Skip to main content
SpringerLink
Log in

Radiation exposure to the patients in thoracic and lumbar spine fusion using a new intraoperative cone-beam computed tomography imaging technique: a preliminary study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The goals of this paper are to assess the ionizing radiation exposure to the patients during thoracic and lumbar spinal fusion using a new intraoperative 3D imaging system and to evaluate the factors that could explain the variability in the observed doses.

Method

We retrospectively reviewed 97 patients who underwent posterior instrumented thoracic and/or lumbar spinal fusion from December 2013 to November 2014. Primary data were the total dose area product (total DAP, Gy cm2) and total skin dose (total SD, mGy). Influence of different variables (patient characteristics, surgical technique, and intraoperative imaging system parameters) that could influence patients’ exposure was analyzed.

Results

Radiation dose imparted to patients depended on four parameters including acquisition protocol, surgical technique, patient’s BMI and operative time. Minimally invasive surgery (MIS) resulted in twofold higher dose for patients, compared to open surgery. The use of low dose acquisition protocols reduced patient exposure by a factor three.

Conclusion

Patient exposure was highly variable. Four parameters were found to explain about 68% of its variance when using a multi-axis robotic C-arm system. MIS technique (with navigation or not) as well as the acquisition protocol dramatically increases the radiation dose for patients. These results show the necessity to develop specific strategies adapted to patients and surgical procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Tian N-F, Huang Q-S, Zhou P et al (2011) Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J 20:846–859. doi:10.1007/s00586-010-1577-5

    Article  PubMed  Google Scholar 

  2. Nelson EM, Monazzam SM, Kim KD et al (2014) Intraoperative fluoroscopy, portable X-ray, and CT: patient and operating room personnel radiation exposure in spinal surgery. Spine J 14:2985–2991. doi:10.1016/j.spinee.2014.06.003

    Article  PubMed  Google Scholar 

  3. Ringel F, Villard J, Ryang Y-M, Meyer B (2014) Navigation, robotics, and intraoperative imaging in spinal surgery. Adv Tech Stand Neurosurg 41:3–22. doi:10.1007/978-3-319-01830-0_1

    Article  PubMed  Google Scholar 

  4. Perisinakis K, Theocharopoulos N, Damilakis J et al (2004) Estimation of patient dose and associated radiogenic risks from fluoroscopically guided pedicle screw insertion. Spine 29:1555–1560

    Article  PubMed  Google Scholar 

  5. Hadelsberg UP, Harel R (2016) Hazards of ionizing radiation and its impact on spine surgery. World Neurosurg 92:353–359. doi:10.1016/j.wneu.2016.05.025

    Article  PubMed  Google Scholar 

  6. IEC (2010) Report 60601 medical electrical equipment—part 2-43: particular requirements for the safety of X-ray equipment for interventional procedures, 2nd edn. International Electrotechnical Commission, Geneva

  7. Stecker MS, Balter S, Towbin RB et al (2009) Guidelines for patient radiation dose management. J Vasc Interv Radiol JVIR 20:S263–S273. doi:10.1016/j.jvir.2009.04.037

    Article  PubMed  Google Scholar 

  8. Lee K, Lee KM, Park MS et al (2012) Measurements of surgeons’ exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy. Spine 37:1240–1244. doi:10.1097/BRS.0b013e31824589d5

    Article  PubMed  Google Scholar 

  9. Mendelsohn D, Strelzow J, Dea N et al (2016) Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation. Spine J 16:343–354. doi:10.1016/j.spinee.2015.11.020

    Article  PubMed  Google Scholar 

  10. Balter S (2006) Methods for measuring fluoroscopic skin dose. Pediatr Radiol 36:136–140. doi:10.1007/s00247-006-0193-3

    Article  PubMed  PubMed Central  Google Scholar 

  11. Harstall R, Heini PF, Mini RL, Orler R (2005) Radiation exposure to the surgeon during fluoroscopically assisted percutaneous vertebroplasty: a prospective study. Spine 30:1893–1898

    Article  PubMed  Google Scholar 

  12. Mulconrey DS (2016) Fluoroscopic radiation exposure in spinal surgery. In vivo evaluation for operating room personnel. Clin Spine Surg 29:E331–E335. doi:10.1097/BSD.0b013e31828673c1

    PubMed  Google Scholar 

  13. Richter PH, Yarboro S, Kraus M, Gebhard F (2015) One year orthopaedic trauma experience using an advanced interdisciplinary hybrid operating room. Injury 46(Suppl 4):S129–S134. doi:10.1016/S0020-1383(15)30032-2

    Article  PubMed  Google Scholar 

  14. Raftopoulos C, Waterkeyn F, Fomekong E, Duprez T (2012) Percutaneous pedicle screw implantation for refractory low back pain: from manual 2D to fully robotic intraoperative 2D/3D fluoroscopy. Adv Tech Stand Neurosurg 38:75–93. doi:10.1007/978-3-7091-0676-1_4

    Article  CAS  PubMed  Google Scholar 

  15. Kraus M, Fischer E, Gebhard F, Richter PH (2015) Image quality and effective dose of a robotic flat panel 3D C-arm vs computed tomography. Int J Med Robot Comput Assist Surg MRCAS. doi:10.1002/rcs.1718

    Google Scholar 

  16. Gebhard FT, Kraus MD, Schneider E et al (2006) Does computer-assisted spine surgery reduce intraoperative radiation doses? Spine 31:2024–2027. doi:10.1097/01.brs.0000229250.69369.ac (discussion 2028)

    Article  PubMed  Google Scholar 

  17. Lange J, Karellas A, Street J et al (2013) Estimating the effective radiation dose imparted to patients by intraoperative cone-beam computed tomography in thoracolumbar spinal surgery. Spine 38:E306–E312. doi:10.1097/BRS.0b013e318281d70b

    Article  PubMed  Google Scholar 

  18. Rampersaud YR, Foley KT, Shen AC et al (2000) Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine 25:2637–2645

    Article  CAS  PubMed  Google Scholar 

  19. Crawley MT, Rogers AT (2000) Dose-area product measurements in a range of common orthopaedic procedures and their possible use in establishing local diagnostic reference levels. Br J Radiol 73:740–744

    Article  CAS  PubMed  Google Scholar 

  20. Schafer S, Nithiananthan S, Mirota DJ et al (2011) Mobile C-arm cone-beam CT for guidance of spine surgery: image quality, radiation dose, and integration with interventional guidance. Med Phys 38:4563–4574. doi:10.1118/1.3597566

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Bronsard N, Boli T, Challali M et al (2013) Comparison between percutaneous and traditional fixation of lumbar spine fracture: intraoperative radiation exposure levels and outcomes. Orthop Traumatol Surg Res OTSR 99:162–168. doi:10.1016/j.otsr.2012.12.012

    Article  CAS  PubMed  Google Scholar 

  22. Erken HY, Burc H, Saka G et al (2013) Can radiation exposure to the surgeon be reduced with free-hand pedicle screw fixation technique in pediatric spinal deformity correction?: a prospective multi-center study. Spine. doi:10.1097/BRS.0000000000000172

    Google Scholar 

  23. Ruatti S, Dubois C, Chipon E et al (2016) Interest of intra-operative 3D imaging in spine surgery: a prospective randomized study. Eur Spine J 25:1738–1744. doi:10.1007/s00586-015-4141-5

    Article  PubMed  Google Scholar 

  24. Rayo MF, Patterson ES, Liston BW et al (2014) Determining the rate of change in exposure to ionizing radiation from CT scans: a database analysis from one hospital. J Am Coll Radiol JACR 11:703–708. doi:10.1016/j.jacr.2013.12.005

    Article  PubMed  Google Scholar 

  25. Abul-Kasim K, Söderberg M, Selariu E et al (2012) Optimization of radiation exposure and image quality of the cone-beam O-arm intraoperative imaging system in spinal surgery. J Spinal Disord Tech 25:52–58. doi:10.1097/BSD.0b013e318211fdea

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service d’Orthopédie et de Traumatologie de l’appareil Locomoteur, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium

    Ludovic Kaminski & M. Van Cauter

  2. Computer Assisted and Robotic Surgery (CARS), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium

    V. Cordemans & O. Cartiaux

Authors
  1. Ludovic Kaminski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Cordemans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Cartiaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Van Cauter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ludovic Kaminski.

Ethics declarations

Conflict of interest

None of the authors has any potential conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaminski, L., Cordemans, V., Cartiaux, O. et al. Radiation exposure to the patients in thoracic and lumbar spine fusion using a new intraoperative cone-beam computed tomography imaging technique: a preliminary study. Eur Spine J 26, 2811–2817 (2017). https://doi.org/10.1007/s00586-017-4968-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-017-4968-z

Keywords

Search

Navigation