A Review of High-Intensity Focused Ultrasound
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe authors reviewed the progress and applications of high-intensity focused ultrasound in recent years. There have already been many review papers in the same topic. The novelty of this article should be stressed for publication. Some physical concepts are not correct. Perspectives on the HIFU clinical outcomes and future development is required.
The title may be changed to emphasize the authors only review HIFU clinical trials done in Oxford.
The position of citation should be consistent.
Line 20 the acoustic intensity of ultrasound diagnosis is not fixed
Line 21-22 the acoustic intensity of HIFU could be higher than 1500 W/cm2
Line 22-24 this statement is not right. If the acoustic attenuation of medium is very low, such as that of water, the temperature at the focus will not be high
Line 24 the term of “lesion” used here is not correct, change it to “coagulative lesion”
Line 38-40 thermal perfusion is the intrinsic characteristics of medium and cannot be eliminated
Line 42-43 how about cavitation histotripsy-induced tissue emusification? Pure mechanical erosion without thermal effect?
Line 66-67 very confusing sentence
Line 70-73 in many HIFU clinical applications, such as uterine fibroids, general anesthesia is not required
Figure 1 only keep JC200 system in the plot and remove the old unit (JC system) that is not used in clinics
Section of Technology needs more detailed information
Line 104-105 What does “A 2010 study” mean? A study in 2010?
Line 146 change “in 1995 be Madersbacher et al.” to “in 1995 by Madersbacher et al.”
Figure 3 put “Axial” in one line
Line 271 specify “(ref)”
ter Haar is the last name, not Haar
Comments on the Quality of English LanguageThe authors reviewed the progress and applications of high-intensity focused ultrasound in recent years. There have already been many review papers in the same topic. The novelty of this article should be stressed for publication. Some physical concepts are not correct. Perspectives on the HIFU clinical outcomes and future development is required.
The title may be changed to emphasize the authors only review HIFU clinical trials done in Oxford.
The position of citation should be consistent.
Line 20 the acoustic intensity of ultrasound diagnosis is not fixed
Line 21-22 the acoustic intensity of HIFU could be higher than 1500 W/cm2
Line 22-24 this statement is not right. If the acoustic attenuation of medium is very low, such as that of water, the temperature at the focus will not be high
Line 24 the term of “lesion” used here is not correct, change it to “coagulative lesion”
Line 38-40 thermal perfusion is the intrinsic characteristics of medium and cannot be eliminated
Line 42-43 how about cavitation histotripsy-induced tissue emusification? Pure mechanical erosion without thermal effect?
Line 66-67 very confusing sentence
Line 70-73 in many HIFU clinical applications, such as uterine fibroids, general anesthesia is not required
Figure 1 only keep JC200 system in the plot and remove the old unit (JC system) that is not used in clinics
Section of Technology needs more detailed information
Line 104-105 What does “A 2010 study” mean? A study in 2010?
Line 146 change “in 1995 be Madersbacher et al.” to “in 1995 by Madersbacher et al.”
Figure 3 put “Axial” in one line
Line 271 specify “(ref)”
ter Haar is the last name, not Haar
Author Response
The majority of these comments are very helpful and the manuscript will be changed accordingly
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsIn this review authors stated that “high-intensity focused ultrasound (HIFU) has been the subject of interest for medical research. It is a non-invasive procedure which causes tissue necrosis in a very well defined area, at a variable distance from the transducer, through heating or cavitation. Over the past two decades, the technology has improved considerably and the clinical indications have broadened. This review is worth to read and the following issues can be addressed.
1. In the abstract, authors should summarize the results of your review and explain their significance in the field of study. Also, you should highlight the contribution of your findings to the current field and suggest possible directions for further research.
2. A scheme or a table is recommend to outline the tools, techniques, or methods you use to collect data, conduct experiments, or analyze.
3. Please be assure that you have the copyrights of the used pictures in figures 1-3.
Author Response
Thank you
Please see attached
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsHigh-Intensity Focused Ultrasound (HIFU) has indeed garnered significant attention over the past 80 years as a non-invasive medical procedure. The review highlights the evolution of HIFU technology, emphasizing its forward trajectory.
While HIFU has shown promise and advancements in medical applications, like any medical technology, it is not without its drawbacks. Some potential limitations and drawbacks of HIFU include:
1. Limited Depth Penetration:
• HIFU may face challenges in treating deep-seated tumors or tissues due to the limited penetration depth of ultrasound waves. This can make it less effective for treating certain conditions located deep within the body.
2. Treatment Duration:
• The time required for a HIFU treatment session can be relatively long, depending on the target area. This may pose challenges for patients and healthcare providers in terms of scheduling and resource allocation.
3. Imaging and Monitoring Challenges:
• Real-time imaging and monitoring during HIFU procedures are crucial for ensuring accurate targeting and assessing treatment efficacy. However, challenges may arise in visualizing the treatment area in real-time, especially in areas with complex anatomy or motion artifacts.
4. Side Effects:
• While HIFU is considered non-invasive, there can still be side effects, including pain, swelling, and skin burns, especially at the treatment site. Minimizing these side effects remains an ongoing focus of research and development.
It's important to note that ongoing research and technological advancements aim to address some of these limitations, and the drawbacks associated with HIFU may evolve as the technology continues to mature. As with any medical procedure, the benefits and risks should be carefully weighed based on individual patient characteristics and the specific medical condition being treated.
Author Response
Thank you. Some helpful points see attached
Author Response File: Author Response.pdf
Reviewer 4 Report
Comments and Suggestions for AuthorsThe submitted paper is entitled: "The Review of HIFU" and presents many reports on using HIFU in medical applications, mainly in cancer treatment. Unfortunately, the prepared literature survey is not comprehensive and presents primarily old papers. More importantly, the central part (Chapter 4) does not comment on the mentioned publications from a perspective, but instead, it simply recollects the results. The review paper should present the perspective of the authors on the presented works.
Some parts of the text are weirdly entitled, e.g., Chapter 3 (The Technology) presents five sentences on the devices used and shows images from advertisements for the equipment (?). In turn, the history of HIFU (Chapter 2) covered some essential facts, but my impression is that it was added only to highlight the importance of the work done by one of the Authors.
Generally, the paper is poorly edited, and it is not proofread. It is hard to believe it is affiliated with the University of Oxford. My more specific technical comments are attached below:
1) The Abstract does not present a description of the covered topics. It is too short and general and could not interest the potential readers.
2) High-Intensity Focused Ultrasound is a common term; however, in the text, it appears in many forms (see, e.g., line 17).
3) The references of publications and figures in the text should be correctly cited (they should be placed before dots and commas). See, e.g., line 48 and 116
4) The sources of figures should be added.
5) It is unclear why the mention of HSPs (quite common knowledge among scientists involved in ultrasound hyperthermia and ablation) is at the end of the paper.
To conclude, I do not see the submitted paper as a publication that could be published in an international journal. It must present the historical background and new perspective on the published works. The topic is broadly discussed in the existing literature, and if needed, the readers could find many novel reviews covering the information described here.
The Authors are native speakers. Therefore, the language is nice and smooth, but if it could be resubmitted in any form in the future, this paper should be: (i) much more comprehensive with relevant novel positions;
(ii) much better structured with logical chapters, figures, and subchapters and, most importantly;
(iii) presents the authors' perspective on the publications, not just list them.
Author Response
Thank you please see attached comments
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsThe authors have made necessary modifications on the manuscript. Now the paper is in a good quality for publication.
Author Response
Thank you
Reviewer 4 Report
Comments and Suggestions for AuthorsThe Authors made some corrections after the comments of reviewers. However, the changes are rather minor corrections, while the whole structure of the "review" does not meet the standards of review papers. The presented text could be a nice base for a much more comprehensive review and I recommend preparing the proper one in the future.
Comments on the Quality of English LanguageThe English language is fine.
Author Response
Three of the four reviewers are now happy with this paper. With respect I disagree with this reviewer about the nature of the review. I have reviewed many papers myself and of course it is true that one could do a far more comprehensive review, but in my view this paper gives a good overview of HIFU for those who have little knowledge in the field
