PubMed · 15647915
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Rafael Inigo Pavlovich. 2005-01-13. Radiofrequency: future applications for current knowledge.. https://doi.org/10.1007/s00264-004-0621-7
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Image-guided radiofrequency (RF) ablation is a minimally invasive therapy option in the treatment of primary and secondary hepatic malignancies. Magnetic resonance (MR) imaging offers an accurate pre-interventional imaging having important impact on patient selection and planning of the ablation procedure. Peri-interventional imaging is used for targeting, monitoring, and controlling of the ablation procedure. Due to a high soft-tissue contrast offering delineation of tumor tissue and the surrounding anatomy, coupled with multiplanar capabilities, MR imaging is an advantageous targeting technique compared with ultrasonography (US) or computed tomography (CT). MR imaging is sensitive to thermal effects enabling a monitoring of ablation therapy subsequently being supportive to control the ablation procedure. Therefore, MR imaging can fulfil the conditions for overlapping ablations by enabling a precise repositioning of the MR compatible RF applicator if required. Thus, the probability of achieving complete coagulation in larger tumors within a single therapy session is potentially increased. A monitoring of thermal effects is moreover essential in order to prevent unintended tissue damage from critical structures in the surrounding of the target tissue. Post-interventional imaging is performed to assess treatment response after RF ablation and has prognostic impact, as an early detection of treatment failure, e.g. residual tumor tissue, enables immediate therapy. Nevertheless, differential diagnostic difficulties arise from benign periablational enhancement which may cover tumor tissue. Hence, further evaluation and improvement in the assessment of treatment response is essential.
AIMS: To perform a comprehensive analysis of all aspects of patient and in-room personnel radiation dosimetry in interventional electrophysiology. METHODS AND RESULTS: Measurements were performed during 19 diagnostic electrophysiology studies and 24 catheter ablations. Kerma-area product and exposure time values were 48.7 (6.4-230) Gy cm2 and 25.5 (4.4-79.2) min for ablation, and 12.5 (4.5-117.2) Gy cm2 and 4.5 (1.2-31) min for diagnostic studies, respectively. Patient effective doses were 15.2 (2.1-59.6) mSv for ablation and 3.2 (1.3-23.9) mSv for diagnostic procedures. Radiation risk to the patient was estimated to be up to eight cases of fatal cancer in 10,000 procedures. The risk of development of fatal cancer was less than 3x10(-6) per procedure to the primary operator. The risk for the nurse and technician was much lower. The dose per procedure for the primary operator was 7.1 microGy at the eyes, 0.79 microGy at the chest under the lead apron, 13.68 microGy at the chest over the apron, 3.82 microGy at the thyroid, 17.76 microGy at the left hand, and 12.11 microGy at the left knee. CONCLUSION: As far as radiation exposure is concerned, electrophysiology studies followed by radiofrequency ablation are safe procedures for both patient and personnel when performed in catheterization laboratories with modern equipment, experienced operators, and standard safety precautions.
The high prevalence of gastroesophageal reflux disease (GERD) in Western societies has accelerated the need for new modalities of treatment. Currently, medical and surgical therapies are widely accepted among patients and physicians. New potent antisecretory drugs and the development of minimally invasive surgery for the management of GERD are at present the pivotal and largely accepted approaches to treatment. The minimally invasive treatment revolution, however, has stimulated several new endoscopic techniques for GERD. Up to now, the data is limited and further studies are necessary to compare the advantages and disadvantages of the various endoscopic techniques to medical and laparoscopic management of GERD. New journal articles and abstracts are continuously being published. The Food and Drug Administration has approved 3 modalities, thus gastroenterologists and surgeons are beginning to apply these techniques. Further trials and device refinements will assist clinicians. This article will present an overview of the various techniques that are currently on study. This review will report the efficacy and durability of various endoscopic therapies for gastroesophageal reflux disease (GERD). The potential for widespread use of these techniques will also be discussed. Articles and abstracts published in English on this topic were retrieved from Pubmed. Due to limited number of studies and remarkable differences between various trials, strict criteria were not used for the pooled data presented, however, an effort was made to avoid bias by including only studies that used off-PPI scoring as baseline and intent to treat.