Beruflich Dokumente
Kultur Dokumente
Dr Jean-Brice GAYET
Département d’imagerie médicale
What are we talking about ?
RF Ablation: 1996
GOLD STANDARD
IS THE
SURGICAL RESECTION
Why ?
Poison them
Starve them
Freeze them
Cook them
Resection is made More Possible if
Combined with Other Techniques
RF needle
Output current
Frictional Conductive
Heating Heating
Current (I)
Time (T)
Lesion size
Temperature
Electrode size
“The extent and nature of thermal injury are
dependent on two important factors, Temperature
& RF Application Duration.”
8 SB XLi
(7 cm)
6 SB XL &
Lesion Size (cm)
Semi- Flex
(5 cm)
4
SB XL &
Cell Semi-Flex
2 Death (3 cm)
Body
StarBurst
0 Temp SDE (2 cm)
30 50 70 90 110
Monitor heat
Thermocouples (Real-time measurement)
Check temps at end to ensure cell death
Monitor duration
Consistent & Reproducible
Methods of Control of Energy
Delivery
Global impedance measurement, no regional
differentiation.
Global impedance measurement and indirect
central temperature measurement by cooling
water temperature.
Direct measurement of regional peripheral
temperatures with power control feedback
system.
Direct regional peripheral temperature endpoint,
control of rehydration by impedance during full
power application.
A few medical and non-
medical considerations
Radionics / Tyco
Duty cycle.
Internal cooling of the Radionics probe.
The power is fully switched on & off
frequently, the ratio of on to off giving an
average power.
This causes shock waves that the patient
can sometimes feel. This is why it was
thought that general anaesthesia was
necessary.
Excess power is removed by cooling the
tissue immediately in contact with the
probe by cooling the probe itself. This is
analogous to controlling your car’s speed
with the brakes instead of the
accelerator.
Remember that the energy deposited in the ablation
volume is useless until converted into the heat that
actually does the work
Measuring temperature is therefore the ONLY way to
know & control what is happening. Radionics’ probes
only measure the temperature of the cooling water, or, if
that is switched off ONLY the temperature of the
CENTRE of the ablation. It is the PERIPHERAL
temperatures that are critical
Radionics only senses the need to reduce power by total
impedance, not by temperature, nor with any zonal
differential information.
Boston
Power control is only by total impedance without
any temperature sensing nor any regional
information. Power is manually adjusted by the
physician, needing constant attention.
Metastasis
Larger necrosis
more important « Post
RFA » syndrome
POST TACE + RFA
To-be resolved question: how and when ?
TACE + RFA
Endocrine Metastasis ?
Combined Treatments
Technological Advances