Fluoroscopic radiation exposure of the kyphoplasty patient

Boszczyk, Bronek M.; Bierschneider, Michael; Panzer, Stephanie; Panzer, W.; Harstall, Roger; Schmid, Katharina; Jaksche, H.

doi:10.1007/s00586-005-0952-0

Cited by 69 publications

(53 citation statements)

References 12 publications

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“…The conversion factors used for this study were taken from an actual publication from Gosch et al [22]. However, Boszczyk et al [8] report a mean effective dose of 4.28 mSv for their 16 estimated patients for kyphoplastie, which is quite similar to our estimated 5.6 mSv. A reason for our slightly higher effective dose can be the presence of the ovaries and uterus by applying radiation to the pelvis/ sacrum and using a sex-averaged conversion factor.…”

Section: Discussionsupporting

confidence: 76%

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Sacroplasty in a cadaveric trial: comparison of CT and fluoroscopic guidance with and without balloon assistance

et al. 2009

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Sacral insufficiency fractures can cause severe, debilitating pain to patients concerned. The incidence of this fracture type correlates with the appearance of osteoporosis in the elderly population. A polymethylmethacrylate (PMMA) cement injection procedure called sacroplasty has been recently described as an optional method for the treatment of this fracture type. However, the correct cement placement in the complex anatomical structure of the sacrum is a surgical challenge. The aim of the study is to compare the precision, safety, and radiation exposure of standard multiplanar fluoroscopy and computed tomography (CT) guidance for PMMA application to the sacrum using both balloon-assisted sacroplasty and conventional sacroplasty. A controlled experimental investigation in a human cadaver trial has been performed. Two imaging and two application modalities to monitor percutaneous PMMA injection to the sacrum were examined. The application forms were randomized from side to side of the pelvis. We found less cement extravasation in the CT-guided groups, but also a significant higher radiation exposure (P \ 0.05) by using CT guidance. The conventional fluoroscopy-guided sacroplasty revealed the shortest procedure time (incision to closure time) of all treatment groups (P \ 0.01). These findings show no difference regarding cement extravasation between ballonassisted and conventional sacroplasty. Further, in comparison to fluoroscopy-assisted technique, the CT-guided cement injection seems to decrease the risk of cement extravasation, irrespective of the use of an additional balloon assistance. However, we have to consider a greater radiation exposure using CT guidance. Further investigations will proof the suitability in the normal course of clinical life.

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Section: Discussionsupporting

confidence: 76%

“…two-third of the DAP) and lateral fluoroscopy (approx. one-third of the DAP) [8]. The conversion factors used for this study were taken from an actual publication from Gosch et al [22].…”

Section: Discussionmentioning

confidence: 99%

Sacroplasty in a cadaveric trial: comparison of CT and fluoroscopic guidance with and without balloon assistance

et al. 2009

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“…However, BKP is associated with nonnegligible radiation exposure for the patient, as well as for the surgeon [15,23]. There are frequent reports of surgeons achieving or exceeding the annual radiation dose limit.…”

Section: Discussionmentioning

confidence: 99%

“…Although the literature contains an impressive number of papers concerning balloon kyphoplasty, there are few data concerning fluoroscopy time during surgery or X-ray exposure dose to both the patient and the surgeon [14,15]. However, MIS is often associated with a high radiation exposure for both the patient and the surgeon due to a limited view of the surgical field [16].…”

mentioning

confidence: 99%

The surgeon’s real dose exposure during balloon kyphoplasty procedure and evaluation of the cement delivery system: a prospective study

2013

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Purpose Balloon kyphoplasty is currently widely used for the treatment of vertebral compression fractures (VCFs). Procedure safety is directly linked to precise radiological imaging generated by various X-ray systems (C-arm, O-arm Ò , angiography table, etc.). This minimally invasive spinal surgery is, by definition, associated with significant radiation exposure for both patient and surgeon. Real dose exposure received by the surgeon is usually difficult to precisely record. In our center, all Balloon Kyphoplasty Procedures (BKP) are now performed using an O-arm Ò image guidance system to control cement augmentation in VCF. Our preliminary experience described reduced dose exposure compared to C-arm guided procedures. We present here an additional way to considerably reduce the amount of radiation received by the surgeon during BKP using a new injection system. Methods We prospectively evaluated O-arm Ò guided BKP in 20 consecutive patients alternatively allocated to either classic O-arm Ò BKP with direct bone filler injection or BKP using a new Cement Delivery System (CDS). Eye, wrist, finger and leg measurements were taken bilaterally and compared between the two groups.Results The radiation dose received by the surgeon's finger, wrist and leg was reduced by greater than 80 % when using the CDS. It allows the surgeon to work way below the most severe annual limit of dose exposure, which may not be the case when using a classical bone filler direct injection mechanism. Conclusion We believe that when using this new intraoperative injection system, the surgeon's overall anatomic exposure is significantly reduced without compromising the critical procedure steps.Keywords Balloon kyphoplasty Á Vertebral compression fractures Á Radiation exposure Á Minimal invasive spinal surgery Á Cement delivery system Purpose As the population continues to age, the challenge for treating vertebral compression fractures (VCFs) due to osteoporosis, trauma, metastases and myeloma, and their respective complications will become increasingly prevalent. VCF mainly due to osteoporosis represents today a major concern amongst elderly patients, frequently leading to pain, disability and deterioration of quality of life. Every year worldwide an estimated 1.4 million VCFs cause pain and suffering [1][2][3]. Annually, there are an estimated 700,000 osteoporotic VCFs in the United States [4,5]. Approximately, 26 % of women over the age of 50 and 40 % of women over 80 years of age are reported to have sustained a VCF [4,6].At present, conservative non-surgical treatment of VCFs with drugs, surgical braces and rehabilitation still has shortcomings. Recently, the development of minimal invasive surgery (MIS), such as balloon kyphoplasty, has Electronic supplementary material The online version of this article

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“…Boszczyk et al [5] showed that with one level kyphoplasty the lifetime risk of developing cancer is theoretically increased by 0.02-0.06% (fluoroscopy guided). We can assume that the radiation dose is higher with CT-guided sacroplasty and so a patient's risk will be increased further.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature

2009

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Fluoroscopic radiation exposure of the kyphoplasty patient

Cited by 69 publications

References 12 publications

Sacroplasty in a cadaveric trial: comparison of CT and fluoroscopic guidance with and without balloon assistance

Sacroplasty in a cadaveric trial: comparison of CT and fluoroscopic guidance with and without balloon assistance

The surgeon’s real dose exposure during balloon kyphoplasty procedure and evaluation of the cement delivery system: a prospective study

Clinical outcomes of sacroplasty in sacral insufficiency fractures: a review of the literature

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