Approaches to overcome current limitations of HIFU treatment

Noninvasive therapy with HIFU has been successfully applied to transrectal treatment of prostate cancer as well as benign prostate hyperplasia. However, there are two major technical reasons why its clinical application to other organs is currently limited: (1) low throughput of treatment and (2) lack of penetration to deep tissues. To multiply the throughput, a split-focus technique, in which the focal spot is enlarged primarily in the lateral direction, was developed. An electronically variable focus array transducer was also developed to enhance the throughput. An approach to treat a large volume of uterus myoma by coagulating its feeding arteries has been studied. The tissue volume to be coagulated can be thereby reduced by orders of magnitude. The penetration and throughput can potentially be improved at the same time by delivering a microbubble agent to the target tissue. It was theoretically predicted that a microbubble agent could multiply the ultrasonic tissue absorption. The effectiveness of this approach was confirmed in animal experiments using Optison. Real-time monitoring of tissue coagulation during HIFU exposure also can enhance the throughput through preventing excess deposition of ultrasonic energy. Monitoring coagulation by imaging local displacement in tissue with ultrasound will be discussed as well.