PT  - JOURNAL ARTICLE
AU  - Cancelliere, Nicole Mariantonia
AU  - Hummel, Eric
AU  - van Nijnatten, Fred
AU  - van de Haar, Peter
AU  - Withagen, Paul
AU  - van Vlimmeren, Marijke
AU  - Hallacoglu, Bertan
AU  - Agid, Ronit
AU  - Nicholson, Patrick
AU  - Mendes Pereira, Vitor
TI  - The butterfly effect: improving brain cone-beam CT image artifacts for stroke assessment using a novel dual-axis trajectory
AID  - 10.1136/neurintsurg-2021-018553
DP  - 2023 Mar 01
TA  - Journal of NeuroInterventional Surgery
PG  - 283--287
VI  - 15
IP  - 3
4099  - http://jnis.bmj.com/content/15/3/283.short
4100  - http://jnis.bmj.com/content/15/3/283.full
SO  - J NeuroIntervent Surg2023 Mar 01; 15
AB  - Background Cone-beam computed tomography (CBCT) imaging of the brain can be performed in the angiography suite to support various neurovascular procedures. Relying on CBCT brain imaging solely, however, still lacks full diagnostic confidence due to the inferior image quality compared with CT and various imaging artifacts that persist even with modern CBCT.Objective To perform a detailed evaluation of image artifact improvement using a new CBCT protocol which implements a novel dual-axis ‘butterfly’ trajectory.Methods Our study included 94 scans from 47 patients who received CBCT imaging for assessment of either ischemia or hemorrhage during a neurovascular procedure. Both a traditional uni-axis ‘circular’ and novel dual-axis ‘butterfly’ protocol were performed on each patient (same-patient control). Each brain scan was divided into six regions and scored out of 3 based on six artifacts originating from various physics-based and patient-based sources.Results The dual-axis trajectory produces CBCT images with significantly fewer image artifacts than the traditional circular scan (whole brain average artifact score, AS: 0.20 vs 0.33), with the greatest improvement in bone beam hardening (AS: 0.13 vs 0.78) and cone-beam artifacts (AS: 0.04 vs 0.55).Conclusions Recent developments in CBCT imaging protocols have significantly improved image artifacts, which has improved diagnostic confidence for stroke and supports a direct-to-angiography suite transfer approach for patients with acute ischemic stroke.All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.