Patient Dose in Fluoroscopically Guided Cervical Discectomy and Fusion

Abstract

Cervical discectomy and fusion (CDF) is a minimally invasive procedure, where the accurate placement of the implants is accomplished using fluoroscopic guidance. Therefore, the evaluation of the radiation dose becomes mandatory. The purpose of the current study was to assess patient dose during fluoroscopically guided anterior and/or posterior CDF procedures. Thirty-three patients undergoing single or multiple-level CDF were studied using a mobile C-arm system. Data regarding fluoroscopy time (FT), air kerma area product (KAP) and cumulative dose (CD) were recorded. Patient entrance surface dose (ESD), thyroid absorbed dose and effective dose (ED) were calculated from KAP measurements, utilizing the CALDoseX software. The average FT was 0.12 min (range 0.02-0.48 min), resulting to a KAP value of 0.21 Gy cm2 (range 0.01-1.46 Gy cm2) and a CD value of 0.96 mGy (range 0.04-6.58 mGy). The ESD ranged between 0.08 and 13.58 mGy (average 1.95 mGy), the ED between 0.001 and 0.097 mSv (average 0.015 mSv), while the dose absorbed by the thyroid ranged between 0.01 and 1.12 mGy (average 0.194 mGy). The dose associated with the CDF procedure is very low, comparable to that delivered by a lateral X-ray radiograph of the cervical spine. However, higher doses can be revealed, due to the non-optimum use of the X-ray system and extended FTs, mainly affected by complex clinical conditions, as well as the experience of the neurosurgeon. Additional studies need to be conducted for further investigation of the patient dose from the CDF procedure.

Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures

“…E may be calculated for interventional fluoroscopy examinations in different ways . In some publications, E is determined by using the irradiation geometry for the clinical protocol and radiation dose data for clinical procedures as inputs into a Monte Carlo radiation transport simulation that uses computational models of human anatomy . In other publications, the irradiation geometry for the clinical protocol and radiation dose data for clinical procedures are used as parameters for irradiation of physical anthropomorphic phantoms containing dosimeters .…”

“…30,35,41 In some publications, E is determined by using the irradiation geometry for the clinical protocol and radiation dose data for clinical procedures as inputs into a Monte Carlo radiation transport simulation that uses computational models of human anatomy. 9,[17][18][19]27,38,42,43 In other publications, the irradiation geometry for the clinical protocol and radiation dose data for clinical procedures are used as parameters for irradiation of physical anthropomorphic phantoms containing dosimeters. 37,[44][45][46] Published values of E in the literature are based on tissue weighting factors (w T ) from either International Commission on Radiological Protection (ICRP) Publication 60 47 or ICRP Publication 103.…”

Decreasing radiation dose with FluoroLESS Standalone Anterior Cervical Fusion

“…In reviewing the literature there were limited studies looking specifically at radiation exposure during anterior cervical discectomy and fusion (ACDF) as this procedure already has a low radiation dose exposure per procedure (33)(34)(35). This shows that more study is required has the cumulative dose can still have been dramatic effects have there are increasing trends in ACDF being performed in the outpatient settings (36).…”

“…This shows that more study is required has the cumulative dose can still have been dramatic effects have there are increasing trends in ACDF being performed in the outpatient settings (36). In a study by Metaxas, they demonstrated a low cumulative dose range of 0.96 mGy (range, 0.04−6.58 mGy) and ED between 0.001 and 0.097 mSv (average 0.015 mSv) (33). This study, however, has some limitations with the use of Caldose software which has no modality to estimate dose to the cervical spine.…”

Evaluation of patient dose during fluoroscopically guided cervical spinal fusion

“…For cervical interventions, the patient ESD, thyroid absorbed dose (which is the most radiosensitive organ inside the x-ray field), as well as the ED were calculated according to the method used in a previous study [478].…”