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Background The increasing longevity of the population coupled with the progress of treatments for primary tumors is enhancing the incidence and the burden of distant metastases such as bone metastases. Bone metastases are the most common cause of cancer-related pain. Quality of life may be significantly impaired as a consequence of painful bone metastases. The treatment of secondary bone lesions will become even more important in the near future. The development of strategies to improve quality of life in patients with bone metastases is fundamental and represents a major clinical challenge. This issue is of huge impact on today health care and economy.

BackgroundOsteoid osteoma is a bone-producing lesion frequentlylocalized in long bones. The most common presentingsymptom is pain with nocturnal exacerbation, respon-sive to nonsteroidal anti-i nflammatory drugs [1]. Mini-mally invasive treatment options have become thestandard of care for osteoid osteoma and at presentradiofrequency ablation is the treatment of choice [2].Only one preliminary study has been performed usingmagnetic resonance guided focused ultrasound(MRgFUS) to treat osteoid osteoma showing MRgFUSto be effective for pain relief through thermal cell deathand periosteal denervation induced by cortical heatingrelative to acoustic energy absorption [3]. The purposeof this research was to evaluate the efficacy of MRgFUSin treating osteoid osteoma and to highlight potentialbenefits and limitations provided by this technology.Materials and methodsSeven patients affected by osteoid osteoma were consecu-tively recruited for MRgFUS (ExAblate 2100, InSightec,Israel on 1.5 T Signa Twin Speed MR system, GE, USA).The diagnosis of osteoid ost eoma was based on typicalclinical and imaging findings (CT and MRI) . Pain andfunction were scored before and after MRgFUS (VAS –0-10 scale), and any intra- and post-procedure complica-tion or adverse effect was recorded. Initial follow-upincluded clinical assessment at discharge, and everymonth.ResultsIn one patient the lesion c ould not be approached dueto the high body mass index (33 Kg/m