Differences in Radiation Exposure of CT-Guided Percutaneous Manual and Powered Drill Bone Biopsy

Abstract Purpose Apart 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. Methods In 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). Results CTDIvol 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. Conclusion Use 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 Evidence Level 3.

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Validity of negative bone biopsy in suspicious bone lesions

Acta Radiologica Open ◽

10.1177/20584601211030662 ◽

2021 ◽

Vol 10 (7) ◽

pp. 205846012110306

Author(s):

Mine B Lange ◽

Lars J Petersen ◽

Michael B Nielsen ◽

Helle D Zacho

Keyword(s):

Bone Biopsy ◽

False Negative ◽

Exclusion Criterion ◽

Bone Lesions ◽

False Negatives ◽

Patient Morbidity ◽

Bone Biopsies ◽

Initial Biopsy ◽

Valid Criterion

Background The presence of malignant cells in bone biopsies is considered gold standard to verify occurrence of cancer, whereas a negative bone biopsy can represent a false negative, with a risk of increasing patient morbidity and mortality and creating misleading conclusions in cancer research. However, a paucity of literature documents the validity of negative bone biopsy as an exclusion criterion for the presence of skeletal malignancies. Purpose To investigate the validity of a negative bone biopsy in bone lesions suspicious of malignancy. Material and Method A retrospective cohort of 215 consecutive targeted non-malignant skeletal biopsies from 207 patients (43% women, 57% men, median age 64, and range 94) representing suspicious focal bone lesions, collected from January 1, 2011, to July 31, 2013, was followed over a 2-year period to examine any additional biopsy, imaging, and clinical follow-up information to categorize the original biopsy as truly benign, malignant, or equivocal. Standard deviations and 95% confidence intervals were calculated. Results 210 of 215 biopsies (98%; 95% CI 0.94–0.99) showed to be truly benign 2 years after initial biopsy. Two biopsies were false negatives (1%; 95% CI 0.001–0.03), and three were equivocal (lack of imaging description). Conclusion Our study documents negative bone biopsy as a valid criterion for the absence of bone metastasis. Since only 28% had a confirmed diagnosis of prior cancer and not all patients received adequately sensitive imaging, our results might not be applicable to all cancer patients with suspicious bone lesions.

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Factors influencing diagnostic yield of CT-guided percutaneous core needle biopsy for bone lesions

Clinical Radiology ◽

10.1016/j.crad.2013.09.003 ◽

2014 ◽

Vol 69 (1) ◽

pp. e43-e47 ◽

Cited By ~ 24

Author(s):

Y. Li ◽

Y. Du ◽

T.Y. Luo ◽

H.F. Yang ◽

J.H. Yu ◽

...

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Diagnostic Yield ◽

Bone Lesions ◽

Ct Guided ◽

Core Needle ◽

Factors Influencing ◽

Percutaneous Core Needle Biopsy

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CT-guided percutaneous biopsy of sclerotic bone lesions: diagnostic yield and accuracy.

American Journal of Roentgenology ◽

10.2214/ajr.172.5.10227522 ◽

1999 ◽

Vol 172 (5) ◽

pp. 1389-1392 ◽

Cited By ~ 72

Author(s):

S G Leffler ◽

F S Chew

Keyword(s):

Diagnostic Yield ◽

Percutaneous Biopsy ◽

Bone Lesions ◽

Ct Guided ◽

Sclerotic Bone ◽

Sclerotic Bone Lesions

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Basics of Computed Tomography

10.1093/med/9780199908004.003.0003 ◽

2016 ◽

Author(s):

Krikor Malajikian ◽

Daniel Finelli

Keyword(s):

Computed Tomography ◽

Soft Tissues ◽

Imaging Modality ◽

Bone Biopsy ◽

Bone Lesions ◽

Disc Space ◽

Ct Guided ◽

Ct Arthrography ◽

Facet Injections ◽

Joint Injections

Computed tomography (CT)-guidance is typically used when precise needle placement is essential for a successful procedure. It uses ionizing radiation, which could pose risks to the patient and operating staff if proper technique is not used. The performing physician should adhere to all principles of minimizing radiation exposure to the patient and clinicians. Common CT-guided imaging procedures include facet injections, nerve root injections, sacroiliac joint injections, intradiscal procedures, vertebroplasty/sacroplasty, and image-guided ablation of painful bone lesions. Computed tomography is also the imaging modality of choice for aspiration of deep paraspinal soft tissues in addition to disc space or bone biopsy in acute discitis/osteomyelitis. In fluoroscopic-guided knee or shoulder joint injections, CT arthrography is a useful adjunct to better assess anatomy when MRI is contraindicated. When imaging the postoperative spine, CT myelography has some advantages over MRI, and CT is also superior to MRI in assessing par intra-articularis defects or spondylolysis.

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Percutaneous CT guided bone biopsy for suspected osteomyelitis: Diagnostic yield and impact on patient’s treatment change and recovery

European Journal of Radiology ◽

10.1016/j.ejrad.2019.01.032 ◽

2019 ◽

Vol 114 ◽

pp. 85-91 ◽

Cited By ~ 7

Author(s):

Diana Hoang ◽

Stephen Fisher ◽

Orhan K. Oz ◽

Javier La Fontaine ◽

Avneesh Chhabra

Keyword(s):

Diagnostic Yield ◽

Bone Biopsy ◽

Treatment Change ◽

Ct Guided

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Psoas hematoma due to segmental vessel injury leads to paresis following CT-guided biopsy of lumbar vertebrae: A case report

Surgical Neurology International ◽

10.25259/sni_759_2020 ◽

2020 ◽

Vol 11 ◽

pp. 457

Author(s):

Pratik Patel ◽

Dhanish Mehendiratta ◽

Vivek Bhambhu ◽

Samir Dalvie ◽

Aniruddha Kulkarni ◽

...

Keyword(s):

Computed Tomography ◽

Needle Biopsy ◽

Bone Biopsy ◽

Lumbar Vertebrae ◽

Metastatic Breast ◽

Hemorrhagic Complication ◽

Ct Guided ◽

Segmental Artery ◽

Adjacent Structures ◽

Left Posterior

Background: Percutaneous bone biopsy is the first-line procedure for obtaining a tissue diagnosis to confirm focal, diffuse vertebral, and/or paravertebral metastatic lesions. Percutaneous bone biopsy to evaluate metastatic disease can be performed under fluoroscopy, ultrasonography, magnetic resonance (MR) imaging, and computed tomography (CT). Notably, CT-scans best direct and demonstrate the needle position for these procedures, decreasing the risk of injury to critical adjacent structures (e.g. major vessels, nerve roots). Hemorrhagic complication to lumbar segmental arteries following needle biopsy are uncommon; only a few cases have been reported. Although percutaneous bone biopsy is typically safe when performed utilizing computed tomography (CT) guidance, here we encountered a 60-year-old-female who developed a L4 lumbar segmental artery psoas hematoma following this procedure requiring emergent embolization. Case Description: A 60-year-old female, with a history of breast cancer, underwent a CT-guided core needle biopsy of an L4 lytic lesion (e.g., likely a metastasis). This acutely resulted in the onset of radicular leg pain and weakness. When the postprocedural CT scan demonstrated a large psoas hematoma attributed to laceration of the left posterior L4 segmental artery, the patient required emergent embolization. Following this procedure, she exhibited a fully neurological recovery. Conclusion: Following a CT-guided L4 vertebral biopsy to document metastatic breast carcinoma, a 60-year-old patient developed an immediate postprocedure CT-documented psoas hematoma due to laceration of the left posterior L4 segmental artery. Following emergent embolization, the patient recovered full neurological function.

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Role of robotic arm assistance in computed tomography guided bone biopsy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192485 ◽

2019 ◽

Vol 7 (6) ◽

pp. 2127

Author(s):

Natasha N. Mehta ◽

Nikit Mehta ◽

Nitin Gorde

Keyword(s):

Image Guidance ◽

Bone Biopsy ◽

Robotic Arm ◽

Bone Lesions ◽

Practical Skills ◽

Ct Guided ◽

Nerve Structure ◽

Metastatic Lesions ◽

Technological Developments

Background: Use of robotic assistance technique has significant benefits over conventional techniques. The present study looks at the recent technological developments in image guidance for bone biopsy procedures.Methods: Patients who were referred to the department of radiodiagnosis, Bharti Hospital and Dot3d scanning center, Sangli, Maharashtra, India from July 2017 till December 2018 with suspected bone lesions were included in the study. These patients underwent robotic arm CT guided bone biopsy of their lesions.Results: In the present study, 47 patients were included. Authors observed that 93.6% had a positive diagnosis based on CT guided bone biopsy. Metastatic lesions were diagnosed in 8 cases. Inflammatory lesions and tuberculosis were other commonly observed diagnosis.Conclusions: Further growth and development of medical imaging devices have allowed more interventional procedures to be performed and more patients to benefit from them. Radiologists needs to develop a thorough understanding of the anatomical structure involved and need to acquire both solid grounding in technology and the practical skills to visualize a nerve structure.

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PET/CT-guided versus CT-guided percutaneous core biopsies in the diagnosis of bone tumors and tumor-like lesions: which is the better choice?

Cancer Imaging ◽

10.1186/s40644-019-0253-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Min-hao Wu ◽

Ling-fei Xiao ◽

Huo-wen Liu ◽

Zhi-qiang Yang ◽

Xiao-xiao Liang ◽

...

Keyword(s):

Bone Tumors ◽

Diagnostic Performance ◽

Bone Biopsy ◽

Chinese Patients ◽

Bone Lesions ◽

Ct Guided ◽

Tumor Dissemination ◽

Pet Ct ◽

Significant Difference ◽

Tumor Like Lesions

Abstract Objective The present study aimed to evaluate the diagnostic performance and safety of PET/CT-guided percutaneous core bone biopsy and to compare the PET/CT-guided method to conventional CT-guided percutaneous core biopsies to diagnose Chinese patients with bone tumors and tumor-like lesions. Methods Data for 97 patients with bone tumors and tumor-like lesions diagnosed by percutaneous core bone biopsy from February 2013 to November 2018 were retrospectively analyzed. The study included 42 cases in the PET/CT group and 55 cases in the CT alone group. The diagnostic performance, cost and complications associated with the intervention were compared between the two groups. All patients were eventually confirmed to have bone tumors and tumor-like lesions according to surgical pathology findings. Results There were no significant differences in patient characteristics (P > 0.05). For the patients in the PET/CT group, the overall diagnostic yield of the initial biopsies and the diagnostic accuracy derived from the surgically proven cases were both 97.62%, which was significantly higher than the values in the CT group during the same period (P < 0.05). No major biopsy-related complications (e.g., serious bleeding or tumor dissemination) occurred before, during, or after the intervention. Therefore, no significant difference was observed between the two groups with regard to the complication rate (P > 0.05). Conclusion Compared with CT-guided percutaneous bone biopsy, PET/CT-guided percutaneous bone biopsy is an effective and safe alternative with high diagnostic performance in the evaluation of hypermetabolic bone lesions to diagnose bone tumors and tumor-like lesions.

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Ultrasound-guided bone lesions biopsies - a systematic review

Medical Ultrasonography ◽

10.11152/mu-1118 ◽

2017 ◽

Vol 19 (3) ◽

pp. 302 ◽

Cited By ~ 1

Author(s):

Romeo Ioan Chira ◽

Alexandra Chira ◽

Roberta Maria Manzat-Saplacan ◽

Georgiana Nagy ◽

Adriana Bintintan ◽

...

Keyword(s):

Needle Biopsy ◽

Diagnostic Yield ◽

Bone Biopsy ◽

Bone Lesion ◽

Final Analysis ◽

Needle Aspiration ◽

Bone Lesions ◽

Ultrasound Guided ◽

The Us ◽

Cutting Needle

Aims: Ultrasound (US) is a highly valuable imagistic tool used to guide numerous interventional procedures. The US guided bone lesions biopsy has not yet received a consensus or a guideline. We aimed to evaluate the evidence to support the US role in guiding bone lesions biopsies.Material and methods: A computer literature search of PubMed was conducted using the keywords “ultrasound” and “bone biopsy”, in order to detect relevant studies regarding the aim of our analysis. Records were screened for eligible studies and data were extracted and analyzed.Results: We included 23 studies (n=610 patients) in the final analysis. The specificity and diagnostic yield of US guided biopsy were very good (between 78-100%), depending on the type and dimensions of the bone lesions. The type of the biopsy – aspiration or cutting – influenced theresults. The studies which included larger groups showed a better performance for cutting needles (83.3-100% vs 50-80.5% for aspiration). The size of the bone lesion influences the diagnostic yield of the US guided bone biopsy. Most of the studies reported nil post-procedural complications.Conclusion: Core needle biopsy provided better diagnostic yield compared to fine needle aspiration. The number of the passages of the cutting needle biopsies in order to achieve the best diagnostic yield wasthree. Further studies are needed in order to standardize US-guided bone lesions biopsy and increase its role in the diagnosis algorithm of the bone lesions.

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