Ms. Titania Juang Profile

Titania Juang

at Univ of California San Francisco

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Author

Publications (9)

Proceedings Article | 23 February 2011 Paper

Catheter-based ultrasound hyperthermia with HDR brachytherapy for treatment of locally advanced cancer of the prostate and cervix

Chris Diederich, Jeff Wootton, Punit Prakash, Vasant Salgaonkar, Titania Juang, Serena Scott, Xin Chen, Adam Cunha, Jean Pouliot, I. Hsu

Proceedings Volume 7901, 79010O (2011) https://doi.org/10.1117/12.876401

KEYWORDS: Ultrasonography, High dynamic range imaging, Cervix, Prostate, Transducers, Computing systems, Control systems, Amplifiers, Thermometry, Rectum

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A clinical treatment delivery platform has been developed and is being evaluated in a clinical pilot study for providing 3D controlled hyperthermia with catheter-based ultrasound applicators in conjunction with high dose rate (HDR) brachytherapy. Catheter-based ultrasound applicators are capable of 3D spatial control of heating in both angle and length of the devices, with enhanced radial penetration of heating compared to other hyperthermia technologies. Interstitial and endocavity ultrasound devices have been developed specifically for applying hyperthermia within HDR brachytherapy implants during radiation therapy in the treatment of cervix and prostate. A pilot study of the combination of catheter based ultrasound with HDR brachytherapy for locally advanced prostate and cervical cancer has been initiated, and preliminary results of the performance and heating distributions are reported herein. The treatment delivery platform consists of a 32 channel RF amplifier and a 48 channel thermocouple monitoring system. Controlling software can monitor and regulate frequency and power to each transducer section as required during the procedure. Interstitial applicators consist of multiple transducer sections of 2-4 cm length × 180 deg and 3-4 cm × 360 deg. heating patterns to be inserted in specific placed 13g implant catheters. The endocavity device, designed to be inserted within a 6 mm OD plastic tandem catheter within the cervix, consists of 2-3 transducers × dual 180 or 360 deg sectors. 3D temperature based treatment planning and optimization is dovetailed to the HDR optimization based planning to best configure and position the applicators within the catheters, and to determine optimal base power levels to each transducer section. To date we have treated eight cervix implants and six prostate implants. 100 % of treatments achieved a goal of >60 min duration, with therapeutic temperatures achieved in all cases. Thermal dosimetry within the hyperthermia target volume (HTV) and clinical target volume (CTV) are reported. Catheter-based ultrasound hyperthermia with HDR appears feasible with therapeutic temperature coverage of the target volume within the prostate or cervix while sparing surrounding more sensitive regions.

Proceedings Article | 12 March 2010 Paper

The ACUSITT ultrasonic ablator: the first steerable needle with an integrated interventional tool

E. Clif Burdette, D. Caleb Rucker, Punit Prakash, Chris Diederich, Jordon Croom, Clyde Clarke, Philipp Stolka, Titania Juang, Emad Boctor, Robert Webster

Proceedings Volume 7629, 76290V (2010) https://doi.org/10.1117/12.845972

KEYWORDS: Tissues, Liver, Ultrasonography, Ultrasonics, Tumors, Thermal modeling, Acoustics, Control systems, Kinematics, Transducers

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Proceedings Article | 24 February 2009 Paper

An intrauterine ultrasound applicator for targeted delivery of thermal therapy in conjunction with HDR brachytherapy to the cervix

Jeffery Wootton, Titania Juang, Jean Pouliot, I-Chow Joe Hsu, Chris Diederich

Proceedings Volume 7181, 71810T (2009) https://doi.org/10.1117/12.808343

KEYWORDS: Ultrasonography, Tissues, High dynamic range imaging, Transducers, Bladder, Cervix, Acoustics, Rectum, Magnetic resonance imaging, Computed tomography

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Proceedings Article | 24 February 2009 Paper

Treatment delivery platform for conformal catheter-based ultrasound hyperthermia

Titania Juang, Jeffery Wootton, I-Chow Hsu, Chris Diederich

Proceedings Volume 7181, 718109 (2009) https://doi.org/10.1117/12.808339

KEYWORDS: Francium, Ultrasonography, Thermometry, Amplifiers, Control systems, Transducers, High dynamic range imaging, Computing systems, Temperature metrology, Human-machine interfaces

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A clinical treatment delivery platform has been developed for providing 3D controlled hyperthermia with catheter-based ultrasound applicators in conjunction with high dose rate (HDR) brachytherapy. This integrated system consists of hardware and software components required for thermal therapy delivery, treatment monitoring and control, and realtime and post-treatment analysis; and interstitial and endocavity ultrasound heating applicators. Hardware includes a 32-channel RF amplifier with independent power (0-25 W) and frequency (5-10 MHz) control for ultrasound power delivery and a 48-channel thermometry system compatible with 0.4 mm OD multi-sensor thermocouple probes. Software graphical user interfaces (GUI) are used to monitor and control both the amplifier and the thermometry system. The amplifier GUI controls, monitors, and records individual channel frequency and power values in real-time; the thermometry GUI monitors and records temperature and thermal dose values in real-time, as well as displaying and allowing dynamic control for temperature and thermal dose target thresholds. The thermometry GUI also incorporates registration of thermocouple positions relative to target anatomy and applicator transducers based on HDR planning tools (CT/MRI/US overlays) for improved treatment control and documentation. The interstitial (2.4 mm) and endocavity (6 mm) ultrasound hyperthermia applicators are composed of linear arrays of 1-4 tubular piezoceramic transducers - sectored at 90°, 180°, 270°, and 360° for single or dual directional heating patterns - that are compatible with plastic implant catheters. QA techniques specific to these catheter-based ultrasound applicators have been devised and implemented, and include rotational beam plots and dynamic force balance efficiency measurements, which are critical to establish applicator performance. A quality assurance test matrix has been devised and used to evaluate and characterize all components of this system prior to clinical implementation.

Proceedings Article | 10 March 2007 Paper

Ultrasound interstitial thermal therapy (USITT) for the treatment of uterine myomas

William Nau, Chris Diederich, Jeff Simko, Titania Juang, Alison Jacoby, E. Burdette

Proceedings Volume 6440, 64400F (2007) https://doi.org/10.1117/12.703220

KEYWORDS: Tissues, Ultrasonography, Transducers, Acoustics, Tumors, Uterus, Chemical elements, Temperature metrology, Control systems, Surgery

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Proceedings Article | 9 February 2007 Paper

Prostate thermal therapy with catheter-based ultrasound devices and MR thermal monitoring

Will Nau, Chris Diederich, Adam Kinsey, Tony Ross, Jeff Wootton, Titania Juang, Kim Butts-Pauly, Viola Ricke, Erin Liu, Jing Chen, Donna Bouley, Maurice Van den Bosch, Graham Sommer

Proceedings Volume 6440, 64400D (2007) https://doi.org/10.1117/12.703184

KEYWORDS: Prostate, Ultrasonography, Bone, Transducers, Magnetic resonance imaging, In vivo imaging, Control systems, Tissues, Rectum, HVAC controls

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Proceedings Article | 9 February 2007 Paper

Progress on conformal microwave array applicators for heating chestwall disease

P. Stauffer, P. Maccarini, T. Juang, S. Jacobsen, C. Gaeta, J. Schlorff, A. Milligan

Proceedings Volume 6440, 64400E (2007) https://doi.org/10.1117/12.701389

KEYWORDS: Antennas, Microwave radiation, Sensors, Tissues, Temperature metrology, Computer aided design, Natural surfaces, Synthetic aperture radar, Dielectrics, Fiber optics sensors

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Previous studies have reported the computer modeling, CAD design, and theoretical performance of single and multiple antenna arrays of Dual Concentric Conductor (DCC) square slot radiators driven at 915 and 433 MHz. Subsequently, practical CAD designs of microstrip antenna arrays constructed on thin and flexible printed circuit board (PCB) material were reported which evolved into large Conformal Microwave Array (CMA) sheets that could wrap around the surface of the human torso for delivering microwave energy to large areas of superficial tissue. Although uniform and adjustable radiation patterns have been demonstrated from multiple element applicators radiating into simple homogeneous phantom loads, the contoured and heterogeneous tissue loads typical of chestwall recurrent breast cancer have required additional design efforts to achieve good coupling and efficient heating from the increasingly larger conformal array applicators used to treat large area contoured patient anatomy. Thus recent work has extended the theoretical optimization of DCC antennas to improve radiation efficiency of each individual aperture and reduce mismatch reflections, radiation losses, noise, and cross coupling of the feedline distribution network of large array configurations. Design improvements have also been incorporated into the supporting bolus structure to maintain effective coupling of DCC antennas into contoured anatomy and to monitor and control surface temperatures under the entire array. New approaches for non-invasive monitoring of surface and sub-surface tissue temperatures under each independent heat source are described that make use of microwave radiometry and flexible sheet grid arrays of thermal sensors. Efforts to optimize the clinical patient interface and move from planar rectangular shapes to contoured vest applicators that accommodate entire disease in a larger number of patients are summarized. By applying heat more uniformly to large areas of contoured anatomy, the CMA applicator resulting from these enhancements should expand the number of patients that can benefit from effective heating of superficial disease in combination with radiation or chemotherapy.

Proceedings Article | 14 April 2005 Paper

Progress on system for applying simultaneous heat and brachytherapy to large-area surface disease

Paul Stauffer, Jaime Schlorff, Titania Juang, Daniel Neuman, Jessi Johnson, Paolo Maccarini, Jean Pouliot

Proceedings Volume 5698, (2005) https://doi.org/10.1117/12.594937

KEYWORDS: Microwave radiation, Antennas, Skin, Tumors, Tissues, High dynamic range imaging, Natural surfaces, Temperature metrology, Radiotherapy, Fiber optics

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Laboratory experiments have shown that thermal enhancement of radiation response increases substantially for higher thermal dose (approaching 100 CEM43) and when hyperthermia and radiation are delivered simultaneously. Unfortunately, equipment capable of delivering uniform doses of heat and radiation simultaneously has not been available to test the clinical potential of this approach. We present recent progress on the clinical implementation of a system that combines the uniform heating capabilities of flexible printed circuit board microwave array applicators with an array of brachytherapy catheters held a fixed distance from the skin for uniform radiation of tissue <1.5 cm deep with a scanning high dose rate (HDR) brachytherapy source. The system is based on the Combination Applicator which consists of an array of up to 32 Dual Concentric Conductor (DCC) apertures driven at 915 MHz for heating tissue, coupled with an array of 1 cm spaced catheters for HDR therapy. Efforts to optimize the clinical interface and move from rectangular to more complex shape applicators that accommodate the entire disease in a larger number of patients are described. Improvements to the system for powering and controlling the applicator are also described. Radiation dosimetry and experimental performance results of a prototype 15 x 15 cm dual-purpose applicator demonstrate dose distributions with good homogeneity under large contoured surfaces typical of diffuse chestwall recurrence of breast carcinoma. Investigations of potential interaction between heat and brachytherapy components of a Combination Applicator demonstrate no perceptible perturbation of the heating field from an HDR source or leadwire, no perceptible effect of a scanning HDR source on fiberoptic thermometry, and <0.5% variation of radiation dose delivered through the CMA applicator. By applying heat and radiation simultaneously for maximum synergism of modalities, this dual therapy system should expand the number of patients that can benefit from effective thermoradiotherapy treatments.

Proceedings Article | 14 April 2005 Paper

Electromagnetic optimization of dual-mode antennas for radiometry-controlled heating of superficial tissue

Paolo Maccarini, Hans Rolfsnes, Daniel Neuman, Jessi Johnson, Titania Juang, Svein Jacobsen, Paul Stauffer

Proceedings Volume 5698, (2005) https://doi.org/10.1117/12.592507

KEYWORDS: Antennas, Tissues, Synthetic aperture radar, Microwave radiation, Metals, Tumors, Dielectrics, Electromagnetism, Radiometry, Temperature metrology

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The large variance of survival in the treatment of large superficial tumors indicates that the efficacy of current therapies can be dramatically improved. Hyperthermia has shown significant enhancement of response when used in combination with chemotherapy and/or radiation. Control of temperature is a critical factor for treatment quality (and thus effectiveness), since the response of tumor and normal cells is significantly different over a range of just a few degrees (41-45°). For diffuse spreading tumors, microwave conformal arrays have been shown to be a sound solution to deposit the power necessary to reach the goal temperature throughout the targeted tissue. Continuous temperature monitoring is required for feedback control of power to compensate for physiologic (e.g. blood perfusion and dielectric properties) changes. Microwave radiometric thermometry has been proposed to complement individual fluoroptic probes to non-invasively map superficial and sub-surface temperatures. The challenge is to integrate the broadband antenna used for radiometric sensing with the high power antenna used for power deposition. A modified version of the dual concentric conductor antenna presented previously is optimized for such use. Several design challenges are presented including preventing unwanted radiating modes and thermal and electromagnetic coupling between the two antennas, and accommodating dielectric changes of the target tissue. Advanced 3D and planar 2D simulation software are used to achieve an initial optimized design, focused on maintaining appropriate radiation efficiency and pattern for both heating and radiometry antennas. A cutting edge automated measurement system has been realized to characterize the antennas in a tissue equivalent material and to confirm the simulation results. Finally, the guidelines for further development and improvement of this initial design are presented together with a preliminary implementation of the feedback program to be used to control the temperature distribution in variable, inhomogeneous tissue.

Showing 5 of 9 publications

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