Based on your MR images, and a physical exam your physician will determine if you are a candidate for a Focused Ultrasound treatment. If you are a candidate, you will be scheduled for treatment and given instructions on how to prepare.
On the day of treatment, a nurse will insert an IV line for administering mild sedation, so you can relax during the procedure. A catheter will be inserted into your bladder to drain it during treatment, so you won’t have to go to the bathroom. The entire treatment area will be shaved.
You will lie on your stomach on the treatment bed. Your head and shoulders will generally remain outside the MRI. You will be awake throughout the entire treatment and you will be able to communicate with the physician through an intercom.
The physician will observe you through a glass window separating the MR room from the control room and the nurse will check on you periodically.
Before the treatment begins, MRI images are taken and used to plan the treatment. Basically, the doctors use the MRI images to identify the exact Fibroid that needs to be treated. Once the plan is complete the treatment may begin.
Focused ultrasound surgery involves using ultrasound energy to heat 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). Similar to the way a magnifying glass focuses light; during a single activation of energy, called a ‘sonication’, ultrasound waves are directed through your abdomen and ablate a small volume of tissue, approximately the size of a jellybean. The treatment is guided by temperature sensitive images created using magnetic resonance imaging. These images allow temperature changes inside the body to be observed during treatment. The combination of focused ultrasound and magnetic resonance imaging allows the physician to perform the procedure without surgical incision. During the treatment, the doctor will first obtain MR images of your uterus and use these images to plan your treatment. Then, individual sonications will destroy pieces of your fibroid until the doctor is satisfied with the amount of fibroid that has been treated. The number of sonications can range from 40 to 100 and each one takes just under 2 minutes. The entire treatment may take up to 3 to 5 hours. After all the sonications are completed, MR images will again be taken to evaluate how effective the treatment has been.
While focused ultrasound is being delivered to your fibroid, you may feel a warm sensation in your pelvis, or a cramp similar to a menstrual cramp. If the feeling becomes unbearable, you can pause the treatment at any time using a hand-held “Stop Sonication” button. Once the entire fibroid is treated, the physician will inject a contrast enhanced agent showing the exact treatment outcome, which will be visible on the MRI.
By the time you get off the table, the physician will be able to assess how effective the treatment was. After the treatment, you will be sent to a recovery room for a couple of hours to allow the sedation medication to wear off.
After the sedation wears off, you can go home. You should be able to return to normal activities within days.
While the side effects from this treatment are very mild, you might experience some abdominal discomfort or soreness from lying on the patient table for a few hours. Your doctor will decide what medications are best for you if this happens.