title: Prospective Randomized Trial for Image-Guided Biopsy Using Cone-Beam CT Navigation Compared with Conventional CT.
abstract: OBJECTIVE
  To compare cone-beam computed tomography (CT) navigation vs conventional CT image guidance during biopsies.
  
  
  METHODS
  Patients scheduled for image-guided biopsies were prospectively and randomly assigned to conventional CT guidance vs cone-beam CT navigation. Radiation dose, accuracy of final needle position, rate of histopathologic diagnosis, and number of needle repositions to reach the target (defined as pullback to adjust position) were compared.
  
  
  RESULTS
  A total of 58 patients (mean age, 57 y; 62.1% men) were randomized: 29 patients underwent 33 biopsies with CT guidance and 29 patients with 33 lesions underwent biopsy with cone-beam CT navigation. The average body mass index (BMI) was similar between groups, at 28.8 kg/m(2) ± 6.55 (P = .18). There was no difference between groups in terms of patient and lesion characteristics (eg, size, depth). The average lesion size was 29.1 ± 12.7mm for CT group vs 32.1mm ±16.8mm for cone-beam CT group (P < 0.59). Location of lesions was equally divided between the 2 groups, 20 lung lesions, 18 renal lesions and 20 other abdominal lesions. Mean number of needle repositions in the cone-beam CT group was 0.3 ± 0.5, compared with 1.9 ± 2.3 with conventional CT (P < .001). The average skin entry dose was 29% lower with cone-beam CT than with conventional CT (P < .04 accounting for BMI). The average estimated effective dose for the planning scan from phantom data was 49% lower with cone-beam CT vs conventional CT (P = .018). Accuracy, defined as the difference between planned and final needle positions, was 4.9 mm ± 4.1 for the cone-beam CT group, compared with 12.2 mm ± 8.1 for conventional CT (P < .001). Histopathologic diagnosis rates were similar between groups, at 90.9% for conventional CT and 93.9% for cone-beam CT (P = .67).
  
  
  CONCLUSIONS
  Cone-beam CT navigation for biopsies improved targeting accuracy with fewer needle repositions, lower skin entry dose, and lower effective dose for planning scan, and a comparable histopathologic diagnosis rate.
authors.affiliation: Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland. Electronic address: nadine@uci.edu.
authors.forename: Nadine
authors.initials: N
authors.lastname: Abi-Jaoudeh
authors.affiliation: Division of Radiation Safety, Office of Research Services, National Institutes of Health, Bethesda, Maryland.
authors.forename: Teresa
authors.initials: T
authors.lastname: Fisher
authors.affiliation: Division of Radiation Safety, Office of Research Services, National Institutes of Health, Bethesda, Maryland.
authors.forename: John
authors.initials: J
authors.lastname: Jacobus
authors.affiliation: Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.
authors.forename: Marlene
authors.initials: M
authors.lastname: Skopec
authors.affiliation: iXR Division, Philips Healthcare, Best, The Netherlands.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Radaelli
authors.affiliation: iXR Division, Philips Healthcare, Best, The Netherlands.
authors.forename: Imramsjah Martijn
authors.initials: IM
authors.lastname: Van Der Bom
authors.affiliation: Office of the Deputy Director for the Clinical Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Robert
authors.initials: R
authors.lastname: Wesley
authors.affiliation: Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D054893:Cone-Beam Computed Tomography / Q000009:adverse effects; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009339:Needles; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects