title: Automatic bone removal for 3D TACE planning with C-arm CBCT: Evaluation of technical feasibility.
abstract: OBJECTIVE
  To evaluate the technical feasibility of automatically removing the ribs and spine from C-arm cone-beam computed tomography (CBCT) images acquired during transcatheter arterial chemoembolization (TACE).
  
  
  METHODS
  Fifty-eight patients (45.8 ± 5.0 years) with unresectable hepatocellular carcinoma (HCC) underwent transcatheter arterial chemoembolization and had intraprocedural CBCT imaging. Automatic bone removal was performed using model-based segmentation of the ventral cavity. Two interventional radiologists independently evaluated the performance of bone removal, remaining soft tissue retention, and general usability (where both the bone is appropriately removed while retaining soft tissue) for 3D TACE planning on a four-level (complete/excellent, adequate/good, incomplete/questionable, insufficient/bad) score. The proportion of inter-reader agreement was calculated.
  
  
  RESULTS
  For ribs and spine removal, 98.3-100% and 100% of cases showed complete or adequate performance, respectively. In 96.6% of the cases, soft tissue was at least adequately retained. 91.3-93.1% of the cases demonstrated good or excellent general usability for TACE planning. Satisfactory inter-reader agreement proportion was achieved in ribs (93.1%) and spine removal (89.7%), soft tissue retention (84.5%), and general usability for TACE planning (72.4%).
  
  
  CONCLUSIONS
  Intraprocedural automatic bone removal on CBCT images is technically feasible and offers good removal of ribs and spine while preserving soft tissue. Its clinical value needs further assessment.
authors.affiliation: a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA ;|b Interventional Radiology Department , Chinese PLA General Hospital , Beijing , China ;
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Wang
authors.affiliation: c Philips Research , Hamburg , Germany ;
authors.forename: Eberhard
authors.initials: E
authors.lastname: Hansis
authors.affiliation: a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA ;
authors.forename: Rongxin
authors.initials: R
authors.lastname: Chen
authors.affiliation: a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA ;
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.affiliation: a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA ;
authors.forename: Julius
authors.initials: J
authors.lastname: Chapiro
authors.affiliation: a Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology , The Johns Hopkins Hospital , Baltimore , MD , USA ;
authors.forename: Yun Robert
authors.initials: YR
authors.lastname: Sheu
authors.affiliation: d Service d'Imagerie Médicale, Unité de Radiologie interventionnelle et thérapeutique Vasculaire et Oncologique, Université Paris-Est Créteil, Assistance Publique-Hôpitaux de Paris, Centre Hospitalo-Universitaire Henri Mondor , France ;
authors.forename: Hicham
authors.initials: H
authors.lastname: Kobeiter
authors.affiliation: c Philips Research , Hamburg , Germany ;
authors.forename: Michael
authors.initials: M
authors.lastname: Grass
authors.affiliation: e Yale University School of Medicine, Department of Radiology and Biomedical Imaging , New Haven , CT , USA ;
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Geschwind
authors.affiliation: e Yale University School of Medicine, Department of Radiology and Biomedical Imaging , New Haven , CT , USA ;|f U/S Imaging and Interventions (UII), Philips Research North America , Cambridge , MA , USA.
authors.forename: MingDe
authors.initials: M
authors.lastname: Lin
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012272:Ribs; D013131:Spine
keywords: Hepatocellular carcinoma; automatic bone removal; cone-beam computed tomography; three-dimensional; transcatheter arterial chemoembolization