Institutional (local) diagnostic reference levels in fluoroscopically guided spine surgery.

Area of Science:

• Medical Physics
• Radiology
• Interventional Neuroradiology

Background:

• Diagnostic Reference Levels (DRLs) and Action Levels (ALs) are crucial for optimizing radiation dose in medical imaging.
• Spine interventional procedures require specific radiation dose monitoring due to their complexity and potential for patient exposure.

Purpose of the Study:

• To report institutional (local) diagnostic reference levels (LDRLs) and action levels (ALs) for cervical and thoraco-lumbar spine interventional procedures.
• To assess factors influencing radiation dose and to compare different methods for dose level calculation.

Main Methods:

• Recorded fluoroscopy time (FT), Kerma Area Product (KAP), and cumulative dose (CD) for 156 patients undergoing spine interventions.
• Estimated patient entrance surface dose (ESD) and effective dose (ED) based on KAP.
• Calculated LDRLs (75th percentile) and ALs (10th percentile) using total patient data, weight banding, and size correction methods.

Main Results:

• Reported LDRLs for FT, KAP, and CD for both cervical and thoraco-lumbar interventions.
• ALs for FT, KAP, and CD were also determined.
• Age and treated levels significantly influenced reference dose values for cervical interventions only.

Conclusions:

• The established LDRLs and ALs can support the development of national DRLs.
• Findings aim to increase neurosurgeon awareness of patient dose and radiation protection during spine interventions.