Patient Dose Comparison for Intraoperative Imaging Devices Used in Orthopaedic Lumbar Spinal Surgery.

Area of Science:

• Medical Imaging
• Radiation Oncology
• Spinal Surgery

Background:

• Intraoperative imaging is essential for lumbar fusion procedures.
• Assessing radiation exposure from different imaging modalities is critical for patient safety.

Purpose of the Study:

• To quantify and compare radiation exposure from various intraoperative imaging systems during two-level and four-level lumbar fusions.
• To evaluate the impact of patient body mass index (BMI) on radiation dose.

Main Methods:

• Five imaging systems were evaluated: multidetector CT (MDCT), two mobile CT units, C-arm, and fluoroscopy.
• Radiation doses were measured using Metal Oxide Semiconductor Field Effect Transistor (MOSFET) dosimeters on an anthropomorphic phantom.
• A fat-equivalent phantom simulated obese patients (BMI).

Main Results:

• Effective doses (ED) for a four-level fusion in normal BMI patients varied widely: MDCT (12.00 mSv), mobile CT B (5.90 mSv), mobile CT C (2.35 mSv), C-arm (0.44 mSv), and fluoroscopy (0.30 mSv).
• Imaging system rankings remained consistent across BMIs, with exceptions for CT C and fluoroscopy at higher BMIs due to system limitations.
• Most systems showed ED trends that correlated with patient BMI.

Conclusions:

• Dose reduction protocols were validated per manufacturer specifications.
• The choice of intraoperative imaging system significantly impacts patient radiation risk.
• Appropriate selection of imaging technology is vital for optimizing patient safety during lumbar fusion surgeries.