Reduction of patient radiation dose during percutaneous CT vertebroplasty: Impact of a new computer-assisted navigation (CAN) system

C Teriitehau,Q Sénéchal,E Pessis,M Bravetti,H Rabeh,F Besse

doi:10.1051/radiopro/2019049

C Teriitehau, Q Sénéchal + Show 4 more

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https://doi.org/10.1051/radiopro/2019049

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Abstract

To assess the impact of a computer assisted navigation system (CAN) (CT-Navigation™ IMACTIS, France) on patient radiation doses during percutaneous CT vertebroplasty a retrospective comparative trial was performed and included 37 patients requiring percutaneous vertebroplasty. This study was approved by CCN (Centre Cardiologique du Nord, Saint-Denis, France) ethical committee; all patients provided informed consent. All procedures were conducted in the interventional radiology department at CCN, by an experienced single radiologist using the same model and CT scan with identical parameters. The interventional dose length product (IDLP), representing the absorbed dose by the length of explored organs during the needle insertion phase, was compared in 15 consecutive patients who underwent a conventional procedure (CT control group), and in 22 patients who underwent CAN CT vertebroplasty (CAN group). The IDLP difference between the two groups was evaluated using Mann–Whitney U test. The median IDLP dose for the CAN group was 305.6 mGy.cm [182.3; 565.4], representing a reduction by a 3.2 factor compared with that of the conventional CT group (median 975.2 mGy.cm [568.3; 1077.1]; p < 0.001). The median procedure duration for the CAN group was 50 min [35; 60] vs. 100 min [82; 100] in the CT group (p < 0.001), representing a 50% reduction. In experienced hands, use of a CT-Navigation™ system (IMACTIS®) significantly reduced both patient radiation dose and procedure duration when compared to conventional CT guided percutaneous vertebroplasty.

Highlights

The number of spinal interventional radiology procedures has increased during the last decade due to rising spine-related disorders (Toma et al, 2007; Friedly et al, 2010)
The first 21 consecutive patients treated with computer assisted navigation system (CAN) vertebroplasty were compared to the last 16 patients treated with a conventional vertebroplasty CT procedure
CT-Navigation allows electromagnetic navigation based on CT-image guidance and consists of three components: a field generator integrated in a patient referential (PR) taped on patient skin, a magnetic receiver integrated in a needle holder, and a central control unit with the appropriate data acquisition system and navigation software (Fig. 1)

Summary

Introduction

The number of spinal interventional radiology procedures has increased during the last decade due to rising spine-related disorders (Toma et al, 2007; Friedly et al, 2010) This trend has led to greater use of X-ray guidance, with higher radiation exposure for both patients and health professionals (Perisinakis et al, 2004). Several researchers highlighted the ongoing unmet need for a solution to help reduce this radiation exposure (Synowitz and Kiwit, 2006; Lonjon et al, 2016) They suggested that navigation systems developed to guide physicians during interventional procedures may have the potential to reduce the X-ray dose delivered (Izadpanah et al, 2009; Narain et al, 2017) to both patients and workers.

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