Emerging technology
Three-Dimensional C-arm Cone-beam CT: Applications in the Interventional Suite

https://doi.org/10.1016/j.jvir.2008.02.018Get rights and content

C-arm cone-beam computed tomography (CT) with a flat-panel detector represents the next generation of imaging technology available in the interventional radiology suite and is predicted to be the platform for many of the three-dimensional (3D) roadmapping and navigational tools that will emerge in parallel with its integration. The combination of current and unappreciated capabilities may be the foundation on which improvements in both safety and effectiveness of complex vascular and nonvascular interventional procedures become possible. These improvements include multiplanar soft tissue imaging, enhanced pretreatment target lesion roadmapping and guidance, and the ability for immediate multiplanar posttreatment assessment. These key features alone may translate to a reduction in the use of iodinated contrast media, a decrease in the radiation dose to the patient and operator, and an increase in the therapeutic index (increase in the safety-vs-benefit ratio). In routine practice, imaging information obtained with C-arm cone-beam CT provides a subjective level of confidence factor to the operator that has not yet been thoroughly quantified.

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Early Reported Clinical Experience

Reports of the use of C-arm cone-beam CT are beginning to emerge in the medical literature, with early case reports of its advantages coming from its use for neurologic interventions. For example, Heran and coworkers (2) used C-arm cone-beam CT to detect intracranial hemorrhages during three neurologic interventions, and Benndorf and coworkers (3, 4) used C-arm cone-beam CT to improve the visualization of intracranial and extracranial stents in four patients. In the study by Benndorf et al (4)

General Considerations

Potential vascular applications of C-arm cone-beam CT include its use for preprocedure anatomic diagnosis and treatment planning, intraprocedure device or implant positioning assessment, and postprocedure assessment of procedure endpoints. Most of these applications require the use of iodinated contrast medium to opacify the vascular system and make its corresponding soft tissue structures opaque. However, the acquisition of implant devices (eg, stents, stent-grafts, and stent filters) to

Spine Interventions

Fluoroscopic guidance, used alone to provide a real-time overview of a large area, usually provides sufficient information to guide appropriate needle placement for the injection of cement in lower thoracic or lumbar spine interventions. However, both C-arm cone-beam and conventional CT can be helpful in difficult spine procedures by revealing, in more detail than fluoroscopy, areas suitable for safe needle placement; C-arm cone-beam CT provides exact needle locations in three dimensions.

Technical Issues

The set-up time required for C-arm cone-beam CT image acquisition can range from 5 to 10 minutes, depending on the experience of the team and the frequency of C-arm cone-beam CT use. This time interval, the main impediment to integrating C-arm cone-beam CT into routine clinical practice, includes the time required to position the patient, examination table, and C-arm so that the area of interest is in the isocenter; the time required to prepare contrast media (eg, contrast medium dilution), if

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M.J.W. received an honorarium for speaking and grant support from Siemens Medical Solutions.

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