Operating room radiation exposure in cone beam computed tomography-based, image-guided spinal surgery: clinical...

Area of Science:

• Neurosurgery
• Medical Imaging
• Radiation Safety

Background:

• Spinal surgery, particularly minimally invasive procedures, increasingly uses 3D image guidance systems.
• Cone beam computed tomography (cbCT) offers an alternative to fluoroscopy, potentially reducing surgeon and staff radiation exposure.
• However, the radiation scatter from cbCT during image acquisition requires careful assessment.

Purpose of the Study:

• To quantify radiation exposure to operating room (OR) staff at various unshielded locations during 3D image-guided spinal surgery using cbCT.
• To evaluate the radiation scatter from the O-ARM system in a clinical setting.

Main Methods:

• Five badge dosimeters were strategically placed in the OR during 25 spinal surgery cases utilizing cbCT-based 3D image guidance (O-ARM and Stealth S7).
• Dosimeters were positioned at varying distances from the cbCT gantry, including areas near anesthesiology equipment and sides of the room.
• Radiation exposure was measured and analyzed by the radiology department after case completion.

Main Results:

• Fifty O-ARM spins were performed for 25 patients, facilitating image-guided placement of 124 screws.
• Minimal radiation exposure (mean 0.7-3.6 mrem/spin) was detected at distances of 6 to 13 feet from the gantry.
• Highest radiation levels were recorded on badges near the gantry (OR table: mean 176.9 mrem/spin; control panel: mean 128.0 mrem/spin).

Conclusions:

• Radiation scatter from the O-ARM system is minimal at distances away from the gantry.
• While exposure levels are generally low, utilizing lead shielding can effectively eliminate radiation exposure for OR staff.
• This highlights the importance of simple safety measures in minimizing radiation risks during image-guided spinal procedures.