This past June I had the opportunity to visit Insight Diagnostics in Dallas, TX and observe a patient’s treatment of her uterine fibroids with Focused Ultrasound performed by Dr. Phyllis Gee. Below is a summary of what I observed and I hope it will give you an idea of what a procedure is like. ~ Joy

The patient had arrived early to prepare for the procedure which included the insertion of a catheter and administration of sedatives to help the patient relax before and during the procedure. While a nurse was helping to prepare the patient for the procedure, the technologist was preparing the instrument by performing a daily quality assurance (DQA) to assure that the instrument was operating properly.

The patient was on the table by 8 AM and the first sonication began at 8:54 AM. The technologist told me that at the start of the procedure, a patient often has difficulty defining what is considered pain and abnormal, versus what is considered normal to the procedure and not necessarily detrimental. Having never felt what ultrasound energy feels like within the body, it is a learning process for the patient while she is experiencing the procedure for the first time – so the beginning sonications are performed slowly to allow the patient to become comfortable with the process. This is one of the main reasons it is important for a patient to be awake and able to communicate with the attending nurse during the procedure.

This patient had 5 fibroids that were treated with Focused Ultrasound. Her symptoms were typically urinary in nature and it is likely that she will find relief for those symptoms practically immediately following the procedure.

During the treatment it is important that the doctor is careful to avoid the skin, bowel, pubic bone and sacral nerves. This is done by identifying and marking both the areas to treat and the areas to avoid on the MRI image, which allows the physician to actively direct the treatment throughout the procedure. Also, the instrument and software have a safety feature that tells the operator when he/she is too close to areas that should be avoided and suggests repositioning.

So, what’s happening during the procedure? Well, the physician begins with a low dose of ultrasound energy in the first sonication and then gradually increases the dose to the most effective dose for treatment. Energy is such a strange thing – increasing the energy seems like a weird statement to translate to destruction of the fibroid, but the ultrasound wave is delivered in joules, a measure of energy, which is monitored by the heat that is observed (measured in degrees) throughout the procedure. In this way the physician is constantly aware of the amount of energy (number of joules) necessary to achieve the appropriate amount of heat to destroy the fibroid.

After 3 hours of sonications (the amount of time approved for treatment by the FDA) the procedure was finished. One of the most interesting things I learned was that they can get nearly immediate feedback about the success of the ablative procedure. Following treatment, a contrast agent is added to view the cell death in the fibroid from the procedure. This patient had a very successful treatment, as visually it appeared that upwards of 60% of the patients fibroids were ablated during the procedure. The patient was able to move freely following the procedure and we spoke for several moments about her experience right afterwards. I was surprised that she said she was feeling great and although lying on the table for 3 hours was difficult, it was a very easy experience for her and she was eager to observe the effects of the treatment.