Traumatic injuries to the liver, spleen and kidneys often pose a challenge in acute care. In addition to conservative and surgical treatment, interventional radiology provides a minimally invasive option for bleeding control and organ preservation. The indications for transarterial embolization depend on the hemodynamic stability, imaging results and accompanying injuries. Special technical aspects, such as the selection of embolization material, microcatheter techniques and consideration of anatomical conditions are crucial for treatment success. Knowledge of the indications, contraindications and technical details enables targeted, patient-oriented treatment. Interventional procedures reduce the need for open surgery, lower the mortality in severely injured patients and help to preserve organ function. This article highlights the role of interventional radiology in the care of trauma patients with bleeding in the solid organs of the upper abdomen.

Abstract Background Septic shock and acute respiratory distress syndrome (ARDS) are major causes of mortality. Intestinal hypoperfusion is a frequent but often unrecognized complication, and the timing and extent of intestinal injury in these syndromes remain unclear. Intestinal fatty acid-binding protein (I-FABP) has emerged as a potential biomarker of intestinal injury. This study aimed to define a clinically relevant I-FABP cutoff for predicting relevant intestinal injury and to assess its association with disease severity and outcome. Methods We performed a post-hoc analysis combining cohorts of critically ill patients from the prospective EXCHANGE-pilot, the RCT EXCHANGE-1, and the SPARE-14 registry. The analysis included 102 patients with septic shock and/or ARDS, 22 patients with non-occlusive mesenteric ischemia (NOMI) from the REPERFUSE study, and 20 healthy individuals. Circulating I-FABP concentrations were measured by ELISA in plasma samples obtained at ICU admission. Receiver operating characteristic (ROC) analysis was used to define the optimal I-FABP threshold for predicting intestinal hypoperfusion, using patients with NOMI as positive- and healthy individuals as negative controls. Associations between I-FABP, disease severity, and 28-day mortality were analyzed. Results ROC analysis identified an initial I-FABP cutoff of 1070 pg/ml (sensitivity 68%, specificity 100%) for the development of intestinal ischemia defined by criteria of manifest NOMI. I-FABP levels at ICU admission were significantly elevated in patients with ARDS and/or septic shock compared with healthy controls (1108 pg/ml (IQR 291–2846) vs. 479 pg/ml (IQR 358–631), p = 0.03), and comparable to those in NOMI patients. Exploratory generalized additive model analyses indicated a non-linear association between I-FABP concentrations and established markers of shock severity. Patients with high I-FABP levels (above 1070 pg/ml) had a higher 28-day mortality (high: 52.9% vs. low: 33.3%, p = 0.02). In a multivariate logistic regression model, I-FABP and SOFA score remained independently associated with 28-day mortality (I-FABP: adjusted OR 1.27 (1.03–1.62), p = 0.023), without independent association of lactate concentration. Conclusion Elevated plasma I-FABP may identify undetected intestinal injury in critically ill patients with septic shock and/or ARDS and might be associated with higher 28-day mortality. Additionally, I-FABP might reflect a distinct facet of critical illness that is not fully captured by conventional measures of organ dysfunction or shock severity and I-FABP concentrations ≥ 1070 pg/ml may help identify patients at high risk for intestinal ischemia who could benefit from early therapeutic interventions.

Traumatische Verletzungen der Leber, Milz und Niere stellen häufig eine Herausforderung in der Akutversorgung dar. Die interventionelle Radiologie bietet neben der konservativen und operativen Therapie eine minimalinvasive Option zur Blutungskontrolle und zur Organerhaltung. Die Indikation zur transarteriellen Embolisation richtet sich nach hämodynamischer Stabilität, Ergebnissen bildgebender Untersuchungen und Begleitverletzungen. Spezielle technische Aspekte wie die Auswahl von Embolisationsmaterial, Mikrokathetertechniken und die Berücksichtigung anatomischer Gegebenheiten sind entscheidend für den Erfolg. Die Kenntnis der Indikationen, Kontraindikationen und technischen Details ermöglicht eine gezielte, patientenorientierte Therapie. Interventionelle Verfahren reduzieren die Notwendigkeit einer offenen Operation, senken die Mortalität bei schwer verletzten Patient:innen und unterstützen die Schonung von Organfunktionen. Im Folgenden wird die Rolle der interventionellen Radiologie bei der Versorgung von Traumapatient:innen mit Blutungen der soliden Oberbauchorgane herausgearbeitet.

Many patients with coronary artery disease are eligible for either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Technical and clinical aspects influence the decision for either treatment. However, biological effects of PCI and CABG on long-term coronary artery anatomy and physiology should be considered but are largely unknown. Eight German landrace swine were used in this study. An artificial atherosclerotic plaque (AAP) was implanted into the left anterior descending coronary artery (LAD) to simulate coronary atherosclerosis. Physiological changes of PCI and surgical CABG in vascular and perivascular tissue were assessed in an ex vivo setting (organ care system OCS). Furthermore, radiological and nuclear imaging was performed using single photon emission computed tomography (SPECT) and computed tomography (CT). Furthermore, interventional (PCI) and surgical (CABG) treatment was evaluated using an ex-vivo setting. Lymphatic flow and myocardial perfusion were improved in pigs in the CABG group compared to the PCI group. The PCI group showed a significantly higher mean count number proximal to the intervention in the LAD area. Stenting experiments showed a significantly higher mean count number proximal to the intervention in the LAD area. This effect could also be demonstrated macroscopically, as myocardial infarct areas were smaller and myocardial function was better after defibrillation in the OCS (organ care system) in the CABG treated hearts. The artificial atherosclerotic plaque model in porcine hearts is a new valuable tool to simulate coronary artery stenosis without damaging other organs. It may serve as a tool for future medical testing and for further specific research on coronary artery physiology. Our data suggest that the cardiac lymphatic vascular system and perfusion capability are partly restricted after PCI as compared to CABG.

The increasing number of women working in medical surgical professions involving ionizing radiation creates new challenges for the safety of both pregnant and breastfeeding employees and the management of prenatal radiation exposure. The aim of this manuscript is to discuss the biological effects of loosely-ionizing radiation, evaluate the associated risks, and discuss the principles of German radiation protection law in the context of pregnancy and breastfeeding. To assess the effects of prenatal radiation exposure, we reviewed relevant sources such as reports from the German Commission on Radiological Protection, United Nations Scientific Commission on Effects of Atomic Radiation (UNSCEAR), and publications from the International Commission on Radiological Protection (ICRP). Additionally, the current German legislation, with focus on radiation protection and maternity protection laws, was outlined in context. The analysis shows that adhering to regulatory dose limits minimizes the risks of pregnancy complications, congenital malformations, developmental delays, mutagenic and carcinogenic effects. Special attention is required during the first trimester, in which radiation sensitivity is highest. Adherence to legal framework and associated protective measures in Germany provides under certain conditions a safe working environment for pregnant and breastfeeding women in surgical professions that involve ionizing radiation. This work highlights that careful risk assessment and strict adherence to radiation protection and occupational safety regulations enable pregnant and lactating women to work safely in areas associated with ionizing radiation and interventional aspects of their occupation. The need for continuous monitoring and adjustment of protective measures as well as the provision of confidential counseling services, are essential to ensure the safety of pregnant and breastfeeding workers and their children.

Zusammenfassung Einleitung Der Ultraschall stellt in der Brustkrebsdiagnostik ein wichtiges und etabliertes Untersuchungsverfahren dar. Der additive Einsatz des Ultraschalls zusätzlich zur Mammografie kann bei Frauen mit einem durchschnittlichen Brustkrebsrisiko zu einer Steigerung der Detektionsrate im Mammografie-Screening führen. Im Mammografie-Screening kommt dieses Verfahren in der Abklärungsdiagnostik zum Einsatz. Fallbeschreibung Wir berichten über eine 65-jährige, postmenopausale Frau mit einem invasiven Mammakarzinom, das sich sonografisch als echoreiche Läsion im Rahmen der Abklärungsdiagnostik im Mammografie-Screening-Programm zeigte. Schlussfolgerung In der täglichen Praxis kann ein breites Spektrum benigner und maligner echoreicher Brustläsionen angetroffen werden, was die Notwendigkeit einer sorgfältigen und gründlichen Beurteilung aller Ultraschallmerkmale zusammen mit den klinischen und mammografischen Befunden unterstreicht. Zur Kategorisierung der erhobenen Brustläsion sollte dabei der Befund im Ultraschall zusammen mit der Mammografie korreliert werden. Für die endgültige Diagnosesicherung ist die histologische Abklärung mittels Biopsie zielführend.

OBJECTIVES:The aim of this study was to evaluate the impact of a prototype grid with a 29:1 ratio (r29) and a 15:1 (r15) grid on the image quality (IQ) and radiation dose in abdominal angiography. MATERIALS AND METHODS:Six typical abdominal angiographic image scenarios were created in 4 pigs. Polymethylmethacrylate and aluminum plates were used to add 10 cm of patient equivalent thickness to simulate different body types. Fluoroscopic images were acquired with a source-to-image receptor distance of 120 cm. Tantalum- and iron-specific acquisition protocols at different IQ levels were acquired. IQ of radiation dose equivalent image pairs, created with the r29 and r15 grids, respectively, was quantitatively evaluated using contrast-to-noise ratio (CNR) measurements. Differences in radiation dose were estimated using the dose-weighted CNR. Two blinded readers compared IQ of these images using a Likert scale. In a second step, the readers selected pairs of the r29 and r15 images with subjectively equivalent IQ. Radiation doses were then compared. RESULTS:Compared with the r15 grid, the r29 grid images achieved similar CNR at an average of 26% (±12%) lower radiation dose at a mean patient equivalent thickness of 26 cm and 36 cm. Both readers noted a significant increase in IQ (P < 0.001) for dose equivalent images, whereas the interobserver agreement was 0.59. For the selected IQ equivalent images, a radiation dose reduction of 38% (±17%; P < 0.001, interobserver agreement 0.92) was noted when using the r29 grid. CONCLUSIONS:The use of an r29 grid at a large source-to-image receptor distance can significantly improve the IQ compared with the r15 grid at the same radiation dose in abdominal angiography or can reduce radiation dose while preserving IQ.

Background: Experimental coronary artery interventions are currently being performed on non-diseased blood vessels in healthy animals. To provide a more realistic pathoanatomical scenario for investigations on novel interventional and surgical therapies, we aimed to fabricate a stenotic lesion, mimicking the morphology and structure of a human atherosclerotic plaque. Methods: In an interdisciplinary setting, we engineered a casting mold to create an atherosclerotic plaque with the dimensions to fit in a porcine coronary artery. Oscillatory rheology experiments took place along with long-term stability tests assessed by microscopic examination and weight monitoring. For the implantability in future in vivo setups, we performed a cytotoxicity assessment, inserted the plaque in resected pig hearts, and performed diagnostic imaging to visualize the plaque in its final position. Results: The most promising composition consists of gelatin, cholesterol, phospholipids, hydroxyapatite, and fine-grained calcium carbonate. It can be inserted in the coronary artery of human-sized pig hearts, producing a local partial stenosis and interacting like the atherosclerotic plaque by stretching and shrinking with the vessel wall and surrounding tissue. Conclusion: This artificial atherosclerotic plaque model works as a simulating tool for future medical testing and could be crucial for further specified research on coronary artery disease and is going to help to provide information about the optimal interventional and surgical care of the disease.

To assess the technical feasibility, safety, and clinical success rate of trans-arterial embolization (TAE) as an emergency treatment for acute lower gastrointestinal bleeding (LGIB). Consecutive patients who received urgent TAE due to active LGIB at five academic centers in Germany were retrospectively analyzed. LGIB was confirmed and localized using contrast-enhanced computed tomography (CT) or endoscopy. Outcome parameters including technical and clinical success rates as well as ischemia-related adverse events were analyzed. Furthermore, treatment-related variables that may affect technical and clinical success were analyzed using a regression model. One hundred and forty-one patients were included. TAE was performed in 91

Background Retroperitoneal and rectus sheath hemorrhage (RRSH) has been described as a potentially fatal condition with mortality rates of up to 30 % due to the risk of exsanguination in combination with often nonspecific clinical symptoms. Patients at risk are > 65 years of age as well as those receiving anticoagulation/antiplatelet medicine. Classifications based on etiology consist of trauma, surgery, and/or underlying vascular pathologies, though spontaneous occurrences without precipitating factors have been reported and are expected to increase with the high number of patients undergoing anticoagulant therapy.Method Analysis, summary, and discussion of published review articles and expert recommendations.Results The most commonly described symptom during clinical examination is abdominal pain. However, depending on the volume loss, clinical symptoms may include signs of abdominal compartment and hemorrhagic shock. Computed tomography angiography (CTA) with high sensitivity and specificity for the presence of active bleeding plays an important role in the detection of RH and RSH. Therapy management is based on different pillars, which include surgical and interventional measures in addition to conservative measures (volume replacement, optimization of coagulation parameters). Due to its lower invasiveness with simultaneously high technical and clinical success rates, interventional therapy in particular has gained increasing importance.Conclusion Diagnostic and therapeutic workup of the patients by an interdisciplinary team is essential for optimal patient care. In case of transcatheter arterial embolization, a standardized approach to the detection of bleeding sites within the vascular territory of the core hematoma appears to favorably influence success and patient outcome.

Purpose The aim was to characterize the framework conditions in academic interventional radiology (IR) in Germany with focus on differences between genders. Materials and methods After IRB approval, all members of The German Society for Interventional Radiology and Minimally Invasive Therapy (n = 1,632) were invited to an online survey on work and research. Statistical comparisons were undertaken with the Fisher's exact test, Wilcoxon rank sum test or Pearson's Chi-squared test. Results From 267 available questionnaires (general response rate 16.4%), 200 were fully completed. 40% of these (78/200) were involved in research (71% men vs. 29% women, p < 0.01) and eligible for further analysis. Of these, 6% worked part-time (2% vs. 17%, p < 0.05). 90% of the respondents spent less than 25% of their research during their paid working hours, and 41% performed more than 75% of their research during. leisure time. 28% received exemption for research. 88% were (rather) satisfied with their career. One in two participants successfully applied for funding, with higher success rates among male applicants (90% vs. 75%) and respondents with protected research time (93% vs. 80%). Compared to men, women rated their entrance in research as harder (p < 0.05), their research career as more important (p < 0.05), felt less noticed at congresses (93% vs. 53%, p < 0.01), less confident (98% vs. 71%, p < 0.01), and not well connected (77% vs. 36%, p < 0.01). Conclusion Women and men did research under the same circumstances; however, women were underrepresented. Future programs should generally focus on protected research time and gather female mentors to advance academic IR in Germany.

Purpose This article presents the results of a nationwide survey addressing the status quo of gender equality and family friendliness within German interventional radiology (IR) with a focus on clinical entry and career development. Materials and Methods All members of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) were invited to participate in an online survey between November 2021 and February 2022. The survey consisted of 39 questions on demographic information, marital and parental status, experiences with entry and promotion in IR, family friendliness, and equality. A descriptive analysis of the responses was conducted. Results 197 surveys from female (n=76; 39%) and male (n=121; 61%) interventional radiologists at various stages of training and career were analyzed. Fewer female attending physicians (58%) and chiefs of departments (23%) lived with children compared to male attending physicians (76%) and chiefs of departments (55%). Fewer men (4%) than women (41%) were primarily responsible for childcare. More female (55%) than male (6%) attending physicians worked part-time. Women rated entry into IR as more difficult than men. 55% of women felt disadvantaged by their gender (men: 6%); this was due to assumptions that women "perform less than men" (46%), "drop out due to family commitments" (35%) and that "men are promoted preferentially" (19%). 54% believed that it is more difficult for women to combine work and family. The reasons for this are "family commitments" and "lack of flexible work schedules and childcare". Parents with primary responsibility spent less than 50% of their working time on clinical interventions. Fathers from a younger generation were more likely to take parental leave than fathers of a previous generation (52% vs. 17%). Similar numbers of men (51%) and women (55%) planned to work part-time in the future. Conclusion There are gender-specific differences in the German IR. To ensure sustainable recruitment of young talent, measures such as the normalization of flexible work schedules should be introduced to create equal conditions for women and men, as well as mothers and fathers, and thus take changing (family) structures adequately into account.

Background Pelvic venous disorders (PeVD) are an underdiagnosed cause of chronic pelvic pain in women. They are caused by venous insufficiency of the pelvic or ovarian veins, leading to the development of mainly periuterine and periovarian varices. It is a progressive disease if left untreated and can cause swelling, dyspareunia, dysmenorrhea, and other symptoms, some non-specific, that affect the patient's quality of life. Interventional therapies are a central component of the treatment of PeVD, with a variety of techniques available for both diagnosis and treatment. Method This review provides an overview of the pathophysiologic background, diagnosis, and, most importantly, interventional treatment options for PeVD. Results There is a lack of standardized nomenclature and internationally accepted diagnostic criteria for PeVD as well as randomized controlled trials demonstrating clinical success. However, in clinical trials, endovascular therapy for PeVD has been shown to be safe and effective. This review presents the various interventional techniques for the treatment of PeVD, including embolization, stenting, and sclerotherapy. Conclusion The importance of PeVD is receiving growing recognition. Recent advances, such as the development of the Symptoms-Varices-Pathophysiology (SVP) classification, provide an impetus to standardize nomenclature and are the first step toward systematizing disease management. Interventional therapies provide a safe and tailored minimally invasive treatment option for patients with PeVD.

Objectives: This phantom and animal pilot study aimed to compare image quality and radiation exposure between detector-dose-driven exposure control (DEC) and contrast-to-noise ratio (CNR)-driven exposure control (CEC) as functions of source-to-image receptor distance (SID) and collimation. Materials and Methods: First, an iron foil simulated a guide wire in a stack of polymethyl methacrylate and aluminum plates representing patient thicknesses of 15, 25, and 35 cm. Fluoroscopic images were acquired using 5 SIDs ranging from 100 to 130 cm and 2 collimations (full field of view, collimated field of view: 6 x 6 cm). The iron foil CNRs were calculated, and radiation doses in terms of air kerma rate were obtained and assessed using a multivariate regression. Second, 5 angiographic scenarios were created in 2 anesthetized pigs. Fluoroscopic images were acquired at 2 SIDs (110 and 130 cm) and both collimations. Two blinded experienced readers compared image quality to the reference image using full field of view at an SID of 110 cm. Air kerma rate was obtained and compared using t tests. Results: Using DEC, both CNR and air kerma rate increased significantly at longer SID and collimation below the air kerma rate limit. When using CEC, CNR was significantly less dependent of SID, collimation, and patient thickness. Air kerma rate decreased at longer SID and tighter collimation. After reaching the air kerma rate limit, CEC behaved similarly to DEC. In the animal study using DEC, image quality and air kerma rate increased with longer SID and collimation (P < 0.005). Using CEC, image quality was not significantly different than using longer SID or tighter collimation. Air kerma rate was not significantly different at longer SID but lower using collimation (P = 0.012). Conclusions: CEC maintains the image quality with varying SID and collimation stricter than DEC, does not increase the air kerma rate at longer SID and reduces it with tighter collimation. After reaching the air kerma rate limit, CEC and DEC perform similarly.

OBJECTIVES:This phantom and animal pilot study aimed to compare image quality and radiation exposure between detector-dose-driven exposure control (DEC) and contrast-to-noise ratio (CNR)-driven exposure control (CEC) as functions of source-to-image receptor distance (SID) and collimation. MATERIALS AND METHODS:First, an iron foil simulated a guide wire in a stack of polymethyl methacrylate and aluminum plates representing patient thicknesses of 15, 25, and 35 cm. Fluoroscopic images were acquired using 5 SIDs ranging from 100 to 130 cm and 2 collimations (full field of view, collimated field of view: 6 × 6 cm). The iron foil CNRs were calculated, and radiation doses in terms of air kerma rate were obtained and assessed using a multivariate regression. Second, 5 angiographic scenarios were created in 2 anesthetized pigs. Fluoroscopic images were acquired at 2 SIDs (110 and 130 cm) and both collimations. Two blinded experienced readers compared image quality to the reference image using full field of view at an SID of 110 cm. Air kerma rate was obtained and compared using t tests. RESULTS:Using DEC, both CNR and air kerma rate increased significantly at longer SID and collimation below the air kerma rate limit. When using CEC, CNR was significantly less dependent of SID, collimation, and patient thickness. Air kerma rate decreased at longer SID and tighter collimation. After reaching the air kerma rate limit, CEC behaved similarly to DEC. In the animal study using DEC, image quality and air kerma rate increased with longer SID and collimation ( P < 0.005). Using CEC, image quality was not significantly different than using longer SID or tighter collimation. Air kerma rate was not significantly different at longer SID but lower using collimation ( P = 0.012). CONCLUSIONS:CEC maintains the image quality with varying SID and collimation stricter than DEC, does not increase the air kerma rate at longer SID and reduces it with tighter collimation. After reaching the air kerma rate limit, CEC and DEC perform similarly.

The purpose of this study was to develop a fully automated and reliable volumetry of the cerebellum of children during infancy and childhood using deep learning algorithms in comparison to manual segmentation. In addition, the clinical usefulness of measuring the cerebellar volume is shown. One hundred patients (0 to 16.3 years old) without infratentorial signal abnormalities on conventional MRI were retrospectively selected from our pool of pediatric MRI examinations. Based on a routinely acquired 3D T1-weighted magnetization prepared rapid gradient echo (MPRAGE) sequence, the cerebella were manually segmented using ITK-SNAP. The data set of all 100 cases was divided into four splits (four-fold cross-validation) to train the network (NN) to delineate the boundaries of the cerebellum. First, the accuracy of the newly created neural network was compared with the manual segmentation. Secondly, age-related volume changes were investigated. Our trained NN achieved an excellent Spearman correlation coefficient of 0.99, a Dice Coefficient of 95.0 ± 2.1%, and an intersection over union (IoU) of 90.6 ± 3.8%. Cerebellar volume increased continuously with age, showing an exponentially rapid growth within the first year of life. Using a convolutional neural network, it was possible to achieve reliable, fully automated cerebellar volume measurements in childhood and infancy, even when based on a relatively small cohort. In this preliminary study, age-dependent cerebellar volume changes could be acquired.

Zielsetzung Technischer und klinischer Erfolg der intraarteriellen Embolisation in drei deutschen Universitätskliniken für die bei Patienten mit lebensbedrohlichen, spontanen retroperitonealen und Rektusscheidenblutungen (SRRSH): Entwicklung von Arbeitsablaufempfehlungen.

Hintergrund Retroperitoneale und Rektusscheidenhämatome (RH/RSH) stellen ein Krankheitsbild dar, das unter anderem wegen unspezifischer klinischer Symptomatik und des drohenden Risikos einer Exsanguination bzw. Folgen des Blutverlustes, Mortalitätsraten bis zu 30 % aufweist. Ätiologisch werden traumatische, iatrogene und spontane Subtypen unterschieden. Mit in der Literatur beschriebenen Risikofaktoren eines Lebensalters > 65 Jahre und der Einnahme antikoagulativer Medikation werden steigende Inzidenzen insbesondere des spontanen Subtyps der RH/SRH in der alternden Gesellschaft prognostiziert. Material und Methodik Analyse, Resümee und Diskussion publizierter Grundlagenarbeiten und Expertenempfehlungen. Ergebnisse Am häufigsten wird das Vorliegen abdomineller Schmerzen im Rahmen der klinischen Untersuchung beschrieben; in Abhängigkeit vom Ausmaß des Volumenverlustes können die Symptome eines abdominellen Kompartments und eines hämorrhagischen Schocks auftreten. Die Computertomographie-Angiographie (CTA), mit hoher Sensitivität und Spezifizität für das Vorliegen aktiver Blutungen, spielt die entscheidende Rolle in der Detektion von RH und RSH. Das Therapiemanagement basiert auf verschiedenen Säulen, welche neben konservativen Maßnahmen (Volumenersatz, Optimierung der Gerinnungsparameter), chirurgische und interventionelle Maßnahmen umfassen, die eng aufeinander abgestimmt werden. Aufgrund ihrer geringeren Invasivität bei simultan hohen technischen und klinischen Erfolgsraten hat insbesondere die Säule der interventionellen Therapie zunehmend an Bedeutung gewonnen. Schlussfolgerung Das Therapiemanagement von Patienten/innen mit RH/SRH erfordert eine niedrige klinische Verdachtsschwelle und die Zusammenarbeit in einem interdisziplinären Team zur bestmöglichen Therapiefindung. Die transarterielle Embolisation erfordert eine systematische, standardisierte Abfolge der Blutungsdetektion und bietet Vorteile hinsichtlich technischer und klinischer Erfolgsraten. Kernaussagen:

Introduction: The use of well-established bone removal (BRM) techniques is crucial for CT angiography (CTA) of the head, body, and lower limbs. The lower body stem, which includes the abdomen and pelvis, does not have a BRM for cone beam CT (CBCT). This frequently necessitates the interventionist doing a manual BRM, particularly in the pelvic area, as in the case of a prostate embolization, necessitating his exit from the interventional room.The aim of this study is to create and clinically test a BRM method for CBCT of the lower body stem that is high-quality, totally automated, and uses a convolutional neural network.