0:00

So let's look at selecting an Imaging modality. So

0:03

what we discuss is it's important to

0:06

understand how we're going to approach a

0:09

particular trajectory. But the question

0:12

is what guidance are we going to use?

0:15

When we think about bone biopsy CT guidance is probably

0:18

the more preferred modality in this

0:21

particular setting what advantages does it have it

0:24

offers us good visualization good cross-sectional appreciation

0:28

of regional anatomy. It gives

0:31

us a high degree of control over our needle path we can

0:34

advance our needle we can take our picture we can

0:37

advance our needle we can take our picture again. We can advance your needle

0:40

some more and we get good certainty as we

0:43

sort of Advance along the intended trajectory and Regional

0:46

appreciation for surrounding Anatomy disadvantages, as

0:50

would have been stated previously is radiation exposure. It's

0:53

important to know that when we're performing biopsies

0:56

using CT guidance that we are being exposed to radiation if

0:59

we're in the room while the CT is active in

1:02

the case of CT fluoroscopy. We want to make sure that we have led on radiation

1:05

protective equipment if we're exiting the room,

1:08

then we may not need lead for

1:11

example, there's also high cost involved when it comes

1:14

to CT as well.

1:15

When it comes to Ultrasound ultrasound is particularly good

1:18

because by the same reason that we are not fans

1:21

of the radiation exposure in case of CT

1:24

where fans of the fact that there's no radiation exposure

1:27

when it comes to Ultrasound when it

1:30

comes to costs cost is something that's also low which

1:33

makes this particularly accessible across the

1:36

globe when it comes to our ability to choose our

1:39

trajectory in real time and Angola prove

1:42

in order to find a nice safe

1:45

needle trajectory ultrasound affords

1:48

us that nice maneuverability in real time. What are some

1:51

disadvantages? Well some disadvantages include the fact that sometimes we're

1:54

not really able to image past the Bony cortex. So

1:57

we're biasing something like xostosis some

2:00

sort of tuberance that's emanating from

2:03

the cortex the cortical bone. Yes and

2:06

ultrasound maybe able to sort of show us some normal

2:09

globular Anatomy that is very very easily identified.

2:12

But if it's any deeper,

2:15

This may actually be particularly inappropriate and what we know is

2:18

that this is highly operated dependent as well when it

2:21

comes to accuracy and safety. You really

2:24

need a high degree of skill in order to evaluate this

2:27

fluoroscopy would be the third modality that

2:30

we can use very advantageous partly because

2:33

of the low cost it's also rapid so when

2:36

it comes to biopsies of bone specifically for

2:39

narrow purposes philosophy is particularly good it

2:42

could be combined in the setting of CTO ultrasound in order

2:45

to enable real-time maneuverability as well and same disadvantage

2:48

of a CT scan. It has radiation

2:51

exposure so may not be appropriate like ultrasound

2:54

in the setting of pediatric populations. There

2:57

may be some inability or challenges image

3:00

surrounding soft issues when it's used

3:03

in isolation as well. Okay?