1. 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

2. Agenda  BSD 20003D Deep Regional Hyperthermia  BSD 20003D-MR Image Guided Hyperthermia  SigmaHyperPlan / SigmaVision

3. capacitive systemsradiative multi antenna systems Regional Hyperthermia Upper (front ) plate Lower (back ) plate Antennas Image courtesy of Dughiero et al.Image courtesy of Gellermann et al.

4. capacitive systems Image courtesy of Dughiero et al.Image courtesy of Gellermann et al. Regional Hyperthermia radiative multi antenna systems

5. 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

6. 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

7. 8 Antennas in 4 pairs Functional Principle: Regional Hyperthermia

8. Sigma 60 Applicator: 8 Antenna Array surrounding the Patient BSD 2000 Concept: Antenna Arrays

9. 24 Antennae in 3 Rings of 8 Antennas each BSD 2000 3D Applicator

10. Lamp phantom Regional Hyperthermia

11. BSD 2000 3D Hyperthermia Treatment Suite

12. Cervix Rectal Bladder Sarcoma BSD-2000 Clinical Indications: Pancreas Abdominal Prostate Pelvic Lung etc….

13. Temperature Monitoring Invasive Thermometry –Intratumoral Min. Invasive Thermometry –Intraluminal Image Guided Thermometry –MRI-Thermometry

14. MR Image Guided Hyperthermia

17. Dockable Patient Cart & 70 cm Bore

18. Thermometry – MR Controlled Hyperthermia

19. Hyperthermia MRI Diagnostics MR Hyperthermia Treatment Suite

20. 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

21. The new user-friendly software for MR-Thermometry

25. 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

32. MR Guided Pediatric Hyperthermia Wessalowski et al.: The Lancet Oncology 2013 on Germ Cell Tumors Department of Pediatric Oncology UMS Düsseldorf - Germany Wessalowski et al. Lancet Oncol. 2013

33. MR Guided Pediatric Hyperthermia Wessalowski et al. Lancet Oncol. 2013

34. MR Guided Pediatric Hyperthermia Applicators of Various Sizes Optimize Pediatric Treatments Wessalowski et al. Lancet Oncol. 2013

35. MR Guided Pediatric Hyperthermia Pediatric Abdominal Treatment in Sigma 40 Applicator Wessalowski et al. Lancet Oncol. 2013

36. 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

37. 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

38. The Atzelsberg Clinical Trial Circle Ott OJ et al., 2009

39. The Atzelsberg Clinical Trial Circle Ott OJ et al., 2009

40. The Atzelsberg Clinical Trial Circle Ott OJ et al., 2009

41. The Atzelsberg Clinical Trial Circle Development of Guidelines and Clinical Trials Ott OJ et al., 2009

42. The Atzelsberg Clinical Trial Circle 42 O. Ott: Rectal Cancer HyRec Trial - Treatment Schedule - Trial is Recruting Recurrent & Locally Advanced Rectal Cancer 123456 Week d2 d9 d23 d30 d 1-14d 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 RESECTIONRESECTION d2 d9 d23 d30 d5 d12 d26 d33 d16 d19 Ott OJ et al., 2009 Required Cases n =59

43. The Atzelsberg Clinical Trial Circle R.D.Issels MD PhD: Randomized Phase III Trial on Postoperative Pancreas Cancer

44. Thank you!

45. MR Guided Hyperthermia in Soft Tissue Sarcomas