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Estimating the effective radiation dose imparted to patients by intraoperative cone-beam computed tomography in thoracolumbar spinal surgery
Authors
Lange, JeffreyKarellas, Andrew
Street, John
Eck, Jason C.
Lapinsky, Anthony
Connolly, Patrick J.
DiPaola, Christian P.
UMass Chan Affiliations
Department of RadiologyDepartment of Orthopedics and Physical Rehabilitation
Document Type
Journal ArticlePublication Date
2013-03-01Keywords
SpineOrthopedic Procedures
Cone-Beam Computed Tomography
Radiation Dosage
Orthopedics
Radiology
Rehabilitation and Therapy
Surgery
Surgical Procedures, Operative
Metadata
Show full item recordAbstract
STUDY DESIGN: Observational. OBJECTIVE: To estimate the radiation dose imparted to patients during typical thoracolumbar spinal surgical scenarios. SUMMARY OF BACKGROUND DATA: Minimally invasive techniques continue to become more common in spine surgery. Computer-assisted navigation systems coupled with intraoperative cone-beam computed tomography (CT) represent one such method used to aid in instrumented spinal procedures. Some studies indicate that cone-beam CT technology delivers a relatively low dose of radiation to patients compared with other x-ray-based imaging modalities. The goal of this study was to estimate the radiation exposure to the patient imparted during typical posterior thoracolumbar instrumented spinal procedures, using intraoperative cone-beam CT and to place these values in the context of standard CT doses. METHODS: Cone-beam CT scans were obtained using Medtronic O-arm (Medtronic, Minneapolis, MN). Thermoluminescence dosimeters were placed in a linear array on a foam-plastic thoracolumbar spine model centered above the radiation source for O-arm presets of lumbar scans for small or large patients. In-air dosimeter measurements were converted to skin surface measurements, using published conversion factors. Dose-length product was calculated from these values. Effective dose was estimated using published effective dose to dose-length product conversion factors. RESULTS: Calculated dosages for many full-length procedures using the small-patient setting fell within the range of published effective doses of abdominal CT scans (1-31 mSv). Calculated dosages for many full-length procedures using the large-patient setting fell within the range of published effective doses of abdominal CT scans when the number of scans did not exceed 3. CONCLUSION: We have demonstrated that single cone-beam CT scans and most full-length posterior instrumented spinal procedures using O-arm in standard mode would likely impart a radiation dose within the range of those imparted by a single standard CT scan of the abdomen. Radiation dose increases with patient size, and the radiation dose received by larger patients as a result of more than 3 O-arm scans in standard mode may exceed the dose received during standard CT of the abdomen. Understanding radiation imparted to patients by cone-beam CT is important for assessing risks and benefits of this technology, especially when spinal surgical procedures require multiple intraoperative scans.Source
Spine (Phila Pa 1976). 2013 Mar 1;38(5):E306-12. doi: 10.1097/BRS.0b013e318281d70b. Link to article on publisher's siteDOI
10.1097/BRS.0b013e318281d70bPermanent Link to this Item
http://hdl.handle.net/20.500.14038/42928PubMed ID
23238490Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1097/BRS.0b013e318281d70b