Lesson 1Adjunctive Techniques: Track Ablation, Artificial Ascites, and Adjunct Embolisation to Reduce Heat SinkThis section reviews supportive techniques to boost safety and effectiveness, such as track ablation to stop bleeding and seeding, artificial ascites for organ shifting, and adjunct embolisation to lessen heat sink effects in ablation.
Track ablation to prevent bleeding and seedingCreating artificial ascites: indications and methodArtificial pleural effusion for dome lesionsAdjunct transarterial embolization for heat sinkCombining ablation with portal vein embolizationDocumentation and follow-up of adjunctive measuresLesson 2Tumour Assessment: Size, Segmental Location, Proximity to Vessels/Bile Ducts, and Surgical CandidacyThis section addresses tumour evaluation before ablation, including size measurement, segmental and subsegmental position, closeness to vessels and bile ducts, and review of surgical suitability and other curative alternatives.
Measuring tumor size and multiplicitySegmental and Couinaud-based localizationProximity to major vessels and bile ductsAssessing heat sink risk from large vesselsEvaluating surgical and transplant candidacySelecting ablation versus other local therapiesLesson 3Ablation Modality Selection: Principles, Advantages, and Limitations of Radiofrequency, Microwave, Cryoablation, and Irreversible ElectroporationThis section compares ablation types, including radiofrequency, microwave, cryoablation, and irreversible electroporation, highlighting action mechanisms, benefits, drawbacks, best uses, and device-specific safety factors.
Biophysics of thermal and nonthermal ablationRadiofrequency ablation: strengths and limitsMicrowave ablation: power and speed advantagesCryoablation: ice ball dynamics and risksIrreversible electroporation: niche indicationsChoosing modality by tumor size and locationLesson 4Needle Path Planning: Safe Trajectories, Avoidance of Pleura, Bowel, and Major Vessels, and Hydrodissection TechniquesThis section explains designing safe needle paths for liver ablation, emphasising avoidance of pleura, bowel, and major vessels, using hydrodissection and other methods to safeguard nearby vital structures.
Analyzing cross‑sectional imaging for safe accessPlanning trajectories to avoid pleura and lung basesStrategies to protect bowel and stomach loopsAvoiding and traversing near major hepatic vesselsHydrodissection: indications, agents, and techniqueUse of patient positioning to optimize needle pathLesson 5Patient Selection and Preprocedural Optimisation: Liver Function (Child-Pugh), Coagulation, and Anaesthesia ConsiderationsThis section covers patient selection and preparation before ablation, assessing liver function via Child-Pugh and MELD, coagulation state, comorbidities, anaesthesia plans, and ways to lower peri-procedural risks.
Oncologic indications and contraindicationsChild-Pugh and MELD scoring for liver reserveCoagulation assessment and correction strategiesRenal function and contrast-related considerationsAnesthesia choice: local, MAC, or generalPreprocedural fasting, medications, and consentLesson 6Imaging Guidance Options: Real-Time Ultrasound, CT-Guidance, CT-Fluoroscopy, MRI Guidance, and Image Fusion WorkflowsThis section explores imaging guidance choices for liver ablation, such as real-time ultrasound, CT, CT-fluoroscopy, MRI, and image fusion, stressing selection, precision, and radiation safety aspects.
Conventional and contrast-enhanced ultrasoundCT and CT-fluoroscopy guidance techniquesMRI-guided ablation: logistics and benefitsImage fusion of US with CT or MRI datasetsNavigation systems and needle tracking toolsRadiation dose optimization during CT guidanceLesson 7Intra-Procedure Monitoring of Ablation Zone and Immediate Technical Success CriteriaThis section details monitoring the ablation zone during procedure using ultrasound, CT, or MRI, criteria for sufficient coverage and margins, immediate success evaluation, and real-time adjustments or repeats.
Real-time imaging of probe position and angleMonitoring ablation zone growth over timeAssessing minimal ablative margin requirementsUse of contrast-enhanced US or CT intra-procedureCriteria for immediate technical success or failureDecision-making for repeat or extended ablationLesson 8Imaging for Planning: Multiphase Liver CT, Contrast-Enhanced MRI, and PET When IndicatedThis section reviews imaging for ablation planning, focusing on multiphase liver CT, contrast-enhanced MRI, and PET as needed, noting lesion visibility, staging, and vascular/biliary mapping details.
Multiphase CT protocols and timing optimizationMRI sequences for lesion detection and marginsUse of hepatobiliary contrast agents in MRIRole of PET and PET/CT in lesion characterizationImaging-based staging and resectability assessmentMapping vascular and biliary anatomy pre-ablationLesson 9Ablation Procedural Steps: Patient Positioning, Sterile Setup, Probe Insertion, Energy Delivery Parameters, Overlapping Ablations for MarginThis section describes step-by-step liver ablation execution, from patient positioning and sterile prep to probe insertion, energy settings, overlapping ablations for margins, and procedure documentation.
Optimal patient positioning by segment locationSterile field setup and antibiotic prophylaxisSkin entry planning and local anesthesiaProbe insertion, adjustment, and confirmationEnergy delivery settings and cycle durationOverlapping ablations to secure tumor marginsLesson 10Complications: Haemorrhage, Bile Leak, Thermal Injury to Adjacent Structures, Abscess — Recognition and ManagementThis section discusses liver ablation complications like haemorrhage, bile leak, thermal damage to nearby organs, abscess, and needle-track seeding, emphasising early recognition, imaging signs, and management steps.
Risk factors for major and minor complicationsRecognition and treatment of hemorrhageDiagnosis and management of bile leakThermal injury to bowel, diaphragm, and skinHepatic abscess: prevention and drainageNeedle-track seeding and long-term outcomesLesson 11Post-Ablation Imaging Protocols and Follow-Up Schedule to Confirm Complete AblationThis section outlines post-ablation imaging plans, including timing and modality choices, standard reporting of zones, criteria for full response vs residual disease, and follow-up schedules with intervals.
Immediate post-procedure imaging objectivesFirst follow-up scan timing and modality choiceImaging criteria for complete ablationDetection of residual or recurrent tumorStandardized reporting of ablation findingsLong-term surveillance intervals and duration
