Switching to a Pediatric Dose O-Arm Protocol in Spine Surgery Significantly Reduced Patient Radiation Exposure

Su, Alvin W.; Luo, T. David; McIntosh, Amy L.; Schueler, Beth A.; Winkler, Jennifer A.; Stans, Anthony A.; Larson, A. Noelle

doi:10.1097/bpo.0000000000000504

Cited by 56 publications

(37 citation statements)

References 31 publications

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“…Centers that both navigate the screws and perform a second check spin afterward or that routinely use the manufacturer settings will impart an even higher radiation dose to their patients with O-arm use. Centers that use the O-arm manufacturer dosing technique will expose patients to a much higher radiation dose, 22 given that the total effective dose of an O-arm scan using the manufacturer's recommended setting is 4.65 mSv compared with 0.65 mSv with low-dose pediatric O-arm settings. 22 Thus, the radiation dosing to the patient with O-arm depends on each individual surgeon's practices.…”

Section: Discussionmentioning

confidence: 99%

“…Centers that use the O-arm manufacturer dosing technique will expose patients to a much higher radiation dose, 22 given that the total effective dose of an O-arm scan using the manufacturer's recommended setting is 4.65 mSv compared with 0.65 mSv with low-dose pediatric O-arm settings. 22 Thus, the radiation dosing to the patient with O-arm depends on each individual surgeon's practices. For this study, we have used a minimal-dose protocol to reduce patient radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

“…22 In short, the effective dose of each scan was computed by converting the doselength product into organ doses using published coefficients, 26 then transformed into effective dose using the tissue weighing factors recommended by ICRP 103. 27 The total number of scans may increase to cover the desired levels of imaging or due to repeated scanning for better image quality.…”

Section: Radiation Dosimetry For Intraoperative O-arm Imagingmentioning

confidence: 99%

“…To minimize radiation exposure, 21 we adopted a "pediatric protocol" for intraoperative CT navigation in 2013, which results in significantly lower radiation dose compared with the manufacturer-recommended settings. 22 Intraoperative fluoroscopic guidance also generates ionizing radiation. The effective dose resulting from fluoroscopy guidance depends on the exposure time, fluoroscopy dose rate, patient distance from imaging source, exposure field of view, projection and levels of spine imaged, type of operating table, and surgeon's experience and may vary from one practice group to another.…”

mentioning

confidence: 99%

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How Does Patient Radiation Exposure Compare With Low-dose O-arm Versus Fluoroscopy for Pedicle Screw Placement in Idiopathic Scoliosis?

McIntosh

Schueler

et al. 2017

Journal of Pediatric Orthopaedics

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Radiation Dosimetry For Intraoperative O-arm Imagingmentioning

confidence: 99%

mentioning

confidence: 99%

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How Does Patient Radiation Exposure Compare With Low-dose O-arm Versus Fluoroscopy for Pedicle Screw Placement in Idiopathic Scoliosis?

McIntosh

Schueler

et al. 2017

Journal of Pediatric Orthopaedics

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“…If the operator does not make these two choices correctly, the degree of error is increased, which can lead to compromised patient care. Clinical sites have developed patient weight ranges to assist the operator in classifying patient size …”

Section: Discussionmentioning

confidence: 99%

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

Nachabé

Strauss

Schueler

et al. 2019

J Applied Clin Med Phys

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Careful protocol selection is required during intraoperative three‐dimensional (3D) imaging for spine surgery to manage patient radiation dose and achieve clinical image quality. Radiation dose and image quality of a Medtronic O‐arm commonly used during spine surgery, and a Philips hybrid operating room equipped with XperCT C‐arm 3D cone‐beam CT (hCBCT) are compared. The mobile O‐arm (mCBCT) offers three different radiation dose settings (low, standard, and high), for four different patient sizes (small, medium, large, and extra large). The patient's radiation dose rate is constant during the entire 3D scan. In contrast, C‐CBCT spine imaging uses three different field of views (27, 37, and 48 cm) using automatic exposure control (AEC) that modulates the patient's radiation dose rate during the 3D scan based on changing patient thickness. hCBCT uses additional x‐ray beam filtration. Small, medium, and large trunk phantoms designed to mimic spine and soft tissue were imaged to assess radiation dose and image quality of the two systems. The estimated measured “patient” dose for the small, medium, and large phantoms imaged by the mCBCT considering all the dose settings ranged from 9.4–27.6 mGy, 8.9–33.3 mGy, and 13.8–40.6 mGy, respectively. The “patient” dose values for the same phantoms imaged with hCBCT were 2.8–4.6 mGy, 5.7–10.0 mGy, and 11.0–15.2 mGy. The CNR for the small, medium, and large phantoms was 2.9 to 3.7, 2.0 to 3.0, and 2.5 to 2.6 times higher with the hCBCT system, respectively. Hounsfield unit accuracy, noise, and uniformity of hCBCT exceeded the performance of the mCBCT; spatial resolution was comparable. Added x‐ray beam filtration and AEC capability achieved clinical image quality for intraoperative spine surgery at reduced radiation dose to the patient in comparison to a reference O‐arm system without these capabilities.

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A review of computer‐assisted orthopaedic surgery systems

Wang

Shang

et al. 2020

Robotics Computer Surgery

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Background: Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. Methods: A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. Results and discussion: In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. Conclusion: Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.

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Switching to a Pediatric Dose O-Arm Protocol in Spine Surgery Significantly Reduced Patient Radiation Exposure

Abstract: Level III-retrospective comparative study.

Cited by 56 publications

References 31 publications

How Does Patient Radiation Exposure Compare With Low-dose O-arm Versus Fluoroscopy for Pedicle Screw Placement in Idiopathic Scoliosis?

How Does Patient Radiation Exposure Compare With Low-dose O-arm Versus Fluoroscopy for Pedicle Screw Placement in Idiopathic Scoliosis?

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

A review of computer‐assisted orthopaedic surgery systems

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