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Lumbar discectomy and fusion: Organs' dose and effective dose estimation using Monte Carlo simulation
Vasileios Metaxas1, Fotios Efthymiou1, Christos Dimitroukas2
1Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece.
Summary
Patient factors and procedure complexity significantly impact radiation doses during lumbar discectomy and fusion (LDF). Optimizing techniques is crucial for minimizing patient radiation exposure in LDF procedures.
Area of Science:
- Medical Physics
- Radiology
- Neurosurgery
Background:
- Lumbar discectomy and fusion (LDF) procedures involve ionizing radiation, necessitating an understanding of dose distribution.
- Patient and procedural variables can influence radiation exposure during intraoperative fluoroscopy.
Purpose of the Study:
- To assess the impact of patient- and procedure-related parameters on organ dose (OD), peak skin dose (PSD), and effective dose (ED) in LDF.
- To identify key factors influencing radiation exposure for optimizing techniques and minimizing patient dose.
Main Methods:
- Utilized VirtualDose-IR software with sex-specific and BMI-adjustable anthropomorphic phantoms for dosimetric calculations.
- Analyzed intra-operative parameters from 102 LDFs, including fluoroscopy time (FT), kerma-area product (KAP), and air-kerma (Kair).
Main Results:
- Higher KAP, Kair, PSD, and ED were observed for male or higher BMI patients and multi-level/fusion/L5/S1 procedures.
- Significant differences in PSD and incident Kair were noted between normal and obese patients; FT differed between discectomy and fusion procedures.
- Spleen, kidneys, and colon received the highest organ doses, with BMI and procedure type significantly affecting doses to various organs.
Conclusions:
- Patient BMI and procedural complexity (multi-level, fusion, L5/S1 level) significantly influence radiation doses during LDF.
- Specific organs like kidneys, spleen, and urinary bladder show increased dose sensitivity to these factors.
- Findings can guide neurosurgeons in optimizing radiation exposure during LDF to achieve As Low As Reasonably Achievable (ALARA) principles.
