Exablate Treatment Stages

Here is what to expect during the Exablate procedure:

1. Screening process
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Based on your MR/CT images and a physical exam, your physician will determine if you are a candidate for the Exablate treatment. Your physician will discuss all your treatment options and their benefits and risks, to make sure the decision is the best for you.  If you are a candidate for, and decide to receive, Exablate treatment, you will be scheduled for treatment and given instructions on how to prepare.

Once you have been evaluated to see if you are a suitable candidate, you may be scheduled for additional imaging to determine if the location of your bone metastasis is accessible to the Exablate ultrasound beam.

2. Patient preparation
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The skin above the target area will be shaved and cleaned. You might have a urinary catheter placed so that you will not need to go the bathroom during the procedure.

An intravenous fluid drip, or IV, will be placed into your arm to administer fluids and medications. You will be positioned on the Exablate treatment bed so you will be comfortable and supported.

You will be sedated to make sure you feel no pain and are lying still throughout the course of the treatment. Your heart rate, blood pressure and blood oxygen levels will be monitored throughout the procedure.

Similar to long international flights, compression socks may be worn during the procedure to reduce any risk of a blood clot forming in your legs due to the lengthy time lying down without moving.

You will be given a “stop sonication” button to use if for any reason you want to stop the procedure.

3. Treatment planning
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Positioning you in a specific location and angle on the Exablate treatment bed will ensure that the target area is directly above the ultrasound transducer.  A gel pad or water bath will be put between the transducer and your skin to make sure the ultrasound beam can reach the target area without interruption.

Before the treatment begins, MRI images are taken and used to plan the treatment. The physician uses the MRI images to define the exact target area that needs to be treated.  Once the plan is complete, the treatment begins. The physician will observe you from the control room which is separated by a glass window from the MR room and the nurse will check on you periodically.

4. Treatment
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The physician will aim the ultrasound beam at the target area in the affected bone and apply energy. This is called a “sonication.” Each sonication heats a small volume of tissue inside the body to the point of thermal ablation (the heating of tissue to a high enough temperature to kill the cells). The process is repeated until all nerves causing the pain are destroyed.

During each sonication, the physician will monitor the heating of the treatment area using temperature maps produced by the MRI.

After completion of the treatment, a contrast agent will be administered through the IV catheter and a final series of MR images is taken to assess how well the treatment went.

The entire treatment may take up to 3 to 4 hours.

5. Post treatment
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After the Exablate treatment, you will be moved to the recovery room for a couple of hours. Your physician will come to evaluate you and to explain the post treatment care that you may need.

Usually, this is performed as an outpatient procedure, however, depending upon the anesthetic used and other clinical considerations, you may stay overnight in the hospital.

You should be able to return to normal activities within days. Most patients feel pain relief within a few days and many reduce their use of pain medications. You might experience some discomfort or soreness from lying on the treatment bed. Your doctor will decide which medications are best for you if this happens.

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