Radiation exposure in spine surgery using an image-guided system based on intraoperative cone-beam computed tomography: analysis of 107 consecutive cases

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The O-arm system in spine surgery allows greater accuracy, lower rate of screw misplacement, and reduced surgical time. Some concerns have been postulated regarding the radiation doses to patients and surgeons. To the best of the authors' knowledge, most of the studies in the literature were performed with the use of phantoms. The authors present data regarding radiation exposure of the surgeon and operating room (OR) staff in a consecutive series of patients undergoing spine surgery.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Radiation exposure data were collected in a series of 107 patients who underwent spine surgery using the O-arm system. The doses received by the surgeon and the staff were collected using electronic dosimeters.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>All patients underwent 1–3 scans. The mean radiation dose to the patients was 5.15 mSv (range 1.48–7.64 mSv). The mean dose registered for the scan operator was 0.005 μSv (range 0.00–0.03 μSv) while the other members of the surgical team positioned outside the OR received 0 μSv.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The O-arm system exposes patients to a higher radiation dose than standard fluoroscopy. However, considering the clear advantages of this system, this adjunctive dose can be considered acceptable. Moreover, the effective dose to the patient can be reduced using collimation or minimizing the parameters of the O-arm system used in this paper. The exposure to operators is essentially negligible when radioprotective garments and protocols are adopted as recommended by the International Commission on Radiological Protection.</jats:p></jats:sec>

Comparison Perioperative Factors During Minimally Invasive Pre-Psoas Lateral Interbody Fusion of the Lumbar Spine Using Either Navigation or Conventional Fluoroscopy

“…Compared to the C-ARM group, the RE to patients was significantly lower in O-arm group. Our results are coincidental to the previous report that RE to patients in whom the O-arm was used was less than a half that of C-arm in MIS lumbar fusion surgery 18 ; however, they are in contrast to the recent report by Costa et al 19 that the O-arm exposed patients to a higher radiation dose than fluoroscopy in spine surgery. The possible reasons were as follows: as the teaching hospital, more C-arm shots were taken as part of teaching for residents and fellows; the other one was that since the trajectory was not direct as in a transpsoas approach, there were times in which extra C-arm shots must be taken to assess the position of the instruments so as to avoid injury to the contralateral nerve root secondary to the oblique approach.…”

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

“…Compared to the C-ARM group, the RE to patients was significantly lower in O-arm group. Our results are coincidental to the previous report that RE to patients in whom the O-arm was used was less than a half that of C-arm in MIS lumbar fusion surgery [18] ; however, they are in contrast to the recent report by Costa et al [19] that the Oarm exposed patients to a higher radiation dose than fluoroscopy in spine surgery. The possible reasons were as follows: as the teaching hospital, more C-arm shots were taken as part of teaching for residents and fellows; the other one was that since the trajectory was not direct as in a transpsoas approach, there were times in which extra C-arm shots must be taken to assess the position of the instruments so as to avoid injury to the contralateral nerve root secondary to the oblique approach.…”

“…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. When compared to C-arm, the difference of dose of radiation would be based on how long the C-arm was used during the surgery.…”

Minimally invasive percutaneous robotic thoracolumbar pedicle screw implantation combined with three‐dimensional fluoroscopy can reduce radiation: A cadaver and phantom study

“…A radiation dose of 559 +/− 235 mGy‐cm for each procedure was described, using a mean of 2.72 intraoperative flat panel CT scans. Costa et al applied a predefined radiation protocol of 12.41 mGy CTDI for the cervical spine and 14.08 mGy CTDI for the lumbar spine using the O‐arm system and measured the mean radiation exposure for the patients, which amounted to 5.15 mSv. Mendelsohn et al measured the effective dose of a flat panel CT, which was 2.19 mSV for the cervical spine and 5.57 mSV for the lumbar spine.…”