E1283. Cone Beam Computed Tomography: Optimizing the Interventional Radiology Suite
  1. Alexander Zhang; Carilion Clinic; Virginia Tech Carilion School of Medicine
  2. Thomas Bishop; Carilion Clinic
  3. Michael Bergen; Carilion Clinic; Virginia Tech Carilion School of Medicine
Interventional radiology (IR) is an ever-growing medical field that employs the use of image-guided techniques to perform minimally invasive procedures for diagnosis and treatment. As patients present with increasingly complex medical conditions to IR, Cone Beam Computed Tomography (CBCT) is an exciting technology with the potential to significantly impact the practice of IR. CBCT allows the operator to triage complex patient procedures to the interventional suite, such as in cases where patients require multiple procedures in a single setting, or where procedures require real-time visualization during needle guidance to ensure optimal patient outcomes. Through our case-based approach, we will highlight how we optimize CBCT in a busy tertiary hospital to triage patients to allow for high quality patient outcomes and operational efficiency in the radiology department as a whole.

Educational Goals / Teaching Points
1. Discuss the use of CBCT as a good alternative to Computed Tomography (CT) in a busy IR practice, given constraints with practice setup and availability of the CT scanner for percutaneous interventions. 2. Describe through a case-based approach, the seamless integration of transitioning from a standard 2D planar view to a cross-sectional view during intraprocedural imaging. 3. Highlight how the use of navigational guidance tools has modernized the way IR delivers care with greater efficacy, safety, and confidence.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
1. Angiographic evaluation and CBCT needle guidance application for the treatment of an Internal Iliac Artery Aneurysm. The anatomical and technical challenges will be discussed. 2. Use of navigational vessel tracking and CBCT to identify target lesions during the hepatic angiography for primary liver cancer. The procedural techniques and imaging findings will be discussed. 3. Discuss the use of the CBCT technique to allow for multiple procedures in a single setting to minimize sedation in a pediatric patient. 4. Describe the treatment of an iliopsoas abscess utilizing CBCT needle guidance for a drainage tube placement and nephrostomy tube exchange.

While promising, CBCT use when performing multiple procedures has not been fully utilized. Here, we showcase this potential by highlighting select cases of when CBCT was used in such a capacity and important takeaways to consider when utilizing this technology.