title: Dynact soft-tissue visualization using an angiographic C-arm system: initial clinical experience in the operating room.
abstract: BACKGROUND
  DynaCT is a clinical application protocol to create computed tomographic (CT)-like images allowing soft-tissue visualization acquired from an angiography system. A cone beam three-dimensional CT reconstruction is produced from the acquisition of two-dimensional projection images by rotating the c-arm with x-ray source and image receptor around the patient. The purpose of this study is to evaluate the clinical efficacy of DynaCT in the operating room.
  
  
  METHODS
  DynaCT was performed in 100 patients undergoing cerebral or spinal interventional procedures in the new-concept operating room. Specially designed AXIOM Artis BA (conventional image intensifier system; 55 patients; Siemens Medical Solutions, Erlangen, Germany) and AXIOM Artis dBA (flat-panel detector; 45 patients; Siemens Medical Solutions) biplane neuroangiographic systems (Siemens Medical Solutions, Germany) were installed in the operating room. The volumetric data set from the AXIOM Artis systems were reconstructed immediately on the three-dimensional workstation in the operating room. We compared DynaCT images with the use of multidetector computed tomography.
  
  
  RESULTS
  DynaCT was performed successfully in all patients. High-contrast structures, such as bone, calcified lesions, and metallic materials, were visualized on DynaCT as well as in multidetector computed tomography for each group. Although contrast differentiation of soft tissue such as cerebral cortex, muscle, and hematoma on DynaCT were inferior to multidetector CT scans, the images were sufficiently used as intraoperative CT-like images. However, DynaCT images acquired from flat panel detector-based systems were found to be superior to those images acquired from image intensifier-based systems. Striking ring artifacts were exhibited and resulted in major limitations in the image intensifier group.
  
  
  CONCLUSIONS
  DynaCT has the potential to be used as a powerful tool for endovascular and neurosurgical procedures and will open new possibilities for neurosurgical management.
authors.affiliation: Division of Endovascular Neurosurgery, Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan. k-irie@jikei.ac.jp
authors.forename: Koreaki
authors.initials: K
authors.lastname: Irie
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Takayuki
authors.initials: T
authors.lastname: Saguchi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ishibashi
authors.forename: Masaki
authors.initials: M
authors.lastname: Ebara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takao
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Abe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000295:instrumentation* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003238:Connective Tissue / Q000000981:diagnostic imaging*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000295:instrumentation* / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D009873:Operating Rooms; D010865:Pilot Projects; D025321:Surgery, Computer-Assisted / Q000379:methods; D036542:Tomography, Spiral Computed / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome