Background Information:

What are the other Names for the Procedure?

• Cryoablation
• Cryosurgery
• Targeted Cryoablation Therapy

What is Cryotherapy radiology procedure? (General Explanation)

• Cryotherapy is a common procedure that uses extremely cold temperatures to destroy abnormal tissues or cancer cells
• The extreme cold environment is created by injecting liquid nitrogen or argon gases through a needle, to the target tissue
• A CT scan, MRI scan, or an ultrasound scan, can be used to guide the needle to the abnormal tissues

What part of the Body does the Procedure involve?

Topical Cryotherapy is used typically in the case of skin and eye lesions.

Why is the Cryotherapy radiology procedure Performed?

Cryotherapy procedure is used for the following reasons:

• Skin disease treatment, such as skin moles, skin tags, nodules, skin tumors, and freckles
• Cancers, such as retinoblastoma, prostate cancer, liver cancer, cervical cancer
• Tumors in kidney, lungs, and breast, can also be treated using Cryotherapy

What is the Equipment used? (Description of Equipment)

Cryotherapy uses the following equipment:

• For percutaneous skin treatments of outside tissue, only a spray device is needed
• In treatments of deep tissues and tumors, a cryoprobe and image guidance is used
  • A cryoprobe is connected to a tank of nitrogen or argon gas
  • A cryoprobe is guided to the abnormal tissue via a CT, MRI, or ultrasound scan

CT scan equipment:

• The CT scanner
• The examination table on which a patient lies down, which slides into the equipment
• An X-ray tube and electronic x-ray detectors that rotate around the patient
• Images are taken from a computer

Ultrasound scan equipment:

• A transducer
• A computer monitor
• A transducer is used to send high frequency sound waves in the body; the computer creates the image based on the echoes of that sound returning from the patient’s body

MRI scan equipment:

• MRI is a large, cylinder-shaped tube and is surrounded by a circular magnet
• The patient lies on the table, which slides back and forth in the cylinder tube
• In some MRI equipment, called short-bore systems, the magnet does not completely surround the patient. This is particularly helpful for patients who are obese, or for those who are afraid of being inside a closed tube

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the Cryotherapy procedure.

What is the Cost of Performing the Cryotherapy radiology procedure?

The cost of the Cryotherapy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Cryotherapy procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=cryo (accessed on 08/03/2014)

Prior to Cryotherapy radiology procedure:

How does the Cryotherapy radiology Procedure work?

• Cryotherapy involves supplying extreme cold gases to the abnormal tissues
• This cold temperature kills the cell by ice formation inside the cells, by freezing blood supply to the abnormal cells, or by bursting of cells due to ice expansion
• More than one cycle of cryotherapy may be needed to kill the cells. Once the cells are killed, the white cells remove all remaining debris

How is the Cryotherapy radiology procedure Performed?

• In the case of percutaneous skin treatment for tissues outside of the body - cotton swab or spray is used, to apply extremely cold liquid nitrogen to the abnormal area
• For tissues deeper in the skin or for tumors:
  • An intravenous line (IV) is inserted into patient’s arm, to inject sedatives or other medications
  • Anesthesia is applied, where the cryoprobe will be inserted
  • The cryoprobe insertion site is cleaned and disinfected
  • For CT or MRI scan, patients are instructed to remain still during the procedure. The physician may use ultrasound for patients having a difficult time staying still. Sedation may be used in children to keep them still
  • The cryoprobe is inserted through the skin and sent to the tissue site, using imaging techniques
  • Once the cryoprobe reaches the target site, nitrogen or argon is gas is delivered
  • Ice formation can be seen using imaging techniques and thus, freezing of the abnormal tissue can be monitored. while the procedure is taking place
  • After the procedure is over, the IV line and the cryoprobe is removed

Where is the Procedure Performed?

Percutaneous skin treatments are outpatient procedures, while treating tumors or other ‘deep’ treatments, require a short hospital stay under supervision of a medical staff.

Who Performs the Procedure?

A specially-trained interventional radiologist usually performs the Cryotherapy procedure.

How long will the Procedure take?

The Cryotherapy procedure takes about 1-3 hours.

Who interprets the Result?

• An interventional radiologist determines the results of the Cryotherapy procedure
• The patients may need a follow-up visit for blood work, or a physical check-up

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Cryotherapy procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, or to the anesthesia, which may be used in the procedure
• During removal of tumors, patients are advised not to take blood thinner medications, such as aspirin or NSAIDS
• For percutaneous skin treatment, patients are given antibiotics to prevent spreading of infections
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the procedure
• It is highly recommended to inform your healthcare professional, if you are pregnant or breastfeeding
• The patient may be asked to avoid eating or drinking, several hours before the test
• The patients may be required to be driven home, after the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for a Cryotherapy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of Cryotherapy:

• Cyrotherapy is minimally-invasive and less painful than most other procedures
• There is a lesser hospital stay and a faster recovery time, than other normal surgical procedures
• Cryotherapy is less expensive and has fewer side effects, than other procedures

Following are the risks of Cryotherapy:

• Normal structures, such as ureter, bile ducts, rectum, or bowel, may get damaged during Cryotherapy
• There are chances of bleeding, due to freezing of body tissues
• Collapse of the lungs or fluid accumulation may occur in the space around the lungs, if freezing is done near the diaphragm
• During Cryotherapy for prostate cancer, nerve damage may lead to impotency; blocking of the urthera may occur due to dead tissues.
• There is a slight chance of cancer, due to excess radiation during the x-ray procedure
• Allergic reactions may occur due to the anesthesia or contrast material, used during the procedure
• Freezing of nerves during the procedure may lead to nerve damage

What are the Limitations of the Cryotherapy radiology procedure?

• Cryotherapy can only be used for cancers, localized at a specific site
• The procedure may miss microscopic cancers, as only tumors seen on radiology images are treated
• The long-term effectiveness of Cryotherapy is still under investigation

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is the Cryotherapy procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Cryotherapy radiology procedure:

What is to be expected during the Cryotherapy radiology procedure?

The following may be expected during a Cryotherapy procedure:

• The patient may feel a slight pain, when the needle is inserted for local anesthesia
• The patient may feel slight pressure, when the cryoprobe is inserted
• Patients are asked to remain still and hold their breath several times, during the procedure

What kind of Anesthesia is given during the Procedure?

General anesthesia is administered during the Cryotherapy procedure.

How much Blood will you lose during the Procedure?

Crytherapy procedure does not involve the loss of blood.

What are the possible Risks and Complications during the Cryotherapy radiology procedure?

The risks of the Cryotherapy include:

• Normal structures, such as ureter, bile ducts, rectum, or bowel, may get damaged during the procedure
• There are chances of bleeding, due to freezing of tissues in the body
• Collapse of the lungs or fluid accumulation may occur in spaces around the lungs, if freezing is done near the diaphragm
• During Cryotherapy for prostate cancer, nerve damage may lead to impotency; blocking of the urthera may occur due to dead tissues
• There is a slight chance of getting cancer due to excess radiation during X-ray.
• Allergic reactions may occur due to the anesthesia or contrast material used during the procedure
• Freezing of nerves during the procedure may lead to nerve damage

What Post-operative Care is needed at the Healthcare Facility after the Cryotherapy radiology procedure?

The patient may be required to stay at the healthcare facility for overnight observation, after the Cryotherapy procedure.

After the Cryotherapy radiology procedure:

What is to be expected after the Cryotherapy radiology procedure?

• Patients should not participate in any heavy lifting or sports, for at least 72 hours after the Cryotherapy procedure
• Patients may resume their normal activities within 7-10 days, per physician’s advise

When do you need to call your Physician?

• If the patient experiences an allergic reaction to the anesthesia after the Cryotherapy procedure, then they should notify the physician immediately
• Also, if there is redness or swelling a week after the procedure, the patient should contact the healthcare provider

What Post-operative Care is needed at Home after the Cryotherapy radiology procedure?

• Generally, there is no post-operative care necessary at home, after the Cryotherapy procedure
• Patients may resume their normal activities within 7-10 days
• A follow-up visit for Cryotherapy may be required, 2 weeks after the procedure

How long does it normally take to recover fully from the Procedure?

The patient should fully recover, a week after the Cryotherapy procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

No tissue sample is taken during the Cryotherapy procedure. 

When should you expect results from the pathologist regarding the tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from after the Cryotherapy radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Radiologist or surgeon, performing the procedure
• Healthcare providers, physicians, who is involved in the process

The patient is advised to inquire and confirm the type of billing, before the Cryotherapy procedure is performed.