Detailed RFA Ablation Procedure for Benign Thyroid Nodules and Recurrent Thyroid Cancers:

Detailed RFA Ablation Procedure for Benign Thyroid Nodules and Recurrent Thyroid Cancers:

Detailed RFA Ablation Procedure for Benign Thyroid Nodules and Recurrent Thyroid Cancers:
 Comments: This is the blueprint for beginning RFA treatment in the USA with a thyroid friendly small thin electrode used in Europe and Asia. A major US endocrine society has formed a task force in Thyroid tumor Ablation with RFA. I am a member of the task force. The most significant finding from this consensus paper was the use of local and not any sedation.This will make it easier for our endocrinologists to do RFA in their offices if they do their own FNA procedures with high quality ultrasound that can be used for RFA monitoring the electrode tip.
Richard Guttler MD,FACE,ECNU
thyroid.com
Call Matt for details of  one on one RFA/PEI Master’s class workshop for endocrinologists in preparation to RFA introduction to the US market.
310-393-8860
thyroid.manager@protonmail.com

Detailed RFA Ablation Procedure for Benign Thyroid Nodules and Recurrent Thyroid Cancers:

Consensus Statement and Recommendations from Korean Society of Thyroid Radiology

Korean J Radiol. 2012 Mar-Apr; 13(2): 117–125.

Detailed RFA Ablation Procedure

Before the RFA a detailed pre-RFA checklist

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1.We recommend that RF ablation be performed using a ‘trans-isthmic approach’ and a ‘moving shot technique’ under local anesthesia because these techniques are useful for the safe and effective RF ablation procedure

moving-shot

Local injection of the thyroid gland capsule

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. A modified, straight, internally cooled electrode is suitable for use in the moving shot technique.

probes

2. Physicians should monitor blood pressure, pulse rate and the voice of each patient by regular conversations during the procedure.

3.If a voice change is suspected, the physician should stop the procedure immediately.

4. Although pain was found to be the most common complaints during RF ablation, it was relieved rapidly when the generator output was reduced or turned off.

5. Painkillers and sedatives can relieve pain during the ablation, but we do not recommend the painkillers or sedatives during the ablation because the early detection of complications is impossible in patients under deep sedation, which disturbs communication.

6. Ultrasound monitoring is important for detecting hemorrhage. If a hematoma is too large or pain is too severe due to hemorrhage, manual compression may be helpful, allowing the procedure to continue.

7. Hematomas usually disappear completely within 2 weeks. When a large hematoma develops, the RF procedure should be delayed for 1-2 weeks .

8. Patient condition should be monitored after the procedure. Patients with severe pain, edema, skin burn, vomiting, dyspnea, or voice change should be continuously monitored. The decision to admit a patient should be at the discretion of each physician.

9.During the follow-up periods, painkillers and steroids can be used to relieve symptoms.

10. Color-Doppler US is a primary imaging modality during follow-up.

11. In addition, patients can be monitored by CT, MRI, thyroid scans, and thyroid function tests.

12. Color-Doppler US is useful for detecting any undertreated or regrowing portion of the ablated nodules.

13. We recommend that patients be followed-up at 1-2, 6 and 12 months after RF ablation, as well as every 6-12 months thereafter, depending on the status of the treated nodules.

14. Additional treatments may be indicated in patients with incompletely resolved clinical concerns or if a viable growing portion of the nodule is detected on US.

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