A Comparison of Intraoperative Fluoroscopic Radiation Emission Using ALARA Methods Versus Image-Enhancement Technology in Single-Position Lateral Lumbar Surgery

Abstract

Background: Expanded interest in minimally invasive spine techniques has led to increased reliance on intraoperative imaging to guide surgical decision making. Attempts to minimize the amount of radiation by using the dosage 'as low as reasonably achievable' (ALARA) has proven acceptable in decreasing the risk to the surgeons and staff to a certain extent, though the reciprocal nature of radiation reduction and image usability (quality) challenge further expansion of ALARA in this setting. Emerging technologies propose to reduce the radiation requirements even further without compromising image quality. In this study, radiation emission and fluoroscopy time were evaluated when image-enhancing technology was applied to minimally invasive single-position lumbar surgery to further our understanding of how imageenhancement technology performs in comparison to established ALARA protocols. Methods: This was a retrospective case-control study which in radiation emission and intra-operative fluoroscopy time was measured in patients undergoing lateral based, single-position surgery. From Oct 2018 through July 2019, 68 patients underwent one-or two-level single-position, lateral-based lumbar fusions by the same surgeon and operative team (including radiation technologist) at one of two hospitals. Both hospitals utilize an ALARA protocol in the operating rooms. One institution has acquired image-enhancing technology which aims to further reduce radiation emission and exposure while the other uses standard ALARA techniques. Intraoperative radiation data were retrospectively reviewed for comparison.Results: Image-enhancing technology allowed for further reduction of radiation emission from the fluoroscope by 36% when compared to the current low-dose ALARA protocols. Operative workflow features within the image-enhancing system allowed for a reduction of overall fluoroscopic time requirements by 34%, which aided in the overall 36% reduction in radiation emission. Conclusion:Emerging image-enhancement technology allows for further reduction of radiation emission in the operating room by 36% when compared to current, low-dose protocols established by ALARA.