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. 2024 Oct;47(10):1402-1406.
doi: 10.1007/s00270-024-03846-2. Epub 2024 Sep 3.

The Paradox of Modern Technology in Standardizing Thermal Liver Ablation: Fostering Uniformity or Diversity?

Coosje A M Verhagen  1 , Ariadne L van der Velden  2 , Reto Bale  3 , Elena Bozzi  4 , Laura Crocetti  4 , Alban Denys  5 , Gonnie C M van Erp  6 , Faeze Gholamiankhah  6 , Giorgio Greco  7 , Pim Hendriks  6 , Robrecht R M M Knapen  2 , Hicham Kobeiter  8 , Rodolfo Lanocita  7 , Martijn R Meijerink  9 , Franco Orsi  10 , Alice Phillips  11 , Hossein Rahmani  2 , Maarten L J Smits  12 , Marco J L van Strijen  13 , Ronald M van Dam  14 , Christiaan van der Leij  2 , Mark C Burgmans  6
Affiliations

The Paradox of Modern Technology in Standardizing Thermal Liver Ablation: Fostering Uniformity or Diversity?

Coosje A M Verhagen et al. Cardiovasc Intervent Radiol. 2024 Oct.

Abstract

Purpose: Currently, significant medical practice variation exists in thermal ablation (TA) of malignant liver tumors with associated differences in outcomes. The IMaging and Advanced Guidance for workflow optimization in Interventional Oncology (IMAGIO) consortium aims to integrate interventional oncology into the standard clinical pathway for cancer treatment in Europe by 2030, by development of a standardized low-complex-high-precision workflow for TA of malignant liver tumors. This study was conducted at the start of the IMAGIO project with the aim to explore the current state and future role of modern technology in TA of malignant liver tumors.

Materials and methods: A cross-sectional questionnaire was conducted followed by an expert focus group discussion with core members and collaborating partners of the consortium.

Results: Of the 13 participants, 10 respondents filled in the questionnaire. During the focus group discussion, there was consensus on the need for international standardization in TA and several aspects of the procedure, such as planning based on cross-sectional images, the adoption of different techniques for needle placement and the importance of needle position- and post-ablative margin confirmation scans. Yet, also considerable heterogeneity was reported in the adoption of modern technology, particularly in navigational systems and computer-assisted margin assessment.

Conclusion: This study mirrored the current diversity in workflow of thermal liver ablation. To obtain comparable outcomes worldwide, standardization is needed. While advancements in tools and software hold the potential to homogenize outcome measurement and minimize operator-dependent variability, the rapid increase in availability also contributes to enhanced workflow variation.

Keywords: Interventional oncology; Liver tumor; Modern technology; Standardization; Thermal ablation.

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Conflict of interest statement

Philips Health Care is a key contributor to the IMAGIO consortium. M.C. Burgmans has received an educational grant from the Dutch Cancer Society, MLDS, Health Holland and Medtronic and a consultancy fee from Philips Health Care. M.C. Burgmans, C. van der Leij and M. L. J. Smits serve as co-PIs within the IMAGIO consortium. R. Bale is a consultant for Interventional Systems (Kitzbühel, Austria). All other authors declare that they have no conflict of interest.

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