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Cone Beam CT

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BackTable is a knowledge resource for physicians by physicians. Get practical advice on Cone Beam CT and how to build your practice by listening to the BackTable VI Podcast, reading exclusing BackTable Articles, and following the work of our Contributors.

Ep 376 New Frontiers in Spinal Tumor Ablation & Augmentation with Dr. Dana Dunleavy

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Pre-Procedure Prep

Indications

• Liver directed therapy
• Prostate artery embolization
• Vertebral augmentation
• Gastrostomy tubes without preoperative cross sectional imaging
• Celiac plexus neurolysis
• Difficult nephrostomy tube access
• And more

How to Achieve High Quality Cone-Beam CT

• REPETITION
• Perform cone-beam CT routinely to get you and staff trained and comfortable

Cone Beam CT Podcasts

Listen to leading physicians discuss cone beam ct on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #376

New Frontiers in Spinal Tumor Ablation & Augmentation

In this episode, host Dr. Jacob Fleming interviews Dr. Dana Dunleavy about spinal tumor ablation and vertebral augmentation. Dana is an interventional radiologist and Director of Windsong Interventional & Vascular Services.

Episode #51

Cone Beam CT Techniques

Dr. Austin Bourgeois and Dr. Christopher Beck discuss ways you can improve your Cone Beam imaging for liver directed therapy, prostate artery embolization and how it can be used to improve safety of other procedures, such as G-tube placement.

Procedure Steps

Room and Patient Setup

• Light sedation vs local only – important for breath holding
• Coach patient on breathing in preprocedural area
• IV location: left arm, away from elbow or locations predisposed to kinking
• BP cuff: left arm or on leg
• Arms by side but not tucked or restrained to allow for quick arms-up position
• C-arm position: left side of patient (as opposed to prop spin) - helps avoid C-arm getting caught on tubes and lines
• Femoral access may be easier for some operators

Cone-Beam CT Parameters

• Motion trumps photons
• Choose spin with shortest acquisition time
• Low-dose spins may provide better pictures than high dose/high quality spin because of shorter acquisition times
• Breath hold on end expiration

Injection Tips

• suggests below were taken from Episode 51 - Cone Beam CT Techniques
• Delay time: time from contrast injection to spin acquisition beginning
• 8 second delay for mCRC – parenchymal phase
• Goal: injections with antegrade flow without reflux

Dr. Bourgeois’ approximate injections for right and left lobe
• Dr. Bourgeois’ approximate right hepatic artery: 2.5 mL/s for 25 ml (or 2.0 for 20)
• Dr. Bourgeois’ approximate left hepatic artery: 1 mL/s for 10 ml (or 1.5 for 15)
• Shorter delay times between 2-4 seconds if interested in arterial anatomy or hypervascular tumors
Dr. Beck's approximate injections for right and left lobe
• Injection rates for mCRC: RHA: 2 ml/s for 22 mL with 6 second delay
• Injection rates for mCRC: LHA: 1 ml/s for 11 mL with 6 second delay

Equipment

• Microcatheter
• High Pressure: 1200 PSI
• Shorter length allows for slightly better flow rates
• 130cm length as opposed to 150 cm from wrist
• If using shorter endhole catheter (65 cm instead of 80 cm), can try using 110 cm microcatheter

Contrast

• Contrast dilution: typically 50:50 dilution
• Examples: 50 mL contrast and 50 cc normal saline
• Agitate contrast mixture occasionally so that saline and contrast mix well

References

[1] Lucatelli P, Argirò R, Bascetta S, et al. Single injection dual phase CBCT technique ameliorates results of trans-arterial chemoembolization for hepatocellular cancer. Transl Gastroenterol Hepatol. 2017;2:83. Published 2017 Oct 24. doi:10.21037/tgh.2017.10.03
[2] Wallace MJ, Kuo MD, Glaiberman C, et al. Three-dimensional C-arm cone-beam CT: applications in the interventional suite. J Vasc Interv Radiol. 2008;19(6):799‐813. doi:10.1016/j.jvir.2008.02.018
[3] Issacson A. Get familiar with PAE. Interventional Oncology Learning. Available from https://www.iolearning.com/PAE

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