Ultra Low Dose Radiation Protocol ( 80 Kv , 3 Mas ) for Ct-Guided Percutaneous Needle Biopsy of Pulmonary Lesions : Feasibility , Efficacy and Safety

Aim: To prospectively determine the feasibility of Ultra Low Dose (ULD) for computed tomography (CT)-guided percutaneous needle biopsy (PNB) of lung lesions, and to evaluate the efficacy and safety of ULD pro-tocol. Materials and Methods: CT-guided needle biopsy of pulmonary lesions were prospectively collected between September 2016 and September 2017, using ultra low-low dose (80 kV, 3 mAs) CT protocol. Has been investi-gated efficacy understood as numbers of diagnostic biopsy and quantity and type of complications, distin-guishing the majors from the minor, relating to lesion’s size and pulmonary site. Results and Discussion: A total of 45 biopsies in 27 men (60%) and 18% women (40%), performed using the ULD protocol were selected. The overall technical success rate was 82,22% (37 patients). There have been only two (4,44%) major complications, that has required hospitalization, and twenty-one patients (46,67%) with mi-nor complication but nobody of these has need of thoracostomy tube placement. We found in our study a sig-nificant correlation between complications and nodule size. These data were compared to a retrospective re-view obtained by data from patients who underwent CT-guided ultra-low dose found in literatures (but we not found in literatures a voltage below 100 Kv and electric intensity lower of 7,5 mAs in similar studies). These re-sults are comparable, so we can affirmed that this protocol is safe enough for patients. Another important re-sult, that we haven’t found in other similar study, is relationship between the complications and biopsies site, that will be very important to make a patient’s selection before biopsy. Finally in this study almost totality of patients (95,5%) has effected the procedure in “day hospital system” and so easier in terms of costs and assis-tance for the sanitary structure in comparison to surgical procedures. Conclusion: We have demonstrated safety, efficacy and feasibility, using this very ultra low dose protocol, if is compared to other similar study. We investigated, also, relationship between complications and nodule size and biopsy site and we can affirmed that these informations biopsy site and we can affirmed that these informations are very significant to select patients to procedure. This is important to create an efficacy model of management of patients, with a reduction of morbidity and sanita-ry economic saving. Open Access Daniele Morosetti1†, Matteo Stefanini2†, Cristina Pace1†‡, Gianluigi Sergiacomi1†, Giorgia Rossi1†, Arezia Di Martino1†, Armando Raso1†, Silvia Roma1†, Amedeo Ferlosio3†, Roberto Floris1† Publisher Acknowledgement • This article has been edited by the Journal of Royal Science with a help of Royal Authors, including the commissioning, peer review process and editorial aspects up to the point of acceptance. Overall research credit goes to author(s). • Any further research and comments regarding this article may publish as continues version for quality purpose. • Readers are requested to verify the journal archive for updated version. www.royalauthors.com Copyright: CC BY © 2019 Morosetti D, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Percutaneous needle biopsy (PNB) is defined as placement of a needle(s) into a suspected abnormal lesion or organ for the purpose of obtaining tissue or cells for diagnosis. [1] It has a role in the recommended plan of management when evaluating solitary pulmonary nodules, and masses, multiple nodules, or persistent focal infiltrates. [2] Image-guided percutaneous biopsy is less invasive than open or excisional biopsy and is associ-ated with lower morbidity and mortality and thus considered the initial approach for diagnosis. [1] CTscanners are more routinely used as a guidance tool for various types of interventional radiological procedures. [3] For patients as these, that have necessity to undergo to multiple scanning during a radiological intervention of CT-guided biopsy, is very important to reduce total radiological dose received. If we compared with CT fluoroscopy, that provides the physician immediate feedback and can be a valuable tool to dynamically assist various types of percutaneous interventions. However, the fixed position of the scanning plane in combination with high exposure factors may lead to high cumulative patient skin doses that can reach deterministic threshold limits. The staff is also exposed to a considerable amount of scatter radiation while standing next to the patient during the procedures. CT fluoroscopy doses are markedly higher than classic CT-scan doses and are comparable to doses from other interventional radiological procedures. They consequently require adequate radiation protection management. Reducing the radiation dose while optimizing image quality remains an important issue. [3] In this study the CT-guided percutaneous needle biopsies of pulmonary needle have been effected using a ultra-low dose protocol (80 kV, 3mAs) for all patients and none radiation exposure for the staff and has been evaluated the feasibility and limitations associated with this new protocol. Materials and Methods ULD (80 kV, 3 mAs) CT-guided biopsy of pulmonary lesions were prospectively collected of a total of 45 patients, between September 2016 and September 2017. The indications for PNB include, but are not limited to: 1. To establish the benign or malignant nature of a lesion. Abbreviations : PNB percutaneous needle biopsy ; ULD ultra low dose.