Zielsetzung Vergleich der Bildqualität von Arthrographien des Handgelenks mittels Photon-Counting-Computertomographie (PCD-CT) vs. Energieintegrierendem Detektor (EID)-CT vs. Flackdetektor (FP)-CT.

Background To assess the feasibility and safety of a gelfoam torpedo plugging technique for embolization of the transsplenic access channel in adult patients following transvenous portal vein interventions. Materials and methods Between 09/2016 and 08/2021, an ultrasound guided transsplenic portalvenous access (TSPVA) was established in twenty-four adult patients with a 21-G needle and 4-F microsheath under ultrasound guidance. Afterwards, sheaths ranging from 4-F to 8-F were inserted as needed for the procedure. Following portal vein intervention, the splenic access tract was embolized with a gelfoam-based tract plugging (GFTP) technique. TSPVA and GFTP were performed twice in two patients. Patients’ pre-interventional and procedural characteristics were analyzed to assess the feasibility and safety of the plugging technique according Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system. Values are given as median (minimum;maximum). Subgroup analysis of intercostal vs. subcostal puncture site for TSPVA was performed using the two-sided Mann–Whitney-U test or Student’s t-test and Fisher’s exact test. Level of significance was p < 0.05. Results The study population’s age was 56 (29;71) years and 54% were female patients. Primary liver disease was predominantly liver cirrhosis with 62% of the patients. Pre-interventional model for end-stage liver disease score was 9 (6;25), international normalized ratio was 1.15 (0.86;1.51), activated partial thromboplastin time was 33s (26s;52s) and platelet count was 88.000/µL (31.000;273.000/µL). Ascites was present in 76% of the cases. Craniocaudal spleen diameter was 17cm (10cm;25cm). Indication for TSPVA was assisted transjugular intrahepatic portosystemic shunt placement in 16 cases and revision in two cases, portal vein stent placement in five cases and variceal embolization in three cases. TSPVA was successfully established in all interventions; interventional success rate was 85% (22/26). The splenic access time was 33min (10min;133min) and the total procedure time was 208min (110min;429min). Splenic access was performed with a subcostal route in 11 interventions and with an intercostal route in 15 interventions. Final sheath size was 4-F in 17 cases, 5-F in three cases, 6-F in five cases, 7-F in two cases and 8-F in one case. A median of two gelfoam cubes was used for GFTP. TSPVA- and GFTP-related complications occurred in 4 of 26 interventions (15%) with a subcapsular hematoma of the spleen in two patients (CIRSE grade 1), access-related infection in one patient (CIRSE grade 3) and both in one patient (CIRSE grade 3). In detail, one access-related complication occurred in a patient with subcostal TSPVA (CIRSE grade 1 complication) and the other three complications occurred in patients with intercostal TSPVA (one CIRSE grade 1 complication and two CIRSE grade 3 complication) ( p = 0.614). No patient required interventional or surgical treatment due to puncture tract bleeding. Conclusion Gelfoam-based plugging of the puncture tract was feasible and safe for transsplenic access in adult patients undergoing percutaneous portal vein interventions. The lack of major bleeding complications and complete absorption of the gelatine sponge make it a safe alternative to transjugular and transhepatic access and re-interventions via the splenic route.

Zielsetzung Vergleich der Bildqualität zur Darstellung von Olecranonfrakturen und Knochentrabekeln im Ellenbogen durch Photon-Counting-Computertomographie (PCD-CT) und Energieintegrierendem Detektor (EID)-CT unter erschwerten Scanbedingungen im post-Trauma Setting mit off-center Positionierung, Ellbogenflexion und Gipsfixation.

The aim of this study was to identify positive predictors for survival in uveal melanoma (UM) patients treated with percutaneous hepatic perfusion with melphalan (M-PHP), by retrospectively pooling data from three centers. Retrospective analysis including patients ( $$\ge$$ 18 years) treated with M-PHP between February 2014 and December 2019 for unresectable liver-dominant or liver-only metastases from UM. Predictors for OS were assessed using uni- and multivariate analyses. Other study outcome measures were response rate, progression-free survival (PFS), liver progression-free survival (LPFS), overall survival (OS) and complications according to CTCAEv5.0. In total, 101 patients (47.5% males; median age 59.0 years) completed a minimum of one M-PHP. At a median follow-up time of 15.0 months, complete response (CR), partial response (PR), stable disease (SD) and progressive disease were seen in five (5.0%), 55 (54.5%), 30 (29.7%) and 11 (10.9%) patients, respectively, leading to a 89.1% disease control rate. Median PFS, LPFS and OS were 9.0, 11.0 and 20.0 months, respectively. Survival analyses stratified for radiological response demonstrated significant improved survival in patients with CR or PR and SD category. Treatment of the primary tumor with radiotherapy, ≥ 2 M-PHP and lactate dehydrogenase (LDH) < 248 U/L were correlated with improved OS. Thirty-day mortality was 1.1% (n = 2). Most common complication was hematological toxicity (self-limiting in most cases). M-PHP is safe and effective in patients with UM liver metastases. Achieving CR, PR or SD is associated with improved survival. Primary tumor treatment with radiotherapy, normal baseline LDH and > 1 M-PHP cycles are associated with improved OS.

To evaluate feasibility, frequency and severity of peri-procedural complications and post-procedural adverse events (AEs) in patients with advanced cholangiocarcinoma or liver metastasis of uveal melanoma and prior hemihepatectomy undergoing chemosaturation percutaneous hepatic perfusion (CS-PHP) and to analyze therapy response and overall survival compared to a matched group without prior surgery. CS-PHP performed between 10/2014 and 02/2018 were retrospectively assessed. To determine peri-procedural safety and post-procedural adverse events, hospital records and hematological, hepatic and biliary function were categorized using Common Terminology Criteria for Adverse Events (CTCAE) v5.0 (1–5; mild-death). Significance was tested using Wilcoxon signed-rank and Mann–Whitney U test. Kaplan–Meier estimation and log-rank test assessed survival. Overall 21 CS-PHP in seven patients (4/7 males; 52 ± 10 years) with hemihepatectomy (group hemihep ) and 22 CS-PHP in seven patients (3/7 males; 63 ± 12 years) without prior surgery (group noresection ) were included. No complications occurred during the CS-PHP procedures. Transient changes (CTCAE grade 1–2) of liver enzymes and blood cells followed all procedures. In comparison, group hemihep presented slightly more AEs grade 3–4 (e.g. thrombocytopenia in 57% (12/21) vs. 41% (9/22; p = 0.37)) 5–7 days after CS-PHP. These AEs were self-limiting or responsive to treatment (insignificant difference of pre-interventional to 21–45 days post-interventional values (p > 0.05)). One patient in group hemihep with high tumor burden died eight days following CS-PHP. No deaths occurred in group noresection . In comparison, overall survival after first diagnosis was insignificantly shorter in group noresection (44.7(32–56.1) months) than in group hemihep (48.3(34.6–72.8) months; p = 0.48). The severity of adverse events following CS-PHP in patients after hemihepatectomy was comparable to a matched group without prior liver surgery. Thus, the performance of CS-PHP is not substantially compromised by a prior hemihepatectomy.

Die interventionelle Radiologie bietet eine Vielzahl von lokoregionären und lokal ablativen Therapieverfahren zur Behandlung von Lebertumoren. Diese können als eigenständige minimal-invasive Therapien, in Kombination mit anderen Therapien und je nach Tumorstadium kurativ oder palliativ angewendet werden. Im vorliegenden Übersichtsbeitrag stellen wir die verschiedenen Techniken vor und beschreiben den klinischen Stellenwert in der Therapie des hepatozellulären Karzinoms und intrahepatischen cholangiozellulären Karzinoms.

Background: Reduction of hyperinflation and improvement of heart function, regional lung ventilation and pulmonary microvascular blood flow after indacaterol/glycopyrronium (IND/GLY) treatment was demonstrated in COPD.

AIM: To evaluate the feasibility of two-dimensional parametric parenchymal blood flow (2D-PPBF) to quantify perfusion changes in the lung parenchyma following balloon pulmonary angioplasty (BPA) for treatment of chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS: Overall, 35 consecutive interventions in 18 patients with 98 treated pulmonary arteries were included. To quantify changes in pulmonary blood flow using 2D-PPBF, the acquired digital subtraction angiography (DSA) series were post-processed using dedicated software. A reference region of interest (ROI; arterial inflow) in the treated pulmonary artery and a distal target ROI, including the whole lung parenchyma distal to the targeted stenosis, were placed in corresponding areas on DSA pre- and post-BPA. Half-peak density (HPD), wash-in rate (WIR), arrival to peak (AP), area under the curve (AUC), and mean transit time (MTT) were assessed. The ratios of the reference ROI to the target ROI (HPDparenchyma/HPDinflow, WIRparenchyma/WIRinflow; AP(parenchyma)/AP(inflow), AUC(parenchyma)/AUC(inflow), MTTparenchyma/MTTinflow) were calculated. The relative differences of the 2D-PPBF parameters were correlated to changes in the pulmonary flow grade score. RESULTS: The pulmonary flow grade score improved significantly after BPA (1 versus 3; p<0.0001). Likewise, the mean HPDparenchyma/HPDinflow (-10.2%; p<0.0001), AP(parenchyma)/AP(inflow) (-24.4%; p=0.0007), and MTTparenchyma/MTTinflow (-3.5%; p=0.0449) decreased significantly, whereas WIRparenchyma/WIRinflow (+82.4%) and AUC(parenchyma)/AUC(inflow) (+58.6%) showed a significant increase (p<0.0001). Furthermore, a significant correlation between changes of the pulmonary flow grade score and changes of HPDparenchyma/HPDinflow (rho=-0.21, p=0.04), WIRparenchyma/WIRinflow (rho=0.43, p<0.0001), AP(parenchyma)/AP(inflow) (rho=-0.22, p=0.03), AUC(parenchyma)/AUC(inflow) (rho=0.48, p<0.0001), and MTTparenchyma/MTTinflow (rho=-0.39, p<0.0001) could be observed. CONCLUSION: The 2D-PPBF technique is feasible for the quantification of perfusion changes following BPA and has the potential to improve monitoring of BPA. (C) 2019 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

PURPOSE:Virtual single source computed tomography (VSS-CT) acquisition on a dual source CT (DSCT) has been demonstrated to allow for dose-neutral intra-individual comparison of three acquisition protocols at different radiation dose levels (RDL) within one acquisition in a phantom. The purpose of this study was twofold: first to evaluate the applicability of VSS-CT in patients and second to optimize the task-dependent trade-off between radiation dose and image quality of lower extremity CT angiography (run-off CTA). MATERIAL AND METHODS:In this IRB-approved prospective study 52 patients underwent run-off CTA between 06/2012 and 06/2013. VSS-CT acquisition was conducted using a first generation DSCT applying equal X-ray tube settings (120 kVp), collimation (2 × 32 × 0.6 mm), and slice thickness (1.0 mm) but different effective tube current-time products (tube A: 80 mAs, tube B: 40 mAs). Three different image datasets representing three different radiation dose levels (RDL40, RDL80, RDL120) were reconstructed using a soft kernel from the raw data of tube B, tube A or both tubes combined. Dose length products (DLP) of each raw data set were documented. Quantitative image quality (IQ) was assessed for five anatomical levels using image noise and contrast-to-noise ratio (CNR). To investigate dose efficiency of each acquisition, the dose-weighted CNR (CNRD) was determined. Qualitative IQ was evaluated by two blinded readers in consensus using a 5-point Likert scale and compared with a Friedman- and posthoc Wilcoxon test. RESULTS:Mean DLP was 200 ± 40, 400 ± 90 and 600 ± 130 mGy·cm for the RDL40, RDL80 and RDL120, respectively. Image noise and CNR were best for RDL120 and decreased significantly for RDL80 and RDL40, independent of the anatomic level (p < 0.001). CNRD showed no significant differences at the abdominal and pelvic level between the investigated radiation dose levels. However, for thigh to foot level a significant increase of CNRD was noted between RDL120, RDL80 and RDL40. Significant differences of qualitative IQ were observed between RDL120 and RDL40 from the abdominal to the foot level, whereas no difference was seen for the other dose levels. CONCLUSION:Radiation dose splitting with VSS-CT can be applied to run-off CTA facilitating intra-individual comparison of different acquisition protocols without additional radiation exposure. Furthermore, a radiation dose reduction potential for run-off CTA of approximately 1/3 as compared to the acquisition protocol recommended by the manufacturer could be identified in this study.

The objective of this study was to compare the diagnostic performance of direct C-arm flat panel computed tomography arthrography (FPCT-A) with direct magnetic resonance arthrography (MR-A) of the wrist in patients with clinically suspected pathologies.

Purpose: To survey integrative teaching in radiology at German universities.Materials and Methods: A questionnaire about radiological education was sent electronically to all 37 chairpersons of university radiology departments in Germany. The questions included the course type, teaching methods, concept, perception, and advantages and disadvantages of integrative teaching. Statistical analysis was performed with nonparametric statistics and chi-square test.Results: The survey was considered representative with a return rate of 68 %. Integrative teaching is established at 4/5 of all departments. Integrative teaching is well accepted with an acceptance rate that is significantly higher in so-called "Modellstudiengangen" [model courses of study] (100 %) compared to conventional courses of study (72 %). The advantages of integrative teaching include linking of content (92 %) and preparation for interdisciplinary work (76 %). The disadvantages include high effort (75 %) and time (67 %) for organization. Furthermore, there is a risk that basic radiological facts and knowledge cannot be conveyed and that the visibility of radiology as an independent discipline is lost. Conventional radiological teaching has a similarly high acceptance (84 %) compared to integrative courses (76 %).Conclusion: Integrative teaching has a high acceptance among chairpersons in radiology in Germany despite the greater effort. A good interdisciplinary collaboration is essential for integrative teaching and at the same time this can be conveyed to the students. However, the visibility of radiology as a discipline and the possibility to cover basic radiological con-tent must be ensured. Therefore, both conventional courses and integrative teaching seems reasonable, especially in cross-disciplinary subjects such as radiology.

Hintergrund/Einleitung: In den letzten Jahren hat die Kernspintomographie eine wichtige Rolle in der bildgebenden Diagnostik des Pankreas erlangt. Ziel der vorliegenden experimentellen Studie war es, die Durchführbarkeit einer hochauflösenden intraduktalen Kernspintomographie durch Einbringen einer endoluminalen MR-Empfänger-Spule in den Pankreasgang an einem Tiermodell zu testen. Dieses neue diagnostische MR-Verfahren ähnelt dem intraduktalen Ultraschall, der im Vergleich zum konventionellen endoskopischen Ultraschall eine höhere Ortsauflösung liefert.

Purpose: Evaluation and analysis of the integrative course "Radiological Anatomy" established since 2007 at the Medical School Hannover (MHH) in comparison with conventional education.Materials and Methods: Anatomy and radiology are usually taught separately with a considerable time lag. Interdisciplinary teaching of these associated subjects seems logical for several reasons. Therefore, the integrative course "Radiological Anatomy" was established in the second year of medical education, combining these two closely related subjects. This interdisciplinary course was retrospectively evaluated by consideration of a student questionnaire and staff observations. The advantages and disadvantages of integrative teaching in medical education are discussed.Results: The course ratings were excellent (median 1; mean 1.3 on a scale of 1 to 6). This is significantly (p < 0.001) better than the average of all evaluated courses in the respective term (grade 2.8). The course improved the anatomical comprehension (90 %) and the students stated that the topics were relevant for their future medical education (90 %). Furthermore, interest in the subject's anatomy and radiology increased during the course (88 %). According to the students' suggestions the course was enhanced by a visitation in the Department of Radiology and the additional topic central nervous system.Conclusion: Integrative teaching of anatomy and radiology was well received by the students. Both, anatomical and radiological comprehension and the motivation to learn were improved. However, it should be considered, that the amount of work and time required by the teaching staff is considerably increased compared to traditional teaching.

Purpose: Smartphone apps for measuring ionizing radiation use the capability of (CMOS) camera chips to detect not only perceivable light. but also electromagnetic wave radiation. The present study evaluates the accuracy of hardware and software and defines possible applications for the detection of X-ray radiation fields. Materials and Methods: 2 apps and 2 different devices were tested in comparison with a calibrated ionization chamber and a personal electronic dosimeter. A calibration curve was determined for dose rates between 12 700 mu Sv/h and 5.7 mu Sv/h generated by a C-arm system. Results: The measured scattered radiation produced by an Alderson-Rando phantom ranged from 117 mu Sv/h (at a distance of 2 m) to 5910 mu Sv/h (at a distance of 0.3 m) and was 1.4 times less than the values of the ionization chamber. The exposure rate for the operator's thyroid was within 4200 - 4400 mu Sv/h. We found a strong dependence of the measurements on the angulation of the Smartphone, especially for short distances from the phantom (at a distance of 0.3 m, a 45 degrees rotation downwards in a vertical direction caused a decrease from 3000 mu Sv/h to 972 mu Sv/h, while an upwards rotation resulted in an increase to 5000 mu Sv/h). For a distance of 1 m, this effect was remarkably smaller. Conclusion: Smartphones can be used to detect ionizing radiation but showed limited accuracy and are heavily dependent on the angulation of the device. Qualitative measurements and utilization for dose alerts are possible.

Abstract Purpose: To assess the benefit of C-arm CT for classification and procedural guidance during interventional therapy of endoleaks (EL) after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA). Materials and Methods: 12 patients with EL diagnosed with CT but undetermined EL classification (ELC) underwent DSA and transarterial contrast-enhanced C-arm CT. ELC (based on DSA, C-arm CT and CT) assessed during the angiographic procedure served as the standard of reference (SOR). Subsequently, ELC was assessed by a blinded second reader based on DSA or C-arm CT and compared to the SOR. In the case of an interventional procedure (n = 6), the added value of C-arm CT for procedure guidance was assessed retrospectively (1: essential, 2: helpful, 3: additional information without impact, 4: no additional information). Results: The blinded reader classified 9/12 EL using DSA alone and 11/12 EL using C-arm CT alone. In one patient, the temporal resolution provided by DSA was essential to establish the diagnosis. In 6 patients, a type 2 EL without need for therapy was diagnosed. The remaining 6 patients showed EL that were treated immediately (type 1 EL, n = 4: 3 stent graft extensions and one angioplasty; type 2 EL, n = 1: translumbar embolization; type 3 EL, n = 1: sealing of a fabric tear). The information provided by C-arm CT was assessed to be essential in three patients and helpful in two. Conclusion: C-arm CT is an ideal adjunct to DSA. In our pilot study, it helped to localize and classify endoleaks more reliably than DSA alone. Citation Format: • Wacker FK, Valdeig S, Raatschen HJ et al. C-Arm CT – An Adjunct to DSA for Endoleak Classification in Patients with Endovascular Repair of Abdominal Aortic Aneurysms. Fortschr Röntgenstr 2014; 186: 247 – 252

Abstract Purpose: Evaluation of the potential usability of an iPad 3 with a high-resolution display in CT emergency diagnosis compared to a 3 D PACS workstation. Materials and Methods: 3 readers used a 5-point Likert scale to evaluate 40 CCT scans and 40 CTPA scans to determine the detectability of early signs of infarction in CCT or segmental and subsegmental pulmonary embolisms in CT angiography of the pulmonary arteries (CTPA) on the iPad 3 (Apple Inc., USA) using an application for image viewing (Visage Ease, Visage Imaging GmbH, Berlin) and on a 3 D PACS workstation (Visage 7.1, Visage Imaging, Berlin) using a certified monitor for image viewing. The results were compared using the Wilcoxon rank sum test, Spearman’s correlation coefficient, and a kappa statistic. Results: There was no significant difference in the median evaluations for the readings of both the CCT scans and the CTPA scans on the iPad 3 and on the workstation (p > 0.05) for all three readers. The mean Spearman’s correlation coefficient for CCT and CTPA was 0.46 (± 0.2) and 0.69 (± 0.16), respectively, for the comparison iPad/PACS, 0.41 (± 0.16) and 0.68 (± 0.06), respectively, for the interobserver agreement on the iPad, and 0.35 (± 0.05) and 0.68 (± 0.10), respectively, for the interobserver agreement on the PACS. Mean kappa values for CCT of 0.52 (± 0.17) for the comparison iPad/PACS and 0.33 (± 0.16) and 0.32 (± 0.16), respectively, for the interobserver agreement on the iPad and the PACS were achieved. For CTPA average kappa values of 0.67 (± 0.19) were calculated for the comparison iPad/PACS and 0.69 (± 0.08) and 0.60 (± 0.14), respectively, for the interobserver concordance on the iPad 3 and the PACS. All differences were not statistically significant (p > 0.05). Conclusion: The variability of the interpretation of typical emergency scans on an iPad 3 with a high-resolution display and on a 3 D PACS workstation does not differ from the interobserver variability. Key Points: Variability of interpretation of emergency scans on an iPad 3 and on a 3 D PACS workstation shows no difference in interobserver variabilitiy. New applications for the Ipad in radiology include quick preliminary evaluation on duty and real-time consultation of radiological background services or expert opinions. Limitations for the application of tablet-computers in radiology are screen size and inconsistent and non-standardized environmental conditions when using a mobile image display device. Citation Format: Tewes S, Rodt T, Marquardt S et al. Evaluation of the Use of a Tablet Computer with a High-Resolution Display for Interpreting Emergency CT Scans. Fortschr Röntgenstr 2013; 185: 1063 – 1069

To assess the influence of different table feeds (TFs) on vascular enhancement and image quality in patients with an abdominal aortic aneurysm (AAA) undergoing computed tomography (CT) angiography of the lower extremities (run-off CTA).

Purpose: To prospectively compare a compact bolus (CB) injection protocol using high-iodine concentration contrast medium with a standard bolus (SB) injection protocol at equi-iodine doses for run-off computed tomographic angiography (CTA).Materials and Methods: 64 patients with suspected peripheral arterial disease who underwent 40 or 64-slice run-off CTA were included in this IRB-approved study. Patients were randomized to undergo the CB protocol (32 patients, iomeprol 400mgl/mL, 100 mL, 4 mL/sec) or the SB protocol (32 patients, iomeprol 300mgl/mL, 134 mL, 4 mL/sec). Luminal contrast density (CD) values were measured and arterial opacification (AO) was scored (5-point scale). Cases of venous overlay or bolus overriding were documented.Results: Overall arterial CD was significantly higher with the compact bolus (CB: 279 +/- 57HU, SB: 234 +/- 32HU, p = 0.0017). Segmental CD was significantly higher (p<0.05) in 7 of 16 evaluated segments. Patency-based comparison revealed superior AO in vessels with relevant (50 - 99%) stenoses (CB: 4.54 vs. SB: 4.18, p = 0.04). Contrast bolus overriding without pathological reasons, i.e., acute occlusions, was noted in one patient in each group. Venous overlay was observed less frequently in the CB group (CB vs. SB: 12 vs. 19 patients, n. s.: 29 of 64 legs [45%] vs. 44 of 64 legs [69%], p = 0.01).Conclusion: At equi-iodine doses, the CB protocol led to a quantitatively and qualitatively higher arterial opacification compared to the SB protocol. Therefore, a CB protocol should be favored for run-off CTA.

Purpose: To assess patient movement on a vacuum mattress compared to a standard viscoelastic mattress during interventional procedures using an electromagnetic tracking device.Materials and Methods: In 17 consecutive patients who underwent a diagnostic or interventional procedure, the patient was positioned using a vacuum mattress (VL, n = 9) or a standard viscoelastic mattress (SL, n = 8). The patient position was recorded continuously after the start of the procedure (S) using an electromagnetic navigation device. After the intervention (E), patients were asked to lift up the upper part of the body and to lie down again (repositioning maneuver, P). Based on the recorded patient positions, the patient movement (PM) at rest Delta P(SE), PM due to the repositioning maneuver Delta P(EP), total PM Delta P(SP) and maximum PM during the intervention Delta PMax(SE) were calculated.Results: Using VL, PM at rest (Delta P[SE]: VL: 4.3 +/- 2.8 mm, SL: 17.1 +/- 15.7 mm; p = 0.036) and total PM (Delta P[SP]: VL: 4.6 mm +/- 2.5 +/- mm. SL: 27.8 +/- 19.6 mm; p = 0.002) were significantly smaller. In contrast, the maximum PM as a parameter for the mobility of the patient (Delta PMax(SE): VL: 14.2 +/- 15.1 mm, SL: 17.6 +/- 13.4 mm; p = 0.48) and the PM due to the repositioning maneuver (Delta P[EP]: VL: 4.4 +/- 2.5 mm, SL: 15.7 mm +/- 15.9 mm, p = 0.32) were similar.Conclusion: Patient positioning on a vacuum mattress is fast, easy, comfortable for the patient and reduces relevant patient movements. Therefore, vacuum mattress positioning can be used for image-guided interventions relying on pre-procedural imaging data, where minimal patient movement is a prerequisite.