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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 HyperthermiaBSD 2000•3D-MR Image Guided Hyperthermia SigmaHyperPlan / SigmaVision
capacitive systems radiative multi antenna systems
Regional Hyperthermia
Upper (front ) plate
Lower (back ) plate
Antennas
Antennas
Image courtesy of Dughiero et al. Image courtesy of Gellermann et al.
capacitive systems
Image courtesy of Dughiero et al. Image courtesy of Gellermann et al.
Regional Hyperthermia
radiative multi antenna systems
Direction of the E-Fields
capacitive systems
Image courtesy of Dughiero et al. Image courtesy of Gellermann et al.
Regional Hyperthermia
radiative multi antenna systems
BSD-2000 System Family
BSD-2000-3D/MR System:
• 3 Rings with 8 Antenna each• MRI Image Guided Thermometry
BSD 2000 Basic System
BSD 2000 3D System
8 Antennas in 4 pairs
Functional Principle:
Regional Hyperthermia
Sigma 60 Applicator: • 8 Antenna Array surrounding the Patient
BSD 2000 Concept: Antenna Arrays
24 Antennae in
3 Rings of 8 Antennas each
BSD 2000 3D Applicator
Lamp phantom
Regional Hyperthermia
BSD 2000 3D Hyperthermia Treatment Suite
• Cervix• Rectal• Bladder• Sarcoma
BSD-2000 Clinical Indications:
• 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 HyperthermiaDockable Patient Cart & 70 cm Bore
Thermometry – MR Controlled Hyperthermia
Hyperthermia MRI Diagnostics
MR Hyperthermia Treatment Suite
MR Imaging Compatible Applicators
Sigma Eye MR:
• 24 antennae• 12 channels• 3 antenna rings• 37 x 54 x 48 cm long
Sigma 40 MR:
• 16 antennae• 8 channels• 2 antenna rings• 42 x 38 cm long
Sigma 30 MR
• 8 antennae• 4 channels• 1 antenna ring• 27 x 25 cm long
The new user-friendly software for MR-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
Thermometry
MR Guided Pediatric Hyperthermia
Wessalowski et al.: The Lancet Oncology 2013 on Germ Cell TumorsDepartment 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
• 44 Patients, All Non-Responders to Standard Chemo Treatment, Treated in HyperPei Protocol Resulting in 25 Complete and 14 Partial Remissions
Combining Hyperthermia & Chemo for Recurrent Germ Cell Tumors:
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
42
O. Ott: Rectal Cancer HyRec Trial - Treatment Schedule - Trial is RecrutingRecurrent & Locally Advanced Rectal Cancer
1 2 3 4 5 6
Week
d2 d9 d23 d30
d 1-14 d 22-35
Radiotherapy PTV: depending on former Tx Dose: 45 Gy
5-FU CIV (250 mg/m²/d)
Oxaliplatin Bolus (50 mg/m²/d)
Deep Regional Hyperthermia
R
E
S
E
C
T
I
O
N
d2 d9 d23 d30 d5 d12 d26 d33 d16 d19
Ott OJ et al., 2009
Required Cases n =59
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
