Fluoroscopically Guided Bone Marrow Biopsy

Bone marrow sampling and analyses are performed to obtain marrow specimens in a minimally invasive, reproducible, time efficient manner to diagnose hematologic disorders such as lymphoma, multiple myeloma, and leukemia.12345678 The American Cancer Society estimates 178520 cases of these diseases will be diagnosed in the United States in 2020.9 Bone marrow biopsies which are also used to evaluate disease progression and treatment response historically have been performed under palpation guidance. The long axis of the posterior ilium is obliquely oriented as can be seen in Figure 1B. [...]the fluoroscopic beam must also be oriented obliquely in order to be parallel to the long axis of the posterior ilium (Figure 3C). Keeping the biopsy needle between these lines ensures an intraosseous course (Figure 4). [...]the obliquity of the fluoroscopic beam providing the widest space between these lines allows for the greatest margin of safety and increases the likelihood of acquiring a longer biopsy sample. Additionally, the medial and lateral cortices are not parallel; they converge anteriorly and diverge posteriorly (Figure 6). [...]each line will be optimally viewed with different obliquities; typically, the medial border is more clearly seen with higher obliquities given its orientation in relation to the lateral border.