Omission of Planning CT Reduces Patient Radiation Exposure during CT-Guided Bone Marrow Biopsy and Aspiration

Comparison of patient radiation exposure and procedure time between CT-fluoroscopy and spiral CT for lumbar epidural steroid injections

OBJECTIVE

To compare patient radiation exposure and procedure time for lumbar epidural steroid injections (ESIs) performed under CT-fluoroscopy (CTF) vs spiral CT-guidance.

MATERIALS AND METHODS

A retrospective cohort study of 767 consecutive lumbar ESIs performed between 2015-2023 using CTF vs spiral CT-guidance was conducted. Patient characteristics (age, sex, weight), procedural characteristics (injection level, type of ESI, trainee participation), and outcomes (patient radiation exposure, procedure time, pain relief, complications) were compared. Student's t and chi-squared tests were performed for statistical analysis.

RESULTS

There were 240 CTF and 527 spiral CT-guided lumbar ESIs. There were no significant differences in patient demographics between groups. Radiation exposure for the CTF group was 37.2 ± 50.5 mGy ∙ cm, compared to 251.1 ± 178.6 mGy ∙ cm in the spiral CT group (p < 0.001). Procedure times were shorter in the CTF group (20.1 ± 6.1 vs 29.6 ± 12.9 min, p < 0.001). There was no significant difference in immediate post-procedure pain reduction in CTF vs spiral CT groups (p = 0.12). There were no intrathecal puncture complications in the CTF group and four in the spiral CT group. Subgroup analysis of attending-only and trainee-performed lumbar ESIs comparing CTF vs spiral-CT groups showed similar results as the primary analysis, with significant reductions in patient radiation (attending: 31.6 ± 40.7 vs 144.4 ± 97.4 mGy ∙ cm; trainee: 40.7 ± 55.5 vs 264.5 ± 182.0 mGy ∙ cm; both p < 0.001) and procedural time (attending: 18.3 ± 4.2 vs 24.4 ± 7.4 min; trainee: 21.2 ± 6.8 vs 30.2 ± 12.4; both p < 0.001).

CONCLUSION

Image-guided lumbar ESIs using CTF were associated with less patient radiation exposure and shorter procedure times without differences in pain relief when compared with spiral CT technique in our practice.

Helical CT versus intermittent CT fluoroscopic guidance for musculoskeletal needle biopsies: impact on radiation exposure, procedure time, diagnostic yield, and adverse events

OBJECTIVE

Image-guided percutaneous needle biopsies are essential in the workup of musculoskeletal (MSK) lesions. While helical CT (HCT) is well established, intermittent CT fluoroscopy (iCTF) is an increasingly used alternative. The purpose of this study is to establish whether differences in subject radiation exposure, procedure time, yield, or adverse events exist between HCT and iCTF guidance.

MATERIALS AND METHODS

This retrospective cohort study included consecutive MSK needle biopsies performed on a single-CT scanner over a 12-month period at a tertiary academic center. Subject demographics, radiation dose, and outcomes were abstracted from the medical record. Comparisons between the two cohorts were performed using Student's t-test for continuous data and using Fisher's exact test for categorical data and a two-tailed p value less than 0.05 was considered significant.

RESULTS

Two hundred sixteen adults (115 (53.2%) females) with a mean age of 58.8 ± 18.4 years, underwent 216 biopsies (109 (50.5%) HCT guided, 107 (49.5%) iCTF guided) between June 2017 and June 2018. Dose-length product (DLP) and volume CT dose index (CTDIvol) were significantly higher for the HCT cohort (HCT 698.9 ± 400.8 mGycm vs iCTF 312.8 ± 170.8 mGycm; p < 0.005 and HCT 19.1 mGy ± 8.8 vs iCTF 6.9 mGy ± 1.5, p < 0.001). No significant difference in diagnostic yield, procedure time, or adverse event rate was identified.

CONCLUSION

For CT-guided MSK needle biopsies, iCTF decreases subject radiation dose compared to HCT without negatively affecting outcomes. iCTF should be strongly considered by radiologists performing MSK biopsies given the reduced patient radiation exposure.