Prostate cancer is the most prevalent cancer and the third-leading cause of cancer-related death among men in the developed world, with the number of cases expected to double within the next 15 years. Conventional therapies offer good control of local disease but are associated with high complication rates reducing long-term health-related quality-of-life significantly. MRI-guided transurethral ultrasound therapy has emerged as an attractive, minimally-invasive alternative for the treatment of localized prostate cancer, where the entire gland is heated to temperatures sufficient to cause irreversible thermal coagulation. A device inserted in the urethra uses multiple ultrasound transducers to produce directional heating patterns directly in the prostate. Adjusting the ultrasound power, frequency and device rotation rate enables high spatial control of the thermal lesion. MRI provides information essential to the accurate targeting of the prostate; anatomical images for device positioning and treatment planning, and quantitative temperature measurements within the prostate to compensate for dynamic tissue changes, using feedback control. This thesis develops a complete treatment delivery strategy for producing conformal regions of thermal coagulation shaped to whole-gland prostate volumes, while limiting the thermal impact to the surrounding important anatomy. First, acoustic and thermal simulations incorporating a novel temperature feedback controller were used to model and shape regions of coagulation to human prostate geometries with a high degree of accuracy. Second, treatment delivery strategies were developed and simulated to reduce thermal injury to the surrounding anatomy, below the threshold for sustained damage. Third, experiments in tissue-mimicking gel phantoms confirmed the predictive accuracy of the simulations and the feasibility of producing conformal volumes of coagulation using transurethral ultrasound devices and MRI-temperature feedback. This work forms the basis of clinical treatment delivery methods and supports the use of the simulations as a planning tool to enhance the inherent compromise between safety and efficacy on a patient-specific basis.

Prostate cancer is the most prevalent cancer and the third-leading cause of cancer-related death among men in the developed world, with the number of cases expected to double within the next 15 years. Conventional therapies offer good control of local disease but are associated with high complication rates reducing long-term health-related quality-of-life significantly. MRI-guided transurethral ultrasound therapy has emerged as an attractive, minimally-invasive alternative for the treatment of localized prostate cancer, where the entire gland is heated to temperatures sufficient to cause irreversible thermal coagulation. A device inserted in the urethra uses multiple ultrasound transducers to produce directional heating patterns directly in the prostate. Adjusting the ultrasound power, frequency and device rotation rate enables high spatial control of the thermal lesion. MRI provides information essential to the accurate targeting of the prostate; anatomical images for device positioning and treatment planning, and quantitative temperature measurements within the prostate to compensate for dynamic tissue changes, using feedback control. This thesis develops a complete treatment delivery strategy for producing conformal regions of thermal coagulation shaped to whole-gland prostate volumes, while limiting the thermal impact to the surrounding important anatomy. First, acoustic and thermal simulations incorporating a novel temperature feedback controller were used to model and shape regions of coagulation to human prostate geometries with a high degree of accuracy. Second, treatment delivery strategies were developed and simulated to reduce thermal injury to the surrounding anatomy, below the threshold for sustained damage. Third, experiments in tissue-mimicking gel phantoms confirmed the predictive accuracy of the simulations and the feasibility of producing conformal volumes of coagulation using transurethral ultrasound devices and MRI-temperature feedback. This work forms the basis of clinical treatment delivery methods and supports the use of the simulations as a planning tool to enhance the inherent compromise between safety and efficacy on a patient-specific basis.

Les travaux de cette Thèse porte sur des éléments de guidage d'une thérapie focale du cancer de la prostate par Ultrasons Focalisés Haute Intensité (HIFU). Actuellement l'IRM est la seule technique d'imagerie qui permet de localiser la tumeur dans la prostate. Par contre, la tumeur n'est pas visible dans l'échographie qui est l'imagerie utilisée pour la planification et le guidage de la thérapie. L'objectif de la Thèse est de proposer des techniques de recalage de l'IRM T2 vers l'échographie. Deux approches ont été explorées : 1) Une approche basée région et plus particulièrement une méthode de descripteurs de la texture en échographie basée sur des moments invariants en rotation et en échelle. Ces descripteurs sont sensibles à la distribution du speckle quelle que soit son échelle ou son orientation. Certains de ces descripteurs permettent de caractériser les régions présentant une même distribution de speckle, mais nous avons également constaté que certains autres de ces descripteurs étaient sensibles aux contours de ces régions. Cette caractéristique nous semble très utile pour les méthodes de segmentation intégrant à la fois l'information de contours et l'information de régions (contours actifs, graph cut, etc.). 2) Une approche basée surface. Nous avons adapté une méthode de Définition Optimale de la Surface (OSD) à la segmentation de la prostate en IRM T2. Et plus particulièrement une segmentation concurrente de la prostate, de la vessie et du rectum par OSD multi-objets. Les surfaces de la prostate extraites du volume échographique et du volume IRM T2 nous ont permis d'envisager une première tentative de recalage surface/surface par la méthode des démons. / The work of this Thesis is focused on image guided focal therapy of prostate cancer by High Intensity Focused Ultrasound (HIFU). Currently MRI is the only imaging technique that can locate the tumor in prostate. In contrast, the tumor is not visible in the ultrasound image which is used to guide the HIFU planning and therapy. The aim of the Thesis is to provide registration techniques of T2 MRI to ultrasound. Two approaches were explored: 1) Region-based registration. More particularly, we studied an ultrasound texture descriptors based on moments invariant to rotation and scaling. These descriptors are sensitive to speckle distribution regardless of the scale or the orientation. As we expected, some of these descriptors can be used to characterize regions sharing a similar speckle spatial distribution. But, we also found that some other descriptors were sensitive to the contours of these regions. This property seems very useful to adapt the classical boundary-based or mixed region/boundary-based segmentation methods (active contours, graph cut, etc.) to process US images. 2) Surface-based registration approach.. We adapted the Optimal Definition Surface (OSD) method to the segmentation of the prostate in T2 MRI, Furthermore, we proposed the multiple-objects OSD which is a concurrent segmentation of the prostate, bladder and rectum. Finally we used the prostate surface extracted from the ultrasound volume and from T2 MRI in a surface-to-surface elastic registration scheme. This registration allowed us to merge the preoperative MR information in the peroperative US volume.

The work of this Thesis is focused on image guided focal therapy of prostate cancer by High Intensity Focused Ultrasound (HIFU). Currently MRI is the only imaging technique that can locate the tumor in prostate. In contrast, the tumor is not visible in the ultrasound image which is used to guide the HIFU planning and therapy. The aim of the Thesis is to provide registration techniques of T2 MRI to ultrasound. Two approaches were explored: 1) Region-based registration. More particularly, we studied an ultrasound texture descriptors based on moments invariant to rotation and scaling. These descriptors are sensitive to speckle distribution regardless of the scale or the orientation. As we expected, some of these descriptors can be used to characterize regions sharing a similar speckle spatial distribution. But, we also found that some other descriptors were sensitive to the contours of these regions. This property seems very useful to adapt the classical boundary-based or mixed region/boundary-based segmentation methods (active contours, graph cut, etc.) to process US images. 2) Surface-based registration approach.. We adapted the Optimal Definition Surface (OSD) method to the segmentation of the prostate in T2 MRI, Furthermore, we proposed the multiple-objects OSD which is a concurrent segmentation of the prostate, bladder and rectum. Finally we used the prostate surface extracted from the ultrasound volume and from T2 MRI in a surface-to-surface elastic registration scheme. This registration allowed us to merge the preoperative MR information in the peroperative US volume.