Commentary on: Intraoperative fluoroscopy, portable X-ray, and CT: patient and operating room personnel radiation exposure in spinal surgery

Abstract OBJECTIVE Exact intraoperative localization of pathologies in spinal and peripheral nerve surgery is not easily achieved. In spinal surgery, intraoperative fluoroscopy is the common method for identification of the level affected. It seldom visualizes the pathology itself and is prone to error in identifying anatomic disorders and superimposing structures. In peripheral nerve surgery, intraoperative fluoroscopy is of little value. The present technical study was conducted to evaluate the feasibility of using a preoperative computed tomography–guided needle marking system, which was previously developed for use in gynecology. The goal was to reduce intraoperative localization error and radiation exposure to patients and operating room personnel. METHODS We used a flexible hooked-wire needle marking system, which has previously been used for preoperative marking of breast lesions, to localize and tag spinal and peripheral nerve pathologies. Marking was carried out under computed tomographic control before surgery. Seven illustrative cases were chosen for this report: 6 patients with disorders of the spine and 1 patient with a peripheral nerve schwannoma. RESULTS No adverse reactions, aside from minor discomfort, were observed in this study. In all cases, the needle could be used as a reliable guide for the surgical approach and led directly to the pathology. In no case was additional intraoperative fluoroscopy needed. The level of radiation exposure to the patient as a result of computed tomography–based marking was similar to or less than that encountered in conventional intraoperative x-ray localization. Radiation exposure to the operating room personnel was eliminated by this method. CONCLUSION Preoperative marking of spinal level or peripheral nerve pathologies with a flexible hooked-wire needle marking system is feasible and appears to be safe and useful for neurosurgical spinal and peripheral procedures.

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Fluoroscopic Radiation Exposure to Operating Room Personnel in Spinal Surgery

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0000000000000083 ◽

2014 ◽

Vol 27 (8) ◽

pp. 448 ◽

Cited By ~ 6

Author(s):

Guoxin Fan ◽

Shan Zhao ◽

Shisheng He ◽

Xin Gu ◽

Xiaofei Guan

Keyword(s):

Radiation Exposure ◽

Operating Room ◽

Spinal Surgery ◽

Operating Room Personnel

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Patient and operating room personnel radiation exposure in spinal surgery

The Spine Journal ◽

10.1016/j.spinee.2014.09.034 ◽

2015 ◽

Vol 15 (4) ◽

pp. 797-799 ◽

Cited By ~ 6

Author(s):

Guoxin Fan ◽

Qingsong Fu ◽

Xinbo Wu ◽

Xiaofei Guan ◽

Guangfei Gu ◽

...

Keyword(s):

Radiation Exposure ◽

Operating Room ◽

Spinal Surgery ◽

Operating Room Personnel

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Radiation Exposure of Patient and Operating Room Personnel by Fluoroscopy and Navigation during Spinal Surgery

Scientific Reports ◽

10.1038/s41598-019-53472-z ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 5

Author(s):

G. Bratschitsch ◽

L. Leitner ◽

G. Stücklschweiger ◽

H. Guss ◽

P. Sadoghi ◽

...

Keyword(s):

Radiation Dose ◽

Radiation Exposure ◽

Operating Room ◽

Spinal Surgery ◽

Real Life ◽

Patient Characteristics ◽

Thoracic Region ◽

Operating Room Personnel ◽

Spinal Implant ◽

Body Regions

AbstractIntraoperative radiography imaging is essential for accurate spinal implant placement. Hazards caused by ionizing radiation raised concern on personnel’s work life long exposure in the operating room (OR). To particularize a cumulative risk estimation of radiation of personnel and patient, depending on used methods (C-arm fluoroscopy, O-arm navigation) and patient characteristics during spinal surgery, detailed investigation of radiation exposure in a clinical setting is required. Lumbosacral dorsal spinal fusion was performed in 37 patients (19 navigated, 18 fluoroscopy) during this prospective study. Radiation exposure was measured on several body regions with thermoluminescent dosimeters on patient and OR personnel (surgeon, assistant, sterile nurse, radiology technologist). Comparison between patient characteristics and radiation exposure was included. The highest patients values were measured in the surgery field and gonads area during navigation (43.2 ± 19.4 mSv; fluoroscopy: 27.7 ± 31.3 mSv; p = 0.02), followed by the thoracic region during fluoroscopy (7.7 ± 14.8 mSv; navigation: 1.1 ± 1.0 mSv; p = 0.06), other measured regions can be considered marginal in comparison. Amongst OR personnel exposure of the surgeon was significant higher during fluoroscopy (right hand: 566 ± 560 µSv and thoracic region: 275 ± 147 µSv; followed by thyroid and forehead) compared to navigation (right finger: 49 ± 19 µSv; similar levels for all regions; p < 0.001 in all regions). When compared to the surgeon, other OR personnel had significantly lower radiation doses on all body regions using fluoroscopy, and similar dose during navigation. The highest eye’s lens region value was measured during fluoroscopy for the patient (185 ± 165 µSv; navigation: 205 ± 60 µSv; p = 0.57) and the surgeon (164 ± 74 µSv; navigation: 92 ± 41 µSv; p < 0.001). There was a significant correlation between patient BMI and radiation exposure to the surgery field during fluoroscopy. To our knowledge, these data present the first real life, detailed comparison of radiation exposure on OR personnel and patients between clinical use of navigation and fluoroscopy. Although patient’s radiation dose is approximately 3-fold during navigation compared to the fluoroscopy, we found that a spinal surgeon could perform up to 10-fold number of surgeries (10.000 versus 883) until maximum permissible annual effective radiation dose would be reached. Especially for a spinal surgeon, who is mainly exposed amongst OR personnel, radiation prevention and protection must remain a main issue.

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P10. Fluoroscopic Radiation Exposure in Degenerative Spinal Surgery: In Vivo Evaluation for Operating Room Personnel

The Spine Journal ◽

10.1016/j.spinee.2009.08.268 ◽

2009 ◽

Vol 9 (10) ◽

pp. 118S ◽

Cited By ~ 1

Author(s):

Daniel Mulconrey

Keyword(s):

Radiation Exposure ◽

Operating Room ◽

Spinal Surgery ◽

Operating Room Personnel ◽

In Vivo Evaluation

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Fluoroscopic Cranial Radiation Exposure in Spine Surgery: A Prospective Single-Center Evaluation in Operating Room Personnel

The International Journal of Spine Surgery ◽

10.14444/6004 ◽

2019 ◽

Vol 13 (1) ◽

pp. 28-32

Author(s):

LAILA MALANI MOHAMMAD ◽

JAMES MESSEGEE ◽

M. OMAR CHOHAN ◽

CHRISTOPHER L. TAYLOR

Keyword(s):

Radiation Exposure ◽

Operating Room ◽

Spine Surgery ◽

Single Center ◽

Operating Room Personnel ◽

Cranial Radiation

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

Journal of Neurosurgery Spine ◽

10.3171/2013.4.spine12719 ◽

2013 ◽

Vol 19 (2) ◽

pp. 226-231 ◽

Cited By ~ 27

Author(s):

Eric W. Nottmeier ◽

Stephen M. Pirris ◽

Steven Edwards ◽

Sherri Kimes ◽

Cammi Bowman ◽

...

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Operating Room ◽

Cone Beam Computed Tomography ◽

Spinal Surgery ◽

Image Guidance ◽

Cone Beam ◽

3D Image ◽

Image Guided ◽

Radiation Scatter

Object Surgeon and operating room (OR) staff radiation exposure during spinal surgery is a concern, especially with the increasing use of multiplanar fluoroscopy in minimally invasive spinal surgery procedures. Cone beam computed tomography (cbCT)–based, 3D image guidance does not involve the use of active fluoroscopy during instrumentation placement and therefore decreases radiation exposure for the surgeon and OR staff during spinal fusion procedures. However, the radiation scatter of a cbCT device can be similar to that of a standard 64-slice CT scanner and thus could expose the surgeon and OR staff to radiation during image acquisition. The purpose of the present study was to measure radiation exposure at several unshielded locations in the OR when using cbCT in conjunction with 3D image-guided spinal surgery in 25 spinal surgery cases. Methods Five unshielded badge dosimeters were placed at set locations in the OR during 25 spinal surgery cases in which cbCT-based, 3D image guidance was used. The cbCT device (O-ARM) was used in conjunction with the Stealth S7 image-guided platform. The radiology department analyzed the badge dosimeters after completion of the last case. Results Fifty high-definition O-ARM spins were performed in 25 patients for spinal registration and to check instrumentation placement. Image-guided placement of 124 screws from C-2 to the ileum was accomplished without complication. Badge dosimetry analysis revealed minimal radiation exposure for the badges 6 feet from the gantry in the area of the anesthesiology equipment, as well as for the badges located 10–13 feet from the gantry on each side of the room (mean 0.7–3.6 mrem/spin). The greatest radiation exposure occurred on the badge attached to the OR table within the gantry (mean 176.9 mrem/spin), as well as on the control panel adjacent to the gantry (mean 128.0 mrem/spin). Conclusions Radiation scatter from the O-ARM was minimal at various distances outside of and not adjacent to the gantry. Although the average radiation exposure at these locations was low, an earlier study, undertaken in a similar fashion, revealed no radiation exposure when the surgeon stood behind a lead shield. This simple precaution can eliminate the small amount of radiation exposure to OR staff in cases in which the O-ARM is used.

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