IMDEA Nanoscience, Madrid, Spain.
Istituto Nazionale di Ricerca Metrologica (INRIM), Turin, Italy.
Int J Hyperthermia. 2021;38(1):846-861. doi: 10.1080/02656736.2021.1909758.
Bearing partially or fully metallic passive implants represents an exclusion criterion for patients undergoing a magnetic hyperthermia procedure, but there are no specific studies backing this restrictive decision. This work assesses how the secondary magnetic field generated at the surface of two common types of prostheses affects the safety and efficiency of magnetic hyperthermia treatments of localized tumors. The paper also proposes the combination of a multi-criteria decision analysis and a graphical representation of calculated data as an initial screening during the preclinical risk assessment for each patient. Heating of a hip joint and a dental implant during the treatment of prostate, colorectal and head and neck tumors have been assessed considering different external field conditions and exposure times. The Maxwell equations including the secondary field produced by metallic prostheses have been solved numerically in a discretized computable human model. The heat exchange problem has been solved through a modified version of the Pennes' bioheat equation assuming a temperature dependency of blood perfusion and metabolic heat, i.e. thermorregulation. The degree of risk has been assessed using a risk index with parameters coming from custom graphs plotting the specific absorption rate (SAR) vs temperature increase, and coefficients derived from a multi-criteria decision analysis performed following the MACBETH approach. The comparison of two common biomaterials for passive implants - Ti6Al4V and CoCrMo - shows that both specific absorption rate (SAR) and local temperature increase are found to be higher for the hip prosthesis made by Ti6Al4V despite its lower electrical and thermal conductivity. By tracking the time evolution of temperature upon field application, it has been established that there is a 30 s delay between the time point for which the thermal equilibrium is reached at prostheses and tissues. Likewise, damage may appear in those tissues adjacent to the prostheses at initial stages of treatment, since recommended thermal thresholds are soon surpassed for higher field intensities. However, it has also been found that under some operational conditions the typical safety rule of staying below or attain a maximum temperature increase or SAR value is met. The current exclusion criterion for implant-bearing patients in magnetic hyperthermia should be revised, since it may be too restrictive for a range of the typical field conditions used. Systematic in silico treatment planning using the proposed methodology after a well-focused diagnostic procedure can aid the clinical staff to find the appropriate limits for a safe treatment window.
带有部分或完全金属被动植入物的患者被排除在接受磁热疗程序之外,但没有具体的研究支持这一限制决策。本工作评估了两种常见类型的假体在表面产生的二次磁场如何影响局部肿瘤的磁热疗治疗的安全性和效率。本文还提出了将多准则决策分析与计算数据的图形表示相结合,作为每个患者临床前风险评估的初步筛选。在考虑不同外部场条件和暴露时间的情况下,评估了髋关节和牙种植体在前列腺、结直肠和头颈部肿瘤治疗过程中的加热情况。通过数值求解麦克斯韦方程,包括金属假体产生的二次场,在离散的可计算人体模型中。通过修改彭内斯生物热方程来求解热交换问题,假设血液灌注和代谢热的温度依赖性,即体温调节。使用风险指数评估风险程度,该指数的参数来自绘制比吸收率 (SAR) 与温度升高关系的定制图,以及根据 MACBETH 方法进行的多准则决策分析得出的系数。对两种常见的被动植入物生物材料 - Ti6Al4V 和 CoCrMo - 的比较表明,尽管 Ti6Al4V 髋关节假体的电导率和热导率较低,但比吸收率 (SAR) 和局部温度升高都较高。通过跟踪施加磁场时温度的时间演变,已经确定在达到假体和组织热平衡的时间点之后,存在 30 秒的延迟。同样,在治疗的初始阶段,由于推荐的热阈值很快超过较高的场强,因此可能会在假体相邻的组织中出现损伤。然而,也发现,在某些操作条件下,满足保持低于或达到最大温度升高或 SAR 值的典型安全规则。在磁热疗中,对于带有植入物的患者的排除标准应该进行修订,因为对于所使用的典型场条件范围来说,它可能过于严格。在经过精心聚焦的诊断程序后,使用所提出的方法进行系统的计算机辅助治疗计划,可以帮助临床工作人员为安全治疗窗口找到适当的限制。
Comput Methods Programs Biomed. 2022-8
Int J Hyperthermia. 2021
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2021-6-25
Int J Hyperthermia. 2016-11
Front Bioeng Biotechnol. 2023-7-21
Materials (Basel). 2021-2-3