by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
The patient was placed on the CT scanner in the supine position. Initial CT images of the upper abdomen were obtained. Automated exposure control was utilized. The skin overlying the liver was prepped and draped in the standard sterile fashion. Under CT guidance 3 IRE ablation probes were advanced to the lesion in the caudate lobe. Once the 3 probes were positioned appropriately, sagittal reconstructions were performed and ablation parameters were calculated.
Ablation was performed using standard protocol and reverse polarity. Probes were removed. 2 IRE probes were then advanced to the peripheral right lobe lesion and ablation was performed in the same manner. Probe were removed and follow-up CT scan was obtained showing expected postablation changes with no significant hemorrhage. IRE ablation was utilized due to the otherwise inaccessible lesion in the caudate lobe. IMPRESSION: CT-guided liver mass ablation x 2.
IRE (irreversible electroporation) is a type of ablation described by codes 0600T (percutaneous) or 0601T (open). Imaging guidance (fluoroscopic and ultrasound guidance) is bundled. The procedure utilizes the “Nanoknife”. These codes describe ablation of one or more tumors at the same session. The device transmits electrical impulses between two probes that causes holes to develop in the cells (electroporation) which results in irreversible cell death.
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