Kim Butts Pauly's Lab

MR-guided Cancer Interventions Program Project

Our Overall Specific Aims are to:

Project Summaries

Project 1 MR-guided Focused Ultrasound Treatment of Soft Tissue Tumors (R. Avedian, MD and P. Ghanouni, MD, PhD)


MRgFUS treatment of 14 year old man with recurrent, painful desmoid tumor in the right buttock. Three years earlier, the patient underwent primary resection of a desmoid in the right popliteal fossa, with recurrence, leading to right above the knee amputation. Despite this, there was recurrence in the thigh and buttock, which did not respond to chemotherapy. Tumor in the buttock (white arrows) was targeted with MRgFUS, with surgical alternative of hemipelvectomy. a) Bulky, enhancing tumor prior to treatment. b) Non-perfused volume immediately after treatment (74% of the tumor volume was ablated). c) 1 year after initial treatment, there is residual or recurrent tumor, ablated in d). In e), 11 months after his last treatment, there is no evidence of residual tumor. Pain also resolved (NRS pre: 6, post: 0).

Relevant Publications

Avedian RS, Gold G, Ghanouni P, Pauly KB. Magnetic resonance guided high-intensity focused ultrasound ablation of musculoskeletal tumors. Current Orthopaedic Practice. 2011; 22(4):303-308. PMID: 26120376 PMCID: PMC4479407

Bitton RR, Webb TD, Butts Pauly K, Ghanouni P, Improving thermal dose accuracy in magnetic resonance-guided focused ultrasound surgery: Long-term thermometry using a prior baseline as a reference, J Magn Reson Imaging. 2015 Jun 26. PMID: 26119129

Gaur P, Partanen A, Werner B, Ghanouni P, Bitton R, Butts Pauly K, Grissom WA. Correcting heat-induced chemical shift distortions in proton resonance frequency-shift thermometry. Magn Reson Med. 2015 Aug 24. [Epub ahead of print] PubMed PMID: 26301458.

Avedian RS, Gold G, Ghanouni P, Pauly KB. Magnetic resonance guided high-intensity focused ultrasound ablation of musculoskeletal tumors. Curr Orthop Pract. 2011 Jul-Aug;22(4):303-308. PubMed PMID: 26120376; PubMed Central PMCID: PMC4479407.

Project 2 MR-Guided Minimally Invasive Management of Prostate Cancer (B. Daniel, MD)


a) Tip-force sensing needle. b) Fiber Bragg gratings in the tip of the inner stylet of an 18g MRI-compatible needle measure strains that reflect tissue-needle interaction forces without losses to due friction or inertia that confound measurements from the needle base alone. Multiple sensors provide both axial and lateral forces which cannot be captured from the base alone. c) These are well seen in the periodic oscillations due to liver excursion during ventilation in a cadaveric pig model. Overall these sensors extend the surgeons sense of touch to the tip of the needle.

Relevant Publications

Park, YL; Elayaperumal, S.; Daniel, B.; Ryu, SC; Shin, M; Savall, J.; Black, R.J.; Moslehi, B.; Cutkosky, M.R., “Real-Time Estimation of Three-Dimensional Needle Shape and Deflection for MRI-Guided Interventions,” Mechatronics, IEEE/ASME Transactions on. 2010 15(6):.906-915. PMID: 26405428 [PubMed] PMCID: PMC4577522

Ghanouni P, Gill H, Kaye E, Pauly KB, Daniel B. MR imaging-guided cryoablation for the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol. 2011 Oct;22(10):1427-30. PubMed PMID: 21961982; PubMed Central PMCID: PMC3185301.

Ryu Seok Chang, Renaud Pierre, Black Richard J., Daniel Bruce L., Cutkosky Mark R., Feasibility Study of an Optically Actuated MR-compatible Active Needle, Rep U S. September 2011: 2564–2569, PMCID: PMC4620048

Lu A, Daniel BL, Kaye E, Butts Pauly K. MRI of frozen tissue demonstrates a phase shift. Magn Reson Med. 2011 Dec;66(6):1582-9. Epub 2011 May 31. PubMed PMID: 21630347; PubMed Central PMCID: PMC3166360.

S. Elayaperumal, JH Bae, D. Christensen, M. R. Cutkosky, B. L. Daniel, R. J. Black, J. M. Costa, F. Faridian, B. Moslehi. MR-compatible biopsy needle with enhanced tip force sensing,Ó Proceedings of the IEEE World Haptics Conference p109-14, April 14-17, 2013, Daejeon, Korea. PMCID: PMC4620047

Elayaperumal S, Plata JC, Holbrook AB, Park YL, Pauly KB, Daniel BL, Cutkosky MR. Autonomous real-time interventional scan plane control with a 3-D shape-sensing needle. IEEE Trans Med Imaging. 2014 Nov;33(11):2128-39. Epub 2014 Jun 23. PubMed PMID: 24968093.

Elayaperumal, S., Bae, J.H., Daniel, B.L. and Cutkosky, M.R.,"Detection of Membrane Puncture with Haptic Feedback using a Tip-Force Sensing Needle," Proceedings of the International Conference on Intelligent Robots and Systems (IROS) 2014 Sep:3975 - 3981,14-18 Sept. 2014. PMID: 26509101. PMCID: PMC4620049

Elayaperumal, S.; Bae, J.H.; Christensen, D.; Cutkosky, M.R.; Daniel, B.L.; Black, R.J.; Costa, J.M.; Faridian, F.; Moslehi, B., "Mr-compatible biopsy needle with enhanced tip force sensing," Joint Eurohaptics Conf Symp Haptic Interfaces Virtual Environ Teleoper Syst. 2013 Apr;2013:109-114. PMID: 26509189. PMCID: PMC4620047

Elayaperumal S, Cutkosky MR, Renaud P, Daniel BL. A Passive Parallel Master-Slave Mechanism for Magnetic Resonance Imaging-Guided Interventions. J Med Device. 2015 Mar;9(1):0110081-1100811. PubMed PMID: 25729467; PubMed Central PMCID: PMC4245788. Ryu, S., Fan Quek, Z., Koh, J-S, Renaud, P., Black, R.J., Moslehi, B., Daniel, B., Cho, K-J and Cutkosky, M.R., "Design of an Optically Controlled MR-compatible Active Needle," accepted for IEEE Transactions on Robotics 2015 Feb;31(1):1-11 PMID: 26512231 PMCID: PMC462058

Ryu Seok Chang, Quek Zhan Fan, Renaud Pierre, Black Richard J., Daniel Bruce L., Cutkosky Mark R., An Optical Actuation System and Curvature Sensor for a MR-compatible Active Needle, IEEE Int Conf Robot Autom, May 2012: 1589–1594, PMC4620050

Plata JC, Holbrook AB, Marx M, Salgaonkar V, Jones P, Pascal-Tenorio A, Bouley D, Diederich C, Sommer G, Pauly KB, A feasibility study on monitoring the evolution of apparent diffusion coefficient decrease during thermal ablation, Med Phys. 2015 Sep;42(9) PMID: 26328964 PMCID: PMC4537482

Project 3 MR-Guided Focused Ultrasound Treatment of Pancreatic Cancer (G. Sommer MD, P. Ghanouni, MD, C. Diederich PhD)



a,b) The endoluminal applicator under test was inserted orally through the esophagus and directed in the stomach, adjacent to the pancreas. Temperature images c) prior and d,e) during sonication in a cadaver pig. f,g) In a live animal, the temperature area is smaller due to perfusion. MR thermometry for the live animal was done with free breathing and with a multi-baseline thermometry processing method.

Relevant Publications

Prakash P, Salgaonkar VA, Diederich CJ. Modelling of endoluminal and interstitial ultrasound hyperthermia and thermal ablation: applications for device design, feedback control and treatment planning. Int J Hyperthermia. 2013 Jun;29(4):296-307. Review. PubMed PMID: 23738697; PubMed Central PMCID: PMC4087028.

Sommer G, Bouley D, Gill H, Daniel B, Pauly KB, Diederich C. Focal ablation of prostate cancer: four roles for magnetic resonance imaging guidance. Can J Urol. 2013 Apr;20(2):6672-81. Review. PubMed PMID: 23587506; PubMed Central PMCID: PMC4045501.

Sommer G, Pauly KB, Holbrook A, Plata J, Daniel B, Bouley D, Gill H, Prakash P, Salgaonkar V, Jones P, Diederich C. Applicators for magnetic resonance-guided ultrasonic ablation of benign prostatic hyperplasia. Invest Radiol. 2013 Jun;48(6):387-94. PubMed PMID: 23462673; PubMed Central PMCID: PMC4045500.

Prakash P, Salgaonkar VA, Scott SJ, Jones P, Hensley D, Holbrook A, Plata J, Sommer G, Diederich CJ. MR guided thermal therapy of pancreatic tumors with endoluminal, intraluminal and interstitial catheter-based ultrasound devices: Preliminary theoretical and experimental investigations. Proc SPIE Int Soc Opt Eng. 2013 Feb 26;8584:85840V. PubMed PMID: 24860246; PubMed Central PMCID: PMC4031683.

Scott SJ, Salgaonkar V, Prakash P, Burdette EC, Diederich CJ. Interstitial ultrasound ablation of vertebral and paraspinal tumours: parametric and patient-specific simulations. Int J Hyperthermia. 2014 Jun;30(4):228-44. PubMed PMID: 25017322.PMCID: PMC4696406

Salgaonkar VA, Diederich CJ. Catheter-based ultrasound technology for image-guided thermal therapy: current technology and applications. Int J Hyperthermia. 2015 Mar;31(2):203-15. Epub 2015 Mar 23. PubMed PMID: 25799287. PMCID: 4659534

Adams M, Scott SJ, Salgaonkar VS, Jones P, Plata-Camargo JC, Sommer G, Diederich CJ, "Development of an endoluminal high-intensity ultrasound applicator for image-guided thermal therapy of pancreatic tumors", Proceedings of SPIE Vol. 9326, 93260F (2015) PMC 4677833

Adams MS, Scott SJ, Salgaonkar VA, Sommer G, Diederich CJ, Thermal therapy of pancreatic tumors using endoluminal ultrasound: parametric and patient-specific modeling, Int J Hyperthermia, 2016 Mar;32(2):97-111, PMID: 27097663

Project 4 MR-Guided Focused Ultrasound BBB Opening for Brain Cancer Immunotherapy Treatment (K. Butts Pauly, M. Wintermark, MD)


a) Simulated specific absortion rate at the focus is a measure of the skull efficiency. b) MR provides temperature rise/power, a metric for experimental efficiency. c) In 17 patients, there is high correlation to a linear fit. This work was presented by Stanford Postdoc Urvi Vyas to Vice President Joe Biden at the FUS Foundation annual meeting in 2014.

Relevant Publications

Kaye EA, Chen J, Pauly KB. Rapid MR-ARFI method for focal spot localization during focused ultrasound therapy. Magn Reson Med. 2011 Mar;65(3):738-43. Epub 2010 Nov 16. PubMed PMID: 21337406; PubMed Central PMCID: PMC4099471.

Kaye EA, Hertzberg Y, Marx M, Werner B, Navon G, Levoy M, Pauly KB. Application of Zernike polynomials towards accelerated adaptive focusing of transcranial high intensity focused ultrasound. Med Phys. 2012 Oct;39(10):6254-63. PubMed PMID: 23039661; PubMed Central PMCID: PMC3470612.

Rieke V, Instrella R, Rosenberg J, Grissom W, Werner B, Martin E, Pauly KB. Comparison of temperature processing methods for monitoring focused ultrasound ablation in the brain. J Magn Reson Imaging. 2013 Dec;38(6):1462-71. Epub 2013 Apr 4. PubMed PMID: 23559437; PubMed Central PMCID: PMC3775924.

Kaye EA, Pauly KB. Adapting MRI acoustic radiation force imaging for in vivo human brain focused ultrasound applications. Magn Reson Med. 2013 Mar 1;69(3):724-33. Epub 2012 May 3. PubMed PMID: 22555751; PubMed Central PMCID: PMC4028045.

Marx M, Plata J, Pauly KB. Toward volumetric MR thermometry with the MASTER sequence. IEEE Trans Med Imaging. 2015 Jan;34(1):148-55. Epub 2014 Aug 21. PubMed PMID: 25163055; PubMed Central PMCID: PMC4280319.

Vyas U, Kaye E, Pauly KB. Transcranial phase aberration correction using beam simulations and MR-ARFI. Med Phys. 2014 Mar;41(3):032901. PubMed PMID: 24593740; PubMed Central PMCID: PMC3978249.

Bitton RR, Pauly KR. MR-acoustic radiation force imaging (MR-ARFI) and susceptibility weighted imaging (SWI) to visualize calcifications in ex vivo swine brain. J Magn Reson Imaging. 2014 May;39(5):1294-300. Epub 2013 Oct 10. PubMed PMID: 24123504; PubMed Central PMCID: PMC3983173.

Ghanouni P, Butts Pauly K, Elias WJ, Henderson J, Sheehan J, Monteith S, Wintermark M, Transcranial MRI-Guided Focused Ultrasound: A Review of the Technologic and Neurologic Applications, AJR Am J Roentgenol. 2015 Jul;205(1):150-9. PMID: 26102394 PMCID: PMC4687492

Marx M, Butts Pauly K, Improved MRI thermometry with multiple-echo spirals, Magn Reson Med. 2015 Aug 29, PMID: 26332512 NIHMSID 721820

Engineering Core (J. Pauly, Ph.D., Greig Scott)


Device visualization in an ex vivo porcine study. b) A toroid drive makes the device a transmit and receive antenna, which allows its position to be clearly visualized. c) The body coil image depicts the surrounding anatomy. d) RF coil elements can be designed to conform to the patient’s anatomy, e) to ensure sensitivity and coverage. This is the basis for the ultrasound transparent coil technology.

Relevant Publications

Holbrook A, Ghanouni P, Santos J, Medan Y, Butts Pauly K, “In Vivo MR Acoustic Radiation Force Imaging in the Porcine Liver,” Medical Physics, 2011 Aug;38(9). PMID: 21978053 PMCID: PMC3170397

Shultz K, Stang P, Kerr A, Pauly J, Scott G, “RF field visualization of RF ablation at the Larmor frequency,” IEEE Trans Med Imaging. 2012 Apr;31(4):938-47, PMID: 21775256 PMCID: PMC3321073

Khalighi MM, Rutt BK, Kerr AB. Adiabatic RF pulse design for Bloch-Siegert B1+ mapping. Magn Reson Med. 2013 Sep;70(3):829-35. Epub 2012 Oct 5. PubMed PMID: 23041985; PubMed Central PMCID: PMC3796009.

Stang PP, Conolly SM, Santos JM, Pauly JM, Scott GC, “Medusa: a scalable MR console using USB,” IEEE Trans Med Imaging. 2012 Feb;31(2):370-9. PMID: 21954200 PMCID: PMC3282593

Qin L, Schmidt EJ, Tse ZT, Santos J, Hoge WS, Tempany-Afdhal C, Butts-Pauly K, Dumoulin CL. “Prospective motion correction using tracking coils.” Magn Reson Med. 2013 Mar 1;69(3):749-59. PMID: 22565377.PMCID: PMC3416927

Rube MA, Holbrook AB, Cox BF, Houston JG, Melzer A. “Wireless MR tracking of interventional devices using phase-field dithering and projection reconstruction.” Magn Reson Imaging. 2014 Jul;32(6):693-701. Epub 2014 Mar 17. PubMed PMID: 24721007. PMCID: 24721007

Holbrook AB, Ghanouni P, Santos JM, Dumoulin C, Medan Y, Pauly KB. Respiration based steering for high intensity focused ultrasound liver ablation. Magn Reson Med. 2014 Feb;71(2):797-806. PubMed PMID: 23460510; PubMed Central PMCID: PMC4040338.

Etezadi-Amoli M, Stang P, Kerr A, Pauly J, Scott G. Controlling radiofrequency-induced currents in guidewires using parallel transmit. Magn Reson Med. 2014 Dec 17. [Epub ahead of print] PubMed PMID: 25521751; PubMed Central PMCID: PMC4470871.

Rube MA, Holbrook AB, Cox BF, Buciuc R, Melzer A. Wireless mobile technology to improve workflow and feasibility of MR-guided percutaneous interventions. Int J Comput Assist Radiol Surg. 2015 May;10(5):665-76. Epub 2014 Sep 2. PubMed PMID: 25179151. PMCID: PMC4646842

Rube MA, Fernandez-Gutierrez F, Cox BF, Holbrook AB, Houston JG, White RD, McLeod H, Fatahi M, Melzer A. Preclinical feasibility of a technology framework for MRI-guided iliac angioplasty. Int J Comput Assist Radiol Surg. 2015 May;10(5):637-50. PMID: 25102933 PMCID: PMC4675134

Etezadi-Amoli M, Stang P, Kerr A, Pauly J, Scott G. Interventional device visualization with toroidal transceiver and optically coupled current sensor for radiofrequency safety monitoring. Magn Reson Med. 2015 Mar;73(3):1315-27. Epub 2014 Apr 1. PubMed PMID: 24691876; PubMed Central PMCID: PMC4182300.

Ellenor CW, Stang PP, Etezadi-Amoli M, Pauly JM, Scott GC. Offline impedance measurements for detection and mitigation of dangerous implant interactions: an RF safety prescreen. Magn Reson Med. 2015 Mar;73(3):1328-39. Epub 2014 Mar 12. PubMed PMID: 24623586; PubMed Central PMCID: PMC4162873.

Johnson EM, Vyas U, Ghanouni P, Butts Pauly K, Pauly JM, Improved Cortical Bone Specificity in UTE MR Imaging, MRM, 2016 Mar 12 [Epub] PMID: 26972442

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