Osteosarcoma (OS) is the most common primary bone tumor with an annual incidence rate of 3-4 individuals per million particularly affecting children and young adults. The 5-year survival rate stands at 60-80% with the current standard of care for human OS patients who do not have metastatic disease at presentation, but this drops to 20% for patients with metastatic disease which frequently occurs in the lungs. OS is much more common in canines, with metastasis being the major contributor to mortality, the same as in humans. Metastatic OS warrants novel treatment strategies to improve prognosis and survival. High-frequency irreversible electroporation (H-FIRE) is a promising, non-thermal, minimally invasive technique that induces cell death by applying pulsed electric fields in targeted regions, potentially triggering an anti-tumor immune response that could also target and prevent metastases. Such a dual functionality of H-FIRE is uniquely suited to treat pulmonary metastatic OS. The goal of this thesis was to study the ablative and immunomodulatory effects of H-FIRE on OS in-vitro with the overall hypothesis that H-FIRE completely ablates OS cells, induces the release of damage-associated molecular patterns (DAMPs), and promotes pro-inflammatory immune activating signatures in macrophages and T cells. Using an in-vitro model, my master's thesis focused on 1) Determining the electric field strength that completely ablates OS cells 2) Evaluating the immunomodulatory effects of H-FIRE by co-culturing H-FIRE treated OS cells with macrophages and T cells separately. Our study has utilized murine, canine, and human OS and immune cells, thus demonstrating a unique cross-species approach, 3) Evaluating DAMPs (ATP, calreticulin, and HMGB1) post-H-FIRE ablation of human OS cells. Overall, our study showed that H-FIRE successfully ablated OS cells in-vitro, induced the release of DAMPs from treated cells, and promoted activation signatures in immune cells. This thesis provides foundational data for future investigations developing H-FIRE as an immunomodulatory strategy for treating metastatic OS. / Master of Science / Osteosarcoma (OS) is the most common primary bone tumor that majorly affects young adults and children with an incidence rate of 3-4 individuals per million per year. When metastasis occurs (i.e. OS spreads from its site of origin to other organs in the body), most frequently to the lungs, patients experience poor chances of recovery and survival. Currently, the treatment protocol followed for patients with metastatic OS largely includes complete surgical removal and chemotherapy both of which can be very grueling for patients. No significant improvement in the overall 5-year survival rate with current mainstay treatment has led to the urgent need of novel treatment modalities for treating patients with pulmonary metastatic OS. High-Frequency Irreversible Electroporation (H-FIRE) is a novel non-thermal tumor ablation strategy that utilizes electrical pulses to create pores on the cell membrane, thus leading to irreversible damage and cell death. These dying tumor cells release certain molecules and proteins that send danger signals to activate the body's own immune system against the tumor. H-FIRE with its dual function of destroying the targeted tumor region via electroporation and distant metastases via activating immune system is uniquely suited to treat pulmonary metastatic OS. This thesis is the first to investigate H-FIRE ablation and immunomodulation for OS. We hypothesized that H-FIRE can completely destructs OS cells, promotes the release of danger signals, and causes immune activation. Using an in-vitro model, this thesis focused on 1) Determining the electric field strength needed for complete OS cell destruction by H-FIRE 2) Evaluating the immune activation potential of H-FIRE by exposing these H-FIRE treated cells to immune cells like macrophages and T cells separately. We utilized human, mouse, and dog-derived OS cells to increase the biological and clinical relevance of our study. 3) Evaluating certain proteins that act as danger signals post-H-FIRE treatment of human OS cells. Overall, our results indicated that H-FIRE can successfully destruct OS cells in-vitro, promotes the release of danger signals, and induces immune activation. This thesis contributes to providing crucial preliminary data in the development of H-FIRE as a novel ablation and immunomodulation treatment strategy for pulmonary metastatic OS.

Master of Science / Department of Electrical and Computer Engineering / Punit Prakash / Thermal therapies employing interstitial microwave applicators for hyperthermia or ablation are in clinical use for treatment of cancer and benign disease in various organs. However, treatment of targets in proximity to critical structures with currently available devices is risky due to unfocused deposition of energy into tissue. For successful treatment, complete thermal coverage of the tumor and margin of surrounding healthy tissue must be achieved, while precluding damage to critical structures. This thesis investigates two approaches to increase precision of microwave thermal therapy. Chapter 2 investigates a novel coaxial antenna design for microwave ablation (MWA) employing a hemi-cylinderical reflector to achieve a directional heating pattern. A proof of concept antenna with an S₁₁ of -29 dB at 2.45 GHz was used in ex vivo experiments to characterize the antennas’ heating pattern with varying input power and geometry of the reflector. Ablation zones up to 20 mm radially were observed in the forward direction, with minimal heating (less than 4 mm) behind the reflector. Chapter 3 investigates the use of magnetic nanoparticles (MNP) of varying size and geometry for enhancing microwave tissue heating. A conventional dipole, operating at 2.45 GHz and radiating 15 W, was inserted into a 20 mm radius sphere of distributed MNPs and heating measurements were taken 5 mm, 10 mm, and 15 mm radially away. A heating rate of 0.08°C/s was observed at 10 mm, an increase of 2-4 times that of the control measurement. These approaches provide strong potential for improving spatial control of tissue heating with interstitial and catheter-based microwave antennas.

Master of Science / Department of Electrical and Computer Engineering / Punit Prakash / Microwave ablation (MWA) is a minimally invasive thermal therapy predominantly used in the treatment of localized cancer. Previous studies have demonstrated clinical use of MWA for treating lung tumors, however, these procedures have relied upon the use of rigid percutaneous MWA applicators which can limit the range of accessible tumors and may have inherent disadvantages for use in lung tissue. The objective of this work was to develop and characterize a bronchoscopic MWA applicator suitable for use in a system that enables bronchoscopic transparencymal nodule access (BTPNA). A 3D coupled FEM electromagnetic-heat transfer model was implemented to optimize the antenna design and evaluate the expected ablation size and shape. A prototype device was fabricated and experimentally evaluated in ex vivo tissue to verify simulation results and demonstrate proof-of-concept. Simulated and experimental results indicate the proposed device could create ablation zones 19.3 – 31.0 mm in diameter with 30 – 45 W of power applied for 5 – 10 minutes. Future bronchoscopic MWA applicators based on the design proposed in this study could allow physicians an even less invasive treatment option for lung cancer with increased accuracy and efficacy and reduced risk of procedural complications immediately following a positive bronchoscopic lung biopsy.

This project studies the removal of non-anatomical objects from medical images. During tumor ablation procedures, the ablation probes appear in the image, hindering the performance of segmentation, registration, and dose computation algorithms. These algorithms can also be affected by artifacts and noise generated by body implants. Image inpainting methods allow the completion of the missing or distorted regions, generating realistic structures coherent with the rest of the image. During the last decade, the study of image inpainting methods has accelerated due to advances in deep learning and the increase in the consumption of multimedia content. Models applying generative adversarial networks have excelled at the task of image synthesis. However, there has not been much study done on medical image inpainting. In this project, a new inpainting method is proposed for recovering missing information from medical images. This method consists of a two-stage model, where a coarse network is followed by a refinement network, both of which are U-Nets. The refinement network is trained together with a discriminator, providing adversarial learning. The model is trained on a dataset of CT images of the liver and, in order the mimic the areas where information is missing, regular and irregular shaped masks are applied. The trained models are compared both quantitatively and qualitatively. Due to the lack of standards and accurate metrics in image inpainting tasks, results cannot be easily compared to current approaches. However, qualitative analysis of the inpainted images shows promising results. In addition, this project identifies the Frechet Inception Distance as a more valid metric than older metrics commonly used for evaluation of image inpainting models. In conclusion, this project provides an inpainting model for medical images, which could be used during tumor ablation procedures and for noise and artifact elimination. Future research could include implementing a 3D model to provide more coherent results for inpainting patients - a stack of images - instead of single images. / I detta projekt undersöks metoder för avlägsnande av icke-anatomiska föremål från medicinska bilder. Bilder tagna under ablationsbehandling av tumörer innehåller själva ablationsnålen, denna kan hindra segmenterings-, registrerings-och dosberäknings-algoritmer för att uppnå önska resultat. Dessa algoritmer kan också påverkas av artefakter och brus som genereras av olika metallimplantat. Bildifyllningsmetoder gör det möjligt att ersätta regioner som saknar eller innehåller inkorrekt bilddata, med realistiska strukturer som är sammanhängande med resten av bilden. Under det senaste decenniet har intresset för metoder för bildifyllning accelererat på grund av framsteg inom djupinlärning och ökad konsumtion av multimediainnehåll. Modeller som använder generative adversarial networks har utmärkt sig i bildsynteseringsuppgifter. Det har dock inte gjorts så många studier gällande bildifyllning av medicinska bilder. I detta projekt föreslås en ny bildifyllningsmetod för att återställa regioner med inkorrekt information i medicinska bilder. Denna metod består av ett tvåstegsnätverk, där ett första nätverk följs av ett förfiningsnätverk, båda av typen U-net. Förfiningsnätverk tränas tillsammans med ett diskriminatornätverk. Modellen tränas på ett dataset av CT-bilder av levern. För att efterlikna de områden där information saknas, applicerades masker av olika former. De färdigtränade modellerna jämfördes både kvantitativt och kvalitativt. På grund av bristen på standarder och noggranna mätvärden för bildifyllningsmetoder, kan resultaten inte enkelt jämföras med existerande metoder. Men kvalitativ analys av de målade bilderna visar ganska lovande resultat. Modellen presterar som bäst i områden inte innehåller komplexa strukturer. Sammanfattningsvis har en fungerande bildifyllningsmetod för medicinska bilder skapats och som kan användas vid tumörablation och för eliminering av bildartefakter. Framtida forskning kan inkludera implementering av en 3D-modell för att ge mer sammanhängande resultat.

Malignant gliomas (MG), most notably glioblastoma multiforme (GBM), are among the most aggressive of all malignancies. High-grade variants of this type of brain cancer are generally considered incurable with singular or multimodal therapies. Many patients with GBM die within one year of diagnosis, and the 5-year survival rate in people is approximately 10%. Despite extensive research in diagnostic and therapeutic technologies, very few developments have emerged that significantly improve survival over the last seven decades. Irreversible electroporation (IRE) is a new non-thermal focal tissue ablation technique that uses low-energy electric pulses to destabilize cell membranes, thus achieving tissue death. The procedure is minimally invasive and is performed through small electrodes inserted into the tissue with treatment duration of about one minute. The pulses create an electric field that induces an increase in the resting transmembrane potential (TMP) of the cells in the tissue. The induced increase in the TMP is dependent on the electric pulse parameters. Depending on the magnitude of the induced TMP the electric pulses can have no effect, transiently increase membrane permeability or cause spontaneous death. In this dissertation we hypothesize that irreversible electroporation is capable of ablating normal (gray and white matter) and pathological (MG and/or GBM) brain tissue in a highly focused non-thermal manner that is modulated through pulse parameters and electrode configuration. Through a comprehensive experimental and numerical investigation, we tested and attained results strongly supporting our hypothesis. Specifically, we developed numerical models that were capable of simulating an entire IRE treatment protocol and would take into account pulse parameters (e.g. duration, frequency, repetition rate and strength) in addition to the dynamic changes in tissue electrical conductivity due to electroporation and joule heating, as well as biologically relevant processes such as blood perfusion and metabolic heat. We also provided a method to isolate the IRE effects from undesired thermal damage in models that were validated with real-time temperature measurements during the delivery of the pulses. Finally we outlined a procedure to use 3D volumetric reconstructions of IRE lesions using patient specific MRI scans in conjunction with the models described for establishing field thresholds or performing treatment planning prior to the surgical procedure; thus supplying the readers with the tools and understanding necessary to design appropriate treatment protocols for their specific application. Experimentally we presented the first systematic in vivo study of IRE in normal canine brain and the multimodal treatment of a canine MG patient. We confirmed that the procedure can be applied safely in the brain and was well tolerated clinically. The lesions created with IRE were sub-millimeter in resolution and we achieved 75% tumor volume reduction within 3 days post-IRE in the patient. In addition to the sharp delineation between necrotic and normal brain, the treatments spared the major blood vessels, making it appropriate for treatment of tumors adjacent to, or enveloping critical vascular structures. We believe that irreversible electroporation will play a key role in the treatment of intracranial disorders including malignant brain cancer in which the intent is to focally kill undesired tissue while minimizing damage to surrounding healthy tissue. / Ph. D.

High-frequency irreversible electroporation (H-FIRE) is a novel tumor ablation therapeutic that applies bipolar, high-frequency pulsed electric fields to tumors, triggering the formation of irreversible membrane pores and to induce tumor cell death. H-FIRE has demonstrated pre-clinical and clinical utility as a therapeutic for brain tumors, including gliomas. H-FIRE has been shown to induce precise, uniform ablation within the tumor tissue, as well as local changes to the tumor microenvironment and systemic changes to the immune landscape. Namely, disruption of the peritumoral blood-brain barrier (BBB) following H-FIRE ablation of brain tumors, and infiltration and activation of the innate immune system are clinically observed following H-FIRE tumor ablation. Such effects persist long after death of the treated tumor, and therefore an understanding of the mechanisms underlying these local and systemic changes are critical for the development of H-FIRE. Using in vitro models of glioma and lung carcinoma-derived brain metastases, we investigate the interactions between cancer cells that have been ablated with H-FIRE and the brain tumor microenvironments. Specifically, we demonstrate that H-FIRE-treated cancer cells can recover treatment-induced damage and proliferative capacity after treatment with specific electric field doses, while higher doses inhibit such recovery. This suggests that after H-FIRE ablation of brain tumors, tumor cells can still secrete factors to trigger alterations in their local and systemic environments. We then specifically investigate the role of tumor-derived extracellular vesicles (TDEVs) in mediating these changes, namely pBBB disruption and changes in innate immunity. We find that, following H-FIRE ablation of brain cancer cells, treated cells immediately release TDEVs that disrupt the blood-brain barrier (BBB) endothelium in vitro, and are uniquely internalized by cerebral endothelial cells in vitro, despite reduced release of TDEVs after H-FIRE. We further demonstrate that H-FIRE significantly alters the proteomic payloads of TDEVs. When TDEVs released by sham- and H-FIRE-treated glioma cells are delivered to healthy rats, only TDEVs released by H-FIRE-ablated cells are retained in the brain, suggesting changes to TDEV organotropism after H-FIRE ablation of glioma. Further, once retained in the brain, these post-H-FIRE TDEVs cluster near cerebral endothelial cells, similarly to in vitro. Although the TDEVs released by H-FIRE ablated glioma cells do not disrupt the BBB in vivo, Iba1+ cells were increased in the brains of rats that received TDEVs released by H-FIRE-ablated glioma cells. Together, these data suggest that H-FIRE immediately alters the secretion and proteome of TDEVs, facilitating changes in TDEV organotropism and cellular tropism and immune cell recruitment to the tumor microenvironment. Together, this research indicates mechanisms by which tumor cells continue to modulate their local and systemic environments via the action of TDEVs, which is critical information for the continued development of H-FIRE and its optimization with adjuvant therapeutics for the treatment of malignant brain tumors. / Doctor of Philosophy / All cells secrete extracellular vesicles, which are packets of information that function as communication highways between cells. In cancer, tumor-derived extracellular vesicles (TDEVs) reprogram local and distant cells to support tumor growth. However, they have also been shown to change local and systemic functions, such as blood vessel function and immune response, after tumors are treated with therapeutics. Therefore, a full understanding of the role of TDEVs in how tumors communicate with the body after cancer treatment is necessary when developing new anti-cancer therapeutics. Here, in developing high-frequency irreversible electroporation (H-FIRE), a novel anti-tumor therapeutic for the treatment of malignant brain tumors, we explore how TDEVs released by brain cancer cells treated with H-FIRE interact with various cell types and structures in the body, and how these interactions may affect the response to treatment. Using a glioma model of primary brain cancer, and a lung carcinoma model of brain metastases, we first explore how tumor cells may be able to recover from damage after treatment with H-FIRE. We discover that brain cancer cells treated with specific doses of H-FIRE recover cell damage and continue to proliferate, but cells treated with higher doses of H-FIRE cannot recover these functions. The fact that tumor cells may be able to recover after H-FIRE suggests that cancer cells may still secrete factors, such as TDEVs, that interact with cells in the microenvironment after tumor treatment. We investigated the role of TDEVs released by brain cancer cells treated with H-FIRE to determine whether they cause changes in surrounding cells and structures in the brain cancer microenvironment. We determined that brain cancer cells treated with H-FIRE release TDEVs that carry proteins different from those carried by TDEVs routinely released by untreated cells. We further found that these TDEVs disrupt the blood-brain barrier (BBB) endothelium in vitro, and are uniquely internalized by cells of the endothelium. When these TDEVs were administered to the brains of healthy rats, they were retained in the brain, clustered near the endothelium, and recruited immune cells from circulation into the brain. Conversely, TDEVs that were routinely released from the brain cancer cells, in the absence of H-FIRE treatment, exhibited none of these functions. Taken together, these results show that H-FIRE changes TDEVs in numerous ways: after H-FIRE, the TDEVs may gravitate toward particular organs and cell types, and recruit immune cells. All of these changes can impact the overall therapeutic response after H-FIRE, and may also be specifically optimized and targeted with additional therapeutics to make H-FIRE more effective for brain cancer.

Biomedical devices play a crucial role in the healthcare system, enabling more effective treatments, less invasive procedures, and more precise diagnoses. Due to these compelling reasons, development of new biomedical devices and biomaterials have always been in high demand. Exploring and refining fabrication methods are essential to the development of new biomedical devices. Some of the common fabrication methods include microfabrication methods (photolithography and soft lithography), 3D printing (additive manufacturing), laser machining, thermal drawing, and electrospinning. The choice of fabrication methods heavily depends on the materials, geometry, and functionalities of biomedical devices. Currently, the thermal drawing process has proven to be an excellent scalable fabrication platform for neural interface, tissue engineering, tumor/cancer treatment, soft robotics, and smart textiles. This Ph.D. dissertation summarizes my research on the fabrication and validation of thermally drawn multifunctional polymer fiber probes for modern biomedical applications, primarily in the fields of neural interfaces and tumor treatments. Understanding the neural basis of behavior requires monitoring and manipulating combinations of physiological elements and their interactions in behaving animals. Utilizing the thermal drawing process, we developed T-DOpE (Tapered Drug delivery, Optical stimulation, and Electrophysiology) probes and Tetro-DOpE (Tetrode-like Drug delivery, Optical stimulation, and Electrophysiology) probes that can simultaneously record and manipulate neural activity in behaving rodents. Taking advantage of the triple-functionality, we monitored local field potential (LFP) while manipulating cannabinoid receptors (CB1R; microfluidic agonist delivery) and CA1 neuronal activity using optogenetics. Focal infusion of CB1R agonist downregulated theta and sharp wave-ripple oscillations (SPW-Rs). Furthermore, we found that CB1R activation reduces sharp wave-ripples by impairing the innate SPW-R-generating ability of the CA1 circuit. Microscale electroporation devices are mostly restricted to in vitro experiments (i.e., microchannel and microcapillary). We developed a flexible microscale electroporation fiber probe through a thermal drawing process and femtosecond laser micromachining techniques. The novel fiber microprobes enable microscale electroporation and arbitrarily select the cell groups of interest to electroporate. Successful reversible and irreversible microscale electroporation was observed in a 3D collagen scaffold (seeded with U251 human glioma cells) using fluorescent staining. Leveraging the scalable thermal drawing process, we envision a wide distribution of multifunctional polymer fiber probes in research facilities and hospitals. Along with the fiber probes presented in this dissertation, additional insight and future perspective on thermally drawn biomedical devices are discussed. / Doctor of Philosophy / The thermal drawing process is a versatile and scalable platform for fabricating functional fiber technology. The process was formerly adapted from fabrication method for silica optical fibers, widely used in telecommunication (e.g., telephone, internet, cable TV, etc.). To name some functionalities of these fibers, they can move, hear, sense touch, change colors, harvest and store energy, record and manipulate brain activity, and ablate tumors. As imagined, these functionalities are derived from the unique geometry and functional materials embedded along the fiber. Therefore, developing the fiber design tailored to a specific application is a critical step to making a successful fiber product. In this dissertation, I will present my work on biomedical devices fabricated with the thermal drawing process and their application in neuroscience and tumor/cancer treatment. Utilizing the thermal drawing process, we developed neural interfaces that can be implanted into the deep brain and record and simultaneously manipulate the neural activity. These neural interfaces (Chapter 2,3; T-DOpE and Tetro-DOpE probes, respectively) are able to record both local field potentials (LFP; activity of thousands or more neurons) and single action potentials (single on/off signal from individual neurons nearby). By manipulating the gene expression, we can control the activity of neurons with specific light (λ= 470nm; blue light) exposure. We implemented optical waveguide in our probes to guide light from a laser source to the tip of the probe and manipulate the neural activity. Furthermore, we fabricated micro-channels within the device to enable focal drug delivery at the tip of the device. Using the T-DOpE probe, we studied the effect of local synthetic cannabinoid injection in the hippocampus. We found that the local injection of the drug in hippocampus CA1 makes neurons incapable of generating sharp wave-ripples (a neural signal associated with memory). Electroporation is a biophysical phenomenon where short high electric field pulses introduce nanoscale defects in cell membrane. These defects can cause unstable cellular homeostasis and eventually leads to cell death. Due to reduced treatment time, no heat effect, and tissue selectivity, electroporation has been used in clinical trials for cancer treatments. Using the thermal drawing process and laser micromachining techniques, we developed a flexible microscale electroporation fiber probe capable of ablating tumor cells. Due to the low-cost and scalability of thermal drawing process, we envision the use of thermally drawn functional fiber technology in biomedical fields. In this dissertation, I also address some challenges and future directions of thermally drawn functional fibers in biomedical fields.

Brain tumors are among the most devastating types of solid tumors to treat. Standard of care for glioblastoma (GBMs), the most aggressive form of primary brain tumors, has failed to improve the current survival rates in the past decades. Despite many other solid tumors, recent advances in cancer immunotherapies have also shown disappointing outcomes in GBMs. The heterogenous nature of GBMs, the immunosuppressive tumor microenvironment and the restrictive role of blood brain barrier (BBB) are some of the main challenges faced for treating GBMs. Electroporation-based treatments have demonstrated promising results, treating preclinical models of GBMs. It has been shown that low and high frequency irreversible electroporation treatments shift the immunosuppressive tumor microenvironment and reversibly open large areas of blood brain barrier (BBB). In this dissertation, in vitro cell culture models are utilized to study electroporation-based treatments for achieving a more optimized treatment for glioblastoma. We are proposing to utilize the immunomodulatory effects of electroporation treatments to improve the outcomes of immunotherapies in the brain. / Doctor of Philosophy / Despite the current advancements in treating solid tumors, brain tumors remain among the most difficult cancers to treat. The special structure of the brain as an organ as well as tumor complexity can lead to treatment failure. It is also known that infiltration of the immune cells within the tumor mass is limited due to the tumor's immunosuppressive nature. Hence, the use of newly advancing immunotherapy techniques is limited in the brain. Local treatments have become one of the most promising tools against brain tumors. Such treatments include methods that use excessive heating of the tissue to kill the tumors. Relying on heat for tissue destruction could damage the critical structures near the tumor and will reduce the favorable immune response after the treatment. A new treatment modality known as electroporation has been introduced for non-thermal treatment of brain tumors. Due to its non-thermal nature, electroporation treatments will allow for sparing of critical structures and can lead to a more robust immune response comparing to thermal treatment modalities. In this dissertation, we utilize electroporation-based treatments to try to overcome some of the challenges associated with treating brain tumors such as tumor heterogeneity and immune suppression.

Glioblastoma Multiforme (GBM) is a highly aggressive and prevalent brain tumor with an average 5-year survival rate of approximately 6.9%. Its complex pathophysiology, characterized by the capacity to invade surrounding tissues beyond the visible tumor margin, intratumor heterogeneity, hypoxic core, and the presence of the blood-brain barrier (BBB) that restricts the penetration of large therapeutic agents, all pose formidable challenges for effective therapeutic intervention. The standard of care for GBM has thus far exhibited limited success, and patients often face a poor prognosis. Electroporation-based therapies, such as irreversible electroporation (IRE), have emerged as promising alternatives to conventional treatments. By utilizing high amplitude pulsed electric fields, IRE is able to permeabilize cells, disrupt the BBB, and induce non thermal ablation of soft tissues. However, IRE is oftentimes accompanied by undesirable secondary effects such as muscle contractions, complex anesthetic protocols, and susceptibility to electrical heterogeneities, which have impeded its clinical translation. To address these limitations, high-frequency IRE (H-FIRE) was developed. H-FIRE employs short bursts of bipolar pulses, similar in duration to the cell charging time constant, enabling the desired tissue ablation while minimizing nerve excitation and muscle contractions. Additionally, H-FIRE reduces susceptibility to electrical heterogeneities, allowing for more predictable treatment volumes, thus enhancing the feasibility of clinical translation. This dissertation investigates H-FIRE for targeting malignant gliomas while looking into improved efficacy when administering the therapy in conjunction with other treatment forms and technologies. Specifically, the presented work focuses on several key areas: (1) determining the effect of pulsing protocol and geometric configuration selection on the biological outcomes from electroporation; (2) using a tumor bearing rodent glioma model to evaluate the effects of H-FIRE as a standalone therapy and as a combinatorial therapy with liposomal doxorubicin; (3) investigating the effects of waveform shape on biological outcomes; (4) utilizing real-time Fourier Analysis SpecTroscopy (FAST) to accurately model rises in temperature during treatment; and (5) modifying real-time FAST methods to determine treatment endpoints for safe and effective ablation volumes. / Doctor of Philosophy / Glioblastoma Multiforme (GBM) is one of the deadliest tumors, with an overall five-year survival rate of approximately 6.9%. Unfortunately, it also holds the position of being the most prevalent malignant brain tumor, constituting nearly 50.1% of all primary malignant brain tumor diagnoses. Despite its widespread occurrence, there has been limited success in improving survival rates. The tumor's infiltrative nature and its location behind the blood-brain barrier (BBB), which often screens out large drug molecules like chemotherapeutics, contribute significantly to these unfavorable treatment outcomes. This dissertation explores the potential of high-frequency irreversible electroporation (H-FIRE) as a solution to these challenges. H-FIRE employs bursts of pulsed electric fields to induce nanoscale defects in the cell membrane. The response to these defects may involve temporary pores that facilitate the uptake of therapeutic molecules into the cell, or larger and longer lasting pores that disrupt cell homeostasis, ultimately leading to cell death. Furthermore, this pulsed field therapy has shown success in enabling molecules to bypass the BBB. Thus, this dissertation aims to elucidate the various biophysical phenomena associated with H-FIRE, shedding light on how to manipulate treatment protocols to maximize BBB disruption and enhance therapy when used in conjunction with combinatorial agents. Additionally, this work aims to further develop technologies to provide real-time feedback, ensuring the safe and effective delivery of the treatment. Through these efforts, this dissertation aspires to offer valuable insights into optimizing H-FIRE for the treatment of malignant gliomas and advancing the understanding of combinatorial therapies in this specific context.

PURPOSE: Thermal ablation therapy is an emerging local cancer treatment to destroy cancer tissue using heat. However variations in blood flow and energy absorption rates make it extremely challenging to monitor thermal changes. Insufficient ablation may lead to recurrence of the cancer while excessive ablation may damage adjacent healthy tissues. Ultrasound could be a convenient and inexpensive imaging modality for real-time monitoring of the ablation. For the development and optimization of these methods, it is essential to have ground truth data and a reliable and quantitative validation technique before beginning clinical trials on humans. In this dissertation, my primary focus was to solve the image-to-physical space registration problem using stereotactic fiducials that provide accurate correlation of ultrasound and pathology (ground truth) images. METHOD: A previously developed validation test-bed prototype was evaluated using phantom experiments to identify the shortcomings and limitations. In order to develop an improved validation platform, a simulator was implemented for evaluating registration methods as well as different line fiducial structures. New fiducial line structures were proposed, and new methods were implemented to overcome the limitations of the old system. The new methods were then tested using simulation results and phantom studies. Phantom experiments were conducted to improve the visibility of fiducials, as well as the quality of acquired ultrasound and pathology image datasets. RESULTS: The new system outperforms the previous one in terms of accuracy, robustness, and simplicity. The new registration method is robust to missing fiducials. I also achieved complete fiducial visibility in all images. Enhancing the tissue fixation medium improved the ultrasound data quality. The quality of pathology images were improved by a new imaging method. Simulation results show improvement in pose recovery accuracy using my proposed fiducial structure. This was validated by phantom studies reducing spatial misalignment between the US and pathology image sets. CONCLUSION: A new generation of test-bed was developed that provides a reliable and quantitative validation technique for evaluating and optimizing ablation monitoring methods. / Thesis (Master, Computing) -- Queen's University, 2011-09-29 20:31:55.159