Fig. 3

Advanced planning on proximal CBCT using Virtual Injection technology (Embo ASSIST, GE Healthcare). Automatic arterial segmentation and bone removal, with Virtual Injection used to highlight the main prostatic artery (red arrow) (a-c). Distality from, and path to the virtual injection point (white arrow) are indicated in green and red, respectively. A separate secondary prostatic artery (blue arrow) was thus detected since unperfused by the injection simulation (d-f). This branch was initially taken to be a rectal branch on the 3D volume rendering (a), but confirmed as a prostatic artery with Virtual Injection (f). Both prostatic arteries were saved as 3D guidance model (g) to facilitate their catheterization using augmented fluoroscopic guidance (h). Prostatic arteries are indicated in blue, with planned points of injection (POI) marked on the overall navigation 3D model (in green). Separate case (i) showing how advanced planning with Virtual Injection allowed detection of a bladder branch (orange arrow) arising from the central prostatic artery, inducing the need for two separate distal points of injection (POIs 1 & 2), as well as a capsular branch (blue arrow), with POI3 defined distally from a branch going to the rectum (yellow arrow). 3D model for augmented fluoroscopic guidance highlighting path to prostatic arteries (in blue), 3 planned points of embolization, and non-target branches to avoid (in orange)