title: Image Registration of Cone-Beam Computer Tomography and Preprocedural Computer Tomography Aids in Localization of Adrenal Veins and Decreasing Radiation Dose in Adrenal Vein Sampling.
abstract: OBJECTIVE
  We assessed whether image registration of cone-beam computed tomography (CT) (CBCT) and contrast-enhanced CT (CE-CT) images indicating the locations of the adrenal veins can aid in increasing the success rate of first-attempts adrenal vein sampling (AVS) and therefore decreasing patient radiation dose.
  
  
  METHODS
  CBCT scans were acquired in the interventional suite (Philips Allura Xper FD20) and rigidly registered to the vertebra in previously acquired CE-CT. Adrenal vein locations were marked on the CT image and superimposed with live fluoroscopy and digital-subtraction angiography (DSA) to guide the AVS. Seventeen first attempts at AVS were performed with image registration and retrospectively compared with 15 first attempts without image registration performed earlier by the same 2 interventional radiologists. First-attempt AVS was considered successful when both adrenal vein samples showed representative cortisol levels. Sampling time, dose-area product (DAP), number of DSA runs, fluoroscopy time, and skin dose were recorded.
  
  
  RESULTS
  Without image registration, the first attempt at sampling was successful in 8 of 15 procedures indicating a success rate of 53.3%. This increased to 76.5% (13 of 17) by adding CBCT and CE-CT image registration to AVS procedures (p = 0.266). DAP values (p = 0.001) and DSA runs (p = 0.026) decreased significantly by adding image registration guidance. Sampling and fluoroscopy times and skin dose showed no significant changes.
  
  
  CONCLUSIONS
  Guidance based on registration of CBCT and previously acquired diagnostic CE-CT can aid in enhancing localization of the adrenal veins thereby increasing the success rate of first-attempt AVS with a significant decrease in the number of used DSA runs and, consequently, radiation dose required.
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Radboud University Medical Center, Internal postal code 766, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands, wendy.busser@radboudumc.nl.
authors.forename: Wendy M H
authors.initials: WM
authors.lastname: Busser
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Arntz
authors.forename: Sjoerd F M
authors.initials: SF
authors.lastname: Jenniskens
authors.forename: Jaap
authors.initials: J
authors.lastname: Deinum
authors.forename: Yvonne L
authors.initials: YL
authors.lastname: Hoogeveen
authors.forename: Frank
authors.initials: F
authors.lastname: de Lange
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Schultze Kool
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply* / Q000000981:diagnostic imaging*; D015901:Angiography, Digital Subtraction; D054893:Cone-Beam Computed Tomography; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media