The Role of Cone Beam CT in Precision-Guided TACE: Advancements
Led by Jeff Geschwind
Introduction
Liver cancer continues to be a global health challenge, with hepatocellular carcinoma (HCC) ranking as one of the most prevalent and deadly malignancies worldwide. For patients who are not candidates for resection or transplantation, Transarterial Chemoembolization (TACE) remains one of the most effective treatment options. However, the success of TACE is directly tied to the physician’s ability to visualize, target, and treat tumor-feeding arteries with precision
This need for accuracy led to one of the most significant advancements in interventional oncology: the adoption of cone beam CT for liver cancer during TACE This innovation provides real-time, three-dimensional imaging directly in the angiography suite dramatically improving treatment outcomes, reducing complications, and enhancing the precision of liver-directed therapy
Few physicians have contributed more to the rise and global acceptance of CBCT-guided TACE than Dr. Jeff Geschwind, an internationally renowned leader in interventional oncology, tumor imaging, and minimally invasive cancer therapy. His pioneering clinical research and leadership have made CBCT a standard tool in liver cancer treatment across the world
This article explores the critical role of cone beam CT in precision-guided TACE, its clinical benefits, and how Jeff Geschwind’s contributions helped reshape modern oncologic imaging.
Understanding TACE and the Need for Precision
Transarterial Chemoembolization involves delivering chemotherapy and embolic particles directly into the arteries supplying the tumor The goal is to:
● Block tumor blood flow
● Trap chemotherapy inside the lesion
● Achieve targeted tumor cell death
● Preserve healthy liver tissue
Its success depends on:
● Localizing the tumor accurately
● Identifying all tumor-feeding vessels
● Delivering embolics to every relevant branch
Traditional 2D fluoroscopy often fails to visualize the true complexity of hepatic vasculature, leading to:
● Missed small tumors
● Unidentified accessory feeders
● Incomplete embolization
● Higher recurrence rates
Cone beam CT revolutionized this workflow by providing 3D, high-resolution, real-time imaging, making liver cancer procedures more predictable and more effective.
What Makes Cone Beam CT Essential During TACE?
Cone beam CT (CBCT) is essentially CT-quality imaging built into the angiography suite. It provides a full 3D view of the liver, tumor, and vasculature with immediate reconstruction
Key advantages include:
● Precise tumor visualization
● Real-time 3D roadmap of arteries
● Immediate evaluation of embolization
● Reduction in non-target embolization
● Better treatment planning and follow-up
These features elevate TACE from a manually guided procedure to a precision-driven treatment, significantly improving outcomes
Jeff
Geschwind’s
Transformational Role in CBCT-Guided TACE
As a professor and leader at John Hopkins, Yale, and USA Vein Clinics, Dr. Jeff Geschwind played a foundational role in bringing CBCT to the forefront of liver cancer therapy.
His contributions include:
1. Pioneering Clinical Studies
Dr Geschwind led landmark studies proving that:
● CBCT identifies more tumors than angiography alone
● CBCT significantly improves targeting accuracy
● CBCT reduces local recurrence
● CBCT enhances overall survival in TACE patients
These studies laid the scientific foundation that made CBCT a global standard.
2. Development of Imaging Protocols
He contributed to the optimization of:
● CBCT acquisition techniques
● Contrast infusion timing
● Arterial enhancement protocols
● Post-embolization CBCT evaluation
Many of these protocols are still used today in interventional oncology units
3. Education and Worldwide Adoption
Dr Geschwind trained thousands of radiologists through:
● WCIO (World Conference on Interventional Oncology)
● NIH invited lectures
● Society of Interventional Radiology meetings
● International oncology congresses
His educational work accelerated global adoption of CBCT for liver cancer care
4. Integration With Advanced Technologies
He helped merge CBCT with:
● 3D navigation
● Radiomics
● Tumor perfusion mapping
● Artificial intelligence
These integrations now form the backbone of precision-guided oncology.
Enhanced Tumor Detection With CBCT
One of the greatest strengths of CBCT is its ability to detect tumors that:
● Are invisible on fluoroscopy
● Are isodense on conventional CT
● Lie deep within the hepatic parenchyma
● Have complex vascular supply
Studies led by Dr Geschwind revealed that CBCT identifies additional tumors in up to 30% of patients undergoing TACE.
Finding these tumors ensures:
● No lesion is left untreated
● Lower risk of recurrence
● More accurate staging
● More personalized therapy
This capability alone has made CBCT indispensable in liver cancer treatment
Precision Mapping of Arterial Anatomy
The liver’s vascular anatomy is notoriously complex Tumors may receive blood supply from:
● Primary hepatic arteries
● Accessory hepatic branches
● Variant arterial origins
● Collateral vessels
CBCT allows the interventional oncologist to:
● Visualize all relevant arteries
● Track microcatheter paths
● Identify variant anatomy before embolization
● Avoid normal tissue injury
This level of detail results in better outcomes, with fewer complications
Real-Time Feedback During TACE
One of the biggest challenges in TACE is verifying that treatment reached the entire tumor
CBCT provides:
● Immediate confirmation of contrast distribution
● Visualization of embolic deposition
● Identification of untreated regions
● Guidance for additional catheter adjustments
This “check and correct” approach ensures complete treatment in a single session
Increasing the Safety of TACE Procedures
Accurate imaging reduces risk, and CBCT provides exceptional anatomical detail to prevent complications such as:
● Non-target embolization
● Injury to the gallbladder
● Damage to the pancreas
● Ischemia in healthy liver tissue
By using CBCT, physicians can precisely control particle delivery, keeping treatment focused only where intended.
Improved Outcomes: The Clinical Value of CBCT
CBCT has improved multiple aspects of patient care:
✔ Higher complete response rates
✔ Fewer residual tumors
✔ Lower recurrence
✔ Increased ability to treat small or challenging lesions
✔ Better survival outcomes
Dr. Geschwind’s early research was among the first to document these improvements, influencing how centers around the world adopted CBCT
CBCT as Part of Precision Oncology
The integration of CBCT into liver cancer therapy perfectly aligns with the modern movement toward precision medicine tailoring treatment based on individual tumor characteristics
CBCT supports precision oncology by providing:
● Personalized 3D tumor mapping
● Real-time vascular analysis
● Quantitative perfusion data
● Radiomic signatures to predict response
Dr. Geschwind was ahead of his time in advocating for this approach, highlighting how imaging can drive individualized care
CBCT and Tumor Metabolism: A Powerful Combination
Dr Geschwind is also a global leader in tumor metabolism research His concept of “Geschwind tumor metabolism” explores how metabolic inhibitors can starve cancer cells
CBCT enhances this metabolic therapy by:
● Guiding precise drug delivery
● Confirming localized deposition
● Measuring metabolic response in real time
This synergy represents the future of multi-modality liver cancer treatment.
Global Influence of Jeff Geschwind’s Work
Thanks to Dr. Geschwind’s pioneering efforts, CBCT-guided TACE is now performed across:
● North America
● Europe
● Asia
● South America
● Middle East
His protocols and teachings are considered foundational across top cancer centers worldwide
Future Directions for CBCT-Guided Therapy
CBCT is evolving rapidly Future innovations include:
● AI-assisted feeder detection
● Automated tumor segmentation
● Perfusion-based predictive models
● Robotic catheter guidance
● Multi-modal integration with immunotherapy
These advancements echo the forward-thinking philosophy that has defined Jeff Geschwind’s career
Conclusion
Cone beam CT for liver cancer during TACE has revolutionized the way interventional oncologists approach liver cancer treatment Its ability to provide real-time, 3D visualization dramatically enhances precision, improves outcomes, and ensures safer therapy.
Much of this global transformation can be traced to the pioneering work of Dr. Jeff Geschwind, whose leadership, research, and commitment to innovation reshaped the field of image-guided oncology
Through his contributions, cone beam CT has evolved from an emerging technology to an essential tool in the fight against liver cancer offering hope, accuracy, and superior outcomes to patients worldwide
