Advertisement

Pediatric Radiology

, Volume 47, Issue 8, pp 963–973 | Cite as

Real-time fluoroscopic needle guidance in the interventional radiology suite using navigational software for percutaneous bone biopsies in children

  • Sphoorti ShellikeriEmail author
  • Randolph M. Setser
  • Tiffany J. Hwang
  • Abhay Srinivasan
  • Ganesh Krishnamurthy
  • Seth Vatsky
  • Erin Girard
  • Xiaowei Zhu
  • Marc S. Keller
  • Anne Marie Cahill
Original Article

Abstract

Background

Navigational software provides real-time fluoroscopic needle guidance for percutaneous procedures in the Interventional Radiology (IR) suite.

Objective

We describe our experience with navigational software for pediatric percutaneous bone biopsies in the IR suite and compare technical success, diagnostic accuracy, radiation dose and procedure time with that of CT-guided biopsies.

Materials and methods

Pediatric bone biopsies performed using navigational software (Syngo iGuide, Siemens Healthcare) from 2011 to 2016 were prospectively included and anatomically matched CT-guided bone biopsies from 2008 to 2016 were retrospectively reviewed with institutional review board approval. C-arm CT protocols used for navigational software-assisted cases included institution-developed low-dose (0.1/0.17 μGy/projection), regular-dose (0.36 μGy/projection), or a combination of low-dose/regular-dose protocols. Estimated effective radiation dose and procedure times were compared between software-assisted and CT-guided biopsies.

Results

Twenty-six patients (15 male; mean age: 10 years) underwent software-assisted biopsies (15 pelvic, 7 lumbar and 4 lower extremity) and 33 patients (13 male; mean age: 9 years) underwent CT-guided biopsies (22 pelvic, 7 lumbar and 4 lower extremity). Both modality biopsies resulted in a 100% technical success rate. Twenty-five of 26 (96%) software-assisted and 29/33 (88%) CT-guided biopsies were diagnostic. Overall, the effective radiation dose was significantly lower in software-assisted than CT-guided cases (3.0±3.4 vs. 6.6±7.7 mSv, P=0.02). The effective dose difference was most dramatic in software-assisted cases using low-dose C-arm CT (1.2±1.8 vs. 6.6±7.7 mSv, P=0.001) or combined low-dose/regular-dose C-arm CT (1.9±2.4 vs. 6.6±7.7 mSv, P=0.04), whereas effective dose was comparable in software-assisted cases using regular-dose C-arm CT (6.0±3.5 vs. 6.6±7.7 mSv, P=0.7). Mean procedure time was significantly lower for software-assisted cases (91±54 vs. 141±68 min, P=0.005).

Conclusion

In our experience, navigational software technology in the IR suite is a promising alternative to CT guidance for pediatric bone biopsies providing comparable technical success and diagnostic accuracy with lower radiation dose and procedure time, in addition to providing real-time fluoroscopic needle guidance.

Keywords

Bone biopsy Children Interventional radiology Navigational software Needle guidance 

Notes

Compliance with ethical standards

Conflicts of interest

Dr. R. Setser and Dr. E. Girard are employees of Siemens Medical Solutions, USA.

References

  1. 1.
    Hryhorczuk AL, Strouse PJ, Biermann JS (2011) Accuracy of CT-guided percutaneous core needle biopsy for assessment of pediatric musculoskeletal lesions. Pediatr Radiol 41:848–857CrossRefPubMedGoogle Scholar
  2. 2.
    Hau A, Kim I, Kattapuram S et al (2002) Accuracy of CT-guided biopsies in 359 patients with musculoskeletal lesions. Skeletal Radiol 31:349–353Google Scholar
  3. 3.
    Maciel MJ, Tyng CJ, Barbosa PN et al (2014) Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications. Radiol Bras 47:269–274CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Puri A, Shingade VU, Agarwal MG et al (2006) CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases. Skeletal Radiol 35:138–143Google Scholar
  5. 5.
    Dupuy DE, Rosenberg AE, Punyaratabandhu T et al (1998) Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. AJR Am J Roentgenol 171:759–762CrossRefPubMedGoogle Scholar
  6. 6.
    Kiatisevi P, Thanakit V, Sukunthanak B et al (2013) Computed tomography-guided core needle biopsy versus incisional biopsy in diagnosing musculoskeletal lesions. J Orthop Surg 21:204–208CrossRefGoogle Scholar
  7. 7.
    Mitton B, Seeger LL, Eckardt MA et al (2014) Image-guided percutaneous core needle biopsy of musculoskeletal tumors in children. J Pediatr Hematol Oncol 36:337–341CrossRefPubMedGoogle Scholar
  8. 8.
    Shin HJ, Amaral JG, Armstrong D et al (2007) Image-guided percutaneous biopsy of musculoskeletal lesions in children. Pediatr Radiol 37:362–369CrossRefPubMedGoogle Scholar
  9. 9.
    Racadio JM, Babic D, Homan R et al (2007) Live 3D guidance in the interventional radiology suite. AJR Am J Roentgenol 189:W357–W364CrossRefPubMedGoogle Scholar
  10. 10.
    Strobel N, Meissner O, Boese J et al (2009) 3D imaging with flat-detector C-arm systems. In: Reiser MF, Becker CR, Nikolaou K, Glazer G (eds) Multislice CT. Springer, Berlin Heidelberg, pp 33–51CrossRefGoogle Scholar
  11. 11.
    Orth RC, Wallace MJ, Kuo MD, Technology Assessment Committee of the Society of Interventional R (2008) C-arm cone-beam CT: general principles and technical considerations for use in interventional radiology. J Vasc Interv Radiol 19:814–820CrossRefGoogle Scholar
  12. 12.
    Struffert T, Doerfler A (2009) Flat-detector computed tomography in diagnostic and interventional neuroradiology. Radiologe 49:820–829CrossRefPubMedGoogle Scholar
  13. 13.
    Braak SJ, van Strijen MJ, van Leersum M et al (2010) Real-time 3D fluoroscopy guidance during needle interventions: technique, accuracy, and feasibility. AJR Am J Roentgenol 194:W445–W451CrossRefPubMedGoogle Scholar
  14. 14.
    Leschka SC, Babic D, El Shikh S et al (2012) C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis. Neuroradiology 54:215–223CrossRefPubMedGoogle Scholar
  15. 15.
    Morimoto M, Numata K, Kondo M et al (2010) C-arm cone beam CT for hepatic tumor ablation under real-time 3D imaging. AJR Am J Roentgenol 194:W452–W454CrossRefPubMedGoogle Scholar
  16. 16.
    Tam AL, Mohamed A, Pfister M et al (2010) C-arm cone beam computed tomography needle path overlay for fluoroscopic guided vertebroplasty. Spine (Phila Pa 1976) 35:1095–1099CrossRefGoogle Scholar
  17. 17.
    Thakor AS, Patel PA, Gu R et al (2016) MR cone-beam CT fusion image overlay for fluoroscopically guided percutaneous biopsies in pediatric patients. Pediatr Radiol 46:407–412CrossRefPubMedGoogle Scholar
  18. 18.
    Cardella JF, Bakal CW, Bertino RE et al (1996) Quality improvement guidelines for image-guided percutaneous biopsy in adults: society of Cardiovascular & interventional radiology standards of practice committee. J Vasc Interv Radiol 7:943–946CrossRefPubMedGoogle Scholar
  19. 19.
    Gupta S, Wallace MJ, Cardella JF et al (2010) Quality improvement guidelines for percutaneous needle biopsy. J Vasc Interv Radiol 21:969–975CrossRefPubMedGoogle Scholar
  20. 20.
    American Association of Physicists in Medicine (2008) The measurement, reporting and management of radiation dose in CT (Report #96). AAPM Task Group 23 of the Diagnostic Imaging Council CT Committee, College Park MDGoogle Scholar
  21. 21.
    Shellikeri S, Girard E, Setser R et al (2016) Metal artefact reduction algorithm for correction of bone biopsy needle artefact in paediatric C-arm CT images: a qualitative and quantitative assessment. Clin Radiol 71:925–931CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Sphoorti Shellikeri
    • 1
    Email author
  • Randolph M. Setser
    • 2
  • Tiffany J. Hwang
    • 3
  • Abhay Srinivasan
    • 1
  • Ganesh Krishnamurthy
    • 1
  • Seth Vatsky
    • 1
  • Erin Girard
    • 4
  • Xiaowei Zhu
    • 1
  • Marc S. Keller
    • 1
  • Anne Marie Cahill
    • 1
  1. 1.Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Siemens Medical Solutions USA, Inc.Hoffman EstatesUSA
  3. 3.Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  4. 4.Siemens Medical Solutions USA, Inc.PrincetonUSA

Personalised recommendations