Purpose: High-resolution multislice CT (HR-MSCT) and cone beam CT (CBCT) are commonly used for preoperative temporal bone imaging, with HR-MSCT often preferred due to its shorter scan duration and lower susceptibility to motion artifacts. However, recent advancements in accelerated flat panel CT (Acc-FPCT) available with the latest generation angiography systems have addressed traditional limitations of CBCT by significantly decreasing scan time. This cadaver-based study evaluates the diagnostic performance and radiation dose of Acc-FPCT compared to HR-MSCT in preoperative temporal bone imaging. Methods: Six different Acc-FPCT protocols were acquired on five whole-head cadaveric specimens (ten temporal bones). Three neuroradiologists experienced in temporal bone imaging assessed the image quality of Acc-FPCT protocols in comparison to that of HR-MSCT for the visualization of 31 landmarks of middle and inner ear using a 5-point Likert scale. We also compared radiation dose parameters (CT dose index and dose length product) among the protocols. Results: Two high-Resolution Acc-FPCT protocols were found to be superior to HR-MSCT by all raters (p < 0.001). There were no significant differences between the two HR-FPCT protocols (p = 0.25). The remaining Acc-FPCT protocols were rated significantly inferior to HR-MSCT. The inter-rater reliability was excellent (ICC (2,k) = 0.925; CI [0.92–0.93]). The dose length product was significantly lower in all Acc-FPCT protocols compared to HR-MSCT. Conclusion: The results of our cadaver-based study highlight the utility of certain Acc-FPCT protocols as a viable alternative to HR-MSCT in preoperative temporal bone imaging, improving the visualization of critical anatomical landmarks without increasing radiation exposure.

Background: Intracranial vessel perforation is a rare but life-threatening complication during endovascular neurointerventions. Despite several described bail-out strategies, there is no consensus on the most effective approach for rapid hemorrhage control. This study aimed to systematically compare common endovascular rescue techniques in a standardized experimental setting. Methods: Patient-specific, 3D-printed vascular models of the anterior circulation were used to simulate standardized vessel perforations at two anatomical sites and three perforation sizes. The impact of the anterior communicating artery (AComA) crossflow was assessed. Proximal balloon guiding catheter inflation, local compliant balloon inflation, temporary coil deployment, and distal intermediate catheter insertion were evaluated against a non-intervention control. The primary outcome was the time it took for 50 ml of fluid extravasation to accumulate. Results: As expected, extravasation time inversely correlated with perforation size ( ρ = –0.95, p < 0.001). Local balloon inflation at the rupture site most effectively halted leakage. Proximal balloon occlusion was only effective in the absence of an AComA crossflow ( p = 0.02). Temporary coil deployment modestly slowed bleeding, especially for small-to-moderate perforations. Distal intermediate catheter placement had no significant effect. Conclusion: Managing iatrogenic intracranial vessel perforation is time-critical, as even a brief bleeding time can be fatal. The most effective hemostasis method is compliant balloon inflation at the rupture site. If unavailable, temporary parent artery coiling can reduce bleeding while maintaining perfusion, but it is less effective for larger perforations. Proximal balloon occlusion is only effective in the absence of collateral crossflow.

Background: Digital subtraction angiography lacks the ability to visualise intimal surface changes. Angioscopy, in contrast, enables direct imaging of the endoluminal surface, revealing luminal alterations, as established in cardiovascular imaging. Its application in the internal carotid artery (ICA) could allow assessment of pathological changes and the visualization of implant structures such as stents or flow diverters, including their apposition to the vessel wall. This study evaluates the feasibility of using a thin fibre-optic endoscope for angioscopy in the ICA anatomy. Methods: Five 3D DSA image sets of the ICA with varying anatomies were selected. Tube-based vessel models were fabricated to replicate the corresponding vascular segments, incorporating a measurement scale and, optionally, a stent or a flow diverter. The advancement of a fibre-optic endoscope and the related influence on vessel deformation were assessed in each model. Spatial and colour resolution were evaluated by applying coloured markings to the inner tube surface to simulate vessel wall discolouration. The visibility of structural details, including flow diverter meshes and stent struts, was assessed based on image contrast and sharpness within the angioscope’s defined field of view. Results: The endoscope was successfully advanced to the distal end in all models. Increased vascular curvature required greater mechanical force for navigation and positioning, leading to observable straightening of the vessel model. In all cases, endoscopic imaging produced clear visualizations of vessel wall markings and implant structures. Stent struts and flow diverter meshes were distinguishable, as were discolorations simulating pathological changes. Conclusion: Angioscopy of the ICA is technically feasible and enables endoluminal visualization, including implant structures. Feasibility was strongly dependent on vessel curvature and required substantial increases in delivery force in highly tortuous anatomies.

Holding a remote keyless entry fob near the head provides a practical opportunity to investigate configuration-dependent changes in operating range. This pilot study examined five head-contact configurations in nine adults using a factory 433.92 MHz fob and its vehicle. Complementary assessments included an anatomically shaped skull phantom and 7 T magnetic resonance imaging (MRI). Operating thresholds were determined using a staircase procedure. The submental configuration yielded positive gains in all nine participants and the largest mean and median gains: 11.11 m and 12 m, respectively. The within-subject analysis identified an overall difference among configurations in eight complete cases (Friedman ${\chi }^2\left(4\right)=23.24$; Monte Carlo $p<0.00001$ based on 200,000 permutations; Kendall’s $W=0.73$). In the phantom series, each condition with distilled water yielded a higher gain than the condition with air at the same location, although gains did not increase consistently across fill levels. These observations identify promising configurations for further investigation. MRI characterized anatomical variation to inform future studies, with no significant associations after correction for multiple comparisons. Each condition was assessed once, and placement was evaluated with fob orientation and hand/body geometry. Building on these observations, repeated measurements with independent control of these factors will help establish repeatability and clarify the electromagnetic contributions.

Background: At present, nonvirtual neurovascular training can be performed using either an angiographic suite under fluoroscopic guidance (entailing radiation exposure) or direct optical visualization with a camera-based system. The angiographic approach offers high-fidelity visualization and catheter control but is constrained by the limited availability of such specialized facilities, whereas the camera-based approach can be implemented virtually anywhere yet lacks comparable realism in key procedural aspects. The objective of this work is to develop and evaluate a novel camera-based angiography training system (CBATS) that generates artificial angiograms and roadmaps, thereby combining the advantages of both imaging techniques while eliminating radiation exposure. Methods: Three distinct aneurysm models were integrated into a novel neurointerventional training platform, which was evaluated by neurointerventionalists across three training imaging modalities (conventional digital subtraction angiography [DSA], camera-only visualization, and CBATS) to simulate general endovascular procedures. Following the training sessions, a questionnaire-based evaluation was conducted to compare the performances of the camera-only and CBATS approaches with the conventional DSA, which served as the gold standard. Results: Ninety percent of the raters agree that the visual realism of our CBATS training system is comparable to real angiography and offers a significant advantage over the camera-only variant. The absence of radiation, in particular, was rated as a major advantage by 89.3% of the raters. Conclusions: In summary, our angiography-like training system is considered comparable to a real angiography system in terms of realism for the training scenarios addressed. However, it offers the advantage of being radiation-free and can be set up in almost any location.