summary
Treatment
Patient positioned in right lateral decubitus
position
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Patient Installation (Immobilization)
Positioning
Summary
Treatment
Patientmovement detector
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Prostate localization (1)
Positioning
Summary
Treatment
Probe insertion Intra-rectal
positioning
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Prostate localization (2)
Positioning
Summary
Treatment
Probe insertion Robotized movements
If the video doesnt start automatically click on
the window
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Prostate localization (3)
Positioning
Summary
Treatment
Automatic imaging phase 3D reconstruction
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Prostate localization (4)
Positioning
Summary
Treatment
Automatic imaging phase 3D reconstruction
If the video doesnt start automatically click on
the window
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Treatment (planning)
Positioning
Summary
Treatment
Treatment area programming Firing phase
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Treatment (planning)
Positioning
Summary
Treatment
Treatment area programming Firing phase
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Treatment (planning)
Positioning
Summary
Treatment
Treatment area programming Firing phase
If the video doesnt start automatically click on
the window
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Treatment (planning)
Positioning
Summary
Treatment
Treatment area programming Firing phase
If the video doesnt start automatically click on
the window
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Treatment (Safety Controls)
Positioning
Summary
Treatment

• Main safety features
• Power / Firing sequence
• Probe position
• Patient movement
• Rectum position
• Temperature

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