title: Feasibility study of needle placement in percutaneous vertebroplasty: cone-beam computed tomography guidance versus conventional fluoroscopy.
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.
  
  
  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 cm(2), 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands. sjbraak@gmail.com
authors.forename: Sicco J
authors.initials: SJ
authors.lastname: Braak
authors.forename: Kirsten
authors.initials: K
authors.lastname: Zuurmond
authors.forename: Hans C J
authors.initials: HC
authors.lastname: Aerts
authors.forename: Marc
authors.initials: M
authors.lastname: van Leersum
authors.forename: Timotheus T Th
authors.initials: TT
authors.lastname: Overtoom
authors.forename: Johannes P M
authors.initials: JP
authors.lastname: van Heesewijk
authors.forename: Marco J L
authors.initials: MJ
authors.lastname: van Strijen
mesh_terms: D002983:Clinical Competence; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005240:Feasibility Studies; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D017145:Models, Educational; D009339:Needles; D019047:Phantoms, Imaging; D011677:Punctures / Q000379:methods; D058996:Quality Improvement; D015641:Radiography, Interventional / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D054854:Vertebroplasty / Q000379:methods*