“The best form of hands-on simulation training available is through cadavers,” said Dr. Hands. “Courses are offered all over the country. Unfortunately, universities are seemingly last on board, not wanting to invest in the process and waiting for Medicare codes for billing, which may take another two years.”
Explore This Issue
March 2022She noted that RGS Healthcare is the support system she uses; she also proctors for them. “They provide excellent hands-on experience to include cadaver training,” she said. Dr. Hands has proctored several courses with more than 30 physicians, including radiologists, surgeons, and endocrinologists, and she has mentored close to 15 surgeons and endocrinologists in her office and on site at clinicians’ offices.
As RFA becomes more popular in the United States, physicians who perform the procedure are increasingly seeing patients who read about RFA online and seek a consultation. “Patients want to keep their thyroid function and don’t want to go to surgery,” said Dr. Hands. “They come from other countries and all over the U.S.”
Talking to Patients
According to Dr. Randolph, the benign nodule diagnosis should be discussed thoroughly with the patient so he or she understands what it is, along with all appropriate options, including following the nodule over time to see whether it’s stable or growing; performing surgery, which removes the nodule permanently; and RFA, which gives candidate patients the ability to have the nodule reduced in size with no incision, under a local anesthetic. RFA can be repeated if needed.
“Radiofrequency should be described as an option, along with other existing options, to patients,” he said. While he doesn’t prefer one procedure over another, he does skew a bit more toward recommending surgery to younger patients with very large nodules, because these patients have many years ahead of them. “If the nodule is large and the patient is young, that means the nodule is quite aggressive in its growth,” he said.
Dr. Sinclair said that whether a physician offers RFA as part of their practice or not, being informed about all options available for a given disease is a physician’s ethical and professional responsibility to their patients. “They should be willing to refer to a colleague who does when appropriate,” she said.
Because not all patient and thyroid nodule anatomy is suited for RFA, however, Dr. Orloff said that determination of candidacy and proper selection are best achieved by a physician with US and RFA experience.