1. Stefan Braunewell 1 A European project on patient-specific modeling and simulation of FUS in moving organs Stefan Braunewell Fraunhofer MEVIS - Institute for Medical Image Computing, Bremen Jenny Dankelman, Thomas Langø, Jürgen Jenne, Michael Müller, Yoav Levy, Mario Bezzi, Christine Tanner, Calin Tiu, Daniel Outmazguine, Matthias Günther, Andreas Melzer, Tobias Preusser

2. Stefan Braunewell 2 Reflection, refraction, absorption, cavitation Heat transfer, tissue reaction Cooling by blood flow and perfusion Breathing motion Occlusion by ribcage Focused Ultrasound in the LiverFocused Ultrasound Computer simulation required for reliable outcome prediction

3. Stefan Braunewell 3 Goal of FUSIMO Develop, implement and validate a multi-level model for FUS simulation in moving abdominal organs FUSIMO software system aids in:  Assessing feasibility  Optimizing outcome  Detecting risks  Monitoring progress, tracking deviations  Training

4. Stefan Braunewell 4 Therapy planning, prediction and monitoring Functional organ modeling Model for ultrasound propagation Motion model for abdominal organs Patient specific data

5. Stefan Braunewell 5 Intra-operative ultrasound On-line Prediction of Respiratory Motion Generic 4D respiratory motion model Off-line 4DMRI to observe organ motion Quantify organ motion for population Prediction On-line Image of patient Pre-therapy

6. Stefan Braunewell 6 Incorporation of motion Heterogeneous media Deactivation of elements US and temperature simulation Rib Target XD [mm] oCoC oCoC

7. Stefan Braunewell 7 Parameter identification Estimate constant thermal conductivity during cooling period from MR thermometry in Agar gel. Temperature along lesion Temperature across lesion MR thermometry of sonication in agar gel Simulated sonication after recalibration

8. Stefan Braunewell 8 Functional Modeling Cooling effects due to vessels Prediction of supply and drainage areas for blood flow Prediction and monitoring of tissue damage

9. Stefan Braunewell 9 Simulation results Pressure Temperature Damage Risk Planning Image

10. Stefan Braunewell 10 Integrated Software System Segmentation Preview of presumed motion Interactive Planning Exploration of Results Progress monitoring Assessment, training

11. Stefan Braunewell 11 Multi-level validation Volunteers Motion tracking Motion model MR imaging protocols Phantoms US, temperature simulation Steered sonications

12. Stefan Braunewell 12 System validation Validate and optimize workflow Positioning using Innomotion Robot Arm Thiel cadavers  Motion model  Perfusion  Steered sonications Renal artery perfusion in cadaver

13. Stefan Braunewell 13 Fraunhofer MEVIS University of Dundee TU DelftMediriIBSmm InSightec Ltd General Electrics Universita LaSapienza ETH Zurich Fundatia MEDIS

14. Stefan Braunewell 14 FUSIMO Take Home Message Integrated software system for FUS in moving organs  Assessing feasibility  Optimizing outcome  Detecting risks  Monitoring progress, tracking deviations  Training