Lesson 1Adjunctive techniques: track ablation, artificial ascites, an' adjunct embolization to reduce heat sinkDis section review adjunctive techniques dat enhance safety an' efficacy, includin' track ablation to prevent bleedin' an' seedin', artificial ascites or pleural effusion fi organ displacement, an' adjunct embolization to mitigate heat sink.
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 2Tumor assessment: size, segmental location, proximity to vessels/bile ducts, an' surgical candidacyDis section address tumor assessment before ablation, includin' measurement of size, segmental an' subsegmental location, proximity to vessels an' bile ducts, an' evaluation of surgical candidacy an' alternative curative options.
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, an' limitations of radiofrequency, microwave, cryoablation, an' irreversible electroporationDis section compare ablation modalities, includin' radiofrequency, microwave, cryoablation, an' irreversible electroporation, focusin' on mechanisms of action, advantages, limitations, ideal indications, an' device-specific safety considerations.
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 plannin': safe trajectories, avoidance of pleura, bowel, an' major vessels, an' hydrodissection techniquesDis section explain how to design safe needle trajectories fi liver ablation, focusin' on avoidance of pleura, bowel, an' major vessels, an' di use of hydrodissection an' ancillary maneuvers to protect adjacent critical 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 an' preprocedural optimization: liver function (Child-Pugh), coagulation, an' anesthesia considerationsDis section cover patient selection an' optimization before ablation, includin' assessment of liver function wid Child-Pugh an' MELD, coagulation status, comorbidities, anesthesia plannin', an' strategies to reduce peri-procedural risk.
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 6Imaghin' guidance options: real-time ultrasound, CT-guidance, CT-fluoroscopy, MRI guidance, an' image fusion workflowsDis section examine imaghin' guidance options fi liver ablation, includin' real-time ultrasound, CT, CT-fluoroscopy, MRI guidance, an' image fusion workflows, wid emphasis on modality selection, accuracy, an' radiation considerations.
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 monitorin' of ablation zone an' immediate technical success criteriaDis section detail intraprocedural monitorin' of di ablation zone usin' ultrasound, CT, or MRI, criteria fi adequate coverage an' margins, assessment of immediate technical success, an' strategies to adjust or repeat ablations in real time.
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 8Imaghin' fi plannin': multiphase liver CT, contrast-enhanced MRI, an' PET when indicatedDis section review imaghin' modalities used fi ablation plannin', emphasizin' multiphase liver CT, contrast-enhanced MRI, an' PET when indicated, wid attention to lesion conspicuity, stagin', an' mappin' of vascular an' biliary anatomy.
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 positionin', sterile setup, probe insertion, energy delivery parameters, overlappin' ablations fi marginDis section describe stepwise execution of liver ablation, from patient positionin' an' sterile preparation to probe insertion, energy delivery parameters, overlappin' ablations fi adequate margins, an' documentation of procedural details.
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: hemorrhage, bile leak, thermal injury to adjacent structures, abscess — recognition an' managementDis section discuss complications of liver ablation, such as hemorrhage, bile leak, thermal injury to adjacent organs, abscess, an' needle-track seedin', wid emphasis on early recognition, imaghin' findin's, an' stepwise management strategies.
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 imaghin' protocols an' follow-up schedule to confirm complete ablationDis section outline post-ablation imaghin' protocols, includin' timin' an' modality selection, standardized reportin' of ablation zones, criteria fi complete response versus residual disease, an' structured follow-up schedules an' 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
