June 2025 | Educational Supplement
Future-focused IR imaging for a broad procedure mix
In a day of sessions showcasing the latest advancements in liver-directed therapies, experts focused on new developments in imaging and guidance systems that enhance procedural precision. Hosted at the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) annual congress (14–18 September 2024, Lisbon, Portugal) and at a later private event hosted by Siemens Healthineers, attendees heard case-based experiences demonstrating the ARTIS icono system’s breadth of use. “ULTIMATELY, THIS TECHNOLOGY allows us to have confidence that we are giving patients better overall survival,” said David Madoff (Yale School of Medicine, New Haven, USA), delivering a talk on improving personalised patient care using the ARTIS icono and DynaCT (Siemens Healthineers AG) smart guidance for liver embolization. Madoff began his presentation by stating that the goal of hepatic transarterial therapy is to maximise treatment to the tumour while limiting non-target intervention. By doing this, successful locoregional therapy can be achieved; however, he noted that sometimes issues can occur through unclear vascular assessment, challenging anatomy, or early stasis or reflux. He explained that these challenges can subsequently cause increased procedural time, radiation exposure, non-target embolization and even aborted treatment.
High-quality intraprocedural imaging is “critical”
In combatting these challenges, Madoff explained that “intraprocedural imaging is critical in optimising tumour targeting and ensuring the success of treatment”, highlighting that cone-beam computed tomography (CBCT) imaging, syngo DynaCT has improved survival rates following transarterial chemoembolization (TACE). “syngo DynaCT—especially when combined with navigational software—helps to better identify tumour feeders which reduces tumour recurrence rates when compared to digital subtraction angiography [DSA] alone,” said Madoff. He noted that further benefits of advanced technology in this setting include the ability to perform immediate post-procedure non-contrast CBCT (Figure 1). This allows for chemoembolic deposition assessment and quantification within targeted tumours which has been found to be a predictor of local tumour recurrence, Madoff added. With this background in mind, the speaker described the ARTIS icono system that he and
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his team use for intraprocedural imaging. He highlighted a new feature, Case Flows, which stores relevant parameters during procedures such as femoral access. This can help to reduce variations in technique, he said. He detailed that other parameters such as C-arm, table and detector positioning, as well as display layout can each be configured with a
Figure 1a-d. syngo DynaCT allows for immediate confirmation of effective tumor treatment. Anteriogram shows residual tumour (a), syngo DynaCT immediate after cTACE (b), CT without non-target deposits (c), contrast enhanced MR one month after shows effective treatment of the tumour (d).
single button, which standardises procedural steps. Among other updates to the ARTIS icono system, Madoff detailed the new Omni Spin feature, which allows for faster rotational speeds performed at 90 degrees per second.
The more vessel detail you see, the more precisely you can place your catheter toward the lesion”
www.interventionalnews.com Three-dimensional (3D) image acquisition from head side can be generated within 2.5 seconds.
Optimising tumour and vessel targeting
Madoff emphasised the “full spectrum of tools from imaging, treatment planning, guidance and, ultimately, to treatment assessment” offered in Siemens Healthineers’ range. With the aid of DynaCT’s Embolization Guidance, which supports guidewire navigation to selective therapy positions for tumour targeting, multiple tumour nodules can be treated during a single procedure, Madoff said. Feeding vessels can also be predefined and colour coded, which “facilitates finding the optimal treatment position for each tumour”. He described that the vessel tree can be overlaid on live fluoroscopy images, and that tumour spheres, safety margins and vessel subtrees can be individually switched off and on, as well as faded in and out. In research carried out by Mohamed E Abdelsalam (The University of Texas MD Anderson, Houston, USA) et al, the application of superselective embolization has been shown to improve overall survival, Madoff stated. “The more vessel detail you see, the more precisely you can place your catheter toward the lesion,” he said. As was shown in the Abdelsalam et al data, Madoff further underlined the “critical” importance of precise imaging patients with a low tumour load.1 “If you are dealing with a case where there are tumours throughout the liver and you’re performing a whole lobar TACE or Y90, [superselective targeting] is not critical, but when you’re trying to specifically target small tumours or tumours in very different locations in order to maximise effective therapy and reduce treatment to non-target tissue, I find it very important,” said Madoff. According to Madoff, the addition of DynaCT has improved personalised patient care through smart embolization guidance, allowing his team to cut down procedure time, radiation dosage and potential injury to vasculature. “It has allowed us to be much more confident in our treatments,” he said, “and ultimately, we are able to be surer in our assessment of tumour treatment zones as well as achieving better overall survival for our patients.” Reference
1 Abdelsalam ME, Appleton-Figueira TM, Ensor J, et al. Survival impact of C-Arm cone-beam computed tomography on hepatocellular carcinoma patients undergoing chemoembolization. Am J Interv Radiol 2021;5:9.
This educational supplement has been sponsored by Siemens Healthineers AG