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52. Pavlin M, Kanduser M, Rebersek M, et al. Effect of cell electro-poration on the conductivity of a cell suspension. Biophys J 2005; 88:4378–4390.

53. Glahder J, Norrild B, Persson MB, Persson BRR. Transfection of HeLa-cells with pEGFP plasmid by impedance power-assisted electroporation.Biotechnol Bioeng 2005; 92:267–276.

54. Neal RE II, Kavnoudias H, Cheung W, Golebiowski B, McLean CA,Thomson KR. Hepatic epithelioid hemangioendothelioma treated withirreversible electroporation and antibiotics. J Clin Oncol 2013; 31:e422–e426.

55. Charpentier KP. Irreversible electroporation for the ablation of livertumors: are we there yet? Arch Surg 2012; 147:1053–1061.

CME TEST QUESTIONS: JULY 2014

Examination available at http://learn.sirweb.org/. To take the online JVIR CME tests, please log into the SIRLearning Center with your SIR user name and password. Nonmembers: If you do not already have an SIR usernameand password, please click on “Create an Account” to gain access to the SIR Learning Center. Once in the LearningCenter, click on the “Publication” activity type for a listing of all available JVIR CME Tests. Each test will beavailable online for 3 years from the month/date of publication.

The CME questions in the July 2014 issue are derived from the article “Irreversible Electroporation for NonthermalTumor Ablation in the Clinical Setting: A Systematic Review of Safety and Efficacy” by Scheffer et al.

1.

Irreversible electroporation (IRE) causes cell death bya. Inducing electrical energy, which in turn gener-

ates heat that permanently damages the cellsb. Decreasing cell permeability, tightening cell junc-

tions, and preventing vital nutrients from enteringthe cell

c. Disrupting the lipid bilayer of the cell membrane,which adversely affects its permeability and cau-ses cell death through loss of homeostasis

d. Generating free radicals that are cytotoxic

2.

Which of the following statements is true?a. IRE-related complications are most common

after treating hepatic tumors but can be mostsevere (grade III, IV, V) following renal ablations

b. The literature suggests that IRE complicationsare low overall, with a high safety margin with noreport of a grade III or higher complication

c. The literature is too conflicted to allow anyconclusions

d. IRE-related complications are most commonafter treating lung tumors but can be most severe(grade III, IV, V) following pancreatic ablations

3.

Regarding cardiac arrhythmias, the literature sug-gests that IREa. Does not interfere with the electrical activity of

the heart and can be disregardedb. Is relatively safe, and synchronized pulsing of the

heart rhythm in a patient without preexistingcardiac abnormalities can effectively reduce therisk to less than 3%

c. Can cause severe ventricular arrhythmia evenwith cardiac gating

d. Can occasionally cause severe, irreversible ven-tricular tachycardia requiring an implantable car-dioverter–defibrillator

4.

Compared to percutaneous radiofrequency (RF)ablation, the limited data suggest that IREa. Has a higher overall complication rate but is

unaffected by heat sink effect and hence may bebetter suited for tumors in close proximity tobiliary ducts and major portal or hepatic veins

b. Has an equivalent complication and efficacy rateand is no different than RF ablation

c. Is better suited for large tumors (4 5 cm), withhigh success and negligible complications

d. Results in a higher conversion of electrical energyto heat than RF ablation, with a high incidence ofbiliary strictures or portal vein thrombosis, or both

5.

Which of the following statements hold true regard-ing pancreatic ablation for pancreatic cancer?a. At least one study has demonstrated improved

local control and better pain palliation whenchemoradiation is combined with IRE thanchemoradiation alone

b. Complication rates following IRE parallel thatof RF ablation, exceeding 50%, outweighing itsbenefit

c. A high success rate with tumor necrosis with anacceptable 10% complication rate make IRE aviable stand-alone alternative to surgery

d. Compared to chemoradiation alone, IRE com-bined with chemoradiation has better local- anddisease-free control and improves survival afterthe onset of distant metastasis