Task Group 101 of the AAPM has prepared this report for medical physicists, clinicians, and therapists in order to outline the best practice guidelines for the external-beam radiation therapy technique referred to as stereotactic body radiation therapy (SBRT). The task group report includes a review of the literature to identify reported clinical findings and expected outcomes for this treatment modality. Information is provided for establishing a SBRT program, including protocols, equipment, resources, and QA procedures. Additionally, suggestions for developing consistent documentation for prescribing, reporting, and recording SBRT treatment delivery is provided.

https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1118/1.3438081

Stereotactic body radiation therapy: The report of AAPM Task Group 101

An endoscopic bipolar forceps includes an elongated shaft having opposing jaw members at a distal end thereof. The jaw members are movable relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. The forceps also includes a source of electrical energy connected to each jaw member such that the jaw members are capable of conducting energy through tissue held therebetween to effect a seal. A generally tube-like cutter is included which is slidably engaged about the elongated shaft and which is selectively movable about the elongated shaft to engage and cut tissue on at least one side of the jaw members while the tissue is engaged between jaw members.

Vessel sealer and divider

In an electrosurgical generator for generating radio frequency power, the generator includes a radio frequency output stage having two or more output connections, and a power supply coupled to the output stage for supplying power to the output stage. A controller is operable to cause the generator to supply a blended output signal alternating constantly between a first output signal across the output connections in which the radio frequency output voltage developed across the output connections is limited to at least a first predetermined threshold value for cutting or vaporisation of tissue, and a second output signal across the output connections in which the radio frequency output voltage developed across the output connections is limited to a second threshold value for coagulation. There is also provided adjustment means, operable by a user of the electrosurgical generator, for changing between various preset settings for the blended signal, the preset settings each having a predetermined duty cycle of the blended signal that is limited to the first threshold value for cutting or vaporisation, and a predetermined duty cycle of the blended signal that is limited to the second threshold value for coagulation.

Electrosurgical generator and system

PURPOSE: To report complications encountered by members of a collaborative group who performed radio-frequency (RF) ablation in patients with focal liver cancer. MATERIALS AND METHODS: Members of 41 Italian centers that were part of a collaborative group used a percutaneous internally cooled RF ablation technique and a standardized protocol for follow-up. They completed a questionnaire regarding number of deaths, presumed cause of death, and likelihood of its relationship to the RF procedure; number and types of major complications; and types of minor complications and side effects. Enrollment included 2,320 patients with 3,554 lesions (size, 3.1 cm ± 1.1 [SD] in diameter): 1,610 had hepatocellular carcinoma with chronic liver disease; 693 had metastases, predominantly from colorectal cancer (n = 501); and 17 had cholangiocellular carcinoma. Number and characteristics of complications (ie, deaths and major and minor complications) attributed to the procedure were reported. Data were subsequently analyzed ...

Treatment of Focal Liver Tumors with Percutaneous Radio-frequency Ablation: Complications Encountered in a Multicenter Study

The field of interventional oncology with use of image-guided tumor ablation requires standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments that use different technologies, such as chemical (ethanol or acetic acid) ablation, and thermal therapies, such as radiofrequency, laser, microwave, ultrasound, and cryoablation. This document provides a framework that will hopefully facilitate the clearest communication between investigators and will provide the greatest flexibility in comparison between the many new, exciting, and emerging technologies. An appropriate vehicle for reporting the various aspects of image-guided ablation therapy, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings, are outlined. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the group's intention that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes.

https://radiologie-uni-frankfurt.de/sites/radiologieinstitut/content/e4864/e299/e1255/e10384/Goldberg_Image-guidedtumorablation_standardizationofterminology_ger.pdf

Image-guided Tumor Ablation: Standardization of Terminology and Reporting Criteria

This patent application is a continuation-in-part of the patent application of the present authors related to target volume ablation in the body using a cooled-tip tissue-heating probe such as a fluid cooled (perfusion cooled) high frequency electrode. The present application relates in part to examples of specific embodiments of high frequency and radiofrequency electrode designs and heating and cooling system designs. It further describes embodiments in conjunction with 3-D or 2-D image data and computer graphic workstions to control, monitor, and pre-plan the process of target ablation. Specific examples of cooled-tip electrode constructions will be given which have utility for percutaneous or intraoperative cancerous tumor ablation. Cooled tip electrode systems with modular or separable components involving an insertion cannula, a radiofrequency electrode element, a cooling element, and a thermo-monitoring and/or radiofrequency connection electrode will be given. A high frequency and cooling system which is controlled and regulated based on the “thermally clamped tip” concept together with control of power, current, or other high frequency power parameters to pre-plan and control lesion size will be shown. Pre- or contemporaneous monitoring methods using CT, MR, ultrasound, and acoustic imaging or monitoring modalities in conjugation with the cooled tip high frequency ablation system will be exemplified. Variations in electrode design for specific target sites in the body will be described and illustrated.

Cool-tip radiofrequency thermosurgery electrode system for tumor ablation

The history and physical principles of radiofrequency (rf) lesion making are reviewed. The advantages of the rf lesion method are presented, with emphasis on its importance in small, critical regions such as the dorsal root entry zone (DREZ). The evolution and specifications of a satisfactory DREZ rf electrode are described. DREZ lesion sizes for this electrode at specific electrode tip temperatures were experimentally determined in animals and were used as a guide to determine acceptable clinical lesioning parameters. Emphasis is placed on lesion temperature monitoring and on the stability of electrode penetration into the spinal cord to achieve consistent and safe results.

Theoretical aspects of radiofrequency lesions in the dorsal root entry zone.

The present invention relates to a technique of relieving back pain by heating of an intervertebral disc. The heating is illustrated by a percutaneous technique where a needle or electrode is inserted into the disc under X-ray or other imaging control and subsequently used to elevate the temperature of the disc. Above a certain temperature, the innervation related to the disc is destroyed to the point that back pain related to that innervation can also be eliminated. Specific examples of methods and apparatus to achieve such disc heating are given. Among the methods are use of radiofrequency heating and direct current heating, use of stimulation and impedance monitoring to improve target control, and the use of temperature monitoring to determine and quantify the appropriate disc temperature to achieve the desired clinical results.

Method and apparatus for heating an intervertebral disc for relief of back pain

For heat ablating living tissue of a body, an ablation electrode (11, 192), contacting a surface of the tissue or within tissue, is coupled to an RF power supply (16, 136, 166, 262) referenced to a second electrode contacting the body. Fluid coolant is circulated to cool the contact surface extending the ablation to an increased volume of tissue. Temperature may be sensed contiguous to the surface to control the flows of RF heating energy and fluid coolant. Computer capability implements control and provides graphics displays of data, preplans, or controls relative to the ablation. Several forms of electrode structures accommodate specific objectives.

Cool-tip electrode thermosurgery system

A method and apparatus are provided for altering a function of tissue in a patient. An electromagnetic signal generated by a signal generator is applied to the tissue to be altered through an electrode. The electromagnetic signal has at least one frequency component above the physiologic stimulation frequency range at an intensity sufficient to produce an alteration of the tissue and a waveform that inhibits temperature elevation to the lethal temperature range of the tissue. Both externally coupled and fully implanted electrode and signal generator systems can be used at tissue sites in various parts of the body.

Modulated high frequency tissue modification

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