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Radiation exposure in navigated techniques for AIS: is there a difference between pre-operative CT and intraoperative CT?

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Abstract

Purpose

Utilization of navigation improves pedicle screw accuracy in adolescent idiopathic scoliosis (AIS). Our center switched from intraoperative CT (ICT) to an optical navigation system that utilizes pre-operative CT (PCT). We aim to evaluate the radiation dose and operative time for low-dose ICT compared to standard and low-dose PCT used for optical navigation in AIS patients undergoing posterior spinal fusion.

Methods

A single-center matched-control cohort study of 38 patients was conducted. Nineteen patients underwent ICT navigation (O-arm) and were matched by sex, age, and weight to 19 patients who underwent PCT for use with an optical-guided navigation (7D, Seaspine). A total of 418 levels were instrumented and reviewed. PCT was either a standard dose (N = 7) or a low dose (N = 12). The mean volume CT dose index, dose-length product, overall effective dose (ED), ED per level instrumented, and operative time per level were compared.

Results

ED per level instrumented was 0.061 ± 0.029 mSv in low-dose PCT and 0.14 ± 0.05 mSv in low-dose ICT (p < 0.0001). ED per level instrumented was significantly higher in standard PCT (1.46 ± 0.39 vs. 0.14 ± 0.03 mSv; p < 0.0001). Mean operative time per level was 31 ± 7 min for ICT and 33 ± 3 min for PCT (p = 0.628).

Conclusion

Low-dose PCT resulted in 0.70 mSv exposure per case and 31 min per level, standard-dose was 16.95 mSv, while ICT resulted in 1.34–1.62 mSv and a similar operative time. Use of a standard-dose PCT involves radiation exposure about 9 times higher than ICT and 23 times higher than low-dose PCT per level instrumented.

Level of evidence

Level III.

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Data availability

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.

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Funding

No external funding was used for this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Mikaela H. Sullivan, Ahmad Nassr, Todd A. Milbrandt & A. Noelle Larson

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Lifeng Yu, Beth A. Schueler & Julie Guerin

Authors
  1. Mikaela H. Sullivan
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  2. Lifeng Yu
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  3. Beth A. Schueler
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  4. Ahmad Nassr
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  5. Julie Guerin
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  6. Todd A. Milbrandt
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  7. A. Noelle Larson
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Contributions

MHS: Data collection, writing-original draft preparation, approval of the final version of the manuscript, agree to be accountable for the work. LY: Data collection, writing-original draft preparation, approval of the final version of the manuscript, agree to be accountable for the work. BAS: Writing-original draft preparation, approval of the final version of the manuscript, agree to be accountable for the work. AN: Data collection, writing-original draft preparation, approval of the final version of the manuscript, agree to be accountable for the work. JG: Writing-original draft preparation, approval of the final version of the manuscript, agree to be accountable for the work. TAM: Data collection, writing-original draft preparation, approval of the final version of the manuscript, agreeing to be accountable for the work. ANL: Data collection, writing-original draft preparation, approval of the final version of the manuscript, agree to be accountable for the work.

Corresponding author

Correspondence to A. Noelle Larson.

Ethics declarations

Conflict of interest

No conflicts of interest by any author are directed related to this study. A. Noelle Larson, M.D. is a consultant in Orthopediatrics for Stryker, nView, Zimmer, Medtronic, and Globus with all funds directed to Pediatric Orthopedic research at Mayo Clinic. Todd. A. Milbrandt, M.D. is a consultant in Orthopediatrics for Depuy Synthes, Medtronic, and Zimmer with all funds directed to Pediatric Orthopedic Surgery at Mayo Clinic. Mayo Clinic has patent 10667845B2 issues with Drs. Larson and Milbrandt as inventors.

Ethics approval

This study was approved by the Mayo Clinic Institutional Review Board (#14-004866) on 6/26/2014.

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Sullivan, M.H., Yu, L., Schueler, B.A. et al. Radiation exposure in navigated techniques for AIS: is there a difference between pre-operative CT and intraoperative CT?. Spine Deform 12, 349–356 (2024). https://doi.org/10.1007/s43390-023-00772-0

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  • DOI: https://doi.org/10.1007/s43390-023-00772-0

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