title: Interventional spine procedures under CT guidance: How to reduce patient radiation dose without compromising the successful outcome of the procedure?
abstract: This technical note proposes a method to reduce radiation dose for spine interventions under CT guidance without compromising the successful outcome of the procedure. Two consecutive periods of 14months before and after optimization were investigated with 162 and 440 patients, respectively. By optimizing the acquisition parameters (decreased kV and mAs) and appropriately adjusting the reconstruction (kernels, slice thickness, etc) and visualization parameters, image quality was maintained suitable to perform the procedure. By reducing both kV and mAs, dose was reduced by 72% on fluoroscopy mode (i-fluoro) and sequential mode (i-sequence). Moreover, dose was reduced by 58% on helical mode (i-spiral). Depending on the radiologist, the fluoroscopy time was decreased by between 37% and 56%. Acquisitions with i-sequence were less irradiating than the i-fluoro or the i-spiral modes. Radiation doses were reduced by 65% for infiltrations, 51% for vertebral expansions, and 56% for bone biopsies. Median (1st quartile; 3rd quartile) effective dose were 2.1 (1.3; 3.5)mSv, 10.8 (6.7; 18.3)mSv for and 3.0 (2.4; 4.3)mSv, respectively. Radiologists reported "satisfactory" image quality. During interventional spine procedures under CT scan, reducing kV and mAs associated with the use of i-sequence substantially reduces patient dose.
authors.affiliation: Department of Radiology, University Hospital Center of Nimes, Medical Imaging Group Nimes, EA 2415, Bd Prof Robert Debré 30029 Nimes Cedex, France. Electronic address: joel.greffier@chu-nimes.fr.
authors.forename: Joël
authors.initials: J
authors.lastname: Greffier
authors.affiliation: Department of Radiology, University Hospital Center of Nimes, Medical Imaging Group Nimes, EA 2415, Bd Prof Robert Debré 30029 Nimes Cedex, France.
authors.forename: Fabricio R
authors.initials: FR
authors.lastname: Pereira
authors.affiliation: Department of Radiology, University Hospital Center of Nimes, Medical Imaging Group Nimes, EA 2415, Bd Prof Robert Debré 30029 Nimes Cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Viala
authors.affiliation: Department of Radiology, University Hospital Center of Nimes, Medical Imaging Group Nimes, EA 2415, Bd Prof Robert Debré 30029 Nimes Cedex, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Macri
authors.affiliation: Department of Radiology, University Hospital Center of Nimes, Medical Imaging Group Nimes, EA 2415, Bd Prof Robert Debré 30029 Nimes Cedex, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Beregi
authors.affiliation: Department of Radiology, University Hospital Center of Nimes, Medical Imaging Group Nimes, EA 2415, Bd Prof Robert Debré 30029 Nimes Cedex, France.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Larbi
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control; D013131:Spine / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: CT scan; Dose reduction; Interventional; Optimization; Spine