Automated feeder detection software of Canon Medical Systems (Embolization Plan: EP) uses computed tomography (CT) images to identify feeding arteries. Compared to AFD using cone beam CT images, EP can utilize various kinds of CT images without depending on the imaging equipment, making it extremely versatile. After marking tumors and the virtual catheter tip on CT images, EP automatically detects the feeders and displays them on volume rendering (VR) and multiplanar reconstruction (MPR) images. With EP, feeder analysis can be performed simultaneously for up to 10 lesions, and the time from CT acquisition to feeder analysis is approximately within 5 minutes. The feeder identification rate of EP in our hospital is about 80-90% at the sub-subsegmental branch level in transcatheter arterial chemoembolization (TACE), and almost 100% at the lobar artery level in renal artery embolization (RAE). In the future, it is expected that virtual embolized area prediction, and analysis using transvenous CT angiography will be possible.

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We introduce syngo Embolization Guidance (EG) and syngo DynaPBV Body (PBV) as Siemens application software that can support transarterial chemoembolization (TACE).
EG is a so-called automated tumor-feeder detection software. The advantages of this software include the flexibility to utilize both automatic and manual detection modes in a complementary manner, and the adaptability to process a variety of images including C-arm CT (cone-beam CT), IVR-CT (multi-detector row CT) and other modalities like contrast enhanced MRI. We mainly use it with IVR-CT. On the other hand, a major limitation of this software is considered to be its fixed shape as spheres to contour the targeting tumor.
PBV is a software that can visualize the blood volume in organs as a color map. We have developed an acquisition protocol that can capture PBV maps in the same series of dual phase CT during hepatic arteriography with C-arm CT, which is useful in TACE for hepatocellular carcinoma. The advantage of this software is its superiority in detecting small tumors with weak contrast effects and residual / recurrent lesions in Lipiodol accumulated tumors.
Future directions in this field would be the expansion of indications to sites other than the liver and the improvement of performance through artificial intelligence (AI) advancement. To that end, it is necessary to establish a collaboration scheme in which medical doctors, information technology researchers and industry engineers can cooperate as one team.

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Selective transcatheter arterial chemoembolization (TACE) has been widely accepted as an effective treatment option for inoperable hepatocellular carcinoma (HCC). Feeder detection is one of the most important steps during selective TACE but feeder detection by conventional angiography is sometimes difficult because of hepatic atrophy due to chronic liver damage or the presence of multifeeders. Recently an automated feeder detection (AFD) system has been developed and studied to survey the tumor feeders for HCC. FlightPlan for Liver (FPFL) has been launched by GE healthcare as an AFD system. The data collection of FPFL is simple compared to conventional cone beam CT. The sensitivity and positive predictive value of FPFL for tumor feeder detection during selective TACE compare favorably with AFD systems of all other companies. This manuscript showed actual steps of FPFL and reviewed the results and current issues of FPFL, and finally introduced the new generation of FPFL.

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Automated tumor-feeder detection software (AFD) using computed tomography (CT) or cone-beam CT (CBCT) technology is a new tool of three-dimensional vessel-tracking. This software is now being used in transarterial targeted therapies, mainly transarterial chemoembolization (TACE) for hepatocellular carcinoma. We use TACE guidance software using CBCT data produced by Philips Healthcare (EmboGuide). The detectability rate of the tumor-feeder is 85-88% in the hepatic artery and 96% in extrahepatic arteries. This software can reduce our workload during the procedure, as well as procedural time and total doses of radiation exposure and contrast material. It can also extend the indications of TACE and improve the teamwork between medical staff members. Moreover, the TACE procedure can be standardized between institutions. Now, we are testing prototype virtual parenchymal perfusion (VPP) software (Virtual Injection) that can indicate a vascular territory corresponding to a virtual embolized area (VEA) on CBCT images according to a user defined catheter position. In our previous analysis, the VEA estimated using VPP showed a good correlation with the real embolized area of conventional TACE. Using this new functionality, further improvement of the technical success and outcomes of TACE are anticipated.

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In recent years, many different navigation and simulation technologies have been developed and are now being used in surgical operations and interventional radiology. At our hospital, we analyzed the data from the perfusion area of the target hepatic artery obtained using a cone beam CT during hepatic arteriography and during transarterial chemoembolization (TACE) using a commercially available 3-dimensional workstation and its software. This is called a virtual embolic area (VEA). We are exploring its use as a simulation during TACE. This article outlines the method of creating this VEA, and discusses and analyzes the accuracy of the VEA, current problems, future improvements, and future prospects for use in clinical practice.

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When OPDIVO^® is administered from the CV port, fine particles may be generated. A safety test was conducted at a pharmaceutical company that sells OPDIVO^®. In this paper, we outline clinical points based on these results.

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