Reduction of Radiation Dose and Scanning Time While Preserving Diagnostic Yield: A Comparison of Battery-Powered and Manual Bone Biopsy Systems

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FIG 1.
Bone biopsy of lytic bone lesions with manual and battery-powered drills. A, A 74-year-old man with multiple myeloma undergoing CT-guided biopsy of a right iliac lytic lesion with the Osteo-site manual system. CT image shows placement of the needle into the right iliac lytic lesion. B, A 58-year-old man with multiple myeloma undergoing CT-guided biopsy of a lytic L3 lesion with the OnControl battery-powered system. CT image shows placement of needle into the L3 vertebral body.
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FIG 2.
Breakdown of the final pathology diagnosis in various bone lesion classes: all bone lesions (A), lytic lesions (B), sclerotic lesions (C), and suspected infectious lesions (D).

Table 1:

Demographic characteristics of patients undergoing bone biopsies^{^a}

	Total	Manual	Battery-Powered	P Value
No.	585	314	271
Age (mean ± SD)	62 ± 13	62 ± 13	61 ± 12	.541
Sex (M/F)	305:280	173:141	132:139	.135
Suspected origin of primary disease				.103
Bone^{^b}	41.7 (244)	38.9 (122)	45 (122)
Prostate	3.8 (22)	4.5 (14)	3.0 (8)
Breast	10.4 (61)	11.5 (36)	9.2 (25)
Lung	2.9 (17)	4.8 (15)	0.7 (2)
Kidney	0.7 (4)	1.0 (3)	0.4 (1)
Systemic^{^c}	0.7 (4)	1.0 (3)	0.4 (1)
Liver	0.3 (2)	0.6 (2)	0 (0)
Bladder	1.7 (10)	1.6 (5)	1.8 (5)
Miscellaneous^{^d}	8.5 (50)	9.2 (29)	7.7 (21)
Unestablished/unknown^{^e}	27 (158)	24.8 (78)	29.5 (80)
Blood	2.2 (13)	2.2 (7)	2.2 (6)
Location of bone lesion				.16
Vertebral column	47.0 (275)	45.2 (142)	49.1 (133)
Cervical	0.6 (4)	0.1 (4)	0 (0)
Thoracic	17.9 (105)	16.2 (51)	19.9 (54)
Lumbar	17.3 (101)	17.5 (55)	17.0 (46)
Sacral	11.1 (65)	10.2 (32)	12.2 (33)
Pelvis	36.9 (216)	39.5 (124)	33.9 (92)
Extremity	8.4 (49)	10.5 (33)	5.9 (16)
Miscellaneous^{^f}	0.5 (3)	0.6 (2)	0.4 (1)
Disc	7.2 (42)	4.1 (13)	10.7 (29)

↵a Values for frequency of suspected origin of primary disease and lesion location represent percentages followed by total number of cases in parentheses.
↵b Primary bone lesions include suspected multiple myeloma from laboratory testing.
↵c Predominantly sarcoidosis.
↵d Includes thyroid, salivary gland, vulvar, tongue, melanoma, and anal cancers.
↵e Includes all cases without known malignancy or suspected primary bone lesion.
↵f Includes sternum, ribs, clavicle, scapula, calvaria, and tarsal bones.

Table 2:

Comparative performance of the drill systems in various lesion classifications^{^a}

	Diagnostic Yield	Crush Artifacts	Radiation Dose (mGy × cm²)	Scanning Time (min)
Lytic lesions
Manual	83.4 (201/241)	5 (12/241)	845	42
Battery-powered	89.0 (161/181)	7.7 (14/181)	657	35
P value	.069	.168	.001^{^b}	.001^{^b}
Sclerotic lesions
Manual	76.4 (42/55)	7.3 (4/55)	1061	44
Battery-powered	89.1 (49/55)	7.3 (4/55)	804	37
P value	.064	1	.028^{^b}	.012^{^b}
Infectious lesions
Manual	50.0 (9/18)	11.1 (2/18)	1113	46
Battery-powered	51.4 (18/35)	0 (0/35)	811	39
P value	.576	.111	.155	.128
All lesions
Manual	80.3 (252/314)	5.7 (18/314)	900	43
Battery-powered	84.1 (228/271)	6.6 (18/271)	704	36
P value	.538	.387	.001^{^b}	.001^{^b}

↵a Percentage followed by the number of cases/total number of cases in parentheses for diagnostic yield and crush artifacts. Mean values are listed for radiation dose and scanning time.
↵b Significant P value (P < .05).

Table 3:

Comparative performance of drill systems in sclerotic lesions based on density^{^a}

Density (HU)	Diagnostic Yield	Crush Artifacts	Radiation Dose (mGy × cm²)	Scanning Time (min)
Manual
250–700	88.5 (23/26)	3.8 (1/26)	1044	45.1
>700	85.7 (12/14)	2.1 (3/14)	1317	46.1
P value	.583	.115	.3	.862
Battery-powered
250–700	89.3 (25/28)	0 (0/28)	889	34.6
>700	85 (17/20)	20 (4/20)	752	41
P value	.562	.025^{^b}	.38	.026^{^b}

↵a Percentage followed by number of cases/total number of cases in parentheses for diagnostic yield and crush artifacts. Mean values are listed for radiation dose and scanning time.
↵b Significant P value (P < .05).