EXAM #2: INTERVENTIONAL RADIOLOGY

Question 1

What is radiofrequency ablation?

Answer 1

Sound waves to increase heat and kill tumors

Question 2

What is microwave ablation?

Answer 2

Use of microwaves to kill tumors

Question 3

What is cryoablation?

Answer 3

Freezing of tumors to kill them

Question 4

What is the most likely diagnosis for a 70 year-old with a renal mass?

Answer 4

Renal cell carcinoma

Question 5

What do you need to do after identifying a renal mass on CT?

Answer 5

Biopsy

Question 6

Describe how cryoablation works.

Answer 6

• Delivery of cold to the tumor
• Formation of intracellular ice and osmotic COAGULATIVE necrosis
  1) Freeze= cell shrink/ dehydration w/ pore formation
  2) Thaw= rush of water back into cell via pores–>cells burst
  3) Delayed= immune response (macrophages) to damaged tissue

Question 7

What are the advantages of cyroablation?

Answer 7

Ability to monitor ablation zone (vs. thermal ablation)

Question 8

What are the disadvantages of cryoablation?

Answer 8

Cryoshock

Question 9

What is cryoshock?

Answer 9

Systemic inflammatory response leading to:

• Hyotension
• Respiratory compromise,
• DIC
• Mutliorgan failure

Question 10

What is the Jules Thompson principle?

Answer 10

Use of Helium and Argon to cause freezing

Question 11

What is the most common type of renal cell carcinoma (RCC)?

Answer 11

Clear cell variant (83-88%)

Question 12

How common is renal cell carcinoma overall (RCC)?

Answer 12

Only seen in 2% of all adult cancers

Question 13

When is RCC typically discovered?

Answer 13

Incidentally during imaging for other indications

Question 14

What is stage 1A RCC?

Answer 14

Tumor less than 4cm confined to kidney

Question 15

What is the treatment of choice for stage 1A RCC?

Answer 15

Laproscopic partial nephrectomy

Note that this is shifting to cryoablation

Question 16

What is the secondary treatment of choice for 1A RCC in poor surgical candidates?

Answer 16

CT or US guided cryoablation

Question 17

What are the advantages of cryoablation?

Answer 17

1) Outpatient procedure
2) Doesn’t require general anesthesia
3) Preserves renal function/ nephron sparing
4) Few complications
5) Can be repeated for residual tumor

Question 18

What is a hepatoma?

Answer 18

Malignant tumor that is derived from hepatocytes

Also called hepatocellular carcinoma

Question 19

What patient population is highly susceptible to develop a hepatoma?

Answer 19

Alcoholics/ cirrhosis

Question 20

What is unique about a hepatoma from a diagnostic standpoint?

Answer 20

Doesn’t require biopsy, can be diagnosed with imaging only

Question 21

What does ECOG stand for? What is an ECOG score?

Answer 21

Eastern Cooperative Oncology Group

• This is a score of how well a patient functions
• 0 is the highest i.e. normal, 5 is dead
• Only intervene in patients with a score of 0,1, or 2

Question 22

What is the treatment of choice for hepatoma?

Answer 22

Local regional therapy

Question 23

What are the risk factors for hepatocellular carcinoma i.e. hepatoma?

Answer 23

1) Hepatitis (B or C)
2) Alcoholic liver disease/ non-alcoholic fatty liver disease (NAFLD)
3) Metabolic Syndrome
4) Aflatoxin exposure

Question 24

Where is HBV most common?

Answer 24

SE Asia

Question 25

Where is HBC most common?

Answer 25

US

Question 26

What is the prognosis for HCC without treatment?

Answer 26

Less than 10% 5-year survival rate

Question 27

What are the local regional therapies available for HCC treatment?

Answer 27

1) Radio-frequency 2) Microwave 3) Transarterial therapy- chemoembolization 4) Radioembolization 5) Drug eluting bead embolization

Question 28

What is Transarterial Chemoembolization (TACE)?

Answer 28

Delivery of concentrated chemotherapy in lipid medium combined with arterial embolization

Question 29

Describe the "dual blood supply" of the liver.

Answer 29

1) Portal venous blood supply --major | 2) Hepatic arterial supply --minor

Question 30

How is the dual blood supply manipulated in TACE of a HCC?

Answer 30

Nearly all HCCs derive vascular supply from the the hepatic artery

Question 31

When is TACE indicated for HCC?

Answer 31

Patients that aren't candidates for - Transplant - Resection - Local ablation i.e. tumors greater than 3 cm

Question 32

What are the side effects of TACE?

Answer 32

Postembolization Syndrome

Question 33

What is postembolization syndrome?

Answer 33

- Nausea and vomiting - Abdominal pain - Fever - Anorexia - Fatigue All seen secondary to embolization; thought to be secondary to immune response to ablation.

Question 34

What is Drug-Eluting Bead Embolization?

Answer 34

Small beads loaded with chemotheraputic drug for delivery to HCC via the hepatic artery

Question 35

What drug is most commonly used in Drug Eluting Bead Embolization?

Answer 35

Doxorubicin

Question 36

What molecules are being agitated in radio-frequency and microwave ablation respectively?

Answer 36

``` Radiofrequency= ionic Microwave= water ```

Question 37

For HCC less than 3cm, what is the preferred treatment?

Answer 37

Radiofrequency or microwave ablation

Question 38

What size of an ablative zone must be achieved with a HCC of 3cm?

Answer 38

4-5cm i.e. you want a normal margin or negative margin of at least 10mm

Question 39

What is radioembolization?

Answer 39

Use of intra-arterially delivered microspheres emitting high dose radation

Question 40

What is radioembolization or Y90 utilized for?

Answer 40

- Unresectable liver tumors - Metastatic colorectal tumors - Neuroendocrine tumors

Question 41

Why is radioembolization a good option for unresectable liver tumors?

Answer 41

Microspheres emitting radiation preferentially lodge in noevasculature of the tumor

Question 42

What is the advantage of radioembolization over TACE?

Answer 42

Can be performed on HCC with portal vein invasion, which in a contraindication for TACE

Question 43

What is a malignant pleural effusion? What is the prognosis?

Answer 43

This is a pleural effusion related to a malignancy - Lung - Breast - Ovarian Prognosis is 4 months

Question 44

What is the IR procedure for a malignant pleural effusion?

Answer 44

Tunneled Pleural Catheter