Arms Down Cone Beam CT Hepatic Angiography Performance Assessment: Vascular Imaging Quality and Imaging Artifacts.
INTRODUCTION
The practice of positioning patients' arms above the head during catheter-injected hepatic arterial phase cone beam CT (A-CBCT) imaging has been inherited from standard CT imaging due to image quality concerns, but interrupts workflow and extends procedure time. We sought to assess A-CBCT image quality and artifacts with arms extended above the head versus down by the side.


METHODS
We performed an IRB approved retrospective evaluation of reformatted and 3D-volume rendered images from 91 consecutive A-CBCTs (43 arms up, 48 arms down) acquired during hepatic tumor arterial embolization procedures. Two interventional radiologists reviewed all A-CBCT imaging and assigned vessel visualization scores (VVS) from 1 to 5, ranging from non-diagnostic to optimal visualization. Streak artifacts across axial images were rated from 1 to 3 based on resulting image quality (none to significant). Presence of respiratory or cardiac motion during acquisition, body mass index and radiation dose area product (DAP) were also recorded and analyzed. Univariate and multivariate analyses were used to assess the impact of arm position on VVS and imaging artifacts.


RESULTS
VVS were not significantly associated with arm position during A-CBCT imaging. One reader reported more streak artifacts across axial images in the arms down group (p = 0.005). DAP was not statistically different between the groups (23.9 Gy cm2 [6.1-73.4] arms up, 26.1 Gy cm2 [4.2-102.6] arms down, p = 0.54).


CONCLUSION
A-CBCT angiography performed with the arms above the head is not superior for clinically relevant hepatic vascular visualization compared to imaging performed with the arms by the patient's side.
['Gonzalez-Aguirre|Adrian J|AJ|http://orcid.org/0000-0002-7604-5788', 'Petre|Elena N|EN|', 'Hsu|Meier|M|', 'Moskowitz|Chaya S|CS|', 'Solomon|Stephen B|SB|', 'Durack|Jeremy C|JC|']
D001132:Arm D016477:Artifacts D000072226:Computed Tomography Angiography D054893:Cone-Beam Computed Tomography D004621:Embolization, Therapeutic D006801:Humans D021621:Imaging, Three-Dimensional D008099:Liver D008113:Liver Neoplasms D008297:Male D011187:Posture D015641:Radiography, Interventional D015203:Reproducibility of Results D012189:Retrospective Studies
Image quality Vessel visualization Arms positioning Cone beam CT angiography Transcatheter hepatic embolization