Surgeon radiation exposure in cone beam computed tomography-based, image-guided spinal surgery

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Medical Imaging

Background:

• Minimally invasive spinal surgery (MISS) increases surgeon radiation exposure concerns.
• Three-dimensional (3D) image guidance with cone beam computed tomography (cbCT) offers theoretical radiation reduction benefits.
• In vivo measurement of surgeon radiation exposure during cbCT-guided spinal surgery is crucial.

Purpose of the Study:

• To quantify surgeon radiation exposure during 3D image-guided spinal surgery utilizing cbCT.
• To assess the effectiveness of cbCT in reducing radiation exposure for surgeons and operating room staff.

Main Methods:

• Two badge dosimeters were worn by the surgeon (thyroid and waistband) during 25 spinal surgery cases.
• cbCT was used for anatomical registration and instrumentation confirmation without surgeon lead protection.
• The surgeon stood behind a clear lead shield, 10 feet from the cbCT device during scans.

Main Results:

• A total of 63 cbCT spins were performed across 25 patients, with 228 screws placed.
• Analysis of badge dosimeters revealed 0 millirem (mRem) radiation exposure to the surgeon.
• No complications were reported related to instrumentation or image guidance.

Conclusions:

• cbCT-based, 3D image-guided spinal surgery procedures result in no measurable radiation exposure to the surgeon.
• Radiation scatter is effectively managed when surgeons maintain distance and use appropriate shielding.
• This technique enhances safety in minimally invasive spinal procedures.