Ing. Jiří Jaroš, Ph.D.

GEORGIOU Panyiotis, JAROŠ Jiří, PAYNE Heather, ALLEN Clare, GIBSON Eli, BARRATT Dean and TREEBY Bradley E. Beam Distortion Due to Gold Fiducial Markers During Salvage High-Intensity Focused Ultrasound in the Prostate. Journal of Medical Physics. 111 River St., Hoboken, NJ 07030-5774: American Association of Physicists in Medicine, 2017, vol. 44, no. 2, pp. 679-693. ISSN 0094-2405. Available from:
Publication language:english
Original title:Beam Distortion Due to Gold Fiducial Markers During Salvage High-Intensity Focused Ultrasound in the Prostate
Title (cs):Vliv fiduciální markerů na distorzi ultrazvukového paprsku při operaci prostaty
Journal:Journal of Medical Physics, Vol. 44, No. 2, 111 River St., Hoboken, NJ 07030-5774, US
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HIFU, Prosate, k-Wave toolbox, ultrasound simulations
Purpose: High intensity focused ultrasound (HIFU) provides a non-invasive
salvage treatment option for patients with recurrence after external beam radiation therapy (EBRT). As part of EBRT the prostate is frequently implanted with permanent fiducial markers. To date, the impact of these markers on subsequent HIFU treatment is unknown. The objective of this work was to systematically investigate, using computational simulations, how these fiducial markers affect the delivery of HIFU treatment.

Methods: A series of simulations was performed modelling the propagation of ultrasound pressure waves in the prostate with a single spherical or cylindrical gold marker at different positions and orientations. For each marker configuration, a set of metrics (spatial-peak temporal-average intensity, focus shift, focal volume) was evaluated to quantify the distortion introduced at the focus. An analytical model was also developed describing the marker effect on the intensity at the focus. The model was used to examine the marker's impact in a clinical setting through case studies.

Results: The simulations show that the presence of the marker in the pre-focal region causes reflections which induce a decrease in the focal intensity and focal volume, and a shift of the maximum pressure point away from the transducer's focus. These effects depend on the shape and orientation of the marker and become more pronounced as its distance from the transducer's focus decreases, with the distortion introduced by the marker greatly increasing when placed within 5mm of the focus. The analytical model approximates the marker's effect and can be used as an alternative method to the computationally intensive and time consuming simulations for quickly estimating the intensity at the focus. A retrospective review of a small patient cohort selected for focal HIFU after failed EBRT indicates that the presence of the marker may affect HIFU treatment delivery.

Conclusions: The distortion introduced by the marker to the HIFU beam
when positioned close to the focus may result in an undertreated region beyond the marker due to less energy arriving at the focus, and an overtreated region due to reflections. Further work is necessary to investigate whether the results presented here justify the revision of the patient selection criteria or the markers' placement protocol.
   author = {Panyiotis Georgiou and Ji{\v{r}}{\'{i}} Jaro{\v{s}} and
	Heather Payne and Clare Allen and Eli Gibson and Dean
	Barratt and E. Bradley Treeby},
   title = {Beam Distortion Due to Gold Fiducial Markers During Salvage
	High-Intensity Focused Ultrasound in the Prostate},
   pages = {679--693},
   journal = {Journal of Medical Physics},
   volume = {44},
   number = {2},
   year = {2017},
   ISSN = {0094-2405},
   language = {english},
   url = {}

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