"With AblaSure® you’ve got the absolute certainty, that you got your margins right"

Dr. Nadeem Shaida, Senior Consultant Vascular and Interventional Radiology at Addenbrookes Hospital Cambridge, United Kingdom

Dr. Nadeem Shaida is a consultant for vascular and interventional radiology at Addenbrookes Hospital in Cambridge (UK). In this interview he talks about his experience with quantitative margin assessment and explains why he thinks that role of the interventional radiologist is changing for the better.


Dr. Nadeem Shaida, Senior Consultant Vascular and Interventional Radiology at Addenbrookes Hospital Cambridge (United Kingdom)

In your opinion, what’s the biggest challenge inventional oncologists are facing today when assessing ablation margins?
We know that sufficient ablation margins are the most important aspect in reducing tumour recurrence. But how can we be sure, that we managed to get a sufficient margin? How can we be sure, that we achieved an A0 ablation? Traditionally we’ve used conventional methods of assessment. With CT-imaging what we tend to do is look at the pre-picture and the post-picture, evaluate them and work out by eyeballing if you have achieved an adequate coverage of the tumour. But the most obvious challenge with this particular approach seems to be that it is highly subjective and prone to inter-reader variability. Even amongst expert oncologists there’s a large variability, when you look at the individual ability to evaluate ct-images by comparing pre- and post-treatment images.

AblaSure allows to quantitively assess the ablation margins. What were your learnings after the first cases using the new feature in the Quality Ablation workflow?
Now that we’ve used the CASCINATION system for quite a few AblaSure procedures in our institution, I found that the role of the interventional oncologist or the operator is slightly different. When you get to that stage of validation, there’s a whole extra bit of thinking involved. It changes your intraoperative decision making, it even slightly changes your role. You have to look at it really carefully in 3D and work out what the margins are. But the semi-automation of the AblaSure technology makes that very easy to do.

Do you see any other advantages in the use of navigation technology in general and in quantitative margin assessment in particular?
I think that incomplete ablation is the achilles heel of thermal ablation. But quantitative margin assessment with technology like AblaSure provides a solution to that. And it does that in a number of ways: It democratizes treatment in a way that you don’t have to be in a specialist center with high-end equipment, that very few people have access to. Technology like this will open the doors for many centers to be able to do more and more complex ablations and do less complex ablations better, than they were previously done. It does this by quantifying the technical success. So you can say with absolut certainty: I’ve got this margin. Well remember the pathologist has to tell the surgeon when he or she’s doing a resection, that all of the tumour is gone. We have no similar ability other than technology like AblaSure. This is a huge step towards achieving that.

Which further implications does that have?
AblaSure increases transparency about what has happened during the procedure. And I have to say, I would love to see these treatment plans in the future forming parts of the patient’s medical record, would that be on paper or ideally in form of an electronic medial record. And finally it has shown that this technology has opened the doors to treating a different, a larger range of treatable tumours.

Quality Ablation Blog

CAS-One IR enabled to provide the patient with ablation as a tissue sparing treatment option. Moreover the intervention fostered to stop growth and further spread of the tumour to adjecent organs or vessels. This allowed to continue the treatment strategy and keep the patient on the waiting list for liver transplant surgery. Post ablation verification of the treatment was done using AblaSure for quantitative margin assessment.


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