Monitoring of tissue temperature during hyperthermia therapy.
Monitoring of tissue temperature during hyperthermia therapy.
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DOI：
10.1111/j.1749-6632.1980.tb50754.x
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发表时间：
1980-01-01
影响因子：
5.2
通讯作者：
Manning, M R
中科院分区：
文献类型：
--
作者：
Cetas, T C;Connor, W G;Manning, M R
如果热疗不再仅仅是记录轶事病历，而是成为治疗癌症的可靠方法，关键是要确定患者整个治疗区域内的温度分布是时间的函数。这对于局部和全身热疗都是必要的。这里不讨论热剂量，它是测量参数、时间和温度的某种综合函数。由于异质组织具有不同的能量吸收参数，如电阻率或超声衰减，以及取决于血液灌流分布或组织元素与表面的接近程度的不同降温速度，我们确定温度分布的问题变得复杂。肿瘤的能量吸收参数可能与周围正常组织不同，肿瘤与血液的热交换导致的降温速率可能低于周围正常组织。当然，后者对于大肿瘤的坏死核心是正确的，在一般情况下也是合理的。此外，组织对加热的生理反应，如血管扩张，或加热的病理效应，如可能的血管破坏，都没有完全了解。两者都会影响由此产生的热量分布。与可用于辐射剂量测定的数学模型类似的详细数学模型既受到组织异质性的复杂性的困扰，也受到缺乏作为模型基础的数据的困扰。因此，由于在数学内插函数中所需的参数是未知的，因此不能计算作为场内每个点上的时间函数的温度分布。也不能在足够多的点上测量温度，因为临床创伤太大，场的扰动太大。我们在这里的目的是指出我们用来估计温度分布的技术。我们不打算进行全面的回顾。论文的第一部分涉及温度计的校准和这些校准的质量保证。第二节给出了两个临床案例，用来演示我们的热剂量学方法，并指出它的特点和局限性。在第三部分中，说明了某些生物实验所需的热测量。最后，我们提出了在不久的将来应该改进热剂量学的研究领域。
If hyperthermic therapy is to progress beyond merely the recording of anecdotal case histories to a reliable means of treating cancer, it is essential that temperature distributions be determined as a function of time throughout the treated field of the patient. This is necessary for both localized and whole-body hyperthermia. The thermal dose, which is some sort of integrated function of the measured parameters, time and temperature, is not addressed here. Our problem of determining the temperature distribution is complicated by the fact that heterogeneous tissues have differing power absorption parameters, such as resistivity or ultrasonic attenuation, and differing rates of cooling depending upon the distribution of blood perfusion or the proximity of the tissue element to the surface. It is probable that the power absorption parameters are different for tumors than for surrounding normal tissue and that cooling rates due to heat exchange with the blood are less for tumors than for the surrounding normal tissue. Certainly, the latter is true for the necrotic core of large tumors and is plausible in the general case. Furthermore, neither the physiological response of tissue to heating, such as vasodilatation, nor the pathological effects of heating, such as possible destruction of blood vessels, are fully understood. Both affect the thermal distributions that result. Detailed mathematical models similar to those available for radiation dosimetry are plagued by both the complexity of the heterogeneity of the tissues and by the lack of data upon which to base the models. Thus, the temperature distribution as a function of time at every point within the field cannot be calculated because the parameters needed in mathematical interpolation functions are not known. Neither can the temperature the measured at a sufficient number of points because the clinical trauma would be too great and the perturbation of the field would be excessive. Our purpose here is to indicate the techniques that we use for estimating the temperature distributions. We do not attempt a comprehensive review.The first section of the paper deals with thermometer calibrations and quality assurance of these calibrations. The second section gives two clinical cases, which are used to demonstrate our approach to thermal dosimetry and to indicate its features and limitations. In the third section, thermal measurements required in certain biological experiments are illustrated. We conclude the paper by suggesting areas of research that should lead to improved thermal dosimetry in the near future.