Episode 51

Cone Beam CT Technique

with Dr. Austin Bourgeois

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. Special thanks to our sponsor RADPAD® Radiation Protection.

Cite this podcast: BackTable, LLC (Producer). (2019, October 31). Ep 51 – Cone Beam CT Technique [Audio podcast]. Retrieved from https://www.backtable.com/podcast

In this Episode

Podcast Participants

Dr. Austin Bourgeois is a practicing IR with Radiology of Huntsville in Huntsville, Alabama.

Host Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.

Contents

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…

Secret to high quality cone beam CT: Repetition

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

Room and patient setup

  • Light sedation vs local only – important for breath holding

  • Coach patient on breathing in pre-op

  • 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 prop spin)

    • Helps avoid C-arm getting caught on tubes and lines

  • Femoral access

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

  • Delay time: time from contrast injection to spin acquisition beginning

    • 8 second delay for mCRC – parenchymal phase

    • Injections with antegrade flow without reflux

    • Dr. Bourgeois’ approximate injections for right and left lobe

      • Right hepatic: 2.5 ml/s for 25 ml (or 2.0 for 20)

      • Left hepatic: 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 injection rates for mCRC

      • RHA: 2 ml/s for 22 ml with 6 second delay

      • LHA: 1 ml/s for 11 ml with 6 second delay

      • Assuming a 5 second scan time

Equipment

  • Microcatheter – Dr. Bourgeois prefers the 0.027” Direxion™

    • High Pressure: 1200 PSI

    • 130 cm length as opposed to 150 cm from wrist

    • Shorter length allows for slightly better flow rates

  • Contrast dilution: typically 50:50 dilution

    • Examples: 50 cc contrast and 50 cc normal saline

Resources

1. Wallace MJ - J Vasc Interv Radiol (2009) Three-dimensional C-arm cone-beam CT applications in
the interventional suite:
https://www.jvir.org/article/S1051-0443(09)00395-9/pdf

2. Lucatelli P - Transl Gastroenterol Hepa (2017) Single injection dual phase CBCT technique
ameliorates results of trans-arterial chemoembolization for hepatocellular cancer:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676208/pdf/tgh-02-2017.10.03.pdf

3. Videos with Dr. Ari Issacons with prostate artery embolization: https://www.iolearning.com/PAE

Protect yourself and your patients. Contact us to request a free RADPAD No Brainer® surgical cap and learn more about radiation protection at www.radpad.com.

Disclaimer: The Materials available on the BackTable Podcast are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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