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

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.

Waste analysis and energy use estimation during MR-HIFU treatment: first steps towards calculating total environmental impact

“…Stage 1: Goal, scope, and system boundaries Our Local Medical Ethical Committee waived this research (study number 20230334). The functional unit was one technically successful uterine fibroid MR-HIFU treatment performed on the latest version of the CE-marked Sonalleve MR-HIFU platform (Profound Medical Corp., Canada) integrated into a 1.5-T MR scanner (Achieva; Philips Healthcare, the Netherlands) [10]. We analyzed three components of this treatment: (1) energy used by the MRI scanner and MR-HIFU device during an MR-HIFU treatment, (2) the medication used during treatment and admission, and (3) solid waste produced during treatment and admission (Fig.…”

“…In 2016, (interventional) radiologists started performing the relatively new non-invasive Magnetic Resonance image-guided High-Intensity Focused Ultrasound (MR-HIFU) treatment for uterine fibroids at our hospital. MR-HIFU uses a focused ultrasound beam to ablate tissue under MRI guidance [10]. Advantages of this treatment over other uterine fibroid treatments include its noninvasive nature, short recovery time, and low incidence of adverse events [10,11].…”

“…MR-HIFU uses a focused ultrasound beam to ablate tissue under MRI guidance [10]. Advantages of this treatment over other uterine fibroid treatments include its noninvasive nature, short recovery time, and low incidence of adverse events [10,11]. Currently, this treatment is not reimbursed in the Netherlands.…”