Cone-Beam CT During Transarterial Chemoembolization for Liver Cancer

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Vascular-Interventional Radiography: 1.00
Procedures: 1.00
Nonvascular Procedures: 1.00

Outline

1. Introduction
2. CBCT Imaging: How it Works
   1. The Principles of Projection Acquisition
   2. Volumetric Reconstruction
   3. Postprocessing
   4. CBCT Radiation Exposure
   5. Limitations of CBCT
3. Patient and Equipment Setup
   1. General Precaution
   2. Patient Positioning and Equipment Setup
   3. Catheterization during TACE
4. CBCT to ìSeeî the Tumor: Rationale and Techniques
   1. Rationale
   2. CBCT Techniques
5. CBCT to ìReachî the Tumor: Rationale and Techniques
   1. Rationale
   2. CBCT Techniques
6. CBCT to ìAssessî Treatment Success: Rational and Techniques
   1. Rationale
   2. CBCT Techniques
7. Suggested Algorithm for the Optimal Use of the Various CBCT Techniques during Each TACE Setup
8. Conclusion

Objectives

Upon completion of this course, students will:

1. explain the use of CBCT in differing disease states
2. differentiate between rotational angiography and CBCT imaging
3. state the most common type of primary liver cancer
4. name the most common therapy performed for HCC patients
5. list the components of image processing algorithms used in CBCT
6. describe the shape of the gantry used in CBCT imaging
7. select the minimum angular range for CBCT data acquisition
8. list how post-processing software affects acquired data
9. state the approximate radiation dose for one CBCT abdominal scan
10. compare CBCT to conventional multi-detector CT
11. explain the benefit of short acquisition times
12. state the maximum transversal liver diameter
13. describe breath holding instructions for patient undergoing CBCT
14. list the benefits of off-center patient positioning with respect to field of view
15. choose the angiographic catheter size for TACE procedures
16. recognize why celiac and common or proper hepatic artery angiograms are performed during TACE
17. describe how CBCT provides detailed information regarding tumors
18. discuss the utility of CBCT in the depiction of HCC
19. choose the most common technique for intra-procedural HCC detection
20. list tumor components demonstrated by the CBCT-HA technique
21. list the components of a contrast injection protocol
22. state acquisition delay rates for CBCT procedures
23. note the gold standard modality in pre-procedural detection of HCC
24. document how volumetric CBCT datasets are acquired
25. state the most commonly identified extra-hepatic feeders seen at CBCT
26. re-state the sensitivity of automatic computed analysis software
27. state the difference between radiopaque and radiolucent with regard to CBCT techniques
28. discuss the CBCT technique used to assess lipiodol deposition into the tumor after drug delivery
29. recall sensitivity of intra-procedural Lip-CBCT compared with pre-procedural diagnostic imaging
30. note the two CBCT techniques recommended for tumor localization