Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation

Mendelsohn, Daniel; Strelzow, Jason; Dea, Nicolas; Ford, Nancy L.; Batke, Juliet; Pennington, Andrew; Yang, Kaiyun; Ailon, Tamir; Boyd, Michael; Dvorak, Marcel F.; Kwon, Brian K.; Paquette, Scott; Charles, Fred; Street, John

doi:10.1016/j.spinee.2015.11.020

Cited by 160 publications

(110 citation statements)

References 53 publications

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“…These effects are subsequently worsened with any additional exposure past that threshold[16]. Examples of pathology associated with deterministic effects includes hair loss, skin erythema, skin burns, and cataract formation[17-19]. As the thresholds for deterministic effects are known in many cases, they can be prevented via careful monitoring of radiation exposure levels over short time-periods.…”

Section: Pathophysiology and Effects Of Radiation Exposurementioning

confidence: 99%

“…More worrisome are stochastic effects, in which incidence increases with exposure without any definitive time period or threshold exposure level[16]. Stochastic effects are most commonly associated with carcinogenesis and teratogenesis[17,20-23]. For example, Mastrangelo et al[21] determined that working as an orthopaedic surgeon was a significant risk factor for tumor development in a survey of cancer incidence amongst 316 hospital employees.…”

Section: Pathophysiology and Effects Of Radiation Exposurementioning

confidence: 99%

“…These imaging modalities are more frequently used because, unlike with preoperative imaging, they do not require as significant a degree of the time-consuming process of anatomic registration[17]. Furthermore, intraoperative imaging is a better representation of surgical anatomy than preoperative studies, as preoperative images do not reflect anatomic shifts and variations due to surgical positioning[35-40].…”

Section: Intraoperative Three-dimensional Imaging and Spinal Navigatimentioning

confidence: 99%

“…Multiple studies have determined that while O-arm imaging reduces radiation exposure to operative room personnel, it increases the radiation exposure to the patient[7,17,25,48-50]. Tabaraee et al[50] demonstrated such findings in a cadaveric study investigating the insertion of 160 pedicle screws under either C-arm or O-arm imaging.…”

Section: Intraoperative Three-dimensional Imaging and Spinal Navigatimentioning

confidence: 99%

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Radiation exposure and reduction in the operating room: Perspectives and future directions in spine surgery

Narain

Hijji

Yom

et al. 2017

WJO

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Intraoperative imaging is vital for accurate placement of instrumentation in spine surgery. However, the use of biplanar fluoroscopy and other intraoperative imaging modalities is associated with the risk of significant radiation exposure in the patient, surgeon, and surgical staff. Radiation exposure in the form of ionizing radiation can lead to cellular damage via the induction of DNA lesions and the production of reactive oxygen species. These effects often result in cell death or genomic instability, leading to various radiation-associated pathologies including an increased risk of malignancy. In attempts to reduce radiation-associated health risks, radiation safety has become an important topic in the medical field. All practitioners, regardless of practice setting, can practice radiation safety techniques including shielding and distance to reduce radiation exposure. Additionally, optimization of fluoroscopic settings and techniques can be used as an effective method of radiation dose reduction. New imaging modalities and spinal navigation systems have also been developed in an effort to replace conventional fluoroscopy and reduce radiation doses. These modalities include Isocentric Three-Dimensional C-Arms, O-Arms, and intraoperative magnetic resonance imaging. While this influx of new technology has advanced radiation safety within the field of spine surgery, more work is still required to overcome specific limitations involving increased costs and inadequate training.

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Section: Pathophysiology and Effects Of Radiation Exposurementioning

confidence: 99%

Section: Pathophysiology and Effects Of Radiation Exposurementioning

confidence: 99%

Section: Intraoperative Three-dimensional Imaging and Spinal Navigatimentioning

confidence: 99%

Section: Intraoperative Three-dimensional Imaging and Spinal Navigatimentioning

confidence: 99%

See 2 more Smart Citations

Radiation exposure and reduction in the operating room: Perspectives and future directions in spine surgery

Narain

Hijji

Yom

et al. 2017

WJO

View full text Add to dashboard Cite

show abstract

“…The use of navigation results in significantly less radiation exposure to the surgeon and OR staff (12). However, when intraoperative CT is used, there is an increased radiation exposure for the patient (12) when compared to the use of fluoroscopic imaging.…”

Section: Navigation and Robotics: What's In The Literature?mentioning

confidence: 99%

Highlights from the First Annual Spinal Navigation, Emerging Technologies and Systems Integration Meeting

Drazin¹,

Grunert²,

Härtl³

et al. 2018

Ann. Transl. Med.

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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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Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation

Cited by 160 publications

References 53 publications

Radiation exposure and reduction in the operating room: Perspectives and future directions in spine surgery

Radiation exposure and reduction in the operating room: Perspectives and future directions in spine surgery

Highlights from the First Annual Spinal Navigation, Emerging Technologies and Systems Integration Meeting

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

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