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Li T, Xu G, Li W, Liu Y. A systematic review and meta-analysis of randomized controlled trials comparing low-dose versus standard-dose computed tomography-guided lung biopsy. J Cardiothorac Surg 2024; 19:297. [PMID: 38778306 PMCID: PMC11110412 DOI: 10.1186/s13019-024-02792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/18/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Despite the existence of several Randomized Controlled Trials (RCTs) investigating Low-Dose Computed Tomography (LDCT) as a guide in lung biopsies, conclusive findings remain elusive. To address this contention, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of LDCT-guided lung biopsies. METHODS A comprehensive search across major databases identified RCTs comparing the effectiveness of LDCT-guided with Standard-Dose Computed Tomography (SDCT)-guided lung biopsies. Subsequently, we utilized a random-effects model meta-analysis to assess diagnostic accuracy, radiation dose, operation duration, and clinical complications associated with these procedures. RESULTS Out of 292 scrutinized studies, six RCTs representing 922 patients were included in the final analysis. Results indicated the differences between the LDCT and SDCT groups were not different with statistical significance in terms of diagnostic accuracy rates (Intent-to-Treat (ITT) populations: Relative Risk (RR) 1.01, 95% Confidence interval [CI] 0.97-1.06, p = 0.61; Per-Protocol (PP) populations: RR 1.01, 95% CI 0.98-1.04, p = 0.46), incidence of pneumothorax (RR 1.00, 95% CI 0.75-1.35, p = 0.98), incidence of hemoptysis (RR 0.95, 95% CI 0.63-1.43, p = 0.80), and operation duration (minutes) (Mean Differences [MD] -0.34, 95% CI -1.67-0.99, p = 0.61). Notably, LDCT group demonstrated a lower radiation dose (mGy·cm) with statistical significance (MD -188.62, 95% CI -273.90 to -103.34, p < 0.0001). CONCLUSIONS The use of LDCT in lung biopsy procedures demonstrated equivalent efficacy and safety to standard methods while notably reducing patient radiation exposure.
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Affiliation(s)
- Teng Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China
| | - Guanghui Xu
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China
| | - Wenjun Li
- Department of Interventional Radiology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China
| | - Yun Liu
- Department of Hematology, The People's Hospital of Weifang, 151 Guangwen Street, Weifang, Shandong, 261041, China.
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Paprottka KJ, Kupfer K, Schultz V, Beer M, Zimmer C, Baum T, Kirschke JS, Sollmann N. Impact of radiation dose reduction and iterative image reconstruction on CT-guided spine biopsies. Sci Rep 2023; 13:5054. [PMID: 36977710 PMCID: PMC10050004 DOI: 10.1038/s41598-023-32102-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
This study aimed to systematically evaluate the impact of dose reduction on image quality and confidence for intervention planning and guidance regarding computed tomography (CT)-based intervertebral disc and vertebral body biopsies. We retrospectively analyzed 96 patients who underwent multi-detector CT (MDCT) acquired for the purpose of biopsies, which were either derived from scanning with standard dose (SD) or low dose (LD; using tube current reduction). The SD cases were matched to LD cases considering sex, age, level of biopsy, presence of spinal instrumentation, and body diameter. All images for planning (reconstruction: "IMR1") and periprocedural guidance (reconstruction: "iDose4") were evaluated by two readers (R1 and R2) using Likert scales. Image noise was measured using attenuation values of paraspinal muscle tissue. The dose length product (DLP) was statistically significantly lower for LD scans regarding the planning scans (SD: 13.8 ± 8.2 mGy*cm, LD: 8.1 ± 4.4 mGy*cm, p < 0.01) and the interventional guidance scans (SD: 43.0 ± 48.8 mGy*cm, LD: 18.4 ± 7.3 mGy*cm, p < 0.01). Image quality, contrast, determination of the target structure, and confidence for planning or intervention guidance were rated good to perfect for SD and LD scans, showing no statistically significant differences between SD and LD scans (p > 0.05). Image noise was similar between SD and LD scans performed for planning of the interventional procedures (SD: 14.62 ± 2.83 HU vs. LD: 15.45 ± 3.22 HU, p = 0.24). Use of a LD protocol for MDCT-guided biopsies along the spine is a practical alternative, maintaining overall image quality and confidence. Increasing availability of model-based iterative reconstruction in clinical routine may facilitate further radiation dose reductions.
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Affiliation(s)
- Karolin J Paprottka
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Karina Kupfer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Vivian Schultz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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Li EL, Ma AL, Wang T, Fu YF, Liu HY, Li GC. Low-dose versus standard-dose computed tomography-guided biopsy for pulmonary nodules: a randomized controlled trial. J Cardiothorac Surg 2023; 18:86. [PMID: 36927419 PMCID: PMC10018993 DOI: 10.1186/s13019-023-02183-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 03/12/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND To assess relative safety and diagnostic performance of low- and standard-dose computed tomography (CT)-guided biopsy for pulmonary nodules (PNs). MATERIALS AND METHODS This was a single-center prospective randomized controlled trial (RCT). From June 2020 to December 2020, consecutive patients with PNs were randomly assigned into low- or standard-dose groups. The primary outcome was diagnosis accuracy. The secondary outcomes included technical success, diagnostic yield, operation time, radiation dose, and biopsy-related complications. This RCT was registered on 3 January 2020 and listed within ClinicalTrials.gov (NCT04217655). RESULTS Two hundred patients were randomly assigned to low-dose (n = 100) and standard-dose (n = 100) groups. All patients achieved the technical success of CT-guided biopsy and definite final diagnoses. No significant difference was found in operation time (n = 0.231) between the two groups. The mean dose-length product was markedly reduced within the low-dose group compared to the standard-dose group (31.5 vs. 333.5 mGy-cm, P < 0.001). The diagnostic yield, sensitivity, specificity, and accuracy of the low-dose group were 68%, 91.5%, 100%, and 94%, respectively. The diagnostic yield, sensitivity, specificity, and accuracy were 65%, 88.6%, 100%, and 92% in the standard-dose group. There was no significant difference observed in diagnostic yield (P = 0.653), diagnostic accuracy (P = 0.579), rates of pneumothorax (P = 0.836), and lung hemorrhage (P = 0.744) between the two groups. CONCLUSIONS Compared with standard-dose CT-guided biopsy for PNs, low-dose CT can significantly reduce the radiation dose, while yielding comparable safety and diagnostic accuracy.
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Affiliation(s)
- Er-Liang Li
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Ai-Li Ma
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Tao Wang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Han-Yang Liu
- Department of Interventional Radiology, Xuzhou Central Hospital, Xuzhou, China.
| | - Guang-Chao Li
- Department of Radiology, Shanghai Sixth People's Hospital, Shanghai, China.
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Li Y, Yang F, Huang YY, Cao W. Comparison between computed tomography-guided core and fine needle lung biopsy: A meta-analysis. Medicine (Baltimore) 2022; 101:e29016. [PMID: 35244081 PMCID: PMC8896491 DOI: 10.1097/md.0000000000029016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/17/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This meta-analysis was conducted to compare the safety and diagnostic performance between computed tomography (CT)-guided core needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in lung nodules/masses patients. METHODS All relevant studies in the Pubmed, Embase, and Cochrane Library databases that were published as of June 2020 were identified. RevMan version 5.3 was used for all data analyses. RESULTS In total, 9 relevant studies were included in the present meta-analysis. These studies were all retrospective and analyzed outcomes associated with 2175 procedures, including both CT-guided CNB (n = 819) and FNAB (n = 1356) procedures. CNB was associated with significantly higher sample adequacy rates than was FNAB (95.7% vs 85.8%, OR: 0.26; P < .00001), while diagnostic accuracy rates did not differ between these groups (90.1% vs 87.6%, OR: 0.8; P = .46). In addition, no differences in rates of pneumothorax (28.6% vs 23.0%, OR: 1.15; P = .71), hemorrhage (17.3% vs 20.1%, OR: 0.91; P = .62), and chest tube insertion (5.9% vs 4.9%, OR: 1.01; P = .97) were detected between these groups. Significant heterogeneity among included studies was detected for the diagnostic accuracy (I2 = 57%) and pneumothorax (I2 = 77%) endpoints. There were no significant differences between CNB and FNAB with respect to diagnostic accuracy rates for lung nodules (P = .90). In addition, we detected no evidence of significant publication bias. CONCLUSIONS CT-guided CNB could achieve better sample adequacy than FNAB did during the lung biopsy procedure. However, the CNB did not show any superiorities in items of diagnostic accuracy and safety.
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Affiliation(s)
- Yong Li
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Fang Yang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ya-Yong Huang
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, China
| | - Wei Cao
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, China
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Computed tomography-guided core needle biopsy for lung nodules: low-dose versus standard-dose protocols. Wideochir Inne Tech Maloinwazyjne 2021; 16:355-361. [PMID: 34136031 PMCID: PMC8193745 DOI: 10.5114/wiitm.2021.103303] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/11/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction Computed tomography (CT)-guided core needle biopsy (CNB) is an essential step in the management of lung nodules (LNs). Low-dose CT (LDCT)-guided CNB has been used to decrease the radiation exposure. Aim To evaluate the technical success, safety, diagnostic capacity, and radiation exposure to patients between LDCT-guided and standard-dose CT (SDCT)-guided CNB for LNs. Material and methods This is a retrospective, single-centre study. Patients who underwent LDCT-guided or SDCT-guided CNB for LNs from January 2015 to December 2017 were included. Data on technical success, diagnostic performance, complications, and radiation exposure were collected and analysed. Results A total of 70 and 65 patients underwent LDCT-guided and SDCT-guided CNB procedure, respectively. The technical success rates were 100% in both groups. The diagnostic yield, sensitivity, specificity, and overall diagnostic accuracy in the LDCT and SDCT groups were 71.4% and 67.7% (p = 0.637), 97.8% and 93.2% (p = 0.625), 100%, and 100%, and 98.6% and 95.4% (p = 0.560), respectively. The independent risk factor of diagnostic failure was less sample tissues (p = 0.012; 95% confidence interval: 0.033–0.651). Pneumothorax was found in 9 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.369). Lung haemorrhage was found in 11 and 12 patients in the LDCT and SDCT groups, respectively (p = 0.671). The mean dose-length product was 38.3 ±17.0 mGy · cm and 376.0 ±118.7 mGy · cm in the LDCT and SDCT groups, respectively (p < 0.001). Conclusions Compared to SDCT, LDCT-guided CNB can provide comparable safety and diagnostic performance for LNs while reducing exposure to radiation.
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Teng F, Wu AL, Yang S, Lin J, Xian YT, Fu YF. Preoperative computed tomography-guided coil localization for multiple lung nodules. Ther Adv Respir Dis 2021; 14:1753466620909762. [PMID: 32167016 PMCID: PMC7074473 DOI: 10.1177/1753466620909762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Preoperative computed tomography (CT)-guided coil localization can increase the technical success of video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection of lung nodules relative to cases treated without localization. When multiple lung nodules (MLNs) are to be resected, preoperative localization for each lung nodule is required. The aim of this study was to explore the feasibility, safety, and clinical efficacy of preoperative CT-guided coil localization of MLNs. Methods: Between November 2015 and July 2019, 31 patients with MLNs were assessed via CT-guided coil localization followed by VATS-guided wedge resection. Rates of technical success for both the localization and wedge resection procedures, as well as data pertaining to patient complication rates and long-term outcomes were recorded and assessed. Results: In total, 68 nodules (average of 2.2 nodules/patient) were localized and resected using this approach. Nodules were unilateral and bilateral in 23 and 8 patients, respectively. The rate of CT-guided coil localization technical success for these nodules was 98.5% (67/68), with a technical success rate of single-stage coil localization on a per-patient basis of 96.8% (30/31). Following localization, asymptomatic pneumothorax occurred in four patients (12.9%). The wedge resection technical success rate was 100%. Mean VATS operative time was 167.3 ± 75.2 min, with a mean blood loss of 92.6 ± 61.5 ml. Patients were followed between 3 and 46 months (median: 24 months), with no evidence of new nodules, distant metastases, or postoperative complications in any patients. Conclusion: Preoperative CT-guided multiple coil localization can be easily and safely used to guide single-stage VATS diagnostic wedge resection in patients with MLNs. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Fei Teng
- Department of Radiology, Ningbo first hospital, Ningbo, Zhejiang, China
| | - An-Le Wu
- Department of Radiology, Ningbo first hospital, Ningbo, Zhejiang, China
| | - Shan Yang
- Department of Radiology, Ningbo first hospital, Ningbo, Zhejiang, China
| | - Jia Lin
- Department of Radiology, Ningbo first hospital, Ningbo, Zhejiang, China
| | - Yu-Tao Xian
- Department of Radiology, Ningbo first hospital, Ningbo, Zhejiang, China
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou central hospital, 199 South Jiefang Road, Xuzhou, Jiangsu, China
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Zhang HM, Huo XB, Wang HL, Zhang X, Fu YF. Computed tomography-guided cutting needle biopsy for lung nodules: A comparative study between low-dose and standard dose protocols. Medicine (Baltimore) 2021; 100:e24001. [PMID: 33545994 PMCID: PMC7837837 DOI: 10.1097/md.0000000000024001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Abstract
We aim to compare the diagnostic accuracy, safety, and radiation exposure between low-dose and standard-dose computed tomography (CT)-guided cutting needle biopsy (CNB) for lung nodules.From January 2016 to August 2017, all consecutive patients admitted with lung nodule underwent low-dose or standard-dose CT-guided CNB procedure in our center. Diagnostic accuracy and radiation dose were compared.A total of 67 and 69 patients who underwent low-dose and standard-dose CT-guided CNB procedure were included in this study. Each patient underwent CT-guided CNB for 1 nodule. The technical success rates were 100% in both groups. The sensitivity, specificity, and overall diagnostic accuracy were 97.7%, 100%, and 98.5% for low-dose group and 91.5%, 100%, and 94.2% for standard-dose group. There was no significant difference in diagnostic accuracy (P = .380) between 2 groups. Pneumothorax was found in 8 and 15 patients in the low-dose and standard-dose groups, respectively (11.9% vs 21.7%, P = .127). Hemoptysis was found in 10 and 10 patients in the low-dose and standard-dose groups, respectively (14.9% vs 14.5%, P = .943). The mean dose-length product was 38.2 ± 17.2 mGy-cm and 375.3 ± 115.7 mGy-cm in the low-dose and standard-dose groups (P < .001). The mean dose-length product was 38.2 ± 17.2 mGy-cm and 375.3 ± 115.7 mGy-cm in the low-dose and standard-dose groups, respectively (P < .001). The mean effective dose was 0.5 ± 0.2 mSv and 5.3 ± 1.6 mSv in the low-dose and standard-dose groups, respectively (P < .001).Low-dose CT-guided CNB of lung nodules significantly decreased radiation dose compared with standard-dose CT. The low-dose protocol could provide similar diagnostic accuracy and safety as standard-dose CT-guided CNB for lung nodules.
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Affiliation(s)
- Hui-Mei Zhang
- Department of Radiology, Binzhou People's Hospital, Binzhou, No. 661 No. 7 Huanghe Road, Binzhou
| | - Xiao-Bing Huo
- Department of Radiology, Binzhou People's Hospital, Binzhou, No. 661 No. 7 Huanghe Road, Binzhou
| | - Hua-Long Wang
- Department of Radiology, Binzhou People's Hospital, Binzhou, No. 661 No. 7 Huanghe Road, Binzhou
| | - Xiao Zhang
- Department of Radiology, Binzhou People's Hospital, Binzhou, No. 661 No. 7 Huanghe Road, Binzhou
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, 199 Jiefang Road, Xuzhou, Jiangsu, China
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Fu YF, Li GC, Xu QS, Shi YB, Wang C, Wang T. Computed tomography-guided lung biopsy: a randomized controlled trial of low-dose versus standard-dose protocol. Eur Radiol 2019; 30:1584-1592. [PMID: 31776740 DOI: 10.1007/s00330-019-06464-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/30/2019] [Accepted: 09/18/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the relative diagnostic utility of low- and standard-dose computed tomography (CT)-guided lung biopsy. METHODS In this single-center, single-blind, prospective, randomized controlled trial, patients were enrolled between November 2016 and June 2017. Enrolled study participants were randomly selected to undergo either low- or standard-dose CT-guided lung biopsy. Diagnostic accuracy was the primary study endpoint, whereas technical success, radiation dose, and associated complications were secondary study endpoints. RESULTS In total, 280 patients underwent study enrollment and randomization, with 271 (low-dose group, 135; standard-dose group, 136) receiving the assigned interventions. Both groups had a 100% technical success rate for CT-guided lung biopsy, and complication rates were similar between groups (p > 0.05). The mean dose-length product (36.0 ± 14.1 mGy cm vs. 361.8 ± 108.0 mGy cm, p < 0.001) and effective dose (0.5 ± 0.2 mSv vs. 5.1 ± 1.5 mSv, p < 0.001) were significantly reduced in the low-dose group participants. Sensitivity, specificity, and overall diagnostic accuracy rates in the low-dose group were 91.8%, 100%, and 94.6%, respectively, whereas in the standard-dose group, the corresponding values were 89.6%, 100%, and 92.4%, respectively. These results indicated that diagnostic performance did not differ significantly between the 2 groups. Using univariate and multivariate analyses, we found larger lesion size (p = 0.038) and procedure-related pneumothorax (p = 0.033) to both be independent predictors of diagnostic failure. CONCLUSIONS Our results demonstrate that low-dose CT-guided lung biopsy can yield comparable diagnostic accuracy to standard-dose CT guidance, while significantly reducing the radiation dose delivered to patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02971176 KEY POINTS: • Low-dose CT-guided lung biopsy is a safe and simple method for diagnosis of lung lesions. • Low-dose CT-guided lung biopsy can yield comparable diagnostic accuracy to standard-dose CT guidance. • Low-dose CT-guided lung biopsy can achieve a 90% reduction in radiation exposure when compared with standard-dose CT guidance.
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Affiliation(s)
- Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, 221009, China
| | - Guang-Chao Li
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, 221009, China
| | - Qing-Song Xu
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, 221009, China
| | - Yi-Bing Shi
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, 221009, China
| | - Chen Wang
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, 221009, China
| | - Tao Wang
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, 221009, China.
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Keller EJ, Lewandowski RJ, Goodwin L, Yaghmai V, Nemcek A, Carr JC, Collins JD. Reinforcing the Importance and Feasibility of Implementing a Low-dose Protocol for CT-guided Biopsies. Acad Radiol 2018; 25:1146-1151. [PMID: 29426686 DOI: 10.1016/j.acra.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/15/2017] [Accepted: 01/06/2018] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study sought to more definitely illustrate the impact and feasibility of implementing a low-dose protocol for computed tomography (CT)-guided biopsies using size-specific dose estimates and multivariate analyses. MATERIALS AND METHODS Fifty consecutive CT-guided lung and extrapulmonary biopsies were reviewed before and after implementation of a low-dose protocol (200 patients total, mean age 61 ± 15 years, 128 women). Analyses of variance with Bonferroni correction were used to compare standard and low-dose protocols in terms of patient demographics, physician experience, target lesion size, total dose-length product, total acquisitions, size-specific dose estimate, signal-to-noise ratio, contrast-to-noise ratio, and lesion conspicuity ratings. All procedures were performed on the same 16-slice CT scanner. RESULTS Voluntary protocol adherence was 100% (lung) and 89% (extrapulmonary). The low-dose protocol achieved significantly lower total average dose-length product [(lung) 735.6 ± 599.4 mGy × cm to 252.1 ± 101.9 mGy × cm, P < .001; (extrapulmonary) 724.7 ± 545.0 mGy × cm to 392.9 ± 239.5 mGy × cm, P < .001] and size-specific dose estimate [(lung) 5.2 ± 0.8 mGy × cm to 4.3 ± 1.5 mGy, P < .001; (extrapulmonary) 10.1 ± 6.7 mGy to 6.5 ± 2.7 mGy, P < .001]. Only the change in protocol was independently associated with lower size-specific dose estimates when controlling for the other variables (P < .0001). This was achieved with no significant differences in signal-to-noise ratio, contrast-to-noise ratio, or lesion conspicuity. CONCLUSIONS Implementation of a low-dose protocol for CT-guided biopsies resulted in 21% and 36% of size-specific dose estimate reduction for lung and extrapulmonary biopsies, respectively, with excellent adherence. Interventional and body radiologists should implement low dose CT-guidance protocols aiming to improve patient safety.
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Affiliation(s)
- Eric J Keller
- Department of Radiology, Division of Cardiovascular Imaging, Northwestern University, 737 N. Michigan Ave. Suite 1600, Chicago, IL 60611.
| | - Robert J Lewandowski
- Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Lee Goodwin
- Department of Radiology, Division of Body Imaging, Northwestern University, Chicago, Illinois
| | - Vahid Yaghmai
- Department of Radiology, Division of Body Imaging, Northwestern University, Chicago, Illinois
| | - Albert Nemcek
- Department of Radiology, Division of Cardiovascular Imaging, Northwestern University, 737 N. Michigan Ave. Suite 1600, Chicago, IL 60611; Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - James C Carr
- Department of Radiology, Division of Cardiovascular Imaging, Northwestern University, 737 N. Michigan Ave. Suite 1600, Chicago, IL 60611; Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Jeremy D Collins
- Department of Radiology, Division of Cardiovascular Imaging, Northwestern University, 737 N. Michigan Ave. Suite 1600, Chicago, IL 60611; Department of Radiology, Division of Interventional Radiology, Northwestern University, Chicago, Illinois
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Green M, Marom EM, Konen E, Kiryati N, Mayer A. Patient-specific image denoising for ultra-low-dose CT-guided lung biopsies. Int J Comput Assist Radiol Surg 2017; 12:2145-2155. [DOI: 10.1007/s11548-017-1621-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/23/2017] [Indexed: 12/30/2022]
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CT-Guided Biopsy of Entirely Endophytic Small Renal Masses: Diagnostic Rates and Complications Using Standard-Dose and Reduced-Dose CT Protocols. AJR Am J Roentgenol 2017; 208:1030-1036. [DOI: 10.2214/ajr.16.16944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kallianos KG, Elicker BM, Henry TS, Ordovas KG, Nguyen J, Naeger DM. Instituting a Low-dose CT-guided Lung Biopsy Protocol. Acad Radiol 2016; 23:1130-6. [PMID: 27317393 DOI: 10.1016/j.acra.2016.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES We aimed to evaluate whether implementation of a low-dose computed tomography (CT)-guided lung biopsy protocol, with the support of individual radiologists in the section, would lead to immediate and sustained decreases in radiation dose associated with CT-guided lung biopsies. MATERIALS AND METHODS A low-dose CT-guided lung biopsy protocol was developed with modifications of kilovoltage peak, milliamperes, and scan coverage. Out of 413 CT-guided lung biopsies evaluated over a 3-year period beginning in 2009, 175 performed with a standard protocol before the development of a low-dose protocol, and 238 performed with a low-dose protocol. The dose-length product (DLP) was recorded for each lung biopsy and retrospectively compared between the two protocols. Individual radiologist level DLPs were also compared before and after the protocol change. RESULTS The mean biopsy dose decreased by 64.4% with the low-dose protocol (113.8 milligray centimeters versus 319.7 milligray centimeters; P < 0.001). This decrease in radiation dose persisted throughout the entire 18 months evaluated following the protocol change. After the protocol change, each attending radiologist demonstrated a decrease in administered radiation dose. The diagnostic outcome rate and complication rate were unchanged over the interval. CONCLUSIONS Implementation of a low-dose CT-guided lung biopsy protocol resulted in an immediate reduction in patient radiation dose that was seen with all attending radiologists and persisted for at least 18 months. Such an intervention may be considered at other institutions wishing to reduce patient doses.
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Affiliation(s)
- Kimberly G Kallianos
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628
| | - Brett M Elicker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628
| | - Travis S Henry
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628
| | - Karen G Ordovas
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628
| | - Janet Nguyen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628
| | - David M Naeger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628.
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Shpilberg KA, Delman BN, Tanenbaum LN, Esses SJ, Subramaniam R, Doshi AH. Radiation dose reduction in CT-guided spine biopsies does not reduce diagnostic yield. AJNR Am J Neuroradiol 2014; 35:2243-7. [PMID: 25034779 DOI: 10.3174/ajnr.a4053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE CT-guided biopsy is the most commonly used method to obtain tissue for diagnosis in suspected cases of malignancy involving the spine. The purpose of this study was to demonstrate that a low-dose CT-guided spine biopsy protocol is as effective in tissue sampling as a regular-dose protocol, without adversely affecting procedural time or complication rates. MATERIALS AND METHODS We retrospectively reviewed all patients who underwent CT-guided spine procedures at our institution between May 2010 and October 2013. Biopsy duration, total number of scans, total volume CT dose index, total dose-length product, and diagnostic tissue yield of low-dose and regular-dose groups were compared. RESULTS Sixty-four patients were included, of whom 31 underwent low-dose and 33 regular-dose spine biopsies. There was a statistically significant difference in total volume CT dose index and total dose-length product between the low-dose and regular-dose groups (P < .0001). There was no significant difference in the total number of scans obtained (P = .3385), duration of procedure (P = .149), or diagnostic tissue yield (P = .6017). CONCLUSIONS Use of a low-dose CT-guided spine biopsy protocol is a practical alternative to regular-dose approaches, maintaining overall quality and efficiency at reduced ionizing radiation dose.
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Affiliation(s)
- K A Shpilberg
- From the Department of Radiology, Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - B N Delman
- From the Department of Radiology, Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - L N Tanenbaum
- From the Department of Radiology, Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - S J Esses
- From the Department of Radiology, Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - R Subramaniam
- From the Department of Radiology, Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - A H Doshi
- From the Department of Radiology, Icahn School of Medicine, Mount Sinai Health System, New York, New York.
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