Automatic bone removal for 3D TACE planning with C-arm CBCT: Evaluation of technical feasibility

Purpose 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). Material and 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%). Conclusion 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.