title: Radiation dose reduction in pediatric CT-guided musculoskeletal procedures.
abstract: BACKGROUND
  Computed-tomography-guided interventions are attractive for tissue sampling of pediatric bone lesions; however, it comes with exposure to ionizing radiation, inherent to CT and magnified by multiple passes during needle localization.
  
  
  OBJECTIVE
  We evaluate a method of CT-guided bone biopsy that minimizes ionizing radiation exposure by lowering CT scanner tube current (mAs) and voltage (kVp) during each localization scan.
  
  
  METHODS
  We retrospectively reviewed all CT-guided bone biopsies (n = 13) over a 1-year period in 12 children. Three blinded readers identified the needle tip on the reduced-dose CT images (mAs = 50, kVp = 80) during the final localization scan at biopsy and rated the image quality as high, moderate or low.
  
  
  RESULTS
  The image quality of the reduced-dose scans during biopsy was rated as either high or moderate, with needle tip visualized in 12 out of 13 biopsies. Twelve of 13 biopsies also returned sufficient sample for a pathological diagnosis. The average savings in exposure using the dose-reduction technique was 87%.
  
  
  CONCLUSIONS
  Our results suggest that a low mAs and kVp strategy for needle localization during CT-guided bone biopsy yields a large dose reduction and produces acceptable image quality without sacrificing yield for biopsy diagnosis.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, UCSF Benioff Children's Hospital, 505 Parnassus Ave., San Francisco, CA, 94143-0628, USA.
authors.forename: Anand S
authors.initials: AS
authors.lastname: Patel
authors.forename: Bruno
authors.initials: B
authors.lastname: Soares
authors.forename: Jesse
authors.initials: J
authors.lastname: Courtier
authors.forename: John D
authors.initials: JD
authors.lastname: Mackenzie
mesh_terms: D000293:Adolescent; D001847:Bone Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods*; D011874:Radiometry; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed