Use of a Soft Guiding Template and Laser Device Improves the Success Rate of Computed Tomography-Guided Bone Biopsies and Reduces Radiation Exposure

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Methods A cohort of 114 patients with bone tumours who required CT-guided biopsies were assigned to the auxiliary device group, utilizing a soft guiding template and a laser device. Another 197 patients, constituting the control group, underwent CT-guided biopsies with conventional guiding templates. The χ 2 test was employed to compare the biopsy success rates and concordance rates between biopsy findings and surgical outcomes in both groups. Additionally, biopsy success rates for limb bones, limb girdles, and axial bones were compared. Independent sample t -tests were used to analyse differences in age, volume CT dose index (CTDI vol ), dose-length product (DLP), and effective dose (ED) between groups, as well as the CTDI vol , DLP, and ED for limb bones, limb girdles, and axial bones individually. Results The biopsy success rate in the auxiliary device group (85.09%) was significantly higher compared to that in the control group (74.62%; P 0.05). In contrast, the biopsy success rate for limb bones was significantly higher in the auxiliary device group (85.51%) than in the control group (70.87%; P < 0.05). However, the concordance rate between biopsy findings and surgical outcomes did not differ significantly between the groups ( P = 1.00). There was no significant difference in the CTDI vol between the two groups for limb girdles, limb bones, and axial bones ( P > 0.05). While DLP and ED showed no significant differences for limb girdles ( P > 0.05), they were significantly lower for limb bones and axial bones in the auxiliary device group compared to those in the control group ( P < 0.05). Conclusion Overall, the combination of a soft guiding template and laser device significantly increased the success rate of CT-guided bone biopsies and reduced the associated radiation dose. CT-guided biopsies bone tumours Radiation dose Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Bone tumours, comprising both primary and secondary forms, exhibit a relatively high incidence rate. According to the 2020 World Health Organization classification, bone tumours are categorised as benign, intermediate (locally aggressive), and malignant, with malignant tumours associated with a notably poor prognosis. In China, the incidence of malignant bone tumours is approximately 1.87 per 100,000 individuals, representing 0.63% of all malignancies, with a mortality rate of 1.38 per 100,000, accounting for 0.78% of all cancer-related deaths [ 1 ] . The five-year relative survival rate for malignant bone tumours in China is approximately 25% [ 2 ] , and most primary malignant bone tumours occur in adolescents and young adults [ 3 ] , highlighting the need for precise early diagnosis and timely intervention to enhance survival and preserve limb function. Computed tomography (CT)-guided percutaneous bone biopsy is the preferred diagnostic method for bone tumours. This minimally invasive technique offers substantial benefits with minimal risks, including bone structure preservation, minimal soft tissue damage, avoidance of general anaesthesia, shortened hospital stays, reduced medical expenses, minimal postoperative complications, and rare tumour dissemination [ 4 – 6 ] . The primary objective of percutaneous bone biopsy is distinction between benign and malignant bone tumours, thereby guiding clinicians to formulate appropriate treatment strategies. Benign bone tumours can be managed or treated with curettage, while malignant tumours typically require extensive resection and may require adjunctive radiotherapy and chemotherapy [ 7 , 8 ] . For an accurate diagnosis, CT-guided biopsy specimens must contain adequate viable tumour tissue for pathological analysis [ 9 ] . However, in bone tumours, particularly those with intact cortices, accessing the medullary cavity via a drilled cortical hole limits needle manoeuvrability post-insertion, thereby underscoring the criticality of precise alignment of the puncture site and angle with the intended trajectory. Generally, achieving such precision relies heavily on operator expertise and dexterity [ 10 , 11 ] . This study aimed to employ a soft guiding template and an in-house developed laser device to enhance puncture site accuracy and establish precise needle insertion angles. The primary objective of employing these tools is to achieve precise targeting, procure a higher yield of tumour cells, and enhance biopsy success rates. Methods Participants This study was approved by the institutional review board(2024Medical Ethics Review Committee 152), and We obtained written informed consent from each patient. We recruited a total of 506 patients who underwent CT-guided bone biopsy at Tianjin Hospital between January 2023 and January 2024. After excluding 167 cases handled by external teams and 28 cases where biopsy was hindered owing to personal reasons or coagulation abnormalities, 311 cases were ultimately included. Among these, 114 cases were randomly assigned to the auxiliary device group, which employed a soft guiding template and a laser device for biopsy assistance. The remaining 197 cases, without the utilisation of auxiliary devices, constituted the control group (Fig. 1 ). Preparation of Auxiliary Equipment Soft Guiding Template The soft guiding template was prepared by mixing 5 g of barium sulphate (Type II) dry suspension (Qingdao Red Butterfly Precision Materials Co., Ltd., China) with 85 g of α, ω-dihydroxyl polydimethylsiloxane (Hoshine Silicon Industry Co., Ltd., China) to form a pre-catalyst viscous liquid compound. This mixture was then combined with 5 g of dimethyl silicone oil (Shin-Etsu Chemical Co., Ltd., China) and 5 g of dibutyltin dilaurate (Foshan Keneng New Materials Co., Ltd., China) to produce a final viscous liquid compound. Subsequently, the generated compound was poured into a pre-fabricated mould and solidified to produce a soft self-adhesive silicone template. This template adheres closely to the skin and facilitates precise selection of epidermal puncture points through its perforations (Fig. 2 , A-D). Laser Device Generally, the puncture angle is determined by the built-in CT gantry lasers, which rotate the gantry to a pre-set angle. However, this approach only aids in positioning the rotation angle of the body’s axial plane and lacks three-dimensional (3D) guidance. Additionally, it requires operator proximity to the scanning gantry, potentially impeding the procedure. In this study, the laser device was enhanced by incorporating two laser projectors (DUKAL1, Shenzhen ATuMan Precision Machinery Technology Co., Ltd., China) positioned on either side of the CT table. These projectors emit lasers parallel and perpendicular to the puncture point at predetermined angles (Figs. 3 , A, B). During the procedure, the operator aligns the biopsy needle with the two lasers to puncture at the specified angle. CT-Guided Biopsy In the control group, a conventional guiding template was positioned on the skin surface at the predetermined puncture site. Conversely, in the auxiliary device group, a soft guiding template was utilised. CT scanning was conducted using a 64-slice CT scanner (Discovery CT750 HD, GE Healthcare, USA), encompassing an area extending 3 cm beyond the tumour both superiorly and inferiorly. The scanning parameters included a tube voltage of 100 kV, effective tube current of 70 mA, pitch of 1, reconstruction slice thickness of 0.625 mm, reconstruction slice interval of 0.625 mm, and field of view L-BODY. Subsequently, the puncture site was marked on the skin based on the acquired images. In the auxiliary device group, the laser device was also employed to determine the puncture angle (Fig. 2 A-D). Local anaesthesia was administered using 2% lidocaine hydrochloride (Shanghai Harvest Pharmaceutical Co., Ltd., China) from the skin to the bone cortex or the soft tissue near the tumour edge at the specified angle. A disposable biopsy needle (PAG0915, STERYLAB S.r.l, Italy) was utilised to extract the biopsy specimens (Fig. 4 , A, B). These specimens were fixed in formaldehyde and sent to the pathology department for evaluation by an experienced bone and soft tissue pathologist. Some patients underwent bone tumour resection surgery at our hospital following the biopsy, with their postoperative pathology results serving as the gold standard for diagnosis. The pathologist assessed the biopsy specimens, and those allowing a definitive diagnosis were categorised as “diagnostic.” However, if a definitive diagnosis could not be made but the nature of the lesion (benign or malignant) could be determined, the specimen was categorised as “acceptable.” Additionally, specimens that did not allow for a definitive diagnosis or determination of the nature of the lesion were categorised as “non-diagnostic.” In this study, biopsies categorised as “diagnostic” or “acceptable” were deemed “successful,” while those categorised as “non-diagnostic” were considered “failed.” Radiation Dose Assessment Radiation dose data for all CT-guided biopsy cases were extracted from the picture archiving and communication system, including the volume CT dose index (CTDI vol ) and dose-length product (DLP). The effective dose (ED) was computed using the formula ED = k × DLP, where k represents the tissue conversion factor derived from reference tables. This study only accounted for the radiation dose incurred during the biopsy procedure, excluding doses from the initial localisation and postoperative scans. Statistical Analysis Data were analysed using SPSS 29.0 (IBM Corp., USA). Normally distributed quantitative data were expressed as the mean ± standard deviation ( x̄ ± s ). The χ 2 test was utilised to compare sex distribution, tumour location, puncture success rate, and concordance rate between successful biopsies and surgical outcomes across the two groups. Furthermore, the puncture success rates for limb bones, limb-girdle bones, and axial bones in both groups were compared using the same test. The independent samples t -test was applied to assess differences in age, CTDI vol , DLP, and ED between the auxiliary device and control groups, as well as the disparities in CTDI vol , DLP, and ED for limb bones, limb-girdle bones, and axial bones between the two groups. Statistical significance was set at P < 0.05. Results General Information In total, 311 patients were enrolled in this study, comprising 160 women and 151 men. The age range of the patients spanned from 5 to 83 years, with an average age of 50.0 ± 19.7 years. The auxiliary device group included 114 patients (55 women and 59 men), with ages ranging from 11 to 82 years and a mean age of 50.91 ± 18.76 years. The control group comprised 197 patients (105 women and 92 men), with an age range of 5 to 83 years and a mean age of 49.51 ± 20.31 years. There were no statistically significant differences in sex or age distributions between the two groups (Table 1 ). The anatomical distribution of the lesions is detailed in Table 2 . Table 1 Patient characteristics Group Age (years) Sex Woman Man Auxiliary Device Group 50.91 ± 18.76 55 59 Control Group 49.51 ± 20.31 105 92 t-value -0.604 χ 2 value 0.738 P-value 0.546 0.412 Table 2 Distribution of tumour locations among enrolled patients Limb Bones Limb Girdles Axial Bones Total Auxiliary Device Group 69 11 34 114 Control Group 103 32 62 197 Total 172 43 96 311 Summary of Puncture Biopsy Success Rates Among all biopsy cases, the proportions of “diagnostic,” “acceptable,” and “non-diagnostic” outcomes were 70.42% (219/311), 8.04% (25/311), and 21.54% (67/311), respectively. The most frequent diagnoses among the “diagnostic” cases were metastatic tumours (20.6%, 64/311), followed by non-tumorous lesions (9.6%, 30/311), and enchondromas (8.0%, 25/311). Among the 30 non-tumorous lesions, there were 24 inflammatory lesions, 2 cases of coagulative necrosis, 1 case of bone infarction, 2 cases of Paget disease, and 1 simple fracture. In the auxiliary device group, the proportions of “diagnostic,” “acceptable,” and “non-diagnostic” outcomes were 71.93% (82/114), 13.16% (15/114), and 14.91% (17/114), respectively. In the control group, these proportions were 69.54% (137/197), 5.08% (10/197), and 25.38% (50/197), respectively. Summary of Patients Undergoing Surgical Resection for Bone Tumours Among the 144 cases where lesions were surgically excised, the most prevalent diagnoses were enchondroma (20 cases) and metastatic tumours (18 cases). The proportions of “diagnostic,” “acceptable,” and “non-diagnostic” cases were 75.69% (109/144), 8.33% (12/144), and 15.97% (23/144), respectively. Within the auxiliary device group, 56 patients underwent surgical resection, with 50 cases classified as successful biopsies. The concordance rate between biopsy outcomes and the gold standard was 90% (45/50). The remaining six cases were categorised as “non-diagnostic,” including two bone cysts, one intermediate lesion, one vascular lymphangioma, one chondromyxoid fibroma, and one non-tumorous lesion (diagnosed as intraosseous fat necrosis with fibrosis, calcification, and focal bone infarction). Conversely, in the control group, 88 patients underwent surgical resection, with 71 successful biopsy cases. The concordance rate between biopsy outcomes and the gold standard was 90.14% (64/71). The remaining 17 cases were classified as “non-diagnostic,” involving 2 aneurysmal bone cysts, 1 haemangioma, 3 benign lesions, 1 metastatic tumour, 1 chondromyxoid fibroma, 1 non-tumorous lesion (no tumour cells found in surgical specimens), 3 lipo-sclerosing myxofibrous tumours, 1 lipoma, 1 intraosseous ganglion cyst, 1 fibrous dysplasia of bone, 1 osteochondroma, and 1 bone cyst. Comparison of Puncture Biopsy Success Rates Between the Auxiliary Device and Control Groups The puncture biopsy success rate in the auxiliary device group was 85.09% (97/114), compared to 74.62% (147/197) in the control group. This difference in the overall puncture biopsy success rates between the auxiliary device and control groups was statistically significant ( χ 2 = 4.682, P = 0.032). Subgroup analysis revealed that for limb bones, the biopsy success rates were 85.51% (59/69) in the auxiliary device group and 70.87% (73/103) in the control group, showing a statistically significant difference ( χ 2 = 4.96, P = 0.028). For limb girdles, the success rates were 72.72% (8/11) in the auxiliary device group and 84.38% (27/32) in the control group, with no statistically significant difference ( χ 2 = 0.73, P = 0.66). For axial bones, the success rates were 88.24% (30/34) in the auxiliary device group and 75.81% (47/62) in the control group. Similarly, the difference was not statistically significant ( χ 2 = 2.14, P = 0.19). The concordance rates between successful biopsy cases and surgical results were 90% (45/50) in the auxiliary device group and 90.14% (64/71) in the control group, and showed no statistically significant difference ( χ 2 = 0.001, P = 1.00). Comparison of Radiation Dose Between Auxiliary Device and Control Groups The CTDI vol , DLP, and ED doses in the auxiliary device and control groups are outlined in Table 3 . There was no significant difference in CTDI vol between the auxiliary device and control groups ( t = -1.12, P = 0.27). However, significant differences were observed in the DLP ( t = 3.49, P < 0.001) and ED ( t = 3.69, P < 0.001), with the auxiliary device group exhibiting lower doses during CT-guided puncture biopsy. Subgroup analysis revealed that for limb girdle bones, there was no significant difference in the CTDI vol between the auxiliary device and control groups for limb girdles ( t = -0.45, P = 0.66), limb bones ( t = -1.20, P = 0.23), or axial bones ( t = 0.25, P = 0.8). Furthermore, no significant differences were observed in the DLP ( t = -0.84, P = 0.41) or ED ( t = -0.82, P = 0.42). Conversely, for limb bones, significant differences were noted in both the DLP ( t = 2.55, P = 0.012) and ED ( t = 2.55, P = 0.012). Similarly, for axial bones, significant differences were observed in the DLP ( t = 2.91, P = 0.005) and ED ( t = 3.21, P = 0.002). Table 3 CTDI vol , DLP, and ED data for puncture biopsies in different tumour locations for the auxiliary device and control groups (units provided) Limb Girdles Limb Bones Axial Bones All Cases CTDI vol (mGy) Control Group 10.48 ± 2.96 10.39 ± 2.65 9.99 ± 1.70 10.28 ± 2.45 Auxiliary Device Group 10.95 ± 2.91 10.97 ± 3.68 9.88 ± 2.27 10.64 ± 3.27 DLP (mGy×cm) Control Group 466.05 ± 191.38 367.30 ± 229.05 602.70 ± 267.76 457.42 ± 257.62 Auxiliary Device Group 536.78 ± 355.92 288.43 ± 175.36 433.94 ± 280.00 353.37 ± 246.46 ED (mSv) Control Group 7.01 ± 2.85 5.47 ± 3.41 8.71 ± 3.99 6.74 ± 3.80 Auxiliary Device Group 8.05 ± 5.33 4.23 ± 2.61 5.99 ± 3.93 5.13 ± 3.56 Discussion According to various reports, the diagnostic accuracy of CT-guided percutaneous biopsy varies significantly, with diagnostic rates ranging from 49–98% and false-negative rates between 2% and 8% [ 12 – 16 ] . In this study, the puncture success rates were 85% in the auxiliary device group and 75% in the control group, indicating a higher success rate in the former. We employed a soft guiding template to enhance the accuracy of the puncture entry point, supplemented by a laser device projecting beams at a predetermined angle. The entry angle of the puncture needle was ensured by aligning it with the laser beams. The combination of these two tools helped match the puncture entry point and angle to the preset path, thereby ensuring that the biopsy sample was procured at the targeted tissue visualised in the CT images. Thus, these findings confirmed a higher puncture success rate in patients using the auxiliary devices. Limited studies exist on the impact of puncture position and angle on biopsy success rates. Despite the increase in the recent use of 3D-printed templates for biopsy and seed implantation, which can effectively improve puncture accuracy [ 17 , 18 ] , these templates are costly and complex to prepare, limiting their widespread adoption. Moreover, most 3D-printed templates are used for lung biopsies and are less suitable for intraosseous lesions that have not breached the cortex. Furthermore, the puncture process through the bone cortex can cause the template to shift, leading to inaccurate positioning. In contrast, the laser device used in this study offers non-contact auxiliary positioning, making it less affected by the puncture process and more suitable for musculoskeletal system biopsies. Certain pathological lesions, such as lymphomas, have lower diagnostic rates compared to those of other malignancies, possibly owing to compression artifacts during biopsy sampling [ 19 ] . Among benign lesions, histiocytosis typically exhibits a lower diagnostic rate [ 20 ] . Cystic lesions and tumours with high necrotic content often result in lower diagnostic rates because of difficulties in obtaining effective samples. Additionally, lesions with a rich blood supply may yield lower diagnostic rates as the sample can be diluted with blood. Consistent with the above, lesions like aneurysmal bone cysts, haemangioendotheliomas, haemangiomas, and intraosseous ganglion cysts showed a 100% failure rate in both the auxiliary device and control groups in this study. We posit that this might be because these lesions predominantly consist of liquid components, making it challenging to extract effective tissue samples through puncture biopsy, thus increasing the failure rate. In this study, there were four cases of failed biopsies where the pathological results of the surgical specimens were only qualitative diagnoses rather than definitive ones. Among these, one was classified as an “intermediate lesion” and three were “benign lesions.” This likely stemmed from the lack of distinctive features within the lesions, making it difficult to derive a definite diagnosis even from surgical specimens. Moreover, as biopsy samples are localised, obtaining a conclusive diagnosis is even more challenging. Remarkably, the biopsy success rate for sclerosing epithelioid fibrosarcoma was 50% (3/6), with all successful cases belonging to the control group. We speculate that this may be attributed to the complex composition of this tumour type [ 21 , 22 ] , where biopsy samples may not adequately represent the entire lesion, leading to a lower success rate. Specifically, in the auxiliary device group, one biopsy failed for chondroblastoma, likely because of procedural errors. In the control group, one patient with a metastatic tumour experienced biopsy failure, possibly because the biopsy needle targeted a necrotic tumour area, leading to a sample with insufficient diagnostic components for a definitive diagnosis. Studies suggest that approximately 1% of newly diagnosed cancers each year are related to medical radiation exposure [ 23 , 24 ] . The dose-response curve between radiation exposure and cancer risk is generally considered linear [ 25 ] . Increased radiation exposure during CT-guided percutaneous biopsies is primarily attributed to the repeated CT scans needed to adjust and confirm the needle direction [ 11 ] . In this study, using a soft guiding template and a laser device for CT-guided bone biopsies resulted in lower DLPs and EDs during biopsies of limb bones and axial bones compared to those in the control group. This finding is likely because the auxiliary devices improved the accuracy of the needle entry point and angle, thereby reducing the need for multiple scans and consequently decreasing overall radiation exposure. However, there was no significant difference in the radiation dose between the two groups for limb girdles. This may be attributed to the irregular shape and small size of these bones, where minor deviations in puncture position can affect the outcome, necessitating multiple confirmations of the needle angle and increasing the number of scans. Despite its strengths, this study has some limitations. First, the total number of cases is relatively small, which, together with the random assignment of groups, could lead to an uneven distribution of certain diseases between the two groups. Secondly, the laser device used in this study was fixed with a stand that had poor stability, potentially causing slight deviations in the laser beam. Future research should thus focus on enhancing the stability of this laser device. Lastly, the auxiliary device in this study only improved the accuracy of the puncture entry point and direction. However, the selection of the entry point and direction still depended on the imaging characteristics of the bone tumour on CT images. Future studies are thus needed to investigate whether combining CT and magnetic resonance images can further improve the biopsy success rate. Conclusion Combining a soft guiding template with a laser device can enhance the accuracy of the puncture entry point and angle in CT-guided bone biopsies, thereby improving biopsy success rates. This approach also minimises the need for repeated scans to adjust the needle angle, resulting in lower radiation exposure for patients during the procedure. Given these benefits, the proposed auxiliary devices demonstrate potential for broader adoption. Abbreviations CT: computed tomography; CTDIvol: volume CT dose index; DLP: dose-length product; ED: effective dose; 3D: three-dimensional Declarations Ethics approval and consent to participate This study was approved by the institutional review board(2024Medical Ethics Review Committee 152, Tianjin Hospital Medical Ethics Committee, Tianjin Hospital, China), and We obtained written informed consent from each patient. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The author(s) declared no potential conflicts of interest with respect to the research, author- ship, and/or publication of this article. Funding We declare that during the research and preparation of the paper titled "Use of a Soft Guiding Template and Laser Device Improves the Success Rate of Computed Tomography-Guided Bone Biopsies and Reduces Radiation Exposure", no external funding or sponsorship from any institution or individual has been received for this study. All research expenses, material costs, and time investments were borne by our personally. This declaration is hereby made. Authors' contributions Xl.W and Xh.M wrote the main manuscript text. Xl.W, Zl.J, Jy.Z, Jw.L, W.W, Zy.S perform CT-guided puncture biopsy procedure. Gy.X, Sh.D perform pathological analysis on specimens. All authors reviewed the manuscript Acknowledgments Authors would like to express my gratitude to the medical personnel who assisted in the diagnosis and treatment of these patients. Their support made our research endeavors possible. And we would like to thank Editage (www.editage.cn) for English language editing. References Zheng RS, Chen R, Han BF, Wang SM, Li L, Sun KX, et al. [Cancer incidence and mortality in China, 2022]. Zhonghua Zhong Liu Za Zhi. 2024;46:221-31. Xu Y, Shi F, Zhang Y, Yin M, Han X, Feng J, et al. Twenty‐year outcome of prevalence, incidence, mortality and survival rate in patients with malignant bone tumors. Int J Cancer. 2024;154:226-40. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5-29. Gami A, Shah A, Shankaralingappa S, Salunke AA, Gandhi J, Patel K, et al. Does an excision of needle bone biopsy tract affect the prognosis in patients with primary bone tumor? J Orthop. 2024;48:13-9. Mills MK, Leake RL, Crawford AM, Soltanolkotabi M, Hansford BG. Concepts in musculoskeletal bone and soft tissue biopsy. Semin Musculoskelet Radiol. 2021;25:711-24. Ariizumi T, Kawashima H, Yamagishi T, Oike N, Murayama Y, Umezu H, et al. Diagnostic accuracy of fine needle aspiration cytology and core needle biopsy in bone and soft tissue tumor: A comparative study of the image-guided and blindly performed procedure. Ann Diagn Pathol. 2022;59:151936. Horstmann PF, Hettwer WH, Petersen MM. Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction. J Orthop Surg (Hong Kong). 2018;26: 614435217:2309499018774929. Gerrand C, Athanasou N, Brennan B, Grimer R, Judson I, Morland B, et al. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res. 2016;6:7. Zensen S, Selvaretnam S, Opitz M, Bos D, Haubold J, Theysohn J, et al. Differences in radiation exposure of CT-guided percutaneous manual and powered drill bone biopsy. CVIR. Cardiovasc Intervent Radiol. 2021;44:1430-8. Kihira S, Koo C, Lee A, Aggarwal A, Pawha P, Doshi A. Reduction of radiation dose and scanning time while preserving diagnostic yield: a comparison of battery-powered and manual bone biopsy systems. AJNR Am J Neuroradiol. 2020;41:387-92. Xin B, Liu D, Lu P, Cao S, Bai G, Gao P, et al. The Application of ultrasonography-computed tomography fusion navigation technology in complex bone tumor biopsy: a randomized double-blind controlled trial. World neurosurg. 2024;181:e963-9. Burke MC, Garg A, Youngner JM, Deshmukh SD, Omar IM. Initial experience with dual-energy computed tomography-guided bone biopsies of bone lesions that are occult on monoenergetic CT[J]. Skeletal Radiol. 2019;48:605-13. Hegde V, Burke ZDC, Park HY, Zoller SD, Johansen D, Kelley BV, et al. Is core needle biopsy reliable in differentiating between aggressive benign and malignant radiolucent bone tumors? Clin Orthop Relat Res. 2018;476:568-77. Mitsuyoshi G, Naito N, Kawai A, Kunisada T, Yoshida A, Yanai H, et al. Accurate diagnosis of musculoskeletal lesions by core needle biopsy. J Surg Oncol. 2006;94:21-7. Wu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG. Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided core-needle biopsy? Radiology. 2008;248:962–70. Kilpatrick SE, Cappellari JO, Bos GD, Gold SH, Ward WG. Is fine-needle aspiration biopsy a practical alternative to open biopsy for the primary diagnosis of sarcoma? Experience with 140 patients. Am J Clin Pathol. 2001;115:59-68. Ji Z, Sun H, Jiang Y, Guo F, Peng R, Fan J, et al. Comparative study for CT-guided (125)I seed implantation assisted by 3D printing coplanar and non-coplanar template in peripheral lung cancer. J Contemp Brachyther. 2019;11:169-73. Chen E, Zhang Y, Zhang H, Jia C, Liang Y, Wang J. Dosimetry study of three-dimensional print template for 125I implantation therapy. Radiat Oncol. 2021;16:115. Chang CY, Huang AJ, Bredella MA, Torriani M, Halpern EF, Rosenthal DI, et al. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies. Skeletal Radiol. 2015;44:1795-803. Yang J, Frassica FJ, Fayad L, Clark DP, Weber KL. Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions. Clin Orthop Relat Res. 2010;468:3103-11. Barnds B, Grote C, Mettman D, Templeton K. Liposclerosing myxofibrous tumor in a patient with prostate cancer: a Case Report. JBJS Case Connect. 2019;9:e0411. Zhang M, Zhang D, Yu W, Wang C. Liposclerosing myxofibrous tumor of the distal femur: a case report. Front Surg. 2022;9:1009975. Lim H, Choi J, Kim JH, Cheong HK, Ha M. Estimation of cancer incidence and mortality risks attributed to diagnostic medical radiation exposure in korea, 2013. J Korean Med Sci. 2018;33:e211. Marant-Micallef C, Shield KD, Vignat J, Cléro E, Kesminiene A, Hill C, et al. The risk of cancer attributable to diagnostic medical radiation: estimation for France in 2015. Int J Cancer. 2019;144:2954-63. Upton AC. National coluncil on radiation protection and measurements scientific COMMITTEE 1-6. The state of the art in the 1990’s. NCRP Rep. 2003;136 on the scientific bases for linearity in the dose-response relationship for ionizing radiation[J]. Health Phys:85. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Apr, 2025 Read the published version in BMC Medical Imaging → Version 1 posted Editorial decision: Revision requested 23 Jan, 2025 Reviews received at journal 23 Jan, 2025 Reviewers agreed at journal 20 Jan, 2025 Reviews received at journal 22 Dec, 2024 Reviewers agreed at journal 05 Dec, 2024 Reviewers agreed at journal 21 Oct, 2024 Reviewers invited by journal 30 Aug, 2024 Editor invited by journal 16 Aug, 2024 Editor assigned by journal 16 Aug, 2024 Submission checks completed at journal 16 Aug, 2024 First submitted to journal 28 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4817712","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":349538982,"identity":"540f2496-92b3-4e76-acd8-9c9eaef0ae84","order_by":0,"name":"Xiaoliang Wang","email":"","orcid":"","institution":"Tianjin Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaoliang","middleName":"","lastName":"Wang","suffix":""},{"id":349538984,"identity":"250f40ad-e093-4fa5-b4a7-b903ca45fc8f","order_by":1,"name":"Zhenye Sun","email":"","orcid":"","institution":"Tianjin Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhenye","middleName":"","lastName":"Sun","suffix":""},{"id":349538985,"identity":"84b55ac4-3b32-4379-b9fa-36b37e1d2ac7","order_by":2,"name":"Zhilin Ji","email":"","orcid":"","institution":"Tianjin Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhilin","middleName":"","lastName":"Ji","suffix":""},{"id":349538986,"identity":"131c2c6d-adc6-4478-a2cc-ebd2f8cb24f1","order_by":3,"name":"Jingyu Zhang","email":"","orcid":"","institution":"Tianjin Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jingyu","middleName":"","lastName":"Zhang","suffix":""},{"id":349538988,"identity":"997815a1-7217-46b5-bca1-d8049ea621f1","order_by":4,"name":"Guangyi Xiong","email":"","orcid":"","institution":"Tianjin Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guangyi","middleName":"","lastName":"Xiong","suffix":""},{"id":349538989,"identity":"fc9891bd-6b07-4408-8d42-d3c221035a14","order_by":5,"name":"Jinwei Liu","email":"","orcid":"","institution":"Tianjin Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinwei","middleName":"","lastName":"Liu","suffix":""},{"id":349538991,"identity":"7311cdb9-f488-46e5-8ac5-957eb660a392","order_by":6,"name":"Wei Wang","email":"","orcid":"","institution":"Tianjin Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Wang","suffix":""},{"id":349538992,"identity":"affef5b2-7566-4c1e-9827-e2768892bd9c","order_by":7,"name":"Shuhui Dong","email":"","orcid":"","institution":"Tianjin Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shuhui","middleName":"","lastName":"Dong","suffix":""},{"id":349538993,"identity":"2e76aee3-f1cb-4892-b8f0-7f43ce5c74e5","order_by":8,"name":"Xianghong Meng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBACNgYeNoYEhgMQ3gcDGzvStDDOKEhLJsIeoBYGqBZmng+HGBsIaeBjP3vswcMddxK38y8+9tnG4AAzA/vhoxvwOownL90g8cyzxJ0zniXPzjG4w8fAk5Z2A68WCR4zicS2w4kbbpwxZs4xeMbMABQhVsv5z8wWBocZG4jXcr6HmZmBKC08OeYGQC3GG26wGTP2GKQlsxHyi3z7GbOHP9sOy244f/gxw48/Nnb87IeP4dWCABIJUHuJUw4C/AeIVzsKRsEoGAUjCwAAlXBMf4uwZmwAAAAASUVORK5CYII=","orcid":"","institution":"Tianjin Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xianghong","middleName":"","lastName":"Meng","suffix":""}],"badges":[],"createdAt":"2024-07-28 17:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4817712/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4817712/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12880-025-01652-x","type":"published","date":"2025-04-07T16:05:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66537333,"identity":"d2bfafda-5088-42b6-bee6-f62955728d4e","added_by":"auto","created_at":"2024-10-14 07:12:11","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":57812,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4817712/v1/8163954e41c58f507959c571.jpg"},{"id":66537335,"identity":"1b96c0c8-d894-4adc-8554-0df50be4b8a7","added_by":"auto","created_at":"2024-10-14 07:12:11","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":95689,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4817712/v1/eb1141e2d480bb0c3e60cce1.jpg"},{"id":66537334,"identity":"f762f6bd-6240-4e17-a863-b347cfbe3ffb","added_by":"auto","created_at":"2024-10-14 07:12:11","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":23508,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4817712/v1/d60cd16296670d1497cbd95d.jpg"},{"id":66537337,"identity":"2d3bf209-4319-401f-9101-7b0ab683216f","added_by":"auto","created_at":"2024-10-14 07:12:11","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":43034,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4817712/v1/8816c90fcd76b8e852080e13.jpg"},{"id":80558560,"identity":"ece24b11-0574-4d18-802b-747f12c2d604","added_by":"auto","created_at":"2025-04-14 16:14:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1041304,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4817712/v1/19a4bf51-0a84-4957-8fd9-3d13454283cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Use of a Soft Guiding Template and Laser Device Improves the Success Rate of Computed Tomography-Guided Bone Biopsies and Reduces Radiation Exposure","fulltext":[{"header":"Background","content":"\u003cp\u003eBone tumours, comprising both primary and secondary forms, exhibit a relatively high incidence rate. According to the 2020 World Health Organization classification, bone tumours are categorised as benign, intermediate (locally aggressive), and malignant, with malignant tumours associated with a notably poor prognosis. In China, the incidence of malignant bone tumours is approximately 1.87 per 100,000 individuals, representing 0.63% of all malignancies, with a mortality rate of 1.38 per 100,000, accounting for 0.78% of all cancer-related deaths \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The five-year relative survival rate for malignant bone tumours in China is approximately 25% \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, and most primary malignant bone tumours occur in adolescents and young adults \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, highlighting the need for precise early diagnosis and timely intervention to enhance survival and preserve limb function.\u003c/p\u003e \u003cp\u003eComputed tomography (CT)-guided percutaneous bone biopsy is the preferred diagnostic method for bone tumours. This minimally invasive technique offers substantial benefits with minimal risks, including bone structure preservation, minimal soft tissue damage, avoidance of general anaesthesia, shortened hospital stays, reduced medical expenses, minimal postoperative complications, and rare tumour dissemination \u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. The primary objective of percutaneous bone biopsy is distinction between benign and malignant bone tumours, thereby guiding clinicians to formulate appropriate treatment strategies. Benign bone tumours can be managed or treated with curettage, while malignant tumours typically require extensive resection and may require adjunctive radiotherapy and chemotherapy \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. For an accurate diagnosis, CT-guided biopsy specimens must contain adequate viable tumour tissue for pathological analysis \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. However, in bone tumours, particularly those with intact cortices, accessing the medullary cavity via a drilled cortical hole limits needle manoeuvrability post-insertion, thereby underscoring the criticality of precise alignment of the puncture site and angle with the intended trajectory. Generally, achieving such precision relies heavily on operator expertise and dexterity \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study aimed to employ a soft guiding template and an in-house developed laser device to enhance puncture site accuracy and establish precise needle insertion angles. The primary objective of employing these tools is to achieve precise targeting, procure a higher yield of tumour cells, and enhance biopsy success rates.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis study was approved by the institutional review board(2024Medical Ethics Review Committee 152), and We obtained written informed consent from each patient. We recruited a total of 506 patients who underwent CT-guided bone biopsy at Tianjin Hospital between January 2023 and January 2024. After excluding 167 cases handled by external teams and 28 cases where biopsy was hindered owing to personal reasons or coagulation abnormalities, 311 cases were ultimately included. Among these, 114 cases were randomly assigned to the auxiliary device group, which employed a soft guiding template and a laser device for biopsy assistance. The remaining 197 cases, without the utilisation of auxiliary devices, constituted the control group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePreparation of Auxiliary Equipment\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eSoft Guiding Template\u003c/h2\u003e \u003cp\u003eThe soft guiding template was prepared by mixing 5 g of barium sulphate (Type II) dry suspension (Qingdao Red Butterfly Precision Materials Co., Ltd., China) with 85 g of α, ω-dihydroxyl polydimethylsiloxane (Hoshine Silicon Industry Co., Ltd., China) to form a pre-catalyst viscous liquid compound. This mixture was then combined with 5 g of dimethyl silicone oil (Shin-Etsu Chemical Co., Ltd., China) and 5 g of dibutyltin dilaurate (Foshan Keneng New Materials Co., Ltd., China) to produce a final viscous liquid compound. Subsequently, the generated compound was poured into a pre-fabricated mould and solidified to produce a soft self-adhesive silicone template. This template adheres closely to the skin and facilitates precise selection of epidermal puncture points through its perforations (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, A-D).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eLaser Device\u003c/h2\u003e \u003cp\u003eGenerally, the puncture angle is determined by the built-in CT gantry lasers, which rotate the gantry to a pre-set angle. However, this approach only aids in positioning the rotation angle of the body\u0026rsquo;s axial plane and lacks three-dimensional (3D) guidance. Additionally, it requires operator proximity to the scanning gantry, potentially impeding the procedure. In this study, the laser device was enhanced by incorporating two laser projectors (DUKAL1, Shenzhen ATuMan Precision Machinery Technology Co., Ltd., China) positioned on either side of the CT table. These projectors emit lasers parallel and perpendicular to the puncture point at predetermined angles (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, A, B). During the procedure, the operator aligns the biopsy needle with the two lasers to puncture at the specified angle.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCT-Guided Biopsy\u003c/h2\u003e \u003cp\u003eIn the control group, a conventional guiding template was positioned on the skin surface at the predetermined puncture site. Conversely, in the auxiliary device group, a soft guiding template was utilised. CT scanning was conducted using a 64-slice CT scanner (Discovery CT750 HD, GE Healthcare, USA), encompassing an area extending 3 cm beyond the tumour both superiorly and inferiorly. The scanning parameters included a tube voltage of 100 kV, effective tube current of 70 mA, pitch of 1, reconstruction slice thickness of 0.625 mm, reconstruction slice interval of 0.625 mm, and field of view L-BODY. Subsequently, the puncture site was marked on the skin based on the acquired images. In the auxiliary device group, the laser device was also employed to determine the puncture angle (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA-D). Local anaesthesia was administered using 2% lidocaine hydrochloride (Shanghai Harvest Pharmaceutical Co., Ltd., China) from the skin to the bone cortex or the soft tissue near the tumour edge at the specified angle. A disposable biopsy needle (PAG0915, STERYLAB S.r.l, Italy) was utilised to extract the biopsy specimens (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, A, B). These specimens were fixed in formaldehyde and sent to the pathology department for evaluation by an experienced bone and soft tissue pathologist. Some patients underwent bone tumour resection surgery at our hospital following the biopsy, with their postoperative pathology results serving as the gold standard for diagnosis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe pathologist assessed the biopsy specimens, and those allowing a definitive diagnosis were categorised as \u0026ldquo;diagnostic.\u0026rdquo; However, if a definitive diagnosis could not be made but the nature of the lesion (benign or malignant) could be determined, the specimen was categorised as \u0026ldquo;acceptable.\u0026rdquo; Additionally, specimens that did not allow for a definitive diagnosis or determination of the nature of the lesion were categorised as \u0026ldquo;non-diagnostic.\u0026rdquo; In this study, biopsies categorised as \u0026ldquo;diagnostic\u0026rdquo; or \u0026ldquo;acceptable\u0026rdquo; were deemed \u0026ldquo;successful,\u0026rdquo; while those categorised as \u0026ldquo;non-diagnostic\u0026rdquo; were considered \u0026ldquo;failed.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRadiation Dose Assessment\u003c/h2\u003e \u003cp\u003eRadiation dose data for all CT-guided biopsy cases were extracted from the picture archiving and communication system, including the volume CT dose index (CTDI\u003csub\u003evol\u003c/sub\u003e) and dose-length product (DLP). The effective dose (ED) was computed using the formula ED\u0026thinsp;=\u0026thinsp;k \u0026times; DLP, where \u003cem\u003ek\u003c/em\u003e represents the tissue conversion factor derived from reference tables. This study only accounted for the radiation dose incurred during the biopsy procedure, excluding doses from the initial localisation and postoperative scans.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analysed using SPSS 29.0 (IBM Corp., USA). Normally distributed quantitative data were expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u003cem\u003ex̄ \u0026plusmn; s\u003c/em\u003e). The \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e test was utilised to compare sex distribution, tumour location, puncture success rate, and concordance rate between successful biopsies and surgical outcomes across the two groups. Furthermore, the puncture success rates for limb bones, limb-girdle bones, and axial bones in both groups were compared using the same test. The independent samples \u003cem\u003et\u003c/em\u003e-test was applied to assess differences in age, CTDI\u003csub\u003evol\u003c/sub\u003e, DLP, and ED between the auxiliary device and control groups, as well as the disparities in CTDI\u003csub\u003evol\u003c/sub\u003e, DLP, and ED for limb bones, limb-girdle bones, and axial bones between the two groups. Statistical significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information\u003c/h2\u003e \u003cp\u003eIn total, 311 patients were enrolled in this study, comprising 160 women and 151 men. The age range of the patients spanned from 5 to 83 years, with an average age of 50.0\u0026thinsp;\u0026plusmn;\u0026thinsp;19.7 years. The auxiliary device group included 114 patients (55 women and 59 men), with ages ranging from 11 to 82 years and a mean age of 50.91\u0026thinsp;\u0026plusmn;\u0026thinsp;18.76 years. The control group comprised 197 patients (105 women and 92 men), with an age range of 5 to 83 years and a mean age of 49.51\u0026thinsp;\u0026plusmn;\u0026thinsp;20.31 years. There were no statistically significant differences in sex or age distributions between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The anatomical distribution of the lesions is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMan\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuxiliary Device Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.91\u0026thinsp;\u0026plusmn;\u0026thinsp;18.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.51\u0026thinsp;\u0026plusmn;\u0026thinsp;20.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of tumour locations among enrolled patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLimb Bones\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLimb Girdles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAxial Bones\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuxiliary Device Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e311\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSummary of Puncture Biopsy Success Rates\u003c/h2\u003e \u003cp\u003eAmong all biopsy cases, the proportions of \u0026ldquo;diagnostic,\u0026rdquo; \u0026ldquo;acceptable,\u0026rdquo; and \u0026ldquo;non-diagnostic\u0026rdquo; outcomes were 70.42% (219/311), 8.04% (25/311), and 21.54% (67/311), respectively. The most frequent diagnoses among the \u0026ldquo;diagnostic\u0026rdquo; cases were metastatic tumours (20.6%, 64/311), followed by non-tumorous lesions (9.6%, 30/311), and enchondromas (8.0%, 25/311). Among the 30 non-tumorous lesions, there were 24 inflammatory lesions, 2 cases of coagulative necrosis, 1 case of bone infarction, 2 cases of Paget disease, and 1 simple fracture.\u003c/p\u003e \u003cp\u003eIn the auxiliary device group, the proportions of \u0026ldquo;diagnostic,\u0026rdquo; \u0026ldquo;acceptable,\u0026rdquo; and \u0026ldquo;non-diagnostic\u0026rdquo; outcomes were 71.93% (82/114), 13.16% (15/114), and 14.91% (17/114), respectively. In the control group, these proportions were 69.54% (137/197), 5.08% (10/197), and 25.38% (50/197), respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSummary of Patients Undergoing Surgical Resection for Bone Tumours\u003c/h2\u003e \u003cp\u003eAmong the 144 cases where lesions were surgically excised, the most prevalent diagnoses were enchondroma (20 cases) and metastatic tumours (18 cases). The proportions of \u0026ldquo;diagnostic,\u0026rdquo; \u0026ldquo;acceptable,\u0026rdquo; and \u0026ldquo;non-diagnostic\u0026rdquo; cases were 75.69% (109/144), 8.33% (12/144), and 15.97% (23/144), respectively. Within the auxiliary device group, 56 patients underwent surgical resection, with 50 cases classified as successful biopsies. The concordance rate between biopsy outcomes and the gold standard was 90% (45/50). The remaining six cases were categorised as \u0026ldquo;non-diagnostic,\u0026rdquo; including two bone cysts, one intermediate lesion, one vascular lymphangioma, one chondromyxoid fibroma, and one non-tumorous lesion (diagnosed as intraosseous fat necrosis with fibrosis, calcification, and focal bone infarction). Conversely, in the control group, 88 patients underwent surgical resection, with 71 successful biopsy cases. The concordance rate between biopsy outcomes and the gold standard was 90.14% (64/71). The remaining 17 cases were classified as \u0026ldquo;non-diagnostic,\u0026rdquo; involving 2 aneurysmal bone cysts, 1 haemangioma, 3 benign lesions, 1 metastatic tumour, 1 chondromyxoid fibroma, 1 non-tumorous lesion (no tumour cells found in surgical specimens), 3 lipo-sclerosing myxofibrous tumours, 1 lipoma, 1 intraosseous ganglion cyst, 1 fibrous dysplasia of bone, 1 osteochondroma, and 1 bone cyst.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Puncture Biopsy Success Rates Between the Auxiliary Device and Control Groups\u003c/h2\u003e \u003cp\u003eThe puncture biopsy success rate in the auxiliary device group was 85.09% (97/114), compared to 74.62% (147/197) in the control group. This difference in the overall puncture biopsy success rates between the auxiliary device and control groups was statistically significant (\u003cb\u003eχ\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.682, \u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;0.032).\u003c/p\u003e \u003cp\u003eSubgroup analysis revealed that for limb bones, the biopsy success rates were 85.51% (59/69) in the auxiliary device group and 70.87% (73/103) in the control group, showing a statistically significant difference (\u003cb\u003eχ\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.96, \u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;0.028). For limb girdles, the success rates were 72.72% (8/11) in the auxiliary device group and 84.38% (27/32) in the control group, with no statistically significant difference (\u003cb\u003eχ\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.73, P\u0026thinsp;=\u0026thinsp;0.66). For axial bones, the success rates were 88.24% (30/34) in the auxiliary device group and 75.81% (47/62) in the control group. Similarly, the difference was not statistically significant (\u003cb\u003eχ\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.14, \u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;0.19).\u003c/p\u003e \u003cp\u003eThe concordance rates between successful biopsy cases and surgical results were 90% (45/50) in the auxiliary device group and 90.14% (64/71) in the control group, and showed no statistically significant difference (\u003cb\u003eχ\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.001, \u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;1.00).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Radiation Dose Between Auxiliary Device and Control Groups\u003c/h2\u003e \u003cp\u003eThe CTDI\u003csub\u003evol\u003c/sub\u003e, DLP, and ED doses in the auxiliary device and control groups are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There was no significant difference in CTDI\u003csub\u003evol\u003c/sub\u003e between the auxiliary device and control groups (\u003cb\u003et\u003c/b\u003e = -1.12, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.27). However, significant differences were observed in the DLP (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.49, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and ED (\u003cb\u003et\u003c/b\u003e\u0026thinsp;=\u0026thinsp;3.69, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with the auxiliary device group exhibiting lower doses during CT-guided puncture biopsy.\u003c/p\u003e \u003cp\u003eSubgroup analysis revealed that for limb girdle bones, there was no significant difference in the CTDI\u003csub\u003evol\u003c/sub\u003e between the auxiliary device and control groups for limb girdles (\u003cem\u003et\u003c/em\u003e = -0.45, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.66), limb bones (\u003cem\u003et\u003c/em\u003e = -1.20, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.23), or axial bones (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.25, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.8). Furthermore, no significant differences were observed in the DLP (\u003cem\u003et\u003c/em\u003e = -0.84, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.41) or ED (\u003cem\u003et\u003c/em\u003e = -0.82, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.42). Conversely, for limb bones, significant differences were noted in both the DLP (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.55, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012) and ED (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.55, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012). Similarly, for axial bones, significant differences were observed in the DLP (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.91, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) and ED (\u003cem\u003et\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCTDI\u003csub\u003evol\u003c/sub\u003e, DLP, and ED data for puncture biopsies in different tumour locations for the auxiliary device and control groups (units provided)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLimb Girdles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLimb Bones\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAxial Bones\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAll Cases\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCTDI\u003csub\u003evol\u003c/sub\u003e\u003c/p\u003e \u003cp\u003e(mGy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuxiliary Device Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDLP\u003c/p\u003e \u003cp\u003e(mGy\u0026times;cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e466.05\u0026thinsp;\u0026plusmn;\u0026thinsp;191.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e367.30\u0026thinsp;\u0026plusmn;\u0026thinsp;229.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e602.70\u0026thinsp;\u0026plusmn;\u0026thinsp;267.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e457.42\u0026thinsp;\u0026plusmn;\u0026thinsp;257.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuxiliary Device Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e536.78\u0026thinsp;\u0026plusmn;\u0026thinsp;355.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e288.43\u0026thinsp;\u0026plusmn;\u0026thinsp;175.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e433.94\u0026thinsp;\u0026plusmn;\u0026thinsp;280.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e353.37\u0026thinsp;\u0026plusmn;\u0026thinsp;246.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eED\u003c/p\u003e \u003cp\u003e(mSv)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.71\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.74\u0026thinsp;\u0026plusmn;\u0026thinsp;3.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuxiliary Device Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.05\u0026thinsp;\u0026plusmn;\u0026thinsp;5.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.99\u0026thinsp;\u0026plusmn;\u0026thinsp;3.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.13\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to various reports, the diagnostic accuracy of CT-guided percutaneous biopsy varies significantly, with diagnostic rates ranging from 49\u0026ndash;98% and false-negative rates between 2% and 8% \u003csup\u003e[\u003cspan additionalcitationids=\"CR13 CR14 CR15\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. In this study, the puncture success rates were 85% in the auxiliary device group and 75% in the control group, indicating a higher success rate in the former. We employed a soft guiding template to enhance the accuracy of the puncture entry point, supplemented by a laser device projecting beams at a predetermined angle. The entry angle of the puncture needle was ensured by aligning it with the laser beams. The combination of these two tools helped match the puncture entry point and angle to the preset path, thereby ensuring that the biopsy sample was procured at the targeted tissue visualised in the CT images. Thus, these findings confirmed a higher puncture success rate in patients using the auxiliary devices.\u003c/p\u003e \u003cp\u003eLimited studies exist on the impact of puncture position and angle on biopsy success rates. Despite the increase in the recent use of 3D-printed templates for biopsy and seed implantation, which can effectively improve puncture accuracy \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, these templates are costly and complex to prepare, limiting their widespread adoption. Moreover, most 3D-printed templates are used for lung biopsies and are less suitable for intraosseous lesions that have not breached the cortex. Furthermore, the puncture process through the bone cortex can cause the template to shift, leading to inaccurate positioning. In contrast, the laser device used in this study offers non-contact auxiliary positioning, making it less affected by the puncture process and more suitable for musculoskeletal system biopsies.\u003c/p\u003e \u003cp\u003eCertain pathological lesions, such as lymphomas, have lower diagnostic rates compared to those of other malignancies, possibly owing to compression artifacts during biopsy sampling \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Among benign lesions, histiocytosis typically exhibits a lower diagnostic rate \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Cystic lesions and tumours with high necrotic content often result in lower diagnostic rates because of difficulties in obtaining effective samples. Additionally, lesions with a rich blood supply may yield lower diagnostic rates as the sample can be diluted with blood. Consistent with the above, lesions like aneurysmal bone cysts, haemangioendotheliomas, haemangiomas, and intraosseous ganglion cysts showed a 100% failure rate in both the auxiliary device and control groups in this study. We posit that this might be because these lesions predominantly consist of liquid components, making it challenging to extract effective tissue samples through puncture biopsy, thus increasing the failure rate.\u003c/p\u003e \u003cp\u003eIn this study, there were four cases of failed biopsies where the pathological results of the surgical specimens were only qualitative diagnoses rather than definitive ones. Among these, one was classified as an \u0026ldquo;intermediate lesion\u0026rdquo; and three were \u0026ldquo;benign lesions.\u0026rdquo; This likely stemmed from the lack of distinctive features within the lesions, making it difficult to derive a definite diagnosis even from surgical specimens. Moreover, as biopsy samples are localised, obtaining a conclusive diagnosis is even more challenging.\u003c/p\u003e \u003cp\u003eRemarkably, the biopsy success rate for sclerosing epithelioid fibrosarcoma was 50% (3/6), with all successful cases belonging to the control group. We speculate that this may be attributed to the complex composition of this tumour type \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, where biopsy samples may not adequately represent the entire lesion, leading to a lower success rate. Specifically, in the auxiliary device group, one biopsy failed for chondroblastoma, likely because of procedural errors. In the control group, one patient with a metastatic tumour experienced biopsy failure, possibly because the biopsy needle targeted a necrotic tumour area, leading to a sample with insufficient diagnostic components for a definitive diagnosis.\u003c/p\u003e \u003cp\u003eStudies suggest that approximately 1% of newly diagnosed cancers each year are related to medical radiation exposure \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. The dose-response curve between radiation exposure and cancer risk is generally considered linear \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Increased radiation exposure during CT-guided percutaneous biopsies is primarily attributed to the repeated CT scans needed to adjust and confirm the needle direction \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. In this study, using a soft guiding template and a laser device for CT-guided bone biopsies resulted in lower DLPs and EDs during biopsies of limb bones and axial bones compared to those in the control group. This finding is likely because the auxiliary devices improved the accuracy of the needle entry point and angle, thereby reducing the need for multiple scans and consequently decreasing overall radiation exposure. However, there was no significant difference in the radiation dose between the two groups for limb girdles. This may be attributed to the irregular shape and small size of these bones, where minor deviations in puncture position can affect the outcome, necessitating multiple confirmations of the needle angle and increasing the number of scans.\u003c/p\u003e \u003cp\u003eDespite its strengths, this study has some limitations. First, the total number of cases is relatively small, which, together with the random assignment of groups, could lead to an uneven distribution of certain diseases between the two groups. Secondly, the laser device used in this study was fixed with a stand that had poor stability, potentially causing slight deviations in the laser beam. Future research should thus focus on enhancing the stability of this laser device. Lastly, the auxiliary device in this study only improved the accuracy of the puncture entry point and direction. However, the selection of the entry point and direction still depended on the imaging characteristics of the bone tumour on CT images. Future studies are thus needed to investigate whether combining CT and magnetic resonance images can further improve the biopsy success rate.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCombining a soft guiding template with a laser device can enhance the accuracy of the puncture entry point and angle in CT-guided bone biopsies, thereby improving biopsy success rates. This approach also minimises the need for repeated scans to adjust the needle angle, resulting in lower radiation exposure for patients during the procedure. Given these benefits, the proposed auxiliary devices demonstrate potential for broader adoption.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCT: computed tomography; CTDIvol: volume CT dose index; DLP: dose-length product; ED: effective dose; 3D: three-dimensional\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional review board(2024Medical Ethics Review Committee\u0026nbsp;152, Tianjin Hospital Medical Ethics Committee, Tianjin Hospital, China), and We obtained written informed consent from each patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, author- ship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe\u0026nbsp;declare that during the research and preparation of the paper titled \u0026quot;Use of a Soft Guiding Template and Laser Device Improves the Success Rate of Computed Tomography-Guided Bone Biopsies and Reduces Radiation Exposure\u0026quot;,\u0026nbsp;no external funding or sponsorship from any institution or individual has been received for this study. All research expenses, material costs, and time investments were borne by\u0026nbsp;our\u0026nbsp;personally.\u003c/p\u003e\n\u003cp\u003eThis declaration is hereby made.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXl.W and Xh.M wrote the main manuscript text.\u0026nbsp;Xl.W, Zl.J, Jy.Z, Jw.L, W.W, Zy.S \u0026nbsp;perform CT-guided puncture biopsy procedure.\u0026nbsp;Gy.X,\u0026nbsp;Sh.D perform pathological analysis on specimens.\u0026nbsp;All authors reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors would like to express my gratitude to the medical personnel who assisted in the diagnosis and treatment of these patients. Their support made our research endeavors possible. And we would like to thank Editage (www.editage.cn) for English language editing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZheng RS, Chen R, Han BF, Wang SM, Li L, Sun KX, et al. [Cancer incidence and mortality in China, 2022]. Zhonghua Zhong Liu Za Zhi. 2024;46:221-31.\u003c/li\u003e\n\u003cli\u003eXu Y, Shi F, Zhang Y, Yin M, Han X, Feng J, et al. Twenty‐year outcome of prevalence, incidence, mortality and survival rate in patients with malignant bone tumors. Int J Cancer. 2024;154:226-40.\u003c/li\u003e\n\u003cli\u003eSiegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5-29.\u003c/li\u003e\n\u003cli\u003eGami A, Shah A, Shankaralingappa S, Salunke AA, Gandhi J, Patel K, et al. Does an excision of needle bone biopsy tract affect the prognosis in patients with primary bone tumor? J Orthop. 2024;48:13-9.\u003c/li\u003e\n\u003cli\u003eMills MK, Leake RL, Crawford AM, Soltanolkotabi M, Hansford BG. Concepts in musculoskeletal bone and soft tissue biopsy. Semin Musculoskelet Radiol. 2021;25:711-24.\u003c/li\u003e\n\u003cli\u003eAriizumi T, Kawashima H, Yamagishi T, Oike N, Murayama Y, Umezu H, et al. Diagnostic accuracy of fine needle aspiration cytology and core needle biopsy in bone and soft tissue tumor: A comparative study of the image-guided and blindly performed procedure. Ann Diagn Pathol. 2022;59:151936.\u003c/li\u003e\n\u003cli\u003eHorstmann PF, Hettwer WH, Petersen MM. Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction. J Orthop Surg (Hong Kong). 2018;26: 614435217:2309499018774929.\u003c/li\u003e\n\u003cli\u003eGerrand C, Athanasou N, Brennan B, Grimer R, Judson I, Morland B, et al. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res. 2016;6:7.\u003c/li\u003e\n\u003cli\u003eZensen S, Selvaretnam S, Opitz M, Bos D, Haubold J, Theysohn J, et al. Differences in radiation exposure of CT-guided percutaneous manual and powered drill bone biopsy. CVIR. Cardiovasc Intervent Radiol. 2021;44:1430-8.\u003c/li\u003e\n\u003cli\u003eKihira S, Koo C, Lee A, Aggarwal A, Pawha P, Doshi A. Reduction of radiation dose and scanning time while preserving diagnostic yield: a comparison of battery-powered and manual bone biopsy systems. AJNR Am J Neuroradiol. 2020;41:387-92.\u003c/li\u003e\n\u003cli\u003eXin B, Liu D, Lu P, Cao S, Bai G, Gao P, et al. The Application of ultrasonography-computed tomography fusion navigation technology in complex bone tumor biopsy: a randomized double-blind controlled trial. World neurosurg. 2024;181:e963-9.\u003c/li\u003e\n\u003cli\u003eBurke MC, Garg A, Youngner JM, Deshmukh SD, Omar IM. Initial experience with dual-energy computed tomography-guided bone biopsies of bone lesions that are occult on monoenergetic CT[J]. Skeletal Radiol. 2019;48:605-13.\u003c/li\u003e\n\u003cli\u003eHegde V, Burke ZDC, Park HY, Zoller SD, Johansen D, Kelley BV, et al. Is core needle biopsy reliable in differentiating between aggressive benign and malignant radiolucent bone tumors? Clin Orthop Relat Res. 2018;476:568-77.\u003c/li\u003e\n\u003cli\u003eMitsuyoshi G, Naito N, Kawai A, Kunisada T, Yoshida A, Yanai H, et al. Accurate diagnosis of musculoskeletal lesions by core needle biopsy. J Surg Oncol. 2006;94:21-7.\u003c/li\u003e\n\u003cli\u003eWu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG. Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided core-needle biopsy? Radiology. 2008;248:962\u0026ndash;70.\u003c/li\u003e\n\u003cli\u003eKilpatrick SE, Cappellari JO, Bos GD, Gold SH, Ward WG. Is fine-needle aspiration biopsy a practical alternative to open biopsy for the primary diagnosis of sarcoma? Experience with 140 patients. Am J Clin Pathol. 2001;115:59-68.\u003c/li\u003e\n\u003cli\u003eJi Z, Sun H, Jiang Y, Guo F, Peng R, Fan J, et al. Comparative study for CT-guided (125)I seed implantation assisted by 3D printing coplanar and non-coplanar template in peripheral lung cancer. J Contemp Brachyther. 2019;11:169-73.\u003c/li\u003e\n\u003cli\u003eChen E, Zhang Y, Zhang H, Jia C, Liang Y, Wang J. Dosimetry study of three-dimensional print template for 125I implantation therapy. Radiat Oncol. 2021;16:115.\u003c/li\u003e\n\u003cli\u003eChang CY, Huang AJ, Bredella MA, Torriani M, Halpern EF, Rosenthal DI, et al. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies. Skeletal Radiol. 2015;44:1795-803.\u003c/li\u003e\n\u003cli\u003eYang J, Frassica FJ, Fayad L, Clark DP, Weber KL. Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions. Clin Orthop Relat Res. 2010;468:3103-11.\u003c/li\u003e\n\u003cli\u003eBarnds B, Grote C, Mettman D, Templeton K. Liposclerosing myxofibrous tumor in a patient with prostate cancer: a Case Report. JBJS Case Connect. 2019;9:e0411.\u003c/li\u003e\n\u003cli\u003eZhang M, Zhang D, Yu W, Wang C. Liposclerosing myxofibrous tumor of the distal femur: a case report. Front Surg. 2022;9:1009975.\u003c/li\u003e\n\u003cli\u003eLim H, Choi J, Kim JH, Cheong HK, Ha M. Estimation of cancer incidence and mortality risks attributed to diagnostic medical radiation exposure in korea, 2013. J Korean Med Sci. 2018;33:e211.\u003c/li\u003e\n\u003cli\u003eMarant-Micallef C, Shield KD, Vignat J, Cl\u0026eacute;ro E, Kesminiene A, Hill C, et al. The risk of cancer attributable to diagnostic medical radiation: estimation for France in 2015. Int J Cancer. 2019;144:2954-63.\u003c/li\u003e\n\u003cli\u003eUpton AC. National coluncil on radiation protection and measurements scientific COMMITTEE 1-6. The state of the art in the 1990\u0026rsquo;s. NCRP Rep. 2003;136 on the scientific bases for linearity in the dose-response relationship for ionizing radiation[J]. Health Phys:85.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"CT-guided biopsies, bone tumours, Radiation dose","lastPublishedDoi":"10.21203/rs.3.rs-4817712/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4817712/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eConsidering the need for precision and operator expertise in performing bone tumour biopsies, this study aimed to investigate the impact of combining a soft guiding template with a laser device on the success rate of computed tomography (CT)-guided bone biopsies and the associated radiation dose.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cohort of 114 patients with bone tumours who required CT-guided biopsies were assigned to the auxiliary device group, utilizing a soft guiding template and a laser device. Another 197 patients, constituting the control group, underwent CT-guided biopsies with conventional guiding templates. The \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e test was employed to compare the biopsy success rates and concordance rates between biopsy findings and surgical outcomes in both groups. Additionally, biopsy success rates for limb bones, limb girdles, and axial bones were compared. Independent sample \u003cem\u003et\u003c/em\u003e-tests were used to analyse differences in age, volume CT dose index (CTDI\u003csub\u003evol\u003c/sub\u003e), dose-length product (DLP), and effective dose (ED) between groups, as well as the CTDI\u003csub\u003evol\u003c/sub\u003e, DLP, and ED for limb bones, limb girdles, and axial bones individually.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe biopsy success rate in the auxiliary device group (85.09%) was significantly higher compared to that in the control group (74.62%; \u003cb\u003eP\u003c/b\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Notably, no statistically significant difference was observed in the biopsy success rates for limb girdles and axial bones between both groups (\u003cb\u003eP\u003c/b\u003e\u0026thinsp;\u003cem\u003e\u0026gt;\u003c/em\u003e\u0026thinsp;0.05). In contrast, the biopsy success rate for limb bones was significantly higher in the auxiliary device group (85.51%) than in the control group (70.87%; \u003cb\u003eP\u003c/b\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, the concordance rate between biopsy findings and surgical outcomes did not differ significantly between the groups (\u003cb\u003eP\u003c/b\u003e\u0026thinsp;=\u0026thinsp;1.00). There was no significant difference in the CTDI\u003csub\u003evol\u003c/sub\u003e between the two groups for limb girdles, limb bones, and axial bones (\u003cb\u003eP\u003c/b\u003e\u0026thinsp;\u003cem\u003e\u0026gt;\u003c/em\u003e\u0026thinsp;0.05). While DLP and ED showed no significant differences for limb girdles (\u003cb\u003eP\u0026thinsp;\u0026gt;\u003c/b\u003e\u0026thinsp;0.05), they were significantly lower for limb bones and axial bones in the auxiliary device group compared to those in the control group (\u003cb\u003eP\u003c/b\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOverall, the combination of a soft guiding template and laser device significantly increased the success rate of CT-guided bone biopsies and reduced the associated radiation dose.\u003c/p\u003e","manuscriptTitle":"Use of a Soft Guiding Template and Laser Device Improves the Success Rate of Computed Tomography-Guided Bone Biopsies and Reduces Radiation Exposure","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-14 07:12:06","doi":"10.21203/rs.3.rs-4817712/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-23T21:55:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-23T21:45:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2025-01-20T11:50:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-22T14:45:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71074801113412524600936432374271852009","date":"2024-12-05T16:04:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13076582522415311335715601483187331058","date":"2024-10-21T12:00:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-30T13:46:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-16T08:28:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-16T08:23:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-16T08:23:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Imaging","date":"2024-07-28T17:20:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a9dd00e7-b41f-4816-a683-767bca264c06","owner":[],"postedDate":"October 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-14T16:08:40+00:00","versionOfRecord":{"articleIdentity":"rs-4817712","link":"https://doi.org/10.1186/s12880-025-01652-x","journal":{"identity":"bmc-medical-imaging","isVorOnly":false,"title":"BMC Medical Imaging"},"publishedOn":"2025-04-07 16:05:10","publishedOnDateReadable":"April 7th, 2025"},"versionCreatedAt":"2024-10-14 07:12:06","video":"","vorDoi":"10.1186/s12880-025-01652-x","vorDoiUrl":"https://doi.org/10.1186/s12880-025-01652-x","workflowStages":[]},"version":"v1","identity":"rs-4817712","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4817712","identity":"rs-4817712","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}