Operating room radiation exposure in cone beam computed tomography–based, image-guided spinal surgery

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Surgeon and operating room (OR) staff radiation exposure during spinal surgery is a concern, especially with the increasing use of multiplanar fluoroscopy in minimally invasive spinal surgery procedures. Cone beam computed tomography (cbCT)–based, 3D image guidance does not involve the use of active fluoroscopy during instrumentation placement and therefore decreases radiation exposure for the surgeon and OR staff during spinal fusion procedures. However, the radiation scatter of a cbCT device can be similar to that of a standard 64-slice CT scanner and thus could expose the surgeon and OR staff to radiation during image acquisition. The purpose of the present study was to measure radiation exposure at several unshielded locations in the OR when using cbCT in conjunction with 3D image-guided spinal surgery in 25 spinal surgery cases.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Five unshielded badge dosimeters were placed at set locations in the OR during 25 spinal surgery cases in which cbCT-based, 3D image guidance was used. The cbCT device (O-ARM) was used in conjunction with the Stealth S7 image-guided platform. The radiology department analyzed the badge dosimeters after completion of the last case.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Fifty high-definition O-ARM spins were performed in 25 patients for spinal registration and to check instrumentation placement. Image-guided placement of 124 screws from C-2 to the ileum was accomplished without complication. Badge dosimetry analysis revealed minimal radiation exposure for the badges 6 feet from the gantry in the area of the anesthesiology equipment, as well as for the badges located 10–13 feet from the gantry on each side of the room (mean 0.7–3.6 mrem/spin). The greatest radiation exposure occurred on the badge attached to the OR table within the gantry (mean 176.9 mrem/spin), as well as on the control panel adjacent to the gantry (mean 128.0 mrem/spin).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Radiation scatter from the O-ARM was minimal at various distances outside of and not adjacent to the gantry. Although the average radiation exposure at these locations was low, an earlier study, undertaken in a similar fashion, revealed no radiation exposure when the surgeon stood behind a lead shield. This simple precaution can eliminate the small amount of radiation exposure to OR staff in cases in which the O-ARM is used.</jats:p></jats:sec>

Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned

“…14 However, our experience suggests that perhaps a larger volume of approximately [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] cases is required to demonstrate breach rates similar to those commonly reported in the literature. To our knowledge, the present report is the largest singlecenter series of thoracolumbar PSs placed using the O-arm and the first in the literature to quantify the learning curve for screw accuracy associ ated with this technology.…”

“…Computed tomography-based IGSS offers several advantages to the spine surgeon including greater accu racy of pedicle screw placement, 4,6,21,[24][25][26][27] minimal to no radiation exposure, 12,15,21,22 and potentially a short regis tration time. 5,[12][13][14] As with any new technology, CT-guid ed spinal surgery is prone to growing pains, which may force novice surgeons to abandon this technology early.…”

Comparison perioperative factors during minimally invasive pre-psoas lateral interbody fusion of the lumbar spine using either navigation or conventional fluoroscopy

“…Studies have shown improved accuracy for pedicle screw placement in spine surgery when using navigation [12][13][14] . In addition, it avoids RE to the surgeon [9,10,14,15] Surgeons have voiced concerns about the radiation dose they receive over a career of spine surgery. The cumulative RE places the surgeon at risk for the development of malignancy.…”

“…The incidence of thyroid cancer in spine surgeons was almost 40 times greater than the general population according to the Scoliosis Research Society Morbidity and Mortality Committee [16] . Navigation is one tool that may decrease this risk, with prior studies reporting navigation generating "0" or undetectable RE to surgeon and OR staff [9,17,18] . Despite the use of navigation greatly improving the accuracy in screw placement in spine surgery, there is still debate regarding the RE to patients by O-arm [18,19] The O-arm delivers a different dose of radiation, which ranged from 6 mGy to 66 mGy depending on the settings of the machine.…”

“…Comparative analysis in the operative records between navigation and fluoroscopy is summarized in Because the operating room staff left the room during the intraoperative O-arm spin, the navigation group showed "zero" in the total RE to the surgeon and room staff and total radiation time [9,10] The RE to the patient in the C-ARM group (44.59 ± 26.65 mGy) was significantly higher compared to the navigation group in view of the average RE of a spin is about 9.38 mGy according to the procedure and instruction of O-arm (P<.05). There were no differences in the overall incidence of surgery-related complications between the navigation group (32%) and C-ARM group (45%).…”