Amish Doshi
At our institution, we perform a variety of image-guided procedures, many of which are spine biopsies. In our practice, CT is often the preferred modality for guidance for these types of procedures. As a result, imaging parameters and radiation dose become important considerations. In an attempt to limit the radiation dose to patients undergoing these procedures, we set out to determine if a modified, low-dose protocol for CT-guided spine biopsies would provide a similar yield to our routine imaging. We found no significant difference in the diagnostic yield between biopsies performed at a lower CT dose and those performed at a standard CT dose. Given the importance of limiting the radiation dose to patients, and the opportunity to modify various protocols to achieve lower radiation, we have modified our practice to include low-dose CT scanning for patients undergoing all CT-guided biopsies.
It is essential that radiologists consider ways to improve safety for their patients. Several published articles have demonstrated overall decreased radiation dose in spine procedures, such as lumbar spine pain injections, when using a modified imaging protocol without sacrificing procedural efficacy.1-3 I believe there is continued opportunity in the field of spine intervention to reduce radiation dose by modifying protocols while maintaining diagnostic yield and procedural success.
Modification of imaging parameters for CT-guided procedures can be readily performed at the scanner console. This allows the proceduralist to modify and determine what CT parameters allow for lower radiation dosage while maintaining the diagnostic image quality that is sufficient to perform these procedures. I believe there is sufficient evidence in our past research and in the literature to support that lower-dose CT imaging during procedures can be employed without reducing the overall yield or efficacy of the procedure.
Finally, with the recent burgeoning interest in artificial intelligence (AI), it is important to consider the potential of producing adequate procedural image quality using AI with even further reductions in CT radiation dose.