Radiofrequency ablation, Cryoablation,  Microwave, Non-Thermal Ablation- IRE and PEF

Advantages:

• What is bone or soft tissue tumor ablation and how does it work?
  • Ablation is a minimally invasive treatment to destroy cancerous cells or tumors using heat, cold or pulsed electrical fields.
• What are the Indications for ablation?
  • Pain associated with a benign or malignant tumor in bone or soft tissues
  • You are not a surgical candidate or the tumor is in a high risk location for surgery
  • You want to decrease your tumor size to be a better canidate for surgery or radiation 
  • Your tumor does not respond well to chemotherapy
  • You do not want sugery or radiation treatment
  • You have pain from your tumor and want a palliative treatment that is minimally invasive
  • Examples of musculoskeletal tumors that can be treated by ablation
    •  Osteoid Osteoma, chondroblastoma, aneurysmal bone cyst
    • Painful Bone Metastasis
    • Painful soft tissue metastasis or masses
    • Primary bone tumors that can’t undergo resection
• How is the procedure performed?
  • • Percutaneous ablation is a minimally invasive procedure where a specialized ablation needle (applicator) is placed into the target tumor under image guidance with CT, US and/ or fluoroscopy. The needle uses extreme heat9 (Radiogrequency ablation and Microwave ablation), extreme cold (Cryoablation) or non-thermal electrical pulses (IRE) to kill tumor cells while surrounding tissue is preserved.
• Can be combined with bone stabilization for impending or current fractures?
  • Bone stabilization can be performed by injecting cement into the targeted bone, percutaneous screw fixation percutaneous polymer implant, or a combination of the above.

Cryoablation:

Radiofrequency Ablation:

Advantages:

• What is tumor embolization?
  • Tumor embolization is a minimally invasive procedure where a small catheter is guided through your blood vessels to shut down the blood supply to the tumor or inject chemotherapy directly to the tumor. By Blocking the blood supply, oxygen and nutrients are cut off from the tumor, causing it to die. The tumor can shrink and offer pain relief.
  • Online information: https://www.radiologyinfo.org/en/info/cathembol

                                                            BEFORE:                                                                                                                                                AFTER:

• Indications:
  • Aneurysmal Bone Cysts, Unicameral Bone Cyst

Advantages: Minimally invasive, relatively high treatment success rates, low complication rates

Indications: Vascular malformations can cause pain, swelling, deformity, bleeding and blood shunting. Treatment is aimed at the type of the vascular malformation including venous, arterial, lymphatic or a combination of these.

Treatment options: Sclerosis, Embolization

• Online information: https://www.radiologyinfo.org/en/info/vascular-malformations

Varicose veins

May Thurners compression

• Superficial venous reflux

• Online information:
  • https://www.radiologyinfo.org/en/info/varicose-veins
  • https://youtu.be/rOtBm-OFN3I

• Advantages:
  • Minimally invasive treatment for osteoarthritis aimed to decrease the blood flow to the lining of your knee that is inflamed, called the synovium. This can help manage the symptoms associated with osteoarthritis.
• Indications:
  • Patients with symptomatic moderate to severe osteoarthritis who are not yet ready to under a knee replacement or who are not surgical candidates. 
• Online information:
  • https://www.sirweb.org/media-and-pubs/media/news-release-archive/sir-2021-knee-pain-031621/

• Indications:
  • Patients with pathologic, osteoporotic, or traumatic fractures of the spine casusing severe or debilitating pain.
•  Can be combined with ablation and/or biopsy of a tumor at the same time
• Online Information:
  • https://www.radiologyinfo.org/en/info/vertebro 
  • https://www.sirweb.org/patient-center/conditions-and-treatments/vertebral-compression-fractures/ 

• Indications:
  • Patients with pathologic, osteoporotic, or insufficiency fractures of the sacrum causing severe or debilitating pain.
• Can be combined with ablation and/or biopsy of a tumor at the same time.

• Advantages:
  • Minimally invasive
  • Opioid-free pain relief alternative
• Image Guided Procedures:

  • Nerve blocks: Intercostal nerve and erector spinae block: Pain from ribs, sternum, chest wall, lung and pleura, breast, upper abdomen Transabdominal plane block: Pain from abdominal wall masses or prior surgery Celiac plexus: Abdominal or back pain Superior hypogastric nerve: Pelvic pain Ganglion Impar: Pain in lower pelvis/ rectum/ vagina Pudendal nerve: Perineal or pelvic pain Sacroiliac joint : Low back and buttock pain

    Permanent Nerve Treatments: Cryoneurolysis Alcohol Neurolysis

    Ablation

    Lumbar sympathectomy: Injection to sympathetic nerves that increase the blood flow to the skin on your legs and help with healing or lower extremity and pelvic pain

• Example patients that can benefit:
  • Rib or chest wall pain from a mass
  • Breast pain from a mass or after mastectomy
  • Abdominal wall or rectus muscle metastasis with pain
  • Lower extremity pain from cancer, refractory peripheral arterial disease or lymphadema
  • Pudendal neuralgia
  • Pelvic pain from cancer
    
• Online information: https://www.radiologyinfo.org/en/info/nerveblock