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Review finds substantial discrepancies in LIFU simulation software and skull modeling approachesSimulation software shows big differences before doctors use it on patients

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Key Takeaway
Recognize that LIFU simulation software and skull modeling methods show substantial discrepancies, requiring validation before clinical use.

This is a simulation comparison study that reviews the consistency of low-intensity focused ultrasound (LIFU) simulation results between two software platforms, k-Plan and BabelBrain, and between two skull modeling approaches (CT vs. pseudo-CT). The review found substantial discrepancies in simulation results both between software platforms and between skull modeling approaches. No pooled effect sizes or statistical measures were reported.

The authors note that the outputs of k-Plan and BabelBrain have not been empirically compared prior to this study, and that CT scans carry radiation risk. These limitations underscore the need for ground-truth validation of current sonication simulation software and further optimization of pseudo-CT algorithms before widespread clinical adoption.

Clinicians should interpret these findings cautiously, as the study does not provide data on clinical efficacy or safety outcomes. The discrepancies highlight the importance of standardizing simulation methods to ensure reliable treatment planning for LIFU.

Two common computer programs used to plan focused ultrasound treatments gave very different answers. One tool used real CT scans, while the other used a fake version called pseudo-CT. The other difference was between two different software platforms called k-Plan and BabelBrain. Both setups produced substantial discrepancies in their simulation results. This means the computers did not agree on the best plan for the treatment.

Before doctors use these tools on real people, we need to know if the plans are trustworthy. The study found that the outputs of k-Plan and BabelBrain have never been compared directly before. This lack of comparison makes it hard to know which tool is better or if they are safe to use together.

Using CT scans carries a small radiation risk. However, the main worry here is that the computer models might not match reality. We need ground-truth validation of current sonication simulation software before widespread clinical adoption. Further optimization of pseudo-CT algorithms is also needed.

This review highlights the urgent need for more testing. Until we have better proof that these simulations match real patient outcomes, doctors should be cautious. The goal is to ensure patients get the safest and most effective treatment possible.

What this means for you:
Simulation tools for focused ultrasound planning show big differences that need more testing before doctors use them.

Study Details

EvidenceLevel 5
PublishedApr 2026
View Original Abstract ↓
Background: Transcranial low-intensity focused ultrasound (LIFU) is an emerging tool for noninvasive neuromodulation, with potential therapeutic applications across a range of neuropsychiatric disorders. As the field advances toward clinical translation, individualized simulations of sonication parameters are critical for estimating dosing to ensure safety, efficacy, and reproducibility. Currently, k-Plan (Brainbox Ltd.) and BabelBrain (open-source) are two widely used software packages for sonication simulation, yet their outputs have not been empirically compared. While CT scans remain the gold standard for capturing fine anatomical details of the skull, their use carries radiation risk. As an alternative, algorithms generating MRI-based pseudo-CTs have been developed to approximate skull bone properties. Objective: In this study, we directly evaluated the consistency of simulation results from the two platforms, k-Plan and BabelBrain. We also examined the impact of skull modeling using CT vs. pseudo-CT on LIFU simulation results. Methods: We compared LIFU simulation results between the two platforms when applied to the same individuals, trajectories, and using the same sonication protocol parameters. To assess the validity of using pseudo-CTs for simulations, we also compared simulation outputs generated using CT versus pseudo-CT inputs. Results: Our results reveal substantial discrepancies both between software platforms (k-Plan vs. BabelBrain) and between skull modeling approaches (CT vs. pseudo-CT). These findings underscore the urgent need for ground-truth validation of current sonication simulation software and highlight the importance of further optimization of pseudo-CT algorithms before widespread clinical adoption.
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