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



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


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.


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).


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.


Bone biopsy Children Interventional radiology Navigational software Needle guidance 


Compliance with ethical standards

Conflicts of interest

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


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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

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