Radiation exposure to the patients in thoracic and lumbar spine fusion using a new intraoperative cone-beam computed tomography imaging technique: a preliminary study

Kaminski, Ludovic; Cordemans, Virginie; Cartiaux, Olivier; Cauter, Maïté Van

doi:10.1007/s00586-017-4968-z

Cited by 24 publications

(12 citation statements)

References 24 publications

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“… 6 , 43 , 44 The radiation dose may be dramatically increased through optical intraoperation navigation technique compared with conventional open freehand pedicle screw insertion. 45 - 48 Although the surgical team have utilized many approaches of radiation protection to decrease the high exposure risk (e.g. whole-body apron, thyroid shield, safe distance, or shield room), the patient was still very exposed.…”

Section: Discussionmentioning

confidence: 99%

“…Because of Mazor's working theory, the combination of preoperative CT and intraoperative imaging can greatly reduce the radiation exposure of the medical team and patients, while the optical navigation robot system conducts intraoperative guidance with the aid of optical navigation, which still needs further research on the radiation exposure of the medical team and patients. Furthermore, Kaminski et al 48 demonstrated that radiation dose imparted to patients not only depended on operating time, surgical technique, and acquisition protocol but also on the patient’s body mass index (BMI). After the different units in radiation dose were removed by employing SMD, the difference in radiation dose between RA and CT was statistically significant (p < 0.001, Z test; I 2 = 97%).…”

Section: Discussionmentioning

confidence: 99%

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The safety and accuracy of robot-assisted pedicle screw internal fixation for spine disease

Chen

et al. 2020

Bone & Joint Research

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Aims The aim of this study was to systematically compare the safety and accuracy of robot-assisted (RA) technique with conventional freehand with/without fluoroscopy-assisted (CT) pedicle screw insertion for spine disease. Methods A systematic search was performed on PubMed, EMBASE, the Cochrane Library, MEDLINE, China National Knowledge Infrastructure (CNKI), and WANFANG for randomized controlled trials (RCTs) that investigated the safety and accuracy of RA compared with conventional freehand with/without fluoroscopy-assisted pedicle screw insertion for spine disease from 2012 to 2019. This meta-analysis used Mantel-Haenszel or inverse variance method with mixed-effects model for heterogeneity, calculating the odds ratio (OR), mean difference (MD), standardized mean difference (SMD), and 95% confidence intervals (CIs). The results of heterogeneity, subgroup analysis, and risk of bias were analyzed. Results Ten RCTs with 713 patients and 3,331 pedicle screws were included. Compared with CT, the accuracy rate of RA was superior in Grade A with statistical significance and Grade A + B without statistical significance. Compared with CT, the operating time of RA was longer. The difference between RA and CT was statistically significant in radiation dose. Proximal facet joint violation occurred less in RA than in CT. The postoperative Oswestry Disability Index (ODI) of RA was smaller than that of CT, and there were some interesting outcomes in our subgroup analysis. Conclusion RA technique could be viewed as an accurate and safe pedicle screw implantation method compared to CT. A robotic system equipped with optical intraoperative navigation is superior to CT in accuracy. RA pedicle screw insertion can improve accuracy and maintain stability for some challenging areas. Cite this article: Bone Joint Res 2020;9(10):653–666.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The safety and accuracy of robot-assisted pedicle screw internal fixation for spine disease

Chen

et al. 2020

Bone & Joint Research

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“…There are reports of higher overall doses of radiation by PIN versus PIF 7,[9][10][11] in heterogeneous groups of patients. However, in a previous investigation, 6 we could show that in patients without deformity operated on using a MIS technique without interbody fusion, dose of exposure to radiation of patients was reduced by 41% and for surgeons by 81%.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, there are reports of higher overall doses, for the patient, of radiation with PIN versus PIF 7,[9][10][11][12] which is a major concern especially in the surgery of paediatric deformities. Doody et al 13 reported that the incidence of breast cancer correlates with dose of radiation and is significantly higher in scoliosis patients than in the normal population.…”

Section: Introductionmentioning

confidence: 99%

Effective dose of radiation per screw in surgery of adolescent idiopathic scoliosis: Matched pair analysis of 293 pedicle screws inserted using three different techniques

Konieczny

Boos

Steuwe

et al. 2020

Journal of Children's Orthopaedics

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Purpose Reports on heterogenous groups of patients have indicated that pedicle screw insertion guided by navigation (PIN) leads to, for the patient, higher doses of radiation compared with pedicle screw insertion guided by fluoroscopy (PIF). This would be a major concern, especially in paediatric deformity correction. Methods After a power analysis (aiming at > 0.8) 293 pedicle screws which were inserted in patients with adolescent idiopathic scoliosis were analyzed by comparing effective dose and fluoroscopy time per screw for three different techniques. Groups 2 and 3 were matched to Group 1 by Lenke type of scoliosis. Group 1 were prospectively enrolled consecutive patients that have been operated on by PIN with image acquisition by preoperative CT scan (CTS). Group 2 were consecutive retrospectively matched patients who have been operated on by PIN with image acquisition by an intraoperative 3D scan (3DS). Group 3 were consecutive retrospectively matched patients who have been operated on by PIF. Results Mean dose of radiation per screw was 1.0 mSv (sd 0.8) per screw in CTS patients, 0.025 mSv (sd 0.001) per screw in 3DS patients and 0.781 mSv (sd 0.12) per screw in PIF patients. The difference was significant (p < 0.0001). Conclusion When we compared different techniques of navigation, navigation by image acquisition with CTS showed a significantly higher (by 97.5%) dose of radiation per screw for the patient than navigation by image acquisition by a 3DS. Navigation by 3DS showed significantly lower effective dose per screw for the adolescent patients than the fluoroscopic technique. Level of Evidence: II

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“…Notwithstanding these benefits, an open issue that merits comment is the amount of radiation exposure associated with the use of iVATS. Accordingly, there have been reports suggesting that the radiation dose delivered in a HOR environment may be even higher than that of a traditional CT-guided localization—especially to the attending personnel (15, 16). This critical point deserves further scrutiny.…”

Section: Discussionmentioning

confidence: 99%

Individualized Strategies for Intraoperative Localization of Non-palpable Pulmonary Nodules in a Hybrid Operating Room

Leow

Chao

2019

Front. Surg.

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Background: Precise preoperative localization of small pulmonary nodules is a key prerequisite to their successful excision. With the advent of hybrid operating rooms (HORs), a patient-tailored approach encompassing simultaneous localization and removal of small pulmonary nodules has become feasible. In this study, we describe our individualized image-guided video assisted thoracoscopic surgery (iVATS) strategies implemented within a HOR environment. Specifically, localization was performed through different marking approaches (single- vs. double-marker) and access routes [percutaneous technique with Dyna-computed tomography (DynaCT) imaging vs. electromagnetic navigation bronchoscopy (ENB)]. Methods: Between April 2017 and November 2018, a total of 159 consecutive patients (harboring 174 pulmonary nodules) were treated with iVATS. The marking approach and access route were individually tailored according to lesion localization and its distance from the pleural surface. The efficacy and safety of our iVATS technique were determined through a retrospective review of clinical charts. Results: All of the localization procedures were performed in a HOR by a single team of thoracic surgeons. The mean tumor size on preoperative CT was 8.28 mm (95% confidence interval [CI]: 7.6–8.96 mm), whereas their mean distance from the pleural surface was 9.44 mm (95% CI: 8.11–10.77 mm). Of the 174 tumors, 150 were localized through a percutaneous DynaCT-guided approach (single-marker: 139, dual-marker: 11), whereas localization in the remaining 24 was accomplished via the ENB-guided approach (single-marker: 4; dual-marker: 20). The mean localization time was 17.78 min (95% CI:16.17–19.39 min). The overall localization success rate was 95.9%. We failed to localize a total of seven nodules either because of technical complications (pneumothorax, n = 3; microcoil dislodgement; n = 1) or machine failure ( n = 3). No operative deaths were observed, and the mean length of postoperative stay was 3.65 days (95% CI: 3.19–4.11 days). Conclusions: The use of tailored marking approaches and access routes allowed us to individualize the iVATS procedure for small pulmonary nodules, ultimately promoting a more patient-centered workflow.

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Radiation exposure to the patients in thoracic and lumbar spine fusion using a new intraoperative cone-beam computed tomography imaging technique: a preliminary study

Cited by 24 publications

References 24 publications

The safety and accuracy of robot-assisted pedicle screw internal fixation for spine disease

The safety and accuracy of robot-assisted pedicle screw internal fixation for spine disease

Effective dose of radiation per screw in surgery of adolescent idiopathic scoliosis: Matched pair analysis of 293 pedicle screws inserted using three different techniques

Individualized Strategies for Intraoperative Localization of Non-palpable Pulmonary Nodules in a Hybrid Operating Room

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