Radiation exposure to the patients in thoracic and lumbar spine fusion using a new intraoperative cone-beam computed tomography imaging technique: a preliminary study.
The goals of this paper are to assess the ionizing radiation exposure to the patients during thoracic and lumbar spinal fusion using a new intraoperative 3D imaging system and to evaluate the factors that could explain the variability in the observed doses.



We retrospectively reviewed 97 patients who underwent posterior instrumented thoracic and/or lumbar spinal fusion from December 2013 to November 2014. Primary data were the total dose area product (total DAP, Gy cm2) and total skin dose (total SD, mGy). Influence of different variables (patient characteristics, surgical technique, and intraoperative imaging system parameters) that could influence patients' exposure was analyzed.



Radiation dose imparted to patients depended on four parameters including acquisition protocol, surgical technique, patient's BMI and operative time. Minimally invasive surgery (MIS) resulted in twofold higher dose for patients, compared to open surgery. The use of low dose acquisition protocols reduced patient exposure by a factor three.



Patient exposure was highly variable. Four parameters were found to explain about 68% of its variance when using a multi-axis robotic C-arm system. MIS technique (with navigation or not) as well as the acquisition protocol dramatically increases the radiation dose for patients. These results show the necessity to develop specific strategies adapted to patients and surgical procedures.
Service d'Orthopédie et de Traumatologie de l'appareil Locomoteur, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium. kaminski.ludovic@gmail.com.
Ludovic
0000-0001-7199-133X
L
Kaminski
Computer Assisted and Robotic Surgery (CARS), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium.
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V
Cordemans
Computer Assisted and Robotic Surgery (CARS), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium.
O
O
Cartiaux
Service d'Orthopédie et de Traumatologie de l'appareil Locomoteur, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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M
Van Cauter
D054893:Cone-Beam Computed Tomography; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D000069079:Radiation Exposure / Q000032:analysis*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*
Cone-beam CT; Dose reduction strategies; Intraoperative imaging; Minimally invasive surgery; Mobile C-arm; Pedicle screws; Radiation exposure