A device for heating tissue

Abstract

A device for heating tissue above a prescribed temperature useful in the treatment of emphysema or COPD is provided. [Solution] A heating energy signal generator and one or more electromagnetic energy signal applicators that receive an output signal from the heating energy signal generator and couple electromagnetic energy from the heating energy signal generator to body tissue, the one or more electromagnetic energy signal applicators having one or more signal applicators selected from the group consisting of electrodes, coils, and antennas, and a controller connected to receive temperature signals indicative of the temperature of the tissue at one or more locations within the body, the controller configured to adjust the heating energy delivered to the body from the heating energy signal generator based at least in part on the temperature signal.

Description

Technical Field

[0001] This application claims priority based on U.S. Application No. 62 / 341,229 filed on May 25, 2016 and U.S. Application No. 62 / 468,869 filed on March 8, 2017. For purposes of the United States, this application claims the benefits under the U.S. Patent Law. U.S. Application No. 62 / 341,229 titled CLOSED LOOP CONTROL OF TREATMENT FOR EMPHYSEMA filed on May 25, 2016 and U.S. Application No. 62 / 468,869 titled SYSTEM FOR TREATING UNWANTED TISSUE filed on March 8, 2017 are hereby incorporated herein by reference for all purposes.

[0002] The present invention relates to the medical field, particularly to the treatment of unwanted tissue. The present invention has applications in the treatment of lung diseases such as chronic obstructive pulmonary disease (COPD), and an example of a lung disease is emphysema.

Background Art

[0003] There are various medical conditions in which treatment may beneficially include the destruction of unwanted tissue or an effect on unwanted tissue. Ideally, such treatment should avoid damaging normal tissue adjacent to the unwanted tissue. For example, there are also lung diseases that can benefit from treatment involving the destruction of diseased lung tissue or an effect on diseased lung tissue. Some of these treatments involve heating of lung tissue.

[0004] Background information on lung diseases is found in medical textbooks such as "Pulmonary Pathophysiology" by Dr. John B. West (ISBN 0-683-08934-X). Emphysema is a disease that damages the alveoli (air sacs) in a patient's lungs. The affected air sacs can rupture. This alters the distribution of air spaces in the lungs, reducing the surface area of ​​the lungs that can take in oxygen. The lung damage caused by emphysema can trap stagnant air in the lungs, reducing the amount of fresh, oxygen-rich air flowing into the lungs. In patients with emphysema, the affected areas of the lungs cannot be easily ventilated through the bronchi and trachea, preventing the lungs from fully contracting and expanding. The trapped air inside the lungs can prevent the natural up-and-down movement of the diaphragm.

[0005] Prior art methods for heating diseased tissue within the lungs involve inserting an ablation device into the affected area through the trachea and bronchi (see, for example, Brannan et al. US2016 / 0184013). This method has several drawbacks, including the limited accessibility of the lung, the need for precise mapping of the affected area, and the requirement for the ablation device to be precisely guided to its location. It would be beneficial to have a system that can automatically heat the affected tissue without precisely identifying its location. Furthermore, it would be beneficial to be able to heat the entire affected area of ​​the lung without overheating healthy tissue or surrounding tissue.

[0006] Armitage's US4269199 discloses a method for inducing local hyperthermia in the treatment of tumors using shortwave diathermy therapy. This method involves moving an induction coil in the tumor-containing part of the body so that the coil axis consistently excises different parts of the tumor.

[0007] Turner's US4798215 discloses a combination of thermotherapy and a non-invasive temperature measurement device.

[0008] Leveen's US5010897 discloses a device for deep hyperthermia treatment of cancer. The device employs two single-turn coaxial coils that rotate synchronously in parallel planes, with the central axes of each coil aligned on the exact same line perpendicular to the coil's plane. The tumor is continuously heated by the combined magnetic field of the rotating coils.

[0009] Evans US5503150 discloses an apparatus and method for non-invasively locating and non-invasively heating a tissue volume, with the ability to detect temperature changes in the tissue volume.

[0010] Kasevich's US6181970 discloses medical systems and devices that utilize microwave energy to provide tissue heating therapy and diagnostic imaging.

[0011] Barry et al. (US8585645) disclose a method of treating multiple locations in a patient's lungs using high-temperature steam delivered through the lumen of a catheter.

[0012] Turnquist et al. US2011 / 0054431 discloses a device and method for non-invasively heating body tissues and fluids using emitted energy to detect and / or treat various physical conditions, such as vesicoureteral reflux, and for non-invasively measuring the resulting temperature changes of target and surrounding fluids and tissues.

[0013] Lichtenstein et al., U.S. Patent 8444635, incorporated herein by reference, discloses a system for exposing unwanted tissue to a scanning focused microwave beam. According to U.S. 8444635, the system is particularly useful for heating tissue whose blood flow has been reduced by the unwanted tissue. The unwanted tissue heats up relatively rapidly, while the surrounding healthy tissue is cooled by the blood flow. The effect of this differential heating is particularly significant in the lungs because healthy lung tissue is less dense and has a higher blood flow. U.S. 8444635 describes the treatment of emphysema as an example of application.

[0014] Vertikov et al., US8467858, describes devices and techniques for optical imaging-based thermotherapy.

[0015] There remains a need for devices and methods useful for controlling and / or administering thermotherapy. [Overview of the Initiative]

[0016] The present invention has numerous embodiments. These embodiments are not limited to, • A device useful for selectively heating tissue inside a patient. • Control system for thermotherapy devices • A method for controlling a device for selectively heating tissue inside a patient. • Treatment methods for patients, including selective heating of tissues within the patient. This includes. Non-limiting applications of the methods and apparatus described herein include the treatment of diseased lung tissue, such as lung tissue affected by emphysema or other forms of COPD.

[0017] The technological innovations described in this specification are Apparatus and method useful for providing closed-loop temperature control in patient tissues. Apparatus and methods useful for planning the irradiation of target tissues of patients with electromagnetic radiation. Apparatus and methods useful for heating patient tissue, which have compensation and / or adaptations for differential perfusion. • Apparatus and method useful for heating patient tissue, including a novel combination of features. Medical methods for treating emphysema and / or COPD This includes the following. These innovations may be applied individually or in any combination.

[0018] Further aspects and examples of embodiments are shown in the accompanying drawings and described below.

[0019] [List of Embodiments] The embodiments listed below illustrate various non-limiting aspects of the present invention. [Aspect 1] A medical thermal ablation device useful for the treatment of emphysema or COPD, The apparatus comprises a plurality of electromagnetic signal inductors, which are adapted to deliver electromagnetic energy to lung tissue for differentiation of heating between the affected and healthier parts of the lung tissue, and the plurality of electromagnetic signal inductors comprises a first set of two or more first electromagnetic signal inductors that can be positioned on one side of the body to be treated such that the body is between the first electromagnetic signal inductor and the second electromagnetic signal inductor (or any other embodiment herein), and a second set of at least one second electromagnetic signal inductor that can be positioned on a second side of the body to be treated, opposite the first side, and the first electromagnetic signal inductor and the second electromagnetic signal inductor are, A heating energy signal generator, A selection circuit connected to receive an output signal from the heating energy signal generator and connected to selectively apply the output signal to one of a plurality of pairs of electromagnetic signal inductors, wherein each pair of electromagnetic signal inductors includes one of the first electromagnetic signal inductors and one of the second electromagnetic signal inductors. A controller connected to control the selection circuit, the controller being operable to switch to apply the output signal from the currently selected one of the pair of electromagnetic signal applicators to a different pair of the pair of electromagnetic signal applicators at intervals of time, the controller and A medical thermal ablation device including [Aspect 2] The medical thermal ablation device according to aspect 1 (or any other aspect in this specification), wherein the electromagnetic signal applicator includes an electrode respectively [Aspect 3] The medical thermal ablation device according to aspect 2 (or any other aspect in this specification), comprising an impedance matching network between the heating energy signal generator and the electrode [Aspect 4] The impedance matching network includes a plurality of settings, each of the settings providing impedance matching for at least one of the plurality of electrode pairs, each of the electrode pairs corresponding to one of the settings, and the controller is connected to control the impedance matching network so as to switch the impedance matching network to the setting corresponding to the currently selected one of the electrode pairs. The medical thermal ablation device according to aspect 3 (or any other aspect in this specification) [Aspect 5] The controller is configured to switch to apply the output signal from the currently selected one of the electrode pairs to a different electrode pair at a frequency of 100 Hz or less. The medical thermal ablation device according to any one of aspects 2 to 4 (or any other aspect in this specification) [Aspect 6] The medical thermal ablation device according to any one of aspects 2 to 5 (or any other aspect in this specification), wherein the electrode selection circuit includes a first switch or switch network switchable to connect the first output of the thermal energy signal generator to one of the first electrodes [Aspect 7] The medical thermal ablation device according to any one of Aspects 2 to 6 (or any other aspect herein), wherein the second electrode includes a plurality of second electrodes, and the electrode selection circuit includes a second switch or a switch network that is switchable to connect the second output of the thermal energy signal generator to one of the plurality of second electrodes. [Aspect 8] The medical thermal ablation device according to Aspect 7 (or any other aspect herein), wherein one of the first output and the second output of the thermal energy signal generator is at a ground potential. [Aspect 9] The medical thermal ablation device according to any one of Aspects 1 to 8 (or any other aspect herein), wherein the heating energy signal generator includes a radio frequency (RF) signal generator. [Aspect 10] The medical thermal ablation device according to Aspect 9 (or any other aspect herein), wherein the RF signal generator is operable to output a signal having a frequency of at least 1 MHz. [Aspect 11] The medical thermal ablation device according to Aspect 10 (or any other aspect herein), wherein the frequency is in the range of about 10 MHz to about 100 MHz. [Aspect 12] The medical thermal ablation device according to any one of Aspects 1 to 11 (or any other aspect herein), wherein the controller is connected to receive a temperature signal indicating the temperature of the tissue at one or more positions inside the body, and is configured to apply feedback control to adjust the heating energy delivered from the thermal energy signal generator to the body based at least in part on the temperature signal. [Aspect 13] The medical thermal ablation device according to any one of Aspects 1 to 12 (or any other aspect herein), wherein the controller is configured to apply time domain modulation to the output signal of the thermal energy signal generator. [Aspect 14]<00001A medical thermal ablation apparatus according to any one of embodiments 1 to 13 (or any other embodiment herein) wherein the controller is configured to control the thermal energy signal generator to emit the output signal as a pulse signal, and the controller is configured to control the width of the pulse. [Aspect 15] The medical thermal ablation apparatus according to any one of embodiments 12 to 14 (or any other embodiment herein) further comprises a subcutaneous and / or invasive temperature sensor, the temperature signal including an output signal from the subcutaneous and / or invasive temperature sensor. [Aspect 16] The subcutaneous and / or invasive temperature sensor includes a thermistor, as described in the medical thermal ablation apparatus according to embodiment 15 (or any other embodiment herein). [Aspect 17] A medical thermal ablation apparatus according to any one of embodiments 12 to 16 (or any other embodiment herein) wherein the controller includes a thermal model of at least a portion of the body, the thermal model relating the temperature at one of the locations to the temperature of the location under study, the controller is configured to apply the thermal model using the temperature signal as input, and to adjust the heating energy at least in part based on the output of the thermal model. [Aspect 18] A medical thermal ablation apparatus according to Embodiment 17 (or any other embodiment herein), wherein the thermal model includes some or all of the thermal conductivity of several different tissue types in the body, the distribution of the several different tissue types in the body, the geometry of the electromagnetic energy injector, and the blood circulation in the body. [Aspect 19] The temperature signal is derived from a non-contact temperature measurement, as described in any one of embodiments 12 to 18 (or any other embodiment in this specification) of a medical thermal ablation apparatus. [Aspect 20] A medical thermal ablation apparatus according to any one of embodiments 12 to 19 (or any other embodiment herein), wherein the temperature signal includes a signal derived from processing magnetic resonance imaging (MRI) signals. [Aspect 21] A medical thermal ablation apparatus according to any one of embodiments 2 to 20 (or any other embodiment herein) wherein at least one of the first set and the second set of electromagnetic signal injectors has electrodes arranged as an array. [Aspect 22] A medical thermal ablation device according to embodiment 21 (or any other embodiment herein), wherein the array has a shape that generally conforms to the projection of the lungs inside the body. [Aspect 23] The medical thermal ablation apparatus according to embodiment 21 or 22 (or any other embodiment herein), wherein the array is a two-dimensional array. [Aspect 24] The medical thermal ablation apparatus according to Embodiment 1 (or any other embodiment herein), wherein the first set and the second set of electromagnetic signal injectors each include a first two-dimensional electrode array and a second two-dimensional electrode array, respectively. [Pattern 25] The medical thermal ablation apparatus according to embodiment 24 (or any other embodiment herein), wherein each of the two-dimensional electrode arrays comprises an equal number of electrodes. [Aspect 26] A medical thermal ablation apparatus according to embodiment 24 or 25 (or any other embodiment herein), wherein each electrode of the first electrode array is positioned directly opposite the corresponding electrode of the second electrode array. [Aspect 27] A medical thermal ablation apparatus according to any one of embodiments 24 to 26 (or any other embodiment herein) wherein the first electrode array includes a first row of electrodes spaced axially along the body and a second row of electrodes spaced axially along the body. [Aspect 28] A medical thermal ablation apparatus according to any one of embodiments 24 to 27 (or any other embodiment in this specification), wherein the first electrode array and the second electrode array have a mirror-image relationship with respect to each other. [Aspect 29] A medical thermal ablation apparatus according to embodiment 27 or 28 (or any other embodiment herein), wherein each of the first row of electrodes and the second row of electrodes consists of three to seven electrodes. [Aspect 30] A medical thermal ablation apparatus according to any one of embodiments 24 to 29 (or any other embodiment herein) wherein the first electrode array comprises at least four electrode rows, and the electrodes of each electrode row are spaced apart axially along the body. [Aspect 31] A medical thermal ablation apparatus according to any one of embodiments 12 to 30 (or any other embodiment herein) wherein the controller is configured to adjust the heating energy to raise the temperature at one of the one or more locations to at least 50°C and to maintain the temperature at 50°C or above for a selected time. [Aspect 32] A medical thermal ablation apparatus according to any one of embodiments 12 to 31 (or any other embodiment herein) wherein the controller is configured to adjust the heating energy to prevent the temperature at one of the one or more locations from exceeding a safe temperature threshold. [Aspect 33] The medical thermal ablation apparatus according to embodiment 32 (or any other embodiment herein) wherein the safety temperature threshold is lower than 50°C. [Aspect 34] The medical thermal ablation apparatus according to embodiment 32 or 33 (or any other embodiment herein) wherein the controller is configured to stop applying the heating energy when the temperature at the one location exceeds the safety temperature threshold. [Aspect 35] A medical thermal ablation apparatus according to embodiment 32 or 33 (or any other embodiment herein) wherein the controller is configured to modulate the application of heating energy from the heating energy signal generator when the temperature at one location is rising toward the safety temperature threshold at a rate faster than the temperature rise threshold and / or is closer to the safety temperature threshold than the safety margin. [Aspect 36] A medical thermal ablation apparatus according to any one of embodiments 2 to 35 (or any other embodiment herein), comprising a shield positioned between one or more of the electrodes and the body. [Aspect 37] The medical thermal ablation apparatus according to embodiment 36 (or any other embodiment herein), wherein the shield is movable relative to the electrode. [Aspect 38] A medical thermal ablation apparatus according to embodiment 36 or 37 (or any other embodiment herein) wherein the electrical impedance of the shield changes spatially. [Aspect 39] A medical thermal ablation apparatus according to any one of embodiments 2 to 38 (or any other embodiment herein), comprising a source of conductive fluid connected to an outlet in the electrode to supply the conductive fluid. [Aspect 40] A medical thermal ablation apparatus according to any one of embodiments 2 to 39 (or any other embodiment in this specification), wherein the electrodes of the first set of electromagnetic signal inductors have a different area from those of the electrodes of the second set of electromagnetic signal inductors. [Aspect 41] A medical thermal ablation apparatus according to any one of embodiments 2 to 40 (or any other embodiment herein), comprising a sac to which at least some of the electrodes are connected to a conductive fluid supply. [Aspect 42] The medical thermal ablation apparatus according to embodiment 41 (or any other embodiment herein), comprising one or more pumps connected to discharge the conductive fluid, the controller configured to operate the one or more pumps to discharge the conductive fluid from one or more of the sacs, and configured to operate an MRI machine to acquire MRI data from the body when the conductive fluid has been discharged from the one or more sacs. [Aspect 43] The medical thermal ablation apparatus according to embodiment 42 (or any other embodiment herein), wherein the controller is configured to process the MRI data to obtain information characterizing the temperature at one or more locations inside the body. [Aspect 44] The electromagnetic signal injector comprises a coil, as described in Embodiment 1 (or any other embodiment herein). [Aspect 45] The electromagnetic signal injector is mounted to move relative to the body, as described in any one of embodiments 1 to 44 (or any other embodiment described herein). [Aspect 46] A medical thermal ablation apparatus according to any one of embodiments 1 to 45 (or any other embodiment herein) wherein the electromagnetic signal applicator is mounted on a frame rotatable relative to the body, and the medical thermal ablation apparatus comprises a motor connected to drive the rotation of the frame. [Aspect 47] The medical thermal ablation apparatus according to embodiment 46 (or any other embodiment herein), wherein the electromagnetic signal inductor is mounted to move axially relative to the body, and the medical thermal ablation apparatus comprises one or more actuators coupled to move the electromagnetic signal inductor axially while the frame is rotated so that the electromagnetic signal inductor moves spirally relative to the body. [Aspect 48] A medical thermal ablation apparatus according to any one of embodiments 1 to 44 (or any other embodiment herein), wherein at least one of the first electromagnetic signal inductor and the second electromagnetic signal inductor is fixed, and the apparatus comprises an actuator controlled by the controller, which is capable of moving the body relative to at least one of the first electromagnetic signal inductor and the second electromagnetic signal inductor. [Aspect 49] A medical thermal ablation apparatus according to any one of embodiments 1 to 48 (or any other embodiment in this specification), comprising a biasing means for biasing one or more of the electromagnetic signal injectors toward the body. [Aspect 50] The biasing means comprises an inflatable chamber, as described in embodiment 49 (or any other embodiment herein). [Aspect 51] A medical thermal ablation apparatus according to embodiment 49 or 50 (or any other embodiment herein), wherein one or more of the electromagnetic signal inductors are flexible, and the biasing means is adapted to bend one or more of the electromagnetic signal inductors to conform to a concave surface. [Aspect 52] A medical thermal ablation apparatus according to embodiment 50 (or any other embodiment herein), comprising a source of pressurized cold fluid in fluid communication with the inflatable chamber. [Aspect 53] A medical thermal ablation device useful for the treatment of emphysema or COPD, A heating energy signal generator, One or more electromagnetic energy signal applicators, connected to receive an output signal from the heating energy signal generator, and capable of coupling electromagnetic energy from the signal generator to body tissue, each having one or more signal applicators selected from the group consisting of electrodes, coils, and antennas, A controller connected to receive a temperature signal indicating the temperature of the tissue at one or more locations inside the body, and configured to apply feedback control to adjust the heating energy delivered to the body from the thermal energy signal generator, at least in part, based on the temperature signal. A device equipped with the following features. [Aspect 54] The medical thermal ablation apparatus according to embodiment 53 (or any other embodiment herein), wherein the controller is configured to apply time-domain modulation to the thermal energy signal generator. [Aspect 55] The medical thermal ablation apparatus according to embodiment 53 or 54 (or any other embodiment herein), wherein the controller is configured to control the thermal energy signal generator to emit the output signal as a pulse signal, and the controller is configured to control the pulse width of the pulse signal. [Aspect 56] The medical thermal ablation apparatus according to any one of embodiments 53 to 55 (or any other embodiment herein) further comprises a subcutaneous and / or invasive temperature sensor, the temperature signal including an output signal from the subcutaneous and / or invasive temperature sensor. [Aspect 57] The subcutaneous and / or invasive temperature sensor includes a thermistor, as described in the medical thermal ablation apparatus according to embodiment 56 (or any other embodiment herein). [Aspect 58] The subcutaneous and / or invasive temperature sensor is positioned within a thin needle in the medical thermal ablation apparatus according to embodiment 56 or 57 (or any other embodiment herein). [Aspect 59] A medical thermal ablation apparatus according to any one of embodiments 53 to 58 (or any other embodiment herein) wherein the controller includes a thermal model of at least a portion of the body, the thermal model relating the temperature at one of the locations to the temperature of a target location, the controller is configured to apply the thermal model using the temperature signal as input, and to adjust the heating energy at least in part based on the output of the thermal model. [Aspect 60] A medical thermal ablation apparatus according to aspect 59 (or any other aspect herein), wherein the thermal model includes some or all of the thermal conductivity of several different tissue types in the body, the distribution of the several different tissue types in the body, the geometry of the electromagnetic energy injector, and the blood circulation in the body. [Aspect 61] The temperature signal is derived from a non-contact temperature measurement, as described in any one of embodiments 53 to 55 (or any other embodiment herein). [Aspect 62] A medical thermal ablation apparatus according to embodiment 61 (or any other embodiment herein), wherein the temperature signal includes a signal derived from processing magnetic resonance imaging (MRI) signals. [Aspect 63] A medical thermal ablation apparatus according to any one of embodiments 53 to 62 (or any other embodiment herein) wherein one or more signal inductors are controllable to change the direction of an electric field, and the controller is configured to periodically control the one or more signal inductors to change the direction thereof. [Aspect 64] The medical thermal ablation apparatus according to embodiment 63 (or any other embodiment according to this specification), wherein the signal applicator comprises an antenna and at least one actuator (or any other embodiment according to this specification) coupled to position the antenna movably, and the controller is configured to move the antenna to change the direction of the electric field. [Aspect 65] The medical thermal ablation apparatus according to embodiment 63 (or any other embodiment herein), wherein the signal applicator comprises a plurality of electrode pairs and an electrode selection circuit, and the controller is configured to operate the electrode selection circuit to apply the output of the heating energy signal generator to different electrode pairs among the electrode pairs at different time points. [Aspect 66] The medical thermal ablation apparatus according to embodiment 63 (or any other embodiment herein) wherein the signal applicator comprises at least one pair of electrodes and at least one actuator capable of moving the at least one pair of electrodes relative to an object, and the controller is connected to control the at least one actuator. [Aspect 67] A medical thermal ablation apparatus according to embodiment 63 (or any other embodiment herein), wherein the signal applicator comprises a plurality of coil pairs and a selection circuit, and the controller is configured to operate the selection circuit to apply the output of the heating energy signal generator to the coil of one of the coil pairs at a time, such that different coil pairs of the coil pairs hold the output signal from the heating energy signal generator at different times. [Pattern 68] The medical thermal ablation apparatus according to embodiment 63 (or any other embodiment herein) wherein the signal applicator comprises at least one pair of coils and at least one actuator capable of moving the at least one pair of coils relative to an object, and the controller is connected to control the at least one actuator. [Aspect 69] Use of the apparatus according to any one of embodiments 1 to 68 (or any other embodiment in this specification) in the treatment of emphysema or COPD. [Aspect 70] A method for controlling a medical thermal ablation device useful for the treatment of emphysema or COPD, A step of applying signals from a heating energy signal generator to a pair of electromagnetic signal inductors, wherein the plurality of electromagnetic signal inductors are adapted to deliver electromagnetic energy to the lung tissue for differentiation of heating between the affected and healthier parts of the lung tissue, and the pair of electromagnetic signal inductors includes one electromagnetic signal inductor from a first set of two or more first electromagnetic signal inductors that can be positioned on one side of the body to be treated, and another electromagnetic signal inductor from a second set of at least one second electromagnetic signal inductor that can be positioned on a second side of the body to be treated, opposite to the first side; A step of switching the signal at time intervals so that the signal is applied to a different pair of electromagnetic signal inductors, wherein each of the different pairs of electromagnetic signal inductors includes one of the first electromagnetic signal inductors and one of the second electromagnetic signal inductors. A method for providing this. [Aspect 71] The method according to embodiment 70 (or any other embodiment herein), wherein each of the plurality of electromagnetic signal inductors has an electrode, and the method comprises the step of matching the impedance of the heating energy signal generator to the impedance represented by each of the pair of electromagnetic signal inductors. [Aspect 72] The method according to embodiment 71 (or any other embodiment herein), comprising the steps of storing the settings of an impedance matching network in a data storage unit, and configuring the impedance matching network according to one of the settings corresponding to the different pair of electromagnetic signal inductors, in conjunction with the steps of switching the signals to apply the signals to the different pair of electromagnetic signal inductors. [Aspect 73] The method according to any one of embodiments 70 to 72 (or any other embodiment herein), wherein the plurality of electromagnetic signal inductors are flexible, and the method comprises the step of forming at least one of the plurality of electromagnetic signal inductors to conform to a concave surface. [Aspect 74] The method according to embodiment 73 (or any other embodiment herein), wherein the step of forming one of the plurality of electromagnetic signal inductors includes the step of inflating a chamber adjacent to the one of the plurality of electromagnetic signal inductors. [Aspect 75] The method according to any one of embodiments 70 to 74 (or any other embodiment herein), wherein the step of switching the signal is performed at 100 Hz or less. [Aspect 76] The method according to any one of embodiments 70 to 75 (or any other embodiment herein) includes a radio frequency (RF) signal. [Aspect 77] The method according to embodiment 76 (or any other embodiment herein), wherein the RF signal includes a frequency of at least 1 MHz. [Aspect 78] The method according to embodiment 76 (or any other embodiment herein), wherein the RF signal includes frequencies in the range of about 10 MHz to about 100 MHz. [Aspect 79] The method according to any one of embodiments 70 to 78 (or any other embodiment herein), comprising the step of adjusting the output of the heating energy signal generator based at least in part on a temperature signal. [Aspect 80] The method according to embodiment 79 (or any other embodiment herein), wherein the step of adjusting the output of the heating energy signal generator includes the step of applying a feedback control algorithm. [Aspect 81] The method according to embodiment 79 or 80 (or any other embodiment herein), wherein the signal includes a pulse signal, and the step of adjusting the output of the heating energy signal generator includes the step of applying time-domain modulation to the pulse signal. [Aspect 82] The time-domain modulation is the method according to embodiment 81 (or any other embodiment herein), including pulse width modulation. [Aspect 83] The first and second sets of electromagnetic signal inductors each include a two-dimensional electrode array, according to any one of embodiments 70 to 82 (or any other embodiment herein). [Aspect 84] The method according to embodiment 83 (or any other embodiment herein), wherein the two-dimensional electrode array has a shape that generally conforms to the human lung. [Aspect 85] The method according to any one of embodiments 70 to 84 (or any other embodiment herein), comprising the step of setting a controller to adjust the heating energy signal generator to raise the temperature at a certain location to a threshold temperature and maintain the temperature above the threshold temperature for a selected time. [Aspect 86] The method according to embodiment 85 (or any other embodiment herein), wherein the threshold temperature is at least 50°C. [Aspect 87] The method according to any one of embodiments 70 to 86 (or any other embodiment herein), comprising the step of setting the controller to adjust the heating energy signal generator to prevent the temperature at a certain location from exceeding a safe temperature threshold. [Pattern 88] The method according to embodiment 87 (or any other embodiment herein), wherein the safe temperature threshold is lower than 50°C. [Aspect 89] A method for treating lung diseases such as emphysema or COPD, The step of applying electromagnetic energy to the lung tissue of the patient between a first electromagnetic signal applicator and a second electromagnetic signal applicator located on opposing sides of the patient's lung, The steps include continuously applying electromagnetic energy at a certain power level so that one or more areas of diseased tissue within the lung are heated to a temperature at least equal to the therapeutic temperature threshold, while the temperature of the healthier tissue areas of the lung is kept below a safety temperature threshold, which is lower than the therapeutic temperature threshold, so that the healthier tissue areas of the lung are cooled by the circulating blood; A method for providing this. [Aspect 90] The method according to embodiment 89, wherein the therapeutic temperature threshold is at least 50°C. [Aspect 91] The method according to embodiment 89 or 90, wherein the step of applying the electromagnetic energy includes matching the impedance of the source of the electromagnetic energy to the impedance represented by the first electromagnetic signal inductor and the second electromagnetic signal inductor. [Aspect 92] The method according to any one of embodiments 89 to 91, further comprising a step of changing the orientation of the patient relative to a vertical line. [Aspect 93] The method according to any one of embodiments 89 to 92, comprising the steps of monitoring the temperature at a first location inside one or more regions of the lesioned tissue, and controlling the application of electromagnetic energy based on the monitored temperature at the first location. [Aspect 94] The method according to any one of embodiments 89 to 93, comprising the steps of monitoring the temperature at a second location within one or more regions of the healthier tissue, and controlling the application of electromagnetic energy based on the monitored temperature at the second location. [Aspect 95] The method according to any one of embodiments 89 to 94, further comprising the step of shaping at least one of the electromagnetic signal inductors to fit the concave surface of the patient. [Aspect 96] The method according to embodiment 95, wherein the step of forming the electromagnetic signal inductor includes the step of inflating an expandable chamber adjacent to the electromagnetic signal inductor. [Aspect 97] The method according to any one of embodiments 89 to 97, further comprising the step of flowing a liquid between the electromagnetic signal applicator and the patient while the electromagnetic energy is being applied. [Aspect 98] The method according to embodiment 97, wherein the liquid is conductive. [Aspect 99] The method according to embodiment 98, wherein the liquid contains physiological saline. [Aspect 100] The method according to any one of embodiments 89 to 99, further comprising the step of supplying cold air for the patient to inhale while the electromagnetic energy is being applied. [Aspect 101] The method according to any one of embodiments 89 to 100, further comprising the step of actively cooling one or more of the electromagnetic signal inductors while the electromagnetic energy is being applied. [Aspect 102] The method according to any one of embodiments 89 to 101, further comprising the step of changing the electromagnetic field direction of the electromagnetic energy while the electromagnetic energy is being applied. [Aspect 103] The method according to embodiment 102, wherein the step of changing the direction of the electromagnetic field of the electromagnetic energy includes moving the first electromagnetic signal inductor and / or the second electromagnetic signal inductor relative to the patient. [Aspect 104] The method according to embodiment 103, wherein the step of moving the first electromagnetic signal inductor and / or the second electromagnetic signal inductor relative to the patient includes the step of moving the first electromagnetic signal inductor and / or the second electromagnetic signal inductor along a spiral path relative to the patient. [Aspect 105] The method according to embodiment 102, wherein the first electromagnetic signal inductor is one of one or more electromagnetic signal inductors of a first set, the second electromagnetic signal inductor is one of two or more electromagnetic signal inductors of a second set, and the step of changing the direction of the electromagnetic field of the electromagnetic energy includes switching to apply the electromagnetic energy to a pair consisting of one of the first set of electromagnetic signal inductors and one of the second set of electromagnetic signal inductors other than the second electromagnetic signal inductor. [Aspect 106] The method according to aspect 105, wherein the second set of electromagnetic signal inductors includes an electromagnetic signal inductor array comprising a first row of electromagnetic signal inductors spaced apart along the patient's body adjacent to a first lung of the patient, and a second row of electromagnetic signal inductors spaced apart along the patient's body adjacent to a second lung of the patient. [Aspect 107] The method according to embodiment 107, wherein the electromagnetic signal inductor array includes a plurality of rows of the electromagnetic signal inductors spaced apart along the patient's body, adjacent to each of the patient's lungs, and each of the plurality of rows includes a plurality of the electromagnetic signal inductors. [Aspect 108] The method according to any one of embodiments 89 to 107, comprising the steps of contracting the patient's lung while one or more areas of the diseased tissue inside the lung are heated to at least a temperature equal to the therapeutic temperature threshold, and then reinflating the patient's lung. [Aspect 109] The method according to any one of embodiments 89 to 108, wherein the electromagnetic signal applicator comprises a plurality of electrodes, and the step of applying the electromagnetic energy to the tissue of the patient's lung includes dielectric heating of the lung tissue. [Aspect 110] The method according to embodiment 109, further comprising the step of moving a shield positioned between one of the plurality of electrodes and the patient while the electromagnetic energy is being applied. [Aspect 111] The method according to embodiment 110, wherein the electrical impedance of the shield changes spatially. [Aspect 112] The method according to any one of embodiments 89 to 108, wherein the electromagnetic signal applicator comprises a coil, and the step of applying the electromagnetic energy to the tissue of the patient's lung includes the step of inductively coupling the energy to the tissue. [Aspect 113] The method according to any one of embodiments 89 to 112, wherein the electromagnetic energy includes radio frequency energy. [Aspect 114] The method according to embodiment 113, wherein the radio frequency energy includes a frequency of at least 1 MHz. [Aspect 115] The method according to embodiment 113, wherein the radio frequency energy includes frequencies in the range of about 10 MHz to about 100 MHz. [Aspect 116] The method according to any one of embodiments 89 to 115, further comprising the step of applying the electromagnetic energy to the entire lungs of the patient. [Aspect 117] Apparatus comprising any feature, combination of features, or partial combination of features that are novel and inventive as described in any part of this specification. [Aspect 118] A method comprising any step, action, combination of steps and / or actions, or partial combination of steps and / or actions, that is novel and inventive as described in any part of this specification. [Brief explanation of the drawing]

[0020] The attached drawings illustrate non-limiting embodiments of the present invention.

[0021] [Figure 1] This is a cross-section of the chest of a patient exposed to an electromagnetic field.

[0022] [Figure 2] This is a diagram of electrodes on the patient's back.

[0023] [Figure 3A] This is a cross-sectional view of the chest of a patient exposed to an electromagnetic field, showing a different electrode configuration. [Figure 3B] This is a cross-sectional view of the chest of a patient exposed to an electromagnetic field, showing a different electrode configuration. [Figure 3C] This is a cross-sectional view of the chest of a patient exposed to an electromagnetic field, showing a different electrode configuration. [Figure 3D] This is a cross-sectional view of the chest of a patient exposed to an electromagnetic field, showing a different electrode configuration.

[0024] [Figure 4] This is a side view of a patient showing how to switch electrodes.

[0025] [Figure 5A] This is a cross-sectional view of a patient's chest showing electrodes supported by an inflatable vest. The vest shown here is deflated. [Figure 5B]This is a cross-sectional view of a patient's chest showing electrodes supported by an inflatable vest. The inflatable vest is shown here.

[0026] [Figure 6] This is a cross-section of a patient's chest exposed to an electromagnetic field generated by a coil.

[0027] [Figure 7A] This is a cross-sectional view of a patient's chest showing a pair of electrodes operating to move along a spiral path around the patient's rib cage while electromagnetic energy is being delivered. [Figure 7B] This is a cross-sectional view of a patient's chest showing a pair of electrodes operating to move along a spiral path around the patient's rib cage while electromagnetic energy is being delivered.

[0028] [Figure 8] This flowchart illustrates an exemplary method for treating unwanted tissue in a patient. [Modes for carrying out the invention]

[0029] The following description provides specific details to allow for a more complete understanding of the present invention. However, the present invention can be carried out without these details. In other cases, well-known elements are not illustrated or described in detail to avoid unnecessarily obscuring the invention. Accordingly, this specification and the drawings should be considered illustrative rather than restrictive.

[0030] To selectively heat the affected area of ​​a patient's tissue while minimizing heating of other tissues in the patient, methods and apparatus according to specific embodiments of the present invention may be applied. Heating can be achieved by exposing the lesioned tissue to an electromagnetic field to induce dielectric heating or eddy current heating. The electromagnetic field may include radio frequency (RF) energy. According to some embodiments, the RF energy includes microwave radiation.

[0031] By applying electromagnetic energy, selected lesion tissue can be heated to a temperature exceeding a threshold temperature. For example, lesion tissue can be heated to a temperature in the range of approximately 55°C to 65°C. The exact upper limit of the temperature to which lesion tissue is heated is often not important. In many cases, heating to a slightly lower maximum temperature can be compensated for by maintaining that temperature for a longer period of time. Overheating healthy tissue can damage it, so it is desirable to avoid heating healthy tissue. The maximum temperature to which healthy tissue can be exposed without long-term damage is unknown.

[0032] Certain embodiments of the present invention are advantageously applied to treat diseased tissue with reduced blood flow compared to adjacent, healthier tissue. In such cases, the affected area can be rapidly heated while the healthier tissue is cooled by blood flow, resulting in a reduced temperature increase compared to the diseased tissue.

[0033] Emphysema is an example of a condition in which blood flow to the affected area is reduced. Due to the low mass (density) of the lungs and the high blood flow to the healthy tissues within the lungs, certain embodiments of the present invention may be particularly effective in treating emphysema.

[0034] In some cases, the diseased tissue is the patient's lung tissue. For example, the patient may have emphysema. For such treatment, electromagnetic energy may be applied to heat the affected area to a temperature of about 50°C or higher. While this is being done, the temperature of the surrounding healthier lung tissue may be kept below the threshold temperature. According to the inventors, healthy lung tissue and organs near the lungs should not be exposed to temperatures exceeding about 40°C or about 45°C.

[0035] Figure 1 shows an apparatus 10 according to one embodiment of the present invention, applied to treat diseased tissue inside the lungs 12 and 14 of patient P. The lungs 12 and 14 are surrounded by the thoracic cage 16 inside the patient's body 1. Multiple electrodes 22 (Figure 1 shows four electrodes individually identified as 22A, 22B, 22C, and 22D) are used to heat the diseased tissue inside the lungs 12 and 14 while minimizing overheating to adjacent organs such as the heart 18 and spine 20. According to some embodiments, the apparatus 10 includes further electrodes 22. These further electrodes 22 may be arranged, for example, on one or both sides of the plane of the cross-section in Figure 1.

[0036] The electrodes 22 are sized and positioned to generate an electric field 24 that covers as much of the lungs 12 and 14 as possible, while minimizing the penetration of the electric field 24 into adjacent organs. Fortunately, such a configuration is possible in the human biological structure.

[0037] To enhance the electrical coupling of electromagnetic energy with body 1 while simultaneously cooling the surface of body 1, saline solution 26 may be optionally introduced between body 1 and the multiple electrodes 22 via a tube 28. Such liquid coupling can significantly increase the consistency of the coupling of RF energy delivered through some or all of the multiple electrodes 22 with body 1. According to another embodiment, the electrodes 22 include a bath of a conductive fluid, such as saline solution. The saline solution 26 may, for example, contain about 1 wt% NaCl in water. According to some other embodiments, a conductive gel is provided between the electrodes 22 and body 1.

[0038] The RF generator 30 supplies RF energy to the electrodes 22 via an impedance matching network 32 and an electrode selection circuit 34. The RF energy is applied to two or more of the multiple electrodes 22 via a wire 36.

[0039] According to some embodiments, the RF generator 30 has a maximum power output in the range of about 1 kW to about 5 kW. According to some embodiments, the RF energy output from the RF generator 30 has one or more frequencies in the range of about 1 MHz to about 100 MHz or about 10 MHz to about 100 MHz.

[0040] While optional, it is generally preferable to select the frequency of the electric field 24 in the Industrial, Scientific, and Medical (ISM) band of the spectrum. By selecting such a frequency, interference between the RF energy generated by the RF generator 30 and other signals, such as communication signals, can be reduced or avoided. For example, the RF generator 30 may have an output frequency of 13.56 MHz or 27 MHz.

[0041] An impedance matching network 32 is provided to match the output impedance of the RF generator 30 to the impedance of body 1. This facilitates the efficient delivery of energy to body 1. Impedance matching networks are well known in the art.

[0042] According to one embodiment, the impedance matching network 32 may include an LC circuit, such as a capacitor, connected in series between one output terminal of the RF generator 30 and the electrode selector 38, which is followed by an inductor connected in parallel with the electrode selector 38. The capacitor and inductor values ​​may be determined after measuring the resistance and capacitance between pairs of electrodes 22 in the body 1. For example, the impedance matching network 32 may match the purely resistive impedance (e.g., 50 Ohms) of the RF generator 30 to the complex impedance of a human or animal body.

[0043] The impedances represented by multiple different patients can vary significantly (for example, patient size can significantly affect the spacing of electrode pairs placed on either side of the patient, and can significantly affect the impedance at the electrode interface, regardless of whether a gel or conductive solution is provided), so it may be desirable to provide an adjustable impedance matching network. The impedance matching network may be adjustable to provide the best impedance matching for each of the multiple electrode pairs.

[0044] According to several embodiments, impedance matching networks are self-adjusting (i.e., auto-adjusting) to maximize the delivery of power to the body. For example, U.S. Patents US5364392, US9028482, and US9192422, as well as other publications known to those skilled in the art, describe techniques that may be used to automatically adjust a matching network to enable optimal power delivery (for example, based on measurements of reflected radiation).

[0045] To prevent resistive current from flowing through body 1, it is desirable to provide capacitive coupling between electrode 22 and body 1 for electrical safety. For example, electrode 22 may be coated with a very thin layer of insulating material. For example, a thin layer of Kapton™ tape may be attached between electrode 22 and body 1.

[0046] By applying the output of an RF generator 30 between two of several electrodes 22 positioned on both sides of the lung to be treated, the lesional tissue inside one or both lungs 12, 14 can be heated. The heating can be continued for a sufficient amount of time to raise the temperature of the lesional tissue to a temperature above the threshold temperature for a sufficient amount of time to achieve the desired therapeutic outcome.

[0047] To minimize heating of adjacent organs, the direction of the electromagnetic field 24 can be periodically changed. This can be achieved by applying the output of the RF generator 30 to multiple pairs of different electrodes 22. Multiple pairs of different electrodes 22 can be selected so that even when the direction of the electric field changes, it always passes through the portion of the lung 12, 14 containing the diseased tissue to be treated. When this is done, the diseased lung tissue is continuously heated, while the surrounding tissue is heated only intermittently. In the device 10, the electrode selector 38 switches the applied output of the RF generator 30 between multiple pairs of different electrodes 22. The switching frequency can be low. For example, the electrode selector 38 may switch electrodes every few seconds. According to some non-limiting examples, the electrode selector 38 switches electrodes so that heating energy can be delivered using different electrode pairs every 30 to 300 seconds. According to some non-limiting examples, the electrode selector 38 switches electrodes to use different electrode pairs at frequencies of 100 Hz or less.

[0048] In some cases, multiple pairs of different electrodes 22 are selected so that the orientation of the electric field within the patient's tissue changes by an angle of at least 15 degrees (there are also options for at least 10 degrees, at least 20 degrees, and at least 25 degrees) at least every few seconds (e.g., at least every 1 to 30 seconds). In some cases, multiple pairs of different electrodes 22 are selected so that the orientation of the electric field does not remain in the same plane for more than a few seconds. This can be facilitated by providing an array of two-dimensional electrodes 22 adjacent to each of the patient's lungs on at least one side of the patient.

[0049] Electrode pairs may be selected such that the volume of tissue (e.g., lung tissue) containing the affected area to be treated lies between the selected pairs of electrodes. By alternately applying heating energy using several different electrode pairs from the selected pair, the affected area within the tissue volume can be continuously heated, while the surrounding tissue can only be heated for a small portion of the time. According to some embodiments, heating energy is delivered to either lung at once via a selected pair of electrodes. According to some embodiments, the delivery of heating energy is performed alternately among three, four, or more selected electrode pairs. In such embodiments, any one of the selected electrode pairs may be operational for approximately 1 / N of the time, where N is the number of selected electrode pairs used to apply heating energy to a particular lung or other tissue volume.

[0050] According to several embodiments, electrode arrays substantially covering a region of the patient's lungs are provided on the patient's chest and back. The electrode arrays may be mirror images of one another. Each of the plurality of electrode arrays may have a shape that conforms to the shape of the patient's lungs. According to several embodiments, each of the plurality of arrays is two-dimensional and comprises a plurality of columns, each containing a plurality of electrodes, and a plurality of rows, each containing a plurality of electrodes. According to several embodiments, such arrays are provided on one of the patient's lungs. According to several embodiments, such arrays are provided on both of the patient's lungs. Such arrays may be mounted as described herein to deliver heating energy to the tissue of one or both of the patient's lungs.

[0051] The electrodes of the electrode pair can be energized with opposite polarity. According to some embodiments, one electrode of the pair is grounded and the other electrode is connected to the output of the RF signal generator 30. According to some embodiments, one electrode of the pair is connected to one output terminal of the RF signal generator and the other electrode is connected to another output terminal of the RF signal generator 30.

[0052] Because healthy lung tissue has far better blood circulation than diseased tissue, the healthier tissue in the lungs 12, 14 may be protected from being heated to damaging temperatures. When a non-contact heat source, such as radio frequency (RF) energy, is directed to the lungs, the affected area of ​​the lungs becomes hot, while blood flow removes heat from the healthy tissue.

[0053] This works because the lung mass (usually around 1 kg in adults) is low, while the blood flow through the lungs is high (usually around 5 kg / min or about 5 liters per minute in adults). This blood flow causes the temperature of the healthy part of the lung to tend to be equal to that of the rest of the body, which effectively acts as a heat sink with a mass of several tens of kilograms. This is 10 to 100 times larger than the mass of the effective heat sink for the affected part of the lung, which is usually less than 1 kilogram. When the lung is exposed to a form of energy that causes heating, such as RF energy, the temperature rise of the lung tissue is inversely proportional to the mass of the effective heat sink. Therefore, diseased tissue with less blood circulation heats up to a significantly higher temperature than healthier tissue with normal blood circulation. Based on this, heating energy can be applied to heat the affected part of the lung tissue to a temperature in the range of 50°C to 70°C, while the healthy part of the lung only heats up to a few degrees above normal body temperature.

[0054] To help keep the temperature of the healthier parts of lungs 12 and 14 lower, patient P may inhale cold air during surgery. The affected parts of lungs 12 and 14 will not receive enough cold air to keep themselves at a low temperature. Cooling may be facilitated using a liquid air aerosol sprayer.

[0055] The methods described herein can be implemented in a way that offers the advantage of not requiring precise prior knowledge of the location of the affected area. Although the heating energy can be directed throughout the lung, the temperature rises significantly only in the affected area.

[0056] The treatment methods described herein may be applied to achieve a variety of desirable outcomes. For example, in some cases, a single treatment in which the lesioned tissue is heated above a threshold temperature may be sufficient to achieve a desired outcome. For example, a desired outcome may be a reduction in the volume of the lesioned tissue. A sufficient reduction in volume may be achieved in a single treatment through fibrosis, ablation, or other procedures. In other cases, two or more treatments may be repeated over several hours, days, weeks, or months to achieve a desired reduction in the volume of the lesioned tissue or other desired outcome.

[0057] In some embodiments, optionally, the fact is utilized that when diseased lung tissue is heated to a temperature of approximately 60°C, it may lose the ability to expand again after lung collapse (pneumothorax). This can occur due to temperature-induced damage to the surfactant layer and other physiological reasons. The treatment method may include the step of heating diseased lung tissue (e.g., tissue affected by COPD or emphysema) to collapse the lung, and then inflating the lung again.

[0058] Heating of the lungs can be performed rapidly (e.g., in seconds or minutes). Collapse of the lungs can be performed by inserting a subcutaneous needle into the pleural cavity and leaking air into the pleural cavity. Supplying pure oxygen to the lungs accelerates collapse as the oxygen is completely absorbed into the blood. The lungs can be kept collapsed for a sufficient amount of time to allow the affected area to collapse and become small in volume. The lungs can be reinflated by emptying the pleural cavity. This can be done, for example, with the same needle used to collapse the lungs. The procedure can be performed on one lung at a time. The patient can then breathe with the remaining lungs. Lung collapse and inflation are performed according to the procedures prescribed in respiratory medicine and do not require further detail here.

[0059] In this treatment, areas affected by emphysema may be allowed to collapse and remain collapsed to prevent them from interfering with the normal function of the healthy parts of the lung. This can achieve results similar to those that can be achieved by surgically removing the diseased lung tissue, without the risks of surgery. Other mechanisms that do not require pneumothorax may also exist. In this case, the heated affected area can be reduced in volume through ablation, fibrosis, or other mechanisms, allowing healthy lung tissue to fill the gap.

[0060] The heating process can be performed using open-loop control (i.e., based on past experimental power and duration calibrations), or using sensing-loop control or closed-loop control. According to some embodiments, the apparatus 10 includes a controller that automatically controls one or more of the following: the power output of the RF generator 30, the electrodes to which the output of the RF generator 30 is applied, the duty cycle of the RF generator 30, and the length of time for which the RF generator 30 applies heating energy to the body 1, at least in part based on real-time measurements of temperature at one or more locations in the patient's tissue.

[0061] Temperature detection may be performed using one or more sensors 36 placed on the patient's body, and / or any optimal non-contact temperature sensing technology. According to one embodiment, the temperature of tissues inside the patient is detected using small temperature sensors such as thermistors. For example, in one prototype embodiment, a small, glass-covered thermistor, such as Digikey® part number 495-5820-ND, was used to measure the temperature of lung tissue. Other examples of methods for measuring tissue temperature include: • Subcutaneous temperature sensors (these may include, for example, electronic temperature sensors held in a very small gauge needle (e.g., a needle with a diameter of approximately 0.6 mm)), • Processed data obtained from a magnetic resonance imaging (MRI) system or another external imaging system capable of monitoring temperature. • Thermocouple, • Bronchoscope equipped with a thermistor or other temperature sensor, • Solid-state temperature sensor, and • Similar items These are some examples.

[0062] The controller may implement any of a variety of control algorithms. For example, the controller of system 10 may implement a PID control loop. The controller may implement a simple algorithm such as shutting off or reducing the power output of the RF generator 30 when a desired temperature (e.g., a temperature in the range of approximately 55°C to 65°C) is reached. According to some embodiments, the controller modulates the power output of the RF generator 30 while the tissue temperature is being raised toward the desired temperature, and shuts off the power delivery by the RF generator 30 when the desired temperature is reached. Feedback control may prevent exceeding the target temperature.

[0063] In embodiments applying open-loop temperature control, the current temperature inside the target tissue can be optionally calculated based on a mathematical model of the heat absorbed by the tissue and the rate of tissue cooling. After the model predicts that a threshold temperature has been reached, the output of the model can be applied to control the power output of the RF generator 30 and / or to prevent the RF generator 30 from further increasing the tissue temperature.

[0064] According to some embodiments, one or more temperature sensors are applied to detect the temperature of non-target tissues. For example, non-target organs that are identified as likely to become the hottest or as the most heat-sensitive organs may be identified, and the temperature inside these organs may be monitored during treatment.

[0065] In one embodiment, a simple temperature sensor attached to a subcutaneous injection needle provides an accurate temperature measurement when the needle is inserted into an organ. The controller of the device 10 may be configured to discontinue treatment if the temperature of the non-target tissue exceeds a safety temperature threshold, and / or to modulate the application of heating energy from the RF generator 30 when the temperature of the non-target tissue is rising toward or approaching the safety temperature threshold.

[0066] A non-target temperature sensor that detects the temperature of non-target tissue may be used alone or in combination with a temperature sensor that measures the temperature of target tissue. According to some embodiments, the same temperature sensor (e.g., an MRI-based temperature sensor or another non-contact temperature sensor) may monitor the internal temperature of both target and non-target tissue.

[0067] In some embodiments, the system described in US8444635 is modified to include a temperature sensor and a controller connected to receive a temperature signal from the temperature sensor and configured to control radiation irradiation for heating patient tissue by a closed-loop control algorithm.

[0068] In some cases, it may be undesirable to place a temperature sensor in a target tissue. For example, inserting a temperature sensor into a specific area of ​​lung tissue could carry the risk of puncturing the lung. According to some embodiments, a model of the patient's biostructure may be used to estimate how the temperature at a specific point in the target tissue, and / or a specific point in the non-target tissue, relates to the temperature at another location within the patient. This other location may be selected so that the temperature sensor can be placed under lower risk and / or less adverse effects. The other location may include one or more of the following: the muscles surrounding the lungs, the temperature of exhaled breath, or the temperature of the blood at a specific location.

[0069] From preoperative images, a thermal model of the patient's biological structure can be generated. Known thermal conductivity of multiple different tissue types can be combined with a known distribution of those tissue types in the patient, a known geometry of the electrodes, the coils or other structures used to deliver heating energy to the tissue, and a cyclic model to estimate how temperatures at other locations correlate with temperatures at the target location. Temperatures measured at other locations can then be used in place of the temperature at the target location, using the correlation determined using the model.

[0070] According to some implementations, patient orientation is taken into consideration. The lower part of the lung typically contains more blood than the higher parts due to gravity. This is called "perfusion difference." The part of the lung with the most blood may vary depending on the patient's orientation. The amount of blood at the location being treated may affect the rate at which the temperature of the tissue at that location rises when electromagnetic energy is delivered to that tissue.

[0071] According to some embodiments, the patient is moved to various positions while treatment is being performed (for example, by rotating and / or tilting the patient, and / or rolling the patient). Apparatus according to some embodiments of the present invention may provide a bench, chair, bed, or other patient support that moves by tilting or rotating in accordance with the performance of treatment. According to some embodiments, the movement of the patient support is controlled by a controller that also controls the application of heating energy to the patient.

[0072] Some embodiments of the apparatus provide commands (e.g., on a display) to change the patient's posture at selected points during treatment.

[0073] Some embodiments of the apparatus estimate the effect of perfusion differences on tissue properties in different parts of the lung (or other parts of the biological structure). Such estimations may be based, for example, on information about the patient's biological structure (e.g., from preoperative imaging). In the profile for delivering energy to the target tissue, perfusion differences may be taken into account by increasing or decreasing the delivered energy depending on whether the target tissue is located in a part of the lung where the target tissue temperature is expected to rise more rapidly as a result of the perfusion differences (e.g., energy may be reduced where the target tissue is deficient in blood due to being at a higher elevation) or whether the target tissue is located in a part of the lung where the target tissue temperature is expected to rise more slowly as a result of the perfusion differences (e.g., energy may be increased where the target tissue contains a large amount of blood due to being at a lower elevation). Some embodiments of the apparatus provide a user interface including a control device that the user can use to instruct the patient's posture during treatment. Compensation for perfusion differences may be based at least in part on the instructed posture.

[0074] It is generally desirable to apply electromagnetic energy to the patient's tissue such that the electric field 24 within the tissue is generally uniform. The uniformity of the electric field 24 is, • Electrode size, shape and position, • Impedance of the interface between the electrode and the patient's body, • One or more frequencies present in the electromagnetic energy transmitted via the electrodes, • When electrodes of varying sizes are used, which electrode will receive the highest voltage? (Since heating rate is related to the density of force lines, tissue near higher voltages will heat up more quickly to higher temperatures.) It may be affected by various factors, including the following. In some embodiments, one or more of these factors are manipulated to achieve a desired electric field distribution in the patient. For example, The electrodes may be constructed by selecting materials and / or paints with spatially varying resistivity. A shield and / or waveguide may be placed between the electrode and the patient's body. The electrode (and / or shield and / or waveguide, if present) may be moved while the treatment is being performed. One or more of the above features may be applied, for example, to achieve a generally uniform electric field distribution in the lung or other tissue volume being treated.

[0075] According to several embodiments, the placement of the electrodes 22 is designed or customized using knowledge of the patient's biostructure and the geometry of the target tissue. For example, MRI and / or computed tomography CT images may be processed to identify areas of different densities in the patient (e.g., adipose tissue / muscle / bone). By working with the known average electrical properties of these materials, ·Electrode arrangement, • The sequence and / or timing of switching electrodes, • Characteristics of RF signals (power, frequency, etc.) A treatment plan can be designed that specifies one or more of the following. Such a treatment plan may help to target the correct target tissue, achieve sufficiently uniform heating, and avoid overheating of vital tissues (e.g., the heart). According to some embodiments, analysis of the patient's biostructure generates an electrode pattern including an electrode array sized to cover the patient's lungs on both sides of the patient's body (e.g., chest and back), and a customized electrode set for the patient is fabricated by a printing, cutting, or other computer-controlled fabrication process using the electrode pattern.

[0076] Figure 2 shows an example of electrode placement on one side of patient P (e.g., the patient's back). A similar electrode placement may be provided on the opposite side of the patient (e.g., the patient's chest). According to this embodiment and several other embodiments, separate sets of electrodes are provided to cover each of the patient's lungs. Here, electrodes 22AA to 22AC are provided across the patient's left lung, and electrodes 22BA to 23BC are provided across the patient's right lung.

[0077] In this example, electromagnetic energy can be delivered to the target lung tissue of patient P by connecting the output of an RF generator 30 between a pair of electrodes 22, which include one electrode on the patient's chest and another electrode on the patient's back. The pair of electrodes 22 may be facing each other directly or offset from each other.

[0078] The electrode arrangement in Figure 2 is, for example, Replacing some or all of the electrodes shown with more electrodes (which may, in some cases, be smaller than the electrodes shown), • Divide the shown electrodes to provide more electrode rows (these rows may, for example, be positioned on one or both sides of the patient, generally parallel to the patient's spine. For example, each of the shown electrodes 22 may be replaced by a row consisting of two or three electrodes. Figures 3A, 3B, 3C, and 3D show exemplary embodiments in which each of electrodes 22A, 22B, 22C, and 22D is replaced by two electrodes). • Divide the shown electrodes to include more electrode rows. It can be modified in various ways, including [mention specific methods / methods].

[0079] For example, the electrode selection circuit 34 shown in Figure 1 can apply heating energy (e.g., output from an RF signal generator) to multiple different electrode pairs of an electrode pair at different times (electrode switching).

[0080] Figure 4 shows an example of electrode switching. Figure 4 is a side view of patient P showing electrodes 22AA to 22CC. Electrodes 22CA to 22CC are on the opposite side of patient P from electrodes 22AA to 22AC. Figure 4 shows that electrodes 22AA to 22CC provide nine pairs of electrodes 22. Here, each pair of electrodes includes one electrode on one side of patient P and another electrode on the opposite side of patient P, so that patient P is sandwiched between the electrodes of the pair.

[0081] The direction of the electric field 24 generated on patient P is determined by which pair of electrodes 22 is used to deliver heating energy. For example, consider three pairs of electrodes with electrode 22CC. The electromagnetic field can be directed by pairing electrode 22CC with electrodes 22AA, 22AB, and 22AC, respectively, as shown by the field lines 44, 42, and 40.

[0082] Figure 4 shows an example of how the electrode selection circuit 34 includes electrically controlled switches or current converters 46 and 48. The impedance matching network can be constructed to provide a balanced output (balanced relative to ground potential) when a balanced configuration is desired. According to the embodiment shown, this is achieved by providing a transformer 50.

[0083] Switches 46 and 48 may include, for example, electromechanical relays such as RF FET transistors or RF relays, electromechanical current converters, and solid-state switches.

[0084] As shown in Figure 4, multiple pairs of different electrodes 22 may have significantly different distances from electrode to electrode. Some embodiments include a mechanism to compensate for multiple different energy densities in the body tissue that may occur when heating energy is switched between multiple pairs of different electrodes. Such compensation may take one or more of the following forms, for example: Depending on which electrode pair is being driven, the controller can automatically set the power output of the RF generator 30 to various values. Several electrodes may be divided into multiple parts. Depending on which other electrodes an electrode is paired with, several different parts, or several different combinations of such parts, may be used. Depending on which pair of electrodes 22 is being driven, pulse width modulation or other time-domain compensation may be applied. More electrodes 22 may be provided so that it is possible to select more different pairs of electrodes 22 that generate similar energy densities when driven. The impedance matching network may be adjusted or switched to match the impedances represented by multiple different electrode pairs. Any two or more of the above combinations. ·others.

[0085] The electrodes 22 used to apply heating energy to the patient may have any of a wide variety of forms, including adhesive electrodes, electrodes attached to a belt or the like, and electrodes supported by clothing such as a vest. Exemplary vests 58 are shown in Figures 5A and 5B. The vest 58 may be inflatable. Figure 5A shows the vest 58 before inflation. Figure 5B shows the inflated vest 58. According to some embodiments, some or all of the electrodes 22 comprise a sac containing a conductive fluid. Such electrodes may be advantageous when the device described herein incorporates or is used in conjunction with an MRI system. If it is desirable to deliver energy to the patient's tissue, the sac may be filled with the conductive fluid. If it is desirable to acquire MRI information, the conductive fluid may be removed from the sac.

[0086] Ideally, electrodes should be provided in a way that simplifies the application of electrodes to the patient's body, ensuring close contact with the patient's body.

[0087] According to some embodiments, some or all of the electrodes 22 have one or more of the following features: The length and / or width of the electrodes are stretchable (for example, the electrodes may be made of a conductive stretchable cloth, or a woven or nonwoven conductive mesh, or a stretchable conductive plastic sheet). • The electrodes are flexible. The electrodes are attached to or can be attached to a vest, belt, or other garment (for example, using adhesive or hook-and-loop fasteners, or clips or removable fasteners). Electrodes are designed to be made smaller, for example, by cutting or tearing them to a size suitable for a particular patient. The electrode consists of multiple smaller electrodes. Optionally, connections can be formed or broken between these smaller electrodes to adjust the size of the electrode to suit individual patients.

[0088] Electrode 22 is, for example, • Adhesives (including self-adhesives and / or separate-application adhesives) and / or gels, Clothing in which electrodes are attached or incorporated, For example, clothing such as stretchable and / or inflatable vests or shirts worn over electrodes, ·others Patient P can be fixed in place by one or more of these.

[0089] If it is desirable to fix the electrode 22 to a part of the patient's body 1 that may be concave (e.g., the spine, the area around the chest), a molded member such as a flexible support or an inflatable chamber (which may be part of an inflatable garment such as a vest) may be provided to fix the electrode to the concave part of the patient's biological structure.

[0090] If some or all of the electrodes 22 are provided to a support such as clothing (e.g., a vest) or patient furniture such as a medical table, bed table, or chair, the support may include a pathway containing and / or circulating a cold fluid. The cold fluid may help keep the patient at a low temperature. If the support is inflatable, the pathway containing the cold fluid may be the same as or different from a chamber that can be pressurized to inflate the support. According to some embodiments, valves are provided so that the circulation of the cold fluid can be obstructed in multiple portions of the support that are close to the target tissue.

[0091] As described below, in some embodiments, a coil is provided instead of or in addition to the electrodes. According to these embodiments, the coil can be supported to the patient in the same or similar manner as described above for the electrodes. This is best illustrated in Figure 6.

[0092] The technological innovations described herein can be applied in situations where heating energy is applied to body tissue in various ways. For example, in order to heat tissue, - At least one pair of electrodes are placed on both sides of the body such that at least a portion of the body is between the electrodes (effectively, the body tissue forms a capacitor within which a dielectric is formed), and RF energy is delivered between the electrodes (heat is generated due to dielectric loss within the tissue). - An inductor is formed by placing at least a part of the body inside a coil or sandwiched between several coils, and an RF signal is driven through this inductor to generate heat in the body's tissues using the losses of this inductor (mainly eddy current losses). (Eddy current heating occurs when eddy currents are induced in the patient's tissues by a changing magnetic field.) For example, as disclosed in U.S. Patent 8444635, radiating electromagnetic energy from an antenna into the body (heating by radiating electromagnetic radiation into the body is primarily optimal at high frequencies such as microwave frequencies). This allows electromagnetic energy to be coupled to the body. Closed-loop temperature control, as described herein, and / or switching the direction of the electromagnetic field lines to reduce heating of non-target tissues may be provided in embodiments applying any of these heating methods.

[0093] To control which areas are heated when using lower RF frequencies (e.g., 1 MHz to 100 MHz), electrodes or coils that apply RF energy to the body should be positioned on opposing sides of the body. Placing electrodes or coils on only one side of the body results in uneven heating, with the greatest heat generated near the electrode or coil.

[0094] This specification describes various embodiments in which electromagnetic energy is applied to the lung or other structures via electrodes. Other corresponding embodiments may be provided by replacing the electrodes with coils.

[0095] For heating of eddy currents primarily induced by a magnetic field, the electrodes can be replaced with RF coils, as shown in Figure 6. The polarity of coils 52 and 54 is selected to generate magnetic field lines 56 through the lungs 12 and 14. Multiple coils may be used in a coil switching device similar to the electrode switching devices disclosed elsewhere in this specification. The magnetic field can be further directed using a ferrite block.

[0096] Instead of providing fixed electrodes or coils, the device may provide electrodes or coils that are movable relative to the patient P. For example, one or more pairs of electrodes may be held in an actuator that is operable to move the electrode pair relative to the patient. Each electrode pair may include a first electrode and a second electrode that are movable on a first and second surface of the patient (e.g., the patient's chest and back), respectively. For example, as shown in Figures 7A and 7B, a pair of electrodes 22 may be actuated to move along a spiral path around the patient's rib cage while electromagnetic energy is being delivered via the electrodes 22. In another example, one or more pairs of electrodes may be fixed in at least one dimension, and the patient may be moved in that dimension relative to the fixed electrodes.

[0097] Some embodiments of the apparatus include, or are used in conjunction with, a Faraday cage or shielded room to reduce electromagnetic interference to other equipment. According to some embodiments, shielding is provided by a wire mesh cage consisting of wires spaced a few centimeters or less apart. The cage may be incorporated into the walls of a room or other structure. [Examples]

[0098] The methods described herein were tested in rats. It was found that small thermistors functioned well as direct temperature sensors, while the tested thermocouples did not. The electric field appeared to interfere with low-level (less than 1mV) signals from the thermocouples, but not with higher-level (volt) signals from the thermistors. For example, the Model H1744 manufactured by US Sensor (http: / / www.ussensor.com / ) is an optimal thermistor. This thermistor has an outer diameter of 0.43 mm.

[0099] The system was tested in several rats in which emphysema was induced in one of the lungs. The parameters used were: • 100W RF power at 13.56MHz, • Electrodes washed with saline solution in a series-C parallel-L matched network That was the case.

[0100] The reflected power was less than 5%. Each electrode was approximately 25 x 50 mm in size, and each electrode was covered with 25 μm thick Kapton® tape. Because the tape is very thin and does not significantly attenuate capacitive current, the capacitance between the electrode and the body is high. The rat's hair in the contact area with the electrode was shaved.

[0101] The heating time was approximately 100 seconds. Healthy lungs reached approximately 41°C, while areas with emphysema reached approximately 55°C. All rats survived this treatment. Subsequent autopsies revealed scar tissue in the areas where emphysema had been induced.

[0102] In studies conducted on rats, dielectric heating was more effective than magnetic field-induced heating, although each method may have its own advantages. [Interpretation of Terms]

[0103] Unless the context clearly indicates otherwise, throughout this specification and the claims, Words like "comprise" and "comprising" should be interpreted in a comprehensive sense, meaning "not limited, but including," as opposed to an exclusive or exhaustive sense. "Connected," "joined," or any variation thereof means any direct or indirect connection or joining between two or more elements, which may be physical, logical, or a combination thereof. When used to describe this Specification, the terms "as specified," "above," "below," and similar terms refer to the entire Specification and not to any particular part thereof. The "or" in relation to a list of two or more items encompasses all possible interpretations of the word, namely, any of the items in the list, all of the items in the list, and any combination of the items in the list. The singular forms "a," "an," and "the" also include the meaning of any appropriate plural form. "Electromagnetic signal inductor" is a general term that encompasses electrodes (for example, which may be used to apply an electric field for dielectric heating), coils (for example, which may be used to apply a magnetic field for eddy current heating), and antennas (for example, which may be used to apply microwaves for heating tissue).

[0104] The terms indicating direction (if any) used in this specification and any appended claims, such as “vertical,” “lateral,” “horizontal,” “upward,” “downward,” “forward,” “backward,” “inward,” “outward,” “vertical,” “lateral,” “left,” “right,” “front,” “backward,” “upper,” “lower,” “upper,” and “down,” are determined by the specific orientation of the described and illustrated apparatus. The subject matter described herein may envision various other orientations. Therefore, these terms indicating direction are not strictly defined and should not be interpreted narrowly.

[0105] Certain embodiments of the present invention incorporate a control system or controller. Such a controller or control system may be implemented using specially designed hardware, configurable hardware, a programmable data processor configured by the provisions of software that can run on a data processor (optionally comprising "firmware"), and a dedicated computer or data processor specially programmed, configured or built to perform one or more steps, and / or two or more combinations thereof, in the manner described herein. Examples of specially designed hardware include logic circuits, application-specific integrated circuits ("ASICs"), large-scale integrated circuits ("LSIs"), and very large-scale integrated circuits ("VLSIs"). Examples of configurable hardware include one or more programmable logic devices such as programmable array logic ("PALs"), programmable logic arrays ("PLAs"), and field-programmable gate arrays ("FPGAs"). Examples of programmable data processors include microprocessors, digital signal processors ("DSPs"), embedded processors, graphics processors, numerical coprocessors, general-purpose computers, server computers, cloud computers, mainframe computers, and computer workstations. For example, one or more data processors in a control circuit for a device may implement the method described herein by executing software instructions in program memory accessible from those processors.

[0106] For example, while processes or blocks are presented in a given order, another example may execute a routine with multiple steps in a different order, or employ a system with multiple blocks. Some processes or blocks may be removed, moved, added, subdivided, combined, and / or modified to provide different combinations or partial combinations. Each of these processes or blocks may be implemented in various different ways. Also, while processes or blocks are sometimes shown as being executed sequentially, these processes or blocks may instead be executed in parallel or at different times.

[0107] Software and other modules may reside in servers, workstations, personal computers, tablet computers, embedded controllers, process controllers, and other devices suitable for the purposes described herein.

[0108] The present invention may also be provided in the form of a program product. The program product may comprise any non-temporary medium that, when executed by a data processor, holds a set of computer-readable instructions causing the data processor to perform the method of the present invention. The program product according to the present invention may take any of many different forms. Such a program product may include, for example, a magnetic data storage medium including a floppy diskette, an optical data storage medium including a hard disk drive, a CD-ROM, or a DVD, an electronic data storage medium including ROM, flash RAM, or an EPROM, or a non-temporary medium such as a chip (e.g., an EEPROM semiconductor chip) or nanotechnology memory that is embedded in hardware or pre-programmed. Computer-readable signals on the program product may optionally be compressed or encrypted.

[0109] According to several embodiments, the present invention may be implemented in software. More specifically, “software” includes any instructions executed on a processor and may include (but not limited to) firmware, resident software, and microcode. As those skilled in the art will know, both processing hardware and software may be centralized or distributed in whole or in part (or a combination thereof). For example, software and other modules may be accessible via local memory, via a network, via a browser or other application in a distributed computing environment, or via other means suitable for the purposes described above.

[0110] Where a component (e.g., an electrode, oscillator, switch, controller, temperature sensor, software module, processor, assembly, device, circuit, etc.) is mentioned, unless otherwise specified, any reference to that component (including any reference to the “means”) should be interpreted as including any component that performs the function of the described component (i.e., is functionally equivalent), including components that perform the function of the exemplary embodiment of the present invention but are not structurally equivalent to the disclosed structure, as equivalent to that component.

[0111] This specification provides specific examples of systems, methods, and apparatus for illustrative purposes only. These are merely examples. The technologies provided herein may be applied to systems other than those described above. Many changes, modifications, additions, omissions, and substitutions are possible in the practice of the invention. The invention includes modifications of the described embodiments which will be obvious to those skilled in the art. Such modifications include replacing features, elements, and / or operations with equivalent features, elements, and / or operations; mixing and matching features, elements, and / or operations from different embodiments; combining features, elements, and / or operations from the embodiments described herein with features, elements, and / or operations of other technologies; and / or modifications obtained by omitting or combining features, elements, and / or operations from the described embodiments.

[0112] The methods relating to the examples described herein may be modified. For example, while multiple elements may be shown as being performed sequentially, these elements may instead be performed simultaneously or in different orders.

[0113] Accordingly, the claims attached below and those introduced below are intended to be interpreted as including all such modifications, substitutions, additions, omissions, and partial combinations that can be reasonably presumed. The scope of the claims should not be limited by the preferred embodiments described in the examples, and the broadest interpretation in whole should be given in accordance with the description.

Claims

1. A device for heating the tissues of a body affected by emphysema or COPD above a threshold temperature for the treatment of emphysema or COPD, A heating energy signal generator, One or more electromagnetic energy signal inductors located outside the body, connected to receive an output signal from the heating energy signal generator and capable of applying heating energy to the tissue by coupling electromagnetic energy from the heating energy signal generator to the tissue, wherein the one or more electromagnetic energy signal inductors each have one or more signal inductors selected from the group consisting of electrodes, coils, and antennas, A controller connected to receive a temperature signal indicating the temperature of the tissue at one or more locations inside the body, wherein the controller is configured to adjust the heating energy applied to the tissue based at least in part on the temperature signal. Equipped with, The controller is configured to estimate the effect of perfusion differences on the characteristics of the lung tissue within the body, and to compensate for the perfusion differences by increasing or decreasing the electromagnetic energy delivered from the heating energy signal generator based on the estimated effect of the perfusion differences. The aforementioned difference in perfusion refers to the difference in blood flow in different parts of the lung. Device.

2. The apparatus according to claim 1, wherein the controller is configured to apply time-domain modulation to the heating energy signal generator.

3. The apparatus according to claim 1 or 2, wherein the controller is configured to control the heating energy signal generator to emit the output signal as a pulse signal, and the controller is configured to control the pulse width of the pulse signal.

4. The apparatus according to any one of claims 1 to 3, further comprising a subcutaneous and / or invasive temperature sensor, wherein the temperature signal includes an output signal from the subcutaneous and / or invasive temperature sensor.

5. The apparatus according to claim 4, wherein the temperature sensor includes a thermistor.

6. The apparatus according to claim 4 or 5, wherein the subcutaneous and / or invasive temperature sensor is located inside a thin needle.

7. The apparatus according to any one of claims 1 to 6, wherein the controller includes a thermal model of at least a portion of the body, the thermal model associates the temperature at one of the one or more locations with the temperature at the target location, the controller is configured to apply the thermal model using the temperature signal as input, and to adjust the heating energy at least in part based on the output of the thermal model.

8. The apparatus according to claim 7, wherein the thermal model comprises some or all of the following: the thermal conductivity of a plurality of different tissue types in the body, the distribution of the plurality of different tissue types in the body, the geometry of the one or more electromagnetic energy signal injectors, and a blood circulation model for estimating how the temperature at another location in the body correlates with the temperature at the target location.

9. The apparatus according to claim 7 or 8, wherein the thermal model includes known geometries of the one or more coils having the one or more electromagnetic energy signal inductors.

10. The apparatus according to any one of claims 1 to 3, wherein the temperature signal is derived from non-contact temperature measurement.

11. The apparatus according to claim 10, wherein the temperature signal includes a signal derived from processing magnetic resonance imaging (MRI) signals.

12. The apparatus according to any one of claims 1 to 11, wherein one or more signal inductors are controllable to change the direction of an electric field, and the controller is configured to periodically control one or more signal inductors to change the direction.

13. The apparatus according to any one of claims 1 to 12, wherein the one or more signal inductors has a coil that houses at least a part of the body inside the coil to form an inductor.

14. The controller includes a thermal model of at least a portion of the body, the thermal model relating the temperature at one of the one or more locations to the temperature at the target location. The thermal model includes a blood circulation model for estimating the correlation between the temperature at another location in the body and the temperature at the target location, some or all of the thermal conductivity of several different tissue types in the body, the distribution of the several different tissue types in the body, and the geometry of one or more electromagnetic energy signal injectors. The apparatus according to any one of claims 1 to 6, wherein the controller is configured to provide temperature control based on a calculation of the current temperature within the target tissue by using the correlation estimated by the thermal model and using the temperature measured at the other location instead of the temperature at the target location.

15. The apparatus according to claim 14, wherein the output of the thermal model is applied to control the power output of the heating energy signal generator.

16. The apparatus according to any one of claims 1 to 15, wherein the body is moved to different positions during treatment, the apparatus provides a user interface that can be operated by the user to indicate each position of the body during treatment, and the controller is configured to compensate for the differences in perfusion based at least partially indicated positions.

17. The aforementioned heating energy signal generator includes a radio frequency signal generator (RF signal generator), The apparatus according to any one of claims 1 to 16, wherein the RF signal generator is operable to output a signal having a frequency of at least 1 MHz.

18. The apparatus according to claim 17, wherein the frequency is in the range of approximately 10 MHz to approximately 100 MHz.

19. The apparatus according to any one of claims 1 to 18, wherein the controller is configured to raise the temperature at one of the one or more locations to at least a threshold temperature and to adjust the heating energy to maintain the temperature at or above the threshold temperature for a selected time.

20. The apparatus according to any one of claims 1 to 19, wherein the controller is configured to adjust the heating energy to prevent the temperature of the healthier lung tissue surrounding the lesional tissue at one of the one or more locations from exceeding a safe temperature threshold lower than 50°C.

21. The apparatus according to claim 20, wherein the controller is configured to stop applying the heating energy when the temperature at one of the locations exceeds the safety temperature threshold.

22. The apparatus according to claim 20 or 21, wherein the controller is configured to modulate the application of heating energy from the heating energy signal generator when the temperature at one of the locations is rising toward the safety temperature threshold at a rate faster than the temperature rise threshold and / or is closer to the safety temperature threshold than the safety margin.

23. The apparatus according to any one of claims 1 to 22, wherein the one or more electromagnetic signal inductors are mounted to move relative to the body.

24. A device for heating the tissues of a body affected by emphysema or COPD above a threshold temperature for the treatment of emphysema or COPD, A heating energy signal generator, One or more electromagnetic energy signal inductors located outside the body, connected to receive an output signal from the heating energy signal generator and capable of coupling electromagnetic energy from the heating energy signal generator to the body's tissues, wherein the one or more electromagnetic energy signal inductors each have one or more signal inductors selected from the group consisting of electrodes, coils, and antennas, A controller configured to provide open-loop temperature control of the target tissue based on a calculation of the current temperature within the target tissue, Equipped with, The controller includes a thermal model of at least a part of the body, and the thermal model relates the temperature at one of the one or more locations to the temperature at the target location. The thermal model includes a blood circulation model for estimating the correlation between the temperature at another location in the body and the temperature at the target location, some or all of the thermal conductivity of several different tissue types in the body, the distribution of the several different tissue types in the body, and the geometry of one or more electromagnetic energy signal injectors. The controller is configured to provide open-loop temperature control based on a calculation of the current temperature within the target tissue by using the correlation estimated by the thermal model and using the temperature measured at the other location instead of the temperature at the target location. Device.

25. The apparatus according to claim 24, wherein the output of the thermal model is applied to control the power output of the heating energy signal generator.

26. The apparatus according to claim 24 or 25, wherein the controller is configured to estimate the effect of perfusion differences on the characteristics of the lung tissue in the body, and to compensate for the perfusion differences by increasing or decreasing the electromagnetic energy delivered from the heating energy signal generator based on the estimated effect of the perfusion differences.

27. The apparatus according to claim 26, wherein the apparatus provides a user interface that can be used by the user to indicate the posture of the body during treatment, and the controller is configured to compensate for the difference in perfusion based at least partially indicated posture.

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