title: Flat detector C-arm CT-guidance system in performing percutaneous transthoracic needle biopsy of small (≤3 cm) pulmonary lesions.
abstract: BACKGROUND
  Nowadays, flat detector (FD) equipped angiographic C-arm computed tomography (CACT) systems can be used to acquire CT-like cross-sectional images directly within the interventional suite. The CACT systems offer real time visualization of transthoracic needle biopsy (TNB) procedure and more flexibility in the orientation of the detector system around the patient compared to traditional CT systems.
  
  
  OBJECTIVE
  To evaluate the value of a flat detector C-arm CT-guidance system in performing percutaneous transthoracic needle biopsy (PTNB) for small (≤3 cm) pulmonary lesions in clinical practice.
  
  
  METHODS
  A total of 60 patients with solid lung lesions were retrospectively enrolled to undergo PTNB procedures. The mean diameter of lesions was 2.3 ± 0.6 cm (range, 0.6-3 cm). The needle path was carefully planned and calculated on the C-arm CT system, which acquired three-dimensional CT-like cross-sectional images. The PTNB procedures were performed under needle guidance with fluoroscopic feedbacks.
  
  
  RESULTS
  Histopathologic tissue was successfully obtained from 59 patients with a puncture success rate of 98.3% (59/60). The diagnostic accuracy rate was found to be 91.5% (54/59). There were only two cases of pneumothorax (3.3%) requiring therapy. The rates of pneumothorax and hemoptysis were low (15.0% [9/60] and 8.3% [5/60], respectively). The overall procedural time was in the range of 12-18 min, resulting in a mean exposure dose of 224.4 ± 4.8 mGy.
  
  
  CONCLUSIONS
  Our study shows that C-arm CT-based needle guidance enables reliable and efficient needle positioning and progression by providing real-time intraoperative guidance for small (≤3 cm) pulmonary lesions in clinical practice.
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
authors.forename: De-Chao
authors.initials: DC
authors.lastname: Jiao
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
authors.forename: Zong-Ming
authors.initials: ZM
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
authors.forename: Hui-Feng
authors.initials: HF
authors.lastname: Yuan
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
authors.forename: Quan-Hui
authors.initials: QH
authors.lastname: Zhang
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
authors.forename: Jian-Zhuang
authors.initials: JZ
authors.lastname: Ren
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
authors.forename: Peng-Li
authors.initials: PL
authors.lastname: Zhou
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
authors.forename: Gang
authors.initials: G
authors.lastname: Wu
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China hanxinwei2006@163.com.
authors.forename: Xin-Wei
authors.initials: XW
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects; D008171:Lung Diseases / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011677:Punctures; D011829:Radiation Dosage; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: 3D computer applications; Interventional; biopsy; lung