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Development and validation of a radiofrequency ablation treatment planning system for vertebral metastases

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Bone-targeted radiofrequency ablation (RFA) is widely used in the treatment of vertebral metastases. While radiation therapy utilizes established treatment planning systems (TPS) based on multimodal imaging to optimize treatment volumes, current RFA of vertebral metastases has been limited to qualitative image-based assessment of tumour location to direct probe selection and access. This study aimed to design, develop and evaluate a computational patient-specific RFA TPS for vertebral metastases.

Methods

A TPS was developed on the open-source 3D slicer platform, including procedural setup, dose calculation (based on finite element modelling), and analysis/visualization modules. Usability testing was carried out by 7 clinicians involved in the treatment of vertebral metastases on retrospective clinical imaging data using a simplified dose calculation engine. In vivo evaluation was performed in a preclinical porcine model (n = 6 vertebrae).

Results

Dose analysis was successfully performed, with generation and display of thermal dose volumes, thermal damage, dose volume histograms and isodose contours. Usability testing showed an overall positive response to the TPS as beneficial to safe and effective RFA. The in vivo porcine study showed good agreement between the manually segmented thermally damaged volumes vs. the damage volumes identified from the TPS (Dice Similarity Coefficient = 0.71 ± 0.03, Hausdorff distance = 1.2 ± 0.1 mm).

Conclusion

A TPS specifically dedicated to RFA in the bony spine could help account for tissue heterogeneities in both thermal and electrical properties. A TPS would enable visualization of damage volumes in 2D and 3D, assisting clinicians in decisions about potential safety and effectiveness prior to performing RFA in the metastatic spine.

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Acknowledgements

Support for this study was provided through a Collaborative Health Research Grant (CHRP#493843-16) funded by the Canadian Institutes of Health and the Natural Sciences and Engineering Research Council of Canada. The grant also included industry support provided by Medtronic Inc and in-kind contribution of the OsteoCoolTM System (probes and generator). Michael Hardisty was supported by the Feldberg Chair in Spinal Research. Gabor Fichtinger was supported as a Canada Research Chair of the Natural Sciences and Engineering Research Council of Canada. Albert Yee was supported by the Tile Chair. Cari Whyne was supported by the Holland Chair in Musculoskeletal Research.

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Authors and Affiliations

  1. Orthopaedic Biomechanics Lab, Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, ON, Canada

    Cari M. Whyne, Normand Robert, Christine Huang, Albert J. M. Yee & Michael Hardisty

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Cari M. Whyne, Margarete K. Akens, Albert J. M. Yee & Michael Hardisty

  3. Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada

    Cari M. Whyne & Albert J. M. Yee

  4. Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada

    Margarete K. Akens

  5. Techna Institute, University Health Network, Toronto, ON, Canada

    Sean R. H. Davidson & Margarete K. Akens

  6. School of Computing, Queen’s University, Kingston, ON, Canada

    Grace Underwood & Gabor Fichtinger

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  1. Cari M. Whyne
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  2. Grace Underwood
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Correspondence to Cari M. Whyne.

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Ethical approvals

All applicable guidelines for the care and use of animals were followed in accordance with the ethical standards of the Sunnybrook Research Institute Animal Care Committee (AUP#21–720) as per the Canadian Council on Animal Care Guidelines. Research Ethics Board Approval for retrospective use of patient CT imaging was granted by Sunnybrook Research Institute (REB#419–2015; formal consent not required).

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Whyne, C.M., Underwood, G., Davidson, S.R.H. et al. Development and validation of a radiofrequency ablation treatment planning system for vertebral metastases. Int J CARS 18, 2339–2347 (2023). https://doi.org/10.1007/s11548-023-02952-9

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  • DOI: https://doi.org/10.1007/s11548-023-02952-9

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