title: [Image guiding techniques and navigation for TACE, SIRT and TIPS].
abstract: OBJECTIVE
  To avoid non-targeted embolization in liver tumors, arteries important for embolization must be detected. In transarterial chemoembolization (TACE) arteries for particle embolization have to be detected and in selective internal radiotherapy (SIRT) extrahepatic arteries which must be protected from embolization have to be detected. In transjugular intrahepatic portosystemic shunt (TIPS) the problem is to achieve an exactly targeted puncture of the portal vein.
  
  
  METHODS
  In TACE and SIRT detection of the vessels is performed from various angles by digital subtraction angiography (DSA). In TIPS puncture is guided by ultrasound or performed blindly.
  
  
  METHODS
  Using cone beam CT (CBCT) very small vessels in the liver can be visualized and 2D-3D back projection is able to detect the exact position of the portal vein in TIPS.
  
  
  RESULTS
  The use of CBCT and 2D-3D back projection significantly enhances navigation of vessels.
  
  
  CONCLUSIONS
  If flat detector technique is available CBCT should be used in TACE and SIRT and 2D-3D navigation needs hardware and software updates.
authors.affiliation: Institut für Radiologie, Klinikum Nürnberg Nord, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland, Adamus@klinikum-nuernberg.de.
authors.forename: R
authors.initials: R
authors.lastname: Adamus
authors.forename: M
authors.initials: M
authors.lastname: Pfister
authors.forename: M
authors.initials: M
authors.lastname: Uder
authors.forename: R W
authors.initials: RW
authors.lastname: Loose
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D002406:Catheterization, Peripheral / Q000379:methods*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D006801:Humans; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*