Lagerungsplanung - Optimierung von Kopfpositionierung und C-Arm Ausrichtung

Introduction: Accurate visualization of intracranial aneurysms (IA) on biplane two-dimensional angiographic images is crucial in the process of planning and carrying out endovascular treatment. This ensures the achievement of a successful occlusion and helps prevent any potential complications. However, little is known about how different interventional neuroradiologists (INRs) understand optimal biplane visualization and how much these working projections chosen for a given anatomy may vary. The aim of our study was to better understand and objectify biplane IA treatment visualization for the future development of AI-assisted optimization of treatment projections, taking into account the possibility of improved head positioning.

Materials and Methods: 3D DSA images containing IAs from 20 patients were used to simulate the best possible biplane treatment projections by five INRs with a software developed in-house. The medians of those biplane projections with the highest agreement in between them were selected as representative projections, with only a monoplane agreement available for three of them. Surface volume renderings with the aneurysm at the center were generated in 5° increments from 5° to 30° in eight equally spaced directions. The 1.776 resulting image montages with the initial and modified viewing angles were evaluated by four other INRs with a yes-no question on their continuing suitability for endovascular treatment.