In this episode of the Back Table MSK podcast, co-hosts and interventional radiologists Dr. Aaron Fritts and Dr. Chris Beck have an in-depth discussion about bone marrow biopsies, including their preferred techniques and devices, potential complications, and management of patient expectations.

To start, they cover the typical referral pathway for biopsies, the majority of which involve hematology/oncology indications. Preoperatively, managing patient expectations is important to communicate, especially regarding sedation and pain control. The IRs also walk through the biopsy steps, anatomy of the ilium, and confirmatory imaging with CT and fluoroscopy.

They also share their experiences with different biopsy needles such as the OnControl, Jamshid, and Trek systems. There are advantages to using a system that comes with a powered drill, but these can also increase patient anxiety. Additionally, it is important to consider the bone density of the patient when selecting the tool. A manual system may offer sufficient force for demineralized or osteoporotic bone. The hosts also discuss potential unintended outcomes of the procedure, including dry taps and entry into joints or sacral foramina. Finally, they review post-procedural care and patient emergence from sedation.

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SHOW NOTES

00:00 Introduction03:36 Indications for Biopsy05:40 Patient Consent and Sedation13:58 Procedural Steps and Confirmatory Imaging27:04 Comparison of Different Biopsy Tools36:11 Dealing with Complications41:00 Post-Procedural Care

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RESOURCES

BackTable VI Episode 381- Anesthesia vs. Moderate Sedation: A Spectrum of Care with Dr. Vishal Kumar:https://www.backtable.com/shows/vi/podcasts/381/anesthesia-vs-moderate-sedation-a-spectrum-of-care

OnControl Powered Bone Biopsy System:https://oncontrolsystem.com/

Jamshidi Evolve Bone Marrow Needle:https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle

Trek Powered Bone Biopsy System:https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system