Radiation Exposure of Patient and Operating Room Personnel by Fluoroscopy and Navigation during Spinal Surgery

Bratschitsch, G.; Leitner, Lukas; Stücklschweiger, G.; Guss, H.; Sadoghi, Patrick; Puchwein, Paul; Leithner, Andreas; Radl, Roman

doi:10.1038/s41598-019-53472-z

Cited by 64 publications

(58 citation statements)

References 15 publications

(12 reference statements)

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“…For spatial scales s of 2 to 8, high errors above 10% occurred mostly outside of the primary X-ray, while for s = 16, the overall error distributions indicate a systematic trend. Figure 6 shows plots of the relative error and runtime performance measures of our method for a reduced number of simulated primary particles ranging from 1×10 6 to 1×10 8 for different scales s. Note that for 1 × 10 7 and 1 × 10 8 particles, the error increased with increasing the spatial scale s, while for fewer particles, the error decreased again with s = 8 and higher.…”

Section: Resultsmentioning

confidence: 99%

“…While diagnostic reference levels [4] serve as a guidance for the expected overall exposure of the patient, it is difficult to draw conclusions on organ dose levels from them. However, for complicated FGIs, e.g., neuro-interventional procedures, repeatedly acquired digital subtraction angiography acquisitions, cone-beam CT reconstructions, and biplane imaging can lead to high dose values [5][6][7][8][9]. They may cause DNA damage [10] or cataract [11].…”

Section: Introductionmentioning

confidence: 99%

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XDose: toward online cross-validation of experimental and computational X-ray dose estimation

et al. 2020

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Purpose As the spectrum of X-ray procedures has increased both for diagnostic and for interventional cases, more attention is paid to X-ray dose management. While the medical benefit to the patient outweighs the risk of radiation injuries in almost all cases, reproducible studies on organ dose values help to plan preventive measures helping both patient as well as staff. Dose studies are either carried out retrospectively, experimentally using anthropomorphic phantoms, or computationally. When performed experimentally, it is helpful to combine them with simulations validating the measurements. In this paper, we show how such a dose simulation method, carried out together with actual X-ray experiments, can be realized to obtain reliable organ dose values efficiently. Methods A Monte Carlo simulation technique was developed combining down-sampling and super-resolution techniques for accelerated processing accompanying X-ray dose measurements. The target volume is down-sampled using the statistical mode first. The estimated dose distribution is then up-sampled using guided filtering and the high-resolution target volume as guidance image. Second, we present a comparison of dose estimates calculated with our Monte Carlo code experimentally obtained values for an anthropomorphic phantom using metal oxide semiconductor field effect transistor dosimeters. Results We reconstructed high-resolution dose distributions from coarse ones (down-sampling factor 2 to 16) with error rates ranging from 1.62 % to 4.91 %. Using down-sampled target volumes further reduced the computation time by 30 % to 60 %. Comparison of measured results to simulated dose values demonstrated high agreement with an average percentage error of under $$10 \%$$ 10 % for all measurement points. Conclusions Our results indicate that Monte Carlo methods can be accelerated hardware-independently and still yield reliable results. This facilitates empirical dose studies that make use of online Monte Carlo simulations to easily cross-validate dose estimates on-site.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

XDose: toward online cross-validation of experimental and computational X-ray dose estimation

et al. 2020

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“…CT‐based navigation systems (including robotic guidance systems) allow the surgery to proceed without much additional intraoperative fluoroscopy and may critically reduce the cumulative radiation dose received by surgeons 11 ,. 14 …”

Section: Discussionmentioning

confidence: 99%

“…The authors demonstrated significantly decreased radiation exposure to the surgeon in the navigation cohort compared to the fluoroscopy cohort. They concluded that a spinal surgeon using navigation could perform up to 10 times the number of surgeries until maximum permissible annual effective radiation dose would be reached compared to fluoroscopy 14 . Although several studies have evaluated radiation burden during fluoroscopic‐guided and CT‐navigated spinal surgeries, detailed comparisons between fluoroscopic and robotic guidance are lacking 14 ,.…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopy time analysis of a prospective, multi‐centre study comparing robotic‐ and fluoroscopic‐guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery

Jamshidi

Massel

Liounakos

et al. 2020

Robotics Computer Surgery

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Background As minimally invasive spine surgery becomes more widespread, concerns regarding radiation exposure to surgeons and patients alike have become a growing concern. Robotic guidance has been developed as a way to increase the accuracy of instrumentation while decreasing radiation burden. Methods A retrospective analysis of a large, multi‐centre, prospective study comparing robotic‐guided (RG) to fluoroscopic‐guided (FG) (Multi‐centre, Partially Randomized, Controlled Trial of MIS Robotic vs. Freehand in Short Adult Degenerative Spinal Fusion Surgeries) was performed to evaluate for differences in radiation exposure between study groups. Results RG was associated with 78.3% (p < 0.001) and 79.8% (p < 0.001) reduction in total and per screw fluoroscopy times, respectively, as compared to FG. RG was also associated with a 50.8% (p < 0.001) reduction in total operative fluoroscopy time. Conclusions RG was associated with significantly lower fluoroscopy times compared to FG. This suggests that utilization of robotic navigation systems may result in decreased operative radiation exposure, which is a growing concern for surgeons performing minimally invasive spine surgery.

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“…der Komplikationen oder der Revisionsraten aufgrund einer Fehllage (Penetration) der Pedikelschrauben [4,17,18]. Da bei der CT-gestützten Navigation (CAN = auf Englisch: CT-assisted navigation) während des CT-Scans ein Verlassen des Operationssaals für Operateure und Personal möglich ist, sind diese kaum einer Strahlenexposition ausgesetzt [19]. Allerdings ist die fluoroskopisch gestützte Navigation (FAN = auf Englisch: fluoroscopic-assisted navigation) mit einer Strahlenexposition für den Operateur verbunden, da dieser bei der fluoroskopisch gestützten Implantation der Pedikelschrauben direkt am Patienten steht [20].…”

Section: Navigationsgestützte Operationsverfahrenunclassified

Intraoperative Radiation Exposure for Patients with Double-Curve Idiopathic Scoliosis in Freehand-Technique in Comparison to Fluoroscopic- and CT-Based Navigation

et al. 2020

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Background In the operative treatment of idiopathic scoliosis, posterior correction and fusion in freehand technique is a proven procedure and is frequently performed. Malpositioned pedicle screws can result in serious neurovascular complications. Intraoperative fluoroscopy and neurophysiological measurements are performed to ensure the correct position of pedicle screws. Newer procedures with fluoroscopic- and computertomographic-assisted navigation are advertised as less dangerous and with a more accurate screw position. Hypothesis Is the freehand technique used in the surgical treatment of idiopathic scoliosis safer than other methods with regard to complications caused by screw malposition and intraoperative radiation exposure? Material and Methods Register data of 34 consecutive idiopathic scoliosis patients with two structural curves (Lenke 3 and 6) were collected prospectively in our scoliosis center and were retrospectively analyzed. The following parameters were evaluated: total radiation product, time of fluoroscopy, number of fused segments, time of operation, blood loss, screw-related complications and number of instrumented pedicle screws. All values were given as mean ± standard deviation and statistically analyzed. Finally, our data were compared on accuracy of screw placement and radiation exposure to data from literature with screw placement under navigation. Results Average age at the time of surgery was 23.6 ± 12 years. The average thoracic curve was 69.2 ± 14.2° preoperatively and 21.7 ± 12.8° postoperatively (correction 69.9%), the average lumbar curve was 64.3° ± 10.8° preoperatively and corrected to 15.6 ± 10.4° postoperatively (correction 76.2%). The total radiation product per patient was 145.7 ± 86.1 cGy*cm², the time of fluoroscopy 31.7 ± 23.5 s (11.5 segments), the time of operation 267.2 ± 64.1 min and the blood loss 700.4 ± 522.3 ml. A total of 803 pedicle screws were placed. No screw-associated complications were detected in the entire collective. The comparison of our data with freehand placement of pedicle screws to literature data showed a noticeable higher radiation exposure for the patient during fluoroscopic- and computertomographic-assisted navigation. Discussion The results showed that positioning of pedicle screws with freehand technique in patients with idiopathic scoliosis is accompanied with considerably lower intraoperative radiation exposure compared to fluoroscopic- or computertomographic-assisted navigation. An increased radiation exposure of these typically young patients is associated with an increased long-term risk for the occurrence of radiation-induced malignant diseases. With appropriate surgical experience, placement of pedicle screws in freehand technique is safe and effective and with similar accuracy than screws placed under navigation, but produces significantly less radiation exposure to the patients.

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Radiation Exposure of Patient and Operating Room Personnel by Fluoroscopy and Navigation during Spinal Surgery

Cited by 64 publications

References 15 publications

XDose: toward online cross-validation of experimental and computational X-ray dose estimation

XDose: toward online cross-validation of experimental and computational X-ray dose estimation

Fluoroscopy time analysis of a prospective, multi‐centre study comparing robotic‐ and fluoroscopic‐guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery

Intraoperative Radiation Exposure for Patients with Double-Curve Idiopathic Scoliosis in Freehand-Technique in Comparison to Fluoroscopic- and CT-Based Navigation

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