BACKGROUND
Microwave liver ablation is a ‘pinhole’ procedure which destroys tumours by heating them directly in a single treatment session. Here, Interventional Radiologists use CT images to accurately place a special needle which imparts heat energy which kills tumours with a treated region called the ‘ablation zone’, visible on scans at the end of treatment. Ablation offers the potential for cure and has several advantages over surgery including:
• Fewer complications
• Shorter hospital stay
• Lower cost
• A liver sparing approach, meaning it can be repeated
• Suitable for patients receiving chemotherapy
• It can also be combined with, or performed before or after surgery

However, high rates of tumours returning after treatment (1 in 3) mean surgery is currently preferred. I seek to address this problem by comparing two new methods that I believe could improve the quality of our treatments. The first uses ‘ablation confirmation software’ to accurately assess whether the ablation zone has fully covered the tumour, and the second uses a robot (the first of its kind in the UK) to guide the treating needle with high accuracy. Early evidence suggests both approaches are promising, although they have not been compared with standard practice in a clinical trial, which is crucial for NHS adoption. To do this, I must first answer some questions in a ‘feasibility study’ including:
• Is a full trial likely to succeed i.e., how many patients might take part, how long will it take, and how many patients will we need?
• Which of these new approaches demonstrates more promise?
• How much does each treatment cost?
• What do patients think of the treatments and how could they be best delivered in the NHS?
It is also important that I build the skills necessary to conduct such a study, which will also form a key part of the objectives of this fellowship.

DESIGN AND METHODS
150 patients referred to our department for microwave liver ablation procedures will be randomly allocated to one of three groups (50 per group):
1. Conventional treatment
2. Ablation confirmation software
3. Robotic guidance
All participants will be asked to answer a questionnaire I will interview selected participants after treatments to explore their views, especially regarding use of the robot. Patients will undergo follow-up scans to determine the success of treatment and will complete quality of life questionnaires for a year. My study methods were chosen to spearhead Interventional Radiology trials in the UK and provide better value for money to the taxpayer before resources are used for a full clinical trial. This work is important because the liver is a very common site for cancer to spread to and patients with liver tumours die sooner than those who do not. The National Institute of Health and Care Excellence (NICE) also recommends more research on this treatment, which has also been shown as very cost effective.

Patients, their families, the NHS, and society could benefit from this work by
• Having better life prolonging treatments
• Avoiding invasive surgery
• Improved satisfaction and quality of life
• Reduced need for multiple hospital visits
• Increasing cost efficiency and reducing working days lost.