Cone Beam Computed Tomography with Navigation Versus Computed Tomography with Navigation for Percutaneous Fixation of Pathologic Fractures: A Comparison of Radiation Dose, Procedural Time, and Outcome.

PURPOSE: To assess the difference in procedure time, radiation dose, and pain outcome of percutaneous fixation by internal cemented screws (FICS) for pathologic fractures using cone beam computed tomography with navigation (CBCT-NAV) versus computed tomography with electromagnetic navigation (CT-NAV).

MATERIALS AND

METHODS

This IRB-approved, single institution retrospective study included patients who underwent percutaneous FICS for pathologic fractures between 2020 and 2025. Radiation dose, procedure time, and pain outcomes were compared between two groups based on the navigation system used during the procedure (CBCT-NAV vs. CT-NAV). Dose parameters were converted to effective dose for comparison.

RESULTS

A total of 37 procedures (32 patients) were identified, 20 in the CBCT-NAV group and 17 in the CT-NAV group. No significant differences were found between groups regarding age, gender, body mass index, primary cancer type, fracture location, lesion size, number of screws placed per patient, ablation performed, cementoplasty performed, pain reduction, or immediate adverse events. No significant differences were observed for effective dose (33.3 ± 30.1 vs. 39.4 ± 25.7 mSv, respectively, p = 0.514). Significant differences were observed for procedural time (108.6 ± 47.9 vs. 228.8 ± 79.8 min, respectively, p < 0.001).

CONCLUSION

CBCT navigation has a significantly lower procedural time compared to CT navigation for FCIS, with similar radiation dose and pain outcomes.