{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T01:52:45Z","timestamp":1781315565931,"version":"3.54.1"},"reference-count":43,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:00:00Z","timestamp":1632873600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>During magnetic resonance\u2010guided focused ultrasound (MRgFUS) thalamotomy for refractory tremor, high temperatures must be achieved and sustained for tissue necrosis. We assessed the impact of both patient\u2010specific as well as procedure\u2010related factors on the efficiency of acoustic energy transfer, or heating efficiency (HE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective analysis of 92 consecutive patients (857 sonications) with essential tremor or tremor\u2010dominant Parkinson's disease treated at a single institution. Temperature elevations at the target were measured for each sonication with MR thermometry. HE of each sonication was defined as the ratio of peak temperature elevation and the delivered energy. HE was analyzed with respect to patient skull features (area, thickness, skull density ratio [SDR]), computed from CT scans, as well as demographic and clinical variables (age, sex, diagnosis, and duration of symptoms).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Across the full range of sonication energies that can be delivered with current devices (up to 36\u00a0kJ), average sonication HE was diminished in patients with lower SDR. In individual subjects, there was a progressive loss in HE as sonication energy was titrated up throughout the course of treatment, with a more rapid decline in patients with higher SDR. This energy\u2010dependent loss in HE was not related to procedural factors, namely, the number of previous sonications, or the cumulative energy deposited during previous sonications. In contrast to SDR, neither skull area nor thickness was an independent predictor of average HE or the rate of its decline with increasing energies. In 11% of patients, all of whom with SDR\u00a0&lt;\u00a00.45, sonication HE fell below the threshold to reach 54\u00b0C even with delivery of maximum energy. In contrast, temperatures 50\u00b0C could be obtained in all but one patient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SDR is predictive of sonication HE, and determines patient\u2010specific limits on the magnitude of temperature elevation that can be achieved with current devices. These data inform strategies for predictable lesioning in MRgFUS thalamotomy.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.15239","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T06:40:10Z","timestamp":1631860810000},"page":"6588-6596","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Patient\u2010specific effects on sonication heating efficiency during magnetic resonance\u2010guided focused ultrasound thalamotomy"],"prefix":"10.1002","volume":"48","author":[{"given":"Andrew I.","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick L.","family":"Hitti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Opeyemi O.","family":"Alabi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Disha","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanane","family":"Chaibainou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenora","family":"Henry","sequence":"additional","affiliation":[{"name":"Insightec Inc  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Clanton","sequence":"additional","affiliation":[{"name":"Insightec Inc  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon H.","family":"Baltuch","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2017.3098"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600159"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/0265673031000119006"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(84)90379-1"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3171\/2017.11.FOCUS17623"},{"key":"e_1_2_7_7_1","first-page":"1","article-title":"Impact of skull density ratio on efficacy and safety of magnetic resonance\u2010guided focused ultrasound treatment of essential tremor","author":"D'Souza M","year":"2019","journal-title":"J Neurosurg"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyz417"},{"key":"e_1_2_7_9_1","first-page":"1","article-title":"What factors impact the clinical outcome of magnetic resonance imaging\u2010guided focused ultrasound thalamotomy for essential tremor?","author":"Fukutome K","year":"2020","journal-title":"J Neurosurg"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13126"},{"key":"e_1_2_7_11_1","first-page":"1","article-title":"Accumulated thermal dose in MRI\u2010guided focused ultrasound for essential tremor: repeated sonications with low focal temperatures","author":"Jones RM","year":"2019","journal-title":"J Neurosurg"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyz395"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.3171\/2016.10.JNS16758"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.3171\/2015.3.JNS142592"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyz566"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2018.0226"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphy.2019.00223"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.3171\/2019.2.JNS182571"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.26746"},{"key":"e_1_2_7_20_1","first-page":"1","article-title":"Technical and radiographic considerations for magnetic resonance imaging\u2013guided focused ultrasound capsulotomy","volume":"1","author":"Davidson B","year":"2020","journal-title":"Journal of Neurosurgery"},{"key":"e_1_2_7_21_1","unstructured":"U.S. Food and Drug Administration.InSightec ExAblate System information for prescribers. 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