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Use of Combined Biplane Fluoroscopy and Flat Panel Volume CT (Siemens Artis Zee DynaCT) in Biopsy of Lesions in the Spine Seen on Cross Sectional Imaging Which Are Fluoroscopically Imperceptible. 2009

Interventional Spine

Timothy D Aadland, MD,
David F Kallmes, MD, ASSR Member
John I Lane, MD, ASSR Member
Harry Cloft, MD, PhD, ASSR Member
Jonathan M Morris, MD, ASSR Member
Kent R Thielen, MD, ASSR Member

Scientific Paper

Mentor Award: Yes

Institution where work was conducted

Mayo Clinic - Rochester, MN

Affiliation and Department

Department of Radiology - Neuroradiology Division.


200 First St SW
Rochester, Minnesota
Phone: 507-284-0440


Demonstrate the utility and accuracy of flat panel volume CT (Siemens Artis Zee DynaCT) used in conjunction with biplane fluoroscopy for biopsies of the spine.

Methods & Materials

We retrospectively reviewed the findings of seven combined biplane fluoroscopic and flat panel volume CT guided biopsies of the spine performed at a single institution between March 1st, 2008 and November 1st, 2008. All patients underwent MRI, CT, or PET/CT for known or suspected malignancy. Pre procedure cross-sectional imaging was used to plan initial needle trajectory and location. Biplane fluoroscopic transpedicular biopsy was performed and flat panel volume CT (DynaCT) was then used to confirm intra-lesion needle location prior to first biopsy sample. Effective dose (ED) was estimated from the total kerma-area-product using conversion coefficients derived from Monte Carlo simulations (Hart et al 1994).


Five of the seven patients’ biopsies confirmed metastatic disease. Of the remaining two patients, one had an atypical hemangioma, and the other patient had biopsy results that were negative for malignancy with fragments of bone, blood, and normal bone marrow cells. No patient had to have a biopsy repeated. All patients had an adequate sample volume. Flat panel volume CT (DynaCT) confirmed needle location in all lesions that were fluoroscopically inconspicuous. There were no complications in any of the seven patients. Kerma-area-product values ranged from 14 to 67 Gy-cm2 with estimated effective dose values of 1.8 to 13.1 mSv per 3D acquisition.


Given the advances of minimally invasive spine biopsies, we believe that flat panel volume CT (DynaCT) is the next logical progression allowing the combined benefits of biplane fluoroscopy and intraprocedure flat panel CT. Flat panel volume CT (DynaCT) assures needle position within fluoroscopically inconspicuous lesions without the need for post biopsy CT confirmation, and without significant increase in biopsy time. In addition we have demonstrated the effective doses of flat panel volume CT (DynaCT).


1. Hart D, Jones DG, Wall BF. Estimation of effective dose in diagnostic radiology from entrance surface dose and dose-area product measurements (NRPB Report R262). Chilton: NRPB, 1994.

2. Tehranzadeh, J, Tao, C, Browing, CA. Percutaneous needle biopsy of the spine. Acta Radiol 2007;48:860-868.