title: Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance.
abstract: OBJECTIVE
  To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA).
  
  
  METHODS
  Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT. Volume rendering-based graphic representations (VRT guidance) were generated indicating the origin and course of the vessels. Based on VRT guidance, the intervention was planned. Procedure durations and radiation exposure data were compared between the two groups (Wilcoxon test).
  
  
  RESULTS
  The overall intervention time was approximately 2 h in both groups (p = 0.31). BPA was successfully performed in G3D 91 % and G2D 94 %. No significant difference was found concerning the mean dose area product (DAP) related to fluoroscopy (p = 0.38), while DAP related to DSA was slightly higher in G3D (p = 0.048). Overall, DAP was significantly higher in G3D (p = 0.002).
  
  
  CONCLUSIONS
  The use of CACT for procedure guidance in patients undergoing BPA is feasible and accurate. Image fusion of a pre-acquired CACT can be used to decrease radiation exposure due to multiple BPA sessions.
  
  
  CONCLUSIONS
  • BPA guidance by CACT overlay is feasible and safe. • 2D3D image fusion for BPA guidance is accurate. • Image fusion can reduce patient radiation dose due to repeated BPA sessions.
authors.affiliation: Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany. hinrichs.jan@mh-hannover.de.|Hannover Medical School, Institute for Diagnostic and Interventional Radiology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. hinrichs.jan@mh-hannover.de.
authors.forename: Jan B
authors.initials: JB
authors.lastname: Hinrichs
authors.affiliation: Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Renne
authors.affiliation: Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.affiliation: Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Olsson
authors.affiliation: Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.
authors.forename: Frank K
authors.initials: FK
authors.lastname: Wacker
authors.affiliation: Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Meyer
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001132:Arm; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D015641:Radiography, Interventional / Q000295:instrumentation* / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods*
keywords: Balloon pulmonary angioplasty; Chronic thromboembolic pulmonary hypertension; Cone-beam computed tomography; Percutaneous transluminal pulmonary angioplasty; Pulmonary hypertension