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• Hematologic disorders such as leukemia, lymphoma, multiple myeloma, anemia, etc.
• Few if any
• Procedure can be performed in setting of thrombocytopenia
• Cellulitis at skin entry site or underlying soft tissue infection should prompt evaluation for different site
• Prior imaging cross sectional imaging of the pelvis
Most common site for bone marrow biopsy is iliac wing.
CT guidance commonly used.
• Prone patient with posterior approach
• Advance needle along length of the iliac wing.
• For right iliac wing biopsy, operator stands on patient's left and skin entry site is midline with lateral trajectory
• Seat needle just beyond cortex. Occasionally, helpful to have mallet to assist with seating the needle beyond the cortex
• Remove inner stylet. Aspirate with large volume syringe (20 - 30 mL)
• Following aspiration, advance biopsy device without inner stylet into iliac wing 2-3 cm,
• Can be helpful to gently rock biopsy device to help capture specimen. Many devices have additional tools to assist with specimen capture
Following successful aspirate and bone biopsy,
• Hemostasis with compression
• Apply sterile dressing
• Option to take final pictures confirming no immediate post operative complication
• Bleeding is most common
• Injury to surround structures
• Patient's can be sore 2-3 days following procedure
• Inadequate sample
• 15 minutes bedrest if local only
• Often times, moderate sedation will necessitate more recovery time than actual biopsy
 Cohen MG, McMahon CJ, Kung JW, Wu JS. Comparison of Battery-Powered and Manual Bone Biopsy Systems for Core Needle Biopsy of Sclerotic Bone Lesions. AJR Am J Roentgenol. 2016;206(5):W83‐W86. doi:10.2214/AJR.15.15067
 Lee RK, Ng AW, Griffith JF. CT-guided bone biopsy with a battery-powered drill system: preliminary results. AJR Am J Roentgenol. 2013;201(5):1093‐1095. doi:10.2214/AJR.12.10521
 BackTable, LLC (Producer). (2017, April 14). Ep 1 - BM BX Devices: Jamshidi vs OnControl [Audio podcast]. Retrieved from