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In JoVE (1)
Other Publications (32)
- Magnetic Resonance Imaging Clinics of North America
- AJR. American Journal of Roentgenology
- Journal of Computer Assisted Tomography
- AJR. American Journal of Roentgenology
- The New England Journal of Medicine
- Techniques in Vascular and Interventional Radiology
- AJR. American Journal of Roentgenology
- Ultrasound Quarterly
- Cancer Treatment and Research
- Journal of Vascular and Interventional Radiology : JVIR
- Radiology
- AJR. American Journal of Roentgenology
- Journal of Vascular and Interventional Radiology : JVIR
- Radiology
- Academic Radiology
- Journal of Surgical Oncology
- AJR. American Journal of Roentgenology
- Conference Proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
- Radiology
- Radiology
- AJR. American Journal of Roentgenology
- Cardiovascular and Interventional Radiology
- Journal of Vascular and Interventional Radiology : JVIR
- Journal of Vascular and Interventional Radiology : JVIR
- Radiology
- Journal of Vascular and Interventional Radiology : JVIR
- Seminars in Roentgenology
- Surgical Oncology Clinics of North America
- AJR. American Journal of Roentgenology
- Journal of the American College of Radiology : JACR
- Journal of Vascular and Interventional Radiology : JVIR
- Journal of Endourology / Endourological Society
Articles by J. Louis Hinshaw in JoVE
JoVE Clinical and Translational Medicine
Thermal Ablation for the Treatment of Abdominal Tumors
1Department of Biomedical Engineering, University of Wisconsin-Madison, 2Department of Radiology, University of Wisconsin-Madison
A thermal tumor ablation procedure is described. The entire procedure is detailed, including pretreatment planning and imaging studies, anesthesia, adjuvant techniques to facilitate a percutaneous approach, imaging guidance of the ablation device to the tumor, thermal treatment, post-treatment care and follow-up.
Other articles by J. Louis Hinshaw on PubMed
Image-guided Ablation of Renal Cell Carcinoma
An increasing number of small asymptomatic renal cell carcinomas (RCCs) are being detected by cross-sectional imaging. Because of the nonaggressive biologic behavior of many of these tumors, there is increasing interest in minimally invasive treatment modalities,particularly for the elderly, infirm, and patients with comorbid conditions. Radiofrequency(RF) ablation, cryoablation, microwave ablation, and laser ablation have all shown promise for the treatment of RCC, with high local control and low complication rates for RF ablation and cryoablation. However, the clinical trial data remain early, and survival data are not yet available for a definitive comparison with conventional surgical techniques for removal of RCC.
Radiofrequency Ablation of Peripheral Liver Tumors: Intraperitoneal 5% Dextrose in Water Decreases Postprocedural Pain
Our objective was to evaluate the clinical efficacy of the intraperitoneal instillation of 5% dextrose in water (D5W) during radiofrequency ablation of peripheral liver tumors for decreasing postradiofrequency pain and narcotic use.
Prospective Blinded Trial Comparing 45-mL and 90-mL Doses of Oral Sodium Phosphate for Bowel Preparation Before Computed Tomographic Colonography
To compare the efficacy of computed tomographic colonography (CTC) bowel preparation using single- (45 mL) versus double-dose sodium phosphate.
CT Colonography Versus Colonoscopy for the Detection of Advanced Neoplasia
Advanced neoplasia represents the primary target for colorectal-cancer screening and prevention. We compared the diagnostic yield from parallel computed tomographic colonography (CTC) and optical colonoscopy (OC) screening programs.
Cryoablation for Liver Cancer
Primary cancer of the liver (hepatocellular carcinoma [HCC]) and metastatic cancer to the liver from a distant primary site of origin are very common problems in the United States and the world. The management of these diseases has become progressively complex as the available treatment options have improved and propagated. One option that has been gaining acceptance is image-guided tumor ablation. Image-guided tumor ablation has been applied to numerous cancers, including renal cell carcinoma, prostate cancer, lung cancer, and liver cancer with promising short-term results. Radiofrequency ablation has been the most widely studied and utilized ablation modality. However, cryoablation has several relative advantages (most significantly, the ability to produce larger and more precise zones of ablation) over RF ablation and the other heat-based ablation modalities. This manuscript is designed to be an up to date, practical and thorough review of the indications for, techniques of, and patient management issues associated with hepatic cryoablation.
Primary 2D Versus Primary 3D Polyp Detection at Screening CT Colonography
Disparate results from the existing large CT colonography (CTC) trials suggest that 2D polyp detection is less sensitive than 3D detection, but no direct evidence exists to support this claim. Our goal was to assess the sensitivity of primary 2D polyp detection with cases from the Department of Defense CTC screening trial and compare results with the primary 3D evaluation and previous 2D CTC trials.
Ultrasound-guided Biopsies in the Abdomen and Pelvis
Ultrasound-guided biopsies in the abdomen and pelvis are generally more effective, safer, faster, and cheaper than those performed under computed tomography guidance. This manuscript will discuss multiple aspects of sonographic biopsies performed between the diaphragm and the symphysis pubis. We begin with systems issues, patient preparation (including bleeding profile and anticoagulant use), pain management, and infection precautions. The procedure itself is then analyzed, including needle guidance, the role of the sonographer, image optimization, patient positioning, core- versus fine-needle aspiration, coaxial versus individual pass, needle technique, and postprocedure management. Issues specific to different sites are then discussed: liver, spleen, pancreas, kidney, adrenal, bowel, retroperitoneum and mesentery, and the pelvis. We finish with a discussion of complications, future trends, and a brief summary.
Imaging of Primary Malignant Tumors of Peritoneal and Retroperitoneal Origin
Peritoneal carcinomatosis and metastatic involvement of the retroperitoneum are relatively common manifestations of many organ-based malignancies and lymphoproliferative disorders. Primary malignancies of peritoneal and retroperitoneal origin occur much less frequently, and can be difficult to distinguish from metastatic disease. In many cases, a precise diagnosis based on imaging findings alone is not possible. However, the imaging features of these primary tumors, in combination with the clinical and demographic data, can be utilized to narrow the scope of the differential diagnosis. This chapter will present the clinical and imaging features of primary peritoneal and retroperitoneal tumors arising from the various tissue components that comprise the ligaments, mesenteries and connective tissues of these anatomic spaces.
Does Selective Intubation Increase Ablation Zone Size During Pulmonary Cryoablation?
To determine the effect of selective intubation on ablation zone size during pulmonary cryoablation.
Unsuspected Extracolonic Findings at Screening CT Colonography: Clinical and Economic Impact
To evaluate the frequency and estimated costs of additional diagnostic workup for extracolonic findings detected at computed tomographic (CT) colonography in a large screening cohort.
Comparison of Percutaneous and Laparoscopic Cryoablation for the Treatment of Solid Renal Masses
The goal of this study was to compare the outcome, complications, and charges of percutaneous renal cryoablation and laparoscopic cryoablation of solid renal masses.
Radiofrequency Ablation: Simultaneous Application of Multiple Electrodes Via Switching Creates Larger, More Confluent Ablations Than Sequential Application in a Large Animal Model
To compare radiofrequency (RF) ablations created by using a sequential technique to those created simultaneously by using a switching algorithm in ex vivo and in vivo liver models.
Pulmonary Thermal Ablation: Comparison of Radiofrequency and Microwave Devices by Using Gross Pathologic and CT Findings in a Swine Model
To compare the performance of equivalently sized radiofrequency and microwave ablation applicators in a normal porcine lung model.
Radiology Faculty Compliance with Recommended Health Guidelines: Comparison with Residents
The aims of this study were to determine diagnostic radiology faculty members' compliance with recommended health guidelines for physical activity, body weight, diet, and related health indicators and to compare faculty members' compliance with that of radiology residents.
Staging Laparoscopy Enhances the Detection of Occult Metastases in Patients with Pancreatic Adenocarcinoma
The use of staging laparoscopy has been highly institutional dependent. We sought to assess the incidence of occult intra-abdominal metastases identified at the time of staging laparoscopy for patients with either potentially resectable or locally advanced pancreatic adenocarcinoma (LAPC). We also compared the rate of occult metastases in patients who underwent staging laparoscopy versus laparotomy.
Evaluation of Uterine Anomalies: 3D FRFSE Cube Versus Standard 2D FRFSE
OBJECTIVE: The purpose of this study was to compare a novel MRI sequence-3D fast-recovery fast spin-echo (FRFSE) cube-with a standard 2D FRFSE sequence for the investigation of uterine anomalies. CONCLUSION: Compared with 2D FRFSE, 3D FRFSE cube provides superior image quality and improved 3D reconstructions in a shorter acquisition time and enables excellent visualization of uterine anatomy in any orientation, regardless of the original scanning plane.
Periodic Contrast-enhanced Computed Tomography for Thermal Ablation Monitoring: a Feasibility Study
Image-guided tumor ablation is rapidly gaining acceptance for treating many tumors. While imaging diagnosis, treatment targeting and follow-up continue to improve, little progress has been made in developing practical imaging techniques for monitoring ablation treatments. In this study we demonstrate the feasibility of using contrast-enhanced computed tomography (CECT) to monitor ablation zone growth with 2 min temporal resolution. Highly constrained back-projection (HYPR) post-processing is applied to the time-series of CECT images, improving image quality by a factor of four after acquiring ten time frames. Such improvements limit the amount of radiation and iodinated contrast material required to visualize the ablation zone, especially at early time points. Additional study of periodic CECT with HYPR processing appears warranted.
Bowel Preparation for CT Colonography: Blinded Comparison of Magnesium Citrate and Sodium Phosphate for Catharsis
To compare colonic cleansing and fluid retention of double-dose magnesium citrate with those of single-dose sodium phosphate in patients undergoing computed tomographic (CT) colonography.
CT Colonography: Performance and Program Outcome Measures in an Older Screening Population
To evaluate computed tomographic (CT) colonography performance and program outcome measures in an older cohort (65-79 years) of an established large-scale colorectal cancer screening program.
Hepatic Steatosis (fatty Liver Disease) in Asymptomatic Adults Identified by Unenhanced Low-dose CT
The purpose of this study was to investigate the prevalence of hepatic steatosis in an asymptomatic U.S. adult population using attenuation values at unenhanced CT as the reference standard. We also assessed the utility of known clinical risk factors for diagnosis.
Optimizing the Protocol for Pulmonary Cryoablation: a Comparison of a Dual- and Triple-freeze Protocol
The purpose of this study was to compare a double freeze-thaw protocol to a triple freeze-thaw protocol for pulmonary cryoablation utilizing an in vivo porcine lung model. A total of 18 cryoablations were performed in normal porcine lung utilizing percutaneous technique with 9 each in a double- (10-5-10) and triple-freeze (3-3-7-7-5) protocol. Serial noncontrast CT images were obtained during the ablation. CT imaging findings and pathology were reviewed. No imaging changes were identified during the initial freeze cycle with either protocol. However, during the first thaw cycle, a region of ground glass opacity developed around the probe with both protocols. Because the initial freeze was shorter with the triple freeze-thaw protocol, the imaging findings were apparent sooner with this protocol (6 vs. 13 min). Also, despite a shorter total freeze time (15 vs. 20 min), the ablation zone identified with the triple freeze-thaw protocol was not significantly different from the double freeze-thaw protocol (mean diameter: 1.67 ± 0.41 cm vs. 1.66 ± 0.21 cm, P = 0.77; area: 2.1 ± 0.48 cm(2) vs. 1.99 ± 0.62 cm(2), P = 0.7; and circularity: 0.95 ± 0.04 vs. 0.96 ± 0.03, P = 0.62, respectively). This study suggests that there may be several advantages of a triple freeze-thaw protocol for pulmonary cryoablation, including earlier identification of the imaging findings associated with the ablation, the promise of a shorter procedure time or larger zones of ablation, and theoretically, more effective cytotoxicity related to the additional freeze-thaw cycle.
Tissue Contraction Caused by Radiofrequency and Microwave Ablation: a Laboratory Study in Liver and Lung
To determine the amount of tissue contraction during radiofrequency (RF) and microwave ablation.
Microwave Tumor Ablation: Mechanism of Action, Clinical Results, and Devices
Microwave ablation uses dielectric hysteresis to produce direct volume heating of tissue. Microwaves are capable of propagating through many tissue types, even those with high impedance such as lung or bone, with less susceptibility to "heat-sink" effects along vessels. Microwaves are highly conducive to the use of multiple applicators, showing the synergy seen with other energies, but also the potential capability for phasing of the electromagnetic field. As a result, larger, more customizable ablation zones may be created in less time. Although multiple microwave ablation systems are currently available, further study and continued development are needed.
Effect of Computer-aided Detection for CT Colonography in a Multireader, Multicase Trial
To assess the effect of using computer-aided detection (CAD) in second-read mode on readers' accuracy in interpreting computed tomographic (CT) colonographic images.
Temperature Isotherms During Pulmonary Cryoablation and Their Correlation with the Zone of Ablation
To determine the expected ablation zone size and associated isotherms when using clinically available percutaneous cryoprobes for pulmonary cryoablation in a porcine lung model.
Thermal Ablation
Image-guided tumor ablation refers to a group of treatment modalities that have emerged during the past 2 decades as important tools in the treatment of a wide range of tumors throughout the body. Although most widely recognized in the treatment of hepatic and renal malignancies, the role of thermal ablation has expanded to include lesions of the lung, breast, prostate, bone, as well as other organs and its clinical applications continue to increase. In the following article, we discuss the major thermal ablation modalities, their respective strengths and weaknesses, potential complications and how to avoid them, as well as possible future applications.
Thermal Ablation of Lung Tumors
The 5-year survival for all stages of nonsmall cell lung cancer (NSCLC) remains bleak, having increased from 13% to just 16% over the past 30 years. Despite promising results in nonoperative patients with NSCLC and pulmonary metastatic disease, thermal ablation appears to be limited by large tumor size and proximity to large vessels. This article discusses the particular challenges of performing thermal ablation in aerated lung tissue and reviews important considerations in performing ablation including treatment complications and imaging follow-up. The article compares and contrasts the three major thermal ablation modalities: radiofrequency ablation, microwave ablation, and cryoablation.
CT-guided Lung Biopsies: Pleural Blood Patching Reduces the Rate of Chest Tube Placement for Postbiopsy Pneumothorax
The objective of our study was to determine whether pleural blood patching reduces the need for chest tube placement and hospital admission for pneumothorax complicating CT-guided percutaneous lung biopsy.
Ionizing Radiation in Abdominal CT: Unindicated Multiphase Scans Are an Important Source of Medically Unnecessary Exposure
CT radiation exposure has come under increasing scrutiny because of dramatically increased utilization. Multiphase CT studies (repeated scanning before and after contrast injection) are a potentially important, overlooked source of medically unnecessary radiation because of the dose-multiplier effect of extra phases. The purpose of this study was to determine the frequency of unindicated multiphase scanning and resultant excess radiation exposure in a sample referral population.
High-Powered Microwave Ablation with a Small-Gauge, Gas-Cooled Antenna: Initial Ex Vivo and In Vivo Results
PURPOSE: To evaluate the performance of a gas-cooled, high-powered microwave system. MATERIALS AND METHODS: Investigators performed 54 ablations in ex vivo bovine livers using three devices-a single 17-gauge cooled radiofrequency(RF) electrode; a cluster RF electrode; and a single 17-gauge, gas-cooled microwave (MW) antenna-at three time points (n = 6 at 4 minutes, 12 minutes, and 16 minutes). RF power was applied using impedance-based pulsing with maximum 200 W generator output. MW power of 135 W at 2.45 GHz was delivered continuously. An approved in vivo study was performed using 13 domestic pigs. Hepatic ablations were performed using single applicators and the above-mentioned MW and RF generator systems at treatment times of 2 minutes (n = 7 MW, n = 6 RF), 5 minutes (n = 23 MW, n = 8 RF), 7 minutes (n = 11 MW, n = 6 RF), and 10 minutes (n = 7 MW, n = 9 RF). Mean transverse diameter and length of the ablation zones were compared using analysis of variance (ANOVA) with post-hoc t tests and Wilcoxon rank-sum tests. RESULTS: Single ex vivo MW ablations were larger than single RF ablations at all time points (MW mean diameter range 3.5-4.8 cm 4-16 minutes; RF mean diameter range 2.6-3.1 cm 4-16 minutes) (P < .05). There was no difference in mean diameter between cluster RF and MW ablations (RF 3.3-4.4 cm 4-16 minutes; P = .4-.9). In vivo lesion diameters for MW (and RF) were as follows: 2.6 cm ± 0.72 (RF 1.5 cm ± 0.14), 3.6 cm ± 0.89 (RF 2.0 cm ± 0.4), 3.4 cm ± 0.87 (RF 1.8 cm ± 0.23), and 3.8 cm ± 0.74 (RF 2.1 cm ± 0.3) at 2 minutes, 5 minutes, 7 minutes, and 10 minutes (P < .05 all time points). CONCLUSIONS: Gas-cooled, high-powered MW ablation allows the generation of large ablation zones in short times.
Hydrodissection Utilizing an Iodinated Contrast Medium During Percutaneous Renal Cryoablation
Introduction We describe our experience using an iodinated contrast solution to hydrodissect adjacent structures prior to percutaneous renal cryoablation. Technique Hydrodissection was performed prior to cryoablation with placement of a 20-gauge 15 cm introducer needle into the retroperitoneum under CT or ultrasound guidance followed by infusion of 5% dextrose in water and 2% iodinated contrast between the kidney and the adjacent organ. Ten patients underwent hydrodissection with an iodinated contrast solution at our institution. The mean tumor size was 3.1±1.2cm. The organs displaced included colon (n=7), small bowel (n=1), pancreas (n=1) and in one case both the colon and ureter were displaced. The average displacement of all organs from the kidney was 2.8 cm (range 2.2-3.5cm). There were no complications and no injuries to any adjacent structures. Conclusions The injection of iodinated contrast allows for safe mobilization and differentiation of adjacent structures from the renal tumor and parenchyma leading to potentially safer cryoablation.
