Abstract
PurposeApart from the commonly applied manual needle biopsy, CT-guided percutaneous biopsies of bone lesions can be performed with battery-powered drill biopsy systems. Due to assumably different radiation doses and procedural durations, the aim of this study is to examine radiation exposure and establish local diagnostic reference levels (DRLs) of CT-guided bone biopsies of different anatomical regions.MethodsIn this retrospective study, dose data of 187 patients who underwent CT-guided bone biopsy with a manual or powered drill biopsy system performed at one of three different multi-slice CT were analyzed. Between January 2012 and November 2019, a total of 27 femur (A), 74 ilium (B), 27 sacrum (C), 28 thoracic vertebrae (D) and 31 lumbar vertebrae (E) biopsies were included. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol) and dose–length product (DLP).ResultsCTDIvol and DLP of manual versus powered drill biopsy were (median, IQR): A: 56.9(41.4–128.5)/66.7(37.6–76.2)mGy, 410(203–683)/303(128–403)mGy·cm, B: 83.5(62.1–128.5)/59.4(46.2–79.8)mGy, 489(322–472)/400(329–695)mGy·cm, C: 97.5(71.6–149.2)/63.1(49.1–83.7)mGy, 627(496–740)/404(316–515)mGy·cm, D: 67.0(40.3–86.6)/39.7(29.9–89.0)mGy, 392(267–596)/207(166–402)mGy·cm and E: 100.1(66.5–162.6)/62.5(48.0–90.0)mGy, 521(385–619)/315(240–452)mGy·cm. Radiation exposure with powered drill was significantly lower for ilium and sacrum, while procedural duration was not increased for any anatomical location. Local DRLs could be depicted as follows (CTDIvol/DLP): A: 91 mGy/522 mGy·cm, B: 90 mGy/530 mGy·cm, C: 116 mGy/740 mGy·cm, D: 87 mGy/578 mGy·cm and E: 115 mGy/546 mGy·cm. The diagnostic yield was 82.4% for manual and 89.4% for powered drill biopsies.ConclusionUse of powered drill bone biopsy systems for CT-guided percutaneous bone biopsies can significantly reduce the radiation burden compared to manual biopsy for specific anatomical locations such as ilium and sacrum and does not increase radiation dose or procedural duration for any of the investigated locations.Level of EvidenceLevel 3.
Highlights
CT-guided percutaneous bone biopsies play a key role for the diagnostic work-up of skeletal lesions such as inflammatory and malignant processes
Our study demonstrated that for both osteolytic and osteoblastic bone lesions, as well as for superficial and deep biopsies, radiation exposure was lower with the powered drill system
Comparable to the results of Cohen et al, our study demonstrated that procedural duration of all evaluated anatomical locations was slightly lower with the powered drill biopsy system, this time saving was not significant [4]
Summary
CT-guided percutaneous bone biopsies play a key role for the diagnostic work-up of skeletal lesions such as inflammatory and malignant processes. Generally well tolerated [4, 5] These procedures can be performed either with a manual approach by placing a bone needle within the skeletal lesion, possibly achieved by hammering technique to perforate the cortical bone, or with a powered drill bone biopsy system such as the commercially available ArrowÒ OnControlÒ powered bone access system. The powered drill approach provides a higher diagnostic yield for sclerotic lesions [4] Alongside these benefits of manual and powered drill CT-guided bone biopsies, CT entails a radiation burden and is a high-dose imaging technique, which causes the major part of collective effective dose of all medical imaging [8, 9]. To compare and evaluate local radiation exposure distributions and optimize radiation protection, 75th percentiles of dose metric distributions are often used as DRL [15]
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