This advertorial is sponsored by Varian, a Siemens Healthineers company.
The increasing integration of planning and confirmation software for microwave ablation procedures is helping to set a new standard for image-guided intervention, as growing evidence works to support a more standardised approach and reproducible outcomes. This is according to Alexander King, consultant oncology radiologist at University Hospital Southampton (Southampton, UK), speaking to Interventional News about the significant developments of the technique and integrated technology over the last decade, with software now playing a central role in both procedural planning and intra-procedural decision-making.
King, whose practice focuses mainly on renal cryoablation and liver microwave ablation, began by describing how early experience with microwave ablation was largely defined by variability and reliance on individual expertise. “In the beginning it was very much an operator-dependent procedure,” he shares. “The outcomes were largely down to the experience and the skill of the person holding the probe and directing the procedure rather than anything else.”
This subjectivity initiated efforts to introduce more objective tools, King describes, explaining that he and his team began using fusion software originally used in diagnostic imaging to do so. “We very quickly started to use it to merge images together rather than just looking at them side by side to work out whether we’d put the probe in the right place or whether the ablation had been adequate,” he notes.
“Over the following 10 years, that’s really developed into something that’s become mandatory in our practice for every liver ablation that we do, not just for HCC [hepatocellular carcinoma] but increasingly for metastatic disease,” King says.
“It has become something that, not just us in Southampton, but people across the world have come to the same conclusion about—that we need to use software more and more. Predominantly, that’s allowing us to create a much more standardised procedure, which is more predictable, more reproducible, and something where we can get the very best out of the microwave equipment,” he noted.
Recent clinical data have reinforced the importance of software integration, King adds, particularly in the treatment of colorectal liver metastases: “The evidence now is exciting. We had the COLLISION trial data that told us that ablation for colorectal liver metastases is at least as good as surgery, while the COVER-ALL trial was so strongly supportive of using software that they abandoned the other arm and really just went with the software.”
King highlights that such findings help to define a more structured approach to microwave ablation, stating that, to get “the very best” out of the technique, three-dimensional (3D) software analysis must be used to determine whether the treatment was adequate.
Regarding ongoing studies, King expects best practice will be clarified further and will work to establish standards across the board. He emphasises that next steps will be to apply these standards consistently across centres, so that all institutions have equitable access to favourable outcomes.
“What we’re getting to is an understanding from the data of how these procedures should be done and how we should measure our success,” says King. “It’s not just about being able to say that centres of academic excellence are able to get great results, but that we’ve now produced a process that, if followed in a particular way with particular equipment, allows you to get the same results at any centre.”
In his practice, King uses myAblation Guide (Siemens Healthineers) for real-time procedural planning, shifting away from pre-procedural planning based on historical imaging. He describes that “at the very beginning of the procedure we can now determine where the probe is going to be placed and how big the ablation needs to be, rather than having to do it the night before on a scan from three or four weeks earlier,” he says. “We can pretty much do it live.”
King highlights that this ability to plan in real time allows clinicians to tailor treatment to the patient’s anatomy and positioning on the day of the procedure. He adds that the adoption of such tools has been relatively straightforward, stating that “the learning curve was very small. Within fewer than 10 cases most people are feeling reasonably competent and confident.”
Beyond planning, King tells Interventional News that the integration of confirmation software has become a critical component of his microwave ablation practice. Historically, assessment of treatment success relied on visual interpretation of two-dimensional (2D) imaging; however, software-enabled 3D analysis now provides a more objective measure of treatment adequacy, he shares.
“This is now a complete process that’s integrated within a single software package that leads me from the beginning to the end of a procedure in a very clear and concise way,” King said. “It means I can assess how well I’m doing objectively, as well as produce evidence that I have reached technical success.”
He describes that the ability to define and verify treatment endpoints during the procedure is seen as a key advantage of software integration when performing microwave ablation.
“Because you’ve set out at the beginning what you intend to do, you’re responsible for achieving that all the way through. The software helps keep you on track,” says King. “You can always refer back to the plan and ask: did I put the needle where I expected it to be? If not, you can either reposition it or adjust the plan accordingly.”
Recently, King has integrated the IntelliBlate microwave ablation system (Varian, a Siemens Healthineers Company) into his practice, “initially on a trial basis but now hopefully becoming a permanent part of our toolkit—I’ve been very impressed,” he notes.
“The standout feature for me is the predictability of the ablation zone,” he describes. “When we place the needle where it’s supposed to go and we prescribe a time and power, we end up with a spherical ablation zone that matches exactly what we wanted.”
King explains that the alignment between planning and execution is critical to achieving optimal outcomes, which is what they are able to achieve with the IntelliBlate system. “Not only does that mean we’re going to get very good treatments, but it also means we can be very safe,” King says.
Looking to the future, King suggests that further integration of planning and confirmation tools with emerging technologies will continue to refine microwave ablation practice. “Fully integrated intelligent systems, combining artificial intelligence-assisted, real-time planning and confirmation within a closed-loop environment, are exactly where we need to get to,” he avers.
For now, reflecting on the past decade, he underscores the extent of progress made: “Ten or twelve years ago, we were just experimenting with software to see if it could help confirm where the needle had been placed or where the ablation zone ended up; now, a decade later, we have something that looks like a complete package,” he states.
As clinical evidence continues to accumulate, the role of planning and confirmation software is expected to expand further, supporting a shift towards more standardised, data-driven microwave ablation procedures across a wider range of indications and clinical settings.
This article reflects the personal clinical experience and opinions of the interviewed clinician and not those of Varian or the clinician’s institution. Product availability, approved indications, and regulatory status vary by country. Varian does not promote the use of its products outside their intended purpose and approved labeling. Varian as a medical device manufacturer cannot and does not recommend specific treatment approaches. Individual treatment results may vary.
