Applications of Virtual Injection in Complex Embolization Procedures: A Case Series Review

Learning Objectives: Demonstrate the utility of Virtual Injection technology in complex embolization procedures. Discuss its impact on procedural workflow and decision-making. Assess limitations and challenges in integrating this technology into clinical practice.

Background: Complex embolization procedures require precise assessment and navigation of intricate vascular anatomy. Traditional digital subtraction angiography has limitations such as delineating vessel overlap and may necessitate multiple acquisitions. The use and benefits of Cone Beam CT (CBCT) with vessel tracking software has been described for liver intra-arterial therapies. This educational exhibit examines the application of Virtual Injection software in various embolization scenarios to assess its potential benefits and limitations.

Clinical Findings/Procedure Details:

We present a series of cases utilizing Virtual Injection software (Embo ASSIST, GE HealthCare) for various embolization indications, such as hemorrhage control.

Key features highlighted include CBCT-based automated vascular segmentation, real-time Virtual Injection to dynamically simulate injections from distal virtual catheter tips, navigation guidance with augmented fluoroscopy and quantitative vessel analysis. The exhibit will address practical aspects of implementing this technology in routine, including the benefits of using it both for planning and navigation, the learning curve for operators, workflow integration challenges and considerations for patient selection.

 

Specific cases will illustrate how Virtual Injection can assist in identifying target vessels to embolize and possible non-target branches on CBCT-pre-operative CT fusion, with augmented fluoroscopy guidance then overlaying the path to the embolization point to facilitate navigation. The potential for this technology to enhance operator confidence and improve procedural efficiency is also examined.


Conclusion and/or Teaching Points: Virtual Injection software shows promise in assisting complex embolization procedures, particularly those involving intricate vascular anatomy. This educational exhibit aims to familiarize interventional radiologists with the potential applications, benefits and limitations of this technology. While initial experiences are encouraging, rigorous studies are needed to quantify the impact on procedure times, radiation exposure and clinical outcomes.