Ultrasound Computed Tomography Imaging Research Articles

Ultrasound computed tomography image reconstruction with multi-mode aperture matching of ring array

Ultrasound computed tomography (USCT) imaging with a ring array holds significant potential for the inspection of small animals, breast tissue, and industrial components. Despite its promise, current techniques face challenges in terms of image quality. This paper presents a multi-mode aperture matching method for USCT image reconstruction with a ring array, aiming to enhance imaging performance. The proposed method utilizes a full ring transducer to transmit signals with a designated sub-aperture, while the receiving sub-aperture is adjusted based on the reference center element. By altering the transmitting and receiving sub-apertures under different conditions, specific imaging effects can be achieved. Experimental validation was conducted using a hair strand of 0.03 mm diameter placed at both center and eccentric positions within the ring array, in conjunction a breast phantom. Image resolution and contrast were assessed using full width at half maximum and contrast-to-noise ratio metrics. The results identified optimal transmitting and receiving sub-aperture matching modes for imaging the hair strand at various positions, and demonstrated the impact of this method on imaging targets at different positions within the breast phantom. These findings and experimental validations provide significant implications for enhancing imaging performance in USCT with a ring array.

A coupling, stabilizing, and shaping strategy for breast ultrasound computed tomography (USCT) with a ring array transducer

Breast ultrasound computed tomography (USCT) has been gradually promoted to clinical application after years of rapid development. Compared with the traditional handheld ultrasound scanning method, the scanning plane of USCT is fixed at the coronal plane, and the scanning path is designed in advance; the acoustic window is not in direct contact with the breast, a lot of coupling medium (usually degassed water is used to fill the gaps between the probe and breast. The clinical application of breast USTC faces challenges: (1) the processes of water degassing, heating, filling, draining, and cleaning prolong the entire scan cycle and reduce patient throughput. (2) The breast is not stabilized and slight movements of the breast may cause motion artifacts in the USCT images. (3) The non-normal incidence of ultrasound into the breast causes reflected and transmitted signals received with a low signal-to-noise ratio (SNR) or even unable to be detected. This article proposes a coupling, stabilizing, and shaping strategy for the clinical application of USCT with a ring array transducer. The solid gel coupling agent (SGCA) is applied for coupling, and a set of SGCA moldings is designed to stabilize and shape the breast during scanning, the breast shape and size which vary from person to person are simplified into several models. The preparation time is reduced to less than 1 min by replacing disposable moldings. The results show that the breast after shaping is close to round in the coronal plane, and slopes of the breast skin are limited in the sagittal and transverse planes, the breast subcutaneous tissue (fat and glands) has a better contrast-to-noise ratio (CNR) and can be better distinguished in the reflection images than that of the breast without shaping. The mean value of the raw beamformed data which represents the reflection signal amplitude of breast subcutaneous tissue after shaping shows 1.5 times that of the breast without shaping, the signal-to-noise ratio (SNR) of the raw transmission signal data after breast shaping is overall higher than that of the breast without shaping. The application of SGCA moldings for breast coupling, stabilizing, and shaping also benefits establishing a standardized scanning process, the standardized diagnosis of the breast lesion, and the localization of breast lesions.

Effect of spatial-domain pulse width on the resolution of scattering images in ultrasound computed tomography

Full-aperture tomography (FAT) is the major image reconstruction method for a circular ring array (CRA)-based ultrasound computed tomography (USCT) system. The FAT technique requires transferring the reconstruction process from the temporal domain to the spatial domain, during which the imaging resolution of the USCT is degraded by the spatial-domain pulse width (SDPW) of backprojection areas. To tackle this challenge, this study investigates the characteristics of the SDPW and how it degrades the image resolution. We show that the SDPW depends on the frequency of the ultrasound and the position of the transmitting elements, receiving elements and the imaging point. To quantify the deterioration of image resolution associated with the position of the transmitting and receiving elements, a SDPW broadening factor (SDPWBF) is introduced. The results of numerical simulation show a smaller SDPWBF provides a better reflection image resolution, and the distribution of SDPWBF shows that a shorter distance between the receiving element and the transmitting element yields a smaller SDPWBF. The SDPWBF is therefore able to be an indicator of selecting the signals acquired from the transmitting and receiving elements to perform optimal image resolution. Single-scatterer phantom and in vivo experiments demonstrate how the SDPWBF affects the USCT image spatial resolution and signal-to-noise ratio (SNR), and the results agree well with the theoretical predictions.

Frequency-domain full-waveform inversion-based musculoskeletal ultrasound computed tomography.

Recently, full-waveform inversion (FWI) has become a promising tool for ultrasound computed tomography (USCT). However, as a computationally intensive technique, FWI suffers from computational burden, especially in conventional time-domain full-waveform inversion (TDFWI). On the contrary, frequency-domain full-waveform inversion (FDFWI) provides a relatively high computational efficiency as the propagation of discrete frequencies is much cheaper than full time-domain modeling. FDFWI has already been applied in soft tissue imaging, such as breast, but for the musculoskeletal model with high impedance contrast between hard and soft tissues, there is still a lack of an effective source estimation method. In this paper, a water-referenced data calibration method is proposed to address the source estimation challenge in the presence of bones, which achieves consistency between the measured and simulated data before the FDFWI procedure. To avoid the cycle-skipping local minimum effect and facilitate the algorithm convergence, a starting frequency criterion for musculoskeletal FDFWI is further proposed. The feasibility of the proposed method is demonstrated by numerical studies on retrieving the anatomies of the leg models and different musculoskeletal lesions. The study extends the advanced FDFWI method to the musculoskeletal system and provides an alternative solution for musculoskeletal USCT imaging with high computational efficiency.

NOVEL HYBRID ALGORITHM USING CONVOLUTIONAL AUTOENCODER WITH SVM FOR ELECTRICAL IMPEDANCE TOMOGRAPHY AND ULTRASOUND COMPUTED TOMOGRAPHY

This paper presents a new hybrid algorithm using multiple Support Vector Machines models with convolutional autoencoder to Electrical Impedance Tomography, and Ultrasound Computed Tomography image reconstruction. The ultimate hybrid solution uses multiple SVM models to convert input measurements to individual autoencoder codes representing a given scene then the decoder part of the autoencoder can reconstruct the scene

Dynamic Speed of Sound Adaptive Transmission-Reflection Ultrasound Computed Tomography.

Ultrasound computed tomography (USCT) can visualize a target with multiple imaging contrasts, which were demonstrated individually previously. Here, to improve the imaging quality, the dynamic speed of sound (SoS) map derived from the transmission USCT will be adapted for the correction of the acoustic speed variation in the reflection USCT. The variable SoS map was firstly restored via the optimized simultaneous algebraic reconstruction technique with the time of flights selected from the transmitted ultrasonic signals. Then, the multi-stencils fast marching method was used to calculate the delay time from each element to the grids in the imaging field of view. Finally, the delay time in conventional constant-speed-assumed delay and sum (DAS) beamforming would be replaced by the practical computed delay time to achieve higher delay accuracy in the reflection USCT. The results from the numerical, phantom, and in vivo experiments show that our approach enables multi-modality imaging, accurate target localization, and precise boundary detection with the full-view fast imaging performance. The proposed method and its implementation are of great value for accurate, fast, and multi-modality USCT imaging, particularly suitable for highly acoustic heterogeneous medium.

Computationally efficient deep learning-based image reconstruction for sound speed estimation in ultrasound computed tomography

Ultrasound computed tomography (USCT) has great potential for breast cancer imaging due to its ability to quantify acoustic tissue properties such as the speed of sound (SOS). Full-waveform inversion (FWI)-based image reconstruction methods can produce high spatial resolution SOS images, but these methods are computationally demanding, especially when formulated in the time-domain. Deep learning (DL)-based methods can be computationally efficient and provide high-quality object estimates as studied in various medical image reconstruction problems. However, there remains a further need to develop and assess the DL-based image reconstruction methods for USCT for use in medical imaging applications. Here, we present a supervised DL approach for USCT image reconstruction that is formulated as an image-to-image translation problem. Specifically, a low-resolution SOS image obtained via traveltime tomography and a high-resolution reflection tomography image are used as inputs to a U-Net, which is trained to estimate a high-resolution SOS map. These input images are complementary, providing both quantitative information about SOS values and information about tissue boundaries. Numerical studies that employ realistic numerical breast phantoms demonstrated that the proposed method produced high-quality SOS estimates based on image quality metrics such as NMSE, SSIM, and PSNR.

Effects of Beamforming Techniques on Quality of Ultrasound Computed Tomography Images.

Background: In body tissues, tumors generally have different speeds of sound (SOS) than normal tissues. In this respect, ultrasound computed tomography (UCT) can generate a cross-sectional SOS map as an innovative ultrasound imaging method. This technique can produce images with a resolution of millimeters and a high signal-to-noise ratio. Objective: This study aimed to improve UCT image quality without increasing breast cancer screening and diagnosis time.Material and Methods: In this analytical study, a ring-shaped UCT breast imaging system was simulated using the K-wave toolbox of MATLAB. The system has a 20 cm diameter and 256 ultrasonic piezoelectrics placed in the ring’s circumference. Different beamforming techniques imaged two designed phantoms (i.e., resolution and contrast), and the resolution and contrast to noise ratio (CNR) were calculated.Results: The results of resolution phantom imaging without any beamforming showed that only bars with the value of 0.125 and 0.167 lp/mm were distinguishable, and the 0.1 bars were not recognizable in the imaging. In addition, increasing the number of transmitters led to no noticeable change in resolution for 0.125 and 0.167 lp/mm bars. In all beamforming techniques for imaging the contrast phantom, the CNR parameter up to an object with a diameter of 8 mm increases with increasing diameter without any change.Conclusion: The beamforming technique using three simultaneous transmitters improved the resolution by about 1 mm compared to the normal strategy. In addition to high-contrast images, beamforming with 9 simultaneous transmitters led to a preferable technique.

Cross-correlation Full Waveform Inversion for Sound Speed Reconstruction in Ultrasound Computed Tomography.

Ultrasound computed tomography (USCT) is considered to have great potential for breast cancer screening. Compared with the ray based methods, the reconstructed image using full waveform inversion (FWI) methods have higher spatial resolution. However, the results of FWI is difficult to converge to the real value when cycle skipping occurs. In this paper, a cross-correlation full waveform inversion(CC-FWI) is proposed for USCT image reconstruction. In the first stage, the ajoint source is adjusted as the residual of predicted signal and time-shifted measured signal to avoid cycle skipping. In the remaining stage, the FWI with source encoding is employed to accelerate convergence. The simulations are conducted to demonstrate the validity of the proposed algorithm. The root mean squared error (RMSE) of the proposed algorithm is much smaller than that of conventional FWI. The results suggest that CC-FWI is effective in avoiding cycle skipping. Clinical Relevance- Clinical relevance- New imaging modalities of high resolution, safety to examines for early-stage breast cancer imaging are urgently needed for researching and development. Ultra-sound computed tomography (USCT) is supposed to meet the above requirements and it can be potentially deployed in breast scanning.

Combination of variational mode decomposition and coherent factor for ultrasound computer tomography.

BACKGROUND: Ultrasound computed tomography (USCT) is a promising technique for improving the detection of breast cancer. Image quality of USCT has a major impact on the breast cancer diagnosis.OBJECTIVE: This paper investigates the combination of variational mode decomposition (VMD) and coherent factor method for USCT image quality enhancement.METHODS: The signals can be decomposed into multiple intrinsic mode functions (IMFs) sifting through the frequency by VMD method. Refactoring the remaining IMFs, spatio-temporally smoothed coherence factor (STSCF) beamforming method is applied to reconstructed data for USCT.RESULTS: The validation of combination the VMD and STSCF is described through the breast phantom experiment and in vivo experiments. The evaluation indicators such as contrast ratio (CR), contrast to noise ratio (CNR) and signal to noise ratio (SNR) have been better improved in the experimental results. For the breast phantom, the proposed method gives a higher resolution and the better contrast properties for the hyperechoic cyst. The borders of cysts and tumors in the breast phantom can be distinguished clearly. For volunteer breast experiments, artifacts are removed more efficiently while the clutters are suppressed simultaneously.CONCLUSION: The combination of VMD and STSCF can further reduce the noise and suppress the side lobes.

Sitting or Standing Data Acquisition Based Breast Ultrasound Computed Tomography

Ultrasound computed tomography (UCT) is a promising approach for early breast cancer screening. However, current studies which use prone posture to collect breast ultrasonic data cause four problems, a long non-data-acquisition time, inconvenient, possible chances for cross infection, and a large area occupied by equipment. The purpose of this study is to estimate a complete breast UCT image by using sitting or standing data acquisition, which can obtains a more rapid, convenient and sanitary examination process, and a less space occupied by equipment. Therefore, this study proposes a sitting or standing data acquisition based breast UCT method, which is a more practical data acquisition method for breast UCT. This study places a uniform soft sleeve on the outside of the breast so that it would not be deformed significantly due to the change of body posture. Because the soft sleeve is an influencing factor from outside for breast imaging, this study discusses the considerations for selecting that. Computer simulations are conducted to prove the effectiveness of the proposed method. Results suggest that, by using a soft sleeve whose sound speed is between 1450m/s and 1550m/s, the proposed method is effective; the biases of the reconstructed images are less than 1% under the 5% noise condition.

Real-time ultrasound-computed tomography image fusion for transforaminal lumbar approach: a lumbosacral spine phantoms study.

Ultrasound (US) is increasingly used for transforaminal approaches. We evaluated whether fusing computed tomography (CT) images with dynamic US could be based on bony and surface landmarks in two phantom models. Recordings were performed in a gelatin-based sonographic phantom and in a computerized imaging reference system training phantom. Three anesthesiologists performed 10 US and CT image fusions via three different techniques: (1) using locations of the fifth lumbar vertebra (L5) spinous process and the two posterior superior iliac spines in both images, (2) using the two lateral edges of the laminae rather than posterior superior iliac spines, and (3) using skin landmarks. Techniques were compared using values of precision (High quality of fusion: VP inferior to 10). Three punctures targeting the L4-L5 right foramina were made, and needle positions were checked using X-ray. Sixty fusions were performed in the gelatin phantom and 90 in the training phantom. VPs values of the 150 fusions were inferior to 5. Technique 2 was superior to one [operator 1: VP: 1.12 ± 0.54 vs. 2.38 ± 1.49; operator 2: 0.6 ± 0.39 vs. 3.66 ± 1.22; operator 3: 0.89 ± 0.31 vs. 1.23 ± 0.63 (p < 0.001)] with the gelatin phantom. There were no differences with the second phantom. X-ray examinations confirmed L4-L5 needle positioning. Bony and surface landmarks allowed for accurate fusion of CT and US images of the lumbar spine. These techniques, performed on phantoms, allowed for precise localization and puncturing of lumbar neural foramina.

Real-Time US-CT fusion imaging for guidance of thermal ablation in of renal tumors invisible or poorly visible with US: results in 97 cases

Purpose To assess the capability of ultrasound-computed tomography (US-CT) fusion imaging to guide a precise targeting of renal tumors invisible or poorly visible with US Materials and methods From 2016 renal tumors poorly visible or inconspicuous/invisible at US were treated at our institution with the guidance of US/CT fusion in a room equipped with CT scanner. Feasibility of the procedure, accuracy of targeting, complications, and technique efficacy were evaluated. Results Of 227 patients treated from 2016 to March 2020, 91 patients (65 males and 26 females, mean age 68.5 ± 10.1 years) with 97 renal lesions (mean maximum diameter 21.6 ± 9.4 mm) inconspicuous/invisible (29/97, 29.9%) or poorly visible (68/97, 70.1%) at US underwent treatment under US-CT fusion guidance. US-CT fusion imaging guidance was always technically feasible and enabled correct targeting in 97/97/(100%) of cases. Technical success was achieved in 93/97 lesions (95.9%). Three lesions were retreated during the same ablative session, while 1 was retreated in a subsequent session. Thus, primary efficacy was achieved in one session in 96/97 (98.9%) cases and secondary efficacy in 97/97 (100%) cases Conclusion US-CT image fusion guidance allows for a correct tumor targeting of renal tumors poorly visible or inconspicuous/invisible with US alone, with a high rate of technical success and technique efficacy.

Numerical Study of Square Border Ultrasonic Transducer Element Arrays for Breast Imaging in Ultrasound Computed Tomography with Waveform Inversion Method

Ultrasound computed tomography (USCT) is a promising approach for early breast cancer screening. Existing studies that estimate breast images using Waveform inversion (WI) methods utilize a Circular ultrasonic transducer element array (CUTA) to collect the measurement data. However, very accurate transducer element positioning and directivity are required for signal calibration in the hardware system of these studies, thereby causing difficulties in hardware manufacturing. The purpose of this study is to estimate high-resolution USCT images using a WI method with a Square border ultrasonic transducer element array (SUTA), which reduces the difficulty of hardware manufacturing and creates accurate correspondence between the continuous and discrete forms of the transducer element positions. Therefore, in this study, an SUTA is adopted to collect the measurement data of breast imaging using the WI method. A penalized least-squares optimization problem is constructed to obtain the numerical solution of a sound speed distribution. Computer simulations are conducted to compare images reconstructed from the measurement data that are collected using an SUTA and a CUTA. The performance is evaluated using a numerical breast phantom. Results suggest that the biases of the images reconstructed are less than 1% with the evenly distributed SUTA and 1% with the CUTA, under a noise condition.

Two-dimensional ultrasound-computed tomography image registration for monitoring percutaneous hepatic intervention.

Deformable registration of ultrasound (US) and contrast enhanced computed tomography (CECT) images are essential for quantitative comparison of ablation boundaries and dimensions determined using these modalities. This comparison is essential as stiffness-based imaging using US has become popular and offers a nonionizing and cost-effective imaging modality for monitoring minimally invasive microwave ablation procedures. A sensible manual registration method is presented that performs the required CT-US image registration. The two-dimensional (2D) virtual CT image plane that corresponds to the clinical US B-mode was obtained by "virtually slicing" the 3D CT volume along the plane containing non-anatomical landmarks, namely points along the microwave ablation antenna. The initial slice plane was generated using the vector acquired by rotating the normal vector of the transverse (i.e., xz) plane along the angle subtended by the antenna. This plane was then further rotated along the ablation antenna and shifted along with the direction of normal vector to obtain similar anatomical structures, such as the liver surface and vasculature that is visualized on both the CT virtual slice and US B-mode images on 20 patients. Finally, an affine transformation was estimated using anatomic and non-anatomic landmarks to account for distortion between the colocated CT virtual slice and US B-mode image resulting in a final registered CT virtual slice. Registration accuracy was measured by estimating the Euclidean distance between corresponding registered points on CT and US B-mode images. Mean and SD of the affine transformed registration error was 1.85±2.14 (mm), computed from 20 coregistered data sets. Our results demonstrate the ability to obtain 2D virtual CT slices that are registered to clinical US B-mode images. The use of both anatomical and non-anatomical landmarks result in accurate registration useful for validating ablative margins and comparison to electrode displacement elastography based images.

An Innovative Practical Automatic Segmentation of Ultrasound Computer Tomography Images Acquired from USCT System

A 3D ultrasound computer tomography (USCT) device with a nearly isotropic and spatially invariant 3D point spread function has been constructed at Institute for Data Processing and Electronic (IPE), Karlsruhe Institute of Technology (KIT). This device is currently applied in clinical studies for breast cancer screening. In this paper, a new method to develop an automated segmentation algorithm for USCT acquired images is proposed. The method employs distance regularized level set evolutionary (DRLSE) active contours along with surface fitting extrapolation and 3D binary mask generation for fully automatic segmentation outcome. In the first stage of the proposed algorithm, DRLSE is applied to those 3D USCT slice images which contain breast and are less affected by noise and ring artifacts named as Cat2. The DRLSE segmentation results are employed to extrapolate the rest of slice images known as Cat1. To overcome defectively segmented slice images, a 3D binary mask is generated out of USCT attenuation images. The 3D binary mask is multiplied by the DRLSE-based segmentation results to form finally segmented 3D USCT images. The method was tested on 12 clinical dataset images. According to F-measure criterion, the proposed method shows higher performance than the previously proposed semiautomatic segmentation one.

Target visualisation and microwave hyperthermia monitoring using nanoparticle-enhanced transmission ultrasound (NETUS)

Purpose: The aim of this study was to examine the feasibility of using nanoparticle-enhanced transmission ultrasound (NETUS) as an image-based monitoring modality for microwave hyperthermia treatment.Methods: A dedicated transmission ultrasound imaging system was used to obtain acoustic projections and ultrasound computed tomography images. Initially, speed-of-sound based images were used to non-invasively monitor temperature changes in in vitro and ex vivo specimens, induced by a microwave needle-type applicator. Next, the hyperthermia acceleration ability of two ultrasound nanoparticles based contrast agents (iron oxide and copper oxide) was examined and visualised. Finally, a two-step image guided microwave therapeutic procedure using NETUS was investigated in a realistic breast mimicking phantom. First, the pathology simulating region borders were detected. Then, a microwave-induced temperature elevation was non-invasively monitored.Results: The transmission ultrasound scanning system was able to detect temperature changes with a resolution of less than 0.5 °C, both in vitro and ex vivo. In accordance with previous studies, it was visually demonstrated that iron oxide nanoparticles expedite the heating process (p < 0.05). Copper oxide nanoparticles, however, did not alter the hyperthermia profile significantly. In the breast mimicking phantom, NETUS yielded accurate detection of the target region as well as thermal monitoring of the microwave heating procedure.Conclusions: NETUS can combine enhanced target visualisation with non-invasive thermometry and accelerated heating effect. Quantitative feedback, however, requires a tissue-specific calibration-curve. A proof of concept for microwave hyperthermia treatment monitoring using NETUS was established. The suggested methodology may potentially provide a non-invasive cost-effective means for monitoring thermal treatment of the breast.

Regularized Dual Averaging Image Reconstruction for Full-Wave Ultrasound Computed Tomography.

Ultrasound computed tomography (USCT) holds great promise for breast cancer screening. Waveform inversion-based image reconstruction methods account for higher order diffraction effects and can produce high-resolution USCT images, but are computationally demanding. Recently, a source encoding technique has been combined with stochastic gradient descent (SGD) to greatly reduce image reconstruction times. However, this method bundles the stochastic data fidelity term with the deterministic regularization term. This limitation can be overcome by replacing SGD with a structured optimization method, such as the regularized dual averaging method, that exploits knowledge of the composition of the cost function. In this paper, the dual averaging method is combined with source encoding techniques to improve the effectiveness of regularization while maintaining the reduced reconstruction times afforded by source encoding. It is demonstrated that each iteration can be decomposed into a gradient descent step based on the data fidelity term and a proximal update step corresponding to the regularization term. Furthermore, the regularization term is never explicitly differentiated, allowing nonsmooth regularization penalties to be naturally incorporated. The wave equation is solved by the use of a time-domain method. The effectiveness of this approach is demonstrated through computer simulation and experimental studies. The results suggest that the dual averaging method can produce images with less noise and comparable resolution to those obtained by the use of SGD.

속도 분포 기반 단층촬영을 위한 최적의 트랜스듀서의 조합

The type of ultrasound transducer used influences the quality of a reconstructed ultrasound image. This study analyzed the effect of transducer type on ultrasound computed tomography (UCT) image quality. The UCT was modeled in an ultrasound simulator by using a 5 cm anatomy model and a ring-shape 5 MHz 128 transducer array, which considered attenuation, refraction, and reflection. Speed-of-sound images were reconstructed by the Radon transform as the UCT image modality. Acoustic impedance images were also reconstructed by the delay-and-sum (DAS) method, which considered the speed of sound information. To determine the optimal combination of transducers in observation, point-source, flat, and focused transducers were tested in combination as trasmitters and receivers; UCT images were constructed from each combination. The combination of point-source/flat transducer as transmitting and receiving devices presented the best reconstructed image quality. In UCT implementation, the combination of a flat transducer for transmitting and a point transducer for receiving permitted acceptable image quality.

Ultrasound Computed Tomography Image Fusion- Guided Radiofrequency Ablation for Difficult Hepatocellular Carcinoma: A Case Report

Ultrasound is a widely used tool for screening and treating hepatocellular carcinoma (HCC) to prolong patient survival, particularly for those who are unable to undergo surgery. Although ultrasound is less expensive and highly accessible, the use of ultrasound alone is sometimes limited in terms of detecting tumors with isoechogenicity, thus hampering further ultrasound-guided therapy. Here, we report a 64-year-old man with chronic hepatitis C-related cirrhosis. A 1-cm HCC was detected during an abdominal computed tomography assessment. Two attempts at ultrasound-guided radiofrequency ablation failed to target the lesion because of the inaccurate localization of the lesion using ultrasound alone. After the introduction of an ultrasound image fusion system in the hospital, the third attempt at radiofrequency ablation of the tumor was successful. Therefore, this case study suggests the use of an ultrasound image fusion system to improve treatment outcomes in complicated HCC cases.