Background: Percutaneous cryoablation has been shown to be effective in the management of painful bone tumors. However, knowledge of the complication rate and risk factors for complication is currently lacking. Purpose:To report the complication rate and associated risk factors for bone tumor cryoablation. Materials and Methods:This retrospective study reviewed complications in 239 consecutive patients (131 men and 108 women; median age, 64 years; age range, 6-86 years) who underwent cryoablation of 320 primary or metastatic bone tumors between January 2008 and November 2017. Common Terminology Criteria for Adverse Events was used to categorize complications as major (grade 3-4) or minor (grade 1-2). Multivariable analysis was performed for variables with P values less than .20, including age, tumor location, adjacent critical structures, number of cryoprobes, and Eastern Cooperative Oncology Group performance status (ECOG-PS).Results: Among the 320 tumors, the total complication rate was 9.1% (29 of 320; 95% confidence interval [CI]: 6%, 12.2%). The major complication rate was 2.5% (eight of 320; 95% CI: 0.8%, 4.2%), with secondary fracture the most frequent complication (1.2% [four of 320]; mean delay, 71 days); cryoablation site infection, tumor seeding, bleeding, and severe hypotension were each observed in 0.3% (one of 320) of procedures. Minor complications included postprocedural pain (2.2% [seven of 320]), peripheral neuropathy (0.9% [three of 320]), and temporary paresthesia (0.9% [three of 320]). For all complications, associated risk factors included ECOG-PS greater than 2 (odds ratio [OR], 3.1 [95% CI: 3, 7.6]; P = .01), long-bone cryoablation (OR, 17.8 [95% CI: 2.3, 136.3]; P = .01), and use of more than three cryoprobes (OR, 2.5 [95% CI: 1.0, 6.0]; P = .04); for major complications, associated risk factors included age greater than 70 years (OR, 7.1 [95% CI: 1.6, 31.7]; P = .01) and use of more than three cryoprobes (OR, 23.6 [95% CI: 2.8, 199.0]; P = .01). Conclusion:Bone tumor cryoablation is safe, with a 2.5% rate of major complications, most commonly secondary fracture (1.2%). Major complications are associated with age greater than 70 years and use of more than three cryoprobes.

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Introduction: Percutaneous image-guided cryo-(CA) and radiofrequency-(RFA) ablations have been widely used in the treatment of painful bone metastases (BM). However, paucity of data is available for the performance of these treatments when used with a curative intent. The aim of this study is to investigate the local progression free-survival (LPFS) after radical percutaneous image-guided ablation of BM in oligometastatic patients, and to identify predictive factors associated with local tumor progression. Materials and Methods: This is a retrospective review of all patients who underwent percutaneous image-guided CA or RFA of BM with a radical intent between 2007 and 2018. Results: Forty-six patients with a total of forty-nine BM underwent percutaneous image-guided CA (N ¼ 37; 75,5%) or RFA (N ¼ 12; 24,5%). Primary malignancies included thyroid (N ¼ 11, 22.5%), breast (N ¼ 21; 42.9%), lung (N ¼ 8; 16.3%) and other (N ¼ 9; 18,3%) cancers. Additional consolidation was performed after ablation in 20.4% cases (N ¼ 10). Mean follow-up was 34.1 ± 22 months. Local progression at the treated site was observed in 28.5% cases (N ¼ 14); 1-and 2-year LPFS was 76.8% and 71.7%, respectively. Size of BM (>2 cm) predicted local tumor progression (p ¼ .002). Conclusions: Percutaneous image-guided locoregional therapies used in the radical treatment of BM in oligometastatic patients demonstrate significant rates of LPFS providing the size of BM 2 cm.

To compare robotic-assisted needle insertions performed under CBCT-guidance to standard manual needle insertions. MATERIALS AND METHODS A homemade robotic prototype was used by two operators to perform robotic and manual needle insertions on a custom-made phantom. Both the operators had no experience with the prototype before starting the trial. The primary endpoint was accuracy (i.e. the minimal distance between the needle tip and the centre of the target) between robotic and manual insertions. Secondary endpoints included total procedure time and operators' radiation exposure. The Wilcoxon test was used. A P value less than 0.05 was considered statistically significant. RESULTS Thirty-three (17 manual, 16 robotic) needle insertions were performed. Mean accuracy for robotic insertion was 2.3 ± 0.9 mm (median 2.1; range 0.8-4.2) vs 2.3 ± 1 mm (median 2.1; range 0.7-4.4) for manual insertion (p=0.84). Mean procedure time was 683 ± 57 sec (median 670; range 671-849) for the robotic group vs 552 ± 40 sec (median 548; range 486-62) for the manual group (p=0.0002). Mean radiation exposure was 3.25 times less for the robotic insertion on comparison to manual insertion for the operator 1 (0.4 vs 1.3 µGy); and 4.15 times less for the operator 2 (1.9 vs 7.9 µGy). CONCLUSION The tested robotic prototype showed accuracy comparable to that achieved with manual punctures coupled to a significant reduction of operators' radiation exposure. Further in-vivo studies are necessary to confirm the efficiency of the system.

The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). Case of the week is a case series hosted on the SCMR website (https://www.scmr.org) that demonstrates the utility and importance of CMR in the clinical diagnosis and management of cardiovascular disease. Each case consists of the clinical presentation and a discussion of the condition and the role of CMR in diagnosis and guiding clinical management. The cases are all instructive and helpful in the approach to patient management. We present a digital archive of the 2020 Case of the Week series of 11 cases as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.