Radiation exposure, organ and effective dose of CT-guided liver biopsy as a function of lesion depth and size

Abstract

Computed tomography (CT)-guided percutaneous biopsies play an important role in the diagnostic workup of liver lesions. Because radiation dose accumulates rapidly due to repeated image acquisition in a relatively small scan area, analysing radiation exposure is critical for improving radiation protection of CT-guided interventions. The aim of this study was to assess the radiation dose of CT-guided liver biopsies and the influence of lesion parameters, and to establish a local diagnostic reference level (DRL). In this observational retrospective cohort study, dose data of 60 CT-guided liver biopsies between September 2016 and July 2017 were analysed. Radiation exposure was reported for volume-weighted CT dose index (CTDIvol), size-specific dose estimate (SSDE), dose-length product (DLP) and effective dose (ED). Radiation dose of CT-guided liver biopsy was (median (interquartile range)): CTDIvol 9.91 mGy (8.33–11.45 mGy), SSDE 10.42 mGy (9.39–11.70 mGy), DLP 542 mGy cm (410–733 mGy cm), ED 8.52 mSv (7.17–13.25 mSv). Radiation exposure was significantly higher in biopsies of deep liver lesions compared to superficial lesions (DLP 679 ± 285 mGy cm vs. 497 ± 167 mGy cm, p = 0.0046). No significant dose differences were observed for differences in lesion or needle size. With helical CT spirals additional to the biopsy-guiding axial CT scans, radiation exposure was significantly increased: 797 ± 287 mGy cm vs. 495 ± 162 mGy cm, p < 0.0001. The local DRL is CTDIvol 9.91 mGy, DLP 542 mGy cm. Radiation dose is significantly increased in biopsies of deeper liver lesions compared with superficial lesions. Interventions with additional biopsy-guiding CT spirals lead to higher radiation doses. This study provides a detailed analysis of local radiation doses for CT-guided liver biopsies and provides a benchmark for optimising radiation protection in interventional radiology.