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guidance : focus on dual guidance
  • Bone biopsy, like other interventional procedures, is usually performed with a single imaging technique: fluoroscopy or CT, both of which have advantages and drawbacks.
  • Fluoroscopy offers multiple planes and direct imaging with the disadvantages of poor soft-tissue contrast and non-negligible radiation exposure for both patient and operator. CT is well-suited for precise interventional needle guidance because it provides good visualization of bone and surrounding soft tissues. It also avoids damage to adjacent vascular, neurological, and visceral structures. The disadvantages of this method are single-plane and delayed imaging.
  • To address these concerns on a routine basis, a combination of CT and fluoroscopy for interventional procedures has been recommended. For fluoroscopy, a mobile C-arm is used , positioned in front of the CT-gantry. By using a rotating fluoroscope and CT, the structure to be punctured can be visualized three dimensionally and with exact differentiation of anatomic structures, which in many cases is not possible with fluoroscopy alone. Two mobile monitors were placed in front of the physician, displaying the last stored image and the fluoroscopic image. The operator can switch from CT to fluoroscopy and vice versa at any time.
  • In percutaneous biopsy, the intervention begins with CT and is continued with fluoroscopy. Fluoroscopy is associated to CT whenever drilling is necessary.

Fig 5: PMSB Dual guidance CT and fluoroscopy

Fig 6: PMSB Dual guidance fluoroscopy and CT

Fig 7: PMSB CT pathway

Fig 8: PMSB CT control