Patient Dose Comparison for Intraoperative Imaging Devices Used in Orthopaedic Lumbar Spinal Surgery

Moore, Bria M.; Womack, Kenneth Roland; Nguyen, Giao; Foster, Norah; Richardson, William; Yoshizumi, Terry

doi:10.5435/jaaosglobal-d-18-00030

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Previous works compared patient dose and IQ of different intraoperative imaging systems used in spinal surgery 14 , 19 – 22 The present work is the first to compare in a systematic way three systems including the dependence on patient size and a subjective evaluation of IQ of both pre-operative and post-operative images (i.e., with the presence of metal artifacts).…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…The authors also decided against organ dose as primary parameter, since artificial bone models, subsequently missing human tissue, were the subject of this study. The locations of the sensors were chosen based on results of studies on radiation dose during intraoperative 2D and 3D imaging of spinal procedures, which assessed the highest organ dose in the small intestine and red bone marrow region in the iliosacral joint and gonads [ 14 , 18 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…One sensor was placed ventral to the spine at the level of L1 (Fig. 2 A) and the second sensor was placed caudal in the area of the bladder or female reproductive organs according to the localizations most commonly used in literature [ 18 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

Radiation exposure for pedicle screw placement with three different navigation system and imaging combinations in a sawbone model

Beisemann,

Gierse,

Mandelka

et al. 2023

BMC Musculoskelet Disord

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Background Studies have shown that pedicle screw placement using navigation can potentially reduce radiation exposure of surgical personnel compared to conventional methods. Spinal navigation is based on an interaction of a navigation software and 3D imaging. The 3D image data can be acquired using different imaging modalities such as iCT and CBCT. These imaging modalities vary regarding acquisition technique and field of view. The current literature varies greatly in study design, in form of dose registration, as well as navigation systems and imaging modalities analyzed. Therefore, the aim of this study was a standardized comparison of three navigation and imaging system combinations in an experimental setting in an artificial spine model. Methods In this experimental study dorsal instrumentation of the thoracolumbar spine was performed using three imaging/navigation system combinations. The system combinations applied were the iCT/Curve, cCBCT/Pulse and oCBCT/StealthStation. Referencing scans were obtained with each imaging modality and served as basis for the respective navigation system. In each group 10 artificial spine models received bilateral dorsal instrumentation from T11-S1. 2 referencing and control scans were acquired with the CBCTs, since their field of view could only depict up to five vertebrae in one scan. The field of view of the iCT enabled the depiction of T11-S1 in one scan. After instrumentation the region of interest was scanned again for evaluation of the screw position, therefore only one referencing and one control scan were obtained. Two dose meters were installed in a spine bed ventral of L1 and S1. The dose measurements in each location and in total were analyzed for each system combination. Time demand regarding screw placement was also assessed for all system combinations. Results The mean radiation dose in the iCT group measured 1,6 ± 1,1 mGy. In the cCBCT group the mean was 3,6 ± 0,3 mGy and in the oCBCT group 10,3 ± 5,7 mGy were measured. The analysis of variance (ANOVA) showed a significant (p < 0.0001) difference between the three groups. The multiple comparisions by the Kruskall-Wallis test showed no significant difference for the comparison of iCT and cCBCT (p1 = 0,13). Significant differences were found for the direct comparison of iCT and oCBCT (p2 < 0,0001), as well as cCBCT and oCBCT (p3 = 0,02). Statistical analysis showed that significantly (iCT vs. oCBCT p = 0,0434; cCBCT vs. oCBCT p = 0,0083) less time was needed for oCBCT based navigated pedicle screw placement compared to the other system combinations (iCT vs. cCBCT p = 0,871). Conclusion Under standardized conditions oCBCT navigation demanded twice as much radiation as the cCBCT for the same number of scans, while the radiation exposure measured for the iCT and cCBCT for one scan was comparable. Yet, time effort was significantly less for oCBCT based navigation. However, for transferability into clinical practice additional studies should follow evaluating parameters regarding feasibility and clinical outcome under standardized conditions.

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State of the art advances in minimally invasive surgery for adult spinal deformity

Hussain

Uribe

et al. 2020

Spine Deform

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Patient Dose Comparison for Intraoperative Imaging Devices Used in Orthopaedic Lumbar Spinal Surgery

Cited by 4 publications

References 8 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

Radiation exposure for pedicle screw placement with three different navigation system and imaging combinations in a sawbone model

State of the art advances in minimally invasive surgery for adult spinal deformity

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