Lange, JeffreyKarellas, AndrewStreet, JohnEck, Jason C.Lapinsky, AnthonyConnolly, Patrick J.DiPaola, Christian P.2022-08-232022-08-232013-03-012013-03-11Spine (Phila Pa 1976). 2013 Mar 1;38(5):E306-12. doi: 10.1097/BRS.0b013e318281d70b. <a href="http://dx.doi.org/10.1097/BRS.0b013e318281d70b">Link to article on publisher's site</a>0362-2436 (Linking)10.1097/BRS.0b013e318281d70b23238490https://hdl.handle.net/20.500.14038/42928STUDY 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.en-USSpineOrthopedic ProceduresCone-Beam Computed TomographyRadiation DosageOrthopedicsRadiologyRehabilitation and TherapySurgerySurgical Procedures, OperativeJournal Articlehttps://escholarship.umassmed.edu/ortho_pp/1313889057ortho_pp/131