Abstract
Recent studies have demonstrated the effectiveness of magnetic resonance-guided focused ultrasound (MRgFUS) in the treatment of osteoid osteoma (OO), a painful, benign bone tumor. As MRgFUS is a noninvasive and radiation-free treatment, it stands to replace the current standard of care, percutaneous radiofrequency, or laser thermal ablation. Within an institution, creation of a clinical OO MRgFUS treatment program would not only provide cutting edge medical treatment at the current time but would also establish the foundation for an MRgFUS clinical service to introduce treatments currently under development into clinical practice in the future. The purpose of this document is to provide information to facilitate creation of a clinical service for MRgFUS treatment of OO by providing (1) recommendations for the multi-disciplinary management of patients and (2) guidelines regarding current best practices for MRgFUS treatment. This paper will discuss establishment of a multi-disciplinary clinic, patient accrual, inclusion/exclusion criteria, diagnosis, preoperative imaging, patient preparation, anesthesia, treatment planning, targeting and treatment execution, complication avoidance, and patient follow-up to assure safety and effectiveness.
Highlights
Magnetic resonance-guided focused ultrasound is an emerging option in the treatment of osteoid osteoma
Osteoid osteoma is a small, painful benign bone lesion that accounts for 10 % of all bone tumors [4]
Magnetic resonance imaging (MRI) is used to provide the anatomical information necessary to safely guide and focus the ultrasound beam on the target and to perform real-time multi-planar thermal mapping [24], required to ensure therapeutic temperatures are produced in the target region and that surrounding healthy tissue structures are spared
Summary
Magnetic resonance-guided focused ultrasound is an emerging option in the treatment of osteoid osteoma. Magnetic resonance imaging (MRI) is used to provide the anatomical information necessary to safely guide and focus the ultrasound beam on the target (i.e., the lesion/ nidus, and adjacent periosteum containing the nerves and vasculature for the nidus) and to perform real-time multi-planar thermal mapping [24], required to ensure therapeutic temperatures are produced in the target region and that surrounding healthy tissue structures are spared. Any object in the beam path that could reflect ultrasound energy, such as a gas-filled viscus or bone, needs to be outside this beam path or refocusing and off-target heating may occur This can best be avoided by using large field of view, three plane planning images so that the entire beam path can be inspected before treatment. As bone lesions can occur anywhere in the body, the MRgFUS community should work with industry partners to create equipment that is more adaptable to a wide range of patient positioning requirements
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