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  1. www.debenedetti1547.org The HIFU Treatment for Localized Prostate Cancer Ablatherm®INTEGRATED IMAGING Exit

  2. www.ar

  3. Ablatherm® HIFU : step by step The device The probe Robotized Placement Scanning 3D imaging Planning Firing phase Ultrasound Final aspect End

  4. Ablatherm® HIFU : step by step The device The probe Robotized Placement Scanning 3D imaging Planning Firing phase Ultrasound Final aspect End

  5. Ablatherm® HIFU : step by step The device The probe Robotized Placement Scanning 3D imaging Planning Firing phase Ultrasound Final aspect End

  6. Ablatherm® HIFU : step by step The device The probe Robotized Placement Scanning 3D imaging Planning Firing phase Ultrasound Final aspect End

  7. 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

  14. Ultrasound Waves Generation Physical Principle Treatment Description Plane transducer Ultrasound waves emission by transducer electro-mechanical vibrations + + + Acoustical pressure - - - Tissue motion Tissue heating

  15. Focused Ultrasound Waves Physical Principle Treatment Description Focused transducer Emitting ultrasound waves Acoustical pressure Tissueheating Over 85°C

  16. Tissue Lesion Formation Physical Principle Treatment Description Thermal effects + Cavitation effects + Time exposure = Tissue lesion Temperature SimulationINSERM U 557 HIC Technology HIFU INDUCED CAVITATION Thermal Dose Simulation INSERM U 557

  17. 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 • Low Temperature (< 45 °C) • High Temperature (>85 °C) • Short Time (< 5 Sec.) • Long Duration (>1 Hr)

  18. Transducer Positioning Physical Principle Treatment Description Precise lesion positioning with dynamic focusing Sparing ofsurrounding tissue

  19. Lesion Distribution within the Prostate Physical Principle Treatment Description • 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

  20. Lesion Distribution within the Prostate Physical Principle Treatment Description

  21. Lesion Distribution within the Prostate Physical Principle Treatment Description The firing head moves until the whole targeted volume is treated

  22. 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 History of the Ablatherm® Project

  23. CE Mark Ablatherm® Marked January 2000

  24. In excess 9000 treatments in 100 sites in Europe 2000 1000 Patients treated with Ablatherm every year

  25. Ablatherm® HIFU

  26. Device Description General Description Probe 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

  27. Endorectal Probe General Description Probe 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.

  28. Integrated imaging General Description Probe High resolutionimaging system 2 different transducers with anIntegrated imaging 7.5 MHz probe

  29. Imaging & Treating Simultaneously General Description Probe 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.

  30. Indications Summary Positioning Treatment Candidate for RPP EBRT failure Recurrence after previous HIFU

  31. Main Steps of a Treatment Summary Positioning 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

  32. Patient Installation (Immobilization) Summary Positioning Treatment Patient positioned in right lateral decubitus position

  33. Patient Installation (Immobilization) Summary Positioning Treatment Patientmovement detector

  34. Prostate localization (1) Summary Positioning Treatment Probe insertion Intra-rectal positioning

  35. Prostate localization (2) Summary Positioning Treatment Probe insertion Robotized movements If the video doesn’t start automatically click on the window

  36. Prostate localization (3) Summary Positioning Treatment Automatic imaging phase 3D reconstruction

  37. Prostate localization (4) Summary Positioning Treatment Automatic imaging phase 3D reconstruction If the video doesn’t start automatically click on the window

  38. Treatment (planning) Summary Positioning Treatment Treatment area programming Firing phase

  39. Treatment (planning) Summary Positioning Treatment Treatment area programming Firing phase

  40. Treatment (planning) Summary Positioning Treatment Treatment area programming Firing phase If the video doesn’t start automatically click on the window

  41. Treatment (planning) Summary Positioning Treatment Treatment area programming Firing phase If the video doesn’t start automatically click on the window

  42. Treatment (Safety Controls) Summary Positioning Treatment • Main safety features • Power / Firing sequence • Probe position • Patient movement • Rectum position • Temperature Exit