Thematic Section Chairperson 1 Introduction F. Piscaglia – C. Nolsøe 2 Generalities D. Cosgrove 3 Equipment H. P. Weskott 4 Investigator’s training O. H. Gilja 5 Terminology F. Piscaglia 6 Safety G. ter Haar 7 Paediatric C. Nolsøe 8 Pancreas M. D’Onofrio 9 Endoscopic CEUS C. F. Dietrich 10 Gastrointestinal tract O. H. Gilja 11 Spleen O. Catalano 12 Kidney M. Bertolotto 13 Vesicoureteral reflux M. Bertolotto 14 Scrotum P. S. Sidhu 15 Abdominal Trauma O. Catalano 16 Lung and pleural lesions G. Mathis 17 Vascular D. Clevert 18 Cerebral vessels G. Seidel 19 Inflammatory joint diseases A. S. Klauser 20 Intracavitary A. Ignee 21 Lymphnodes M. Hocke 22 Tumour response assessment E. Leen 23 Breast D. Cosgrove 24 Adrenals H. P. Weskott 25 Emerging CEUS applications and future perspectives A Gynecology D. Timmerman B Perineum C. F. Dietrich C Urinary Bladder F. M. Drudi D Transplanted Kidney M. Bertolotto E Prostate Cancer J. M. Correas F Aorto-caval fistula D. Clevert G Free Tissue Transplants E. M. Jung H Extrahepatic Biliary System C. F. Dietrich 26 Use of CEUS in patients with renal failure J. M. Correas – T. Albrecht 27 Technical Appendix F. Piscaglia – C. Nolsøe

High intensity focused ultrasound (HIFU) is gaining rapid clinical acceptance as a treatment modality enabling non-invasive tissue heating and ablation for numerous applications. HIFU treatments are usually carried out in a single session, often as a day case procedure, with the patient either fully conscious, lightly sedated or under light general anaesthesia. A major advantage of HIFU over other thermal ablation techniques is that there is no necessity for the transcutaneous insertion of probes into the target tissue. The high powered focused beams employed are generated from sources placed either outside the body (for treatment of tumours of the liver, kidney, breast, uterus, pancreas and bone) or in the rectum (for treatment of the prostate), and are designed to enable rapid heating of a target tissue volume, while leaving tissue in the ultrasound propagation path relatively unaffected. Given the wide-ranging applicability of HIFU, numerous extra-corporeal, transrectal and interstitial devices have been designed to optimise application-specific treatment delivery. Their principle of operation is described here, alongside an overview of the physical mechanisms governing HIFU propagation and HIFU-induced heating. Present methods of characterising HIFU fields and of quantifying HIFU exposure and its associated effects are also addressed.

For 50 years, high intensity focused ultrasound (HIFU) has been a subject of interest for medical research. HIFU causes selective tissue necrosis in a very well defined volume, at a variable distance from the transducer, through heating or cavitation. Over the past decade, the use of HIFU has been investigated in many clinical settings. This literature review aims to summarize recent advances made in the field. A Medline-based literature search (1965-2002) was conducted using the keywords "HIFU" and "high intensity focused ultrasound". Additional literature was obtained from original papers and published meeting abstracts. The most abundant clinical trial data comes from studies investigating its use in the treatment of prostatic disease, although early research looked at applications in neurosurgery. More recently horizons have been broadened, and the potential of HIFU as a non-invasive surgical tool has been demonstrated in many settings including the treatment of tumours of the liver, kidney, breast, bone, uterus and pancreas, as well as conduction defects in the heart, for surgical haemostasis, and the relief of chronic pain of malignant origin. Further clinical evaluation will follow, but recent technological development suggests that HIFU is likely to play a significant role in future surgical practice.

High-intensity focused ultrasound (HIFU) provides a potential noninvasive alternative to conventional therapies. We report our preliminary experience from clinical trials designed to evaluate the safety and feasibility of a novel, extracorporeal HIFU device for the treatment of liver and kidney tumours in a Western population. The extracorporeal, ultrasound-guided Model-JC Tumor Therapy System (HAIFU Technology Company, China) has been used to treat 30 patients according to four trial protocols. Patients with hepatic or renal tumours underwent a single therapeutic HIFU session under general anaesthesia. Magnetic resonance imaging 12 days after treatment provided assessment of response. The patients were subdivided into those followed up with further imaging alone or those undergoing surgical resection of their tumours, which enabled both radiological and histological assessment. HIFU exposure resulted in discrete zones of ablation in 25 of 27 evaluable patients (93%). Ablation of liver tumours was achieved more consistently than for kidney tumours (100 vs 67%, assessed radiologically). The adverse event profile was favourable when compared to more invasive techniques. HIFU treatment of liver and kidney tumours in a Western population is both safe and feasible. These findings have significant implications for future noninvasive image-guided tumour ablation.