0:00

So let's look at a little bit of an overview of procedural.

0:04

And some very procedural considerations important in image guided biopsies specific

0:07

the bone lesions.

0:09

So for every procedure, we must know the

0:12

indications and the contraindications for

0:15

every reason to do a procedure. There is a reason not

0:18

to do one.

0:20

So while we're practicing offense in performing procedures and

0:23

doing them, well, we should never not know.

0:26

The reason why I particular patient should not be on

0:29

our procedural table. So let's keep these

0:32

in mind as we move through. So that's impact the

0:35

indications. So it's important to understand whether

0:38

we're targeting something that's potentially neoplastic

0:41

or not neoplastic in nature. It's also

0:44

important to know if we're targeting something that could be

0:47

primary bone lesion versus one that could be

0:50

a metastatic bone lesion and so in this

0:53

particular setting that's our goal. We want to

0:56

identify and discriminate between

0:59

one type of tumor and

1:02

another type of tumor one being the primary second

1:05

being the metastatic.

1:07

Similarly, if we're dealing with something that

1:10

is really sort of thought to be cancer. Could

1:13

it also be infection? And

1:16

so we also have situations where there's

1:19

concern for infection in the setting of osteomyelitis or

1:22

dicitis when in fact that is an appropriate

1:25

indication for us to take a sample of the bone.

1:28

So for example, if a patient was treated

1:31

for this guide is osteomyelitis several months

1:34

prior.

1:35

And now they continue to have pain and they've

1:38

exhausted their antibiotic regimen but now they're coming

1:41

back with continued or recurrent pain new

1:44

pain. This may be inappropriate setting to evaluate for

1:47

the treatment response or to identify. If there

1:50

is an additional bug that can be

1:53

treated in this case a culture and sensitivity analysis would

1:56

guide our antibiotic therapy in this particular setting if there

1:59

is a patient that had a disease process that was

2:02

none infectious, for example, that was treated such as multiple myeloma

2:05

now, perhaps they may have continued pain or

2:08

what new or occurring pain in this particular setting.

2:11

We may want to evaluate the treatment response by

2:14

getting a tissue sample in order to see whether

2:17

or not there's active myeloma lesions in

2:20

that location.

2:21

So let's look at some contraindications for bone biopsies

2:24

when we're performing a procedure. We're not

2:27

just performing a procedure a biopsy on a lesion of

2:30

Interest. We're performing it in the context of a patient with a

2:33

clinical environment that is specific

2:36

to them hemodynamics are very important.

2:39

If a patient is hypotensive or

2:42

tacky cardic this may not

2:45

be the appropriate setting to perform this biopsy in so we want

2:48

to make sure that we are aware of the patients hemodynamic status

2:51

and we're not performing a biopsy in this specific setting where

2:54

the patient may be deemed to be critical second is

2:57

if the patient has skin infection overlying

3:00

the site that we're actually

3:03

biops in so we don't want to introduce infection into

3:06

non-infected underlying tissues. So this

3:09

would essentially be a contraindication. So if we can't find a safe

3:12

route that avoids that skin infection, this may

3:15

be a no-go for us if a patient has sepsis

3:18

in this particular setting we don't want to cause seeding

3:21

That site provoking abscess formation,

3:24

for example, or just spreading anything that

3:27

may actually be systemic to a

3:30

particular site to cause more locally Advanced condition

3:33

infection or tumor being

3:36

that particular thing. If there is a safe route

3:39

by all means we want to move forward with accessing the

3:42

site in question, but if a tumor

3:45

is not deemed to be inaccessible by a safe route. This

3:48

may be due to intervening by all blood vessels

3:51

or nerves we want to make sure that we are aware of that

3:54

and if they are then this also would be a no go

3:58

What if we have an uncooperative patient? What if we have a patient

4:01

that is not deemed to be with it

4:04

Delirious. For example, perhaps this is something

4:07

that the patient just doesn't want in the

4:10

patient that may not have capacity and their family is making

4:13

the decision for them. This may need to be a patient that may need

4:16

to actually be intubated and given monitored anesthesia

4:19

care or general anesthesia for this procedure. If this

4:22

is what the team and the family thinks is in

4:25

their best interests.