Comparative Radiation Exposure Using Standard Fluoroscopy Versus Cone-Beam Computed Tomography for Posterior Instrumented Fusion in Adolescent Idiopathic Scoliosis

Abstract Background Radiographs are integral in evaluating implant space and inter-root distance. The purpose of this report is to introduce a method for evaluating the 3D root position with minimal radiation using a 3D tooth model composed of an intraoral-scanned crown and a cone-beam computed tomography (CBCT)-scanned root. Materials and methods Intraoral scan and CBCT scan of the patient were obtained before treatment. In the CBCT image, tooth segmentation was performed by isolating individual teeth from the maxillary and mandibular alveolar bone using software program. The 3D tooth model was fabricated by combining segmented individual teeth with the intraoral scan. Results A post-treatment intraoral scan was integrated into the tooth model, and the resulting position of the root could be predicted without additional radiographs. It is possible to monitor the root position after a pretreatment CBCT scan using a 3D tooth model without additional radiographs. Conclusion The application of the 3D tooth model benefits the patient by reducing repeated radiation exposure while providing the clinician with a precise treatment evaluation to monitor tooth movement.

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Surgeon radiation exposure in cone beam computed tomography-based, image-guided spinal surgery

International Journal of Medical Robotics and Computer Assisted Surgery ◽

10.1002/rcs.450 ◽

2011 ◽

Vol 8 (2) ◽

pp. 196-200 ◽

Cited By ~ 25

Author(s):

Eric W. Nottmeier ◽

Cammi Bowman ◽

Kevin L. Nelson

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Cone Beam Computed Tomography ◽

Spinal Surgery ◽

Cone Beam ◽

Image Guided

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Cone beam computed tomography: Rejuvenating dentistry

Faculty Dental Journal ◽

10.1308/rcsfdj.2016.74 ◽

2016 ◽

Vol 7 (2) ◽

pp. 74-77 ◽

Cited By ~ 1

Author(s):

Zaid Baqain ◽

Abeer Al Hadidi

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Radiation Protection ◽

Cone Beam Computed Tomography ◽

Developing World ◽

Image Interpretation ◽

Three Dimensional ◽

Cone Beam ◽

Three Dimensional Imaging ◽

Developed World

Dental cone beam computed tomography (CBCT) is the three-dimensional imaging of choice in modern dentistry. In the developed world, guidelines have been published on the use of CBCT in dentistry, largely in response to the risks associated with ionising radiation exposure. However, the availability of different models on the market at affordable prices has made this machine an integral part of the contemporary dentists’ apparatus, even in the developing world. Here, we underline the importance of awareness on radiation protection, image acquisition, familiarity with the software and image interpretation.

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Analysis of Intraoperative Cone-Beam Computed Tomography Combined With Image Guidance for Lateral Lumbar Interbody Fusion

Operative Neurosurgery ◽

10.1093/ons/opx176 ◽

2017 ◽

Vol 14 (6) ◽

pp. 620-626

Author(s):

Xilin Liu ◽

Jacob R Joseph ◽

Brandon W Smith ◽

Yamaan Saadeh ◽

Paul Park

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Cone Beam Computed Tomography ◽

Interbody Fusion ◽

Cone Beam ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Spinal Navigation ◽

Male Patients ◽

Biplanar Fluoroscopy

Abstract BACKGROUND Minimally invasive lateral lumbar interbody fusion (LLIF) is traditionally performed with biplanar fluoroscopy. Recent literature demonstrates that intraoperative cone-beam computed tomography combined with spinal navigation can be safely utilized for localization and cage placement in LLIF. OBJECTIVE To evaluate the accuracy and safety of cage placement using spinal navigation in LLIF, as well as to evaluate the radiation exposure to surgeon and staff during the procedure. METHODS The authors performed a retrospective analysis of a prospectively acquired database of patients undergoing LLIF with image-based navigation performed from April 2014 to July 2016 at a single institution. The medical records were reviewed, and data on clinical outcomes, cage accuracy, complications, and radiation exposure were recorded. All patients underwent a minimum 30-d clinical follow-up to assess intraoperative and short-term complications associated with their LLIF. RESULTS Sixty-three patients comprising 117 spinal levels were included in the study. There were 36 (57.1%) female and 27 (42.9%) male patients. Mean age was 62.7 yr (range 24-79 yr). A mean 1.9 (range 1-4) levels per patient were treated. Cages were placed in the anterior or middle of 115 (98.3%) disc spaces. Image-guided cage trajectory was accurate in 116/117 levels (99.1%). In a subgroup analysis of 18 patients, mean fluoroscopy time was 11.7 ± 9.7 s per level. Sixteen (25.4%) patients experienced a complication related to approach. CONCLUSION Use of intraoperative cone-beam computed tomography combined with spinal navigation for LLIF results in accurate and safe cage placement as well as significantly decreased surgeon and staff radiation exposure.

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Optimal Lowest Instrumented Vertebra Selection for Posterior Instrumented Fusion of Lenke Type 5 and 6 Adolescent Idiopathic Scoliosis: Is There a Difference in Outcome Between L3 and L4?

The Spine Journal ◽

10.1016/j.spinee.2013.07.122 ◽

2013 ◽

Vol 13 (9) ◽

pp. S38 ◽

Cited By ~ 1

Author(s):

Leah Y. Carreon ◽

Charles H. Crawford ◽

Lawrence G. Lenke ◽

Daniel J. Sucato ◽

Steven D. Glassman

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Instrumented Fusion ◽

Lowest Instrumented Vertebra ◽

Selection For ◽

Posterior Instrumented Fusion

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Erratum: Radiation exposure in spine surgery using an image-guided system based on intraoperative cone-beam computed tomography: analysis of 107 consecutive cases

Journal of Neurosurgery Spine ◽

10.3171/2016.11.spine151139a ◽

2017 ◽

Vol 26 (4) ◽

pp. 542 ◽

Cited By ~ 1

Author(s):

Francesco Costa

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Spine Surgery ◽

Cone Beam Computed Tomography ◽

Cone Beam ◽

Image Guided ◽

Tomography Analysis

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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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