CT Fluoroscopy-guided Abdominal Interventions: Techniques, Results, and Radiation Exposure
Abstract
PURPOSE: To evaluate the benefits of computed tomographic (CT) fluoroscopy–guided interventions and assess radiation exposures incurred with CT fluoroscopy.
MATERIALS AND METHODS: A 6-month period of use of CT fluoroscopy to guide abdominal biopsy procedures and catheter drainage was analyzed. Efficacy measures and needle placement and procedure room times were compared with those of the preceding 6 months during which conventional CT was used. CT fluoroscopic times and estimated radiation exposures were compared for two CT fluoroscopic methods.
RESULTS: The sensitivity and negative predictive values for biopsy procedures and the success rate for needle aspiration or catheter drainages for CT fluoroscopy—98%, 86%, and 100%, respectively—were not significantly different from those for conventional CT—95%, 80%, and 97%, respectively. Room time was not reduced significantly, but mean needle placement time for CT fluoroscopy (29 minutes; n = 95) was significantly lower than that for conventional CT (36 minutes; n = 93; P < .005). The mean patient dose index was 74 cGy. Limiting CT fluoroscopy to scanning the needle tip rather than scanning the entire needle pass significantly reduced the dose to the patient and the operator.
CONCLUSION: Although CT fluoroscopy is a useful targeting technique, significant radiation exposures may result. Therefore, radiologists need to be aware of different methods of CT fluoroscopic guidance and the factors that contribute to radiation exposure.
References
- 1 Mueller PR, vanSonnenberg E. Interventional radiology in the chest and abdomen. N Engl J Med 1990; 322:1364-1374. Crossref, Medline, Google Scholar
- 2 Katada K, Anno H, Koga S, et al. Initial trial with CT fluoroscopy (abstr). Radiology 1994; 190(P):662. Google Scholar
- 3 Katada K, Anno H, Ogura Y, et al. Early clinical experience with real-time CT fluoroscopy (abstr). Radiology 1994; 193(P):339. Google Scholar
- 4 Katada K, Anno H, Takeshita G, et al. Development of real-time CT fluoroscopy. Nippon Acta Radiol 1994; 54:1172-1174. Medline, Google Scholar
- 5 Katada K, Anno H, Ogura Y, et al. Development and early trials of real-time CT fluoroscopy. Neuroradiology 1995; 37(suppl):587-588. Google Scholar
- 6 Katada K, Anno H, Ogura Y, Koga S, Nonomura K, Kanno T. Puncture and drainage of intracranial lesions with CT: fluoroscopic guidance (abstr). Radiology 1995; 197(P):494. Google Scholar
- 7 Katada K, Kato R, Anno H, et al. Guidance with real-time CT fluoroscopy: early clinical experience. Radiology 1996; 200:851-856. Link, Google Scholar
- 8 Kato R, Katada K, Anno H, Ida Y, Suetsugu S, Koga S. Transthoracic needle biopsy with real-time CT fluoroscopy (abstr). Radiology 1995; 197(P):529. Google Scholar
- 9 Kato R, Katada K, Anno H. Radiation dosimetry at CT fluoroscopy: physician's hand dose and development of needle holders. Radiology 1996; 201:576-578. Link, Google Scholar
- 10 Daly BD, Krebs TL, Wong-You-Cheong JJ, Hastings GS, Pais SO. Therapeutic percutaneous interventional procedures of the gastrointestinal tract guided by continuous CT fluoroscopy (abstr). Radiology 1997; 205(P):374. Link, Google Scholar
- 11 Seibel RM, Sehnert C, Plassmann J, Schmidt AM. First 318 interventional procedures with real-time CT (abstr). Radiology 1997; 205(P):383. Google Scholar
- 12 Gianfelice D, Lepanto L. CT-fluoroscopy: an important technological development facilitating CT-guided interventional procedures (abstr). AJR 1998; 170(suppl):80. Google Scholar
- 13 White CS, Templeton PA, Hasday JD. CT-assisted transbronchial needle aspiration: usefulness of CT fluoroscopy. AJR 1998; 169:393-394. Google Scholar
- 14 Meyer CA, White CS, Wu J, Futterer SF, Templeton PA. Real time CT fluoroscopy: usefulness in thoracic drainage. AJR 1998; 171:1097-1101. Crossref, Medline, Google Scholar
- 15 Mori M, Nitta N, Murata K, Sakamoto T, Morita R. A newly-developed equipment for biopsy under CT fluoroscopy (abstr). AJR 1998; 170(suppl):128. Google Scholar
- 16 Sonin AH, Penrod B, Owens-Brown E. CT-fluoroscopic guidance of sacroiliac joint injection (abstr). AJR 1998; 170(suppl):38. Crossref, Medline, Google Scholar
- 17 Froelich JJ, Saar B, Hoppe M, et al. Real-time CT-fluoroscopy for guidance of percutaneous drainage procedures. JVIR 1998; 9:735-740. Crossref, Google Scholar
- 18 Gazelle GS, Haaga JR. Guided percutaneous biopsy of intraabdominal lesions. AJR 1989; 153:929-935. Crossref, Medline, Google Scholar
- 19 Silverman SG, Bloom DA, Seltzer SE, Tempany CM, Adams DF. Needle-tip localization during CT-guided abdominal biopsy: comparison of conventional and spiral CT. AJR 1992; 159:1095-1097. Crossref, Medline, Google Scholar
- 20 Nawfel RD, Judy PF, Silverman SG, Hooton S, Tuncali K, Adams DF. Patient and personnel exposure during CT fluoroscopy (abstr). Med Phys 1998; 25:156. Google Scholar
- 21 Haaga JR, Alfidi RJ. Precise biopsy localization by computed tomography. Radiology 1976; 118:603-607. Link, Google Scholar
- 22 Renaud L. A 5-y follow-up of the radiation exposure to in-room personnel during cardiac catheterization. Health Phys 1992; 62:10-15. Crossref, Medline, Google Scholar
- 23 Kalender WA, Wolf H, Suess C, et al. Dose reduction in CT by anatomically adapted tube current modulation: experimental results and first patient studies (abstr). Radiology 1997; 205(P):471. Link, Google Scholar