Thyroid Tumor Ablation with Radiofrequency RFA 101: The basics
1. Radiofrequency ablation is performed using a generator and internally cooled 7-cm electrodes with an 18-gauge active tip measuring 0.5, 0.7, or 1 cm.
2. The RF power and the size of the active tip chosen depend on the size and internal characteristics of the targeted nodule.
3.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.
4. 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.
5. Maximum 30 W with a 0.5 cm tip and 50 W with a 0.7 cm tip).
6.Using a trans-isthmic approach, the electrode is inserted from the isthmus to the lateral aspect of a target nodule.
7. The entire length of the electrode should be visualized to minimize possible complications.
8. Benign thyroid nodules can be treated using the moving-shot technique.
9. Given that most nodules are usually ellipsoid in shape, there is little margin between the nodule and the normal thyroid parenchyma.
10. Therefore, a fixed electrode technique, which creates a round ablation zone, is considered unsuitable.
11. The nodule is divided into multiple small conceptual ablation units and RFA is performed unit-by-unit by moving the electrode.
12.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.
13.This prevents visual disturbances caused by echogenic bubbles.
14. RFA is terminated when all conceptual units of the targeted nodule have been transformed into transient hyperechoic zones.
Thyroid RFA treatment is offered in Europe and Korea until USA FDA approval. See if you can have this treatment without surgery, neck scar and thyroid hormone treatment by call Matt at 310-393-8860 or firstname.lastname@example.org for details of my referral evaluation to be treated outside the USA.
Richard Guttler MD,FACE,ECNU