Low‐Dose Computed Tomography With Two‐ and Three‐Dimensional Postprocessing as an Alternative to Plain Radiography for Intrathecal Catheter Visualization: A Phantom Pilot Study

OBJECTIVES: In intrathecal drug delivery, visualization of the device has been performed with plain radiography. However, the visibility of the related structures can be problematic. In troubleshooting, after the contrast material injection via the catheter access port, a computed tomography (CT) scan has been used. In troubleshooting, we also used a non‐contrast CT scan with 2D and 3D reconstructions. With the current phantom study, we aimed to obtain high‐resolution imaging of a poor opaque catheter with the use of a low‐dose single‐energy 2D and 3D CT scan with limited radiation exposure as a substitute for plain radiography. MATERIALS AND METHODS: The catheter was placed into a fatty substance and mounted on an anthropomorphic abdomen phantom followed by CT with varying kVp settings and with added tin beam filtering. Dose levels corrected based on the spinal catheter tip on T8 would result in a calculated effective dose in the range of the mSv's calculated for the plain x‐ray examination. RESULTS: Ultimately, Sn100 kVp has the best trade‐off between visibility, artifacts, and noise for a fixed dose. Although 3D VRT imaging was challenging at this low dose level, we could make a full evaluation possible with complementary 2D projections. CONCLUSIONS: We could correctly identify the catheter and related structures, which supports the investigation of this in vivo and side‐by‐side evaluation with plain radiography. If found superior, then this technique may be able to replace plain radiography, while providing better visualization and acceptable radiation exposure. CONFLICT OF INTEREST: Dr. Delhaas reports personal fees from Medtronic Inc., as a previous consultant, outside the submitted work; Prof. van der Lugt reports grants from GE Healthcare, Siemens, Stryker, Medtronic, and Penumbra outside the submitted work.