Current status and challenges of minimally invasive ultrasound thermal ablation technology.

Image-guided minimally invasive ultrasound thermal ablation has been widely studied for disease treatment due to its unique advantages, such as large treatment volumes and conformal delivery of ablation energy. This review presents the state-of-the-art of this technology and highlights the challenges. Ultrasound applicator designs, common image guidance methods, and treatment sites are first summarized. The recent decade has shown that despite the continuous development of this technology, only limited clinical translations have succeeded. To push this technology forward, challenges regarding the advancement of applicators, precise and real-time imaging guidance methods, and the validation of the clinical effectiveness of potential treatment sites are described. Finally, future directions are discussed. It is envisioned that future development of artificial intelligence-powered applicators with conformal ablation ability and multi-modal image guidance will enable surgeons to perform precise, visible, customizable treatment.