I remember seeing a demo from people who could slap a raw steak into one of these machines, and with ultrasound, sear their logo into the meat at sub mm precision. But that was long ago & not ready for medical usage yet. Cool that it seems to be used for actually treating people now.
I just spoke to a oncologist surgeon about this. Even though their facially doesn't have one (they are expensive machines) he said it's looking like it'll be standard care in the future.
He did an evaluation about getting one for my local hospital.
yup. If the stone is mineral-based and within certain sizes, you can break it up with a special ultrasound. Except.... in morbidly obese patients, if you can imagine the why.
> "Cancer is awful," Xu says. "What's making it even worse is cancer treatment."
Well said. And it's either terrible or expensive (and sometimes also terrible as well).
Proton therapy for instance is amazing at targeting hard to reach tumors like those in the eye, but costs close to fix figures as it requires a team of people to design the treatment.
An eye opener for me was when a friend of my was dying of cancer there was a period where he got sepsis, ultimately because of the effects of chemotherapy not directly because of the cancer. But had he passed from sepsis (he survived that incident), the cause of death would ultimately be attributed to cancer and not chemotherapy.
I looked into it deeper at the time and it's very difficult to untangle the true cause of death in many of these situations. While certainly these treatments are ultimately beneficial statistically, it is concerning that there's not as much discussion around their harm and the real risk rewards behind various treatments. I know from my own (non-cancer) experience that there is a very strong bias towards treatment even in cases where, once you break down all the risk and rewards, there is a strong argument for non-intervention.
Proton therapy offers incremental, if any advantage, over standard IMRT for non-pediatric cases. In the case of the prostate, recent evidence shows no benefit at all. It suffers from near hyperbolic marketing from debt-ridden therapy centers pushing dubious claims that are now being exposed by high quality phase III comparison trials.
HIFU for prostate also is a ripe area for grifters as it is advertised and marketed towards low risk cases that would probably benefit from active surveillance.
Don’t the out of pocket maximums make the costs of the treatment irrelevant for most people if you have insurance. For both of those the patient would probably end up paying the same $15,000 out of pocket maximums.
The only thing the article fails to mention is the use of more than one transducer used to focus multiple ultrasound beams to an intersection point in the body, increasing the heating power of all beams
At the intersection of ultrasound and startups (since this is HN), does anyone have any thoughts about that Openwater project? They are apparently working on open source ultrasonic medical devices.
I don’t actually know much about them, I just heard of them because their CEO (Mary Lou Jepsen, she’s quite famous, right?) was on the AMC podcast (months ago, actually, I was just going randomly though the back catalogue).
Tech folks pivoting to medical always throws off some alarm bells to me, but she was fairly compelling on the podcast and the basic idea seemed to make sense. Ultrasonic treatments, using diagnostic-level energies, using focusing and resonance based tricks, I guess. (It is way outside my wheelhouse, sorry if the description is inaccurate).
> Tech folks pivoting to medical always throws off some alarm bells to me, but she was fairly compelling on the podcast and the basic idea seemed to make sense.
The best way to evaluate biotech startups from the outside is to look at their investors. If they’re full of VCs specializing in biotech, chances are someone did the bare minimum due diligence on the science.
Theranos for example didn’t have a single one because biotech VCs steered clear of that mess entirely.
> Tech folks pivoting to medical always throws off some alarm bells to me
Same for me. I've been in the medical device industry for 15+ years now and came from "tech". What a lot of techies under/don't appreciate is that the medical device industry is heavily regulated and moves at a muuuch slower pace than other technologies.
There are lots of regulatory and quality/testing hurdles that you must clear (namely verification and validation testing, in addition to your 510(k) clearance or approval, if PMA) before you can market and sell your device.
I tell customers, on average, a Class II medical device project can take 18-24 months and cost $3M to 4M, minimum.
I had the absolute pleasure during my engineering undergraduate (Oxford) to take a biomedical module. One of my 'labs' was on nonlinear acoustics, specifically ultrasound applied for therapeutic uses. It was very captivating seeing a very focused point within a block of gel become ablated. A part I found particularly exciting was realising that it was a phased array of ultrasonic emitters, so that the point where the ablation occurred could in fact be placed anywhere you desired in the gel.
They showed us results of HIFU applied to real patients to non-invasively ablate tumours and treat prostate issues. As far as I can tell the probe creating the ultrasonic waves needs to be relatively close.
A thought I had at the time was if you knew all of the material properties of all of the tissues inside someone and their locations (say with an MRI) you could in theory apply this even deeper in someone than is currently possible - with a larger stick-on patch of actuators as a phased array.
Finally, another memorable thing that was discussed was what another researcher was doing with ultrasonics.
Stride (who I am delighted to say was a fantastic lecturer) was very interested in bubbles. She would construct tiny bubbles where the surface (or interior?) was made of a chemotherapy drug. These bubbles could then be injected into someone's blood stream and would be ruptured using ultrasound to allow for extremely targeted application of chemotherapy (the jet formed from rupture would be so strong it would inject the drug into nearby tissue).
Fascinating, fascinating stuff but of course developed over many years of hard work.
It also drives home the serendipity of science. One can easily pander a researcher spending their days thinking about bubbles from a place of ignorance. Yet this is what basic research often looks like—play.
"Ablation (Latin: ablatio – removal) is the removal or destruction of something from an object by vaporization, chipping, erosive processes, or by other means."
There was a game in the early '80s called Microsurgeon where you piloted a robot probe into a body to cure it of diseases. It was armed with an array of tools, one of which was ultrasound that you could use to destroy cancer. I wonder how long this idea has been around for.
I've got a node in my thyroid that can reasonably only be removed chemically, which has risks of blowing out my whole thyroid. ultrasound treatment is now available for it, however have been going to my endocrinologist every four months for a bloodwork checkup (because I need to take thyroid-suppressing drugs until the node can be removed) and am still waiting for him to have heard about this treatment outside of my own telling him so (even though his larger medical organization, NYU, offers it, it still seems to not be routine within his practice).
A few points based on comments I’m seeing about the article.
This method of ultrasound treatment is called histotripsy. The underlying mechanism it uses to treat tumors is by focused ultrasound beams that mechanically disrupt cell membranes . It basically turns the lesion into soup. It does not treat the lesion by heating, although there are other techniques that do use ultrasound to ablate tissue with thermal energy.
Where I have seen it used and discussed is in the liver, whether that be metastatic disease to the liver or primary liver tumors.
One challenge is that in the liver you can’t use it for lesions that are near the capsule of the liver. It can also be difficult to keep the ultrasound beam focused on the lesion with respiration, especially if the tumor is small.
It’s an interesting technique and I think more people will use it over time. Whether it will be better than other established techniques like microwave ablation or radioembolization (for liver tumors) remains to be seen. I’m an interventional radiologist.
There are already lots and lots of treatments for localized tumors in the liver - radiofrequency oblation, cryo oblation, microwaves, etc. These kinds of articles often tout new treatments as a bold new thing, but they don't really change the state of medicine, and it's not like they would be a replacement for chemo, for example. I'd be very curious how histotripsy compares to these other localized tumor treatments.
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[ 3.0 ms ] story [ 57.1 ms ] threadHe did an evaluation about getting one for my local hospital.
Fun fact: using this ultrasound for prostate cancer treatment reduces the risk of erectile disfunction
Well said. And it's either terrible or expensive (and sometimes also terrible as well).
Proton therapy for instance is amazing at targeting hard to reach tumors like those in the eye, but costs close to fix figures as it requires a team of people to design the treatment.
For comparison, a liver histotripsy costs $17.5k:
https://histosonics.com/news/histosonics-notches-significant...
Not a bad deal for a non-invasive life-saving surgery.
I looked into it deeper at the time and it's very difficult to untangle the true cause of death in many of these situations. While certainly these treatments are ultimately beneficial statistically, it is concerning that there's not as much discussion around their harm and the real risk rewards behind various treatments. I know from my own (non-cancer) experience that there is a very strong bias towards treatment even in cases where, once you break down all the risk and rewards, there is a strong argument for non-intervention.
HIFU for prostate also is a ripe area for grifters as it is advertised and marketed towards low risk cases that would probably benefit from active surveillance.
https://www.fusfoundation.org/diseases-and-conditions/
I don’t actually know much about them, I just heard of them because their CEO (Mary Lou Jepsen, she’s quite famous, right?) was on the AMC podcast (months ago, actually, I was just going randomly though the back catalogue).
Tech folks pivoting to medical always throws off some alarm bells to me, but she was fairly compelling on the podcast and the basic idea seemed to make sense. Ultrasonic treatments, using diagnostic-level energies, using focusing and resonance based tricks, I guess. (It is way outside my wheelhouse, sorry if the description is inaccurate).
The best way to evaluate biotech startups from the outside is to look at their investors. If they’re full of VCs specializing in biotech, chances are someone did the bare minimum due diligence on the science.
Theranos for example didn’t have a single one because biotech VCs steered clear of that mess entirely.
Same for me. I've been in the medical device industry for 15+ years now and came from "tech". What a lot of techies under/don't appreciate is that the medical device industry is heavily regulated and moves at a muuuch slower pace than other technologies.
There are lots of regulatory and quality/testing hurdles that you must clear (namely verification and validation testing, in addition to your 510(k) clearance or approval, if PMA) before you can market and sell your device.
I tell customers, on average, a Class II medical device project can take 18-24 months and cost $3M to 4M, minimum.
They showed us results of HIFU applied to real patients to non-invasively ablate tumours and treat prostate issues. As far as I can tell the probe creating the ultrasonic waves needs to be relatively close.
A thought I had at the time was if you knew all of the material properties of all of the tissues inside someone and their locations (say with an MRI) you could in theory apply this even deeper in someone than is currently possible - with a larger stick-on patch of actuators as a phased array.
Finally, another memorable thing that was discussed was what another researcher was doing with ultrasonics. Stride (who I am delighted to say was a fantastic lecturer) was very interested in bubbles. She would construct tiny bubbles where the surface (or interior?) was made of a chemotherapy drug. These bubbles could then be injected into someone's blood stream and would be ruptured using ultrasound to allow for extremely targeted application of chemotherapy (the jet formed from rupture would be so strong it would inject the drug into nearby tissue).
Fascinating, fascinating stuff but of course developed over many years of hard work.
This reminds me of Feynman s spinning plates.
It also drives home the serendipity of science. One can easily pander a researcher spending their days thinking about bubbles from a place of ignorance. Yet this is what basic research often looks like—play.
Is prostate size reduction possible?
https://en.wikipedia.org/wiki/Microsurgeon_(video_game)
This method of ultrasound treatment is called histotripsy. The underlying mechanism it uses to treat tumors is by focused ultrasound beams that mechanically disrupt cell membranes . It basically turns the lesion into soup. It does not treat the lesion by heating, although there are other techniques that do use ultrasound to ablate tissue with thermal energy.
Where I have seen it used and discussed is in the liver, whether that be metastatic disease to the liver or primary liver tumors.
One challenge is that in the liver you can’t use it for lesions that are near the capsule of the liver. It can also be difficult to keep the ultrasound beam focused on the lesion with respiration, especially if the tumor is small.
It’s an interesting technique and I think more people will use it over time. Whether it will be better than other established techniques like microwave ablation or radioembolization (for liver tumors) remains to be seen. I’m an interventional radiologist.
https://en.wikipedia.org/wiki/Stereotactic_surgery
Ok, that's gonna become a secret MI6 weapon.