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

Abstract

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.

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

“…Intraoperative 3D imaging improves the accuracy compared to preoperative 3D registration as well as the time per screw placement, which significantly reduces radiation dose to the patients . 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 …”

Safety of Esophageal Stent Placement Without Fluoroscopy

“…Radiation may cause cellular damage by inducing DNA lesions. These effects often result in cell death or genetic instability, leading to an increased risk of malignancy (9). There are publications in the literature reporting that the procedure has been performed without fluoroscopy (10).…”

Brust- und Lendenwirbelsäulenfrakturen: Neues und Bewährtes

“…Geringere [6,9]. Ebenso ist trotz anders lautender Untersuchungsergebnisse [33] von einer Reduktion der intraoperativen Röntgenstrahlung auszugehen [2,19].…”