Comparative Radiation Exposure Using Standard Fluoroscopy Versus Cone-Beam Computed Tomography for Posterior Instrumented Fusion in Adolescent Idiopathic Scoliosis

O’Donnell, Courtney; Maertens, Andrew; Bompadre, Viviana; Wagner, Theodore A.; Krengel, Walter F.

doi:10.1097/brs.0000000000000363

Cited by 22 publications

(24 citation statements)

References 17 publications

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“…16 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…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

White

Potts

et al. 2017

Global Spine Journal

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Study Design:Retrospective clinical study.Objectives:The aim of this study was to compare intraoperative conditions and clinical results of patients undergoing pre-psoas oblique lateral interbody fusion (OLIF) using navigation or conventional fluoroscopy (C-ARM) techniques.Methods:Forty-two patients (22 patients by navigation and 20 by fluoroscopy) underwent the OLIF procedure at 2 medical centers, and records were reviewed. Clinical data was collected and compared between the 2 groups. Patients were followed-up with a range of 6 to 24 months.Results:There were no significant differences on demographic data between groups. The navigation group had zero radiation exposure (RE) to the surgeon and radiation time compared to the C-ARM group, with total RE of 44.59 ± 26.65 mGy and radiation time of 88.30 ± 58.28 seconds (P < .05). The RE to the patient was significantly lower in the O-ARM group (9.38 mGy) compared to the C-ARM group (44.59 ± 26.65 mGy). Operating room time was slightly longer in the navigation group (2.49 ± 1.35 hours) compared to the C-ARM group (2.30 ± 1.17 hours; P > .05), although not statistically significant. No differences were found in estimated blood loss, length of hospitalization, surgery-related complications, and outcome scores with an average of 8-month follow-up.Conclusions:Compared with C-ARM techniques, using navigation can eliminate RE to surgeon and decrease RE to the patient, and it had no significant effect on operating time, estimated blood loss, length of hospitalization, or perioperative complications in the patients with OLIF procedure. This study shows that navigation is a safe alternative to fluoroscopy during the OLIF procedure in the treatment of degenerative lumbar conditions.

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“…16 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…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

White

Potts

et al. 2017

Global Spine Journal

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“…According to published effective doses of radiation estimated by O’Donnell et al, the total effective dose to 5 vertebral segments from navigation and confirmation scans using 3-D fluoroscopic navigation (O-arm) was 14.58 mSv. 23 , 24 Two-leveled TPS fixation above and below fractured levels is demanded in unstable TL spine fractures. Effective dose of radiation may be higher when using 3-D fluoroscopic navigation compared with the iCT navigation because 3 to 4 vertebral segments are visualized within 1 single scan of 3-D fluoroscopic navigation and more than 2 scans will be needed for multiple TL fractured levels.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Computed Tomography Navigation for Transpedicular Screw Fixation to Treat Unstable Thoracic and Lumbar Spine Fractures

Lee

et al. 2015

Medicine

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Transpedicular screw (TPS) fixation in unstable thoracic and lumbar (TL) spine fractures remains technically difficult because of destroyed anatomical landmarks, unstable gross segments, and discrepancies in anatomic orientation using conventional anatomic landmarks, fluoroscopic guidance, or computed tomography (CT)-based navigation. In this study, we evaluated the safety and accuracy of TPS placement under intraoperative computed tomography (iCT) navigation in managing unstable TL spine fractures.From 2010 to 2013, we retrospectively reviewed the Spine Operation Registry records of patients who underwent posterior instrumented fusion to treat unstable TL spine fractures via the iCT navigation system. An unstable spine fracture was identified as AO/Magerl classification type B or type C.In all, 316 screws in 37 patients with unstable TL spine fractures were evaluated and involved 7 thoracic, 23 thoracolumbar junctional, and 7 lumbar fractures. The accuracy of TPS positioning in the pedicle without breach was 98% (310/316). The average number of iCT scans per patient was 2.1 (range 2–3). The average total radiation dose to patients was 15.8 mSv; the dose per single level exposure was 2.7 mSv. The TPS intraoperative revision rate was 0.6% (2/316) and no neurovascular sequela was observed. TPS fixation using the iCT navigation system obtained a 98% accuracy in stabilizing unstable TL spine fractures. A malplaced TPS could be revised during real-time confirmation of the TPS position, and no secondary operation was required to revise malplaced screws.The iCT navigation system provides accurate and safe management of unstable TL spine fractures. In addition, operating room personnel, including surgeons and nurses, did not need to wear heavy lead aprons as they were not exposed to radiation.

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“…Other studies have investigated the patient's radiation dose from available systems and focused on the care needed to insure patient safety . While some radiation dose reduction during intraoperative 3D navigation compared to C‐arm fluoroscopy‐guided spine surgery may occur, complex spine deformity remains a surgery where radiation dose to the patient is still significant when performed with intraoperative 3D navigation compared to other conventional techniques …”

Section: Introductionmentioning

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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Comparative Radiation Exposure Using Standard Fluoroscopy Versus Cone-Beam Computed Tomography for Posterior Instrumented Fusion in Adolescent Idiopathic Scoliosis

Abstract: 4.

Cited by 22 publications

References 17 publications

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

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

Intraoperative Computed Tomography Navigation for Transpedicular Screw Fixation to Treat Unstable Thoracic and Lumbar Spine Fractures

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

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