title: CT fluoroscopy-guided biopsy of the lung or upper abdomen with a breath-hold monitoring and feedback system: a prospective randomized controlled clinical trial.
abstract: OBJECTIVE
  To prospectively determine the clinical effectiveness of a breath-hold monitoring and feedback system in computed tomographic (CT) fluoroscopy-guided biopsies in which respiratory motion is a problem.
  
  
  METHODS
  Institutional review board approval and oral and written informed consent were obtained. This study was HIPAA compliant. A bellows-based system was used to monitor respiration and provide patient feedback. A randomized controlled clinical trial compared intermittent mode CT fluoroscopy-guided biopsies of the lung or upper abdomen performed with (n = 56) and without (n = 57) the bellows system. Inclusion criteria for 113 patients were lesions 6 cm or smaller in maximum dimension that were not affixed to the chest or abdominal wall. Primary outcome measurements were CT fluoroscopy exposure time and patient dose. Wilcoxon rank sum, chi(2), and Fisher exact tests were used for statistical analysis.
  
  
  RESULTS
  Median CT fluoroscopy exposure time was 12.6 seconds (range, 2.4-44.4 seconds) for the bellows group and 18.0 seconds (range, 6.0-118.0 seconds) for the nonbellows group (P = .004). Patient dose was decreased in the bellows group (median dose, 29.5 mGy; range, 4.7-135.8 mGy) versus the nonbellows group (median, 41.3 mGy; range, 11.8-155.9 mGy) (P = .01). Lesions were accessed successfully with one needle puncture attempt in 43 of 56 patients (77%) in the bellows group and 30 of 57 patients (53%) in the nonbellows group (P = .007). Pneumothorax developed in 11 of 50 patients (22%) in the bellows group who underwent lung biopsy compared with 16 of 50 (32%) patients in the nonbellows group.
  
  
  CONCLUSIONS
  A breath-hold monitoring and feedback system allows depiction of mobile target lesions throughout CT fluoroscopy-guided biopsy of the lung and upper abdomen.
authors.affiliation: Department of Radiology, Section of Safety, Mayo Clinic, Rochester, MN 55905, USA. scarlson@mayo.edu
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Carlson
authors.forename: Joel P
authors.initials: JP
authors.lastname: Felmlee
authors.forename: Claire E
authors.initials: CE
authors.lastname: Bender
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ehman
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Classic
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Hoskin
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: Houchun H
authors.initials: HH
authors.lastname: Hu
mesh_terms: D000005:Abdomen / Q000473:pathology*; D001706:Biopsy / Q000379:methods*; D016009:Chi-Square Distribution; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D011829:Radiation Dosage; D011834:Radiation Monitoring; D011860:Radiography, Abdominal; D015641:Radiography, Interventional; D013902:Radiography, Thoracic; D015656:Respiratory Mechanics; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed