A proposed combination of flat-panel detector and mobile X-ray systems for low-dose image-guided central venous catheter insertion

A central venous catheter (CVC) should be inserted at the optimum position to infuse medicines, blood products, nutrients, or fluids. Positioning of the catheter tip is commonly performed under landmark or fluoroscopic guidance. However, Japanese regulations do not allow the performing of fluoroscopy-guided procedures outside of the fluoroscopy room. We hypothesized that a new image-guided CVC placement technique by combining a wireless flat-panel detector (FPD) and a mobile X-ray system could be applied at the bedside to support CVC insertion. A CVC attached to a chest phantom in conjunction with the polymethyl methacrylate (PMMA) phantom was imaged, contrast-to-noise ratio (CNR) was measured with images, and radiologists and emergency physicians rated the catheter images using a Likert scale for visual evaluation. The minimum dose of the FPD and mobile X-ray system was reduced by at least 98% compared with that of the X-ray fluoroscopy system. The CNR decreased with the increasing PMMA phantom thickness. However, results of the visual evaluation were maintained at the clinically usable score with low-dose imaging up to a 6-cm thickness of the PMMA phantom. In conclusion, the combination of FPD and mobile X-ray systems is particularly effective in the emergency room setting where such procedures are required to be performed with urgency.