Preoperative MRI-Derived Navigation Reduces Radiation Exposure in Pediatric Spinal Fusion

Area of Science:

• Orthopedic Surgery
• Medical Imaging
• Radiation Oncology

Background:

• Minimizing cumulative radiation exposure in pediatric spinal deformity correction is vital.
• Ionizing radiation poses long-term health risks for children.
• This study explores reducing radiation by eliminating preoperative CT scans using MRI-derived synthetic CT data.

Purpose of the Study:

• To evaluate the efficacy of MRI-to-synthetic CT navigation in reducing radiation exposure during spinal fusion for adolescent idiopathic scoliosis (AIS).
• To compare radiation doses and surgical parameters between fluoroscopy-only, CT-based navigation, and MRI-to-CT navigation.

Main Methods:

• Retrospective comparative study of 94 pediatric patients undergoing posterior spinal fusion for AIS.
• Three groups: fluoroscopy-only, CT-based navigation, and MRI-to-CT navigation.
• Machine learning models converted MRI signals to CT Hounsfield units for registration.

Main Results:

• Both navigation groups significantly reduced intraoperative fluoroscopy time and effective radiation dose compared to fluoroscopy-only.
• MRI-to-CT navigation achieved radiation profiles comparable to CT-based navigation.
• The MRI-to-CT group eliminated the need for preoperative CT scans, significantly reducing overall radiation exposure.

Conclusions:

• MRI-to-synthetic CT navigation is a safe and effective radiation-sparing alternative for pedicle screw placement in pediatric deformity surgery.
• This technique offers comparable intraoperative radiation profiles to CT-based navigation without requiring a preoperative CT.
• Reducing radiation load is critical for long-term pediatric patient outcomes.