Abstract
Background
Computed-tomography-guided interventions are attractive for tissue sampling of pediatric bone lesions; however, it comes with exposure to ionizing radiation, inherent to CT and magnified by multiple passes during needle localization.
Objective
We evaluate a method of CT-guided bone biopsy that minimizes ionizing radiation exposure by lowering CT scanner tube current (mAs) and voltage (kVp) during each localization scan.
Materials and methods
We retrospectively reviewed all CT-guided bone biopsies (n = 13) over a 1-year period in 12 children. Three blinded readers identified the needle tip on the reduced-dose CT images (mAs = 50, kVp = 80) during the final localization scan at biopsy and rated the image quality as high, moderate or low.
Results
The image quality of the reduced-dose scans during biopsy was rated as either high or moderate, with needle tip visualized in 12 out of 13 biopsies. Twelve of 13 biopsies also returned sufficient sample for a pathological diagnosis. The average savings in exposure using the dose-reduction technique was 87%.
Conclusion
Our results suggest that a low mAs and kVp strategy for needle localization during CT-guided bone biopsy yields a large dose reduction and produces acceptable image quality without sacrificing yield for biopsy diagnosis.
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References
Gogna A, Peh WC, Munk PL (2008) Image-guided musculoskeletal biopsy. Radiol Clin North Am 46:455–473
Huang AJ, Kattapuram SV (2011) Musculoskeletal neoplasms: biopsy and intervention. Radiol Clin North Am 49:1287–1305
Ward WG Sr, Kilpatrick S (2000) Fine needle aspiration biopsy of primary bone tumors. Clin Orthop Relat Res (373):80–87
Goske MJ, Applegate KE, Boylan J et al (2008) The ‘Image Gently’ campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatr Radiol 38:265–269
Sidhu M, Coley BD, Goske MJ et al (2009) Image Gently, Step Lightly: increasing radiation dose awareness in pediatric interventional radiology. Pediatr Radiol 39:1135–1138
Hryhorczuk AL, Strouse PJ, Biermann JS (2011) Accuracy of CT-guided percutaneous core needle biopsy for assessment of pediatric musculoskeletal lesions. Pediatr Radiol 41:848–857
Paulson EK, Sheafor DH, Enterline DS et al (2001) CT fluoroscopy-guided interventional procedures: techniques and radiation dose to radiologists. Radiology 220:161–167
Abul-Kasim K, Ohlin A, Strombeck A et al (2010) Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography. Eur Spine J 19:96–104
Dupuy DE, Rosenberg AE, Punyaratabandhu T et al (1998) Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol 171:759–762
Fayad LM, Johnson P, Fishman EK (2005) Multidetector CT of musculoskeletal disease in the pediatric patient: principles, techniques, and clinical applications. Radiographics 25:603–618
Salamipour H, Jimenez RM, Brec SL et al (2005) Multidetector row CT in pediatric musculoskeletal imaging. Pediatr Radiol 35:555–564
Shin HJ, Amaral JG, Armstrong D et al (2007) Image-guided percutaneous biopsy of musculoskeletal lesions in children. Pediatr Radiol 37:362–369
Smith JC, Jin DH, Watkins GE et al (2011) Ultra-low-dose protocol for CT-guided lung biopsies. J Vasc Interv Radiol 22:431–436
Heyer CM, Lemburg SP, Kagel T et al (2005) Evaluation of chronic infectious interstitial pulmonary disease in children by low-dose CT-guided transthoracic lung biopsy. Eur Radiol 15:1289–1295
Heyer CM, Nusslein TG, Stephan V et al (2007) Low-dose CT-guided transthoracic lung biopsy for evaluation of non-infectious chronic interstitial lung disease in children. Pneumologie 61:499–508
Rosenthal DI (2006) Radiofrequency treatment. Orthop Clin North Am 37:475–484
Leng S, Christner JA, Carlson SK et al (2011) Radiation dose levels for interventional CT procedures. AJR Am J Roentgenol 197:W97–W103
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Patel, A.S., Soares, B., Courtier, J. et al. Radiation dose reduction in pediatric CT-guided musculoskeletal procedures. Pediatr Radiol 43, 1303–1308 (2013). https://doi.org/10.1007/s00247-013-2691-4
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DOI: https://doi.org/10.1007/s00247-013-2691-4