Radiofrequency Ablation RFA of Thyroid Nodules 101
- Radiofrequency ablation is performed using a generator and internally cooled 7-cm electrodes with an 18-gauge active tip measuring 1 cm.
- Thyroid RF Mini-Probe
2. The initial RF power is usually 30–50 W with a 1-cm active tip, but may be 10 W with a 0.5-cm tip or 20 W with a 0.7-cm tip.
3, If a transient hyperechoic zone does not appear at the tip of the electrode within 5–10 seconds, the RF power on a 1 cm tip is increased at 10 W increments to a maximum of 80 W.
4. Using a trans-isthmic approach, the electrode is inserted from the isthmus to the lateral aspect of a target nodule.
AceNeedle ME Demos trans-isthmic approach
DR.Roberto Valcavi doing RFA from above the patient
5. The entire length of the electrode should be visualized to minimize possible complications.
6. Benign thyroid nodules can be treated using the moving-shot technique.
7. Given that most nodules are usually ellipsoid in shape, there is little margin between the nodule and the normal thyroid parenchyma. Therefore, a fixed electrode technique, which creates a round ablation zone, is considered unsuitable.
8. For this procedure, the target nodule is divided into multiple small conceptual ablation units and RFA is performed unit-by-unit by moving the electrode.
9. The electrode tip is initially positioned in the deepest and most lateral portion of the nodule, after which it is moved backward to the most superficial and most medial portion, thereby preventing visual disturbances caused by echogenic bubbles.
10. RFA is terminated when all conceptual units of the targeted nodule have been transformed into transient hyperechoic zones.
Day 1 post ablation
one month post ablation
5 months post ablation