CT guided biopsy

CT Appointments – RVI: 0191 2824330 Freeman Hospital: 0191 2231012

What is a CT Scan?

CT stands for Computerized Tomography and is a special type of x-ray that can look at various parts of the body including the brain, spine, chest, abdomen and joints.  The information from the x-rays is recorded in a series of cross sectional pictures or scans that can be built up into a three dimensional image of the area being examined.

What is a biopsy?

A biopsy is a test performed in the hospital to investigate the cause of a lump or other abnormal area within a patient.  A doctor takes a small piece of the tissue from the lump using a special type of needle.

What is a CT guided biopsy?

A CT guided biopsy is a biopsy test performed in the x-ray department.  A CT scanner is used to check the position of the biopsy needle, making sure that the correct piece of tissue is taken.

Who performs the scan?

The person who carries out the examination is called a radiologist (specialist x-ray doctor) and a radiographer. They will explain the procedure to you and show you how to position yourself.  It is important that you lie still for the duration of the scan.

Will anything prevent me from having the biopsy?

Yes. You should inform the hospital consultant looking after you, or the x-ray department as soon as possible if you are taking any tablets to thin the blood (warfarin, aspirin or clopidogrel) or if you have a medical condition which makes it hard for your blood to clot.  In the event of either of these, we may need to check your blood before the biopsy to ensure you are not at risk of bleeding too much after the test. You should also let your hospital consultant know if you are diabetic.

If I am diabetic, does this change anything?

Yes.  The preparation procedure may change. If you are diabetic and take insulin, you may need a drip to keep your blood sugars controlled.  This will be discussed with you on the ward prior to the procedure. Please ring the hospital department that you are attending, as below, and speak to a member of the medical staff (also see next question):

I take Metformin (Glucophage, Avandamet) Tablet. Does this change anything?

Yes – Metformin (Glucophage, Avandamet) is most commonly taken by diabetic patients to control blood sugar, but occasionally is taken for other conditions.  If you are taking Metformin, your preparation for the procedure may change.   Please ring the appropriate helpline telephone number, as above, and speak to a member of staff, who will be able to advise you.

What if I am pregnant?

CT scanning of pregnant women should be avoided whenever possible.

If you think you may be pregnant it is very important that you tell the nurse or radiographer before your scan.  To avoid accidental irradiation, all females between the ages of 11 and 55 years are asked the date of their last menstrual period (LMP).  From this information X-ray staff will decide if there is cause for the CT examination to be postponed or if it is safe to continue.

What preparation will I need?

You will need very little preparation. Almost all CT guided biopsies are performed while the patient is awake, with local anaesthetic (see below) used to numb the area.  Sometimes a sedative may be given, and very occasionally a general anaesthetic may be used.  If this is the case, you will be given specific instructions about eating and drinking before the test.  Otherwise you should eat and drink normally and continue to take any medication prescribed by your doctor.  You will be admitted to a hospital ward before your biopsy is performed and will usually be asked to change into a hospital gown before you are taken to the x-ray department.

What does the CT biopsy involve?

You will come to the x-ray department on a trolley or in your bed.  

The staff will check your details and you will be taken into the CT scan room. 

The doctor who will be performing the biopsy will talk to you about why it is being done, what will happen and what problems can occur following a biopsy.  You will be given the chance to ask any questions you may have. You will be asked to sign a consent form to confirm you understand this information before the test begins. 

You will be asked to lie on a couch which passes in and out of the CT scanner, and a wire marker will be placed over the area where the biopsy will be taken. 

You will move through the CT scanner as the first scans are taken. You may be asked to obey verbal instructions, for example “hold your breath” for a few seconds, if the chest or upper abdomen is being examined. The radiographer operating the scanner will explain if you need to do anything.

Once the doctor has decided where to put the needle, a pen mark will be made on your skin and it will be cleaned with a sterilising solution to kill any bacteria on the skin surface. 

Local anaesthetic (see below) will be injected into the skin and muscle underneath, by the doctor. This causes a brief stinging sensation and then makes the area numb. 

The doctor will then position the needle. This may involve briefly moving the couch in and out of the CT scanner to check the position of the needle. Once the doctor is happy that the needle is in the right place, the biopsy will be taken. 

You may hear or be aware of the clicking sound at this stage. The doctor will remove the needle and check the sample.  Sometimes more than one piece of tissue will be taken and if so, the biopsy needle will be put back into position for the next sample. 

Once the doctor has taken sufficient samples, a dressing will be placed over the area and you will be transferred back your bed or trolley. 

A nurse will come down from the ward and you will be taken back there. 

Once on the ward, the staff will check your pulse and blood pressure for several hours. 

During the injection of local anaesthetic:

• Your radiologist will ask you to keep quite still while the injection is given. 
• You may notice a stinging sensation or warm tingling feeling as the anaesthetic begins to take effect.
• Your procedure will only go ahead when you and your radiologist are sure that the area is numb.
• If you are not having sedation, you will remain alert and aware of your surroundings.
• Your radiologist is always near to you and you can speak to him/her whenever you want to.

 After the biopsy:

• Provided your pulse and blood pressure are normal, you will be allowed to go home later the same day. 
• The biopsy samples are sent to the laboratory where they are assessed by a pathologist.  
• The pathologist will send a report to your hospital doctor saying what has been found. 
• The results will then be discussed with you in clinic.

How long does my CT guided biopsy take?

The length of the procedure is variable. Some simple biopsies are performed within twenty minutes, but other more complex cases may take up to an hour. The radiology department staff will try to make you as comfortable as possible while you are having the procedure because it is important that you remain as still as possible.

How does it feel?

You should not experience anything to cause discomfort. A stinging sensation or warm tingling feeling as the local anaesthetic begins to take effect may be noticed.  Your procedure will only go ahead when you and your radiologist are sure that the area is numb.

When will I get my results?

The biopsy samples are sent to the laboratory where they are assessed by a pathologist.  The pathologist will send a report to your hospital doctor saying what has been found.  This usually takes about a week, but some more complex cases need longer time with the pathologist. The results will then be discussed with you in clinic.

What are the benefits of having a CT guided biopsy?

This examination will help us make the correct diagnosis so you will be able to be given the correct treatment.

Are there any risks associated with CT guided biopsy?

Like all X-ray machines, a CT scanner produces potentially harmful X-rays.  Modern equipment is designed to keep the dose to patients as low as possible.  If your doctor has asked for a scan, then he or she will have decided that the benefit of having the information that the scan gives, is greater than the risk of the dose of radiation.

The biopsy equipment can cause bleeding and damage to other structures in your body, but the CT scanner is used to identify the position of the biopsy needle and minimise the risk of this happening. You will have an opportunity to discuss the risks of the specific procedure you are having with the radiologist before the procedure is undertaken.

Since X-rays can harm unborn babies, if you are, or could be pregnant, please tell the radiographer or nurse before you have the scan. This is very important.

Can I drive home afterwards?

We advise that you do not drive home on the day of the biopsy. You should arrange alternative transport.

I need an ambulance/ transport. Do you arrange it?

If you need an ambulance/ transport, you should ask your GP Surgery to arrange it. You will need to give them three working days’ notice.  Please note that hospital transport is provided on medical need only.

What if I cannot attend for my appointment?

If your appointment time is not convenient please contact the relevant hospital department so that a more appropriate time can be arranged.  This will enable us to reallocate valuable scanning time to someone else.

What if I have any suggestions, questions or comments?

Should you have any suggestions or concerns, please make these known to the person conducting your examination or by letter addressed to the hospital that you are attending your examination:

The Departmental Manager, X-ray Department, Level 3, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP

The Departmental Manager, Main X-ray Department, Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN

Telephone: 0191 282 1099

Monday to Friday 8.30am to 5.00pm

Switchboard: 0191 233 6161 (24 hours)

The Patient Advice and Liaison Service (PALS) can offer on-the-spot advice and information about the NHS. You can contact them on freephone 0800 032 02 02 or email northoftynepals@nhct.nhs.uk.

Information produced by Sharon Iles, Superintendent Radiographer, Dr G Hide, Consultant Radiologist and Dr J Tuckett Consultant Radiologist.

Diagnostic Imaging Dataset

Information from your diagnostic test will contribute to the Diagnostic Imaging Dataset. 

The Diagnostic Imaging Dataset (DID) is a database that holds information on the imaging tests and scans carried out on NHS patients. This will allow the Health and Social Care Information Centre to see how different tests are used across the country.

Nothing will ever be reported that identifies you.  All information is stored securely. It is only made available to appropriate staff, and is kept strictly confidential. However, if you do not want your information to be stored in the DID, please tell the people who are treating you. They will make sure your information is not copied into the DID.

You may, at a later date, still decide to opt out.  Please contact the Health and Social Care Information Centre directly, their contact details are:

Telephone: 0845 300 6016 

Email: enquiries@ic.nhs.uk 

Website: www.ic.nhs.uk