MR Image Guided Hyperthermia
Gerhard Sennewald PhD, Munich, Germany
Kazakh Medical Diagnostic Forum “Technological
Innovations in radiology & functional diagnosis“
Astana, Kazakhstan, September 23 & 24, 2014
Agenda
Agenda
BSD 2000•3D Deep Regional Hyperthermia
BSD 2000•3D-MR Image Guided
Hyperthermia
SigmaHyperPlan / SigmaVision
Regional Hyperthermia
Upper (front ) plate
Antennas
Lower (back ) plate
Antennas
capacitive systems
Image courtesy of Dughiero et al.
radiative multi antenna systems
Image courtesy of Gellermann et al.
Regional Hyperthermia
capacitive systems
Image courtesy of Dughiero et al.
radiative multi antenna systems
Image courtesy of Gellermann et al.
Regional Hyperthermia
Direction of the E-Fields
capacitive systems
Image courtesy of Dughiero et al.
radiative multi antenna systems
Image courtesy of Gellermann et al.
BSD-2000 System Family
BSD 2000 Basic System
BSD-2000-3D/MR System:
• 3 Rings with 8 Antenna each
• MRI Image Guided Thermometry
BSD 2000 3D System
Regional Hyperthermia
Functional Principle:
8 Antennas in 4 pairs
BSD 2000 Concept: Antenna Arrays
Sigma 60 Applicator:
• 8 Antenna Array surrounding the Patient
BSD 2000 3D Applicator
24 Antennae in
3 Rings of 8 Antennas each
Regional Hyperthermia
Lamp phantom
BSD 2000 3D Hyperthermia
Treatment Suite
BSD-2000 Clinical Indications:
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•
•
•
Cervix
Rectal
Bladder
Sarcoma
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•
•
•
•
•
Pancreas
Abdominal
Prostate
Pelvic
Lung
etc….
Temperature Monitoring
• Invasive Thermometry
– Intratumoral
• Min. Invasive Thermometry
– Intraluminal
• Image Guided Thermometry
– MRI-Thermometry
MR Image Guided Hyperthermia
MR Image Guided Hyperthermia
MR Image Guided Hyperthermia
MR Image Guided Hyperthermia
Dockable Patient Cart & 70 cm Bore
Thermometry –
MR Controlled Hyperthermia
MR Hyperthermia Treatment Suite
Hyperthermia
MRI Diagnostics
MR Imaging Compatible Applicators
Sigma Eye MR:
Sigma 40 MR:
Sigma 30 MR
•
•
•
•
•
•
•
•
•
•
•
•
24 antennae
12 channels
3 antenna rings
37 x 54 x 48 cm long
16 antennae
8 channels
2 antenna rings
42 x 38 cm long
8 antennae
4 channels
1 antenna ring
27 x 25 cm long
The new user-friendly software for MR-Thermometry
Thermometry
• Color overlay to display the temperature
changes
• Total and Difference PRFS
• Timeline feature to monitor the chronological
sequence of the treatment
• T90 temperature calculation
• Timeline documentation for each step
MR Guided Pediatric Hyperthermia
Wessalowski et al.: The Lancet Oncology 2013 on Germ Cell Tumors
Department of Pediatric Oncology UMS Düsseldorf - Germany
Wessalowski et al. Lancet Oncol. 2013
MR Guided Pediatric Hyperthermia
Wessalowski et al. Lancet Oncol. 2013
MR Guided Pediatric Hyperthermia
Applicators of Various Sizes Optimize Pediatric Treatments
Wessalowski et al. Lancet Oncol. 2013
MR Guided Pediatric Hyperthermia
Pediatric Abdominal Treatment in Sigma 40 Applicator
Wessalowski et al. Lancet Oncol. 2013
MR Guided Pediatric Hyperthermia
Combining Hyperthermia & Chemo for Recurrent Germ Cell Tumors:
• 44 Patients, All Non-Responders to Standard Chemo Treatment, Treated in HyperPei
Protocol Resulting in 25 Complete and 14 Partial Remissions
Wessalowski et al. Lancet Oncol. 2013
MR Guided Pediatric Hyperthermia
Editorial T. Olson in „The Lancet Oncology“ 2013:
Hyperthermia in Pediatric Germ Cell Tumors – a New Treatment Standard ?
Wessalowski et al. Lancet Oncol. 2013
The Atzelsberg Clinical Trial Circle
Ott OJ et al., 2009
The Atzelsberg Clinical Trial Circle
Ott OJ et al., 2009
The Atzelsberg Clinical Trial Circle
Ott OJ et al., 2009
The Atzelsberg Clinical Trial Circle
• Development of Guidelines and Clinical Trials
Ott OJ et al., 2009
The Atzelsberg Clinical Trial Circle
O. Ott: Rectal Cancer HyRec Trial - Treatment Schedule - Trial is Recruting
Recurrent & Locally Advanced Rectal Cancer
Radiotherapy
PTV: depending on
former Tx
Dose: 45 Gy
R
E
S
5-FU
CIV (250 mg/m²/d)
d 1-14
E
d 22-35
C
d2
d9
d23
d30
T
Oxaliplatin
Bolus (50 mg/m²/d)
I
d2
d5
d9
d12
d16
d19
d23
d26
d30
O
d33
Deep Regional
Hyperthermia
Required Cases
n =59
N
1
2
3
4
5
6
Week
Ott OJ et al., 2009
42
The Atzelsberg Clinical Trial Circle
R.D.Issels MD PhD: Randomized Phase III Trial on Postoperative Pancreas Cancer
Thank you!
MR Guided Hyperthermia in Soft Tissue
Sarcomas