Image Quality and Dose Comparison of 3 Mobile Intraoperative Three-Dimensional Imaging Systems in Spine Surgery

Foster, Norah; Shaffrey, Christopher I.; Buchholz, Avery L.; Turner, Raymond D; Yang, Lexie Zidanyue; Niedzwiecki, Donna; Goode, Allen R.

doi:10.1016/j.wneu.2021.12.103

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…4). Similar results were obtained in Foster et al., 16 where O-arm images resulted in the poorest IQ among three intraoperative imaging devices when considering streak artifacts from metal implants. On the other hand, this explanation is in disagreement with the quantitative measurement of the streak artifacts where larger σartifact values were measured for the ClarifEye system compared to O-arm.…”

Section: Discussionsupporting

confidence: 88%

“…An assessment of the metal artifacts in the ART images was performed with the method suggested by Foster et al 16 Circular profiles centered in one of the titanium inserts were acquired (see Fig. 4), and the standard deviation of the soft tissue VD (σ artifact ) was calculated.…”

Section: Discussionmentioning

confidence: 99%

“…In spinal surgery, titanium pedicle screws are placed along the axial plane while titanium inserts were placed in the detector holes of the phantom perpendicularly to the axial plane. Moreover, bulkier implants are usually implanted resulting in larger artifacts as seen in Foster et al 16 Assessment of metal artifacts in a clinical setup (i.e., cadaveric studies as performed in Foster et al 16 ) should be performed for a comprehensive comparison of the systems. It should also be noted that MAR algorithms are in continuous development.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, bulkier implants are usually implanted resulting in larger artifacts as seen in Foster et al 16 . Assessment of metal artifacts in a clinical setup (i.e., cadaveric studies as performed in Foster et al 16 ) should be performed for a comprehensive comparison of the systems. It should also be noted that MAR algorithms are in continuous development 31 .…”

Section: Discussionmentioning

confidence: 99%

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Image quality and radiation dose in spinal surgery: a comparison of three imaging systems in phantom

et al. 2023

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.PurposeUsing optimal settings for x-ray scans is crucial for obtaining three-dimensional images of high quality while keeping the patient dose low. Our work compares dose and image quality (IQ) of three intraoperative imaging systems [O-arm cone-beam computed tomography (CBCT), ClarifEye C-arm CBCT, and Airo computed tomography] used for spinal surgery.ApproachPatients of 70, 90, and 110 kg were simulated with an anthropomorphic phantom by adding tissue-equivalent material. Titanium inserts were placed in the phantom spine for reproducing metal artifacts in the images. Organ dose was measured with thermo-luminescent dosimeters for effective dose (E) calculation. Subjective IQ was assessed by ranking the images acquired with the manufacturer-defined imaging protocols. Objective IQ was assessed with a customized Catphan phantom.ResultsThe ClarifEye protocols resulted in the lowest E ranging from 1.4 to 5.1 mSv according to phantom size and protocol. The highest E was measured for the high-definition protocol of O-arm (E 2.2 to 9 mSv) providing the best subjective IQ for imaging of the spine without titanium inserts. For the images with metal, the best IQ was obtained with ClarifEye. Airo (E 5.5 to 8.4 mSv) was ranked with the lowest IQ for images without metal while the rank improved for images with metal. Airo images had better uniformity, noise, and contrast sensitivity compared with CBCTs but worse high-contrast resolution. The values of these parameters were comparable between the CBCT systems.ConclusionsBoth CBCT systems provided better IQ compared with Airo for navigation of lumbar spinal surgery for the original phantom. Metal artifacts particularly affect O-arm images decreasing the subjective IQ. The high spatial resolution of CBCT systems resulted in a relevant parameter for the visibility of anatomical features important for spine navigation. Low dose protocols were enough to obtain a clinically acceptable contrast-to-noise ratio in the bones.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Image quality and radiation dose in spinal surgery: a comparison of three imaging systems in phantom

et al. 2023

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“…For screw evaluation, on the other hand, image quality may—depending on the imaging device—be highly influenced by metal artefacts. Comparative studies on image quality in posterior fixation have been performed in a specimen setting by Keil et al and, more recently, Foster et al who both investigated imaging devices also used in this study 27 , 43 . Their results indicate that the assessment of screw accuracy obtained in the present study may be due to the misplacement rate being overestimated as a consequence of the amount of artefacts surrounding the screw, which may also be indicated in Fig.…”

Section: Discussionmentioning

confidence: 97%

Comparison of three imaging and navigation systems regarding accuracy of pedicle screw placement in a sawbone model

Beisemann

Gierse

Mandelka

et al. 2022

Sci Rep

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Abstract3D-navigated pedicle screw placement is increasingly performed as the accuracy has been shown to be considerably higher compared to fluoroscopy-guidance. While different imaging and navigation devices can be used, there are few studies comparing these under similar conditions. Thus, the objective of this study was to compare the accuracy of two combinations most used in the literature for spinal navigation and a recently approved combination of imaging device and navigation system. With each combination of imaging system and navigation interface, 160 navigated screws were placed percutaneously in spine levels T11-S1 in ten artificial spine models. 470 screws were included in the final evaluation. Two blinded observers classified screw placement according to the Gertzbein Robbins grading system. Grades A and B were considered acceptable and Grades C-E unacceptable. Weighted kappa was used to calculate reliability between the observers. Mean accuracy was 94.9% (149/157) for iCT/Curve, 97.5% (154/158) for C-arm CBCT/Pulse and 89.0% for CBCT/StealthStation (138/155). The differences between the different combinations were not statistically significant except for the comparison of C-arm CBCT/Pulse and CBCT/StealthStation (p = 0.003). Relevant perforations of the medial pedicle wall were only seen in the CBCT group. Weighted interrater reliability was found to be 0.896 for iCT, 0.424 for C-arm CBCT and 0.709 for CBCT. Under quasi-identical conditions, higher screw accuracy was achieved with the combinations iCT/Curve and C-arm CBCT/Pulse compared with CBCT/StealthStation. However, the exact reasons for the difference in accuracy remain unclear. Weighted interrater reliability for Gertzbein Robbins grading was moderate for C-arm CBCT, substantial for CBCT and almost perfect for iCT.

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Comparing standard- and low-dose CBCT in diagnosis and treatment decisions for impacted mandibular third molars: a non-inferiority randomised clinical study

Hung,

Yeung,

Wong

et al. 2024

Clin Oral Invest

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Objective This randomised clinical study aimed to assess the influence of low-dose cone-beam computed tomography (CBCT) on the visibility of the mandibular canal (MC) and its proximity to mandibular third molars (M3Ms) as assessed by general dental practitioners (GPs) and oral-maxillofacial surgeons (OMFSs), as well as its impact on their clinical decisions, when compared to standard-dose CBCT. Methods 154 impacted M3Ms from 90 patients were randomly assigned to three groups for two CBCT exposures using one standard-dose (333 mGy×cm2) and one of the three investigated low-dose (78–131 mGy×cm2) protocols. Blinded assessments of the MC visibility, M3M-MC proximity, surgical approach, crown/root sectioning, and referral decisions, were made by GPs and OMFSs on the images separately. Pairwise comparisons for MC visibility between paired scans were evaluated using Wilcoxon signed rank test, followed by a non-inferiority test with non-inferiority margin of 0.5 on a four-point scale. Differences in other variables between paired scans were evaluated using Wilcoxon signed-rank or McNemar tests. Results The majority (78.5–99.3%) of MCs were clearly identified on standard-dose CBCT by all observers. Pairwise comparisons showed significant differences between paired scans only in MC visibility but not in the M3M-MC proximity or treatment decisions. The mean differences in MC visibility between paired scans ranged 0-0.22 with the upper bounds of the 95% confidence intervals (0.09–0.36) falling within the non-inferiority region. Conclusions The investigated low-dose CBCT protocols could provide acceptable image quality for the evaluation of impacted M3Ms in most cases. When compared to standard-dose CBCT, these low-dose CBCT images did not significantly affect the assessments of the M3M-MC proximity, treatment strategies, and patient management decisions made by GPs and OMFSs. Clinical relevance The low-dose protocols might be clinically acceptable for M3M management while greatly reducing radiation exposure.

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Image Quality and Dose Comparison of 3 Mobile Intraoperative Three-Dimensional Imaging Systems in Spine Surgery

Cited by 8 publications

References 22 publications

Image quality and radiation dose in spinal surgery: a comparison of three imaging systems in phantom

Image quality and radiation dose in spinal surgery: a comparison of three imaging systems in phantom

Comparison of three imaging and navigation systems regarding accuracy of pedicle screw placement in a sawbone model

Comparing standard- and low-dose CBCT in diagnosis and treatment decisions for impacted mandibular third molars: a non-inferiority randomised clinical study

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