I did my Masters' thesis with the group that invented and developed this in Toronto. I know some of the co-authors on the paper personally since we worked together.
AMA.
AMA.
1) Any idea on where to look to find out when this might become available? Looks like it was just cleared by FDA with 510(k) clearance.
2) My guess is that if you want this done - you would have to travel to UCLA? and Dr. Raman (or colleague) would perform the operation?
3) Is there anywhere to find a real discussion of down side risks with actual rates and figures?
For example, the RSNA article has a statement:
>"There were low rates of severe toxicity and no bowel complications."
4a) What does `severe toxicity` entail? 4b) Is that a operational complication that is remedied at the hospital and overcome in the short-term? or is that a long term quality of life issue?
5a) Furthermore what is this actual "low" rate? is it 2/115 or is more like 10/115? It looks like the base rate for these is perhaps around 3%-7% is how would I compare this study of 115 to something published like: [1]
Similarly RSNA states:
> "We saw very good results in the patients, with a dramatic reduction of over 90 percent in prostate volume and low rates of impotence with almost no incontinence" --Dr. Raman said.
5b) Where could I look to find the actual rates of each of these negative side effects? 5c) Or would you guess they are not published?
Things like liver cancer you're probably better off just doing a surgery for, as you'll have more chance of getting it all, spotting metastasized offshoots, etc., and it's fairly accessible.
Thus, at least at our site, it was used to develop treatments for uterine fibroids, some types of breast cancer, and some types of brain cancer (using transcranial ultrasound, which is much harder to do because you have to go through bone and adjust for that medium). Generally, areas that you can reach from the skin and/or with a special probe, are potential treatment targets.
Lung cancers are hard to treat with ultrasound, for a few reasons. The biggest is that it moves, which makes it hell for the MRI and system as a whole to keep up without hitting unwanted areas. The other is that ultrasound doesn't travel well through air. For ultrasound ablation to work, you need a good conduction interface. That's why ultrasound technicians slather that clear gel on you when they're imaging you. It's possible to do in the lungs, just exceedingly difficult. It's unlikely that someone will commercialize something there.
The liver and kidneys won't be targeted either because the only way to reach them is by performing an incision. You might as well use other techniques like laparoscopy.
You'll note that it's measured in dB/(MHz-cm), and that soft tissue is 0.5, while bone is 6.9. Just like light, anytime ultrasound hits an interface, there are reflections and refractions. Furthermore, since bone attenuates ultrasound so much, you have to increase your amplitude greatly (and even more so with higher frequencies) in order to get enough thermal energy to be deposited at your target. If you don't do it right, you can create dangerous hotspots at the bone-tissue interface, and you can also deposit energy where you didn't intend to. Given that ultrasound therapy intends to be more precise than other techniques, you're kind of defeating the purpose!
Edit: in response to your edit, yes that's exactly what they do. They create an array of transmitters to be able to precisely target various locations within the skull. It wasn't my area of research, but I'm pretty sure they used them to create interference patterns as well, so many emitters were activated to work in concert to target one area.
See this image: https://sunnybrook.ca/uploads/1/_research/about/fus/3-ultras...
Transcranial ultrasound + monitoring via MRI. Requires a rock-solid transmitter clamped on the skull.
Put them in a coma
Lower their T to significantly decrease the matabolism
Fill their lungs with a liquid air solution (it’s a perfluorinate liquid that absorbs lots of O2. It works, but sucks)
Since CO2 isn’t soluble in fluorinated liquids. Intravenously remove the CO2 (hard, but you’ve lowered the metabolism rate)
Slowly circulate the fluid
Starts blasting away at the tumors.
https://www.uclahealth.org/fibroids/mr-guided-focused-ultras...
And after a quick search it looks like there's some movement there: https://fusfoundation.org/diseases-and-conditions/urological...
@HorizonXP, any thoughts on this and it's potential to go mainstream? Asking for a friend...
Any focused ultrasound tech has potential to gain wide acceptance but it is mostly the imaging component (MRI guided in most cases) that hold it back due to costs and availability.
Pro: hair growth. Con: decimated libido.
Not every procedure lends well to alternative imaging modality (Brain surgery is one) but ultrasound guided FUS is really where there is potential to increase adoption.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064817/
The "expensive thermometer" point is interesing. Cant we develop a cheaper one?
The (un)fortunate point of MRI thermometry is that is not only very effective at reading temperatures, but it can also produce thermal dosage maps that help in characterizing tissue leisioning (the exact response of HIFU ablated tissue is still be debated). On top of that you also get traditional MRI imaging essentially for free.
[1] https://www.nature.com/articles/s41598-018-25904-9
[2] https://www.fusfoundation.org/diseases-and-conditions/neurol...
Thanks.
I'm always wary of reading too much into articles about promising medical developments, because it seems like often the headlines look great but they are actually referring to some relatively early stage of trials, so results of later trials might not be so good or even if they are it might still be a long time before the treatment is used routinely.
However, in this case, the article reads as if this is literally a cure for (one sort of) cancer, with an 80% success rate, which can be done as an outpatient procedure with a relatively low risk of complications. That seems like about 80% of the holy grail, at least in terms of treating prostate cancer specifically.
Can you give an expert perspective on how excited we should or shouldn't be about this result?
When I left my Masters in 2012, the clinical trials being done still resulted in a prostatetectomy. Meaning, these generous men donated their time to allow us to use them as guinea pigs, yet received no benefit since their prostates were removed anyway. That did allow us to perform in-depth pathology reports about the efficacy of the treatment.
This paper has 115 men that were treated and allowed to not have the surgery done, so this is the first time that we were able to see what the outcomes of the treatment truly are. Based on the results in the abstract, it looks like the hypothesis that men would be "cured" and have a better quality of life (i.e. no incontinence or sexual dysfunction) seems to be well-supported.
More of these trials will need to occur before it becomes approved as a viable alternative to surgery. The big benefit though is that even if the the treatment fails to kill all of the cancer, it probably kills enough of it that you can go back to a watchful waiting approach, keep monitoring PSA levels and symptoms, and if anything was missed, follow up with full surgery. That is, surgery can become the last-ditch approach vs. being the only approach.
It's less about the pain of the heat, and more about the discomfort of having probes in your genitals, and the requirement that you stay perfectly still.