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.
As someone who has worked on bubbles from a bioengineering/synthetic biology perspective, it is definitely play at some level. Like “what happens if we freeze dry them?” And of course determining which extremely specific kind works best for whatever application, etc.
The example that I saw was of a patient whose prostate had swollen closing up the urethra. HIFU was applied to ablate the urethra which “opened it back up” so that fluids could pass through again un-impeded. As a consequence the patient could then live a normal life.
"Ablation (Latin: ablatio – removal) is the removal or destruction of something from an object by vaporization, chipping, erosive processes, or by other means."
> "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.
I have friends and relatives who went through this process and what I believe is not repeated enough to the patient's immediate social circle is that the recovery process takes months and the procedure itself can leave lasting changes.
What's crazy is that this used to be much worse, but advancements in targeting and new treatments improved things quite a bit.
I suspect the medical industry is so heavily regulated that it is very difficult for doctors to recommend non-treatment or risk being sued into oblivion, though maybe it depends on the country.
Here in Canada, before assisted suicide was legalized, my grandfather (in his late 80s) refused any treatment for his kidney failure. He was ready to die and could barely walk or eat on his own anymore. There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal. The death certificate still said renal failure, though.
For me, if I ever got terminal cancer, I'd weigh the quality of life of treatment versus non-treatment. I've seen people go both ways and I've seen the results being right and wrong both ways. I don't want to spend my final months semi-alive on a bed or constantly messed up, though.
> it is very difficult for doctors to recommend non-treatment or risk being sued into oblivion
Not my experience. I have a loved one going through cancer treatment right now and they've been very up front about risks, side effects, and even talked about DNRs with them what they mean and how they can be applied.
People and their loved ones don't want to experience death. It's often as simple as that.
> There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal.
In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
> I'd weigh the quality of life of treatment versus non-treatment.
Something to consider, it's not a binary and treatment can look entirely different depending on the cancer.
You can, for example, do a lower than effective dose of chemo which will still be effective at slowing the growth of cancer.
Some therapies, such as immunotherapy, can be practically a walk in the park.
I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.
> People and their loved ones don't want to experience death. It's often as simple as that.
People also don't want (their loved ones) to suffer, especially needlessly. (I want to also stress that I'm not advocating terminating life, though I do think it should be an option - just that this is what my grandfather wanted).
> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
I've anecdotally heard that a huge percentage of US medicare costs is desperately saving elderly people at the end-stages of life instead of a more palliative (and some would argue dignified) end. This was made worse during the Terri Schiavo case when the very idea was put up as anti-life and we were warned that "death panels" would be inevitably setup. DNRs are allowed, but alleviating the suffering leading up to the end is, for both better and worse, heavily restricted.
> I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.
I've been extremely lucky that cancer hasn't been much of an experience I've had to deal with in my circles. I'm mostly pro-modern medicine and I know a lot of progress is also being made. I hope that it never happens, but if it did I'd want to be informed as possible to make my own decisions. The decisions I'd make depend so much on where I'm at. I'd be likely more willing to risk it now as I have a 7 year old to live for, than I would be in my 90s where the odds are a lot less for a comfortable experience.
> People also don't want (their loved ones) to suffer, especially needlessly.
You might be very surprised how family actions very often are not consistent with this supposed desire. 98 year olds in the hospital with multiple end stage illnesses - full code, happens all the time. Ask any healthcare worker in the US, pretty classic the elderly rotting away in a nursing home, rarely visited, then they get admitted and their healthcare proxy wants “everything done”. Often seems to be a reflection of their own guilt. Sometimes it’s just poor healthcare literacy.
But no, regardless of what you think these people may
> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
This is basically false. Most large systems have comfort care order set, with opioid drips. Transition to hospice is readily available. Usually the barrier to these are patients themselves or their families.
Also even the US, the principle of double effect prevails in palliative care.
Chemotherapy is essentially a bet that the drugs will kill the cancer faster than you. Because ultimately, cancer isn't a virus, bacteria, fungus, parasite, nor even a prion (this one is nightmare fuel) -- it's your own cells acting as a parasite. This reason alone makes cancer horrific to treat as it is.
Sort of at the opposite end, I knew a PT who harped on balance exercises and pointed out that a lot of old people have pneumonia as cause of death on their death certificate. The pneumonia was often acquired while immobilized by a broken hip. The broken hip was caused by falling (+ lower body atrophy), so really these people died from falling. It just took a while.
I don’t know what the right answer is for coding death certificates. Maybe the correct answer is to record several so we can see comorbidities and contributing factors more easily when deciding what science to fund, charities to endow, and which treatments to disfavor.
Died of complications of cancer, reaction to chemo. Died of complications of hip fracture, pneumonia.
A relative of mine was dying of stage 4 lung cancer and after they were admitted to the hospital, they contracted COVID and passed away two weeks later.
Their life expectancy upon admission was estimated to be less than a year, so it's hard to pin this on just the pandemic.
Personally I would put "smoking" in the form, because truth be told that was the single largest contributing factor.
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.
> 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.
Unfortunately, I have extensive first hand experience with practices that do this, and you are 100% correct.
The grift is very insidious. If you scan people over a certain age with prostate MRI, you will find suspicious lesions in a large percentage. And using fusion MRI/US guided biopsies, you will inevitable get cancer cells in the sample.
Many (most?) of these people being treated will die WITH prostate cancer, not FROM prostate cancer.
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 real cost will matter at least from an allocation perspective. You can't keep relying on a treatment that costs $100m even if the patient pays nothing. Someone needs to pay that cost.
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.
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 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.
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.
Yeah, it seems that their pitch is that they want to move at consumer electronics speed, I mean, their website explicitly says
“Our tech-driven approach leverages software, hardware and AI […]
That means we can iterate at the speed of consumer electronics”
Which is kind of scary but also a bit interesting.
How would you go about regulating an open source medical device? The user can just plop whatever software on there that they want, and ultrasound themselves wherever… play with resonance and focusing, right?
> How would you go about regulating an open source medical device? The user can just plop whatever software on there that they want, and ultrasound themselves wherever… play with resonance and focusing, right?
The manufacturer will still need to validate their own firmware and subsequent updates. Whether it’s open source or not doesn’t matter because a huge part of the approval process is quality control tied to a specific manufacturer.
Anyone who plops their own software will be liable for the consequences and I doubt malpractice insurance would allow it in the vast majority of cases.
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.
>But you cannot use this anywhere where the ultrasound would be blocked by other organs.
Yes you can. If you had an array of ultrasonic transducers around the body you could have each of them in phase targeting a single spot. Beamforming is a thing we've been doing for years with RF. It's even more trivial with sound.
We were privy to a lab that accidentally cooked mice with gold nanoparticles in the late 90s with multiple IR lasers. After they figured the power side, it turns out that gold nanoparticles are wildly cytotoxic on a number of axes.
How is it more trivial with sound? Sound is just a wave just like ultrasound. In fact, ultrasound has the word sound in it making it sound. So your conclusion is not sound.
Ugh, yes. Not sure how the wires got crossed like that. However, sound is just a wave while RF is also waves even if at higher frequencies. Just as ultrasound is higher frequency that audible sound (which I guess is how "sound" was being used). If you continue increasing the frequencies past the RF range you will eventually get into light.
The article mentions that this is a different type of ultrasound treatment than the one that has been in use for prostate cancer treatment for some time.
Can’t the surgery be then with a small probe just to get the ultra sound tip near the cancer? I don’t know the size of the ultrasound tip but seems to me it can be smaller then a hand or tweezers.
Often constructive and destructive interference of waves can be used to focus the ultrasound through tissue without any incisions at all. Kidney stones are sometimes broken up this way.
> Fun fact: using this ultrasound for prostate cancer treatment reduces the risk of erectile disfunction
I’m not aware of strong evidence in this area (not saying you’re incorrect).
For the liver indications, several elite radiology departments have had very poor outcomes with their patients, despite the strong public data. I would not, with my own prostate, try a new technology until at least a decade out, at least.
Urinary and erectile function are a major issue with partial and radical prostatectomy. These ultrasound treatments are showing significant improvements in both areas.
This technology is also now used to treat non-cancerous prostate enlargement (BPH).
True, but currently prostatectomy is the most common intervention and second is radiotherapy which as mentioned in a comment above is a very expensive alternative with known side effects.
Histotripsy is early in its clinical life but I wouldn't say untested.
“Lithotripsy” is the name of the kidney stone treatment. My understanding is it’s based on vibration, not ultrasound (I know, vibration is sound - my understanding is the method on the linked article uses higher frequency + intensity + shorter pulses than the kidney stone method - so sorta like microwaving tumors vs using a massage gun on kidney stones?)
My surgeon told me my previous kidney cancer surgery (partial nephrectomy) meant my 7/8 size kidney wouldn't handle ultrasound treatment for the big kidney stone I'd developed 10 years after the cancer. So laser instead! Worked well but not much fun at the time.
Having had kidney stones, they're both used. I think for the sonic one they put you in a water bath because it conducts better. But as I understand it, the docs can pick whichever one is more optimal, be it shattering the stone sonically or zapping it with a laser.
AFIKR two facilities do this kind of treatment. One in Canada and one in China. There already was a HN threads with some reporting to have been treated in Canada.
Apparently, only some tumors have a distinct and unique shape / size. The “trick” is to calibrate the resonance exactly to the size of the cancer cell. So that resonance would “hurt” only that kind of shape / size cell. Which was much harder to do than it sounds. Sadly not all cancer cells are unique and not that “easily” distinguishable by size
But I am not in the medical field and just repeating what I’ve read.
Watching Hank Green's YouTube video where he found out that his cloudy pee was cancer leaving his body, he was surprised that doctors don't tell you to expect it. It can be such a morale boost.
If I interpret the article correctly, the ultrasound energy does two things: it effectively destroys the cancer cells by overheating them, and it physically breaks apart the tumour. Your immune system can further break up and get rid of dead cells the way it deals with normal dead cells.
> Some researchers have raised concerns about histotripsy potentially seeding new cancer growths as tumours are broken up inside the body, meaning they can be transported to other areas. That fear, however, hasn't borne out in animal studies so far.
I doubt ultrasound would trigger apoptosis in cancer cells, one of the reasons they're cancerous is that they refuse to commit suicide when they should.
Okay… and is that something that is beneficial? How? Will it flow out from an incision? Will it just target white or brown fat? Any other effects like also liquifying muscle tissue?
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
There was a startup in Shanghai in the early 2000. Their device used multiple transducers. The probe was at least 40 cm in diameter. They did trials on uterine fibroids, among other diseases. One of the difficulties was while it looks good in theory, but the path ultrasound travels in the body is more complicated than, say x-ray or gamma ray. They expected a fine focal zone, but sometimes the focal zone was much larger than expected. This new wave of ultrasound equipment may have discovered better ways to control the sound beam.
This is amazing!
That HIFU 20 years ago used phase array to steer beam. Don't know the size of transducer. One of the tests I heard of was on a pig leg. The damage was bigger than expected, could be in the range of few centimeters, probably due to the leg has skin, subcutaneous fat, muscle and bone. All have different sound characteristic.
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).
Don't know about mRNA but individualized remedies based on CAR-T technology have been making significant strides in this area, with major commercialisation expected in the next 1-2 years
| Pulse Duration | Microseconds (∼1–5 µs typical) | Microseconds to milliseconds (short bursts for mechanical disruption) |
Its kind of hard to know what this means - some of the numbers seem pretty close/crossover - but I don't think saying the difference is akin to a laser and a light.
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.
> Stride…was very interested in bubbles
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.
As someone who has worked on bubbles from a bioengineering/synthetic biology perspective, it is definitely play at some level. Like “what happens if we freeze dry them?” And of course determining which extremely specific kind works best for whatever application, etc.
Okay, you sold me. Where can I get an ultrasonic massage?
a high percentage of physical therapists have an ultrasound massage device.
> treat prostate issues
Is prostate size reduction possible?
The example that I saw was of a patient whose prostate had swollen closing up the urethra. HIFU was applied to ablate the urethra which “opened it back up” so that fluids could pass through again un-impeded. As a consequence the patient could then live a normal life.
"Ablation (Latin: ablatio – removal) is the removal or destruction of something from an object by vaporization, chipping, erosive processes, or by other means."
> "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.
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.
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.
I have friends and relatives who went through this process and what I believe is not repeated enough to the patient's immediate social circle is that the recovery process takes months and the procedure itself can leave lasting changes.
What's crazy is that this used to be much worse, but advancements in targeting and new treatments improved things quite a bit.
I suspect the medical industry is so heavily regulated that it is very difficult for doctors to recommend non-treatment or risk being sued into oblivion, though maybe it depends on the country.
Here in Canada, before assisted suicide was legalized, my grandfather (in his late 80s) refused any treatment for his kidney failure. He was ready to die and could barely walk or eat on his own anymore. There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal. The death certificate still said renal failure, though.
For me, if I ever got terminal cancer, I'd weigh the quality of life of treatment versus non-treatment. I've seen people go both ways and I've seen the results being right and wrong both ways. I don't want to spend my final months semi-alive on a bed or constantly messed up, though.
> it is very difficult for doctors to recommend non-treatment or risk being sued into oblivion
Not my experience. I have a loved one going through cancer treatment right now and they've been very up front about risks, side effects, and even talked about DNRs with them what they mean and how they can be applied.
People and their loved ones don't want to experience death. It's often as simple as that.
> There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal.
In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
> I'd weigh the quality of life of treatment versus non-treatment.
Something to consider, it's not a binary and treatment can look entirely different depending on the cancer.
You can, for example, do a lower than effective dose of chemo which will still be effective at slowing the growth of cancer.
Some therapies, such as immunotherapy, can be practically a walk in the park.
I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.
> People and their loved ones don't want to experience death. It's often as simple as that.
People also don't want (their loved ones) to suffer, especially needlessly. (I want to also stress that I'm not advocating terminating life, though I do think it should be an option - just that this is what my grandfather wanted).
> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
I've anecdotally heard that a huge percentage of US medicare costs is desperately saving elderly people at the end-stages of life instead of a more palliative (and some would argue dignified) end. This was made worse during the Terri Schiavo case when the very idea was put up as anti-life and we were warned that "death panels" would be inevitably setup. DNRs are allowed, but alleviating the suffering leading up to the end is, for both better and worse, heavily restricted.
> I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.
I've been extremely lucky that cancer hasn't been much of an experience I've had to deal with in my circles. I'm mostly pro-modern medicine and I know a lot of progress is also being made. I hope that it never happens, but if it did I'd want to be informed as possible to make my own decisions. The decisions I'd make depend so much on where I'm at. I'd be likely more willing to risk it now as I have a 7 year old to live for, than I would be in my 90s where the odds are a lot less for a comfortable experience.
> People also don't want (their loved ones) to suffer, especially needlessly.
You might be very surprised how family actions very often are not consistent with this supposed desire. 98 year olds in the hospital with multiple end stage illnesses - full code, happens all the time. Ask any healthcare worker in the US, pretty classic the elderly rotting away in a nursing home, rarely visited, then they get admitted and their healthcare proxy wants “everything done”. Often seems to be a reflection of their own guilt. Sometimes it’s just poor healthcare literacy.
But no, regardless of what you think these people may
> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
This is basically false. Most large systems have comfort care order set, with opioid drips. Transition to hospice is readily available. Usually the barrier to these are patients themselves or their families.
Also even the US, the principle of double effect prevails in palliative care.
Chemotherapy is essentially a bet that the drugs will kill the cancer faster than you. Because ultimately, cancer isn't a virus, bacteria, fungus, parasite, nor even a prion (this one is nightmare fuel) -- it's your own cells acting as a parasite. This reason alone makes cancer horrific to treat as it is.
There are multiple types of chemo. There's not just 1 chemo drug and how it looks can be all over the board.
Sort of at the opposite end, I knew a PT who harped on balance exercises and pointed out that a lot of old people have pneumonia as cause of death on their death certificate. The pneumonia was often acquired while immobilized by a broken hip. The broken hip was caused by falling (+ lower body atrophy), so really these people died from falling. It just took a while.
I don’t know what the right answer is for coding death certificates. Maybe the correct answer is to record several so we can see comorbidities and contributing factors more easily when deciding what science to fund, charities to endow, and which treatments to disfavor.
Died of complications of cancer, reaction to chemo. Died of complications of hip fracture, pneumonia.
A relative of mine was dying of stage 4 lung cancer and after they were admitted to the hospital, they contracted COVID and passed away two weeks later.
Their life expectancy upon admission was estimated to be less than a year, so it's hard to pin this on just the pandemic.
Personally I would put "smoking" in the form, because truth be told that was the single largest contributing factor.
No one gets paid 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.
> 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.
Unfortunately, I have extensive first hand experience with practices that do this, and you are 100% correct.
The grift is very insidious. If you scan people over a certain age with prostate MRI, you will find suspicious lesions in a large percentage. And using fusion MRI/US guided biopsies, you will inevitable get cancer cells in the sample.
Many (most?) of these people being treated will die WITH prostate cancer, not FROM prostate cancer.
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 real cost will matter at least from an allocation perspective. You can't keep relying on a treatment that costs $100m even if the patient pays nothing. Someone needs to pay that cost.
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.
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 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.
https://en.wikipedia.org/wiki/Microsurgeon_(video_game)
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.
Yeah, it seems that their pitch is that they want to move at consumer electronics speed, I mean, their website explicitly says
“Our tech-driven approach leverages software, hardware and AI […]
That means we can iterate at the speed of consumer electronics”
Which is kind of scary but also a bit interesting.
How would you go about regulating an open source medical device? The user can just plop whatever software on there that they want, and ultrasound themselves wherever… play with resonance and focusing, right?
> How would you go about regulating an open source medical device? The user can just plop whatever software on there that they want, and ultrasound themselves wherever… play with resonance and focusing, right?
The manufacturer will still need to validate their own firmware and subsequent updates. Whether it’s open source or not doesn’t matter because a huge part of the approval process is quality control tied to a specific manufacturer.
Anyone who plops their own software will be liable for the consequences and I doubt malpractice insurance would allow it in the vast majority of cases.
She has a couple of TED talks on this tech from several years ago.
I was aware of her from the OLPC project and the cool Pixel Qi screen tech from that, but haven't watched the talks.
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.
This can also be used for prostate, it's nothing new. But you cannot use this anywhere where the ultrasound would be blocked by other organs.
Fun fact: using this ultrasound for prostate cancer treatment reduces the risk of erectile disfunction
>But you cannot use this anywhere where the ultrasound would be blocked by other organs.
Yes you can. If you had an array of ultrasonic transducers around the body you could have each of them in phase targeting a single spot. Beamforming is a thing we've been doing for years with RF. It's even more trivial with sound.
We were privy to a lab that accidentally cooked mice with gold nanoparticles in the late 90s with multiple IR lasers. After they figured the power side, it turns out that gold nanoparticles are wildly cytotoxic on a number of axes.
https://house.fandom.com/wiki/Clueless
IN fact, they do this today to break up kidney stones. Multiple beams.
How is it more trivial with sound? Sound is just a wave just like ultrasound. In fact, ultrasound has the word sound in it making it sound. So your conclusion is not sound.
Reread, and you'll realize it means more trivial than RF.
Ugh, yes. Not sure how the wires got crossed like that. However, sound is just a wave while RF is also waves even if at higher frequencies. Just as ultrasound is higher frequency that audible sound (which I guess is how "sound" was being used). If you continue increasing the frequencies past the RF range you will eventually get into light.
You just gotta catch the right wave
The article mentions that this is a different type of ultrasound treatment than the one that has been in use for prostate cancer treatment for some time.
Can’t the surgery be then with a small probe just to get the ultra sound tip near the cancer? I don’t know the size of the ultrasound tip but seems to me it can be smaller then a hand or tweezers.
Often constructive and destructive interference of waves can be used to focus the ultrasound through tissue without any incisions at all. Kidney stones are sometimes broken up this way.
See currentsurgical.com
> Fun fact: using this ultrasound for prostate cancer treatment reduces the risk of erectile disfunction
I’m not aware of strong evidence in this area (not saying you’re incorrect).
For the liver indications, several elite radiology departments have had very poor outcomes with their patients, despite the strong public data. I would not, with my own prostate, try a new technology until at least a decade out, at least.
Urinary and erectile function are a major issue with partial and radical prostatectomy. These ultrasound treatments are showing significant improvements in both areas.
This technology is also now used to treat non-cancerous prostate enlargement (BPH).
> Urinary and erectile function are a major issue with partial and radical prostatectomy
There are other options besides prostatectomy or the untested histotripsy.
True, but currently prostatectomy is the most common intervention and second is radiotherapy which as mentioned in a comment above is a very expensive alternative with known side effects.
Histotripsy is early in its clinical life but I wouldn't say untested.
I’m not sure why we’re plugging a brand new entity when PAE is already in guidelines.
People who aren’t in medicine are very susceptible to advertising - this is why I’m writing so stridently
Here is a trial (2022): https://pubmed.ncbi.nlm.nih.gov/35714666/
And a review: https://pubmed.ncbi.nlm.nih.gov/36686753/
How does it compare with stereotactic radiosurgery (Gamma Knife)?
https://en.wikipedia.org/wiki/Stereotactic_surgery
Gamma Knife is used in brain lesions where focused ultrasound is not a viable treatment option or likely to ever be.
Is ultrasound preferable where it is viable?
Don't they break up kidney stones using ultrasound as well? Or is that a different type of "ultrasound"?
“Lithotripsy” is the name of the kidney stone treatment. My understanding is it’s based on vibration, not ultrasound (I know, vibration is sound - my understanding is the method on the linked article uses higher frequency + intensity + shorter pulses than the kidney stone method - so sorta like microwaving tumors vs using a massage gun on kidney stones?)
I think parent is thinking of "Ultrasonic lithotripsy" which does use ultrasound.
I’ve had it, it’s ultrasound but it’s not always effective against hard stones.
I think that's traditionally done with lasers.
My surgeon told me my previous kidney cancer surgery (partial nephrectomy) meant my 7/8 size kidney wouldn't handle ultrasound treatment for the big kidney stone I'd developed 10 years after the cancer. So laser instead! Worked well but not much fun at the time.
Having had kidney stones, they're both used. I think for the sonic one they put you in a water bath because it conducts better. But as I understand it, the docs can pick whichever one is more optimal, be it shattering the stone sonically or zapping it with a laser.
That’s transurethral lithotripsy.
AFIKR two facilities do this kind of treatment. One in Canada and one in China. There already was a HN threads with some reporting to have been treated in Canada.
https://news.ycombinator.com/item?id=31630679
Apparently, only some tumors have a distinct and unique shape / size. The “trick” is to calibrate the resonance exactly to the size of the cancer cell. So that resonance would “hurt” only that kind of shape / size cell. Which was much harder to do than it sounds. Sadly not all cancer cells are unique and not that “easily” distinguishable by size
But I am not in the medical field and just repeating what I’ve read.
Once you've destroyed the tumor, how do you get it out of the body?
https://www.statnews.com/2024/06/22/hank-green-pissing-out-c...
Watching Hank Green's YouTube video where he found out that his cloudy pee was cancer leaving his body, he was surprised that doctors don't tell you to expect it. It can be such a morale boost.
The recycling of dead cells is a normal biological process the same thing happens when they use radiation to kill cancer cells
If I interpret the article correctly, the ultrasound energy does two things: it effectively destroys the cancer cells by overheating them, and it physically breaks apart the tumour. Your immune system can further break up and get rid of dead cells the way it deals with normal dead cells.
Won't there still be some broken up live cells that can now migrate around the body and cause cancer in other areas?
This was an issue with uterine morcellation; https://en.wikipedia.org/wiki/Morcellator. Per the article, though:
> Some researchers have raised concerns about histotripsy potentially seeding new cancer growths as tumours are broken up inside the body, meaning they can be transported to other areas. That fear, however, hasn't borne out in animal studies so far.
Usually, it suffices to initiate apoptosis, the self-destruction mechanisms of the cells.
I doubt ultrasound would trigger apoptosis in cancer cells, one of the reasons they're cancerous is that they refuse to commit suicide when they should.
It heats them until enough damage is done that they die regardless.
So more like necrosis, not apoptosis. Maybe non-biologists are not aware, but apoptosis is not just cell death.
Or just tears them apart in the case of Histosonics.
You can get a ultrasonic fat cavitation machine off Ali Express for a few hundred bucks. The technology has gotten surprisingly cheap.
It looks like this can be used to burst and liquify body fat, near to the surface of the skin! Wild.
Okay… and is that something that is beneficial? How? Will it flow out from an incision? Will it just target white or brown fat? Any other effects like also liquifying muscle tissue?
It's amazing how we're turning sound waves into healing tools.
It's a highly promising direction for many diseases, I specifically remember Alzheimer's as one
https://www.fusfoundation.org/diseases-and-conditions/
My mother received ultrasound ablation as brain surgery to treat idiopathic tremors. It was wild.
Also very very interesting for brain modulation!
I hope for a great future of this therapy.
I really hope she didn't damage her (or her colleague's) hearing while doing these experiments!
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
There was a startup in Shanghai in the early 2000. Their device used multiple transducers. The probe was at least 40 cm in diameter. They did trials on uterine fibroids, among other diseases. One of the difficulties was while it looks good in theory, but the path ultrasound travels in the body is more complicated than, say x-ray or gamma ray. They expected a fine focal zone, but sometimes the focal zone was much larger than expected. This new wave of ultrasound equipment may have discovered better ways to control the sound beam.
it seems like the intesection point can be smaller than a grain of rice, and moved at 0.1mm three dimensionally [0]
[0] https://youtu.be/3Bwq2YxD9eU
This is amazing! That HIFU 20 years ago used phase array to steer beam. Don't know the size of transducer. One of the tests I heard of was on a pig leg. The damage was bigger than expected, could be in the range of few centimeters, probably due to the leg has skin, subcutaneous fat, muscle and bone. All have different sound characteristic.
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).
There has to be a way to find a practice that uses this tech?
absoultely but I am in no hurry and I would like it to be Very Boring and Ordinary For My Particular Condition before I go anywhere near it
How's progress on individualized cancer remedies based on mRNA?
Don't know about mRNA but individualized remedies based on CAR-T technology have been making significant strides in this area, with major commercialisation expected in the next 1-2 years
If it can target and kill cancer, how can it also be safe for foetuses?
That's like asking how if a laser can cut through steel how lamps can be safe to have indoors.
Do you have a link or something that compares the power in both? I can't find one.
This is the summary I get from chatgpt - comparing Histotripsy and ultrasound imaging
| Property | Strongest Diagnostic / Imaging Ultrasound | Histotripsy (Therapeutic Ultrasound |
| Frequency | 2 – 10 MHz (obstetric: 2–5 MHz; high-res imaging up to 15 MHz) | 0.25 – 3 MHz (sometimes up to 6 MHz) |
| Pressure (Peak Negative) | Up to ~5–6 MPa (mechanical index limit ≈ 1.9) | 10 – 100 MPa (depending on type: intrinsic vs. boiling histotripsy) |
| Intensity (Spatial Peak, Temporal Average) | Typically < 0.1 W/cm²; upper safe limit ≈ 0.72 W/cm² (FDA/AIUM) | 100 – 10,000 W/cm² (very high peak intensities) |
| Pulse Duration | Microseconds (∼1–5 µs typical) | Microseconds to milliseconds (short bursts for mechanical disruption) |
Its kind of hard to know what this means - some of the numbers seem pretty close/crossover - but I don't think saying the difference is akin to a laser and a light.
There are 2 to 5 orders of magnitude difference in intensity. That alone is a pretty big difference.
You can vary the frequency, power, energy, focus... is not the SAME ultrasound.
But surely it could cause some damage at a lower frequency, power, etc anyway?
Shit, you figured it out. It's not! That's whats been causing all the autism! Big ultrasound has been managing to keep this under wraps for decades!