title: Assessment of needle guidance devices for their potential to reduce fluoroscopy time and operator hand dose during C-arm cone-beam computed tomography-guided needle interventions.
abstract: OBJECTIVE
  To assess whether the use of needle guidance devices can reduce fluoroscopy time and operator hand dose during cone-beam computed tomography-guided needle interventions.
  
  
  METHODS
  The freehand technique was compared with techniques employing two distinct needle holders and a ceiling-mounted laser guidance technique. Laser guidance was used either alone or in combination with needle holders. Four interventional radiologists were instructed to reach predetermined targets in an abdominal phantom using these techniques. Each operator used all six techniques three times. Fluoroscopy time, procedure time, operator hand dose, and needle tip deviation were obtained for all simulated needle interventions. All data are presented as median (ranges).
  
  
  RESULTS
  All procedures were successfully completed within 2-4 minutes, resulting in a deviation from target of 0.8 mm (0-4.7). In freehand procedures, the fluoroscopy time to reach the target was 50 seconds (31-98 s). Laser guidance, used alone or in combination with needle holders, reduced fluoroscopy time to 31 seconds (14-68 s) (P<.02). The operator hand dose in freehand procedures was 275 μSv (20-603 μSv). Laser guidance alone or in combination with needle holders resulted in a reduction of the hand dose to<36 μSv (5-82 μSv) per procedure (P<.001). There were no statistically significant effects on hand dose levels or fluoroscopy time when the needle holders were employed alone.
  
  
  CONCLUSIONS
  Compared with the freehand technique, all three tested needle guidance devices performed with equivalent efficiency in terms of accuracy and procedure time. Only the addition of laser guidance was found to reduce both fluoroscopy time and operator hand dose.
authors.affiliation: Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.kroes@rad.umcn.nl
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Kroes
authors.forename: Wendy M H
authors.initials: WM
authors.lastname: Busser
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Arntz
authors.forename: Caroline M M
authors.initials: CM
authors.lastname: Janssen
authors.forename: Yvonne L
authors.initials: YL
authors.lastname: Hoogeveen
authors.forename: Frank
authors.initials: F
authors.lastname: de Lange
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Schultze Kool
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005471:Fluoroscopy / Q000295:instrumentation*; D006225:Hand / Q000528:radiation effects*; D006801:Humans; D009339:Needles; D016273:Occupational Exposure / Q000032:analysis*; D011829:Radiation Dosage; D011835:Radiation Protection / Q000295:instrumentation; D015641:Radiography, Interventional / Q000295:instrumentation*; D011874:Radiometry; D013997:Time Factors