Radiation Dose Reduction in CT-Guided Spine Biopsies Does Not Reduce Diagnostic Yield

Shpilberg, Katya A.; Delman, Bradley N.; Tanenbaum, Lawrence N.; Esses, Steven J.; Subramaniam, R.; Doshi, Amish

doi:10.3174/ajnr.a4053

Cited by 15 publications

(10 citation statements)

References 38 publications

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“…12 In another study of two techniques of CT-guided spine biopsies by Shpilberg et al, the mean duration of the procedure was found to be 34.31 ± 12.19 minutes for the low-dose group versus 38.17 ± 8.92 minutes for the regular-dose group. 13 In our study, the mean time taken for biopsy was slightly longer than in other recent studies (44.6 minutes). This could be accounted for by various technical differences, foremost among which is that we did not use CT fluoroscopy for the biopsies.…”

Section: Discussioncontrasting

confidence: 64%

“…In the context of vertebral biopsies, this was also studied by Shpilberg et al who found a statistically significant difference between the low-dose (80 kVp, 40-60 mAs) and regular-dose (120 kVp, mAs > 200) groups in total CTDI vol (69.47 ± 24.76 mGy for low dose vs. 285.2 + 132.6 mGy for regular dose; p < 0.0001). 13 Also, newer generations of CT scanners involve markedly lower radiation doses as compared with older devices. This was demonstrated in a study by Guberina et al, who found CTDI vol was 13.3 mGy on a 64-slice CT scanner compared with 14.4 mGy on a 4-slice CT scanner.…”

Section: Discussionmentioning

confidence: 99%

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Computed Tomography-Guided Vertebral Biopsy in Suspected Tuberculous Spondylodiscitis: Comparing a New Navigational Tram-Track Technique versus Conventional Method

Singh

Sharma

Boruah

et al. 2020

Journal of Clinical Interventional Radiology ISVIR

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Introduction Computed tomography (CT)-guided vertebral biopsy is always recommended for histopathological and microbiological confirmation in cases of tuberculous spondylodiscitis and for antimycobacterial drug sensitivity testing. Aim To compare the conventional technique and a novel axis-defined tram-track technique of CT-guided vertebral biopsy in suspected tuberculous spondylodiscitis. Materials and Methods Sixty-seven patients of clinico-radiologically suspected tuberculous spondylodiscitis referred for CT-guided vertebral biopsy were categorized into two groups: “Group A” patients (n = 32) underwent biopsy by conventional technique, and “Group B” patients (n = 35) by axis-defined tram-track technique. The time taken for procedure, radiation exposure, and any procedural complications were recorded for both the groups. Results A statistically significant difference in procedure time and mean radiation dose was observed between the two groups: a longer procedural time was required in “Group A” (52.5 ± 3.5 minutes) as compared to “Group B” (37.3 ± 3.6 minutes) (p < 0.0001); and mean radiation dose (CTDIvol) in “Group A” and “Group B” was 8.64 ± 1.06 mGy and 5.73 ± 0.71 mGy, respectively (p < 0.0001). However, the difference in complication rate and tissue yield for successful diagnosis of the biopsies in the two groups was found to be statistically insignificant. Conclusion Axis-defined tram-track technique was found to have a significantly shorter procedural time as well as lower radiation exposure compared to the conventional technique of vertebral biopsy in our study.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Computed Tomography-Guided Vertebral Biopsy in Suspected Tuberculous Spondylodiscitis: Comparing a New Navigational Tram-Track Technique versus Conventional Method

Singh

Sharma

Boruah

et al. 2020

Journal of Clinical Interventional Radiology ISVIR

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show abstract

“…The use of potentially harmful ionizing radiation should also be taken into account. 8 Culture Yield of Percutaneous Image-Guided Biopsy: The Actual Numbers A crucial topic is the culture yield of the spinal or paraspinal biopsy samples that have been obtained. According to a meta-analysis that included 33 studies, image-guided biopsy has a positive culture yield of 48%.…”

Section: Arguments For Routinely Performing Percutaneous Image-guided Biopsymentioning

confidence: 99%

Time to Reconsider Routine Percutaneous Biopsy in Spondylodiscitis?

Kasalak

Wouthuyzen-Bakker

Dierckx

et al. 2021

AJNR Am J Neuroradiol

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Percutaneous image-guided biopsy currently has a central role in the diagnostic work-up of patients with suspected spondylodiscitis. However, on the basis of recent evidence, the value of routine image-guided biopsy in this disease can be challenged. In this article, we discuss this recent evidence and also share a new diagnostic algorithm for spondylodiscitis that was recently introduced at our institution. Thus, we may move from a rather dogmatic approach in which routine image-guided biopsy is performed in any case to a more individualized use of this procedure.

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“…Previous work has shown the success of low-dose protocols in a variety of procedural settings, including CT-guided spine procedures [5, 6] and CT-guided lung biopsies [7–9]. However, the previous work with low-dose CT-guided lung biopsies was limited by small sample sizes, relatively short follow up periods to evaluate dose reductions, and limited analysis of the effect of a standardized low-dose protocol on multiple operators.…”

Section: Introductionmentioning

confidence: 99%

Instituting a Low-dose CT-guided Lung Biopsy Protocol

et al. 2016

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Rationale and Objectives We aimed to evaluate whether implementation of a low-dose CT-guided lung biopsy protocol, with the support of individual radiologists in the section, would lead to immediate and sustained decreases in radiation dose associated with CT-guided lung biopsies. Materials and Methods A low-dose CT-guided lung biopsy protocol was developed with modifications of kilovoltage peak (kVp), milliamperes (mA), and scan coverage. 413 CT guided lung biopsies were evaluated over a three-year period beginning in 2009, 175 performed with a standard protocol prior to development of a low dose protocol and 238 performed with a low dose protocol. The dose-length product (DLP) was recorded for each lung biopsy and retrospectively compared between the two protocols. Individual radiologist level DLPs were also compared before and after the protocol change. Results The mean biopsy dose decreased 64.4% with the low dose protocol (113.8 mGy-cm versus 319.7 mGy-cm; p <0.001). This decrease in radiation dose persisted throughout the entire 18 months evaluated following the protocol change. After the protocol change, each attending radiologist demonstrated a decrease in administered radiation dose. The diagnostic outcome rate and complication rate were unchanged over the interval. Conclusion Implementation of a low-dose CT-guided lung biopsy protocol resulted in an immediate reduction in patient radiation dose that was seen with all attending radiologists and persisted for at least 18 months. Such an intervention may be considered at other institutions wishing to reduce patient doses.

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Radiation Dose Reduction in CT-Guided Spine Biopsies Does Not Reduce Diagnostic Yield

Cited by 15 publications

References 38 publications

Computed Tomography-Guided Vertebral Biopsy in Suspected Tuberculous Spondylodiscitis: Comparing a New Navigational Tram-Track Technique versus Conventional Method

Computed Tomography-Guided Vertebral Biopsy in Suspected Tuberculous Spondylodiscitis: Comparing a New Navigational Tram-Track Technique versus Conventional Method

Time to Reconsider Routine Percutaneous Biopsy in Spondylodiscitis?

Instituting a Low-dose CT-guided Lung Biopsy Protocol

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