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Feasibility Study of Needle Placement in Percutaneous Vertebroplasty: Cone-Beam Computed Tomography Guidance Versus Conventional Fluoroscopy

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Abstract

Objective

To investigate the accuracy, procedure time, fluoroscopy time, and dose area product (DAP) of needle placement during percutaneous vertebroplasty (PVP) using cone-beam computed tomography (CBCT) guidance versus fluoroscopy.

Materials and Methods

On 4 spine phantoms with 11 vertebrae (Th7–L5), 4 interventional radiologists (2 experienced with CBCT guidance and two inexperienced) punctured all vertebrae in a bipedicular fashion. Each side was randomization to either CBCT guidance or fluoroscopy. CBCT guidance is a sophisticated needle guidance technique using CBCT, navigation software, and real-time fluoroscopy. The placement of the needle had to be to a specific target point. After the procedure, CBCT was performed to determine the accuracy, procedure time, fluoroscopy time, and DAP. Analysis of the difference between methods and experience level was performed.

Results

Mean accuracy using CBCT guidance (2.61 mm) was significantly better compared with fluoroscopy (5.86 mm) (p < 0.0001). Procedure time was in favor of fluoroscopy (7.39 vs. 10.13 min; p = 0.001). Fluoroscopy time during CBCT guidance was lower, but this difference is not significant (71.3 vs. 95.8 s; p = 0.056). DAP values for CBCT guidance and fluoroscopy were 514 and 174 mGy cm2, respectively (p < 0.0001). There was a significant difference in favor of experienced CBCT guidance users regarding accuracy for both methods, procedure time of CBCT guidance, and added DAP values for fluoroscopy.

Conclusion

CBCT guidance allows users to perform PVP more accurately at the cost of higher patient dose and longer procedure time. Because procedural complications (e.g., cement leakage) are related to the accuracy of the needle placement, improvements in accuracy are clinically relevant. Training in CBCT guidance is essential to achieve greater accuracy and decrease procedure time/dose values.

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Conflict of interest

Sicco J. Braak, Kirsten Zuurmond, Hans C. J. Aerts, Marc van Leersum, Timotheus T. Th Overtoom, Johannes P. M. van Heesewijk, Marco J. L. van Strijen have no conflict of interest

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Authors and Affiliations

  1. Department of Radiology, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands

    Sicco J. Braak, Marc van Leersum, Timotheus T. Th. Overtoom, Johannes P. M. van Heesewijk & Marco J. L. van Strijen

  2. Department of Clinical Development, Philips Medical, Best, The Netherlands

    Kirsten Zuurmond & Hans C. J. Aerts

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  1. Sicco J. Braak
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  2. Kirsten Zuurmond
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  3. Hans C. J. Aerts
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  6. Johannes P. M. van Heesewijk
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  7. Marco J. L. van Strijen
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Correspondence to Sicco J. Braak.

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Braak, S.J., Zuurmond, K., Aerts, H.C.J. et al. Feasibility Study of Needle Placement in Percutaneous Vertebroplasty: Cone-Beam Computed Tomography Guidance Versus Conventional Fluoroscopy. Cardiovasc Intervent Radiol 36, 1120–1126 (2013). https://doi.org/10.1007/s00270-013-0598-y

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  • DOI: https://doi.org/10.1007/s00270-013-0598-y

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