Chinese expert consensus on magnetic resonance-guided focused ultrasound surgery for painful bone metastases

Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is an emerging noninvasive treatment for painful bone metastases. The therapeutic mechanism involves precise thermal ablation of periosteal nerve endings combined with controlled necrosis of tumor-involved soft tissue, achieving both immediate pain relief and local disease control. Compared to conventional treatments such as opioid therapy, radiation, or chemotherapy, MRgFUS offers distinct advantages, including non-addictiveness, rapid pain relief, minimal systemic side effects, and excellent patient tolerance. To standardize and optimize MRgFUS clinical practice, the Radiology Department Association of Hospitals of Shanghai and the Micro/Non-invasive Treatment Committee of the Chinese Research Hospital Association have jointly developed this expert consensus document through a structured face-to-face consensus meeting involving 29 experts, combined with anonymous voting. This consensus comprehensively outlines the clinical application of MRgFUS, detailing indications and contraindications, while establishing standardized protocols for preoperative multidisciplinary evaluation, intraoperative workflow (encompassing team responsibilities, technical specifications, treatment planning, and real-time thermal monitoring), postoperative care, adverse event management, and long-term follow-up to assess treatment efficacy and safety outcomes. This consensus further proposes future development strategies for MRgFUS, emphasizing the establishment of global case data registries for collaborative research and the application of AI technologies to identify optimal candidates, thereby standardizing and optimizing procedural efficiency to advance MRgFUS applications in painful bone metastases. CRITICAL RELEVANCE STATEMENT: This expert consensus provides a detailed analysis of the advantages and target populations of MRgFUS, along with comprehensive technical considerations for the procedure. KEY POINTS: Magnetic resonance-guided focused ultrasound surgery (MRgFUS) requires expert consensus to standardize clinical application. MRgFUS is an effective alternative therapy‌, and this consensus detailed MRgFUS operational standards for painful bone metastases. This consensus enhances operator understanding of MRgFUS and facilitates its clinical adoption for painful bone metastases.