Omission of Planning CT Reduces Patient Radiation Exposure during CT-Guided Bone Marrow Biopsy and Aspiration.

Robert Devita,Vijaya Kosaraju,David Jordan,Jon Davidson,Salim Abboud,Jared Durieux,Kaushik Chagarlamudi,Brian Nguyen

doi:10.3390/tomography7040062

Robert Devita, Vijaya Kosaraju + Show 6 more

Open Access

https://doi.org/10.3390/tomography7040062

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Abstract

The purpose of this study is to evaluate the impact of eliminating a preprocedural planning computed tomography during CT-guided bone marrow biopsy on the technical aspects of the procedure, including patient dose, sample quality, procedure time, and CT fluoroscopy usage. Retrospective analysis of 109 patients between 1 June 2018 and 1 January 2021 was performed. Patients were grouped based on whether they received a planning CT scan. Relative radiation exposure was measured using dose-length product (DLP). Secondary metrics included number of CT fluoroscopic acquisitions until target localization, total number of CT fluoroscopic acquisitions, biopsy diagnostic yield, and procedure time. A total of 43 bone marrow biopsies with planning CT scans (Group 1) and 66 bone marrow biopsies without planning CT scans (Group 2) were performed. The average total DLP for Group 1 and Group 2 was 268.73 mGy*cm and 50.92 mGy*cm, respectively. The mean radiation dose reduction between the groups was 81% (p < 0.0001). Significantly more CT fluoroscopy acquisitions were needed for needle localization in Group 2 than Group 1 (p < 0.0001). Total number of CT fluoroscopy acquisitions was four for Group 1 and eight for Group 2 (p = 0.0002). There was no significant difference between the groups in procedure time or diagnostic yield. Patients without a planning CT scan received more fluoroscopic CT acquisitions but overall were exposed to significantly less radiation without an increase in procedure time.

Highlights

CT has become an important image-guidance modality for many types of tissue sampling, including bone marrow biopsy and aspiration [1]
The purpose of this study is to evaluate the impact of eliminating the preprocedural planning scan (PPS) on various technical aspects of CT-guided BMB, including total radiation dose, changes in utilization of intermittent CT fluoroscopy, procedure time, and biopsy quality
There were no significant differences in patient BMI, patient age, procedure time, and skin-to-bone distance (Table 1)

Summary

Introduction

CT (computed tomography) has become an important image-guidance modality for many types of tissue sampling, including bone marrow biopsy and aspiration [1]. Radiologists should endeavor to reduce unnecessary radiation exposure while performing CT-guided procedures. If a PPS is deemed necessary by the radiologist, methods to limit radiation exposure include reducing the craniocaudal scan length (z-axis), increasing the pitch, decreasing the photon fluence (mA), and/or decreasing the beam energy (kVp) [2]. The utility of a PPS for bone marrow biopsies has not been described. In a recent large-scale study comparing the biopsy yield of CT-guided vs blind BMB, all CT-guided procedures utilized a PPS [4]. The purpose of this study is to evaluate the impact of eliminating the PPS on various technical aspects of CT-guided BMB, including total radiation dose, changes in utilization of intermittent CT fluoroscopy, procedure time, and biopsy quality

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