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. 2021 Dec 18;12(1):188.
doi: 10.1186/s13244-021-01128-w.

Lessons learned during implementation of MR-guided High-Intensity Focused Ultrasound treatment of uterine fibroids

K J Anneveldt  1   2 , I M Verpalen  3 , I M Nijholt  4 , J R Dijkstra  5 , R D van den Hoed  4 , M Van't Veer-Ten Kate  4 , E de Boer  4 , J A C van Osch  6 , E Heijman  7   8 , H R Naber  9 , E Ista  10 , A Franx  11 , S Veersema  12 , J A F Huirne  13 , J M Schutte  5 , M F Boomsma  4
Affiliations

Lessons learned during implementation of MR-guided High-Intensity Focused Ultrasound treatment of uterine fibroids

K J Anneveldt et al. Insights Imaging. .

Abstract

Background: Although promising results have been reported for Magnetic Resonance image-guided High-Intensity Focused Ultrasound (MR-HIFU) treatment of uterine fibroids, this treatment is not yet widely implemented in clinical practice. During the implementation of a new technology, lessons are learned and an institutional learning-curve often has to be completed. The primary aim of our prospective cohort study was to characterize our learning-curve based on our clinical outcomes. Secondary aims included identifying our lessons learned during implementation of MR-HIFU on a technical, patient selection, patient counseling, medical specialists and organizational level.

Results: Our first seventy patients showed significant symptom reduction and improvement of quality of life at 3, 6 and 12 months after MR-HIFU treatment compared to baseline. After the first 25 cases, a clear plateau phase was reached in terms of failed treatments. The median non-perfused volume percentage of these first 25 treatments was 44.6% (range: 0-99.7), compared to a median of 74.7% (range: 0-120.6) for the subsequent treatments.

Conclusions: Our findings describe the learning-curve during the implementation of MR-HIFU and include straightforward suggestions to shorten learning-curves for future users. Moreover, the lessons we learned on technique, patient selection, patient counseling, medical specialists and organization, together with the provided supplements, may be of benefit to other institutions aiming to implement MR-HIFU treatment of uterine fibroids. Trial registration ISRCTN14634593. Registered January 12, 2021-Retrospectively registered, https://www.isrctn.com/ISRCTN14634593 .

Keywords: Learning-curve; MR-HIFU; Magnetic resonance imaging; Minimally invasive surgery; Uterine fibroids.

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Conflict of interest statement

Author EH is an employee of Philips Research, Eindhoven, the Netherlands. Philips developed the used MR-HIFU equipment in the subject matter discussed in the submitted manuscript. All authors state that this study complies with the Declaration of Helsinki.

Figures

Fig. 1
Fig. 1
Funaki classification. a Funaki I fibroid (signal intensity lower than myometrium and muscle); b Funaki II fibroid (signal intensity lower than myometrium, but higher than muscle); c Funaki III fibroid (signal intensity higher than muscle and myometrium). Asterisks (*) are located in the uterine fibroid. Arrows point at abdominal muscle. Cross (X) is located in myometrium tissue
Fig. 2
Fig. 2
Appearance of treatment failure when plotted against the number of treatments. Blue dots represent treatment failures; pink dots represent screening failures
See this image and copyright information in PMC

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