A critical need has emerged for volumetric thermometry to visualize 3D temperature distributions in real time during
deep hyperthermia treatments used as an adjuvant to radiation or chemotherapy for cancer. For the current effort,
magnetic resonance thermal imaging (MRTI) is used to measure 2D temperature rise distributions in four cross sections
of large extremity soft tissue sarcomas during hyperthermia treatments. Novel hardware and software techniques are
described which improve the signal to noise ratio of MR images, minimize motion artifact from circulating coupling
fluids, and provide accurate high resolution volumetric thermal dosimetry. For the first 10 extremity sarcoma patients,
the mean difference between MRTI region of interest and adjacent interstitial point measurements during the period of
steady state temperature was 0.85°C. With 1min temporal resolution of measurements in four image planes, this noninvasive
MRTI approach has demonstrated its utility for accurate monitoring and realtime steering of heat into tumors at
depth in the body.
Purpose: Blood perfusion is a well-known factor that complicates accurate control of heating during hyperthermia treatments of cancer. Since blood perfusion varies as a function of time, temperature and
location, determination of appropriate power deposition pattern from multiple antenna array Hyperthermia systems and heterogeneous tissues is a difficult control problem. Therefore, we investigate the applicability of a real-time eigenvalue model reduction (virtual source - VS) reduced-order controller for hyperthermic
treatments of tissue with nonlinearly varying perfusion. Methods: We impose a piecewise linear approximation to a set of heat pulses, each consisting of a 1-min heat-up, followed by a 2-min cool-down.
The controller is designed for feedback from magnetic resonance temperature images (MRTI) obtained after each iteration of heat pulses to adjust the projected optimal setting of antenna phase and magnitude for selective tumor heating. Simulated temperature patterns with additive Gaussian noise with a standard deviation of 1.0°C and zero mean were used as a surrogate for MRTI. Robustness tests were conducted numerically for a patient's right leg placed at the middle of a water bolus surrounded by a 10-antenna applicator driven at 150 MHz. Robustness tests included added discrepancies in perfusion, electrical and thermal properties, and patient model simplifications. Results: The controller improved selective tumor heating after an average of 4-9 iterative adjustments of power and phase, and fulfilled satisfactory therapeutic outcomes with approximately 75% of tumor volumes heated to temperatures >43°C while maintaining about 93% of healthy tissue volume < 41°C. Adequate sarcoma heating was realized by using
only 2 to 3 VSs rather than a much larger number of control signals for all 10 antennas, which reduced the convergence time to only 4 to 9% of the original value. Conclusions: Using a piecewise linear
approximation to a set of heat pulses in a VS reduced-order controller, the proposed algorithm greatly improves the efficiency of hyperthermic treatment of leg sarcomas while accommodating practical
nonlinear variation of tissue properties such as perfusion.