David J. Grand MD, Presenter: Research support, Bayer AG

Michael Kemal Atalay MD, PhD, Abstract Co-Author: Speaker, Toshiba Corporation

John Joseph Cronan MD, Abstract Co-Author: Nothing to Disclose

William W. Mayo-Smith MD, Abstract Co-Author: Research support, Covidien AG Research support, Bracco Group

Damian E. Dupuy MD, Abstract Co-Author: Consultant, Veran Medical Technologies, Inc Grant, Veran Medical Technologies, Inc Grant, Angiodynamics, Inc Speakers Bureau, Covidien AG

To determine if use of an electromagnetic navigation system (EMN) in conjunction with CT fluoroscopy (CTF) decreases radiation dose and procedure time of CT guided lung biopsy in lesions smaller than 2.5 cm.

This study was approved by our hospital IRB and all collected data was evaluated in a HIPAA compliant manner. 20 patients with small lung masses (<2.5 cm) referred for CT-guided lung biopsy were randomized to undergo biopsy with conventional CT  fluoroscopy (9 patients) or CT fluoroscopy in conjunction with an electromagnetic navigation system (11 patients) by 5 attending radiologists with an average of 14.8 years of experience (range 4-27 years). Multiple parameters were then compared including fluoroscopy time, radiation dose, number of needle repositions, procedure time, diagnostic sample rate and incidence of pneumothorax.  

The average fluoroscopy time using EMN was 28 sec compared to 35 sec for CTF (p = 0.35). The average radiation dose was 103.5 mGy using EMN and 110.2 mGy for CTF (p = 0.5). The average number of needle repositions was 4.4 for EMN and 3.4 for CTF (p = 0.4). Average procedure time, measured from time of skin anesthesia to biopsy, was 19 minutes for EMN and 12 minutes for CTF (p = 0.06). Diagnostic specimens were obtained in all procedures. There were no pneumothoraces during or immediately following the procedure in either group. 2 pneumothoraces developed in each patient group at 2 hour post-procedural chest x-ray. One pneumothorax in the EMN group required chest tube placement.

EMN is a promising tool to decrease radiation dose and limit procedure time and complications of CT guided procedures. These benefits were not statistically significant in this small cohort of patients which may be due to the learning curve associated with the adaptation of the new technology as well as the extensive experience of the radiologists performing the procedure under conventional CT fluoroscopy.

 Use of electromagnetic navigation in conjunction with CT fluoroscopy has the potential to limit radiation dose, decrease procedure time and increase accuracy of CT guided lung biopsies.

Grand, D, Atalay, M, Cronan, J, Mayo-Smith, W, Dupuy, D, CT-guided Percutaneous Lung Biopsy Using an Electromagnetic Navigation System: Initial Experience.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8009523.html