title: Does computer-assisted spine surgery reduce intraoperative radiation doses?
abstract: METHODS
  Prospective clinical study.
  
  
  OBJECTIVE
  Computer-assisted surgery (CAS) means improved accuracy in inserting screws. Usually the required time of the intraoperative use of a C-arm device is reduced. The aim of the study was to quantify the radiation doses during spine surgery in different types of computer-assisted surgical procedures (i.e., computerized tomography [CT] based and C-arm) compared to standard methods and, as a new technique, the Iso-C3D C-arm (Siemens, GER).
  
  
  BACKGROUND
  A total of 38 individuals were enrolled in the study, including 8 who underwent standard spine surgery, 10 with CT-based, 9 with C-arm based, and 11 with Iso-C3D C-arm based. The thermoluminescence dosimetry measurements were 2 at the radiation source, 2 at the patient, and 2 at the receiver.
  
  
  METHODS
  This study is based on the thermoluminescence method. A total of 38 individuals were enrolled in the study. Despite the small number of patients, the existing results up until now showed a clear reduction of the duration of radiation time using CAS compared to standard methods in spine surgery. Much more important is the fact that the radiation doses were clearly reduced from a median of 1091 mGy using the standard procedure versus 432 mGy in CT-based and 664 mGy in C-arm based guided surgery. The Iso-C3D C-arm showed a median of 152 mGy.
  
  
  RESULTS
  The duration of radiation was reduced from 177 seconds in the standard spine procedure to 75 seconds in CT-based CAS spine intervention. Comparing the different types of CAS application at the spine, the Iso-C3D C-arm based surgery is the method with the lowest duration of radiation. The radiation doses at the C-arm tube (source) are reduced from a median of 1091 mGy in the standard procedure versus 432 mGy in CT-based and 664 mGy in C-arm based guided surgery. In this study, the median dose of an Iso-C3D C-arm was 152 mGy.
  
  
  CONCLUSIONS
  These findings are important for the operating room personnel, which is exposed daily to radiation intraoperatively, as well as the patients, when using CAS procedures.
authors.affiliation: Department of Orthopaedic Trauma, Hand- and Reconstructive Surgery, University of Ulm Hospital, Ulm, Germany. florian.gebhard@uniklinik-ulm.de
authors.forename: Florian T
authors.initials: FT
authors.lastname: Gebhard
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kraus
authors.forename: Eugen
authors.initials: E
authors.lastname: Schneider
authors.forename: Ulrich C
authors.initials: UC
authors.lastname: Liener
authors.forename: Lothar
authors.initials: L
authors.lastname: Kinzl
authors.forename: Markus
authors.initials: M
authors.lastname: Arand
mesh_terms: D001863:Bone Screws; D006801:Humans; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D019637:Orthopedic Procedures; D011446:Prospective Studies; D011829:Radiation Dosage; D011874:Radiometry / Q000295:instrumentation; D013131:Spine / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013819:Thermoluminescent Dosimetry; D013997:Time Factors; D014057:Tomography, X-Ray Computed