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Abstract

Background

The use of computed tomography (CT) for image guidance during biopsies is a powerful approach. The method is, however, often associated with a significant level of radiation exposure to the patient and operator.

Purpose

To investigate if a low-dose protocol for CT-guided musculoskeletal (MSK) biopsies, including a combination of different radiation dose (RD) techniques, is feasible in a clinical setting.

Material and Methods

Fifty-seven patients underwent CT-guided fine-needle aspiration cytology (FNAC) utilizing the low-dose protocol (group A). A similar number of patients underwent CT-guided FNAC using the reference protocol (group B). Between-group comparisons comprised radiation dose, success rate, image quality parameters, and workflow.

Results

In group A, the mean total dose-length product (DLP) was 41.2 ± 2.9 mGy*cm, which was statistically significantly lower than of group B (257.4 ± 22.0 mGy*cm), corresponding to a mean dose reduction of 84% (P<0.001). The mean CTDI_vol for the control scans were 1.88 ± 0.09 mGy and 13.16 ± 0.40 mGy for groups A and B, respectively (P < 0.001). The success rate in group A was 91.2% and 87.9% in group B (P = 0.56). No negative effect on image-quality parameters, time of FNAC, and number of control scans were found.

Conclusion

We successfully developed a low-dose protocol for CT-guided MSK biopsies that maintains diagnostic accuracy and image quality at a fraction of the RD compared to the reference biopsy protocol at our clinic.

Keywords

Image-guided biopsy interventional radiology multidetector computed tomography musculoskeletal system radiation dosage

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References

Lee

Munk

PL.

Image-guided musculoskeletal biopsies.

Semin Intervent Radiol 2010; 27:191–198.

Motamedi

Levine

Seeger

, et al. Success rates for computed tomography-guided musculoskeletal biopsies performed using a low-dose technique. Skeletal Radiol 2014; 43:1599–1603.

International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007; 37:1–332.

Kim

Lee

, et al. Head CT: image quality improvement with ASIR-V using a reduced radiation dose protocol for children. Eur Radiol 2017; 27:3609–3617.

Kwon

Cho

, et al. The adaptive statistical iterative reconstruction-V technique for radiation dose reduction in abdominal CT: comparison with the adaptive statistical iterative reconstruction technique. Br J Radiol 2015; 88:20150463.

Alagic Z, Eriksson A, Drageryd E, et al. A new low-dose multi-phase trauma CT protocol and its impact on diagnostic assessment and radiation dose in multi-trauma patients. Emerg Radiol 2017;24:509–518.

Tam

Ensor

Zvavanjanja

, et al. Standardizing CT-guided biopsy procedures: patient dose and image noise. Am J Roentgenol 2015; 205:390–399.

Shpilberg

Delman

Tanenbaum

, et al. Radiation dose reduction in CT-guided spine biopsies does not reduce diagnostic yield. Am J Neuroradiol 2014; 35:2243–2247.

Kloeckner

dos Santos

Schneider

, et al. Radiation exposure in CT-guided interventions. Eur J Radiol 2013; 82:2253–2257.

10.

Hakim

Pelly

Kulendran

, et al. Benign tumours of the bone: a review. J Bone Oncol 2015; 4:37–41.

11.

Stiller

Craft

Corazziari

Survival of children with bone sarcoma in Europe since 1978: results from the EUROCARE study.

Eur J Cancer 2001; 37:760–766.

12.

Holt

GE.

Orthopaedic pathology. In: Miller

Thompson

, eds. Miller’s Review of Orthopaedics. 7th ed. Elsevier Health Sciences, 2015:713–718.

13.

Fenzl

Mehrmann

Kremp

, et al. Soft tissue tumors: epidemiology, classification and staging. Radiologe 2017; 57:973–986.

14.

Chang

Davidson

TB.

Childhood exposures and risk of malignancy in adulthood. Pediatr Ann 2015; 44:270–273.

15.

Hall

EJ.

Radiation biology for pediatric radiologists.

Pediatr Radiol 2015; 39(Suppl 1):57–64.

16.

Linsk JA. Aspiration cytology in Sweden: The Karolinska Group. Diagn Cytopathol 1985;1:332–335.

17.

Hua

Kim

Kattapuram

, et al. Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 2002; 31:349–353.

18.

Dupuy

Rosenberg

Punyaratabandhu

, et al. Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. Am J Roentgenol 1998; 171:759–762.

19.

Zhang

CT-guided transcutaneous fine-needle aspiration biopsy. A report of 350 cases.

Chin Med J 1990; 103:599–603.

20.

Maisel

Frank

, et al. Diagnostic utility of fine-needle aspiration cytology of lesions involving bone. Diagn Cytopathol 2017; 45:608–613.

21.

Kaur

Handa

Kundu

, et al. Role of fine-needle aspiration cytology and core needle biopsy in diagnosing musculoskeletal neoplasms. J Cytol 2016; 33:7–12.

22.

Wahane

Lele

Bobhate

SK.

Fine needle aspiration cytology of bone tumors.

Acta Cytol 2007; 51:711–720.

23.

Yang

Damron

TA.

Comparison of needle core biopsy and fine-needle aspiration for diagnostic accuracy in musculoskeletal lesions.

Arch Pathol Lab Med 2004; 128:759–764.

24.

Costa

Campman

Davis

, et al. Fine-needle aspiration cytology of sarcoma: retrospective review of diagnostic utility and specificity. Diagn Cytopathol 1996; 15:23–32.

25.

Bennert

Abdul-Karim

FW.

Fine needle aspiration cytology vs. needle core biopsy of soft tissue tumors. A comparison.

Acta Cytol 1994; 38:381–384.

26.

Willemink

Noël

PB.

The evolution of image reconstruction for CT-from filtered back projection to artificial intelligence. Eur Radiol 2019; 29:2185–2195.

27.

Söderberg

Gunnarsson

Automatic exposure control in computed tomography–an evolution of systems from different manufacturers.

Acta Radiol 2010; 51:625–34.

28.

Lewis

Pascoal

Keevil

, et al. Selecting a CT scanner for cardiac imaging: the heart of the matter. Br J Radiol 2016; 89:20160376.

First experiences of a low-dose protocol for CT-guided musculoskeletal biopsies combining different radiation dose reduction techniques