Cone-Beam Computed Tomography (CBCT) from Head to Toe: Improving Technical Success and Patient Safety in Extra-hepatic Interventions

Learning Objectives: a. Understand how cone beam CT (CBCT) and conventional CT differ in image acquisition, spatial/temporal resolution, and utility in peri-procedural planning. b. Describe how CBCT improves technical success and patient safety in extra-hepatic cases from our institution. c. Understand how CBCT enhances IR capabilities by reducing procedure time, radiation, limiting high-risk needle passes, and improving anatomy visualization and real-time needle tracking.

Background: CBCT has historically been widely used in hepatic interventions for its ability to generate on‑table 3D reconstructions, real‑time needle/catheter guidance, and fusion with live fluoroscopy. It also has impressive utility in extra-hepatic interventions, where lesser-used functionalities can increase technical success and improve patient safety. The following cases demonstrate CBCT’s value and how it can be used to build on conventional crosssectional imaging data to solve complex intra-procedural problems on the fly.

Clinical Findings/Procedure Details: a. Mediastinal biopsy: Challenging approach. CBCT enabled precise needle tracking, avoiding pericardium, internal mammary vessels, lung, allowing safe core biopsy near the heart. b. Percutaneous nephrostomy: Clot-filled collecting system obscured visualization with ultrasound and identification of collecting system under fluoroscopy. CBCT allowed for expedient two-stick technique. c. Tracheal AVM embolization: CBCT defined nidus/feeding branch anatomy, enabling confident needle placement and reducing non-target embolization. d. Gastrojejunostomy placement in a patient with ruptured esophagus: CBCT enabled direct stick into a decompressed stomach with Chiba needle for insufflation. e. Transgluteal embolization of an excluded internal iliac artery aneurysm: CBCT fused with pre-op CT guided direct access of superior gluteal artery, then direct puncture of the aneurysm in a previously embolized internal iliac artery. f. Peri‑aortic lymph node biopsy: CBCT mapped aorta-adjacent structures in real-time, allowing safe needle trajectory, avoiding high-risk passes while ensuring adequate sampling.

Conclusion and/or Teaching Points: These cases show CBCT improves trajectory planning, anatomy definition, and reduces nontarget embolization-enhancing technical success and patient safety in difficult cases. CBCT-driven approaches in complex extra-hepatic interventions are central to advancing IR care at our institution and achieving favorable outcomes.