Reducing Time and Patient Radiation of Computed Tomography–guided Thoracic Needle Biopsies With Single-rotation Axial Acquisitions

Abstract

Purpose: To investigate the effect on procedure time and patient radiation indices of replacing helical acquisitions for needle guidance during thoracic needle biopsy (TNB) with intermittent singlerotation axial acquisitions. Materials and Methods:This retrospective intervention study included 215 consecutive TNBs performed by a single operator from 2014 to 2018. Characteristics of patients, lesions, and procedures were compared between TNBs guided only by helical acquisitions initiated in the control room (helical group, n = 141) and TNBs guided in part by intermittent single-rotation axial computed tomography controlled by foot pedal (single-rotation group, n = 74). Procedure time and patient radiation indices were primary outcomes, complications, and radiologist radiation dose were secondary outcomes.Results: Patient, lesion, and procedural characteristics did not differ between helical and single-rotation groups. Use of single-rotation axial acquisitions decreased procedure time by 10.5 minutes (95% confidence interval [CI]: 8.2-12.8 min) or 27% (95% CI: 22%-32%; P < 0.001). Patient dose in cumulative volume computed tomography dose index decreased by 23% (95% CI: 12%-33%) or 8 mGy (95% CI: 4.3-31.6 mGy; P = 0.01). Dose-length product decreased by 50% (95% CI: 40%-60%) or 270 mGy cm (95% CI: 195-345 mGy cm; P < 0.001). No operator radiation exposure was detected. Rate of diagnostic result, pneumothorax, hemoptysis, and hemorrhage did not differ between groups.Conclusions: Replacing helical acquisitions with intermittent singlerotation axial acquisitions significantly decreases TNB procedure time and patient radiation indices without adversely affecting diagnostic rate, procedural complications, or operator radiation dose.

Optimizing molecular testing of lung cancer needle biopsy specimens: potential solutions from an interdisciplinary qualitative study

“…The shorter procedure time afforded by realtime CT, often referred to as "CT fluoroscopy, " creates time for ROSE and the collection of additional samples [32]. A minimum of at least four tissue cores was recommended by the panel, exceeding the minimum of three recommended by the CAP guideline since research has demonstrated that sensitivity for histopathologic diagnosis and molecular testing increases significantly between the second and fourth samples [24,[33][34][35]. ROSE remains best practice according to the literature [36], despite the limitations noted by the panel.…”

“…The National Cancer Institute Molecular Analysis for Therapy Choice trial similarly recommends splitting each core into two specimens, one for diagnosis and one for ancillary studies such as molecular testing [40]. During ROSE, pathologists and cytotechnologists should use specific terminology to distinguish between "diagnostic adequacy" versus "ancillary testing adequacy" [33]. Optical coherence tomography may, one day, be used to perioperatively quantify viable tumor cells versus scar in tissue cores [41].…”

Prediction of Complication Risk in Computed Tomography-guided Thoracic Biopsy

“…With 16 to 64 multidetector row CTs, the biopsies were performed using intermittent axial acquisitions triggered with a foot pedal at the scanner, akin to the previously described "single-rotation" technique for needle guidance. 19 The recovery protocol consisted of 2 hours of continuous vital sign monitoring in bed, with the biopsied side in a dependent position, and with portable chest radiographs obtained before and after. In the absence of complications, patients were discharged 2 hours after completion of the procedure.…”

Magnetic Resonance Imaging for Guidance and Follow-up of Thoracic Needle Biopsies and Thermal Ablations

“…Therefore, CT is commonly used to guide percutaneous thoracic needle biopsies and thermal ablations. [2][3][4][5][6] Reasons to consider guidance with MR instead of CT include limiting ionizing radiation, especially for children and young adults. In the helical mode, reported median radiation exposure of CT-guided thoracic needle biopsies and thermal ablations amount to dose length products of 569 and 1446 mGy×cm, respectively.…”

“…Compared with MRI, computed tomography (CT) offers fast image acquisition, is less expensive, and is widely available. Therefore, CT is commonly used to guide percutaneous thoracic needle biopsies and thermal ablations 2–6…”