• Elmar M Delhaas and Aad van der Lugt.
• Center for Pain Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
• Neuromodulation. 2019 Oct 1; 22 (7): 818-822.

ObjectivesIn 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 MethodsThe 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.ResultsUltimately, 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.ConclusionsWe 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 InterestDr. 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.© 2019 The Authors. Neuromodulation: Technology at the Neural Interface published by Wiley Periodicals, Inc. on behalf of International Neuromodulation Society.

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