By Nick Klenske
Hospital emergency departments regularly face situations requiring interventional radiology (IR). When such situations happen during working hours, they are readily handled by experienced IR personnel.
But the reality is that traumas, embolisms and ruptures don’t always occur between nine and five. That’s why emergency departments must build a collaborative team capable of performing quick and safe IR around the clock.
According to Rina Sugihara, a radiologic technologist at Japan’s NHO Mito Medical Center, a good place to start is with virtual fluoroscopy.
Making her remarks during a Tuesday RSNA session, Sugihara noted how, in emergency coronary care, a non-contrast whole body (chest-abdomen) CT is often acquired to rule out aortic dissection before primary percutaneous coronary intervention (PCI) in suspected acute myocardial infarction (AMI).
“We wondered whether we could repurpose that routine CT—without any extra scan, radiation, or cost—into an immediate, catheter-lab–ready anatomic roadmap,” she said.
Specifically, researchers wanted to see if virtual fluoroscopy images (VFI) reconstructed from the non-contrast CT could improve the safety and efficiency of urgent catheterization.
To find out, they performed a single-center, retrospective analysis of 50 consecutive AMI patients who underwent non-contrast chest CT prior to primary PCI.“By improving first-pass cannulation and reducing fluoroscopy and contrast, VFI may translate to faster reperfusion, fewer access-site issues, and lower risk of contrast-associated kidney injury, which is particularly relevant in hemodynamically unstable or renally vulnerable patients. The net effect is an immediate, radiation-free roadmap for a streamlined door-to-balloon workflow with fewer procedural detours.”
Rina Sugihara
During the study, CT data was exported to a 3D workstation, where it was converted into VFI, ray-summation projections that emulate fluoroscopy. Next, two blinded interventional cardiologists prospectively reviewed the VFI to localize right/left coronary ostia, pre-select a safe arterial puncture trajectory and anticipate aortic-root calcification that could hinder torque.
Researchers then compared procedural metrics against historical PCI cases where the CT was not shared with operators.
What they found was that VFI successfully depicted both coronary ostia and aortic course in 94% of cases, while heavy calcifications that could hinder catheter torque were visualized in 88%.
More so, pre-procedural VFI review changed planned sheath entry in 38% of patients and eliminated all second-attempt punctures—lowering the access site retry rate from a historical 15% to zero.
Median fluoroscopy time also fell from 11.2 minutes to 8.1 and contrast use from 78 mL to 63 mL.
No catheter-related vascular complications occurred.
“By improving first-pass cannulation and reducing fluoroscopy and contrast, VFI may translate to faster reperfusion, fewer access-site issues, and lower risk of contrast-associated kidney injury, which is particularly relevant in hemodynamically unstable or renally vulnerable patients,” Sugihara explained. “The net effect is an immediate, radiation-free roadmap for a streamlined door-to-balloon workflow with fewer procedural detours.”
Furthermore, because the method leverages existing workstations and doesn’t require new scanners or protocols, it represents a cost-neutral upgrade that can strengthen a radiology department’s interdisciplinary impact while also showcasing CT’s value beyond diagnosis.
“Radiology becomes an even more active partner in emergent cardiology by transforming an ‘exclusion CT’ into a real-time roadmap that directly informs access planning and catheter selection,” Sugihara said.
Access the presentation, “Next-Generation Virtual Fluoroscopy Image from Non-Contrast CT-Optimizing Cardiac Catheterization in Acute Myocardial Infarction,” (T7-SSBR06-3) on demand at RSNA.org/MeetingCentral
© 2025 RSNA.
The RSNA 2025 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, November 30 — Thursday, December 4.
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