F. Edward Boas, MD, PhD Memorial Sloan Kettering Cancer Center

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Presentation transcript:

Development of a searchable database of cryoablation simulations, for use in treatment planning F. Edward Boas, MD, PhD Memorial Sloan Kettering Cancer Center SIR 2016

Financial disclosures F. Edward Boas: co-founder of Claripacs, LLC. Jeremy C. Durack: Scientific Advisory Board member and investor in Adient Medical. Stephen B. Solomon: PI on a multicenter lung cryoablation trial sponsored by Galil; receives research support from AngioDynamics and GE Healthcare. Hooman Yarmohammadi: co-PI on a multicenter lung cryoablation trial sponsored by Galil.

Cryoablation instructions for use Room temperature gel 10 minute freeze, 5 minute thaw, 10 minute freeze What about multiple probes? Longer or shorter ablations? Image credit: Galil Medical

Cryoablation simulation Pennes bioheat equation 3D grid, 1 mm voxels Heat diffusion Tissue perfusion 1 minute 2 minutes 3 minutes 5 minutes 7 minutes 10 minutes

Cryoablation simulation: Heat diffusion 1 mm Diffusion depends on tissue- and temperature-specific: thermal conductivity heat capacity water content

Cryoablation simulation: Tissue perfusion Perfusion heats up tissue < 37°C (and cools tissue > 37°C) Kidney (high perfusion) Liver (intermediate perfusion) Muscle (low perfusion) Fat (very low perfusion)

Cryoablation simulation IceRod Plus probes in kidney 2 cm spacing 10 min freeze, 8 min thaw, 10 min freeze

Accuracy: Predicting ice ball size in gel 1-4 probe ablations (IceRod Plus and IceSphere) in gel, with 1-2 cm spacing between probes Average error: 1 mm Maximum error: 3 mm (26 measurements) Gel data: Shah TT et al., 2016, Urology. In press.

Synergy Multiple probe ablations are larger than you’d expect:  1-probe ice ball  2-probe ice ball IceRod Plus in water, 2 cm spacing, 10 min freeze, 5 min thaw, 10 min freeze .

Accuracy: Predicting synergy Up to 1.2 cm of synergy. Accurately predicted by simulations. More synergy seen with: More ablation probes Closer probe spacing

Accuracy: Predicting ice ball size in patients Actual ice ball Predicted ice ball 3-probe renal cryoablation.

Accuracy: Predicting ice ball size in patients 1-6 probe clinical cryoablation procedures in kidney and liver. Average error: 4 mm Maximum error: 10 mm (42 measurements).

Cryoablation planning We can accurately predict the cryoablation zone. Now let’s use this to plan cryoablation procedures! Problem: 25 minute cryoablation takes 35 minutes to simulate. Solution: Precompute a database of thousands of different probe configuations.

Cryoablation planning database 5670 simulations: 5 tissue types (kidney, liver, muscle, fat, and water) 2 probe types (Galil IceRod Plus 1.5 or IceSphere) 21 probe configurations (1-6 probes) 1-2 cm probe spacing 27 ablation schedules

Probe configurations

Ablation schedules 1-20 min. freeze, in 1 min. increments 2 min. freeze, 1 min. passive thaw, 2 min. freeze 4 min. freeze, 2 min. passive thaw, 4 min. freeze 6 min. freeze, 3 min. passive thaw, 6 min. freeze 8 min. freeze, 4 min. passive thaw, 8 min. freeze 10 min. freeze, 5 min passive thaw, 10 or 15 or 20 min. freeze

Cryoablation database coverage Good coverage of a wide range of ice ball sizes and shapes up to 9.8 cm. For any desired ice ball size a × b × c cm, where each dimension is between 3 and 6 cm, there is always a match in the database within 0.9 cm, and the average match is within 0.2 cm.

Web-based cryoablation planning tool http://www.edboas.com/calc/cryo/index.html Login: jvir Password: cryoablation

Conclusion Cryoablation planning software is: Accurate 1 mm error in gel, 4 mm error in patients model includes tissue-specific perfusion Fast precomputed database Comprehensive database contains 5670 procedures covering a wide range of geometries

Acknowledgements Co-authors: Govindarajan Srimathveeravalli, Jeremy C. Durack, Elena A. Kaye, Joseph P. Erinjeri, Etay Ziv, Majid Maybody, Hooman Yarmohammadi, Stephen B. Solomon Galil gel data: Vineel Vallapureddy, Sonja Foss, Luan Chan, Satish Ramadhyani, and Uri Arbel This research was funded in part through an NIH/NCI Cancer Center Support Grant (P30 CA008748).