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Optimization of radiation doses for open lumbar spinal fusion using C-arm fluoroscopy and impact on radiation-induced cancer: a pilot study

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Abstract

Purpose

Intraoperative fluoroscopy use is essential during spinal fusion procedures. The amount of radiation dose should always be minimized. This study aimed to determine the feasibility of halving the frame rate from 12.5 to 6.25 frames per second (fps) and to quantify the reduction in the risk of developing radiation-induced cancer.

Methods

This pilot study included 34 consecutive patients operated for open lumbar posterolateral fusion (PLF) with or without transforaminal lumbar interbody fusion (TLIF). C-arm modes were changed from half-dose (12.5 frames per second (fps), group I) to quarter-dose (6.25 fps, group II). Age, body mass index, surgical procedure, number of treated levels, and complications were collected. Kerma area product (KAP), cumulative air kerma (CAK), and fluoroscopy time were compared. Effective dose and radiation-induced cancer risk were estimated.

Results

Eighteen and 16 patients were, respectively, included in group I and II. Demographic, surgical data, and fluoroscopy time were similar in both groups. However, CAK, KAP, and effective dose were significantly lower in group II, respectively, 0.56 versus 0.41 mGy (p = 0.03), 0.09 versus 0.06 Gy cm2 (p = 0.04), and 0.03 versus 0.02 mSv (p = 0.04). Radiation-induced cancer risk decreased by 47.7% from 1.49 × 10–6 to 7.77 × 10–7 after optimization. No complications were recorded in either group.

Conclusion

This study demonstrates the feasibility of setting 6.25 fps for TLIF with and without PLF. By halving the fps, radiation-induced cancer risk could be almost divided by two, without compromising surgical outcome. Finally, after optimization, the risk of developing radiation-induced cancer was less than one in a million.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

BMI:

Body mass index

CAK:

Cumulative air kerma

C-arm:

Conventional fluoroscopy unit

KAP:

Kerma area product

E:

Effective dose

fps:

Frames per second

MIS-TLIF:

Minimally invasive surgery transforaminal lumbar interbody fusion

PLF:

Posterolateral fusion

TLIF:

Transforaminal lumbar interbody fusion surgery

ULD:

Ultra-low dose

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique – Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France

    Claire Van Ngoc Ty & Isabelle Fitton

  2. Department of Orthopaedic, Hôpital Européen Georges Pompidou, Assistance Publique – Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France

    Robin Arvieu, Emmanuelle Ferrero, Christian Garreau de Loubresse & Marc Khalifé

  3. Institut du Rachis, 59 rue Geoffroy Saint-Hilaire, 75005, Paris, France

    Robin Arvieu

Authors
  1. Claire Van Ngoc Ty
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  2. Isabelle Fitton
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  3. Robin Arvieu
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  4. Emmanuelle Ferrero
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  5. Christian Garreau de Loubresse
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  6. Marc Khalifé
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Contributions

(1) The conception and design of the study, or acquisition of data, or analysis and interpretation of data was contributed by C.VNT, I.F., R.A., C.G.L., and M.K. (2) Drafting the article or revising it critically for important intellectual content was involved by C.VNT, I.F, R.A., E.F., C.G.L., and M.K. (3) Final approval of the version to be submitted by C.VNT, E.F., and M.K. (4) Statistics was performed by C.VNT, R.A. M.K. (5) Experimentation or surgery performance was done by R.A., C.G.L., and M.K.

Corresponding author

Correspondence to Claire Van Ngoc Ty.

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Conflict of interest

C.VNT, I.F., R.A., C.G.L., and M.K.: no conflict of interest. E.F.: Implanet, Medtronic.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. This study was approved by the local institutional review board under the number 11928 of Hôpital Européen Georges Pompidou.

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Van Ngoc Ty, C., Fitton, I., Arvieu, R. et al. Optimization of radiation doses for open lumbar spinal fusion using C-arm fluoroscopy and impact on radiation-induced cancer: a pilot study. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08236-3

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  • DOI: https://doi.org/10.1007/s00586-024-08236-3

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